Modern history

BOOK THREE

The Builders
1904–1914

15

The Imperturbable Dr. Gorgas

The world requires at least ten years to understand a new idea, however important or simple it may be.

—SIR RONALD ROSS

I

“It is all unspeakably loathsome,” concluded a New York reporter who was among the earliest to arrive at Colón. That his countrymen could and would build the mighty ship canal, he, like his countrymen, took as a matter of course. Any contrary view would have placed him among an all but indistinguishable minority. Having tamed a continent, having achieved industrial supremacy, having embarked upon the great adventure of world leadership, the American people—some 80,000,000 strong—would now triumph where the French had failed so ignobly. “There is nothing in the nature of the work . . . to daunt an American,” the reporter insisted. “I have made three excursions over the canal route . . . and while I do not pretend to speak expertly of the engineering aspects of the problem, I should say that the building of the canal will be a comparatively easy task for knowing, enterprising and energetic Americans.”

Still, Colón was troubling. The Negroes lived in the most appalling fashion in rotting shanties propped on stilts in a swamp, “a morass, a vast expanse of black water covered with green scum.” There was no plumbing, not one sewer. The stench was like nothing in his experience; the nights were made “hideous” by the interminable din of thousands of frogs.

He described the poisonous mists rising over the Chagres River, mists quite visible from Colón in the early morning; and not wishing to appear ignorant of advanced medical theory, he wrote also of the mosquitoes. What conceivable chance, he asked, was there to make so vile a place safe for white men?

•   •

The article appeared in the New York Tribune the first week in February 1904, three months before Lieutenant Brooke raised the flag over the old French administration building, and three weeks before the President emphasized comparable concern to the chairman of his new Isthmian Canal Commission. “As you know, I feel that the sanitary and hygienic problems . . . on the Isthmus are those which are literally of the first importance, coming even before the engineering . . .” Roosevelt declared.

The tragic experience of the French was never far from mind. But more immediate and vivid was the memory of Cuba in 1898, when thirteen times the number of American troops killed by the enemy had died of yellow fever, malaria, and typhoid fever. For Roosevelt personally, Cuba had been an unforgettable lesson in the havoc disease could bring down on an expeditionary force. Cuba had been primarily the fault of bad or indifferent leadership in the field and “not too many gleams of good sense” in Washington. It was Roosevelt, following the capture of Santiago, who with Leonard Wood wrote the famous round-robin letter to General Shafter, saying that the army must be moved at once or else perish of malaria. His own brigade, he said in a second letter, was “ripe for dying like rotten sheep.”

To head the new commission, he had turned again to old John G. Walker, who, as time would tell, was an unfortunate choice; he was as ill-suited for his responsibilities as had been the Secretary of War in 1898, Russell Alger, the cause of much of the anguish in Cuba. But the difficulties of mounting the task at Panama were compounded still more by the unwieldly composition of the commission itself, a matter over which Roosevelt had no say. The Spooner Act required that there be seven members, at least four of whom must be “learned and skilled in the science of engineering,” and of those four, two must be military officers (one Army, one Navy). All seven were to have equal authority.

Walker was the Navy man; for the Army there was General George W. Davis, “a fine old plains warrior” who had been a vice-president of the defunct Nicaragua Canal Construction Company. The civilian engineers were Professor William H. Burr (from the prior Walker Commission), Benjamin M. Harrod, Carl E. Grunsky, and William Barclay Parsons. The seventh member, Frank J. Hecker, was a businessman. On the surface it was a distinguished body. But none of them had ever organized a gigantic construction project. None was accustomed to handling problems of supply, labor, or overall planning on a scale even approaching what was now called for.

Nor had any of them had the least medical training. Congress had looked upon the canal as a problem of engineering construction exclusively. The presence on the commission of a physician or of someone experienced in sanitation had not been deemed essential, so none had been named.

That a sanitary officer was assigned to serve under the commission was due primarily to the insistence of Dr. William Henry Welch, of Johns Hopkins, who, during a personal call at the White House, had urged Roosevelt to tackle the sources of disease prior to every other effort on the Isthmus. Welch, one of the celebrated “big four” (Welch, Osler, Kelley, and Halsted) at the Johns Hopkins Medical School, went to the White House with a delegation of prominent physicians, plus, significantly, the chief of the Bureau of Entomology at the Department of Agriculture, Leland O. Howard. “We passed through a room crowded with persons waiting to see the President,” Welch recalled, “and I felt that he must begrudge every minute we occupied . . .” But Roosevelt afterward told Walker to find the very best medical man in the country to take charge of the hospitals and sanitary work at Panama, and although he did not tell Walker who that man should be, Walker was instructed not to make the appointment before consulting with Welch.

The result was the naming of an Army doctor, a former student of Welch’s, Colonel William Crawford Gorgas, who since the death of Walter Reed (of appendicitis in 1902) was known in professional circles as the outstanding authority on tropical disease. Gorgas was forty-nine years old, a courtly, white-haired man whose humorous eyes and “sunny” Alabama manner concealed a marvelous tenacity. Everyone had a good word for him. He was the son of the Confederate general Josiah Gorgas, the career soldier from Pennsylvania who became Jefferson Davis’ chief of ordnance; and so, for political purposes, the appointment helped offset a preponderance of Yankees on the commission.

The seven had been chosen rather hastily—too hastily, Roosevelt later conceded—during the last week of February. On March 4, he sent seven telegrams announcing the appointments and giving each recipient four days to drop what he was doing and convene at the White House. (Walker and General Davis were already in Washington; Burr and Parsons in New York, Hecker in Detroit, Harrod in New Orleans, Grunsky in San Francisco.) He was not interested in their politics, Roosevelt said at their first meeting. They had been picked solely on their reputations for integrity and ability. He had nothing to offer concerning the details of the work. “What this nation will insist upon is that the results be achieved.”

The commission set up headquarters in the Star Building on 14th Street and the position of chief engineer was offered to a Chicago railroad official named John Findley Wallace, an offer he accepted with the understanding that the job required residence on the Isthmus. His salary was to be $25,000 a year, which was more than that of any other government employee in 1904, with the exception of the President, and $10,000 more than he, Wallace, was receiving as general manager of the Illinois Central. William Gorgas’ annual income as an Army colonel was $4,000.

On May 9 came the executive order placing the commission under the direct supervision of the new Secretary of War, William Howard Taft.1 The commission thus had full authority to proceed with the canal.

So six months following the Panama revolution, everything seemed set to go. To the Yale professors who still challenged the legality of his part in the revolution, the Harvard man in the White House responded with another of those spontaneous, eminently quotable retorts for which he had such a gift, wholly avoiding the issue but greatly pleasing the country: “Tell them that I am going to make the dirt fly!”

•   •

To William Gorgas there was no real problem about what had to be done at Panama. Nor does he appear to have had any doubt that he could succeed, his assumption being that full support would be forthcoming from the office in the Star Building. He would concentrate on yellow fever first. Malaria was the larger, more serious threat in his judgment, but an outbreak of yellow fever could result in panic and yellow fever was his specialty. Though the means by which both diseases are transmitted had become known, only yellow fever had been eradicated in any one plague spot as a result of such knowledge—in Havana in 1901—and he had been the man chiefly responsible.

The carrier of yellow fever, it had been determined, was the small, quiet, silvery household mosquito known as Stegomyia fasciata, exactly as the Cuban physician Carlos Finlay had announced years earlier. As is presently known there are no fewer than 2,500 different species of mosquito (rather than 800-odd, as Finlay believed), and these belong to three important genera: Culex, Anopheles, and Aëdes. The Culex group includes the ordinary gray household mosquito found in northern latitudes (Culex pipiens pipiens).The Anopheles are the only known carriers of malaria and also transmit encephalitis, or sleeping sickness. The Aëdes aegypti is Stegomyia fasciata, as it was then called, the yellow-fever mosquito.

Credit for finding the cause of malaria, one of the greatest medical discoveries of all time, belonged to the English physician Ronald Ross, who had addressed himself to the problem alone in a remote field hospital in Secunderabad, India. Though malaria was a worldwide killer, flourishing in a broad zone on both sides of the equator, its greatest toll in human life was in Asia, and in India it was the arch destroyer, taking possibly a million lives a year. Ross, once the indifferent student, amateur poet and musician, had figured out the pattern by which the disease is spread, a pattern that seemed simple enough only after he had explained it. In the summer of 1897 he dissected under a microscope an Anopheles mosquito after it had fed on a malaria patient. In the insect’s stomach he saw the same circular cells that the French physician Laveran had discovered in Algeria in 1880, the malaria parasite Plasmodium falciparum. Besides, he determined that the cells were growing.

In his notebook that night he wrote a poem describing the moment. It was to be his only published verse, the last stanza of which became famous:

I know this little thing

A myriad men will save.

O Death, where is thy sting?

Thy victory, O Grave?

Not until the following year, however, was he able at last to prove the mosquito theory by locating the mosquito’s salivary gland and determining that the expanding parasite within the mosquito’s stomach eventually penetrates all parts of the mosquito’s body, including that gland. “The door is unlocked,” he wrote in an exultant letter to England, “and I am walking in and collecting the treasures.”

The solution was this: Anopheles, comparatively large, brown mosquitoes with little black dots on their wings, transmitted malaria only after having bitten someone already infected with the disease. The mosquito drew the blood containing the parasite, the parasite multiplied in the stomach of the mosquito, then moved to the salivary gland whence the parasite was delivered to the bloodstream of whomever the mosquito bit next. The insect was not the source, in other words, only the agent of conveyance. But this particular insect was the only means of conveyance. Furthermore, it could cause damage only when there was infected blood to feed on, when there were people about who were sick with malaria. So the way to stamp out malaria was not simply to get rid of theAnopheles mosquito, but to make it as difficult as possible for the Anopheles mosquito to get at anyone who had the disease.

The idea of preventing malarial epidemics by exterminating the Anopheles was first put forth in a letter addressed by Ross to the government of India on February 18, 1901. The following year Ross published a small book, Mosquito Brigades, explaining how such a campaign should be organized. By then, however, Gorgas and his Army doctors had demonstrated at Havana what almost no one had believed possible. In 1901, in one of the worst fever cities on earth, they had eliminated yellow fever in less than eight months and very nearly got rid of malaria. There had been nothing comparable in medical or military history to their war on mosquitoes.

Gorgas had played no part in determining the cause of yellow fever. As it happens, he had been one of the last of the Army doctors in Cuba to accept the mosquito theory. Like Ross he had even come to the practice of medicine itself without noticeable interest or enthusiasm and most of his professional life had been spent at “hitching post” forts, as far removed as Secunderabad from the salient discoveries and innovations that had so dramatically transformed medical science during the last part of the nineteenth century. In 1880, the year Gorgas finished his training at Bellevue, the germ theory of disease was still a subject of debate; from 1880 to 1900—the years that marked the emergence of Pasteur, Koch, Lister, the founding of Johns Hopkins—Gorgas was at such places as Fort Brown, Texas, or Fort Randall, South Dakota, attending to routine duty. Fort Randall, set in a boundless prairie, was seventy-five miles from the nearest railroad.

Gorgas became a doctor because of a boyhood determination to have a military career. As a child in Richmond he had seen Lee and Jackson confer with his father in the front parlor, and in the final winter of the war, as ragged Confederate troops filled the streets, he insisted, at age ten, on going barefoot. He received a bachelor of arts degree from the struggling little University of the South at Sewanee, Tennessee, where his father had been made president, but still determined to be a soldier, much against his father’s wishes, he tried for an appointment to West Point. When West Point turned him down, he chose medicine because it was the only way left to get into the Army.

Classmates at the Bellevue Medical College in New York would remember “Billy” Gorgas as a devout Christian, a careless speller, too poor to go home for vacations, the most likable man in the class, and “imperturbable.” It was at Bellevue that he encountered Dr. Welch, then in his late twenties, and after receiving his degree in June 1879 Gorgas spent another year as an intern at Bellevue Hospital.

His father, meantime, learning that his ambition remained unchanged, protested that the life of an Army doctor “would not be a life to look forward to as a permanent thing. It is not in the army that the sphere of a doctor is ennobling.”

To Gorgas later it would seem that the pattern of his life had a large, definable purpose, perhaps God-willed. It was as if every important turn had been designed to prepare him for one historic task. He was not a person to dwell overly on questions of cosmic destiny. Rather, genuine modesty was an important part of his considerable charm. “I am not much of a doctor,” he once remarked to a gathering of prominent physicians, “that is, I am not experienced in the care of the sick, and I am not very much of a military man, although I have been in the army service practically all my professional life.” But while he seemed incapable of taking himself seriously, he was intensely serious about his work and what it could mean to his fellow mortals.

To him the years at frontier outposts had been supremely invigorating. He had grown physically rugged, accustomed to riding out hardships and boredom of a kind to defeat other men. He learned discipline, acquired an unequivocating devotion to duty. His wife would recall nights when, wrapped in buffalo robes, he would set off in a sleigh in the midst of a North Dakota blizzard to deliver an Indian baby in a cabin sometimes thirty miles away. “Life like this was more than an education in medicine,” she would write.

The degree to which yellow fever had affected his career, his personal life, even his very existence, was quite uncanny. It was because of a yellow-fever epidemic at Mobile in 1853 that his mother and father first met. She was Amelia Gayle, daughter of a former governor of Alabama, who for her safety had been sent to stay with an older brother at Mount Vernon, a small town on high, dry ground to the north of Mobile and the site of a federal arsenal. Her brother, the company surgeon at the arsenal, lived next door to the young ordnance officer who was in command, Josiah Gorgas. The wedding was in December that same year, and William, the first of six children, was born the following year, October 3, 1854. The attending physician, as noted earlier, was Alabama’s pioneer yellow-fever specialist, Josiah Nott.

Gorgas’ own first test as a young officer in the Army Medical Corps was a yellow-fever outbreak in Texas. In 1882 he was assigned to Fort Brown, on the Rio Grande, close to the border settlement of Brownsville where the epidemic raged. “I am sending you the most progressive young surgeon under my command,” the surgeon general informed the post commander, and having set himself to work, Gorgas proved so very persistent, ignoring strict orders to keep away from the infected wards, that he was put temporarily under arrest.

Of particular concern as the epidemic worsened was Miss Marie Doughty, sister-in-law of the post commander, for whom little hope was given. A grave had been dug for her in the yellow-fever burial ground on an island in the Rio Grande and Gorgas had volunteered to go with the body and read the last rites. But then he too fell ill, nearly died, but recovered, as did Miss Doughty, with the result that they were convalescent at the same time and fell in love. She became the doctor’s wife following a visit to Tuscaloosa to meet his widowed mother, and since they were now permanently immune to yellow fever, he would be summoned repeatedly for special duty wherever the disease broke out.

He advanced in rank, to major by the time of the Cuban war, but preferred then, as later, to be called Dr. Gorgas. When the American forces occupied Havana in 1898, he was put in charge of the yellow-fever camp at the village of Siboney. One patient, recalling Gorgas’ efficiency and kindness, wrote that had it not been for him the death rate among the troops might have been twice what it was. But Gorgas was no closer to understanding the cause of yellow fever than he had ever been. When the situation at Siboney became critical, his only solution was to burn the town, along with all the medical supplies.

•   •

The great yellow-fever discoveries at Cuba, those later dramatized in Sidney Howard’s play Yellow Jack and in a movie made from the play, were the work of Gorgas’ superior officer, Dr. Walter Reed, who had taken his lead from Carlos Finlay. At the time the Americans moved into Havana, Finlay was still laboring to prove that Stegomyia fasciata—and only Stegomyia fasciata—was the yellow-fever carrier. And for all his persistence he had gotten nowhere. His carefully tended laboratory mosquitoes drew blood from diseased patients and were then permitted to attack the bare arms of willing victims. Yet no yellow-fever cases had ever resulted for Finlay. His notion that the mosquito had to be the transmitting agent was perfectly correct and like Ross in India he had hit upon it alone. What he did not know, what Reed and his staff were to demonstrate, was that Stegomyia fasciata transmits the yellow-fever parasite only according to a very particular time pattern, that the development of the parasite within the insect requires what is known as the period of “extrinsic incubation.”

For the mosquito to become infected it must suck the blood of the yellow-fever patient within the first three days after the patient has contracted the disease. Then once the mosquito has taken the blood, another twelve to twenty days must pass before the mosquito can transmit the infection. Finlay had simply been applying his infected mosquitoes too soon.

Determination of this critical time factor, a phenomenon that evaded not just Finlay but all previous investigators, had been made in Mississippi the year of the Cuban war by an aristocratic Virginian who was with the Public Health Service. Dr. Henry Rose Carter, like Gorgas, had been immunized by a previous attack of yellow fever and consequently made the disease a specialty. He had noted that often when a man developed yellow fever on board ship none of his shipmates became ill. He wondered if somehow there might be a period of delay, or incubation, at the source of the disease. So during an epidemic in Mississippi, he made a statistical study among isolated rural families, meticulously recording how many people—relatives, visitors—came near a yellow-fever patient, when, and with what result. What he found was that a yellow-fever patient could be visited without hazard so long as the visit was made within ten to twelve days after the patient became ill. But beyond that period, even after the patient had died and the body had been removed from the house, family or visitors were in mortal danger. Hence the sick man could not possibly be the source of contamination. Hence there had to be a period of “extrinsic incubation,” as Carter named it.

Carter’s findings were published two years later, in 1900, just as the Army Yellow Fever Commission under Reed arrived in Havana.2 Impressed by Finlay, who volunteered to help in any way he could, and by Carter, who had been sent to Havana as a quarantine officer, Reed decided to concentrate on Stegomyia fasciata, to prove that yellow fever was not a filth disease. Gorgas, who remained positive it was, had been reassigned meanwhile to clean up the city, street by street, house by house.

Associated with Reed were Dr. James Carroll, Dr. Aristides Agramonte, and Dr. Jesse W. Lazear. Late in August, a few days after he had allowed a mosquito to bite him, Dr. Carroll fell ill with yellow fever, and though he recovered, his health was so damaged that he died a few years later. In mid-September, while placing mosquitoes on patients in a fever ward, Lazear saw a free mosquito of undetermined species land on his hand and he also purposefully allowed the insect to take its feed of blood. Five days later Lazear had what Gorgas described as one of the most violent cases of yellow fever he had ever attended. On September 25, the day Lazear died, he was in such wild delirium that it took two men to hold him in bed.

Convinced now of the truth of Finlay’s theory, Reed pressed on with further experiments proving conclusively that Stegomyia fasciata was the carrier, and that neither filth nor “fomites,” the term used for the soiled clothes or bedding of yellow-fever patients, had anything whatever to do with spreading the disease. For twenty nights, as part of one experiment, a doctor and three volunteer soldiers, confined to a one-room shack, slept in the soiled pajamas of yellow-fever patients, on beds reeking of black vomit and other excreta; and for all the discomfort of the experience, none of them suffered the least sign of illness.

Gorgas had been at the bedside of Carroll and Lazear. He had become a close friend of Finlay’s and knew Reed’s work to be of paramount importance. Still, he remained “unconvinced.” He did not believe mosquitoes to be even the principal cause, much less the only cause. There was only one way to determine whether Stegomyia fasciata was the carrier, he insisted, and that was to rid the city of the insect and see if yellow fever disappeared. Reed agreed in theory but is said to have told Gorgas, “It can’t be done.” Gorgas, no less doubtful of success, proceeded because “it was our duty to take precautions in this direction.”

His historic Havana campaign commenced in February 1901. The year before, there had been 1,400 known cases of yellow fever in the city. In 1901 there were 37 cases. But starting in October 1901 there were none. “For the first time since English occupation in 1762,” Gorgas wrote to Ronald Ross, “we have an October free from yellow fever, and malaria decreased more than one half.” In 1902 there was no yellow fever at all and deaths from malaria totaled 77, in contrast to 325 in 1900.

The techniques developed at Havana were what Gorgas intended to use on the Isthmus. However, as he had explained to Surgeon General Sternberg, there were considerable differences between the task at Havana and what had to be faced in a place such as Panama. Sternberg had been one of those in Washington who so badly underestimated the problems of disease when fighting the Cuban war. But he had also been responsible, at the war’s end, for establishing the Yellow Fever Commission. He was one of the very few to appreciate the vast significance of what Gorgas achieved at Havana, and it was he who decided that Gorgas must become the Army’s man on tropical disease. In particular, Gorgas was to prepare himself for a role in building the interoceanic canal, which both men had then assumed would be in Nicaragua. In 1902 Gorgas was sent to attend a world conference on tropical medicine at Cairo and to inspect the work being done on malaria at the Suez Canal according to precepts laid down by Ross. With Sternberg’s blessing, Gorgas also spent several months in Paris going over the medical reports and records on file at the offices of the Compagnie Nouvelle in an effort to determine as nearly as possible what the French experience had been at Panama. But Sternberg had since retired from active duty; it was John G. Walker to whom Gorgas had now to address his explanations and upon whom he became dependent for support.

II

Before leaving for Panama, Gorgas made an ardent appeal for proper supplies and sufficient experienced personnel to carry out his program. The commission deliberated and decided that for the time being considerably fewer personnel would suffice than what he had in mind and that the question of supplies required further study. So the advance party that landed at Colón in June 1904 consisted of a mere seven men, including Dr. Carter and one woman, an English nurse named Eugenie Hibbard, and they were forced to begin their campaign without benefit of even such essential supplies as wire screening and disinfectants. “It is hardly an exaggeration to say . . . when they landed at Panama to engage in the mighty task of ridding this jungle of disease, [they] had little more than their own hands and their own determined spirit to work with,” Marie Gorgas would recall.

The whole of the Isthmus, they found, was a “mosquito paradise.” The temperature, scarcely changing the year around, allowed constant breeding of the insects. A first inspection of Panama City revealed an abundance of Stegomyia in practically every building.Anopheles were still more numerous. By local custom, household drinking water was kept indoors in red earthenware jars, tinajas, within which Stegomyia larvae abounded. Mosquito larvae, or “wrigglers,” swarmed in the open cisterns and rain barrels beside nearly every building. It was the rainy season and innumerable pockets of water, perfect for mosquito breeding, collected everywhere—in large quantities along the old French diggings, in small quantities in the impressions left where railroad ties had been pulled up or in the hoofprints of cattle that grazed in an open field on Ancon Hill.

At Ancon Hospital, where Gorgas established his headquarters, there were no screens in the windows; plants in the surrounding gardens created by the French were still protected from umbrella ants by crockery rings filled with water. In the wards it was still the practice to set the legs of the beds in shallow pans of water. There was no yellow fever among the few patients in the wards, only malaria; but most of the hospital’s small staff—French Sisters of Charity, two French doctors, one priest—were also infected with malaria. After dark the mosquitoes were so thick in the wards that work had to be done in relays, one set of doctors or nurses using fans to protect those working. A nurse named Jessie Murdock, who arrived in July with a small contingent of American nurses, would tell how during night duty they wrapped themselves in bandages soaked in citronella.

At Havana the task had been confined to a comparatively small area and the success with malaria had been largely a side effect of the main campaign: the assault on Stegomyia had simply resulted in the destruction of most Anopheles as well. But StegomyiaandAnopheles are quite different creatures, just as yellow fever and malaria are quite different diseases, and here, at Panama, there was not one city but two, and fifty miles of jungle between.

It was by considering the mosquitoes as predators more deadly than the most savage beasts of the jungle that Gorgas intended to solve the problem. Only by understanding the exact nature of the particular mosquitoes in question—their reproductive processes, feeding habits, flight range, and so forth—could he hope to destroy them.

Until the Cuban war comparatively little had been known about mosquitoes. It was not until 1895, for example, that a full account was published of even the common North American variety. The general impression was that all mosquitoes were more or less alike. At the time Reed and his co-workers identified Stegomyia fasciata as the yellow-fever mosquito, no studies had ever been made of the insect’s natural life history. So this too had been part of Gorgas’ task at Havana and consequently he and his associates had discovered astonishing peculiarities that were of enormous value.

Seen under the microscope, Stegomyia is a creature of striking beauty. Its general color is dark gray, but the thorax is marked with a silvery-white lyre-shaped pattern; the abdomen is banded with silvery-white stripes and the six-jointed legs are striped alternately with black and pure white. Among mosquitoes Stegomyia is the height of elegance.

Stegomyia is also, like the rat, a creature of human society. It survives by maintaining a close proximity to human beings. As among all mosquitoes it is only the female that bites—that is, only the female feeds on blood, while the male gets by on other liquids such as fruit juices and is quite harmless. For the female, blood is essential to mature her eggs. Though the female Stegomyia can feed on any warmblooded animal, her decided preference is for human blood, and thus the whole life cycle of the insect must be maintained in close association with human society.

While all mosquitoes lay their eggs in water, the yellow-fever mosquito is extremely particular about where the water is located and its condition. The female Stegomyia will deposit her eggs only in or near a building occupied by human beings and only in water held in some sort of artificial container such as an earthenware jar or a rain barrel. In addition, it is essential that the water be clean.

With such information available, all acquired during the work at Havana, the problem of destroying the yellow-fever carrier became infinitely more manageable. “Men who achieve greatness,” the brothers Mayo were to write in an essay about Gorgas, “do not work more complexly than the average man, but more simply . . . . In dealing with complex problems, with the simplicity natural to him he went directly to the point, unaffected by the confusion of details in which a smaller man would have lost himself.” At Havana the hopeless task of destroying all mosquitoes was reduced to destroying a particular mosquito; then, once the natural peculiarities of that species were recognized, it was possible to reduce the task further still. The campaign would center on the insect’s method of propagation. The task, very simply, was to eliminate every possible opportunity for the female Stegomyia to deposit her eggs. Yellow fever was eradicated chiefly by ridding the city of all standing fresh water, or by sealing it off with wire screening or wooden lids, or with a skim of oil or kerosene, an idea first suggested for mosquito control in 1892 by the entomologist Leland O. Howard. (The oil not only discouraged the mosquito from depositing her eggs, but killed any larvae already in the water, since the larvae require air to survive.)

Thousands of adult mosquitoes had been destroyed in Havana by systematic fumigation of houses wherein yellow-fever cases had been found. Doors and windows had been sealed off with newspaper, room by room, and pans full of sulphur or powdered pyrethrum (a dried flower used as an insecticide) had been burned for an hour or more. But the main attack had been on water jars, barrels, cisterns, any stray bucket, tin can, or broken dish in which rainwater might collect. A card file had been made on every house and building within city limits; the city had been divided into sections and inspectors had been sent out daily to report on the Stegomyia-producing status of households within their districts. Water kept indoors for household use had to be covered. It had been a laborious, often thankless task, yet extremely simple in concept, and the results had been amazingly rapid.

The female Stegomyia lays anywhere from 35 to 120 minute black eggs and the maturation cycle from egg to larva to pupa to mosquito takes less than ten days. So with the campaign fully organized and in effect, Havana’s Stegomyia population diminished quite suddenly. Adult mosquitoes died off, of fumigation or of old age, after three or four weeks, and because Stegomyia has an extremely limited flight range (another crucial characteristic discovered by Gorgas and his people), few replacements migrated into the city from outlying villages. It was thus that victory over yellow fever had come so quickly and decisively.

Anopheles, the malaria mosquitoes, were quite different creatures and thus a wholly different kind of problem. Anopheles, to begin with, are not purely house-bred insects. The female, unlike her Stegomyia counterpart, will deposit her eggs in still water of any kind—any stagnant swamp, marsh, any clogged drain or ditch or mud puddle. Anopheles, therefore, are as much creatures of field or jungle as of the backyard. So while Stegomyia mosquitoes were always readily within range, their breeding grounds closely, neatly defined, Anopheles were literally everywhere, and in fantastic numbers, since the female deposits as many as two hundred eggs every ten days.

The sanitary measures taken at Havana—the clearing away of garbage and refuse, the installation of proper drainage systems plus the campaign on Stegomyia’s breeding grounds had had the effect of giving no mosquito, Anopheles included, much chance to propagate within the city limits. But what chance would there be at Colón with its swamps or along the canal line?

Malaria, not yellow fever, Gorgas stressed to his associates, was the problem upon which their success would ride or fall. Malaria, he emphasized, had accounted for the greatest loss of life during the French years. “If we can control malaria, I feel very little anxiety about other diseases. If we do not control malaria our mortality is going to be heavy.” Knowledge of the kind gathered at Havana on Stegomyia would now have to be gathered on Anopheles.

The initial question was which particular species of Anopheles to go after. “It was not known how many different species of Anopheles existed,” wrote Joseph Le Prince, one of Gorgas’ advance guard, “nor was it definitely known which of them were the important malaria carriers.” To Le Prince, who had also been Gorgas’ right hand at Havana, it was evident that “much investigative or pioneer work” was still called for.

We had no means of determining how seasonal changes would affect propagation, and the available data were unreliable. It was generally believed at that time that all mosquitoes traveled more or less with gentle air currents, but there was no positive knowledge of habits of flight, and the length of flight of Anopheles . . . was yet to be determined. It was not known if or how topography affected the distribution of species, whether Anopheles larvae thriving in small collections of water held by plants were of . . . importance, or whether certain species were confined to fixed geographical limits.

So while detailed information was being gathered and put on file concerning the whereabouts of Stegomyia larvae in Panama City, Anopheles larvae and pupae were being carefully taken from puddles and swamps along the canal line, scooped up in white-enameled dippers, poured into wide-mouthed jars, and carried back to a makeshift laboratory at Ancon Hospital. Live adult Anopheles collected in villages along the railroad could not survive the return trip, it was found, unless carefully protected from direct sunlight, rain, and strong air currents—an observation that was to have considerable subsequent value.

This preliminary survey disclosed the presence of Anopheles breeding grounds in or near every existing settlement, every abandoned camp built by the French. At a work camp at Culebra, a village of roughly five hundred Jamaicans, Gorgas found that every child he examined had a greatly enlarged spleen, a sign of chronic malarial infection. Every adult he talked to spoke of attacks of chills and fever within the preceding six months. On a hill above this same village a detachment of United States Marines was encamped, half of whom already had malaria. “The condition,” he wrote, “is very much the same as if these four or five hundred natives had smallpox, and our Marines had never been vaccinated.”

No one even tried to approximate the numbers of Anopheles present at any given point. Within the hospital compound itself their presence was phenomenal. On the panel of a single doorway one dutiful assistant counted fifty-four. Like Stegomyia, theAnopheleswere easily recognized by their resting stance. In contrast to the common northern mosquito, which stands with proboscis and head crooked at right angles to its body, Stegomyia and Anopheles kept proboscis, head, and body on a straight line, but at an angle to the resting surface. When feeding on an arm or wrist, an Anopheles looked as though it were standing on its head.

To determine the time of day or night when the Anopheles would take blood, the men stretched out on cots in one of the wards, each man with a supply of pillboxes and a pocket watch. Every time a mosquito bit, or tried to, it was captured, put in a pillbox, and the date and hour were recorded on the box. The Anopheles, it was learned, would attack a human at rest at any hour, though the night hours were by far the worst. The life span of the insect seemed to be about a month and in that time the female required a meal of blood every two to three nights. Her bite did not cause any appreciable swelling, nor was the itch especially bothersome. Often a person was not even aware of being bitten by an Anopheles.

After a month or so, with only a few exceptions, all the small American force, Gorgas as well, had been down with malaria.

•   •

Time was the pressing concern. For although there were but one or two yellow-fever cases, and none serious, at the moment, that condition would change rapidly as soon as new human material became available for the Stegomyia fasciata—and thus the disease—to feed on. Gorgas’ analogy to explain the violent wave effect of yellow fever—the apparent absence of the disease followed by a sudden, vicious outbreak—was the exhausted fire wherein concealed embers lay in wait for fresh supplies of fuel. The arrival of several thousand nonimmunes would be equivalent to heaping on dry kindling: nothing much would happen at first; then the disease would catch; the carrier mosquitoes would infect ever more victims with the deadly parasite, thereby creating more diseased blood for still more mosquitoes to feed upon. Unchecked, the disease would flare into a monstrous geometrical progression of death, taking hundreds, possibly thousands, of lives.

Were conditions on the Isthmus to remain as they were, and were upwards of twenty to thirty thousand men to be brought to Panama, as planned, then, Gorgas calculated, the annual death toll from yellow fever alone could run to three or four thousand.

The build-up of men and equipment was beginning. Every arriving steamer had its contingent of prospective carpenters, mechanics, file clerks, assistant engineers, all eager to be “in at the start at Panama.” General Davis, who had been named the first Governor of the Canal Zone, and Chief Engineer Wallace had arrived and had taken up residence in Panama City. Gorgas, still working with the same small staff, tried to explain the situation, the need for immediate decisions, for men and supplies, and he got nowhere.

In August Admiral Walker and several of the commission came for an inspection tour and Gorgas again made his case as explicit as he knew how. The admiral and his party departed, weeks passed, nothing happened. Gorgas’ cabled requests were answered evasively, if at all. Presently he was reminded by return cable that cables were costly and henceforth to use the mails.

III

The problem in essence was that Admiral Walker, Governor Davis, and several others on the Isthmian Canal Commission, as well as a very large part of the populace and its political leadership, did not seriously entertain the notion that mosquitoes could be the cause of yellow fever or malaria. To spend time and money chasing after mosquitoes in Panama would be to squander time and money in a most irresponsible fashion.

That the minds of men in such positions could be so closed in the face of all that had been learned and demonstrated in Cuba, not to mention the insistent warnings from Roosevelt and Welch, may seem inconceivable. In the conventional understanding of history, human advancement is marked by specific momentous steps: on December 17, 1903, at Kitty Hawk, the Wright brothers fly in a heavier-than-air machine and at once a new age dawns; in a hospital ward outside Havana Dr. Jesse Lazear dies a martyr’s death and the baffling horror of yellow jack is at last resolved. But seldom does it happen that way. Ideas too have their period of extrinsic incubation, and particularly if they run contrary to what has always seemed common sense. In the case of the Wright brothers, it was five years after Kitty Hawk before the world accepted the idea that their machine could fly.

During the long hearings of the Morgan Committee in 1902, prior to the vote on the Spooner Bill, despite all the concern expressed over disease in Panama, the recounting of the French tragedy, the mosquito theory had not even been discussed. George Morison mentioned it once in passing, but without evoking the slightest interest among the others, who had been content to dwell on miasmatic fumes emanating from the rank isthmian landscape. No reference was made to the breakthroughs achieved by either Ross or Reed, nor was anything ever said of Gorgas’ demonstrated success at Havana. Yet all the efforts of the Yellow Fever Commission, all of Gorgas’ work, had been initiated by the Army, all the resulting reports had been published at government expense.

In the autumn of 1904, with the situation on the Isthmus unimproved, Gorgas returned to Washington to plead his case. It had been nearly four years since the epochal report of the Yellow Fever Commission. Ross had won the Nobel Prize in 1902 for his discoveries. A scientific congress held in Paris in 1903 had thoroughly reviewed Reed’s work and declared that the mosquito transmission of yellow fever was a “scientifically determined fact.” But to Walker, Davis, and their fellow commissioners, Gorgas was wasting their time. Walker’s word for the theory of mosquito infection was “balderdash.” Gorgas spent hours waiting in Walker’s anteroom, hours more with Walker going over the evidence in support of the theory. The correct procedure, Walker insisted, was to get rid of the garbage and the dead cats, paint the houses, pave the streets. In his zeal he even offered to give Gorgas a detailed set of rules to guide him in the work.

Walker remained a bastion of integrity. The years he had devoted to the canal question, his study of the French disaster in particular, had convinced him that material wastefulness and graft were the gravest threats to American success at Panama. To Gorgas he remarked, “ . . . whether we build the canal or not we will leave things so fixed that those fellows up on the Hill can’t find anything in the shape of graft after us.”

With Davis, who had returned briefly to Washington, Gorgas had no better success. “What’s that got to do with digging the canal?” was his rejoinder to Gorgas’ plan. Davis professed great friendship for Gorgas, then in tones that Gorgas later described as kindly and patient, Davis tried to “set him right.” “On the mosquito you are simply wild,” Davis said. “All who agree with you are wild. Get the idea out of your head.”

Before Gorgas had left for Washington, several of his staff had urged him to resign rather than face such continuing ignorance and obstructionism. But having gotten nowhere with the commission—indeed, having been shown how very little actual authority he possessed—he sailed again for Colón within a few weeks. Old Walker’s attitude, however galling, was of a kind he had experienced before in the military. He had kept his temper. He made no attempt to undermine or dislodge anyone on the commission, nor did he resort to political or social by-paths to the War Department or to the White House. The doctor was neither fighter nor schemer. But then neither would he give up. “That persistence which had always been his chief asset . . . forced him to the task,” according to his wife. He was not merely returning, moreover; he was returning to stay, for this time he took her with him.

Of all those who had been named to positions of importance that year, only Gorgas would stay on. Not only was he the one perfectly qualified man for his particular role and the one really solid appointment made in 1904, he was also to be the only major official of importance to stay with the work on the Isthmus from start to finish.

•   •

It is in Marie Gorgas’ published reminiscences that we find some of the earliest first impressions of Panama as recorded by one of the American canal force. Colón was “unspeakably dirty,” swarming with naked children, ugly, dilapidated, and terribly depressing. Yet the two-hour ride on the Panama Railroad more than compensated. In places the jungle swept the sides of their car and the jungle itself she found astonishingly beautiful. From the depot at Panama City they rode to Ancon in an open victoria through “a sea of mud reaching at times almost to the hub . . .” Their quarters were to be on the second floor of the hospital, in Ward Eleven, once the officers’ ward for the French.

 . . . Dr. Carter was on hand to greet us . . . A flight of stairs led to the gallery of the second floor. Although it was only a little after five o’clock, the short twilight gave a somber though refreshingly cool aspect. My spirits rose. On the right, facing the stairs, was the large living room, comfortably furnished . . . with wicker chairs and small tables—a room of many windows. Following the gallery to the right was a bedroom running across the back porch . . . Two small rooms across the back porch were fitted up as bath and servants’ rooms. There was no running water, and, as I found out afterward, water was exceedingly scarce, being delivered daily in small quantities.

During the years of French occupation, she was told, more men had died of yellow fever in this building—in these very rooms—than in any other building on the Isthmus.

After dinner with the staff—served “Spanish style” in six or seven courses, in a screened, candlelit room on the ground floor—she, her husband, Dr. Carter, and several others returned to the upper gallery.

There is an alluring something about a night in the tropics. Dr. Gorgas experienced a melancholy pleasure listening to the sighing of the royal palms . . . in imagination visioning through the haze of his cigar the ghosts that haunted the old building. . . .

It was a beautiful and starry evening. Beyond stretched the great Pacific, the dotted islands in the distance dimly seen . . . every place teeming with the history of departed glory and vast enterprise.

The night, with its “creeping noises on the roof and on the floor,” had considerably less charm. In the morning she had her first full view of the city and bay spread below.

We were on a high point, with only the road separating our ward from the sheer descent to the valley below, a descent so steep that a retaining wall had been built as a protection. The road was bordered by a row of stately royal palms, planted by the French . . . Beyond a stretch of green valley the hills and mountains were seen emerging from the heavy mist . . . The sun was rising from the Pacific, a strange phenomenon, and the rays gave a jeweled appearance to the dew-soaked plants and the leaves of the trees. . . .

The city of Panama lay tantalizingly near . . . From our high point . . . the pastel shades of the Spanish tiled roofs were easily discernible; also the animation and movement of the streets. . . .

She remained “content,” however, to confine her excursions to walks about Ancon Hill in company with the French nuns in their blue gowns and vast white headdresses, or with Laura Carter, wife of Dr. Carter, who arrived in midsummer.

Miss Hibbard, the head nurse, Jessie Murdock, and the other American nurses (Margaret Magurk, Mary Markham, Eleanor Smith, Anna Turner) were quartered in still another ward. “Old rusted French beds, with mildewed mattresses and pillows lined the walls,” Bessie Murdock remembered. “Each [bed] had a candle, but it was soon found that it was not wise to keep these burning, as they attracted moths and all sorts of flying insects. Yet, in spite of these many difficulties, we were not disheartened, but thoroughly enjoyed the novel experience.”

Accommodations in the ward for the unmarried male members of the staff were no less “deluxe,” as one of them, W. C. Haskins, would recall for his fellow townsmen in Oelwein, Iowa:

One straight-backed chair was made to do for the entire bunch . . . . We had but one lamp . . . . There were no mirrors, and the fortunate possessor of an individual looking glass was to be envied. Some combed their hair and shaved with the aid of the swinging glass windows backed up against the wall. There were but two washstands for all of us . . . . We lived in constant dread of the alacrán, or scorpion, who seems to have a penchant for buildings long unused, and for going to sleep in your clothes or shoe. . . .

Gorgas, who spoke a little Spanish, had already done more to win the trust and friendship of the Panamanians than any other American on the Isthmus. The name Gorgas was Spanish. According to family tradition, he was descended from a Spaniard who settled in Holland in the sixteenth century, when Spain ruled the Low Countries. And from his experience in Cuba he was appreciative of Latin pride and humor. In Manuel Amador, a fellow physician, he had an especially important ally. His tact, his sensitivity to the feelings of others, were unfailing. An American engineer would remember him as “a grand, quiet, lovable man.” Dr. Victor Heiser, a young American physician who was passing through en route to the Philippines, saw Gorgas stopped in the street by a beggar. “He bowed to the man, shook his hand, even inquired for his name, then gave him a single penny—the only coin he had I suppose—but it was all done so perfectly naturally, with such dignity that the man walked away very pleased.”

From Gorgas’ private secretary it would also be learned years later that the kindly doctor, seemingly as imperturbable as ever, could also become so incensed over red tape and bureaucrats in Washington that he would sweep the papers from his desk, lock them in a drawer, and storm out of the office, not to be seen again for a day or more.

He rose early, cared little about his clothes, his customary ensemble a rumpled three-piece civilian suit, stiff detachable collar, black tie with stickpin. His main pleasures were food—virtually anything set before him—horseback riding, a glass of beer, conversation, and books, his reading being done according to a lifelong routine. He always kept three books at hand—one scientific, one of classical literature or history, one light fiction—which he took up in turn, giving each exactly twenty minutes according to a pocket watch placed on the table beside his chair. In this fashion, he said, he was able to remember what he read.

“He loved especially the adventure stories of H. Rider Haggard,” his daughter would recall; “King Solomon’s Mines! I think those books had a great deal to do with his enthusiasm for the adventure of Panama, for being there in the jungle then.”

•   •

It was in the autumn of 1904, during the time Gorgas was on home leave, that Ronald Ross made his brief, almost universally ignored, visit to Panama as the result of an invitation issued by Gorgas. Ross crossed the Atlantic to attend the world’s fair in St. Louis, where, among other things, he noted surprising numbers of both Stegomyia and Anopheles mosquitoes nicely thriving. Then, following a pleasant few days with William Osler at Baltimore, he sailed for Colón on the steamer Advance. Gorgas came down to the New York pier to see him off. For an hour before the ship sailed, they sat chatting on the fantail, the two men who had done more than any others alive to rid the world of tropical plague and whose lonely, unending battle with official indifference or official enmity had long since made them brothers of the same blood.

After a week on the Isthmus, Ross described Gorgas’ projected campaign as sound in every particular. Panama, Ross declared, could be made an example for the entire world.

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NATIONAL ARCHIVES

John F. Wallace

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John Stevens

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PANAMA CANAL COMPANY

Fumigation brigade, Panama City

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U.S. DEPARTMENT OF AGRICULTURE

Stegomyia fasciata, an adult female (much enlarged)

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NATIONAL ARCHIVES

Yellow-fever patient inside a portable isolation cage at Ancon Hospital

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LIBRARY OF CONGRESS

“The Man and the Machine”: Theodore Roosevelt strikes his famous pose at the controls of a ninety-five-ton Bucyrus shovel at Pedro Miguel.

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COLLECTION OF J. W. D. COLLINS

Five unidentified American workers, one of whom holds an issue of the Canal Record, the weekly paper that began publication in 1907

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FROM THE PANAMA GATEWAY, JOSEPH BUCKLIN BISHOP, CHARLES SCRIBNER’S SONS, 1913

Goethals and his high command on the steps of the Administration Building at Culebra. Left to right, Lieutenant Colonel William L. Sibert, Joseph C. S. Blackburn, Rear Admiral Harry H. Rousseau, Joseph Bucklin Bishop, Colonel George W. Goethals, Lieutenant Colonel Harry F. Hodges, Colonel William C. Gorgas, and Lieutenant Colonel David D. Gaillard

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PANAMA CANAL COMPANY

Spanish track gang

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PANAMA CANAL COMPANY

West Indian dynamite crew

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NATIONAL ARCHIVES

Motion-picture still of a mechanical track shifter in operation

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PANAMA CANAL COMPANY

Culebra Cut


1 This was done “inasmuch as the War Department is the department which has always supervised the construction of the great civil works for improving the Rivers and Harbors of the country and the extended military works of public defense . . .”

2 Publication of Carter’s vitally important observations had been delayed because the editor of a medical journal returned his paper saying it was too long.

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