But these, our brothers, fought for her, At life's dear peril wrought for her, So loved her that they died for her.
Fortunately, the commander-in-chief at the time in Cuba was General Leonard Wood, who had been an army surgeon, and he was the first to appreciate the importance of the discovery. The sanitation of Havana was placed in the hands of Dr. Gorgas, and within nine months the city was cleared of yellow fever, and, with the exception of a slight outbreak after the withdrawal of the American troops, has since remained free from a disease which had been its scourge for centuries. As General Wood remarked, "Reed's discovery has resulted in the saving of more lives annually than were lost in the Cuban War, and saves the commercial interest of the world a greater financial loss each year than the cost of the Cuban War. He came to Cuba at a time when one third of the officers of my staff died of yellow fever, and we were discouraged at the failure of our efforts to control it." Following the example of Havana other centres were attacked, at Vera Cruz and in Brazil, with the same success, and it is safe to say that now, thanks to the researches of Reed and his colleagues, with proper measures, no country need fear a paralyzing outbreak of this once dreaded disease.
The scientific researches in the last two decades of the nineteenth century made possible the completion of the Panama Canal. The narrow isthmus separating the two great oceans and joining the two great continents, has borne for four centuries an evil repute as the White Man's Grave. Silent upon a peak of Darien, stout Cortez with eagle eye had gazed on the Pacific. As early as 1520, Saavedra proposed to cut a canal through the Isthmus. There the first city was founded by the conquerors of the new world, which still bears the name of Panama. Spaniards, English and French fought along its coasts; to it the founder of the Bank of England took his ill-fated colony; Raleigh, Drake, Morgan the buccaneer, and scores of adventurers seeking gold, found in fever an enemy stronger than the Spaniard. For years the plague-stricken Isthmus was abandoned to the negroes and the half-breeds, until in 1849, stimulated by the gold fever of California, a railway was begun by the American engineers, Totten and Trautwine, and completed in 1855, a railway every tie of which cost the life of a man. The dream of navigators and practical engineers was taken in hand by Ferdinand de Lesseps in January, 1881. The story of the French Canal Company is a tragedy unparalleled in the history of finance, and, one may add, in the ravages of tropical disease. Yellow fever, malaria, dysentery, typhus, carried off in nine years nearly twenty thousand employees. The mortality frequently rose above 100, sometimes to 130, 140 and in September, 1885, it reached the appalling figure of 176.97 per thousand work people. This was about the maximum death rate of the British Army in the West Indies in the nineteenth century.
When, in 1904, the United States undertook to complete the Canal, everyone felt that the success or failure was largely a matter of sanitary control. The necessary knowledge existed, but under the circumstances could it be made effective? Many were doubtful.
Fortunately, there was at the time in the United States Army a man who had already served an apprenticeship in Cuba, and to whom more than to anyone else was due the disappearance of yellow fever from that island. To a man, the profession in the United States felt that could Dr. Gorgas be given full control of the sanitary affairs of the Panama Zone, the health problem, which meant the Canal problem, could be solved. There was at first a serious difficulty relating to the necessary administrative control by a sanitary officer. In an interview which Dr. Welch and I had with President Roosevelt, he keenly felt this difficulty and promised to do his best to have it rectified. It is an open secret that at first, as was perhaps only natural, matters did not go very smoothly, and it took a year or more to get properly organized. Yellow fever recurred on the Isthmus in 1904 and in the early part of 1905. It was really a colossal task in itself to undertake the cleaning of the city of Panama, which had been for centuries a pest-house, the mortality in which, even after the American occupation, reached during one month the rate of 71 per thousand living. There have been a great many brilliant illustrations of the practical application of science in preserving the health of a community and in saving life, but it is safe to say that, considering the circumstances, the past history, and the extraordinary difficulties to be overcome, the work accomplished by the Isthmian Canal Commission is unique. The year 1905 was devoted to organization; yellow fever was got rid of, and at the end of the year the total mortality among the whites had fallen to 8 per thousand, but among the blacks it was still high, 44. For three years, with a progressively increasing staff which had risen to above 40,000, of whom more than 12,000 were white, the death rate progressively fell.
Of the six important tropical diseases, plague, which reached the Isthmus one year, was quickly held in check. Yellow fever, the most dreaded of them all, never recurred. Beri-beri, which in 1906 caused sixty-eight deaths, has gradually disappeared. The hookworm disease, ankylostomiasis, has steadily decreased. From the very outset, malaria has been taken as the measure of sanitary efficiency. Throughout the French occupation it was the chief enemy to be considered, not only because of its fatality, but on account of the prolonged incapacity following infection.
