the evolution of modern medicine(现代医药的演变)-第43章
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Philadelphia； 1793。
＇6＇ R。 La Roche： Yellow Fever； 2 vols。； Philadelphia； 1855。
Many scientific discoveries have afforded brilliant illustrations of
method in research； but in the work of these men one is at a loss to know
which to admire morethe remarkable accuracy and precision of the
experiments； or the heroism of the menofficers and rank and file of the
United States Army； they knew all the time that they were playing with
death； and some of them had to pay the penalty！ The demonstration was
successfulbeyond peradventurethat yellow fever could be transmitted
by mosquitoes； and equally the negative proposition that it could not be
transmitted by fomites。 An interval of twelve or more days was found to
be necessary after the mosquito has bitten a yellow fever patient before it
is capable of transmitting the infection。 Lazear permitted himself to be
bitten by a stray mosquito while conducting his experiments in the yellow
fever hospital。 Bitten on the thirteenth； he sickened on the eighteenth and
died on the twenty…fifth of September； but not until he had succeeded in
showing in two instances that mosquitoes could convey the infection。 He
added another to the long list of members of the profession who have laid
down their lives in search of the causes of disease。 Of such men as Lazear
and of Myers of the Liverpool Yellow…Fever Commission； Dutton and
young Manson； may fitly be sung from the noblest of American poems the
tribute which Lowell paid to Harvard's sons who fell in the War of
Secession：
Many in sad faith sought for her； Many with crossed hands sighed for
her； 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
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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；
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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
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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。 In
1906； out of every 1000 employees there were admitted to the hospital
from malaria 821； in 1907； 424； in 1908； 282； in 1912； 110； in 1915； 51； in
1917； 14。 The fatalities from the disease have fallen from 233 in 1906 to
154 in 1907； to 73 in 1908 and to 7 in 1914。 The death rate for malarial
fever per 1000 population sank from 8。49 in 1906 to 0。11 in 1918。
Dysentery； next to malaria the most serious of the tropical diseases in the
Zone； caused 69 deaths in 1906； 48 in 1907； in 1908； with nearly 44；000；
only 16 deaths； and in 1914； 4。＇*＇ But it is when the general figures are
taken that we see the extraordinary reduction that has taken place。 Out of
every 1000 engaged in 1908 only a third of the number died that died in
1906； and half the number that died in 1907。
＇*＇ Figures for recent years supplied by editors。
In 1914； the death rate from disease among white males had fallen to
3。13 per thousand。 The rate among the 2674 American women and
children connected with the Commission was only 9。72 per thousand。 But
by far the most gratifying reduction is among the blacks； among whom the
rate from disease had fallen to the surprisingly low figure in 1912 of 8。77
per thousand； in 1906 it was 47 per thousand。 A remarkable result is that in
1908 the combined tropical diseasesmalaria； dysentery and beri…beri
killed fewer than the two great killing diseases of the temperate zone；
pneumonia and tuberculosis 127 in one group and 137 in the other。 The
whole story is expressed in two words； EFFECTIVE ORGANIZATION；
and the special value of this experiment in sanitation is that it has been
made； and made successfully； in one of the great plague spots of the world。
Month by month a little； gray…covered pamphlet was published by
Colonel Gorgas； a 〃Report of the Department of Sanitation of the Isthmian
Canal Commission。〃 I have been one of the favored to whom it has been
sent year by year； and； keenly interested as I have alway
