Immunisation, by the direct use of an infected mosquito, may be compared with the old custom of inoculation against smallpox. The use of Sanarelli's serum-treatment has not gone far. There remains for consideration the method of keeping down infection by keeping down Culex.
Three reports, in 1901-1902, come from Dr. Guitéras (Havana), Surgeon-Major Gorgas, chief sanitary officer (Havana), and the Commission at New Orleans. Dr. Guitéras reports that 6 cases of yellow fever (inoculation) were treated in a large "mosquito-proof" building, which also contained cases of other diseases. No prophylaxis was enforced, save the exclusion of mosquitoes; non-immunes visited the yellow fever cases, non-immunes nursed them, and most of the attendants and labourers about the place were non-immunes; but not a single case of infection occurred. The New Orleans Commission reports that, of 200 cisterns, &c., examined in the city for the presence of larvæ, the larva of Culex (Stegomyia) predominated in more than 60 per cent.
The report of Surgeon-Major Gorgas is very pleasant reading. For two centuries, Cuba had been cursed with yellow fever; then, after the war with Spain, America took it over:—
"The army took charge of the health department of Havana, when deaths (from all causes) were occurring at the rate of 21,252 per year. It gives it up, with deaths occurring at the rate of 5720 per year. It took charge, with smallpox endemic for years. It gives it up, with not a case having occurred in the city for over eighteen months. It took charge, with yellow fever endemic for two centuries—the relentless foe of every foreigner who came within Havana's borders, which he could not escape, and from whose attack he well knew every fourth man must die. The army has stamped out this disease in its greatest stronghold."
Make fair allowance for the wide variation, from year to year, of the number of yellow fever cases in any town within the geographical belt of the disease; admit that a town may, in the course of nature, have many hundred cases in one year, and only half a dozen in another year. Again, make fair allowance for all other good influences of the American occupation of Cuba, beside those that were concerned with the stamping out of Culex; admit that the general death-rate of Havana, in the last February of Spanish rule (1898), was 82.32 per thousand, and in February 1901, was 19.32. Still, there is an example here, in the 1901 work in Havana, for the world to follow, wherever yellow fever exists. The following abstract of Surgeon-Major Gorgas' results was published in the Practitioner, May 1902, by Professor Hewlett, one of the foremost of English bacteriologists:—
"Commencing in February 1901, orders were issued that every suspected case of yellow fever should be screened with wire gauze at the public expense, so as to render the room or rooms mosquito-proof. All mosquitoes in the infected house and in contiguous houses were destroyed. After the middle of February, 100 men were employed in carrying out the destruction of the mosquito-larvæ in their breeding places, putting oil in the cesspools of all houses, clearing the streams, draining pools, and oiling the larger bodies of water. Up to June, quarantine was enforced, together with disinfection of the house and fomites. After that, however, rigid quarantine of the patient was stopped, and disinfection of fabrics and clothing ceased. It was merely required that the patient should be reported, his house placarded and screened, and a guard placed over each case to report how general sick-room sanitation was carried out, to see that the screen-door communicating with the screened part of the house was kept properly closed, and to see that communication with the sick-room was not too free, four or five non-immunes only being allowed in. By the end of September, the last focus of the disease had been got rid of, and since then, up to the beginning of January, there has not been a single case. Whereas, for the years since 1889, from 1st April to 1st December, yellow fever caused an average of 410.54 deaths, with a maximum of 1175 for 1896, and a minimum of 79 for 1899, it caused in 1901 5 deaths only. In the months of October and November, when the disease has hitherto been exceedingly rife in Havana, there has not been a single case. For the first time in 150 years, Havana has been free from yellow fever."
Sir Patrick Manson, lecturing in America, last year, on tropical diseases, summed up the work as follows:—
"Time will not permit—what to you is probably quite unnecessary—the recapitulation of the story of the labours of Reed and his coadjutors. I cannot pass on, however, to what I have to say in connection with this work without a word of admiration for the insight, the energy, the skill, the courage, and withal the modesty and simplicity of the leader of that remarkable band of workers. If any man deserved a monument to his memory, it was Reed. If any band of men deserve recognition at the hands of their countrymen, it is Reed's colleagues.
"The principal outcome of the labours of these men has been the demonstration, first, that the ultra-microscopic germ of yellow fever is present in the blood of the patient during the first three days of the disease. Second, that the first step in the passage of the germ from the sick to the sound is made, under natural conditions, in the stegomyia mosquito. And third, that after about twelve days and upwards in stegomyia, the yellow fever germ, when implanted by the said mosquito into another human host, is capable of reproduction, so that at the end of a further period of about three days it has established itself throughout the blood, is causing the violent reaction, the clinical manifestations of which we call yellow fever, and is once more in a condition to re-enter the mosquito.