Sanitation in Panama

by William Crawford Gorgas

CHAPTER VI
THE RESULTS ACCOMPLISHED IN HAVANA

From the account already given of yellow fever it is evident that the parasite has to be introduced into a locality, either in the body of a human being sick of yellow fever, or in the body of a female stegomyia mosquito which has become infected by the parasite. It is evident that if the health authorities can keep out these two sources of infection, yellow fever can never occur in that locality.

With this object in view we established a modern quarantine at Havana. Any ship coming in with yellow fever aboard was placed in quarantine. The vessel itself was fumigated so as to kill all the mosquitoes. This rendered the ship safe. All the non-immune crew were taken off, carried to quarantine station, where they were cared for during a period of six days. If no sickness developed during this period, it was concluded that the infected mosquitoes aboard the ship had not bitten these non-immunes up to the time of their departure. They were therefore released and allowed to return. The immunes were not considered liable to yellow fever, even if they had been bitten by the infected mosquitoes.

One attack of yellow fever gives such great protection that, in practice, a man who can prove that he has once had the disease is looked upon as entirely safe. But of course he has to prove this to the satisfaction of the quarantine physician. 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. But a quarantine greatly lessens the number of times and the frequency with which infection is introduced into a locality.

For some reason yellow fever, in the minds of people generally, is covered with a cloak of mystery. In communities where it prevails there are hundreds of remedies and courses of treatment that are vaunted as being infallible cures, and the more ignorant and uneducated the possessors of these specifics, the more readily they seem to be accepted by the people generally. But yellow fever, like every other acute disease, has its own natural history, and man at present knows no remedy that can shorten or change its course. Many a time I have found myself completely routed in cases of yellow fever by the old negro mammy, who would insist that if the patient would take orange-leaf tea and adopt certain other procedures which she advocated, the patient would certainly get well. Now, on the average with severe yellow fever, seventy-five per cent. will recover and twenty-five per cent. will die. The negro mammy did not know this, but was firmly convinced that it was the orange-leaf tea which caused the recovery in the cases of those who recovered, and some departure from her directions that caused death in the case of those who died. She believed that if her routine had been carried out in the fatal cases, they would have recovered. I must confess, however, that in my experience the measures generally advocated by the negro mammy did little or no harm, and in looking back over a yellow-fever experience of thirty years, I cannot by any means make so strong a statement with regard to my professional brethren.

One of the most general superstitions with regard to yellow fever was that all air must be kept from the patient. With this in view, the room in which the patient was treated was kept closed and entirely dark. No water for washing the face and hands, no change of body or bed clothing was allowed during the course of the disease. The conditions, therefore, as to filth when a patient had been ill five or six days can be better imagined than described.

I was once called into consultation by a medical friend of very high standing in one of the best and most aristocratic Havanese families. The patient was a young American teacher who had been brought to Havana a few months before in connection with the education of a large family of children. She had been sick with yellow fever some five or six days when I saw her, and I recognized without much examination that she was fatally ill and had but a few hours to live. Her Cuban friends were devoted to her, and were willing to do anything for her comfort and recovery that their wealth could command. As is generally the case in yellow fever, her mental faculties were perfectly clear, and her physical strength good, although she died within six hours after I saw her. She was delighted to see me, and begged me earnestly to induce her friends to let her bathe her face and hands and have clean clothing; for neither of these luxuries had been granted her since she was taken sick. I urged my medical friend who had called me into the case to allow the poor girl to have these things, and I knew that he agreed with me that they could do no possible harm. He said that he would try, but that probably the only result would be that he would lose the confidence of the family and do the poor girl no good. We both urged this upon the family, but so strong was their belief that such a measure would deprive their friend of such little chance of recovery as was left that they would not consent.

In times of stress and danger such as come about as the result of an epidemic of yellow fever, many tragic and cruel phases of human nature are brought out, as well as many brave and unselfish ones. Some tragedies stand out prominently in my recollection.

When yellow fever was at its height in Havana, our chief commissary, an officer of the regular Army, was taken sick and his disease was soon recognized as being yellow fever. His wife had left Havana a few weeks before to make a short visit to her home in Cincinnati. I had promised that if my friend should get yellow fever, I would cable his wife. I did so, and the wife received the cable while at a dinner-party. She started for Havana at once and reached Las Animas Hospital a day or two before the Major, her husband, died. The tie between husband and wife was unusually strong, and as she was assured that hope was departing, her grief was very great. This was before we knew that the mosquito alone could convey the disease, and when we had some general idea that it was infectious, and in some way contracted by contact with fomites, and with those who were sick of the disease.

The wife as she saw death approaching determined, if possible, herself to contract the dread disease. I heard her appeal to her husband in most moving terms not to die and leave her alone. She was with her husband at the moment of his death, and held him in her arms at the time. One who is familiar with a deathbed scene from yellow fever can appreciate what this means. It is a very gruesome death, and the young wife was covered with “vomito negro.”