Sanitation in Panama

by William Crawford Gorgas

Such instances of mortality could be adduced ad infinitum. Leprosy in the fourteenth century was more common in England than it is now in Palestine, so common that every county had a lazaretto where lepers were strictly confined, and laws are still on the statute books prescribing the method of their confinement, and the disposition of their property.

The inhabitants of Europe at this time were subject to all the contagious and infectious diseases to which, with one or two exceptions, they are now subject, but most of these diseases, for some reason, were vastly more virulent than they are at the present time.

In the fifteenth century when America was discovered by the Europeans, the Indians undoubtedly suffered from disease. They probably had some diseases from which Europeans, up to that time, had not suffered, and the Europeans, no doubt, brought with them some diseases from which the Indians had not suffered. Yellow fever is a good example of the first, and syphilis of the second. And this must necessarily have been the case if we give a little thought to the matter.

According to generally accepted scientific belief, the buffalo developed from the first created cell from which we have all descended. If his ancestry could be traced, the line would run straight back to this first cell. But he developed into the present buffalo in a limited area in North America. The ox, at some period in the distant past, branched off from the same line of descent from which the buffalo came, yet he developed into the present ox within a very limited area in Central Asia. These animals were originally native to a very small area of country, and this seems to have been the case in the development of all animal life.

The yellow-fever germ is primarily an animal very much like the buffalo or ox, and must have come from the first created cell just as did all life, and must have developed as did other animals in a very limited area or territory. Exactly the same could be said of the tuberculosis germ. It is, therefore, just as natural that the western hemisphere should have had its peculiar diseases as that it should have had its peculiar animals.

Everywhere that the European attempted to colonize he suffered from disease, and this always occurred within the first two or three years. In Columbus’ settlement on Santo Domingo, he lost within the first three years a very large number of the colonists settled there. When the English colonized Virginia at Jamestown, they lost from disease about one-half of the total number of colonists, and the same is true of the settlers at Plymouth. Everywhere that settlements were attempted, the settlers were so nearly destroyed by disease that, in many instances, the few survivors could not be persuaded to remain.

Yellow fever is an acute specific, very fatal, febrile disease, lasting about a week, and characterized by fever, vomiting, muscular pains and albuminuria, and in the graver cases by black vomit and hematogenous jaundice. It is transmitted from person to person by the female stegomyia mosquito. The sick person does not infect the biting mosquito after the third day of the disease. One attack gives immunity against a second attack.

Like all other diseases, its origin is enveloped in a cloud of obscurity. The yellow-fever organism, like the horse or the dog, developed in some particular locality. The horse had his whole lifetime in which to wander from place to place, and so spread very rapidly and widely as compared with the yellow-fever organism. The yellow-fever organism was dependent upon the mosquito and man for his locomotion. On the average, he had not more than a week in which to travel. I presume that a week would be long for the average life of a stegomyia mosquito, and the traveling ability of the organism would be limited by the life of the mosquito. For while the female stegomyia mosquito has to live two weeks after she has bitten the yellow-fever patient before she can convey the disease to another non-immune human being, still the average length of life in the mosquito cannot be as great as this. The various conditions of unfavorable environment, the natural enemies of all kinds, wind, etc., must kill a large proportion of mosquitoes within the first week. If we consider the total number of stegomyia mosquitoes in an infected locality, we must see that only an infinitesimal proportion succeed in biting a yellow-fever patient within the first three days. This small proportion, however, has the best protection and is more likely to have a long life than the average of the female stegomyia, for they necessarily bite inside of the houses, and in such places have the best protection from the wind and sun, their greatest enemies.

In this other host, man, the parasite had only three days to travel. During these three days the man would be sick and not likely to move about much. During man’s savage state he traveled very little more than did the mosquito. We would expect, therefore, the yellow-fever organism’s rate of spread to be very much less rapid than the spread of the horse.

When America was discovered, the horse had not yet reached that continent. The evidence with regard to the yellow-fever organism seems to me to indicate that, at this same time, it had not spread further than a limited area about Vera Cruz. It is probably the latest disease to which man has been subject.