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.”
I felt myself more or less responsible, and thought that she was
going into the jaws of death by this kind of exposure. I therefore
called for the assistance of one of the nurses, and used some force
in getting her into the next room. She at first reproached me, but
as soon as we got her into the adjoining room she seemed at once to
regain her mental balance, spoke rationally to Mrs. Gorgas, and asked
me to arrange the details so that she could take her husband’s body
with her when she sailed on the next vessel for the United States.
Mrs. Gorgas and I walked with her to her room and gave certain
directions with regard to her care and comfort for the night. She
asked me for a sleeping dose which she might take in case she was
unable to sleep. I recollect that I put this up in such quantity that
she could not hurt herself even if she took it all. The rooms were
separated by very thin wooden partitions, and she asked about the
location of persons in the adjoining rooms.
About two A. M. Mrs. Gorgas and I went to our quarters. We had been
home just a short time when I was aroused by a hurried step and a
knock at the door. I found it was a messenger summoning me to the
hospital, with the information that the lady had killed herself.
When the door of her room was forced, we entered and found our
friend apparently in a peaceful, quiet sleep. One arm had dropped
naturally to the side, and the right arm was lying across the chest,
the hand still holding the pistol with which she had killed herself.
The appearance was exactly that of a piece of marble. She had shot
herself behind the ear, and the hemorrhage had been so sharp that
the body was entirely blanched. From where we stood the hemorrhage
did not show. She had concealed a pistol in her trunk which she had
procured in the United States at the time she started for Havana.
She had placed fresh clothing on a chair by the bedside, apparently
with the intention of being robed in it after death.
In looking back I could see various things in her actions and
conversation that indicated the intention of taking her life. At
other times she had entirely forgotten this, and was preparing for
her sad future in this life. She had apparently been dazed by her
grief and was temporarily unbalanced, unable for any length of time
to follow in her mind any definite plan of action.
The Major having been our chief commissary and a man with whom we
were in daily contact, this tragedy profoundly affected the military
community. The next day we took husband and wife out to the little
military cemetery at Camp Columbia where the American troops were
cantoned, some five miles from Havana, and laid them to rest in the
presence of a large concourse, military and civil.
While there, a member of the Commanding General’s staff, Captain
Page, had a chill, returned home sick, developed a severe case of
yellow fever and died within a week. This was looked upon by all
the community as evidence that the disease had been contracted by
contagion from the Captain’s having attended the funeral.
From the table on page 71 it will be seen that for ten years
preceding our occupation of Havana there had been an average of more
than five hundred deaths per year from this disease in the city; that
in 1900, two years after we had taken possession of the city there
were 310 deaths from yellow fever. A further search of the mortality
statistics shows that yellow fever had existed in Havana continuously
from the year 1762. This was the year during which Havana was
besieged and captured by the English forces. The troops were largely
made up of colonials from the North American colonies, and they
suffered severely from yellow fever. For two hundred years before
this time Havana had been subject to epidemics of yellow fever, but
from 1762 up to the year 1901, there was probably not a single day
when Havana did not have a case of this disease within its bounds.
DEATHS FROM YELLOW FEVER IN THE CITY OF HAVANA
===========================================================
YEARS | 1856 | 1857 | 1858 | 1859 | 1860
—————————————————+——————+——————+——————+——————+——————
MONTHS | | | | |
January | | | | |
February | | | | |
March | | | | |
April | | | | |
May | | | | |
June | | | | |
July | | | | |
August | | | | |
September | | | | |
October | | | | |
November | | | | |
December | | | | |
—————————————————+——————+——————+——————+——————+——————
TOTAL | 1309 | 2058 | 1396 | 1193 | 439
===========================================================
YEARS | 1861 | 1862 | 1863 | 1864 | 1865 | 1866
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | | | | | |
February | | | | | |
March | | | | | |
April | | | | | |
May | | | | | |
June | | | | | |
July | | | | | |
August | | | | | |
September | | | | | |
October | | | | | |
November | | | | | |
December | | | | | |
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 1020 | 1386 | 550 | 555 | 238 51
===========================================================
YEARS | 1867 | 1868 | 1869 | 1870 | 1871 | 1872
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | | | | | 18 | 20
February | | | | | 23 | 13
March | | | | | 12 | 4
April | | | | | 54 | 4
May | | | | | 91 | 13
June | | | | | 201 | 68
July | | | | | 234 | 68
August | | | | | 138 | 70
September | | | | | 72 | 59
October | | | | | 55 | 38
November | | | | | 51 | 85
December | | | | | 42 | 73
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 591 | 290 | 1000 | 572 | 991 | 515
===========================================================
YEARS | 1873 | 1874 | 1875 | 1876 | 1877 | 1878
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | 32 | 7 | 16 | 24 | 8 | 26
February | 23 | 4 | 16 | 24 | 9 | 13
March | 27 | 18 | 32 | 29 | 11 | 5
April | 37 | 22 | 34 | 33 | 8 | 28
May | 127 | 85 | 32 | 103 | 16 | 53
June | 378 | 172 | 142 | 292 | 143 | 184
July | 416 | 361 | 187 | 675 | 249 | 504
August | 127 | 416 | 144 | 250 | 285 | 374
September | 35 | 186 | 102 | 97 | 234 | 179
October | 28 | 91 | 109 | 42 | 185 | 106
November | 5 | 42 | 105 | 31 | 150 | 53
December | 9 | 21 | 82 | 19 | 76 | 34
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 1244 | 1425 | 1001 | 1619 | 1374 | 1559
===========================================================
YEARS | 1879 | 1880 | 1881 | 1882 | 1883 | 1884
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | 11 | 16 | 7 | 9 | 14 | 26
February | 13 | 9 | 3 | 11 | 9 | 16
March | 6 | 20 | 3 | 14 | 21 | 8
April | 13 | 44 | 6 | 18 | 34 | 32
May | 40 | 40 | 6 | 84 | 75 | 55
June | 237 | 50 | 37 | 176 | 162 | 66
July | 475 | 179 | 90 | 195 | 177 | 131
August | 417 | 48 | 127 | 73 | 148 | 97
September | 148 | 75 | 94 | 56 | 50 | 41
October | 44 | 32 | 39 | 33 | 72 | 24
November | 31 | 21 | 38 | 36 | 45 | 8
December | 9 | 11 | 35 | 24 | 42 | 7
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 1444 | 645 | 485 | 729 | 849 | 511
===========================================================
YEARS | 1885 | 1886 | 1887 | 1888 | 1889 | 1890
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | 4 | 4 | 5 | 8 | 17 | 10
February | 3 | 0 | 6 | 8 | 5 | 4
March | 1 | 0 | 8 | 14 | 5 | 4
April | 2 | 1 | 22 | 24 | 8 | 13
May | 3 | 1 | 84 | 26 | 17 | 23
June | 4 | 14 | 128 | 36 | 37 | 38
July | 13 | 33 | 102 | 74 | 48 | 67
August | 34 | 39 | 73 | 113 | 73 | 60
September | 32 | 37 | 36 | 63 | 37 | 33
October | 41 | 16 | 33 | 48 | 21 | 32
November | 22 | 13 | 20 | 33 | 21 | 15
December | 6 | 9 | 15 | 21 | 14 | 9
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 165 | 167 | 532 | 468 | 303 | 308
===========================================================
YEARS | 1891 | 1892 | 1893 | 1894 | 1895 | 1896
—————————————————+——————+——————+——————+——————+——————+——————
MONTHS | | | | | |
January | 10 | 15 | 15 | 7 | 15 | 10
February | 3 | 10 | 6 | 4 | 4 | 7
March | 4 | 1 | 4 | 2 | 2 | 3
April | 5 | 8 | 8 | 4 | 6 | 14
May | 7 | 7 | 23 | 16 | 10 | 27
June | 41 | 13 | 69 | 31 | 16 | 46
July | 66 | 27 | 118 | 77 | 88 | 116
August | 66 | 67 | 100 | 73 | 120 | 262
September | 65 | 70 | 68 | 76 | 135 | 166
October | 48 | 54 | 46 | 40 | 102 | 240
November | 24 | 52 | 28 | 23 | 35 | 244
December | 17 | 33 | 11 | 29 | 20 | 147
—————————————————+——————+——————+——————+——————+——————+——————
TOTAL | 356 | 357 | 496 | 382 | 553 | 1282
===========================================================
YEARS | 1897 | 1898 | 1899 | 1900 | 1901
—————————————————+——————+——————+——————+——————+——————
MONTHS | | | | |
January | 69 | 7 | 1 | 8 | 7
February | 24 | 1 | 0 | 9 | 5
March | 30 | 2 | 1 | 4 | 1
April | 71 | 1 | 2 | 0 | 0
May | 83 | 4 | 0 | 2 | 0
June | 174 | 3 | 1 | 8 | 0
July | 168 | 16 | 2 | 30 | 1
August | 102 | 16 | 13 | 49 | 2
September | 56 | 34 | 18 | 52 | 2
October | 42 | 26 | 25 | 74 | 0
November | 26 | 13 | 18 | 54 | 0
December | 8 | 13 | 22 | 20 | 0
—————————————————+——————+——————+——————+——————+——————
TOTAL | 858 | 136 | 103 | 310 | 18
===========================================================
In February, 1901, the measures above described were begun. Under
these measures yellow fever rapidly disappeared, and in September of
that year, the last case of yellow fever occurred. With one exception
there has been no case of this disease in Havana since that date.
The work directed against mosquitoes had an equally good effect upon
malaria. While the work done with the view of getting rid of the
stegomyia was effective to a certain extent against the anopheles,
the principal anti-anopheles work was executed in the suburbs of the
city. It is a general rule that malaria does not occur in the heart
of a city, but generally in its outlying districts. The reasons for
this will become evident when I describe anti-malarial work in one of
our future chapters.
DEATHS FROM MALARIA IN THE CITY OF HAVANA
Year No.
1871 262
1872 316
1873 329
1874 288
1875 284
1876 334
1877 422
1878 453
1879 343
1880 384
1881 251
1882 223
1883 183
1884 196
1885 101
1886 135
1887 269
1888 208
1889 228
1890 256
1891 292
1892 286
1893 246
1894 201
1895 206
1896 450
1897 811
1898 1907
1899 909
1900 325
1901 151
1902 77
1903 51
1904 44
1905 32
1906 26
1907 23
1908 19
1909 6
1910 15
1911 12
1912 4
It will be seen from this table that before the year 1901 Havana had
yearly from 300 to 500 deaths from malaria, rising as high in 1898
as 1,900 deaths. Since 1901 there has been a steady decrease in the
malarial death rate until the last year of the table, 1912, when
there were only four deaths. Four deaths from malaria in a city of
the size of Havana, about 300,000 population, means the extinction of
malaria in that city. For the island of Cuba is in the tropics, and
there are many malarious localities through the country districts.
Havana is the metropolis of Cuba, and has in its environs the largest
and best equipped hospitals of the country, as well as the most
distinguished surgeons and physicians. The sick, therefore, are
brought from the country in considerable numbers, and a great many
cases of malaria are brought in among these outside sick. The tables
quoted above include all persons who died within the limits of the
city of Havana, whether they came from the outside, or were residents
of the city; whether they died in the large hospitals of the city, or
in private houses.
Four deaths in one year from malaria can very safely be put down as
coming from the outside, and it can with equal safety be said that by
1912, malaria had become as completely extinguished in Havana, as had
yellow fever in 1902.
The extinction of malaria, however, did not attract anything like the
attention that the extinction of yellow fever had aroused. The work
of Dr. Ronald Ross and his co-workers with the anopheles mosquito,
and of Reed and his associates with the stegomyia, undoubtedly gave
the knowledge whereby the practical extinction of malaria and yellow
fever was accomplished at Havana, but the accomplishment of this
work with regard to yellow fever was the event which attracted the
greatest attention. It seems almost providential that we had all the
machinery at hand whereby the discoveries of the Reed Board could
be immediately tested and demonstrated. Here was a large city of
250,000 inhabitants in which yellow fever had been endemic for one
hundred and fifty years. The American Army had been in control of
the city for two years, and the Health Department was thoroughly
organized and equipped and under the charge of a medical officer
of the regular Army. Dr. Reed himself was strongly impressed with
the advantage it had been to him to have his discoveries given so
thorough and conspicuous a test, and wrote me to that effect many
times.
There has been a great deal of discussion as to who deserves the
credit for this great discovery. Undoubtedly Reed and his Board
brought all the threads together and actually made the great
discovery, but Finlay, Sternberg, Carter and others, started the
spinning of many of these threads. Like all great discoveries
everywhere it was gradually led up to by many workers.
Nothing is more true than the following quotation from one of Huber’s
papers:
And let me premise here, that in science at least, great names are
landmarks; and the owners of these names have traversed and gleaned
in fields where many a devoted laborer had delved and sown, and
pathetically sweated blood in his altruistic zeal. In science at
least no man works in vain. Full many an one, worthy of an elegy,
has given his whole life to establishing a fact, or indeed only an
item to a fact; his work unrealized, ridicule and even persecution
ofttimes his only compensation, throughout perhaps in the meanest
destitution, yet his life and his work have been absolutely
essential to the building of a mighty fabric. Martyrs have been
many among such—dying from the diseases from which they sought to
defend others; knowing, too, full well, what their own fate would
be. Nor does it in any wise detract from the gratitude due the
great man that he has profited by the labors of others, adding
what he can of his own, scrutinizing every detail, every datum,
permeating and illuminating with his own genius, cementing the mass
with his own deductions.
And from Flexner:
Remarkable achievements are never unique occurrences in nature.
Even the greatest men rest on the shoulders of a multitude of
smaller ones who have preceded them; and epochal discoveries emerge
out of a period of intellectual restlessness that affects many
minds.