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I was

a

The Malaria Campaign in Panama DR. WHIPPLE:

on the isthmus

year, 1907 and 1908, and had the opportunity to work with General Gorgas and his assistants, and to see a great deal of that work about which you have heard so much.

Now, when individuals have done things well, notably so, it is always interesting, even if it has been done before, to repeat two or three or four factors which perhaps are mainly responsible for the success of the work which is under consideration. So one always tries, in looking over the sanitary campaign in Panama, to put his finger on the point or points which stand out.

When it was decided that the sanitary conditions on the isthmus must be under control before work could be carried forward, a great many men in the United States were consulted, and they were unanimous that the thing to do was to find a man who knew, and they were very fortunate in finding General Gorgas, as you will agree; secondly, to give that man authority; and thirdly, to give him financial support. That is sufficient to handle any matter pertaining to sanitation-get the man, give him authority, and give him money.

One of the things which anyone who has worked with General Gorgas considers very important is his method of handling people. Anybody dealing with sanitary matters has to enforce certain things, and to get things done without friction and without trouble, and to persuade people to do things which they do not want to do and swear they will not do. That is a very vital thing, and that is a matter in which General Gorgas is paramount. He can get things done. He can get them done even by people who are hostile to him. General Gorgas always impresses on his staff of workers the importance of getting things done by persuasion rather than by force, and that is responsible for no small part of the success that his campaigns have had in Panama, where there were many difficulties.

There was not time to educate the people in the sense that we have had education, by lectures and talks. General Gorgas tried to make every sanitary inspector, every first-class or “gold” employee, give a hand in educating the people. These men told the natives, or colored people, as well as the Americans, what he was doing and why he was doing it. And in the control of malaria or yellow feverwhich is another example of disease mosquito-borne—the thing to do is to keep the mosquitos from associating with human beings. In the case of yellow fever, it is a relatively simple thing. When a man is sick, he knows it; he is under treatment. The yellow fever mosquito is a house mosquito and is easy to get rid of. But with malaria there are carriers, infants, children and other infected persons, who do not know it; they won't stand for treatment, but they are carriers and can infect mosquitos.

Anopheles are wild mosquitos. They breed out in the woods, and they come into houses only occasionally. Their breeding places are sometimes impossible to uncover. I think it is rather interesting to consider some of the places in which these sanitary inspectors have found mosquitos. Major Carter, who was one of the conspicuous aides on General Gorgas' staff, says that every time he sees a cow or horse walking across a swamp or soft ground he has a chill; for this reason: the animal walking across such ground makes holes up to six inches deep in which water accumulates, and those little cups are the ideal places for the breeding of anopheles. Of course, gutters on houses were banned. None of the buildings constructed by the commissioners could have gutters, because they are the well-known home of the mosquito. You will be amused, perhaps, to know that knotholes in trees are found to be very favored spots for breeding these wild mosquitos. They did not find that out until they had been at work quite a while. Generally in reservoirs or in lakes, either considerable or small in size, one can see accumulations of the scum forming little islands, which will drift back and forth across the lake, blown by the breeze. The mosquitos breed in these little islands; so at one time they may be on one side of the lake, and at another time on the other side. It was some time before that dawned on the sanitary inspectors. Moreover, they find that in these scum islands the fish cannot get at the mosquito larvae, and the larvae thrive correspondingly.

What about the protection they give the individual worker? Every house is screened. They have mosquito traps which would interest you. The mosquitos may be trapped coming in and going out, because mosquitos come in at night, and they prefer to get out during the day time; so traps are arranged in certain locations which are known to be best adapted for getting mosquitos when they come into or leave the house. Also, there is a squad of men who go around to every house usually between seven and ten in the morning to catch mosquitos. It sounds, perhaps, to you quite difficult to go into a house and catch mosquitos. These men have small vials or test tubes with a little chloroform in them, and one may see a man go into a bunkhouse peering under the bunks and sticking up the test tube. It is difficult to imagine what is going on until he comes out with a test tube containing perhaps forty or fifty mosquitos, especially if it is a colored camp house, where the workmen may have the habit of leaving the screen door open at night. They catch those mosquitos when they are full of blood and torpid, and the insects are taken to the sanitary office for enumeration and study.

It has been found that to make a place habitable in Panama the brush and grass must be cleared in a neighborhood of one hundred to two hundred yards. That is necessary, because these shrubs and grasses give a resting place for the mosquitos.

Much work has been done there--rather useless, you might say at first thought, but all these little things that are found out about mosquitos, although they seem useless, are often of great value to the sanitary expert, who must know all the little habits, bad habits as well as good, of the mosquito.

Much work has been done in determining the length of flight. They find that anopheles mosquitos often fly one hundred or two hundred yards. Many do not believe a mosquito often goes over a quarter of a mile unless there are very peculiar conditions. One of the little things which interested me a great deal looks like a crossroads signboard, only the board was made of glass, could be adjusted at various levels, and covered with some sticky stuff; at various periods this little glass signboard of four pieces placed at right angles could be inspected by a sanitary inspector. In this manner can information be obtained about the flights of mosquitos, at what times the flights occur, in what direction, influence of the direction of the wind, etc. Mosquitos may fly across wind and even up against the wind when it is not strong.

The sanitary workers, aside from the routine work and seeing that the work is done, study all these little details of the habits of the mosquitos, perhaps a great deal more than the habits of the laborers, and they think it much more important. General Gorgas, himself, constantly impresses upon his men the necessity of studying the insects, as they are the most important factor in controlling malaria. Many people have an idea that it is easy enough to say, "Go down and clean out this place.” But that is not the best method for the sanitary expert, if he wants to get things done. He goes out and shows people how to do it, and sees that they do it; and when ignorant colored labor is used, as on the isthmus, he must be on the job all the time in order to get results. The General has impressed on his assistants that results can not be gotten unless one is on the ground to supervise and see exactly what is being done. His field work is perhaps one of the pleasantest sides of his work down there, and not the least important. He takes juniors out with him and walks their legs off, and shows them how to become efficient sanitary inspectors. He goes anywhere at any time; obstacles never stop him. He nearly drowned one of his men on one trip, because they came to the Chagres river, where there was no bridge. The General decided to swim across rather than turn back. The junior was not much of a swimmer, and the General had to rescue him. That is an example of the way difficulties react on General Gorgas. After all, he was the main factor in the solution of the sanitary problem in Panama. (Applause.)

THE PRESIDENt: Dr. Whipple's address concludes the formal papers of the evening. There are a few minutes left. If any others desire to take up the discussion further, we would be glad to hear from them.

Remarks by C. E. Grunsky MR. GRUNSKY: May I be permitted, Mr. President, to add a few words to what Dr. Whipple has said about the sanitation work on the Isthmus of Panama? I desire to pay tribute to the work done so effectively by Dr. Gorgas and his able assistants. They made the isthmus habitable. They knew what was to be done and they did their work well. But theirs was an exceptional opportunity. They undertook a big job; but they had the United States, and practically unlimited means, back of them, and, as all the world knows, the desired result was accomplished. When the first canal commission went to the Isthmus of Panama early in 1904 to look over thc situation in order to be prepared for action when the property was turned over to the United States by the French canal company, Dr. Gorgas accompanied the commission. As soon as the canal property was taken over by the United States in May, 1904, Dr. Gorgas was among the first to be sent again to the Canal Zone and he was given full authority, in advance of the permanent organization of a health department, to do anything that might seem necessary, under the conditions as found on the isthmus, to make the Canal Zone as safe as possible for canal employees and their families. General Gorgas (at that time Colonel) lost no time in getting to work. His staff at the outset consisted of Dr. John W. Ross, director of hospitals; Dr. H. R. Carter, in charge of quarantine; Dr. Louis La Garde, superintendent of Ancon Hospital (700 beds), and Dr. Sprattling, superintendent of Colon Hospital and in charge of sanitary matters at Colon. The organization of the health department of the Canal Zone was perfected several months later, and by that time Mr. Joseph A. Le Prince had brought into active service a corps of mosquito fighters. The stegomyia, the carrier of the yellow fever germ, was deprived of access to clear, fresh water, where they breed, and the anopheles were pursued in the field.

In 1904, the water supply of Panama was primitive. Rain water was used for laundry work, and drinking water, obtained from springs, was distributed by water carts. The clear water of the rain barrel was a favorite breeding place for the stegomyia; but the rain barrel could not be at once condemned. It was first necessary to bring in a perma. nent supply of good water. Steps to do this were at once taken by the canal commission, but a water project requires time in its execution, and it was not until July, 1905, that water delivered by a pipe system could be made available. In the meantime the rain barrel had to be made inaccessible to the mosquito. This was done by covering all water containers with screens through which the water entered the container and by forbidding the dipping of water from the top, as had been the practice. Some four thousand faucets were supplied by the canal commission and inserted in water containers to make the drawing of water possible without lifting the screens, which served the twofold purpose of preventing the young mosquito from getting out and of barring out the female when desiring to lay her eggs. It is hardly, necessary to say that the mosquitos were plentiful in Panama in 1904, and an estimate made by a local expert showed that in the city about ninety-eight per cent. were of the yellow fever carrying type. Some credit is due to those on the Panama Canal work at and soon after its inception, not alone for results accomplished, but also for braving the dangers incident to life on the isthmus. It took time to get rid of the yellow fever, and to so reduce the number of yellow-fever carrying mosquitos that the danger of being impregnated with the disease germ was made negligible. But this was ultimately brought about—though not until after one 'unfortunate outbreak of the dread disease. Since May, 1906, however, there has been no case of yellow fever originating in the Canal Zone.

Of the thoroughness with which the work was done on the isthmus you have been told by Dr. Whipple. I do not intend to enlarge upon this matter, but did not wish to let the opportunity pass of saying a word in praise of what was done in the Canal Zone, at Colon and at Panama, where the sanitation work made the construction of the canal possible, with no greater amount of sickness and no greater loss of life than might be expected on such work in a temperate climate. (Applause.)

THE PRESIDENT: I knew Mr. Grunsky was on the commission there, but I did not remember that he was with General Gorgas, or I would have had him up on the platform.

We have three or four minutes left. I think I will call on Dr. Cumming for a few remarks. Dr. Cumming was brought out here from Ann Arbor to take up the work of Director of the State Board of

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