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.”

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.

DEATHS FROM YELLOW FEVER IN THE CITY OF HAVANA

Years 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878

Months

January 18 20 32 7 16 24 8 26

February 23 13 23 4 16 24 9 13

March 12 4 27 18 32 29 11 5

April 54 4 37 22 34 33 8 28

May 91 13 127 85 32 103 16 53

June 201 68 378 172 142 292 143 184

July 234 68 416 361 187 675 249 504

August 138 70 127 416 144 250 285 374

September 72 59 35 186 102 97 234 179

October 55 38 28 91 109 42 185 106

November 51 85 5 42 105 31 150 53

December 42 73 9 21 82 19 76 34

Total 1309 2058 1396 1193 439 1020 1386 550 555 238 51 591 290 1000 572 991 515 1244 1425 1001 1619 1374 1559

Years 1879 1880 1881 1882 1883 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901

Months

January 11 16 7 9 14 26 4 4 5 8 17 10 10 15 15 7 15 10 69 7 1 8 7

February 13 9 3 11 9 16 3 0 6 8 5 4 3 10 6 4 4 7 24 1 0 9 5

March 6 20 3 14 21 8 1 0 8 14 5 4 4 1 4 2 2 3 30 2 1 4 1

April 13 44 6 18 34 32 2 1 22 24 8 13 5 8 8 4 6 14 71 1 2 0 0

May 40 40 6 84 75 55 3 1 84 26 17 23 7 7 23 16 10 27 83 4 0 2 0

June 237 50 37 176 162 66 4 14 128 36 37 38 41 13 69 31 16 46 174 3 1 8 0

July 475 179 90 195 177 131 13 33 102 74 48 67 66 27 118 77 88 116 168 16 2 30 1

August 417 48 127 73 148 97 34 39 73 113 73 60 66 67 100 73 120 262 102 16 13 49 2

September 148 75 94 56 50 41 32 37 36 63 37 33 65 70 68 76 135 166 56 34 18 52 2

October 44 32 39 33 72 24 41 16 33 48 21 32 48 54 46 40 102 240 42 26 25 74 0

November 31 21 38 36 45 8 22 13 20 33 21 15 24 52 28 23 35 244 26 13 18 54 0

December 9 11 35 24 42 7 6 9 15 21 14 9 17 33 11 29 20 147 8 13 22 20 0

Total 1444 645 485 729 849 511 165 167 532 468 303 308 356 357 496 382 553 1282 858 136 103 310 18

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.

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. Year No. Year No. Year No.

1871 262 1882 223 1893 246 1904 44

1872 316 1883 183 1894 201 1905 32

1873 329 1884 196 1895 206 1906 26

1874 288 1885 101 1896 450 1907 23

1875 284 1886 135 1897 811 1908 19

1876 334 1887 269 1898 1907 1909 6

1877 422 1888 208 1899 909 1910 15

1878 453 1889 228 1900 325 1911 12

1879 343 1890 256 1901 151 1912 4

1880 384 1891 292 1902 77

1881 251 1892 286 1903 51

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.