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©2000 National Council for the Social Studies. All rights reserved.
I know this little thing
A myriad of men will save.
O Death, where is thy sting?
Thy victory, O Grave?
written by Dr. Ronald Ross the night he discovered
malaria protozoa in the stomach of the Anopheles mosquito
Wynell Schamel and Lee Ann Potter
Guest Editor: Jean M. West
December 31, 1999, marked, among other things, the day that the Republic of Panama first exercised sovereignty over the Panama Canal. The engineering triumph of the cana#146;s construction; its continuing economic, commercial, and communications value; and its strategic and political importance all remain impressive. Yet, improved global health may be the most far-reaching and long-lasting benefit of the United States enterprise in Panama.
In the late1800s, infectious diseases were the leading cause of death worldwide. The Isthmus of Panama, a province of Colombia at that time, suffered a number of scourges, many of which had been unwittingly introduced by Spanish colonizers. Malaria was chronic year-round, while yellow fever appeared during the rainy season between April and December. Malaria, the less lethal of the two, caused recurring and debilitating fever, while yellow fever with its massive infection of the liver produced jaundice, extremely high fever, and higher incidences of death.
Frances attempt to construct an isthmian canal between 1881 and 1884 was doomed by ignorance about the causes of infectious diseases and the resultant deaths of nearly twenty thousand workers. Although the French built hospitals, nearly 75 percent of those hospitalized died because the buildings were unscreened, the wards were divided not by disease type but by nationality, and water-filled dishes placed under bed legs to thwart ants caused mosquitoes to proliferate and so spread both yellow fever and malaria.
Yet knowledge of the connection between mosquitoes and both of these diseases had in fact been accumulating throughout the second half of the 19th century. As early as 1848, Alabama doctor Josiah C. Nott wrote that the physics of air movement could not account for malaria and yellow fever, suggesting instead that these diseases were insect-borne and that mosquitoes were the most likely agents. French military doctor Alphonse Laveran, posted in Algeria, first described the malaria protozoa in 1880. The following year, Dr. Juan Carlos
Finlay of Havana, Cuba, identified
Stegomyia fasciata (now called Aedes aegypti) mosquitoes as the carriers of the yellow fever virus.
In 1882, Professor Albert Freeman Africanus King of Washington, D.C. (one of the first physicians to attend the dying Abraham Lincoln) devised a mosquito control program for the capital city by installing screens and drainage. British army doctor Ronald Ross, serving in India in 1897, found the malaria parasite in the Anopheles mosquito, and concluded that it transmitted malaria. Ross published a book in 1902 called Mosquito Brigades that theorized that malaria could be prevented through mosquito eradication. Meanwhile, Dr. Henry Rose Carter of Virginia in 1900 proved that yellow fever infects and incubates under very strict time constraints, conclusively ruling out its transmission by patients or their soiled clothing.
Practical application of this new information began in Cuba during the Spanish-American War. When yellow fever killed two hundred soldiers in a 1900 outbreak in Havana, a team led by U.S. Army doctor Walter Reed was sent to investigate. Following Finlay and Carters urging, Reeds Yellow Fever Commission studied suspect mosquitoes and conclusively identified them as the culprits. Reed isolated yellow fever cases, then began a systematic mosquito eradication program. In eight months, yellow fever had disappeared from Havana, and malaria cases had dropped by 75 percent.
Following its success in the Spanish-American War, the United States in rapid succession negotiated with the French and Colombians for the canal excavations already under way in Panama, backed Panamanian insurrectionists against Colombia, and concluded a treaty with Panama to construct a canal in exchange for perpetual sovereignty. President Theodore Roosevelt, a pivotal figure throughout, had been an eyewitness to the ravages of disease in Cuba and believed that health measures would determine U.S. success in Panama. He adamantly declared, As you know, I feel that the sanitary and hygienic problems ... on the Isthmus are those which are literally of the first importance, coming even before the engineering.
Roosevelt appointed Colonel William Crawford Gorgas as Sanitary Officer for the canal. Interestingly, yellow fever had shadowed this forty-nine-year-old Alabamian throughout his life. Pioneering researcher Josiah Nott attended Gorgass birth. As a young Army doctor, Gorgas contracted yellow fever, convalesced with the similarly stricken daughter of his commander, and subsequently wed her. Most importantly, Gorgas had served in Havana under Walter Reed.
Despite the lessons of Reeds medical success in Havana and Rosss receipt of the 1902 Nobel Prize, public officials and average citizens alike clung to the notion that malaria was caused by lethal marsh gases or night air, and that yellow fever was spawned from filth or tropical fruit. Admiral John G. Walker, first head of the Panama Commission, declared, I am not going to spend good American dollars on a group of insane enthusiasts who spend their time chasing mosquitoes. . . . As everyone knows, what causes yellow fever is not mosquitoes but filth and dirt. Accordingly, Gorgas arrived in Panama in June 1904 with a sanitary team consisting of seven doctors (including Dr. Carter) and a single nurse, no funds, and no supplies. Nearly all members of the team, including Gorgas, contracted malaria within the first two months.
In spite of these handicaps, Gorgas proceeded, focusing first on yellow fever and then on malaria. He divided Panama City into eleven districts, inspected every building within each district, and created a separate card recording the findings for each structure. Mosquitoes were everywhere in this rainy, tropical land filled with lakes and rivers. They proliferated in earthenware drinking water jars (tinajas), in open cisterns and rain barrels, in ruts caused by livestock and railroad ties, in the French diggings, and even in the holy water fonts of the Catholic churches. One inspector counted fifty-four Anopheles mosquitoes on a single door panel at Ancon Hospital.
Gorgas, who already knew that Stegomyia mosquitoes needed clean, fresh, still water for breeding, soon learned that Anopheles mosquitoes could lay eggs in murky, stagnant water. While gathering Anopheles larvae and pupae for study, Gorgass team also discovered that direct sunlight, rain, and strong breezes killed immature Anopheles.
The first yellow fever case since the arrival of Gorgass sanitary team in Panama City occurred in November 1904. Gorgas isolated the patient in a screened enclosure and ordered all city residents to close unscreened windows. However, few people complied, and yellow fever became epidemic. On July 26, 1905, the new chief engineer for the canal, John Stevens, arrived in Panama. Stevens gave Gorgas four months to eradicate yellow fever, but guaranteed him whatever supplies he needed and the first call on labor.
The Sanitation Department mushroomed from eight employees operating under a $50,000 budget to more than 4,000 employees with a $2 million budget by the end of 1906. Gorgas immediately spent $90,000 to screen operational buildings, residences, hospitals, and railway car windows and doors. He ordered 120 tons of pyrethrum powder (a dried flower that served as an insecticide), 300 tons of sulphur, and 50,000 gallons of kerosene oil per month to begin a massive fumigation program. And, he divided sanitation workers into Stegomyia and Anopheles brigades.
Stegomyia fumigation trucks went out daily with ladders, buckets of paste, and newspaper. Armed with Gorgass note cards, squads consisting of six men would descend on a building, seal doors and windows with paper, then go from room to room, burning sulphur or pyrethrum for at least an hour. Recalling that the arrival of piped running water in New York City corresponded with the end of yellow fever, Gorgas installed water pipes throughout Panama City. Sanitation workers covered, emptied, or laid a skim of oil on all water containers, cisterns, cesspools, and drainage ditches weekly to prevent mosquito propagation. Anyone who left uncovered standing water around was fined five dollars. The main roads of Panama City and Colon were paved to eliminate water-trapping ruts. As a result of the Sanitation Departments efforts, the yellow fever epidemic ended in November with only forty-seven fatalities.
Anopheles brigades were supplied with mowers, machetes, and even flamethrowers. They hacked and burned away jungle vegetation to create sunny, windy areas that deprived Anopheles of its preferred habitat. They dug ditches to drain swamps, then oiled eight million feet of ditches to kill larvae. One oiling method was to place a galvanized can full of kerosene on a plank over a stream so that oil dripped steadily, coating the flowing water. Workers set out scrubbed, flat, water-filled pans to entice mosquitoes to lay eggs, then dumped the larvae down a disinfected drain.
New, screened, well-staffed hospitals were built with isolation quarters and separate wards for each disease. Every train that ran along the canal excavation pulled a hospital car to expedite treatment of ill or injured workers. Hospital care was free to all canal employees. Low mortality rates encouraged employees to receive medical treatment each time they suffered illness or injury, further improving health. In 1914 alone, 24,723 workers (nearly half the workforce) were hospitalized at least once.
Although disease wards were further segregated by race and ethnic origin, most non-white or foreign workers felt they received excellent care. Jamaican James Williams, treated for typhoid fever in 1910, declared, What I can truthfull say those American Nurses my own dear mother could not be more kind and tender to me. They did everything lies humanly even to let me take a little nourishment so to keep life in my body.
Not one U.S. citizen died in Panama in the last three months of 1906, although 30 could have been expected to die in a U.S. city of comparable size. The last yellow fever case in Panama occurred in May 1906. Between 1906 and 1914, the year the canal was completed, malaria cases were cut by 90 percent, while malaria deaths during the same period continued to decline, from 186 to 14 (see graph). The average death rate of all employees in Panama in 1914 was 7.92 per 1,000 compared to the U.S. death rate of 14.1 per 1,000. Panama had gone from death-trap to virtual health spa, a distinction it enjoys to the present.
The story of the fight against disease in Panama was not one of unfailing triumph. The so-called silver/gold employee system segregated workers according to their ethnic and racial backgrounds. Housing was segregated and decidedly unequal since colored laborersPanamanians, African Americans and blacks from the Caribbean, East Indians, and Chineselived in unscreened quarters along unpaved, rutted roads. Over time, some improvements were made in workers housing, notably for African Americans who constituted a special category of silver employees. However, because of their increased exposure to mosquitoes, thousands of ordinary workers contracted malaria. Many also worked dangerous jobs, digging in landslide-prone Culebra Cut and working with explosives, so that they were four times as likely to die as white laborers.
Among all workers, incidences of other diseasesincluding typhoid fever and tuberculosiswere on the rise in 1914. More than five thousand workers died, many from pneumonia, building the canal. An additional problem was the resentment some Panamanians felt over the intrusive methods of the Sanitation Department.
Nonetheless, it is estimated that 78,000 canal workers and thousands more Panamanians would have died had Dr. Gorgas not implemented his program. Although Gorgas was forced out of his job by political machinations in 1906, he had the satisfaction of knowing he had changed health practices and public attitudes toward them forever. It is impossible to calculate the number of people around the world who have survived and lived in better health since the United States sent its first workers to Panama in 1904. Of all the wonders of the Panama Canal, surely the legacy of health is the greatest.
Note: The documentary photographs and
graph featured in this article are from the
Records of the Panama Canal, Record Group
185, in the holdings of the National Archives
of the United States.
Outlining the Historical Background
Begin by assigning students to read the accompanying article. Then lead the class in discussing the health hazards presented by mosquitoes carrying the malaria protozoa or yellow fever virus at the time the Panama Canal was constructed. Students could consider the circumstances that favored the spread of each disease, and why the French effort at containment failed. They could also discuss the global nature of the threat, and how the efforts of doctors in farflung places led to more understanding of how these diseases were being conveyed. Assign students to use the article and additional research to create either: (a) a timeline of efforts to isolate the causes of malaria and yellow fever, or (b) a chart distinguishing between each disease with regard to its biological cause, precipitating conditions, medical symptoms, and effects on human health.
Analyzing Photographic Documents
Use the photographs in this article and the accompanying Photograph Analysis Worksheet to prompt questions and discussion about the effort to control mosquito-borne diseases in the Canal Zone. Divide the class into small groups and provide each group with copies of the photographs and a worksheet to be filled out for each. Invite students to ask questions about any terms (e.g., larvacide) that require further explanation. Students could follow up analysis of these photographs with a discussion of their value as primary source materials.
Examining the Gorgas Effort in Detail
Ask students to consider the efforts of Gorgas and his Sanitation Department in the Canal Zone using these questions and others they may devise:
> What prompted United States President Theodore Roosevelt to appoint Colonel William Gorgas as Sanitary Officer in the Canal Zone?
> How was the Gorgas team equipped to fight disease upon its arrival in Panama in 1904?
> What were the first steps Gorgas took to combat mosquito-borne diseases in the Canal Zone?
> What were the differing reactions of Admiral John G. Walker and Engineer John Stevens to Gorgass effort?
> How was the work of the Stegomyia and Anopheles brigades alike and different?
> What hospital developments aided in the control of malaria and yellow fever?
> To what extent, if any, were the actions of the Sanitation Department in the Canal Zone an intrusion on individual freedom?
> How was the public health effort in Panama a success, and in what ways was it a failure? What would you have done the same as, or differently from, the Gorgas team?
Doing Research on Epidemiology
Assign students working in teams to research and report on historical or contemporary disease epidemics and the efforts taken to counter them. Begin by helping students to distinguish between the terms endemic (constantly present to a greater or lesser extent in a particular place), epidemic (affecting many persons within a community, area, or region at one time), and pandemic (affecting a high proportion of the population over a wide geographic area, possibly including many countries). Tell students they may choose varying forms of oral and visual presentation for their reports, but all should include information about the cause, symptoms of, medical treatment for, public health effort against, and historical impact of a particular disease epidemic. Some examples to choose from are:
n Black Death in Europe, 1347-1351
n Smallpox and measles in the Americas, 1500s
n Yellow fever in Haiti, 1801-1803
n Spanish influenza pandemic, 1918-1919
n Poliomyletis in the United States, 1946
n AIDS pandemic, contemporary
Reflecting on Public Health Issues
A. Help students to examine the graph featured in this article, which tracks the decline of malaria among canal employees in Panama from 1909-1914. In what year was the greatest fall-off in the incidence of malaria recorded? Ask students the following questions based on their reading of the article: (1) What medical factors caused decline in the malaria rate? (2) What social factors caused malaria to decline faster among some groups of workers than among others?
B. Explain that public health balances personal rights with the common good, and that some of the issues requiring balance are individual privacy, religious beliefs, ecological concerns, and health costs and benefits. The accompanying article mentions that some Panamanians resented the efforts of the Gorgas team as intrusive on their lives. Ask students to debate whether the ends (improved health) justified the means (involuntary measures imposed on the population) in Panama.
C. Ask students to volunteer information about which health inoculations they have received. Point out that many states have compulsory inoculation requirements for public school students and that, resultantly, certain diseases formerly considered part of childhood (e. g., measles and mumps) have been all but eliminated. The recently introduced vaccine for chicken pox is cutting down on the childhood incidence of this disease as well. Do students think the public health measures taken against these diseases are justified? Ask students what they think might be important factors in considering whether to inoculate all public school children against another disease, e.g., influenza?
D. The concept of vaccination was introduced by Edward Jenner when he used the cowpox virus to inoculate against smallpox in the late 18th century. Today, this great health scourge has been eradicated around the globe, and only a few laboratory samples of the smallpox virus still exist. There is currently a debate over whether to eliminate these samples as well. Ask students to list and discuss the factors they think are important in this international public health debate.
E. Although efforts to control malaria in the Canal Zone were quite successful, this disease continues to be a worldwide threat almost one hundred years later. Use of DDTthe most effective insecticideproved to be dangerous to other animal life as well, nearly causing the extinction of the bald eagle, for one example. Students might consider the following questions. (1) How can society balance the short-term medical effects and the long-term ecological effects of fighting disease with pesticides? (2) Given todays global society in which diseases move rapidly from one place to another, who isor should beultimately responsible for determining the measures needed to defeat modern epidemics and pandemics?
Aaseng, Nathan. The Disease Fighters: The Nobel Prize in Medicine. Minneapolis: Lerner Publications, 1987.
Gordon, Richard. Great Medical Disasters. New York: Dorset Press, 1983.
Mann, Elizabeth. The Panama Canal. New York: Mikaya Press, 1998.
McCullough, David. The Path Between the Seas: The Creation of the Panama Canal, 1870-1914. New York: Simon and Schuster, 1977.
Metos, Thomas. Communicable Diseases. New York: Franklin Watts, 1987.
McNeil, William H. Plagues and People. New York: Anchor Books, 1998.
Oliver, Carl. Panamas Canal. New York: Franklin Watts, 1990.
Viola, Herman J. and Carolyn Margolis. Seeds of Change. Washington, DC: Smithsonian Institution Press, 1991.
Wynell Schamel and Lee Ann Potter are education specialists at the National Archives and Records Administration, Washington, D.C . Guest Editor Jean M. West is an educational consultant. Schamel serves as editor for Teaching with Documents, a regular department of Social Education. You may reproduce the documents shown here in any quantity. For more information, write, call, or e-mail the Education Staff at NARA, NWE-E, 8601 Adelphi Road, College Park, MD 20740; (301) 713-6274; firstname.lastname@example.org.
Photograph Analysis Worksheet
Step 1. Observation
> Study the photograph long enough to form an overall impression. Then examine the photograph for details, dividing the picture into quadrants to see whether anything more becomes visible.
> Read the caption provided by the official Records of the Panama Canal. Does it help you to interpret the picture? If so, how?
> Make a chart with three column headings: People, Objects, Activities. Examine the photograph again, and list the important details in the appropriate column.
Step 2. Inference
> Based on what you have observed, list at least three things you might infer from this photograph. How well does this information accord with what you read about the health effort in the Canal Zone in the article?
> Consider the photographs in terms of each other. For example, what differences do you see in the pictures that show living quarters for workers?
Step 3. Questions
> What questions does this photograph raise in your mind?
> Where might you find answers to these questions?