CHAPTER VI. The Results Accomplished in Havana

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.