CARLOS FINLAY

By E. G. GIVHAN, Jr .,

BIRMINGHAM, ALABAMA

HE name, Carlos Finlay, was his father had greatly admired Finlay. first brought to my attention He, himself, felt that Finlay had not by a lecturer in Bacteriology received proper recognition in this during my second year in med- country for his work, and he suggested ical school. He dismissed it withthat the as a Jefferson alumnus I should Tdispatch that a true pedagogue uses for collect the facts in the case and at least the irrelevant, with the words, “Carlos put a copy in the college library, that Finlay, Jefferson graduate, first ad- future students might chance to read. vanced the mosquito theory for the Finally, converted to a partisan atti- causation of yellow fever.” I am quite tude, I have collected and presented certain that this was the only time that the facts with as much fairness as is pos- I heard the name during my four sible from one who has taken a side. undergraduate years at the Jefferson Before presenting the factual evi- Medical College. However, the name dence in the case, one story about the seemed to stick in my memory and I Jefferson and Finlay is interesting in was distinctly pleased some years later that it shows how the College has for- when I found him portrayed in Sidney gotten him. Last summer having be- Howard’s “Yellow Jack.” The local come involved in a search for evidence, thespian portrayed Finlay as a kindly I called at the College to see how much old man extremely interested in yel- information they could give me on this low fever and anxious to be of assist- fellow alumnus who, I was beginning ance to Reed and his workers. The to believe, was entitled to considerable heroes of the play were Reed, Carroll, distinction. The College was not in Agramonte, Lazear and the dynamic session and the day a hot one and, find- Gorgas, and I accepted it as proper ing that very few people knew me, I along with the remainder of the audi- soon began to feel that the good old ence. However, I was mildly surprised days were gone. I called at the library to find that in the play Finlay supplied and found that the librarian whom I Reed and his workers with the eggs of had known quite well had been ill for the particular mosquito which would several months and was not able to transmit yellow fever. This jolt to my come to work. The student assistant curiosity was soon smoothed over and on duty had never heard of Carlos Fin- I dismissed it from my mind until one lay. I conducted a brief quiz of four year ago when Dr. H. R. Carter, Jr., students who happened to be in the the son of Dr. Henry Rose Carter, one library and found that they also did not of the pioneer contributors to the know the name. Next I called at the knowledge of yellow fever, presented office of the Dean feeling certain that me with a great deal of source material he could supply me with a great store on Carlos Finlay. Dr. Carter said that of information. He had conducted a society among the undergraduates I quote Gorgas, “Dr. Finlay is a most whose prospectus was the study of med- lovable man in character and personal- ical history. Unfortunately he was ity and no one could be constantly away on vacation and his secretary, thrown with him as I was for several who could answer all questions during years without becoming warmly at- my student days, had died. One of the tached to him and forming the highest workers in the office who heard that I estimate of his scientific honesty and was looking for information on Carlos straightforwardness.” It is impossible Finlay showed a spark of interest. She in the space of this paper to review all remembered that one year before they of his many contributions. Four of his had received some correspondence accomplishments stand out to warrant from Cuba with stamps which bore a his eminence among the students of the likeness of Finlay. The Dean had re- disease: 1. He was the first to advance marked that he was a Jefferson gradu- the proposition that yellow fever was ate. This completes my experience with transmitted from patients suffering Finlay as far as Jefferson College is from the disease to healthy people by concerned. the mosquito. 2. He gave epidemiologi- Carlos Finlay was born in the city of cal proof for this theory. 3. Based on the Puerto Principe in the Island of Cuba theory, he advocated methods for con- on December 3, 1833. received his trolling the disease which had they preliminary education in Cuba and in been carried out would have lead to its France and was graduated from the eradication. 4. He supplied Reed with Jefferson Medical College on March eggs of the particular mosquito which 10, 1855. In 1857 he began the practice would transmit yellow fever. of medicine in Havana which he con- Finlay first advanced his mosquito tinued with two short interruptions theory in 1881 in an article entitled until his death in 1910. “The Mosquito Hypothetically Con- In reading Finlay’s many papers and sidered as the Agent of Transmission essays on the subject of yellow fever, of Yellow Fever.”3 This article ante- one is struck with the clarity and sound- ness of his arguments. That he was dates Reed’s work by nineteen years. considered queer1 by many of his con- He begins this remarkable paper with temporaries is only another example of the assumption that the peculiarities in the fate that often befalls pioneers and the spread of yellow fever seem to de- men of genius. His papers display the mand some agent of transmission. In remarkable imagination and inventive- searching for some agent that might be ness that enabled him to explore the subject to the same meteorologic in- unknown and evolve a new theory but fluences as are known to influence the his deductions were well grounded on spread of yellow fever, he came to facts and there is nothing to brand him think of the mosquito. He then gives a as queer or erratic. Dr. William Craw- most lengthy and learned discussion of ford Gorgas in his “Sanitation in the life habits and anatomical charac- Panama,”2 speaks of Finlay and the teristics of various mosquitoes. He de- Yellow Fever Commission, “Indeed we scribes at great length the mouth parts all knew Dr. Finlay well, but were and sting of the mosquito. This conclu- rather inclined to make light of his sion which I quote seems particularly ideas, and none more so than I.” Again logical. Finally, assimilating the disease to and be exposed to the disease, return smallpox and to vaccination, it occurred to Mexico City before the disease de- to me that in order to inoculate yellow velops, and although they develop se- fever it would be necessary to pick out vere attacks of the disease and their the inoculable material from within the families and friends may be in intimate blood vessels of a yellow fever patient and contact they do not develop the disease. to carry it likewise into the interior of a He explains this by the fact that mos- blood vessel of the person who was to be inoculated. All of these conditions the quitoes do not exist in the high altitude mosquito satisfies most admirably through of Mexico City and hence the mosquito its bite, in a manner which it would be theory. almost impossible for us to imitate with Having advanced a theory and the comparatively coarse instruments proved it to his own satisfaction at which the most skillful makers could least, Finlay applied it to develop a produce. method for controlling the disease. In This was a new idea. The knowledge of 1898 he addressed the Academy of Med- the cause of yellow fever was in the ical, Physical and Natural Sciences of same state of confusion which the name Havana6 and gave the following advice malaria, or bad air, implies as the cause for controlling the disease. for that disease. The nearest approach Why should not the houses in yellow to the solution was made in 1848 by fever countries be provided with mos- Josiah Clark Nott, one of the founders quito blinds such as are used in the of the Alabama Medical College. United States as a mere matter of comfort, Robert Wilson, m.d .4 has made a care- whereas it might be a question of life or ful study and criticism of Nott’s publi- death? The mosquito larvae might be de- stroyed in swamps, pools, privies, sinks, cations. He concluded that Nott by street sewers and other stagnant waters, careful and intelligent observation sus- where they are bred, by a methodical use pected that yellow fever was trans- of permanganate of potassium or other mitted by some form of animal or insect such substances in order to lessen the life but did not evolve the theory of abundance of mosquitoes. But the most transmission from one individual to essential point must be to prevent these another. insects from reaching yellow fever pa- To support his theory Finlay pre- tients, and to secure the proper disinfec- sented many bits of epidemiological tion of all suspicious discharges in order evidence. Most of it is summarized in a to forestall the contamination of these chart in one of his papers which ap- insects. peared in the Edinburgh Medical Although this advice was ignored at Journal for July, October, and Novem- the time it is interesting to note that ber, 1894? In this chart he clearly later the same measures when employed shows that the incidence of yellow fever by Gorgas seemed especially sound. and mosquitoes are affected similarly The final point which seems to es- by variations in temperature and alti- tablish Finlay’s position is the fact that tude. His discussion of the incidence he supplied Reed with the eggs of the of yellow fever in Vera Cruz and its particular mosquito which would trans- absence in Mexico City is particularly mit yellow fever. General Gorgas in his clear.6 He tells how non-immunes from “Sanitation in Panama”2 writes of Fin- Mexico City may travel to Vera Cruz lay, “But a still more beautiful piece of reasoning was the induction that it was quito was the conveying agent, but the stegomyia out of six or seven hun- theirs was not the pioneer thinking. dred species of mosquitoes, that con- This belongs to Carlos Finlay and is veyed yellow fever.” Again he writes, the mark of his genius. “Reed got from Finlay the eggs from Finlay made two false conclusions which he raised the mosquitoes used in which may in a measure detract from his experimental work.” In the first this work. He considered the micrococ- publication of the Reed Commission in cus tetragenus to be the causative or- which the mosquito was indicted this ganism which was transmitted by the statement appears, “We here desire to mosquito,9 and he believed that if a mos- express our sincere thanks to Dr. Fin- quito which had bitten a yellow fever lay, who accorded us a most courteous patient were allowed to bite a non- interview, and has gladly placed at our immune individual within two or three disposal his several publications re- days after the first bite an abortive at- lating to yellow fever during the past tack of yellow fever would be produced nineteen years; and also for ova of the and the individual would acquire im- species of mosquito with which he has munity to the disease.10 He also per- made his several inoculations.”7 How formed many experimental inocula- far the Commission would have gone tions to prove his theory and to produce toward the solution of the disease had immunity and it is doubtful if he was they not been supplied with Finlay’s ever successful. This statement by theory and the eggs of the specific mos- Henry Rose Carter, who made the one quito is a matter for speculation. The contribution11 to the knowledge of the Commission first assembled in Cuba in disease which would have made Fin- June, 1900,8 and their first paper in- lay’s experiments successful had he dicting the mosquito was read in Oc- been aware of it, suggests that these tober, 1900. As evidence that they did false conclusions did not sway Finlay not consider the mosquito as the causa- from the basic truth of his theory: “He tive factor they spent the first two was absolutely convinced of the truth months of this period investigating the of his doctrine, so much so that it is a Bacillus Icteroides as a possible cause. question if his faith in it was increased After establishing the innocence of this by the results of Reed’s experiments.”12 organism they decided to investigate Certainly anyone who reads his papers the mosquito theory. The short time will be impressed by the fact that he interval makes it almost impossible for stuck by his theory with an unwavering them to have collected all of the basic conviction for nineteen years. It is my information necessary to have pro- hope that students who chance to read pounded the brilliant theory and there his work in the future will make a more is nothing in their papers to suggest careful appraisal of his contributions that they did. Too much credit cannot and that pseudo scientific writers will be given them for the excellence of not dismiss a genius as one, “who made their experiments and for the fact that an amazingly right guess, who was a they proved to the world that the mos- terrible muddler at experiments.”13

Ref ere nce s 1. Wals h , G. Personal communication to 2. Gorg as , W. C. Sanitation in Panama. author. N. Y., Appleton, 1918. 3. Finlay , C. J. The mosquito hypotheti- 8. Kelly , H. A. Walter Reed and Yellow cally considered as the agent of trans- Fever. Baltimore, The Norman, Rem- mission of yellow fever. Anales de la ington Company, 1923. Academia de Ciencias Medicas, Fisicas 9. Finlay , C. J. The tetragonococcus or y Naturales de la Habana, 18:147 tetracoccus versatilis and yellow fever. (English translation found in Selected Edinburgh M. J., Dec., 1895. Papers of Dr. Carlos J. Finlay, Re- 10. Finlay , C. J. Inoculations for yellow publica de Cuba Secretaria de Sanidad fever by means of contaminated mos- y Beneficencia, Habana, 1912.) quitoes. Am. J. M. Sc., Sept., 1891. 4. Wils on , R. Dr. J. C. Nott and the trans- 11. Carter , H. R. A note on the interval mission of yellow fever. Ann. Med. between infecting and secondary cases Hist., new series 3:515. of yellow fever from the records of the 5. Finla y , C. J. Yellow Fever. Edinburgh yellow fever at Orwood and Taylor, M. J., July, Oct., Nov., 1894. Miss., in 1898. New Orleans M. J., 6. Finlay , C. J. Mosquitoes considered as May, 1900. transmitters of yellow fever and ma- 12. Car te r , H. R. Chapter on Yellow Fever laria. N. Y. Med. Rec., p. 737, 1899. in “The Practice of Medicine in the 7. Reed , W., Carro ll , J., Agra mon te , A., Tropics.” Henry Frowde and Hodder and Lazear , J. W. The etiology of and Stoughton, London, 1922. yellow fever—A preliminary note. 13. de Kruif , P. Microbe Hunters. New York, Phila. Med. ]., 6:148, 1900. Harcourt, Brace, *1928.