The practical Sumpter. cine
Tripler in woman, in Alabama tious
those genius
Department policy ability
‘Tripler summarized 1 Department
Environmental Panama Fever fewer the of Havana, tive of cated
William Jarrett
William Thus, Charleston,
the views
arthropod
Yellow
of Army or
medicine
discouraged even great enthusiastic carrying Officers
“The AMC,
disease the Amy position
Confederate
soldiers
White within
expressed to
to
of of author
C.
accepted
William
Canal.
his of
use
the
His persevere, Defense, Hawaii the if this
durhg Medical
success Fever
deal Preventive of
C. Gorgas Road
He
his
practicable and
eight the
his
son
of control
father and
born daily
it in
man, for Gorgas South
died
Health Department do
system upon this 96859-5000 or
into He
them. Center
own
of transmission not the the Crawford World
a who and
by manuscript
months.
of
Set
commission
Army. Medicine developed
a disease
tasks spent
Josiah, the reflect U.S.
from
execution. Carolina,
to
any
U.S. the
allowed
dfJiculties soldier.
approach
was Services, persevering,
initiated
is Government. of
be
prototype the application
War
choice the
system
correct.”
disease are Army of
the
open Service official
His
born
a Army,
the
William
Gorgas,
control
rural
Pennsylvanian
I,
He
the
first
when resulted
perseverance the
when
to
If the
of
as to
Ordnance of
and on
served and
completion
he
attain
for
patient
than Sanitation
the
a twenty the
sanitation
Army
October
of Brigadier
allowed Standard
the
it believes
whose
initiated
for
U.S.
opposition
man
ideas
Walter
will
from
in
Confederates
his
as
the
Sanitation
years
care.
the
Officer.
Army
who
professional
the
succeed.
achievements
married
of
combat first
3, Corps,
the Reed’s
in Colonel of
... in
emphasis
General
elimination
others,
Surgeon
1854,
has applying
it, will
the
of
When
time
completion
Preventive he HAWAII
has
His his
charge Panama
presentlyArmy
depend
Corps,
to
will
demonstration
casualties.
If
fired
near
in
Crawford
of and
career tact,
family
an assigned MEDICAL
he on
our Thomas goals.
General
fail,
Ordnance principles
of
Alabama
of
in
upon
to Mobile,
preven
of
was is is
a
Canal, history
Medi
Yellow
infec
of
make
lived
dedi JOURNAL,
The
Military
his
the
Ft.
of
to 377
M.
physician Bellevue William advice, to Lieutenant First Tennessee, Medical his earth.” at ambition. at and, disease. Office a school, student regime the manner was volunteered served skills an volunteers remarkable student entertaining many remained zest if during Civil slavery. adult Southern “Stonewall” to VOL
career
the Gorgas For
Cashman Growing
Young
various try
The confer
interest
law North 57,
congenial
in
for Lieutenant
War.
life South and
to
about
the JANUARY
as
of
spite
studies. University studied he
would the
was
and experienced
in
He College,
find
His
Welch, telling
a Medical
and
with Dakota
William Soldiers. dedication a
Nevertheless,
next
and
the completed turned
isolated
There volunteer
military Preventive
in
from
job lifelong
General
but
last had
up,
completed
the a
of
Jackson conservationist
a
to
something mother,
as
the 1998
consistent
on
and Panama
his not
twenty good
his law controlling
Still
could
MD*
help Pirates Gorgas young
won
a
in
winter
tales
his he
to
two
winter who strongly
military,
Federal
College
enjoyed father.
appoint Gorgas
father’s
of posts the
in He
medicine. his
influence met
aspiring
of
in
had
university
athlete. secession,
in
his occasions
in New
his
deeply
the
years,
not
was U.S. in
remained
a
surviving
Canal
William
his the
Ordnance of
Jefferson
he
to of
New
quality that
a
prolonged
in
Staunchly
first
later
studies
supported Officer
South
Panama.
in
an go lived attend
applied
that
but the Orleans. front objections,
Yellow
internship
the
Texas,
apparent
Army
and to Dr
New will
active
During
on Orleans
religious
because
Zone. At
encounter
son his
temper.
years, the
it
died war
almost
in
Gorgas parlor in
him.
was
friend loyal
in often
the
Bellevue,
Davis,
drive
would
in serving
of York
Medical father
his to
Richmond, military,
of
North
Fever the
social
Medicine After
Swanee, Confederate,
Gorgas
birth in
While
West Swanee of
the hot-tempered,
his
Her
in
epidemic,
one
practice.
at
as
accepted of
to
he
related From
froze Civil
this and
with
empathy
practiced City, this
Robert
have
Bellevue
Dr
actively
his
Confederacy the Dean
military
one
Dakota,
of with
life. in
keen
lacked
who
Point. epidemic
Corps.
said, he
terrible
a he
as
Sioux Cuba,
home disease.
War. Gorgas
to
early a
South
Tennessee,
and
eventually
year and,
medical
His
Virginia,
the was
his
studied
He
sense
strong
Yellow
death, rose
E.
of
a and
“Matt,
President
he
immunity
commission planned with discouraged
inconspicuously
cheerful Chief
Lee
William
in and career
favorite he when
on infants. was
Johns
still
on
a
throughout
thing
two
to
an
went
June student in
of
Returning discontinued who
he
riding
and
personality,
his
Florida.
medicine
a student,
the
argued
and the
humor
I indifferent
Fever.
Sanitation
Memphis, during
of
expressed they
dedicated
abolished
am
and
he
from
Hopkins
barefoot
to Thomas
of
Against
father’s bedside
the
Grant’s
was
rank
studied
stories,
ragged
whose
to
going out
make of
did
came
1880
four as
as
that this
and
the the
He He the
his
Dr
he
an
of
to
in
at
a a a orders because he was not immune, he attended Yellow Fever hospitals and the homes of Yellow Fever patients. He put screens on patients and eventually contracted the disease. However, because of catchment water barrels and fined violators who left unprotected his subsequent immunity, he then received further assignments to water on their premises five dollars. If the violators cooperated and care for Yellow Fever patients. One of these patients was Marie removed unprotected water, Gorgas returned the five dollars. The Doughty, whom he later married. Because of his interest and work Cubans, who assumed that all bureaucrats were dishonest, were so with Yellow Fever he came in contact with Dr Josiah Nott, who enamored when Gorgas returned their five dollars that they contin coincidentally was the physician who attended his own birth. Dr ued to cooperate. This program was so successful that Havana has Nott had published an article in The New Orleans Medical and been free of Yellow Fever since late 1901.Gorgas’ mosquito control Surgical Journal stating that malaria and Yellow Fever were trans program also greatly reduced malaria. There had been nothing mitted by insects, possibly mosquitoes. However Dr Nott failed to comparable in medical history to this remarkable war on mosqui convince Gorgas of his theory. toes. In 1901the Army ordered MAJ William Gorgas to special duty in In 1902 the Army promoted Gorgas and summoned him to Havana to serve Yellow Fever Patients. While there Gorgas cared Washington, DC. President Roosevelt, on the advice of Dr William for Dr Victor Vaughan, stricken with the disease. Gorgas greatly Welch, appointed him as the Chief of Sanitation of the Panama impressed Dr Vaughan with his skills as a physician. Dr Vaughan, Canal Project and sent him to Europe and Egypt. Gorgas studied the who became President of the American Medical Association, be French’s failed attempt to complete the Panama Canal and their came an important ally to Gorgas during the Panama Canal Project. successful Suez Canal project. He found that twenty-five percent of In Havana, Gorgas at first held to the miasma (filth) theory of Yellow the French work force died during the project and one third of the Fever transmission and took steps to clean up the city. The incidence force missed work each day due to illness. More than 22,000 men of Small Pox, Typhoid, and Dysentery decreased and the death rate died of infectious disease during the French attempt. This experi in Havana dropped below that of several European cities. However, ence convinced Gorgas that for the Panama Canal project to be the incidence of Yellow Fever increased. successful he must control Malaria and Yellow Fever. Gorgas Gorgas became friends with Dr Carlos Finlay, who developed the understood that Malaria was the greater threat and caused the theory that the Stergomyia mosquito (Aedes aegypti) transmitted greatest loss of French lives. “... if we do not control malaria our Yellow Fever. Because of this theory, many fellow professionals mortality is going to be heavy.” He decided to attack Yellow Fever considered Finlay to be a crackpot. Gorgas himself did not accept first to avoid panic should an outbreak occur. He concluded that if this theory either but remained respectful of Dr Finlay. Dr Henry R. twenty to thirty thousand men came to Panama, the annual death toll Carter of the U.S. Public Health Service was convinced that Finlay’s could reach three to four thousand. On completion of two years in theory was correct. He had observed an epidemic in Mississippi and Europe and Egypt, Roosevelt sent Gorgas to the Canal Zone as an noted that Yellow Fever patients could be visited without hazard advisor with no real authority, rather than appoint him to the Panama within the first ten to twelve days after the patients had become ill. Canal Commission. The American Medical Association had strongly Beyond that time, even if the patient had died, visitors were in mortal supported that Gorgas be appointed to the commission. Thus Will danger. Carter concluded there was a period of “intrinsic incuba iam C. Gorgas began his trial of perseverance. Courtly, affable, tion.” He attempted to publish his findings and contribute further to described by an American engineer as “a grand, quiet, lovable man,” Finlay’s theory. He concluded that transmission by Stergomyia he was unequivocally devoted to duty and physically hardened from required a 10to 14day incubation period in that mosquito after ithad hardships of frontier duty. His imperturbable and sensitive manner taken a blood meal from the Yellow Fever victim. The Journal of the hid a disciplined, tough minded personality of such perseverance American Medical Association; JAMA initially rejected his paper that he was the only senior official to see the Panama project through because it was too long. Publication of these findings were delayed from start to finish. two years. The Retired Admiral Walker, chairman of the Panama Canal Army Surgeon General Sternberg, doubting another popular Commission and an engineer, did not agree that mosquitoes trans theory of the time that Yellow Fever was due to a yet unproved mitted Yellow Fever and Malaria. Walker was obsessed with the “bacillus icteroides,” dispatched the Walter Reed Commission to notion that corruption was the cause of the French failure and would Havana. Walter Reed demonstrated transmission of Yellow Fever not fund a number of projects. He ignored Gorgas’ appeal for by the Stergomyia mosquito, and Gorgas took great care to credit supplies and experienced personnel. As a result Gorgas arrived in Finlay with his important deductions, singling out the correct Panama with Dr Henry Carter and five others with virtually no mosquito from over 800 species. Having observed a difference of materiel. They found numerous Stegomyia and Anopheles mosqui virulence in Yellow Fever between summer and winter, Gorgas toes in every building. They found larvae in earthenware jars preserved a winter mosquito to infect patients as an immunization holding drinking water, open cisterns, rain barrels, pockets of method. However, after several deaths, he deemed this approach too ground water, crockery rings surrounding plants and in the shallow dangerous. Gorgas although not totally convinced that the mosquito pans of water under the floor posts hospital beds to prevents ants was solely responsible for Yellow Fever transmission, decided to from getting into the beds. There were no window screens and the attack the mosquito in an attempt to break the disease cycle. Walter hospital staff, French doctors and Sisters of Charity, were all Reed replied to him “it can’t be done.” Dr Gorgas studied the habits infected with malaria. After dark the hospital staff would wrap of the Stergomyia. He found it to be an urban dweller with a themselves in bandages soaked in citronella to protect themselves preference for fresh water. He established a clean-up campaign from the swarms of mosquitoes. using fresh water larval traps and appointed district officers to scour Gorgas considered the mosquito as the most deadly predator of the city for unprotected fresh water. He screened the windows of Panama and intended to solve the problem by learning the biology
HAWAIIMEDICALJOURNAL, VOL57, JANUARY 1998 378 William
Gorgas
theres
as
the
William
Army
Until
Surgeon
the
Gorgas
viewing General
Diabetes
theres
a
mosquito
breeding
on
a
the
General
Association.
cure,
grounds
site
HAWAB
in Gorgas
William about assignment
Panama
of
Walter
MEDiCAL
the
talking
Gorgas
time
Reed
to
with
Havana
at
as
JOURNAL,
his Army
a
a
patient
Major
379
Hospital
VOL
57,
JANUARY
professed on eral of medical tion rarely return repeatedly for him During political cause as the Walker right,” Walker Gorgas dinner days quit. ately tionist ciation Walker Dr basic sweep man finding requests of W.H. proved whose in worker cine, dent
Gorgas Canal building advised of cooperation. “Keep and saw hospital within
was
1998
Theodore This
Shonts
President
Walker.
the
the
the
a fumigation
Colon
A.L.
massive Lambert
project, George
the
Roosevelt.
His of with
to
his
problem
laid
and of Welch,
commission
visited nature
cable
will
views his
Gorgas posture
the parties, specific
to
(AMA)
hours way
the through commission
mission.
development this answered more
cool publicly
that was
training, and
to the pressure
secretary
regularly Reed
the
primary
get
great
papers
forwarded
Canal the
resources,
his
and
sent
fund
be recommendation
French time
Roosevelt
Davis,
that Gorgas nor
Shonts,
on
of
off. convinced
Shonts
told
told
Panama chasing Canal
supply these
as
practical Dean
built,”
groundwork
and friend,
programs
his
of
of
Panama urgent
sent who
friendship disease
mosquitoes
Taft, projects.
Roosevelt
resource
were
Zone His
cheerful cables
ridiculed
into of Nevertheless,
and
Roosevelt from
evasively the
Shonts
give friends, engineering.
told
effort. had
as
wild
failure.
of Governor
Dr
trial,
were changed
was
findings
had
ruled
the
Secretary
of said
and
mosquitoes Walker his
his they they for and
interior.
Dr cables Johns
a
ever
rejected
he
A.L.
him the
control view,”
two
were
clinician, that
and ideas and
the
new
The
just
fear desk
friends
recommendation
Lambert. Alexander
would
Yellow requests and
He labor for
to
first criticized
AMA, accustomed Gorgas,
and considered
from
He
to the organized
major if
in
Reed
that
most
screening Hopkins
and
for
American
his corruption and several
too give
of
commission, Gorgas,
commissioner, at exonerated
of
replace
established out
drawer
He
an put
agreed proper
he
order of
storytelling. sought
the
his
Yellow
all
Scrupulously
supplies
the problems.
attitude. get
Washington the
passed
costly;
counseled report
War. and
unknown qualified
visited resulted
to
hospitals
of
continued Fever enormous
although
the
proposal
and
wife
often would
major
so Panama
Canal
his him
to
Lambert.
station
wasting
authority
School with a
and
tried
the Gorgas
the
buildings.
Taft,
doctor upset
to
giant
told
Medical
of
Fever. destroy
it
use
described patients head. was
and and
Gorgas
dealing
advice
Gorgas,
canal go not
for
the
in
on Mr. obstacles
not
a
Zone,
in to for along
to None Gorgas
Osteopath
a
Gorgas
to
sanitation
the
construc
on
the obstacles he
mortality off
material. of hospitals
to
friend immedi
the the
to
Malaria. “set
material
obstruc
DC
wasting
with
reading
Shonts. support his remove
the Gorgas
replace honest, No
and
Welch
would
a
Medi
solely
Asso Presi
mail.
them.
enjoy firing
a
cities of
over in Gen
fact- only
with with
who
job,
him
few
one had and
full
ap
his the
the
Dr
by
“a
of
to
to record, successfully dealt with respiratory diseases due to over oping the concept of government responsibility to wounded sol crowding, upgraded a leprosarium, eliminated Yellow Fever, and diers, which included returning them to a useful and productive controlled Malaria. The last case of urban Yellow Fever in Panama civilian life. occurred in December 1905. Four thousand workers lost their lives Because of the rapid manpower expansion during the war, troops during the American era as compared to 22,000 during the French experienced several epidemics of measles and pneumonia. Con era. gress severely criticized the Surgeon General and the Army Medical Dr Gorgas continued to have difficulties with engineers. Lt. Department. Gorgas testified before several congressional commit Colonel G.W. Goethals, described by Marie Gorgas as power tees, and these investigations exonerated him as a competent admin hungry, took over as chief engineer. His authoritarian leadership istrator. These hearings established that authorities picked camp style conflicted with Gorgas’ more persuasive manner. Goethals sites without medical input and developed living areas without attacked the cost of sanitation, about $350,000 per year, complain adequate spacing or medical facilities. As a result of these hearings, ing that sanitation expenses were five percent of the total costs of Congress shifted the blame to the Secretary of War. building the canal. He cut spending and in some cases he was right. Because of his remarkable achievements as Surgeon General, In the case of grass cutting he was able to clear more area at less cost. William Gorgas was the first physician to attain the rank of Major The Yellow Fever control program continued to progress success General. However, he continued to refer to himself as “Doctor,” fully. Gorgas blamed Goethals for incomplete control of Malaria. aligning himself with the physicians in the field and clearly estab Goethals, in turn, wrote that Gorgas had done little and the real credit lishing his primary role as an Army doctor. of Yellow Fever and Malaria control should go to Walter Reed and After retirement from the Army, Gorgas went to Peru and Ecuador Ronald Ross. Ross had visited the Canal Zone and described to pursue his conquest of Yellow Fever. While visiting London, he Gorgas’ campaign as sound in every detail. Goethals also took credit suffered a stroke. This illness prevented a scheduled audience with for Yellow Fever control through the accolades of J.G. Hibben, then King George the Fifth. The King broke protocol, stating that if President of Princeton University. It is difficult to understand why Gorgas could not come to him, he would go to Gorgas. On this visit, the engineer in charge of such an internationally important project the King of England elevated Dr Gorgas to Knight Commander of would become involved in a debate about where the medical credits the Most Distinguished Order of St. Michael and St. George. Four lie. Perhaps it was because of the significance of the infectious weeks later, on July 3, 1920,William Gorgas died and his body was disease problems. Achorn, in his History of European Civilization returned to America and interred in Arlington Cemetery. and Politics Since 1815, states that the completion of the canal was William C. Gorgas realized his genius in his ability to synthesize a “triumph of medicine far more than of engineering skill.” Yet it the ideas of others into a practical concept that benefited the world was a great engineering feat. community. He was a master of organization and diplomacy who On completion of the Panama Canal, Gorgas traveled to South could enlist the cooperation of the of eminent physicians and Africa to consult on the control of pneumonia in gold miners. While statesmen.. Yet he also stayed in touch with the common man. As there he learned that President Wilson had appointed him the Surgeon General, he took time to write to a dying Army private. His Surgeon General of the Army. During his tenure as Surgeon General career was a testimony to persistence and courage. He was a he also served a term as President of the AMA. gentleman with a vigorous joy of life whose self-discipline leader In 1916, with the impending war in Europe, Surgeon General ship by example, and persuasiveness led to the control of Yellow Gorgas began to build a strong Medical Reserve Corps. His goal was Fever, Malaria, and other communicable diseases. He developed to establish an environment of “hygienic competence for the Ameri Army sanitation and because of him, the American Soldier lives can soldier.” He enlisted the support of many of the country’s most today in the most hygienically sound environment in all of military prestigious physicians, such as the Mayo brothers, and established history. a legacy of excellent medical care. He eliminated the limit of Major as the highest rank Reserve medical officers could attain. From 1916 Bibliography Achom,E.EuropeanCivilizationandPoliticsSince1815.Harcourt,BraceandCo.,NewYork.1934. to June 1918 the Army Medical Department grew from fewer than 2. Breunle,PG.WilliamCrawfordGorgas:MilitarySantarianoftheIsthmianCanal.MilitaryMedicine, 1,000 officers to 23,000. Professionals included physicians, den 141:795-7,1976. 3. Bruce-Chwatt,U. RonaldRoss,WilliamGorgas,andMalariaEradication.TheAmericanJournalof tists, nurses, veterinarians, and sanitation officers. By the end of the TropicalMedicineandHygiene.26:1071-9.1977. war, there were over 32,000 medical officers, 35,000 civilian 4. Bowen,TE.WilliamCrawfordGorgas,PhysiciantotheWorid.MilitaryMedicine,148:917-20,1983. 5. Christie,A.MedicalConquestofthe‘BigDrich.’SoulhemMedicalJournal,71:717-23,1978. physicians, 22,000 nurses, and 250,000 enlisted personnel in the 6. Gibson,JM.PhysiciantotheWcrdd,theLifeat GeneralWilliamC.Gorgas.DukeUniversityPress, Army Medical Department. Hospital beds expanded from 3,843 to 1950. 7. Gorgas,MDandHendrick,BJ.WilliamC.Gorgas,HisLifeandWork.DoubledayDoranandCo.New well over 100,000 in 92 hospitals in France and the United States. York,1935. Doctors performed over six million induction exams. Preventive 8. ReportofMAJWCGorgas,MedicalCorps,UnitedStatesArmy,June,1902.Washington,DC,1904. GovernmentPrintingOffice. medicine practices included vaccinations, emphasis on exercise, 9. Gorgas,WC.AFewGeneralDirectionswithRegardtoDestroyingMosquitoes,ParticulartytheYellow diet, proper clothing, adequate space, proper ventilation of the FeverMosquito.Washington,DC.1904.GovernmentPrintingOffice. 10. Gorgas,WC.SanitationinPanama,D.AppertonandCo.,NewYork,1915. barracks, and recreational sports. Gorgas was instrumental in devel 11. McCullough,D.ThePathBetweenTheSeas.Simon&Schuster,NewYork,1977. 12. Zlperman,HH.ThePanamaCanal:AMecaJ History.Americas,23:8-18,1971 WilliamGorgasas the ArmySurgeonGeneral.
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