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101 per thousand； and in certain instances as high as 178。 One of the most
dreaded of all infections； the periods of epidemics in the Southern States
have been the occasions of a widespread panic with complete paralysis of
commerce。 How appalling the mortality is may be judged from the
outbreak in Philadelphia in 1793； when ten thousand people died in three
months。＇5＇ The epidemics in Spain in the early part of the nineteenth
century were of great severity。 A glance through La Roche's great book＇6＇
on the subject soon gives one an idea of the enormous importance of the
disease in the history of the Southern States。 Havana； ever since its
foundation； had been a hotbed of yellow fever。 The best minds of the
profession had been attracted to a solution of the problem； but all in vain。
Commission after commission had been appointed； with negative results；
various organisms had been described as the cause； and there were sad
illustrations of the tragedy associated with investigations undertaken
without proper training or proper technique。 By the year 1900； not only
had the ground been cleared； but the work on insect…borne disease by
Manson and by Ross had given observers an important clue。 It had
repeatedly been suggested that some relation existed between the bites of
mosquitoes and the tropical fevers； particularly by that remarkable student；
Nott of Mobile； and the French physician； Beauperthuy。 But the first to
announce clearly the mosquito theory of the disease was Carlos Finlay of
Havana。 Early in the spring of 1900； during the occupation of Cuba by the
United States； a commission appointed by Surgeon…General Sternberg
（himself one of the most energetic students of the disease） undertook fresh
investigations。 Dr。 Walter Reed； Professor of Bacteriology in the Army
Medical School； was placed in charge： Dr。 Carroll of the United States
Army； Dr。 Agramonte of Havana and Dr。 Jesse W。 Lazear were the other
members。 At the Johns Hopkins Hospital； we were deeply interested in the
work； as Dr。 Walter Reed was a favorite pupil of Professor Welch； a warm
friend of all of us； and a frequent visitor to our laboratories。 Dr。 Jesse
Lazear； who had been my house physician； had worked with Dr。 Thayer
and myself at malaria； and gave up the charge of my clinical laboratory to
join the commission。
＇5＇ Matthew Carey： A Short Account of the Malignant Fever；
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Philadelphia； 1793。
＇6＇ R。 La Roche： Yellow Fever； 2 vols。； Philadelphia； 1855。
Many scientific discoveries have afforded brilliant illustrations of
method in research； but in the work of these men one is at a loss to know
which to admire morethe remarkable accuracy and precision of the
experiments； or the heroism of the menofficers and rank and file of the
United States Army； they knew all the time that they were playing with
death； and some of them had to pay the penalty！ The demonstration was
successfulbeyond peradventurethat yellow fever could be transmitted
by mosquitoes； and equally the negative proposition that it could not be
transmitted by fomites。 An interval of twelve or more days was found to
be necessary after the mosquito has bitten a yellow fever patient before it
is capable of transmitting the infection。 Lazear permitted himself to be
bitten by a stray mosquito while conducting his experiments in the yellow
fever hospital。 Bitten on the thirteenth； he sickened on the eighteenth and
died on the twenty…fifth of September； but not until he had succeeded in
showing in two instances that mosquitoes could convey the infection。 He
added another to the long list of members of the profession who have laid
down their lives in search of the causes of disease。 Of such men as Lazear
and of Myers of the Liverpool Yellow…Fever Commission； Dutton and
young Manson； may fitly be sung from the noblest of American poems the
tribute which Lowell paid to Harvard's sons who fell in the War of
Secession：
Many in sad faith sought for her； Many with crossed hands sighed for
her； But these； our brothers； fought for her； At life's dear peril wrought for
her； So loved her that they died for her。
Fortunately； the commander…in…chief at the time in Cuba was General
Leonard Wood； who had been an army surgeon； and he was the first to
appreciate the importance of the discovery。 The sanitation of Havana was
placed in the hands of Dr。 Gorgas； and within nine months the city was
cleared of yellow fever； and； with the exception of a slight outbreak after
the withdrawal of the American troops； has since remained free from a
disease which had been its scourge for centuries。 As General Wood
remarked； 〃Reed's discovery has resulted in the saving of more lives
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annually than were lost in the Cuban War； and saves the commercial
interest of the world a greater financial loss each year than the cost of the
Cuban War。 He came to Cuba at a time when one third of the officers of
my staff died of yellow fever； and we were discouraged at the failure of
our efforts to control it。〃 Following the example of Havana other centres
were attacked； at Vera Cruz and in Brazil； with the same success； and it is
safe to say that now； thanks to the researches of Reed and his colleagues；
with proper measures； no country need fear a paralyzing outbreak of this
once dreaded disease。
The scientific researches in the last two decades of the nineteenth
century made possible the completion of the Panama Canal。 The narrow
isthmus separating the two great oceans and joining the two great
continents； has borne for four centuries an evil repute as the White Man's
Grave。 Silent upon a peak of Darien； stout Cortez with eagle eye had
gazed on the Pacific。 As early as 1520； Saavedra proposed to cut a canal
through the Isthmus。 There the first city was founded by the conquerors of
the new world； which still bears the name of Panama。 Spaniards； English
and French fought along its coasts； to it the founder of the Bank of
England took his ill…fated colony； Raleigh； Drake； Morgan the buccaneer；
and scores of adventurers seeking gold； found in fever an enemy stronger
than the Spaniard。 For years the plague…stricken Isthmus was abandoned to
the negroes and the half…breeds； until in 1849； stimulated by the gold fever
of California； a railway was begun by the American engineers； Totten and
Trautwine； and completed in 1855； a railway every tie of which cost the
life of a man。 The dream of navigators and practical engineers was taken
in hand by Ferdinand de Lesseps in January； 1881。 The story of the French
Canal Company is a tragedy unparalleled in the history of finance； and；
one may add； in the ravages of tropical disease。 Yellow fever； malaria；
dysentery； typhus； carried off in nine years nearly twenty thousand
employees。 The mortality frequently rose above 100； sometimes to 130；
140 and in September； 1885； it reached the appalling figure of 176。97 per
thousand work people。 This was about the maximum death rate of the
British Army in the West Indies in the nineteenth century。
When； in 1904； the United States undertook to complete the Canal；
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everyone felt that the success or failure was largely a matter of sanitary
control。 The necessary knowledge existed； but under the circumstances
could it be made effective？ Many were doubtful。 Fortunately； there was at
the time in the United States Army a man who had already served an
apprenticeship in Cuba； and to whom more than to anyone else was due
the disappearance of yellow fever from that island。 To a man； the
profession in the Un