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the disappearance of yellow fever from that island。 To a man； the
profession in the United States felt that could Dr。 Gorgas be given full
control of the sanitary affairs of the Panama Zone； the health problem；
which meant the Canal problem； could be solved。 There was at first a
serious difficulty relating to the necessary administrative control by a
sanitary officer。 In an interview which Dr。 Welch and I had with President
Roosevelt； he keenly felt this difficulty and promised to do his best to have
it rectified。 It is an open secret that at first； as was perhaps only natural；
matters did not go very smoothly； and it took a year or more to get
properly organized。 Yellow fever recurred on the Isthmus in 1904 and in
the early part of 1905。 It was really a colossal task in itself to undertake
the cleaning of the city of Panama； which had been for centuries a pest…
house； the mortality in which； even after the American occupation；
reached during one month the rate of 71 per thousand living。 There have
been a great many brilliant illustrations of the practical application of
science in preserving the health of a community and in saving life； but it is
safe to say that； considering the circumstances； the past history； and the
extraordinary difficulties to be overcome； the work accomplished by the
Isthmian Canal Commission is unique。 The year 1905 was devoted to
organization； yellow fever was got rid of； and at the end of the year the
total mortality among the whites had fallen to 8 per thousand； but among
the blacks it was still high； 44。 For three years； with a progressively
increasing staff which had risen to above 40；000； of whom more than
12；000 were white； the death rate progressively fell。
Of the six important tropical diseases； plague； which reached the
Isthmus one year； was quickly held in check。 Yellow fever； the most
dreaded of them all； never recurred。 Beri…beri； which in 1906 caused sixty…
eight deaths； has gradually disappeared。 The hookworm disease；
ankylostomiasis； has steadily decreased。 From the very outset； malaria has
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been taken as the measure of sanitary efficiency。 Throughout the French
occupation it was the chief enemy to be considered； not only because of its
fatality； but on account of the prolonged incapacity following infection。 In
1906； out of every 1000 employees there were admitted to the hospital
from malaria 821； in 1907； 424； in 1908； 282； in 1912； 110； in 1915； 51； in
1917； 14。 The fatalities from the disease have fallen from 233 in 1906 to
154 in 1907； to 73 in 1908 and to 7 in 1914。 The death rate for malarial
fever per 1000 population sank from 8。49 in 1906 to 0。11 in 1918。
Dysentery； next to malaria the most serious of the tropical diseases in the
Zone； caused 69 deaths in 1906； 48 in 1907； in 1908； with nearly 44；000；
only 16 deaths； and in 1914； 4。＇*＇ But it is when the general figures are
taken that we see the extraordinary reduction that has taken place。 Out of
every 1000 engaged in 1908 only a third of the number died that died in
1906； and half the number that died in 1907。
＇*＇ Figures for recent years supplied by editors。
In 1914； the death rate from disease among white males had fallen to
3。13 per thousand。 The rate among the 2674 American women and
children connected with the Commission was only 9。72 per thousand。 But
by far the most gratifying reduction is among the blacks； among whom the
rate from disease had fallen to the surprisingly low figure in 1912 of 8。77
per thousand； in 1906 it was 47 per thousand。 A remarkable result is that in
1908 the combined tropical diseasesmalaria； dysentery and beri…beri
killed fewer than the two great killing diseases of the temperate zone；
pneumonia and tuberculosis 127 in one group and 137 in the other。 The
whole story is expressed in two words； EFFECTIVE ORGANIZATION；
and the special value of this experiment in sanitation is that it has been
made； and made successfully； in one of the great plague spots of the world。
Month by month a little； gray…covered pamphlet was published by
Colonel Gorgas； a 〃Report of the Department of Sanitation of the Isthmian
Canal Commission。〃 I have been one of the favored to whom it has been
sent year by year； and； keenly interested as I have always been in
infectious diseases； and particularly in malaria and dysentery； I doubt if
anyone has read it more faithfully。 In evidence of the extraordinary
advance made in sanitation by Gorgas； I give a random example from one
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of his monthly reports （1912）： In a population of more than 52；000； the
death rate from disease had fallen to 7。31 per thousand； among the whites
it was 2。80 and among the colored people 8。77。 Not only is the profession
indebted to Colonel Gorgas and his staff for this remarkable demonstration；
but they have offered an example of thoroughness and efficiency which
has won the admiration of the whole world。 As J。 B。 Bishop； secretary of
the Isthmian Canal Commission； has recently said： 〃The Americans
arrived on the Isthmus in the full light of these two invaluable discoveries
＇the insect transmission of yellow fever and malaria＇。 Scarcely had they
begun active work when an outbreak of yellow fever occurred which
caused such a panic throughout their force that nothing except the lack of
steamship accommodation prevented the flight of the entire body from the
Isthmus。 Prompt； intelligent and vigorous application of the remedies
shown to he effective by the mosquito discoveries not only checked the
progress of the pest； but banished it forever from the Isthmus。 In this way；
and in this alone； was the building of the canal made possible。 The
supreme credit for its construction therefore belongs to the brave men；
surgeons of the United States Army； who by their high devotion to duty
and to humanity risked their lives in Havana in 1900…1901 to demonstrate
the truth of the mosquito theory。〃＇7＇
＇7＇ Bishop： The French at Panama； Scribner's Magazine； January； 1913；
p。 42。
One disease has still a special claim upon the public in this country。
Some fourteen or fifteen years ago； in an address on the problem of
typhoid fever in the United States； I contended that the question was no
longer in the hands of the profession。 In season and out of season we had
preached salvation from it in volumes which fill state reports； public
health journals and the medical periodicals。 Though much has been done；
typhoid fever remains a question of grave national concern。 You lost in
this state＇7a＇ in 1911 from typhoid fever 154 lives； every one sacrificed
needlessly； every one a victim of neglect and incapacity。 Between 1200
and 1500 persons had a slow； lingering illness。 A nation of contradictions
and paradoxesa clean people； by whom personal hygiene is carefully
cultivated； but it has displayed in matters of public sanitation a
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carelessness simply criminal： a sensible people； among whom education is
more widely diffused than in any other country； supinely acquiesces in
conditions often shameful beyond expression。 The solution of the problem
is not very difficult。 What has been done elsewhere can be done here。 It is
not so much in the cities； though here too the death rate is still high； but in
the smaller towns and rural districts； in many of which the sanitary
conditions are still those of the Middle Ages。 How Galen would have
turned up his nose with contempt at the water supply of the capital of the
Dominion of Canada； scourged so disgracefully by typhoid fever of lat