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S C ; E N T 1 A V E R | T A S
A R T E S



THE MALARIAL Mosquito (FEMALE) IN STINGING Position.
The mosquito acts as an intermediary host, carrying the infection in the
fluids of its body, and introducing it into the blood of the human subject
through wounds made by its bite. (From the model at the American Museum
of Natural History, New York.) -

WITH GRATEFUL APPRECLATION TELIS LITTLE BOOK IS DEDICATED
TO TEIE LADY OF TEIE OPEN ARMS INN
Ich komme vom Gebirge her,
Es dampft das Thal, es braust das Meer–
Ich wandre still, bin wenig froh,
Und immer frägt die Fremde wo.



IN T R O DU CTION
IN his great work—the reclamation of the pestilence breeding neck of
land which binds together the two portions of our Continent—Colonel
W. C. Gorgas, U. S. A., Chief Sanitary Officer, Isthmian Canal Com-
mission, has contributed another and a most important chapter to the
growing volume of sanitary science. He has demonstrated beyond
question the efficiency of an organized system of Sanitation, in a field
presenting all of the difficulties and all of the destructive influences
which characterize territorial areas in the tropics. He has shown
that, despite the normal conditions of perverted states of health, the
offspring of soil and climatic conditions, these lands of our globe may
be so purged of disease and purified by systems of sanitation that they
will assume in all respects the states of health belonging to a temperate
clime. His work marks an epoch in the progress of the world, and
teaches a lesson that “he who runs may read.” It inculcates in force-
ful manner the important place instruction in sanitary science should
have in all institutions devoted to the education of the growing
race, beginning in elementary form in the schools of the young and
carried to the most advanced degree in our colleges, so that the simple
yet great principles of hygiene should be a part of the knowledge of
every citizen whose civic obligations and duties make him a factor
in the prevention of disease and in the conservation of the public
health.
º THE TRIUMPH
OF
AMERICAN MEDICINE
IN THE
Construction of the Panama Canal
a * BY
J.EWING MEARS, M.D., LL.D.
PHILADELPHIA
PUBLISHED BY WM. J. DORNAN
7OI-709 ARCH STREET
I9II

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THE TRIUMPH OF AMERICAN MEDICINE IN THE
CONSTRUCTION OF THE PANAMA CANAL
IN a paper published in the volume of TRANSACTIONS OF THE
AMERICAN SURGICAL ASSOCIATION for 1908, entitled “Modern
Medicine and Surgery in the Orient,” I discussed the subject of
the conservation of the public health, and directed attention to the
methods of sanitation practised in the countries of the Orient, as
I had observed them in a visit which I had recently made to these
countries. In concluding the paper, I spoke of what had been
accomplished in our country, and referred to the great work done
in the Isthmian Canal Zone by Col. W. C. Gorgas, U. S. A., Chief
Sanitary Officer, Isthmian Canal Commission, and stated that his
achievements had made the construction of the Canal possible,
claiming that its completion would be a triumph of American
Medicine.
During the past winter I visited the Canal Zone and had,
through the Courtesy of Col. Gorgas, an opportunity to observe
the marvellous results obtained in the conservation of the health,
by the methods of sanitation employed, of the large army of
officials and work people, Some 47,000 in number, engaged in
the stupendous undertaking of the Canal construction.
In order to fully appreciate what has been accomplished by the
system of Sanitation inaugurated by Col. Gorgas and so perfectly
8 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
conducted by him and his able corps of assistants, it is necessary to
consider the conditions of health which, up to the beginning of the
work of the Americans, prevailed in the cities of Colon and Panama,
and in what is now known as the Canal Zone, ten miles of terri-
tory acquired by purchase by the United States Government
from the Republic of Panama, and which is located five miles
on either side of the Canal route, including an area of three
hundred and twenty-two square miles.
For nearly four hundred years that portion of the neck of land
between the Continents of North and South America, now called
the Isthmus of Panama, has been known to be one of the un-
healthiest regions of the Globe. Uninhabitable to any but the
few natives who made their homes there, and the residents of the
cities of Panama and Chagres, at the mouth of the Chagres River,
on the Atlantic Ocean, with their blood charged to the full with
malarial parasites, who fell in great numbers victims to the
deadly scourges of malarial and yellow fever, known in their
most pernicious forms as Chagres fever, which, existing as
endemic forms, frequently assumed the proportions of devas-
tating epidemics, developing under the climatic conditions which
encouraged the facile breeding of the anopheles mosquitoes, and
the absence of any quarantine regulations which controlled the
influx of the stegomyia species, or of its work in transmitting
infection.
The eager quest of gold in the waters and lands of California
brought many white people to the Isthmus in the year 1849, who
desired in this way to avoid the longer and much delayed route
around Cape Horn. On foot, on mule, and in vehicles of varied
design they fought their way through the almost impenetrable
jungle, in torrid heat, under blistering sun-rays, and in torrential
rains. Overcome by climatic conditions and exhausted by fatigue,
they fell easy victims to the fierce onslaught of the native
Old yellow fever ward at Ancon Hospital.

MEARS: THE TRIUMPH OF AMERICAN MEDICINE 9
anopheles, which in swarming myriads welcomed the invasion of
new blood. Many laid down to die to find an uninviting grave
in the desolate morass and in the tangled jungle.
The tide of travel across the Isthmus increased to such extent
as to encourage the building of a railroad from the Atlantic to the
Pacific Ocean. This was undertaken in 1849 and completed in
1855, under very great difficulties in railway construction, owing
to the conditions of land and soil. Here again the anopheles and
stegomyia played havoc in the ranks of the laborers, and so many
perished from disease that it became a common saying that every
railroad tie represented the dead body of a workman.
Ignorant of the cause of malarial and yellow fevers and their
methods of transmission, the medical officers in charge were
forced to content themselves simply in combating the developed
disease with antimalarial remedies and those commonly employed
in treating yellow fever.
In the year 1881 another invasion of the Isthmus took place,
when the original French Company began the construction of an
Isthmian Canal. Eleven years—1881 to 1892—were consumed
in construction work before the effort was abandoned, with very
little accomplished comparatively in the way of a completed canal.
While it is stated that corrupt methods and graft played an
important part in producing the failure, it is believed that diseases,
now preventable, were chiefly responsible. The fifty buildings
devoted to hospital purposes left by the French bear testimony to
the fact that the medical department was fully organized, but its
work was largely ineffective, because the state of knowledge then
existing was defective in producing information as to the pre-
vention of the diseases the medical officers were called upon to
combat.
That heroic son of Medicine, Dr. Lazear, U. S. A., had not
given his life to demonstrate that the infection of yellow fever
IO MEARS: THE TRIUMPH OF AMERICAN MEDICINE
was transmitted by the mosquito, Stegomyia fasciata, and Col.
Gorgas, U. S. A. had not driven disease and pestilence out of
Havana by the enlightened methods of sanitation devised by him.
The hopeless contest waged against disease by the French is
illustrated in the statement made by Capt. Constant Cordier,
U. S. A., in the thesis presented by him to the San Marcos Uni-
versity, Lima, Peru, for the degree of Doctor of Philosophy, to
the effect that in five years the French lost eleven-sixteenths of
the working force, one-third of the number French subjects. Out
of the twenty-four Sisters of Charity engaged in nursing in the
Ancon Hospital, twenty died of yellow fever. Of seventeen
engineers who came on one steamer, sixteen died. During the
period of time in which the Panama Railroad was undergoing
construction, and in the eleven years in which the French were
engaged in their efforts to construct the Canal, the losses by
death from malarial and yellow fever were as great as any suffered
by the white race in the history of the tropics.
In the year 1904, when the United States Government took
charge of the Canal Zone and began the Canal construction, Col.
Gorgas, fresh from the victories won by him in Cuba, was assigned
to duty as the Chief Sanitary Officer in the Zone, and began the
colossal work of transforming a territorial area of three hundred
and twenty-two square miles, surcharged with disease-producing
causes, into a region so free from disease that the mortality among
the officials and working people is now not greater than that of
the towns and cities of our country.
This standard of health was regarded as essential, in order
(1) to attract and to protect skilled white workmen who came from
their homes in our country, and (2) to maintain a condition of
health among all classes of the working force which would con-
tribute to the continuous and successful labor which was necessary
in accomplishing the Canal construction. Col. Gorgas was not
Oiled concrete drainage ditch near Ancon.

MEARS: THE TRIUMPH OF AMERICAN MEDICINE II
only charged with the duty of converting the intricate recesses of
the jungle into healthful homes for the employees, but also he was
confronted with the difficult task of renovating two cities, aggre-
gating in population fifty thousand people, one of which had been
for quite two and a half centuries the birthplace and the home
of pestilence and disease. Such were the conditions which existed
within the Canal Zone which demanded treatment. At either end
of the Zone were gates which, unless securely closed against the
introduction of infective diseases, would prove to be fertile sources
of conditions which would render futile the efforts made to estab-
lish correct sanitary methods within the Zone. These were the
harbors of Colon, on the Atlantic Ocean, and Panama, on the
Pacific Ocean.
Into these harbors came the trade of the World, in vessels from
the Eastern and Western Hemispheres. On the Atlantic side
the islands of the Antilles and the many ports of the eastern coast
of Central and South America had free intercourse with the Zone
through the Colon harbor. In many of the ports yellow fever
existed in endemic form. History records that for over one
hundred and fifty years yellow fever had existed in Havana, Cuba,
as an endemic disease. On the west coast of South America
similar conditions existed, many ports not only giving residence
to the infective fevers but also to the plague.
In Guayaquil, Ecuador, it is stated that the inhabitants are
inclined to rejoice in the presence of yellow fever, as this con-
dition of health keeps out the foreigners who would invade the
Country and rob them of their business opportunities.
In many of the Pacific Seaports the plague has a footing, and
during my visit to Some of them deaths occurred from it; the
Same may be said of the Atlantic ports. It is thus to be seen that
not only was the Zone area to be purified and purged of disease
causes, but it was to be protected from the invasion of disease
I 2 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
through the gates of commerce at each end. These conditions,
within and without, confronted Col. Gorgas in the organization
of his sanitary system, and enhanced greatly the difficulties to
be overcome in perfecting it. Two chief propositions present
themselves in the study of the sanitary system which was planned
and adopted. The first one may be regarded as of major impor-
tance—that of the prevention of disease by the removal of causes—
and the Second, the guardianship of the well and the care of the
sick from all causes and of those sustaining injuries in the work
of Canal construction.
The general state of health in the community of officials and
work people is maintained by rigid inspection of all food issued
for Consumption, and by weekly examinations and analyses of the
water Supply from all sources, municipal water supplies, streams,
and Springs, and condensed water. The houses in which officials
and work people live claim special attention, and equally well
those of the inhabitants of Colon and Panama City. While the
political government of these cities, which are within the limits
of the Canal Zone, rests with the governmental authorities of
the Republic, the sanitary and police control are Supervised by
the officers of the Canal Commission under the authority of the
United States Government. This is absolutely necessary for the
maintenance of public order and of correct Sanitary conditions
within the Zone. The plans for the construction of new houses
must be submitted for approval to the health officers of these
cities, and the buildings within the Zone for the employees are
constructed under the same exacting conditions. Owing to the
presence of the Plague on both coasts of Central and South
America, it is especially necessary that new houses should be con-
structed so as to make them rat-proof and prevent the harboring
of rats. These conditions are accomplished by either raising them
three feet from the ground on supports of concrete or other
Typical malarial mosquito (Anopheles) breeding pool near dump

MEARS: THE TRIUMPH OF AMERICAN MEDICINE I3
, material, covered with tin, so that the rats cannot secure a footing
on them, or if placed on the ground they must rest on a floor of
concrete. All buildings are submitted to inspection at regular
intervals; those not in a sanitary condition in the cities must be
placed in that condition, if possible, by the owner, or they are
condemned and destroyed. Disinfection and fumigation are
practised in all buildings in which cases of infectious diseases have
occurred. Permits to repair buildings and to occupy them tem-
porarily or permanently must be obtained from the health officials.
In the cities of Panama and Colon systems of sewerage have
been installed, and all buildings must make connections with the
sewers. This condition exists in all of the communities in which
residential or hospital buildings are located. Outside of the sewered
areas in the native villages pit closets are used, and are disinfected
weekly with a solution of larvacide, a very effective and cheap
preparation, consisting of crude carbolic acid, resin, and caustic
Soda.
Uncompromising warfare is carried on against the mosquito,
anopheles and stegomyia. In the cities and in the regions of the
Zone occupied by officers or laborers all breeding places are either
destroyed or kept in a sanitary condition, free from larvae, by
oiling or the use of larvacide. Stagnant pools and collections of
water are filled up or in large areas drained by ditches which are
maintained in Sanitary condition. Special attention is given to
defective roof gutters, which become prolific breeding places in
the water which remains in them owing to the want of proper
inclination to carry off all water which comes into them in a
rainfall. When very defective by reason of sagging, they are
removed, and the owners of buildings are required to replace
those thus disposed of by new gutters. In some instances simple
punching of the Sagging portion keeps the gutter empty.
At first, considerable opposition was met with, and the Governor
I4. MEARS: THE TRIUMPH OF AMERICAN MEDICINE
of the District was requested to amend the decree giving authority
to the health officials, so that this important work could not be
interfered with. All receptacles containing water for use are
required to be Screened. The constant inspection of known
breeding places is maintained, and the mosquito brigade is on
Continuous and vigilant duty. Persistent search is made for sus-
pected places, and the surveillance is never relaxed. Although no
case of yellow fever has occurred on the Canal Zone since the year
I905, the Search for the Stegomyia and its destruction continues.
The fact that both the adult and larvae of stegomyia species
are transported by railroad trains exposes the Zone to dangers
which require that the most exacting precautions should be
taken; their escape from patients before entering quarantine is
quite within the range of possibility and greatly increases the
work of prevention. Fortunately their recognition is within
scientific knowledge, and their detection is thus facilitated. All
patients are transported to the hospitals on Screened stretchers or
in screened ambulances.
Notwithstanding the rigid system of prevention, through
sanitary measures which have been established on the Zone, the
community is still further protected from the invasion of the
mosquito, the breeding places of which may happen to escape
destruction, by a most perfect plan of house Screening. Resi-
dences particularly are screened, the rustless wire (copper) being
employed for this purpose. Not only are the doors and windows
protected, but the porches, including first and second story, are
securely enclosed. On first view, the appearance is novel, and
quite suggestive of huge bird cages. The assured safety thus
given dissipates any feeling that the inmates are unwilling occu-
pants of the apparent houses of detention.
The known part taken by the fly, the common house fly, in
transporting germs of diseases makes it a source of grave danger,
Water barrel made mosquito proof.

MEARS: THE TRIUMPH OF AMERICAN MEDICINE I5
and provokes measures of protection against its existence. These
measures consist in supplying all buildings of the Commission
with range closets, water, and sewer connections. The pit closets
in the native villages are, so far as possible, made fly-proof, and
are disinfected weekly by a solution of larvacide to prevent fly-
breeding. By this means of prevention the fly becomes a “rara
avis” within the Zone limits, and is very much less in number
than in the villages and towns of our country. During my stay I
saw but one specimen, and the comfort and freedom from danger
enjoyed in the homes by their absence is very great, and quite
in contrast to the conditions caused by them in our homes, be it
in the country or in the city.
The rat as the habitat in its hairy integument of the plague
flea demands extermination. The annual report of the Department
of Sanitation, of the Isthmian Canal Commission for Igog, gives
the number of rats caught and killed in Panama City during the
year as 17,004; in the city of Colon the number killed was 7284.
In Panama City 672 dogs were poisoned, and in Colon 66. The
report of the Board of Health Laboratory, included in the report
of the Department of Sanitation, contains record of 24 examina-
tions of rabies and Suspects, and II cases of preventive treat-
ment for hydrophobia were completed.
An interesting item relates to the existence of crab-holes along
the shores. In Colon 7600 were oiled and 224,220 were worked.
In Cristobel 43,200 were worked, and in Mount Hope 73,229.
Grass and weeds afford a harbor for mosquitoes. In Panama
City I,961,395 Square feet of weeds and grass were cut and
removed. In Bocas del Toro 340 Square yards were cut and
burned. In Colon 460 acres of vegetation were removed. In
Colon I,319,514 water receptacles were treated, and in Bocas del
Toro 554 were overturned-I58 breeding places of the mosquito
were found in barrels, tubs, etc., and destroyed.
I6 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
The antimalarial crusade is carried into the houses and into
the public eating places of the employees of the Canal Commission.
On the tables are placed bottles of the tonic quinine solution which
is taken with the meals. Blood examinations are made to deter-
mine the presence of the malarial parasite. The complete report
of Col. Gorgas for the year 1909 states the issues of quinine for
the year to have been 3,148,053 pounds avoirdupois, an average
per month of 262,337 pounds, representing an issue of 66.74
pounds during the year for each of the 47,167 employees reported
as being present and engaged in the Canal construction.
I have selected these few items from Col. Gorgas' report to
illustrate, in brief, the character and magnitude of the work
carried on to prevent sickness among the employees of the Isthmian
Canal Commission, and to maintain a state of health conducive to
the most successful results in conducting the constructive work
on the Canal. As a test of the success of the sanitary work, it is
interesting to consider, among other diseases, the hospital admis-
sions and deaths from malaria in the years 1905 to 1909.
Hospital admissions per thousand of employees: 1905, 514;
1906, 821; 1908, 282; 1909, 215. In 1906, owing to exceptional
rains, mosquitoes were bred in many places and in large numbers,
and it seemed not quite possible to control their existence by
the measures which, under ordinary conditions, proved to be so
successful. In the same period of time the deaths from malaria
were: 1905, 86; 1906, 233; 1908, 73; 1909, 52. The vital statistics
for 1909, as given by Col. Gorgas in his report, show a marked
improvement. In 1905 and 1906, with the number of employees
16,512 and 26,547 respectively, the death rate was 25.86 and 41.73.
In 1908 and 1909, with the number of employees 43,891 and 47,167
respectively, the death rate was 13.01 and Io.64. In the year
1909 the annual death rate per thousand of II,662 white employees
was 6.43 from disease and 3.43 from violence; total, 9.86. Of
MEARS: THE TRIUMPH OF AMERICAN MEDICINE I7
Americans, average number 8386, including employees and their
families, the death rate per thousand was from disease, 4.05;
from violence, 2.27; total, 6.32. A further statement of the
death rate of the total population, including the cities of Colon
and Panama, and the country between them, shows it to have been
in 1905, 49.94, and in 1909, 18.19.
Assuredly nothing can be added to these clear and authentic
statements to demonstrate the value of the system of Sanitary
work inaugurated by Col. Gorgas and so faithfully and Success-
fully conducted by him and his corps of able assistants.
From the consideration of the measures taken to prevent
disease it will be interesting to observe how the sick are cared for.
For the entire sanitary work on the Zone and in the cities of
Panama and Colon there is a personnel of 1244, the average
number of employees at work during the year, distributed in the
chief Sanitary office, care of property, quarantine service, health
officers, in hospitals, sanitarium, asylum for lepers, and dispen-
Saries. There are four hospitals, including a leper asylum, and
one Sanitarium and nineteen dispensaries. There is a hospital
for the insane, which is conducted for the Republic of Panama,
which pays to the Commission for each patient, seventy-five cents
per day. The Canal Zone Government pays thirty cents a day
in the hospitals for patients, and outside patients, as members of
the families of employees and others, pay the same. Altogether
the paying patients from all sources in the Zone contribute in the
year $98,081.72.
Ancon is the Zone town at the Panama end of the Canal and
opposite to Panama City. Here is the office of the Chief Sanitary
Officer and the Ancon Hospital, which is the largest. This was
the site of the French Hospitals. Of the seventy-five buildings
for hospital purposes, about fifty were built by the French, which
were found by the Americans covered by the jungle. Twenty-five
I8 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
of the buildings are occupied by the Staff. In the Ancon Hos-
pital there are 900 beds for medical purposes, in 27 wards; 320
beds for surgical patients, in Io wards; 5 wards for contagious
and infectious diseases; 2 wards and six rooms for tuberculosis.
A maternity department is conducted for the families of white
American employees, who pay in private rooms $2.50 a day and
$1.oo in the general wards. Thirty contract physicians are
employed by the Isthmian Commission, who report to Colonel
Gorgas, Chief Medical Officer. One hundred and two trained
nurses, 93 female, 9 male, trained in the United States, are on
duty, with 138 attendants acting as orderlies. The Colon, Culebra,
and Santo Tomas Hospitals, with the Leper Asylum at Palo Seco
and the Tobago Sanitarium, have much less capacity, and require
the services of a much smaller corps of officers and attendants.
Attached to the daily trains on the Panama Railroad from Colon
to Panama are hospital cars, arranged with berths which can be
raised and lowered conveniently, forming comfortable stretchers
and beds for the sick and injured who may be taken aboard at
the different stations, and in this manner transported with a
minimum degree of discomfort to the Ancon Hospital. In charge
of these cars is a medical officer, with attendants, who gives
attention to patients en route, and such medical services as may be
needed. Four chaplains are assigned to duty in the hospitals, and
two chapels, one Protestant and one Roman Catholic, Supply
places of worship. Seven buildings, at different points in the Zone,
provided by the Isthmian Commission, are devoted to the work
of the Young Men’s Christian Association, containing reading,
library, and amusement rooms.
The milk supply comes from the dairy, in which there are 93
cows, which were brought from the United States and were care-
fully tested for tuberculosis before being sent and after arrival on
the Zone. Great care is given to the feeding, stabling, and milking
MEARS: THE TRIUMPH OF AMERICAN MEDICINE I9
of the cows, and prompt measures taken in the treatment of any
diseases which may occur. The milk is pasteurized. The poultry
farm contains some six hundred chickens which are carefully
watched for diseases. An autopsy is made of all dying from
disease and the cause of death determined and recorded.
One of the most important sections of the Isthmian Canal
Commission is the Laboratory of the Board of Health, forming
a part of the department of sanitation, in charge of Samuel T.
Darling, M.D., Chief of the Laboratory. Through the courtesy
of Dr. Darling I was permitted to observe the methods of work
carried on in the laboratory, which made my visit full of interest.
The equipment of the laboratory is complete, the Government,
through the Canal Commission, providing all that is necessary
to conduct the important work of this department. The routine
work in the laboratory includes examinations, pathological and
bacteriological, for the hospitals, autopsies, Surgical pathology
studies, Wassermann reactions, blood cultures, vaccines, chemical
analyses for the Commission and chemical examinations for the
Ancon and other hospitals, of milk and foods (toxicological),
Special examinations of urine, etc., chemical, bacteriological, and
microscopic examination of all Zone water supplies, including five
reservoirs. The research work involves various subjects, reports
upon which have been published by Dr. Darling. Possibly the
most important is that entitled “Studies in Relation to Malaria,”
published by the Government Printing Office, Washington, 1910.
Most elaborate experiments were conducted in determining some
of the factors Concerned in the prevention and transmission of
malarial fever in the Canal Zone. Among the most interesting
results obtained was the determination of the influence exerted by
quinine upon the malarial parasite.
The recognition of the mosquitoes common to the Zone, their
breeding habits, and the determination made of the species of
2O MEARS: THE TRIUMPH OF AMERICAN MEDICINE
anopheles hospitable to malaria and those transmitting it claimed
Critical attention and study. Eleven species of anopheles were
Collected in the Canal Zone in the five years given to the study.
It is interesting to note that observation determined the fact that
the characteristic musical note of the mosquito is caused by the
vibration of the proboscis and not by the wings, as commonly
believed. The proboscis is therefore not only a weapon of offence,
but an organ of harmony—an inharmonious combination.
In concluding this necessarily brief and incomplete recital
of what sanitary Science in this day has accomplished in the con-
servation of the health of the working community in the Canal
Zone, many questions of far-reaching importance Suggest them-
selves for consideration and for study. To one, as is the writer,
familiar by actual contact in field and hospital with the appalling
conditions which, through the absence of Scientific knowledge,
confronted the Medical Officer of the Army in the days of the
Civil War, great must be his satisfaction in noting the changes
which the last half century has wrought in the development and
progress of Scientific medicine.
In truth and in justice it can be said that in no department
of medical effort has progress been more pronounced than in the
medical corps of our public service, army, navy, and marine
hospital service. The writer feels in this respect that he may be
permitted to speak with a shadow of authority as it came to him
in his earlier teaching days to place in the medical department of
the public service about ninety of his private students. He knew
of the conditions existing in those days and of the requirements
exacted by the Boards of Examination guarding the gates of admis-
sion into the service, and with inspiring appreciation and gratifying
pride he has watched the gradual but sure advancement in scien-
tific knowledge and in adaptive methods which have taken place.
The war colleges of our army, the hospital ships of our navy,
MEARS: THE TRIUMPH OF AMERICAN MEDICINE 2I
the research laboratories of our marine hospital Service, all Speak
in resounding tones of progress in Scientific medicine, and place
our public medical service in the very forefront of achievement
among the nations of the world. No longer does the medical
department of the different branches of the military and public
service occupy the subordinate position assigned to them in the
days of the Napoleonic campaigns, or even in those of more recent
times.
In the earlier days the commanding general of the army
concerned himself much, through his under-officers, about the
state of efficiency of his commissary and quartermasters' depart-
ments, in order that he might without interruption continue his
line of march to meet the enemy and engage him in battle. The
medical department was, in a certain Sense, an after-thought; the
sick and wounded could be left behind in field hospital or in
barracks, but the impedimenta, the quartermaster and commissary
stores must be in as efficient state as possible. He did not know
and his medical officers could not tell him at that time how impor-
tant, absolutely necessary, it was that the medical officer should
march side by side, as it were, with the soldier.
Under his care the soldier endures the fatigue of the march or
comes to the battle line as an efficient agent in the conflict; between
him and disease and pestilence the medical officer stands, without
fear and with undaunted courage, erecting barriers of defence
and battling, it may be with greater skill than the officer of the
line, against the onslaught of the oft-times concealed enemy.
In his hands the Soldier becomes a unit of protection against all
of the influences of his environment and the methods of his life—
he is not only taught to protect himself, but to protect all about
him. In a Sense every act of his life, as every function of his
physical being, becomes the intelligent care of the medical officer.
Such, in truth, are the conditions in existence today under the
22 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
progressive methods which the advanced state of medical science
Confers.
It may be urged that it requires military discipline to achieve
such results as we observe in the Canal Zone. Recognizing, as
We all must, the influence exerted by a state of military control
in conquering unsanitary conditions, and in obtaining unresisting
compliance with those which are conducive, in all respects, to the
Conservation of health which may be permanently maintained,
we find some examples of places presenting conditions similar
to those which had existed in the Canal Zone, and which have
been Completely removed by civic efforts.
In a visit made in the last winter to South America, I landed
in Santos, Brazil, a city of 41,000 population, and one of the best
ports on the Atlantic Ocean. A few years ago this port was
devastated by raging epidemics of yellow fever. To such extent
did the disease prevail that vessels coming into the port lost in
Several instances, and very quickly, their entire crews from the
disease, officers and men, before they could be unloaded. I was
told of one instance in which a vessel lay anchored in the harbor
for a period of eighteen months, unloaded, with cargo perishing
in the hold.
Inspired by the fact that this city was the greatest shipping
port of coffee in the world, the government and municipal author-
ities inaugurated a system of modern hygienic improvements which
destroyed the breeding places of the Stegomyia mosquito, and
banished yellow fever, converting its beautiful harbor from a
home of pestilence into an attractive seaside home, with the ships
of many nations unloading and loading in guaranteed Security
alongside of its commodious and well arranged quays.
Such results had been obtained by civic effort, and they may
be accomplished in other places where knowledge of Sanitary
science, combined with intelligent coöperation—freed from the
MEARS: THE TRIUMPH OF AMERICAN MEDICINE 23
demoralizing and destroying grasp of the political boss, surcharged
with graft—is employed in correcting unsanitary conditions,
conducing, in this manner, to the prevention and to the staying
of the ravages of disease.
The world should not, as we hope and believe it will not, look
again upon a picture such as the Chickamauga Camp in the
Spanish-American War, which portrayed in such lurid colors the
humiliation of American medicine and as well the inefficiency
of military control. While it is true we were on the eve of
discoveries of great import, born of the experience which we
gained in the occurrence and in the progress of the war, it may
be said, without fear of successful contradiction, that the con-
ditions which provoked such holocausts were in large measure
preventable. It is true that we did not know of vaccination as
a prophylactic measure against typhoid fever—a recent gift of
laboratory research and of experimental medicine, which will
take its place with vaccination against Smallpox, as a monumental
contribution to the promotion of the well-being and welfare of
the human race—we did know, however, of the great necessity
of microscopic, chemical, and bacteriological examinations of
food and drink Supplies. The bacillus of typhoid fever had been
isolated in the year 1880, and we knew the importance of its destruc-
tion in the excreta. We knew of the necessity of maintaining all
sinks and pits in rigid Sanitary conditions, destroying by the free
application of the most powerful disinfectants all microörganisms.
Our knowledge, at the time, of the part taken by the common house
fly in Conveying disease germs was sufficient to provoke measures
of protection against it, and the employment of agents to prevent
fly breeding in all places favorable to such conditions. We had
sat for two decades or more under the instruction of the great
teacher who had taught us the far-reaching principles of antisepsis,
and had demonstrated its practical application in all conditions
24 MEARS: THE TRIUMPH OF AMERICAN MEDICINE
involving the sick and wounded—the subjects of the wounds of
accident and of the wounds of intention. We knew the value of
incineration in the disposal of all refuse matter. The gospel of
Cleanliness, evolving asepsis, as the physician and the surgeon
understand it, or should understand it, had been preached abroad
in the land, enjoining all to be clean, through its unremitting
application in practice.
All of these things and many more we did know, and yet the
dread disease typhoid fever, stalked through the camp, apparently
unrestrained, laying low one-sixth of the entire command—
2O,OOO cases out of an army corps of I2O,Ooo troops—with a case
mortality of 7 per cent. The annals of civilized warfare do not
present a page quite so black, recording conditions which the
knowledge of the day should not have permitted to exist.
The progress of scientific medicine is onward, and today in the
camps of our armies, on the battleships of our navy, and at the
quarantine stations of our marine hospital Service it shines with
added luster, the medical officer taking his place, as of right it
belongs to him, in the front rank with those whose efforts con-
tribute to civil and military efficiency. Moved with pride by the
achievements of his noble profession and inspired by loyal devo-
tion to the corps of which he is a member, he bears aloft the banner
of progress and scientific research, unfurled by that distinguished
disciple of medicine and honored medical officer of the United
States Army, William Beaumont, who nearly a century ago gave
to the world and to scientific medicine, obtained through accurate
research work in the living subject, the first knowledge it had
of the functions of the stomach and of the Constituent elements
of the gastric juice and their action on foods. His name will live
as the pioneer in scientific research in the history of American
medicine.
Truly, may we not congratulate our professional brethren
MEARS: THE TRIUMPH OF AMERICAN MEDICINE 25
who have so unselfishly devoted their talents and their lives to the
service of their country upon the great work they have accom-
plished, which stirs our national pride, and proclaims to the
world their monumental achievements, as the President and their
Commander-in-Chief has so well proclaimed them, “Marvels of
American courage, energy, and Scientific thoroughness, skill,
research, and original discovery.” So long as preventable
destroying diseases flee before the conquering hosts of efficient
sanitation, so long will the labors of these noble benefactors of the
human race be cherished. Upon their brows we place wreaths of
victory, laurels won not in the fierce conflict of clashing arms, but
in the home and in the daily walk in life, over which the Angel of
Peace spreads her golden wings. As we acclaim them victors
in peace, no less than in war, we enshrine them in the grateful
hearts of their countrymen.

3 9015 00200 9960
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