Through the self-sacrifice of three United States army officers it was proved that the source of infection in a yellow fever epidemic was a species of mosquito, This knowledge enabled the people of New Orleans to wage a successful war against the yellow fever plaque last Summer. The story of the struggle of man against the mosquito is as absorbing as that of any war in history.
ALL the world of science now knows that yellow fever is transmitted by the bite of a single species of mosquito and by that agency alone. Patient and perilous experiments have established the responsibility of the little gnat to which is given the name of stegomyia, proving to be the deadliest of all creatures of prey, it kills more human beings every year than the dreaded cobra; more, probably, than all the wild animals of the world put together. Yet so little understood and so difficult to combat has been this tiny man slayer that those of our cities which are subject to its ravages have lain supine before its onslaught, up to last year. Then came the yellow fever outbreak in New Orleans, and the first great American victory over an epidemic.
Eight years before, the mosquito plague had infected the great, busy, joyous metropolis of the South. Ignorant of the real processes of the infection. New Orleans had fought it blindly, frantically, in an agony of panic and when at last the frost put an end to the helpless city’s plight, she lay spent and prostrate. The yellow fever of 1905 came with a more formidable and unexpected suddenness than that of 1897. It sprang into life like a secret and armed uprising in the midst of the city, full-fledged and terrible. But there arose against it the trained fighting line of scientific knowledge. Accepting with a fine courage of faith that, most important preventive discovery since vaccination, the mosquito dogma, the Crescent City marshaled her defenses. This time there was no panic, no mob-rule of terrified thousands, no mad rushing from stunned inertia to wildly impractical action; but instead the enlistment of the whole city in an army of sanitation. Every citizen became a soldier of the public health. And when, long before the plague-killing frost came, the battle was over, New Orleans had triumphed not only in the most brilliant hygienic victory ever achieved in America, but in a principle for which the whole nation owes her a debt of gratitude.
For the foundation of her defenses New Orleans must acknowledge her debt to three young U. S. Army surgeons. Reed, Carroll and Lazear established near Havana in 1900 an experiment station to test on human subjects the mosquito theory suggested by Finlay and earlier observers.
Two adjoining houses were selected, presenting precisely the same conditions of hygiene, sanitation, and temperature, and in these squads of volunteers were domiciled. In one was put the soiled sheets, pillows, and blankets from the hospital at Havana in which yellow fever patients had slept and died. This dwelling was carefully screened to prevent the entrance of mosquitos. In the foul bedding the volunteers slept for two months. Not one case of yellow fever developed among them. The other house was, kept as clean as sanitary science could make it. Everything used by the men who volunteered for this part of the work, was sterilized. Into the room were introduced specimens of the stegomyia mosquito which had, bitten yellow fever patients. Of the occupants of this room, fifty per cent, developed yellow fever. Finally, men who had lived unaffected for twenty days amidst the foul surroundings of the first establishment, allowed themselves to be bitten by the infected mosquito, and 70 per cent, of them took the disease. No low order of courage was required in those who submitted to either test, since, on the one hand, the fever was universally regarded at that time as a mysteriously airborne disease, while on the other, the physicians frankly told those who submitted themselves to the mosquitos that they would probably take the infection.
On the old military principle of leadership, that an officer must not ask his men to go where he himself would not venture, the three surgeons, put their own persons to the ordeal. Lazear died, a martyr to humanity, and is remembered by one where the lesser heroes of our Cuban battle fields are acclaimed by thousands. Carroll barely escaped with his life, and Reed, shrinking from no peril which his companions braved, came through unscathed by virtue of some natural immunity, only to die of another illness in the following year. At the price of martyrdom for several men (for some of the volunteers died), of patience and peril and suffering for the others, it was proved in the utmost detail that only through the bite of an infected mosquito does yellow fever attack the human subject; that the fever-bearing insect itself becomes infected only by biting a patient in the first five days of the disease; and that not until twelve days thereafter can the insect transmit the infection. Reduced to its practical terms, this means that yellow fever can exist only where the stegomyia breds; that it can spread from city to city only by transportation of the infected mosquito (practically a negligible consideration) or of human beings in the early stages of the disease going to places where the stegomyia is awaiting them; and finally that the infected community which can kill off its mosquitos can stamp out the infection.
How the fever came, or when, no man will ever surely know. From Havana, some think, but the weight of evidence indicates the infected port of Belize, whence come the United Fruit Company’s vessels, bearing fruit, passengers, and sometimes mosquitos. Perhaps it is too much to expect of a corporation that it should give information in the interests of the public health as against its own traffic. Corporations have not, usually, that quality of good citizenship. Yet I am inclined to believe that this year, should yellow fever prevail at one of its ports, the United Fruit Company will make the fact known to the quarantine authorities, regardless of the immediate effect upon its trade. There has been a considerable change of business sentiment in New Orleans since the bitter lesson of last summer. However, some two hundred refugees from Belize landed in New Orleans, late in May. Subsequent study of the passenger list showed a number of Italian names. Whose the first case no man has ever known. But that there came to the Italian quarter of New Orleans (which is almost coterminous with the famous “French Quarter”) late in May a yellow fever patient; that the mosquitos which breed in the water barrels and swarm in the houses of the Quarter sucked the infection from the feverous veins to spread it to other men, ten or twelve days later when the disease has developed in themselves; that these men. bitten by still other mosquitos radiated the infection in various circles; and that this ever-widening process continued insidiously until the epidemic had the unsuspecting city in its grip—all this can be mapped out from the form and distribution of the infection when, full-grown it suddenly sprang, nearly two months after the first case into the light of public notice.
The city rang with the wildest rumors. Monstrous exaggerations grew as they spread. The exodus of the terrified began. Men and women hastily gathered their belongings and flocked to the trains before quarantine should pen them in. Panic was in the balance. In that hour of supreme test the city proved herself. To the grisly voice of impending disaster, as to a trumpet call, all that was best in the citizenship of New Orleans rallied to her from near and far, in courage and indomitable hope. Midsummer is not a particularly pleasant season in the low-lying city. Many persons who are able, get away for July and August. Now they hurried back to the stricken town; business and professional men, physicians, clergymen, cotton-growers, bankers, ready to volunteer.
Money was needed. Charles A. Janvier, one of the leading bankers, cancelled his tickets to Europe and started in to raise a fund of $100,000; no small sum in the face of a panic. It was pledged at the call. The state contributed a like sum and the city council appropriated $50,000. Men were needed. In every ward a protective organization sprang into being. Meetings were called and money was raised, each ward providing as a “district” the sinews of war for its own defence. The tone of the newspapers was admirable; no “scare heads,” no superlative adjectives; no attempt to make capital of the imminent peril. The very gravity of the situation inspired local journalism with a fine sense of its responsibility. The Times-Democrat struck the key-note of the coming struggle in its call to the people of New Orleans: “to prove our energy and civic spirit before the world.” The mayor issued a proclamation declaring the situation to be “serious but not dangerous” and calling on the citizens to protect all open water against mosquitos. “Kill the mosquitos” was the battle cry, and there began, the greatest hunt for the smallest game ever undertaken by any community since the Pied Piper fluted the rats out of Hamelin town. The stegomyia was, of course, the chief quarry, but all species were put under the ban. “Let the innocent suffer with the guilty” said a speaker at one of the meetings of education. “We know the other mosquitos don’t carry yellow fever, but they’re better dead anyhow. Kill them all, and you’ll get the right ones as well as the wrong.” It was a truly Herodian plan of slaughter.
Among those who hastened back from their vacations to proffer such help as they might give, was the Rev. Beverly Warner, rector of the fashionable Trinity Church. A ward heeler whom I met afterward in one of the slums advanced the theory for my consideration that “the Lord made Warner to order for the job.” Certainly it was the right man in the right place when the clergyman accepted the general control of the district organizations. These bodies had charge of all the city “above Canal Street,” in the effort to confine the infection to the district below Canal Street. At the first meeting of the representatives from the various localities Dr. Warner found himself facing a crowd of the typical “district leaders” of ward politics. Some of his friends had horrid misgivings.
“Those ward heelers,” said they, “will take all the money you give them, use just enough of it to make a showing and to give fat jobs to their followers, and pocket the rest."
Had the new superintendent proceeded on this theory, undoubtedly the pessimistic prophecy would have been widely fulfilled, but he is one of those clergymen, none too common many church, whose faith in God is paralleled by a faith, almost as strong, in his fellow men. After it was all over he said to a friend of his that he guessed that at the start the ward leaders had more misgivings about him than he had about them. From the first he assumed that they were single-minded in their loyalty to the city. There was money for the fight, he told them, and it would be handed over to them as they needed it. At the same time the war was likely to be a long and costly one, and they must set all the volunteers possible for the labor and use the money for the necessary supplies. These included oil to kill the mosquito “wigglers" in the water; netting to cover watertanks and barrels, so that the insect having developed from the “wiggler” could not get out; and sulphur to smother the stegomyia in the houses. Immediately there sprang up a spirit of emulation among the leaders, each striving to keep down the expense in his own district. The outcome splendidly justified Dr. Warner’s, confidence in his fellow-workers, for, at the close of the campaign, every district turned back to him a surplus.
The task to which the organizations set themselves was a peculiarly difficult one. Few cities in this country—probably no other large city offer such favorable terms to the mosquito as New Orleans, Nearly every house has its private breeding ground for the little pests. This is because the local water company supplies, at an exorbitant price, liquid so dirty that it is unfit to drink and unpleasant even to bathe in. Therefore, the better class of houses have large cisterns and the poorer class water barrels in which the roof-drainage is stored for family use. Nothing more convenient and comfortable for the mosquitos could be devised; more particularly for the stegomyia, as she is a house-haunter, and also exhibits a preference for clear water over muddy. Here, then, right at hand, was a device which to her instinct must have seemed providential, a plentiful supply of suitable water within a wing-flap of the house. Pretty nearly every cistern, waterbarrel, tub, and other receptacle for storing water in New Orleans was found, when the investigation was on, to harbor the larvae of the stegomyia.
The first move of the district workers was to inspect all premises and note all conditions favorable to the development of the insects. Then arrangements were made either to spread oil over the surface of the water, so that the “wigglers” coming up, should be destroyed, or to protect the water by netting. This last method was used for the cisterns. Before it was half done the supply of wire netting was gone. “Use cheese cloth temporarily" came the order from headquarters. Thereafter many quarters of the city presented a most eerie appearance, especially at night, each house being haunted by huge, shrouded ghosts, towering beside it.
By the first of August every district, outside of the infected region which was in charge of the federal authorities, was able to announce itself approximately protected. Then came one of those dire events that seem like the direct interposition of a demoniac agency. The weather allied itself to the epidemic. A terrific night-storm of wind and rain fell upon the city. It tore loose the cheese-cloth and the lighter netting. It over-flowed the water receptacles, carrying off the safeguarding surface oil. It formed thousands of little pools where the stegomyia might drop her eggs. It not only undid the work of toilful days and nights, but it established new conditions of difficulty.
The call to the work was sounded in every quarter of the city; in banks, in office-buildings, on the floor of the exchanges, in the wholesale districts, in the crowded stores, in clubs, in church meetings, in restaurants and saloons, the summons came to every able man to help rebuild the defenses of the city. That day and the next day and for days thereafter, coatless and hatless lawyers and clerks., merchants, doctors, bar-keepers, book-keepers, ministers, and bankers, perching perilously on roof-slopes and cistern tops, hammered alternately their unpractised fingers and the nails that made sound the netting-fortifications, of the beleaguered town. And in the evening they betook themselves weary, sore, and enthusiastic to meetings in churches, in halls, in theatres, in schools, in assembly rooms, in every place possible for gatherings, and listened to lectures devoted, entirely to the mosquito and the destruction thereof. A genuine revival spirit possessed the people, arousing such an enthusiasm in the cause of public health as the skilled exhorter produces by his emotional appeals to religious exaltation; with this difference, that the hygienic revival proceeded from the people themselves, with no factitious or artificial stimulus. The preachers of the common defense even penetrated factories and workshops, and got from the employers half-hour recesses in which to give the hands instruction on the mosquito. Never was a city so thoroughly and exhaustively enlightened in any department of science, as, New Orleans in this particular branch of entomology.
Meantime, in the infected district matters were growing steadily worse. The city and state health authorities working together had obviously lost control of the situation below Canal Street. Early in August the leading men of New Orleans realized that the fight was going against them. Some of the older citizens remembered with sinking hearts the terrible slaughter of 1878 with its death list of more than 4,000 victims, which, from all indications, might well be equalled or even exceeded. The community was facing a great disaster; and the means at its disposal for the battle in the infected district, if not inefficient, were at best insufficient. The district organizations, conscientious, and unremitting as had been their work, had been unable to prevent an occasional appearance of the disease in the region above Canal Street. Slowly the volunteer army was beaten back. The time had come to forget local pride and states rights sentiment, and call on the regulars of the Army of Public Health. An appeal was sent to President Roosevelt, who instantly ordered the Public Health and Marine Hospital Service to take charge of the situation. Surgeon J. H. White, a veteran of many epidemics, was put in command at New Orleans. To him, as staff-officers, in a sense, were sent the seasoned men of the service ; Richardson, Blue, Steger, Berry and others. Formally, the control of the situation was turned over to Surgeon White on August 8; the campaign of the new staff was actually started actively on August 12. It was now literally a fight for life— for the life of the city. The fever had a long start. It was widely disseminated before its existence had been known, and still more widely before its existence was acknowledged and the city warned. So it was reasonably certain, when the federal authorities assumed control, that there were infected mosquitos in every part of the French Quarter, that there were probably more than 100 cases in the stage where mosquitos biting them would become contaminated, and that there were an unreckonable number of people who. having the disease, had not yet developed it.
Another difficulty was found in the nature of the people among whom the disease had its stronghold. Partly because these aliens are held in suspicion, partly because they do not understand their new environment, and partly by the heritage of centuries of oppression, the low class Southern Italians are an intensely suspicious people. A superstition is prevalent among them that pestilences are introduced by the Americans, through physicians, to kill off the aliens because of race hatred. Last winter in my hearing an Italian said to one of the physicians who had worked in the quarter, “you bring da fever again dees year, Doctor?” It was said jocularly, but the Italian’s wife standing near hurriedly made the sign that averts evil. Among such a people the task of discovering and tracking infection was one of the utmost difficulty. At first all cases were concealed, and to this secretiveness is largely due the late discovery of the presence of the disease in the French Quarter.
No sooner had the Marine Hospital Service taken hold, however, than its thorough and scientific inspection at once brought to light a number of unreported cases. In each instance, the house where the sick person lay was thoroughly fumigated to kill all mosquitos and the patient, unless too ill, removed to a hospital. The first yellow-fever hospital represented one of the few mistakes that was made; and this was due to the necessity of instant action. It was an old tenement, within a stone’s throw of the French market. In thirty-six hours after its selection the medical authorities had completely furnished, netted, and wired it, a record in hospital work. But the building was ill-suited to its new purpose. The ventilation was poor. Some of the rooms were wholly dark. The proportion of deaths was higher than it should have been, and owing to the unfavorable surroundings, a large number of the sick became delirious. Moreover, the people in the neighborhood evinced an active hostility, making it difficult for the authorities to get servants. Threatening letters were sent to the physicians, and there was some alarm lest the place might be attacked. After a few weeks’ trial, it was apparent that the location must be changed. The New Orleans Terminal Co. offered the use of the McDonough public school, which it owns and which is fairly central to the infected district. The building was thoroughly renovated; sanitary appliances were put in; the windows were covered with netting, and within a short time the school house was transformed into as good a hospital in all practical senses, as if built for the purpose. Dr. Hamilton P. Jones, a young New Orleans physician, an immune, and a veteran of two epidemics, was put in charge. Realizing that the great point to be gained was the confidence and goodwill of the Italians, he established a system which, a few years ago. would have been regarded as sheer lunacy. He permitted visitors to come and go freely in the hospital. All that was required of them was that they be thoroughly brushed in a screened ante-room, to remove any mosquitos that might be clinging to them, and that any packages brought in by them be examined for the same purpose. Not a single case of fever developed from these visits. An Italian priest was kept in the hospital, helping to inspire confidence. Measures such as these became a potent educational influence to uproot the suspicions of the Italians. Presently they came to see that, after all, the American’s hospital was the best place for a sick man, and before the epidemic was over they had begun to report cases of their own free will. This very class of people it was who in 1897 had mobbed Dr. Jones and set fire to the yellow-fever hospital on the day it was finished, in the sheer brutality of panic.
All the forces of the Marine Hospital Service were concentrated in a two-fold endeavor: first to discover all cases and so dispose of them that they should be guarded against mosquito bites; second to destroy all mosquitos. A house-to-house inspection was established with a system of daily reports. Where a case in any way suspicious was found, netting was immediately put over the bed and across the windows. Did it develop into yellow fever, the patient, if able to be moved, was taken to the hospital in a screened ambulance, and the house, having been sealed at doors and windows with gummed paper, was treated to a thorough sulphur fumigation.
All this time New Orleans, harassed by the stringent quarantine, half-strangled in its business life, was steadfastly, cheerfully, bravely fighting the good fight. Even when matters looked blackest, there was no sign of public gloom or despair. The newspapers printed all the news, but with calmness and restraint from sensationalism; printed also optimistic editorials; and almost daily instructions how to destroy mosquitoes and to escape infection. Not only this, but specially prepared articles were sent out to hundreds of newspapers throughout the South by a special bureau in pursuance of an established policy of sanitary education. Business houses ran at a heavy loss, some of them practically at a standstill, rather than tacitly admit defeat by closing their doors temporarily. I remember particularly one advertisement of a large house, denying, in terms of the most inspiring exasperation, that it had shut up shop or had any idea of shutting up shop, for any such insignificant cause as the trifling local epidemic.
Through August little headway was made. The army of sanitation was barely holding its own; at times it was doubtful whether it was doing that. Always there was the imminent danger that the infection, bursting forth suddenly with renewed virulence, would break through the defenses of science and rage through the helpless city as it had in ’78. Up to the end of August, there had been two hundred and seventy-five deaths and one thousand nine hundred and nineteen cases, By midsummer the record was three hundred and twenty-nine deaths, and two thousand one hundred and thirty-three cases. The figures rose and fell, uncertainly; but there was this vitally hopeful feature: that the disease established no real foothold outside of the area below Canal Street. Cases appeared in other parts of the city, but probably none of them spread infection. For this the district organizations under Dr. Beverly Warner were largely responsible. Ill-done as much of their early work was—for it was the effort of amateurs—it was re-done again and again with unflinching patience until the districts were at last fairly mosquito-proof. Finally, toward the end of September, the experts began to realize that they were making headway. The figures were dropping, not regularly, but with a steady downward tendency.
The workers hardly dared admit it to themselves. The test would come early in October after the schools opened. And when the first of October came, the public school doors were thrown open; the children poured in in almost undiminished numbers, and the venture justified itself for no increase of the fever followed. It was the first sign of victory. And this, it must be remembered, in a city which only eight years before had gone mob-mad, in abject, brutal panic over an epidemic less serious. Two weeks later the ward organizations ordained a final cleaning-up and fumigation. A real jubilee spirit prevailed; the work was performed like the chores at a picnic. The epidemic was, really over by this time; so safely over that the district forces disbanded. Sporadic cases still appeared, and continued to appear, for a month. There was no cessation of watchfulness in the infected district. But it was only the last chance firing of a defeated enemy. New Orleans had fought the greatest fight for the public health on record; she had won as complete a victory as ever was won over an epidemic; for when the pestilence was routed, frost, the only victor heretofore, was still nearly two months away. The reward of valor was this: that whereas, after ’97 the commerce of the city lay prostrate for years, there was no business depression following this last epidemic. One other mark of honor must be credited to the city’s account: the final establishment beyond all doubting and by the test of fire and blood, of the dogma that the mosquito and the mosquito alone transmits yellow fever from man to man.