Mariel Tishma
Chicago, Illinois, United States

The Panama Canal Zone in the early 1900s was described as “one of the must unhealthful places in the world.”¹ Ridden with mosquitoes, the Isthmus of Panama was a hotbed of yellow fever, malaria, and pneumonia. Previous efforts to render the Isthmus healthy and habitable to outsiders had been unsuccessful. But Dr. William C. Gorgas, armed with knowledge and passion acquired throughout his life, was ready to take on the task.

Born in Alabama on October 3, 1854, Gorgas was the son of a military man. His father, Josiah Gorgas, had served in the Confederate army and later with the United States. This was young William’s first exposure to the world of war and it instantly fascinated him. He decided then that he would follow in his father’s footsteps, and contribute to military efforts through whatever means necessary. When he grew older and was unable to attend West Point, the premier military school, Gorgas did not waver in his course. Instead of becoming a soldier, he chose to pursue medicine with the intention of becoming a military doctor.²

Gorgas attended Bellevue Medical College in New York and graduated in 1879. He briefly interned at Bellevue Hospital and took on a few temporary positions before he could finally volunteer for the Army as a doctor in 1880.³ Much of Gorgas’ earliest medical career was spent in rural military outposts in Texas, North Dakota, and Florida, where he tended both civilian and military patients. When some patients began to present symptoms of yellow fever, Gorgas was ordered not to treat them, as he was not immune. He ignored this order though, and contracted yellow fever himself.⁴ Despite the odds Gorgas survived the disease, and during his treatment and recovery met the woman who would become his wife, Marie Doughty.⁵

Now immune, Gorgas was able to tend to patients suffering from yellow fever without fear. The memory of his infection never left, and it served as a focal point that guided his career. If possible, he would not allow others to suffer as he had. Treating and eliminating the disease became his mission, his campaign, the enemy he fought. Inspired by his goal, Gorgas accepted new challenges, the most significant of which were his terms in Cuba and Panama.⁶

Gorgas’ first target was the yellow fever epidemic in Havana, Cuba. It was reported that “yellow fever [had] been continuously present in this city [Havana] since 1762,” and so it was difficult to believe it could ever be eliminated there.⁷ When Gorgas began his service, the theory of mosquitoes as transmission vector for yellow fever was still controversial. Experiments to prove transmission performed under Walter Reed seemed convincing, but Gorgas remained unconvinced it was the only transmission method. As such, he performed experiments of his own, including one that involved the now famous nurse Clara Maass, to confirm the vector and explore the best way to induce immunity. These experiments helped verify the truth, and possibly helped convince many of those in authority who remained unconvinced about the mosquito vector theory.^8,9 Once Gorgas was confident mosquitoes were a – if not the only – vector of infection, he began a massive cleanup of the city.

Gorgas’ plan contained a three-part approach, the first centered on cleaning general waste, trash, and debris from the city’s streets. This reduced the infection rate of many diseases, but had only a small effect on yellow fever. To counter this, Gorgas established a team of responders who would visit the house of anyone infected. Once there they would line all openings with screens to keep infected mosquitoes in and uninfected mosquitoes out. The team would then use sulfur to kill off any mosquitoes inside the house. This drastically lowered infections, but in order to decrease the number of adult mosquitoes, the third portion of the plan was larvae destruction. As yellow fever mosquitoes breed in water, Gorgas eliminated sources of standing water, and lined those he could not eliminate with oil to suffocate mosquito larvae.

Despite the complexity of his work, Gorgas remained humble, writing in his report that “the same thing could be accomplished by any community anywhere else,” so long as the community put in the effort and resources. “No elaborate machinery of any kind is necessary; merely men and brooms.”¹⁰

Gorgas’ cleanup and vector control efforts proved wildly successful, reducing deaths from both malaria and yellow fever. Between 1890 and 1900, just at the start of Gorgas’ work, 462 people on average died of yellow fever in Havana each year. By 1901 the number of deaths from yellow fever had dropped to 12.¹¹ Sources reported 5,643 deaths from malaria between 1890 and 1900, and only 444 deaths between 1900 and 1910.¹² A portion of this success can be attributed to Gorgas’ personality. He was excellent at calmly and clearly communicating the goal of his work to the people of Havana, and worked hard to listen to their complaints without malice. This helped him convince the people to work with an occupying power. Consequently, Gorgas, his team, and the people of Havana were able to control yellow fever and malaria for many years to come.¹³

With the success in Havana under his belt, Gorgas was sent to Panama in 1904 where he was “intrusted [sic.] the organization of the sanitary department,” for the US Panama Canal project.¹⁴ Creating a passage across the Isthmus of Panama had been attempted and abandoned before, mostly due to disease and health issues. During the French Panama railroad efforts, one hospital in Panama City recorded 1,041 deaths over nine years from yellow fever alone.¹⁵ But within two years, Gorgas had effectively eliminated yellow fever and controlled malaria using the same methods he had developed in Havana, thus allowing the United States to complete the canal.¹⁶

As part of his mission to eradicate yellow fever, Gorgas shifted the focus of his career from treating disease to preventing it. In doing so he spread concepts of proper sanitation and hygiene further, continuing the Sanitary Revolution that was sweeping society in the late nineteenth and early twentieth century.¹⁷ Sanitation had become increasingly important within the surgeon’s suite and the treatment room, but public sanitation and hygiene had often been disregarded. This was especially true for disease prevention, where immunization tended to take the forefront. Gorgas, however, was one of the pioneers who pushed for keeping cities clean, helping to establish disease prevention as a significant part of medicine.

Gorgas was elected president of the American Medical Association in 1908, six years before the Panama Canal opened in 1914.¹⁸ He was one of the few important figures in the canal project to remain part of the team until the end of construction.¹⁹ After the canal’s completion, Gorgas continued to work in public health as a consultant, advising on pneumonia for a project in South Africa. While there, he was informed that he had been appointed Surgeon General, putting him in charge of policy and organization for the Army’s medical systems.²⁰ At the start of World War I, Gorgas, still serving as Surgeon General, lent his expertise in sanitation to the military. In this role he issued “detailed instructions designed to end the lax sanitary practices that had allowed disease to run rampant in previous wars.” In addition, Gorgas used his position with the American Medical Association and his celebrity status in the medical community, to increase volunteers for the American Medical Corps. By November of 1918, Gorgas had gathered a force of 30,591 physicians and 21,849 nurses.²¹

Gorgas survived the war, and by the end of his career he had acquired numerous promotions, honorary degrees, and awards. He had even been granted a knighthood, which King George V conferred on him just before Gorgas’ death following a stroke.²² In spite of it all Gorgas only referred to himself as “Doctor,” remaining firmly aligned with the medical profession which had allowed him to see the world and given his life purpose.²³

End Notes

1. Francis P. McCarthy, “A review of sanitation in Panama,” Boston medical and surgical journal volume clxiv, no. [2]. (January, 1911) 1, Accessed February 13, 2019, https://id.lib.harvard.edu/curiosity/contagion/36-990065643300203941.
2. Sarah Woolfolk Wiggins, “William Crawford Gorgas.” in Encyclopedia of Alabama, February 26, 2007 ; http://www.encyclopediaofalabama.org/article/h-1048
3. Jonathan Leonard, “William Gorgas, Soldier of Public Health,” Pan American Journal of Public Health volume 25, no. [2] (1991): 168, accessed: February 12, 2019, http://iris.paho.org/xmlui/bitstream/handle/123456789/27091/ev25n2p166.pdf?sequence=1.
4. Thomas M. Cashman, “William Crawford Gorgas: He Set the Standard of Military Preventive Medicine,” Hawaii Medical Journal volume 57 (January 1998): 377, accessed: February 12, 2019, https://core.ac.uk/download/pdf/77123462.pdf.
5. Sarah Woolfolk Wiggins, “William Crawford Gorgas.”
6. Eduardo Faerstein and Warren Winkelstein Jr., “William Gorgas: Yellow Fever Meets Its Nemesis,” Epidemiology volume 22, no. [6] (November, 2011): 872, accessed: February 12, 2019, doi: 10.1097/EDE.0b013e31822e18fa.
7.  U.S. Congress. Senate. Yellow fever: a compilation of various publications : results of the work of Maj. Walter Reed, Medical Corps, United States Army, and the Yellow Fever Commission. Presented by Robert L. Owen. 61st Cong., no 822. 1911. https://id.lib.harvard.edu/curiosity/contagion/36-990061691590203941.
8. Mariel Tishma, “Clara Maass, yellow fever, and the early days of ethical medical testing,” Hektoen International Hektorama, Infectious Diseases (Winter 2019).
9. William B. Ashworth, Jr, “Scientist of the Day – William Gorgas,” Linda Hall Library, October 3, 2018, accessed: February 12, 2019, https://www.lindahall.org/william-gorgas/.
10. U.S. Congress. Senate. Yellow fever: a compilation of various publications.
11. Rita Isabel Lechuga and Ana Cristina Castro, “Dramatic effects of control measures on deaths from yellow fever in Havana, Cuba, in the early 1900s,” Journal of the Royal Society of Medicine volume 110, no. [3] (2017): 119, accessed: February 12, 2019, DOI: 10.1177/0141076817694583.
12. Joseph A. Le Prince, and A. J. Orenstein, Mosquito control in Panama: the eradication of malaria and yellow fever in Cuba and Panama, (. New York: G.P. Putnam’s Sons, 1916.), 14, https://id.lib.harvard.edu/curiosity/contagion/36-990015792000203941.
13. Jonathan Leonard, “William Gorgas, Soldier of Public Health.” 170.
14. Francis P. McCarthy, “A review of sanitation in Panama,” 6.
15. Ibid. 3.
16. Encyclopaedia Britannica, “William Crawford Gorgas.” (Last Updated: Jan 22, 2019), https://www.britannica.com/biography/William-Crawford-Gorgas.
17. “sanitary revolution.” Oxford Reference. . ,. Date of access 22 Feb. 2019, <http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100440898>
18. Eduardo Faerstein and Warren Winkelstein Jr, “William Gorgas: Yellow Fever Meets Its Nemesis,” 872.
19. Jonathan Leonard, “William Gorgas, Soldier of Public Health.” 175.
20. Thomas M. Cashman, “William Crawford Gorgas: He Set the Standard of Military Preventive Medicine,” 380.
21. Jonathan Leonard, “William Gorgas, Soldier of Public Health.” 182.
22. Eduardo Faerstein and Warren Winkelstein Jr, “William Gorgas: Yellow Fever Meets Its Nemesis,” 872.
23. Thomas M. Cashman, “William Crawford Gorgas: He Set the Standard of Military Preventive Medicine,” 380.

Bibliography

• Ashworth, William B. Jr. “Scientist of the Day – William Gorgas.” Linda Hall Library. October 3, 2018. Accessed: February 12, 2019. https://www.lindahall.org/william-gorgas/.
• Cachman, Thomas M.. “William Crawford Gorgas:He Set the Standard of Military Preventive Medicine.” Hawaii Medical Journal vol. 57 (January 1998): 377-380. https://core.ac.uk/download/pdf/77123462.pdf.
• Encyclopaedia Britannica. “William Crawford Gorgas” Last Updated: Jan 22, 2019. https://www.britannica.com/biography/William-Crawford-Gorgas.
• Faerstein, Eduardo and Warren Winkelstein Jr.. “William Gorgas: Yellow Fever Meets Its Nemesis.” Epidemiology vol. 22, no. 6 (November, 2011): 872. doi: 10.1097/EDE.0b013e31822e18fa.
• Gorgas, William Crawford. Sanitation in Panama. New York: D. Appleton, 1915. https://id.lib.harvard.edu/curiosity/contagion/36-990014454080203941.
• Lechuga, Rita Isabel and Ana Cristina Castro. “Dramatic effects of control measures on deaths from yellow fever in Havana, Cuba, in the early 1900s.” Journal of the Royal Society of Medicine vol. 110, no. 3 (2017): 118-120. DOI: 10.1177/0141076817694583.
• Leonard, Johnathan. “William Gorgas, Soldier of Public Health.” Pan American Journal of Public Health vol. 25, no. 2 (1991): 166-185. http://iris.paho.org/xmlui/bitstream/handle/123456789/27091/ev25n2p166.pdf?sequence=1.
• Le Prince, Joseph A. and A. J. Orenstein. Mosquito control in Panama: the eradication of malaria and yellow fever in Cuba and Panama. New York: G.P. Putnam’s Sons, 1916. https://id.lib.harvard.edu/curiosity/contagion/36-990015792000203941.
• McCarthy, Francis P. “A review of sanitation in Panama.” Boston medical and surgical journal vol. clxiv, no. 2 (January, 1911): 49-53. https://id.lib.harvard.edu/curiosity/contagion/36-990065643300203941.
• “sanitary revolution.” Oxford Reference. . ,. Date of access 22 Feb. 2019, <http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100440898>
• U.S. Congress, Senate, Yellow fever: a compilation of various publications : results of the work of Maj. Walter Reed, Medical Corps, United States Army, and the Yellow Fever Commission. Presented by Robert L. Owen. 61st Cong., no 822. 1911. https://id.lib.harvard.edu/curiosity/contagion/36-990061691590203941.
• Wiggins, Sarah Woolfolk. “William Crawford Gorgas.” Encyclopedia of Alabama. February 26, 2007. http://www.encyclopediaofalabama.org/article/h-1048 (accessed February 13, 2019).