8
TIIE SUNDAY OREGONIAJT, PORTLAND, DECE3IBER 31, 1923
Only One of the Vividly Human and Romantic Experiences in the Life
of General Carter, Who Helped Push Yellow Fever Off the Earth
"w MM a-if' l. j
-S Jilt , . - t
To the horror of the Panamanians,
Dr. Carter's daughter would sit on the
$teps of the contagions disease hos
pital and wait for him.
BT MATMH OBEB PEAK.
IB DI0GENE9 were looking for the
most modest man he would find Mm,
after considerable search, In an old
CasMoned frame house In Washington,
tacked behind a fashionable apartment
on one of the capital's famous avenues.
He would find a strong link between the
old-fashioned frame house with Its
rambler rose over the porch, and the
fashionable apartment hotel with Us
canopied porte cochere.
In a top suite of the apartment hotel
the widow of Surgeon General Oorgas has
been living for two years in quiet se
clusion writing the biography of her hus
iband and his eminent work, while in the
Jrame house up the hill, Dr. Henry Rose
Carter, assistant surgeon general-at-large
of the United States public health service
end Gorgas, devoted friend and collabo
rator, is writing the history of yellow
fever, which will take him perhaps two
years to complete.
To get General Cartel' or Dr. Carter,
as he prefers to be called to talk about
fiimself and his distinguished honors Is
'as impossible as to walk through a thick
vail. To get him to talk malaria or yel-
low fever Is to yault the wall In two
Jumps.
For an Informative sketch of his unique
experience in hospital, quarantine and
epidemic work In the United States,
Cuba, the canal zone, Russia, South Amer
ica the writer was forced to refer to
medical Journals. Often spoken of by
General Gorgas as "one of the great pio
neers in malaria and yellow fever work,"
end now considered with Juan Guiteras
one of the two ranking living authorities
the subject of yellow fever, Dr. Carter
Is as distinguished as he Is modest. He
will go down In history with America's
great peace heroes.
His work on "The Determination, of
the Period of Extrinsic Incubation of Yel
low Fever" placed him among such im
mortal physicians as Fin lay, Lazear, Reed
end Carrel, who demonstrated the mos
quito transmission of yellow fever upon
which was based Gorgas' work in freeing
Cuba from the disease for the first time
in a century, which has resulted in prac
tically driving the scourge from the face
of the earth.
During the war this eminent sanitarian
was in charge of the control of malaria
In the extra-cantonment areas rof the
camps and in the regions around the big
industrial plants engaged in the produc
tion of war material. In 1920 he served
as sanitary adviser to the Peruvian gov
ernment, and'at present is a member of
the yellow fever council of the interna
tional health board of the Rockefeller
foundation.
Briefly summarizing the most notable
of his achievements, I quote from the
Southern Medical Journal of June, 1915,
which gives them, as follows:
First The determination of the pe
riod of extrinsic incubation of yellow
. fever.
Second The institution of a rational
relation between the disinfection of ves
- sels and the detention of their personnel,
permitting the fixing of minimum periods
, of detention in quarantine.
Third The encouragement of . uni
formity in quarantine practice, resulting
in the adoption of a system of federal
Quarantine regulations.
Fourth The transfer of the Bruns
wick, Ga., quarantine station to the fed
4i fiovernmen .the first state or mu-
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Dr. Henry Rose Carter, assistant surgeon-general at large of the United States
public health service, and the hero of many campaigns against
contagious disease. ,
nicipal quarantine to be thus sur
rendered. Fifth The control of numerous yel
low fever epidemics in the southern
states, and especially that of McHenry,
Miss., which was the first epidemic of
yellow fever to be suppressed in the
south in the summer time.
Sixth The inauguration of the quar-
antine systems of Cuba and the canal
zone.
Seventh The enunciation of princi
ples relating to; the bearing of impound
ing reservoirs on malaria incidence.
For the conspicuous service rendered
in the construction of the Panama canal,
congress created for Dr. Carter the posi
tion of assistant surgeon general-at-large
of the United States publio health serv
ice, thus breaking all precedents in
recognizing the work of a member of
that service-
Since many people hold that publio
health is a problem for engineers rather
than doctors, Dr. Carter's accomplish
ment as a scientific worker in sanitation
Is probably largely due to the fact that
he is both an engineer and a doctor.
Member of the well-known "Cawtah"
family of Virginia, he was graduated
from the University of Virginia in 1873
as an engineer. A few years later he
graduated in medicine at the University
of Maryland and, in 1879, entered the
marine hospital service. In the fall of
that year he saw his first case of yellow
fever, being ordered to Ship Island quar
antine station In the Gulf of Mexico.
To this federal refuge station came all
vessels infected or thought to be infected.
Many of them were sailing vessels from
Rio, Santos, Havana and Colon, which at
that time were especially dangerous. Op
portunity was afforded him not only to
study f. disease of far-reaching public
health and economic importance, but to
prevent Its entrance Into the country.
Here on this lonely island, cut off from
communication with' the outside world
except by boat call, Dr. Carter, with a
young family growing up around him,
began the study of yellow fever and laid
the foundation of his great work for Its
control and prevention.
It was a far cry from Ship Island to
Panama, where Dr. Carter was detailed
for duty in 1904 and where he organized
the quarantine service and later served
as director of hospitals and chairman of
the board of diagnosis. He remained with
the Panama canal commission five years,
and was connected with much of the or
ganization and early work on the
Isthmus.
Reminiscing on his Panama experiences,
the writer caught the general one night
in a mellow mood. It was immediately
after dinner, his cigar was lighted, and
the low card table on which he does his
work was temporarily empty and pushed
back from its accustomed place in the
middle of the room.
"We were Just three old odgers," he
said, resting his cane against the fire
place and lifting his glance to the finely
chiseled features of "the chief" General
Gorgas, framed on the wall, "when we
went down to Panama to clean up yellow
fever, Gorgas, then colonel, came to me
when he was appointed chief sanitary of
ficer of the canal and asked me to go
along. He said that Surgeon LaPrince,
who had done the mosquito work with
us In Havana, had promised to go if I
would, and that as it would probably be
the last work we old codgers would do,
he thought we ought to go.
"I agreed with him, and we set forth
on the adventure in high spirit Rear
Admiral John Ross, of the navy, who had
had experience with yellow fever on the
ships, joined us. We reached Panama
in extremely hot weather, in June. It
rained four times a day. When it stopped
raining, and the sun would come out, it
was like opening the door of a furnace.
"We were assigned quarters in an old
French building in Ancon. Gorgas, La
Prince and I shared the same room, the
same bureau. Gorga3 had the top draw
er, I had the middle, LaPrince the bot
tom. If any guests came, they put their
things on the floor. We hung our top
clothes on the wall, covering them with
a gorgeous flowered curtain purchased
from a Chinaman in Panama.
"The private bath was my trunk,
turned upside down, with bowl and
pitcher on top. The washstand proper
had to be used for a desk. We slept on
cots and had pillows that you blow up.
Everybody had to turn in at the same
time at night. There were no lamps
then and, as I was the only one who had
thought to bring candles, they had to be
made to go a long way. For each of the
" tour sleeping rooms, occupied by 15 oth
er officers and employes, the nightly al
lotment was a fourth of a candle. No
man dared to go to bed without first
killing all the mosquitos in his net
period.
"Galleries ran all around the building,
upstairs and down. We bought all the
wire netting we could find in Panama
and screened off a small portion of the
upper gallery, dubbing it 'the cage.' Here
. we sat after dinner, talking shop and en
joying the soft, cool breezes and the
lovely view. We looked over the royal
palms and flat plains of the sabanas,
One of the nurses
across the harbor with its twinkling
lights, Into the city of Panama. Behind
us, rising almost perpendicularly, we
could see the green wall of Ancon, so
densely wooded that it was a favorite
haunt of the 'tigers,' who could be heard
crying far Into the night and who made
frequent descents upon our storehouse.
"For the Americans, the food and the
lack of Ice were the greatest hardships.
"The first thing we had to do before
starting to work was to find out what
sanitary laws or regulations there were
to work under. General Davis, gover
nor of the isthmus, informed us that
President Roosevelt did not want any
work done on the canal until the sani
tary men had their say, but that the
commission had adjourned without mak
ing any legislation to go by.
"When we asked what laws had al
ready, been enacted, he said: "Nothing
but the old Colombian laws, and you can
imagine what they are.'
"I, suspected that they were pretty
good laws, ' but that where they had
failed was in execution. We went to see
President Amador. He spoke almost no
English and we spoke little Spanish, but
fortunately no two of us had the same
vocabulary, so among us we managed to
piece out enough conversation to make
ourselves understood. We had to have
the help and authority of the Panama
president in order to proceed, as only
the canal zone was under the United
States, the cities being exempted.
"We asked it he would sign a decree
first to prevent the introduction of yel
low fever and bubonic plague, and, sec
ond, for control and elimination if found
in the cities. He said he would sign it
it we would write out the decree 'in
terms.' Because it was very annoying
to sign a decree Monday, explain It Tues
day, write an amendment to it on
Wednesday and have , to repeal it on
Thursday or Friday.
"That night we wrote out two decrees,
one for President Amador, in which we
asked for Gorgas' appointment as chief
sanitary officer, with, authority to take
, such measures as were necessary to pre
vent the introduction of communicable
diseases, for the control and elimination
of such if found In the cities. ' In the
ether decree, for Governor Davis, we took
pains to state that he would give to
Gorgas all such authority as he possessed
for this purpose in the canal zone.
"Amador signed his decree in due time.
but Davis demurred, stating that he
didn't know what authority he had to
give. We told him we didn't either, but
that he had offered to help us In any way
he could and this was asking him to do
that very thing. He demurred again,
saying he feared we'd get him into trou
ble. It wasn't exactly like buying a pig
In a poke, but selling one. We told him
that he could only give us what author
ity he had under the law and that If we
went without it, it would not be his
lookout, but ours1. He agreed and signed
the decree. But Davis didn't believe in
the theory of mosquito transmission of
yellow fever. And while he didn't do
anything to hinder us, he didn't do any
thing to help. Combined with the natural
disadvantages, we had much opposition
at first on our own side to meet.
"With great difficulty, we succeeded
In translating into English as much of
the sanitary coda of the Colombian laws
as was necessary for our purpose. The
laws were In folios, in pamphlet form,
running back 15 years. We found, as I
expected, that they were extremely good
laws far more efficient than we have in
the states, because the Spanish haven't
any idea of what we call 'personal lib
erty.' The only trouble was that the
laws had been enacted, printed and then
filed away and forgotten.
"After getting the necessary legal au
thority, the next difficulty was to get the
necessary sanitary supplies. We had per
sonally seen to it that the tons of sulphur,
acids, alcohol and sulphur pots purchased
were carried to the New York wharf of
the Panama Steamship company and put
on the same ship with us only to find it
tied up on arrival in red tape that took
us months to unwind. LaPrince billed
his consignment to the Isthmian commis
sion; I billed mine to myself at La Boca.
He got his by the requisition route in
the spring. I got mine by cart as I could
personally haul it away.
"In the beginning we paid too much
contracted yellow fever.
attention to isolating the patient. Hav
ing proved the responsibility of the
Stegomyia f asciata for the carriage of
yellow fever, we knew that there is no
danger from close contact with the pa
tient even from sleeping in the same
bed with him. The only danger is from
the mosquitoes that have bitten him.
"Another thing we have proved is that
mosquitoes do not breed in swamps, mud
puddles or street gutters unless they are
lined with something and have no mud
sides. We have formulated that they do
not breed in any collection of water the
sides of which at the water's edge are of
mud. They do breed in collections of
water in artificial containers and in simi
lar things such as cisterns, tin pans,
water put out for the chickens to drink,
saucers under the legs of tables to keep
the ants off, and so on.
"In Panama, the Stegomyia bred in
Just these things. There was no water
supply. Everybody stored water in their
houses in artificial containers. They
saved rain water or bought from the
aguadoras carriers who obtained water
from the wells and peddled it on the
backs of mules through the streets.
"A dlshpan came very near causing the
death of the personnel of a battleship. I
was called out of bed one night by an
orderly from the Boston, then In harbor,
stating that the captain wanted me to
come out in the morning to see some sick
men aboard. Questioning him, the symp
toms sounded so suspicious that I de
cided not to wait till morning, but re
turned with him In the launch to the
ship.
"I found six men ill four with yellow
fever, the ship's doctor, two lieutenants
and the mess steward. When the captain
appeared protesting at my unnecessary
hurry, I informed him that we hadn't
been quick enough; that one man would
die before morning, two were too ill to
be moved, and two more would die if they
were not taken to the hospital at once.
"The doctor died that night, moaning
to the last: 'I ought to have known; I
ought to have known!' Another man
died, but we saved the others and the
whole ship from infection. On searching
the ship, I found outside the cook's quar
ters a dispan of water that was almost a
soup of wlggletales of Stegomyia. On
New Year's night we had been Invited to
a sing-song on board the ship. Evidently
there had been a walking case of yellow
fever among the numerous guests. The
Stegomyia that had bitten him were '
breeding death for the whole ship in a
dishpan!
"It was difficult for the natives to get
used to our treatment of yellow fever.
Though immune themselves, having had
yellow fever when they were children,
they remembered the toll it had exacted
from the French and were terrified at
'the risks' the Americans took. When
Mrs. Gorgas and my family joined us, six
months after arriving on the Isthmus, we
shared quarters .on the second floor of
an old French building formerly used as
a hospital for the officers of the French
Canal company. Under us was the of
ficers' mess, 'where we all ate together,
and under that was the chapel where we
had the yellow fever funerals.
"Diagonally across the road was the
yellow fever hospital, the doors and win
dows always open. While the windows
had no glass and the doors only shutters,
they were both thickly screened. There
were double screen doors at the entrance,
with a smudge fire burning between, and
an orderly constantly on duty to keep
them going and to brush off the clothes
of the doctors and nurses as they went ia
and out Also the yellow fever patients
were in mosquito proof cages, so that It
was really Impossible for Stegomyia to
get In and become infected by them. But,
to the horror of the Panamanians, my
daughter would sit on the steps of the
hospital and wait tor me whenever she
felt inclined. 'You must wish her to
become an angel,' they protested.
"When an official died with yellow
fever, there was a general panic. It an
Italian laborer died, no notice was taken
of it, though there was as much danger
from one as the other. Those who were
'case-hardened or educated up to the
mosquito theory of course could joke
about it. I remember when the isthmian
canal commission came to Panama or
rather six of them, the seventh member
being in Paris at the time one of the
commissioners noticed six metallio cof
fins that had been unloaded from the
ship and laid out on the dock.
" 'Why the six metallio cofflnsr he
asked of an official.
" 'Well, you know Mr. Parsons dldnt
come,' was the quick reply.
"The commissioner slept on board that
night, and every other night while in
Panama."
"Just what are the symptoms of yel
low fever?" I queried, curious to know.
"Similar to the first stages of acute
alcoholism red, flushed face, swollen
Hps, vomiting, headache. As the tem
perature rises, the pulse falls away from
It. If the pulse rises and crosses the tem
perature, as you will see by this chart,
then It is le noeud fatal the fatal knot,
as the French say."
"What is the treatment'
"It rests upon a tripod absolute rest
in bed; complete starvation for a rea
sonable time, and as much water as
patient can be made to take without
vomiting."
"Are there any ill effects?"
"None whatever. Yellow fever has no
sequence. The poison passes rapidly
through the system, either killing you In
five or seven days or leaving entirely.
There is little suffering connected with
it. The victim lies in a coma or stupor,
and Is very, very weak."
"Did you ever have It?"
"Yes, in the summer of 1897, follow
ing our campaign In the fever infected
districts of Louisiana and Mississippi. I
knew I had it and spent the first day
winding up official matters. For days
after I entered the hospital at New Or
leans I was so weak that only when the
thirst became more than I could bear
would I expend enough strength to lift
my thumb, to which a bell was tied, to
call the nurse. I figured it out that
while, water was a word of two syllable,
it required less effort to say 'drink' and
this was the one mental effort I made
and the one word I uttered.
"During the Panama campaign, I Jolly
well sympathized with one of the patients
who had black water fever. He insisted
upon going home before he was well
enough. 'Don't you know you are a
mighty weak man?' the colonel reminded
him. 'That's Just it,' he replied; let me
go home and get a little strength, and
then I'll come back and you can doctor
me all you want' "
"Did any of the nurses or doctors con
tract yellow fever in Panama?"
"Only one a nurse. She didn't get
It from the patients, but went downtown
strictly against orders for non-Im-munes
and contracted it there. She
had an unusually bad case. I had been
away for a few days and when I got back
was hustled in a cab to the nurses' quar
ters at Anconcita. I found her tossing
from one side of the bed to the other;
neither morphia nor cocaine quieted her.
Finally, I said to her: "Now, child, you've
got a fine constitution and you ought to
get well. But if you don't lie still in
that bed, you're going to die.'
"She insisted that she couldn't keep
still but suggested that it Major
(calling the name of one of the younger
doctors on duty) would hold her hand,
x she would try. I gave Major a
call, and stationed him at his post She
quieted down immediately, and the major
sat by her all night The girl got well,
and it wasn't many years after that when
I got cards to their wedding."
"So there's romance even in yellow
fever," I laughed.
A year from the time the sanitary de
partment got to work, Panama was free
from yellow fever. The last case oc
curred In Colon, in December, 1905. The
following January the isthmus was e-lven
a clean bill of health, and the construc
tion of the Panama canal was made pos
sible. Without the spirit of "the chief"
and the comradely work of "the three
old codgers", for the prevention of the
baffling scourge of the tropics, this
greatest engineering feat of the agea.
might never have been completed,