Category Archives: disease

September 11, 2014 · 5:28 pm

The Panama Canal – And Then Came the Americans

Roosevelt visits the Panama Canal under construction, in 1906 (Source: BBC)

Roosevelt visits the Panama Canal under construction, in 1906 (Source: BBC)

Teddy Roosevelt wanted to build a canal through the Isthmus of Panama, and no one was going to stop him. First, we need to remember that before the Americans began the massive engineering project, what we now know as Panama was part of Colombia. When the Colombian government did not agree to the terms desired by the Roosevelt administration, the United States supported a junta-led rebellion that otherwise would have been crushed by the Colombian military.

The United States sent gunboats to both shores and a battleship to Colón, Panama to insure success of the rebellion. The collaboration included a French engineer (and investor in the earlier French project, who stood to gain significantly when the United States compensated the French company for its rights) who immediately after the rebellion negotiated an agreement with Secretary of State John Hay on behalf of the junta. The terms included United States sovereignty over a ten-mile-wide swath of land from the Atlantic to the Pacific. This was not one of those bright, shining moments in United States history.

Once the United States took control of what would become the Panama Canal Zone, the Isthmus Canal Commission, the governing body of the zone, had to conquer the enemy that had ground the French to a halt – the yellow fever- and malaria-carrying mosquitoes.

Timing is everything. In 1880, French Army Surgeon Charles Laveran first discovered parasites in the blood of a patient suffering from malaria. In 1886, 1890, and 1897, Italian scientists made further discoveries about the specific malaria parasites. Also in 1897, British medical officer Ronald Ross demonstrated that malaria parasites could be transmitted from patients to mosquitoes and from bird to bird, and that the parasites could be developed in and spread by mosquitoes.

During the American occupation of Havana after the Spanish-American War, army surgeons developed programs that reduced mosquito breeding, thereby eradicating yellow fever and greatly reducing malaria. In 1904, Colonel W.C. Gorgas applied the lessons of Cuba in a seven-prong program to attack mosquito breeding in tropical Panama: draining pools near villages and homes; cutting brush and grass near villages and homes; using oil to kill mosquito larvae where drainage was not possible; spreading larvacide where oiling was ineffective; dispensing quinine to workers as a prophylactic measure; screening government buildings and living quarters (screening for living quarters was limited largely to quarters for white workers); killing adult mosquitoes found in houses during the daytime.

Just as in Cuba, the program largely eradicated yellow fever and dramatically reduced deaths from malaria. Hospitalizations for malaria decreased from 9.6% of employees in 1905 to 1.6% in 1909.

As I said earlier, timing is everything. Without the discoveries made in the decades preceding the United States’ success in Panama, the Americans may well have met the same fate as their French predecessors.

SOURCES:

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November 27, 2013 · 5:00 am

The Family Tragedies of Lincoln and Davis

Willie Lincoln (1850-1862) Source: wttv.com

Willie Lincoln (1850-1862) Source: wttv.com

The Lincolns lost their eleven-year-old son, Willie, in February 1862, to typhoid fever. Another son, Eddie, had died of an illness two months shy of his fourth birthday in 1850. The President, in the middle of managing the Union war effort, had little time to grieve. Mrs. Lincoln took Willie’s death particularly hard, later seeking to make contact with him in séances. She often cited Willie’s death as a reason her husband should keep their oldest son, Robert, out of the army. However, despite the Lincolns’ efforts, Robert ultimately served on Grant’s staff in the waning months of the war.

Tad Lincoln also died young at the age of 18 (Source: White House Historical Society)

Tad Lincoln also died young at the age of 18 (Source: White House Historical Society)

One hundred air miles to the south, the Confederacy’s executive couple suffered a tragedy of their own in April 1864, when their five-year-old son, Joe, fell to his death from a second-floor balcony. Like his northern counterpart, President Davis had to continue managing the Southern war effort while grieving a son’s tragic death. Mrs. Davis had to deal with her grief while in the seventh month of pregnancy.

Both deaths were tragic. Willie’s, however, was not out of the ordinary in the 1860s.

Take a look at the obituaries in your local newspaper. This morning, my local paper lists 26 deaths (actually 27, but one obituary does not list the decedent’s age). Twenty-one of those are people who reached at least seventy years of age. In contrast, children five years old or younger accounted for fully half of all deaths in mid-nineteenth-century urban America. The leading causes of death for children were diarrheal (cholera, dysentery, typhoid) and respiratory (tuberculosis, influenza, bronchitis, and pneumonia). 1

Contaminated drinking water was the leading culprit. Death rates for children did not decline appreciably until cities improved water supplies and sewer systems. By 1925, childhood deaths accounted for 25% of all deaths in Chicago.

Improvements in medical science have reduced the numbers even further. In 2007, the CDC reported that children under the age of five accounted for 6.6% of all deaths, with children ages one to four accounting for only 0.12% of all deaths. 2

More recent statistics show accidents as responsible for 34% of deaths for American children under the age of five, whereas pneumonia and influenza contribute to only 2% of such deaths, essentially a reversal of their roles in the 1860s. 3

While soldiers identified their enemies by the color of their uniforms 150 years ago, the country’s children were threatened daily by an invisible enemy lurking in their water supply. Among our blessings this Thanksgiving, we can thank the engineers and scientists who have improved the prospects of our children and grandchildren by providing all of us with cleaner water and significant improvements in medical science.

Sources:

1 Ferrie and Troesken, Death and the City: Chicago’s Mortality Transition, 1850-1925, Working Paper 11427, National Bureau of Economic Research, Cambridge, MA (June 2005)

2 CDC, National Vital Statistics System, Mortality, www.cdc.gov/nchs/nvss/mortality

3 Singh, GK. Childhood Mortality in the United States, 1935-2007: Large Racial and Socioeconomic Disparities Have Persisted Over Time, A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, MD. Department of Health and Human Services (2010)

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October 23, 2013 · 2:56 am

Pandemics

Source: New-York Historical Society

Source: New-York Historical Society

Most of us shrug off pandemics as the stuff of movies (Outbreak, starring Dustin Hoffman) or events that occurred long ago and are unlikely to occur in our lifetimes despite what seem like annual panic reports emanating from the media.  One of the most recent events, the Spanish flu epidemic of 1918, killed 20 million people in a worldwide population of 1.8 billion, including the character Lavinia in Downton Abbey and 575,000 Americans in a population of 106 million.Let’s look at one pandemic, the Second Cholera Epidemic of 1830-1851, focusing on the California Gold Rush years.

First, what is cholera? The CDC (Centers for Disease Control and Prevention) defines the disease as “an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholera and is transmitted by contaminated food or water. The infection is often mild or without symptoms, but sometimes it can be severe.” The incubation period is one to five days and the proper treatment is intravenous rehydration.

Source: Wikipedia

Drawing of death wiping out a large crowd with cholera Le Petit Journal. Source: Wikipedia

Before medical professionals understood the science – largely the need for clean water supplies – the infection was rarely “mild.” One could appear perfectly healthy at dawn and be dead by sundown. Cholera, yellow fever, and malaria were the principal reasons fortune hunters from the eastern United States chose to sail around Cape Horn (i.e., the entire continent of South America) or to travel across the continent (before the advent of railroads) rather than take a “short cut” 47 miles across the isthmus of Panama (before the completion of the Panama Company Railroad in 1855).Travelers made the trip in mosquito-infested territory partly by canoe and partly by mules. If all went well, which it seldom did, due to the overwhelming number of travelers, one could make the trip across the isthmus in four to eight days and then pray that a steamship bound for San Francisco was on time and not overbooked. Delays meant increasing chances of infection by mosquitoes or unsanitary food or water. As H.W. Brands (The Age of Gold) and David Lavender (The Great Persuader) graphically illustrate, many fortune hunters who chose the short cut ended their quest in a Panamanian grave. Perhaps being stuck on that tarmac for two hours was not so terrible after all.

But making it to California did not guarantee the good health of the Forty-Niners. Lavender describes an outbreak in Sacramento as follows:

“Cholera, a periodic scourge in the East and Midwest, reached California by ship during the fall of 1850. Sacramento’s first case was a man who dropped writhing on the new levee on October 20. Soon sixty cases were cropping up each day. In a single week 188 of the victims died. By November 9 the toll was said to have reached 600, including seventeen doctors – an estimate, since no one was keeping accurate records. In any event, it was bad enough that four fifths of the city’s terrified populace fled from the town.” (Note: Sacramento’s population in 1850 was approximately 6,800)

– The Great Persuader, p. 38

How would we deal with such a pandemic today? We would like to think cholera has been eradicated, but the CDC reports that worldwide there are an estimated three to five million cases of cholera and roughly one hundred thousand deaths from the disease every year. We can only hope that advances in science and more plentiful resources will make cholera a disease of the past.

Sources

  • H.W. Brands, The Age of Gold. New York, New York. Anchor Books, 2002.
  • David Lavender, The Great Persuader. Garden City, New York. Doubleday & Co., 1970.
  • CDC, Cholera – Vibrio cholera infection. http://www.cdc.gov/cholera/illness.html

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