The Fever: How Malaria Has Ruled Humankind for 500,000 Years (28 page)

Attacking Panama’s resilient mosquito vectors would be a much bigger job than the assault on the yellow fever mosquito,
Aedes aegypti
, in Havana had been.
Aedes aegypti
lay its eggs exclusively in artificial containers of water found around human dwellings, making the species a pitifully soft target. In Panama, malaria burrowed as deeply into the isthmus’s ecology as the spooky mangroves, whose roots rendered miles of Panama’s swamps and shorelines impenetrable.
Anopheles albimanus
, which transmitted most of Panama’s malaria, lay its eggs in fresh or salty water, in sunny puddles or lagoons, and fed on the blood of man or animal (although it particularly fancied horses), either indoors or out. No single point of attack could deter it for long. And like any creature well embedded in an ecosystem,
Plasmodium
enjoyed other alliances: the indiscriminate biters
Anopheles albitarsis
and
Anopheles punctimacula
, the saltwater
Anopheles aquasalis
, and the jungle mosquito
Anopheles darlingii
all ferried it into new bloodstreams when
A. albimanus
could not.
³³

Gorgas and his team set up shop in one of the French-built hospitals still languishing on the isthmus. Mosquitoes hatched from the potted plants in the hospital’s elaborate gardens and sailed into the wards through unscreened windows to feed on the patients and their caretakers. Their tiny bodies covered the walls and doors of the hospital, each panel speckled with more than fifty at a time. After the sun went down, the staff could tend to patients only if a colleague stood beside them furiously fanning the mosquitoes away, while the
night-duty nurses wilted, mummified in citronella-soaked bandages. Locals avoided the malarious hospital as much as possible.
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Gorgas immediately cabled Washington with a list of supplies. He requested great volumes of insecticidal pyrethrum and sulphur for fumigating, two tons of newspaper to seal the buildings from mosquitoes, masses of wire screening, a slew of workers, including at least twenty inspectors and one hundred trained nurses, plus start-up funds for a research lab.
³⁵

At first it seemed to Gorgas’s team that their list of supplies must have glued itself to some “invisible spot” in Washington. They waited (“with the patience of angels,” as LePrince put it). Finally, responses from Washington trickled in. Why was Gorgas sending so many costly cables? the officials in D.C. asked. He should use the mails instead. Wire screening and a research lab were out of the question, they informed him. As were the giant quantities of materials and labor. He’d get a quarter of the required volume of pyrethrum and sulphur, along with eight of the requested twenty inspectors and forty of the requested one hundred nurses. If he needed more workers, he’d have to “get a few niggers,” they told him. Washington certainly wouldn’t be sending any newspaper, either. In that case, they’d misunderstood Gorgas’s meaning; they’d thought the good doctor wanted reading material.
³⁶

Dressed down, Gorgas dolefully made his rounds throughout Panama, watching the mosquitoes hatch and getting an earful of scorn from the engineers as he did. With his paltry supplies, Gorgas’s staff focused on oiling puddles to smother mosquito larvae and fumigating the few buildings they could—in other words, making dirty puddles dirtier and stinky buildings stinkier. The canal commissioners were not impressed. “It’s silly to spend all this money just to kill a few mosquitoes,” one said.
³⁷
“A dollar spent on sanitation is like throwing it into the bay,” another added.
³⁸
“On the mosquito you are simply wild,” another said. “All who agree with you are wild. Get the idea out of your head.”
³⁹

Gorgas’s assault on Panama’s mosquitoes began in earnest only after yellow fever broke out. Three quarters of all the Americans on the isthmus, including the chief engineer, fled. “A white man’s a fool to go there,” one refugee said, “and a bigger fool to stay.” The Canal Commission members who traveled back and forth from Panama to the United States took to bringing their ornate coffins in tow, just in case.
⁴⁰

Alarmed, Roosevelt showered Gorgas with resources to do something about the mosquitoes.
⁴¹
(The canal commissioners and William Howard Taft, Roosevelt’s secretary of war, still were not convinced; Taft complained that Gorgas had “no executive ability at all.”) Soon Gorgas commanded a staff of 4,100 workers, a budget of $250,000, and the entire U.S. supply of sulphur, pyrethrum, and kerosene oil.
⁴²

The chosen few for his campaign would be the canal officials and those workers who lived within a narrow swath around the canal, called the Canal Zone. There, and in the parts of Panama City where canal officials lived and worked, Gorgas oiled puddles, fumigated buildings, screened houses, and drained swamps. He ensured that window and door screens remained in good condition, and assigned workers to stalk and smash adult mosquitoes by hand. He hired workers to manufacture a special pink soft drink loaded with quinine and serve it in the workers’ mess halls, and still others to run dispensaries distributing free quinine. He wielded the authority to ban the keeping of cattle (which left puddle-forming hoofprints in the mud), to punish anyone caught harboring unsealed containers (which could fill with larvae-attracting rainwater), and to line workers up for quinine doses. It was a blitzkrieg.
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Beyond those circumscribed areas, malaria was allowed to feast unhindered. Despite their proximity to the Canal Zone, parasitized locals were considered outside Gorgas’s purview. A series of malaria surveys in the 1930s, for example, found that more than 60 percent of villagers in towns within the canal’s province, such as Portobelo and Nombre de Diós, carried malaria parasites. In other provinces,
malaria rates among children ranged between 30 and 50 percent. In Darién, up to 70 percent were infected. “In a large part of this country the incidence of disease is probably as high as it ever was,” wrote American military physician James Stevens Simmons in 1939. The Canal Zone was an oasis in the desert, “practically surrounded” by a “great prevalence of malaria.”
⁴⁴

The anti-mosquito campaign excluded many canal workers, too, in part because they were the dark-skinned descendants of African slaves and thus relegated to second-class status. With few European or American workers willing to toil on the canal for a dollar a day, five sevenths of the canal work force hailed from the Caribbean, with forty-five thousand workers from Barbados alone.
⁴⁵
The Canal Commission’s explicit policy was to assign workers who were “undoubtedly black” or mixed race to “silver roll” status, and a much smaller group of white workers to “gold roll” status. While gold roll status entitled workers to plump paychecks, well-screened and fumigated cottages, clubhouses, and hotels and churches run by canal authorities, the silver roll workers got crammed into barracks, thirty of them to a five-hundred-cubic-foot interior,
⁴⁶
sent to segregated hospitals, and barred from white facilities.
⁴⁷

Many fled the cramped barracks to take their chances outside well-heeled Panama City and the Canal Zone, hacking into mosquito-ridden jungles and swamps.
⁴⁸
Photographs of their rough-hewn shacks show how vulnerable they would have been to insects during the prime biting hours, regardless of how mosquito-free the environments of their working hours might have been.

Gorgas himself encouraged black workers to abandon the Canal Zone and take shelter in the jungle, where none of his anti-mosquito methods could possibly benefit them.
⁴⁹
In part, he thought that this would protect them from pneumonia, to which they seemed especially vulnerable. He also held, like many Southerners of his time, that black people shared a special biology that inured them to malaria and yellow fever. “The negroes seemed to resist the dangers of infection,” he noted in a 1907 speech.
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In fact, just the opposite may have been true, for the tens of thousands of workers from Barbados, for example, would have had no immunity at all. Malaria was unknown on the island, so much so that for centuries Barbados was considered an antimalarial sanatorium.
⁵¹
It was canal workers from Panama who infected the island with malaria, triggering epidemics such as one in 1927, which took nearly two hundred lives.
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Nobody recorded the black canal workers’ mortality and morbidity from malaria and other causes. Many of them simply left the isthmus, with daily steamers full of fleeing Caribbean workers departing with
Plasmodium
parasites in lieu of paychecks.
⁵³
Labor historians such as Michael Conniff estimate that one out of ten black canal workers perished of disease and disfigurement,
⁵⁴
a death rate four times that of the white workers whom they outnumbered by three to one.
⁵⁵

Unlike the unapologetically exclusionary Brits, however, populist Americans could not bring themselves to acknowledge Gorgas’s de facto antimalarial segregation. Commentators dismissed the very notion of sickness among black canal workers. A
New York Times
reporter, for example, derided black canal workers seeking medical care as “lazy Negroes who are tired of working on the canal” trying to “look crazy enough to pass the examination before the hospital surgeon.”
⁵⁶
Visiting journalists and dignitaries scrunched up their noses at the workers’ ramshackle settlements. “These people are of no more use than mosquitoes and buzzards,” a member of a congressional committee remarked. “They ought all to be exterminated together.” Whatever sickness they may have suffered stemmed from their own bad habits, Roosevelt opined. “A resolute effort should be made to teach the Negro some of the principles of personal hygiene,” the president remarked.
⁵⁷
Gorgas claimed to have tried. But “on the negroes,” he explained, “we have difficulty in impressing the necessity of cleanliness.”
⁵⁸

Fans exaggerated the extent of Gorgas’s limited and expensive gains against the parasite. There was “nothing to match it in the history of human achievement,” said influential physician William Osler, of Gorgas’s work in Panama. “The whole world owes him a debt,” said the
London Daily Mail
.
⁵⁹
The Liverpool School of Tropical Medicine awarded Gorgas the Mary Kingsley Medal. The American Medical Association elected him its president. The University of Alabama also invited him to be its president, as did the University of the South. In 1914, he was appointed surgeon general of the U.S. Army.
⁶⁰
A century later, Gorgas is still remembered as the “man who cleansed the Panama Canal of malaria,” as
The New Yorker
’s Malcolm Gladwell wrote in 2001.
⁶¹

Gorgas himself knew the limits of his achievement. “We did not get rid of malaria on the Isthmus of Panama, as we did at Havana,” he admitted to a reporter. Rather, he’d shown simply that “the white man could flourish in the tropics.”
⁶²
And even there, to be fair, Gorgas could not claim full credit. During the building of the canal, level roads were laid and water and sewer systems established throughout the zone, as required by the terms of the treaty between the United States and Panama. Mosquito-infested puddles and rainwater containers diminished accordingly.
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Acknowledged or not, the Americans’ selective antimalarial approach continued for years after the canal opened in 1914, even in Gorgas’s home state of Alabama. Malaria in the U.S. South spiked in the first decades of the twentieth century, in the wake of a booming hydropower industry, which dammed dozens of wild rivers across the region, creating vast artificial lakes. Newly developed high-tension transmission lines meant that the rivers’ pent-up power could be carried over vast distances to urban markets. But in many places, the dams worsened malaria. As the rivers disappeared, so did the little forest mosquitoes that lived in their shady running waters, such as
Anopheles punctipennis
, which hardly ever carried malaria. The
resulting lakes were often clogged with branches, logs, and other debris, creating an unsightly mess rife with food and shelter for
Anopheles quadrimaculatus
, the region’s most efficient malaria vector. Malaria parasites from all over the country arrived in the bodies of workers hired to build the dams.
⁶⁴

Hydropower companies didn’t bother clearing the land before they flooded it, in part because reservoir clearing was expensive. Removing all the trees, rock, and brush along the sides of a river such as northern Alabama’s Coosa, for example, could run to $60,000.
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As a result, when Alabama Power Company closed the dam it had built over the Coosa in 1914, acres of benign
A. punctipennis
habitat turned into malevolent
A. quadrimaculatus
territory, and malaria followed soon afterward. The year before the dam closed, there’d been twenty-five cases of malaria in the area. After, at least six hundred residents fell ill.
⁶⁶
The local school closed down, the teacher so sick with fever he couldn’t rouse himself out of bed. Fields of mature cotton lay unpicked, as sick and frightened sharecroppers fled their homes. “A poor man don’t stand no more chance than a June bug in January,” remembered sharecropper Willie Bass.
⁶⁷
Even at the construction camp built by the power company, where employees enjoyed screened houses, sewage services, and regular medical attention, nearly every family sickened with malaria.
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