Over a century now after Dr. William Gorgas wiped Yellow Fever out of Havana and Panama, and by that out of an entire continent, and more than half a century after Fred Lowe Soper led the eradication of Anopheles gambiae out of Northeast Brazil, their names are unknown, their carefully-detailed, boots-on-the-ground methods that they described in detail to leave expressly for generations to study and learn from to apply to malaria - and specifically they both had the desire for the destruction of malaria in Africa on their minds - is unread. The mistakes they warned about, the assumptions that they discovered to be useless and ineffectual in the field against disease-bearing mosquitoes are repeated today, while what Gorgas and Soper found to be effective and efficient in real-life conditions are routinely ignored or unknown, avoidable errors blithely doomed to be repeated thanks to modern ignorance of their incredibly important and transformative historical successes in public health. In the battles against malaria, to be ignorant of Gorgas’ and Soper's work in eradicating the mosquito that carries it is to be hobbled by the lack of hard-earned field knowledge, practical and effective discoveries that remain completely relevant and critical to success in eradicating malaria today.
Eradication represents a complete change of philosophy and a recognition of the equal rights of all citizens to protection from infection, no matter where they live. Eradication, by its very nature, is public health with a conscience. The public health control officer can sleep tranquilly, salving his conscience with the thought that most of his responsibility has been discharged – that he did not have enough money to do any more. The eradicator knows that his success is not measured by what has been accomplished but, rather, is the extent of his failure indicated by what remains to be done. He must stamp out the last embers of infection in his jurisdiction. His slogan must be: ANY IS TOO MANY.
My dear Gorgas,Instead of being simply satisfied to make friends and draw your pay, it is worth doing your duty, to the best of your ability, for duty’s sake; and in doing this, while the indolent sleep, you may accomplish something that will be of real value to humanity. Your good friend, ReedDr. Walter Reed encouraging Dr. William Gorgas who went on to make history eradicating Yellow Fever in Havana, 1902 and Panama, 1906, liberating the entire North American continent from centuries of Yellow Fever epidemics.
Fortunately for the cause of science and of humanity, we had as Governor-General of Cuba at that time General Leonard Wood, of the United States Army. General Wood had been educated as a physician, and had a very proper idea of the great advantages which would accrue to the world if we could establish the fact that yellow fever was conveyed by the mosquito, and his medical training made him a very competent judge as to the steps necessary to establish such fact. General Wood during the whole course of the investigations took the greatest interest in the experiments, and assisted the Board in every way he could.
Amateurs are fond of advising that all practical measures should be postponed pending carrying out detailed researches upon the habits of anophelines, the parasite rate of localities, the effect of minor works, and so on. In my opinion, this is a fundamental mistake. It implies the sacrifice of life and health on a large scale while researches which may have little real value and which may be continued indefinitely are being attempted… In practical life we observe that the best practical discoveries are obtained during the execution of practical work and that long academic discussions are apt to lead to nothing but academic profit. Action and investigation together do more than either of these alone.
But such is the nature of man that as soon as you begin to force him to do a thing, from that moment he begins to seek ways by which he can avoid doing the thing you are trying to force upon him. A man with malaria parasites in his blood is a danger to his companions. To kill all the parasites, he was then required to continue doses of quinine a week or ten days after his fever. When the convalescing men were given their daily dose of quinine they would manage to throw their tablets out of the dispensary window. The old turkey-gobbler pet of the hospital gobbled up all the tablets he could find. He became so dissipated he finally developed a species of blindness caused by too much quinine. I cannot vouch for this, but I was often twitted with this story as an illustration of how the men were treating prophylactic quinine.
It is almost impossible for contemporaries to judge the true value of discoveries, or to give the proper position to the men of their own time who make these discoveries. The Surgeon-General of the Public Health Service expected the greatest results to flow from his commission of medical officers, but the conclusions of the Board turned out to be all wrong, while he did not notice the report from his own subordinate, Dr. H. R. Carter, which turned out to be pure gold and was one of the great steps in establishing the true method of the transmission of Yellow Fever.
Will Brazilian antigambiae measures succeed in Africa? As time goes by it will almost certainly be found that an increasing number of areas can be cleaned of gambiae and be freed of gambiae-transmitted malaria. In Africa, where the species is already widely disseminated, it would seem logical to attempt eradication by beginning in the center of the area to be cleaned and working always outward. It has been demonstrated in Brazil that species eradication of Aedes aegypti and Anopheles gambiae is feasible.
The case which I reported on September 26, 1901, was really the last which occurred in Havana. Of course we did not know it at the time, but this case marked the first conquest of yellow fever in an endemic center; the first application of the mosquito theory to practical sanitary work in any disease.
The entire world has benefited and prospered since the decisive defeat of Yellow Fever, an unconventional and far-reaching military victory derived from the field medical discoveries of U.S. Army Major Dr. Walter Reed, designed and carried out by U.S. Army Major Dr. William Gorgas with the overall support under the command of U.S. Army General Leonard Wood.