the evolution of modern medicine-第34章

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　due　to　the　great　increase　of　this　disease。　Its　clinical　manifestations　were　well　known　and　admirably　described　by　the　older　writers。　　In　the　seventeenth　century；　as　I　have　already　told　you；　the　remarkable　discovery　was　made　that　the　bark　of　the　cinchona　tree　was　a　specific。　Between　the　date　of　the　Countess's　recovery　in　Lima　and　the　year　1880　a　colossal　literature　on　the　disease　had　accumulated。　Literally　thousands　of　workers　had　studied　the　various　aspects　of　its　many　problems；　the　literature　of　this　country；　particularly　of　the　Southern　States；　in　the　first　half　of　the　last　century　may　be　said　to　be　predominantly　malarial。　Ordinary　observation　carried　on　for　long　centuries　had　done　as　much　as　was　possible。　　In　1880；　a　young　French　army　surgeon；　Laveran　by　name；　working　in　Algiers；　found　in　the　microscopic　examination　of　the　blood　that　there　were　little　bodies　in　the　red　blood　corpuscles；　amoeboid　in　character；　which　he　believed　to　be　the　germs　of　the　disease。　　Very　little　attention　at　first　was　paid　to　his　work；　and　it　is　not　surprising。　It　was　the　old　story　of　〃Wolf；　wolf〃；　there　had　been　so　many　supposed　〃germs〃　that　the　profession　had　become　suspicious。　Several　years　elapsed　before　Surgeon…General　Sternberg　called　the　attention　of　the　English…speaking　world　to　Laveran's　work：　it　was　taken　up　actively　in　Italy；　and　in　America　by　Councilman；　Abbott　and　by　others　among　us　in　Baltimore。　　The　result　of　these　widespread　observations　was　the　confirmation　in　every　respect　of　Laveran's　discovery　of　the　association　with　malaria　of　a　protozoan　parasite。　This　was　step　number　three。　　Clinical　observation；　empirical　discovery　of　the　cure；　determination　of　the　presence　of　a　parasite。　Two　other　steps　followed　rapidly。　　Another　army　surgeon；　Ronald　Ross；　working　in　India；　influenced　by　the　work　of　Manson；　proved　that　the　disease　was　transmitted　by　certain　varieties　of　mosquitoes。　Experiments　came　in　to　support　the　studies　in　etiology；　two　of　those　may　be　quoted。　　Mosquitoes　which　had　bitten　malarial　patients　in　Italy　were　sent　to　London　and　there　allowed　to　bite　Mr。　Manson；　son　of　Dr。　Manson。　　This　gentleman　had　not　lived　out　of　England；　where　there　is　now　no　acute　malaria。　He　had　been　a　perfectly　healthy；　strong　man。　　In　a　few　days　following　the　bites　of　the　infected　mosquitoes；　he　had　a　typical　attack　of　malarial　fever。

＇3＇　Journal　Linnaean　Society；　London；　1879；　XIV；　304…311。

＇4＇　Medical　News；　Philadelphia；　1889；　LV；　689…693；　and　monograph　with　Kilborne；　Washington；　1893。


The　other　experiment；　though　of　a　different　character；　is　quite　as　convincing。　In　certain　regions　about　Rome；　in　the　Campania；　malaria　is　so　prevalent　that；　in　the　autumn；　almost　everyone　in　the　district　is　attacked；　particularly　if　he　is　a　newcomer。　　Dr。　Sambon　and　a　friend　lived　in　this　district　from　June　1　to　September　1；　1900。　The　test　was　whether　they　could　live　in　this　exceedingly　dangerous　climate　for　the　three　months　without　catching　malaria；　if　they　used　stringent　precautions　against　the　bites　of　mosquitoes。　For　this　purpose　the　hut　in　which　they　lived　was　thoroughly　wired；　and　they　slept　under　netting。　　Both　of　these　gentlemen；　at　the　end　of　the　period；　had　escaped　the　disease。

Then　came　the　fifth　and　final　triumphthe　prevention　of　the　disease。　The　anti…malarial　crusade　which　has　been　preached　by　Sir　Ronald　Ross　and　has　been　carried　out　successfully　on　a　wholesale　scale　in　Italy　and　in　parts　of　India　and　Africa；　has　reduced　enormously　the　incidence　of　the　disease。　　Professor　Celli　of　Rome；　in　his　lecture　room；　has　an　interesting　chart　which　shows　the　reduction　in　the　mortality　from　malaria　in　Italy　since　the　preventive　measures　have　been　adoptedthe　deaths　have　fallen　from　above　28；000　in　1888　to　below　2000　in　1910。　There　is　needed　a　stirring　campaign　against　the　disease　throughout　the　Southern　States　of　this　country。

The　story　of　yellow　fever　illustrates　one　of　the　greatest　practical　triumphs　of　scientific　medicine；　indeed；　in　view　of　its　far…reaching　commercial　consequences；　it　may　range　as　one　of　the　first　achievements　of　the　race。　　Ever　since　the　discovery　of　America；　the　disease　has　been　one　of　its　great　scourges；　permanently　endemic　in　the　Spanish　Main；　often　extending　to　the　Southern　States；　occasionally　into　the　North；　and　not　infrequently　it　has　crossed　the　Atlantic。　　The　records　of　the　British　Army　in　the　West　Indies　show　an　appalling　death　rate；　chiefly　from　this　disease。　At　Jamaica；　for　the　twenty　years　ending　in　1836；　the　average　mortality　was　101　per　thousand；　and　in　certain　instances　as　high　as　178。　One　of　the　most　dreaded　of　all　infections；　the　periods　of　epidemics　in　the　Southern　States　have　been　the　occasions　of　a　widespread　panic　with　complete　paralysis　of　commerce。　　How　appalling　the　mortality　is　may　be　judged　from　the　outbreak　in　Philadelphia　in　1793；　when　ten　thousand　people　died　in　three　months。＇5＇　The　epidemics　in　Spain　in　the　early　part　of　the　nineteenth　century　were　of　great　severity。　A　glance　through　La　Roche's　great　book＇6＇　on　the　subject　soon　gives　one　an　idea　of　the　enormous　importance　of　the　disease　in　the　history　of　the　Southern　States。　　Havana；　ever　since　its　foundation；　had　been　a　hotbed　of　yellow　fever。　　The　best　minds　of　the　profession　had　been　attracted　to　a　solution　of　the　problem；　but　all　in　vain。　Commission　after　commission　had　been　appointed；　with　negative　results；　various　organisms　had　been　described　as　the　cause；　and　there　were　sad　illustrations　of　the　tragedy　associated　with　investigations　undertaken　without　proper　training　or　proper　technique。　　By　the　year　1900；　not　only　had　the　ground　been　cleared；　but　the　work　on　insect…borne　disease　by　Manson　and　by　Ross　had　given　observers　an　important　clue。　It　had　repeatedly　been　suggested　that　some　relation　existed　between　the　bites　of　mosquitoes　and　the　tropical　fevers；　particularly　by　that　remarkable　student；　Nott　of　Mobile；　and　the　French　physician；　Beauperthuy。　　But　the　first　to　announce　clearly　the　mosquito　theory　of　the　disease　was　Carlos　Finlay　of　Havana。　　Early　in　the　spring　of　1900；　during　the　occupation　of　Cuba　by　the　United　States；　a　commission　appointed　by　Surgeon…General　Sternberg　（himself　one　of　the　most　energetic　students　of　the　disease）　undertook　fresh　investigations。　　Dr。　Walter　Reed；　Professor　of　Bacteriology　in　the　Army　Medical　School；　was　placed　in　charge：　Dr。　Carroll　of　the　United　States　Army；　Dr。　Agramonte　of　Havana　and　Dr。　Jesse　W。　Lazear　were　the　other　members。　At　the　Johns　Hopkins　Hospital；　we　were　deeply　interested　in　the　work；　as　Dr。　Walter　Reed　was　a　favorite　pupil　of　Professor　Welch；　a　warm　friend　of　all　of　us；　and　a　frequent　visitor　to　our　laboratories。　Dr。　Jesse　Lazear；　who　had　been　my　house　physician；　had　worked　with　Dr。　Thayer　and　myself　at　malaria；　and　gave　up　the　charge　of　my　clinical　laboratory　to　join　the　commission。

＇5＇　Matthew　Carey：　　A　Short　Account　of　the　Malignant　Fever；　Philadelphia；　1793。

＇6＇　R。　La　Roche：　　Yellow　Fever；　2　vols。；　Philadelphia；　1855。


Many　scientific　discoveries　have　afforded　brilliant　illustrations　of　method　in　research；　but　in　the　work　of　these　men　one　is　at　a　loss　to　know　which　to　admire　morethe　remarkable　accuracy　and　precision　of　the　experiments；　or　the　heroism　of　the　menofficers　and　rank　and　file　of　the　United　States　Army；　they　knew　all　the　time　that　they　were　playing　with　death；　and　some　of　them　had　to　pay　the　penalty！　The　demonstration　was　successfulbeyond　peradventurethat　yellow　fever　could　be　transmitted　by　mosquitoes；　and　equally　the　negative　proposition　that　it　could　not　be　transmitted　by　fomites。　　An　interval　of　twelve　or　more　days　was　found　to　be　necessary　after　the　mosquito　has　bitten　a　yellow　fever　patient　before　it　is　capable　of　transmitting　the　infection。　Lazear　permitted　himself　to　be　bitten　by　a　stray　mosquito　while　conducting　his　experiments　in　the　yellow　fever　hospital。　　Bitten　on　the　thirteenth；　he　sickened　on　the　eighteenth　and　died　on　the　twenty…fifth　of　September；　but　not　until　he　had　succeeded　in　showing　in　two　instances　that　mosquitoes　could　convey　the　infection。　　He　added　another　to　the　long　list　of　members　of　the　profession　who　have　laid　down　their　lives　in　search　of　the　causes　of　disease。　　Of　such　men　as　Lazear　and　of　Myers　of　the　Liverpool　Yellow…Fever　Commission；　Dutton　and　young　Manson；　may　fitly　be　sung　from　the　noblest　of　American　poems　the　tribute　which　Lowell　paid　to　Harvard's　sons　who　fell　in　the　War　of　Secession：

　Many　in　sad　faith　sought　for　her；　　Many　with　crossed　hands　sighed　for　her；　　But　these；　our　brothers；　fought　for　her；　　At　life's　dear　peril　wrought　for　her；　　So　loved　her　that　they　died　for　her。

Fortunately；　the　commander…in…chief　at　the　time　in　Cuba　was　General　Leonard　Wood；　who　had　been　an　army　surgeon；　and　he　was　the　first　to　appreciate　the　importance　of　the　discovery。　The　sanitation　of　Havana　was　placed　in　the　hands　of　Dr。　Gorgas；　and　within　nine　months　the　city　was　cleared　of　yellow　fever；　and；　with　the　exception　of　a　slight　outbreak　after　the　withdrawal　of　the　American　troops；　has　since　remained　free　from　a　disease　which　had　been　its　scourge　for　centuries。　　As　General　Wood　remarked；　〃Reed's　discovery　has　resulted　in　the　saving　of　more　lives　annually　than　were　lost　in　the　Cuban　War；　and　saves　the　commercial　interest　of　the　world　a　greater　financial　loss　each　year　than　the　cost　of　the　Cuban　War。　　He　came　to　Cuba　at　a　time　when　one　third　of　the　officers　of　my　staff　died　of　yellow　fever；　and　we　were　discouraged　at　the　failure　of　our　efforts　to　control　it。〃　Following　the　example　of　Havana　other　centres　were　attacked；　at　Vera　Cruz　and　in　Brazil；　with　the　same　success；　and　it　is　safe　to　say　that　now；　thanks　to　the　researches　of　Reed　and　his　colleagues；　with　proper　measures；　no　country　need　fear　a　paralyzing　outbreak　of　this　once　dreaded　disease。

The　scientific　researches　in　the　last　two　decades　of　the　nineteenth　century　made　possible　the　completion　of　the　Panama　Canal。　　The　narrow　isthmus　separating　the　two　great　oceans　and　joining　the　two　great　continents；　has　borne　for　four　centuries　an　evil　repute　as　the　White　Man's　Grave。　　Silent　upon　a　peak　of　Darien；　stout　Cortez　with　eagle　eye　had　gazed　on　the　Pacific。　　As　early　as　1520；　Saavedra　proposed　to　cut　a　canal　through　the　Isthmus。　　There　the　first　city　was　founded　by　the　conquerors　of　the　new　world；　which　still　bears　the　name　of　Panama。　　Spaniards；　English　and　French　fought　along　its　coasts；　to　it　the　founder　of　the　Bank　of　England　took　his　ill…fated　colony；　Raleigh；　Drake；　Morgan　the　buccaneer；　and　scores　of　adventurers　seeking　gold；　found　in　fever　an　enemy　stronger　than　the　Spaniard。　　For　years　the　plague…stricken　Isthmus　was　abandoned　to　the　negroes　and　the　half…breeds；　until　in　1849；　stimulated　by　the　gold　fever　of　California；　a　railway　was　begun　by　the　American　engineers；　Totten　and　Trautwine；　and　completed　in　1855；　a　railway　every　tie　of　which　cost　the　life　of　a　man。　The　dream　of　navigators　and　practical　engineers　was　taken　in　hand　by　Ferdinand　de　Lesseps　in　January；　1881。　　The　story　of　the　French　Canal　Company　is　a　tragedy　unparalleled　in　the　history　of　finance；　and；　one　may　add；　in　the　ravages　of　tropical　disease。　Yellow　fever；　malaria；　dysentery；　typhus；　carried　off　in　nine　years　nearly　twenty　thousand　employees。　　The　mortality　frequently　rose　above　100；　sometimes　to　130；　140　and　in　September；　1