the evolution of modern medicine-第48章
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que。 The year 1905 was devoted to organization； yellow fever was got rid of； and at the end of the year the total mortality among the whites had fallen to 8 per thousand； but among the blacks it was still high； 44。 For three years； with a progressively increasing staff which had risen to above 40；000； of whom more than 12；000 were white； the death rate progressively fell。
Of the six important tropical diseases； plague； which reached the Isthmus one year； was quickly held in check。 Yellow fever； the most dreaded of them all； never recurred。 Beri…beri； which in 1906 caused sixty…eight deaths； has gradually disappeared。 The hookworm disease； ankylostomiasis； has steadily decreased。 From the very outset； malaria has been taken as the measure of sanitary efficiency。 Throughout the French occupation it was the chief enemy to be considered； not only because of its fatality； but on account of the prolonged incapacity following infection。 In 1906； out of every 1000 employees there were admitted to the hospital from malaria 821； in 1907； 424； in 1908； 282； in 1912； 110； in 1915； 51； in 1917； 14。 The fatalities from the disease have fallen from 233 in 1906 to 154 in 1907； to 73 in 1908 and to 7 in 1914。 The death rate for malarial fever per 1000 population sank from 8。49 in 1906 to 0。11 in 1918。 Dysentery； next to malaria the most serious of the tropical diseases in the Zone； caused 69 deaths in 1906； 48 in 1907； in 1908； with nearly 44；000； only 16 deaths； and in 1914； 4。＇*＇ But it is when the general figures are taken that we see the extraordinary reduction that has taken place。 Out of every 1000 engaged in 1908 only a third of the number died that died in 1906； and half the number that died in 1907。
＇*＇ Figures for recent years supplied by editors。
In 1914； the death rate from disease among white males had fallen to 3。13 per thousand。 The rate among the 2674 American women and children connected with the Commission was only 9。72 per thousand。 But by far the most gratifying reduction is among the blacks； among whom the rate from disease had fallen to the surprisingly low figure in 1912 of 8。77 per thousand； in 1906 it was 47 per thousand。 A remarkable result is that in 1908 the combined tropical diseasesmalaria； dysentery and beri…berikilled fewer than the two great killing diseases of the temperate zone； pneumonia and tuberculosis 127 in one group and 137 in the other。 The whole story is expressed in two words； EFFECTIVE ORGANIZATION； and the special value of this experiment in sanitation is that it has been made； and made successfully； in one of the great plague spots of the world。
Month by month a little； gray…covered pamphlet was published by Colonel Gorgas； a 〃Report of the Department of Sanitation of the Isthmian Canal Commission。〃 I have been one of the favored to whom it has been sent year by year； and； keenly interested as I have always been in infectious diseases； and particularly in malaria and dysentery； I doubt if anyone has read it more faithfully。 In evidence of the extraordinary advance made in sanitation by Gorgas； I give a random example from one of his monthly reports （1912）： In a population of more than 52；000； the death rate from disease had fallen to 7。31 per thousand； among the whites it was 2。80 and among the colored people 8。77。 Not only is the profession indebted to Colonel Gorgas and his staff for this remarkable demonstration； but they have offered an example of thoroughness and efficiency which has won the admiration of the whole world。 As J。 B。 Bishop； secretary of the Isthmian Canal Commission； has recently said： 〃The Americans arrived on the Isthmus in the full light of these two invaluable discoveries ＇the insect transmission of yellow fever and malaria＇。 Scarcely had they begun active work when an outbreak of yellow fever occurred which caused such a panic throughout their force that nothing except the lack of steamship accommodation prevented the flight of the entire body from the Isthmus。 Prompt； intelligent and vigorous application of the remedies shown to he effective by the mosquito discoveries not only checked the progress of the pest； but banished it forever from the Isthmus。 In this way； and in this alone； was the building of the canal made possible。 The supreme credit for its construction therefore belongs to the brave men； surgeons of the United States Army； who by their high devotion to duty and to humanity risked their lives in Havana in 1900…1901 to demonstrate the truth of the mosquito theory。〃＇7＇
＇7＇ Bishop： The French at Panama； Scribner's Magazine； January； 1913； p。 42。
One disease has still a special claim upon the public in this country。 Some fourteen or fifteen years ago； in an address on the problem of typhoid fever in the United States； I contended that the question was no longer in the hands of the profession。 In season and out of season we had preached salvation from it in volumes which fill state reports； public health journals and the medical periodicals。 Though much has been done； typhoid fever remains a question of grave national concern。 You lost in this state＇7a＇ in 1911 from typhoid fever 154 lives； every one sacrificed needlessly； every one a victim of neglect and incapacity。 Between 1200 and 1500 persons had a slow； lingering illness。 A nation of contradictions and paradoxesa clean people； by whom personal hygiene is carefully cultivated； but it has displayed in matters of public sanitation a carelessness simply criminal： a sensible people； among whom education is more widely diffused than in any other country； supinely acquiesces in conditions often shameful beyond expression。 The solution of the problem is not very difficult。 What has been done elsewhere can be done here。 It is not so much in the cities； though here too the death rate is still high； but in the smaller towns and rural districts； in many of which the sanitary conditions are still those of the Middle Ages。 How Galen would have turned up his nose with contempt at the water supply of the capital of the Dominion of Canada； scourged so disgracefully by typhoid fever of late！ There is no question that the public is awakening； but many State Boards of Health need more efficient organization； and larger appropriations。 Others are models； and it is not for lack of example that many lag behind。 The health officers should have special training in sanitary science and special courses leading to diplomas in public health should be given in the medical schools。 Were the health of the people made a question of public and not of party policy； only a skilled expert could possibly be appointed as a public health officer； not； as is now so often the case； the man with the political pull。
＇7a＇ Connecticut。
It is a long and tragic story in the annals of this country。 That distinguished man； the first professor of physic in this University in the early years of last century； Dr。 Nathan Smith； in that notable monograph on 〃Typhus Fever〃 （1824）； tells how the disease had followed him in his various migrations； from 1787； when he began to practice； all through his career； and could he return this year； in some hundred and forty or one hundred and fifty families of the state he would find the same miserable tragedy which he had witnessed so often in the same heedless sacrifice of the young on the altar of ignorance and incapacity。
TUBERCULOSIS
IN a population of about one million； seventeen hundred persons died of tuberculosis in this state in the year 1911 a reduction in thirty years of nearly 50 per cent。 A generation has changed completely our outlook on one of the most terrible scourges of the race。 It is simply appalling to think of the ravages of this disease in civilized communities。 Before the discovery by Robert Koch of the bacillus； we were helpless and hopeless； in an Oriental fatalism we accepted with folded hands a state of affairs which use and wont had made bearable。 Today； look at the contrast！ We are both helpful and hopeful。 Knowing the cause of the disease； knowing how it is distributed； better able to recognize the early symptoms； better able to cure a very considerable portion of all early cases； we have gradually organized an enthusiastic campaign which is c
