malaria both in the acute and chronic forms was selected for
experimental work. This section consisted of a basin or low-
land about a mile square, containing about one hundred small
dwelling-houses some distance apart. Within its boundaries
were a large number of stagnant pools varying in size from
ten feet in diameter to an acre or more in area. A house-to-
house visit showed that at least 20% of the inhabitants of this
4i] STATEN ISLAND 337
district were suffering with some form of malaria, and in the
immediate vicinity of every house were found typical breeding-
places in the shape of old tinware, rain-water barrels, cisterns,
cesspools and ground depressions, many of which contained
larvae. For the purpose of detecting the presence of adult
Anopheles, glass tubes fitted with cotton plugs were distributed
among the occupants of these houses with the request that the
mosquitos found in the house at night be captured and placed
in the tubes. In the collection were found many Anopheles.
These were particularly numerous in tubes coming from a small
group of houses. In one of the latter was found a family con-
sisting of five persons, all of whom showed the acute or chronic
form of malaria. Dr Doty himself secured live mosquitos from
the interior of this house. On the first evening five were
captured, and all but one were Anopheles. On the second
evening twenty-two were collected, and of these more than one
\\2\{-w^xt. Anopheles. In the house on the opposite corner was
found a patient suffering from an acute attack.
In the beginning considerable difficulty was found in detect-
ing the breeding - places of the Anopheles, but this became
easier as the inspections became more thorough. For instance,
in a group of two or three houses close together a number of
Anopheles were captured, but their breeding - place could not
be found for some time. Finally, in the backyard of one of
the houses, overgrown with weeds, was discovered a very large
metal receptacle filled with Anopheles larvae, and with many
adults in the immediate vicinity. This receptacle was almost
entirely covered by underbrush.
After this experience the men employed learned to make
the closest possible search, and to find probably every breeding-
place.
The island was then divided into small districts, which
were visited by mosquito corps consisting of five men, one of
whom was a sanitary police officer connected with the New York
City Department of Health. The equipment of the mosquito
Y
338 ANTI-MALARIA WORK IN THE UNITED STATES [Sect.
corps consisted of a large waggon provided with spades, rakes,
hoes, scythes, and petroleum oil. A house-to-house inspection
was made in each district. House owners or tenants were
required to remove from about the premises all receptacles
which might act as breeding-places, or to protect them. Rain-
water barrels and cisterns were covered with wire-netting, all
roof gutters were repaired, and pools of water were covered
with petroleum. In certain instances orders were sent to the
owners of property containing depressions in the soil to fill
them in or drain them. If these orders could not be enforced,
the mosquito corps returned every ten days or two weeks
and applied more petroleum. Copies of a circular of informa-
tion were delivered so far as possible to each house on Staten
Island by police officers, and this educational campaign brought
about valuable co-operation on the part of the public.
In 1905 the details of this work were presented to the
Department of Health of the city of New York, and the
city government granted an appropriation for the drainage
of the swamp land along the entire coast of the island. With
the aid of this appropriation, ditching was carried on somewhat
in the same manner in which it has been carried on in New
Jersey. Down to the present time between 800 and i,0CXD miles
of ditches have been dug. The swarms of mosquitos soon
practically disappeared, window screens were discarded, and
meals were served upon the verandas of the hotels.
With the malarial and other inland mosquitos the work
was carried on in the manner above described, not only in
the built-up portion of the island, but also in the open spaces
between the small and scattered settlements. During the past
two years cases of malaria on Staten Island are becoming
practically unknown, and for the past year Dr Doty has been
unable to secure any Anopheles, whereas, in the beginning of
the investigation they were found almost everywhere on the
island. The statistics of the Department of Health indicate
the decrease of malaria from 1905 on. Prior to 1905 malaria
4i] RESULTS OF DR DOTY'S WORK 339
was not regularly reported, but the number of cases was surely
very much greater than that reported in that year. Since 1905,
however, they are stated to be as follows : ā 1905, thirty-three
cases ; 1906, fifty-four cases ; 1907, four cases ; 1908, six cases ;
1909, five cases.
The work of exterminating malarial mosquitos has been
necessarily slow, as the area involved is considerable, the island
being about 16 miles long and 4 to 6 miles wide, probably
containing over eighty thousand inhabitants in large areas
between the various towns.
The expense of the operations down to the present date
has been about $50,000 ; this, of course, includes the expense
of the extensive drainage operations in the salt marshes. Dr
Doty, in addition to being the Health Officer of the Port of
New York, is a Commissioner of Health of New York City,
and he carried out this work in his capacity as a municipal
officer, and not as a State official.
Earlier and very much smaller pieces of work have
previously been described by the writer in "Mosquitos" (New
York, 1901), including the work done by Dr W. N. Berkeley
in a small town near New York City during the summer of
1900, and the work done at Chaptico, Maryland, by the Rev.
William Brayshaw, in both of these cases the work being
directed primarily against malaria. Later, some excellent
work was instituted through the combined action of the
boards of health of Cambridge and Belmont, Massachusetts,
to improve the sanitary conditions of the cities of Cambridge
and Somerville, and the towns of Arlington and Belmont, at
the inspiration of Mr W. L. Underwood, a member of one
of the boards of health. This was effectively carried out at
an expense of S600 without assessment upon land-holders.
In 1903 some extensive work was done at Newport, Rhode
Island, at the expense of a single property holder, and the
following year the Citizens' Association of Flushing, Long
Island, took up the problem, and with the assistance of the
340 ANTI-MALARIA WORK IN THE UNITED STATES [SECT.
Board of Health extensive drainage operations have been carried
on, but are not yet completed.
In 1903 the American Mosquito Extermination Society was
founded, and took an active part in interesting the people of
the United States in the mosquito crusade. It was founded
for the purpose of educating the public, of bringing about
legislation, and of securing co-operation and exchange of ideas.
It held its first anti-mosquito convention i6th December 1903,
and continued its organisation, publishing several bulletins,
finally disbanding in 1907 in consideration of the fact that the
objects of its existence would be taken over by the National
Drainage Association.
In 1903 and 1904 work against mosquitos was undertaken
by the state entomologist of Connecticut, Dr W. E. Britton,
who made careful mosquito surveys over the whole state, and
he published in his Annual Report for 1904 a careful and well-
illustrated article devoted to showing how the mosquito nuisance
can be abated.
The largest-scale work taken up in the United States, how-
ever, has been carried on by the state of New Jersey, and this
is the first of the United States to take official action in this
direction. This work was instigated by Dr John B, Smith,
the state entomologist, under whose direction it has been
carried on, and resulted largely from his discovery of the exact
habits of the salt marsh mosquitos. An admirable state law
was passed carrying a very considerable appropriation. The law
provided for a survey at the request of the board of health of
any city, town or township, which should map all mosquito
breeding- places, and provided that the board of health must,
after the survey, proceed to abolish the breeding-places. The
law provides further that if the necessary cost of the work shall
equal or exceed the value of the land without increasing its
taxable value the board may apply to the director of the work,
who may, if he deems the matter of sufficient public interest,
contribute from the state funds to the cost of the necessary
4i] NEW JERSEY 341
work, providing that not more than 50% of the amount
shall be contributed in any case. Under this appropriation
and during the past three years much admirable work has
been done upon the salt marshes of the New Jersey coast. In
all 25,192 acres of marsh land have been reclaimed by 3,633,974
feet of ditching, and this includes a shore line of nearly 70
miles. Other work has been done also, more specifically against
inland mosquitos, including Anopheles.
The work that was done in New Orleans during the yellow
fever outbreak of 1905 was an object lesson to the people of the
United States. This work was so thorough that it resulted in
the reduction of the numbers of the yellow fever mosquito to
a minimum, and at the same time sensibly decreased the
numbers of Anopheles. This work, while carried on originally
under the United States Public Health and Marine Hospital
Service, has been continued by the city Board of Health, and
the example of New Orleans in this direction has been slowly
followed by other southern cities.
The city of San Antonio, Texas, has the honour of instituting
and carrying forward a large-scale effort to educate the children
in the public schools, which is worthy of rather specific mention
on account of its widespread application.
In November 1903 there were a few cases of yellow fever
in San Antonio which caused several deaths, and an inexcusable
interruption of commerce that cost hundreds of thousands of
dollars. In the effort to allay the panic, the existence of yellow
fever was denied, not only by persons having business interests
in the city, but by many medical men as well. Very many
adults not only denied the existence of the fever in the city,
but denied the relation between the mosquitos and the fever.
Perhaps the majority of the adults seemed too old to learn ;
and to the enlightened physicians it appeared that it was
impossible to begin education at the wrong end of life.
The Chairman of the Sanitary Committee of the School
Board (Dr J. S. Lankford) grasped the happy idea that if the
342 ANTI-MALARIA WORK IN THE UNITED STATES [Sect.
children were properly educated, sanitary matters in the future
would be much better attended to. He suggested to the Board
that it would be valuable to educate all of the school children
of the city in prophylaxis and make sanitarians out of them all.
The School Board heartily approved of the proposition, and the
campaign was at once begun to educate the children on the
subject of Insects as Disease Carriers. The best recent medical
literature on the subject was procured and furnished to the
teachers, and a circular letter was sent to them outlining a
proposed course and offering a cash prize for the best model
lesson on the subject. Teachers became deeply interested in
the subject. A crude aquarium, with eggs and wrigglers,
was kept in every schoolroom, where the pupils could watch
them develop ; and large magnifying glasses were furnished in
order that they might study to better advantage. The children
were encouraged to make drawings on the blackboard of
mosquitos in all stages of development ; lessons were given and
compositions were written on the subject. Competitive ex-
aminations were held, and groups of boys and girls were sent
out with the teachers on searching expeditions to find the
breeding-places. Rivalry sprung up between the 10,000 public
school children of the city in the matter of finding and reporting
to the Health Office the greatest number of breeding-places
found and breeding-places destroyed. Record was kept on the
blackboards in the schools for information as to the progress
of the competition, and great enthusiasm was stirred up. In
addition to these measures, a course of stereopticon lectures
was arranged, grouping the pupils in audiences of about one
thousand from the high school down, and, in Dr Lankford's
words, " It was an inspiring sight to watch these audiences of a
thousand children, thoughtful, still as death, and staring with
wide-open eyes at the wonders revealed by a microscope. It
seemed to me that in bringing this great question of preventive
medicine before public school children we had hit upon a power
for good that could scarcely be over-estimated." The result of
4i] COST OF MALARIA 343
this work, it is pleasing to say, was a decided diminution in
the number of mosquitos in San Antonio. There was some
opposition among the people, but the movement on the whole
was very popular. One result of this work was that while
there had previously been from fifty to sixty deaths a year from
malarial trouble, the mortality was reduced 75^ the first year
after this work was begun, and in the second year it was entirely
eliminated from the mortality records of San Antonio.
In organising community work against mosquitos, the
school children hereafter must be counted upon as most
important factors. Almost every child is a born naturalist,
and interest in such things comes to them more readily than
anything else outside of the necessities of life. They are
quick-witted, wonderfully quick-sighted, and as finders-out of
breeding-places they cannot be approached except by adults
of the most especial training. One of the first steps that a
community should take is, therefore, the encouragement of the
interest of the children in the public schools.
I fear that it will appear from what precedes that, consider-
ing the economic loss existing in the United States through
malaria, which has been estimated by the writer at surely not
less than S 100,000,000 per year (see Bulletin No. 78, Bureau
of Entomology, United States Department of Agriculture),
nothing like the competent work has been done that should
be done, or really that should have been done in the past
eight years, within the territorial limits of the United States
themselves. While very many sections of the country that
were originally extremely malarious have been practically freed
from malaria by the drainage of swamp areas, undertaken not
as a measure of sanitation but in order to add to the supply
of arable land, it is nevertheless seen that the conditions of
improved civilisation have brought about steadily increased
opportunities for Anopheles to breed, and this increase in the
number of breeding - places and kinds of breeding - places is
constantly growing. The introduction of irrigation into many
344 ANTI-MALARIA WORK IN THE UNITED STATES [Sect.
portions of the western country has resulted in the introduction
of malaria, and these operations are going on with a very
rapid increment. Moreover, in regions which are not dry and
which need no irrigation, the construction of mill-dams, the
excavation of stone quarries, the building of railroad embank-
ments and many other operations which follow rapidly increas-
ing populations have resulted in the multiplication ol Anopheles,
and in many instances the introduction of malaria has been
followed by its rapid spread through extended regions. On
the whole, under such conditions it would not be surprising if
malaria were increasing rather than decreasing in the United
States, and the mosquito crusade is bound to become an
extremely important matter within the next few years.
References on Anti-malarial Work in the United States.
American Mosquito Extermination Society. Mosquito Brief. 1904.
American Mosquito Extermination Society. Bulletins 1-2, 1904 -1906.
{Bulletin i is issued by the National Mosquito Extermination
Society.)
American Mosquito Extermination Society. Yearbook for 1903- 1905, con-
taining the proceedings of the ist and 2nd anti-mosquito convention.
Edited by Henry Clay Weeks and Edward Hagaman Hall. New
York, 1 904- 1 906.
Britton, W. E. & H. L. Viereck. ā Report on mosquito investigations.
(Fourth report of the State entomologist of Connecticut Agr. Coll. Exp.
Station for the year 1904, pp. 253-310, pi. X.-XVII.)
Chase, H. Lincoln & J. Albert C. Nyhen.ā" Abatement of the Mosquito
Nuisance in Brooklyn." (Reprint from the Journal of the Mass. Assoc,
of Boards of Health, Boston, 1902- 1903, vol. xii. pp. 190-203, Jan. 1903.
Reprint is 14 pages.)
Doty, Alvah H. ā "The Mosquito: Its Relation to Disease and Its
Extermination." New York, 1908. 26pp. (Reprinted from the New
York State Journal of Medicine, May 1908.)
Doty, A. H.ā "On the Extermination of the Mosquito." New York, 1906.
lopp. (From the American Journal of the Medical Scietices, Feb. 1906.)
4i] REFERENCES 345
Doty, A. H. ā " The Use of Sulphate of Copper alone, and its Combination
with Lime, for the Destruction of Mosquito Larvae, as a Deodorant, and
as a Disinfectant." New York, William Wood & Co., 1905. 12pp.
(Reprint from the Medical Record^ 21st Jan. 1905.)
Howard, L. O. ā "Economic Loss to the People of the United States
through Insects that carry Disease." Washington, 1909. 40pp. (U.S.
Dept. of Agr. Bureau of Entomology, Bulletin No. 78.)
Howard, L. O. ā " Mosquitos : how they live ; how they carry disease ;
how they are classified ; how they may be destroyed." New York,
M'Clure, Phillips & Co., 1901. xv. 241pp.
Lankford, J. S. ā " Public School Children and Preventive Medicine."
New York, 1904. 9pp. (Reprinted from the New York Medical Journal
for loth Dec. 1904.)
M'KiBBEN, William W. ā "Malaria and Mosquitos of Worcester. A
Year's Observations on the Habits of Culex and Anopheles." Boston,
1903. 9pp. (Reprinted from the Boston Medical and Surgical Journal^
vol. cxlix. No. 25, pp. 665-669, 17th Dec. 1903, and No. 26, pp. 704-
708, 24th Dec. 1903.)
North Shore Improvement Association. Reports on plans for the extermi-
nation of mosquitos on the north shore of Long Island between
Hempstead Harbour and Cold Spring Harbour. New York, 1902.
124pp.
North Shore Improvement Association. Report of the Association's experts,
Frank E. Lutz and William W. Chambers, upon the work of mosquito
extermination during the summer of 1902. New York, 1902. 26pp.
QUAYLE, H. J. ā "Mosquito Control." (Univ. of California, College of Agr.
Agr. Exp. Station, Bulletin No. 178, 1906.)
Smith, John B. ā Report of the New Jersey State Agricultural Experiment
Station upon the mosquitos occurring within the state, their habits,
life history, etc. Trenton, 1904. 482pp.
Smith, John B. ā Report on mosquito investigations. (In Reports of the
Entomological Department, New Jersey Agri. Coll. Exp. Station,
for the years 1902- 1908.)
By Colonel W. C. GORGAS, United States Army
Chief Sanitary Officer, Isthmian Canal Commission, Panama
42. Malaria Prevention on the Isthmus of Panama.ā
The Panama Canal extends diagonally across the Isthmus of
Panama from south-east to north-west, a distance of 42 miles
from shore to shore.
Commencing on the South Sea at Panama it runs up the
valley of the Rio Grande river to Pedro Miguel, then across
the divide to Bas Obispo, and from there down the valley of
the Chagres to Colon. Roughly, about two - thirds of this
distance is broken and mountainous, and one - third low and
swampy. About one - fourth of the population lives in the
lowlands and three-fourths in the highlands.
Before coming to Panama in 1904 the Army Medical Corps
had had very little experience in dealing with malaria on a
large scale in rural districts. The mosquito work established
by the Army medical officers in the city of Havana in 1901
had not only gotten rid of yellow fever but also of malaria.
This work has now been going on in Havana for the past
eight years, part of the time under Army medical officers,
and part of the time under Cuban officers, and is the most
successful example of municipal malarial work that I know of
The following table shows the decrease of malaria under these
measures, and at the present time, its practical extinction : ā
1890 1891 1892 1893 1894 1895 1896 1897 1898 1899
170 203 202 240 201 207 450 811 910 909
Mosquito work commenced February of this year, 1901.
1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 (to July)
325 151 87 51 44 32 26 23 19 2
Sect. 42] DRAINAGE 347
Ronald Ross's work at Ismailia was the only example at
this time that I knew of, pertaining to successful anti-malaria
work in rural districts.
At Panama our anti - malarial work is principally rural,
located for 47 miles along the line of the railroad between
Panama and Colon. The railroad in general follows the line
of the canal. In this distance we have a population of about
eighty thousand living within a half a mile of the railroad,
and occupying some thirty villages and camps, and more or
less isolated houses scattered between.
In this article I shall describe the sanitary organisation as
it existed in July 1908.
This strip of 47 miles along the railroad is divided into
eighteen districts, each district in charge of an inspector. The
inspector's duties consist in the carrying out of the sanitary
work of the district, and for this purpose he had at his disposal,
on an average, about fifty men. The anti-malarial work con-
sists in the order of its importance, of: ā
(i). Drainage,
(2). Brush and grass cutting.
(3). Oiling.
(4). Use of larvicide.
(5). Prophylactic quinine.
(6). Screening.
(7). Killing mosquitos in quarters.
Drainage. ā He is required to drain and do away with
all pools within, approximately, 200 yards of all villages, and
100 yards of all individual houses. For this purpose we con-
sider subsoil-drainage by far the most effective and economical ;
second, open concrete ditches ; and, third, open ditches.
The porous subsoil pipes give a perfect anti - malarial
drainage. Besides doing away with all breeding-places, they
enable you to use a horse - mower on the ground so drained,
and thus much cheapen the cost of subsequent grass cutting.
We use the open concrete ditch in localities where
348 MALARIA PREVENTION ON ISTHMUS OF PANAMA [Sect.
subsoil drainage is not practicable, such as flat places where
the fall is not sufficient, and small natural rills where the volume
of water is too large for subsoil drainage, etc.
The objection to this style of ditch as compared with the
subsoil is that it requires supervision for the purpose of keeping
it free. Any obstacle in the ditch will make a small collection
of water, which in this warm climate will breed mosquitos at
any time of the year.
Open ditches we only use when the occupancy is going
to be temporary, not more than two years. While the first
cost is smaller than in either of the other class of ditches, the
ultimate cost is very large. In a locality such as Panama,
vegetation grows so rapidly that the ditches have to be cleared
out at least once a month, and when clean they will breed
larvae unless treated with larvicide.
We pay our inspectors from one hundred and twenty-five
dollars per month to one hundred and seventy-five, and thus
get, in general, an educated intelligent class of men. We have
attached to the department an inspector of sufficient engineering
education to lay out the ditches, but the local inspector is
entirely responsible for their execution. In general, it is the
character of work such as the farmer does through our country,
and any man of ordinary intelligence is capable of carrying it
out. But for its anti-malarial success it is important that the
man in charge should have a good knowledge of the breeding
habits of the species of mosquitos in his neighbourhood.
Brush and grass cutting. ā The inspector is required to keep
the tropical undergrowth cut off within 200 yards of villages
and 100 yards of isolated houses. Within this area the grass
must be kept less than a foot high. I consider this scarcely
less important than drainage. Brush and grass shelter the
adult mosquito, and they will reach a habitation from distant
breeding-places by short flight, if they have the continuous
protection of brush, whereas the Anopheles will not cross