by Sonia Shah
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.43
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.50
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.52
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.63
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 $60,000.65
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 stan
d 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.68
Local health officers knew as well as the residents that the impounded water played a role in the malaria outbreak. “The more I see of malaria conditions,” a U.S. public health service officer wrote to his boss in 1913, “the more I think that ‘p-o-n-d’ spells ‘malaria.’”69 “The fever come when the water was backed up over the trees,” remembered Bass. “They began rotting and that put the fever in the air.”70 Similar transformations had wreaked misery upon the New England residents near milldams in the late eighteenth century. And entomologists had by then recorded precisely how subtle changes in larval habitats could transform malaria transmission by attracting more effective malaria vectors.
County health officials pleaded for funding to enact Gorgas’s antimalarial methods. Malaria “exacts the heaviest tribute from the energies of our people,” wrote one health officer in a 1914 report. “Will not the same kind of antimalarial work as was done on the Canal Zone bear the same kind of fruit if done around every household and every farm in Alabama?”71
But the power company denied any connection between its dam and the malaria. After all, it could see that many of the residents lived on properties rife with mosquito hatcheries, from muddy hog and cow pens to old wells, and couldn’t figure out how a few more, along the edges of the new lake, could hurt. Plus, the residents’ antipathy toward the company, which they didn’t think would provide much electricity to them in the end anyway, was well known. Even before the dam closed, the “dam business” had been something of a “cuss word” for area residents, the local paper noted.72 Company officials dismissed their complaints as the work of “rip-off artists looking for another way to make money without having to work,” as the historian Harvey H. Jackson says.73
Enraged, the Coosa’s fevered residents filed more than seven hundred lawsuits against Alabama Power, seeking over $3 million in damages. One resident sued the company for “the biggest figure of money he could think of.” Area merchants banked on their impending victory, extending credit to customers who’d filed suits.74
Landrift Hand’s case against the power company was one of the first to be heard. A rough-and-tumble sixty-five-year-old farmer, Hand lived on the river a few miles east of Shelby, Alabama. His land had always been boggy and mosquito-infested,75 but every thing had changed for Hand when the dam closed. Water flooded his land, its still edges lined with green scum, and a different, more malevolent type of mosquito infested his home. By the time the court heard his case, Hand had been suffering from malaria for weeks. Ears ringing from quinine, he’d been hit by a train he hadn’t heard coming, mangling his right arm.76
Gorgas himself took the stand as an expert witness against Hand, on behalf of the company. He testified that Hand’s malaria couldn’t possibly have come from mosquitoes roosting in the dammed lake. Hand’s domicile, some fifteen hundred yards away from the lake’s edge, was too far away, Gorgas said, and the mosquitoes wouldn’t have been able to fly that far. Rather, they must have emerged from the small dirty pools and puddles that littered Hand’s property, just as the company maintained.
In fact, the lake’s edge was the only viable larval site for the malaria-carrying mosquitoes that most likely bit Hand. Anopheles quadrimaculatus specialize in clear water with marginal vegetation, not dirty puddles. Entomologists had established as much years earlier, in a 1903 entomology book with which Gorgas was likely familiar. (The Harvard malariologist Andrew Spielman had a copy of the text on his bookshelf, signed by Gorgas’s colleague LePrince.)77 But in his testimony, Gorgas didn’t distinguish Anopheles by species, which he said he considered as relevant as “the various subdivisions of the dog family.”78
Nor was it true, as Gorgas testified, that Anopheles mosquitoes never flew more than two hundred yards from their birthplace. Military officers of the time had reported finding Anopheles two miles away from the bodies of water from which it hatched. Today, most mosquito biologists consider no less than five miles a safe distance.79
Nevertheless, Gorgas’s testimony carried the day. After all, he was a national hero, an esteemed Alabaman, and the surgeon general of the U.S. Army. The Supreme Court of Alabama ruled that the Coosa’s frightened locals suffered from “imaginary fears” of “imaginary dangers,” and were not “qualified to form or have an opinion” on the condition of their flooded lands. The court threw out Hand’s case after just a half hour of deliberation, and dismissed the 699 others.80
In 1916 and 1917, Alabama experienced “the greatest outbreak of malaria the state has ever seen,” according to the state’s health officer, S. W. Welch. “Not a family within three miles of the impounded water on both sides escaped malaria.”81 The state board of health felt helpless. “The stage is set in Alabama for epidemics of every known disease,” Welch wrote in his annual report, “and your Board is helpless to prevent the impending catastrophe because it has no money.”82 There wasn’t much they could do. Alabama Power had been authorized to build its dams by an act of Congress, and its activities were sanctioned by the most famous doctor in the world.83
The selective antimalarial approach of nineteenth-century Britain and the early twentieth-century United States could have vanquished malaria. Aggressively stanching the disease for a select population in a circumscribed area allows the malaria-free to achieve important political or economic goals. Through this limited strategy, wars are won and engineering feats are accomplished, which brings greater security and prosperity, which in turn allows for more malaria control, and more prosperity, and so on. Some modern malariologists, such as Harvard’s Spielman, think so. It’s the trickle-down theory of malaria control.
We’ll never know. For in both the United States and Britain, malaria receded on its own, thanks to demographic and agricultural changes that disrupted malarial ecologies.
In the United States, the first rumblings occurred in the 1830s, when Americans discovered the rich seams of coal underlying their vast continent. The industrial development that coal unleashed paved over acres of mosquito habitat. Hundreds of thousands of miles of railroad track laid across the country for new coal-fired steam engines allowed people to move themselves, their homes, and their goods away from the Anopheles-dense riversides and toward the rails. Coal-fired factories sited conveniently close to workers and markets rapidly eclipsed the quaint riverside facilities, and the Anopheles-laden mill-ponds that powered them.84
In the Mississippi Valley, farmers agitated for drainage schemes to rid the Midwest of its sixty million acres of wetlands, those squishy barriers to agricultural expansion that slowed horse travel around Chicago to as little as twelve miles a day. The wetlands were “solely tenanted by every worthless specimen of amphibious, vegetable, and animal creation,” an 1847 farm journal article complained. Eradicating them by drainage was “all that is necessary to secure millions of acres” for wholesome, productive agriculture.85 First by burying U-shaped tiles underground and later with industrial-strength machines, farmers shipped the pesky water off their lands into ditches and then into rivers and streams. Soon the valley’s wetlands “began to look just like the other farmland,” writes the environmental historian Ann Vileisis. “In a matter of generations, farmers would even forget where the tiles were laid unless they kept their grandfather’s drainage plans in a desk drawer.” As the spongy land dried out, downstream flooding worsened, and waterfowl and shorebird populations plummeted.86 Mosquito habitats steadily vanished. The dairy cows that dotted the region’s farms diverted the few mosquitoes that remained, and malaria parasites died out in the ruminants’ inhospitable bodies.
By the end of the 1930s, malaria was a thing of the past in the Upper Mississippi Valley.87
Economic uplift measures in the South sent malaria packing there, too.88 In 1933, Pr
esident Roosevelt signed the Agricultural Adjustment Act, which helped Southern farmers mechanize their farms. A stream of black sharecroppers, made redundant by the farm machines, abandoned their swampy cabins for the city. Malarial mosquitoes’ access to their bodies declined accordingly.89
Roosevelt also created the Tennessee Valley Authority, which built nine dams across the Tennessee River. By then, federal officials had established antimalarial regulations for the hydropower industry, requiring the clearing of potential reservoirs, the modulation of the level of impounded waters to alternately strand and wash away mosquito larvae, and the diagnosis and treatment of malaria-infected workers. (The industry’s vulnerability to the animus of the “species Homo,” who are “willing to go to any length to harass and extract money,” as one public health official noted, had inspired the regulations.)90 The TVA’s cheap, plentiful electricity enriched the region, allowing for better roads and housing, which further reduced the mosquito’s habitat and protected humans from its bite.91
By the time Rockefeller Foundation malariologists started staging popular anti-mosquito projects, and the United States created the Malaria Control in War Areas program in 1942 (which would later become the Centers for Disease Control), the weaknesses of their antimalarial methods didn’t matter anymore. Malaria had already nearly vanished.92
Agricultural, economic, and demographic shifts broke malaria in Britain, too.
There, the first seismic shock occurred in the early eighteenth century, when a former politician named Charles Townshend started proselytizing to English farmers about a new agricultural method, borrowed from Holland, of planting four crops—wheat, barley, clover, and turnips—in constant rotation. For centuries, England’s agricultural production had remained stubbornly stagnant. At any given moment, about one fifth of the country’s arable land lay fallow, slowly recharging for another round of planting.93 Medieval British farmers ritually slaughtered all their livestock on November 11, during the festival of Martinmas, before the cold set in, for they didn’t produce enough to feed the animals over the winter. With four-crop rotation, no land had to stay fallow, and there’d be enough turnips to nourish livestock during the cold season.94