HISTORY OF YELLOW FEVER- OPENING OF PANAMA CANAL

On July 22, 1905 , Harper's Weekly featured a cartoon about the problem of yellow fever during construction of the Panama Canal

In all of ancient medical literature there is no reference to Yellow Fever, by that or any other name. Since epidemic yellow fever is a dramatic disease, it seems unlikely that it could have escaped the attention of even very early medical writers. It is perhaps reasonable to conclude that the disease did not exist in ancient civilizations (Warren, 1951).

          There are reports of disease with clinical description similar to yellow fever in 1498 in San Domingo and 1585 in West Africa (Scott, 1939). Carter found the earliest record in a Mayan manuscript describing an epidemic with hematemesis (black vomit, or “xekik”) in the Yucatan in 1648, and suggested that the virus and mosquito vector were introduced from Africa during the slave trade (Carter, 1931).

          According to Garrison (1929) the term yellow fever was first employed by Griffin Hughes in his “Natural History of Barbados” (1750). The yellow in yellow fever does not indicate the association of the disease with jaundice but is derived from the yellow quarantine flag used by the ships during the 17^th century (Singh and Bhatia, 1993).

          Yellow Fever was responsible for several epidemics among the settlers in tropical areas of the Americas and Africa during the 17^th to the 19^th centuries. In addition, epidemics were also reported in Europe following importation of the virus in sailing ships. However, the origin of the disease is in doubt but the susceptibility of ‘New World Monkeys’ but not African monkeys to latent infection by yellow fever indicates African origin of disease (Monath, 1994).

          Until the 20^th century, yellow fever was widely believed to be an airborne “miasma” arising from filth, sewage, and rotting organic matter. The series of developments thereafter in disease etiology, etiological agent, epidemiology and vaccine are given below:

1848:

          View, that spread of yellow fever required the presence of an intermediate host, appears to have first advanced by Dr. Josiah Clark Nott of Mobile, Alabama. Nott suggested the mosquito as a possible agent for the dissociation of both yellow fever and malaria (Warren, 1951). Dr Louis Daniel Beauperthuy in Venezuela made a similar suggestion in 1854.

1880:

          The first attempt to dig Panama Canal in 1880-88 failed after 52000 cases of yellow fever and malaria were reported among the 85000 workers (Bres, 1986).

1881:

          The first really serious proponent of the mosquito transmission in yellow fever was Dr. Carlos J. Finlay of Havana, Cuba (Warren, 1951; Burke and Monath, 2001; WHO, 1998).

1897:

          Dr. Giuseppe Sanarelli, an Italian bacteriologist working in the islands of Flores off Montevideo announced that he had discovered the cause of yellow fever to be a bacillus present in about 50% of patients examined by him. He named it Bacillus icteroides (Sanarelli, 1897).

1900:

          In May United States Army organized a commission to study the infectious diseases of Cuba but more specifically yellow fever. Dr. Walter Reed was appointed as president.

          Dr. Reed and colleagues from their studies concluded that “Bacillus icteroides” stand in no causative relation to yellow fever, but when present should be considered as a secondary invader in this disease” (Reed, Carrol et. al., 1900).

          Influenced by the work of Sir Ronald Ross and of Italian observers on the propagation of malaria by the mosquito the commission directed their attention on the Finlay’s theory of the propagation of yellow fever by mosquito (Warren, 1951).

          The Reed Commission recorded 3 cases of yellow fever transmission by mosquitoes that had fed previously on patients clinically ill with yellow fever.  Subsequent work of the commission proved conclusively that:

a)              the mosquito was a vector of yellow fever;

b)             there was an interval of about twelve days between the time the mosquito took an infectious blood meal and the time it could convey the infection to another human being;

c)              yellow fever could be produced experimentally by subcutaneous injection of blood taken from the general circulation of a yellow fever patient during the 1^st and 2^nd days his illness; and

d)             yellow fever was not conveyed by fomites.

          In the consequence of these findings, Reed and his coworkers (Dr.James Carrol, Dr.Jesse, W.Lazear, and Dr.Aristides Agramonte) suggested that the spread of yellow fever could be most effectively controlled by antimosquito measures and the protection of sick from the bites of mosquitoes (Reed, Carrol and Agramonte, 1901).

1901:

          On October 15, Reed and Carrol injected subcutaneously 3cc of diluted filtered serum from an experimentally infected yellow fever patient into three non-immune persons. Two of these developed clinical yellow fever (Reed and Carrol, 1902).

          Thus for the first time a filterable virus was proved to be the cause of specific human disease.

          In February the Chief sanitary officer in Havana, then Major William C. Gorgas instituted measures to wipe out yellow fever which were based entirely on conclusions of the yellow fever commission.          The results were as dramatic as the scientific findings of the commission. By September, 1901 the disease had been completely eradicated, and it has not reappeared. The antimosquito measures in Havana, in addition to eliminating yellow fever, greatly reduced the incidence of malaria. Gorgas in Panama applied similar approach. Eradication of yellow fever from Panama led to the resumption of work of Panama Canal in 1904 and its completion in 1914 (Warren, 1951).

       

           The Havana and Panama campaigns now constitute an epic chapter in the history of sanitation and preventive medicine.

1913:

          The Rockefeller Foundation was organized for “the well-being of mankind throughout the world”.

          The International Health Commission of the Foundation was created the same year, with Mr. Wickliffe Rose as its director.

          The foundation began its work when the real danger of spreading the disease to countries with high density of population, such as India and Far Eastern countries became obvious as a consequence to the opening of the Panama Canal. Dr. S. P. James of the Indian Medical Service made a thorough investigation of the situation on behalf of the Indian Government and reported that the menace was sufficiently great to call for a permanent quarantine force in Panama, Hong Kong or Singapore, to be maintained at the expense of the English colonies in the East.

         

          Fortunate we are that the disease has not reached India so far, although Aedes ageypti is found in abundance in this country.

Rockefeller Institute of Medical Research















Panama Canal Route Map