William Crawford Gorgas

Physician

• Born: October 3, 1854
• Birthplace: Toulminville, Alabama
• Died: July 4, 1920
• Place of death: London, England

American physician

Gorgas, a dedicated physician and humanitarian, led the effort that eliminated yellow fever as one of the major epidemic diseases throughout the world. This feat was accomplished through the diligent and practical application of scientific discoveries concerning the disease.

Areas of achievement Medicine, public health

Early Life

William Crawford Gorgas (GOHR-gahs) was born to Josiah Gorgas, an officer in the U.S. Army and a Northerner, and to Amelia (Gayle) Gorgas, a Southerner. The sectional strife in the late 1850’s caused Josiah Gorgas considerable anxiety, for both marriage and experience inclined him to the Southern side. Eventually, he resigned his commission and offered his services to the Confederacy. The family was soon living in Richmond, where Josiah was serving as chief of ordnance with the rank of general. His son, known as Willie while a child and W.C. as an adult, spent his early formative years intoxicated with the military romanticism of the rebellion. He never stopped wanting to be a soldier or wishing that the rebels had won.

When the war ended, the family settled in Brierfield, Alabama, where Josiah Gorgas invested his small remaining capital in a blast furnace. Willie got what schooling was available and was in fact fortunate that his father’s business quickly failed. When the senior Gorgas obtained a position at the University of the South in Sewanee, Tennessee, his son entered as a preparatory student. In 1870, the young Gorgas went as a volunteer to fight a yellow fever epidemic in New Orleans, an experience that started his lifelong interest in the disease. He still wanted to be a soldier, and when he was graduated, his father, who wanted him to study law, reluctantly and unsuccessfully tried to get him an appointment to West Point. Gorgas decided to get into the Army via the medical corps. In 1876, he entered Bellevue Hospital Medical College in New York. Although he had felt no initial call to the profession, he found that medicine fascinated him. After graduation and a year of internship at Bellevue Hospital, he realized his longtime ambition by becoming in June, 1880, a lieutenant in the U.S. Army.

Gorgas was tested both physically and spiritually during his first two decades in the Army. He was stationed at out-of-the-way posts in Texas, North Dakota, and Florida, where, as the only doctor in the area, he worked long hours serving the local civilian population as well as keeping up with his military duties. His small frame and frail appearance belied his toughness, and his devotion to military life never dimmed. He charted his own future course when in 1883, while stationed at Fort Brown, Texas, he violated orders by working with victims of a yellow fever epidemic. Having been exposed, he was kept at the task, and he met his future wife, Marie Doughty; she was the sister of the post commander, whom he treated and with whom, after contracting the disease himself, he convalesced. Gorgas and Doughty were married the next year. His illness not only led him to a bride but also deepened his interest in yellow fever, which he continued to study over the next few years. Gorgas was soon recognized as an expert on the disease, though he was not impressed with the mosquito transmission theory that was gaining more and more attention. Little did the hardworking small-post Army doctor know it, but yellow fever was about to become the center of his life.

Life’s Work

When, in 1898, the Spanish-American War put large numbers of American soldiers into the Caribbean region, the medical corps proved ill-prepared to handle the inevitable outbreaks of tropical disease. Already known for his work with yellow fever, Gorgas was assigned to the yellow fever camp at Siboney, near Havana. His best advice was to burn everything that might have been exposed to victims even buildings. Later in 1898, Major Gorgas was appointed sanitary officer of Havana. The city was littered with sewage and filth and was a pool of yellow fever infection, exporting the disease with trade goods to American ports. Gorgas went to work on the needed cleaning only to find that, contrary to expectations, yellow fever became increasingly common. This was, of course, a result of the arrival of more and more nonimmunes. At first the bitterly disappointed Gorgas seemed headed for failure, but the solution to his problem was at hand.

An American medical commission headed by Walter Reed had come to Cuba to study the problem of yellow fever. With Gorgas as fascinated observer, the Reed Commission combined past discoveries with new experiments to answer the question of transmission. A number of investigators most recently Carlos J. Finlay had suggested mosquitoes as the carrier, but no one had actually been able to show such a transmission. Henry Rose Carter in Mississippi had, however, established that there was a period of development for the germ in the mosquito’s system before it could be passed along. The Reed Commission was able to show conclusively that the mosquito had to bite an infected person within three days of the initial infection and that the mosquito itself was not dangerous for at least ten days. It was also determined that the carrier was the Stegomyia fasciata (now called Aëdes aegypti). This proved the vital information.

Despite the efforts of the Reed Commission, Gorgas remained dubious. The only real test, he believed, was to rid the city of the mosquito and see what happened. Reed agreed but believed that such an extermination was impossible. Gorgas first tried for a vaccine but soon focused his attack on the insect. Studying its habits, he found that it preferred to live in and around human habitations and lay its eggs in fresh water held in artificial containers. It also had a fairly limited range. Dividing the city into zones, Gorgas assigned teams to eliminate or put a film of kerosene on all open water. Windows were screened and houses, especially those where a case of yellow fever had occurred, were fumigated. Civilian objections to such intrusions were gently but firmly put aside. October, 1901, would become the first October in the recorded history of Havana without a case of yellow fever. A happy side effect of the campaign was that malaria cases were reduced by fully three-quarters as well. The surgeon general of the Army recognized Gorgas’s efforts by deciding that he should become the Army expert on tropical diseases. In 1902-1903, he was sent to attend the world conference on tropical medicine in Cairo and to have a look at the antimalaria work done at Suez. He was also promoted to colonel.

These assignments were to help prepare him for a job in the planned construction of a canal across the Isthmus of Panama. The American Medical Association (AMA) lobbied for his appointment to the Canal Commission, headed by Admiral John G. Walker, but he was merely appointed chief sanitary officer. Problems caused by disease had played a substantial part in the failure of the French effort to construct a canal in Panama, and Gorgas believed that he could prevent such problems. Admiral Walker and the other commissioners, however, considered the idea of mosquito transmission of disease foolish and were much more concerned with economy and avoidance of even the appearance of graft than with sanitation. Indeed, the sanitary staff was hopelessly inadequate in number, and its requests for supplies were often denied or reduced to a fraction of the amount requested. Pay scales were set so low that qualified medical personnel were uninterested in the positions.

Gorgas protested as strongly as his sense of military hierarchy and his courtly southern demeanor would allow, but to no avail. During the first yellow fever season, the disease was at low ebb, but Gorgas knew that, as in Havana, the influx of nonimmunes would provide the raw material for an epidemic. In the spring and summer of 1905, the number of cases began to increase rapidly, and official reaction was to blame Gorgas. Fortunately, the AMA sent a physician, Charles A. L. Reed, to investigate and report to Secretary of War William Howard Taft. The report, which was made public, supported Gorgas totally, and in addition to other studies led President Theodore Roosevelt to reorganize the Canal Commission. The new chair, however, Theodore P. Shonts, also rejected the mosquito transmission theory and tried to get rid of Gorgas. Although inclined to agree with Shonts and other doubters, the president sought the advice of several prominent physicians, all of whom maintained that Gorgas was the best person for the job and that mosquito transmission had been proved. Roosevelt ordered that Gorgas be given full support.

Gorgas quickly began to apply the lessons learned in Havana. By November, 1905, he had four thousand men, and although earlier his entire budget had been fifty thousand dollars a year, he was able to order ninety thousand dollars’ worth of window-screen wire alone. Panama City and Colón were fumigated house by house, piped water was supplied to end the need for open household cisterns, and pools of standing water that could not be drained were regularly sprayed with kerosene. By the end of 1905, yellow fever was under control. Other diseases that had threatened, such as cholera and bubonic plague, were gone, and malaria was much reduced. Health care for workers was very good generally, and death rates would have been acceptable in virtually any American city. The arrival in April, 1907, however, of George Washington Goethals as chief engineer, proved a beginning of renewed frustration for Gorgas. Goethals had been given extremely broad powers and used them dictatorially. His efforts at economy, Gorgas feared, would weaken the sanitary effort. The two rarely found common ground personally or professionally, but the sanitary foundation had been laid, and morbidity rates did not increase.

Gorgas’s success in the Panama Canal Zone led to numerous honors. In 1907, he received the Mary Kingsley Medal and in 1908 was elected president of the AMA. He was also granted many honorary degrees. An invitation came in 1913 to consult on the problem of pneumonia among miners in South Africa, and with the canal nearing completion, he received permission to accept. Although his visit was cut short in February, 1914, by his appointment as surgeon general of the Army with promotion to the rank of brigadier general his report proved the basis for a program that improved the miners’ situation significantly.

As surgeon general, Gorgas was responsible for reforms that prepared the Army Medical Corps for World War I. He encouraged doctors to join the service and helped develop the Medical Reserve Corps, which supplied many of the physicians needed when the United States entered the war in 1917. Between the beginning of American participation and the armistice, the number of doctors in the military service increased by more than thirty times its original amount. Sanitation in military camps proved a problem, and at times Gorgas faced strong criticism. He was able to defend himself by pointing out failures to follow basic regulations through ignorance or more often through pressure to enlist and train an army before the British and French were overwhelmed. He also became involved in a controversial political struggle over provision of higher rank for American medical officers and eventually saw the necessary legislation through Congress. On October 3, 1918, Gorgas turned sixty-four, and despite protests from friends and admirers, he had to retire from active duty. He spent the rest of his life working on behalf of the Rockefeller Foundation trying to eliminate the remaining pockets of yellow fever in the world. After getting the program started in South America, he died in London on July 4, 1920, while on a journey that had been intended to take him to West Africa, where yellow fever was still often epidemic. British king George V visited the hospital to bestow on Lieutenant General Gorgas, the only son of a Confederate general officer to achieve a similar rank in the Army, the Order of St. Michael and St. George. It was a high and fitting last honor.

Significance

Two quintessentially American qualities are the hallmarks of Gorgas’s career: practicality and hard work. Although he made none of the basic scientific discoveries needed to end the scourge of yellow fever, when those discoveries were made he took advantage of them. His dogged and eventually successful struggle to get the necessary support for his sanitation program saved thousands of lives among the workforce that built the Panama Canal and was a key factor in making construction possible. He proved that controlling the mosquitoes that spread the disease would prevent epidemics. These lessons, when applied throughout the world, saved countless thousands more.

Gorgas’s work as surgeon general of the Army was also extremely successful. The American Expeditionary Force in World War I suffered almost twice as many combat deaths as deaths from disease. The Army as a whole had fewer than 25 percent more deaths from disease than in battle. While to modern ears the latter may not sound like success, it was unprecedented for its day.

Gentle and soft-spoken, Gorgas was widely admired and often loved. Although a brasher person might have gotten things done in a shorter time, his courtesy made it very difficult to turn him away, and his gentleness masked an iron determination. His achievements helped to establish modern standards of public health, standards that have improved the quality of life in almost every part of the globe.

Bibliography

Crosby, Molly Caldwell. The American Plague: The Untold Story of Yellow Fever, the Epidemic That Shaped Our History. New York: Berkley Books, 2006. This historical account of yellow fever includes information about Walter Reed’s trip to Cuba and Gorgas’s efforts to combat the disease.

Duffy, John. Sword of Pestilence: The New Orleans Yellow Fever Epidemic of 1853. Baton Rouge: Louisiana State University Press, 1966. Although its subject predates Gorgas’s activity, this short book gives an excellent picture of what a yellow fever epidemic meant before modern public health brought the disease under control.

Gibson, John M. Physician to the World: The Life of General William C. Gorgas. Durham, N.C.: Duke University Press, 1950. The most recent and scholarly biography of Gorgas, it contains some anecdotes of dubious authenticity and is flawed by racial and ethnic stereotypes.

Gorgas, Marie D., and Burton J. Hendrick. William Crawford Gorgas: His Life and Work. Garden City, N.Y.: Doubleday, Page, 1924. Written by Gorgas’s daughter, this biography is overly kind to its subject but does contain interesting personal observations.

Gorgas, William Crawford. Sanitation in Panama. New York: D. Appleton, 1915. Gorgas’s own account of his program in the canal effort. While not the easiest of reading, this book is the best source about Gorgas’s ideas while he was working on the canal.

McCullough, David. The Path Between the Seas: The Creation of the Panama Canal, 1870-1914. New York: Simon & Schuster, 1977. Well-written study of the canal with a chapter on Gorgas’s life and the problems of sanitation woven throughout. Excellent background for anyone interested in Gorgas or the canal.

Martin, Franklin H. Fifty Years of Medicine and Surgery. Chicago: Surgical Publications, 1934. A colleague and admirer of Gorgas, Martin supplies the observations of a trained colleague as well as personal commentary.

Pierce, John R., and Jim Writer. Yellow Jack: How Yellow Fever Ravaged America and Walter Reed Discovered Its Deadly Secrets. Hoboken, N.J.: Wiley, 2005. A history of yellow fever, including information about Gorgas’s efforts to eliminate the disease.

Spielman, Andrew, and Michael D’Antonio. Mosquito: A Natural History of Our Most Persistent and Deadly Foe. New York: Hyperion, 2001. A history of the global problems associated with the mosquito, including malaria.

Related Articles in Great Events from History: The Twentieth Century

1901-1940: February 4, 1901: Reed Reports That Mosquitoes Transmit Yellow Fever; November 18, 1903: U.S. Acquisition of the Panama Canal Zone; 1904-1905: Gorgas Develops Effective Methods of Mosquito Control; Summer, 1904: Construction Begins on the Panama Canal.