The Stegomyia fasciata carried yellow fever

For the men leading the Panama Canal project in 1904, challenges of building the canal were exacerbated by the infectious diseases that ran rampant in the hot, wet Panamanian climate. By 1906, more than 85% of the canal workers had been hospitalized. The threat of yellow fever created panic and made the site undesirable and feared by employees. Malaria was no better -- someone who fell ill usually required a stay in the hospital, and recovery did not ensure immunity. During the course of canal construction, tens of thousands of workers fell ill with yellow fever or malaria.

Yellow fever's gruesome symptoms and high death rate were so horrifying to American canal workers that even a whisper of an outbreak sent boatloads of men fleeing. Early symptoms of yellow fever were headaches, fever, and muscle pain. As the disease progressed, however, the patient experienced jaundice, thirst, and a dark black vomit caused by internal hemorrhaging. Ultimately, the disease could lead to kidney failure, delirium, seizures, coma, and often death.

Patients with malaria also experienced chills, headaches, fever, aching, fatigue, and nausea. In the worst cases, malaria caused kidney failure and potentially even coma or death. Unlike survivors of yellow fever, however, malaria survivors were not immune to recurrences of the disease. Malaria's lower fatality rate and frequent reappearance resulted in frequent and expensive hospital stays.

At the time, doctors disagreed on how to stop either yellow fever or malaria; mosquitoes had not yet been accepted as the primary transmitters. Hospitals treated patients with high doses of whiskey, eggnog, or by rubbing a solution of kerosene and oil on the skin. There were mustard baths and ice baths. Quinine, made from the bark of a cinchona tree, was taken as a fever reducer and painkiller, although the bitter-tasting liquid often caused deafness as a side effect. The most common treatment was simply to keep the patient quiet and comfortable, and hope that they survived.A male patient in quarantine

Doctor William Gorgas saw malaria as a bigger threat than yellow fever because of its prevalence not only in the cities and camps, but along the entire Canal Zone. "If we can control malaria, I feel very little anxiety about other diseases, " Gorgas stated. "[And] our mortality is going to be heavy."

Colonel Gorgas arrived in the canal zone in June of 1904 as Chief Medical Officer. A few years earlier, he had read about discoveries linking mosquitoes with malaria while living in Havana, Cuba. Acting on the possibility that the insects could also be the primary transmitters of yellow fever, he successfully eradicated the mosquitoes -- and thus the disease -- from the area in 1901. He was confident he could stop infection in Panama, but he needed the political will and the financial resources to rid nearly 500 square miles of swamp and jungle clear of the disease-carrying mosquitoes.

In the fall of 1904, Gorgas returned to Washington with a $1 million plan to fumigate the isthmus and eradicate the disease. But officials scoffed at Gorgas' high price tag and his mosquito hypothesis, instead adhering to the prevailing "miasma theory" which stipulated that diseases are carried by bad air or toxins in tropical soil.

The following spring, the first significant yellow fever scare hit the canal zone. Quarantining patients in Ancon Hospital did little to slow the rate of disease, and the panic reached a fever pitch as more and more workers fell ill. Chief Engineer John Wallace was powerless to calm his workers and a quarter of the U.S. workforce deserted the project. If the numbers of ill and deserting laborers continued to rise, the project would face significant production delays or worse.

Back in Washington, Alexander Lambert, President Roosevelt's personal physician, appealed to the president. "You are facing one of the greatest decisions of your career," he told him.Sanitizing a field with a mosquito oiler "If you fall back on the old methods you will fail, just as the French failed.  If you back Gorgas you will get your canal."

President Roosevelt granted the funding, and Gorgas unleashed one of the most extensive sanitary campaigns in history. In the summer and fall of 1905, more than 4,000 people worked for Gorgas on his "mosquito brigades" in what would become a yearlong effort to prevent the insects from depositing their eggs. An army of fumigators visited every private home in Panama repeatedly, armed with cleaning agents, insecticide powder, and wire mesh for screen windows and doors. Teams sprayed drains and cesspools with oil and filled in pools of standing water. In all, Gorgas' group used 120 tons of pyrethrum powder, 300 tons of sulfur, 600,000 gallons of oil, 3,000 garbage cans, 4,000 buckets, 1,000 brooms, and 1,200 fumigation pots.

In 1906, of the 26,000 people working on the canal, more than 21,000 had been hospitalized for malaria at some time during their employment. The Sanitation Department at work in GatunBut Gorgas' effort did seem to be working. By August, the monthly tally of new yellow fever cases had fallen by nearly half. In September, there were just seven new cases. On November 11, 1906, the last victim of yellow fever on the Panama Canal died. Malaria would take longer to conquer, but death rates would drop to less than one percent by January of 1910.

The eradication of yellow fever and significant reduction in the number of malaria cases on the isthmus were two of the most revolutionary developments in the Canal Project. Workers no longer feared becoming ill on the job, and tourism began to flourish along the construction route.

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