[ Pobierz całość w formacie PDF ]
.is to be regarded merely as anentering wedge toward a larger and more permanent service in the medical field.It willlead inevitably to the consideration of the whole question of medical education, theorganization of systems of public health and the training of men for the public healthservice.[T]he South American people have come to know us mainly as a peopleinterested in our own business advancement.Such service as the Foundation has torender will tend to counteract the effect of the purely mercenary spirit and to establisha basis of real cooperation.41Hookworm control, so important in engaging the participation of govern-ments across the tropical belt and in securing John D.Rockefeller s own inter-est in public health was far from a pressing international health priority in anera when infant mortality rates soared as high as 500 deaths/1000 live births,and a range of infectious diseases raged.But it was hookworm that paved the wayfor the broader ends of Rockefeller philanthropy at home and abroad.Hookworm was the first and in many ways the ideal Rockefeller diseasecampaign, but it was not the only disease pursued by the IHB.Beginning in 1915, a match made i n heaven? 27the IHB was involved in several small malaria studies in Arkansas and Mississippithat evaluated the effectiveness of quinine medication and mosquito controlmeasures such as window screens and swamp draining.With the adoption ofParis green as mosquito larvicide in the early 1920s, IHB malaria programsquickly expanded throughout the U.S.South and to Puerto Rico, CentralAmerica, Brazil, the Philippines, Palestine, and elsewhere, by this time focusingalmost exclusively on mosquito control.42 These efforts emphasized field resea-rch and training activities, with large-scale disease control measures in thebackground.43Two campaign locales served as dramatic exceptions to this characterization.In Italy, the IHB (then IHD) joined pre-existing malaria control efforts in the1920s and early 1930s.44 After World War II, the RF returned to Sardinia withthe United Nations Relief and Rehabilitation Administration to organize anantimalaria army of thousands of Sardinians to literally soak their island withthe new insecticide DDT, effectively eradicating malaria (and communist polit-ical power) but not the Anopheles mosquito.45 A similarly militaristic effort tookplace in Northeastern Brazil in 1939 41 where Dr.Frederick Soper fameddirector of the IHD s yellow fever operations in Brazil, subsequently head of thePASB, and proponent of the WHO s Global Malaria Eradication campaignjoined with national authorities to eradicate the Anopheles gambiae mosquitowhich had been introduced from West Africa.46 The extreme difficulties in ful-filling Soper s dream of species eradication through larvicides and insecticides(other than on islands and in places where particular mosquito species werenewly resident) revealed the limitations of the RF s technical approach tomalaria.47By far the most visible and costly of the IHB s international health efforts wasits campaign against yellow fever, begun at almost the same time as the malariaeffort.A deadly mosquito-borne virus, in its urban form transmitted via thedomestic mosquito vector Aedes aegypti (known at the time as Stegomyia fasciata),yellow fever had paid ominous visits to North and South American ports for hun-dreds of years, killing up to half of its victims typically new migrants, who had48no acquired immunity to the virus from a painful hemorrhagic fever.In1878, Cuban physician Carlos Finlay had proposed that yellow fever was trans-mitted by the Stegomyia vector, a theory confirmed in 1900 in Havana by U.S.Army Surgeon Walter Reed and his associates.49 These findings became the basisfor a massive sanitary campaign by U.S.Colonel William Crawford Gorgas, chiefsanitary officer for the Department of Cuba under U.S.occupation.Gorgasclaimed responsibility for successively ridding occupied Havana and then thePanama Canal construction zone of yellow fever and malaria through fumiga-tion, quarantine, isolation, and demolition.50In 1914, Gorgas, by this time army surgeon-general, convinced Wickliffe Rosethat the soon-to-be opened Panama Canal might facilitate the spread of yellowfever.Gorgas who had contracted yellow fever at a Texas army base early in hisg' 28 a match made i n heaven?g'career believed that eradicating yellow fever would be a most promising taskfor the RF.Regarded as a grave threat to world commerce and offering a chancefor Rockefeller scientists to showcase their expertise internationally, yellow feverserved as an expensive exception to the IHB rule of reasonably priced programswith a ready cure.It was Rose s recognition of the global not just local impli-cations of yellow fever eradication that led to this exception.Rose took up Gorgas s challenge with gusto, innocent of the difficultiesahead.51 Yellow fever s possibilities as a disease campaign were recognizedbeyond medical and commercial quarters.A Harvard archaeologist working insouthern Mexico in the early 1920s shared Rose s enthusiasm, noting that the great glory for [yellow fever s] reduced state belongs to the United States andthat the RF s splendid organization meant that we may confidently await thefinal announcement that yellow fever has been stamped out forever.It will notbe long in coming. 52Initially, the RF had considered that private companies, such as the UnitedFruit Company, might support yellow fever work, which offers an immediateand direct benefit to them.53 Instead the RF decided to keep itself separatefrom U.S.business interests in Latin America once it became clear that an effi-cient campaign could be based on the destruction of mosquito larvae breedingsites.In 1916, the IHB constituted a Yellow Fever Commission headed by Gorgasto make a yellow fever reconnaissance trip through South America.The com-mission included Dr.Henry Rose Carter, who helped to develop the key cen-ters theory, which led the RF to concentrate eradication efforts on cities thatharbored endemic yellow fever, so-called seed beds of the disease.Despite theobservations of Colombian and Brazilian doctors that yellow fever also existed ina sylvan form (known as jungle yellow fever ),54 Carter s theory focused thecommission s travel and subsequent eradication efforts on urban locales sus-pected of being endemic yellow fever loci in Ecuador, Peru, Colombia,Venezuela, and Brazil.Following this criterion, the commission found that onlythe port of Guayaquil, Ecuador harbored yellow fever, and in 1918 after adelay due to the United States entry into World War I the IHB began a two-year disinfection campaign.Notwithstanding requests from both Guayaquil offi-cials and commission observers that the IHB s efforts include the improvementof water supply and sewage, the campaign was aimed solely at mosquito exter-mination.55With equal single-mindedness, the IHB s yellow fever campaign moved on toColombia, Peru, and Central America, as well as to Brazil, where epidemic yel-low fever was initially believed to be more problematic in the north than thesouth.The disease s unexpected reemergence in Rio de Janeiro in the late1920s combined with a new government committed to modernizationresulted in a massive two-decade long RF Brazilian yellow fever campaign thateventually extended into rural areas [ Pobierz całość w formacie PDF ]
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.is to be regarded merely as anentering wedge toward a larger and more permanent service in the medical field.It willlead inevitably to the consideration of the whole question of medical education, theorganization of systems of public health and the training of men for the public healthservice.[T]he South American people have come to know us mainly as a peopleinterested in our own business advancement.Such service as the Foundation has torender will tend to counteract the effect of the purely mercenary spirit and to establisha basis of real cooperation.41Hookworm control, so important in engaging the participation of govern-ments across the tropical belt and in securing John D.Rockefeller s own inter-est in public health was far from a pressing international health priority in anera when infant mortality rates soared as high as 500 deaths/1000 live births,and a range of infectious diseases raged.But it was hookworm that paved the wayfor the broader ends of Rockefeller philanthropy at home and abroad.Hookworm was the first and in many ways the ideal Rockefeller diseasecampaign, but it was not the only disease pursued by the IHB.Beginning in 1915, a match made i n heaven? 27the IHB was involved in several small malaria studies in Arkansas and Mississippithat evaluated the effectiveness of quinine medication and mosquito controlmeasures such as window screens and swamp draining.With the adoption ofParis green as mosquito larvicide in the early 1920s, IHB malaria programsquickly expanded throughout the U.S.South and to Puerto Rico, CentralAmerica, Brazil, the Philippines, Palestine, and elsewhere, by this time focusingalmost exclusively on mosquito control.42 These efforts emphasized field resea-rch and training activities, with large-scale disease control measures in thebackground.43Two campaign locales served as dramatic exceptions to this characterization.In Italy, the IHB (then IHD) joined pre-existing malaria control efforts in the1920s and early 1930s.44 After World War II, the RF returned to Sardinia withthe United Nations Relief and Rehabilitation Administration to organize anantimalaria army of thousands of Sardinians to literally soak their island withthe new insecticide DDT, effectively eradicating malaria (and communist polit-ical power) but not the Anopheles mosquito.45 A similarly militaristic effort tookplace in Northeastern Brazil in 1939 41 where Dr.Frederick Soper fameddirector of the IHD s yellow fever operations in Brazil, subsequently head of thePASB, and proponent of the WHO s Global Malaria Eradication campaignjoined with national authorities to eradicate the Anopheles gambiae mosquitowhich had been introduced from West Africa.46 The extreme difficulties in ful-filling Soper s dream of species eradication through larvicides and insecticides(other than on islands and in places where particular mosquito species werenewly resident) revealed the limitations of the RF s technical approach tomalaria.47By far the most visible and costly of the IHB s international health efforts wasits campaign against yellow fever, begun at almost the same time as the malariaeffort.A deadly mosquito-borne virus, in its urban form transmitted via thedomestic mosquito vector Aedes aegypti (known at the time as Stegomyia fasciata),yellow fever had paid ominous visits to North and South American ports for hun-dreds of years, killing up to half of its victims typically new migrants, who had48no acquired immunity to the virus from a painful hemorrhagic fever.In1878, Cuban physician Carlos Finlay had proposed that yellow fever was trans-mitted by the Stegomyia vector, a theory confirmed in 1900 in Havana by U.S.Army Surgeon Walter Reed and his associates.49 These findings became the basisfor a massive sanitary campaign by U.S.Colonel William Crawford Gorgas, chiefsanitary officer for the Department of Cuba under U.S.occupation.Gorgasclaimed responsibility for successively ridding occupied Havana and then thePanama Canal construction zone of yellow fever and malaria through fumiga-tion, quarantine, isolation, and demolition.50In 1914, Gorgas, by this time army surgeon-general, convinced Wickliffe Rosethat the soon-to-be opened Panama Canal might facilitate the spread of yellowfever.Gorgas who had contracted yellow fever at a Texas army base early in hisg' 28 a match made i n heaven?g'career believed that eradicating yellow fever would be a most promising taskfor the RF.Regarded as a grave threat to world commerce and offering a chancefor Rockefeller scientists to showcase their expertise internationally, yellow feverserved as an expensive exception to the IHB rule of reasonably priced programswith a ready cure.It was Rose s recognition of the global not just local impli-cations of yellow fever eradication that led to this exception.Rose took up Gorgas s challenge with gusto, innocent of the difficultiesahead.51 Yellow fever s possibilities as a disease campaign were recognizedbeyond medical and commercial quarters.A Harvard archaeologist working insouthern Mexico in the early 1920s shared Rose s enthusiasm, noting that the great glory for [yellow fever s] reduced state belongs to the United States andthat the RF s splendid organization meant that we may confidently await thefinal announcement that yellow fever has been stamped out forever.It will notbe long in coming. 52Initially, the RF had considered that private companies, such as the UnitedFruit Company, might support yellow fever work, which offers an immediateand direct benefit to them.53 Instead the RF decided to keep itself separatefrom U.S.business interests in Latin America once it became clear that an effi-cient campaign could be based on the destruction of mosquito larvae breedingsites.In 1916, the IHB constituted a Yellow Fever Commission headed by Gorgasto make a yellow fever reconnaissance trip through South America.The com-mission included Dr.Henry Rose Carter, who helped to develop the key cen-ters theory, which led the RF to concentrate eradication efforts on cities thatharbored endemic yellow fever, so-called seed beds of the disease.Despite theobservations of Colombian and Brazilian doctors that yellow fever also existed ina sylvan form (known as jungle yellow fever ),54 Carter s theory focused thecommission s travel and subsequent eradication efforts on urban locales sus-pected of being endemic yellow fever loci in Ecuador, Peru, Colombia,Venezuela, and Brazil.Following this criterion, the commission found that onlythe port of Guayaquil, Ecuador harbored yellow fever, and in 1918 after adelay due to the United States entry into World War I the IHB began a two-year disinfection campaign.Notwithstanding requests from both Guayaquil offi-cials and commission observers that the IHB s efforts include the improvementof water supply and sewage, the campaign was aimed solely at mosquito exter-mination.55With equal single-mindedness, the IHB s yellow fever campaign moved on toColombia, Peru, and Central America, as well as to Brazil, where epidemic yel-low fever was initially believed to be more problematic in the north than thesouth.The disease s unexpected reemergence in Rio de Janeiro in the late1920s combined with a new government committed to modernizationresulted in a massive two-decade long RF Brazilian yellow fever campaign thateventually extended into rural areas [ Pobierz całość w formacie PDF ]