1.In 1916, when the survey by the Rockefeller Foundation was made, Guayaquil was the key to the yellow fever situation of the West Coast of South America. It was a permanent endemic focus, from time to time infecting the coast both north and south of itself.
The elimination of yellow fever from Guayaquil at this time would have eliminated it from this entire coast and probably in perpetuity. It was therefore planned.
2.This was postponed on account of the war and before it was accomplished yellow fever had been introduced (in early 1919) from Guayaquil into northern Peru, where it spread rather widely during that year and the next, threatening both to reinfect Guayaquil, now free of it, and to spread into the populous districts to the south where there was a good chance of its forming a more or less permanent focus.
3.In the campaign against this epidemic the ultimate dependence was exclusively on the control of Stegomyia by elimination of their breeding places, isolation of the sick and fumigation of infected premises being disregarded.
4.This was pressed only at certain places of strategic importance, key places, and little attention paid to outbreaks elsewhere. The prime object was to prevent further extension of infection rather than the elimination of that already existing, except as a means to prevent extension.
5.It was urged that the same measures—Stegomyia control—be extended to healthy places in the south exposed to infection, key places, so as to render them incapable of propagating yellow fever should it be introduced.
This was not done efficiently, reliance being placed on a military Cordon Sanitaire and the natural defence furnished by a waterless desert about 60 miles wide to the south.
6.Yellow fever was eliminated from the northern department, where the above campaign was undertaken, the last (doubtful) cases occurring in September, but passed the Cordon Sanitaire and was found in epidemic form in Janurary, 1920, well to the south, where it had been some months.
7.General outline of plan of campaign for 1921, now being carried on by Hanson.
8.Importance of this work: It should free the entire Pacific coast of South America from yellow fever—and permanently.