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Before the 20^th century, the tropics were widely feared as home to dread diseases such as yellow fever and malaria. Building the Panama Canal helped change that view, but the brighter perception didn’t fully match the grittier truth.

The U.S. construction of the canal, between 1904 and 1914, was seen as a triumph of engineering and an opening for global maritime commerce.

But the completion of the canal was also “a watershed episode in thinking about the tropics,” argues Paul Sutter, associate professor of history at the University of ŷ���ڱ���Ƶ Boulder.

The episode was no simple parable of human accomplishment, Sutter contends. Though U.S. officials eliminated yellow fever and reduced the incidence of malaria among canal workers, their focus on these so-called tropical diseases obscured other public health problems, particularly among black West Indian workers who experienced high rates of pneumonia and tuberculosis, which were the number-one killers during U.S. construction era.

Sutter writes: “By 1915, the Americans could claim that they had ‘pulled the teeth of the tropics’—that they had made a small zone on the Panamanian isthmus as healthy as most of the temperate United States; but their achievement was less a universal public-health breakthrough than it was an object lesson in how to make tropical imperial administration healthy for white outsiders.”

Sutter has been researching the Panama Canal project for years. Now, he has won a three-year $146,886 grant for Scholarly Works in Biomedicine and Health from the National Institutes of Health.

His project (and forthcoming book) is titled “Pulling the Teeth of the Tropics: An Environmental and Public Health History of the Panama Canal – 2011-2014.”

It is unusual for a historian’s work to be supported by an agency that usually funds basic medical research. “Grants from NIH for humanists are as rare as hen’s teeth,” notes Susan Kent, professor of history and chair of ŷ���ڱ���Ƶ-Boulder’s history department.

But Sutter’s work aims to provide a fuller understanding of a pivotal episode in medical history. As Sutter notes, the French had attempted to build a canal in Panama in the late 19^th century and had lost more than 20,000 workers to disease, mostly malaria and yellow fever.

The French attempt was privately financed, but the American effort was federally funded—the largest public-works project undertaken to that date.  And the lessons of the French effort were clearly on the minds of the Americans.

Though perilous, Panama was strategically and economically important.

Yellow fever, in particular, was “clinically gruesome.” For instance, in the latter stages of the disease, victims vomited coagulated blood, also known as “vomito negro.”  Yellow fever didn’t just kill people, Sutter adds; it killed them in an “incendiary way.”

“The Americans had to get rid of yellow fever, because it was much scarier than the other public health challenges on the Isthmus,” Sutter says. It had undermined French support for their canal effort, and it promised to do the same for the American effort if it weren’t controlled.

Fortunately, the Americans benefited from new medical knowledge. Historically, humans saw tropical diseases as miasmic in origin, as products of the tropical environment. But in the late 1800s, humans learned that mosquitoes spread malaria and yellow fever, which made their public health interventions much more effective.

Before these discoveries, people thought soil harbored the disease, which might be released when soil was disturbed. Sutter notes that idea was “wrong but strangely accurate in some ways.”

Americans officials attempted to control both of these diseases by minimizing the breeding of vector mosquitoes.  Even as they recognized and confronted mosquitoes with oil, insecticides, improved sanitation and other measures, they nonetheless still ascribed these diseases to natural conditions on the Isthmus.  Most weren’t fully aware of the human contribution to mosquito populations.  But a select group of scientists and sanitarians came to understand that American canal building, by disturbing the soil to such a degree, “created ideal breeding conditions for mosquitoes.”

“Americans passed off as diseases of nature what were in fact diseases that they had a strong hand in creating,” Sutter notes.

Once the Americans controlled yellow fever, which they did fairly quickly, workers streamed into Panama. But laborers’ health, compensation and working conditions varied widely by race.

A majority of the workers were black West Indians. White American workers composed 10 to 15 percent of the labor force, and the vast majority of workers were non-Americans. More than 4,500 black workers died during U.S. construction—compared to 350 white workers.

“There was a lot of concern and some scandal about whether Americans could take care of their workers, meaning white American workers,” Sutter says.  In the end there was less concern about non-white and non-American workers, as the differential mortality statistics suggest.

Many Americans of the time assumed that so-called tropical peoples were immune to tropical diseases and well-suited to working in tropical conditions.  So Sutter’s history is also about the relationship between ideas of race and medical inequality.

Sutter says “Pulling the Teeth of the Tropics” will provide the only book-length treatment of one of the most formative and influential moments in the history of U.S. public-health administration.

As an interpretative history that assesses both the benefits and the inequities produced by a massive public-health intervention in the developing world, Sutter’s book will provide a model for thinking critically about, and applying the lessons of history to, similar governmental and non-governmental interventions today.

Sutter hopes to complete the manuscript by 2014, when the Panama Canal will celebrate the centennial of its opening and when a new, wider set of locks is scheduled to be completed.

Sutter says that he will emphasize the major strides made during the canal’s initial construction, but his will also be a critical history of what was often a self-serving public health intervention in Panama. “When you just get triumphalist about a story like this, you miss some of the most important details.”

Kent said the Sutter is part of a team of first-rate Western and environmental history. That team includes historians Phoebe Young along with newly hired scholars Thomas Andrews of ŷ���ڱ���Ƶ-Denver and Elizabeth “Lil” Fenn of Duke University. Calling the team a “powerhouse,” Kent adds:

“It’s an extraordinary line-up, and enables us to position ourselves as one of the premier institutions in America for the study of environmental and Western/borderlands history.”