 | CHAPTER XIX Manuscript Draft: Walter Reed: Doctor in Uniform, by Laura Wood, [19—] |  |
19. CHAPTER XIX
The slave trade, fertile source of so much other ill, seems
also to have been responsible for introducing yellow fever into
the Western Hemisphere. The disease was probably carried in slave
ships from the west coast of Africa to the Barbadoes in September,
1864 where it caused thousands of deaths. It raged through the
neighboring islands West Indian islands of St. Christopher and
Guadaloupe, jumped across to Yucatan on the mainland, and then struck
disastrously, probably in the summer of 19 1649, in Havana, Cuba.
This was the end of its first eruption in the New World; but the
disease had established itself. For the next two and a half cen-
turies it was to be a major affliction.
201.
It was called by different names in different places -
American plague, malignant infectious fever, Barbadoes distemper,
coup-de-barre (blow of a rod), yellow fever -and it was e-
qually dreaded in all. In some epidemics as many as eighty-five
out of every hundred victims died. One attack, happily, usually
produced immunity.
Its onset came with chills and headache. Severe pains
in the back and arms and legs (hence coup de barre) followed, with
high fever, nausea and vomiting. This feverish stage might last
a few hours, or several days, and was sometimes accompanied by the
jaundice that gave the disease its name. Next came the “stage of
calm,” during which the severity of the symptoms subsided and the
fever dropped. In mild cases the patient was then on the mend;
in more severe ones “febrile reaction” set in. The fever again
mounted, the aching in back and limbs became acute, jaun-
dice was pronounced. Bleeding from the kidneys and gums sometimes
occurred, and blood vessels occasionally broke into the skin. The
most dreaded symptom of all was the “black vomit,” the ejection
of blood released into the stomach by the breaking of its blood
vessels. When a yellow fever patient had the black vomit, his
chance of recovery was slight indeed.
Yellow fever scourged our coast from the Rio Grande to
Nantucket for more than two centuries, but did its most frequent,
fatal work in the southern ports. One authority tells us that
there were ninety epidemics in the United States from the time
of the first proven outbreak at Boston, in 1668, until its con-
trol at the beginning of the twentieth century; another, that
in the hundred years between 1798 and 1898 there were three hun-
dred thousand cases and eighty thousand deaths.
202.
One of the worst of the early outbreaks took place in Philadelphia
in the summer of 1793. The roads were packed with fleeing refu-
gees, many of whom were turned away from neighboring cities and
left to wander and starve in the countryside. Over the city a
heavy silence rested, broken by the rattle of the dead-wagons col-
lecting corpses. They were buried, without service or ceremony,
in shallow graves dug by the Negroes who carted them away. The
living shunned each other and abandoned their dearest and closest
connections at the first symptom. Dr. Benjamin Rush, one of the
foremost doctors in the city and a signer of the Declaration of
Independence, prescribed for a time for more than a hundred and
fifty patients a day, had no time to eat or sleep or rest, and
later recalled, with grief, that he in passing through the streets
he sometimes had to whip up his horse to escape the desperate dcries
of people imploring help. Whole families were erased, and the un-
tended sick lay in the same room with the decomposing dead until
they died themselves. The life of the entire community was halted
by the plague. At the sight of a man cutting wood, early,
in October, for the coming winter, Rush was struck with surprise.
“I should as soon have thought of making provision for a dinner on
the first day of the year 1800,” he said. By the time the pesti-
lence was over, in December, it had killed more than four thousand
people, one tenth of the whole population. “Moschetoes (the usu-
al attendants of a sickly season) were uncommonly numerous,” Dr.
Rush innocently observed.
In the epidemic at Memphis in 1878 more than half the
population fled, and those that remained died faster than they
could be buried. The police force was reduced by the disease
from forty-seven to seven, and the replacements could not keep
203.
prostrated city, and many of them died by the disaster from which
they had expected to profit. It has been estimated that the total
cost, in loss of trade and money paid out, of the 1878 epidemic,
which was widespread in the South, was about a hundred million dol-
lars. There is, of course, no measure of the cost in human grief
and suffering.
The worst of it was that, at the end of that epidemic,
little more was known about the cause of yellow fever than had been
known at the time of the great Philadelphia pestilence. Then some
thought the disease was contagious -that is, could be passed from
a sick person to a well one by contact; others thought it was not
contagious, but was spread through the air by poisonous vapors
arising from decaying vegetable and animal matter.
In 1804 a determined University of Pennsylvania medical
student named Stubbins Ffirth tried to settle the question. He
swallowed pills made of fresh balck vomit, inserted small quan-
tities of it into cuts in his arms and legs, and injected blood
serum from a yellow fever patient into his own blood stream. These
courageous and drastic experiments were negative. He did not con-
tract the disease. We know now, however, that he missed it by a
hair. Had he taken blood from a patient in the first three days
of illness, he would -unless he himself was immune -surely have
been rewarded with yellow fever. In any case, his experiments
convinced him that it could not be transmitted by contact, that
it was not contagious.
As doctors observed more epidemics and noticed how the
people in intimate contact with the sick and their soiled clothes
204.
fell into disrepute. We know now that Stubbins Ffirth and those
who agreed with him were right; yellow fever is not spread by con-
tact. But they still could not explain how it was spread.
Some accurate observations had, however, been made about
it. It had been remarked, not only by Dr. Rush, that mosquitoes
were numerous when yellow fever was epidemic. It was known, too,
that epidemics always ended with the coming of cool weather. Tho-
mas Jefferson, and others before and after him, had noticed that
the malady was “generalted near the waterside, under warm climates,”
and seemed “pretty exactly circumscribed.” It was realized, also,
that it was not a filth disease, since rich and poor, clean and
squalid neighborhoods were equally victimized.
Doctors kept on making guesses about its cause. Dr. J. C.
Nott of Mobile, Alabama, in 1848 suggested that insects might car-
ry it, and was hooted by his professional brethren. By the late
1870's theories far more fantastic than Doctor Nott's were serious-
ly discussed.
But in more serious scientific circles the idea was gaining
ground that it was due to a specific germ: and it was but a step
to the conclusion that the germ was carried in fomites -black
vomit and other emanations of the sick, and articles soiled by them.
Thus the contagion theory, in new scientific trappings, was well
established again by the end of the 1878 epidemic. Stubbins Ffirth's
experiments were forgotten. That fomites spread yellow fever was
something that “everybody knew.”
For twenty years this belief was generally accepted -twen-
ty years in which the bedding and furniture of sick rooms were burned,
baggage and wearing apparel of people traveling from a yellow fe-
205.
ground, millions of dollars worth of property destroyed -all to
kill the germs thought to be lurking in fomites.
For twenty years, too, Dr. Carlos Finlay of Havana kept in-
sisting that yellow fever was spread by the bite of a certain mos-
quito, the female of Culex fasciatus, now called Aedes aegypti.
Everyone laughed at him indulgently: he was a nice old gentleman,
but tiresome about his ridiculous theory. He was known as the
“mosquito man.”
* * *
Surgeon General Sternberg was this country's leading
authority on yellow fever. It was his most ardent ambition to
identify its germ and to discover how the plague spread. He had
an old score to settle with it: it had almost killed him in 1875
at Pensacola, Florida. He had spent fourteen years, from 1879
until he became Surgeon General, searching for the germ in the
blood -most expert opinion held that it must live in the blood
stream -as well as in tissues and the intestinal tract.
Serving on the Havana Yellow Fever Commission in 1879, he
had become a close friend of Dr. Finlay's. Even his friendship and
respect for the Cuban doctor, however, did not incline
him to take seriously the mosquito theory, when Finlay announced
it on February 18th, 1881, before the International Sanitary Con-
ference of Washington, and again the next August before the Havana
Academy of Medicine. Sternberg persistently pursued yellow fever
in Brazil, Mexico, Cuba and the United States, and examined and
exploded every assertionclaim that the specific agent had at last been
cornered. He finally concluded that the only remaining competitor
206.
called bacillus x. He was not sure of bacillus x, since repeated
inoculations with it had failed to produce the disease in any lab-
oratory animal, but he regarded it as a possibility. What he was
sure of, however, was that yellow fever investigation had gone
as far as it could until experiments could be done on human beings.
When the Italian scientist, Sanarelli Giuseppe Sanarelli,
electrified the medical world by in 1897 by announcing that he
had identified the bacillus causing yellow fever, Sternberg was
skeptical. He did not see how a germ which was easily seen under
a microscope and grown in ordinary cultures could have escaped him
for years. He obtained some of Sanarelli's germ, bacillus icter-
oides, and toward the end of 1897 set Reed and Carroll to work on
the problem. Off and on for eighteen months, as their other work
permitted, they studied the new germ and experimented with it.
Early in 1899 they published a paper asserting that Sanarelli's
bacillus was not It; it belonged to the group causing hog-cholera,
the disease which Welch and the veterinarian Clement had been
studying while Reed was working in the Hopkins laboratory in the
early 1890's. In the same paper they added that Sternberg's
bacillus x also had no connection with yellow fever.
During the same period Aristides Agramonte, a young con-
tract doctor, on orders from Sternberg was trying to find bacillus
icteroides in the yellow fever cases he autopsied in Cuba during
the war. A Cuban himself and the son of an insurgent general who
had been killed in an earlier war between the island and Spain,
he had been educated in New York City and graduated from the College of
Physicians and Surgeons in 1892. After several years as a sani-
207.
Health Department, he joined the Army and was put in charge of the
laboratory at Military Hospital Number One in Havana. He not
only failed to find bacillus icteroides in seventy percent of
the cases he autopsied, but also he did find in it many that were
not yellow fever.
/Rom
These findings might have disposed of Sanarelli's claim
but for two things: the Italian he asserted that Reed's and Carroll's results
were due to faulty work and prejudice; and two doctors of the
United States Marine Hospital Service (now the Public Health Ser-
vice) said that they have had found bacillus icteroides in almost
every yellow fever victim they had autopsied in the past two years.
Bacillus icteroides remained a strong contender for the unsavory
honor of being the yellow fever agent. Interest in it was very
keen throughout the medical profession.
/Roman
Rom/
The issue, obviously, had to be settled one way or an-
other. And for that matter, Sternberg thought impatiently, it was
about time that something was done to solve the whole question
of yellow fever. There had to be an answer somewhere. How would
it be, he wondered, to appoint a commission to go into the whole
matter thoroughly?
* * *
RReed, standing with his legs apart to brace himself
against the slight motion of the anchored ship, looked curiously
at the little pill before he swallowed it. If it was as good as
it was supposed to be, he would go to bed in Tampa harbor, and
wake up next morning with most of the trip to Havana behind him -
and never a touch of seasickness. He popped it into his mouth,
washed it down with a gulp of water, wiped his mustache on his
208.
He woke up in the morning feeling fine. He lay in the nar-
row bunk for a minute, enjoying the unusual sensation of not be-
ing seasick and admiring the bar of sunlight that came through
the porthole. As he got up a doubt assailed him. He couldn't
feel any engine vibration and, unless he had overslept, they could
hardly be in Havana harbor already. He opened the cabin door and
looked out. A seaman was mopping the floor.
“Where are we?” Reed inquired.
“In Tampa, sir,” the sailor told him. “The sea was so
heavy last night we didn't leave port.”
Reed closed the door unhappily. He was sick for the whole
trip.
* * *
General Leonard Wood, the handsome, energetic military
governor of Cuba, was making everyone work so hard that the Cu-
bans were poking good-natured fun at him with a rueful rhyme.
Or smoke or scratch your ear.
Go work while the stars are lit!
Come home when night is near.
Write till the ink runs dry!
The man who works for Wood
Is the man who wants to die!”
But they liked him, too. Taxes were honestly collected,
justice was more properly administered, prisons were reformed,
the insane had been collected out of cellars and jails and placed
209.
was straightening out and municipal self-government was being
started. The island's cities, which had been in a shocking state
of filth and ruin, were being systematically cleaned up.
Reed's mission on this trip in March, 1900, was to report on
a disinfectant which was manufactured locally and used to flush the
city streets. While he conducted his investigation, he lived at
Camp Columbia.
Camp Columbia, where the Seventh Cavalry was stationed, was
near Quemados, a suburb some half dozen miles west of Havana. The
flat ground of the camp, almost unbroken by trees or shrubs, sloped
gradually to the sea. It was healthful, well drained and swept by
the wind. Except during mid-daymidday, when the sun beat directly on
the unshaded wood buildings, it was pleasantly cool.
The post hospital, a group of frame buildings, stood by it-
self at the south end of the grounds. Its buildings included wards,
offices, barracks for the Hospital Corps, quarters for the non-
commissioned officers, nurses' quarters and small houses for the
medical officers who had brought their families with them to Cuba.
It was in the long, one story bungalow, with a wide veranda on all
sides, which provided quarters for the bachelor medical officers,
that Reed stayed.
It took him only a short time to decided that he did not
think much of the new disinfectant. But he enjoyed the camp, the
excellent mess at the bachelors' quarters, and the friendly, inter-
esting group of young men. Among them was First Lieutenant Truby,
Albert E. Truby, clean-shaven, round-faced, smiling, whom he had
examined for a commission in the Medical Corps two years before
and of whom he had since grown very fond. His friend Kean, Chief
210.
Lee's headquarters in nearby Marianao, and another doctor, Jesse
W. Lazear, in whom Reed took great interest, was in charge of the
laboratory at Camp Columbia.
A handsome young man with a heavy, close-cropped dark beard,
Lazear was a thoroughly trained bacteriologist. Born in Balti-
more in 1866, he had been educated at Washington and Jefferson
College and at Johns Hopkins University. After taking his medical
degree at the College of Physicians and Surgeons in the same class
as Agramonte, he had spent most of his time in research, and was
a bacteriologist at Johns Hopkins Hospital when he joined the
Army as a contract doctor. He was an authority on malaria, which
had recently been proved to be spread by mosquitoes, and especially
interested in mosquitoes as carriers of disease. Reed, won by
his personal charm and his intelligence, spent much time with him
in the laboratory where, as a matter of diagnostic routine, La-
zear did blood tests of all fever cases.
In the warm, bright evenings after dinner, the young doc-
tors, dressed in fresh white uniforms, sat on the veranda
of the officers' quarters and talked to Reed. They had at first
been inclined to be a little stiff and diffident with the major -
the gap is wide between the rank of lieutenant and major -but
his sparkling good-humor and genial manner had put them completely
at ease. Kean, Agramonte and others of Reed's friends would come
to see him and all of them would sit long after the tropical dark-
ness had fall closed down, talking about their work and especially
about yellow fever, in which Reed's interest was tireless.
“It's a fascinating problem,” he observed one night,
211.
credited all the mistaken ideas before Sanarelli's; and we're
pretty sure, from the work done in our laboratory and in Washington, and
by Agramonte here, that Sanarelli's wrong. The field is clear, now,
for the definitive piece of work.”
“It's clear,” Lazear concurred, “and the relation of
mosquitoes to malaria may be the clue to follow.”
Reed looked dubious. All the best authorities -except
nice, stubborn, old Finlay -said yellow fever was spread by fo-
mites, and he believed them.
* * *
On May 23rd, 1900, in Washington, Reed and the Surgeon
General had a long talk.
“Then we understand each other on every point, Major?”
Sternberg, seated behind his big desk, concluded.
“Perfectly, I think, General,” Reed told him.
Sternberg scribbled a memorandum in his sprawling hand-
writing. “I'll ask the Adjutant General to issue the order today,”
he promised. “You, Carroll, Agramonte and Lazear. How I wish I
could be on the board with you!” He sighed. “For twenty years
it's been my dearest hope to lick yellow fever.”
“If you hadn't done all the necessary preliminary work so
thoroughly,” Reed reminded him, “we would have to start 'way back
from scratch. It might add several years to our work.”
“That's some little comfort,” Stermberg admitted. “Now,
when the AG's order comes through, I'll give you written instruc-
tions. General ones. Needless to say, some of the things we've
discussed won't be covered. If the anti-vivisectionists got hold
of the news that we were prepared even for human experimentation,
212.
would plenty of others, especially doctors.”
Reed said gravely, “We'll be prepared to experiment on hu-
man beings, provided they give their full consent. But it's a
terrible responsibility, General, to take a man's life in your
hands and run a deliberate risk with it.”
“It is indeed, Major, But it's a responsibility which we
shall all share. And I know no man more fit by nature and training
to assume it than you.”
“One more thing, General. This mosquito theory of Finlay's -
do you take any stock at all in it?”
Sternberg smiled. “Major Reed, you know I'm devoted to Fin-
lay. He's a fine old man, and an expert on yellow fever treatment.
But frankly, I think you'll be wasting your time if you investi-
gate the mosquito possibility.”
“I'm inclined to agree with you. Still, maybe we'd better
look into it sometime, just to leave no stone unturned.” Reed
stood up. “I'll expect the order, then, appointing the commission
immediately.”
“Tomorrow.” Sternberg accompanied his colleague to the door
and shock hands cordially, “And, Major...”
“Yes, General?”
“The very best of luck!”
* * *
On May 24th, 1900, the Adjutant General issued the order
creating a board of medical officers composed of Major Walter Reed
and Acting Assistant Surgeons James Carroll, Aristides Agramonte
and Jesse W. Lazear “to meet at Camp Columbia, Quemados, Cuba,
for the purpose of pursuing scientific investigations with refer-
213.
And the Surgeon General wrote, “You will naturally give special
attention to questions relating to the etiology [the bacterial
cause] and prevention of yellow fever. As you are familiar with
what has already been done by other bacteriologists in this field
of investigation, I do not consider it necessary to give you any
suggestions or detailed instructions.”
These papers were the death warrant of epidemic yellow
fever in the Western Hemisphere.
214.
| CHAPTER XIX Manuscript Draft: Walter Reed: Doctor in Uniform, by Laura Wood, [19—] | |