University of Virginia Library

21. CHAPTER XXI

Reed had been worrying about the typhoid study. Shortly
before he was to have met Vaughan in Atlantic City to write the re-
port, Shakespeare had died. The board had not yet published any-
thing except its recommendations on the Army's sanitary reorganiz-
ation. Reed therefore requested Sternberg to order him back to the
United States so that he and Vaughan could, finally, announce their
conclusions in a formal report. Sternberg did so, and the first
week in August, just after the visit to Finlay, Reed returned to
Washington, traveling on a transport with Truby, who was able to
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cheer him somewhat during his usual seasickness.

The Quemados epidemic was subsiding, so the three remaining
members of the board had to rely on the cases which kept coming into
Las Animas and Military Hospital Number one in Havana. Lazear had
hatched the eggs given them by Finlay and sent some of the mosquitoes
for further information to Dr. L.O. Howard, the insect expert who
was head of the Department of Agriculture's Bureau of Entomology. With
the mosquitoes he kept, and their offspring, he Lazear made almost dai-
ly trips to Las Animas where, accompanied bywith Guiteras or Agramonte
or Carroll, he would go into the yellow fever ward and feed his “birds.”

The technique, which Finlay had worked out, was simple. Each
mosquito was carried in a test tube stoppered with a piece of gauze.
When he was going to feed one, Lazear would turn the test tube upside
down so that the mosquito flew upward, toward its bottom. He would
then pull the stopper and press the open end against a patient's arm
or abdomen. When the mosquito had settled and drawn blood, Lazear
would tap the tube, causing it to fly up again, and replace the gauze.
Each tube was labelled, and Lazear kept careful track of each biting.

Being reluctant to introduce mosquitoes of whose dangerous
powers he was already half convinced among Camp Columbia's fourteen
hundred non-immunes, He kept them at Agramonte's laboratory and
carried them in their test tubes to and from Las Animas, where he
tried to infect them.

Pinto, one of the Camp Columbia doctors, was bitten by these
presumably infected mosquitoes without result. On August 16th La-
zear himself fed one that twelve days earlier had bitten a victim on
the fifth day of his attack. Altogether, nine men volunteered for the
experiment and were bitten. Nothing happened. Finlay was upset -
surely it was the technique of the board, not his precious theory,
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that was at fault. The Cuban doctors, who earlier had watched their
own “mosquito man” try similar experiments, observed the efforts of
the American board with keen, and skeptical, interest. When the
insects failed to produce any infections, it began to look, even
to Lazear, as though the skepticism, rather than the interest, was
justified.

His scruples about taking the mosquitoes to Camp Columbia
dwindled. Apparently they were not dangerous; even if they were,
he could trust the hospital steward assigned to his laboratory, John
Neate, an intelligent and capable man, to take conscientious care of
them.

* * *

It was after lunch on the 27th of August, and Carroll and La-
zear were at work in the Camp Columbia laboratory. Lazear was
preparing the stomach of a mosquito for microscopic study, and
Carroll, at the work bench, was examining a blood culture that he had got
three days earlier in Agramonte's autopsy room. The little rhesus
monkey, which had resisted Agramonte's efforts to infect him, watched
the two scientists with alert and meaningless curiosity and scratched
his head.

“It doesn't seem to be a very fruitful line of investigation,
so far at least, you'll have to admit,” Carroll was remarking.

“It's far from exhausted when we've made only nine
tries,” Lazear argued, scowling into the eye piece of his microscope.

“That's one hundred percent failure,” Carroll observed.

“It is, and it's discouraging,” Lazear admitted. “that re-
minds me -I was in a hurry before lunch and didn't leave my mos-
quitoes at Agramonte's lab. One of them didn't bite at Las Animas -
seemed listless. I'd hate to lose her.” He went over to the
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bench where the mosquitoes, each transferred to a large jar from
the test tube in which shetravelled traveled, were kept.

“Yes. She's looking dopey, all right. Too bad.” He took
his little record book out of his pocket, and sconsulted it. "
“Twelve days ago she bit a case of in its second day. Theyn she
bit four cases again on the 21st and on the 23rd and last time
on the 25th. If there's anything in this theory of Finlay's she
ought to be well loaded with yellow jack after all that.”

Carroll left his microscope and walked over to look at the
ailing insect. “Maybe she is,” he said. “How about trying her
out on me?”

“She may give you yellow fever,” Lazear warned him soberly.

Carroll smiled. “I'm seriously afraid, old man, that
there's not much danger of it. Whatever risk there is, I'm will-
ing to take it.”

The top of the jar was covered with a gauze sleeve closed
by a draw stringdrawstring. Reaching in, Lazear captured the mosquito in
a test tube and brought her out. Carroll rolled up his sleeve
and sat on a high stool, while Lazear held the mouth of the tube
to his arm.

The mosquito clung to the side for a moment, then dropped
onto Carrolls's skin. Lazear, his face intent, watched her and
held the tube steady so as not to disturb her. The mosquito sat
motionless. No one spoke. Neate moverd closer to see, and the
monkey in a sudden frenzy of activity sprang screeching across
his cage. Carroll, perched uncomfortably on the stool, shifted
a little and the mosquito hopped and settled again.

Lazear sighed. “It looks as if she wouldn't bite.”

“Here,” Carroll suggested, “let me hold it a while.”

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Lazear relinquished the tube. Carroll held it a minute.

“Now,” he whispered.

The mosquito, her legs drawn up, had assumed her biting
position and introduced her sting. When she finished, Lazear put
her back in the jar.

“This is going to make a monkey out of you, Lazear,” Car-
roll assured him good-humoredly.

“I almost hope it does,” Lazear answered seriously. “I'd
hate to think I'd given you yellow jack.”

Two afternoons later, Carroll didn't finish the tour of the
Las Animas ward with Lazear and Agramonte. “I'll wait for you on
the porch,” he said. “I'm feeling rather used up today.”

The next evening Lazear telephoned Agramonte. His voice
sounded strained.

“Carroll's sick,” he announced. “He went swimming at the
beach this afternoon, and had a chill when he got back.” He
paused, and added, “He thinks he's got a touch of malaria.”

“Suppose I come out in the morning,” Agramonte suggested,
“and we'll take a look at his blood.”

When Agramonte arrived at the camp he found Carroll in the
laboratory examining his blood for the malaria plasmodium. He
did not find it. His friends made him go to bed in the officers'
quarters. Two days later he was carried off to the yellow fever
ward, feebly insisting that he must have picked up his yellow jack
in Agramonte's dead room or the Las Animas ward.

Neither Agramonte nor Lazear doubted that Carroll's attack
was due to the mosquito bite. Agramonte was almost bowled over.

“Lazear,” he exclaimed solemnly, “do you realize what
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this means? You, you, have produced the first case of yellow fe-
ver experimentally, by the bite of a mosquito! It's momentous!”

Lazear was distraught. Maybe he had produced the first case
of experimental yellow fever on record, but maybe he had killed
his colleague doing it!

“He offered to feed it,” he exclaimed repeatedly. “It
was his own idea. He even held the test tube himself!
How can I forgive myself if he doesn't get well!”

Agramonte tried to comfort him. “Take it easy, old man.
Ames will bring him through.” He hoped his words didn't sound
hollow. Carroll, rather frail at best, was dangerously sick, and
yellow fever went hard with a man past forty. They were both get-
ting a new idea of what it meant to assume the terrible respon-
sibility of taking chances with another man's life.

But when the next opportunity for human experimentation
came, Lazear did not shirk it, even though the outcome of
Carroll's illness was still doubtful.

* * *

On the morning of August 31st, Private William H. Dean of
the Seventh Cavalry strolled, with nothing much on his mind, past
the laboratory. He saw the bearded doctor, the nice young one,
standing in the doorway, trying to persuade a mosquito to go from
one test tube to another.

Dean saluted. “You still fooling with mosquitoes, sir?”
he asked. It was certainly funny, he thought, the things grown
men did for a living.

Lazear admitted he was. Learning that Dean had not been
outside the camp or exposed to any infection for many days, he
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explained the risk to him fully and asked if he would take a bite.
Dean said he wouldn't mind.

“This is serious, you understand, Dean,” Lazear warned. “This
one here,” he showed the young man the mosquito sitting innocently
on the side of its jar, “I truly believed almost killed Dr. Carroll,
and can do as much -or more -for you.”

“That's all right, sir,” Dean was skeptical. “I'm not afraid
of any little old gnat. Put him on me.”

“Her,” Lazear corrected him mechanically, as he reached in the
jar and captured the mosquito. He applied that insect and three
others to the doubting cavalryman's arm.

Seven days later Dean joined Carroll in the yellow fever ward.

* * *

Reed ran up the steps of the brick building at Seventh and
B Streets. Beechner, the museum messenger, looked after him as
he strode briskly into his office, and reflected that it was nice
to see the major looking cheerful again -he had seemed so wor-
ried for a while over Dr. Carroll.

The major had reason to feel cheerful. The preliminary ty-
phoid report was finished. Carroll was out of danger and writing
glowing letters about his recovery; convinced by Dean's case,
he was proud, too, that his was the first case of experimental
yellow fever on record. Dean's illness, which seemed almost
certainly due to mosquitoes, was mild and progressing satisfac-
torily. How, if only Lazear would get well fast! It had been
a shock to learn that he had an attack. But he was only thirty-
four, in good health, and under Ame's Ames' excellent care he
should pull out of it easily, Reed thought confidently.

He reached for the stationery and looked at the calendar.
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“September 25th, 1900,” he wrote in his clear, quick hand. “Dear
Kean:.... I am so distressed to hear that Lazear is down with yel-
low fever.... I shall await your next [cable] with much anxiety....
I somehow feel that Lazear will pull through, as he is such a good,
brave fellow.” He frowned and moved impatiently as he wrote on.
“I am so ashamed of myself for being here in a safe country while
my associates have been coming down with Yellow Jack. The
[Surgeon] General has suggested that I do not return, but somehow
I feel that as the senior member of a Board investigating yellow
fever my place is in Cuba....”

“Just how far Carroll's and Lazear's cases go to support
that conclusion [that a mosquito carrieds yellow fever] I don't
know, but hope to find out when I get there. Personally, I feel
that we are on the eve of an important ‘find’.....”

They were, but Lazear did not share it with them. Toward
evening that same day he died.

* * *

Reed arrived at Camp Columbia about noon on October 4th.
This time the greetings on the veranda of the officers' quarters
were subdued. The shadow of Lazear's death was too heavy for any
gaiety. None of the younger men had ever before seen Reed look
so sad and stern. In this tired, face there was no hint of the
quick smile, the kindly humor, that usually made the blue eyes
sparkle.

“You've heard about Lazear,” Truby stated. There was no
need to ask. Truby himself had returned to Cuba just a few days
before his death.

“We touched at Matanzas yesterday,” Reed explained.

Truby nodded. Kean and Havard, the Chief Surgeon of Cuba,
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had gone there on an inspection trip. They, of course, had met
Reed and told him.

“I'd like to see Carroll, first of all, Ames,” Reed re-
quested.

When he rejoined the others on the porch, he looked almost
bewildered.

“I was quite unprepared for Carroll,” he said wearily.
“His letters have been so cheerful, so full of energy -he even
said he'd done an autopsy.”

“We were lucky to save him,” Ames said. “He came within
an inch of goiogng out, and he's still quite shattered. He didn't
want to worry you, Major, with the news that he
wasn't convalescing well, and he's been terribly anxious to
spare his wife anxiety. alarm.”

“We'll have to send him home on sick leave as soon as
he can travel. Now I'd like to have the details of
these cases, particularly poor Lazear's.”

They first suspected Lazear wasn't feeling well, Ames
and Truby told him, when he missed a couple of meals. But he
went about his work and didn't complain until the evening of
September 18th, when he had a chill. Ames, Truby and Pinto had
immediately diagnosed his illness as yellow fever, and had him
carried on a litter to the isolation ward.

“You know what a reticent fellow he was, Major,” Ames
said. “All he'sd say was that he ‘might’ have got it from a mos-
quito. Although now that I come to think of it, he made quite
a point of telling Carroll and Major Gorgas when they visited
him that a mosquito bit him on the hand in the ward at Las Ani-
mas on the 13th. He didn't bother to brush it off because he
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didn't suppose it was a Culex fasciatus, he said; anyway, he
thought he was immune -he was bitten in August, you know, and
nothing happened.”

Reed nodded thoughtfully. It occurred to him that it
was strange that a man as familiar with Culex fasciatus as La-
zear should “suppose” the mosquito was not of that species. Sure-
ly, he would know.

“I want to see all Lazear's records,” he said.

* * *

Reed, going over Lazear's papers, struggled between
depression and elation. Lazear,-dear, brilliant Lazear, the first
man on the board to scent the mosquito clue -was dead; and Car-
roll, his almost indispensable assistant, was too ill now to work
on the probability so strikingly and disastrously revealed.

But the probability was almost a certainty! The secret
of yellow jack was in their grasp, Reed was sure. He was con-
fident now that Culex fasciatus spread the fever. Of course,
Lazear's and Carroll's cases were not conclusive, since both had
repeatedly been exposed to possible infection in the wards and
the autopsy room; but Dean's case was a different story.

He had been outside of Camp Columbia only oncein the
in the last fifty-seven days, and then just for a short horseback
ride toward the shore. It seemed that he could have contracted
the disease only through the mosquitoes that Lazear put on him.
There was no other possible way in which he could have picked
it up.

Sitting at the portable field desk in his two room
suite in the officers' quarters, Reed frowned, puzzled.

“But if a mosquito does carry yellow fever, why didn't
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the first nine experimental bitings produce a single case?” he
wondered. “Certainly not because the volunteers all happened to
be immune; Lazear was one of them -his case settles that.”

Where was the explanation?

Reed searched Lazear's papers for his records of
the bitings. In the little notebook that the dead doctor had al-
ways carried in his military blouse pocket, he found the answer.

Lazear had carefully recorded, in each experiment, how
far along the yellow fever case was when the mosquito fed on it,
and how many days then elapsed until the insect bit a volunteer.
Studying the rows of figures, Reed's well trained mind suddenly
caught at the critical point. There was the answer, staring at
him out of the neat figures written in a dead man's hand! How
obvious, how beautifully simple, it was! Eagerly he checked t
through the figures again, to be sure he had made no mistake.
No, that must be it!

“A yellow fever victim has the active agent of the disease
circulating in his blood stream only in the first two or three
days of his illness! After that, even when he's dying, it's gone,”
he exclaimed aloud, slowly. “And at least twelve days must elapse
between the time the mosquito bites a yellow fever case in its
early stage, and the time it can pass on yellow jack to the next
victoim. I thank God, I believe that this is our answer!”

The nine experiments that had failed had been performed
with mosquitoes that had bitten yellow fever cases at least five
days old, or with insects that had fed on yellow jack less
than twelve days earlier. Finlay's hundred failures, and Lazear's
nine, were explained. Lazear's success with Carroll and Dean, too,
was explained. The mosquito that bit Carroll had fed on a yellow
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fever patient in the second day of his illness; it had bitten
the skeptical doctor twelve days later, and the incredulous
cavalryman four days after that. It had met all the conditions.

What agency spreads yellow fever, and how does it work
was a question two hundred and fifty years old. Walter Reed,
studying Lazear's pocket notebook that October afternoon, hit
on the answer.

“If only,” he thought sadly, “Lazear could be with us
still! But even if he can't share our work any more, at least
he shall always share the credit.”

* * *

There was something curious about the notebook, Reed
noticed: its final entries were incomplete, and they seemed to
indicate that Lazear had himself secretly undergone experimental
bitings. It was not like Lazear, an accurate scientist, to keep
incomplete records; nor, for that matter, was it like an accur-
ate scientist, who knew the danger involved, to allow himself
to be bitten by an unidentified mosquito. How account for these
two strangely unscientific pieces of carelessness? Reed could
think of only one explanation: both were deliberate.

When he confided his suspicion to Truby and one or two
others, they agreed with him: Lazear, realizing that he had
given Carroll and Dean yellow fever, determined to take the same
risk to which he had subjected them. He must have inoculated
himself secretly; then, ill, he had worried lest his insurance be
forfeited and his wife and two small children left destitute, if
it became known that he had purposely exposed himself to a dan-
gerous disease. He had decided, they guessed, to withhold the
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facts, and had told Gorgas and Carroll about the stray mosquito
so as to lend the fatal experiment the air of accident.

If Lazear wanted his death to appear an accident, an ac-
cident it should appear. They would respect their dead
friend's unspoken wish, and help to protect his family. This bene-
volent conspiracy of silence remained in force for more than forty
years. Not until the danger feared by the dying doc-
tor was long past were the facts revealed, even to his family.

* * *

Reed cast aside his usual deliberation and worked like a
whirlwind writing a report of these first yellow fever experi-
ments. He was to leave for the United States October 13th to at-
tend the meeting of the American Public Health Association at In-
dianapolis, where he intended to read it. Before going, he had,
as a formality, to ask the military governor's permission to
leave the island, and Kean offered to drive him into Havana to
see Wood.

“Do you know why I borrowed the general's team and am
going to the city with you?” Kean asked as the carriage, driven by Fitzhugh Lee's fine
horses, rolled along the road.

“No, Kean, why?”

“I have something serious to talk to you about, Reed.”

“What is it?”

“I want to persuade you to ask General Wood for a
considerable sum of money to pay the expenses of a series of
yellow fever experiments, and give bonuses to volunteers. That
way I believe you can get a number of Spanish immigrants to of-
fer themselves, especially since they almost always expect an
attack when they come to Cuba.”

242.

Reed wouldn't commit himself, and all the way to General
Wood's office Kean wondered what he would do.

Wood's greeting was cordial. Reed received permission to
leave the following day for the United States. Then he said,
“General, I have something else I want to discuss with you.”

The two officers moved into the window embrasure which
looked over the plaza and the blue harbor, flanked on the one side
by Morro Castle and on the other by La Fuerze, forts harmless with
antiquity.

Kean, silently watching, caught the quick sense of a histor-
ic moment. This informal meeting in the old Governor's Palace
between the Army doctor and the military governor could change
the medical history of the world, the course of
millions of lives. Reed, slender and animated, confronted the
massive Wood and told him, with the irresistible clarity already
familiar to his former pupil, about the three yellow fever
cases. Wood's cool blue eyes did not shift, nor his expression
change, as he listened. Reed, his eyes sprakling with enthusi-
asm, summed up the evidence. He paused a moment, and said very
earnestly,

“General Wood, will you give me ten thousand dollars to
continue and complete these experiments? I know we have the
answer, but we must have conclusive proof.”

Wood's answer was unhesitating. “I have this morning
signed a warrant for that amount to aid the police in the capture
of criminals. Surely this work is of more importance to Cuba
than the catching of a few thieves. I will give you ten thousand
dollars. If that isn't enough, I will give you ten thousand more.”

Reed and Kean, toasting their success in a bottle of claret
243.

at lunch, congratulated each other that the military governor was
also a medical man who could appreciate the vast implications of
the proposed experiments.

Two days later, on October 15th, Kean issued a circular
for the departments of Havana and Pinar del Rio, of which he was
chief surgeon, stating that it was now believed that mosquitoes
spread yellow fever and directing that their breeding places be
eliminated.

“Major Kean, I'm a little worried,” General Lee told him
confidentially. He was a short, fat man with a little goatee.
He had known Kean's father well, and was devoted to the son.
“This nothingnotion of Reed's about mosquitoes -I hope you won't iden-
tify yourself with it. If you'd seen as many yellow fever
theories come and go as I have,” he shook his head, “you'd hesi-
tate a long time before you'd commit yourself. If it blows up
under you, it can damage your professional standing badly.”

“General Lee,” Kean assured him, “I'm willing to risk
all the professional standing I may ever have on the theory that
the mosquito is the villain!”

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