University of Virginia Library

23. CHAPTER XXIII

Kissinger and the three Spaniards had proved that mosqui-
toes carried yellow fever. Cooke and the six other volunteers
had proved that fomites did not. Moran, now happily well, and the
two non-immune controls had shown that a house was infected with
the fever only when it contained loaded yellow fever mosquitoes.

With all that accomplished, Reed thought thankfully, the
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end of the experiments was in sight. Next they would inject the
blood of a yellow fever patient into non-immunes to prove that the
parasite was in the blood, and to find out if passage through the
mosquito was necessary to its development. Then they would see how
long a loaded mosquito kept the ability to spread
yellow jack by continuing the biting experiments with old
mosquitoes. And finally, he would himself undergo one of these ex-
periments in which he had risked other men's lives.

So far, they had not lost a single one of their five exper-
imental cases, a remarkable achievement in a disease with
as high a death rate as yellow fever. Reed still looked forward to
each experiment with dread, and held his breath over every
one until the patient was well on the mend. If only their perfect
record would hold to the end of this dangerous gamble!

He looked forward longingly to February when his exhausting
work would be over and he could go home. After the Pan-American
Medical Congress in Havana the beginning of the month, at which he
was going to read a paper on the board's work, he would return to
the United States -to Emilie and Blossom, to the beloved
cottage in the Pennsylvania mountains, to the laboratory and the
examining boards, to his classes at the Army school and Columbian.
Taking up his old duties, he would finally be relieved of this
crushing responsibility.

Meanwhile, he had to get on with his job.

* * *

Twenty nights contact with fomites and a number of mosquito
bites late in December had not given Jernegan yellow fever, but he
kept on trying. Two cubic centimeters of blood from a yellow fe-
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ver patient brought him down with it in four days, on January 1st.
Three days later, William Olson, injected with Jernegan's infected
blood, was carried to the yellow fever ward. Wallace Forbes, with
half a centimeter from a case of natural yellow fever, was put to
bed on the 24th. Just one more case, Reed decided, and the board
would stop the injection experiments.

* * *

John H. Andrus had swept out the laboratory, given the
guinea pigs and the monkey fresh food and water, and was busy with
his mosquitoes when the door was thrown open.

“.... impossible!” Carroll's voice was raised, his tone
pleading.

“It is not only not impossible, but it is necessary,” Reed
answered with a touch of sharpness. He sat down at his microscope
but made no move to uncover it.

“It isn't necessary! We can find another volunteer.”

“We can't wait. Forbes' blood should be right for the next
test tomorrow. When our volunteer got frightened and backed out,
he left us in a hole. We can't waste time trying to line up some-
body else, so I'll take his place. I'm not asking these men to
do something I won't do myself.”

“Major, you are almost fifty years old. You haven't been
well lately. You're tired and run down. If you persist in
submitting to this inoculation, you're inviting grave and maybe
fatal results.”

“Oh, nonsense, Carroll! With a specialist of Ames' ability
to look after me, it's perfectly safe. He hasn't lost a single
one of these experimental cases.”

“He couldn't save Lazear.”

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“Lazear didn't go to him until he'd been sick two days. Any-
way, there's a chance that I'm immune.”

“That's what Lazear thought, too.”

Andrus, going quietly about his work, glanced quickly at Reed.
His face was set, and he looked as if he were trying not to get angry.

“There's a chance I'm immune,” he repeated with irritation,
“if Finlay's new theory is correct that the offspring of loaded mos-
quitoes are themselves loaded. I've fed a dozen next generation
mosquitoes, without any bad result.”

“Do you believe that theory of Finlay's?”

“The next generation of ticks are loaded with cattle fever,
aren't they?”

“I know that. Do you believe Finlay's theory?” Carroll in-
sisted.

“As a matter of fact, no. But that's all the more reason for
my being inoculated. If I get yellow jack, it will prove there's
nothing in it.”

Carroll groaned. “Really, Major! I thought we'd convinced
you -Kean and Truby and Stark and Agramonte and the rest of us -
that you are too necessary to this work to take this dangerous,
needless risk. You have no right to sacrifice yourself!”

“I'm not going to discuss it any more, Carroll. I'll be in-
oculated tomorrow, and that's the end of it.” Reed got up abruptly
and strode out of the laboratory.

Andrus spent the rest of the day, and most of the night, think-
ing hard.

The next morning, January 25th, Carroll arrived first at the
laboratory. He looked worried and tired. Andrus wondered if he had
slept badly, too.

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"Dr. Carroll," he began.

“What is it, Andrus?”

“I've been thinking -won't I do just as well for this blood
injection as Major Reed?”

Carroll's face brightened for a moment, then he shook his head.

“No, I'm afraid not. Major Reed wants to test Dr. Finlay's
second generation theory, too, you see.”

“But I've fed more mosquitoes hatched from the eggs of in-
fected insects than the major has, sir,” Andrus objected. “I do it
all the time, just to keep them laying.” (The mosquito needed, as
Finlay had told the board, blood before she could lay her eggs.)

“That's perfectly true. So you do.” Carroll looked at the
laboratory attendant with fresh interest. “Have you any dependents?”

“No, sir.”

“Then I'll ask the major.”

Reed, composed again and cheerful, came in a few minutes later.
Carroll sent Andrus out on an errand. The private wondered what the
two medical men were saying. Would Reed yield? Would he let a
younger, stronger man replace him? He hoped so. He knew what
the work of the board would mean to the world, and he knew that Reed
was the engine that made the apparatus run. In trying to take over
the risk that Reed had selected for himself, Andrus felt that he
was being practical, in an impersonal sort of way. Somebody had to
take the chance. He could better be spared than Reed, so it was
only sensible that he should take it. It did not occur to
him that this was a high order of unselfishness.

When he came back to the laboratory Reed questioned him.

“You understand, Andrus, what you're getting into?”

Andrus' heart jumped. So the major was going to let
him take the injection!

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“I've nursed yellow fever, sir, and seen men die of it.”

“Why are you volunteering then?”

“I'm interested in your work, Major Reed. I'd like to take
some part in it, even just a little one.”

That afternoon at Camp Lazear, Andrus, with a cubic centi-
meter of Forbes' fever-laden blood circulating poisonously in his
blood stream, sat on the edge of his cot, a block of paper on his knees.

“Dear Mother,” he wrote, “you won't hear from me for two or
three weeks, because I have been detailed to accompany a troop of
the Seventh Cavalry on a practice march into the interior. I didn't
want you to worry....” He finished writing and sealed the letter.
He felt awful -he had lied to his mother, lied to her in what might
be the last letter he would ever write her. But at least he was
sparing her worry.

There was nothing he could do, though, to spare Reed worry
when his temperature hung around a hundred and four degrees for
three days. Would the boy live or die? Reed wondered desper-
ately. “Should he die,” he wrote the Surgeon General, “I shall re-
gret that I ever undertook the work. The responsibility for the
life of a human being weighs upon me very heavily at present, and I
am dreadfully melancholic.” The melancholy, happily, passed; Andrus
slowly recovered.

Since the offspring of loaded mosquitoes had failed to in-
fect the non-immune Andrus, Finlay's theory of their infectiousness
was definitely disproved. The injection experiments also showed,
among other things, that the parasite of yellow fever was in the blood
during the first few days of illness, and that passage through a
mosquito, although Nature's ingenious way of spreading it, was not
necessary to its development.

His scare over Andrus did not prevent Reed from pushing
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pushing the other phase of the experiments to a conclusion. Levi
Folk, who had undergone the fomites test, came down with yellow jack
from the bite of a mosquito that had fed on yellow fever thirty-nine
days before. Another insect which had bitten a patient fifty-one
days earlier proved its virulence of Clyde West. James Hanberry,
a gradualte like Folk and Jernegan of the fomites experiment, re-
ceived an attack from a mosquito fifty-seven days after its contam-
ination. Charles Sonntag was the last subject of this series. The
last loaded mosquito finally died seventy-one days after its meal
of yellow jack. This demonstration showed
why a house or region could remain infectious even after its sick
occupants had been gone for more than two months.

* * *

The Yellow Fever Commission had, in all, produced at will and
under perfect control fourteen cases of unmistakable yellow fever
between the opening of Camp Lazear on November 20th and February 10th,
without the loss of a single life. Their skill and good for-
tune in saving every case was pointed up a few months later when
another board, under Dr. Guiteras, conducted further experiments.
The death of three out of their first seven cases put an abrupt stop
to the work.

* * *

Reed, facing the delegates to the Pan-American Medical Con-
gress on February 6th, turned the page and glanced at his audience.
It was a large one -even the door were packed with listeners -and
it was motionless with attention. After reading the report of the
experiments, he was ready to announce the conclusions, the conclusions
at which he and his board had arrived with such risk and labor.

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Raising his voice so that those in the back of the room should
miss nothing, he read clearly, "The mosquito Culex fasciatus serves
as the intermediate host for the parasite of yellow fever.

"Yellow fever is transmitted to the non-immune individual by
means of the bite of the mosquito that has previously fed on the
blood of those sick of the disease.

"An interval of about twelve days or more after contamination
appears to be necessary before the mosquito is capable of conveying
the disease.

"Yellow fever can also be experimentally produced by the sub-
cutaneous injection of blood taken from the general circulation
during the first and second days of this disease.

,

"Yellow fever is not conveyed by fomites, and hence disinfec-
tion of articles of clothing, bedding or merchandise, supposedly
contaminated by contact with those sick of this disease, is unnecessary.

"A house may be said to be infected with yellow fever only when
there are present within its walls contaminated mosquitoes capable
of conveying the parasite of this disease.

"The spread of yellow fever can be most effectually controlled
by measures directed to the destruction of mosquitoes and the pro-
tection of the sick against the bites of these insects.

“While the mode of propagation of yellow fever has now been
definitely determined, the specific cause of this disease remains to
be discovered.”

It was not the applause that resounded in the crowded hall, or
the congratulations of enthusiastic doctors from two continents that
gratified Reed most. It was the certainty that the burdensome and
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momentous work which he and his colleagues had faithfully performed
would mean a safer and a happier life for humanity in future years.

273.