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FACTORS WHICH LED TO THE APPOINTMENT OF THE BOARD

One may well believe that such a scourge as yellow fever could not have been long neglected by medical investigators, and so we find that from the earliest days, when the germ-theory of disease took its proper place in modern science, a search for the causative agent of this infection was more or less actively instituted.

Men of the highest attainments in bacteriology engaged in numerous attempts to isolate the yellow fever microbe: unfortunately not a few charlatans took advantage of the dread and terror which the disease inspires, to proclaim their discoveries and their specific cures; one of these obtained wealth and honor in one of the South American republics for presumably having discovered the "germ'' and prepared a so-called vaccination which was expected to eradicate the disease from that country, but for many years after the foreign population continued to suffer as before and the intensity and the spread of yellow fever remained unabated, although thousands of "preventive inoculations'' were made every month.

Geo. M. Sternberg in 1880, then an army surgeon, was directly instrumental in exposing the swindle that was being perpetrated, putting an end, after the most painstaking investigation, to all the claims to discovery of the "germ'' of yellow fever that had been made by several medical men in Spanish America. The experience which he obtained during a scientific excursion through Mexico, Cuba and South America gave him a wonderful insight as to the difficulties one has to contend with in such work and made him realize the importance of special laboratory training for such undertaking. It is interesting to note that, as surgeon general of the U. S. Army, twenty years after, General Sternberg chose and appointed the men who constituted the yellow fever board, in Cuba.

The year before the Spanish-American war, an Italian savant, who had obtained a well-deserved reputation as bacteriologist while working in the Institute Pasteur of Paris, came out with the announcement from Montevideo, Uruguay, that he had actually discovered the much-sought-for cause of yellow fever; his descriptions of the methods employed, though not materially different from those followed by Sternberg many years before, bore the imprint of truth and his experimental inoculations had apparently been successful. Sanarelli—that is his name—for about two years was the "hero of the hour,'' yet his claims have been proved absolutely false.

The question of the identity of his "germ'' was first taken up by the writer under instructions from General Sternberg: during the Santiago campaign I had opportunity to autopsy a considerable number of yellow-fever cases and, following closely upon Sanarelli's directions, only three times out of ten could his bacillus be demonstrated; at almost the same time, Drs. Reed and Carroll, in Washington, were carrying out experiments which showed that Sanarelli's bacillus belonged to the hog-cholera group of bacteria and thus when found in yellow fever cadavers could play there only a secondary rôle as far as the infection is concerned.

Unfortunately, two investigators belonging to the U. S. Marine Hospital Service, Drs. Wasdin and Gleddings, were, according to their claims, corroborating Sanarelli's findings: there was nothing to do but that the investigation should continue, and so I was sent by General Sternberg to Havana in December, 1898, with instructions and power to do all that might be necessary to clear up the matter. Wasdin and Geddings had preceded me; the work carried us through the summer of 1899; we frequently investigated the same cases; I often autopsied bodies from which we took the same specimens and made the same cultures, in generally the same kind of media, and finally we rendered our reports to our respective departments, Wasdin and Geddings affirming that Sanarelli's bacillus was present in almost all the cases, while I denied that it had such specific character and showed its occurrence in cases not yellow fever. A virulent epidemic which raged in the city of Santiago and vicinity during 1899 afforded me abundant material for research.

In the meantime the city of Havana was being rendered sanitary in a way which experience had taught would have overcome any bacterial infection, and, in fact, the diseases of filth, such as dysentery, tuberculosis, children's complaints and others, decreased in a surprising manner, while yellow fever seemed to have been little affected if at all.

Evidently, a more thorough overhauling of the matter was necessary to arrive at the truth, and while the question of Sanarelli and his claims was practically put aside, Surgeon-General Sternberg, recognizing the importance of the work before us and that its proportions were such as to render the outcome more satisfactory by the cooperation of several

investigators in the same direction, wisely decided to create a board for the purpose and so caused the following to be issued:

Extract

34. By direction of the Secretary of War, a board of medical officers is appointed to meet at Camp Columbia, Quemados, Cuba, for the purpose of pursuing scientific investigations with reference to the infectious diseases prevalent on the Island of Cuba. Detail for the board:

Major Walter Reed, surgeon, U. S. Army;

Acting Assistant Surgeon James Carroll, U. S. Army;

Acting Assistant Surgeon Aristides Agramonte, U. S. Army;

Acting Assistant Surgeon Jesse W. Lazear, U. S. Army.

The board will act under general instructions to be communicated to Major Reed by the Surgeon General of the Army.