University of Virginia Library

On the afternoon of June 25, 1900, the four officers met for the first time in their new capacity, on the veranda of the officers' quarters at Columbia Barracks Hospital. We were fully appreciative of the trust and aware of the responsibility placed upon us and with a feeling akin to reverence heard the instructions which Major Reed had brought from the surgeon general; they comprised the investigation also of malaria, leprosy and unclassified febrile conditions, and were given with such detail and precision as only a man of General Sternberg's experience and knowledge in such matters could have prepared. After deciding upon the first steps to be taken, it was unanimously agreed that whatever the result of our investigation should turn out to be, it was to be considered as the work of the board as a body, and never as the outcome of any individual effort; that each one of us was to work in harmony with a general plan, though at liberty to carry out his individual methods of research. We were to meet whenever necessary, Drs. Reed, Carroll and Lazear to remain at the Barracks Hospital and I to stay in charge of the laboratory in Havana, at the Military Hospital, where I also had a ward into which yellow-fever cases from the city were often admitted.

Work was begun at once. Fortunately for our purpose, an epidemic of yellow fever existed in the town of Quemados, in close proximity to the military reservation of Camp Columbia. Even before the arrival of Reed and Carroll, Lazear and I had been studying its spread, following the cases very closely; subsequently a few autopsies were made by me, Carroll making cultures from the various tissues and Lazear securing fragments for microscopical examination; a careful record was kept and the results noted; cases gradually became less in number as the epidemic slowly died out, about the middle of August.

In the meantime a rather severe outbreak of yellow fever had occurred in Santa Clara, a city in the interior of the island, having invaded the garrison and caused the death of several soldiers; as the origin of the infection was shrouded in mystery, and cases continued to appear among the troops even after they had moved out of the town, it was agreed that I should endeavor to trace the source of the epidemic and aid the medical authorities in establishing whatever preventive measures might seem proper. This service is here recorded because in the general discussion of the start and course of the epidemic with Dr. J. Hamilton Stone, the officer in charge of the military hospital, we incidentally spoke of the possible agency of insects in spreading the disease, pointing particularly in this direction the fact of the infection of a trooper who,

suffering from another complaint, occupied a bed in a ward across the yard from where a yellow fever case had developed two weeks before.

The infection of the city of Santa Clara had evidently taken place from Havana, distant only one night's journey by train. Captain Stone, a particularly able officer, had already instituted effective quarantine measures before my arrival, so that I only remained there a few days.

But as to the actual cause of the disease we were still entirely at sea; it helped us little to know that a man could be infected in Havana, take the train for a town in the interior and start an outbreak there in the course of time.

Upon rejoining my colleagues (July 2) we resumed our routine investigations; not only in Quemados, where the disease was being stamped out, but also in Havana, at "Las Animas'' Hospital and at Military Hospital No. 1, where my laboratory (the division laboratory) was located. There was no scarcity of material and the two members who until then had never seen a case of yellow fever (Reed and Carroll) had ample opportunity, and took advantage of it, to become acquainted with the many details of its clinical picture which escape the ordinary practitioner, the knowledge and the appreciation of which, in their relative value, give the right to the title of "expert.''

Since the later part of June, reports had been coming to headquarters of an extraordinary increase of sickness among the soldiers stationed at Pinar del Rio, the capital of the extreme western province, and very soon the great mortality from so-called "pernicious malarial fever'' attracted the attention of the chief surgeon, Captain A. N. Stark, who, after consulting with Major Reed, ordered me to go there and investigate. A man had died, supposedly from malaria, just before my arrival on the afternoon of July 19. The autopsy which I performed at once showed me that yellow fever had been the cause of his death, and a search through the military hospital wards revealed the existence of several unrecognized cases being treated as malaria; a consultation held with the medical officer in charge showed me his absolute incapacity, as he was under the influence of opium most of the time (he committed suicide several months afterwards), and so I telegraphed the condition of things to headquarters; in answer I received the following:

Report received last night. My thanks are due for your prompt action and confirmation of my suspicions.