The American Plague

by Molly Caldwell Crosby

  The small shower bath had its own dwelling about one hundred feet away from the main house, but Lazear had hopes of having a real bathroom affixed to the house that autumn. The shower bath was in essence a bathtub with sprays of water that came out the side, so that one could shower without wetting one’s hair, as one soldier described it.

  Mabel had done her best to make it feel like a home. Shopping in Havana, she had found matting at a Chinese store to sew and hang as a partition, giving them a bedroom on one side and sitting room on the other. Mosquito nets, while practical, also added a web of gauze to the otherwise hard, plank-wood bedrooms. Even with the netting, nature could not be contained. Fleas would often bite the baby. And tree frogs settled into the rafters, falling with a damp thud against the beds, sometimes landing in the water bucket. Soldiers would often begin their morning shave only to look down and find a tree frog with all four feet sucking the side of the pail and its head barely above the surface of the water. Eventually, covers were issued for the water pails.

  The surrounding countryside was the real charm of their situation. Only a few miles from the beach, Lazear went, almost daily, for a sea bath. Sea grapes and mangroves tangled the shoreline, where white sand sloped toward a green-blue ocean. Houston played in the sand and collected shells. Every afternoon, Gertrude took Houston on a long walk in the countryside and let him chase chickens.

  Carts of fresh produce or mules strapped with baskets of vegetables regularly came into the camp from Havana. Fresh meats were shipped from Chicago, packed in ice. Mabel had brought Borden’s condensed milk for the baby. Houston also had a healthy supply of oatmeal, eggs and meat juice.

  As the rainy season, and more important, the quarantine season, approached, Mabel and Houston planned to sail for the U.S. In her sixth month of pregnancy, her condition was certainly a factor, but there was also a more practical reason. Once quarantine was under way, the fumigation process in New York would ruin all of Mabel’s clothes and personal belongings. On April 14, Lazear took Mabel and Houston to the Havana harbor to ship out on the steamer Sedgwick, where he bought her a twelve-dollar ticket and said good-bye. Jesse Lazear probably had another reason to send his wife and son away—locals were already referring to this one as a yellow fever year. It must have been a sad parting. The fever seasonwould last several months, and Lazear’s work in Cuba would keep him too busy to travel back anytime soon. Houston would grow and change during those months away, and most likely, Mabel would give birth to their next child before the family could be together again.

  Lazear continued with his daily work in the hospital wards and lab after Mabel and Houston left. He swam in the sea and ate with the other officers in the mess hall, where they drank red wine in an attempt to keep fever at bay. The men entertained themselves with cards, a brass spittoon at the foot of each chair, or on special occasions, smoked an old Madre rolled cigar. Potted ferns and palms climbed the walls of the social hall, as though the flora of Cuba would not be kept out. Open shutters and high ceilings crisscrossed in wooden beams helped keep the room cool. Dances were held there on Saturday nights, and as always, the music continued to infuse the tropical night. Lazear listened from his porch in the dark, though he rarely walked to the dance hall unless it was a clear, moonlit night. Without a full moon, the tropical dark felt oppressive with only the patchwork of yellow window light and pinpoints of starlight to break up the blackness. And on quiet nights, he could hear the sounding of the hour fired from El Morro Castle.

  On May 1, Major Jefferson Randolph Kean began keeping a journal to record any cases of yellow fever. Kean was the chief medical officer for western Cuba, and he lived in Quemados, Marianao. Kean was also a close friend of Walter Reed’s. Both graduates of the University of Virginia, the two met in Key West investigating a smallpox outbreak. Kean found Reed’s “whimsical humor” and penchant for “quaint stories” entertaining, and they would becomelifelong friends. The two had even exchanged frustrated letters when Surgeon General Sternberg had denied their placements in Cuba when the Spanish-American War broke out. Sternberg did not want to risk two of his best medical officers; neither had ever had yellow fever.

  On May 21, Kean recorded in his diary that two cases of yellow fever appeared on General Lee Street, several blocks apart and in homes that had no contact with one another. General Lee Street ran through Quemados, a town of rainbow-colored houses set against ripe hillsides and thickets of tropical plant life. Palm fronds and bougainvillea blossoms, like fuchsia petals of parchment, enclosed the homes, one of which held the feverish wife of a cavalryman. She was too afraid to call the doctor, even as the bleeding began, for fear of being sent to die in the yellow fever ward.

  Two days later, Lazear was called to No. 20 General Lee Street to investigate Sergeant Sherwood. When Lazear arrived, Sherwood was running a temperature of 100.4 and complained of a headache. By the next day, Sherwood’s temperature rose to 102. Lazear suspected the worst, quarantined the house and sent the sergeant to the yellow fever hospital. He conducted the Widal test to rule out typhoid and studied the blood for malarial parasites, but Sherwood’s skin grew mustard colored and his gums began to bleed. By nightfall, he was delirious and slipped into a coma, his breathing heavy and strained. The following day, May 30, Sergeant Sherwood died at 11:30 a.m. Lazear autopsied the dead soldier, making comments in his notebook: “Extreme jaundice, peculiar mucus like applesauce, liver was a bright yellow color, stomach contained about a pint of black coffee ground fluid.” It was a clear case of yellow fever. Another twenty-three cases would quickly arise in the town of Quemados.

  Lazear also kept detailed records of the mosquitoes beginning to swarm in May, sending samples to an entomologist in the United States. Lazear’s meticulous nature was perfectly suited to this sort of study; as described by one tropical medicine professor: “keying in an identity depends on anatomical minutiae—how the insect’s hairs are placed and grouped, the formation of the mouth parts, the sex parts, the bewildering pattern of wing venation.” During this time, Lazear began killing and dissecting his pet collection of mosquitoes, or “birds” as they were nicknamed, most of which, he noted, had striped legs and bodies.

  The fever appeared dangerously agile, jumping from one house to another, traveling from Calzada Real and back to General Lee Street. On Real Street, in close proximity to No. 20, a saloon and a number of local bordellos were shut down when it looked as if the risk of yellow fever was greater in those men who frequented them. For physicians trying to track the disease, it proved evasive and unpredictable, as if it engaged their interest as sport. “This epidemic,” wrote Truby, “with fifty cases and twelve deaths in one of the finest and most sanitary villages in Cuba disturbed everyone and left a lasting impression.”

  On June 21, 1900, the entries in Jefferson Kean’s diary came to an abrupt stop.

  A few days earlier, Kean had learned that a friend and neighbor was down with yellow fever. Kean had been ordered to stay out of the infected district, but early one morning, he decided to make a visit to his sick friend. He took every precaution, never entering the infected house, and instead sat outside on the porch where the air was clear. “I obeyed the letter but not the spirit of the order,” Kean would later write. He spoke to a nurse through the iron bars of the open window. He never came in contact with any of the infected items, nor with his friend. Kean was shocked, five days later, when he fell feverish and was admitted to hut number 118 in the yellow fever ward of Camp Columbia.

  CHAPTER 13

  The Yellow Fever Commission

  WAR DEPARTMENT,

  Surgeon General’s Office

  Washington, May 23, 1900.

  To the ADJUTANT GENERAL OF THE ARMY.

  Sir:

  I have the honor to recommend that Major Walter Reed, Surgeon, U.S. Army, and Contract Surgeon James Carroll, U.S. Army, be ordered to proceed from this city to Camp Columbia, Cuba, reporting their arrival and instructions to the commanding officer of the post, the co
mmanding general, Department of Havana and Pinar del Rio and the commanding general Division of Cuba.

  I also recommend the organization of a medical board, with headquartersat Camp Columbia, for the purpose of pursuing scientific investigations with reference to the infectious diseases prevalent on the island of Cuba. —Stricken

  The board to be constituted as follows:—Major Walter Reed, Surgeon, U.S. Army; Contract Surgeon James Carroll, U.S. Army; Contract Surgeon Aristides Agramonte, U.S. Army; and Contract Surgeon Jesse W. Lazear, U.S. Army.

  Contract Surgeon Agramonte is now on duty in the City of Havana and Contract Surgeon Lazear at Camp Columbia. It is not considered necessary to relieve them from the duties to which they are at present assigned.

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

  Very respectfully, George M. Sternberg, Surgeon General, U.S. Army

  On the evening of June 25, 1900, Walter Reed sat on the deck of the Sedgwick and wrote a letter to his wife. A chill imbued the inky sky, and Reed fastened the overcoat his wife had sent aboard just moments before the steamer set sail from New York that morning. He had not thought to pack it; after all, he would hardly need it once he arrived in Cuba.

  The unfinished letter to his wife would take several more attempts to finish, which Reed literally chronicled as Effort no. 1, Effort no. 2, Effort no. 3 at the tops of the pages. As with most of Reed’s voyages, he would spend much of it sucking lemons and eating crushed ice to keep the motion sickness at bay. Regardless of his efforts, and regular doses of bromide, Reed consistently “fed the fish” over the railing of the boat, losing five pounds on the voyage.

  As the breeze began to warm and clouds gathered over the green fringe of the Florida coast, Reed managed to keep down an orange, a cup of coffee and dry toast. A ribbon of rain showers lined the coast, and from the deck, the men watched schools of flying fish and porpoises chase the Sedgwick as the 5,000-ton steamer barreled toward Cuba.

  In the wan morning light, before the sun had burned off the haze, the buildings of Havana appeared in shades of gray and blue, wedged between the dark sea and pale sky. But as the light rose, the buildings brightened, and the weary stone of El Morro Castillo warmed, incandescent bursts of green growing amid its stones. Waves knocked against the fortress to one side of the harbor and against the seawall on the other as though the sea itself were sleeping, its breast rising and falling in heavy, rhythmic breaths.

  Reed sat on the deck, again writing a letter to his wife, and watched Havana come into focus, smelling the salt, steam and wet stone, and farther off, the scent of smoke, coffee and old hay. The harbor blazed with color: The flags of nations all over the world whipped in the breeze, white sails skimmed between steamers, and green treetops glowed against cobalt-colored mountains far in the distance. Then his eyes fell on an iron corpse, mostly submerged but for a tangle of beams like splintered bone, wires flailing and an American flag at half-mast. His handwriting grew wilder and slanted as he wrote, “The City of Havana from the shore is certainly very beautiful, but as I write I see the wreck of the Maine not more than 400 yards away, and it makes my very blood to boil—The whole Island wasn’t worth the loss of those brave men & gallant ship—Damn every Spaniard that ever lived!”

  On May 21, the same day that Jefferson Kean had recorded the first two cases of yellow fever in Quemados, Surgeon General Sternberg had put in a request in Washington, D.C., to form a board to examine yellow fever. Though the directive would be to study “all infectious disease” afflicting the camps in Cuba, Sternberg made sure, verbally, that the focus would be yellow fever.

  Sternberg had assigned Walter Reed and James Carroll to probe the finding of Dr. Sanarelli, an Italian bacteriologist who claimed to have found the microbe that caused yellow fever. For almost a decade after the congressional committee’s conclusion that bacteria caused yellow fever, medical theories and experiments on the subject of the disease stagnated until, on July 3, 1897, the British Medical Journal published an article about Dr. Giuseppe Sanarelli’s discovery of Bacillus icteroides: the bacteria that caused yellow fever. Sternberg’s pride had been wounded. Sternberg had missed his opportunity for fame with diseases like tuberculosis, pneumonia and malaria. A skilled microbe hunter, he had a personal passion to find and solve the yellow fever question, and after Sanarelli made some caustic remarks about a germ Sternberg had discovered, it became a battle of the egos. It also became another clash between the U.S. Army Medical Corps and the Marine Hospital Service. Sternberg was surgeon general of the Army Medical Corps while the Marine Hospital Service backed Sanarelli. The confrontation would continue for years.

  A fresh outbreak of yellow fever in Havana and nearby camps provided Sternberg with the opportunity to test Sanarelli’s new bacteria. He asked Reed to investigate it, and soon thereafter, to head the Yellow Fever Board. Though Sternberg would later take credit for recommending the three other members of the board, it seems more likely that Reed himself chose or at least suggested them. After his return from Cuba in April, Reed had submitted his report on electrozone to Surgeon General Sternberg, ending with, “In carrying out the experimental part of this report, I desire to state that I have received valuable aid from Acting Assistant Surgeons A. Agramonte, Jesse Lazear, and James Carroll, U.S. Army.” Appointment to the board would forever change the lives of the four doctors.

  First choice and second in command was James Carroll, Reed’s longtime assistant. Carroll was by far the most eccentric of the group. The men called him “Sunny Jim” because of his bald head. Born in England in 1854 to a working-class family, his background was a hodgepodge of professions. Originally, he planned to enter the British Army as an engineering student; instead, he was a self-described “wandering good-for-nothing who fell in love at fourteen and left home at fifteen, roughed it in the Canadian backwoods for several years and finally drifted into the Army.”

  After his love affair at age fourteen ended in heartbreak, he abandoned his plans for army life and emigrated to Canada where he worked at one time or another as a blacksmith’s helper, a railroad laborer and a cordwood chopper. In 1874, he moved to the U.S. and joined the army as an enlisted man, a distinction that would color the remainder of his career and his ego. He would serve twenty-four years before wearing the uniform of an officer.

  It was in the army that Carroll decided to pursue medicine. His was not a conventional background for medical school—he had no advanced degrees, he had taken one year of French and two years of German at a time when most doctors were fluent in a number of languages. Carroll began his studies in medicine as an apprentice to a doctor at Fort Custer, Montana. Carroll then applied to medical classes in New York and was at first rejected, then later allowed to attend classes at the University of the City of New York and the University of Maryland, finally graduating in medicinefrom the latter in 1891. He also took courses in bacteriology and pathology at Johns Hopkins, which placed him at the Army Medical Museum in Washington working as Walter Reed’s assistant. At first, Carroll’s fortune in achieving his degree and finding placement with such a highly respected physician pleased him. Later, it would turn into a lifelong torment.

  James Carroll exuded an almost bitter work ethic. Jesse Lazear, in a letter to his wife, described him: “Dr. Carroll is not a very entertaining person. He is a bacteriologist pure and simple. To me bacteriology is interesting only in its relation to medicine. He is interested in germs for their own sake, and has a very narrow horizon . . . Carroll would amuse you very much. He is very tall and thin. Wears spectacles, bald headed, has a light red mustache, projecting ears and a rather dull expression.”

  Some colleagues found him reticent, crude and surly, while others described him as reliable and straightforward, though prone to “improper” behavior. He was kind and helpful in the laboratory, but also capable of profanity that would be the envy of any sailor, as one student put it.

  Carro
ll proved in many ways to be the exact opposite of Reed, though their working relationship was described as warm and effective. Carroll’s skill in the laboratory was undisputed, but he was a self-made man, intent upon self-improvement, who worked hard to achieve what men like Reed, Agramonte and Lazear seemed to accomplish with ease. Another colleague wrote, “Carroll was a most efficient worker, but he had to be led by a man with vision, like Reed.”

  Carroll’s personal relationships also seemed in dramatic contrast to those of his fellow board members. Reed sent letters to his wife showered with terms of endearment and unabashed affection. Lazear was also a doting husband and an even more doting son. Carroll’s letters to his wife, however, were cold and sometimes even cruel. In one, he chastised her for sending him fresh peaches when the price was probably exorbitant, and they would spoil anyway. In another he wrote, “Don’t bother to send me any more letters that do not interest me.”

  In all, the image of James Carroll is that of a tragically conflicted man—a working-class Englishman in America; a soldier who was an enlisted officer, rather than a commissioned one; a doctor who was self-made; a frustrated husband who spoke of a lost love for the rest of his life; and a colleague who was innately proud to see his mentor recognized, while at the same time, riddled with envy.

  It was a rancor that would extend to the next generation. After Carroll’s death, his son hoarded the personal letters of his father, and many records belonging to Walter Reed, in disheveled trunks in his attic. When historians in the 1940s and 1950s attempted to acquire the material, he appeared paranoid and angry, refusing to accommodate a government that he believed had robbed his father of so much.