The American Plague

by Molly Caldwell Crosby

  For the next member of his team, Reed chose Dr. Aristides Agramonte, a Cuban-born doctor working in Havana. Agramonte was young, only thirty-two years old. He looked the part of a Cuban gentleman with a waxed pencil moustache, pompadour hairstyle and aristocratic features. Some of the soldiers found him to be vain, but very capable. The two men had met before in the Hopkins labs and again during Reed’s visit to Camp Columbia. Agramonte worked with Reed and Carroll for several months before the surgeon general ordered him to Havana to look for Sanarelli’s bacteria in the autopsies of yellow fever patients.Born in Cuba, Agramonte was believed to be immune to yellow fever like most other locals who had been exposed to the fever in childhood. He had come to America when he was only three years old, after his father was killed in the first Cuban war for independence. His education in America continued, and he studied medicine at Columbia in New York, where he was a classmate of Jesse Lazear’s.

  Finally, Reed asked Sternberg to appoint Dr. Jesse Lazear to the board. He seemed like a fine doctor and a likable person. His work with malaria and yellow fever had impressed Reed. He also came highly recommended by Welch and William Osler, and there could hardly be any higher endorsement. William Welch, Lazear’s mentor at Johns Hopkins, had written a glowing review of Lazear, describing him as “a good clinical man, a bacteriologist and withal a gentleman of enclivation and agreeable personality . . . and I am convinced that he would prove a very valuable addition to your corps of army surgeons.”

  Each of the four men could appreciate the skills of the other and respected one another. As individuals, they probably could not have achieved anything so great. Even Reed, the team’s leader, had lacked the foresight to see a connection between mosquitoes and malaria early on. At a medical conference—on April Fool’s Day—Reed refuted the idea that an insect could transmit disease. But what Reed lacked in vision, he made up for in an earnest devotion to knowledge and the scientific process. If there was a visionary in the group, it was certainly Jesse Lazear. With their talents pooled together, they knew there was a good chance of conquering this disease.

  Michael Oldstone, in his book Viruses, Plagues, and History, wrote: “The obliteration of diseases that impinge on our health is a regal yardstick of civilization’s success, and those (scientists) who accomplish that task will be among the true navigators of a brave new world.”

  With his team assembled, Reed was ready to begin work at Camp Columbia. He and Carroll left New York on the Sedgwick bound for Havana harbor on June 21, 1900, the same day Kean was stricken with the fever. His would be Reed’s very first case of yellow fever. Walter Reed, head of the Yellow Fever Board, had never before seen a case of yellow jack.

  Reed and Carroll landed on the busy Havana wharf where women carried metal pots of coffee and soldiers hauled supplies onto the shore, loading mule-drawn wagons. American voices mingled with foreign accents. There were shouted orders and laughter, neighing horses and barking dogs. Gulls called overhead, and buzzards flew high over the dirt roads leading out of the town, their black wingspans like line engravings in the blue sky.

  Reed and Carroll rode by carriage into Havana, through Plaza de Armas where soldier tents surrounded the fountain and an American flag flew from the top of the Governor’s Palace, General Wood’s new headquarters. The carriage bounced along cobblestones, spraying dust as they passed Spanish churches and colorful, narrow town houses. Reed was excited to be returning to Cuba. Havana was unlike any place he’d seen before—the bones of the buildings unmistakably grand and European, while the fleshy surroundings were tropical and Caribbean. It was at one time elegant, and at another, raw. They passed palm trees, almond trees and gnarled jaguey. Plumes of red sprouted on poinciana. Hibiscus blooms erupted.

  The road rose before them as they approached the elevated outskirts of Havana and rode into Quemados, Marianao. The air seemed to thin as they moved farther away from the harbor’s output of humidity, steam and smoke into lush jungle, and finally, the windswept farmland where Camp Columbia stood.

  Reed went immediately to the hospital tents to see Kean. Kean’s temperature was high, and his gums bleeding, but it would prove to be a moderate case, and when he was well enough, Jefferson Kean was shipped to family in New Jersey to recuperate.

  On the evening of Reed’s arrival, the Yellow Fever Board met on the veranda of the officer’s quarters at Camp Columbia for the first time. It was a familiar scene for Reed, Lazear and Agramonte, who had stood there just three months before, only on this occasion, it felt much more formal. The officers, dressed in their army whites, listened as Reed quickly relayed the surgeon general’s orders, which included the investigation of malaria, leprosy and unclassified febrile conditions. Reed stood straight-backed as he spoke. Whether speaking to a classroom of students or a handful of officers, Reed had the rare ability to be simultaneously amicable and commanding. A former student described Reed as someone who “spoke with great clarity, precision and force. His lectures were models in English and his scientific data were assembled in perfect order. There was nothing of the dramatic in his speech or manner, but he impressed one with his earnestness, thoroughness, and mastery of his subject.”

  The members of the board listened to Reed give the directive from the surgeon general with as much reverence and attention as his former students. Lazear had written to his mother that he was excited to be working with such an impressive and well-known man as Dr. Walter Reed. As the commission listened to Reed, another thought must have entered their minds: The crowning glory of this task would be yellow fever. To solve the American plague would be the greatest achievement of all. They agreed unanimously that whatever their discovery should be, it would be considered the work of the board as a body and not an individual achievement.

  Reed instructed Cuban-born Agramonte, the group’s pathologist and the only member thought to be immune to the fever, to stay in Havana in charge of the lab at the Military Hospital, where there would be no shortage of yellow fever autopsies. Agramonte had already done some impressive work on the Sanarelli bacteria, so he would continue that as well. Carroll, Lazear and Reed would remain at the barracks hospital at Camp Columbia, where Carroll would make cultures from various tissues, and Lazear would study them under the microscope. Lazear could continue with his mosquito investigations as well.

  It is not known how seriously Reed considered the mosquito theory at this point. His letters to Emilie do not mention it, and he kept no records of the inner workings of the board. As an investigative scientist, he surely felt curiosity at the very least. Albert Truby believed Reed had been interested in the insect theory from the start, that Reed knew this was the time and the place to finally conquer yellow fever. But Reed was also a soldier, one who took orders, followed them and led men accordingly. That left little room for thinking outside the boundaries of a given task. An officer to duty first and foremost—and under pressure from Sternberg—Reed knew that the first order of the board should be to disprove the Sanarelli bacteria once and for all, putting that ongoing and very public controversy to rest. There wasn’t time to deviate from the given course in search of a vector.

  Just before he left for Cuba, Reed met with George Sternberg and discussed a possible connection between yellow fever and mosquitoes. “No,” Sternberg answered. “That has already been decided to be a useless investigation.”

  CHAPTER 14

  Insects

  By the time the board had assembled at Camp Columbia, the yellow fever epidemic in Quemados was waning, if not entirely over. Yellow fever, it seemed, had taken its last victim for the season— though it left a lasting impression. Quemados, high on a plateau, had at one time been a safe haven for those fleeing Havana’s fever epidemics. That year, it struck the beautiful suburb with ferocity.

  The momentous beginning and the enthusiasm the Yellow Fever Board felt soon stalled. Without active cases to investigate, Reed focused on setting up a lab. Built in what had once been the camp’s operating room, the lab became t
he focal point of their work. Along one wood-frame wall stood a tall table pushed against the window. Strong northern light fell in planes onto the microscopes of Walter Reed and James Carroll, who worked side by side. Against the far wall of the lab was another table covered in jars and lab equipment, like a glass menagerie of winged insects.

  Off of the lab was a room for Reed’s lab assistant John Neate, which contained shelves with rows of test tubes, jars of black vomit and an incubator. And across from it, another small room held two caged monkeys, supplies and guinea pigs.

  On a wooden table in the center of the board’s lab, Lazear kept his own pet mosquitoes in jars with sweetened water and bits of banana. He collected his “birds” from different areas: Havana, Pinar del Rio, the Post Hospital. But all had fed from the blood of yellow fever patients. And, for each mosquito, Lazear scribbled an entry into his red notebook, his handwriting becoming quicker, sloppier and abbreviated as he went.

  It also took a little time for Reed to adjust to life in Cuba. Within days of arriving, he was already sunburned, and his northeastern clothes were too warm. Reed traveled into Havana to buy two linen crash suits and a cork helmet. It was hot, but not as hot as a Washington summer, he wrote to Emilie. That first week, Reed awoke at 5:30 or 6:00 every morning, sitting at the desk in his pajamas to write a letter to his wife. He always addressed the envelope the night before so he could drop the letter in the mail as soon as he heard the mail wagon. After a shower-bath and breakfast, Reed headed into the lab to work. It wasn’t long before he started sleeping later in the mornings and writing later in the day or napping after lunch. Camp Columbia was also growing quieter; nearly half of the garrison had been shipped out to China.

  Things were so slow at the camp that Reed began to talk of returning to the U.S. in a few weeks to finish his typhoid report. His presence was not really needed in Cuba at the moment as badly as it was in Washington, where the typhoid report was in its final stages.

  Reed was also a little homesick, writing every day about the gardens at his summer home Keewaydin in Pennsylvania, where the strawberries, blackberries and grapes were on the vine. The rhododendrons were in bloom. He missed his favorite foods and mint juleps, instructing Emilie not to let the patch of mint die during the summer heat because he would be very thirsty upon his return. But, Reed had also grown to love Cuba. Red hibiscus bloomed wildly throughout the countryside there, and the umbrella-shaped royal poinciana trees, he wrote, appeared as a “flaming mass of scarlet.”

  It was the wet season, and rain fell every afternoon, sometimes twice a day, dimming the light in the lab. Steam rose from the railroad tracks in Camp Columbia as the first drops hit the hot metal. And as the storms passed, heading out to sea, lightning would play across the surface of the water, igniting the ceiling of blue-gray cloud cover.

  When it wasn’t raining, the soldiers at the camp played baseball or went horseback riding. The men worked together all day, only breaking to go to the mess hall. Most men at the camp, twenty years younger than Reed, ate hearty amounts of the meat shipped from the U.S. and local fruits and vegetables. Reed, on the other hand, was more careful with his diet, often joking, “Boys, have mercy on your poor kidneys, they can’t be replaced.” Reed had adopted the latest trend in Victorian America: healthy eating habits. Large, meat-heavy breakfasts that could include steak, bacon, eggs, sausage, potatoes, porridge and doughnuts were evolving into lighter, healthier meals. Fruits and vegetables replaced primarily potato side dishes. Fresh fish, especially red snapper, were plentiful in Cuba, prepared by the camp’s Chinese cook. But Reed was also careful of his diet because he seemed to suffer from stomach ailments—though no one paid much attention to it at the time.

  For the most part, the men at Camp Columbia enjoyed Reed’s company and he theirs. Practical jokes were common, as were games and sports. The overwhelming opinion of Reed was that he behaved exactly as a major should behave: He was approachable, had a good sense of humor and a genuine concern for the men, but felt a duty to maintain the respect afforded the position. But, as an officer, Reed also stood apart from the men. He could seem uncompromising at times, even rigid.

  One contract surgeon described Reed: “He was smart and knew about everything, but he was a man to whom you had to prove what you said . . . he was domineering . . . a good friend, but he insisted upon you being worthy of his friendship.”

  Reed was not the only one growing impatient with the sleepy pace of work at Camp Columbia. Lazear wrote to his wife that the Quemados epidemic was over, but he would at least now have the opportunity to focus on some of his work with mosquitoes. Since he had been assigned to explore the mosquito theory, Lazear had a lot of time to work independently, traveling back and forth to Havana, where yellow fever outbreaks persisted. Lazear was also sent by Doherty wagon into the countryside whenever outbreaks occurred. He continued adding to his collection, taking the insects from inside the netting around hospital cots, caging them and returning to the lab at Camp Columbia.

  Lazear also sounded homesick in his letters home—it had been three months since Mabel and Houston sailed for the U.S. He worried about how little Houston would react to his father after not seeing him for months. Mabel was suffering complications with the pregnancy and had already been admitted to the hospital for the final weeks. Lazear began to talk about what sort of work he might pursue in Washington once his service was over. He was having his mother’s portrait painted and looked forward to the day he would have a permanent home in which to hang it. Lazear was very close to his mother. Twice widowed, his mother had also lost both of Lazear’s brothers. Jesse Lazear was all she had left. He began to make plans to sail home for a visit in October.

  Reed sat at his desk one afternoon in July to write to Emilie. A photo of their daughter Blossom was propped up before him. Reed had just returned from Havana, chased back to the barracks by a heavy storm settling in for the afternoon. In Havana, Reed had seen his son, Lawrence, also stationed in Cuba, and he wrote Emilie to tell her about their meeting. Lawrence looked cool and collected, wrote Reed, with a helmet perched on his head. Army life suited Lawrence far more that academics did, and Reed was proud to see his son come into his own. At their home in Washington, Reed had noticed his son’s lack of interest in studies and reproached him, refusing to send him to college. Lawrence Reed would not disappoint his father; by the end of his forty-two years in the army, Lawrence would become a major general.

  In Havana, Lawrence told his father that he had just bought a khaki suit and a linen crash one for the warm weather. Reed told him to buy a second crash suit, and he would foot the bill. Lawrence smiled. “I will not neglect to do so.”

  The only real excitement the board had thus far was a visit from two English doctors, Dr. Herbert Durham and Dr. Walter Myers, who were part of the Liverpool School of Tropical Medicine. Reed wrote to Emilie: “I enjoyed meeting them very much, as they were two of the most typical English men, ‘don’t you know,’ that one could possibly meet. We have placed our laboratories at their disposal during the ten days they will be in Havana.” The doctors also met Dr. Henry Rose Carter, an American doctor from the South who had made some interesting observations about the incubationperiod of yellow fever, most notably the five-to-seven-day time span between the first cases of yellow fever and the next wave of infections. And the doctors spent some time with Dr. Carlos Finlay in Havana as well.

  The British doctors, like the American Yellow Fever Board, were intrigued by the idea that yellow fever might be spread by an insect. They later published an article in which they thanked the Americans for their hospitality in Cuba. In it, Durham and Myers wrote, “The suggestion propounded by Dr. C. Finlay, of Havana, some twenty years ago, that the disease was spread by means of mosquitoes hardly appears so fanciful in the light of recent discoveries.” Six months later, both Durham and Myers contracted yellow fever during their studies in South America. Durham recovered, but Myers died.

  As Reed wrote to Emilie that
July afternoon, Carroll and Lazear worked in the lab, but Agramonte had been sent into the countryside to investigate a fever outbreak. Again, Reed was thinking of when he could sail for the U.S. and finish his typhoid work. Then, a telegram arrived.

  Agramonte, inspecting a camp at Pinar del Rio, the capital of Cuba’s westernmost province, had found something. Reports surfaced about a sudden increase of sickness among soldiers. The fevers had an unusually high mortality rate, and on July 19, Agramonte was dispatched to investigate the outbreak. The recent death of a soldier, supposedly suffering from malaria, afforded Agramonte with a fresh autopsy. He began his investigation of the dead, following the internal clues of gilded organs and tar-like blood remnants, searching the bloodstream for malarial parasites. But the yellow corpses left little doubt as to what had caused the death.

  Agramonte walked the hot corridors of the military hospital where he found, in bed after bed, patients burning with fever. No quarantine or disinfection measures had been taken. He sent a telegram to headquarters to the chief surgeon describing the gross negligence on the part of the doctors in charge of the hospital and asked for direction. He received a telegram in response with instructions: Take charge of cases. Reed goes on morning train. Wire for anything wanted. Nurses will be sent. Instructions wired commanding officer. Other doctors should not attend cases. Establish strict quarantine at hospital. You will be relieved as soon as an immune can be sent to replace you. Report daily by wire.