The American Plague

by Molly Caldwell Crosby

  Reed left Camp Columbia immediately for the western interior of Cuba, traveling by train through a valley of tobacco and sugarcane fields, the smell of molasses thick in the air. Pinar del Rio boasts the most dramatic topography in Cuba. Giant limestone formations, remnants of the Jurassic era, tower over the fields like stone haystacks. A low-lying spine of mountains stands in the distance, and pine trees rise like spires in the countryside.

  Reed met Agramonte, and together, they surveyed the sleeping quarters of the barracks where hundreds of beds stood in regimented rows. In such close quarters, the fever should have spread rampantly from one soiled bed to the next. Conditions were filthy, with ample opportunity for germs to spread. The doctors at Pinar del Rio performed only the barest practices of disinfecting bedding, soaking sheets and pillowcases in bichloride, then sponging the mattress. Reed and Agramonte placed all blame for the fiasco on the army doctors stationed there and filed a formal complaint with the surgeon general.

  Before he left, Reed noted one other peculiar circumstance at Pinar del Rio. In early June, a private had been court-martialed and sentenced to three months of hard labor. During this time, he was kept in a cell in Pinar del Rio. The private and seven other men were locked in their cells on June 1 and had no contact with the outside world. No visitors saw the prisoners. Nonetheless, by the end of June, the private and one other cellmate had come down with yellow fever and died. None of the other men in the cell, nor any of the guards, became ill. It was as if something blew through the bars of the windows to afflict only those two men.

  Reed met with Lazear and Carroll when he returned to Camp Columbia, while Agramonte continued on the train to Havana. Later, much would be made of the fact that Agramonte was not present at that meeting. In an article published several years later, James Carroll would accuse Agramonte of hardly being involved with the board’s work and not even being aware of their experiments. But, Agramonte’s lab was located in Havana, as it had been long before the Yellow Fever Board was convened. It was not unusual at all for Reed to meet with Carroll and Lazear at Columbia Barracks while Agramonte continued his work elsewhere. And, most likely, Reed had already discussed his new ideas with Agramonte at Pinar del Rio. As Albert Truby remarked, Reed enjoyed talking about his work: “He had no secrets about his experiments and everyone knew from day to day just what was going on.”

  During that meeting, it was decided that Lazear would focus more heavily on the mosquito theory, building on the work he had already compiled over the previous months. Since the first outbreak of fever in May, Lazear had been making notations about yellow fever—the symptoms of patients, where the fever broke out and where it turned up next, weather observations and careful study of the mosquitoes local to the area. Lazear still believed that if malaria could be spread by mosquitoes, it was possible that yellow fever could as well. Carroll and Agramonte would continue their autopsies and tissue samples in search of something in the body—whether microbe or otherwise—that appears in yellow fever patients.

  The lab work would be helpful, but most likely inconclusive; Reed knew that the next step would have to be human experiments. In a letter to Sternberg, Reed wrote, “Personally, I feel that only can experimentation on human beings serve to clear the field for further effective work.” He never indicates in letters or otherwise whether he believes the mosquito theory will be proven or disproved by such action, only that “with one or two points cleared up, we could then work to so much better advantage.” Reed took his idea of human experiments to the board, and they agreed that should they be willing to experiment on human beings, they should be prepared to experiment on themselves as well. How could they ask for the self-sacrifice of others without submitting to the same studies?

  Agramonte’s departure from the board that August would not be the only one noted. According to James Carroll, Walter Reed left without explanation the morning after the board decided to self-experiment and sailed for the United States. Carroll overtly implied that Reed did so to avoid infecting himself. It became a stain on the board’s work and indirectly accused Reed of cowardice. In truth, whether or not Reed planned to infect himself, he had been plotting his return to the United States weeks before this meeting took place. In letters to Emilie, as well as Sternberg, Reed wrote about plans to catch the Rawlins whenever it came into port. What’s more, travel to and from Cuba was unreliable at best. Transports could be days late, and baggage was subject to a lengthy disinfecting process before the steamer could set sail. In letters to Emilie, Reed tried to sound reassuring: “The Quartermaster told me this afternoon that the Rawlins would be here Tuesday afternoon,& would leave either Wednesday evening or Thursday morning—So that the chances of getting away August 1 or 2nd are very good.” In other words, it would be nearly impossible to jump aboard a ship the morning after the board met and flee.

  Carroll went so far as to suggest that Reed fabricated a reason to leave Cuba as well, having a carte blanche to sail to and from Cuba whenever he liked. When Reed and Carroll arrived in Cuba that June to work with the Yellow Fever Board, they learned that Dr. Shakespeare, Reed’s partner in the typhoid study, had died suddenly from a heart attack. That left only Dr. Victor Vaughan to finish all of the work. Reed wrote on several occasions about plans to return to help Vaughan finish the report, and under some pressure from the surgeon general to present the typhoid paper, Reed undoubtedly felt a priority to that study. After all, yellow fever had been well contained at Quemados, and with the sickly season coming to a close, even autopsies were few and far between. The fact that Carroll would make such a slanderous suggestion about his friend and colleague seems to further illuminate his emotional deterioration during the time he served on the board. For Carroll, the work would soon prove to be physically harrowing as well, bringing him to the brink of death and back again.

  The steamer Rawlins was scheduled to reach the Havana harbor around July 30. Slightly irritated, Reed waited as all of his baggage was disinfected in the days before the transport arrived. All wearing apparel was steamed or soaked in a disinfectant called formalin. No exceptions were made—even for the head of the Yellow Fever Commission. Then, much to Reed’s frustration, the steamer’s departure was postponed after several soldiers decided to celebrate their departure at a nearby café. At long last, the Rawlins, which Reed nicknamed the Rollins in anticipation of his usual seasickness, set sail close to midnight on Thursday, August 2, 1900. Reed wrote to Emilie that he wanted fried chicken, cabbage and waffles upon his return.

  Albert Truby boarded the Rawlins late that night with the rowdy group of homeward-bound soldiers from the café. He made his way through the drunken shouts and cheers to his stateroom, where he was surprised to find Walter Reed on the lower bunk. In all the confusion, the only two medical officers on board had been given one room until separate quarters could be assigned.

  As the lights in their cabin went out that night, Reed asked, “Doctor, were you mixed up in the celebration?” Truby dutifully explained that he had been at the quarantine station all day, but secretly, he was flattered by Reed’s concern. “He had always shown some interest in me since my entrance examination,” Truby would later write.

  During the few days at sea, Reed and Truby discussed yellow fever. Reed was excited by the work the board had done examining the blood of yellow fever victims. Their findings, along with Agramonte’s independent blood cultures, had finally put an end to Sanarelli’s claims; Reed was satisfied that they’d finished that first, important objective, and he was anxious to see what Lazear had found in his insect work. Now, they could finally turn their attention to the mosquito theory.

  As the Rawlins made its way north, and the sea air cooled, Reed talked to Truby openly and excitedly about the work on yellow fever. Duty done, he looked forward to returning to Cuba as soon as possible to launch the investigative portion of their study—his real passion. “He was much pleased,” wrote Truby, “with the deep interest Lazear was showing in the mosquito work.”<
br />
  Yellow fever had been arguably the most feared disease in America and the Caribbean for two centuries; a few more weeks could hardly make a difference.

  CHAPTER 15

  Vivisection

  Giuseppe Sanarelli’s paper on yellow fever had done more than spark a public brawl with Surgeon General Sternberg over the cause of the fever; it spotlighted the protest against vivisection and human experimentation in the late nineteenth century. Sanarelli, bruised by skepticism from Sternberg and the Hopkins doctors, boldly countered that he had managed to produce yellow fever in five hospital patients. His attempt at “scientific murder” brought a firestorm of opposition from the antivivisectionists, as well as the John Hopkins doctors. Sir William Osler spoke out publicly: “To deliberately inject a poison of known high degree of virulency into a human being, unless you obtain that man’s sanction, is not ridiculous, it is criminal.”

  Vivisection, literally to cut open or dissect a living organism, was an umbrella term that not only applied to surgery and autopsy, but all medical experiments—those on animals, as well as humans.

  In the late Victorian age, amid macabre tales of Jack the Ripper dissecting his victims and medical students robbing graves to find cadavers for autopsy study, the antivivisection activists rallied behind their cause—to place limitations on the physicians and scientists assuming a Godlike power over the human body, whether it is alive or dead.

  As with most causes, the extremes dominated the argument. Antivivisectionists often quoted Alfred Lord Tennyson whose poem “In the Children’s Hospital” described the surgeon, with his ghastly tools, who “was happier using the knife than in trying to save the limb.” Scientists countered that no advances in medicine could be made without surgery, autopsy and experimentation. The antivivisection movement had even slowed the Typhoid Commission’s work, as Vaughan wrote, “To order autopsies would increase the public furor which at that time was running high among the people.” What’s more, if the antivivisectionists pushed to outlaw all animal testing, they forced doctors to carry out experiments on humans. The activists, vehemently against the mistreatment of animals, had brought humans into the debate as more of an afterthought; in fact, the Humane Society would one day splinter from the antivivisectionist movement.

  Human vivisection had a long history, and it would not come to an end until the Tuskegee Syphilis Study in 1972, but it was in its heyday in the late nineteenth century. As one writer observed, “The use of human beings to confirm that a microbe caused a particular disease or to demonstrate the mode of transmission was a harsh legacy of the germ theory of disease.” Louis Pasteur and Robert Koch had provided the techniques necessary for studying germs, which included isolating a bug, growing a culture and finally using the germ to generate disease in a healthy organism, most often a human. Physicians routinely infected themselves, their children, unknowing patients, as well as infants, criminals, the dying and the mentally impaired.

  Children were often subjects for medical testing since they were essentially clean slates with little exposure to disease. Nearly a decade before Edward Jenner’s famous vaccination against smallpox, he infected his ten-month-old son with swinepox. When the infant became ill, he tested him with smallpox at least six times. Jenner’s son would remain a sickly and mentally impaired child who finally died at age twenty-one. For the rest of his life, Jenner could not discuss his son without crying. Nearly a century later, Surgeon General George Sternberg and Walter Reed, in 1895, also used children in several orphanages to test a smallpox vaccine. The fact that Sternberg and Reed certainly believed they controlled the experiments and were not putting the children at risk only furthered the idea that they, like God, could conjure disease and cures at will.

  One of the notable examples of self-experimentation was that of William Halsted, who tested the anesthetic capabilities of cocaine on himself. He would continue his brilliant career at Johns Hopkins, but suffered a lifelong battle with addiction. George Sternberg had gone so far as to self-experiment with gonorrhea in the 1880s, though fortunately for his wife, he failed to produce a positive result. And even yellow fever had been the subject of self-experimentation in the past. Dr. Stubbins Ffirth, in 1802, attempted to prove the fever was not contagious by injecting himself with tainted blood and swallowing pills made of black vomit. By not understanding the incubation period of the virus, Ffirth unknowingly spared himself a case of yellow fever. Carlos Finlay had been trying since 1880 to prove his mosquito theory of yellow fever, infecting around ninety human subjects, including a group of Jesuit priests, with the blood of fever patients. All had proved unsuccessful.

  History’s most famous case of vivisection was yet to come however. As the Yellow Fever Board agreed to self-experiment in the following months, they seemed to have little confidence in the studies. At the very least, they believed it would be a long process with at least a year or two of work ahead of them.

  CHAPTER 16

  Did the Mosquito Do It?

  When the epidemic in Quemados ended, and Reed had sailed for the U.S., the doctors of the Yellow Fever Board found themselves without subjects to research. They decided to move their studies to Las Animas Hospital, literally “the Souls Hospital,” in Havana, where there existed a large number of yellow fever patients, but also Agramonte’s fully equipped laboratory. The doctors settled into a quiet pattern: Agramonte performed autopsies on the yellow fever cadavers in Havana, Carroll continued his work with tissue samples in his lab at Camp Columbia, and Lazear nurtured his mosquitoes.

  To Dr. Carlos Finlay’s delight, the Yellow Fever Board had paid him a visit to request samples of mosquito eggs. Finlay was now sixty-five years old, and he had been arguing his case for mosquitoes for twenty years. He took them into his library and pulled a few eggs from the glass edge of a bowl half full of water. Lazear listened intently as Finlay described the life cycle of this particular type of striped house mosquito, its peculiar aptitude for dwellings and fresh-water cisterns, its tendency to stay in a localized area rather than traveling great lengths, the female’s persistence in biting at all times of the day, its genius for adapting from its native forests to human habitats. Aedes aegypti was also a low flyer, drawn to the human scents of carbon dioxide and lactic acid that were heavier than the air and sank downward toward the exposed flesh of ankles and legs. Then, Finlay gave several dried eggs of that particular mosquito species to Lazear to raise for his own studies.

  In addition to the stages of the mosquito’s development, there were anatomical details to track. Given Lazear’s methodical nature, the care of the “birds” was perfectly suited for him. As the eggs hatched, Lazear carefully labeled the glass tubes and shipped a few more of the mosquitoes to Dr. Leland Howard, an entomologist with the Department of Agriculture in the U.S. Sure enough, the samples proved to be the striped house mosquito so common in North America. As that generation of insects died, Lazear nurtured the eggs of the next. The most essential factor in rearing a batch of mosquitoes and producing new eggs is a fresh blood supply. The pregnant females need blood in order to lay eggs; and once hatched, the new generation relies on blood meals to thrive.

  Las Animas Hospital housed an ample source of yellow fever patients. Lazear carried his fledgling mosquitoes in glass tubes plugged with cotton to the yellow fever ward. He removed the cotton and turned the tube upside down against a man’s arm or abdomen until the mosquito zigzagged its way downward, legs arched, and struck.

  Though each of the members of the Yellow Fever Board had volunteered to self-infect, it turned out to be more complicated than that: Reed’s work in the U.S. had detained him longer than planned as he prepared his typhoid report, Cuban-born Agramonte was thought to be immune, and Carroll spent most of his time working at Camp Columbia. Only Lazear, who frequented Havana, was left to test the mosquito theory.

  On August 11, Jesse Lazear took one of his carefully labeled yellow fever mosquitoes, flipped the tube upside down and waited as the insect landed and bi
t his forearm. When the mosquito seemed to have had her fill, Lazear tapped the glass, and she flew upward again. He marked it in his logbook. Contract surgeon Alva Sherman Pinto also volunteered to be bitten. Neither resulted in a case of yellow fever, though the mosquitoes had fed on infected patients and should have been carrying the virus in their wiry, winged bodies. Lazear’s notebook lists a number of other volunteers from Las Animas Hospital, none of whom developed yellow fever. The board became discouraged, especially Lazear, who was ready to “throw up the sponge.”

  Then, the prey turned on the predator.

  On August 23, Lazear sat down and wrote to his wife, who was now in the hospital on bed rest as she awaited the birth of their baby. In his letter, Lazear expressed his frustration with the fact that both Reed and Carroll seemed so preoccupied with the Sanarelli controversy: “Reed and Carroll have been at that for a long time and they have notions as to what we should do that I don’t agree with. They are not inclined to attempt as much as I would like to see done . . . I would rather try to find the germ without bothering about Sanarelli.”

  In letters to both his mother and his wife, Lazear never mentions the experiments he conducted on himself. It may be that he did not want to worry them; two days later, he received word that his wife, Mabel, gave birth to a daughter named Margaret. He wrote to his mother, “The distance seems very great at a time like this.”

  On August 27, Lazear finished his work at the lab at Las Animas Hospital in Havana and collected his glass tubes of mosquitoes to take with him to Camp Columbia. It was getting close to noon, the rooms of Las Animas grew stale, and the sun beat down against the tile floor. If he didn’t hurry, the afternoon rain would set in during their ride back to camp. Lazear didn’t want to take the time to return his glass-caged insects to Agramonte’s lab at the military hospital, so he carefully packed up the test tubes in a carrying case to take with him. Cuban doctors watched with curious amusement as Lazear came and went, his arms full of caged mosquitoes, just as Finlay had done twenty years before. As he left the hospital, Lazear noticed that the mosquitoes seemed to be thriving—all but one that is. Lazear made a note that morning that one of the females, who had bitten a new yellow fever patient twelve days before, had refused to feed.