Table of Contents
Title Page
Table of Contents
Copyright
Dedication
Acknowledgments
A Note to the Reader
Photo
Meeting the Monster
“Feeding the Fishes”
Plans
Going Nowhere
The First Clue?
Bugs
“I Have No Such Thing”
Delirious?
“Did the Mosquito Do It?”
“Doctor, Are You Sick?”
Sorting It Out
Problems
“We Are Doing It for Medical Science”
Testing Times
More Bugs
Celebration
Epilogue
Appendix
Glossary of Scientific Terms
Chapter Notes
Photo Credits
Bibliography
Index
About the Author
Copyright © 2009 by Suzanne Jurmain
All rights reserved. For information about permission to reproduce selections from this book, write to Permissions, Houghton Mifflin Harcourt Publishing Company, 215 Park Avenue South, New York, New York 10003.
www.hmhco.com
Photo credits appear on [>].
The Library of Congress has cataloged the print edition as follows:
Jurmain, Suzanne.
The secret of the yellow death : a true story of medical sleuthing / by Suzanne Jurmain.
p. cm.
ISBN 978-0-547-74624-1
1. Yellow fever—Diagnosis—Cuba—Juvenile literature. 2. Yellow fever—Juvenile literature. I. Title.
RC212.C9J87 2009
614.5'41097291—dc22
2009022499
eISBN 978-0-547-52835-9
v1.0614
To Dr. Jay Marks, Dr. Charles Burstin, and
Dr. Philip Brooks, with honor, gratitude, and deep appreciation.
Acknowledgments
Two of the most important words in all the English language are “thank you,” and I certainly owe thanks to the many people who made it possible for me to write this book.
As always, I am grateful to my agent, Edward Necarsulmer, for his encouragement and to my editor, Ann Rider, for her good ideas, cheering words, and thought-provoking comments.
Dr. Martha Sonnenberg kindly took time out of her busy schedule to answer my strange questions, and I must also extend my thanks to the librarians at the New York Academy of Medicine and the UCLA Biomedical Library who graciously allowed me to examine the material in their collections.
To Claudia Sueyras, a wonderful researcher at the University of Virginia, I owe a huge debt. She combed the archives, answered questions, sent me photographs, and was always ready to provide more help.
My heartfelt thanks must also go to Paul Song of Superior Galleries for providing photographs and information about the Congressional Gold Medal; to Professor Barbara Becker at the University of California, Irvine, who suggested sources for many of the photos; and to my son, David Jurmain, who came to my rescue with much-needed computer expertise.
Robert Scott moved heaven and earth to find me examples of the postage stamps showing Dr. Finlay; and my brother, David Tripp, provided contacts, source material, and, as always, a shoulder to lean on.
Finally, my greatest thanks must go to my husband, Richard, who took photos, answered questions, provided comfort, and reminded me time and time again through his own personal actions that doctors really can be heroes.
* * *
A Note to the Reader
Just over one hundred years ago a band of scientists and volunteers from two countries decided to fight against one of the world’s deadliest diseases. Some members of this group came from Cuba; some, from the United States. Unfortunately, today relatively little is known about the Cubans who took part in this important battle, while libraries contain many rich sources of information about the American team. For this reason, I have concentrated on the extremely well documented American part of the story. But readers should remember that without the great Cuban scientific contribution, there might have been no story to tell.
* * *
Summer 1899
The young man didn’t feel well. First, there was the chill: an icy, bone-freezing chill in the middle of a warm summer evening. Then there was the terrible crushing headache. His back hurt. His stomach twisted with pain. And then he was hot, boiling hot, with a fever that hovered around 104 degrees. His skin turned yellow. The whites of his eyes looked like lemons. Nauseated, he gagged and threw up again and again, spewing streams of vomit black with digested clots of blood across the pillow. Sometimes he cried out or babbled in delirium. Violent spasms jolted his body. It took two grown men to hold him in his bed as a nurse wiped away the drops of blood that trickled from his nose and mouth. Nights and mornings passed. Then, five days after that first freezing chill, the young man died: another victim of a terrible disease called yellow fever.
A yellow fever patient in a Cuban hospital around 1900.
Doctors didn’t know what caused it. They couldn’t cure it. But they knew that yellow fever was a killer. For centuries the disease had swept through parts of the Americas and Africa, leaving behind a trail of loss and misery. It turned cities into ghost towns and left the local graveyards filled with corpses. In New Orleans, Dr. Kennedy took sick and collapsed while he was tending patients. In Philadelphia, Dr. Hodge’s little girl caught the fever, turned yellow, and died in two short days. And when the sickness killed the Memphis snack shop woman Kate Bionda, she left behind her husband and two small children. The fever struck the rich. It struck the poor. It killed the humble, and it humbled the important. Jefferson Davis, president of the Confederate States of America during the U.S. Civil War, lost his son to yellow fever. George Clymer, who’d signed the Declaration of Independence, watched helplessly as the sickness struck his wife and family. And every single year the illness took its toll. In 1793, 4,044 people in Philadelphia died during a plague of yellow fever. New Orleans counted 8,101 yellow fever deaths in 1853. And when the disease hit Memphis, Tennessee, in 1878, 17,000 citizens sickened in a single month. Stores closed. Work stopped. Thousands fled, and those who remained wandered through a nightmare city—where sick children huddled next to dying parents and hungry dogs roamed the silent streets searching for their lost dead masters.
“Yellow fever [is] . . . an enemy which imperils life and cripples commerce and industry,” Surgeon General John Woodworth told the U.S. Congress in 1879. And he was right. In one single century—between 1800 and 1900—the disease sickened approximately 500,000 U.S. citizens and killed about 100,000.
The question was, what could be done about it?
By the 1890s doctors had found that many illnesses are caused by one-celled microscopic organisms called bacteria. With the help of this new knowledge, they taught the public how to kill these dangerous bacterial “germs” with things like heat and disinfectant. They also learned how to use dead or weakened germs to make vaccines—special types of medicine that prevent illness by forcing a living body to produce its own disease-fighting substances. Slowly, physicians began to conquer deadly sicknesses like cholera, typhoid, anthrax, and diphtheria. But yellow fever still raged. Researchers studied the disease. Doctors argued about the cause. Scientists peered through their microscopes, looking for the yellow fever germ. But there was no progress. Each year the hot summer weather brought on yellow fever epidemics. Each year desperate people burned clothing, bedding, and even buildings that had housed yellow fever victims in hopes of stopping the disease. Frantic doctors bled the sick, stuck them in musta
rd baths, dosed them with opium, or gave them drugs that might make them vomit out the germ—but nothing helped. Each year thousands of people caught the disease. Thousands died of it. And then, suddenly, something happened—something that at first didn’t seem to have anything to do with yellow fever or with medical science.
On February 9, 1898, the U.S. battleship Maine blew up in the harbor of Havana, Cuba. Two hundred and sixty-eight American servicemen were killed. U.S. officials told a shocked nation that Spanish government agents had deliberately caused the explosion. And by the end of April the United States had decided to go to war with Spain.
U.S. soldiers prepare to board a ship that will take them to Cuba to fight in the Spanish-American War.
In the next four months American soldiers beat the Spanish army in Cuba. They beat the Spanish navy in the Pacific. And when the Spanish-American War ended in July, the victorious U.S. forces had won the right to govern Cuba and Puerto Rico (two islands off the southern coast of Florida), as well as the Pacific Ocean islands of Guam and the Philippines. Unfortunately, the war had also brought the United States face-to-face with another deadly enemy: yellow fever.
Because of the disease, the newly conquered Cuban territory was a deathtrap. Yellow fever epidemics swept the country. Visitors often contracted the illness soon after landing on the island’s shores. Some U.S. troops had already died of the disease in Cuba, and Washington officials were alarmed.
In 1900 yellow fever (sometimes called yellow jack) was viewed as a monster. In this cartoon the monster is killing a woman who represents the state of Florida while another woman (labeled “Columbia”) who represents the United States cries for help.
What would happen to American soldiers in Cuba if a full-scale epidemic broke out on the island? Or, worse, what would happen if homecoming U.S. troops carried yellow fever back to North America? That was the kind of thinking that gave United States officials nightmares.
Something had to be done.
Somehow the country had to find a way to prevent more attacks of yellow fever.
But before U.S. scientists could stop or cure the disease, they had to understand it. They had to know what caused the sickness. They had to know what spread it. And it was important that they find out soon.
On May 24, 1900, the U.S. government sent orders to four American army doctors. Their mission was to go to Cuba and find the cause of yellow fever.
June 21–24, 1900
The USS Sedgwick lurched, and Major Walter Reed, M.D., promptly threw up. The ship was barely out of New York. Already he was seasick. And now, now that he was facing the biggest, most important challenge of his whole career, Dr. Walter Reed didn’t need to waste time leaning over the rail and doing what he called “feeding the fishes.”
For roughly twenty years, Reed had dreamed of being able to do something big, something important, something that he hoped would “alleviate human suffering.” It was a dream he’d had when he was a young army doctor tending settlers, soldiers, and Apaches on lonely frontier outposts. It was something he’d thought about when he went back to school at age thirty-nine to study bacteriology—a brand-new branch of medical science that dealt with the disease-causing germs that researchers called bacteria. For ten more years Reed had hoped to make a major contribution while he did research and taught students at the U.S. Army Medical School in Washington, D.C. And now, finally, at age forty-nine, he had a chance to take on the most exciting and important project of his whole career. Just a few weeks earlier, the U.S. Army had ordered Dr. Walter Reed to go to Cuba, head a team of three other doctors, and find the cause of yellow fever.
But where was he going to start? Before leaving Washington, Reed had read the latest medical books and done some preliminary experiments. He’d looked at scientific articles on yellow fever, and he’d also talked to people who’d spent time studying the illness. By now he knew that there were several current theories on the cause of the disease, and he could tick off on his fingers the first three items that had to be investigated.
Photograph of Walter Reed at age thirty-one, about twenty years before he began his work on yellow fever.
First was an idea suggested by Dr Giuseppe Sanarelli. A few years earlier this Italian researcher had announced that a type of bacteria called Bacillus icteroides was the cause of yellow fever. That sounded good. But Reed’s recent experiments had shown that Bacillus icteroides actually caused a pig disease called hog cholera. Now scientists were arguing about which research results were right, and Walter Reed knew that his team would have to find a way of settling the issue. That was a big project, and it was only the beginning.
Next on the list was an old theory—one that had been around for years. It claimed that healthy people got the disease by touching clothing, bedding, or furniture that had been used by yellow fever patients. That idea was so popular that it had appeared in medical books. Many health authorities believed it. So did many doctors. Of course, no scientist had ever proved the theory to be true. But it was definitely a matter for Reed and his assistants to consider.
Carlos Finlay, the Cuban doctor who tried to prove that mosquito bites caused yellow fever.
And then, finally, there was another idea. A very different one. For almost twenty years, in more than one hundred experiments, a Cuban doctor named Carlos Finlay had tried to prove that mosquito bites caused yellow fever. Time and time again, the Cuban scientist had attempted to show that bugs could carry the disease by letting mosquitoes he thought might be infected with the germ bite groups of healthy patients. But none of Finlay’s patients ever developed a truly clear-cut case of yellow fever from the bites. The experiments were unsuccessful. Many scientists laughed at the Cuban doctor’s failures. The mosquito theory didn’t seem to fit the facts, and no one understood why Finlay still continued to believe it. Maybe, some people said, the Cuban doctor was “touched.” Others came right out and called him “crazy.” Even Reed’s boss, the surgeon general of the army, George Sternberg—a leading American bacteriologist—thought that the mosquito theory was a joke. Investigating it was “useless,” he told Reed. And there was a good chance that the army surgeon general was right. Most sensible scientists did think the mosquito theory sounded pretty flaky. And Bacillus icteroides? Well, because of his own research, Reed privately thought that was probably pretty flaky, too.
But, of course, what Reed thought didn’t matter. Science wasn’t about opinions or theories. It was about facts. And Reed’s job was clear. With the help of his team, he had to find the facts. He had to test each one of the theories.
He had to find out—once and for all—if any of them was right. And if all three current theories were wrong, Reed would have to come up with a new idea—and test that. It was a big job. A tough one. But if Reed and his team could do it . . . if somehow they could find the cause of yellow fever, it might help scientists prevent the disease—or cure it.
But that was all in the future.
At the moment, the only cure Reed really needed was a remedy for seasickness. In a letter to his wife and daughter, he said that there seemed to be “two or three tons of brick in . . . [his] stomach.”
And when the USS Sedgwick rolled again, Dr. Walter Reed leaned over, threw up, and “fed the fishes.”
June 25, 1900
The sun was warm. The sea was blue. The orange juice, black coffee, and dry toast had stayed down. And Walter Reed was standing at the rail watching as his ship steamed past wharves, past the wreck of the battleship Maine, and into the harbor of Havana, Cuba.
When the ship docked at around eleven, Reed was ready to move. An epidemic of yellow fever had recently broken out in the Cuban town of Quemados. Some people in Havana were also sick with the disease. Even the chief U.S. medical officer for Western Cuba, Reed’s good friend Major Jefferson Kean, had come down with the illness several days earlier. There was no time to waste.
The hospital tents, nurses, and other medical personnel at Camp Columbia as they looked about
a year before Reed arrived.
Reed quickly loaded his bags into a carriage and drove through the bustling city streets of Havana and across eight miles of country roads until he reached the U.S. Army post at Camp Columbia. After dropping his bags at the Officers’ Quarters, he was off again, dashing across the grounds to visit Major Kean in the camp’s yellow fever hospital just outside the base.
There the news was good. Kean’s case was fairly mild. He was expected to live. At the bedside Reed probably chatted like any other visitor, but he must have also assessed the patient with a scientific eye. Was Kean’s skin yellow? Was his temperature high? Were his gums bleeding? What had he been doing in the days before he got sick? Had he been near mosquitoes? Infected clothing? Reed had read descriptions of yellow fever, but this was the first live case he’d ever seen. He was hungry for information. He wanted clues. But he couldn’t spend the rest of the day at Kean’s bedside. If Reed was going to get the research started, he had to organize his team.
The first meeting had already been called, and late in the afternoon Reed walked onto the garden patio outside Camp Columbia’s Officers’ Quarters to greet the three men he’d be working with.
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