The Secret of the Yellow Death

by Suzanne Jurmain

  Modern photo of a ladle of water containing mosquito eggs and larvae (immature mosquitoes). In 1900, when billions of mosquitoes swarmed through Cuba, sights such as this were common.

  That was one piece of good news. Then, around the middle of November, there was another. James Carroll returned from sick leave. He still wasn’t one hundred percent healthy, but he immediately pitched in by helping to raise, infect, and keep records of the mosquitoes that were going to be used in the new series of experiments.

  Things were going well, but the team still had to face one enormously important problem: Where were the scientists going to find volunteers who were willing to take part in the new experimental tests?

  To present a watertight case, the team had to show that the mosquito hypothesis was true and that all the other old ideas about the cause of yellow fever were completely false. With the help of his colleagues, Reed had already proved that Bacillus icteroides didn’t cause the illness. Now the team needed to deal with the last two remaining theories. First, they had to prove once and for all that infected mosquitoes did cause yellow fever. And, second, they needed to show that being in contact with infected clothing and bedding was definitely not the cause of the disease. To do that, they needed two sets of human volunteers for a series of experiments. The first set would have to spend several weeks wearing and using clothing and sheets that had been stained by the sweat, vomit, urine, and feces of yellow fever patients. The second set would have to do what Carroll, Dean, and Lazear had done. They would have to be bitten by infected mosquitoes.

  But how many normal, healthy, sensible people would volunteer for such disgusting and dangerous experiments?

  A highly magnified modern photo of a fish about to eat a tiny immature mosquito. Mosquitoes live in water before they become adults. In very warm weather, it may take a mosquito egg a week to develop into a mature insect; in cold weather, it may take almost a month. By eating large quantities of immature mosquitoes (larvae), fish (like the one in his photo) help to keep down the number of these insect pests.

  Of course, Reed could order soldiers to take part in the tests without telling them about the dangers or asking their permission. In 1900 scientists sometimes did something that is now illegal in the United States and many other countries. They sometimes dosed unsuspecting patients with disease germs or untested drugs without bothering to explain the risks or to ask these victims for consent. But Reed refused to do that. Like William Osier, the famous nineteenth-century doctor and professor of medicine, Walter Reed thought that “deliberately injecting a poison . . . into a human being, unless you obtain that man’s sanction [permission], is . . . criminal.”

  Syringes similar to those used in Walter Reed’s time. In 1900 syringes like these were sometimes used to inject germs and untested drugs into unsuspecting patients. Dr. Giuseppe Sanarelli, for example, injected Bacillus icteroides into five patients without asking for their consent.

  If Reed was going to do yellow fever experiments, he wanted to be honest and up-front about it. He wanted volunteers to know they were risking sickness and death by participating. What’s more, he wanted to do something new—something that scientists hadn’t done before. Because he felt his yellow fever insect experiments were extremely dangerous, Reed wanted each and every volunteer to sign a consent form indicating in writing that he or she was willing to undertake the experiment and truly understood the hazards.

  The question was, would Reed find anyone brave enough to sign up?

  November 1900

  As the days went by, Reed and his team began looking for volunteers. Candidates had to be young and healthy—because young, healthy people had the best chance of surviving yellow fever. They had to be single, so that their sickness or death would not injure an entire family. And, of course, they had to be willing to risk getting the disease.

  The truth, however, was that yellow fever was so common in Cuba that anyone who set foot on the island and hadn’t previously had the illness was likely to come down with it anyway. And that piece of information gave the Reed team an idea.

  Immigrants from Spain were landing in Cuba all the time. Many were young, healthy, and single. All of them knew that they might get yellow fever in Cuba. And, maybe, the team thought, since these newcomers were already running the risk of getting the disease naturally, some of them would be willing to volunteer for the experiments.

  With Reed’s permission, Agramonte interviewed a group of recent immigrants and carefully explained the requirements and terms. Each volunteer who signed Reed’s consent form and agreed to be bitten by mosquitoes would be paid $100 (the equivalent of about $2,400 in today’s money). In addition, those who came down with yellow fever would receive an extra $100 and the very best medical care the U.S. Army team could possibly provide. By the time Agramonte had finished, four Spanish men—Antonio Benigno, Nicanor Fernandez, Becente Presedo, and Jose Martinez—had agreed to volunteer and had signed a consent form written in English and Spanish.

  It was a start. And Agramonte wasn’t the only recruiter.

  One afternoon, medical officer Dr. Roger Ames saw a twenty-four-year-old civilian clerk named John Moran walking across the Camp Columbia parade ground. When Moran stopped to chat, Ames told the young man that Reed was offering money to anyone who’d volunteer for the new series of experiments. Was Moran interested in signing up?

  Like everyone else at Camp Columbia, Moran knew that Dr. Jesse Lazear had died of yellow fever. He knew that the disease had just about killed Carroll. But young John Moran badly wanted to become a doctor. He needed a lot of money to pay for medical school. When Ames spoke, Moran later wrote in his memoirs, the first idea that popped into his head was, “Just think, Johnny, what that . . . [amount of money] will mean to you.” The offer was tempting. But Moran didn’t want to make a snap decision. He told Ames to let him “sleep over it.” Then he went back to his quarters to discuss the proposal with his roommate, Private John Kissinger.

  An English translation of the consent form stating the volunteer Antonio Benigno (misspelled as “Benino”) was willing to participate in the mosquito experiments.

  At midnight the men were still talking. The danger was clear. The money was attractive. But that wasn’t all. As the night wore on, Moran got more and more excited about being part of the experiments. Signing up was more than just a fast way to make some cash. It was a chance to help save lives. A chance to help make medical history. In fact, getting involved in the fight to conquer yellow fever seemed so important that Moran decided to refuse the money. He was going to take part in the experiments solely for the sake of helping science.

  “[Don’t be] a fool,” Kissinger told him. But Moran had made up his mind. He was positive. Finally, even Kissinger was convinced. “Whatever you do, John, I am with you,” Kissinger said. “We’ll volunteer together.”

  Dr. Roger P. Ames. Dr. Ames, who was considered an expert at treating yellow fever, took care of patients who came down with the disease at Camp Columbia and Camp Lazear.

  The next morning, the two men went to Reed’s room in the Officers’ Quarters. The door was open. “Good morning,” Reed said. ‘What can I do for you?” For a minute Moran struggled for words. Then the young man poured out the story. He and Kissinger were volunteering, Moran told Reed, “without the bonus or money award which [the army was] offering. . . . We are doing it,” Moran said, “for medical science.”

  Now, some people say that Reed turned to the two volunteers and said, “I take my hat off to you, gentlemen.” And some people claim that Reed said simply, “I salute you.” But Moran wrote in his memoir that Reed just “gladly accepted” with “a gleam in his eyes . . . of pleasure and satisfaction.”

  Later, however, the major voiced his actual feelings. Those who volunteered for the experiments, Reed said, showed a type of “courage [that] has never been surpassed in the annals of the Army of the United States.”

  That was high praise, and soon many men deserved it. In the we
eks that followed, fifteen other Americans signed up for the experiments. Although many agreed to accept money for their participation, at least one other man refused the reward and agreed to take part solely for the sake of science.

  The volunteer problem had been solved more easily than Reed could have expected, and it was time for the real scientific work to start.

  Members of the Hospital Corps at Camp Columbia. Many of Reed’s volunteers came from this group. John Kissinger is number 10. (Other volunteers are identified in the Appendix.)

  November–December 1900

  On November 20, 1900, Camp Lazear officially opened. Volunteers and other personnel were housed in seven newly erected tents. Two specially constructed small wooden buildings were ready to be used for the experiments, and a barbed-wire fence kept out unwanted visitors.

  To make sure all the men in his experimental group were healthy, Reed ordered medics to take the volunteers’ pulse and temperature three times a day. There were going to be no slip-ups, no accidental illnesses, nothing that would allow critics to find fault with the experiments—not if Reed could help it. Everything seemed to be in place, but Reed still had a nagging worry. He knew he’d made sure that his volunteers were young and healthy enough to have a good chance of surviving yellow fever. He knew the men who were volunteering understood the risks. He’d made sure that any volunteer who got the disease would have the best possible medical care. But what if the worst happened? What if one of the volunteers died during the experiments? If that happened, Reed wrote his boss, Army Surgeon General George Sternberg, “I shall regret that I ever undertook this work. The responsibility for the life of a human being weighs upon me very heavily.”

  Still, thousands of people in Cuba, Africa, and the Americas were dying of yellow fever every year. If the team failed to find the cause, the vicious disease would undoubtedly kill thousands more. Somehow, Reed had to take the necessary steps to find an answer; and on Friday evening, November 30, experiments in Building 1, the “infected clothing” building, got under way.

  Stethoscope made in 1891. The doctors at Camp Lazear probably used similar instruments when examining volunteers and patients.

  From the outside the little wooden structure looked like a shack. Its tiny windows were screened and tightly closed to keep out fresh air and mosquitoes. Inside there were three beds, a group of closed boxes, and a stove that heated the place to a germ-friendly temperature of between 90 and 100 degrees. At the entrance stood three American volunteers: Dr. Robert Cooke, Private Warren Jernegan, and Private Levi Folk. As members of the scientific team watched through a window, the three American servicemen entered the building, opened the boxes, and took out nightshirts, underwear, blankets, sheets, and towels that were soiled with the blood, vomit, urine, and feces of yellow fever patients. The stench was terrible. One man threw up, and all three volunteers ran outside gagging. Then they went back into the stinking house. They dressed themselves in the filthy clothing, put the dirty sheets and blankets on their beds, waved some of the towels and bedding around to spread the “germs,” and slept in the hot, fetid little building for the next twenty nights.

  Three weeks later, on December 19, Cooke, Folk, and Jernegan walked out of the “infected clothing building.” None of them was sick.

  That certainly seemed to show that yellow fever wasn’t caused by contact with infected items. But the team wanted to be absolutely sure. To prove that the test results could not have been an accident, they repeated the experiment—twice. Two other groups of men did exactly what Cooke, Folk, and Jernagen had done, and each time the volunteers stayed healthy. That confirmed the findings, and the team knew they’d made real progress. Since starting work, they’d shown that Bacillus icteroides and infected clothing didn’t have anything to do with the spread of the disease.

  But could they prove that infected mosquitoes were the cause of yellow fever?

  The small building in the center was used for the infected clothing and bedding experiments at Camp Lazear. “Building 2” was used for the mosquito experiments.

  November–December 1900

  Everything was riding on the mosquito work. Almost as soon as Camp Lazear opened, the team began to experiment with bugs.

  In November, Private John Kissinger was bitten twice by infected insects. His roommate, John Moran, was also bitten twice. So were several other men. But—although Reed used only mosquitoes that had bitten yellow fever patients at least twelve days before—none of the volunteers ran a temperature. None developed a chill. And none of them showed the slightest sign of yellow fever.

  Something was wrong.

  Reed, Carroll, and Agramonte anxiously examined the data. Surely, there had to be some logical explanation. But what?

  Maybe, Reed thought, the colder fall weather had somehow affected the mosquitoes. Maybe it took longer for the germ to mature inside the insect when temperatures were cool.

  Patiently, the scientists adjusted the timing. Then they tried again.

  On December 5 at eleven thirty a.m., one of the doctors pressed a glass tube containing an infected mosquito against John Kissinger’s arm. After that insect had bitten the young soldier, the doctor repeated the procedure with other infected mosquitoes. By the end of the morning, Kissinger had five itchy bites.

  Three days later, Private Kissinger woke a few minutes before midnight feeling, he later said, a little cool. He was just getting up to close the tent flap, when suddenly his body felt like ice. For several long minutes, he huddled, freezing, in his cot. Then, as a little warmth crept back into his limbs, he reached out, lit a candle, and took his temperature. The mercury registered 101. Kissinger quickly sent a guard to fetch the doctor who was sleeping about twenty-five feet away. Ames arrived in minutes. By then, John Kissinger was in agony. “I felt,” he later said, “as though six Ford cars had run over my body. Every bone . . . ached. My spine felt twisted and my head swollen and my eyes felt as if they would pop out of my head, even the ends of my fingers . . . [were] aching.”

  Private John Kissinger, as the looked at the time of the mosquito experiments.

  John Kissinger had yellow fever.

  At Reed’s request, a panel of distinguished Cuban yellow fever specialists—including Dr. Finlay—examined the young private and confirmed the diagnosis.

  For the first time one of the team’s mosquito experiments had worked.

  In his quarters Reed grabbed a pen and started a letter to his wife. “It is with a great deal of pleasure that I hasten to tell you that we have succeeded in producing an unmistakable case of yellow fever,” he started formally. Then all his excitement burst out. “Rejoice with me, sweetheart,” he wrote. “. . . I could shout for very joy that heaven has permitted me to establish this. . . . Indeed, my precious heart, you cannot tell what a relief from suspense and anxious waiting this day has been.”

  It was a big breakthrough. But it was only one experiment. Reed and the rest of the team knew that the results of any one experiment could be an accident. More confirming evidence was needed, and the researchers waited tensely for the next results.

  Then, a few days later, Antonio Benigno and two of the other Spanish immigrants who had been bitten by infected mosquitoes became sick. When the panel of experts from Havana examined the patients, the diagnosis was clear. All three Spanish immigrants had come down with yellow fever.

  Unidentified man standing beside Building 2, the mosquito building, at Camp Lazear. This building was used for the insect experiments.

  Burning buildings in the town of Siboney, Cuba, 1898.

  These buildings were burned in an attempt to stop a yellow fever epidemic.

  The evidence now seemed to show that mosquitoes could carry the illness, but Reed and the team were still not completely satisfied. As Kissinger and the Spaniards slowly recovered, the scientists set out to establish one final and important fact.

  For years people had claimed that the yellow fever germ could somehow contaminate whole buildings
like a kind of poison gas. The idea was so common that once, in 1898, every building in the Cuban town of Siboney had been burned down to stop a yellow fever epidemic. Now Reed, Carroll, and Agramonte wanted to show that a building could be infected with yellow fever only if it contained infected mosquitoes. And that meant doing a new experiment in Building 2, the other wooden building at Camp Lazear.

  Inside the little wooden shack was absolutely spic and span. A large wire mesh screen split the room into two parts. Two perfectly clean beds stood on one side of the screen. On the other side was another clean bed and fifteen live, free infected mosquitoes.

  At noon on December 21, two male volunteers entered and lay on the beds on the mosquito-free side. John Moran lay undressed on the clean bed in the mosquito area. Within half an hour, he had been bitten by seven bugs. After breaks, during which the participants left the hut, the procedure was repeated one more time that day and again on the next.

  By late afternoon on December 22, Moran had fifteen bites and the volunteers on the other side of the screen had none. John Moran then returned to his tent. The two other men slept on the mosquito-free side of the room for the next eighteen nights—breathing the same air that Moran had breathed, being close to the bedding he had touched, and listening to the whine of the mosquitoes on the other side of the screen.