It was twilight; she could hear the music from the main hall and the drone of soldier’s voices in the distance. Inside the clapboard ward, the dim light and smell of death took Warner out of the camp in Cuba to another time, twenty years before, when she lay on the floor of a plantation house outside of Memphis surrounded by the corpses of her family. Her skin burned at the memory. Flies had swarmed around the bodies, and as always, there was the sound of mosquitoes, the hum of their wings flinching in the hot air.
Lena Warner heard Lazear’s restless stirring in the bed, felt the intimacy of watching someone sleep. But the quiet did not last. Lazear’s body began to lurch, and black vomit roiled from his mouth, through the bar hanging above his hospital cot. He writhed in the bed, and his skin grew deep yellow. His 104 temperature slowly fell, leveling out at 99 degrees, and Jesse Lazear died at 8:45 p.m. at the age of thirty-four.
His arm and leg restraints were removed, and Albert Truby signed the death certificate for the quartermaster: “I have the honor to inform you that Jesse W. Lazear, Acting Assistant Surgeon, U.S.A., died at this hospital at 8:45 pm, Septr 25, 1900.” For the diagnosis, he wrote “yellow fever.” For the immediate cause of death, Truby left the space blank; a diagnosis of yellow fever was explanation enough.
Plans were made for a quiet burial so as not to affect the overall morale of the camp; but Truby insisted that Lazear receive full military honors. The entire military personnel of the camp, along with many other friends and officers, walked to the cemetery, while ambulances carried the nurses. Everyone wore white uniforms as they surrounded the gravesite like a colonnade and listened to the post band play taps. Though close to fifty mourners attended the service, only one member of the Yellow Fever Board was there: James Carroll. Reed was still in the U.S., and Agramonte had left a few days before on orders from General Wood to gather supplies in New York.
The same day as the funeral, September 26, Mabel Lazear sat in the home of her mother-in-law on Atlantic Avenue in Beverly, Massachusetts. She felt exhausted after recovering from childbirth and looking after a newborn; she had only been out of the hospital for a couple of weeks. The bell rang that morning, and she was handed a cable message. Her first thought must have been that it was from her husband—she had not heard from him in two weeks, and he had plans to return to the U.S. sometime in October. Then, she read the short cable: Dr. Lazear died at 8 this evening. It was signed by Kean, who thought that Mabel received word days ago that her husband was ill with yellow fever. She had not.
Jesse Lazear’s logbook, tall, thin, edged in dark red leather, had its last entry on September 13 with the listing of Guinea Pig No. 1. Lazear’s distinctive handwriting, with flourishing letters and elegant shape, ended that September, and new entries in different handwriting, most likely that of Walter Reed’s, did not begin again until December.
Reed retrieved Lazear’s logbook and studied it for clues. After careful examination, Reed concluded that Lazear had most likely infected himself and thus died of a medical suicide. Insurance would not be paid out to his family if this proved to be the case, and in all likelihood, that is why Lazear neither listed his name in the ledger nor admitted to self-infecting. Or, perhaps, Lazear did not want his family to know the truth. Mabel wrote to James Carroll asking for the details of her husband’s death, pleading that in spite of his passion for medicine, she could not believe her husband would ever deliberately infect himself. After all, he had a wife and two children.
Shortly after the experiments in Cuba ended, Lazear’s logbook disappeared from Walter Reed’s office and was not seen for fifty years. The second, smaller notebook that Truby found in the pocket of Lazear’s uniform was never seen again. The real cause of Jesse Lazear’s death was a secret carried to the grave by every member of the Yellow Fever Board.
CHAPTER 18
Camp Lazear
Walter Reed sailed on the Crook, by way of Matanzas, into Havana, on October 4, 1900. This time he approached the city with a poignant mixture of sorrow and purpose. He could smell coal, Cuban coffee, fruit fallen from the trees and carbolic acid in the streets: September had seen 269 cases of yellow fever, the worst epidemic Havana had experienced since the start of the Spanish-American War. When he had sailed out of Cuba in August, yellow fever had been an assignment, a challenge he felt equal to as a scientist. Few cases had plagued their camp, and the majority of Reed’s offensive had been fought beneath the lens of a microscope. Now, the disease was much more than that. It had taken the life of a beloved friend and colleague and impaired the life of another. The war to conquer this disease was nearing its end, but Reed knew that in order to defeat it, he would have to come dangerouslyclose to the enemy, sending his soldiers into the frontlines.
Even worse, the leader of the Yellow Fever Board had not even been there for the incredible breakthrough. Reed had never expected the results to come so fast, and he was guilt-ridden that he had not been present when two of his team members contracted the fever. He did not even get to attend the funeral of his friend Jesse Lazear. Lazear’s death cast a dark shadow over the success of the board, and personally, it would make it much harder for Reed to submit more men to the studies needed to prove their theory.
Once again, Reed had not been alone in his cabin on his sail to Havana. This time, Robert P. Cooke, a young contract doctor recently out of the University of Virginia, shared his cabin. Reed and Cooke were already acquainted; Cooke had been one of the doctors in charge of the yellow fever ward at Pinar del Rio that summer when Agramonte and Reed found horrible conditions and an unreported epidemic of fever in the camp. In fact, Cooke had nearly lost his contract with the army as a result of Reed’s formal reprimand. The acting chief surgeon had written a letter to Cooke: “Let this awful experience be a lesson to you . . . While you are not as culpable as your associates, do not flatter yourself that the authorities will hold you guiltless.”
It was decided that Cooke’s mistake was due to youth and inexperience above all else, and he kept his job. Cooke took the criticism and reprimand without argument, and his modest nature impressed his superiors. Reed took a liking to him as well on board the Crook, and the two doctors—one just beginning his medical career, the other approaching the highest peak of his— discussed the potential of the yellow fever work and the tragedy of Jesse Lazear. Perhaps Cooke felt some guilt about his mistakes at Pinar del Rio, or maybe he was inspired by Reed and the martyredLazear. As the two men left the ship, those conversations onboard settled like silt into the conscience of Robert P. Cooke.
Once back at Camp Columbia, Reed went almost immediately to visit Carroll. A full month had passed since he first contracted the fever, and Reed was shocked to find Carroll still so weak and depressed. It would take another week for Carroll to be strong enough to travel, and then Reed insisted that he return to Washington to spend some time with his family while he recovered. Agramonte was still on leave in the U.S., and that left Walter Reed without his Yellow Fever Board on the brink of one of medicine’s greatest discoveries. Usually slow, methodical and deliberate, Reed was kinetic in those first few weeks—he spread out paperwork and books across his oak mess table and worked nonstop. Reed had been given Lazear’s lab notebooks immediately upon his return, and he scoured the pages trying to find the right combinations linking the infected mosquito, when it bit the feverish patient and when it bit the healthy one, to the onset of yellow fever. The biggest question in his mind was why on those three attempts, Carroll’s, Dean’s and Lazear’s, the mosquito had been able to pass the virus, when it had failed in all other experiments. Unfortunately, the cases of James Carroll and Jesse Lazear were useless as scientific evidence—both men had been exposed to yellow fever in various other circumstances that could negate the mosquito theory. The only possible pure case was that of Dean, their patient XY. Dean denied ever leaving the camp, but Reed could not be certain, so he had Albert Truby wait on the veranda and record their dialogue as Reed casually engaged Dean in conversation.
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br /> “My man, I am studying your case of yellow fever and I want to ask you a few questions. Before questioning you, however, I will give you this ten-dollar gold piece if you will say that you were off this reservation at any time after you left the hospital until you returned sick with yellow fever.” Reed fixed his eyes on Dean, who replied, “I’m sorry, sir, but I did not leave the post at any time during that period.” The two men sat down, and Reed listened to Dean’s straightforward version of what happened. He later told Truby that he was willing “to risk his own reputation” on the veracity of the story.
In the following days, Reed relied heavily on his assistant John Neate and Private John H. Andrus, who had been assigned to help in Lazear’s place. Reed contacted Dr. Carlos Finlay, requesting all of his previously published papers about yellow fever, and sent his driver to fetch them. He handwrote the drafts, then asked clerks to type pages for him. Over an eight-day period, Reed wrote a report, 5,000 words long, outlining the mosquito theory. Once his paper had been typed, he had Truby and the other men mail copies to a long list of people with a handwritten note attached: Compliments of the writers.
There was urgency to the matter: The American Public Health Association would hold its annual meeting on October 23 in Indianapolis. Reed had already cabled Washington to ask permission to attend, and Sternberg, ever anxious to report the cause of yellow fever, had made space among the 150 delegates for Walter Reed. It was such a last-minute entry, however, that Reed’s name would never even appear in the printed program. Reed wrote to Emilie and told her to expect him by October 18, when he would travel to Indianapolis for the presentation of his paper, “The Etiology of Yellow Fever: A Preliminary Note.”
Reed had been given twenty minutes to speak, but was then granted an additional twenty for his presentation. He was explicit in his credit to others involved in the discovery, most especially Dr. Carlos Finlay, the “Mosquito Man,” who had been ridiculed by both the Spanish and American press. Reed publicly thanked Finlay for supplying the mosquito eggs necessary to the experiments and cited several of his published articles. The Indianapolis Journal called Reed’s presentation “fascinating,” and the New York Times published an article in which one health officer praised Reed’s theory. “If the Finlay theory is true,” said the officer, “the sufferer from abroad can be made harmless at the cost of a few yards of mosquito netting. He may die himself, but he will not kill others and he will not interrupt the business of railways or steamboats.”
Reed had hoped to make some final changes to his study before it went to print, but Sternberg, probably anxious for the Sanarelli camp to read it, prematurely sent the article without Reed’s approval to the Philadelphia Medical Journal, where James Carroll, Aristides Agramonte and Jesse Lazear were all listed as contributing authors. In the article, Reed discounted Sanarelli and his supposed yellow fever bacteria, calling it merely a “secondary invader.” Instead, Reed explained, “The mosquito serves as the intermediate host for the parasite of yellow fever.”
Naturally, Reed’s article received some criticism, especially from those who believed Sanarelli’s germ theory. The Washington Post, in particular, was harsh in its opinion of the mosquito hypothesis. In one article, they referred to the Yellow Fever Board, “whoever they may be,” as putting forth a theory that is “the silliest beyond compare.” While the article seems unduly subjective considering the recent connections between malaria and mosquitoes, it also confirmed what Reed had felt all along: That his professional reputation was riding on only one experimentally produced case of yellow fever. Just before leaving Cuba for the Indianapolis presentation, Reed and Kean had met with General Wood to discuss what actions to take when he returned. Kean wrote that Reed stood before the general, “tall, slender, keen and emotional” and convinced Wood with his “earnest and persuasive eloquence of which he was a master” to use $10,000 to fund a camp for further mosquito experiments.
It would be called Camp Lazear.
Wild and uncultivated, a clearing of two acres stood angled steeply between sea and sun. The ground was far enough from highway travel to discourage wayward visitors, and it was well drained and windswept enough to deter unwanted mosquitoes. It was also an area that had never seen yellow fever.
Walter Reed had returned to Cuba on November 5, 1900, and in his absence, he had Agramonte search out a locale for Camp Lazear. Agramonte was the natural choice—he was the only board member present in Cuba at the time, and he had lived there the longest. The land belonged to an ancestral home, 150 years old, called Finca San Jose in Marianao, and it was owned by a friend of Agramonte’s. They would lease part of the property for twenty dollars a month and begin building Camp Lazear. The land also had one other important feature: It was only two miles from the yellow fever hospitals of Quemados and Camp Columbia. If their experiments proved successful, they would need those hospitals.
During construction and the experiments, Reed would often wander over and sit on the front porch belonging to the couple who owned the farm. He told them how he loved Cuba and even talked of taking his wife and daughter Blossom to visit, maybe even moving there once he retired.
While the camp was under construction, Reed turned his attention to building a healthy supply of mosquitoes. Finlay’s earlier samples might not be enough to sustain the experiments, and as cool weather approached, fewer mosquitoes would be available.
Reed picked up where Lazear had left off in his entomological studies, contacting Leland Howard in the U.S. with insect samples and questions. Boxes of paperwork covered Reed’s desk, as did two large leather volumes— 600 pages each—of La Roche’s history of yellow fever, published in 1853. If Reed’s enthusiasm wasn’t immediately contagious among the men, it soon would be. As they sat around tables playing cards or visiting on the veranda in the autumn evenings, Reed would interrupt, “Gentlemen! Listen to what La Roche says about the terrible epidemic in Philadelphia in 1793!” The men would gather in the study and listen to Reed read from mosquito pamphlets and studies. Soon, the hunt for new specimens began. Using large-mouthed cyanide bottles, they collected mosquitoes and studied them beneath a strong hand lens.
One night in mid-November, a tropical storm pounded Cuba. The low sky grew gunmetal gray as heavy winds uprooted trees, tossed tents and shook the wooden buildings. Shutters blew open and papers flew, wet and tattered. Reed’s collection of lab mosquitoes was blown out to sea. When the storm subsided, only a few dry eggs remained, and the experiments were scheduled to begin any day. Colleagues tried to convince Reed that warm weather would return soon enough, and a new supply of mosquitoes would hatch, but Reed persuaded his men to hunt new mosquitoes with him. They searched drainpipes, upturned cans, broken containers and even privy buckets to skim the surface for mosquito larvae, “wigglers,” as they called them. Along the still surface of water, they collected the black, cylinder-shaped eggs, which could be dried or frozen or hatched immediately. Returning to the lab, Reed, Neate and Andrus picked through the findings, separating “wigglers” from eggs and harvesting a whole new batch of the lyre-marked Aedes aegypti mosquitoes.
The storm aside, the construction of Camp Lazear was nearly complete. Everything about the camp had to be uncontaminated. Wagons carried new tents and equipment, all in their original packaging, to Camp Lazear. Wooden floors were built where seven tents would be pitched. Personnel were carefully chosen based on their impeccable military records and an interest in experimental medicine. They also had to be in perfect health—all of the volunteers but one were under the age of thirty. The men were then quarantined.
Reed himself designed the most critical buildings for the camp with meticulous care. One would be dedicated to the mosquitoes; the other would be used to disprove once and for all the theory that yellow fever could be transmitted by objects, infected clothes or close contact. The entire compound would be enclosed in a barbed wire fence with a military guard to deter anyone from entering or leaving.
Building No. 1 be
came known as the “Infected Clothing Building.” Its tongue and groove wooden frame was twenty feet by fourteen feet with glass pane windows and a solid-wood, double-door entry; the windows and door were screened then boarded shut. Every precaution was made to keep the structure free of mosquitoes and sunlight. Three beds stood in the center of the room, surrounded by crates and boxes still sealed shut.
Reed sought out volunteers for the Infected Clothing Building, and the doctor chosen to lead the group was Robert P. Cooke. Six months earlier, Cooke had nearly lost his job thanks to the reprimand by Agramonte and Reed. He had also neglected a potentially explosive epidemic of yellow fever at Pinar del Rio. Now, both Agramonte and Reed watched as Cooke and two other volunteers entered their first experimental building. Though the other two volunteers would receive $100 each, Cooke refused any compensation.
In modern times, it’s hard to understand the mentality that would lead a soldier into knowingly risking his life for the purpose of medicine. Soldiers are trained to fight and defend; if any illness befalls them, it’s considered a cruel and unjust turn of events. But prior to World War II and the introduction of penicillin, soldiers lost their lives to disease far more than bullets. From the time of the American Revolution through World War I, a soldier knew his odds of dying from dysentery, cholera, typhoid, smallpox, influenza or yellow fever were greater than those on the battlefield, so volunteering for human experiments might not seem as much of a psychological departure as it would today. After all, a soldier’s duty is to defense, and many men felt that the greatest threat to the American people lay not in enemy warships or troops, but in disease.
On the evening of November 30, Cooke and the two other men entered Reed’s carefully crafted building and sealed the solid wood door behind them. A single stove stood in the one-room house, and it kept the temperature inside somewhere between 90 and 100 degrees at all times. Impenetrable to light or air, the small room felt like a furnace. The three men began breaking open the crates and boxes left in the center of the room. As they opened the first trunk, the odor was so pungent that the men ran outdoors, hands over their mouths, to keep from retching. After a few minutes, the three men returned and finished unpacking boxes full of soiled sheets, covered in vomit, sweat and feces from the yellow fever ward. They dressed in the filthy clothing that had been worn by dying patients, they covered their cots in sheets stained with black vomit, and then they spent the next twenty nights the same way.
The American Plague Page 18
