The American Plague

by Molly Caldwell Crosby

  Lazear’s quote that Walter Reed was another convert of the mosquito theory was found in Hench’s interview with Reed’s children, as well as Hench’s questionnaire for Jefferson Kean in 1946.

  The account of the officers in their dress whites discussing medicine on the veranda in the evenings was based on Truby’s book. Truby noted that Reed’s interest in yellow fever was tireless.

  The details about Lazear’s courtship with Mabel, his trips to California to meet her family and visit their ranch, as well as the date and place of their marriage, came from a series of letters written by Jesse Lazear to his mother, Charlotte Sweitzer, in July, August and September of 1896. Those letters are part of Hench’s collection at the University of Virginia.

  Lazear’s description of Havana was taken from a letter to his mother on February 11, 1900. Lazear’s personal photo album of their first few months in Havana and Marianao is held in the Hench collection. The letter Lazear wrote to his mother requesting that she store the boxes of golf clubs, Shakespeare, linens and dishes was dated February 15, 1900. Additional descriptions about the Lazears’ home in Cuba—like a partition made of matting from a Chinese store, the shower bath and physical details about the home—were found in letters Lazear wrote to his mother during February and March of 1900. Additional details about what they ate and what they fed the baby, as well as descriptions of taking Houston to the beach were found in letters to Lazear’s mother, dated February 15 and March 15, 1900.

  The account of tree frogs settling into the rafters of buildings at Columbia Barracks was found in Truby’s Memoir of Walter Reed.

  On April 6, 1900, Lazear wrote to his mother to tell her that Mabel and Houston would be returning to the States on the Sedgwick around April 14. As transports were often a day early or a day late, that date may not be exact. Walter Reed, in a letter to his wife, makes reference to a ticket on a transport like the Sedgwick costing $12.

  Additional details about the soldiers’ time at the Columbia Barracks were gathered from various letters and photographs of the social hall. Jesse Lazear wrote to his mother that he often stood on his porch, but rarely ventured to the weekly dances. I know he could hear the firing of the hour at El Morro Castillo becauseWalter Reed wrote to his wife, on December 31, 1900, that they could hear it on quiet nights.

  Information about Major Jefferson Randolph Kean and the diary of yellow fever cases that he kept was taken primarily from Bean’s Walter Reed. Kean’s description of Reed, his whimsical humor and penchant for quaint stories, was found in a letter Kean wrote to Philip S. Hench on January 23, 1944.

  I found all information about Lazear’s investigation of Sergeant Sherwood’s case of yellow fever—the tests conducted and the autopsy notes—in a notebook kept at the New York Academy of Medicine. The notebook has a fascinating history. It mysteriously disappeared after Reed’s work in Cuba was completed. It was discovered thirty years later in an ash barrel and sold for twenty-five dollars to Archibald Malloch, who gave it to the academy. The New York Academy of Medicine has the notebook labeled as the “Record of the Yellow Fever Commission’s work in the handwriting of Dr. Neate.” Neate was Walter Reed’s lab assistant. However, historians Philip S. Hench and Reed biographer Laura Wood Roper located the notebook at the academy in the 1940s, and both believed the handwriting in the notebook to be that of Lazear’s and Reed’s. Likewise, when I visited the New York Academy of Medicine in 2004, I took samples of Lazear’s and Reed’s distinctive handwriting; they matched the records in the notebook perfectly. In my book, I have therefore described this notebook as the one belonging to Jesse Lazear until September 1900. In December of that year, the records began again in Walter Reed’s handwriting.

  The quote about entomology, keying in anatomical minutiae, the formation of mouthparts, the bewildering pattern of wing venation is from Robert Desowitz’s book.

  Truby’s quote about the epidemic in Quemados was taken from his book Memoir of Walter Reed.

  The account of Kean’s illness and his visit to Major Edmunds is based on a letter from Jefferson Randolph Kean to Philip S. Hench on January 23, 1941.

  The Yellow Fever Commission

  The letter from Surgeon General George Miller Sternberg to the adjutant general on May 23, 1900, is held in the Philip S. Hench Walter Reed Collection at the University of Virginia. In the original, typed version the reference to yellow fever has been stricken by hand. The reason for this is not known, but Hench believes it may have been to avoid offending the Cubans. At that time, yellow fever was still considered a disease associated with filth.

  Again, for an impression of the Havana harbor I relied on personal experience as well as descriptions from letters. The account of Reed’s trip to Havana on board the Sedgwick was from a letter he wrote to Emilie on June 25, 1900. It is held in the Hench collection.

  Information about Sanarelli and the bacteria he believed caused yellow fever was taken from Kelly’s book. As Kelly was a contemporary of both Sternberg and Reed, he was well aware of the controversy.

  I based the theory that Reed, rather than Sternberg, chose the members of the Yellow Fever Board on the electrozone report he filed with the surgeon general on April 20, 1900. It can be found in the archives of the National Library of Medicine. In the report, Reed specifically thanks Carroll, Agramonte and Lazear for all of their help.

  Biographical information about James Carroll came from several sources. I found a reference to his nickname as “Sunny Jim” in an interview Hench conducted with Kean on November 19, 1946. Carroll himself provided a lot of the information about his backgroundto Caroline Latimer in a letter in 1905. Latimer later wrote an article about Carroll published in A Cyclopedia of American Medical Biography, 1920. Additional information was taken from Bean’s book.

  Lazear’s description of Carroll was in a letter written to Mabel on July 15, 1900. And other impressions of Carroll were taken from an interview with Pinto and the memory of Charles S. White, a former student of Carroll’s and Reed’s. All can be found in Hench’s collection.

  The quote by a colleague about Carroll needing to be led by a man with vision was in a letter Albert Truby wrote to Hench on September 3, 1941.

  The letters in which Carroll chastises Jennie were written on August 27, 1900, and December 1, 1900. Both are held in the Hench collection and there are references to them in Bean’s book. Not all of his letters were so negative, but those two were chosen because they reflect what seemed to be a strained relationship between Carroll and his wife, as well as his children. In many other letters, he is perfectly cordial though never very affectionate. The information about Carroll’s son was found in a memorandum written by Hench on November 11, 1954.

  Biographical information about Aristides Agramonte was taken primarily from the curriculum vitae of Aristides Agramonte, held in the Hench collection. There is also a photo in the collection on which I based the physical description of Agramonte. The reference to Agramonte’s work with Reed in Washington prior to their appointment in Cuba was found in Hench’s “Timeline of Agramonte’s Service in the Army Medical Corps.” Agramonte was assigned to work with Reed at the lab in Washington for the month of May, 1898.

  William Welch’s recommendation of Lazear was part of a letter written to the surgeon general on January 12, 1900.

  Reed’s account of the journey on board the Sedgwick was taken from his letter to Emilie on June 25, 1900. Details about the harbor, Plaza de Armas, and the Governor’s Palace came from personal observation during the trip to Havana. Descriptions of the plant life came from both personal observation and Reed’s descriptions in letters to his wife.

  The board’s meetings on the veranda and the instructions from Sternberg come from Truby’s account as well as Sternberg’s biography. Agramonte described the scene in full, including the reverence with which they listened to Reed. The description of Reed as a teacher comes from Hench’s Notes on Reed and Carroll by Charles S. White, January 10, 1942. And, Lazear’s excitement a
bout working with Reed was found in a letter to his mother, Charlotte Sweitzer, on May 29, 1900. The specific orders from Sternberg to the board can be found in the letter from George Miller Sternberg to Walter Reed, May 29, 1900, in the Hench collection.

  Sternberg’s quote about mosquitoes being a useless investigation came from a letter in the Hench collection from Henry Hurd to Caroline Latimer, February 11, 1905. In the letter, Hurd relates a conversation he and Reed had in which Reed described the scene and quoted the surgeon general. The veracity of the story cannot be proven, but it does seem plausible. In what was a sad end to a skillful, twenty-year study of yellow fever, Sternberg’s judgment had become clouded by the controversy with Sanarelli. In the end, Sternberg would take credit for suggesting the mosquito possibility to Reed.

  Insects

  The majority of the description of the Board’s lab came from Albert Truby’s Memoir of Walter Reed, 1943. A few details were taken from other sources: The fact that the lab used to be the operating room came from John Moran’s account, and the description of the jars of black vomit was found in Philip S. Hench’s interview with Gustav Lambert in 1946.

  The finer points of Reed’s first weeks in Cuba were taken directly from his letters to Emilie dated July 2, 7, 19, 20, 23, 27 and 30. Reed’s reference to returning to the United States to finish the typhoid report came from a letter written to Surgeon General Sternberg on July 24, 1900. Some details were also provided by Philip S. Hench’s interview with Blossom Reed in 1946. All of the letters are held in the Philip S. Hench Walter Reed Collection at the University of Virginia.

  Other details in the chapter—like the pastimes for the soldiers—came from Truby’s account.

  The majority of the material about Lazear’s time in Cuba during the summer of 1900 came from letters to his wife, Mabel, and his mother, Charlotte Sweitzer. The letters are held in the Hench collection. Additional information about his mother being twice widowed and losing two of her sons came from J. A. del Regato’s “Jesse William Lazear: The Successful Experimental Transmission of Yellow Fever by the Mosquito,” published in Medical Heritage in 1986.

  Details about the visit from Dr. Herbert Durham and Dr. Walter Myers of the Liverpool School of Tropical Medicine came from a letter written by Reed to his wife on July 19, 1900, and from an article by Durham and Myers, “Yellow Fever Expedition,” published in the British Medical Journal on September 8, 1900. Additional information about both Durham and Myers contracting yellow fever came from B. G. Maegraith’s “History of the Liverpool School of Tropical Medicine,” in Medical History, October 1972 and William Petri’s “100 years of Tropical Medicine and Hygiene,” in the Americans Journal of Tropical Medicine and Hygiene, 2004.

  The account of Aristides Agramonte’s visit to Pinar del Rio came primarily from his own account, The Inside History of a Great Medical Discovery. Additional details were provided by Reed’s letter to Surgeon General Sternberg on July 24, 1900.

  The descriptions of Pinar del Rio were taken from Christopher Baker’s Cuba. Although I visited the city of Havana, I was not able to venture into the countryside around Pinar del Rio.

  The remarks about Aristides Agramonte not being present at the meeting when the board decided to self-experiment were published by John C. Hemmeter in the American Public Health Reports in 1908 under the title “Major James Carroll of the United States Army, Yellow Fever Commission, and the Discovery of the Transmission of Yellow Fever by the Bite of the Mosquito ‘Stegomyia Fasciata.’ ” Most historians agree that the article was very one-sided in favor of Carroll. It was written by a former classmate of his. While there is a great deal of helpful information, his criticism of Agramonte seems unjust. Likewise, his reference to Reed abruptly leaving Cuba the morning after the meeting, found in a letter from James Carroll to Howard A. Kelly on June 23, 1906, is unsubstantiated. In fact, as outlined in this book, there were a number of earlier references made by Reed that indicate he planned to leave on that date. Carroll’s attack on Agramonte and Reed offers further evidence of his mental state after his work in Cuba. He obviously felt that he was not given due recognition.

  Reed’s reference to human experimentation came from his July 24th letter to Sternberg.

  The story of Reed’s return trip to the United States was taken from Truby’s account—including Reed’s joke about the “Rollins.”

  Vivisection

  The best book I’ve found on vivisection and the source for much of this chapter is Susan Lederer’s Subjected to Science. I also consultedLawrence Altman’s Who Goes First? The Story of Self-Experimentation in Medicine.

  Information about Edward Jenner’s experiments on his son was taken from Greer Williams’s Virus Hunters.

  The study that George Sternberg and Walter Reed conducted on children in orphanages was published in 1895 in Transactions of the Association of American Physicians as “Report on Immunity against Vaccination Conferred upon the Monkey by Use of the Serum of the Vaccinated Calf and Monkey.”

  The Tennyson quote comes from his poem “In the Children’s Hospital,” published in The Poems of Alfred Lord Tennyson. The reference to the poem was found in Lederer’s book.

  Did the Mosquito Do It?

  The dates surrounding the time the board first visited Carlos Finlay were kept purposely vague. Some accounts claim that the Yellow Fever Board first visited Finlay in early July, just after their arrival. Other accounts say it didn’t happen until early August. There is no definitive proof either way.

  Much of the details surrounding Carroll’s infection came from Agramonte’s account, as well as Philip S. Hench’s speech “The Conquest of Yellow Fever,” written on January 1, 1955. I also found details about the illness that Lazear wrote in his logbook, now held at the New York Academy of Medicine.

  Lazear’s mention of trying to find the real yellow fever germ rather than bothering with Sanarelli came from a letter written to wife, Mabel, on August 23, 1900. His reference to the distance seeming very great at a time like this was found in a letter to his mother dated August 27, 1900. Both letters are held in the Hench collection.

  Carroll’s impression of the mosquito hypothesis—that it was useless—come from his own words in a letter to an editor on June 26, 1903.

  I pieced together the scene of Carroll’s first symptoms of the illness from a few different sources. The description of sea bathing came from a letter that Lazear wrote to his mother on September 18, 1900, describing the water as feeling as warm as the air. Dr. William Bean’s book, Walter Reed, also offers Alva Sherman Pinto’s recollection of that afternoon.

  The details about Carroll’s illness were taken from Agramonte’s account, Lena Warner’s personal account of nursing Carroll and Howard A. Kelly’s book.

  The scene in which William E. Dean is infected has been debated over the years. In some accounts, including a popular play called Yellow Jack, Dean was infected knowingly or unknowingly while he was bedridden and recovering in Las Animas Hospital. For this book, I based the scene on Agramonte’s own account, as he was one of the four members of the board.

  Reed’s letters to Kean during Carroll’s illness, as well as his letter to Carroll on September 7, 1900, are held in the Hench collection.

  Lazear’s letter to his wife, Mabel, was written on September 8, 1900, and is held in the Hench collection. I refer to the debate over the resulting tragedy as one that continued through the next five decades because a number of historians and participants attempted to explain what happened. Philip S. Hench was still piecing the story together in the 1940s and 1950s—five decades after the incident.

  Guinea Pig No. 1

  The description of the hospital room at Las Animas is based on a photograph held in the Hench collection. For a time, that room was marked with a plaque in honor of Jesse Lazear. The information about Aedes aegypti as a vector came from Robert Desowitz’s Mosquito.

  The scene in this hospital room is a re-creation from Agramonte’s The Inside History of a Great
Medical Discovery. This was the story Jesse Lazear adamantly told colleagues—he never wavered from this account. His colleagues agreed that the story did not seem reasonable—Lazear would have known exactly what kind of mosquito landed on his arm, and he was far too meticulous to have let it go at that. Reed, Agramonte and Carroll all believed Lazear himself was the “Guinea Pig” in his logbook. Nonetheless, they assumed Lazear had his reasons for not telling the truth— reasons that even today are a mystery—so they kept to the story Lazear himself had told just before he died.

  All information and recordings from the logbook were taken from the book itself on my visit to the New York Academy of Medicine.

  Details about how Lazear spent his time—sea bathing and reading each night before bed—came from a letter he wrote to his mother on September 18, 1900. The quote about how much he missed Houston is also taken from that letter.

  Lazear’s complaint about feeling “out of sorts” came from Agramonte’s account, and the description of how Lazear spent that first night with yellow fever—organizing his notes—was taken from Truby’s Memoir of Walter Reed. In that book, Truby also describes the following morning when Lazear was taken by litter out of his home and moved into the yellow fever ward.

  There are several references in Truby’s writings and Gustav Lambert’s account to Lena Warner nursing both James Carroll and Jesse Lazear. Warner’s own account is full of inaccuracies, even untruths. Whenever taking facts directly from her account, I was sure to find a second or third source to back up her claims. I used creative license in the section where Warner remembers her own case of yellow fever. Her writings refer to how the incident stayed with her, so it seems natural to assume nursing fever patients took her back to that place and time.

  The description of the record book required by the chief surgeon is based on my visit to the National Library of Medicine where the original record books can be found. All that is left of Jesse Lazear’s is his fever chart, which is part of the Hench collection.