The American Plague

by Molly Caldwell Crosby

  James Carroll’s remark about being profoundly shaken by the sight of his friend came from his interview with Caroline Latimer, published in A Cyclopedia of American Medical Biography. Agramonte’s impression was found in his The Inside History of a Great Medical Discovery.

  Walter Reed’s letter to Carroll was written on September 24, 1900, and Reed’s letter to Jefferson Randolph Kean was written on September 25, 1900. Both letters are held in the Hench collection.

  The description of Lazear’s spiraling illness and eventual death were based on Lena Warner’s “Recollections of Lena A. Warner.” Similar details were taken from Gustav Lambert’s account, Truby’s memoir and Hench’s research. His fever chart shows his temperature falling from 104 to 99 degrees, where it flatlined. In trying to do justice to Lazear’s horrible death, I relied wholly on facts recorded by others—his running madly around the room destroying things and the vomit roiling over the bar. In that instance, it is not bars of the cot but the mosquito bar and netting hanging over the hospital bed. The only point when I added a detail not explicitly described firsthand was in restraining Lazear. Warner recalled two soldiers having to hold him down and restrain him, but there is no record of how they restrained him. In this account, I presumed they tied his wrists and ankles.

  A copy of Jesse Lazear’s death certificate can be found in the Hench collection, and the original is at the National Library of Medicine. The account of his burial was based on Truby’s description. There have been discrepancies about whether or not James Carroll was present at the funeral. Reed was in the United States, and Agramonte had just been sent there on orders from General Wood (copies of those orders are in the Hench collection). Some sources have excluded Carroll’s presence or said that no members of the board were present; however, James Carroll wrote to his wife, Jennie, on September 28, 1900, that he had just returned from Lazear’s burial.

  Details of how Mabel Lazear learned of her husband’s death come from Hench’s “An Illustrated Talk by Philip S. Hench” on January 31, 1955, as well as Hench’s “Interview with Jefferson Randolph Kean,” on January 6, 1944. Mabel’s letter to Carroll, dated November 10, 1900, is part of the Hench collection.

  The account of Reed retrieving Lazear’s logbook is based on Truby’s account, as well as Bean’s Walter Reed.

  Camp Lazear

  Details of Walter Reed’s return to Cuba aboard the Crook were part of Hench’s “The Conquest of Yellow Fever.” The account of Robert P. Cooke sharing a cabin with Reed comes from Yellow Jack. The letter reprimanding Cooke, written on July 24, 1900, was written by the acting chief surgeon, Alexander Stark. The letter is part of the Hench collection.

  Statistics about the yellow fever epidemic in Havana that year came from Bean’s book.

  Reed’s general depression over the death of Lazear was noticed by Truby, as well as others at Camp Columbia. He also wrote to Emilie about it. His guilt at being in the United States while his board self-experimented was recorded in his letter to Kean on September 25, 1900.

  Truby’s Memoir of Walter Reed describes the following weeks when Reed wrote and researched his paper on yellow fever. He also related the scene when Reed questioned William Dean about his yellow fever case. Reed’s paper “The Etiology of Yellow Fever: A Preliminary Note” can be found in the Hench collection and at the National Library of Medicine. The excerpt from the Indianapolis Journal was taken from a letter by Mary Fishback to Philip S. Hench, August 30, 1940. The New York Times quote about the presentation appeared in their “Topics of the Times” on November 10, 1900. The criticism from the Washington Post was published on November 2, 1900.

  The letter in which Sternberg informs Reed that he has submitted the paper for publication was dated October 23, 1900, and is part of the Hench collection. That paper appeared in the Philadelphia Medical Journal on October 27.

  The account of Reed meeting with General Wood in the Governor’s Palace, Havana, to request money for Camp Lazear was written in “A Review of Dr. Howard A. Kelly’s Book Walter Reed and Yellow Fever,” by Kean. The review was never published, but is held in the Hench collection.

  Details about the development of Camp Lazear came primarily from Agramonte’s account. Carroll later denied that Agramonte had anything to do with selecting the site for the camp, but it made the most sense to have Agramonte scout out a location. He had lived in Cuba the longest, and the final location of the camp was on a farm belonging to some of his friends—Finca San Jose in Marianao outside of Havana.

  The description of LaRoche’s books was based on personal observation. I looked through a copy of the original 1853 publication at the library of Southwestern Medical School in Dallas, Texas. And the account of Reed quoting LaRoche, the storm that destroyed their batch of mosquitoes and the hunt for new ones, all came from Truby.

  The dimensions and details about Building No. 1 (the Infected Clothing Building) and Building No. 2 (Infected Mosquito Building) came from a number of sources. First and foremost, in 2005, I visited the site of what remains of Camp Lazear in Marianao, which is now a slum section outside of Havana. Only Building No. 1 still stands, but it was discovered by Hench and John Moran in the 1940s and returned to its original state as part of a memorial park dedicated to the yellow fever experiments. Hench worked with a number of medical officials and the Cuban government under Batista to renovate the building and erect a memorial wall. By the time I visited in 2005, few people in Havana knew where the park was, and the building was in a state of disrepair. However, it was still the same dimensions that Reed designed, and looking through broken boards I could see remains of the original tongue and groove construction, although the wood was rotting in a number of places and patched together in others.

  Other descriptions of the building came from Reed’s hand-drawn plans, Truby’s account and “Memorandum on Yellow Fever Experiments,” written by Robert P. Cooke in 1940. Additional details about the men’s experience inside the building came from Agramonte’s article.

  The majority of information about John Moran, how he came to be one of the volunteers, his stay in the Infected Mosquito Building and his resulting illness came from his own unpublished autobiography Memoirs of a Human Guinea Pig, written at Hench’s request in 1937.

  The story of Major Peterson was told in an account written by Kean on May 8, 1941, the Recollections of Lena A. Warner and Recollections of Personal Experiences in Connection with Yellow Fever by Chauncey Baker. All three sources can be found in the Hench collection.

  Information about Roger Post Ames came from Moran’s account, as well as the account of Gustav Lambert, Ames’s nurse.

  Lawrence Reed’s remark about the veracity of Reed’s famous statement to Moran and Kissinger came from an interview with Lawrence and Blossom Reed by Hench on November 21, 1946.

  Reed’s written recommendation for John Moran was found in Moran’s My Date with Walter Reed and Yellow Jack. Both Reed and Moran were on the same transport back to the U.S. Reed approached Moran and gave him the recommendation, adding that he should have done it long before then.

  The account of procuring the Spanish volunteers at the Immigration Station came from Agramonte. And the details about the consent form came from Bean’s book, Walter Reed.

  The description of the experiments performed on John Kissinger came from his own account given to Hench, “Memorandum: Experiences with the Yellow Fever Commission in Cuba 1900, by John R. Kissinger.” The details about how the men responded to Kissinger as a hero from that point forward was found in an account written by Paul L. Tate on July 27, 1954, for Hench. Tate also provided the “old army saying.”

  For the sake of pacing, I streamlined some of the details about the experiments in November, December and January. The facts are all there, but I chose not to outline every single experiment performed during that three-month period. To recreate the experiments, I relied on several different sources. Philip S. Hench provided a “Summary of Research,” written on August 20, 1940, which
I used as a general guideline. I also relied on the personal accounts written by Kissinger, Moran and Truby. Other details came out in original letters: One was written by Hench to Truby, January 7, 1941, and the other was a letter Reed wrote to Truby on December 10, 1900. Reed’s quote about the importance of these discoveries came from his letter to Emilie on December 9, 1900. An excerpt of that letter was provided by Blossom Reed in her “Biographical Sketch,” written for Hench.

  The rumors about the bleached bones of Walter Reed’s yellow fever volunteers came from Bean’s book, as well as a letter Reed wrote to Emilie.

  In developing the scene where Walter Reed walks through the streets of Havana on his way to a banquet on December 22, 1900, I used personal experience, old photographs and Hench’s notes. It was December when I visited Havana, so I had the opportunity to see huge poinsettia bushes in bloom and Christmas decorations around the city. I visited Parque Central, the Hotel Inglaterra and the site of what used to be Old Delmonico’s. In Hotel Inglaterra, they have an old print of the area from 1904. From the sketch, I took details of the park as it appeared in 1900, as well as the Tacón theater, which is now the beautiful Gran Teatro. The building where the restaurant stood in 1900 is now abandoned, but I was still able to climb the staircase and study details about the architecture. Details about the banquet itself came from a speech given by Hench on December 3, 1952, entitled, “The Historic Role of the Finca San Jose and Camp Lazear in the Conquest of Yellow Fever by Carlos Finlay, Walter Reed and Their Associates.” Information about Finlay’s career after the Reed experiments—the fact that he was nominated for the Nobel Prize seven different times—came from the official website for the Nobel Prize, which lists past nominees and winners.

  Carroll’s letter to Jennie is held in the Carroll Box, as part of the Hench collection at the University of Virginia. The description of the Christmas party, the makeshift mosquito and the poem for Reed came from letters he wrote to Emilie on December 25 and 26, 1900.

  A New Century

  Walter Reed’s original letter to Emilie on New Year’s Eve is part of the Philip S. Hench Walter Reed Collection at the University of Virginia.

  Blood

  Details surrounding the blood inoculations came from two main sources: Truby provided some background information in his memoir, but the majority of the chapter came from John H. Andrus’s “I Became a Guinea Pig,” held in the Hench collection.

  Instructions from the surgeon general came from letters exchanged between Sternberg and Reed in December 1900.

  The description of Roger Post Ames was taken from Lambert’s account, as well as Paul Tate’s “Essay: Roger Post Ames,” written for Hench in 1954.

  Reed’s letter to Sternberg expressing his concern for Andrus was written on January 31, 1901. Excerpts from that letter appear in Andrus’s own account, as well as the biography George M. Sternberg.

  The Etiology of Yellow Fever

  The account of Reed’s presentation to the Pan-American Medical Congress in Havana came from his own descriptions in family letters submitted to the Philip S. Hench collection by Blossom Reed.

  The remark about Reed’s voice rising to a falsetto note when he emphasized important points was taken from Hench’s interview with Lawrence Reed on November 21, 1946. The quote about Reed as a teacher came from Captain J. Hamilton Stone’s remarks in Kelly’s book Walter Reed.

  The Washington Post quote was from a clipping dated February 11, 1901, held in the Hench collection.

  Retribution

  Walter Reed was given military orders to report to Buffalo, New York, on September 5, 1901. Those original orders are held in the Philip S. Hench Walter Reed Collection.

  The account of McKinley’s assassination came from a New York Times article published on September 7, 1901. The facts of the article were also checked against Encyclopaedia Britannica.

  Proceedings from the 1901 American Public Health Association meeting are held in the Hench collection under the title Public Health Papers and Reports, Volume XXVII, Presented at the Twenty-ninth Annual Meeting of the American Public Health Association, Buffalo, NY, September 16-20, 1901.

  The information about Wasdin’s theory of a poisoned bullet came from a New York Times article dated September 16, 1901.

  Reed’s opinion of the Guitéras experiments came from a letter written by Reed to Gorgas, May 23, 1901. The letter is held in the Walter Reed Papers at the National Library of Medicine. Reed’s disappointment in hearing about the deaths resulting from the Guitéras experiments was found in another letter to Gorgas, dated September 2, 1901, also held at the National Library of Medicine.

  The account of Clara Maass’s death during the experiments came from Philip S. Hench’s personal notes, as well as a New York Times article published on August 25, 1901. James Carroll’s experiments passing blood through the Berkefeld filter were outlined in his Report to the Surgeon General, August 18, 1906, held in the Hench collection.

  Reed’s frustration in being passed over for surgeon general, as well as his statements about doing something for the real benefit of humanity, were expressed in a letter to Gorgas on July 21, 1902. The letter is part of the Walter Reed Papers at the National Library of Medicine.

  The description of Keewaydin and the inscription above the fireplace was relayed in a “Biographical Sketch of Walter Reed” written by Emilie Lawrence Reed, held in the Hench collection.

  The quote about Reed’s failing health and his frustration over having persons in high authority rob him of his just fame was taken from a letter from Henry Hurd, a friend of Reed’s, to Caroline Latimer on February 11, 1905. The letter can be found in the Hench collection. A similar reference, though with slightly different wording, can be found in Kelly’s book.

  The statements by George M. Sternberg appeared in the July 1901 Popular Science Monthly. Reed’s anger at these remarks was expressed in a letter to Gorgas dated July 27, 1901, and held at the National Library of Medicine. Sternberg’s letter requesting a promotion to major general was dated January 25, 1901, and is held in the Sternberg papers at the National Library of Medicine.

  The description of Reed’s final days and illness came from Emilie Lawrence Reed in notes held in the Hench collection, as well as “Notes on Reed and Carroll,” written by Philip S. Hench on January 10, 1942. Additional details were found in the Walter Reed Papers at the National Library of Medicine. The account of Reed’s death was taken from three sources: Kean’s letter to Howard Kelly on March 25, 1901, William Borden’s letter to Howard Kelly on March 16, 1905, and the Report: History of Doctor Walter Reed’s Illness from Appendicitis by William Borden, 1903. All three are held in the National Library of Medicine.

  Details of Reed’s funeral were taken from Kean’s letter to Howard Kelly on March 25, 1901, Truby’s recollection, Hench’s interview with Lawrence and Blossom Reed on November 21, 1946, and a Biographical Sketch: Life and Letters of Dr. Walter Reed by His Daughter. Welch’s remarks were found in the Message from the President of the United States Transmitting Certain Papers in regard to Experiments Conducted for the Purpose of Coping with Yellow Fever, by Theodore Roosevelt, December 5, 1906. Roosevelt’s quote about Reed’s contribution to the betterment of mankind came from Senate Document No. 10, Fifty-ninth Congress. All of the above are held in the Hench collection.

  The list of names who contributed to the Walter Reed Memorial Association were found in Writer and Pierce’s Yellow Jack and Bean’s Walter Reed.

  The Mosquito

  Biographical information about Major William C. Gorgas came from Greer Williams’s book The Plague Hunters, as well as William Crawford Gorgas: His Life and Work.

  In an interview with an anonymous source in Havana, I confirmed that the same method used in 1900 for monitoring mosquitoes is still in use today.

  Part IV: United States, Present Day Epidemic

  The introductory quote for Part IV was found in T. P. Monath’s “Yellow Fever: An Update,” published in Lancet Infectiou
s Disease, 2001.

  The account of Tom McCullough’s death from yellow fever came from the Centers for Disease Control and Prevention: “Fatal Yellow Fever in a Traveler Returning from Amazonas, Brazil, 2002,” Morbidity and Mortality Weekly Report. I also consulted another article, “Fatal Yellow Fever in a Traveler Returning from Venezuela, 1999,” in the Morbidity and Mortality Weekly Report for information about similar cases. Some of the more personal details about McCullough’s hospital stay and death were taken from two articles in the Corpus Christi Caller-Times, March 27, 2002, and May 14, 2004.

  To describe what would happen in the case of an epidemic in the United States, I followed the CDC’s “Response to an Epidemic of Yellow Fever,” published in November 2005 specifically for Africa and the Americas. In the report, the CDC outlines the response of field investigators, armed forces, border officials, medical personnel, educational campaigns and vaccine usage.

  For additional information about yellow fever vaccine production and stockpiling, I consulted the WHO’s “State of the World’s Vaccines and Immunizations” and the Global Alliance for Vaccines and Immunization. Prior to 2002, there was a global shortage of the yellow fever vaccine due to the lack of funds and too few labs producing the vaccine. Since then, the GAVI, with help from the Vaccine Fund, has been able to keep stockpiles of six million vaccines in the case of an epidemic, as well as an additional six million for yearly routine use in African and South American countries where yellow fever is endemic. According to the WHO report, there are four main manufacturers of the yellow fever vaccine, with a total global production capacity of 270 million.