"COLUMBIA BARRACKS, QUEMADOS, CUBA 11:50 P.M. Dec. 31, 1900"
"Only ten minutes of the old century remain. Here I have been sitting, reading that most wonderful book, "La Roche on Yellow Fever." Forty seven years later it has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most wonderful, dreadful pest of humanity and to put it on a rational and scientific basis. I thank God that it has been accomplished during the latter days of the old century. May its cure be wrought out in the early days of the new!The prayer that has been mine for twenty years, that I might be permitted in some way or at some time to alleviate human suffering has been granted!
A thousand Happy New Years.
Hark, there go the twenty-four buglers in concert, all sounding 'Taps' for the old year."
Major Doctor Walter Reed, U.S. Army Medical Corps
Walter Reed and Yellow Fever, 1906, Howard Kelly
"Only ten minutes of the old century remain. Here I have been sitting, reading that most wonderful book, "La Roche on Yellow Fever." Forty seven years later it has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most wonderful, dreadful pest of humanity and to put it on a rational and scientific basis. I thank God that it has been accomplished during the latter days of the old century. May its cure be wrought out in the early days of the new!The prayer that has been mine for twenty years, that I might be permitted in some way or at some time to alleviate human suffering has been granted!
A thousand Happy New Years.
Hark, there go the twenty-four buglers in concert, all sounding 'Taps' for the old year."
Major Doctor Walter Reed, U.S. Army Medical Corps
Walter Reed and Yellow Fever, 1906, Howard Kelly
"Major Walter C. Reed
Office of the Surgeon General,
Washington, D.C.
This case which I report on September 26, 1901 was really the last which occurred in Havana. Of course we did not know it at the time, but this case marked the first conquest of yellow fever in an endemic center; the first application of the mosquito theory to practical sanitary work in any disease.
With kindest regards, I remain,
Yours very sincerely,
W.C. Gorgas,
Major & Surgeon, U.S.A, Chief Sanitary Officer"
Dr. William Crawford Gorgas, Sanitation in Panama, 1915
Office of the Surgeon General,
Washington, D.C.
This case which I report on September 26, 1901 was really the last which occurred in Havana. Of course we did not know it at the time, but this case marked the first conquest of yellow fever in an endemic center; the first application of the mosquito theory to practical sanitary work in any disease.
With kindest regards, I remain,
Yours very sincerely,
W.C. Gorgas,
Major & Surgeon, U.S.A, Chief Sanitary Officer"
Dr. William Crawford Gorgas, Sanitation in Panama, 1915
« La Havane, à Cuba, ville où la fièvre jaune sévissait chaque année en une période donnée, et cela pendant 140 ans, a été libérée de cette maladie en moins de 90 jours. »
Dr. Reed, Walter, 1901.
En fin d’année 1900, Dr. Reed a établi qu’Aedes aegypti transmit la fièvre jaune.
Dr. Reed, Walter, 1901.
En fin d’année 1900, Dr. Reed a établi qu’Aedes aegypti transmit la fièvre jaune.
"Havana, Cuba, a city where yellow fever had revisited every year in a given period, and that during 140 years, was liberated from this disease in less than 90 days."
Dr. Walter Reed, 1901
By year-end 1900, Dr. Reed had established that Aedes aegypti transmits yellow fever.
Dr. Walter Reed, 1901
By year-end 1900, Dr. Reed had established that Aedes aegypti transmits yellow fever.
Yellow fever starts quite abruptly with a headache, chills and fever, followed by pain in the back, arms and legs; it causes nausea and vomiting and inability of the body to pass urine and waste. The name comes from the jaundice - a clear sign of the stress this disease puts on the liver - turning the victim’s skin yellow, the whites of the eyes yellow. In severe cases with increasing fever, the victim can go into a delirium, with a loss of conscious awareness.
Yellow fever is classed in the category of ‘hemorrhagic’ fevers that can provoke bleeding - bruising - under the skin, and bleeding from the organs and eyes. The other name of this disease ‘the black vomit,’ came from the fatal symptoms of violent vomiting of a mixture of body fluids and hemorrhaged blood from the stomach. Fatal yellow fever symptoms are almost identical to the fatal symptoms of Ebola viral fever, another hemorrhagic fever.
Historically, fatalities from yellow fever ranged from 15% to 85% of total cases, sometimes over 90%. If a city had yellow fever fatalities of 7,900, then there were over 30,000 sickened and incapacitated victims who required help.
An epidemic outbreak of yellow fever in the United States always brought social chaos and huge economic losses, with entire households incapacitated, others abandoned, almost all business activity came to a standstill as thousands of people would flee their homes, leaving towns and urban neighborhoods deserted, to be ransacked by looters and thieves. An outbreak of yellow fever could quickly destroy an army, and did.
Yellow fever outbreaks had long plagued the Americas - the first verifiable record was in 1596 in Central America, then an outbreak among New England Native Indians was noted in 1618. In 1664, yellow fever killed 1411 out of 1500 soldiers stationed at the Island of St. Lucia. Yellow Jack appeared to kill in New York City in 1668, in Boston in 1691 and 1693 and in Philadelphia in 1695.
In the United States, yellow fever outbreaks were always in the warm months of the year, late spring through early fall. In sea and river port cities, summer was a time to dread, not enjoy; only the cool and cold months were safe.
It was often referred to as ‘Yellow Jack,’ a play on the yellow-colored quarantine warning flag, called a ‘jack’ raised at city limits or on ships signaling there was a yellow fever outbreak.
Superstition ruled. Yellow fever struck in one city neighborhood, then not the next, but in another city, as if magic. If one person fell ill with yellow fever in a house, the house seemed to have been cursed with yellow fever able to strike anyone entering that house for months afterward, even if everyone had fled. Ships drifted aground, with entire crews dead.
Yellow fever was the most compelling disease problem of the 1800s in the United States. It perpetually smoldered in Central, Caribbean and South America ports from Mexico to Rio de Janeiro, but seemed to explode in deadly epidemics in the southern United States.
Here is the incredible chronology of the march of this mysterious, seemingly unstoppable disease which finally hit an unlikely wall made of a handful of soldier-doctors of the United States Army Medical Corps. How these modest heroes defeated yellow fever and then malaria, was applied throughout North, Central and South America and remains the key to success in destroying mosquito-borne disease in Africa, and these great men did have Africa in mind.
First, the amazing efforts to replace superstition with scientific discovery.
Yellow fever is classed in the category of ‘hemorrhagic’ fevers that can provoke bleeding - bruising - under the skin, and bleeding from the organs and eyes. The other name of this disease ‘the black vomit,’ came from the fatal symptoms of violent vomiting of a mixture of body fluids and hemorrhaged blood from the stomach. Fatal yellow fever symptoms are almost identical to the fatal symptoms of Ebola viral fever, another hemorrhagic fever.
Historically, fatalities from yellow fever ranged from 15% to 85% of total cases, sometimes over 90%. If a city had yellow fever fatalities of 7,900, then there were over 30,000 sickened and incapacitated victims who required help.
An epidemic outbreak of yellow fever in the United States always brought social chaos and huge economic losses, with entire households incapacitated, others abandoned, almost all business activity came to a standstill as thousands of people would flee their homes, leaving towns and urban neighborhoods deserted, to be ransacked by looters and thieves. An outbreak of yellow fever could quickly destroy an army, and did.
Yellow fever outbreaks had long plagued the Americas - the first verifiable record was in 1596 in Central America, then an outbreak among New England Native Indians was noted in 1618. In 1664, yellow fever killed 1411 out of 1500 soldiers stationed at the Island of St. Lucia. Yellow Jack appeared to kill in New York City in 1668, in Boston in 1691 and 1693 and in Philadelphia in 1695.
In the United States, yellow fever outbreaks were always in the warm months of the year, late spring through early fall. In sea and river port cities, summer was a time to dread, not enjoy; only the cool and cold months were safe.
It was often referred to as ‘Yellow Jack,’ a play on the yellow-colored quarantine warning flag, called a ‘jack’ raised at city limits or on ships signaling there was a yellow fever outbreak.
Superstition ruled. Yellow fever struck in one city neighborhood, then not the next, but in another city, as if magic. If one person fell ill with yellow fever in a house, the house seemed to have been cursed with yellow fever able to strike anyone entering that house for months afterward, even if everyone had fled. Ships drifted aground, with entire crews dead.
Yellow fever was the most compelling disease problem of the 1800s in the United States. It perpetually smoldered in Central, Caribbean and South America ports from Mexico to Rio de Janeiro, but seemed to explode in deadly epidemics in the southern United States.
Here is the incredible chronology of the march of this mysterious, seemingly unstoppable disease which finally hit an unlikely wall made of a handful of soldier-doctors of the United States Army Medical Corps. How these modest heroes defeated yellow fever and then malaria, was applied throughout North, Central and South America and remains the key to success in destroying mosquito-borne disease in Africa, and these great men did have Africa in mind.
First, the amazing efforts to replace superstition with scientific discovery.
Yellow fever outbreaks had long plagued the Americas - the first verifiable record was in 1596 in Central America, then an outbreak among New England Native Indians was noted in 1618. In 1664, yellow fever killed 1411 out of 1500 soldiers stationed at the Island of St. Lucia. Yellow Jack appeared to kill in New York City in 1668, in Boston in 1691 and 1693 and in Philadelphia in 1695.
The Philadelphia epidemic of 1793 which decimated the population of Philadelphia - killing one in ten of the city population - frightened the country. But it occurred at a time of medical discipline that was keen to find answers, while also provoking an important, yet unfortunately century-long bitter and polarizing medical and scientific debate that did produce one of the keys to understanding yellow fever, while also setting in place one of the most stubborn and hostile obstacles to science to overcome. Over a hundred years later, this intransigence almost derailed the fight against the disease and almost destroyed the careers of the men first tasked to defeat it.
In 1793, there were two questions to be answered: 1) in which category did yellow fever belong? Contagious as in something like the measles or was it non-contagious? If it was non-contagious, how then did it spread? 2) was it locally-acquired or was it imported from outside?
The definitive assertion according to yellow fever history compiler, R. La Roche, was widely attributed to Dr. Jean Deveze of Philadelphia who arrived from the West Indies during the 1793 Philadelphia epidemic. By his observations, yellow fever was not a contagious disease. Even though many medical doctors were convinced by Deveze's assessment, there was a sizable group of influential doctors who held to the hypothesis of spontaneous generation - because yellow fever outbreaks only manifested in warm weather - in conditions of heat, humidity and filth. By this hypothesis, yellow fever would be classed as a locally-acquired and contagious disease.
Yet, the importation argument was compelling. America's economy was tied to free trade to and from foreign ports.
The Philadelphia epidemic of 1793 which decimated the population of Philadelphia - killing one in ten of the city population - frightened the country. But it occurred at a time of medical discipline that was keen to find answers, while also provoking an important, yet unfortunately century-long bitter and polarizing medical and scientific debate that did produce one of the keys to understanding yellow fever, while also setting in place one of the most stubborn and hostile obstacles to science to overcome. Over a hundred years later, this intransigence almost derailed the fight against the disease and almost destroyed the careers of the men first tasked to defeat it.
In 1793, there were two questions to be answered: 1) in which category did yellow fever belong? Contagious as in something like the measles or was it non-contagious? If it was non-contagious, how then did it spread? 2) was it locally-acquired or was it imported from outside?
The definitive assertion according to yellow fever history compiler, R. La Roche, was widely attributed to Dr. Jean Deveze of Philadelphia who arrived from the West Indies during the 1793 Philadelphia epidemic. By his observations, yellow fever was not a contagious disease. Even though many medical doctors were convinced by Deveze's assessment, there was a sizable group of influential doctors who held to the hypothesis of spontaneous generation - because yellow fever outbreaks only manifested in warm weather - in conditions of heat, humidity and filth. By this hypothesis, yellow fever would be classed as a locally-acquired and contagious disease.
Yet, the importation argument was compelling. America's economy was tied to free trade to and from foreign ports.
In 1793, Dr. Deveze, working during the Philadelphia 1793 epidemic noticed that medical and primary care people such as family members could work closely with serious, even fatal cases of yellow fever, yet never fall sick.
An Inquiry into and Observations upon the Causes and Effects of the Epidemic which Raged in Philadelphia from the month of August toward the Middle of December, 1793, by Jean Deveze, 1794.
Meanwhile, a number of influential doctors were still eager to promote spontaneous generation. Somehow, with the right conditions, yellow fever would appear. Dr. Benjamin Rush of Philadelphia, present during the 1793 epidemic, was convinced that yellow fever was of a local origin and contagious, and vigorously leveraged his respected standing in the medical community to promote this view in opposition to what Dr. Deveze had concluded.
In 1793, according to yellow fever chronicler R. La Roche, the Philadelphia yellow fever epidemic had "dated the origin of the interminable dispute about contagion and non-contagion which has continued ever since to occupy the attention of the medical community in this and in other countries."
In 1794, a new outbreak of yellow fever had according to La Roche, given the Philadelphian, Dr. Rush, reasons to doubt his previous position and Rush later decisively changed his mind, even openly regretting that his "influence might have increased the misery and mortality" associated with the disease by leading medical opinion astray by his incorrect support to designate yellow fever as contagious, and that he hoped that he had enough reputation left to "insure the world the benefits which would necessarily flow from the doctrines of non-contagion."
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work,
Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
An Inquiry into and Observations upon the Causes and Effects of the Epidemic which Raged in Philadelphia from the month of August toward the Middle of December, 1793, by Jean Deveze, 1794.
Meanwhile, a number of influential doctors were still eager to promote spontaneous generation. Somehow, with the right conditions, yellow fever would appear. Dr. Benjamin Rush of Philadelphia, present during the 1793 epidemic, was convinced that yellow fever was of a local origin and contagious, and vigorously leveraged his respected standing in the medical community to promote this view in opposition to what Dr. Deveze had concluded.
In 1793, according to yellow fever chronicler R. La Roche, the Philadelphia yellow fever epidemic had "dated the origin of the interminable dispute about contagion and non-contagion which has continued ever since to occupy the attention of the medical community in this and in other countries."
In 1794, a new outbreak of yellow fever had according to La Roche, given the Philadelphian, Dr. Rush, reasons to doubt his previous position and Rush later decisively changed his mind, even openly regretting that his "influence might have increased the misery and mortality" associated with the disease by leading medical opinion astray by his incorrect support to designate yellow fever as contagious, and that he hoped that he had enough reputation left to "insure the world the benefits which would necessarily flow from the doctrines of non-contagion."
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work,
Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
In the 1800s the general public was not generally aware of the concept of insects as vectors of disease, but it was not unknown among medical researchers.
In 1498, Bishop Knud of Aarhus, Denmark discussed insects as vectors in his document, De Regimime Pestilentico; and
In 1659, priest and naturalist, Athanasius Kircher in Rome, made a firm connection that insects do have roles in spreading disease, for example that flies can spread the plague, discussed in his paper, Scrutunium Physico-Medicum.
In 1805, the long reach and capriciousness of yellow fever was evidenced by the cities afflicted during the summer and fall of 1805: New Haven, Connecticut, Baltimore, Boston, Gloucester City, New Jersey; Delaware River, New York City; even astonishingly, Quebec, Canada where a company of fifty-five English soldiers newly arrived only to all but six perish of yellow fever; Chester County, Pennsylvania; Westerly, Rhode Island, Charleston, South Carolina, Norfolk, Virginia; Providence, Rhode Island; Barbados, Havana, Cuba; West Indies.
A History of the Yellow Fever, The Yellow Fever Epidemic of 1878 of Memphis, Tennessee, by J.M. Keating, 1879
In the 1800s, the U.S. cities of New Orleans, Memphis and Mobile were the worse-afflicted by annual yellow fever outbreaks that would begin mid-summer and end mid-fall. A sizeable portion each of the populations simply quit these cities for the summer and returned after the yellow fever season had ended in mid-fall.
In 1848, Dr. Josiah C. Nott of Mobile, Alabama published his paper, On the Cause of Yellow Fever. In it, Dr. Nott disputed the ideas about malaria as a gaseous or molecular emission from the earth. Dr. Nott referenced Kircher’s 1659 contributions, and presented several known facts about malaria that Dr. Nott urged strongly supported insect transmission, and noted the similarity of the known oddities of yellow fever that Dr. Nott asserted could be explained only by insect transmission.
“We may therefore understand that it can at the same time be transported in the form of a germ yet not be contagious.” Dr. Josiah C. Nott, 1848
Dr. Nott was unsuccessful in his attempts to provide proof.
In 1853 Army Officer Josiah Gorgas of Pennsylvania was assigned to the command of the arsenal at Mount Vernon, a few miles north of Mobile, Alabama. Years later, he would become the Chief Ordnance Officer of the Confederacy. In the summer of 1853 as yellow fever exploded across the South, Josiah Gorgas was an immune - having had survived a bout of yellow fever as a first lieutenant during a yellow fever outbreak among U.S. troops during the siege of Vera Cruz.
In 1853, the New Orleans yellow fever epidemic produced 29,020 cases with 8,101 deaths for a mortality rate of 29.9 %. The overwhelming majority of cases occurred in only three months: June, July and August among a city population of about 150,000.
________________________________________________________________
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; A History of the Yellow Fever, The Yellow Fever Epidemic of 1878 of Memphis, Tennessee, by J.M. Keating, 1879
In 1498, Bishop Knud of Aarhus, Denmark discussed insects as vectors in his document, De Regimime Pestilentico; and
In 1659, priest and naturalist, Athanasius Kircher in Rome, made a firm connection that insects do have roles in spreading disease, for example that flies can spread the plague, discussed in his paper, Scrutunium Physico-Medicum.
In 1805, the long reach and capriciousness of yellow fever was evidenced by the cities afflicted during the summer and fall of 1805: New Haven, Connecticut, Baltimore, Boston, Gloucester City, New Jersey; Delaware River, New York City; even astonishingly, Quebec, Canada where a company of fifty-five English soldiers newly arrived only to all but six perish of yellow fever; Chester County, Pennsylvania; Westerly, Rhode Island, Charleston, South Carolina, Norfolk, Virginia; Providence, Rhode Island; Barbados, Havana, Cuba; West Indies.
A History of the Yellow Fever, The Yellow Fever Epidemic of 1878 of Memphis, Tennessee, by J.M. Keating, 1879
In the 1800s, the U.S. cities of New Orleans, Memphis and Mobile were the worse-afflicted by annual yellow fever outbreaks that would begin mid-summer and end mid-fall. A sizeable portion each of the populations simply quit these cities for the summer and returned after the yellow fever season had ended in mid-fall.
In 1848, Dr. Josiah C. Nott of Mobile, Alabama published his paper, On the Cause of Yellow Fever. In it, Dr. Nott disputed the ideas about malaria as a gaseous or molecular emission from the earth. Dr. Nott referenced Kircher’s 1659 contributions, and presented several known facts about malaria that Dr. Nott urged strongly supported insect transmission, and noted the similarity of the known oddities of yellow fever that Dr. Nott asserted could be explained only by insect transmission.
“We may therefore understand that it can at the same time be transported in the form of a germ yet not be contagious.” Dr. Josiah C. Nott, 1848
Dr. Nott was unsuccessful in his attempts to provide proof.
In 1853 Army Officer Josiah Gorgas of Pennsylvania was assigned to the command of the arsenal at Mount Vernon, a few miles north of Mobile, Alabama. Years later, he would become the Chief Ordnance Officer of the Confederacy. In the summer of 1853 as yellow fever exploded across the South, Josiah Gorgas was an immune - having had survived a bout of yellow fever as a first lieutenant during a yellow fever outbreak among U.S. troops during the siege of Vera Cruz.
In 1853, the New Orleans yellow fever epidemic produced 29,020 cases with 8,101 deaths for a mortality rate of 29.9 %. The overwhelming majority of cases occurred in only three months: June, July and August among a city population of about 150,000.
________________________________________________________________
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; A History of the Yellow Fever, The Yellow Fever Epidemic of 1878 of Memphis, Tennessee, by J.M. Keating, 1879
"Mount Vernon was located on high and dry ground... it offered an excellent place of refuge."
Among the many summer evacuees escaping Mobile during the 1853 yellow fever epidemic was the daughter of Governor John Gayle of Alabama, Miss Amelia Gayle.
In 1853 Army Officer Josiah Gorgas was smitten by his enchanting new neighbor just arrived from Mobile. Equally charmed, Amelia Gayle became Mrs. Josiah Gorgas in December 1853.
In 1854, Dr. Josiah C. Nott of Mobile, Alabama, an able and well-liked doctor despite his unconventional ideas about insects spreading yellow fever was called during October to assist during a mother’s labor, delivering a newborn baby, William Crawford Gorgas.
In 1855, Dr. R. La Roche's invaluable resource book, Yellow Fever compiled the known history of the disease, along with the competing contemporary ideas about yellow fever.
In 1862, Louis Pasteur proved that life must come from pre-existing life, decisively dis-proving the concept of 'spontaneous generation.' This met all the required proofs in the scientific method to qualify as a scientific law: The Law of Bio-genesis. Complementing this, Pasteur's Germ Theory of Disease asserted that all disease has some sort of causative organism, but these disciplined scientifically-tested proofs did not deter the adherents of 'filth, heat and moisture.' Even the term malaria - 'mal' 'air' - that is to say, 'bad air' - still shows its name origins in those same sorts of spontaneous generation ideas. But to many other researchers, Pasteur's proof meant that there must some causative organism for yellow fever - just waiting to be identified.
In 1869, Walter Reed at age 17, was the youngest student ever to graduate with a doctorate in medicine from the University of Virginia. Unusually intelligent and very hard-working, over the next four years, Reed finished all his academic and hospital experience younger in age than his medical peers, but his youth and boyish looks hampered his attempts to build a private practice in New York.
Among the many summer evacuees escaping Mobile during the 1853 yellow fever epidemic was the daughter of Governor John Gayle of Alabama, Miss Amelia Gayle.
In 1853 Army Officer Josiah Gorgas was smitten by his enchanting new neighbor just arrived from Mobile. Equally charmed, Amelia Gayle became Mrs. Josiah Gorgas in December 1853.
In 1854, Dr. Josiah C. Nott of Mobile, Alabama, an able and well-liked doctor despite his unconventional ideas about insects spreading yellow fever was called during October to assist during a mother’s labor, delivering a newborn baby, William Crawford Gorgas.
In 1855, Dr. R. La Roche's invaluable resource book, Yellow Fever compiled the known history of the disease, along with the competing contemporary ideas about yellow fever.
In 1862, Louis Pasteur proved that life must come from pre-existing life, decisively dis-proving the concept of 'spontaneous generation.' This met all the required proofs in the scientific method to qualify as a scientific law: The Law of Bio-genesis. Complementing this, Pasteur's Germ Theory of Disease asserted that all disease has some sort of causative organism, but these disciplined scientifically-tested proofs did not deter the adherents of 'filth, heat and moisture.' Even the term malaria - 'mal' 'air' - that is to say, 'bad air' - still shows its name origins in those same sorts of spontaneous generation ideas. But to many other researchers, Pasteur's proof meant that there must some causative organism for yellow fever - just waiting to be identified.
In 1869, Walter Reed at age 17, was the youngest student ever to graduate with a doctorate in medicine from the University of Virginia. Unusually intelligent and very hard-working, over the next four years, Reed finished all his academic and hospital experience younger in age than his medical peers, but his youth and boyish looks hampered his attempts to build a private practice in New York.
In 1875, Dr. Walter Reed after passing rigorous qualification exams, received a commission as Assistant Surgeon at the rank of First Lieutenant. A year later, his Army career started in earnest with being assigned four years on the frontier first at remote Camp Lowell, then at Camp Apache in Arizona.
In 1878, the horrific Mississippi Valley yellow fever epidemic ended with an estimated over 15,000 deaths. Memphis, Tennessee alone endured about 17,600 yellow fever cases with 5,150 deaths, a mortality rate of 1 in 3.3. The closest modern equivalent epidemic in geographical reach, size of population affected, social and economic chaos, panic and disruption would be the Ebola viral fever epidemic in West Africa in 2014-2015, yet the Mississippi Valley yellow fever epidemic achieved its destruction over a much shorter period of time. People fled homes, towns, cities; looting and lawlessness were widespread.
The 1878 Mississippi Valley yellow fever epidemic suddenly flared, then blazed through the summer and early fall months only to abruptly disappear as fall arrived and segued into winter. Both belonging to the category of hemorrhagic viral fevers, fatal yellow fever and fatal Ebola fever can share many symptoms, equally terrifying to populations that had no idea how to deal with them.
In 1878, during the devastating yellow fever epidemic centered in Memphis, Tennessee, as panic, superstitious cures and protections abounded, doctors were looking seriously at a germ cause of yellow fever. The epidemic prompted competing ideas that yellow fever was some sort of airborne fungus, a product of some sort of fermentation, an explosive poison in the air and finally and most persistent, it might be a representative of a hypothetical third type of germ disease - somewhere between contagious and non-contagious, able to be transported long distances in sort of theoretical 'package' forms which were called 'fomites.'
The solution thus, was obvious: aggressive 'sanitation' to remove all local sources of filth that might carry or somehow produce fomites of yellow fever.
________________________________________________
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
The 1878 Mississippi Valley yellow fever epidemic suddenly flared, then blazed through the summer and early fall months only to abruptly disappear as fall arrived and segued into winter. Both belonging to the category of hemorrhagic viral fevers, fatal yellow fever and fatal Ebola fever can share many symptoms, equally terrifying to populations that had no idea how to deal with them.
In 1878, during the devastating yellow fever epidemic centered in Memphis, Tennessee, as panic, superstitious cures and protections abounded, doctors were looking seriously at a germ cause of yellow fever. The epidemic prompted competing ideas that yellow fever was some sort of airborne fungus, a product of some sort of fermentation, an explosive poison in the air and finally and most persistent, it might be a representative of a hypothetical third type of germ disease - somewhere between contagious and non-contagious, able to be transported long distances in sort of theoretical 'package' forms which were called 'fomites.'
The solution thus, was obvious: aggressive 'sanitation' to remove all local sources of filth that might carry or somehow produce fomites of yellow fever.
________________________________________________
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
In June of 1880, Dr. William Gorgas disappointed his father by joining the U.S. Army Medical Corps. Having lost everything, ruined by the war, Josiah Gorgas had not encouraged his son to go into the army. But his son had found a way - the army needed doctors.
In 1880, Dr. Patrick Manson demonstrated that insects were able to act as carriers of disease. Manson provided scientific proof that mosquitoes were the carriers for the parasite Filaria Sanguinis Hominus, that causes elephantiasis and chyluria.
In 1880, Major Dr. Walter Reed began work at Johns Hopkins Hospital in Baltimore, Maryland, soon adding clinical and laboratory research in bacteriology to complement his long practical field experience to tackle the problems of infectious diseases.
Despite Dr. Manson's discovery setting a plain precedent that at least one insect species is able to convey diseases to people, and Pasteur's decisive scientific debunking of 'spontaneous generation', the unproven hypothesis of undiscovered fomites would become the popular conventional wisdom in the general public and held sway in government public health policy of the latter part of the 1800s.
In 1881, medical consensus was against Dr. Carlos Finlay of Havana, Cuba who presented his paper, The Mosquito Hypothetically Considered as the Agent of Yellow Fever. Yellow fever didn't cooperate; despite all his efforts, Finlay could not prove his hypothesis so it was not accepted or even attempted to be investigated by the medical community which favored researching the fomite hypothesis. In the face of this unyielding skepticism, Finlay began doubting himself - in subsequent years, undertaking numerous modifications of his original correct hypothesis to bring it further in line with conventional thinking, inadvertently taking it further away from the truth.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
In 1880, Dr. Patrick Manson demonstrated that insects were able to act as carriers of disease. Manson provided scientific proof that mosquitoes were the carriers for the parasite Filaria Sanguinis Hominus, that causes elephantiasis and chyluria.
In 1880, Major Dr. Walter Reed began work at Johns Hopkins Hospital in Baltimore, Maryland, soon adding clinical and laboratory research in bacteriology to complement his long practical field experience to tackle the problems of infectious diseases.
Despite Dr. Manson's discovery setting a plain precedent that at least one insect species is able to convey diseases to people, and Pasteur's decisive scientific debunking of 'spontaneous generation', the unproven hypothesis of undiscovered fomites would become the popular conventional wisdom in the general public and held sway in government public health policy of the latter part of the 1800s.
In 1881, medical consensus was against Dr. Carlos Finlay of Havana, Cuba who presented his paper, The Mosquito Hypothetically Considered as the Agent of Yellow Fever. Yellow fever didn't cooperate; despite all his efforts, Finlay could not prove his hypothesis so it was not accepted or even attempted to be investigated by the medical community which favored researching the fomite hypothesis. In the face of this unyielding skepticism, Finlay began doubting himself - in subsequent years, undertaking numerous modifications of his original correct hypothesis to bring it further in line with conventional thinking, inadvertently taking it further away from the truth.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
In 1882, U.S. Army Medical Corps Dr. William Gorgas was sent to Fort Brown, Texas, "the advance guard of a large number of medical personnel sent to take care of nearly twenty-three hundred cases of yellow fever."
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work,
Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work,
Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
Not long after his arrival, one of the victims of the 1882 yellow fever outbreak was the sister-in-law of the fort's commanding officer, Miss Marie Doughty. She quickly deteriorated to the most severe symptoms, and a grave was dug for her. Surprising everyone, she unexpectedly passed through the worst and began recovering as her attending physician, Dr. Gorgas began manifesting symptoms. Dr. Gorgas was sent to the yellow fever ward suffering with a severe case of yellow fever, but his fellow Army physician colleagues concluded that he would survive. Miss Doughty and Dr. Gorgas wound up convalescing together.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
“It would be untrue to say Yellow Jack was the best man at our wedding, but it would be perfectly true to say that in a sense he was an usher.”
Marie Doughty, Mrs. William Gorgas,
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
Marie Doughty, Mrs. William Gorgas,
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
One bout of yellow fever confers life-long immunity. Dr. William Gorgas was then one of the few U.S. Army doctors who could work safely during any yellow fever outbreak or live in any yellow fever endemic area.
In 1885, Dr. George M. Sternberg of the United States Army was sent to Rio de Janeiro to investigate Dr. Domingo Freire's reports that he'd isolated the causative organism of yellow fever, which he had enthusiastically named, Cryptococcus zanthogenicus. Dr. Sternberg discovered it was the well-known Staphylococcus pyrogenes. Dr. Sternberg also examined Dr. Carlos Finlay's claim for a Micrococcus tetragenus, but found only common organisms that had no connection to yellow fever.
In 1888, in Havana, Cuba, Dr. George M. Sternberg examined blood and internal organs from yellow fever cases and firmly concluded that the specific agent that causes yellow fever was still unknown.
In 1888, Captain Dr. William Gorgas was sent to Fort Barrancas, Florida to aid in control of a yellow fever outbreak.
In 1888, U.S. Military official policy to combat yellow fever outbreaks was sanitation to remove all filth that might produce fomites.
In 1889, in another clinical confirmation that some insects can indeed transmit certain diseases, Dr. Theobald Smith and Dr. H.L. Kilborne reported the results of their research that proved that the cattle disease known as Texas fever was transmitted by a certain tick.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
In 1888, Captain Dr. William Gorgas was sent to Fort Barrancas, Florida to aid in control of a yellow fever outbreak.
In 1888, U.S. Military official policy to combat yellow fever outbreaks was sanitation to remove all filth that might produce fomites.
In 1889, in another clinical confirmation that some insects can indeed transmit certain diseases, Dr. Theobald Smith and Dr. H.L. Kilborne reported the results of their research that proved that the cattle disease known as Texas fever was transmitted by a certain tick.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
1890, in Baltimore, in addition to his Army medical duties, Major Dr. Walter Reed was a regular attendant at the Hospital Medical Societies, able to observe alongside Dr. William Welch and Dr. Clement as they studied the hog-cholera bacillus; and with Dr. Abbott and Flexner as they studied the diphtheria toxin and diphtheria anti-toxin, discovered by Dr. Behring in 1890. Always with an eye to practical field applications to improving soldiers’ health, Dr. Reed also closely followed the studies conducted by Dr. Councilman and Dr. Lafleur on amoebic dysentery, as well as any on-going investigations on malaria.
In 1892, Dr. George M. Sternberg published his Manual of Bacteriology in which he postulated that the germ of yellow fever could well be ultra-microscopic.
In 1893, Dr. James Carroll was assigned to duty at the Army Medical School in Washington, D.C. where met Dr. Walter Reed and worked with him on a number of collaborative work assignments.
In 1895, Major Ronald Ross, based in India received Dr. Manson’s work on mosquito conveyance of the filaria parasite and began his study on a connection between malaria and mosquitoes.
In 1897, it was publicized that in 1896, Italian scientist Dr. Giuseppe Sanarelli had isolated the cause of yellow fever, a bacillus he named, Bacillus icteroides.
In 1897, in India, with over two years without any success, Major Ross was tempted to give up, but then received a bottle of larvae and flying adults from a different species of mosquito than he’d been using.
In 1898, Surgeon-General Walter Wyman of the Public Health and Marine Hospital Service sent a special, blue-ribbon Public Health commission on yellow fever to Havana, Cuba to investigate Sanarelli's bacillus and sanitation.
In 1898, meanwhile, Surgeon Henry R. Carter of the Public Health and Marine Hospital Service working in Mississippi with yellow fever quarantine work, had discovered a well-defined period between primary and secondary cases of yellow fever in isolated households, strongly suggesting that yellow fever required an extrinsic incubation period. Surgeon-General Walter Wyman, Carter’s supervisor, ignored it. Carter submitted his paper, A Note on the Interval Between Infecting and Secondary Cases of Yellow Fever, etc., for publication, but it was rejected by the editor for being too long.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1892, Dr. George M. Sternberg published his Manual of Bacteriology in which he postulated that the germ of yellow fever could well be ultra-microscopic.
In 1893, Dr. James Carroll was assigned to duty at the Army Medical School in Washington, D.C. where met Dr. Walter Reed and worked with him on a number of collaborative work assignments.
In 1895, Major Ronald Ross, based in India received Dr. Manson’s work on mosquito conveyance of the filaria parasite and began his study on a connection between malaria and mosquitoes.
In 1897, it was publicized that in 1896, Italian scientist Dr. Giuseppe Sanarelli had isolated the cause of yellow fever, a bacillus he named, Bacillus icteroides.
In 1897, in India, with over two years without any success, Major Ross was tempted to give up, but then received a bottle of larvae and flying adults from a different species of mosquito than he’d been using.
In 1898, Surgeon-General Walter Wyman of the Public Health and Marine Hospital Service sent a special, blue-ribbon Public Health commission on yellow fever to Havana, Cuba to investigate Sanarelli's bacillus and sanitation.
In 1898, meanwhile, Surgeon Henry R. Carter of the Public Health and Marine Hospital Service working in Mississippi with yellow fever quarantine work, had discovered a well-defined period between primary and secondary cases of yellow fever in isolated households, strongly suggesting that yellow fever required an extrinsic incubation period. Surgeon-General Walter Wyman, Carter’s supervisor, ignored it. Carter submitted his paper, A Note on the Interval Between Infecting and Secondary Cases of Yellow Fever, etc., for publication, but it was rejected by the editor for being too long.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1898, the United States went to war with Spain.
American troops were sent to wage battle in the Caribbean stronghold of yellow fever - Cuba.
American troops were sent to wage battle in the Caribbean stronghold of yellow fever - Cuba.
In 1898, after a dangerous typhoid outbreak among U.S. troop camps in Cuba, U.S. Army Major Dr. Walter Reed was urgently tasked as chairman of a medical committee, with Dr. V.C. Vaughn of the University of Michigan and Dr. E.O Shakespeare of Philadelphia to determine how typhoid fever was spreading in those military camps and to provide recommendations on how to stop it.
In 1898, Surgeon-General Walter Wyman of the Public Health and Marine Hospital Service reported the board's high-level committee consensus on yellow fever: "Yellow fever was a communicable disease, but not contagious in the usual sense, but by infection (soiling) of objects such as clothes, bedding and furniture... " thus the Board plainly favored a variation on the hypothesis of fomites. "Yellow fever required an extrinsic infection period during which a patient is harmless to others." They offered no actual evidence for this assertion: "The germ of yellow fever was inhaled in some obscure manner and after incubating in the blood, then poisons it, 'an almost inexplicable poison so insidious in its approach and entrance that no trace of it is found.” They concurred that the germ was Sanarelli's Bacillus icteroides. Prevention required aggressive sanitation measures.
In 1898, the yellow-fever camp at Siboney, Cuba and every supply in it was burned by the commanding officer on the advice of Major Dr. William Gorgas and Dr. Victor Vaughn, as per the standard sanitation protocols to control yellow fever by destroying anything that could act as fomites for its spread. Dr. Vaughn had been working with Dr. Reed on the typhoid issue and was both a colleague and patient of Dr. Gorgas, having come down with yellow fever during his assignment to Cuba. A few years later, Vaughn served a term as the president of the American Medical Association.
In 1898, the yellow-fever camp at Siboney, Cuba and every supply in it was burned by the commanding officer on the advice of Major Dr. William Gorgas and Dr. Victor Vaughn, as per the standard sanitation protocols to control yellow fever by destroying anything that could act as fomites for its spread. Dr. Vaughn had been working with Dr. Reed on the typhoid issue and was both a colleague and patient of Dr. Gorgas, having come down with yellow fever during his assignment to Cuba. A few years later, Vaughn served a term as the president of the American Medical Association.
“Being immune to yellow fever, I made application to go with the troops that took possession of Havana. We arrived there in December 1898.”
William Crawford Gorgas, Sanitation in Panama, 1915
William Crawford Gorgas, Sanitation in Panama, 1915
In 1899, after a year of work, Dr. Walter Reed, Dr. Vaughn and Dr. Shakespeare comprising the typhoid fever committee submitted the results of their highly-detailed and comprehensive, two-volume, “Report of the Origin and Spread of the Typhoid Fever in the United States Military Camps during the Spanish-American War of 1898.” They determined that typhoid fever was contagious; the camps were heavily contaminated with the bacillus that causes it via the spread of the bacillus by flies that freely circulated between latrines and the food dining mess halls, depositing the bacillus everywhere they touched, plus by bacillus-contaminated hands, clothing, eating utensils and everything else on which the bacillus could be deposited. The committee recommended stringent hygiene protocols, plus practices to disinfect the contaminated areas to kill the bacillus distributed throughout the afflicted camps, including burning what couldn't be disinfected. In the case of typhoid fever, the concept of fomites was somewhat relevant – the bacillus was able to survive on the surfaces of objects that if not disinfected could then, if touched, allow the bacillus to contact and thus infect other people.
In 1899 the publication Medical News of April 29, 1899 printed a short report from a larger paper written by Dr. Walter Reed and Dr. James Carroll, “Bacillus icteroids and bacillus cholerae suis – A Preliminary Note.” The Army report completely contradicted the 1898 results of the Marine Hospital Service Board that had validated Sanarelli's assertions. The Army's laboratory investigation revealed that Sanarelli's ostensibly newly-discovered yellow fever Bacillus icteroides had been promptly identified by Dr. Walter Reed and Dr. Carroll, who were familiar with it from their associations with Dr. Welch and Dr. Clement's bacteriology research in Baltimore, as a known hog-cholera bacillus.
In 1899, the Medical News issue of August 12, 1899, printed Sanarelli’s irate rebuttal to Reed and Carroll’s April 29 report, even darkly suggesting their work wasn’t motivated by pure science, but by a perhaps jealous Army Surgeon-General Dr. Sternberg behind Reed and Carroll to discredit Sanarelli’s discovery and Marine Hospital Service Surgeon-General Wyman along with the members of Wyman's 1898 Yellow Fever Board.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1899, the Medical News issue of August 12, 1899, printed Sanarelli’s irate rebuttal to Reed and Carroll’s April 29 report, even darkly suggesting their work wasn’t motivated by pure science, but by a perhaps jealous Army Surgeon-General Dr. Sternberg behind Reed and Carroll to discredit Sanarelli’s discovery and Marine Hospital Service Surgeon-General Wyman along with the members of Wyman's 1898 Yellow Fever Board.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
"Between 1853 and 1900 there were a recorded 35,952 deaths from yellow fever
in the city of Havana, Cuba."
William Crawford Gorgas, Sanitation in Panama, 1915
in the city of Havana, Cuba."
William Crawford Gorgas, Sanitation in Panama, 1915
In 1899, the Liverpool Tropical School of Medicine in Sierra Leone announced that it had confirmed Major Ross’s reporting of the life stages of the malaria parasite in certain mosquitoes, then in humans and then back to mosquitoes.
In 1899, Dr. Gorgas was assigned new duties as the Chief Sanitation Officer for Havana, Cuba with the American occupation forces. Decrepit and war-damaged Havana was at that point perhaps the filthiest and most fetid city in the Americas. With the health of U.S. troops at stake, the U.S. Army was keen to protect U.S. troops from disease, particularly yellow fever. U.S. Army Surgeon-General Dr. Sternberg tasked Dr. Gorgas to rigorously apply all known sanitation and city infrastructure repair actions to protect against outbreaks of typhoid, cholera, dysentery and yellow fever. Gorgas’s sanitation teams began a massive cleanup, removing human and animal corpses, trash and rubble, repairing roads, water lines, sewers and buildings.
In 1899 during December, to provide the clinical detail necessary to defuse Sanarelli’s odious efforts to defend his bacillus claims by agitating the medical research community against them, Dr. Reed and Dr. Carroll published their complete investigation of Sanarelli’s claim that the bacillus he had named, bacillus icteroides, was the organism that caused yellow fever, including additional data from pathologist Dr. Aristides Agramonte in Cuba that demonstrated clearly that Sanarelli’s bacillus belonged to the hog-cholera group, and had nothing to do with yellow fever.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1899, Dr. Gorgas was assigned new duties as the Chief Sanitation Officer for Havana, Cuba with the American occupation forces. Decrepit and war-damaged Havana was at that point perhaps the filthiest and most fetid city in the Americas. With the health of U.S. troops at stake, the U.S. Army was keen to protect U.S. troops from disease, particularly yellow fever. U.S. Army Surgeon-General Dr. Sternberg tasked Dr. Gorgas to rigorously apply all known sanitation and city infrastructure repair actions to protect against outbreaks of typhoid, cholera, dysentery and yellow fever. Gorgas’s sanitation teams began a massive cleanup, removing human and animal corpses, trash and rubble, repairing roads, water lines, sewers and buildings.
In 1899 during December, to provide the clinical detail necessary to defuse Sanarelli’s odious efforts to defend his bacillus claims by agitating the medical research community against them, Dr. Reed and Dr. Carroll published their complete investigation of Sanarelli’s claim that the bacillus he had named, bacillus icteroides, was the organism that caused yellow fever, including additional data from pathologist Dr. Aristides Agramonte in Cuba that demonstrated clearly that Sanarelli’s bacillus belonged to the hog-cholera group, and had nothing to do with yellow fever.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1900, in late spring, arguably transformed into the cleanest city in the Americas, Havana, with all sorts of diseases like typhoid, cholera and dysentery at historically low numbers, the annual yellow fever season started, then inexorably surged. Governor-General Dr. Leonard Wood ordered Gorgas to redouble his efforts, but seemingly perversely, the cases of yellow fever increased and the death toll climbed.
Against all accepted protocols and expectations of sanitation as the solution to yellow fever, the nicest and cleanest parts of the city had the most yellow fever cases.
"Seldom had such a superhuman task been so inadequately rewarded."
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
Against all accepted protocols and expectations of sanitation as the solution to yellow fever, the nicest and cleanest parts of the city had the most yellow fever cases.
"Seldom had such a superhuman task been so inadequately rewarded."
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
Havana, Cuba Yellow fever deaths
1897 1898 1899 1900
(pre-war) (war) (sanitation) - (sanitation)
May 88 4 0 2
July 168 16 2 30
August 102 16 13 49
Year totals 858 136 103 310
1897 1898 1899 1900
(pre-war) (war) (sanitation) - (sanitation)
May 88 4 0 2
July 168 16 2 30
August 102 16 13 49
Year totals 858 136 103 310
In 1900 as the year progressed, yellow fever cases surged and fatalities were trending triple the previous year in Havana, including three officers of the military governor’s staff and the American superintendent of the San Jose Asylum, thus “a good part of the community was frantic.”
“Nothing advertises a plague so much as a few important victims.”
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
“Nothing advertises a plague so much as a few important victims.”
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
“General George M. Sternberg, the then Surgeon-General of the Army, was one of the leading bacteriologists of the profession and was also one of the best-known authorities on yellow fever. He doubted the findings of this Board, and obtained authority from the Secretary of War to appoint a board of Army medical officers to investigate this same subject."
Dr. Gorgas had his own very good reason to question the accuracy of the 1898 Marine Hospital Service Yellow Fever Board's research and conclusions:
"It is an interesting historical fact that one of the yellow fever patients in whom the Board of Public Health Service found Sanarelli’s organism was a patient of mine. The case continued long enough to convince me that the disease was not yellow fever. The symptoms in a case of yellow fever dying on the ninth day are so well-marked that the diagnosis should not be in doubt.
But the Board found Sanarelli’s organism, and being themselves convinced that this was the organism of yellow fever, they believed this case to be that disease. It shows the necessity in scientific matters of being on one's guard,
and of approaching investigation with an open mind.”
Dr. William Crawford Gorgas, Sanitation in Panama, 1915, Howard Kelly, Walter Reed and Yellow Fever, 1906
Dr. Gorgas had his own very good reason to question the accuracy of the 1898 Marine Hospital Service Yellow Fever Board's research and conclusions:
"It is an interesting historical fact that one of the yellow fever patients in whom the Board of Public Health Service found Sanarelli’s organism was a patient of mine. The case continued long enough to convince me that the disease was not yellow fever. The symptoms in a case of yellow fever dying on the ninth day are so well-marked that the diagnosis should not be in doubt.
But the Board found Sanarelli’s organism, and being themselves convinced that this was the organism of yellow fever, they believed this case to be that disease. It shows the necessity in scientific matters of being on one's guard,
and of approaching investigation with an open mind.”
Dr. William Crawford Gorgas, Sanitation in Panama, 1915, Howard Kelly, Walter Reed and Yellow Fever, 1906
~ 24 May 1900 ~
“Hundreds of similar medical commissions had…faded into forgetfulness. There was nothing to indicate that this commission would not have a similar fate.”
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
“Hundreds of similar medical commissions had…faded into forgetfulness. There was nothing to indicate that this commission would not have a similar fate.”
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1900 during the months of June and July, Dr. Reed and his team had numerous briefings with Governor-General Leonard Wood and Chief Sanitation Officer, Major Dr. William Gorgas, to discuss the task of the Board as envisioned by Army Surgeon-General Dr. Stenberg to identify the causative organism of yellow fever, expressly to help resolve the problem Dr. Gorgas was facing.
Sanitation to control yellow fever was still the priority, and Dr. Gorgas was still convinced it had merit, but wondered that perhaps something had been overlooked in the design or implementation of the sanitation program, which had dramatically reduced all contagious diseases in Havana… but not yellow fever. All medical doctors, Wood, Reed and Gorgas, they did in fact know the core reason for the size of the outbreak.
Yellow fever had appeared to be on the decline, but only because the pool of humanity that was available to it was the Havana citizens who were already immune from early childhood exposure. With the war ended at last and Havana not only restored, but vastly improved, thousands of non-immunes from Spain had poured in to immigrate for work and settlement.
The outbreaks were consistently among non-immune U.S. Army troops and newly-arrived non-immune Spanish and other foreigners. Yellow fever had been like hidden hot embers in a bed of ash, just waiting for more fuel. This fuel was provided by every arriving ship docking at the port, off-loading non-immune passengers and every U.S. Army transport off-loading a new troop rotation of non-immunes.
Sanitation to control yellow fever was still the priority, and Dr. Gorgas was still convinced it had merit, but wondered that perhaps something had been overlooked in the design or implementation of the sanitation program, which had dramatically reduced all contagious diseases in Havana… but not yellow fever. All medical doctors, Wood, Reed and Gorgas, they did in fact know the core reason for the size of the outbreak.
Yellow fever had appeared to be on the decline, but only because the pool of humanity that was available to it was the Havana citizens who were already immune from early childhood exposure. With the war ended at last and Havana not only restored, but vastly improved, thousands of non-immunes from Spain had poured in to immigrate for work and settlement.
The outbreaks were consistently among non-immune U.S. Army troops and newly-arrived non-immune Spanish and other foreigners. Yellow fever had been like hidden hot embers in a bed of ash, just waiting for more fuel. This fuel was provided by every arriving ship docking at the port, off-loading non-immune passengers and every U.S. Army transport off-loading a new troop rotation of non-immunes.
In 1900, in June Dr. Reed and Dr. Carroll arrived in Havana, Cuba to join the two board members already there, Dr. Jesse Lazear and Dr. Aristides Agramonte. Only Cuban-borne Dr. Agramonte is immune among the members of this yellow fever research board. The board was placed at the Army base at Quemados, just outside of Havana. It was convenient to the city, yet free of yellow fever.
In one of those oddities of yellow fever, Havana’s yellow fever seemed to be able to infect people living in the ports of New Orleans, Memphis and Charlotte, to name a few cities hundreds of miles away, but not any people living just one mile beyond Havana city limits.
In one of those oddities of yellow fever, Havana’s yellow fever seemed to be able to infect people living in the ports of New Orleans, Memphis and Charlotte, to name a few cities hundreds of miles away, but not any people living just one mile beyond Havana city limits.
In 1900 during June and early July, Dr. Jesse Lazear who had been actively studying the work of Ronald Ross and the Italian researchers on the development of the malaria parasite in mosquitoes was well-qualified and positioned to strongly encourage Dr. Reed to consider Dr. Carlos Finlay’s 1881 paper on yellow fever and mosquitoes and to discuss it with Finlay himself.
Further, Dr. Lazear had encountered Dr. H.R. Carter of the Marine Hospital Service who had been stationed in Cuba as the Quarantine Officer. Dr. Carter had provided Dr. Lazear his un-published 1898 paper about the delay between primary and secondary cases of yellow fever.
Further, Dr. Lazear had encountered Dr. H.R. Carter of the Marine Hospital Service who had been stationed in Cuba as the Quarantine Officer. Dr. Carter had provided Dr. Lazear his un-published 1898 paper about the delay between primary and secondary cases of yellow fever.
In 1900 during early July, Dr. Reed meticulously continued to collect as much information as he could from Dr. Gorgas and the Havana doctors who were highly experienced in diagnosis and treatment of yellow fever to be able to design a research structure for the board to implement. No one yet had been able to find any organism in any yellow fever patient, despite plentiful pathology data from years of thousands of known cases and hundreds of autopsies.
In 1900 at the end of July, on 31 July, Dr. Reed and Dr. Agramonte traveled together to the Army barracks at Pinar del Rio. Pathologist Dr. Agramonte’s autopsy of a possible malaria fatality revealed instead the distinctive liver damage caused by yellow fever. His diagnosis of yellow fever was quickly rejected by the local Army health authorities. But solidly backed by Major Dr. Reed, Dr. Agramonte’s analysis prevailed and he and Dr. Reed quickly confirmed that a yellow fever outbreak had been underway at the Army barracks at Pinar del Rio barracks, with about 35 cases and 11 fatalities, without being adequately reported as such.
Dr. Reed and Dr. Agramonte noticed that no hygiene protocols had been taken as required by the Army to control yellow fever outbreaks, thus there had been plenty of opportunities for people taking care of the patients sickened with yellow fever to also have been infected. Contaminated clothing from fatal cases had not been destroyed, but was found in every barrack, yet there had not been any mass outbreak in any of the barracks. They discovered that the common factor among the stricken soldiers was that they had all spent time in the nearby town, where soldiers had free access to visit and where yellow fever was endemic.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
In 1900 at the end of July, on 31 July, Dr. Reed and Dr. Agramonte traveled together to the Army barracks at Pinar del Rio. Pathologist Dr. Agramonte’s autopsy of a possible malaria fatality revealed instead the distinctive liver damage caused by yellow fever. His diagnosis of yellow fever was quickly rejected by the local Army health authorities. But solidly backed by Major Dr. Reed, Dr. Agramonte’s analysis prevailed and he and Dr. Reed quickly confirmed that a yellow fever outbreak had been underway at the Army barracks at Pinar del Rio barracks, with about 35 cases and 11 fatalities, without being adequately reported as such.
Dr. Reed and Dr. Agramonte noticed that no hygiene protocols had been taken as required by the Army to control yellow fever outbreaks, thus there had been plenty of opportunities for people taking care of the patients sickened with yellow fever to also have been infected. Contaminated clothing from fatal cases had not been destroyed, but was found in every barrack, yet there had not been any mass outbreak in any of the barracks. They discovered that the common factor among the stricken soldiers was that they had all spent time in the nearby town, where soldiers had free access to visit and where yellow fever was endemic.
From: Walter Reed and Yellow Fever, Howard Kelly, 1906; Sanitation in Panama, William Gorgas, 1915; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924
"Interval between infecting and secondary cases"
The hypothesis of yellow fever transmission by filth and fomites was completely inadequate for explaining how only one man was struck down by yellow fever while locked in a confined space with eight other men. Dr. Reed’s growing dissatisfaction with this long-held hypothesis seems dryly droll in his report of another incident.
“On July 18th the very bed vacated by the Commissary Sergeant who died on July 21, was occupied by a soldier the night of July 19th and 20th of July. Although this individual was badly frightened when the true character of the sergeant’s attack was announced, the combination of fright and exposure to fomites was not sufficient to produce an attack of yellow fever.” Dr. Walter Reed
Walter Reed and Yellow Fever, Kelly, 1906
“On July 18th the very bed vacated by the Commissary Sergeant who died on July 21, was occupied by a soldier the night of July 19th and 20th of July. Although this individual was badly frightened when the true character of the sergeant’s attack was announced, the combination of fright and exposure to fomites was not sufficient to produce an attack of yellow fever.” Dr. Walter Reed
Walter Reed and Yellow Fever, Kelly, 1906
In 1900, in August, Dr. Reed's inspection tours of Havana and briefings with Governor-General Wood and Dr. Gorgas were complete, complementing what he and Dr. Agramonte had found at Pinar del Rio. With Ronald Ross’s newly-published report on the life cycle of the malaria parasite in the mosquito, Dr. Reed had Dr. Lazear and Quarantine Officer, Dr. H.R. Carter share Carter's meticulous Mississippi observations with the board.
Reed had Dr. Carter’s ignored yellow fever report in hand and in mind, plus Major Ronald Ross's report that had shown that the malaria parasite required a period of time to develop inside the mosquitoes before being passed on to humans. With a growing sense of certainty that the key to Dr. Finlay’s mosquito hypothesis – the key to proof that had been eluding not just Finlay, but the medical world to be able to understand yellow fever - Dr. Reed decided was in one word:
Incubation
“It spells an insect host.”
Dr. Walter Reed, 1900
Reed had Dr. Carter’s ignored yellow fever report in hand and in mind, plus Major Ronald Ross's report that had shown that the malaria parasite required a period of time to develop inside the mosquitoes before being passed on to humans. With a growing sense of certainty that the key to Dr. Finlay’s mosquito hypothesis – the key to proof that had been eluding not just Finlay, but the medical world to be able to understand yellow fever - Dr. Reed decided was in one word:
Incubation
“It spells an insect host.”
Dr. Walter Reed, 1900
“At this stage of our investigation, it seemed to me, and I so expressed the opinion to my colleagues, that the time had arrived when the plan of our work should be radically altered and that the search for the specific agent of yellow fever, while not abandoned, should be given secondary consideration, until we had first definitely learned something about the way or ways the disease was propagated from the sick to the well…. And in view of the splendid work of Ross, Bigmani and others with regard to the propagation of malarial fever… it was of the highest importance that the agency of an intermediate host, such as the mosquito, should either be proven or disproven.”
“Notwithstanding the fact that Finlay had no results to show in support of his theory, and that the latter had been rejected by other investigators, the argument in favor of an intermediate host seemed so strong, as I have already said, that investigation along this line was determined upon."
Dr. Walter Reed, 1900
“Notwithstanding the fact that Finlay had no results to show in support of his theory, and that the latter had been rejected by other investigators, the argument in favor of an intermediate host seemed so strong, as I have already said, that investigation along this line was determined upon."
Dr. Walter Reed, 1900
With the pressure mounting, as yellow fever continued to surge in Havana, Dr. Reed deliberately stepped away from his assigned duty – to identify the causative organism of yellow fever. He instead considered the apparently disparate information he had collected – including that the organism of yellow fever could be exactly as Dr. Sternberg himself had suggested in 1892, not anything insidiously mysterious, but simply ‘ultra-miscroscopic.’ If that was the case, it would indeed explain why yellow fever left nothing visible apart from the physical damage it had done. The Board might not be able to show anyone the organism, no matter how much effort they expended, but only because the means to do so hadn't been invented yet.
The malaria parasites inside mosquitoes and in human blood cells were visible under the microscope, but this was not the case with yellow fever. Dr. Reed was faced with the same problem as Louis Pasteur had faced when tackling the problem of rabies. Pasteur’s years of microscopic investigations – Pasteur had in fact coined many of the words the modern world is familiar with – micro-organisms, germs – made him confident that rabies would be the same sort of study. To Pasteur’s surprise and concern, the rabies organism was too tiny to be seen with the microscope technology of Pasteur’s time. Pasteur’s experiments to create a vaccine against rabies had to be conducted ‘blind’ waiting for outcomes of trials conducted with a deadly, invisible disease.
Walter Reed, of the generation of bacteriologists and laboratory explorers building on Pasteur’s pioneering work, had added his own important research achievements over the years, strong experience he brought to the task, but like Pasteur, it had all been with micro-organisms visible with a microscope. With a skeptical world firmly attached to the hypothesis of filth and fomites, to the point of assuming that this completely unproven Hypothesis had somehow taken on the validity of scientific Law, Dr. Reed’s problem was to create a clinical structure that would decisively provide to the doubting medical and research professions solid results that didn’t require actually having to see the organism for proof.
The recent unpleasant and unwanted conflict with Dr. Sanarelli and the Marine Hospital Yellow Fever Board was also fresh in Dr. Reed and Dr. Carroll's minds. They had inadvertently made enemies by reporting the truth. Sanarelli wasn't the only researcher at that time who was invested in making a name for himself in discovering the why and how of yellow fever, to the point of forgetting that the effort wasn't to promote careers, but to save lives. There was already a group of hostile professionals on the mainland waiting to pounce on them and subject them to every criticism when they emerged. Dr. Reed knew no matter what they as the Army Yellow Fever Board found, they would need to produce unassailable, meticulous proof and be very prepared to defend it to the world. There was zero support in Washington, including Reed's boss, Army Surgeon-General Dr. Sternberg who wrote the book on bacteriology to investigate mosquitoes.
Dr. Reed’s other critical problem was to make sure that this change in focus from investigating a causative organism to investigating a mosquito vector for the yellow fever Board wouldn’t quickly result in having its funds frozen or him or all the Board's four members recalled for insubordination or misuse of funds.
The malaria parasites inside mosquitoes and in human blood cells were visible under the microscope, but this was not the case with yellow fever. Dr. Reed was faced with the same problem as Louis Pasteur had faced when tackling the problem of rabies. Pasteur’s years of microscopic investigations – Pasteur had in fact coined many of the words the modern world is familiar with – micro-organisms, germs – made him confident that rabies would be the same sort of study. To Pasteur’s surprise and concern, the rabies organism was too tiny to be seen with the microscope technology of Pasteur’s time. Pasteur’s experiments to create a vaccine against rabies had to be conducted ‘blind’ waiting for outcomes of trials conducted with a deadly, invisible disease.
Walter Reed, of the generation of bacteriologists and laboratory explorers building on Pasteur’s pioneering work, had added his own important research achievements over the years, strong experience he brought to the task, but like Pasteur, it had all been with micro-organisms visible with a microscope. With a skeptical world firmly attached to the hypothesis of filth and fomites, to the point of assuming that this completely unproven Hypothesis had somehow taken on the validity of scientific Law, Dr. Reed’s problem was to create a clinical structure that would decisively provide to the doubting medical and research professions solid results that didn’t require actually having to see the organism for proof.
The recent unpleasant and unwanted conflict with Dr. Sanarelli and the Marine Hospital Yellow Fever Board was also fresh in Dr. Reed and Dr. Carroll's minds. They had inadvertently made enemies by reporting the truth. Sanarelli wasn't the only researcher at that time who was invested in making a name for himself in discovering the why and how of yellow fever, to the point of forgetting that the effort wasn't to promote careers, but to save lives. There was already a group of hostile professionals on the mainland waiting to pounce on them and subject them to every criticism when they emerged. Dr. Reed knew no matter what they as the Army Yellow Fever Board found, they would need to produce unassailable, meticulous proof and be very prepared to defend it to the world. There was zero support in Washington, including Reed's boss, Army Surgeon-General Dr. Sternberg who wrote the book on bacteriology to investigate mosquitoes.
Dr. Reed’s other critical problem was to make sure that this change in focus from investigating a causative organism to investigating a mosquito vector for the yellow fever Board wouldn’t quickly result in having its funds frozen or him or all the Board's four members recalled for insubordination or misuse of funds.
“The Board had come to Cuba for entirely different investigations, and had not been supplied with sufficient funds for these experiments. Fortunately for the cause of science and of humanity, we had as governor-general of Cuba at the time General Leonard Wood of the United States Army. General Wood had been educated as a physician, and had a very proper idea of the great advantages which would accrue to the world if we could establish the fact that yellow fever was conveyed by the mosquito, and his medical training made him a very competent judge as to the steps necessary to establish such fact. General Wood during the whole course of the investigations took the greatest interest … and assisted the Board in every way he could.
Dr. Reed outlined to General Wood the course he expected to pursue, and General Wood was so convinced by Dr. Reed’s argument that he authorized the expenditure from Cuban funds of a sufficient sum and gave Dr. Reed powers as to the method of expenditure.”
William Crawford Gorgas, Sanitation in Panama, 1915
Dr. Reed outlined to General Wood the course he expected to pursue, and General Wood was so convinced by Dr. Reed’s argument that he authorized the expenditure from Cuban funds of a sufficient sum and gave Dr. Reed powers as to the method of expenditure.”
William Crawford Gorgas, Sanitation in Panama, 1915
1900 August. It wasn't every day people encountered a doctor who kept a large stock of mosquitoes in his house, his odd hobby to go along with his fanciful idea that those tiny little bugs - not just any mosquitoes, but one particular species - were the ones responsible for infecting humans with yellow fever. Dr. Reed was slightly unsure that Dr. Finlay would be willing to work with them after their initial reluctance to follow-up on his mosquito hypothesis, but Finlay cheerfully and enthusiastically shared with Reed and the Board everything he had, and gave them his blessing.
"Dr. Finlay is a most lovable man in character and personality, and no one could be constantly thrown with him as I was daily for several years without becoming warmly attached to him and forming the highest estimation of his scientific honesty and straightforwardness."
Dr. William Crawford Gorgas
Sanitation in Panama, Gorgas, 1915
Dr. William Crawford Gorgas
Sanitation in Panama, Gorgas, 1915
“Others of course had also leveled accusing fingers at the mosquito… But those others, Dr. Nott and the rest had accused – without naming a particular species. Inasmuch as there are said to be three thousand different varieties of mosquitoes… left much of the distance still to be traveled. It was just as though a detective insisted that a certain crime had been committed… in a community of some three thousand population but could not give
… any idea as to which of these... was or were guilty.
But Dr. Finlay, like a master criminal-seeker, had walked confidently into the mosquito
community, so to speak, and unhesitatingly placed his hand upon one…”
Physician to the World, The Life of William C. Gorgas, Gibson, 1989
… any idea as to which of these... was or were guilty.
But Dr. Finlay, like a master criminal-seeker, had walked confidently into the mosquito
community, so to speak, and unhesitatingly placed his hand upon one…”
Physician to the World, The Life of William C. Gorgas, Gibson, 1989
“The particular species used by Dr. Finlay… is the one referred to in this country as Culex fasciatus Fabricius, but Mr. F.V. Theobald, who has been investigating the mosquitoes of the world, has decided that… on account of scale structure and other… peculiarities, it must be placed in another genus which has received the name Stegomyia. It is the female of one particular species, Stegomyia fasciata which Dr. Reed made use of in his experiments upon yellow fever.”
Walter Reed and Yellow Fever, Kelly, 1906
“This mosquito is rather a striking looking insect.”
Dr. Walter Reed
Walter Reed and Yellow Fever, Kelly, 1906
Walter Reed and Yellow Fever, Kelly, 1906
“This mosquito is rather a striking looking insect.”
Dr. Walter Reed
Walter Reed and Yellow Fever, Kelly, 1906
“The reports of the Army Commission on yellow fever are so modest and self-restrained that they give little or no idea of the dangers to which the members were so incessantly exposed nor of the painful scenes they were daily called upon to witness.”
Walter Reed and Yellow Fever, Kelly, 1906
Walter Reed and Yellow Fever, Kelly, 1906
~ Black September 1900 ~
The yellow fever epidemic in 1900 was following its usual annual pattern, with August, September and October always the worst months. The Yellow Fever Commission was working in the deceptive calm of the eye of the storm.
In 1900 in mid-August, it was necessary for Dr. Reed to return for a few weeks to the States, without having much time prior to his departure to work out the new experimental protocols using mosquitoes.
In Reed’s absence, Dr. Lazear, as the mosquito expert of the Board was responsible for hatching out the eggs Dr. Finlay had supplied and for keeping ready in the laboratory a quantity of live female stegomyia mosquitoes to be used for the experiments. Only female mosquitoes bite as they require a blood meal to produce eggs.
In 1900, during the latter days of August and the first half of the month of September, despite having a few volunteers, Dr. Lazear and Dr. Carroll had decided to test on themselves. To infect Lazear’s laboratory-raised female Stegomyia mosquitoes, these were allowed to feed on yellow fever patients in the yellow fever ward.
Dr. Lazear and Dr. Carroll then let these mosquitoes feed on the two of them, without any result at all; quite the feat while yellow fever casualties were effortlessly piling up around them without any prompting whatsoever.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
The yellow fever epidemic in 1900 was following its usual annual pattern, with August, September and October always the worst months. The Yellow Fever Commission was working in the deceptive calm of the eye of the storm.
In 1900 in mid-August, it was necessary for Dr. Reed to return for a few weeks to the States, without having much time prior to his departure to work out the new experimental protocols using mosquitoes.
In Reed’s absence, Dr. Lazear, as the mosquito expert of the Board was responsible for hatching out the eggs Dr. Finlay had supplied and for keeping ready in the laboratory a quantity of live female stegomyia mosquitoes to be used for the experiments. Only female mosquitoes bite as they require a blood meal to produce eggs.
In 1900, during the latter days of August and the first half of the month of September, despite having a few volunteers, Dr. Lazear and Dr. Carroll had decided to test on themselves. To infect Lazear’s laboratory-raised female Stegomyia mosquitoes, these were allowed to feed on yellow fever patients in the yellow fever ward.
Dr. Lazear and Dr. Carroll then let these mosquitoes feed on the two of them, without any result at all; quite the feat while yellow fever casualties were effortlessly piling up around them without any prompting whatsoever.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
The yellow fever onslaught was in full force in August/September 1900 and may have ranked as one of the worse periods in Dr. William Gorgas’s life. Because yellow fever was considered 'contagious,' the corpses of the fatalities were required to be buried immediately so the attending doctor often had to fulfill the roles of internment supervisor and preacher to lead the prayers over the deceased, at any hour of the night or day, even dig the grave if no grave diggers could be found.
Mrs. Lena Warne had been a survivor of the 1878 epidemic that had utterly devastated Grenada, Mississippi, who while as a child laying sick and helpless with yellow fever had witnessed her dying father be robbed and beaten by cruel looters had had posed as humanitarian aid workers. She was one of only two in her entire family to survive. Immune for life, Mrs. Warne recalled:
“When our Government called for volunteer nurses to go to Cuba I availed myself of this opportunity. In August 1900, I was ordered from Matanzas to Havana.”
Mrs. Lena Warne
Walter Reed and Yellow Fever, Kelly, 1906
Mrs. Warne had several opportunities to work alongside Dr. Gorgas as the number of cases climbed, most were fellow Americans in the U.S. Army and civilian contract support functions.
“Major Gorgas was very successful in his treatment of the fever and upon my
return to Camp Columbia I determined to imitate his directions.”
Mrs. Lena Warne, Nurse
Walter Reed and Yellow Fever, Kelly, 1906
Her accounts provide more details as to the grim conditions in which the medical staffs assigned to the patients in the quarantine yellow fever wards had to work. Warne witnessed numerous preventable tragedies among American military officers and soldiers who had accepted being posted to Cuba on the mistaken belief that they were immune.
“I recognized Major Cartwright; he said he could not possibly have yellow fever as he certainly had a genuine case in ’98. On the sixth day after his arrival he died of the black vomit. Major Peterson also thought that he’d had the fever, but he was taken ill again with it, and his wife… two hours after his death committed suicide by shooting herself in our quarters at Las Animas… The only nurse with me… was one that claimed to be an immune; she was sent to Major Edmund’s residence at Quemados the night before his death; she returned to the camp with a mild case. We lost that week Major Peterson, Captain Page, the quartermaster sergeant, one soldier and one civilian employee.”
Mrs. Lena Warne
Walter Reed and Yellow Fever, Kelly, 1906
The suicide of the Major’s wife after he had died in her arms – a scene that Dr. Gorgas had to report and could barely bring himself to describe, only to tersely say that she had been covered in the black vomit, apparently intentionally trying to be infected with yellow fever to die with her husband – shocked everyone. The details of the distressing incident can be found on record, and a “white-faced” Mrs. Gorgas stayed at her husband’s side as he assisted with the double burial and funeral of husband and wife. Returning from attending this double funeral, Captain Page fell ill, then a few days later died of yellow fever.
“This was looked upon by all the community as evidence that the disease had been
contracted by contagion from the Captain’s having attended the funeral.”
William Crawford Gorgas
Sanitation in Panama, Gorgas 1915
It was as there were two universes on one island. Immune Cubans went about the hustle and bustle of their daily lives almost completely unaffected while disease, deaths and morbid despair plagued the expatriate community during those months of August/September/October 1900. Yellow fever seemed relentless, worsening as August segued into September, then as September segued into October.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855;
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
____________________________________________
Mrs. Lena Warne had been a survivor of the 1878 epidemic that had utterly devastated Grenada, Mississippi, who while as a child laying sick and helpless with yellow fever had witnessed her dying father be robbed and beaten by cruel looters had had posed as humanitarian aid workers. She was one of only two in her entire family to survive. Immune for life, Mrs. Warne recalled:
“When our Government called for volunteer nurses to go to Cuba I availed myself of this opportunity. In August 1900, I was ordered from Matanzas to Havana.”
Mrs. Lena Warne
Walter Reed and Yellow Fever, Kelly, 1906
Mrs. Warne had several opportunities to work alongside Dr. Gorgas as the number of cases climbed, most were fellow Americans in the U.S. Army and civilian contract support functions.
“Major Gorgas was very successful in his treatment of the fever and upon my
return to Camp Columbia I determined to imitate his directions.”
Mrs. Lena Warne, Nurse
Walter Reed and Yellow Fever, Kelly, 1906
Her accounts provide more details as to the grim conditions in which the medical staffs assigned to the patients in the quarantine yellow fever wards had to work. Warne witnessed numerous preventable tragedies among American military officers and soldiers who had accepted being posted to Cuba on the mistaken belief that they were immune.
“I recognized Major Cartwright; he said he could not possibly have yellow fever as he certainly had a genuine case in ’98. On the sixth day after his arrival he died of the black vomit. Major Peterson also thought that he’d had the fever, but he was taken ill again with it, and his wife… two hours after his death committed suicide by shooting herself in our quarters at Las Animas… The only nurse with me… was one that claimed to be an immune; she was sent to Major Edmund’s residence at Quemados the night before his death; she returned to the camp with a mild case. We lost that week Major Peterson, Captain Page, the quartermaster sergeant, one soldier and one civilian employee.”
Mrs. Lena Warne
Walter Reed and Yellow Fever, Kelly, 1906
The suicide of the Major’s wife after he had died in her arms – a scene that Dr. Gorgas had to report and could barely bring himself to describe, only to tersely say that she had been covered in the black vomit, apparently intentionally trying to be infected with yellow fever to die with her husband – shocked everyone. The details of the distressing incident can be found on record, and a “white-faced” Mrs. Gorgas stayed at her husband’s side as he assisted with the double burial and funeral of husband and wife. Returning from attending this double funeral, Captain Page fell ill, then a few days later died of yellow fever.
“This was looked upon by all the community as evidence that the disease had been
contracted by contagion from the Captain’s having attended the funeral.”
William Crawford Gorgas
Sanitation in Panama, Gorgas 1915
It was as there were two universes on one island. Immune Cubans went about the hustle and bustle of their daily lives almost completely unaffected while disease, deaths and morbid despair plagued the expatriate community during those months of August/September/October 1900. Yellow fever seemed relentless, worsening as August segued into September, then as September segued into October.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855;
William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953
____________________________________________
In 1900, on the first day of September, an unsuspecting Dr. Gorgas was asked to check on Dr. Carroll who, Gorgas was informed, was suffering from a “slight indisposition.” To Gorgas’s alarm, Dr. Carroll was sinking into a yellow fever delirium.
“The insect had been caused to feed upon four cases of yellow fever…In writing to Dr. Reed on the night after the incident I remarked jokingly that if there was anything to this mosquito theory I should have a good dose. I was taken sick on August 31 and on September 1st, I was carried to the yellow fever camp.
My life was in the balance for three days."
Dr. James Carroll
A Brief Review of the Etiology of Yellow Fever, N.Y. Medical Journal, 1903; Walter Reed and Yellow Fever, Kelly 1906
My life was in the balance for three days."
Dr. James Carroll
A Brief Review of the Etiology of Yellow Fever, N.Y. Medical Journal, 1903; Walter Reed and Yellow Fever, Kelly 1906
“I nursed Dr. Carroll, a member of Major Reed’s staff of Commissioners, and he told me he had experimented upon himself with the mosquito; while he had a severe case he did not have the hemorrhages,
but even to the whites of his eyes he was as yellow as saffron.”
Mrs. Lena Warner
Walter Reed and Yellow Fever, Kelly, 1906
but even to the whites of his eyes he was as yellow as saffron.”
Mrs. Lena Warner
Walter Reed and Yellow Fever, Kelly, 1906
Dr. Carroll sustained heart damage, but by the time he was strong enough to be discharged from the hospital, he was immune for life and his enthusiasm and excitement had reasserted as he had determined that he’d made history:
“I was the first person to whom the mosquito was proved to convey the disease.”
Dr. James Carroll
A Brief Review of the Etiology of Yellow Fever, N.Y. Medical Journal, 1903; Walter Reed and Yellow Fever, Kelly 1906
“I was the first person to whom the mosquito was proved to convey the disease.”
Dr. James Carroll
A Brief Review of the Etiology of Yellow Fever, N.Y. Medical Journal, 1903; Walter Reed and Yellow Fever, Kelly 1906
Near-disaster for the Yellow Fever Board was immediately followed by disaster.
1900, on September 18, a few days after getting Dr. Carroll back on his feet; Dr. Gorgas was urgently summoned to discover a second member of the Reed Commission in the throes of the disease, Dr. Jesse Lazear. Gorgas soon recognized that Lazear was doomed. Dr. Lazear was able to tell Gorgas and Carroll that he'd allowed himself to have been bitten by a mosquito. Harrowingly, Dr. Lazear could diagnose himself that he was manifesting fatal symptoms before he sank into incoherence.
1900, September 25, capable, handsome and well-liked Dr. Jesse Lazear, thirty-four years old, married with two young children, the youngest who he hadn’t yet seen, died of fatal yellow fever. His was the second known mosquito-conveyed case of yellow fever. Dr. Gorgas was the one who had to report it was one of the most horrific yellow fever deaths he’d ever seen in his life.
Dr. Walter Reed, shocked upon hearing the news, returned as quickly as he could to Cuba.
Inexplicably, as they’d discussed all this together as a Board before Reed left for the States, Dr. Carroll and Dr. Lazear seemed to have been caught up by their enthusiasm and had made two mistakes: 1) they hadn’t taken to heart what Quarantine Officer, Dr. Carter’s data had revealed – the interval between primary and secondary cases of yellow fever. They hadn’t fallen sick during their first attempts to be infected by the lab mosquitoes because the laboratory mosquitoes had to be first infected by humans, then the virus needed about 12 days to incubate in the mosquito before it could be passed live to infect them. They had been operating in the exact same zone of no results that had foiled Dr. Finlay’s experiments for twenty years.
2) It’s simple to say that they underestimated the risk, but how did that happen? Even though they were at the cutting edge of discovery, inadvertently, old habits die hard. Mosquito-borne disease wasn’t established enough as a concept in anyone’s mind to have any defensive gut reaction that this fragile little insect, unlike tougher flies or ticks or even bees, destroyed easily with a light brush of the hand, was dangerous.
There’s truth in this – it is a very fragile bug and this mosquito just goes about its business with no sense a tiny foreign organism is taking advantage of it. The danger wasn’t actually the mosquito, but the lurking yellow fever organism, never seen, with four hundred years of a more mythical presence than real.
Dr. Carroll and Dr. Lazear had an intellectual concept – they were thinking conceptually, not of the connection to the brute reality of the stricken people lying on the cots in the yellow fever wards. They were very busy – with lab work, moving almost all the time from wards to towns to barracks interviewing, reporting, constantly pressed by worried Americans every place they went asking if they’d found anything. A little mosquito bite appeared to be nothing; they knew the possibilities intellectually, but it hadn’t been real – not in the way a person instantly recoils from a serpent, fearing the venomous bite.
Deceptively, nothing at all happened from the first efforts, luring Dr. Carroll and Dr. Lazear into a false sense of security. But in only a few days, the safe interval passed, the immature yellow fever organisms had matured and without any noticeable hint that anything had changed, the mosquitoes were loaded with fully-dangerous live yellow fever. Carroll and Lazear were quickly overwhelmed a few days after being bitten, the abstract had become reality, completely proving the hypothesis, but at a terrible cost.
Compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
1900, on September 18, a few days after getting Dr. Carroll back on his feet; Dr. Gorgas was urgently summoned to discover a second member of the Reed Commission in the throes of the disease, Dr. Jesse Lazear. Gorgas soon recognized that Lazear was doomed. Dr. Lazear was able to tell Gorgas and Carroll that he'd allowed himself to have been bitten by a mosquito. Harrowingly, Dr. Lazear could diagnose himself that he was manifesting fatal symptoms before he sank into incoherence.
1900, September 25, capable, handsome and well-liked Dr. Jesse Lazear, thirty-four years old, married with two young children, the youngest who he hadn’t yet seen, died of fatal yellow fever. His was the second known mosquito-conveyed case of yellow fever. Dr. Gorgas was the one who had to report it was one of the most horrific yellow fever deaths he’d ever seen in his life.
Dr. Walter Reed, shocked upon hearing the news, returned as quickly as he could to Cuba.
Inexplicably, as they’d discussed all this together as a Board before Reed left for the States, Dr. Carroll and Dr. Lazear seemed to have been caught up by their enthusiasm and had made two mistakes: 1) they hadn’t taken to heart what Quarantine Officer, Dr. Carter’s data had revealed – the interval between primary and secondary cases of yellow fever. They hadn’t fallen sick during their first attempts to be infected by the lab mosquitoes because the laboratory mosquitoes had to be first infected by humans, then the virus needed about 12 days to incubate in the mosquito before it could be passed live to infect them. They had been operating in the exact same zone of no results that had foiled Dr. Finlay’s experiments for twenty years.
2) It’s simple to say that they underestimated the risk, but how did that happen? Even though they were at the cutting edge of discovery, inadvertently, old habits die hard. Mosquito-borne disease wasn’t established enough as a concept in anyone’s mind to have any defensive gut reaction that this fragile little insect, unlike tougher flies or ticks or even bees, destroyed easily with a light brush of the hand, was dangerous.
There’s truth in this – it is a very fragile bug and this mosquito just goes about its business with no sense a tiny foreign organism is taking advantage of it. The danger wasn’t actually the mosquito, but the lurking yellow fever organism, never seen, with four hundred years of a more mythical presence than real.
Dr. Carroll and Dr. Lazear had an intellectual concept – they were thinking conceptually, not of the connection to the brute reality of the stricken people lying on the cots in the yellow fever wards. They were very busy – with lab work, moving almost all the time from wards to towns to barracks interviewing, reporting, constantly pressed by worried Americans every place they went asking if they’d found anything. A little mosquito bite appeared to be nothing; they knew the possibilities intellectually, but it hadn’t been real – not in the way a person instantly recoils from a serpent, fearing the venomous bite.
Deceptively, nothing at all happened from the first efforts, luring Dr. Carroll and Dr. Lazear into a false sense of security. But in only a few days, the safe interval passed, the immature yellow fever organisms had matured and without any noticeable hint that anything had changed, the mosquitoes were loaded with fully-dangerous live yellow fever. Carroll and Lazear were quickly overwhelmed a few days after being bitten, the abstract had become reality, completely proving the hypothesis, but at a terrible cost.
Compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
~ OCTOBER 1900 ~
In 1900 during October, going into the worst month for yellow fever of every year, with one board member dead and the other still recovering, Dr. Walter Reed sat the Board down – Carroll, Agramonte and himself and explained how they were going to proceed. Reed personally didn’t need any more proof of the Hypothesis of Mosquito Conveyance to know it was correct than the dreadful experience of his own Board colleagues, but there was a lot to prove to the medical community and subjecting Board members to the plague was not the way to go about it.
Both Carroll and Lazear’s mosquito-induced infections could be used anecdotally, but not clinically as in both cases, skeptical outside researchers could argue that both situations were not in controlled environments. During the period in question, both Carroll and Lazear had visited other barracks, towns and camps; they could have been infected by a contagion somewhere besides the yellow fever ward.
They were going to need an isolated fully-controlled experimental station; plus a steady stock of live mosquitoes that were individually identified and validated as infected or not infected; and human volunteers.
Dr. Lazear had left copious notes full of information along with the mosquitoes he’d hatched out in his lab, each carefully identified – when they had been hatched out, which were uninfected, which had been infected, on which days and by whom. These would be the base of mosquitoes for the experiments.
The moral and ethical issues of asking for volunteers were debated before the Board decided to move forward with it. They did not know of any animal cases of yellow fever, so all experiments had to be done with humans. They hesitated to ask anyone to submit themselves to being infected with yellow fever after what had happened to Carroll and Lazear.
But, the circumstances of yellow fever in Cuba eased their concerns. Cubans, by and large in and around Havana were immune; they couldn’t be volunteers. The longer a person had stayed in Cuba, the more likely he or she would have sustained an attack of yellow fever, thus making them immune and not suitable for the experiments. It would be better experimentally to only accept volunteers who had never been in any endemic yellow zone, which meant new arrivals from only non-endemic yellow fever geographical areas.
They had at hand two distinct potential pools of volunteers. The non-immunes were Spanish immigrants and American soldiers. Among the Spanish non-immunes, there was a certain highly practical and fatalistic attitude that - calculating the odds - the majority of people were surviving yellow fever in Cuba. Therefore, the sooner one got sick with yellow fever, the sooner it would be over and most likely successfully. One would then receive a certificate of immunity from the doctor. Workers with yellow fever immunity certificates were in demand and were paid higher wages, not just in Cuba, but in many places in Central and South America such as the Panama Canal project.
In 1900 during October, going into the worst month for yellow fever of every year, with one board member dead and the other still recovering, Dr. Walter Reed sat the Board down – Carroll, Agramonte and himself and explained how they were going to proceed. Reed personally didn’t need any more proof of the Hypothesis of Mosquito Conveyance to know it was correct than the dreadful experience of his own Board colleagues, but there was a lot to prove to the medical community and subjecting Board members to the plague was not the way to go about it.
Both Carroll and Lazear’s mosquito-induced infections could be used anecdotally, but not clinically as in both cases, skeptical outside researchers could argue that both situations were not in controlled environments. During the period in question, both Carroll and Lazear had visited other barracks, towns and camps; they could have been infected by a contagion somewhere besides the yellow fever ward.
They were going to need an isolated fully-controlled experimental station; plus a steady stock of live mosquitoes that were individually identified and validated as infected or not infected; and human volunteers.
Dr. Lazear had left copious notes full of information along with the mosquitoes he’d hatched out in his lab, each carefully identified – when they had been hatched out, which were uninfected, which had been infected, on which days and by whom. These would be the base of mosquitoes for the experiments.
The moral and ethical issues of asking for volunteers were debated before the Board decided to move forward with it. They did not know of any animal cases of yellow fever, so all experiments had to be done with humans. They hesitated to ask anyone to submit themselves to being infected with yellow fever after what had happened to Carroll and Lazear.
But, the circumstances of yellow fever in Cuba eased their concerns. Cubans, by and large in and around Havana were immune; they couldn’t be volunteers. The longer a person had stayed in Cuba, the more likely he or she would have sustained an attack of yellow fever, thus making them immune and not suitable for the experiments. It would be better experimentally to only accept volunteers who had never been in any endemic yellow zone, which meant new arrivals from only non-endemic yellow fever geographical areas.
They had at hand two distinct potential pools of volunteers. The non-immunes were Spanish immigrants and American soldiers. Among the Spanish non-immunes, there was a certain highly practical and fatalistic attitude that - calculating the odds - the majority of people were surviving yellow fever in Cuba. Therefore, the sooner one got sick with yellow fever, the sooner it would be over and most likely successfully. One would then receive a certificate of immunity from the doctor. Workers with yellow fever immunity certificates were in demand and were paid higher wages, not just in Cuba, but in many places in Central and South America such as the Panama Canal project.
The Reed Yellow Fever Commission posted its offer:
Any volunteer had to be a recently-arrived non-immune;
They would have to sign a contract that they understood what they were agreeing to;
Any volunteers who actually contracted yellow fever as a result of the experiments would have the best medical care in all of Cuba, greatly enhancing survival odds;
They would receive their yellow fever immunity certificate;
Payment would be $250 for their efforts.
Within a few days, the Board had so many Spanish applicant volunteers that they had to turn many away. If one had arrived in Cuba fully expecting to fall sick with yellow fever regardless, there was absolutely no sense in passing up an opportunity to be very well-paid for the ordeal.
Bizarrely, the lines of Spanish volunteer applicants suddenly began to evaporate.
"But Dr. Reed's work was now brought to a standstill. He found that all his Spaniards were
deserting and he could get no more for love or money to come to the camp."
William Crawford Gorgas
Sanitation in Panama, 1915
American troops had initially been completely uninterested in the appeal for volunteers, and scoffed at the pay for such a risk, but after seeing the long lines of Spaniards eager to sign up, a number of U.S. soldiers began doing the same arithmetic the Spaniards had done. Just like the Spaniards, it was only a matter of time before any American soldier would fall ill with yellow fever, and being immune with a valid certificate had its monetary benefits even in the U.S. Army.
If one was going to be sick with yellow fever, why not be pampered at the best hospital ward in the entire Caribbean instead of any average dingy yellow fever quarantine ward, and $250 was excellent pay for only two or three weeks work. The problem was the American soldiers were late to the game, last in line after after the Spaniards.
The solution then was simple: get rid of the competition.
Spaniards walking to sign up for the yellow fever experiments were casually coaxed to notice a new large stack of bones that had accumulated by a kiln near the Reed Yellow Fever Board headquarters. The whispered rumor passed quickly that these were the remains of previous volunteers of Dr. Reed’s experiments.
After reflection, an exasperated Dr. Reed decided it wasn’t worth complaining. The vanishing Spaniards were being replaced by American soldiers, so once the applicants had been interviewed and selected for suitability as scheduled, the experiments could start.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson,
1950.
Any volunteer had to be a recently-arrived non-immune;
They would have to sign a contract that they understood what they were agreeing to;
Any volunteers who actually contracted yellow fever as a result of the experiments would have the best medical care in all of Cuba, greatly enhancing survival odds;
They would receive their yellow fever immunity certificate;
Payment would be $250 for their efforts.
Within a few days, the Board had so many Spanish applicant volunteers that they had to turn many away. If one had arrived in Cuba fully expecting to fall sick with yellow fever regardless, there was absolutely no sense in passing up an opportunity to be very well-paid for the ordeal.
Bizarrely, the lines of Spanish volunteer applicants suddenly began to evaporate.
"But Dr. Reed's work was now brought to a standstill. He found that all his Spaniards were
deserting and he could get no more for love or money to come to the camp."
William Crawford Gorgas
Sanitation in Panama, 1915
American troops had initially been completely uninterested in the appeal for volunteers, and scoffed at the pay for such a risk, but after seeing the long lines of Spaniards eager to sign up, a number of U.S. soldiers began doing the same arithmetic the Spaniards had done. Just like the Spaniards, it was only a matter of time before any American soldier would fall ill with yellow fever, and being immune with a valid certificate had its monetary benefits even in the U.S. Army.
If one was going to be sick with yellow fever, why not be pampered at the best hospital ward in the entire Caribbean instead of any average dingy yellow fever quarantine ward, and $250 was excellent pay for only two or three weeks work. The problem was the American soldiers were late to the game, last in line after after the Spaniards.
The solution then was simple: get rid of the competition.
Spaniards walking to sign up for the yellow fever experiments were casually coaxed to notice a new large stack of bones that had accumulated by a kiln near the Reed Yellow Fever Board headquarters. The whispered rumor passed quickly that these were the remains of previous volunteers of Dr. Reed’s experiments.
After reflection, an exasperated Dr. Reed decided it wasn’t worth complaining. The vanishing Spaniards were being replaced by American soldiers, so once the applicants had been interviewed and selected for suitability as scheduled, the experiments could start.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson,
1950.
The experimental station was quite straightforward to create. It required an open piece of land outside the city, yet close enough to be convenient to town and medical facilities, several specially-designed structures and around-the-clock guards, which the Army had plenty of to provide security to completely control arrivals and departures. Board member Dr. Aristides Agramonte found and arranged for a suitable site near Quemados; Drs. Reed, Carroll and Agramonte named it Camp Lazear.
1900 by mid-November, Camp Lazear was ready for experiments. The volunteers had been selected and quarantined to be sure they had no chance to be exposed by any filth, fomites or stegomyia mosquitoes before beginning the trials. There would be two distinct experimental projects – one to test the Finlay hypothesis that Stegomyia mosquitoes transmitted yellow fever, and the other to test the filth and fomite hypothesis.
Two separate buildings set isolated from each other on the open field had the exact same size and construction, but inside they were designed quite differently. One was the 'Infected Mosquito Building' which was purposely airy yet tightly screened and the other, purposely stuffy with very poor ventilation. It was called the 'Infected Clothing Building.'
Two young Americans, both hailing from the state of Ohio, John J. Moran and John R. Kissinger, volunteered to be infected – and to Reed’s and the Commission’s - Carroll and Agramonte - astonishment – the two young men both refused payment. They explained that it would be their personal contribution to what they genuinely felt was for the advancement of science and betterment of humanity.
“I salute you.”
Dr. Walter Reed, November 1900
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
©2023
1900 by mid-November, Camp Lazear was ready for experiments. The volunteers had been selected and quarantined to be sure they had no chance to be exposed by any filth, fomites or stegomyia mosquitoes before beginning the trials. There would be two distinct experimental projects – one to test the Finlay hypothesis that Stegomyia mosquitoes transmitted yellow fever, and the other to test the filth and fomite hypothesis.
Two separate buildings set isolated from each other on the open field had the exact same size and construction, but inside they were designed quite differently. One was the 'Infected Mosquito Building' which was purposely airy yet tightly screened and the other, purposely stuffy with very poor ventilation. It was called the 'Infected Clothing Building.'
Two young Americans, both hailing from the state of Ohio, John J. Moran and John R. Kissinger, volunteered to be infected – and to Reed’s and the Commission’s - Carroll and Agramonte - astonishment – the two young men both refused payment. They explained that it would be their personal contribution to what they genuinely felt was for the advancement of science and betterment of humanity.
“I salute you.”
Dr. Walter Reed, November 1900
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
©2023
1900 on December 5th in completely-controlled experimental conditions and after being in quarantine prior to this; U.S. Army Private John R. Kissinger entered the Infected Mosquito Building. Inside, there were two rooms separated by screening, with tightly-screened windows. Two volunteers occupied one side. They all breathed the same air and enjoyed good ventilation, but in only one side of the screening were Stegomyia mosquitoes released. Those volunteers were the 'controls.' Kissinger entered on the other side of the screening and was deliberately allowed to be bitten by yellow-fever-infected Stegomyia mosquitoes released on that side.
1900 on December 8th, Kissinger began manifesting fever symptoms and was soon confirmed as having yellow fever while the control volunteers stayed healthy.
1900, on December 25th just before noon on Christmas Day, four days after being deliberately bitten by yellow fever-infected Stegomyia mosquitoes, the recovering Kissinger's fellow Buckeye State Ohioan, John J. Moran, developed a fever, then 'had a sharp attack which he bore without a murmur."
1900 on December 8th, Kissinger began manifesting fever symptoms and was soon confirmed as having yellow fever while the control volunteers stayed healthy.
1900, on December 25th just before noon on Christmas Day, four days after being deliberately bitten by yellow fever-infected Stegomyia mosquitoes, the recovering Kissinger's fellow Buckeye State Ohioan, John J. Moran, developed a fever, then 'had a sharp attack which he bore without a murmur."
"Tomorrow afternoon we will have the Havana Board of Experts, Drs. Guiteras, Albertini and Finlay come out and diagnose the case. I shan't tell them how the infection was acquired until after they have satisfied themselves concerning the character of the case, then I will let them know.
I suppose that old Dr. Finlay will be delighted beyond bounds as he will see his theory at last fully vindicated."
~ Walter Reed ~
Columbia Barracks, Quemados, Cuba, December 9, 1900
I suppose that old Dr. Finlay will be delighted beyond bounds as he will see his theory at last fully vindicated."
~ Walter Reed ~
Columbia Barracks, Quemados, Cuba, December 9, 1900
The Infected Clothing Building
The fall of fomites
The fall of fomites
There were a lot of medical professionals in 1900 who were not at all ready to give up the hypothesis of fomites and filth. Walter Reed and James Carroll with their bacteriology experience and with Reed’s investigations in controlling typhoid in military camps had a very good idea how to test this. If fomites and filth conveyed yellow fever, then it should be very easy to prove.
The Infected Clothing Building, set a good distance from the Infected Mosquito Building also in a clear area, had been built to be stuffy with very poor ventilation – expressly to keep inside any fomites and contagious filth matter. It was also tightly screened to keep any and all mosquitoes out.
Three American volunteers, Dr. Robert Cooke, Acting Assistant Surgeon of the U.S. Army and Hospital Corps Private Folk and Private Jernigan had a simple job: spend three weeks sleeping inside the Infected Clothing Building on the most horrifyingly contaminated and filthy bedding and clothing in the world: straight from the yellow fever wards, the soiled linens and clothing from fatal cases of yellow fever, absolutely soaked through by the ‘black vomit.’
The first minutes started well for the three volunteers who had been quarantined prior to entering the building; it was brand new and had been thoroughly scrubbed and sterilized. This didn’t seem too terrible. Boxes full of clothing and sheets were carried in. The volunteers’ instructions were to wear the clothes out of the boxes and to sleep on the pillows and sheets.
Upon opening the boxes, the men had to flee the building, vomiting violently from the stench. But they recovered their determination, their noses calmed down and they re-entered and closed the doors to do what they’d been tasked to do. They were wearing completely contaminated clothing and the stuffy environment inside the building guaranteed they would be inhaling fomite contamination in with every breath – if there were any fomites. In case any researcher might complain that maybe the objects had been too old, new batches of vile materials from the yellow fever wards at the hospitals were supplied, to keep it all ‘fresh.’
It was so unhealthy; the three men were allowed to spend part of the daylight hours outside in fresh air. It was horribly uncomfortable and almost impossible for them to sleep, especially the first few nights for them, because if yellow fever could be conveyed by fomites and filth, they were doomed.
Yet, after a few days of this, Cooke, Folk and Jernigan themselves were surprised that they were still healthy. Better, as they marked the days they’d agreed to do this off the calendar, they were following the progress of their counterparts going into the Infected Mosquito Building and discovered they were staying healthy while the volunteers going into the Infected Mosquito Building even for short periods, were consistently falling sick with yellow fever.
1900 on December 19, the first three fomites volunteers had completed their experimental period spending every night closed inside the stuffy Infected Clothing Building without falling sick with yellow fever. Over three teams in all participated. None of them contracted yellow fever.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
The Infected Clothing Building, set a good distance from the Infected Mosquito Building also in a clear area, had been built to be stuffy with very poor ventilation – expressly to keep inside any fomites and contagious filth matter. It was also tightly screened to keep any and all mosquitoes out.
Three American volunteers, Dr. Robert Cooke, Acting Assistant Surgeon of the U.S. Army and Hospital Corps Private Folk and Private Jernigan had a simple job: spend three weeks sleeping inside the Infected Clothing Building on the most horrifyingly contaminated and filthy bedding and clothing in the world: straight from the yellow fever wards, the soiled linens and clothing from fatal cases of yellow fever, absolutely soaked through by the ‘black vomit.’
The first minutes started well for the three volunteers who had been quarantined prior to entering the building; it was brand new and had been thoroughly scrubbed and sterilized. This didn’t seem too terrible. Boxes full of clothing and sheets were carried in. The volunteers’ instructions were to wear the clothes out of the boxes and to sleep on the pillows and sheets.
Upon opening the boxes, the men had to flee the building, vomiting violently from the stench. But they recovered their determination, their noses calmed down and they re-entered and closed the doors to do what they’d been tasked to do. They were wearing completely contaminated clothing and the stuffy environment inside the building guaranteed they would be inhaling fomite contamination in with every breath – if there were any fomites. In case any researcher might complain that maybe the objects had been too old, new batches of vile materials from the yellow fever wards at the hospitals were supplied, to keep it all ‘fresh.’
It was so unhealthy; the three men were allowed to spend part of the daylight hours outside in fresh air. It was horribly uncomfortable and almost impossible for them to sleep, especially the first few nights for them, because if yellow fever could be conveyed by fomites and filth, they were doomed.
Yet, after a few days of this, Cooke, Folk and Jernigan themselves were surprised that they were still healthy. Better, as they marked the days they’d agreed to do this off the calendar, they were following the progress of their counterparts going into the Infected Mosquito Building and discovered they were staying healthy while the volunteers going into the Infected Mosquito Building even for short periods, were consistently falling sick with yellow fever.
1900 on December 19, the first three fomites volunteers had completed their experimental period spending every night closed inside the stuffy Infected Clothing Building without falling sick with yellow fever. Over three teams in all participated. None of them contracted yellow fever.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950.
“The three young Americans who had consented to jeopardize their lives by exposure to fomites, with the occurrence of these cases of mosquito infection,
from this time their contempt for ‘fomites’ could not find sufficient expression.”
Walter Reed
Columbia Barracks, Quemados, Cuba, December, 1900; Walter Reed and Yellow Fever, Kelly, 1906
from this time their contempt for ‘fomites’ could not find sufficient expression.”
Walter Reed
Columbia Barracks, Quemados, Cuba, December, 1900; Walter Reed and Yellow Fever, Kelly, 1906
"A little careful testing of this theory has knocked it to smithereens... I thank God that I didn't accept anyone's opinion on this subject but determined to put it to a thorough test with human beings to see what would happen."
Walter Reed
December 1900, Cuba; Walter Reed and Yellow Fever, Kelly, 1906
Walter Reed
December 1900, Cuba; Walter Reed and Yellow Fever, Kelly, 1906
1900 by the last day, December 31, even though the trials hadn't finished, with the American and Spanish volunteers who'd stayed with them, it had become obvious that the Reed Yellow Fever Commission had shown its ability to consistently produce yellow fever infections almost like clockwork from the Infected Mosquito Building, while at the same time consistently exiting completely healthy men from the Infected Clothing Building.
The proof of the high diligence of the Reed yellow fever experiments was that despite the many deliberate infections of yellow fever, either by mosquito or direct laboratory injection, there was not one single yellow fever fatality among those volunteers who manifested the disease.
The proof of the high diligence of the Reed yellow fever experiments was that despite the many deliberate infections of yellow fever, either by mosquito or direct laboratory injection, there was not one single yellow fever fatality among those volunteers who manifested the disease.
"COLUMBIA BARRACKS, QUEMADOS, CUBA 11:50 P.M. Dec. 31, 1900"
"Only ten minutes of the old century remain. Here I have been sitting, reading that most wonderful book, "La Roche on Yellow Fever." Forty seven years later it has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most wonderful, dreadful pest of humanity and to put it on a rational and scientific basis. I thank God that it has been accomplished during the latter days of the old century. May its cure be wrought out in the early days of the new! The prayer that has been mine for twenty years, that I might be permitted in some way or at some time to alleviate human suffering has been granted!
A thousand Happy New Years.
Hark, there go the twenty-four buglers in concert, all sounding 'Taps' for the old year."
Major Doctor Walter Reed, U.S. Army Medical Corps
Walter Reed and Yellow Fever, 1906, Howard Kelly
"Only ten minutes of the old century remain. Here I have been sitting, reading that most wonderful book, "La Roche on Yellow Fever." Forty seven years later it has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most wonderful, dreadful pest of humanity and to put it on a rational and scientific basis. I thank God that it has been accomplished during the latter days of the old century. May its cure be wrought out in the early days of the new! The prayer that has been mine for twenty years, that I might be permitted in some way or at some time to alleviate human suffering has been granted!
A thousand Happy New Years.
Hark, there go the twenty-four buglers in concert, all sounding 'Taps' for the old year."
Major Doctor Walter Reed, U.S. Army Medical Corps
Walter Reed and Yellow Fever, 1906, Howard Kelly
The Defeat of Mosquito-Borne Yellow Fever 1901
A New Century
FROM EXPERIMENTAL PROOF TO PRACTICAL APPLICATION
A New Century
FROM EXPERIMENTAL PROOF TO PRACTICAL APPLICATION
1901 January: The old century had closed on December 31, 1900 with a victory for science and knowledge. The United States Army Reed Yellow Fever Board had decisively solved the mystery of the conveyance of yellow fever.
1901 January was in keeping with the traditional low season for yellow fever in Cuba, a handful of cases and mortality reduced to almost zero in the fresh, cooler weather, mercifully for Major Dr. William Crawford Gorgas and the U.S. Army Medical Corps of doctors and nurses who had toughed through the grueling months of the August-September-October peak. 1900 had finally closed, arguably one of the hardest years of William Gorgas’s medical and Army career.
In 1901 during early February, Major Dr. Walter Reed, Chairman of the United States Army Yellow Fever Commission presented a summary of the Commission’s proof validating Dr. Carlos Finlay’s long-waiting, 1881 The Mosquito Hypothetically Considered as the Agent of Yellow Fever, experimentally elevating its proven reliability from Hypothesis, to solid scientific Theory, to the Pan American Medical Congress that was meeting in Havana.
1901 January was in keeping with the traditional low season for yellow fever in Cuba, a handful of cases and mortality reduced to almost zero in the fresh, cooler weather, mercifully for Major Dr. William Crawford Gorgas and the U.S. Army Medical Corps of doctors and nurses who had toughed through the grueling months of the August-September-October peak. 1900 had finally closed, arguably one of the hardest years of William Gorgas’s medical and Army career.
In 1901 during early February, Major Dr. Walter Reed, Chairman of the United States Army Yellow Fever Commission presented a summary of the Commission’s proof validating Dr. Carlos Finlay’s long-waiting, 1881 The Mosquito Hypothetically Considered as the Agent of Yellow Fever, experimentally elevating its proven reliability from Hypothesis, to solid scientific Theory, to the Pan American Medical Congress that was meeting in Havana.
Dr. Walter Reed’s presentation of the United States Army’s Yellow Fever Commission’s findings to the Pan American Medical Congress, 1901
1) The mosquito, C. fasciatus, serves as the intermediate host for yellow fever.
2) Yellow fever is transmitted to the non-immune individual by the means of the bite of the mosquito that has previously fed on the blood of those sick with the disease.
3) An interval of about twelve days or more after the contamination appears to be necessary before the mosquito is capable of conveying the disease.
4) The bite of the mosquito at an earlier period after contamination does not appear to confer any immunity against a subsequent attack.
5) Yellow fever can also be experimentally produced by subcutaneous injection of blood taken from the general circulation during the first and second days of this disease.
6) An attack of yellow fever, produced by the bite of the mosquito, confers immunity against the subsequent injection of the blood of an individual suffering from the non-experimental form of the disease.
7) The period of incubation in thirteen cases of experimental fever has varied from forty-one hours to five days and seventeen hours.
8) Yellow fever is not conveyed by fomites, and hence disinfection of articles of clothing, bedding or merchandise, supposedly contaminated by contact with those sick with this disease, is unnecessary.
9) A house may be said to be infected with yellow fever only when there are present within its walls contaminated mosquitoes capable of conveying the parasite of this disease.
10) The spread of yellow fever can be most effectually controlled by measures directed to the destruction of the mosquitoes and the protection of the sick against the bites of those insects.
11) While the mode of propagation of yellow fever has been definitely determined, the specific cause of this disease remains to be discovered."
It was a fitting place there in Havana and a perfect occasion to announce this. Reed’s presentation was extremely well-received by an audience with many attending who knew and liked Dr. Finlay, but hadn’t given Finlay’s 1881 Mosquito Hypothesis any credence for the preceding two decades, but the proof Reed provided was definitive.
1) The mosquito, C. fasciatus, serves as the intermediate host for yellow fever.
2) Yellow fever is transmitted to the non-immune individual by the means of the bite of the mosquito that has previously fed on the blood of those sick with the disease.
3) An interval of about twelve days or more after the contamination appears to be necessary before the mosquito is capable of conveying the disease.
4) The bite of the mosquito at an earlier period after contamination does not appear to confer any immunity against a subsequent attack.
5) Yellow fever can also be experimentally produced by subcutaneous injection of blood taken from the general circulation during the first and second days of this disease.
6) An attack of yellow fever, produced by the bite of the mosquito, confers immunity against the subsequent injection of the blood of an individual suffering from the non-experimental form of the disease.
7) The period of incubation in thirteen cases of experimental fever has varied from forty-one hours to five days and seventeen hours.
8) Yellow fever is not conveyed by fomites, and hence disinfection of articles of clothing, bedding or merchandise, supposedly contaminated by contact with those sick with this disease, is unnecessary.
9) A house may be said to be infected with yellow fever only when there are present within its walls contaminated mosquitoes capable of conveying the parasite of this disease.
10) The spread of yellow fever can be most effectually controlled by measures directed to the destruction of the mosquitoes and the protection of the sick against the bites of those insects.
11) While the mode of propagation of yellow fever has been definitely determined, the specific cause of this disease remains to be discovered."
It was a fitting place there in Havana and a perfect occasion to announce this. Reed’s presentation was extremely well-received by an audience with many attending who knew and liked Dr. Finlay, but hadn’t given Finlay’s 1881 Mosquito Hypothesis any credence for the preceding two decades, but the proof Reed provided was definitive.
To-day the paper was read and met with a most favorable reception. The attention during the reading was all that I could have asked for and the applause at its conclusion was long and hearty. A resolution expressive of the high appreciation in which our work was held, together with the thanks of the Congress, was unanimously adopted. I received dozens of the warmest handshakes from Cuban, Spanish, Mexican, South American and North American physicians, men whom I had not even met. The hall was crowded and even the doors were packed with listeners.
It was indeed a signal triumph for our work.”
Walter Reed, in a letter to his wife from Columbia Barracks, Quemados, Cuba, 6 February 1901
Walter Reed and Yellow Fever, Kelly 1906
It was indeed a signal triumph for our work.”
Walter Reed, in a letter to his wife from Columbia Barracks, Quemados, Cuba, 6 February 1901
Walter Reed and Yellow Fever, Kelly 1906
These were all medical people who constantly had to deal with endemic yellow fever in their home countries. They knew yellow fever intimately, so Reed’s Yellow Fever Commission’s findings made all the puzzle pieces fall into place. Dr. Finlay’s professional stock immediately rose from lovable, capable, yet slightly eccentric doctor to visionary national hero.
There was the problem for the new century of 1901: even though they had detailed everything in the transmission, incubation periods, infectious periods of yellow fever, not one of the Army Yellow Fever Board members - Reed, Carroll or Agramonte had the slightest clue as to how to stop mosquito-borne yellow fever. No one in the Pan American Medical Congress had a clue as to what to do. The mosquitoes – those were everywhere.
There was the problem for the new century of 1901: even though they had detailed everything in the transmission, incubation periods, infectious periods of yellow fever, not one of the Army Yellow Fever Board members - Reed, Carroll or Agramonte had the slightest clue as to how to stop mosquito-borne yellow fever. No one in the Pan American Medical Congress had a clue as to what to do. The mosquitoes – those were everywhere.
As Walter Reed wrapped up his Cuba-based Yellow Fever Commission work and packed his bags to leave Cuba to present the Commission’s results to the Army and to the world, Reed worried that they’d only made life worse – everyone seized with fright every time a mosquito landed on an arm – with no feasible way to deal with it. The practical problem almost seemed worse than before – it seemed simpler to clean a street of fomites and filth than to clean it of mosquitoes.
The Havana winter wouldn’t be cool enough to qualify as winter in the United States, it was just enough to coolness to slow down the local mosquito activity. This would very soon end and the 1901 yellow fever season would inexorably begin… a handful of cases in February, March, few more in April, May and then begin mounting in June and July, to unleash its worst destruction from August through October.
So many known odd characteristics of yellow fever had become glaringly obvious: why low peak yellow fever season was always paired with low mosquito season, and visa-versa. That it was easier for the port of Havana to ship yellow fever to New Orleans or even Quebec than to Quemados, a mile away, simply because Stegomyia mosquitoes found it easier to flit into ships tied for loading at the crowded piers than to struggle exposed across a large, dry open field. Drier and cooler did not favor Stegomyia mosquitoes, but warmer and wetter did because they absolutely needed standing water for their larvae.
The Havana winter wouldn’t be cool enough to qualify as winter in the United States, it was just enough to coolness to slow down the local mosquito activity. This would very soon end and the 1901 yellow fever season would inexorably begin… a handful of cases in February, March, few more in April, May and then begin mounting in June and July, to unleash its worst destruction from August through October.
So many known odd characteristics of yellow fever had become glaringly obvious: why low peak yellow fever season was always paired with low mosquito season, and visa-versa. That it was easier for the port of Havana to ship yellow fever to New Orleans or even Quebec than to Quemados, a mile away, simply because Stegomyia mosquitoes found it easier to flit into ships tied for loading at the crowded piers than to struggle exposed across a large, dry open field. Drier and cooler did not favor Stegomyia mosquitoes, but warmer and wetter did because they absolutely needed standing water for their larvae.
Major Dr. Walter Reed of the United States Army Medical Corps had achieved what he could do in the fight against yellow fever. He and his commission had unlocked its secret of transmission. It was time for someone else to take it to the practical application... ironically, one of the last of Dr. Walter Reed's medical peers in Cuba to be convinced of the validity of medical colleague Dr. Carlos Finlay's "Mosquito Theory."
"Indeed, we all knew Dr. Finlay well, but were rather inclined to make light of his ideas,
and none more so than I."
Dr. William Crawford Gorgas
Sanitation in Panama, Gorgas, 1915
"Indeed, we all knew Dr. Finlay well, but were rather inclined to make light of his ideas,
and none more so than I."
Dr. William Crawford Gorgas
Sanitation in Panama, Gorgas, 1915
1901 February, Havana, Cuba
One of the most skeptical of all the doctors in Havana regarding Dr. Finlay’s Hypothesis of Mosquito Conveyance of Yellow Fever was about to become the most effective yellow fever and malaria destroyer in all human history.
One of the most skeptical of all the doctors in Havana regarding Dr. Finlay’s Hypothesis of Mosquito Conveyance of Yellow Fever was about to become the most effective yellow fever and malaria destroyer in all human history.
1901 February. Was there any man on the planet in 1901 who was as motivated as Dr. William Crawford Gorgas was to right the one huge, inadvertent wrong of his entire career? He had succeeded in ridding Havana of all sorts of filth-spreading contagions. Typhoid, cholera, dysentery had almost vanished. Havana had been turned into one of the most pleasant and healthiest cities in the entire Americas.
But none of it had worked against yellow fever because the accepted science hadn’t been science but elaborate protocols based on no more than a superstition. It was time to rid Havana of the Stegomyia mosquito… something no one had ever imagined to do, much less actually attempt it.
Chief Sanitation Officer U.S. Army Major Dr. Gorgas called in the experts, the first time ever entomologists were mobilized for war. Dr. Gorgas sat down with Dr. Finlay, no more to debate, but to pick his brain. What did they all know about Stegomyia and how could this be used against it?
But none of it had worked against yellow fever because the accepted science hadn’t been science but elaborate protocols based on no more than a superstition. It was time to rid Havana of the Stegomyia mosquito… something no one had ever imagined to do, much less actually attempt it.
Chief Sanitation Officer U.S. Army Major Dr. Gorgas called in the experts, the first time ever entomologists were mobilized for war. Dr. Gorgas sat down with Dr. Finlay, no more to debate, but to pick his brain. What did they all know about Stegomyia and how could this be used against it?
Key Characteristics of the Stegomyia (Aedes aegypti) Mosquito Species:
(From Dr. Carlos Finlay’s Observations)
Altitude sensitive, never found in higher altitudes
Cold sensitive – becomes sluggish and stops biting as temperatures drop
Poor roaming
Weak flyer
Stays in sheltered areas close to people, inside houses, gardens
Prefers sheltered pockets of water for its larvae
Larvae require about seven days - a week before going into a pupae stage and then emerging as flying adults
Mosquito and larvae are fragile
The eggs are very hardy, surviving prolonged dry and freezing temperatures
Only the females bite, for a blood meal required to produce eggs
The adult females can survive inside human-occupied sheltered buildings and residences over three months
A Stegomyia (Aedes aegypti) mosquito is infected when it bites an infected person, after this it is infected for life
In 1901 Cuba's February’s typical warmer weather with a rise in mosquito populations was converging with boatloads of new arrivals of Spaniards looking for work, plus fresh U.S. troops. Yellow fever cases one-by-one, two-by-two began to collect at the hospitals. But with the monthly case records for 1900 and years prior in hand, and a new, never–before-seen plan of attack, Dr. Gorgas sent out his troops.
The Havana citizens who had grumbled under Gorgas’s strict 1899 and 1900 sanitation requirements were about to be re-visited by even more intrusive absurdities – Gorgas’s re-designed sanitation teams hunting precisely one species of mosquito inside and outside their homes.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950. Sanitation in Panama, Gorgas, 1915
(From Dr. Carlos Finlay’s Observations)
Altitude sensitive, never found in higher altitudes
Cold sensitive – becomes sluggish and stops biting as temperatures drop
Poor roaming
Weak flyer
Stays in sheltered areas close to people, inside houses, gardens
Prefers sheltered pockets of water for its larvae
Larvae require about seven days - a week before going into a pupae stage and then emerging as flying adults
Mosquito and larvae are fragile
The eggs are very hardy, surviving prolonged dry and freezing temperatures
Only the females bite, for a blood meal required to produce eggs
The adult females can survive inside human-occupied sheltered buildings and residences over three months
A Stegomyia (Aedes aegypti) mosquito is infected when it bites an infected person, after this it is infected for life
In 1901 Cuba's February’s typical warmer weather with a rise in mosquito populations was converging with boatloads of new arrivals of Spaniards looking for work, plus fresh U.S. troops. Yellow fever cases one-by-one, two-by-two began to collect at the hospitals. But with the monthly case records for 1900 and years prior in hand, and a new, never–before-seen plan of attack, Dr. Gorgas sent out his troops.
The Havana citizens who had grumbled under Gorgas’s strict 1899 and 1900 sanitation requirements were about to be re-visited by even more intrusive absurdities – Gorgas’s re-designed sanitation teams hunting precisely one species of mosquito inside and outside their homes.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; Yellow Fever, R. La Roche, 1855; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950. Sanitation in Panama, Gorgas, 1915
1901 February. True to Gorgas’s trademark comprehensive way of going about his work, the initial assault had several aspects:
Mosquito barriers:
Screening buildings and residences to block Stegomyia mosquito entry
Framing or papering any open gaps in walls and doors
Controlling the spread during patient infectious periods:
Rapid diagnosis and isolation of yellow fever cases in hospital wards, keeping them under nets so infected people could not infect Stegomyia mosquitoes. If patients physically could not or refused to come to the ward, a team was dispatched immediately to their homes to screen them in their rooms.
Locating and destroying mosquito larvae:
Search and destroy teams went to every single building
Stegomyia larvae was found in indoor kitchen cooking pots and bowls used to hold water for the kitchen, rain gutters, rain water collection barrels, old tires, filled flower vases, underground in household cisterns, pockets of water in holes dug for trash, filled pitchers for hand-washing, in the little fish bowls and fish ponds in household courtyards. Any unsealed undisturbed amount of water, even less than a single cup in volume anywhere in and around a household was found to contain Stegomyia larvae, including the water saucers for the potted plants.
Urban renewal
Cleaning out blocked city drains so they drained completely without allowing pooling water
Covering all open water drainage
Removing any type of trash that could hold pockets of water – cans, old tires, etc.
Filling in any holes or puddling areas that held water.
Using cement to keep weeds from regrowing in ditches
Installing underground culverts for water drainage
Improving street drainage with better grading and cementing
Mosquito barriers:
Screening buildings and residences to block Stegomyia mosquito entry
Framing or papering any open gaps in walls and doors
Controlling the spread during patient infectious periods:
Rapid diagnosis and isolation of yellow fever cases in hospital wards, keeping them under nets so infected people could not infect Stegomyia mosquitoes. If patients physically could not or refused to come to the ward, a team was dispatched immediately to their homes to screen them in their rooms.
Locating and destroying mosquito larvae:
Search and destroy teams went to every single building
Stegomyia larvae was found in indoor kitchen cooking pots and bowls used to hold water for the kitchen, rain gutters, rain water collection barrels, old tires, filled flower vases, underground in household cisterns, pockets of water in holes dug for trash, filled pitchers for hand-washing, in the little fish bowls and fish ponds in household courtyards. Any unsealed undisturbed amount of water, even less than a single cup in volume anywhere in and around a household was found to contain Stegomyia larvae, including the water saucers for the potted plants.
Urban renewal
Cleaning out blocked city drains so they drained completely without allowing pooling water
Covering all open water drainage
Removing any type of trash that could hold pockets of water – cans, old tires, etc.
Filling in any holes or puddling areas that held water.
Using cement to keep weeds from regrowing in ditches
Installing underground culverts for water drainage
Improving street drainage with better grading and cementing
Gorgas and his teams conducted one of the most unusual city-wide search-and-destroy missions by an army in history - into of all places, Havana kitchens, rainwater collection barrels, toilets, cisterns, rain gutters, gardens and flower pots – to the very vocal protests of the completely disbelieving and befuddled Havana citizens, sternly levying fines and summons on any household discovered to be harboring the enemy - Stegomyia mosquitoes.
No one had ever been fined - ever - in human history for a having a mosquito in the house. It was unbelievable, and in any other hands could have been a civic management disaster for the occupying American Army.
Chief Sanitation Officer, the Big Man, U.S. Army Major Dr. Gorgas, brought his Southern honey tones, soothing voice and charming demeanor that was so endearing to and beloved by his patients as a velvet-covered weapon into the battle, personally arriving on any Havana doorstep to patiently hear the complaints, discuss the matter and explain the situation to any reluctant Havana housewife and homeowner.
In the highly class-conscious Havana society, it was un-heard-of for Major Gorgas as Chief Sanitation Officer – that is, someone of his rank and authority - to make the effort to meet with everyday citizens, no matter what their social status. In future analysis of the success of the yellow fever eradication drive in Havana, the example of Gorgas’s honesty, personalized initiative and sincere efforts to win over the citizens of Havana would be held as a model to emulate of public health relations excellence – how to build trust, provide transparency, and by that cooperation and good will in the community.
In another first in the history of occupying armies and imposed foreign public bureaucracies, Havana citizens were even more astonished that if a follow-up inspection by Gorgas’s Sanitation Department verified that residents had rectified their household mosquito problem and were no longer out of compliance, their fine payments were promptly and fully refunded on the spot in cash.
This Mosquito Eradication thing might be daft, but Dr. Gorgas’s personal popularity and the honest reputation of the sanitation officers among Havana citizens surged. It really was about the mosquito and yellow fever and not just another unfair tax burden extortion on the citizens.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950; Sanitation in Panama, Gorgas, 1915
No one had ever been fined - ever - in human history for a having a mosquito in the house. It was unbelievable, and in any other hands could have been a civic management disaster for the occupying American Army.
Chief Sanitation Officer, the Big Man, U.S. Army Major Dr. Gorgas, brought his Southern honey tones, soothing voice and charming demeanor that was so endearing to and beloved by his patients as a velvet-covered weapon into the battle, personally arriving on any Havana doorstep to patiently hear the complaints, discuss the matter and explain the situation to any reluctant Havana housewife and homeowner.
In the highly class-conscious Havana society, it was un-heard-of for Major Gorgas as Chief Sanitation Officer – that is, someone of his rank and authority - to make the effort to meet with everyday citizens, no matter what their social status. In future analysis of the success of the yellow fever eradication drive in Havana, the example of Gorgas’s honesty, personalized initiative and sincere efforts to win over the citizens of Havana would be held as a model to emulate of public health relations excellence – how to build trust, provide transparency, and by that cooperation and good will in the community.
In another first in the history of occupying armies and imposed foreign public bureaucracies, Havana citizens were even more astonished that if a follow-up inspection by Gorgas’s Sanitation Department verified that residents had rectified their household mosquito problem and were no longer out of compliance, their fine payments were promptly and fully refunded on the spot in cash.
This Mosquito Eradication thing might be daft, but Dr. Gorgas’s personal popularity and the honest reputation of the sanitation officers among Havana citizens surged. It really was about the mosquito and yellow fever and not just another unfair tax burden extortion on the citizens.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950; Sanitation in Panama, Gorgas, 1915
After their initial astonishment and skeptical reaction to their new priority, Gorgas’s men began to enjoy the call for ingenuity to attack this specific bug. They fumigated homes and buildings, swept up the mosquitoes and burned them.
But fumigation, spraying and trapping of flying adults are inefficient because at higher cost, they only kill a relatively few flying adults because the flying insects are dispersed and present in low densities. A breeze can easily dissipate aerosol pesticide away from the targets. Larvae however are concentrated in water and can't escape.
Most holes that held water with larvae could be filled in with dirt, others drained, pots and barrels were simply dumped out to spill the larvae on the ground to die. Dumping out bowls, containers and pots wasn't perfect as any unhatched eggs could survive until washed into another bit of water to hatch. Very quickly, the sanitation men discovered what would be their most devastating weapon against the Stegomyia (Aedes aegypti) mosquito.
The larvae, though in water, must breathe air. Knowing that oil floats on the surface of the water, the enterprising sanitation men quickly discovered that larvae were very efficiently suffocated when oil was poured over the water.
They tinkered with thinning the thick oil with kerosene to create the optimum layer of suffocating oil without requiring copious stocks of motor oil. The mixture they ended up with was gratifyingly cheap, easily obtainable and utterly devastating to the Stegomyia mosquito larvae, without really even inconveniencing or harming much of anything else, be it other bugs, fish or humans.
After a short period of time, this floating oil/kerosene or oil/diesel mixture layer degrades naturally, leaving no harmful residues. A re-application once a week kept the layer at the optimum thickness so no larvae could survive in that water. Unlike a pesticide, the kerosene oil mixture won't create a resistance problem. It simply blocks the breathing tubes of the larvae.
This mixture was poured down and into every drain and cistern that could harbor Stegomyia larvae, over every surface of standing water that couldn’t be drained in and around residences and buildings where people stayed or worked. The swarms of mosquitoes suddenly vanished.
But fumigation, spraying and trapping of flying adults are inefficient because at higher cost, they only kill a relatively few flying adults because the flying insects are dispersed and present in low densities. A breeze can easily dissipate aerosol pesticide away from the targets. Larvae however are concentrated in water and can't escape.
Most holes that held water with larvae could be filled in with dirt, others drained, pots and barrels were simply dumped out to spill the larvae on the ground to die. Dumping out bowls, containers and pots wasn't perfect as any unhatched eggs could survive until washed into another bit of water to hatch. Very quickly, the sanitation men discovered what would be their most devastating weapon against the Stegomyia (Aedes aegypti) mosquito.
The larvae, though in water, must breathe air. Knowing that oil floats on the surface of the water, the enterprising sanitation men quickly discovered that larvae were very efficiently suffocated when oil was poured over the water.
They tinkered with thinning the thick oil with kerosene to create the optimum layer of suffocating oil without requiring copious stocks of motor oil. The mixture they ended up with was gratifyingly cheap, easily obtainable and utterly devastating to the Stegomyia mosquito larvae, without really even inconveniencing or harming much of anything else, be it other bugs, fish or humans.
After a short period of time, this floating oil/kerosene or oil/diesel mixture layer degrades naturally, leaving no harmful residues. A re-application once a week kept the layer at the optimum thickness so no larvae could survive in that water. Unlike a pesticide, the kerosene oil mixture won't create a resistance problem. It simply blocks the breathing tubes of the larvae.
This mixture was poured down and into every drain and cistern that could harbor Stegomyia larvae, over every surface of standing water that couldn’t be drained in and around residences and buildings where people stayed or worked. The swarms of mosquitoes suddenly vanished.
“I am inclined to attribute our freedom to the manner in which we killed the mosquitoes. We have fifty men at this work, oiling and draining small collections of water in every house and putting oil in all the sinks and closets so that it will run down into all the cesspools… I have had all the little streams and ditches in the suburbs cleaned and oiled; we have killed a great number of larvae…You can go to any sewer mouth now and see the dead larvae running out in considerable quantities… they have been killed by the oil.”
Major Dr. William Crawford Gorgas, 1901 Havana, Cuba
Major Dr. William Crawford Gorgas, 1901 Havana, Cuba
"Sing a song of kerosene
Of barrels deep and wide
Doctors have become so mean
Mosquitoes have to hide!"
Walter Reed, Doctor in Uniform, Wood, 1945
Of barrels deep and wide
Doctors have become so mean
Mosquitoes have to hide!"
Walter Reed, Doctor in Uniform, Wood, 1945
The proof of Gorgas’s teams’ anti-mosquito efforts having any effect against yellow fever would be in the hospital numbers. Every new yellow fever case no matter where in the city was diligently reported and recorded.
They didn’t have to wait long and could hardly believe their eyes when they saw the numbers. Instead of steadily increasing over the weeks as yellow fever cases had done for the past hundred and fifty years in that same period, the hospital weekly tallies of new cases of yellow fever were plummeting. Fewer cases meant fewer fatalities.
DEATHS FROM YELLOW FEVER
HAVANA, CUBA
1899 1900 1901
January 1 8 7
February 0 9 5 Stegomyia-targeted mosquito eradication begins in earnest
March 1 4 1
April 2 0 0
May 0 2 0
June 1 8 0
July 2 30 0
August 13 49 2
September 18 52 2 The last cases of yellow fever in Havana, Cuba.
October 25 74 0
Gorgas, Sanitation in Panama, 1915
They didn’t have to wait long and could hardly believe their eyes when they saw the numbers. Instead of steadily increasing over the weeks as yellow fever cases had done for the past hundred and fifty years in that same period, the hospital weekly tallies of new cases of yellow fever were plummeting. Fewer cases meant fewer fatalities.
DEATHS FROM YELLOW FEVER
HAVANA, CUBA
1899 1900 1901
January 1 8 7
February 0 9 5 Stegomyia-targeted mosquito eradication begins in earnest
March 1 4 1
April 2 0 0
May 0 2 0
June 1 8 0
July 2 30 0
August 13 49 2
September 18 52 2 The last cases of yellow fever in Havana, Cuba.
October 25 74 0
Gorgas, Sanitation in Panama, 1915
"Major Walter C. Reed
Office of the Surgeon General,
Washington, D.C.
This case which I report on September 26, 1901 was really the last which occurred in Havana. Of course we did not know it at the time, but this case marked the first conquest of yellow fever in an endemic center; the first application of the mosquito theory to practical sanitary work in any disease."
With kindest regards, I remain,
Yours very sincerely,
W.C. Gorgas,
Major & Surgeon, U.S.A, Chief Sanitary Officer"
Dr. William Crawford Gorgas, Sanitation in Panama, 1915
Office of the Surgeon General,
Washington, D.C.
This case which I report on September 26, 1901 was really the last which occurred in Havana. Of course we did not know it at the time, but this case marked the first conquest of yellow fever in an endemic center; the first application of the mosquito theory to practical sanitary work in any disease."
With kindest regards, I remain,
Yours very sincerely,
W.C. Gorgas,
Major & Surgeon, U.S.A, Chief Sanitary Officer"
Dr. William Crawford Gorgas, Sanitation in Panama, 1915
September 26, 1901, the last case of yellow fever in Havana as a direct result of the Stegomyia (Aedes aegypti) mosquito eradication drive, was exactly one day after the first anniversary of the Yellow Fever Commission’s Dr. Jesse Lazear’s death from yellow fever on September 25, 1900.
1901 September, U.S. Army Medical Corps Major Dr. William Crawford Gorgas and his mosquito-targeting sanitation teams had made history. Dr. Gorgas would never have to endure another year like 1900. Never again would ships depart Havana to deliver the yellow fever plague to the United States. There would never be another Mississippi Valley yellow fever epidemic like 1878. Yellow fever had been eradicated out of its Caribbean stronghold by a stunningly effective alliance of entomologists, sanitation technicians and U.S. Army medical personnel.
In 1901 September, Major Dr. William Crawford Gorgas had actually, finally decisively achieved what he’d been sent to Havana in December 1898 to do: destroy yellow fever in Cuba.
As late fall 1901 segued into early 1902, Dr. Carroll and Dr. Agramonte continued to work in Cuba on research testing other types of transmission and developing better treatment protocols for yellow fever. Major Dr. Walter Reed had returned to the States, busy with lectures and presenting the ground-breaking results of the Yellow Fever Commission to packed audiences which gave him standing ovations.
In early 1902, medical professionals who were just absorbing the revelation that yellow fever was indeed a mosquito-borne disease were further astounded when Dr. Reed was suddenly announcing that yellow fever had been destroyed in Havana, Cuba by the eradication of the mosquitoes – and not all mosquitoes, but the one species that carried it. It was a sensation.
In 1902, medical doctors especially in yellow fever endemic Central and South America countries were energized by the miracle of Havana and excitedly pressed for more information so they could do the same for their home country, yellow fever-endemic cities.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950. Sanitation in Panama, Gorgas, 1915
In 1901 September, Major Dr. William Crawford Gorgas had actually, finally decisively achieved what he’d been sent to Havana in December 1898 to do: destroy yellow fever in Cuba.
As late fall 1901 segued into early 1902, Dr. Carroll and Dr. Agramonte continued to work in Cuba on research testing other types of transmission and developing better treatment protocols for yellow fever. Major Dr. Walter Reed had returned to the States, busy with lectures and presenting the ground-breaking results of the Yellow Fever Commission to packed audiences which gave him standing ovations.
In early 1902, medical professionals who were just absorbing the revelation that yellow fever was indeed a mosquito-borne disease were further astounded when Dr. Reed was suddenly announcing that yellow fever had been destroyed in Havana, Cuba by the eradication of the mosquitoes – and not all mosquitoes, but the one species that carried it. It was a sensation.
In 1902, medical doctors especially in yellow fever endemic Central and South America countries were energized by the miracle of Havana and excitedly pressed for more information so they could do the same for their home country, yellow fever-endemic cities.
compiled from: Walter Reed and Yellow Fever, Howard Kelly, 1906; William Crawford Gorgas, His Life and Work, Gorgas & Hendrick, 1924; William Crawford Gorgas, Tropic Fever Fighter, Williams & Epstein, 1953, Physician to the World, Gibson, 1950. Sanitation in Panama, Gorgas, 1915
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1902 January-February. With mosquito-borne yellow fever broken and mosquito-borne malaria being destroyed throughout Cuba, Dr. Gorgas already had a bigger project in mind. In the early months of 1902, he suggested to Army Surgeon-General Sternberg a plan to apply the successful Havana anti-mosquito program to the Panama Canal Isthmus. Sternberg immediately put his influence behind Gorgas’s proposal to have Gorgas appointed to the Canal project.
In 1902, terribly, in the U.S., Dr. Reed, despite his earlier research reporting in 1899 that identified Sanarelli’s bacillus as a hog cholera bacillus, plus the 1901 published results of the decisive Yellow Fever Commission findings that yellow fever was mosquito-borne and ‘ultra-microscopic,’ still had to respond to chilly and in some cases, hostile inquiries that favored Sanarelli’s organism. In the U.S. in particular there were highly-placed people in the U.S government and military who retained a measure of political influence that were simply not willing to give up the scientifically un-supported hypothesis of filth and fomites.
Frustratingly, Reed’s announcements of Dr. Gorgas’s spectacular results in Havana didn’t seem to influence the thinking of the Sanarelli bacillus, filth and fomites – that is the anti-mosquito theory group - at all. Others scoffed that despite all the work he had done, Reed hadn’t added anything to what Dr. Carlos Finlay hadn’t already published.
This wasn’t an opinion that Finlay, who had worked closely with Reed in Cuba, had shared with anyone. Finlay knew exactly what it felt like to be ignored and belittled by the medical community for twenty years; he was very appreciative of Reed’s leadership and contributions that completely vindicated his work.
Reed had never failed in any measure to give Finlay the credit Finlay deserved nor had he ever obscured the important contributions of Lazear, Carroll and Agramonte. They all wrote and spoke highly of Reed and his style of leadership. But the close camaraderie that had provided so much mutual support in that crucible of the yellow fever endemic in Havana in 1900 suffered from the great distances and each to his own projects.
The Yellow Fever Commission had successfully completed its mandate – as much as could be completed as the technology did not yet exist to actually see the actual yellow fever organism – much later identified as a virus - under the microscope. Reed was in the U.S., Lazear had died, and Carroll was still in Cuba doing yellow fever-related research on improved medical treatments that favored his particular set of research skills, while Agramonte was very busy continuing his medical and pathology work in Cuba as well.
In 1902, in the U.S., during the summer graduation ceremonies, Harvard University honored Dr. Reed with an honorary degree of M.A:
“Walter Reed, graduate of the University of Virginia, the army surgeon who planned and directed in Cuba the experiments which have given man control over that fearful scourge, yellow fever.”
In 1902 soon after, the University of Michigan conferred on Dr. Walter Reed the degree of LL.D. in recognition for his achievement in the understanding of yellow fever.
In 1902, in October, Major Dr. Gorgas’s assignment in Cuba was over. He departed Havana to begin consultations on his proposals for the Isthmus of Panama sanitation program, with the goal of eradication of yellow fever and malaria by the targeted eradication of the Stegomyia and Anopheles mosquitoes.
In 1902 at the same time, in late October and early November, colleagues and friends were worried that Walter Reed seemed too exhausted, worn down by a workload that he normally would have easily tolerated. After feeling too sick to work, he confided to his colleague Major Borden that he thought he might have appendicitis.
On November 17th Dr. Borden operated on Dr. Reed and discovered an advanced condition of appendicitis, which showed evidence of long-term inflammation and deterioration, which Bordon recognized as having a high possibly of a fatal infection. After the operation, as Reed lay sick and worried about providing for his wife and family, he was told by Major Keen that the Secretary of War had recommended his promotion from major to colonel.
“I care nothing for that now.”
Major Dr. Walter Reed, 1902
A second operation confirmed the surgeon’s grim assessment of unavoidable peritonitis infection. Reed would not see the era of antibiotics that would save millions in the years to come. The conqueror of yellow fever, U.S. Army Medical Corps Major Dr. Walter Reed died November 22, 1902 of sepsis complications from appendicitis.
In 1902, terribly, in the U.S., Dr. Reed, despite his earlier research reporting in 1899 that identified Sanarelli’s bacillus as a hog cholera bacillus, plus the 1901 published results of the decisive Yellow Fever Commission findings that yellow fever was mosquito-borne and ‘ultra-microscopic,’ still had to respond to chilly and in some cases, hostile inquiries that favored Sanarelli’s organism. In the U.S. in particular there were highly-placed people in the U.S government and military who retained a measure of political influence that were simply not willing to give up the scientifically un-supported hypothesis of filth and fomites.
Frustratingly, Reed’s announcements of Dr. Gorgas’s spectacular results in Havana didn’t seem to influence the thinking of the Sanarelli bacillus, filth and fomites – that is the anti-mosquito theory group - at all. Others scoffed that despite all the work he had done, Reed hadn’t added anything to what Dr. Carlos Finlay hadn’t already published.
This wasn’t an opinion that Finlay, who had worked closely with Reed in Cuba, had shared with anyone. Finlay knew exactly what it felt like to be ignored and belittled by the medical community for twenty years; he was very appreciative of Reed’s leadership and contributions that completely vindicated his work.
Reed had never failed in any measure to give Finlay the credit Finlay deserved nor had he ever obscured the important contributions of Lazear, Carroll and Agramonte. They all wrote and spoke highly of Reed and his style of leadership. But the close camaraderie that had provided so much mutual support in that crucible of the yellow fever endemic in Havana in 1900 suffered from the great distances and each to his own projects.
The Yellow Fever Commission had successfully completed its mandate – as much as could be completed as the technology did not yet exist to actually see the actual yellow fever organism – much later identified as a virus - under the microscope. Reed was in the U.S., Lazear had died, and Carroll was still in Cuba doing yellow fever-related research on improved medical treatments that favored his particular set of research skills, while Agramonte was very busy continuing his medical and pathology work in Cuba as well.
In 1902, in the U.S., during the summer graduation ceremonies, Harvard University honored Dr. Reed with an honorary degree of M.A:
“Walter Reed, graduate of the University of Virginia, the army surgeon who planned and directed in Cuba the experiments which have given man control over that fearful scourge, yellow fever.”
In 1902 soon after, the University of Michigan conferred on Dr. Walter Reed the degree of LL.D. in recognition for his achievement in the understanding of yellow fever.
In 1902, in October, Major Dr. Gorgas’s assignment in Cuba was over. He departed Havana to begin consultations on his proposals for the Isthmus of Panama sanitation program, with the goal of eradication of yellow fever and malaria by the targeted eradication of the Stegomyia and Anopheles mosquitoes.
In 1902 at the same time, in late October and early November, colleagues and friends were worried that Walter Reed seemed too exhausted, worn down by a workload that he normally would have easily tolerated. After feeling too sick to work, he confided to his colleague Major Borden that he thought he might have appendicitis.
On November 17th Dr. Borden operated on Dr. Reed and discovered an advanced condition of appendicitis, which showed evidence of long-term inflammation and deterioration, which Bordon recognized as having a high possibly of a fatal infection. After the operation, as Reed lay sick and worried about providing for his wife and family, he was told by Major Keen that the Secretary of War had recommended his promotion from major to colonel.
“I care nothing for that now.”
Major Dr. Walter Reed, 1902
A second operation confirmed the surgeon’s grim assessment of unavoidable peritonitis infection. Reed would not see the era of antibiotics that would save millions in the years to come. The conqueror of yellow fever, U.S. Army Medical Corps Major Dr. Walter Reed died November 22, 1902 of sepsis complications from appendicitis.
Major Dr. Walter Reed was buried at Arlington. His tombstone was inscribed:
“He gave to man control over that dreadful scourge, Yellow Fever.”
“He gave to man control over that dreadful scourge, Yellow Fever.”
1902. November. What can be said adequately about how the news of Dr. Reed’s untimely death was received when it arrived to Dr. William Gorgas, Dr. Carlos Finlay, Dr. James Carroll and Dr. Aristides Agramonte? They all saw death daily, even though they worked for people to live.
The amazing year they all shared, their camaraderie and cooperation in that terrible 1900, then suddenly the miracle – they had all been part of solving the most astounding and devastating mystery of centuries - and then incredibly in 1901 that knowledge was put to practical purpose with stunning, life-saving success. Then, for this to happen? Lazear was gone and then Reed, both were accomplished, disciplined, diligent, generous and talented men who had been struck down in their most productive years of their lives.
In 1902, Major Ronald Ross was awarded the Nobel Prize for his malaria work. Among many honors, he was knighted by his government for his efforts, henceforth to be known as Sir Ronald Ross. What similar effort did the United States of America make to recognize and honor the hard-earned contributions to world medicine and world public health by a cadre of its own U.S. Army Medical Corps doctors? Yellow fever had been more feared than malaria, shaping the course of history, foiling the best-laid plans of men and empires by its terrifying and devastating epidemics. The rapid eradication of it out of Havana was not only astounding but was the start of transforming the quality of life for millions of people in the southern United States.
Why was there no Nobel Prize for the Reed Yellow Fever Commission along with Dr. Carlos Finlay, Dr. Henry Carter and Dr. William Gorgas, even including the critical support of Governor-General Dr. Leonard Woods? Civilian contractor Dr. Jesse Lazear paid with his life. Army doctor James Carroll almost lost his and had permanent heart damage because of it. Walter Reed had died worried he hadn’t provided enough for his wife and family to carry on without his salary.
The positive and historic transformation of the quality of life for every citizen where yellow fever once plagued North, Central and South America cannot be understated.
The amazing year they all shared, their camaraderie and cooperation in that terrible 1900, then suddenly the miracle – they had all been part of solving the most astounding and devastating mystery of centuries - and then incredibly in 1901 that knowledge was put to practical purpose with stunning, life-saving success. Then, for this to happen? Lazear was gone and then Reed, both were accomplished, disciplined, diligent, generous and talented men who had been struck down in their most productive years of their lives.
In 1902, Major Ronald Ross was awarded the Nobel Prize for his malaria work. Among many honors, he was knighted by his government for his efforts, henceforth to be known as Sir Ronald Ross. What similar effort did the United States of America make to recognize and honor the hard-earned contributions to world medicine and world public health by a cadre of its own U.S. Army Medical Corps doctors? Yellow fever had been more feared than malaria, shaping the course of history, foiling the best-laid plans of men and empires by its terrifying and devastating epidemics. The rapid eradication of it out of Havana was not only astounding but was the start of transforming the quality of life for millions of people in the southern United States.
Why was there no Nobel Prize for the Reed Yellow Fever Commission along with Dr. Carlos Finlay, Dr. Henry Carter and Dr. William Gorgas, even including the critical support of Governor-General Dr. Leonard Woods? Civilian contractor Dr. Jesse Lazear paid with his life. Army doctor James Carroll almost lost his and had permanent heart damage because of it. Walter Reed had died worried he hadn’t provided enough for his wife and family to carry on without his salary.
The positive and historic transformation of the quality of life for every citizen where yellow fever once plagued North, Central and South America cannot be understated.
These are important things to keep in mind as the next period of this awesome story of the defeat of yellow fever and malaria by targeted mosquito species eradication is told. In 1903, the international medical community throughout the Americas was excited and organizing for targeted anti-mosquito eradication programs. Port cities from the United States to Brazil that had been notorious epicenters for mosquito-borne yellow fever had the Gorgas Methods to follow - the path to decisively freeing their citizens from this scourge.
1903 Dr. Gorgas was earnestly preparing to head to Panama, not expecting to be received by a commission of political appointees who – despite the majority of the international medical community - openly declared that they thought the ‘Mosquito Theory’ was stupidity.