The American Plague: The Untold Story of Yellow Fever, the Epidemic that Shaped Our History - Molly Caldwell Crosby (2006)

Part II. Memphis, 1878

Chapter 7. The Havana Commission

While Memphis struggled to rebuild itself, the nation continued to grapple over the question of what to do about yellow fever. Hayes’s Board of Experts had failed to do anything more than provide statistics for past epidemics and the dismal results of the most recent one. What Hayes needed now was a group of experts to go to the source of the problem: Cuba. After all, Cuba had proven to be the hub for all major epidemics of the American plague over the last two centuries. The country could not afford to wait for yellow fever to strike another severe blow. It had to go to the source of the problem and seek out the virus. The National Board of Health organized a group of yellow fever experts to travel to Cuba and study the disease—they were the Havana Yellow Fever Commission.

Dr. Carlos Finlay had an air of madness about him. He was not mad, quite the opposite; he was brilliant. But he had trouble expressing himself, in part because his mind seemed to work faster than words could accommodate, but mostly because a childhood bout with a nervous system disorder had left him with a distinct stutter.

Juan Carlos Finlay was born in Cuba in 1833. The Finlay family moved to Havana when Carlos, as he would choose to be called, was only one year old. His father was a Scottish physician who was on a British expeditionary force when his ship wrecked near Trinidad, and he met Finlay’s mother. In Cuba, Finlay’s father practiced medicine and owned a coffee plantation, where Carlos was homeschooled as a child. Finlay’s father also loved to travel, and he took Carlos with him on trips throughout the West Indies, South America, and later, Europe.

Finlay’s education was multinational as well. He was sent to school in France, but eventually returned after a bout of typhoid. Like his father, Carlos Finlay wanted to practice medicine, but he needed a bachelor of arts degree to do so in Havana. Finlay moved to the United States where medical education was still substandard, and he would not need a degree to enter medical school. He graduated from Jefferson Medical College in Philadelphia.

What Finlay really wanted, however, was to return home to Havana; but, before he could practice medicine there, he would need to pass the oral board examination. Finlay’s stutter—paired with Havana’s low opinion of American medicine—caused him to fail at his first attempt, but persistence was a hallmark of Finlay’s personality. After a year of traveling with his father, Finlay settled back in Havana for good, finally passing his oral boards, and beginning his practice.

Dr. Carlos Finlay was a true intellectual of the Victorian age. He spoke fluent English, French, German and Spanish, and could read Latin; he liked to have breakfast in one language, lunch in a second and dinner in a third. He excelled at chess. Finlay was a member of Havana’s Royal Academy of Medical, Physical and Natural Sciences. He was also charitable, often taking on patients who could not afford care. Finlay published articles on subjects varying from cholera to leprosy, gravity to plant diseases, but his most prolific writing involved yellow fever. During his life, he published forty articles on the subject. He was particularly interested in the atmospheric conditions surrounding yellow fever— especially after the 1878 epidemic in the United States. In direct opposition to the prevailing contagionists versus noncontagionists view, Finlay believed that an intermediary host was responsible for the spread of the fever.

In 1879, just after the devastating yellow fever epidemic in the Mississippi Valley and beyond, the group of American yellow fever experts arrived in Havana. The Havana Yellow Fever Commission consisted of several members, including the chairman, Dr. Stanley E. Chaillé of New Orleans, Dr. George M. Sternberg of the U.S. Army Medical Corps and Dr. Juan Guitéras of the Marine Hospital Service. The Spanish government assigned counterparts in Havana to work with the commission, and Dr. Carlos Finlay was a natural choice. Finlay’s international background, his congenial nature and his knowledge of tropical diseases made him a perfect fit. One member of the commission would later describe Finlay as “an original, penetrating, tenacious, untiring investigator . . . a mentor worthy of imitation by anyone with a dedicated vocation to science and humanity.”

The commission moved into Havana’s Hotel San Carlos during their three-month stay. Chaillé was assigned to work on the prevalence of yellow fever in Cuba. Guitéras, a Cuban-born, American-educated professor of tropical medicine, looked for microorganisms and pathologic changes in the tissue of yellow fever cadavers. And Sternberg searched for a pathogen in the blood samples. Carlos Finlay, Juan Guitéras and George Sternberg would form a lasting friendship during the work—all three would spend the next twenty-five years fighting this disease.

Dr. Sternberg was an expert at photomicroscopy. Using oil immersion objectives and a Tolles amplifier, he produced 105 photographs of blood smears during his months in Cuba. Sternberg, America’s “pioneer bacteriologist,” also had an impressive résumé. He was captured by Confederates during the Battle of Bull Run, escaped and made his way back to Washington. After the Civil War, he served on the western frontier. During service at Fort Barranacas, Florida, Sternberg contracted yellow fever. He survived the fever, but it launched a twenty-year grudge against the disease he searched tirelessly for beneath the microscope. Like Finlay, Sternberg would publish roughly forty articles on the subject of yellow fever; but Sternberg’s expertise was not limited to yellow fever alone. He discovered, the same year as Louis Pasteur, the pathogen responsible for pneumonia, and he was the first in this country to show the malarial parasite and tuberculosis germ. But Sternberg was anxious for his own fame. He was ambitious, and it would take him far. Two decades later, Sternberg and Finlay would again battle yellow fever, one as the most powerful medical mind in America, the other as the most ridiculed scientist in Cuba.

The commission admired and worked well with Finlay, but ultimately were uninterested in his theory about atmospheric conditions, instead focusing on the ever-popular germ theory. They failed to discover any new groundbreaking information on the disease and soon returned to the United States. Finlay’s interest in the disease, however, was roused, and he began extensive studies building on the work of the commission. For his part, Finlay was more interested in the hemorrhaging so common to the disease. He believed the “germ” or agent of infection must be spread through the blood. What could pass blood from one person to another? What independent agent could take the blood of one sick person and spread disease to a second one?

There had been some very recent studies on insects as vectors by Patrick Manson, who would later make the connection between mosquitoes and malaria. There was also a French scientist named Louis-Daniel Beauperthuy who had suggested twenty years before that a mosquito—a striped one—had an intrinsic relationship to yellow fever. The fewer mosquitoes, the fewer incidences of fever. Where Beauperthuy missed the mark was in believing that the mosquito just carried filth or decomposing matter, spreading the disease through its bite. Around the same time as Beauperthuy, an American physician, Josiah C. Nott, had also suggested a sort of insect theory, wondering if the yellow fever germ could travel through air much like insects. Beauperthuy saw the mosquito as a vehicle for infected matter; Nott saw infected matter as taking flight like the insect. Both were wrong, but their theories circled the truth nonetheless and broadened thought for future scientists.

To Finlay, the insect theory would also explain why yellow fever epidemics were so sporadic, striking different cities during different years, in spite of quarantines. Finlay was particularly interested in a common striped mosquito, known later as Aedes aegypti, which proliferated in areas where yellow fever was present. That particular mosquito had a few peculiar habits that would make it an ideal vector of disease. As soon as it had digested a blood meal, Aedes aegypti went in search of another, which would enable it to carry and spread disease easily. The mosquito is also benumbed when the temperature drops below sixty degrees, which correlated with Finlay’s atmospheric studies on areas where epidemics are common and at what times of year they begin and end in places like New Orleans and Memphis. For the first time, it seemed there was a connection between the pest and the pestilence.

It was with a bitter sense of irony that Memphians would one day learn the yellow fever epidemics that nearly destroyed their city, a city named for Memphis, Egypt, would be spread by Aedes aeygpti: the Egyptian mosquito.

In 1881, Finlay began studies on Aedes aegypti and blood inoculations. His experiments were partially successful, producing a few mild cases. He presented his theory on August 14, 1881, to the Royal Academy under the title The Mosquito Hypothetically Considered as the Agent of Transmission of Yellow Fever. To Finlay, the theory made perfect sense, in spite of some inconclusive experiments. But to a medical age wholly dedicated to the germ theory and the idea of contagion, his ideas seemed bizarre. His experiments had also been riddled with problems, leaving more questions than answers. Finlay stood at the lectern and stuttered his way through his presentation, trying to explain his strange theory through fits and starts in his voice. When he finished reading his paper, he looked up and awaited questions from the audience. Instead, he was met with complete silence. The combination of his speech impediment and outlandish theories about mosquitoes left him ridiculed and rejected by the medical community. He was dubbed “Mosquito Man” by the U.S. press and became known as a “crank” and a “crazy old man” in Havana.

Finlay continued to conduct experiments, including several on Jesuit priests at their monastery outside of Havana. The farm, located high on a plateau in a suburb of Havana, had been leased to the priests for summer residence. In spite of rampant yellow fever epidemics throughout Havana and elsewhere in Cuba, the property, known as Finca San Jose, had never had an epidemic. In coming years, those 150 acres would be a critical setting in the conquest of yellow fever. And for the next two decades, Finlay retreated into his own quiet obsession with mosquitoes.