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

Part III. Cuba, 1900

Chapter 11. An Unlikely Hero

Walter Reed wore immortality modestly. He had a moustache, long and ribbonlike, on an otherwise boyish face. He referred to his wife and daughter with gushing pet names and had a habit of rubbing his palms together when pleased about something. His favorite drink was mint julep, though he was a minister’s son who could recite Scripture flawlessly. His lanky build belied a posture spent crooked over a microscope. His narrow, gray eyes were earnest, his brow creased with age. He looked more like a physician than a soldier, which is probably how he liked it since he preferred the men under his command to call him doctor, rather than major. Still, Reed was the type of army man and physician always in uniform and always within code; throughout his life he would write the word duty with a capital D. His favorite poet was Sir Walter Scott, the poet of chivalry and honor. If any pride or egotism existed within him, it did so far beneath an exterior of humility—his brother Christopher once remarked about him that every modest man is not great, but it is equally true that every great man is modest.

That Walter Reed’s name would survive among the greatest names in medical history would certainly have come as a shock to him had he lived long enough to learn of it.

Reed was born September 13, 1851, in a small, milk-white cabin in Gloucester County, Virginia, to a Methodist minister named Lemuel Sutton Reed and a mother named Pharaba White Reed. The cabin was on loan to the family after the parsonage burned shortly before their arrival, so Pharaba gave birth to her youngest child in a two-room cabin cradled by an elm tree.

Both Lemuel and Pharaba came from colonial families out of North Carolina, their heritage rich in self-reliance, inventiveness and fairness, traits that were fast becoming the trademarks of American ingenuity and success. In this new world, there was no sense of entitlement or aristocracy; determination and hard work were the blueprints for achievement. Pharaba’s finest attributes surfaced in Reed, even at a young age. Aside from her fair hair and blue eyes, Reed inherited her intelligence, vivacity, sharp wit and a love of gardening. He would follow his mother around the garden, imitating her, as she pruned the cornflowers, roses and larkspur. It was a passionate hobby he carried with him during his nomadic years in the army.

As a “circuit rider,” Reed’s father moved every two years throughout Virginia, wherever Methodist churches were in need of a new minister. Ministers of small towns maintained a certain celebrity and power over parishioners, and with it came social responsibility. Towns would wait to see if the new minister would tolerate dancing, drinking. Would he be a strong speaker? Would his family set the right example? Receiving very little pay, ministers and their families relied heavily upon their philanthropic neighbors. Reed may not have taken so well to the evangelical lifestyle though; he would not officially join the Methodist Church until he was a teenager. He joined the day his mother died. And, years later, when his son, Lawrence, was in school, Reed was incensed to learn of a Methodist revival there: “I don’t approve of such things for Children,” he wrote. “My boy hasn’t done anything that he should be told that he is lost since and in danger of hell-fire.”

During the 1850s, Virginia breathed promise in her verdant landscape, still largely made up of tightly knit farm communities. For a young boy, there could be little else to worry about but hiding among the languid leaves of tobacco plants, playing with siblings, and studies in the one-room schoolhouse. Then war came.

As “Lee’s Miserables,” as the troops came to be known, waged a losing war, Union soldiers swarmed into Virginia, toward Richmond. The sound of cannons trembled in the night air, smoke garlanding above the farmland. For Virginians, it meant food shortages, rationing, ruined farmland, failed crops. War pierced the general calm of the Reed household as well when Reed’s two oldest brothers enlisted. At Antietam, a cannonball struck his brother James. In a crude hospital tent, the surgeon amputated James’s hand. He returned home like so many of his peers, physically clipped and psychologically broken.

Though the battlefield proved treacherous during the Civil War, disease was the greatest enemy. An estimated two-thirds of Union and Confederate soldiers died of disease, not wounds. Yellow fever was one of the most deadly. With this in mind, one of history’s more famous examples of germ warfare surfaced. Dr. Luke Pryor Blackburn of Kentucky, known as “Dr. Black Vomit,” attempted to ship infected clothing from yellow fever victims to major northern cities. He also had plans to poison New York’s water supply, as well as burn the city. He then turned his attention to assassination, sending trunks of clothes from the yellow fever wards to President Lincoln in hopes of giving him a lethal dose of the fever. Again, his attempts were unsuccessful thanks to ignorance about how the disease was spread. His criminal efforts did little to harm his career, however. After the war, Dr. Blackburn continued to practice medicine and aided victims during the 1878 epidemic in Memphis. In the following years, he would become the governor of Kentucky.

A good student, Reed attended school every year except one during the height of the Civil War. He drank knowledge. Not born to privilege, he was equipped instead with other tools for success— lofty principles and swelling determination. As his older brothers finished their schooling, Reed’s father asked the Methodist Church if he might move to Charlottesville to minister and allow his boys to attend the university.

Walter Reed was fourteen when the family moved to Charlottesville, on the cusp of the Shenandoah Mountains. Charlottesville rattled with traffic along the cobblestone streets. Churches and storefronts lined the walks. The town even had its own daily paper. It was here that the Reed brothers entered Mr. Jefferson’s university; the school made an exception in allowing Walter Reed to begin at age fifteen because his elder brothers were also in attendance.

As a boy, Reed was thin boned, determination and conviction visible on his face. His cheekbones were high, his eyes set close to one another and his brow narrow, so that he had a look of steadfast concern that would stay with him well into adulthood. But it was not his physical appearance that people noticed. People took to his gracious and well-mannered nature. He was honest and likable, and that left a marked impression.

Reed appeared before the board at the University of Virginia with an erect posture, chin set forward, trying to look older than his age. Reed had two older brothers at the university, and his father would not be able to afford the remainder of Walter Reed’s education. To earn a master of arts degree, a student completed studies in eight different departments ranging from Latin and Greek to mathematics. Reed had only finished courses in Latin, Greek and history and literature—he was far short of the requirements for an M.A. degree. Reed asked permission to attain a degree in medicine instead. True to the time period, an M.D. could be earned more easily and in less time than an M.A. The board considered his request impossible, so they gave their consent. They made a gentleman’s agreement on the deal. Should this boy with only one year of university experience pass the medical examination, the school would allow him to graduate with a degree in medicine.

Reed studied for nine months, taking courses in anatomy, chemistry, pharmacy, surgery, among others, and slept only three or four hours a night. At the end of the term, he passed the examination, and the board kept their promise. Walter Reed remains the youngest graduate of the University of Virginia’s medical school—he was seventeen years old.

Following his graduation, Walter Reed moved to Brooklyn with his brother, Christopher, an attorney who wanted to practice law in New York where he would never run out of clients. For Reed, New York represented the best in medicine—its hospitals highly regarded and its many citizens in need of help. It was not, however,an easy choice for either brother to make as southerners. A mere four years since a war still bitterly fresh in the minds of both sides, the North felt like enemy territory.

Reed earned his second medical degree from Bellevue Hospital Medical College, the premier teaching hospital at the time. Because he was only eighteen years old, Bellevue withheld his degree until he was twenty-one. At Bellevue, Reed had his first opportunity to use a microscope, as well as a thermometer—measuring ten inches long and taking five minutes for a reading. Medical studies at that time were still very crude. Cadavers were not preserved well, so doctors often kept handkerchiefs over their mouths while working. The stethoscope had been around for only fifty years. Disease prevention was unheard of. Links between sanitation and illness had not yet been realized.

Reed continued to practice medicine in Brooklyn and New York, as well as serving on the Brooklyn Board of Health as a sanitary officer. New York City teemed with immigrants after the Civil War. For the first time, Reed met Italians, Irish, Asians, Germans. With the mass immigration came new epidemics, which spread rapidly among the conditions of filth and poor nutrition in the city. Reed was assigned as district physician to the poorest district in New York. Many of his patients included the destitute “squatters” who lived in colonies in Central Park.

Growing up in Virginia, Reed lived mostly among farms, his family dependent upon the goodwill of parishioners for extra provisions. Neighbors helped one another. Never had he seen real urban poverty and the self-serving individualism that accompanied it. He was appalled by the unsanitary living conditions and poor medical attention given to lower classes in the cities. His anguish over their pitiable circumstances and the epidemics that routinely rained over the communities planted in him a desire—and later an obsession—to do something toward the improvement of humanity. In order to wage such a war, you have to identify the enemy, and Reed found his: disease, filth and poverty.

One night he returned home to the apartment he shared with Christopher. Walter Reed stood for a long time at the dark window, his silhouette backlit by gas lamps. He thought his brother was sleeping as he stared out the black glass and said quietly: “Woe unto thee, Chorazin, woe unto thee, Bethsaida, for if the mighty works which were done in you had been done in Tyre and Sion, they would long ago have repented in sackcloth and ashes.” The brothers never spoke of it; as Christopher later explained, “There are some things too sacred for the invasion of words.”

On a trip to North Carolina where his family now lived, Reed met his wife, Emilie Lawrence, the daughter of a prominent planter. Emilie, who changed the spelling from Emily to be more elegant, was pretty, though not conventionally beautiful. She had a long, straight nose, honey-colored hair and lean lips. Reed wrote of Emilie’s “beauty of character, your womanly worth, the purity of your Christianity, the charm of your intellect.”

“Should you spurn my affection,” he wrote to her, “I should never be ashamed of having revealed my love to so noble a woman.”

It was upon meeting Emilie that Reed’s work in New York lost its luster once and for all. He wrote to her that if he “could find some fair damsel, who was foolish enough to trust me, I think I would get—married, and settle down to sober work for the rest of my days in some small city where one could enjoy the advantages of a city and at the same time not feel as if lost.”

Reed wanted to apply for a position as a surgeon in the U.S. Army. He lacked the wealth and connections for a viable medical practice on his own—medicine at that time had much more to do with social position than actual education. What’s more, Reed’s age was proving to be an obstacle. He wrote to Emilie: “It is a remarkable fact that a man’s success during the first decade depends more upon his beard than his brains.” Army medicine would offer stability and direction to the profession, and it would provide Reed with the opportunity to do research and to travel. “Who would have thought ten years ago that one of us would want to wear the army blue?” his brother Chris remarked.

Reed studied for months before appearing in front of the examining board of the Medical Corps—an exam that would take thirty hours over the course of six days. The exam would cover not only medical topics, but also history, mathematics, Greek, Latin and even Shakespeare. One question from the examination dealt with a timely topic—yellow fever. Reed answered in handwriting neater than usual that the disease was spread by poor sanitation and prevented by quarantine.

Out of 500 candidates, Reed was one of the 30 commissioned as an assistant surgeon. After a short stay on Long Island, Reed would report to the Arizona territory. This presented a new problem.

On the frontier it would be hard for Reed to have a wife, especially a wife who had been born and raised in the East. First Lieutenant Walter Reed traveled to Washington to meet with the surgeon general, “His Highness,” as he called him in letters to Emilie.

“Sit down,” the surgeon general barked at Reed. “What do you want?”

“I would like to know, General, if I can get a leave while I am in Arizona. I am engaged to be married and would want to return.”

The surgeon general looked at the young soldier in front of him and gruffly told him, “Young man, if you don’t want to go to Arizona, resign from the Service.”

“General, I did not labor for my commission with the will I did to throw it away so hastily, nor can you deprive me of it till I act so unworthily as to cause dismissal.”

The surgeon general’s manner changed. “Have a cigar, Dr. Reed, and let’s talk it over. This is the advice I give you. Don’t marry now—go to Arizona and no doubt some soldier will become insane, you can bring him east, there will be your chance for your wedding.”

Reed decided against the surgeon general’s advice and married Emilie on April 26, 1876, taking her west with him. It was a wise decision; it would be another thirteen years before he was ordered back to Washington. The Reeds’ assignment would not end with Arizona: They served a short stint in Maryland; three different camps in Nebraska; and finally Alabama, where Reed looked after several hundred Apache Indians, including Geronimo. During his years on frontier camps Reed would deliver both his son and his daughter, and the family would adopt an Indian girl named Susie.

As the family physician for frontier camps, Reed worked among the soldiers and neighboring Indians binding wounds, performing surgery, treating venereal disease and caring for soldiers and their families when an epidemic coursed through the camp. Reed and Emilie both loved to garden and planted what vegetables and fruit would grow in the arid soil. In the Victorian era, gardening had become en vogue. In keeping with ornate Victorian architecture and the fairly new emphasis on outdoor recreation, people planted beautiful, well-kept gardens and green lawns. But Reed also saw gardening as a health benefit, planting fruits to cure scurvy, herbs for treatments and handing out vegetables to accompany the mostly game diets of the soldiers. He also strictly enforced cleanliness, believing it to be essential to preventing the spread of disease.

Nonetheless, medicine was in a period of great transition, and Walter Reed was missing it. In Europe, use of the microscope had given birth to the new field of pathology, finally separating general patient-focused medicine from real science. Laboratories had become the epicenter for experimental medicine. And medical education had turned from mere lectures to investigative study. The United States had decided to join, at last, the progressive movement in medicine.

Johns Hopkins had been established in Baltimore in 1876 as a school dedicated to modern science, modeled after European institutes, particularly the German ones. Germany had long been at the forefront for not only medicine, but their system of education. In Germany, knowledge was readily available, and students could move freely from one university to another, picking and choosing their subjects. British and American doctors flocked to Germany, and later France, for this independent, experimental system of study. In Europe, physicians and scientists could focus their energies on evidenced-based medicine and the life sciences in a culture unencumbered by theocratic shackles. It was time for America to offer its own institute for such study, but like many progressive ideas, it would be met with controversy.

When Thomas Huxley, the great evolutionist, was asked to speak at the launch of Johns Hopkins University, it outraged Baltimore society. One minister wrote: “It were better to have asked God to be there. It would have been absurd to ask them both.” In his book, The Great Influenza, historian John M. Barry wrote that Huxley did not even mention God in his speech, and it came in an era when “American universities had nearly two hundred endowed chairs of theology and fewer than five in medicine.” Barry added, “In no area did the United States lag behind the rest of the world so much as in its study of the life sciences and medicine.”

Though the Johns Hopkins medical school would not officially open until 1893, its research labs were in full operation. Finally, America had a place for real scientific study, and in the following two decades, nearly every distinguished physician or scientist would come out of those labs.

The new American frontier extended beyond geography; it influenced medicine as well. Doctors began to push the limits of science beyond the boundaries of the Victorian era, into the Progressive one. The United States would finally have the opportunity to produce its own Pasteur, Lister, Koch.

Walter Reed had been out of touch with the world of medical research for nearly fifteen years. By 1890, when Reed, Emilie and their children returned to the East Coast, he ached to learn of the latest advancements, begin work in the lab and attend lectures. Reed was granted permission to begin studies under Dr. William Welch, a doctor only one year older than Reed, who had studied in Germany with Robert Koch and Paul Ehrlich. Balding and be-whiskered, Welch was known as “Popsy.” One historian wrote: “No one symbolized the Germanic spirit in American experimental medicine better than Welch.”

Welch had been handpicked by John Shaw Billings to join the staff at Johns Hopkins in 1884, and he is largely credited with selecting or influencing America’s greatest medical minds—William Osler, William Halsted, Howard Kelly, Simon Flexner and Walter Reed. Under Welch, Johns Hopkins attracted brilliance the way a lens draws light.

Reed worked with Welch in the “Pathological,” as they called their lab. Rather than listening to instruction, they engaged in learning, studying and identifying bacteria beneath the microscope, dissecting animals and experimenting. The Hopkins doctors would break from their work to lunch on wild duck or fish at the “church,” a pet term for the local tavern that seemed more appropriate to scientists than a pub.

Reed thrived in the new atmosphere and appealed to a superior, John Shaw Billings, to stay at Hopkins. His request was denied, and he was sent, yet again, for a short stint at various forts, binding wounds from the Indian Wars and thwarting epidemics.

In 1893, a new surgeon general was selected: George M. Sternberg. Like Reed, Sternberg had been serving on the frontier, but more than simply treating disease, he was studying it, creating labs on dusty frontier outposts. Sternberg was not just an army man; he was a scientist. “The fossil age has passed,” wrote Reed.

Sternberg opened a new Army Medical School in Washington, D.C. Reed was promoted to the rank of major and asked to join the faculty, as well as serve as the curator of the Army Medical Museum, a position recently vacated by John Shaw Billings. Reed and his assistant, James Carroll, taught bacteriology, while continuing their lab work, shuttling back and forth between Baltimore and Washington. Knowledge unfurled before them; new studies and papers appeared almost faster than they could keep up.

Reed had worked among the filth in America’s largest city. He watched epidemics of infectious disease consume entire communities. He had labored in frontier camps and on army bases, observing the conditions of soldiers, their habits of hygiene. In his research, he quickly moved beyond simply identifying disease toward understanding ways to prevent it. Reed’s work as both a practicing physician on the frontier and a scientist at the center of the latest theories made him uniquely qualified for investigative medicine.

Surgeon General George Sternberg’s first commission for Walter Reed came during the Spanish-American War—war had a way of bringing science and soldiers together. Reed was to join Victor Vaughan and Edward Shakespeare in a study of typhoid. In spite of the fact that Sternberg was a staunch believer in sanitary practices, the army had been slow to act, and the surgeon general was now under heavy criticism for it. Thousands of soldiers crowded together in filthy camps waiting for orders; filth was expected in foreign camps, but it was scandalous that camps on American soil were in such poor shape. Ninety percent of the regiments reportedly contained cases of typhoid where the disease had been known to infect as many as one in four soldiers. “The government,” one newspaper column read, “may well consider the propriety of ordering all the troops at that point to Cuba or Puerto Rico for the improvement of their health.” When Reed’s Typhoid Board arrived at Camp Alger in Virginia, they found that the hospital barracks had no microscope. No autopsies had been performed. The camp doctors routinely confused cases of typhoid for malaria. But worst of all, the camp was filthy.

When the commission visited another camp to inspect sanitary conditions, the colonel gave them a tour of the grounds, which were foul. Reed turned to the colonel and said, “Shakespeare and Vaughan are on this commission because they know something of camp sanitation. I am here because I can damn a colonel.” Then, he lectured the officer on the responsibility an officer has to enforce good sanitation and health among his troops.

The worst camp they visited was Chickamauga Park on the border of Tennessee and Georgia; it was the largest camp in the country, and its name literally means “River of Death.” When the commission first arrived, the better part of 60,000 troops had just moved out, and piles of human excrement littered the ground at every step, soaking into the soil and water supply.

The common element in all of the camps was poor sanitation. The commission studied the conditions at all of the camps, plotting the arrival and departure of new troops, the supply of water, the food prepared in the mess hall and the orderlies who would empty bedpans, then eat lunch without washing their hands. The board sprinkled lime on the latrines and then watched as the same flies landed on food in the mess hall, their fine-haired legs tinged with the disinfectant. Finally, the commission put all of the pieces together.

Typhoid, the commission showed, was not only infectious, but also contagious. It seeped into the water supply through poor sanitation and spread among the troops through poor hygiene. Departing regiments left scores of infected tents and bedding behind when they moved out, and a new regiment soon occupied them. And flies carried the bacteria all through the camp, depositing it in new places. The Typhoid Commission found the order of feces, filth, fingers and flies as the agents spreading the disease. With basic sanitation practices, the camps could improve their odds against typhoid dramatically.

With new sanitation measures in place, the surgeon general had great hopes for eliminating not only typhoid but other diseases as well—especially yellow fever. The Spanish-American War had ended, but troops remained, occupying Cuba and dying of disease. Though typhoid and dysentery had proven to be most disastrous, yellow fever was the most feared. The haunting stigma surrounding the American plague remained. Soldiers who had never even seen it feared it above all others; stories of the 1878 epidemic still circulated. “Medical men for centuries had been working in the dark, not knowing what to fight. That fact alone made yellow fever the most fearful of all diseases,” wrote one army doctor.

Sternberg’s hopes perished with the onset of another yellow fever epidemic in Havana in 1900.

Cleaning up the camps had done nothing to slow the spread of yellow fever. Two hundred years of scourges and two decades of Surgeon General Sternberg’s personal study had yielded no definitive answers about the disease. So Sternberg handpicked a frontier physician who had shown remarkable promise in the lab and swift success with typhoid. Sternberg had a special assignment in mind for Reed, and he would soon report to a camp just outside of Havana called Camp Columbia.

Victor Vaughan and Edward Shakespeare would be left on their own to finish the typhoid report. Vaughan would hardly fade behind the fame of Walter Reed. His career had only begun— Victor Vaughan became one of the heroes in the fight against the 1918 influenza pandemic, and one historian would call him “second only to Welch in his influence on American medical education.” Still, Vaughan would also learn a valuable lesson, one that many other doctors failed to realize. “Never again allow me to say that medical science is on the verge of conquering disease,” he later said.