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

Part III. Cuba, 1900

Chapter 12. A Meeting of Minds

Everything about Camp Columbia was vivid. The colors were bold: bright blue sky, yellow heat, the flat swath of green, the clapboard buildings standing row after row like game pieces carved from bone. Though several miles from shore, the white light of the camp was suffused with salt and sea wind. The scent of overripened pineapples in nearby fields sugared the air, but beneath the sweetness, the chemicals were pungent. The smell of disinfectants, iodine and alcohol crossed the breeze. The landscape appeared vast, unbroken, except for the shadeless royal palms with their gray trunks standing like granite columns among the buildings. At the northeastern point of the camp, the Gulf of Mexico stretched in staggered shades of blue. The weather existed in extremes as well with only two seasons: wet or dry.

Camp Columbia’s focus was the care and treatment of sick soldiers. Three hospital buildings stood on stilts of varying heights that leveled the walking porches connecting them, and walkways of white limestone led to the main entrance. One housed a convalescent ward. Another held a small restroom and bathing rooms connected by a large iron pipe to funnel in heated water. There was also a surgical ward with eighteen beds, an operating room and dressing rooms. And one ward, lined with thirty beds and fine mesh netting, held the typhoid and undiagnosed fever patients. Several hundred feet away, across the La Playa road and a footbridge, even past the railroad tracks on the outer edge of the Columbia Barracks, were eight small huts. They were the yellow fever wards.

The camp had been built on a high plain about six miles west of Havana near the town of Quemados, Marianao, and it housed 1,900 American soldiers—part of the 15,000 men and women left behind to occupy Cuba following the war. The men woke early to the bugle calls, working in the hospital wards until noon. After lunch and an hour of “bunk fatigue,” the doctors, nurses and enlisted men were back at work.

The enlisted men came from all parts of the United States. They were young, many only twenty or twenty-one years old, and made to look even younger by their clean-shaven faces. With the advent of disposable razor blades, the heavy beards of the last century were gone, and facial hair now signaled status. A moustache was an indication of rank in the army. The bigger the moustache, like Teddy Roosevelt’s walrus whiskers, the higher the rank. Most of the officers went for something in between, opting for a pencil moustache or handlebar style. And accordingly, the enlisted men went clean shaven.

For entertainment, the men traveled into Havana, where they saw ball games and bought pastries and snacks like Bermuda onions and Norwegian sardines. Sometimes, they bought brandy.

The Cubans, who were accustomed to the local cocktails, found the drunken, staggering Americans very amusing. There was also the occasional afternoon swim off La Playa one mile away from Camp Columbia. In the evenings, classical music from the camp’s band filled the night sky.

Dr. Albert Truby first arrived at Camp Columbia in 1898, sailing into the Havana harbor, where Spanish soldiers stood along the Cabaña Fortress, and Cuban locals sat along the seawall to see the American ships arrive. It was December, and Truby and his men wore their winter wool uniforms, now damp with sea air and sweat. Under his watch, Truby had 1,000 soldiers—all nonimmunes.

Truby looked like a doctor. He wore small, wire-rimmed spectacles on a round, almost cherubic face. His hairline was receding, and in general, he appeared gentle. Truby had just earned his commission from the medical examination board at the Army Medical Museum in Washington, D.C. As Truby and the applicants stood before the board, he noticed a tall, slender officer. The officer was especially interested in the applicants’ knowledge of malaria. Prepared slides were placed beneath the microscope, and the applicants were asked to identify common bacteria and malarial parasites. The officer was quiet and courteous. He seemed like a teacher, one who knew his subject very well, and he gave Truby a feeling of confidence. When asked about malaria, Truby remarked on the recent work proving that mosquitoes can transmit the fever. The officer seemed momentarily pleased then continued the questioning. Only two of the applicants were accepted that day, and Albert Truby was one of them. He would be recommended to the surgeon general for an appointment in Cuba. Truby thanked the medical examination board and the slender officer who had been so interested in malaria. It was the first time Albert Truby met Walter Reed. The second time they met was in Cuba.

Although he had never seen a case of yellow fever prior to his appointment, it was Truby’s job to field all fever cases. The patients, taken to the mesh-wire receiving ward, had their blood screened for malarial parasites and their urine tested for albumen. There were local doctors, self-described yellow fever experts, but they rarely showed the talent to back up the claim. There were two doctors, however, that Truby and other contract surgeons relied upon for a yellow fever diagnosis. One was Carlos Finlay, and the other was Juan Guitéras; both had been members of the original Yellow Fever Commission in 1879.

The surgeon general sent Walter Reed to Cuba in March of 1900. Reed left the typhoid report, stalled due to a lack of funds, in the capable hands of Victor Vaughan and Edward Shakespeare. Prone to bad bouts of seasickness, Reed, on the advice of a friend, took a dose of bromide before they set sail for Havana. He retired to his stateroom and went to sleep. When he awoke, he was impressed with the medication. He didn’t feel sick at all, until he went up to the deck and realized that the ship had not yet set sail. For the next two days, he spent most of the voyage sick in his cabin.

Reed was sent to the Columbia Barracks to investigate a new disinfectant made from seawater called electrozone. Tank wagons rolled through Havana showering city streets with the expensive, salt-laced sanitizer. The disinfectant didn’t impress Reed, but Camp Columbia and its physicians did.

Reed stayed in a new bungalow flanked by a wide veranda on each side. The building served as quarters for bachelor medical officers. Its clapboard frame shored up a large tile rooftop that draped over the edges of the wide porches where rain would soon fall in fixed streams. Shutters on every wall allowed for a breeze-way, and in some of the nicer buildings the windows were made of glass. In many, however, there were only the wooden shutters to close against the rain. It was on this veranda that Reed and the other doctors stationed at Camp Columbia sat in their army whites and listened as the band’s music drifted in the approaching dusk. The insects were not yet prolific, but soon, as the wet season approached, the hum of mosquitoes would hang on the melody of the nighttime music.

Albert Truby stood on the porch with Reed, as did two other contract surgeons. Reed’s good friend Jefferson Randolph Kean, chief surgeon of western Cuba, was also there, as was Dr. Aristides Agramonte, an American doctor of Cuban descent. Agramonte had worked with Reed in Washington before being sent to Havana.

Another doctor sat on the veranda that night. Though he looked younger than the other men, he was an assistant surgeon for the army and the resident bacteriologist who headed the camp’s lab. Just a few months before, Albert Truby had put in a request to Major Kean for a full-time bacteriologist to head the lab at Camp Columbia, and the army appointed Jesse Lazear.

Dr. Jesse Lazear was from the East, born and raised near Baltimore at Windsor, the estate of his grandfather. He had a close-cropped beard and black hair offset by blue eyes. He rarely spoke and asked questions even less. Lazear was well liked by everyone, even described as lovable by a number of the men. Agramonte, who had been a fellow classmate at Columbia, would later write of Lazear, “A thorough university man, he was the type of old southern gentleman, kind, affectionate, dignified, with a high sense of honor, a staunch friend and a faithful soldier.” The word most often used in reference to him was gentleman, and in that age of moral high-mindedness, manners and codes of conduct, it was the greatest compliment one could bestow. Jesse Lazear was the type of man who wrote to his mother every day and loved Cuba because he didn’t have to play golf.

At only thirty-four years of age, he was highly accomplished, and often, more qualified than medical officers who outranked him. Lazear attended Washington and Jefferson College, graduated from medical school at the College of Physicians and Surgeons at Columbia University in New York, as well as Johns Hopkins University. Soon after graduating, he left for Europe to study with the greatest minds in science at the Pasteur Institute. His studies continued in Scotland, Germany and France, where he wanted to improve his language skills. As most groundbreaking scientific studies came out of Europe, they were usually in German or French, so Lazear wanted to read and understand them in their original language. When he sailed back to the States, he returned to Baltimore, where at the age of thirty, he became the first doctor in charge of a clinical lab at Johns Hopkins.

While Lazear was a physician who would be talented in any number of fields, lab work was particularly suited to his ability. He was gifted with perception, a sort of insight for the way things work, and he was meticulous. His thick glass slides, smeared with blood, were kept in perfect order in a wooden box alongside a leather logbook for notations. Next to the slides sat his microscope, which resembled a spyglass. It was his attention to detail, his obsession with accuracy, which would prove to be the haunting mystery left in Cuba long after the doctors departed the island.

As Lazear sat on the veranda that warm March night, he and the other men watched Reed with a sort of reverence. Not only Reed’s rank but his reputation impressed colleagues. He was twenty years Lazear’s senior, and a close friend of Welch and the surgeon general. Lazear also felt a sort of kinship in their work; they had worked in the camp lab often. Walter Reed even visited Jesse Lazear and his wife at their home in Cuba. “Mabel,” Lazear proclaimed, “I have another convert. Major Reed also believes the mosquito theory.”

Lazear was enthusiastic about his work with yellow fever and the theory of Cuban physician Carlos Finlay, the scientist who had put forth a theory that the fever was spread by mosquitoes. Once the connection between malaria and mosquitoes was made, Finlay’s theory seemed all the more plausible to Lazear. Finlay was thrilled when Lazear approached him about his theory. Finlay was now in his sixties with long burnside whiskers. It had been twenty years since he first proposed his theory; the mad scientist would finally be given the chance to be taken seriously.

As the sky grew plum colored, and the music had long since silenced, Reed sat with the other doctors on the veranda and talked about medicine. But most of all, they discussed yellow fever. Reed’s interest was tireless.

When Reed finished his investigation of electrozone, he sailed back to the States to give his opinion of the disinfectant to Surgeon General Sternberg. Though Sternberg had sent Reed to Camp Columbia on orders to examine the disinfectant, it’s more likely that he wanted to pique Reed’s interest in yellow fever. It is not known whether Reed approached the surgeon general about a yellow fever study, or if Sternberg proposed the idea to Reed, but in the end, it was a moot point. In less than two months time, Reed would be on his way back to Camp Columbia.

After Reed left Cuba, Lazear’s work continued as it had before. He spent his days in the hospital or lab and his nights at home with his wife, Mabel, and their one-year-old son, Houston.

Jesse Lazear met Mabel in Europe, where they were both traveling with their mothers. Mabel was described as a young lady with expressive eyes and an intriguing introspective appearance. Like Lazear, she had a love of the outdoors, and at her family ranch in California, Lazear and Mabel had enjoyed trout fishing, hunting and climbing together. They married on September 8, 1896, in San Francisco when Lazear was thirty and Mabel was twenty-two years old. They settled in Baltimore, and Houston was born three years later. All three moved to Cuba the following year when Lazear joined the army as a contract surgeon. Considering the Victorian age, it is not unusual that there is no mention in any correspondence about the fact that Mabel was four months pregnant with their second child when they arrived in Havana.

Lazear thrived during those first few months in Cuba. He wrote to his mother, “We were surprised to find Havana a most beautiful city, entirely unlike anything we had ever seen before. The color effects are charming—wonderful greens and pinks. There are numerous fine gardens with magnificent palms and flowers.”

Lazear kept a ribbon-bound photo album of their stay in Cuba. The recent invention of the Kodak box camera allowed for the first time average people to take snapshots of their lives candidly, rather than posed formally in front of a photographer. In his album, Lazear pasted pictures of Cuban landscape, Havana street scenes and his family: Houston toddling through a grass field; Mabel, with the sea air blowing strands of her hair from its bun, holding Houston and a toy guitar on the beach. The last photo in the album is a loose-leaf one of Jesse Lazear. He sits on a wooden fence with mountains in the background. The snapshot is a striking difference from the posed, stiff photos of recent times. His posture is relaxed as he perches on the top board of the fence, his two feet balancing him. His arms rest on his legs, his hands folded one over the other in the middle. He is dressed casually with a cap tilted on his head while he smokes his pipe. There is a hint of a smile on his face. He looks content, happy even.

Lazear’s living quarters were not quite what they were in Baltimore. He quickly wrote to his mother to unpack the boxes of golf clubs, books of Shakespeare, linen napkins and dishes. They need not be shipped. Much in the style of the other buildings at Camp Columbia, Lazear’s family quarters consisted of a two-room house made of wide, pine boards. A wooden bridge connected the two wings. In one house, Lazear and his wife lived; in the other, Houston and his nanny, Gertrude, slept. There was a roof and rafters, but no ceiling. There were shutters, but no glass windowpanes. A sloping roofline covered the walk-around porch.

The small shower bath had its own dwelling about one hundred feet away from the main house, but Lazear had hopes of having a real bathroom affixed to the house that autumn. The shower bath was in essence a bathtub with sprays of water that came out the side, so that one could shower without wetting one’s hair, as one soldier described it.

Mabel had done her best to make it feel like a home. Shopping in Havana, she had found matting at a Chinese store to sew and hang as a partition, giving them a bedroom on one side and sitting room on the other. Mosquito nets, while practical, also added a web of gauze to the otherwise hard, plank-wood bedrooms. Even with the netting, nature could not be contained. Fleas would often bite the baby. And tree frogs settled into the rafters, falling with a damp thud against the beds, sometimes landing in the water bucket. Soldiers would often begin their morning shave only to look down and find a tree frog with all four feet sucking the side of the pail and its head barely above the surface of the water. Eventually, covers were issued for the water pails.

The surrounding countryside was the real charm of their situation. Only a few miles from the beach, Lazear went, almost daily, for a sea bath. Sea grapes and mangroves tangled the shoreline, where white sand sloped toward a green-blue ocean. Houston played in the sand and collected shells. Every afternoon, Gertrude took Houston on a long walk in the countryside and let him chase chickens.

Carts of fresh produce or mules strapped with baskets of vegetables regularly came into the camp from Havana. Fresh meats were shipped from Chicago, packed in ice. Mabel had brought Borden’s condensed milk for the baby. Houston also had a healthy supply of oatmeal, eggs and meat juice.

As the rainy season, and more important, the quarantine season, approached, Mabel and Houston planned to sail for the U.S. In her sixth month of pregnancy, her condition was certainly a factor, but there was also a more practical reason. Once quarantine was under way, the fumigation process in New York would ruin all of Mabel’s clothes and personal belongings. On April 14, Lazear took Mabel and Houston to the Havana harbor to ship out on the steamer Sedgwick, where he bought her a twelve-dollar ticket and said good-bye. Jesse Lazear probably had another reason to send his wife and son away—locals were already referring to this one as a yellow fever year. It must have been a sad parting. The fever seasonwould last several months, and Lazear’s work in Cuba would keep him too busy to travel back anytime soon. Houston would grow and change during those months away, and most likely, Mabel would give birth to their next child before the family could be together again.

Lazear continued with his daily work in the hospital wards and lab after Mabel and Houston left. He swam in the sea and ate with the other officers in the mess hall, where they drank red wine in an attempt to keep fever at bay. The men entertained themselves with cards, a brass spittoon at the foot of each chair, or on special occasions, smoked an old Madre rolled cigar. Potted ferns and palms climbed the walls of the social hall, as though the flora of Cuba would not be kept out. Open shutters and high ceilings crisscrossed in wooden beams helped keep the room cool. Dances were held there on Saturday nights, and as always, the music continued to infuse the tropical night. Lazear listened from his porch in the dark, though he rarely walked to the dance hall unless it was a clear, moonlit night. Without a full moon, the tropical dark felt oppressive with only the patchwork of yellow window light and pinpoints of starlight to break up the blackness. And on quiet nights, he could hear the sounding of the hour fired from El Morro Castle.

On May 1, Major Jefferson Randolph Kean began keeping a journal to record any cases of yellow fever. Kean was the chief medical officer for western Cuba, and he lived in Quemados, Marianao. Kean was also a close friend of Walter Reed’s. Both graduates of the University of Virginia, the two met in Key West investigating a smallpox outbreak. Kean found Reed’s “whimsical humor” and penchant for “quaint stories” entertaining, and they would becomelifelong friends. The two had even exchanged frustrated letters when Surgeon General Sternberg had denied their placements in Cuba when the Spanish-American War broke out. Sternberg did not want to risk two of his best medical officers; neither had ever had yellow fever.

On May 21, Kean recorded in his diary that two cases of yellow fever appeared on General Lee Street, several blocks apart and in homes that had no contact with one another. General Lee Street ran through Quemados, a town of rainbow-colored houses set against ripe hillsides and thickets of tropical plant life. Palm fronds and bougainvillea blossoms, like fuchsia petals of parchment, enclosed the homes, one of which held the feverish wife of a cavalryman. She was too afraid to call the doctor, even as the bleeding began, for fear of being sent to die in the yellow fever ward.

Two days later, Lazear was called to No. 20 General Lee Street to investigate Sergeant Sherwood. When Lazear arrived, Sherwood was running a temperature of 100.4 and complained of a headache. By the next day, Sherwood’s temperature rose to 102. Lazear suspected the worst, quarantined the house and sent the sergeant to the yellow fever hospital. He conducted the Widal test to rule out typhoid and studied the blood for malarial parasites, but Sherwood’s skin grew mustard colored and his gums began to bleed. By nightfall, he was delirious and slipped into a coma, his breathing heavy and strained. The following day, May 30, Sergeant Sherwood died at 11:30 a.m. Lazear autopsied the dead soldier, making comments in his notebook: “Extreme jaundice, peculiar mucus like applesauce, liver was a bright yellow color, stomach contained about a pint of black coffee ground fluid.” It was a clear case of yellow fever. Another twenty-three cases would quickly arise in the town of Quemados.

Lazear also kept detailed records of the mosquitoes beginning to swarm in May, sending samples to an entomologist in the United States. Lazear’s meticulous nature was perfectly suited to this sort of study; as described by one tropical medicine professor: “keying in an identity depends on anatomical minutiae—how the insect’s hairs are placed and grouped, the formation of the mouth parts, the sex parts, the bewildering pattern of wing venation.” During this time, Lazear began killing and dissecting his pet collection of mosquitoes, or “birds” as they were nicknamed, most of which, he noted, had striped legs and bodies.

The fever appeared dangerously agile, jumping from one house to another, traveling from Calzada Real and back to General Lee Street. On Real Street, in close proximity to No. 20, a saloon and a number of local bordellos were shut down when it looked as if the risk of yellow fever was greater in those men who frequented them. For physicians trying to track the disease, it proved evasive and unpredictable, as if it engaged their interest as sport. “This epidemic,” wrote Truby, “with fifty cases and twelve deaths in one of the finest and most sanitary villages in Cuba disturbed everyone and left a lasting impression.”

On June 21, 1900, the entries in Jefferson Kean’s diary came to an abrupt stop.

A few days earlier, Kean had learned that a friend and neighbor was down with yellow fever. Kean had been ordered to stay out of the infected district, but early one morning, he decided to make a visit to his sick friend. He took every precaution, never entering the infected house, and instead sat outside on the porch where the air was clear. “I obeyed the letter but not the spirit of the order,” Kean would later write. He spoke to a nurse through the iron bars of the open window. He never came in contact with any of the infected items, nor with his friend. Kean was shocked, five days later, when he fell feverish and was admitted to hut number 118 in the yellow fever ward of Camp Columbia.