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

Part III. Cuba, 1900

Chapter 14. Insects

By the time the board had assembled at Camp Columbia, the yellow fever epidemic in Quemados was waning, if not entirely over. Yellow fever, it seemed, had taken its last victim for the season— though it left a lasting impression. Quemados, high on a plateau, had at one time been a safe haven for those fleeing Havana’s fever epidemics. That year, it struck the beautiful suburb with ferocity.

The momentous beginning and the enthusiasm the Yellow Fever Board felt soon stalled. Without active cases to investigate, Reed focused on setting up a lab. Built in what had once been the camp’s operating room, the lab became the focal point of their work. Along one wood-frame wall stood a tall table pushed against the window. Strong northern light fell in planes onto the microscopes of Walter Reed and James Carroll, who worked side by side. Against the far wall of the lab was another table covered in jars and lab equipment, like a glass menagerie of winged insects.

Off of the lab was a room for Reed’s lab assistant John Neate, which contained shelves with rows of test tubes, jars of black vomit and an incubator. And across from it, another small room held two caged monkeys, supplies and guinea pigs.

On a wooden table in the center of the board’s lab, Lazear kept his own pet mosquitoes in jars with sweetened water and bits of banana. He collected his “birds” from different areas: Havana, Pinar del Rio, the Post Hospital. But all had fed from the blood of yellow fever patients. And, for each mosquito, Lazear scribbled an entry into his red notebook, his handwriting becoming quicker, sloppier and abbreviated as he went.

It also took a little time for Reed to adjust to life in Cuba. Within days of arriving, he was already sunburned, and his northeastern clothes were too warm. Reed traveled into Havana to buy two linen crash suits and a cork helmet. It was hot, but not as hot as a Washington summer, he wrote to Emilie. That first week, Reed awoke at 5:30 or 6:00 every morning, sitting at the desk in his pajamas to write a letter to his wife. He always addressed the envelope the night before so he could drop the letter in the mail as soon as he heard the mail wagon. After a shower-bath and breakfast, Reed headed into the lab to work. It wasn’t long before he started sleeping later in the mornings and writing later in the day or napping after lunch. Camp Columbia was also growing quieter; nearly half of the garrison had been shipped out to China.

Things were so slow at the camp that Reed began to talk of returning to the U.S. in a few weeks to finish his typhoid report. His presence was not really needed in Cuba at the moment as badly as it was in Washington, where the typhoid report was in its final stages.

Reed was also a little homesick, writing every day about the gardens at his summer home Keewaydin in Pennsylvania, where the strawberries, blackberries and grapes were on the vine. The rhododendrons were in bloom. He missed his favorite foods and mint juleps, instructing Emilie not to let the patch of mint die during the summer heat because he would be very thirsty upon his return. But, Reed had also grown to love Cuba. Red hibiscus bloomed wildly throughout the countryside there, and the umbrella-shaped royal poinciana trees, he wrote, appeared as a “flaming mass of scarlet.”

It was the wet season, and rain fell every afternoon, sometimes twice a day, dimming the light in the lab. Steam rose from the railroad tracks in Camp Columbia as the first drops hit the hot metal. And as the storms passed, heading out to sea, lightning would play across the surface of the water, igniting the ceiling of blue-gray cloud cover.

When it wasn’t raining, the soldiers at the camp played baseball or went horseback riding. The men worked together all day, only breaking to go to the mess hall. Most men at the camp, twenty years younger than Reed, ate hearty amounts of the meat shipped from the U.S. and local fruits and vegetables. Reed, on the other hand, was more careful with his diet, often joking, “Boys, have mercy on your poor kidneys, they can’t be replaced.” Reed had adopted the latest trend in Victorian America: healthy eating habits. Large, meat-heavy breakfasts that could include steak, bacon, eggs, sausage, potatoes, porridge and doughnuts were evolving into lighter, healthier meals. Fruits and vegetables replaced primarily potato side dishes. Fresh fish, especially red snapper, were plentiful in Cuba, prepared by the camp’s Chinese cook. But Reed was also careful of his diet because he seemed to suffer from stomach ailments—though no one paid much attention to it at the time.

For the most part, the men at Camp Columbia enjoyed Reed’s company and he theirs. Practical jokes were common, as were games and sports. The overwhelming opinion of Reed was that he behaved exactly as a major should behave: He was approachable, had a good sense of humor and a genuine concern for the men, but felt a duty to maintain the respect afforded the position. But, as an officer, Reed also stood apart from the men. He could seem uncompromising at times, even rigid.

One contract surgeon described Reed: “He was smart and knew about everything, but he was a man to whom you had to prove what you said . . . he was domineering . . . a good friend, but he insisted upon you being worthy of his friendship.”

Reed was not the only one growing impatient with the sleepy pace of work at Camp Columbia. Lazear wrote to his wife that the Quemados epidemic was over, but he would at least now have the opportunity to focus on some of his work with mosquitoes. Since he had been assigned to explore the mosquito theory, Lazear had a lot of time to work independently, traveling back and forth to Havana, where yellow fever outbreaks persisted. Lazear was also sent by Doherty wagon into the countryside whenever outbreaks occurred. He continued adding to his collection, taking the insects from inside the netting around hospital cots, caging them and returning to the lab at Camp Columbia.

Lazear also sounded homesick in his letters home—it had been three months since Mabel and Houston sailed for the U.S. He worried about how little Houston would react to his father after not seeing him for months. Mabel was suffering complications with the pregnancy and had already been admitted to the hospital for the final weeks. Lazear began to talk about what sort of work he might pursue in Washington once his service was over. He was having his mother’s portrait painted and looked forward to the day he would have a permanent home in which to hang it. Lazear was very close to his mother. Twice widowed, his mother had also lost both of Lazear’s brothers. Jesse Lazear was all she had left. He began to make plans to sail home for a visit in October.

Reed sat at his desk one afternoon in July to write to Emilie. A photo of their daughter Blossom was propped up before him. Reed had just returned from Havana, chased back to the barracks by a heavy storm settling in for the afternoon. In Havana, Reed had seen his son, Lawrence, also stationed in Cuba, and he wrote Emilie to tell her about their meeting. Lawrence looked cool and collected, wrote Reed, with a helmet perched on his head. Army life suited Lawrence far more that academics did, and Reed was proud to see his son come into his own. At their home in Washington, Reed had noticed his son’s lack of interest in studies and reproached him, refusing to send him to college. Lawrence Reed would not disappoint his father; by the end of his forty-two years in the army, Lawrence would become a major general.

In Havana, Lawrence told his father that he had just bought a khaki suit and a linen crash one for the warm weather. Reed told him to buy a second crash suit, and he would foot the bill. Lawrence smiled. “I will not neglect to do so.”

The only real excitement the board had thus far was a visit from two English doctors, Dr. Herbert Durham and Dr. Walter Myers, who were part of the Liverpool School of Tropical Medicine. Reed wrote to Emilie: “I enjoyed meeting them very much, as they were two of the most typical English men, ‘don’t you know,’ that one could possibly meet. We have placed our laboratories at their disposal during the ten days they will be in Havana.” The doctors also met Dr. Henry Rose Carter, an American doctor from the South who had made some interesting observations about the incubationperiod of yellow fever, most notably the five-to-seven-day time span between the first cases of yellow fever and the next wave of infections. And the doctors spent some time with Dr. Carlos Finlay in Havana as well.

The British doctors, like the American Yellow Fever Board, were intrigued by the idea that yellow fever might be spread by an insect. They later published an article in which they thanked the Americans for their hospitality in Cuba. In it, Durham and Myers wrote, “The suggestion propounded by Dr. C. Finlay, of Havana, some twenty years ago, that the disease was spread by means of mosquitoes hardly appears so fanciful in the light of recent discoveries.” Six months later, both Durham and Myers contracted yellow fever during their studies in South America. Durham recovered, but Myers died.

As Reed wrote to Emilie that July afternoon, Carroll and Lazear worked in the lab, but Agramonte had been sent into the countryside to investigate a fever outbreak. Again, Reed was thinking of when he could sail for the U.S. and finish his typhoid work. Then, a telegram arrived.

Agramonte, inspecting a camp at Pinar del Rio, the capital of Cuba’s westernmost province, had found something. Reports surfaced about a sudden increase of sickness among soldiers. The fevers had an unusually high mortality rate, and on July 19, Agramonte was dispatched to investigate the outbreak. The recent death of a soldier, supposedly suffering from malaria, afforded Agramonte with a fresh autopsy. He began his investigation of the dead, following the internal clues of gilded organs and tar-like blood remnants, searching the bloodstream for malarial parasites. But the yellow corpses left little doubt as to what had caused the death.

Agramonte walked the hot corridors of the military hospital where he found, in bed after bed, patients burning with fever. No quarantine or disinfection measures had been taken. He sent a telegram to headquarters to the chief surgeon describing the gross negligence on the part of the doctors in charge of the hospital and asked for direction. He received a telegram in response with instructions: Take charge of cases. Reed goes on morning train. Wire for anything wanted. Nurses will be sent. Instructions wired commanding officer. Other doctors should not attend cases. Establish strict quarantine at hospital. You will be relieved as soon as an immune can be sent to replace you. Report daily by wire.

Reed left Camp Columbia immediately for the western interior of Cuba, traveling by train through a valley of tobacco and sugarcane fields, the smell of molasses thick in the air. Pinar del Rio boasts the most dramatic topography in Cuba. Giant limestone formations, remnants of the Jurassic era, tower over the fields like stone haystacks. A low-lying spine of mountains stands in the distance, and pine trees rise like spires in the countryside.

Reed met Agramonte, and together, they surveyed the sleeping quarters of the barracks where hundreds of beds stood in regimented rows. In such close quarters, the fever should have spread rampantly from one soiled bed to the next. Conditions were filthy, with ample opportunity for germs to spread. The doctors at Pinar del Rio performed only the barest practices of disinfecting bedding, soaking sheets and pillowcases in bichloride, then sponging the mattress. Reed and Agramonte placed all blame for the fiasco on the army doctors stationed there and filed a formal complaint with the surgeon general.

Before he left, Reed noted one other peculiar circumstance at Pinar del Rio. In early June, a private had been court-martialed and sentenced to three months of hard labor. During this time, he was kept in a cell in Pinar del Rio. The private and seven other men were locked in their cells on June 1 and had no contact with the outside world. No visitors saw the prisoners. Nonetheless, by the end of June, the private and one other cellmate had come down with yellow fever and died. None of the other men in the cell, nor any of the guards, became ill. It was as if something blew through the bars of the windows to afflict only those two men.

Reed met with Lazear and Carroll when he returned to Camp Columbia, while Agramonte continued on the train to Havana. Later, much would be made of the fact that Agramonte was not present at that meeting. In an article published several years later, James Carroll would accuse Agramonte of hardly being involved with the board’s work and not even being aware of their experiments. But, Agramonte’s lab was located in Havana, as it had been long before the Yellow Fever Board was convened. It was not unusual at all for Reed to meet with Carroll and Lazear at Columbia Barracks while Agramonte continued his work elsewhere. And, most likely, Reed had already discussed his new ideas with Agramonte at Pinar del Rio. As Albert Truby remarked, Reed enjoyed talking about his work: “He had no secrets about his experiments and everyone knew from day to day just what was going on.”

During that meeting, it was decided that Lazear would focus more heavily on the mosquito theory, building on the work he had already compiled over the previous months. Since the first outbreak of fever in May, Lazear had been making notations about yellow fever—the symptoms of patients, where the fever broke out and where it turned up next, weather observations and careful study of the mosquitoes local to the area. Lazear still believed that if malaria could be spread by mosquitoes, it was possible that yellow fever could as well. Carroll and Agramonte would continue their autopsies and tissue samples in search of something in the body—whether microbe or otherwise—that appears in yellow fever patients.

The lab work would be helpful, but most likely inconclusive; Reed knew that the next step would have to be human experiments. In a letter to Sternberg, Reed wrote, “Personally, I feel that only can experimentation on human beings serve to clear the field for further effective work.” He never indicates in letters or otherwise whether he believes the mosquito theory will be proven or disproved by such action, only that “with one or two points cleared up, we could then work to so much better advantage.” Reed took his idea of human experiments to the board, and they agreed that should they be willing to experiment on human beings, they should be prepared to experiment on themselves as well. How could they ask for the self-sacrifice of others without submitting to the same studies?

Agramonte’s departure from the board that August would not be the only one noted. According to James Carroll, Walter Reed left without explanation the morning after the board decided to self-experiment and sailed for the United States. Carroll overtly implied that Reed did so to avoid infecting himself. It became a stain on the board’s work and indirectly accused Reed of cowardice. In truth, whether or not Reed planned to infect himself, he had been plotting his return to the United States weeks before this meeting took place. In letters to Emilie, as well as Sternberg, Reed wrote about plans to catch the Rawlins whenever it came into port. What’s more, travel to and from Cuba was unreliable at best. Transports could be days late, and baggage was subject to a lengthy disinfecting process before the steamer could set sail. In letters to Emilie, Reed tried to sound reassuring: “The Quartermaster told me this afternoon that the Rawlins would be here Tuesday afternoon,& would leave either Wednesday evening or Thursday morning—So that the chances of getting away August 1 or 2nd are very good.” In other words, it would be nearly impossible to jump aboard a ship the morning after the board met and flee.

Carroll went so far as to suggest that Reed fabricated a reason to leave Cuba as well, having a carte blanche to sail to and from Cuba whenever he liked. When Reed and Carroll arrived in Cuba that June to work with the Yellow Fever Board, they learned that Dr. Shakespeare, Reed’s partner in the typhoid study, had died suddenly from a heart attack. That left only Dr. Victor Vaughan to finish all of the work. Reed wrote on several occasions about plans to return to help Vaughan finish the report, and under some pressure from the surgeon general to present the typhoid paper, Reed undoubtedly felt a priority to that study. After all, yellow fever had been well contained at Quemados, and with the sickly season coming to a close, even autopsies were few and far between. The fact that Carroll would make such a slanderous suggestion about his friend and colleague seems to further illuminate his emotional deterioration during the time he served on the board. For Carroll, the work would soon prove to be physically harrowing as well, bringing him to the brink of death and back again.

The steamer Rawlins was scheduled to reach the Havana harbor around July 30. Slightly irritated, Reed waited as all of his baggage was disinfected in the days before the transport arrived. All wearing apparel was steamed or soaked in a disinfectant called formalin. No exceptions were made—even for the head of the Yellow Fever Commission. Then, much to Reed’s frustration, the steamer’s departure was postponed after several soldiers decided to celebrate their departure at a nearby café. At long last, the Rawlins, which Reed nicknamed the Rollins in anticipation of his usual seasickness, set sail close to midnight on Thursday, August 2, 1900. Reed wrote to Emilie that he wanted fried chicken, cabbage and waffles upon his return.

Albert Truby boarded the Rawlins late that night with the rowdy group of homeward-bound soldiers from the café. He made his way through the drunken shouts and cheers to his stateroom, where he was surprised to find Walter Reed on the lower bunk. In all the confusion, the only two medical officers on board had been given one room until separate quarters could be assigned.

As the lights in their cabin went out that night, Reed asked, “Doctor, were you mixed up in the celebration?” Truby dutifully explained that he had been at the quarantine station all day, but secretly, he was flattered by Reed’s concern. “He had always shown some interest in me since my entrance examination,” Truby would later write.

During the few days at sea, Reed and Truby discussed yellow fever. Reed was excited by the work the board had done examining the blood of yellow fever victims. Their findings, along with Agramonte’s independent blood cultures, had finally put an end to Sanarelli’s claims; Reed was satisfied that they’d finished that first, important objective, and he was anxious to see what Lazear had found in his insect work. Now, they could finally turn their attention to the mosquito theory.

As the Rawlins made its way north, and the sea air cooled, Reed talked to Truby openly and excitedly about the work on yellow fever. Duty done, he looked forward to returning to Cuba as soon as possible to launch the investigative portion of their study—his real passion. “He was much pleased,” wrote Truby, “with the deep interest Lazear was showing in the mosquito work.”

Yellow fever had been arguably the most feared disease in America and the Caribbean for two centuries; a few more weeks could hardly make a difference.