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

Part III. Cuba, 1900

Chapter 23. The Mosquito

It would not take long for the mosquito theory to prove true. After the Yellow Fever Board left Cuba at the turn of the century, Major William C. Gorgas turned his focus to eradicating the Aedes aegypti mosquito in Havana, and later Panama, basing his work on Reed’s findings. If science could not yet conquer the virus, man would at least destroy its accomplice.

Gorgas, a southerner who had been rejected from West Point, was known by a number of women as “the gorgeous doctor” around the army bases. He had been appointed to oversee sanitation in Havana during the Spanish-American War. He was also a close friend of Walter Reed’s. The two men had a number of things in common. Both had studied at Bellevue; both had served as frontier doctors; both sought out knowledge, relishing books. But there were also differences. Reed was a physician who ended up in the military; Gorgas was a military man who ended up a doctor.Where Walter Reed would fight disease in the lab, Gorgas would attack it head-on.

Gorgas’s campaign was one of the most successful and widespread sanitation campaigns in history. Not only adult mosquitoes but also their breeding grounds had to be destroyed. That meant addressing every single open-water source in the city, whether it was a flower vase, broken pot or puddle of water. Gutters were disinfected. Ponds were filled with larvae-eating fish. This was also a time when water was still stored in barrels and cisterns—perfect breeding grounds for the fresh-water-loving Aedes aegypti. Where the pipe connected to the barrel, Gorgas insisted screens had to cover the opening.

The city was divided into districts, and Gorgas sent his men into every home and dwelling in Havana for inspection. It was not an easy task. The locals would often hide containers when the “mosquito hunters” came through the neighborhood, but Gorgas would not be deterred. He soon had his officers keep accurate count of every container that could hold water—all had to be accounted for during an inspection. Barrels, jars and containers were given a slick, top layer of oil to suffocate mosquito eggs and wigglers. If people feared the oil or complained that it changed the taste of water, mosquito wire was strung across the top. Even mosquito traps were used—pans of fresh water were left out where the female mosquito could lay eggs. The water was then disinfected and the eggs killed before they could hatch.

Gorgas also attacked the problem at local hospitals. Fever patients were strictly quarantined with mosquito netting over their beds and strips of paper sealing any cracks in the wooden-frame buildings. Pyrethrum, an insect powder, was burned inside the room, and a light was held in the corner to attract wayward mosquitoes and stun them.

Finally, Gorgas made mosquito control a personal responsibility,sending out inspectors and fining citizens when mosquito larvae were found on their property or in their home. It is a practice still used today in Havana.

Gorgas’s persistence proved highly effective. There was one yellow fever death in March 1901 and not a single one in the months of April, May or June. Malaria rates dropped dramatically as well. In their book Yellow Jack, John Pierce and Jim Writer wrote, “Yellow fever had been constantly present in Havana for 150 years and was nearly wiped out in less than 150 days.” Gorgas himself would write: “It seems to me that yellow fever will entirely disappear within this generation, and that the next generation will look on yellow fever as an extinct disease having only a historic interest. They will look on the yellow fever parasites as we do on the three-toed horse—as an animal that existed in the past, without any possibility of reappearing on the earth at any future time.”

Gorgas would go on to apply the same techniques in the development of the Panama Canal. French engineer Ferdinand de Lesseps, who had earned fame building the Suez Canal, had attempted to build the Panama Canal in 1881. The seventy-four-year-old engineer was met with disastrous results and lost as many as one-third of the men to yellow fever and malaria. Eventually, the project was abandoned. In 1904, Gorgas was assigned as the medical officer to America’s Panama Canal project. President Theodore Roosevelt, a veteran of the Spanish-American War who could fully appreciate the devastating effects of yellow fever, fought to keep Gorgas in Panama in spite of political pressure to fire Gorgas and abandon his wild ideas about mosquitoes. Even Secretary of War William H. Taft pressured the president to remove Gorgas. Finally, a friend and doctor recommended to Roosevelt, “You must choose between the old method and the new; you must choose between failure with mosquitoes or success without them.”

Gorgas again applied his aggressive techniques toward destroying the mosquito and all of its breeding grounds. Once again, Gorgas met with success. Though he continued to receive criticism from skeptics during the first few years of the canal project, he outlasted them all; and he was still the officer on duty when, in 1914, the first ships sailed through the Panama Canal. Gorgas wiped out the mosquitoes, and the cases of yellow fever and malaria dropped off the charts. By 1908, William C. Gorgas had been appointed president of the American Medical Association, and then he was named surgeon general of the U.S. Army, occupying that office during World War I and the 1918 influenza pandemic. But what Gorgas most looked forward to was returning his focus to the eradication of yellow fever. In 1920, Gorgas traveled to London en route to Africa where he would take part in a yellow fever study. While in London, Gorgas was to be honored by King George V. Before he could attend his own ceremony, however, Gorgas suffered a stroke and was admitted to a London hospital. The king visited Gorgas there, granting him knighthood. Sir William C. Gorgas died four weeks later.

After the death of Juan Guitéras’s volunteers in Havana, most notably Clara Maass, the public protest against human volunteers reached an all-time high. That, with the fact that the army had eliminated most of the mosquito’s breeding places in Havana and surrounding areas, prompted the government to halt any further testing. Carroll returned to the United States. Though Sternberg recommended that Carroll be promoted to the rank of major, it was denied due to a moratorium on promotions. Instead, Carroll received a regular army commission as first lieutenant. It was not until 1907 that he would be promoted to the rank of major as a Special Act of Congress. In the same year, Carroll began suffering from heart problems. It was suspected that because of his age and the tremendous toll yellow fever took on his body, his heart had suffered irreparable damage. James Carroll died of valvular heart disease on September 16, 1907.

When the Yellow Fever Board was dismantled, Agramonte decided to stay in Cuba where he began teaching at the University of Havana. His work with yellow fever, however, did not come to an end. He continued to champion Dr. Carlos Finlay and also defended the commission’s findings against future medical experiments involving yellow fever. Agramonte returned to the U.S. as a professor of tropical medicine at Louisiana State University in New Orleans, where he died in 1931. He was the only member of the Yellow Fever Board still alive to receive the gratitude of the U.S. government.

In 1929, through an Act of Congress, Walter Reed, Jesse Lazear, Aristides Agramonte, James Carroll and the men who volunteered for the human experiments were awarded the Congressional Gold Medal, so that their services, in the interest of humanity, may never be forgotten. The names of those men are: James H. Andrus, John R. Bullard, A. W. Covington, William H. Dean, Wallace W. Forbes, Levi E. Folk, Paul Hamann, James L. Hanberry, Warren G. Jernegan, John R. Kissinger, John J. Moran, William Olsen, Charles G. Sontag, Clyde L. West, R. P. Cooke, Thomas M. England, James Hildebrand and Edward Weatherwalks. Nearly thirty years later, two more names were added to that list: Gustaf E. Lambert and Roger P. Ames, the nurse and doctor who treated the majority of yellow fever cases at Camp Lazear.

Major William Borden, the friend who had performed Reed’s operation, began a campaign to build what would become known as “Borden’s Dream.” Borden wanted to combine the Army Medical Museum, Army Medical School and Surgeon General’s Library into a single medical center. And he wanted to name it for his friend Walter Reed.

It would take years to get the appropriate funding to buy the forty-three acres of land at Georgia Avenue, NW, and Sixteenth Street, NW, in Washington, D.C. The Walter Reed General Hospital would admit its first patients in 1909. Other buildings were added over the years, including the Army Medical School, which would one day become the Walter Reed Army Institute of Research. And the Surgeon General’s Library, located downtown, would become the National Library of Medicine. The campus would change its name to the Walter Reed Army Medical Center in 1951 on the 100th anniversary of Reed’s birth.

The redbrick hospital, complete with white columns and a fountain, originally held only 80 beds. When World War I broke out, that number jumped to 2,500. Today, the hospital admits close to 16,000 patients a year. Eventually, the center required more space and now has buildings in three different states, though the original hospital still stands in the District of Columbia. But not for long. The Walter Reed Army Medical Center is scheduled to close its doors for good by 2011, just over a century after it first opened. It will be combined with the Naval Medical Center in Bethesda, Maryland. Walter Reed’s name will live on, however; the new campus will be called the Walter Reed National Military Medical Center.