Armed Forces Institute of Pathology: Its First Century 1862-1962/Chapter VI

by Robert S. Henry

CHAPTER VI

The Walter Reed Chapter

In three tremendous years of achievement, from 1898 to the end of 1900, Maj. Walter Reed, Curator of the Army Medical Museum, and professor in the Army Medical School, wrote imperishable pages in the history of medicine.

First, as president of an Army Board of medical officers set up to investigate the typhoid fever epidemic in the camps within the United States, he helped to broaden the understanding of the ways in which typhoid spreads—an essential step in the triumph of the next decade over that disease, to be dealt with in a subsequent chapter of this story.

And then, after the field work of the Typhoid Board was completed but before its report was compiled and published, Reed was called upon to head another board of medical officers to investigate infectious diseases in Cuba, which was to discover, and prove beyond a doubt, the method of transmission of the most dreaded disease of the Tropics—yellow fever.

Yellow Fever Epidemics

Yellow fever, indeed, was more than a tropical disease. Endemic in the American tropics, it had an unaccountable and disconcerting way of breaking out in epidemic form in the cities and villages of the Temperate Zone of North America. In at least 35 years of the 18th century, yellow fever invaded the United States, extending as far north as Nantucket Island, where 259 persons died of it in 1763, and New York, where there were 2,300 deaths in 1798, and raching a climax of destructiveness in 1793, with 4,041 deaths in 6 weeks among the 40,144 inhabitants of Philadelphia, then the Capital City of the Nation.

The 19th century was even worse, with invasions in at least 77 years, rising upon occasion to great epidemics such as those of 1853, which took 7,848 lives in New Orleans; of 1855, with 2,670 deaths in New Orleans and 2,000 in Norfolk; of 1878, when 4,046 died in New Orleans and 5,150 in Memphis; and as many more in smaller and scattered communities in the Mississippi Valley. Altogether, in the years since 1793, New Orleans had suffered more than 40,000 deaths, Philadelphia more than 10,000, Memphis more than 7,500, Charleston more than 4,500, and New York almost 3,500, while the total for the United States exceeded 100,000 deaths. 1^[1]

Perhaps worse than the sickness, which attacked from three to five persons for every one who died of the disease, and certainly worse than the economic disruption, was the sheer terror of the deadly infection which struck no one knew how and against which no precautions, no defenses, seemed to avail.

Writing of the Philadelphia epidemic of 1793, eyewitness Mathew Carey says in his "Short Account of the Malignant Fever Lately Prevalent in Philadelphia," that the "consternation of the people * * * was carried beyond all bounds. Dismay and affright were in the countenance of almost every person." Flight from the city was sought by many, including some of the representatives of the Federal government while "of those who remained many shut themselves in their houses and were afraid to walk the streets * * *."

The "marks of terror" seen on every hand included burial of "the corpses of the most respectable citizens, even those who did not die of the epidemic * * * unattended by a friend or relative, and without any sort of ceremony." Pedestrians kept to the middle of the streets "to avoid being infected in passing by houses wherein people had died." The custom of shaking hands was discontinued, and it became common practice to try to keep to the windward of persons met abroad in the streets." 2^[2]

Nearly a century later, when the great epidemic of 1878 struck the Mississippi Valley, causing a loss of 16,000 lives, J. M. Keating, who lived through them, wrote of the scenes in Memphis. "Men, women and children," he said, "poured out of the city by every avenue of escape * * * by every possible conveyance — by hacks, by carriages, buggies, wagons, furniture vans, and street-drays; by bateaux, by anything that could float on the river; and by the rail-roads * * *. The aisles of the cars were filled and the platforms packed * * *. The ordinary courtesies of life were ignored, politeness gave way to selfishness, and the desire for personal safety broke through all social amenities." Twenty-five thousand persons, half the population, left the city and 5,000 more went into camp to escape the city's streets where "trade and traffic were suspended" and "death was everywhere triumphant."

The terror of the time was heightened by the fact that "neither cleanliness nor right living were a shield to stay the hand of the destroyer. He invaded the homes of the most chaste and the den of the vilest. He took innocence and infamy at the same moment and spread terror everywhere. Where sorrow was so general there could be no parade of it. There were no funerals and but little demand for funeral services * * *. Not infrequently bodies were left in the cemetery unburied for a night, so hard pressed were the managers for labor, and so numerous were the demands upon what they had * * *." 3^[3]

For every act of depravity or inhumanity there were, doubtless, deeds of devotion and unselfishness, but the overall effect of an epidemic attack of yellow fever — and any outbreak might develop into epidemic proportions— was the utter demoralization of community life. The direat that hung over the cities and villages of the United States was ample warrant for the creation of a special commission to visit the West Indies and study yellow jack in its home haunts.

Such a commission was formed in 1879, with Maj. George M. Sternberg, a future Surgeon General of the Army, as secretary. After 6 months' study in Cuba and Brazil, the Commission reported, on 16 November 1879, that "yellow fever is an epidemic, transmissable disease and the agent capable of transmitting the disease must be in the air." 4^[4]

Studies on Transmission

The suggestion of an airborne agency of transmission of the disease found lodgment in the mind of Dr. Carlos Juan Finlay of Havana (fig. 41). Dr. Finlay was Cuban-born, of Scottish and French parentage, educated in France and Germany, a graduate of the Jefferson Medical College of Philadelphia, fluent in four languages, a student of the classics, and a man of scientific attainments. He was first connected with the study of yellow fever when he was named, by the Spanish Governor General of Cuba, to work with the United States Commission of 1879 on the subject. The most meaningful consequence of the work of that commission, as it turned out, was the idea implanted in the mind of its Cuban collaborator. On 14 August 1881, Dr. Finlay read before the Royal Academy of Medico-Physical and Natural Sciences in Havana a paper entitled "The Mosquito Hypothetically Considered as the Agent in the Transmission of Yellow Fever." This was not the first suggestion of the possibility of the mosquite as a carrier of yellow fever — Dr. Josiah Clarke Nott, of Mobile, Ala., had speculated upon the possibility as early as 1848 — but Dr. Finlay was the first to go beyond speculation to the working out of a definite theory of the method of transmission, based upon experiments with a particular species of mosquito, then called Culex fasciatus, later known as Stegomyia fasciata, and now classified as Aedes aegypti.

Dr. Finlay 's theory was not ignored — he was too respected a figure for that — but it met with almost universal disbelief, and even encountered ridicule as the theory of "that crazy Cuban doctor." For this, there were more than the usual reasons for nonacceptance of a new idea. Perhaps the most potent reason of all was the lack of positive proofs resulting from Dr. Finlay's own continued experiments in which he was never able to produce a clear-cut and undoubted case of experimental yellow fever from the bite of a mosquito. 5^[5]

In the very spirit of the time, there were reasons why the Finlay mosquito theory did not receive the attention it merited. It was propounded in a period when bacteriology, in the first flush of widespread acceptance of its basic premise, was announcing with almost breathtaking frequency discoveries of new bacteria as the specific causes of particular diseases — tuberculosis among them, and tetanus, pneumonia, typhoid fever, anthrax, and diphtheria, to name a few of the scourges for which a disease-causing microorganism was found.

Naturally, the eyes of the scientific world were focused on the minute organisms which were being made visible by improved instruments and procedures, and inevitably, bacteriologists saw organisms which were taken to be the cause of yellow fever. Such "discoveries" were announced in Brazil, Mexico, and Cuba during the 1880's but further investigation by Dr. Sternberg, outstanding among American authorities on the subject, demonstrated in each instance that the supposed causative agent was not, in fact, related to yellow fever. The specific agent of the disease, according to Sternberg's report, in 1890, of his investigations carried on in Havana, Vera Cruz, and Rio de Janeiro, had not been discovered and demonstrated.

There matters stood until, in 1897, Dr. Giuseppe Sanarelli, an Italian bacteriologist of the University of Bologna, who had worked in Montevideo

Figure 41.—Dr. Carlos Juan Finlay, whose theory of transmission of yellow fever by the bite of mosquitoes was tested and proved by Walter Reed.

and Rio de Janeiro, announced his discovery of the cause of yellow fever as an organism which he called Bacillus icteroides.

The announcement created great interest in America, where studies were promptly undertaken to check and, if possible, to confirm the reported finding. One such investigation, ordered by Surgeon General Walter W. Wyman of the Marine Hospital Service—now the United States Public Health Service—resulted in a report, in 1899, which accepted Dr. Sanarelli's claim in the fullest.^[6]

Sternberg, by this time Surgeon General of the Army, assigned the task of checking the Sanarelli discovery to two members of the staff of the Army Medical Museum—Walter Reed and James Carroll—who performed the work in the laboratories of the Museum. In a "Preliminary Report," published in the Medical News of 29 April 1899, they reported that the Sanarelli bacillus was apparently a strain of the bacillus of hog cholera rather than a cause of yellow fever. Dr. Sanarelli hotly resented the Reed-Carroll findings in a communication in the Medical News of 12 August, in which he charged his "obstinate opponents" with "hiatuses of observation and inexactness in * * * experiment," leading to "gross and inexcusable error." Reed and Carroll made reply in the same journal of 9 September, refuting the charges and outlining the careful procedures of the respected laboratories of the Museum. 7^[7]

By 1899, the subject of yellow fever was of all the more pressing interest because on 1 January of that year the American Forces had formally taken over from Spain the occupation of Havana, a city which had not been entirely free of the pestilence for 140 years. Yellow fever, feeding on the non-immune personnel of the occupation forces, again broke out in epidemic form, in 1900. The opportunity and the need for a fresh, thorough, and searching investigation of the source and the spread of yellow fever had come together — and the Army, fortunately, had the men who could make the most of the opportunity and could meet the need.

The Yellow Fever Board at Work

The Surgeon General again turned to Major Reed, who had so ably directed the investigations of the Typhoid Board, and to James Carroll, his second in command at the Army Medical Museum, who had participated in the investigation of the Sanarelli bacillus. These two, with Dr. Jesse W. Lazear and Dr. Aristides Agramonte, were designated as a board to investigate infectious diseases in Cuba, set up by War Department Special Orders No. 22, 24 May 1900. All four members of the Board were happy, one might say almost inspired, choices.

Walter Reed was born on 13 September 1851, in Gloucester County, Va., 8^[8] where his father was a Methodist minister, and was reared in Farmville, Va., and Charlottesville, seat of the University of Virginia. After a year at the University in the study of the classics, Reed, compelled by slender family finances to curtail his education, managed to compress the 2-year course in medicine into 1 year, graduating third in his class before his 18th birthday. A year later, in 1870, he received a second M.D. degree from the Bellevue Hospital Medical College in New York. After 5 years as a hospital intern and a health department inspector in Brooklyn, he took the examinations for the Medical Department of the Army, partly because he wished to ask Miss Emilie Lawrence of Murfreesboro, N.C., to marry him and felt that the prospects of establishing a sufficiently assured private practice, which he said depended "more on his beard than on his brains," were not sufficiently promising to sustain the venture. He succeeded in passing the examinations, was commissioned a first lieutenant, and won his bride.

There followed 4 years of frontier service in Arizona, and a year at Fort McHenry, Baltimore, where he took advantage of the opportunity to study physiology at Johns Hopkins. The next 5 years were spent in Nebraska, after which he had a tour of 2 years at Mount Vernon Barracks in Alabama. In 1889, Reed was back in Baltimore as attending surgeon and examiner of recruits, with permission of Surgeon General Jedediah H. Baxter to pursue such courses at Hopkins as would be of practical benefit to any army surgeon, but not to take laboratory courses. After General Baxter's death, Captain Reed was permitted to take courses in pathology and bacteriology — subjects which were to determine the direction of his future career.

After 2 years more of frontier service in the Dakotas, Reed was named to the positions in the Medical Museum and the School which he held at the time of his appointment to investigate yellow fever— the appointment which he was to make of such shining service to medicine and mankind. 9^[9]

James Carroll (fig. 42) was born in England in 1854, emigrated to Canada at the age of 15, and enlisted in the U.S. Army in 1874 at the age of 20. Twelve years later, he took advantage of a tour of duty in New York to begin his medical education, which he finished with the degree of M.D. from the University of Maryland, earned while stationed in Baltimore in 1891. Postgraduate work in bacteriology and pathology at the Johns Hopkins Hospital followed, in 1892 and 1893. In the latter year, he was assigned to the Museum, where he served with the rank of Hospital Steward until 1898, when he became Acting Assistant Surgeon. 10^[10]

Jesse William Lazear (fig. 43), the third member of the Yellow Fever Board, was born in 1866 in Baltimore, where he graduated in academic studies

Figure 42.—Lt. James Carroll, a member of the Yellow Fever Board, who contracted the disease in its experiments, became sixth Curator of the Army Medical Museum, 1902-1907.

at the Johns Hopkins University in 1889. He took his medical degree at Columbia University in 1892, served at the Bellevue Hospital in New York for 2 years, and studied in Europe for a year, including time in Italy and a period at the Pasteur Institute in Paris. Back in the United States, he became bacteriologist on the staff of the Johns Hopkins University and assistant in clinical microscopy in the medical school, until he was selected by the Surgeon General's Office to go to Cuba as a bacteriologist at Camp Columbia, where he arrived in February 1900.^[11]

Aristides Agramonte (fig. 44), the youngest member of the Board and the only member who was an "immune" to the disease which was to be investigated, was born in Puerto Principe, Cuba, in 1868, the son of a Cuban patriot

Figure 43.—Dr. Jesse W. Lazear, a member of the Yellow Fever Board, who lost his life in its experiments.

insurgent against the rule of Spain. After the death of General Agramonte in battle, in 1872, the family moved to New York, where Aristides graduated from the College of the City of New York and received his M.D. in 1890, at the College of Physicians and Surgeons of Columbia University. In May 1898, at the outbreak of the war with Spain, he was appointed acting assistant surgeon in the U.S. Army, and participated in the Santiago campaign of that summer. At the time of his appointment to the Yellow Fever Board, he was in Havana, making bacteriologic studies of yellow fever cases.^[12]

Major Reed was acquainted with all three of the other members of the new Board. Carroll was his close associate at the Museum, Lazear he knew through their connections with the Johns Hopkins school, and Agramonte had done work in the laboratories of the Museum. When appointed, Doctors Lazear and Agramonte were already at work on yellow fever in Cuba, where Reed had renewed his acquaintance with them in the early spring of 1900,

Figure 44.—Dr. Aristides Agramonte, Cuban member of the Yellow Fever Board, was its only "Immune."

when he was there investigating the germicidal qualities of an "electronzone" product being offered to the Army. The personalities and capabilities of the Board which was to be created in late May were well known to its president.^[13]

The senior members of the Board, Reed and Carroll, arrived in Havana on 25 June 1900, and work was undertaken immediately. Headquarters was established at Columbia Barracks in the suburban village of Quemados de Marianao, 6 miles west of Havana. Quemados, as it happened, was in the grip of an outbreak of yellow fever, with 50 cases and 12 deaths, despite an almost ideal situation from the standpoint of general sanitation.

The first work undertaken was a further investigation of the Sanarelli bacillus, making use of the wealth of yellow fever materials available in Cuba. Blood drawn from 18 yellow fever patients and autopsies performed on 11 who had died of the disease yielded no trace of the organism so, quite early in the investigation, the Sanarelli theory as to the cause of the disease was discarded. 14 ^[14]

Reed, in fact, was to be criticized, in the clear light of knowledge after the fact, for the time spent on disproving the Sanarelli theory. With the unsolved problem before him, however, and especially with the knowledge that the Marine Hospital Service accepted Sanarelli's claims, it is hard to see how Reed could have done otherwise than make the most thorough test possible of all approaches to the mystery of the cause and propagation of yellow fever.

At any rate, little time was lost, for even while the cultures were being tested and the autopsies performed, preparations went ahead for trying other approaches. The "search for the specific agent of yellow fever," in Dr. Reed s words, was not to be abandoned but was "to be given secondary consideration, until we had first definitely learned something about the way or ways in which the disease was propagated from the sick to the well." It was regarded "as of the highest importance that the agency of an intermediate host, such as the mosquito, should either be proven or disproven." 15^[15]

Reed's attention had been drawn to the possibility of the mosquito as a transmitter of disease by the then recent work of Ronald Ross, of the British Indian Medical Service, in demonstrating that the Anopheles mosquito carried the plasmodium causing malaria between birds, while Sir Patrick Manson demonstrated that the bite of an infected mosquito could cause malaria in man. To the "brilliant work of Ross and the Italian observers"— Grassi, Bastianelh, Bignani, and others — Reed expressed his indebtedness. 16^[16]

Coming closer to the problem of an intermediate host for the cause of yellow fever, Dr. Reed was impressed by the observations of Surgeon Henry Rose Carter of the Marine Hospital Service, made during an outbreak of yellow fever in Mississippi in 1898 and published in the New Orleans Medical Journal in May 1900. These observations showed that between the occurrence of the first cases at isolated farmhouses and of the first succeeding groups of cases at the same houses there was a lapse of 2 or 3 weeks, while subsequent cases developed in a shorter period of incubation of from 1 to 7 days. To Dr. Carter, this indicated that there was in a life cycle of the infecting organism an intermediate host, such as the mosquito, which harbored the cause of the disease for a period before passing it on. 17^[17]

To the work of Ross and of Carter, Reed added a perspicacious observation of his own at Pinar del Rio, 100 miles west of Havana, where yellow fever broke out in the American garrison. One of the victims was a general prisoner, under confinement in the guardhouse since 6 June 1900, who fell sick on 12 July and died on the 18th, and was autopsied by Dr. Agramonte on the 19th. The fact that this guardhouse prisoner, effectively in quarantine insofar as yellow fever exposure by ordinary means was concerned, should sicken and die of yellow fever, led to the conjecture "that, perhaps, some insect capable of conveying the infection, such as the mosquito, had entered through the cell window, bitten this particular prisoner, and then passed out again." This, Dr. Reed added, was only a supposition, but it was a supposition no doubt strengthened by the reflection that iron bars at the windows and armed guards at the door could keep the prisoner from visiting places of infection, but would not keep infected mosquitoes from visiting the prisoner. 18^[18]

Dr. Finlay' s Mosquito Theory

And then there was Dr. Finlay and his long-held mosquito theory which he had "ingeniously discussed," as Reed put it, as early as 1881 and had repeated since, notably in papers published in 1891, 1894, 1895, and as recently as 1899. Although the Cuban doctor had "no results in support of his theory" Reed wrote, * * * the argument in favor of an intermediate host seemed so strong * * * that investigation along this line was determined upon." 19^[19]

Already, around the 1st of July, members of the Yellow Fever Board had called upon Dr. Finlay and had received his most cordial cooperation, for which Reed expressed "sincere thanks." The doctor turned over larvae and eggs of the suspected species of mosquito, which became the foundation of the breeding stock used in the experiments. Dr. Lazear, who had had entomologic training and experience with mosquitoes in Italy, was placed in charge of the work of breeding, rearing, and caring for Dr. Finlay's mosquitoes and those obtained from other sources. Hospital Steward John S. Neate, of the staff of the Medical Museum, who was sent to Cuba in June for service with the Reed Board, had the hazardous and exacting task of the daily care and feeding of Dr. Lazear's "birds." 20^[20]

To carry out the contemplated experiments, however, there had to be more than a theory and a breeding stock of mosquitoes. There had to be money, for one thing — precious little money by comparison with modern expenditures or in relation to the results accomplished, but money just the same. And there had to be experimental "animals" — and so far as anyone then knew, the only animal subject to yellow fever was the genus Man, himself.

This disturbing fact led to another problem — not where to get the men necessary for the experiments, for that problem was to be solved by ready volunteers, but whether to authorize experiments on human subjects. In the light of the results accomplished, that question does not seem as thorny now as it must have seemed to Dr. Reed, who had the responsibility for proposing such a course to Surgeon General Sternberg, and to Maj. Gen. Leonard Wood, Governor General of Cuba, who had the final responsibility for authorizing human experimentation.

It happens that the experiment was brilliantly successful, and that the only life lost was that of one of the experimenters, but it is easy to imagine, if things had turned out differently, the outcry that would have assailed those responsible. Fortunately, the United States was represented in Cuba in 1900 by a governor general who, being a medical officer himself, had the understanding of the problem and the courage to face it in his own responsibility — and Walter Reed got the necessary authority and backing.

Before all arrangements for the mosquito tests could be set up, Reed was compelled, on account of the death of Dr. Edward O. Shakespeare of the Typhoid Board, to hasten back to the United States to work on the preparation of the report of that board for publication.21^[21] He left Cuba on 2 August, and did not get back to Quemados until 4 October. In his absence, there had been developments both tragic and triumphant in the work on yellow fever.

Human "Guinea Pigs"

One of the conditions upon which the Yellow Fever Board had recommended the use of human "guinea pigs" in its work was that the members of the Board should themselves be the subject of experiment. Consequently, in the first group of eight inoculations by the bites of mosquitoes hatched from Dr. Fin lay's eggs, administered between i August and 19 August, Dr. Lazear was included as Case No. 6. The result in all eight cases, listed in the report by number only, was negative — no yellow fever. The same thing was true of Case No. 9, that of Dr. A. S. Pinto, bitten on 25 August by a mosquito infected 10 days earlier." 22^[22]

But on 27 August, Dr. Carroll was bitten by a mosquito infected 12 days before — and on 31 August, Dr. Carroll sickened with a well-defined and very severe case of yellow fever, the first such case traceable to the bite of an infected mosquito under experimental conditions. Dr. Carroll's case came very near to proving fatal and, in its aftereffects, undoubtedly shortened his life.

The second case of experimental yellow fever was that of Pvt. William H. Dean of the Seventh Cavalry who, on 31 August, the day that Dr. Carroll was taken sick, was bitten by the same mosquito which had infected him, and also by three others which 12 days before had fed on the blood of yellow fever patients. Dean, referred to in the original reports of the investigation as "XY," had a mild but definite attack of yellow fever. 23^[23]

Up to this time, there had been eleven "bitings" by the experimental mosquitoes, with but two cases of fever resulting — a circumstance which was afterward found to be due to the fact that only the female of the species could transmit the disease, and she could not do so until at least 12 days after becoming herself infected, and that the first nine "bitings" had been too soon after the mosquitoes had been fed on yellow-fever blood. Moreover, there was a shadow of doubt as to whether Major Carroll's case was of experimental or accidental origin, since he had been in infected areas before and after being bitten. As to the case of Private Dean, however, there was no doubt, since he had been a patient in the post hospital at Columbia Barracks, and had not been exposed to any source of infection other than the four experimental mosquitoes.

The Death of Dr. Lazear

In addition to the two cases of Carroll and Dean, there was the tragic case of Dr. Lazear, who was stricken on 18 September and died a week later. After his death, a notebook containing entries about his experiments was found in the pocket of a uniform which he had been wearing. This little notebook, when analyzed by Reed, furnished the clue to the secret of mosquito transmis sion of the disease— namely, that it was a matter of timing of the bites, both of the original patient from whom the disease was transferred and also of the transferee. To become infected, the mosquito must bite the sick patient within the first 3 days of illness; to transfer the infection, at least 12 days must have elapsed since the infection was acquired by the mosquito. The nine unsuccessful attempts to produce the disease were explained by the recorded fact that the original patient was bitten after the third day of his illness, or that the attempt to convey the disease was made less than 12 days after the mosquito was infected.

Dr. Lazear's own case presented a puzzle. Reed had no doubt that it was due to the bite of a mosquito but could not be sure that the mosquito was one of those reared in the laboratory. Dr. Lazear told Major Carroll and Maj. William C. Gorgas that, while engaged in letting his experimental mosquitoes bite yellow fever patients at the Las Animas Hospital in Havana, a stray mosquito had landed on his hand, and he had permitted it to drink its fill. Obscure and unfinished notations in Lazear's pocket memorandum book, however, indicated that he might have applied some of the laboratory mosquitoes to his own arm, knowing by that time that there was every chance of infecting himself with a possibly fatal disease.

This raised a question as to how the case of Lazear would be treated in the report. There was no doubt in Reed's mind of his illness and death from the bite of a mosquito, and there is persuasive evidence that he believed that the mosquito was actually one of the purebred laboratory strain which Lazear had deliberately applied to himself, and not the stray insect which Lazear hail mentioned during his illness to Carroll and Gorgas. The reason for the discrepancy, it is surmised, was possibly an apprehension on the part of the sick man that his life insurance might be forfeited if he deliberately infected himself with a possibly fatal disease.^[24] Reed decided to list the cause of Dr. Lazear's lamented death as the bite of the mosquito in Las Animas Hospital, as related by Lazear. but he accepted the case as evidence of the validity of the mosquito theory, adding strength to the Carroll and Dean cases.

While analyzing the evidence resulting from the preliminary experiments, Reed was intensely occupied in setting up arrangements for further experiments under controlled conditions designed to test the truth of the theory beyond any question.

Meanwhile, Reed felt warranted in making a report of results as far as the work had gone. This he did, in person, in a paper, "The Etiology of Yellow Fever: a Preliminary Note," read before the American Public Health Association, meeting at Indianapolis from 22 October to 26 October 1900, and published in the Philadelphia Medical Journal of 27 October. The "Preliminary Note" disposed of the bacillus icteroides of Sanarelli, and drew the flat conclusion that "The mosquito acts as the intermediate host for the parasite of yellow fever."

Reed's preliminary report got a rather cool reception, and aroused some opposition, notably from Dr. Eugene Wasdin of the Marine Hospital Service, who was committed to the Sanarelli thesis, and who attacked Reed's conclusions in the Medical Journal of November 17. 25^[25]

Studies at Camp Lazear

Before that time, Reed was back in Cuba and had plunged into the work of planning and providing a camp— Camp Lazear, it was appropriately called— where tests of the transmission of yellow fever could be carried on under conditions controlled with certainty. A site was picked near Columbia Barracks but far enough away from habitation to insure isolation. The distinguishing feature of the camp, located at Quemados de Marianao, a suburb of Havana, was two small frame buildings, each 14 by 20 feet, located on the opposite slopes of a little valley about 80 yards from each other and the same distance from the camp proper. One, the "Infected Mosquito Building," was designed to test the mosquito theory; the other, the "Infected Clothing Building," was designed to test the currently accepted theory of infection by contact with the clothing, bedding, and other articles which had been in close contact with yellow fever patients (fig. 45). 26^[26]

Camp Lazear was put in operation on 20 November 1900, manned by a service detachment of volunteers— two doctors, one an immune; one hospital steward, an immune; nine privates of the hospital corps, one of whom was immune; and an immune ambulance driver. A strict quarantine was established, with no one except the four immunes permitted to enter or leave the isolated camp.

Figure 45.—Camp Lazear. A. The small cabins in the distance are the "Infected Mosquito Building" and the "Infected Clothing Building." The tents housed the detachment. B. Building in which the fomites theory was disproved.

For subjects upon whom the experiment was to be carried out, the original reliance was placed upon securing the services of some of the numerous new Spanish immigrants to Cuba who, in the language of the agreement which each one signed, understood "perfectly well that in case of development of yellow fever in him, that he endangers his life to a certain extent but it being entirely impossible for him to avoid the infection during his stay in this island, he prefers to take the chance of contracting it itentionally in the belief that he will receive * * * the greatest care and the most skillful medical service."

A further consideration was the payment of $100.00 in American gold and, in case of contracting yellow fever, an additional $100.00, to be paid to the subject if he survived; otherwise, to the person whom he designated. The subject bound himself not to leave the camp during the period of the experiments, forfeiting all benefits if he should do so. 27^[27]

Some of the Havana newspapers "have abused us soundly and have charged us with all kinds of inhumanity and barbarity," Reed wrote General Sternberg on 26 November, but, he added, "the Spanish consul, a most courteous and intelligent gentleman, assures us that we shall have his support, as long as we do not use minors and the individual gives his written consent * * *." 28^[28]

Soldier Volunteers

Although no United States soldier was asked to submit to the inoculation tests, Pvt. John R. Kissinger, of the hospital detachment, and John J. Moran, a civilian clerk in the headquarters of Brig. Gen. Fitzhugh Lee, astonished and delighted Reed by volunteering, upon the condition that they receive no money. There is an apocryphal story that Major Reed, upon receiving their unsolicited offer, which was renewed after the risks they ran had been carefullv explained to them, rose, touched his forehead, and said, "Gentlemen, I salute you." The story of the salute is probably not true in detail, but he did say in his published account of the experiment that "in my opinion this exhibition of moral courage has never been surpassed in the annals of the Army of the United States." 29^[29]

The remark was made of Private Kissinger, who was the first to become the subject of experiment and to contract yellow fever, but the same remark would apply to Moran, who volunteered along with him, and to the other 12 who volunteered to subject themselves to inoculation with fever — Dr. Robert P. Cooke of Virginia, James A. Andrus of Pennsylvania, Thomas M. England of Ohio, Levi E. Folk of South Carolina, Wallace W. Forbes of Illinois, James F. Hanberry of South Carolina, James Hildebrand of Georgia, Warren G. Jernegan of Florida, William Olsen of Wisconsin, Charles G. Sontag of South Carolina, Edward Weather walks of New Jersey, and Clyde L. West of Indiana. 30^[30]

The first inoculation by mosquito bite which produced yellow fever was that of Kissinger, who was bitten on 5 December, and fell sick on the night of the 8th. "As he had been in our camp 15 days before being inoculated," Reed exultantly wrote his wife, "and had no other possible exposure, the case is as clear as the sun at noonday, and sustains brilliantly and conclusively our conclusions." 31^[31] Between the 10th and the 15th, the proof was strengthened by the development of three more cases, after which there were no cases for 10 days, due to a cessation of inoculations— a hiatus which demonstrated that the four cases in 1 week did not mean that the camp itself was infected. " 32^[32]

While continuing his experiments with mosquito bites, Dr. Reed was carrying on a rigorous test of the theory that infected clothing and bedding was the transmitting agent of the fever — a theory unquestioningly accepted by the medical profession and acted upon in framing and enforcing quarantine regulations. The very name given to these infected articles, supposed to be capable of passing on the flame of infection— "fomites," a word derived from the Latin term for "tinder" — indicates how seriously they were regarded as a means of spreading the flames of the fever. The fomites theory, as Reed remarked, was "not disputed by anyone." 33^[33] To establish the mosquito-infection theory was not enough so long as the theory of infection by fomites was left undisturbed.

Testing the "Fomites" Theory

Consequently, on 30 November the testing of the infective power of fomites was begun in the "Infected Clothing Building"— a tight little structure, proofed against the entrance of mosquitoes, with a minimum of ventilation, and heated above 90 ° F. Into this environment, there were introduced four large locked boxes of sheets, blankets, pillowslips, and other articles "contaminated by contact with cases of yellow fever and their discharge * * * purposely soiled with a liberal quantity of black vomit, urine and fecal matter * * *." Dr. Cooke and Privates Folk and Jernegan, all nonimmunes, entered the building, unpacked the boxes, handled and shook out their contents so as to "disseminate through the air of the room the specific agent of yellow fever, if contained in these fomites * * *," used the fomites to make their beds, and lay down to sleep upon the beds so made— and continued to do likewise for each of the next 19 nights, after which they were quarantined while other soldiers— England, Hanberry, Hildebrand, and Weatherwalks — repeated the horrible experience, even adding to it the macabre touch of sleeping in the shirts which had been worn by yellow fever victims.' 34^[34]

Summing up the ordeal of the fomites, Major Reed said, in his address at Baltimore, that these volunteers, sleeping every night in a building into "which no sunlight ever came" and which was purposely designed to lack air ventilation, "engaged in the morning in packing boxes with garments much soiled by contact with the bodies and excreta of yellow fever patients, and at night unpacking these same boxes in order to obtain articles for their beds and clothing for their bodies; in other words, sleeping in the very beds and garments just vacated by cases of yellow fever * * * averaging each 21 nights amid such surroundings, came out of this pesthouse * * * none the worse for their exposure. Not one had contracted the disease." 35^[35]

"Yellow fever can no more be transmitted in that way than intermittent fever," Dr. Reed wrote his wife, while the experiments were still underway. Later, in an address before the American Public Health Association, meeting at Buffalo on 18 September 1901— a year after he had presented his "Preliminary Note" to the same organization— Reed declared that the doctrine of the spread of yellow fever by fomites "burst like a bubble" at the first touch of "actual experiment upon human beings." 36^[36]

In clearing up theories, there was another that called for attention— the theory of infection from a contaminated house. To test this, there was the "Infected Mosquito Building"— well ventilated, tightly screened, with a mosquito-proof screen dividing its interior into two parts, differing only in that one side of the building was free from mosquitoes, while infected insects were released in the other side. In this side, Mr. Moran allowed 15 mosquitoes to bite him during three visits, while two other nonimmunes, acting as controls, occupied the other side of the building, free of mosquitoes. Moran, who had been in quarantine for 32 days before being bitten and had had no other chance to catch yellow fever, sickened on Christmas morning. The controls, who spent 14 nights in the room protected by the wire screen, but who had breathed the same air as Moran, remained well. The demonstration was complete that a house is infected with yellow fever only if it contains infected mosquitoes.37^[37]

To insure that the particular species of mosquito which possessed this infective potency should be accurately depicted for surer identification, Major Reed asked General Sternberg, on 22 December, to have Dr. J. C. McConnell of the Medical Museum sent to Cuba to "make drawings of the mosquito and larvae from live specimens." Dr. McConnell, who had returned to the Museum as anatomist and who acted, in addition, as a one-man Medical Illustration Service, came down bringing his camera lucida and paper, and by the end of the year was at work on his sketches. 38^[38]

Transmission by Mosquitoes Established

As the year ended, Reed had every reason for gratification. The fomites experiment was still underway, as were experiments with the transmission of yellow fever by direct infusion of infected blood from an active case to nonimmune volunteers. These experiments, mostly carried out in January and February 1901, proved that the presumptive "parasite" of yellow fever circulates in the bloodstream and is directly transmissible from man to man without the necessity of an intermediate host. These experiments, however, in no way vitiated the conclusion that the only method of propagating yellow fever in nature is by the bite of a mosquito which has drunk the blood of a yellow fever patient— a conclusion which was to be presented by Reed, on behalf of himself, Carroll, and Agramonte, and with a tribute to Lazear, before the Pan American Medical Congress, meeting in Havana on 6 February 1901.

This, and the other conclusions of the report, backed by the unimpeachable testimony of unassailable research techniques, were to be almost immediately accepted by the medical world and the world at large. To Dr. Finlay, as Reed said, "must be given full credit" for the original idea and for the persistence with which it was maintained in the face of indifference and even ridicule. But to Walter Reed, James Carroll, Aristides Agramonte, and the lamented Jesse W. Lazear, and to the corps of intrepid and dedicated volunteers who offered themselves for experiment, must go the credit for demonstrating and establishing the fact that explained the mysterious behavior of yellow fever and offered a method of successfully combating it. As Dr. Agramonte wrote in his biographical sketch of Dr. Finlay, speaking of the parts played by the Cuban doctor and the U.S. Army Board, "the great credit due the one robs not the other of a particle of his glory." 39^[39]

Already, even before the experiments were concluded and the results presented, the findings had begun to be put into effect in the American Forces occupying Cuba. At the suggestion of Maj. Jefferson Randolph Kean, Acting Chief Surgeon, General Wood issued General Orders No. 6 on 21 December 1900, prescribing mosquito-control methods for application at all posts on the island, "the Chief Surgeon of the Department having reported that it is now well established that * * * yellow fever * * * (is) transmitted by the bites of mosquitoes * * *." 40^[40]

Reed himself had been positive ever since Kissinger came down with yellow fever that, as he wrote Lt. Albert E. Truby on the 10th, "the theory is all right." 41^[41] The theory, as he wrote his wife on 9 December, was Finlay's, "and he deserves great credit for having suggested it, but as he did nothing to prove it, it was rejected by all, including General Sternberg. Now we have put it beyond cavil * * *." 42^[42]

Writing to his wife again, in the closing minutes of the closing year of the 19th century, Reed expressed feelingly the glow of modest exultation at this great accomplishment:

Only ten minutes of the old century remains. Here I have been sitting, reading that most wonderful book, La Roche on Yellow Fever written in 1853. Forty-seven years later it has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most wonderful, dreadful pest of humanity and to put it on a rational and scientific basis. I thank God that this has been accomplished during the latter days of the old century. May its cure be wrought in the early days of the new! The prayer that has been mine for twenty years, that I might be permitted to do something to alleviate human suffering has been granted! * * * Hark, there go the twenty-four buglers in concert, all sounding "taps" for the old year. 43^[43] On February 9, 1901, 3 days after he had presented to the Pan American Medical Congress the results of the experiments at Camp Lazear, Major Reed sailed for home, leaving Carroll behind in Havana to finish up certain details, including winding up the affairs of Camp Lazear, which was closed on 1 March 1901." 44^[44]

In Havana also were Dr. Finlay, the theorist whose theories had been vindicated by experiment, and his friend— and Reed's— Maj. William Crawford Gorgas, whose original skepticism as to the theory hat! been replaced by acceptance, and whose acceptance and resulting action was to give the theory its first practical application. Dr. Gorgas still was not convinced that the mosquito was the only means of natural transmission of the disease, but realizing that the insects were effective carriers, he declared war on the Stegomyia fasciata in Havana.

Yellow fever had claimed an average of nearly 500 lives in Havana annually for the 20 years, 1880-1899. In 1899 and 1900, the city was "cleaned up," with good effect as to general health, but still there were, in 1900, more than 300 deaths from yellow fever. In January 1901, there were seven deaths, and in February, five. In February, the new regulations as to mosquito control were put into effect. In March, four new cases were reported, with one death. In April, there were three cases and no deaths; in May, four cases and no deaths; in June, neither a case nor a death. In July, the disease was re-introduced into Havana from the interior, with three cases and one death. August saw eight new cases and two deaths; September, five cases and one death; October, two cases but no death— and thereafter, for the remainder of 1901 and the entire year of 1902, neither new cases nor deaths from the scourge that for over 140 years had never been absent from Havana's streets and homes. 45^[45]

The task of mosquito control in a tropical city was prodigious in its difficulties and infinitely vexing in its details, but it was accomplished by the vigor, firmness, patience, and tact of the great health administrator, Gorgas. And in its accomplishment, it provided the perfect proof of the correctness of the conclusions of the great medical discoverer, Reed.

Back in Washington, Reed continued his work for the Yellow Fever Commission, as well as his work as Curator of the Medical Museum and professor of bacteriology at Columbian (now George Washington) University. He was, for the season, relieved of his work as professor of the Army Medical School which had been suspended for the period of the Spanish War and was not to resume its sessions until October 1901. Meanwhile, Reed, as he wrote to Carroll, who was still in Havana, was "tied down to the Army Examining Board." 46^[46]

Search for a Cause

The Yellow Fever Commission had succeeded in demonstrating to the satisfaction of the world the method of transmission of the disease, but the discovery of the activating cause of the disease itself was unfinished business. In 1898, Friederich A. J. Löffler and Paul Frosch had demonstrated that hoof-and-mouth disease in animals is due to something called, for want of a better name, a "virus." Prof. William H. Welch, who had taught Reed at Johns Hopkins, and who had been a fellow-pupil of Loffler's under the great Robert Koch, called Reed's attention to the Löffler-Frosch findings in the early summer of 1901.

To Reed and Carroll, it appeared possible that the same sort of substance might be the cause of yellow fever. A brief outbreak of tht disease in Santiago de las Vegas offered an opportunity to put the supposition to the test, so Carroll was sent back to Cuba in August 1901 to carry on the experiments. The tests showed that the infective agent was present in the blood and in the blood serum of fever patients, and that the power to produce fever persisted even after the serum had passed through "the pores of a filter which ordinarily serves to prevent the passage of all known bacteria." 47^[47] It was to be yet another quarter of a century before it was finally established that the infecting agent of yellow fever is not a visible "parasite" such as Reed and Carroll sought, but is a virus which filters had not yet trapped nor microscopes revealed.

In the little more than a year which remained of what has been described as the "fifty-one years of Walter Reed's industrious, blameless life," 48^[48] Reed lost no appropriate opportunity to give the medical world the lessons learned in the work of the Yellow Fever Commission. Besides his appearance before die Medical and Chirurgical Faculty of Maryland at Baltimore in April 1901, and his second appearance before the American Public Health Association in September, both of which have already been referred to, he appeared before the American Association of Physicians, meeting in Washington in July,"49^[49] and before the Society of American Bacteriologists, meeting in Chicago at the end of the year. 50^[50] In addition, he published in the Journal of Hygiene, a British periodical, a summary article of recent researches concerning the etiology, propagation, and prevention of yellow fever by the United States Army Commission. 51^[51]

In these various papers and publications, he outlined in detail the experimental procedures followed and the results obtained, demonstrating to all who heard and read that both in its occurrences and its nonoccurrences at Camp Lazear, "yellow fever strictly obeyed the behests of the experimenters."

Dr. Reed resumed his teaching, while continuing as Curator of the Medical Museum, but by the fall of 1902, it became evident that his strength was failing. In November, he suffered an attack which was diagnosed as appendicitis. On the 17th, at the Army General Hospital at Washington Barracks, he under-went an operation for removal of a ruptured appendix. "Major Reed received the accepted treatment" of that period, according to Dr. Charles Stanley White, and "was in most competent hands." 52^[52] Everything was done for him that medical experience dictated and the personal solicitude of affectionate association could suggest— but on 22 November 1902, Walter Reed, who "gave to man control over that dreadful scourge, Yellow Fever," 53^[53] being but 51 years of age, died, to live among the medical immortals.

1. 1 (1) Yellow Fever: A Symposium in Commemoration of Carlos Juan Finlay. The Jefferson Medical College of Philadelphia, 22-23 September 1955, pp. 4, 5. [Hereinafter cited as Symposium.] (2) Kelly, Howard A.: Walter Reed and Yellow Fever, 2d edition. Baltimore: Medical Standard Book Co., 1906, pp. 83, 84, 204, 210, 221, 233, 238. (3) Reed, W., and Carroll, J.: The Prevention of Yellow Fever. Medical Record (New York) 60: 641, 26 October 1901.
2. 2 Carey, Mathew: A Short Account of the Malignant Fever Lately Prevalent in Philadelphia, Philadelphia. 1793, quoted in Kelly, op. cit., pp. 212-215.
3. 3 Keating, J. M.: History of the Yellow Fever Epidemic of 1878 in Memphis. Tenn.. quoted in Kelly, op. cit., pp. 223-228.
4. 4 Symposium, p. 5.
5. 5 ( 1 ) Symposium, pp. 96—101. Dr. Nott's suggestion as to mosquitoes was published in the New Orleans Medical Journal, volume IV, pp. 563 ff., under the title "Yellow Fever Contrasted with Bilious Fever: probably insect or animalcular origin." Dr. Finlay's theory first appeared in the Annales de la Real Academia. volume LVIII. pp. 147-169.
6. Reed, Walter: The Propagation of Yellow fever: Observations Based on Recent Researches. (An address given before the 103d Annual Meeting of the Medical and Chirurgical Faculty of the State of Maryland, held in Baltimore, 24-27 April 1901.) Published in the Medical Record (New York) 60: 201-209, 10 August 1901. [Hereinafter cited as Baltimore Address.]
7. 7 Medical News, Philadelphia, 74: 513-514, 29 April 1899; 75 : 193-199, 12 August 1899; 75: 321- 329, 9 September 1899.
8. 8 A piece of one of the original logs of which the house at "Belroi," where Walter Reed was born, was constructed, is exhibited at the Medical Museum, AFIP.
9. 9 Reed's career up to the time of the creation of the Yellow Fever Board is based on Kelly, op. cit., chapters I, II, and III, and upon Maj. Jefferson Randolph Kean's memoir, included in Senate Document 822, 61st Congress, 3d session, 1911, pp. 14-16 and 38-40. Major Kean refers in these memoirs to a little Indian girl who had been so badly burned in a campfire that she had been abandoned to die by her people, but whom Dr. Reed had rescued and saved, taking her into his home for rearing. The story is told in greater detail in an account of an interview, with Miss Blossom Reed, the major's daughter, at her home at Blue Ridge Summit, Pa., on the 109th anniversary of his birthday, which appeared in the Washington Daily News of 14 September 1960.
10. 10 (1) Kelly, op. cit., pp. 262, 263. (2) Lamb, D. S.: A History of the Army Medical Museum. 1862-1917, compiled from the Official Records. Mimeographed copy in historical records of AFIP, p. 114.
11. (1) Kelly, op. cit., pp. 281-283. (2) Truby, Albert E.: Memoir of Walter Reed: The Yellow Fever Episode. New York: Paul B. Hoeber. Inc.. 1943, pp. 61; 73, 82.
12. Kelly, op. cit., pp. 288-299.
13. (1) Truby, op. cit., pp. 73-77. (2) Lamb, op. cit., p. 118. (3) Senate Document 822, 61st Congress, 3d session, p. 26 (Dr. Agramonte's statement).
14. 14 Reed, W., Carroll, J., Agramonte, A., and Lazear, J. W.: The Etiology of Yellow Fever. A Preliminary Note. Philadelphia Medical Journal 6: 790-796, 27 October 1900.
15. 15 Baltimore Address, p. 203.
16. 16 (1) Reed et al., Philadelphia Medical Journal, 6 (1900), p. 791. (2) Reed, W.: Recent Researches Concerning the Etiology, Propagation and Prevention of Yellow Fever, by the United States Army Commission. Journal of Hygiene 2: 107, April 1902. Ross had demonstrated the role of the mosquito as the intermediate host to the plasmodium of malaria in 1897. The year before, 1896, Major Reed had reported to The Surgeon General upon a malaria epidemic at Washington Barracks (now Fort Lesley J. McNair) and Fort Myer, Va. By careful epidemiological investigation, he had ruled out the possibility of drinking water as a cause and concluded that the fevers were due to "emanations from the Potomac flats. As Col. Hugh R. Gilmore, Jr., Curator of the Medical Museum, put it, Reed "correctly implicated airborne 'emanations' — but the 'emanations' had wings!" In Gilmore, H. R., Jr.: Malaria at Washington Barracks and Fort Myer: Survey by Walter Reed. Bulletin of the History of Medicine 29: 346-351 (July-August) 1955.
17. 17 Reed et al., Philadelphia Medical journal, 6 (1900), pp. 791, 792.
18. 18 Baltimore Address, pp. 202, 203.
19. 19 Reed et al., Philadelphia Medical Journal, 6 (1900), p. 792.
20. 20 (1) Truby, op. cit., pp. 92, 93. (2) Lamb, op. cit., p. 119.
21. 21 Ireland, M. W.: The Conquest of Yellow Fever. The Military Surgeon 64: 244-251, February 1929.
22. 22 (1) Reed et al., Philadelphia Medical Journal, 6 (1900), p. 792. (2) Truby, op. cit., pp. 126, 220.
23. 23 Reed et al., Philadelphia Medical Journal, 6 (1900), p. 792.
24. (I) Truby, op. at., pp. .23-127. (2) Hench, Philip S.: Conquerors of Yellow Fever. Hygeia (The Health Magazine) October ,941, p. 5. Dr. Hench. of the Mayo Clinic, has found in the study of the Walter Reed epic an absorbing avocation. In 1940. he visited the remains of Camp Lazear, accompanied by John J. Moran. one of the original volunteers, who identified the "infected bedding and clothing building," falling into decay. Efforts to have the building restored and preserved failed. New York Times, 4 November 1951.
25. 25 Dr. Wasdin's article appears in: Philadelphia Medical Journal 6: 951, 952, 17 November 1900.
26. 26 Reed, W., Carroll, J., and Ajramonte, A.: The Etiology of Yellow Fever. An Additional Note. Journal of the American Medical Association 36: 431-440, 16 February 1907.
27. 27 An original contract, in Spanish, signed by Walter Reed and Vicente Presedo, with an English translation, is displayed in the Medical Museum of the Armed Forces Institute of Pathology.
28. 28 Truby. op. cit., p. 153.
29. 29 Baltimore Address, p. 205.
30. 30 The names of the "Participants of Yellow Fever Investigations in Cuba" appear annually in a special "Role of Honor" in the Army Register, in compliance with an Act of Congress approved by President Calvin Coolidge on 28 February 1929. In addition to those who took part in the first series of experiments, the Roll of Honor includes those who volunteered in 1901 to undergo injection of blood from infected persons, as follows: Assistant Surgeon Roger P. Ames of Louisiana, John R. Bullard of Massachusetts, Albert Coyington of North Carolina, Wallace W. Forbes of Illinois, and Paul B. Hammann of Illinois (born in Germany). In special category was Gustaf E. Lambert, male nurse, born in Sweden, who cared for the fomites in the infected clothing experiment. Not to be forgotten also are the five Spanish volunteers, who stayed to the end of the first series of experiments, four of whom developed yellow fever — Jacinto Mendez Alvarado, Antonio Benigno. Micanor Fernandez, Jose Martinez, and Vicente Presedo; and two others who participated in the 1901 experiments — Pablo Ruiz Castillo and Manuel Gutteriez Moran.
31. 31 Kelly, op. cit., pp. 140-142.
32. 32 Reed et al., Journal of the American Medical Association, 36 (1901), p. 435.
33. 33 Baltimore Address, p. 202.
34. 34 Reed et al.. Journal of the American Medical Association, 36 (1901), pp. 431-440.
35. 35 Baltimore Address, pp. 207, 208.
36. 36 (1) Kelly, op. cit., p. 149. (2) Reed and Carroll, Medical Record, 60 (1901), p. 642.
37. 37 Baltimore Address, pp. 204, 205.
38. 38 Truby, op. cit., pp. 166, 172. 177.
39. 39 Agramonte, A.: Dr. Carlos J. Finlay: A Biographical Sketch. Transactions of the American Society of Tropical Medicine 10: 27-31, 1916.
40. 40 Truby, op. cit., pp. 187, 224, 225.
41. 41 lbid. figure 26.
42. 42 Kelly, op. cit., p. 141.
43. 43 Ibid., pp. 152, 153.
44. 44 (1) Ibid., p. 163. (2) Reed, Journal of Hygiene, 2 (1902), p. 108.
45. 45 (1) Reed, Journal of Hygiene, 2 (1902), pp . 101, 102. (2) Kelly, op. cit., pp. 182-187. (3) Senate Document 822, 61st Congress, 3d session, pp. 221, 235, 236.
46. 46 Senate Document 822, 61st Congress, 3d session, pp. 163, 164 (letter of 26 February 1901).
47. 47 (1) Ibid., p. 165. (2) Reed, Journal of Hygiene, 2 (1902), p. 106.
48. 48 McCaw, Walter : Walter Reed: A Memoir. Washington: The Walter Reed Memorial Association, 1004. p. 1.
49. 49 Reed, W.. Carroll, J., and Agramonte, A.: Experimental Yellow Fever. American Medicine. Philadelphia 2: 15-23, 6 July 1901.
50. 50 Reed, W., and Carroll. J.: The Etiology of Yellow Fever. A Supplemental Note. American Medicine, Philadelphia 3: 301-305, 22 February 1902.
51. 51 Reed, Journal of Hygiene, 2 (1902), pp. 101-110.
52. 52 White Dr. Charles Stanley: The Last Illness of Major Walter Reed. Medical Annals of the District of Columbia '24: 396-398, August 1955. The surgeon in charge was Maj. William Cline Borden assisted by Lieutenants Ford and Conner, with Dr. White as anesthesiologist. Others in attendance were: Surgeon General O'Reilly, Maj. J. R. Kean, Capt F. P. Reynolds, and Doctors Wallace Neff and Bovee. Dr. Borden, who was Reed's devoted friend, was more than any other one individual responsible for the creation of the Army Medical Center which bears the name of Walter Reed-a project "known to his contemporaries as "Borden's dream'." In Ramsey, Herbert P.: Washington Medical Institutions: Walter Reed Army Medical Center. Medical Annals of the District of Columbia 28: 225-231. April 1959.
53. 53 (1) The quotation is from the citation accompanying the award of an honorary M.A. degree by Harvard University in 1902. (2) In 1911 the U.S. Senate published Document 822. 61st Congress, 3d session, under the title "Yellow Fever." The document includes tributes to Reed and his work among them the declaration of President Theodore Roosevelt that Reed left "mankind his debtor and the statement of Gen. Leonard Wood that "his was the originating, dieting, and controlling mind in this work • * *" The document also reprints seven of Reed's papers and addresses on yellow fever and three by Carroll on the same subject, together with cop.es of reports of the practical application of the discoveries of the Yellow Fever Board, by Col. Valery Havard, Chief Sanitary Officer of the Department of Cuba, and by Maj. W. C. Gorgas, Chief Sanitary Officer in Havana.