CHAPTER 13

The Yellow Fever Commission

WAR DEPARTMENT,

Surgeon General’s Office

Washington, May 23, 1900.

To the ADJUTANT GENERAL OF THE ARMY.

Sir:

I have the honor to recommend that Major Walter Reed, Surgeon, U.S. Army, and Contract Surgeon James Carroll, U.S. Army, be ordered to proceed from this city to Camp Columbia, Cuba, reporting their arrival and instructions to the commanding officer of the post, the commanding general, Department of Havana and Pinar del Rio and the commanding general Division of Cuba.

I also recommend the organization of a medical board, with headquartersat Camp Columbia, for the purpose of pursuing scientific investigations with reference to the infectious diseases prevalent on the island of Cuba. —Stricken

The board to be constituted as follows:—Major Walter Reed, Surgeon, U.S. Army; Contract Surgeon James Carroll, U.S. Army; Contract Surgeon Aristides Agramonte, U.S. Army; and Contract Surgeon Jesse W. Lazear, U.S. Army.

Contract Surgeon Agramonte is now on duty in the City of Havana and Contract Surgeon Lazear at Camp Columbia. It is not considered necessary to relieve them from the duties to which they are at present assigned.

The board should act under general instructions which will be communicated to Major Reed by the Surgeon General of the Army.

Very respectfully, George M. Sternberg, Surgeon General, U.S. Army

On the evening of June 25, 1900, Walter Reed sat on the deck of the Sedgwick and wrote a letter to his wife. A chill imbued the inky sky, and Reed fastened the overcoat his wife had sent aboard just moments before the steamer set sail from New York that morning. He had not thought to pack it; after all, he would hardly need it once he arrived in Cuba.

The unfinished letter to his wife would take several more attempts to finish, which Reed literally chronicled as Effort no. 1, Effort no. 2, Effort no. 3 at the tops of the pages. As with most of Reed’s voyages, he would spend much of it sucking lemons and eating crushed ice to keep the motion sickness at bay. Regardless of his efforts, and regular doses of bromide, Reed consistently “fed the fish” over the railing of the boat, losing five pounds on the voyage.

As the breeze began to warm and clouds gathered over the green fringe of the Florida coast, Reed managed to keep down an orange, a cup of coffee and dry toast. A ribbon of rain showers lined the coast, and from the deck, the men watched schools of flying fish and porpoises chase the Sedgwick as the 5,000-ton steamer barreled toward Cuba.

In the wan morning light, before the sun had burned off the haze, the buildings of Havana appeared in shades of gray and blue, wedged between the dark sea and pale sky. But as the light rose, the buildings brightened, and the weary stone of El Morro Castillo warmed, incandescent bursts of green growing amid its stones. Waves knocked against the fortress to one side of the harbor and against the seawall on the other as though the sea itself were sleeping, its breast rising and falling in heavy, rhythmic breaths.

Reed sat on the deck, again writing a letter to his wife, and watched Havana come into focus, smelling the salt, steam and wet stone, and farther off, the scent of smoke, coffee and old hay. The harbor blazed with color: The flags of nations all over the world whipped in the breeze, white sails skimmed between steamers, and green treetops glowed against cobalt-colored mountains far in the distance. Then his eyes fell on an iron corpse, mostly submerged but for a tangle of beams like splintered bone, wires flailing and an American flag at half-mast. His handwriting grew wilder and slanted as he wrote, “The City of Havana from the shore is certainly very beautiful, but as I write I see the wreck of the Maine not more than 400 yards away, and it makes my very blood to boil—The whole Island wasn’t worth the loss of those brave men & gallant ship—Damn every Spaniard that ever lived!”

On May 21, the same day that Jefferson Kean had recorded the first two cases of yellow fever in Quemados, Surgeon General Sternberg had put in a request in Washington, D.C., to form a board to examine yellow fever. Though the directive would be to study “all infectious disease” afflicting the camps in Cuba, Sternberg made sure, verbally, that the focus would be yellow fever.

Sternberg had assigned Walter Reed and James Carroll to probe the finding of Dr. Sanarelli, an Italian bacteriologist who claimed to have found the microbe that caused yellow fever. For almost a decade after the congressional committee’s conclusion that bacteria caused yellow fever, medical theories and experiments on the subject of the disease stagnated until, on July 3, 1897, the British Medical Journal published an article about Dr. Giuseppe Sanarelli’s discovery of Bacillus icteroides: the bacteria that caused yellow fever. Sternberg’s pride had been wounded. Sternberg had missed his opportunity for fame with diseases like tuberculosis, pneumonia and malaria. A skilled microbe hunter, he had a personal passion to find and solve the yellow fever question, and after Sanarelli made some caustic remarks about a germ Sternberg had discovered, it became a battle of the egos. It also became another clash between the U.S. Army Medical Corps and the Marine Hospital Service. Sternberg was surgeon general of the Army Medical Corps while the Marine Hospital Service backed Sanarelli. The confrontation would continue for years.

A fresh outbreak of yellow fever in Havana and nearby camps provided Sternberg with the opportunity to test Sanarelli’s new bacteria. He asked Reed to investigate it, and soon thereafter, to head the Yellow Fever Board. Though Sternberg would later take credit for recommending the three other members of the board, it seems more likely that Reed himself chose or at least suggested them. After his return from Cuba in April, Reed had submitted his report on electrozone to Surgeon General Sternberg, ending with, “In carrying out the experimental part of this report, I desire to state that I have received valuable aid from Acting Assistant Surgeons A. Agramonte, Jesse Lazear, and James Carroll, U.S. Army.” Appointment to the board would forever change the lives of the four doctors.

First choice and second in command was James Carroll, Reed’s longtime assistant. Carroll was by far the most eccentric of the group. The men called him “Sunny Jim” because of his bald head. Born in England in 1854 to a working-class family, his background was a hodgepodge of professions. Originally, he planned to enter the British Army as an engineering student; instead, he was a self-described “wandering good-for-nothing who fell in love at fourteen and left home at fifteen, roughed it in the Canadian backwoods for several years and finally drifted into the Army.”

After his love affair at age fourteen ended in heartbreak, he abandoned his plans for army life and emigrated to Canada where he worked at one time or another as a blacksmith’s helper, a railroad laborer and a cordwood chopper. In 1874, he moved to the U.S. and joined the army as an enlisted man, a distinction that would color the remainder of his career and his ego. He would serve twenty-four years before wearing the uniform of an officer.

It was in the army that Carroll decided to pursue medicine. His was not a conventional background for medical school—he had no advanced degrees, he had taken one year of French and two years of German at a time when most doctors were fluent in a number of languages. Carroll began his studies in medicine as an apprentice to a doctor at Fort Custer, Montana. Carroll then applied to medical classes in New York and was at first rejected, then later allowed to attend classes at the University of the City of New York and the University of Maryland, finally graduating in medicinefrom the latter in 1891. He also took courses in bacteriology and pathology at Johns Hopkins, which placed him at the Army Medical Museum in Washington working as Walter Reed’s assistant. At first, Carroll’s fortune in achieving his degree and finding placement with such a highly respected physician pleased him. Later, it would turn into a lifelong torment.

James Carroll exuded an almost bitter work ethic. Jesse Lazear, in a letter to his wife, described him: “Dr. Carroll is not a very entertaining person. He is a bacteriologist pure and simple. To me bacteriology is interesting only in its relation to medicine. He is interested in germs for their own sake, and has a very narrow horizon . . . Carroll would amuse you very much. He is very tall and thin. Wears spectacles, bald headed, has a light red mustache, projecting ears and a rather dull expression.”

Some colleagues found him reticent, crude and surly, while others described him as reliable and straightforward, though prone to “improper” behavior. He was kind and helpful in the laboratory, but also capable of profanity that would be the envy of any sailor, as one student put it.

Carroll proved in many ways to be the exact opposite of Reed, though their working relationship was described as warm and effective. Carroll’s skill in the laboratory was undisputed, but he was a self-made man, intent upon self-improvement, who worked hard to achieve what men like Reed, Agramonte and Lazear seemed to accomplish with ease. Another colleague wrote, “Carroll was a most efficient worker, but he had to be led by a man with vision, like Reed.”

Carroll’s personal relationships also seemed in dramatic contrast to those of his fellow board members. Reed sent letters to his wife showered with terms of endearment and unabashed affection. Lazear was also a doting husband and an even more doting son. Carroll’s letters to his wife, however, were cold and sometimes even cruel. In one, he chastised her for sending him fresh peaches when the price was probably exorbitant, and they would spoil anyway. In another he wrote, “Don’t bother to send me any more letters that do not interest me.”

In all, the image of James Carroll is that of a tragically conflicted man—a working-class Englishman in America; a soldier who was an enlisted officer, rather than a commissioned one; a doctor who was self-made; a frustrated husband who spoke of a lost love for the rest of his life; and a colleague who was innately proud to see his mentor recognized, while at the same time, riddled with envy.

It was a rancor that would extend to the next generation. After Carroll’s death, his son hoarded the personal letters of his father, and many records belonging to Walter Reed, in disheveled trunks in his attic. When historians in the 1940s and 1950s attempted to acquire the material, he appeared paranoid and angry, refusing to accommodate a government that he believed had robbed his father of so much.

For the next member of his team, Reed chose Dr. Aristides Agramonte, a Cuban-born doctor working in Havana. Agramonte was young, only thirty-two years old. He looked the part of a Cuban gentleman with a waxed pencil moustache, pompadour hairstyle and aristocratic features. Some of the soldiers found him to be vain, but very capable. The two men had met before in the Hopkins labs and again during Reed’s visit to Camp Columbia. Agramonte worked with Reed and Carroll for several months before the surgeon general ordered him to Havana to look for Sanarelli’s bacteria in the autopsies of yellow fever patients.Born in Cuba, Agramonte was believed to be immune to yellow fever like most other locals who had been exposed to the fever in childhood. He had come to America when he was only three years old, after his father was killed in the first Cuban war for independence. His education in America continued, and he studied medicine at Columbia in New York, where he was a classmate of Jesse Lazear’s.

Finally, Reed asked Sternberg to appoint Dr. Jesse Lazear to the board. He seemed like a fine doctor and a likable person. His work with malaria and yellow fever had impressed Reed. He also came highly recommended by Welch and William Osler, and there could hardly be any higher endorsement. William Welch, Lazear’s mentor at Johns Hopkins, had written a glowing review of Lazear, describing him as “a good clinical man, a bacteriologist and withal a gentleman of enclivation and agreeable personality . . . and I am convinced that he would prove a very valuable addition to your corps of army surgeons.”

Each of the four men could appreciate the skills of the other and respected one another. As individuals, they probably could not have achieved anything so great. Even Reed, the team’s leader, had lacked the foresight to see a connection between mosquitoes and malaria early on. At a medical conference—on April Fool’s Day—Reed refuted the idea that an insect could transmit disease. But what Reed lacked in vision, he made up for in an earnest devotion to knowledge and the scientific process. If there was a visionary in the group, it was certainly Jesse Lazear. With their talents pooled together, they knew there was a good chance of conquering this disease.

Michael Oldstone, in his book Viruses, Plagues, and History, wrote: “The obliteration of diseases that impinge on our health is a regal yardstick of civilization’s success, and those (scientists) who accomplish that task will be among the true navigators of a brave new world.”

With his team assembled, Reed was ready to begin work at Camp Columbia. He and Carroll left New York on the Sedgwick bound for Havana harbor on June 21, 1900, the same day Kean was stricken with the fever. His would be Reed’s very first case of yellow fever. Walter Reed, head of the Yellow Fever Board, had never before seen a case of yellow jack.

Reed and Carroll landed on the busy Havana wharf where women carried metal pots of coffee and soldiers hauled supplies onto the shore, loading mule-drawn wagons. American voices mingled with foreign accents. There were shouted orders and laughter, neighing horses and barking dogs. Gulls called overhead, and buzzards flew high over the dirt roads leading out of the town, their black wingspans like line engravings in the blue sky.

Reed and Carroll rode by carriage into Havana, through Plaza de Armas where soldier tents surrounded the fountain and an American flag flew from the top of the Governor’s Palace, General Wood’s new headquarters. The carriage bounced along cobblestones, spraying dust as they passed Spanish churches and colorful, narrow town houses. Reed was excited to be returning to Cuba. Havana was unlike any place he’d seen before—the bones of the buildings unmistakably grand and European, while the fleshy surroundings were tropical and Caribbean. It was at one time elegant, and at another, raw. They passed palm trees, almond trees and gnarled jaguey. Plumes of red sprouted on poinciana. Hibiscus blooms erupted.

The road rose before them as they approached the elevated outskirts of Havana and rode into Quemados, Marianao. The air seemed to thin as they moved farther away from the harbor’s output of humidity, steam and smoke into lush jungle, and finally, the windswept farmland where Camp Columbia stood.

Reed went immediately to the hospital tents to see Kean. Kean’s temperature was high, and his gums bleeding, but it would prove to be a moderate case, and when he was well enough, Jefferson Kean was shipped to family in New Jersey to recuperate.

On the evening of Reed’s arrival, the Yellow Fever Board met on the veranda of the officer’s quarters at Camp Columbia for the first time. It was a familiar scene for Reed, Lazear and Agramonte, who had stood there just three months before, only on this occasion, it felt much more formal. The officers, dressed in their army whites, listened as Reed quickly relayed the surgeon general’s orders, which included the investigation of malaria, leprosy and unclassified febrile conditions. Reed stood straight-backed as he spoke. Whether speaking to a classroom of students or a handful of officers, Reed had the rare ability to be simultaneously amicable and commanding. A former student described Reed as someone who “spoke with great clarity, precision and force. His lectures were models in English and his scientific data were assembled in perfect order. There was nothing of the dramatic in his speech or manner, but he impressed one with his earnestness, thoroughness, and mastery of his subject.”

The members of the board listened to Reed give the directive from the surgeon general with as much reverence and attention as his former students. Lazear had written to his mother that he was excited to be working with such an impressive and well-known man as Dr. Walter Reed. As the commission listened to Reed, another thought must have entered their minds: The crowning glory of this task would be yellow fever. To solve the American plague would be the greatest achievement of all. They agreed unanimously that whatever their discovery should be, it would be considered the work of the board as a body and not an individual achievement.

Reed instructed Cuban-born Agramonte, the group’s pathologist and the only member thought to be immune to the fever, to stay in Havana in charge of the lab at the Military Hospital, where there would be no shortage of yellow fever autopsies. Agramonte had already done some impressive work on the Sanarelli bacteria, so he would continue that as well. Carroll, Lazear and Reed would remain at the barracks hospital at Camp Columbia, where Carroll would make cultures from various tissues, and Lazear would study them under the microscope. Lazear could continue with his mosquito investigations as well.

It is not known how seriously Reed considered the mosquito theory at this point. His letters to Emilie do not mention it, and he kept no records of the inner workings of the board. As an investigative scientist, he surely felt curiosity at the very least. Albert Truby believed Reed had been interested in the insect theory from the start, that Reed knew this was the time and the place to finally conquer yellow fever. But Reed was also a soldier, one who took orders, followed them and led men accordingly. That left little room for thinking outside the boundaries of a given task. An officer to duty first and foremost—and under pressure from Sternberg—Reed knew that the first order of the board should be to disprove the Sanarelli bacteria once and for all, putting that ongoing and very public controversy to rest. There wasn’t time to deviate from the given course in search of a vector.

Just before he left for Cuba, Reed met with George Sternberg and discussed a possible connection between yellow fever and mosquitoes. “No,” Sternberg answered. “That has already been decided to be a useless investigation.”