Notes

The introductory quote is from John Edgar Wideman’s Fever, part of his collection first published by Henry Holt and Company in 1989.

Prologue: A House Boarded Shut

My account of the Angevine family and their deaths from yellow fever in 1878 is based on two primary sources. One is a letter written by Ray Isbell in 1978 to the Press-Scimitar newspaper. Lena Angevine Warner was the great-great-aunt of Isbell. Isbell recounted family stories of how an old slave investigated the house, breaking open a window, and found the corpses of the Angevine family in their various states of decomposition. The Isbell letter also described how the slave saved Lena, who was a child at the time. Isbell’s letter is part of the Eldon Roark Papers held in the Mississippi Valley Collection at the University of Memphis.

The second source is a letter written by Lena A. Warner in 1904. She tells of her father being robbed and choked while she was too ill to help. She also describes her experience as a nurse during the Spanish-American War. The Warner letter is held in the Lena Warner file of the Memphis Library, Memphis Historical Collection.

Biographical information about Lena Angevine Warner was collected from various newspaper sources, including a 1948 obituary from the Associated Press, a 1948 obituary in the Knoxville News Sentinel, a 1953 story in the Memphis Commercial Appeal and a 1994 article by Perre Magness in the Commercial Appeal. Biographical information is also available in Patricia LaPointe’s From Saddlebags to Science, E. Diane Greenhill’s From Diploma to Doctorate: 100 Years of Nursing and Paul Coppock’s Memphis Memoirs.

There were a number of discrepancies in the facts surrounding Lena Angevine Warner, especially involving her marriage and her role in the Walter Reed discoveries. One source wildly claimed that Lena Warner delivered a Cuban baby, passed her own kidney stones and performed a circumcision, a tonsillectomy and an amputation with a kitchen knife—all in one night. In this book, I adhered to the facts presented by Warner, her family or those who worked with her. When a fact could not be verified by another source, I said as much or left the material out of the book.

Part I: The American Plague

To recreate the path yellow fever followed out of Africa and across the Atlantic, I studied the virus’s behavior today. The process by which the mosquitoes lay eggs in the hollows of trees and how the virus was first transmitted from mosquitoes to monkeys to men entering the West African forests for logging was based on research from two main sources: Andrew Spielman and Michael D’Antonio’s book Mosquito and Michael Oldstone’s Viruses, Plagues, and History. In both Africa and South America, yellow fever follows a similar course today.

Scientists generally agree that yellow fever originated in West Africa in any number of countries—where it still exists today in its purest genetic form. I chose to focus on Nigeria because that country is currently considered the hotbed of yellow fever. Descriptions of Nigeria, its plant life, topography, trade and weather, including the southwest monsoon, are based on a series of country studies published by the Federal Research Division of the Library of Congress and are available on-line or in hard copy.

I based my description of viruses in general, as well as the specifics of the yellow fever virus, on the book Epidemic!, which was edited by Rob De Salle and published for the American Museum of Natural History. I also relied on virus descriptions from John M. Barry’s The Great Influenza and Gina Kolata’s Flu. Both books do an excellent job of taking a complex subject and presenting it in comprehensible terms. For the specifics of the yellow fever virus, I studied information provided by the Centers for Disease Control and Prevention and the World Health Organization. For descriptions of the way the yellow fever virus reacts to a human cell, I relied on material from the National Institutes of Health. All of the technical information aside, personification of the virus—the idea that the virus itself is evolving, thinking, trying to conquer—is obviously a creative technique of my own making. There is no scientific evidence to suggest such.

For information about the slave trade—the Middle Passage— I based my descriptions on Madeleine Burnside and Rosemarie Robotham’s book Spirits of the Passage. Their book not only provides general statistics about the trade but also illustrations and firsthand accounts that include some of the more disturbing details like the fact that Europeans might taste the sweat of slaves as a test for disease or that sharks trailed slave ships waiting for bodies to be thrown overboard.

The idea that yellow fever altered the history of the United States is not a new idea; after all, the virus’s moniker “the American plague” says it all. Margaret Humphreys, in her book Yellow Fever and the South, writes, “Tuberculosis, smallpox, or typhoid might well kill as many or more every year yet fail to stir the public from apathy . . . Yellow fever was a disease whose presence often created mass panic, a response that brought commercial interactions to a standstill.” To support my argument that it shaped our country’s history, I compiled statistics from a wealth of sources.

Basic statistics about the number of countries and states stricken with yellow fever, as well as the number of people afflicted, were taken from the Conclusions of the Board of Experts authorized by congress to investigate the yellow fever epidemic of 1878. The report was written in 1879 and is available in the Rare Book Collection of the Library of Congress. The report also estimates the cost of the 1878 epidemic as $200 million, which today would be calculated as over $350 million. The reason why yellow fever has never afflicted Asia despite the right climate and the right mosquito is a mystery. Robert S. Desowitz, a professor of tropical medicine and author of Who Gave Pinta to the Santa Maria, suggests that it may be due to the fact that the African slave trade never extended to that part of the world.

The quote about yellow fever striking the Atlantic and Gulf states with more force than the one that bombed Pearl Harbor was taken from J. L. Cloudsley-Thompson’s Insects and History.

The suggestion that yellow fever was the most dreaded epidemic disease for 200 years comes from Khaled Bloom’s The MississippiValley’s Great Yellow Fever Epidemic of 1878. Other historians have given similar opinions, and a number of doctors serving during the Memphis epidemic, and later in Cuba, offered the same impression.

That yellow fever was directly linked to the slave trade can be traced as far back as the mid-nineteenth century. In her article, “Yellow Fever: Scourge of the South,” published in Disease and Distinctiveness in the American South, Jo Ann Carrigan writes: “Some abolitionists suggested that yellow fever was not only the result of slavery, having been introduced by the African slave trade, but that the disease served as a penalty or punishment, afflicting those areas where the institution prevailed.” It was in Carrigan’s article where I found the statement that yellow fever ceased in the North about the same time that slavery was abolished there. Henry Rose Carter, a friend and colleague of Walter Reed, also traced the history of yellow fever to West Africa and was one of the first to suggest that it made its way to North America through the slave trade in his 1931 book, Yellow Fever: An Epidemiological and Historical Study of Its Place of Origin.

The theory that yellow fever seemed divinely directed is based on some of the beliefs at the time. It was not uncommon for people to attach greater meaning to epidemics of disease—it still happens today. Even the word plague implies punishment in biblical terms.

According to the Greenwich Village Society for Historic Preservation, “the Village” in New York enjoyed a certain amount of seclusion until epidemics of yellow fever and cholera hit the city in 1799, 1803, 1805 and 1821. Temporary housing and businesses sprang up. The 1822 fever epidemic was an especially virulent one, and many New Yorker’s settled in “the Village” for good, finally adjoining it to New York City.

The fact that Napoleon lost 23,000 troops to yellow fever in Haiti and sold his Louisiana holdings to Thomas Jefferson, wanting to abandon conquests in this pestilent place, is taken from Desowitz’s book.

The reference to yellow fever as one of the country’s first forms of biological warfare comes from a Washington Post article by Jane Singer, “The Fiend in Gray,” about Dr. Louis Blackburn. I also used information from a 2002 article in The Canadian Journal of Diagnosis entitled “The Yellow Fever Plot: Germ Warfare during the Civil War.”

The impact of yellow fever on the Spanish-American War comes from a number of sources, including the Philip S. Hench Walter Reed Collection, held at the University of Virginia; G.J.A. O’Toole’s book The Spanish War and Hugh Thomas’s Cuba or The Pursuit of Freedom, as well as personal correspondence of the surgeon general, Theodore Roosevelt and William McKinley, among others.

The timeline of yellow fever in North America—its prevalence in the northeast and its long reign in the South—comes from Desowitz.

Theories about why the 1878 yellow fever epidemic proved so deadly have appeared in a variety of publications. Many historians have simply responded that we don’t know why it was such a deadly epidemic. In this book, I put forth the idea that it was the combination of an El Niño cycle, an increase in new immigration and transportation and the theory that the virus may have arrived on ships directly from Africa rather than making its way from endemic areas in South America.

Information about yellow fever and El Niño came from an article, “A Possible Connection between the 1878 Yellow Fever Epidemic in the Southern United States and the 1877-78 El Niño Episode,” published in the Bulletin of the American Meteorological Society in 1999. The article includes a timeline of El Niño cycles during the nineteenth century; nearly all coincide with major outbreaks of yellow fever. The World Health Organization also considers El Niño weather cycles a factor in the spread of yellow fever (WHO report Yellow Fever, 1998).

The reference to hyacinth blooms in January comes from Bloom’s book, as well as personal observation. I know that Memphians began complaining about mosquitoes based on newspaper clippings from January 1878.

The theory that Memphis was poised for greatness before the 1878 epidemic is cited in several Memphis history books. It was second only to New Orleans in population. It had survived the Civil War with very little damage. Businesses proliferated. It was the largest inland cotton market. Even the fact that Jefferson Davis chose Memphis as his home after the Civil War seems to support that idea. Unfortunately, there were also circumstances that would make Memphis vulnerable to an epidemic: poor sanitation, no clean water supply and misguided politicians.

I found the dramatic statistic about the 1878 epidemic in Memphis taking more lives than the Chicago fire, San Francisco earthquake and Johnstown flood combined in the Memphis Avalanche as well as in Bloom’s book.

The quote that yellow fever is more calamitous to the United States of America above all other countries comes from the report of the Board of Experts, 1879, held at the Library of Congress.

Part II: Memphis, 1878 Carnival

The Edgar Allan Poe quote from “The Masque of the Red Death” is considered by some historians to be a reference to yellow fever. Poe was living during the time period when yellow fever plagued so many cities, and the red death may have alluded to the bleeding common from yellow fever, which is a hemorrhagic fever. The poem tells the story of a king who locks his people away in a castle to prevent disease. Celebrating his victory over epidemic, he throws a lavish masque, only to find that death has indeed made its way into the castle wearing a mask. I thought the allegory was a chilling and perfect introduction to Memphis and its Carnival in 1878.

The description of the Mardi Gras invitation from 1878 comes from visiting the Pink Palace Museum’s Memphis History exhibit. Though they only have a few invitations from the years that Mardi Gras took place, 1878 happens to be one of them. The museum also displays illustrations of the Mardi Gras parades from Harper’s. Remarks about the number of people who attended the parades, including the president of the United States, are from the Mardi Gras file held in the Memphis History Collection of the Memphis Library. The file contains various clippings, descriptions and newspaper illustrations. I also used an article entitled “History of the Memphis Cotton Carnival” in the West Tennessee Historical Society Papers. To recreate the 1878 parade, I read the February and March issues from 1878 of the Memphis Appeal (later to become the Commercial Appeal) and the Memphis Avalanche. The majority of the details that re-create the 1878 Mardi Gras for this book came from those sources. Not only did they give lengthy descriptions that today would seem trivial and heavy-handed, but in reading advertisements in the newspapers, I could piece together where shops were located on Main Street or Second Street, what sort of clothes people wore and the fact that caramels were sold at one store and kid gloves at another. The newspaper is also where I found the impressive fact that the fountain in Court Square flowed with champagne during 1878 Mardi Gras or such quaint details as the feathers escaping from ladies’ fans during the ball.

For an accurate account of the weather on those two days, as well as for the remainder of 1878, I read the U.S. Department of Agriculture’s Weather Bureau from the Memphis Station Records. I would refer to that source again and again to determine if it rained, what the clouds looked like, if a light frost fell or what the temperature might be on a given day. The weather bureau reports are held at the University of Memphis as part of the Mississippi Valley Collection.

For information about Colton Greene and the Mystic Memphi, I again went to files held in the Memphis History Collection of the Memphis Library. In those files, I found biographical information—including a description of Greene looking like Stalin—and the small details that give personality to Greene—the card allowing him admittance to the Vatican and a copy of Greene’s Last Will and Testament. Likewise, I learned about the Mystic Memphi from those files, including a 1933 newspaper interview in which J. M. Semmes reminisced about the secret society that answered to the letters UEUQ.

I based my summary and description of Memphis history on three very good books written by Memphis historians: Gerald M. Capers’s The Biography of a River Town, Memphis: Its Heroic Age; Paul Coppock’s Memphis Memoirs; and Charles Crawford’s Yesterday’s Memphis. I also included material from Carole Ornelas-Struve and Joan Hassel’s Memphis, 1800-1900, Volume III: Years of Courage and William Sorrels’s Memphis’ Greatest Debate; a Question of Water. The quote about Memphis refusing to take the trouble to distinguish between prosperity and progress came from Sorrels’s book. A few of the specifics—like the fact that Memphis had 115 saloonkeepers—came from newspaper reports at the time.

Information about Charles C. Parsons is held in boxes as part of the Yellow Fever Collection of the Memphis Library. The boxes include letters that he wrote to his wife, as well as general opinions of Parsons. A fellow classmate from West Point described the sort of fanaticism evident on Parsons’s face. Men who served with him during the Civil War described his courage at the Battle of Perryville. There is even a letter from Jefferson Davis to Parsons. I found the sermon Parsons gave on the eve of the 1878 Mardi Gras in a scrapbook that belonged to George C. Harris, whose papers are also held in the Yellow Fever Collection at the Memphis Library. The sermon had been printed in the Ledger newspaper in February 1878, and Harris kept it for his scrapbook. Although I only included part of it, the full sermon can be found in the Harris papers.

Very few photos from that decade exist. In order to create a visual sense of downtown Memphis from a visitor’s point of view, I studied an 1870 map of Memphis drawn by the U.S. Departments of Agriculture and Commerce. The original map is held at the Library of Congress, though copies are in wide circulation. The Mississippi Valley Collection at the University of Memphis has vignettes of the Victorian houses along Adams Street—an area now known as Victorian Village—in the Eldon Roark Papers. I also studied architectural drawings of Memphis buildings. I was surprised to find that in addition to the wooden and brick buildings one would expect, Memphis had several grand structures designed by prominent architects. The columns of the Gayoso Hotel, the building-in-progress of the Customs House, the glass-covered Water Works, and an elaborate prison, among others, would offer a stunning view from the river. None of those buildings exist in Memphis today—only the gates of the prison are still standing near the entrance of Mud Island.

I relied on descriptions of the Greenlaw Opera House and the Exposition Building from articles in the West Tennessee Historical Society Papers, an excellent resource for details and specifics about any number of subjects relating to Memphis history.

Other sources consulted for descriptions of Memphis, photographs or illustrations were Robert A. Sigafoos’s Cotton Row to Beale Street, Beverly G. Bond and Janann Sherman’s Memphis in Black and White, Robert W. Dye’s Images of America: Shelby Countyand Ginny Parfitt’s Memories of Memphis: A History of Postcards.

Bright Canary Yellow

It was widely believed in 1878 that the yellow fever epidemic could be traced to the steamer Emily B. Souder, which sparked a number of cases in New Orleans. For a physical description of the Emily B. Souder, its history and to learn its fate, I looked up American Lloyd’s Register of American and Foreign Shipping (1865) and the Record of American and Foreign Shipping (1871)—originals of both documents have been scanned and are available on-line. During that time period, news of a ship’s landing and departure was also printed in the newspaper. As the Souder sailed out of New York, I found references to the ship in the New York Times and ultimately found the most fateful one: the Souder sank in December 1878.

For my account of the Souder’s trip to New Orleans, the deaths of John Clark and Thomas Elliott and the autopsies, I relied on two primary sources: “History of the Importation of Yellow Fever into the United States, 1693-1878,” presented by Dr. Samuel Choppin at the meeting of the American Public Health Association on November 21, 1878, and the “Report upon Yellow Fever in Louisiana in 1878,” by Dr. S. M. Bemiss in the New Orleans Medical and Surgical Journal (1883). Information about the John D. Porter was also taken from Bemiss’s report and J. M. Keating’s account of the epidemic.

I found corroborating information from additional sources: Khaled Bloom’s The Mississippi Valley’s Great Yellow Fever Epidemic of 1878, J. H. Ellis’s Yellow Fever and Public Health in the New South and Jo Ann Carrigan’s The Saffron Scourge. It was in Choppin’s own report to the American Public Health Association that I found his statement about Thomas Elliot’s death: “These are all the usual appearances observed in the examination of a person dead of yellow fever, and we had no doubt that the man had been the subject of this disease.” Prior to that, Choppin had claimed that he had no idea the crewmembers of the Souder had yellow fever; he also denied that the subsequent yellow fever outbreak had anything to do with the Souder’s May arrival. Using Choppin’s own paper and details from the minutes of the Memphis Board of Health, held in the Memphis History Collection of the Memphis Library, I pieced together the timeline in which Choppin and New Orleans officials were first aware of yellow fever cases and when Memphis was officially notified two months later.

My account of the Aedes aegypti mosquito and its behavior was based on Spielman and D’Antonio’s Mosquito, Jerome Goddard’s Physician’s Guide to Arthropods of Medical Importance and Carlos Finlay’s studies of the mosquito.

Information about the prevalence of yellow fever in Cuba came from Henry Rose Carter’s book, and statistics about the marked virulence of the 1878 epidemic can be found in Jo Ann Carrigan’s book, as well as Humphreys’s and Bloom’s.

The Doctors

To construct what downtown Memphis would have felt like in 1878, I relied on a book written by the Reverend D. A. Quinn, Heroes and Heroines of Memphis or Reminiscences of the Yellow Fever Epidemics. The book, published in 1883, is part of the Yellow Fever Collection at the Memphis Library. In it, I found detailed descriptions of Court Square, the flowers blooming there, women pushing baby carriages, bootblacks, the milkman’s morning cry “Wide Awake!” and the newsboys shouting headlines.

For descriptions of the weather—namely the drought and heat—I used newspaper clippings from 1878 and the U.S. Department of Agriculture Weather Bureau, Memphis Station Records in the Mississippi Valley Collection at the University of Memphis. Details about the raw sewage and dead animals came from J. M. Keating’s A History of Yellow Fever: The Yellow Fever Epidemic of 1878. Keating was the editor of a local newspaper and survived the epidemic. A year later, he published the definitive book on the subject.

Information about medicine in the nineteenth century came from a variety of sources: W. F. Bynum’s Science and the Practice of Medicine in the Nineteenth Century, Thomas J. Schlereth’s Victorian America and Paul Starr’s The Social Transformation of American Medicine. For more specific information about medical practices in Memphis, I relied on Patricia LaPointe’s book, From Saddlebags to Science. I found references to medications like Tutt’s pills or doctors specializing in “secret diseases” in 1878 newspaper clippings.

For further explanation on the contagionists versus noncontagionists and the local versus exotic origin of yellow fever, see Simon R. Bruesch’s article in the Journal of the Tennessee Medical Association, Margaret Humphreys’s Yellow Fever and the South and Margaret Warner’s “Hunting the Yellow Fever Germ” in the Bulletin of Historical Medicine (1985). Details about the history of quarantines was taken from Keating’s book. Details about the Quarantine Act came from John Ellis’s Yellow Fever and Public Health in the New South.

Information about “the war of the doctors” and the activities of the Memphis Board of Health during June, July and August, was found in the minutes recorded at their meetings, which are held in the Memphis History Collection of the Memphis Library. I also followed “the war of the doctors” in the Memphis Appeal and in a 1978-79 article in the Journal of the Tennessee Medical Association by Dr. Simon R. Bruesch, whose collection of materials is held at the Health Sciences Historical Collections of the University of Tennessee, Memphis.

For a description of Dr. Robert Wood Mitchell, I looked to the Simon Rulin Bruesch Collection. I based my descriptions of John Erskine on the Erskine file in the Memphis History Room of the Memphis Library, as well as Bruesch’s article.

The quote about privies and the general state of water in Memphis during that time period was taken from Sorrels’s book, held in the Mississippi Valley Collection at the University of Memphis.

“Memphis is about the healthiest city on the continent at present” was printed in the Memphis Appeal, June 22, 1878.

“Is it not better to expend a few thousand as a safeguard than lose millions . . . besides the thousands of valued lives that will have passed away” appeared in the Memphis Appeal, July 4, 1878.

The amount of money—$8,000—secured at the July 6 meeting of the Board of Health to clean up the city was reported in the Memphis Appeal, July 6, 1878.

“Should an epidemic reach Memphis . . . those who opposed the establishment of a quarantine will be held responsible” was printed in the Memphis Appeal, July 11, 1878.

Mitchell’s letter of resignation from the Memphis Board of Health appeared in the Appeal, July 11, 1878.

“The yellow fever scare is about over in Memphis” was printed in the Memphis Appeal, July 30, 1878.

The details of Dr. John Erskine boarding the John D. Porter for inspection appeared in the Memphis Appeal, July 30, 1878.

Information about the strange occurrences in July of 1878— the streetlights exploding, the Edison speaking phonograph, the rattlesnake, the cocktails and the eclipse—were all taken from the Memphis Appeal and Avalanche newspapers.

The description of the constellation Ophiuchus was based on information in Encyclopaedia Britannica. Imhotep, the man on whom the constellation is based, was called by Sir William Osler “the first figure of a physician to stand out clearly from the mists of antiquity.” It is said that the medical sign of two serpents coiled around a staff is based on Imhotep.

The timeline of the first yellow fever cases and the description of the mass exodus out of Memphis were taken from Keating’s book. Additional information about William Warren was found in 1878 copies of the newspapers. Descriptions of the Pinch District were taken from files by the same name held in the Mississippi Valley Collection of the University of Memphis and the Memphis Historical Collection at the Library of Memphis. And specifics about Bionda’s snack house in the Pinch were found in Thomas Baker’s article “The Yellow Fever Epidemic of 1878 in Memphis, Tennessee” in the Bulletin of the History of Medicine, 1968.

The New York Times editorial about New York’s filthy tenement houses appeared in John Ellis’s Yellow Fever and Public Health in the New South.

The quote about the tales circulated by sensationalists was from the Appeal, August 4, 1878.

The estimated number of people left in Memphis during the epidemic and the number stricken is based on Keating’s book. According to Keating, 19,600 remained, and 17,600 had yellow fever. According to Baker’s article, 25,000 people had fled the city— over half of the population—in the four days after Bionda’s death. “For the sake of humanity, men became inhuman” was taken from Keating’s book.

The story of the Memphians released from the trains in Milan for provisions appeared in an Evening Appeal clipping found in the Yellow Fever Collection at the Memphis Library.

The description of the Citizen’s Relief Committee and their actions was based on Bloom’s book, reports in the local newspapers and the Charles G. Fisher Papers at the University of Memphis. Information about the Howard Association was taken from Bruesch’s article.

The Board of Health’s declaration of a yellow fever epidemic on August 23 was taken from the board’s minutes.

A City of Corpses

Descriptions of the city during the epidemic came from a number of sources: Keating’s firsthand account of the epidemic in his book; Reverend D. A. Quinn’s book Heroes and Heroines of Memphis or Reminiscences of the Yellow Fever Epidemics; and Dr. J. P. Dromgoogle’s Yellow Fever Heroes, Honors, and Horrors of 1878. All three books are part of the Yellow Fever Collection at the Memphis Library. I also consulted the George C. Harris papers at the Memphis Library, Charles G. Fisher papers at the University of Memphis and the accounts of the nuns at St. Mary’s. A number of the descriptions came from the accounts of the epidemic in the Appeal and the Avalanche.

I found the quote from Rutherford B. Hayes’s personal letter calling the Memphis epidemic “greatly exaggerated” in the Rutherford B. Hayes Presidential Center on-line collection of the president’s letters and diaries. The dates when the mayor of Memphis and other officials wired the president were found in local papers.

Nearly all information pertaining to Sister Constance and the nuns at St. Mary’s was taken from a series of notes and letters found among Constance’s personal items after her death—they were collected and printed, though not published, as The Sisters of St. Mary at Memphis: With the Acts and Sufferings of the Priests and Others Who Were There with Them during the Yellow Fever Season of 1878. St. Mary’s Cathedral in Memphis houses that book.

Descriptions of St. Mary’s Episcopal Cathedral and information about it were based on visits there and an interview with Elizabeth Wirls. I also read the bound, printed history of St. Mary’s, available at the church. While St. Mary’s still has the original altar belonging to the nuns, the stole worn by Charles Parsons and the stained-glass rose window—that is almost all that remains of the original cathedral, which burned down several years after the epidemic. During a stay in Kansas City, however, I visited the St. Mary’s Episcopal Church, which was built in the likeness of the Memphis church. It even has stained-glass windows commemorating the Martyrs of Memphis. It was there that I was able to get a sense of the dark-wood interior and Victorian, gothic architecture of the Memphis cathedral as it was when the nuns served there.

Some details, like the yellow cardboard hanging from doors, “bring out your dead” and the burning of infected clothing appeared in a 1932 Press-Scimitar clipping held in the Yellow Fever Collection at the Memphis Library.

I based my descriptions of Victorian mourning on the books Victorian America: Transformations in Everyday Life and Elmwood: In the Shadows of the Elms.

“A stranger in Memphis might have believed he was in hell” appeared in an article, “City Still Bears Scars of Epidemic Century Ago,” in the Commercial Appeal, June 18, 1978. The article was found in the Yellow Fever Collection. Also from that article came the statistic about one railroad ticket agent who sold $35,000 worth of train tickets in three days.

Descriptions of Elmwood Cemetery during the epidemic came from Elmwood, History of the Cemetery, written in 1874, and available at the Elmwood offices. I also visited the cemetery to read through its ledger book for 1878.

I found a reference to letters with holes punched through and fumigated with a studded paddle in a 1938 Commercial Appeal clipping in the Yellow Fever Collection of the Memphis Library.

The Destroying Angel

All information about Armstrong came from his original letters held in the William Armstrong papers in the Yellow Fever Collection and from an article in the West Tennessee Historical Papers, 1950. Additional information about him was found in the papers belonging to Constance and the nuns at St. Mary’s, as well as the William Armstrong file held at Elmwood Cemetery.

To recreate scenes involving Constance, Parsons and Armstrong, I relied on their personal letters, already cited, and accounts of the nuns. Though Constance and Parsons often met, as did Constance and Armstrong, I could only find only one case where all three were together—the one included in this book— when Dean Harris fell ill.

Information about doctors during the epidemic as well as general information about Victorian medicine came from a variety of sources: the Breusch Papers, LaPointe’s From Saddlebags to Science, Dromgoogle’s Yellow Fever Heroes, Honors, and Horrors of 1878, Keating’s The Yellow Fever Epidemic of 1878, Paul Starr’s The Social Transformation of American Medicine, T. O. Summers’s Yellow Fever and Goodman and Gillman’s The Pharmacological Basis of Therapeutics. I also based some of the details like spring-loaded lancets or leaden glass bottles on visits to the Memphis history exhibit at the Pink Palace.

Descriptions of the day-to-day work of the Howard physicians were taken from Breusch’s article in the Journal of the Tennessee Medical Association. Details about Mitchell’s specific treatment for fever cases was found in Dromgoogle’s account. The bizarre treatment for yellow fever involving sitting on a chair and passing out was taken from Dr. S. S. Fitch’s The Family Physician, 1876.

The quote from the 1878 Boston Medical and Surgical Journal about surgeons serving in war versus the yellow fever epidemic was found in the Breusch papers.

“Only one change was noticeable—the decrease of their numbers” is from Keating’s The History of Yellow Fever.

All information pertaining to Charles C. Parsons was taken from the Parsons file, George C. Harris papers and papers belonging to the Sisterhood at St. Mary’s—all are held in the Yellow Fever Collection at the Memphis Library.

“A man on Poplar . . . cowardly deserted his wife and little daughter, both of whom were ill with the fever; if he isn’t dead, somebody ought to kill him” appeared in the September 6, 1878, Appeal.

The account of Louis Schuyler was taken from the papers belonging to the Sisterhood of St. Mary’s, as well as the George C. Harris papers. A fictional description of his death is also available in Charles Turner’s The Celebrant. It was never confirmed, nor denied, that Louis Schuyler was moved into the death alley still alive. After his death, letters from concerned friends and family were sent to Dean George C. Harris. Those letters, as well as his explanation, are part of the Yellow Fever Collection.

The description of the illness and deaths of Constance and Thecla were taken from the papers belonging to the Sisterhood of St. Mary’s. A few of the details were also found in the William J. Armstrong papers. The obituary quote, “Of them it may be said they were lovely in their lives, and in their death they were not divided,” was found in the scrapbook of George C. Harris.

The account of Dr. William J. Armstrong’s final days and death were taken from his personal correspondence and the article about his life and letters in the West Tennessee Historical Papers, 1950.

The final list of those who perished in the epidemic was taken from several sources, including Keating’s book, Breusch’s papers, the Elmwood book, the Charles G. Fisher papers, and Memphis 1800-1900, Volume III: Years of Courage.

Descriptions of the citizen’s meeting at the Greenlaw on Thanksgiving Day was taken from newspaper accounts.

I found that the Emily B. Souder sank in December of 1878 in the shipping news of the New York Times.

Greatly Exaggerated

Statistics from the 1878 epidemic came from three sources: Bloom’s The Mississippi Valley’s Great Yellow Fever Epidemic, Carrigan’s The Saffron Scourge and the Conclusions of the Board of Experts, 1879.

Information about the state of the country following the epidemic and the battle over the National Board of Health came from John Ellis’s Yellow Fever and Public Health in the New South and Margaret Humphreys’s Yellow Fever and the South. The quote about the president not wanting to commit the recessed congress to an investigation was taken from Ellis’s book, as was the quote from Harper’s.

Statistics about financial aid and provisions sent to Memphis appeared in Keating’s book.

My account of the Board of Experts was taken from the Proceedings of the Board of Experts and the Conclusions of the Board of Experts, 1878. Both are held in the Rare Books Collection of the Library of Congress. Statistics for the number of blacks and whites who died were taken from those reports, as well as Keating’s book.

The peculiar incidence of the fever among white children in New Orleans was taken from Carrigan’s book.

The Havana Commission

Biographical information about Juan Carlos Finlay was taken primarily from an article, “Carlos Finlay’s Life and the Death of Yellow Jack,” published in the Bulletin of the Pan American Health Organization (1989).

Biographical information about George M. Sternberg came from the George Miller Sternberg papers at the National Library of Medicine, John Pierce and Jim Writer’s Yellow Jack, Martha Sternberg’s George Miller Sternberg: A Biography and “The Trials and Tribulations of George Miller Sternberg—America’s First Bacteriologist,” published in Perspectives in Biology and Medicine.

Reparations

Historians agree that 5,150 people died during the Memphis 1878 epidemic. That number comes from Keating’s book written only one year after the epidemic. The number represents roughly one-tenth of the total population of Memphis, which was estimated to be just under 50,000 in 1878.

The evolution of Memphis from a cosmopolitan, diverse, progressive city to one in which Protestant fundamentalism and white supremacy flourished is taken from Memphis historian Gerald M. Capers in his book The Biography of a River Town. The quote suggesting that Atlanta owes its present position to the work of the Aedes aegypti in Memphis is from the same source.

The statistic taken from the National Bureau of Education census is also from Capers book: “The extent to which newcomers took the places of former residents in the years following 1880 is revealed in a census taken in 1918 by the National Bureau of Education. Of the 11,781 white parents residing in Memphis forty years after the great epidemic, only 183, less than 2 per cent, had been born there.”

Information about George Waring and the account of his death came from William W. Sorrels’s Memphis’ Greatest Debate; a Question of Water, as well as his New York Times obituary on October 30, 1898, the Commercial Appeal obituary, the Memphis Avalanche obituary and Waring’s own report, The Memphis Sewerage System.

Part III: Cuba, 1900 A Splendid Little War

The introductory quote for Part III is part of a letter written by Walter Reed to his wife, Emilie, on December 31, 1900.

The description of the sinking of the USS Maine was taken from Captain Sigsbee’s own book, The Maine, written in 1899, and held in the Rare Book Collection of the Library of Congress. I also relied on G.J.A. O’Toole’s The Spanish War: An American Epic 1898, an excellent book on the war. There is information from Hugh Thomas’s Cuba or the Pursuit of Freedom and Pierce and Writer’s Yellow Jack as well.

The four presidents who attempted to purchase Cuba at one time or another were James Polk, Franklin Pierce, James Buchanan, and William McKinley. The quote from Thomas Jefferson was taken from Yellow Jack. Robert Desowitz’s quote appeared in his book Who Gave Pinta to the Santa Maria?

Siboney

I based the majority of the “Siboney” chapter on Victor Clarence Vaughn’s autobiography, A Doctor’s Memories.

Additional information, including the Round Robin letter controversy, was taken from O’Toole’s The Spanish War. Shafter’s quote was also taken from that source. It has been disputed whether or not the Round Robin letter was Shafter’s idea or Roosevelt’s. The Spanish War uses Roosevelt’s own autobiography as the source for the account in which Shafter came up with the plan and wrangled Roosevelt into it; but, in a footnote, O’Toole adds that Roosevelt had written a letter to a friend four days before the meeting with Shafter in which he enclosed a draft of the Round Robin letter.

Biographical information about George M. Sternberg came from the George Miller Sternberg papers at the National Library of Medicine, The Philip S. Hench Walter Reed Collection, John Pierce and Jim Writer’s Yellow Jack, Martha Sternberg’s George Miller Sternberg: A Biography and “The Trials and Tribulations of George Miller Sternberg—America’s First Bacteriologist,” published in Perspectives in Biology and Medicine. The editorial from the New York Times calling Sternberg unfit for the position of surgeon general appeared in “The Trials and Tribulations of George Miller Sternberg—America’s First Bacteriologist.”

An Unlikely Hero

The majority of Reed’s biographical information came from Dr. William Bean’s excellent biography Walter Reed, published in 1982. It is a well written and thorough account of Reed’s work in Cuba. Additional information was taken from Howard A. Kelly’s WalterReed and Yellow Fever,1906; Laura Wood Roper’s Walter Reed: Doctor in Uniform, 1943; and Pierce and Writer’s Yellow Jack, 2005. Several personal details and excerpts from letters were taken from the Philip S. Hench Walter Reed Collection, which houses a wealth of personal correspondence between Reed and Emilie, as well as other family members, and from the Walter Reed Papers at the National Library of Medicine.

Information about Dr. Luke P. Blackburn was taken from Jane Singer’s “The Fiend in Gray,” published in the Washington Post. Some information regarding Blackburn was also found in Quinn’s 1887 book Heroes and Heroines of Memphis or Reminiscences of the Yellow Fever Epidemics.

Historical information about Johns Hopkins University was taken from three sources: John M. Barry’s The Great Influenza, Roper’s Walter Reed: Doctor in Uniform and Kelly’s Walter Reed and Yellow Fever. Kelly, one of the Great Four, worked with Reed at Hopkins.

For the account of the Typhoid Board’s work, I relied on Victor Vaughan’s A Doctor’s Memories. Information about Vaughan’s medical advancements after the Typhoid Board and his quote at the end of the chapter were taken from Barry’s The Great Influenza.

A Meeting of Minds

Many of the descriptive details about the sights, smells, sounds and feel of Havana came from personal experience when I visited the city in December 2005 while researching this book.

According to historian Philip S. Hench, the military camp six miles outside of Havana was known as Camp Columbia during the Spanish-American War. Following the war, the regimental tents were replaced with wooden buildings, and the “army of occupation” moved in, renaming the camp the Columbia Barracks. I use the terms interchangeably since many of the principle characters were still in the habit of calling the barracks Camp Columbia.

To recreate scenes at Camp Columbia, I relied on several different sources: Albert Truby’s Memoir of Walter Reed: The Yellow Fever Episode, Bean’s Walter Reed, Pierce and Writer’s Yellow Jack, as well as personal letters from soldiers who stayed there and Philip S. Hench’s own documentation.

For details about entertainment for the enlisted men and trips to Havana, I used an interview between Philip S. Hench and Paul Tate conducted in 1954.

For the description of Walter Reed’s voyage to Havana in March 1900, I relied on Philip S. Hench’s interview with Lawrence Reed and Blossom Reed in 1946. Information about electrozone and Reed’s work with it was taken from Reed’s own report to the surgeon general, dated April 20, 1900, and Truby’s Memoir of Walter Reed.

For information about Jesse W. Lazear, I used a number of sources, including Philip S. Hench’s biographical notes on Lazear, photographs from Lazear’s own photo album in Cuba, photographs from the Philip S. Hench Walter Reed Collection at the University of Virginia, letters from Lazear to his mother, a Baltimore Sun article dated September 9, 1905, and Aristides Agramonte’s The Inside History of a Great Medical Discovery.

Lazear’s quote that Walter Reed was another convert of the mosquito theory was found in Hench’s interview with Reed’s children, as well as Hench’s questionnaire for Jefferson Kean in 1946.

The account of the officers in their dress whites discussing medicine on the veranda in the evenings was based on Truby’s book. Truby noted that Reed’s interest in yellow fever was tireless.

The details about Lazear’s courtship with Mabel, his trips to California to meet her family and visit their ranch, as well as the date and place of their marriage, came from a series of letters written by Jesse Lazear to his mother, Charlotte Sweitzer, in July, August and September of 1896. Those letters are part of Hench’s collection at the University of Virginia.

Lazear’s description of Havana was taken from a letter to his mother on February 11, 1900. Lazear’s personal photo album of their first few months in Havana and Marianao is held in the Hench collection. The letter Lazear wrote to his mother requesting that she store the boxes of golf clubs, Shakespeare, linens and dishes was dated February 15, 1900. Additional descriptions about the Lazears’ home in Cuba—like a partition made of matting from a Chinese store, the shower bath and physical details about the home—were found in letters Lazear wrote to his mother during February and March of 1900. Additional details about what they ate and what they fed the baby, as well as descriptions of taking Houston to the beach were found in letters to Lazear’s mother, dated February 15 and March 15, 1900.

The account of tree frogs settling into the rafters of buildings at Columbia Barracks was found in Truby’s Memoir of Walter Reed.

On April 6, 1900, Lazear wrote to his mother to tell her that Mabel and Houston would be returning to the States on the Sedgwick around April 14. As transports were often a day early or a day late, that date may not be exact. Walter Reed, in a letter to his wife, makes reference to a ticket on a transport like the Sedgwick costing $12.

Additional details about the soldiers’ time at the Columbia Barracks were gathered from various letters and photographs of the social hall. Jesse Lazear wrote to his mother that he often stood on his porch, but rarely ventured to the weekly dances. I know he could hear the firing of the hour at El Morro Castillo becauseWalter Reed wrote to his wife, on December 31, 1900, that they could hear it on quiet nights.

Information about Major Jefferson Randolph Kean and the diary of yellow fever cases that he kept was taken primarily from Bean’s Walter Reed. Kean’s description of Reed, his whimsical humor and penchant for quaint stories, was found in a letter Kean wrote to Philip S. Hench on January 23, 1944.

I found all information about Lazear’s investigation of Sergeant Sherwood’s case of yellow fever—the tests conducted and the autopsy notes—in a notebook kept at the New York Academy of Medicine. The notebook has a fascinating history. It mysteriously disappeared after Reed’s work in Cuba was completed. It was discovered thirty years later in an ash barrel and sold for twenty-five dollars to Archibald Malloch, who gave it to the academy. The New York Academy of Medicine has the notebook labeled as the “Record of the Yellow Fever Commission’s work in the handwriting of Dr. Neate.” Neate was Walter Reed’s lab assistant. However, historians Philip S. Hench and Reed biographer Laura Wood Roper located the notebook at the academy in the 1940s, and both believed the handwriting in the notebook to be that of Lazear’s and Reed’s. Likewise, when I visited the New York Academy of Medicine in 2004, I took samples of Lazear’s and Reed’s distinctive handwriting; they matched the records in the notebook perfectly. In my book, I have therefore described this notebook as the one belonging to Jesse Lazear until September 1900. In December of that year, the records began again in Walter Reed’s handwriting.

The quote about entomology, keying in anatomical minutiae, the formation of mouthparts, the bewildering pattern of wing venation is from Robert Desowitz’s book.

Truby’s quote about the epidemic in Quemados was taken from his book Memoir of Walter Reed.

The account of Kean’s illness and his visit to Major Edmunds is based on a letter from Jefferson Randolph Kean to Philip S. Hench on January 23, 1941.

The Yellow Fever Commission

The letter from Surgeon General George Miller Sternberg to the adjutant general on May 23, 1900, is held in the Philip S. Hench Walter Reed Collection at the University of Virginia. In the original, typed version the reference to yellow fever has been stricken by hand. The reason for this is not known, but Hench believes it may have been to avoid offending the Cubans. At that time, yellow fever was still considered a disease associated with filth.

Again, for an impression of the Havana harbor I relied on personal experience as well as descriptions from letters. The account of Reed’s trip to Havana on board the Sedgwick was from a letter he wrote to Emilie on June 25, 1900. It is held in the Hench collection.

Information about Sanarelli and the bacteria he believed caused yellow fever was taken from Kelly’s book. As Kelly was a contemporary of both Sternberg and Reed, he was well aware of the controversy.

I based the theory that Reed, rather than Sternberg, chose the members of the Yellow Fever Board on the electrozone report he filed with the surgeon general on April 20, 1900. It can be found in the archives of the National Library of Medicine. In the report, Reed specifically thanks Carroll, Agramonte and Lazear for all of their help.

Biographical information about James Carroll came from several sources. I found a reference to his nickname as “Sunny Jim” in an interview Hench conducted with Kean on November 19, 1946. Carroll himself provided a lot of the information about his backgroundto Caroline Latimer in a letter in 1905. Latimer later wrote an article about Carroll published in A Cyclopedia of American Medical Biography, 1920. Additional information was taken from Bean’s book.

Lazear’s description of Carroll was in a letter written to Mabel on July 15, 1900. And other impressions of Carroll were taken from an interview with Pinto and the memory of Charles S. White, a former student of Carroll’s and Reed’s. All can be found in Hench’s collection.

The quote by a colleague about Carroll needing to be led by a man with vision was in a letter Albert Truby wrote to Hench on September 3, 1941.

The letters in which Carroll chastises Jennie were written on August 27, 1900, and December 1, 1900. Both are held in the Hench collection and there are references to them in Bean’s book. Not all of his letters were so negative, but those two were chosen because they reflect what seemed to be a strained relationship between Carroll and his wife, as well as his children. In many other letters, he is perfectly cordial though never very affectionate. The information about Carroll’s son was found in a memorandum written by Hench on November 11, 1954.

Biographical information about Aristides Agramonte was taken primarily from the curriculum vitae of Aristides Agramonte, held in the Hench collection. There is also a photo in the collection on which I based the physical description of Agramonte. The reference to Agramonte’s work with Reed in Washington prior to their appointment in Cuba was found in Hench’s “Timeline of Agramonte’s Service in the Army Medical Corps.” Agramonte was assigned to work with Reed at the lab in Washington for the month of May, 1898.

William Welch’s recommendation of Lazear was part of a letter written to the surgeon general on January 12, 1900.

Reed’s account of the journey on board the Sedgwick was taken from his letter to Emilie on June 25, 1900. Details about the harbor, Plaza de Armas, and the Governor’s Palace came from personal observation during the trip to Havana. Descriptions of the plant life came from both personal observation and Reed’s descriptions in letters to his wife.

The board’s meetings on the veranda and the instructions from Sternberg come from Truby’s account as well as Sternberg’s biography. Agramonte described the scene in full, including the reverence with which they listened to Reed. The description of Reed as a teacher comes from Hench’s Notes on Reed and Carroll by Charles S. White, January 10, 1942. And, Lazear’s excitement about working with Reed was found in a letter to his mother, Charlotte Sweitzer, on May 29, 1900. The specific orders from Sternberg to the board can be found in the letter from George Miller Sternberg to Walter Reed, May 29, 1900, in the Hench collection.

Sternberg’s quote about mosquitoes being a useless investigation came from a letter in the Hench collection from Henry Hurd to Caroline Latimer, February 11, 1905. In the letter, Hurd relates a conversation he and Reed had in which Reed described the scene and quoted the surgeon general. The veracity of the story cannot be proven, but it does seem plausible. In what was a sad end to a skillful, twenty-year study of yellow fever, Sternberg’s judgment had become clouded by the controversy with Sanarelli. In the end, Sternberg would take credit for suggesting the mosquito possibility to Reed.

Insects

The majority of the description of the Board’s lab came from Albert Truby’s Memoir of Walter Reed, 1943. A few details were taken from other sources: The fact that the lab used to be the operating room came from John Moran’s account, and the description of the jars of black vomit was found in Philip S. Hench’s interview with Gustav Lambert in 1946.

The finer points of Reed’s first weeks in Cuba were taken directly from his letters to Emilie dated July 2, 7, 19, 20, 23, 27 and 30. Reed’s reference to returning to the United States to finish the typhoid report came from a letter written to Surgeon General Sternberg on July 24, 1900. Some details were also provided by Philip S. Hench’s interview with Blossom Reed in 1946. All of the letters are held in the Philip S. Hench Walter Reed Collection at the University of Virginia.

Other details in the chapter—like the pastimes for the soldiers—came from Truby’s account.

The majority of the material about Lazear’s time in Cuba during the summer of 1900 came from letters to his wife, Mabel, and his mother, Charlotte Sweitzer. The letters are held in the Hench collection. Additional information about his mother being twice widowed and losing two of her sons came from J. A. del Regato’s “Jesse William Lazear: The Successful Experimental Transmission of Yellow Fever by the Mosquito,” published in Medical Heritage in 1986.

Details about the visit from Dr. Herbert Durham and Dr. Walter Myers of the Liverpool School of Tropical Medicine came from a letter written by Reed to his wife on July 19, 1900, and from an article by Durham and Myers, “Yellow Fever Expedition,” published in the British Medical Journalon September 8, 1900. Additional information about both Durham and Myers contracting yellow fever came from B. G. Maegraith’s “History of the Liverpool School of Tropical Medicine,” in Medical History, October 1972 and William Petri’s “100 years of Tropical Medicine and Hygiene,” in the Americans Journal of Tropical Medicine and Hygiene, 2004.

The account of Aristides Agramonte’s visit to Pinar del Rio came primarily from his own account, The Inside History of a Great Medical Discovery. Additional details were provided by Reed’s letter to Surgeon General Sternberg on July 24, 1900.

The descriptions of Pinar del Rio were taken from Christopher Baker’s Cuba. Although I visited the city of Havana, I was not able to venture into the countryside around Pinar del Rio.

The remarks about Aristides Agramonte not being present at the meeting when the board decided to self-experiment were published by John C. Hemmeter in the American Public Health Reports in 1908 under the title “Major James Carroll of the United States Army, Yellow Fever Commission, and the Discovery of the Transmission of Yellow Fever by the Bite of the Mosquito ‘Stegomyia Fasciata.’ ” Most historians agree that the article was very one-sided in favor of Carroll. It was written by a former classmate of his. While there is a great deal of helpful information, his criticism of Agramonte seems unjust. Likewise, his reference to Reed abruptly leaving Cuba the morning after the meeting, found in a letter from James Carroll to Howard A. Kelly on June 23, 1906, is unsubstantiated. In fact, as outlined in this book, there were a number of earlier references made by Reed that indicate he planned to leave on that date. Carroll’s attack on Agramonte and Reed offers further evidence of his mental state after his work in Cuba. He obviously felt that he was not given due recognition.

Reed’s reference to human experimentation came from his July 24th letter to Sternberg.

The story of Reed’s return trip to the United States was taken from Truby’s account—including Reed’s joke about the “Rollins.”

Vivisection

The best book I’ve found on vivisection and the source for much of this chapter is Susan Lederer’s Subjected to Science. I also consultedLawrence Altman’s Who Goes First? The Story of Self-Experimentation in Medicine.

Information about Edward Jenner’s experiments on his son was taken from Greer Williams’s Virus Hunters.

The study that George Sternberg and Walter Reed conducted on children in orphanages was published in 1895 in Transactions of the Association of American Physicians as “Report on Immunity against Vaccination Conferred upon the Monkey by Use of the Serum of the Vaccinated Calf and Monkey.”

The Tennyson quote comes from his poem “In the Children’s Hospital,” published in The Poems of Alfred Lord Tennyson. The reference to the poem was found in Lederer’s book.

Did the Mosquito Do It?

The dates surrounding the time the board first visited Carlos Finlay were kept purposely vague. Some accounts claim that the Yellow Fever Board first visited Finlay in early July, just after their arrival. Other accounts say it didn’t happen until early August. There is no definitive proof either way.

Much of the details surrounding Carroll’s infection came from Agramonte’s account, as well as Philip S. Hench’s speech “The Conquest of Yellow Fever,” written on January 1, 1955. I also found details about the illness that Lazear wrote in his logbook, now held at the New York Academy of Medicine.

Lazear’s mention of trying to find the real yellow fever germ rather than bothering with Sanarelli came from a letter written to wife, Mabel, on August 23, 1900. His reference to the distance seeming very great at a time like this was found in a letter to his mother dated August 27, 1900. Both letters are held in the Hench collection.

Carroll’s impression of the mosquito hypothesis—that it was useless—come from his own words in a letter to an editor on June 26, 1903.

I pieced together the scene of Carroll’s first symptoms of the illness from a few different sources. The description of sea bathing came from a letter that Lazear wrote to his mother on September 18, 1900, describing the water as feeling as warm as the air. Dr. William Bean’s book, Walter Reed,also offers Alva Sherman Pinto’s recollection of that afternoon.

The details about Carroll’s illness were taken from Agramonte’s account, Lena Warner’s personal account of nursing Carroll and Howard A. Kelly’s book.

The scene in which William E. Dean is infected has been debated over the years. In some accounts, including a popular play called Yellow Jack, Dean was infected knowingly or unknowingly while he was bedridden and recovering in Las Animas Hospital. For this book, I based the scene on Agramonte’s own account, as he was one of the four members of the board.

Reed’s letters to Kean during Carroll’s illness, as well as his letter to Carroll on September 7, 1900, are held in the Hench collection.

Lazear’s letter to his wife, Mabel, was written on September 8, 1900, and is held in the Hench collection. I refer to the debate over the resulting tragedy as one that continued through the next five decades because a number of historians and participants attempted to explain what happened. Philip S. Hench was still piecing the story together in the 1940s and 1950s—five decades after the incident.

Guinea Pig No. 1

The description of the hospital room at Las Animas is based on a photograph held in the Hench collection. For a time, that room was marked with a plaque in honor of Jesse Lazear. The information about Aedes aegypti as a vector came from Robert Desowitz’sMosquito.

The scene in this hospital room is a re-creation from Agramonte’s The Inside History of a Great Medical Discovery. This was the story Jesse Lazear adamantly told colleagues—he never wavered from this account. His colleagues agreed that the story did not seem reasonable—Lazear would have known exactly what kind of mosquito landed on his arm, and he was far too meticulous to have let it go at that. Reed, Agramonte and Carroll all believed Lazear himself was the “Guinea Pig” in his logbook. Nonetheless, they assumed Lazear had his reasons for not telling the truth— reasons that even today are a mystery—so they kept to the story Lazear himself had told just before he died.

All information and recordings from the logbook were taken from the book itself on my visit to the New York Academy of Medicine.

Details about how Lazear spent his time—sea bathing and reading each night before bed—came from a letter he wrote to his mother on September 18, 1900. The quote about how much he missed Houston is also taken from that letter.

Lazear’s complaint about feeling “out of sorts” came from Agramonte’s account, and the description of how Lazear spent that first night with yellow fever—organizing his notes—was taken from Truby’s Memoir of Walter Reed. In that book, Truby also describes the following morning when Lazear was taken by litter out of his home and moved into the yellow fever ward.

There are several references in Truby’s writings and Gustav Lambert’s account to Lena Warner nursing both James Carroll and Jesse Lazear. Warner’s own account is full of inaccuracies, even untruths. Whenever taking facts directly from her account, I was sure to find a second or third source to back up her claims. I used creative license in the section where Warner remembers her own case of yellow fever. Her writings refer to how the incident stayed with her, so it seems natural to assume nursing fever patients took her back to that place and time.

The description of the record book required by the chief surgeon is based on my visit to the National Library of Medicine where the original record books can be found. All that is left of Jesse Lazear’s is his fever chart, which is part of the Hench collection.

James Carroll’s remark about being profoundly shaken by the sight of his friend came from his interview with Caroline Latimer, published in A Cyclopedia of American Medical Biography. Agramonte’s impression was found in his The Inside History of a Great Medical Discovery.

Walter Reed’s letter to Carroll was written on September 24, 1900, and Reed’s letter to Jefferson Randolph Kean was written on September 25, 1900. Both letters are held in the Hench collection.

The description of Lazear’s spiraling illness and eventual death were based on Lena Warner’s “Recollections of Lena A. Warner.” Similar details were taken from Gustav Lambert’s account, Truby’s memoir and Hench’s research. His fever chart shows his temperature falling from 104 to 99 degrees, where it flatlined. In trying to do justice to Lazear’s horrible death, I relied wholly on facts recorded by others—his running madly around the room destroying things and the vomit roiling over the bar. In that instance, it is not bars of the cot but the mosquito bar and netting hanging over the hospital bed. The only point when I added a detail not explicitly described firsthand was in restraining Lazear. Warner recalled two soldiers having to hold him down and restrain him, but there is no record of how they restrained him. In this account, I presumed they tied his wrists and ankles.

A copy of Jesse Lazear’s death certificate can be found in the Hench collection, and the original is at the National Library of Medicine. The account of his burial was based on Truby’s description. There have been discrepancies about whether or not James Carroll was present at the funeral. Reed was in the United States, and Agramonte had just been sent there on orders from General Wood (copies of those orders are in the Hench collection). Some sources have excluded Carroll’s presence or said that no members of the board were present; however, James Carroll wrote to his wife, Jennie, on September 28, 1900, that he had just returned from Lazear’s burial.

Details of how Mabel Lazear learned of her husband’s death come from Hench’s “An Illustrated Talk by Philip S. Hench” on January 31, 1955, as well as Hench’s “Interview with Jefferson Randolph Kean,” on January 6, 1944. Mabel’s letter to Carroll, dated November 10, 1900, is part of the Hench collection.

The account of Reed retrieving Lazear’s logbook is based on Truby’s account, as well as Bean’s Walter Reed.

Camp Lazear

Details of Walter Reed’s return to Cuba aboard the Crook were part of Hench’s “The Conquest of Yellow Fever.” The account of Robert P. Cooke sharing a cabin with Reed comes from Yellow Jack. The letter reprimanding Cooke, written on July 24, 1900, was written by the acting chief surgeon, Alexander Stark. The letter is part of the Hench collection.

Statistics about the yellow fever epidemic in Havana that year came from Bean’s book.

Reed’s general depression over the death of Lazear was noticed by Truby, as well as others at Camp Columbia. He also wrote to Emilie about it. His guilt at being in the United States while his board self-experimented was recorded in his letter to Kean on September 25, 1900.

Truby’s Memoir of Walter Reed describes the following weeks when Reed wrote and researched his paper on yellow fever. He also related the scene when Reed questioned William Dean about his yellow fever case. Reed’s paper “The Etiology of Yellow Fever: A Preliminary Note” can be found in the Hench collection and at the National Library of Medicine. The excerpt from the Indianapolis Journal was taken from a letter by Mary Fishback to Philip S. Hench, August 30, 1940. The New York Times quote about the presentation appeared in their “Topics of the Times” on November 10, 1900. The criticism from the Washington Post was published on November 2, 1900.

The letter in which Sternberg informs Reed that he has submitted the paper for publication was dated October 23, 1900, and is part of the Hench collection. That paper appeared in the Philadelphia Medical Journal on October 27.

The account of Reed meeting with General Wood in the Governor’s Palace, Havana, to request money for Camp Lazear was written in “A Review of Dr. Howard A. Kelly’s Book Walter Reed and Yellow Fever,” by Kean. The review was never published, but is held in the Hench collection.

Details about the development of Camp Lazear came primarily from Agramonte’s account. Carroll later denied that Agramonte had anything to do with selecting the site for the camp, but it made the most sense to have Agramonte scout out a location. He had lived in Cuba the longest, and the final location of the camp was on a farm belonging to some of his friends—Finca San Jose in Marianao outside of Havana.

The description of LaRoche’s books was based on personal observation. I looked through a copy of the original 1853 publication at the library of Southwestern Medical School in Dallas, Texas. And the account of Reed quoting LaRoche, the storm that destroyed their batch of mosquitoes and the hunt for new ones, all came from Truby.

The dimensions and details about Building No. 1 (the Infected Clothing Building) and Building No. 2 (Infected Mosquito Building) came from a number of sources. First and foremost, in 2005, I visited the site of what remains of Camp Lazear in Marianao, which is now a slum section outside of Havana. Only Building No. 1 still stands, but it was discovered by Hench and John Moran in the 1940s and returned to its original state as part of a memorial park dedicated to the yellow fever experiments. Hench worked with a number of medical officials and the Cuban government under Batista to renovate the building and erect a memorial wall. By the time I visited in 2005, few people in Havana knew where the park was, and the building was in a state of disrepair. However, it was still the same dimensions that Reed designed, and looking through broken boards I could see remains of the original tongue and groove construction, although the wood was rotting in a number of places and patched together in others.

Other descriptions of the building came from Reed’s hand-drawn plans, Truby’s account and “Memorandum on Yellow Fever Experiments,” written by Robert P. Cooke in 1940. Additional details about the men’s experience inside the building came from Agramonte’s article.

The majority of information about John Moran, how he came to be one of the volunteers, his stay in the Infected Mosquito Building and his resulting illness came from his own unpublished autobiography Memoirs of a Human Guinea Pig, written at Hench’s request in 1937.

The story of Major Peterson was told in an account written by Kean on May 8, 1941, the Recollections of Lena A. Warner and Recollections of Personal Experiences in Connection with Yellow Fever by Chauncey Baker. All three sources can be found in the Hench collection.

Information about Roger Post Ames came from Moran’s account, as well as the account of Gustav Lambert, Ames’s nurse.

Lawrence Reed’s remark about the veracity of Reed’s famous statement to Moran and Kissinger came from an interview with Lawrence and Blossom Reed by Hench on November 21, 1946.

Reed’s written recommendation for John Moran was found in Moran’s My Date with Walter Reed and Yellow Jack. Both Reed and Moran were on the same transport back to the U.S. Reed approached Moran and gave him the recommendation, adding that he should have done it long before then.

The account of procuring the Spanish volunteers at the Immigration Station came from Agramonte. And the details about the consent form came from Bean’s book, Walter Reed.

The description of the experiments performed on John Kissinger came from his own account given to Hench, “Memorandum: Experiences with the Yellow Fever Commission in Cuba 1900, by John R. Kissinger.” The details about how the men responded to Kissinger as a hero from that point forward was found in an account written by Paul L. Tate on July 27, 1954, for Hench. Tate also provided the “old army saying.”

For the sake of pacing, I streamlined some of the details about the experiments in November, December and January. The facts are all there, but I chose not to outline every single experiment performed during that three-month period. To recreate the experiments, I relied on several different sources. Philip S. Hench provided a “Summary of Research,” written on August 20, 1940, which I used as a general guideline. I also relied on the personal accounts written by Kissinger, Moran and Truby. Other details came out in original letters: One was written by Hench to Truby, January 7, 1941, and the other was a letter Reed wrote to Truby on December 10, 1900. Reed’s quote about the importance of these discoveries came from his letter to Emilie on December 9, 1900. An excerpt of that letter was provided by Blossom Reed in her “Biographical Sketch,” written for Hench.

The rumors about the bleached bones of Walter Reed’s yellow fever volunteers came from Bean’s book, as well as a letter Reed wrote to Emilie.

In developing the scene where Walter Reed walks through the streets of Havana on his way to a banquet on December 22, 1900, I used personal experience, old photographs and Hench’s notes. It was December when I visited Havana, so I had the opportunity to see huge poinsettia bushes in bloom and Christmas decorations around the city. I visited Parque Central, the Hotel Inglaterra and the site of what used to be Old Delmonico’s. In Hotel Inglaterra, they have an old print of the area from 1904. From the sketch, I took details of the park as it appeared in 1900, as well as the Tacón theater, which is now the beautiful Gran Teatro. The building where the restaurant stood in 1900 is now abandoned, but I was still able to climb the staircase and study details about the architecture. Details about the banquet itself came from a speech given by Hench on December 3, 1952, entitled, “The Historic Role of the Finca San Jose and Camp Lazear in the Conquest of Yellow Fever by Carlos Finlay, Walter Reed and Their Associates.” Information about Finlay’s career after the Reed experiments—the fact that he was nominated for the Nobel Prize seven different times—came from the official website for the Nobel Prize, which lists past nominees and winners.

Carroll’s letter to Jennie is held in the Carroll Box, as part of the Hench collection at the University of Virginia. The description of the Christmas party, the makeshift mosquito and the poem for Reed came from letters he wrote to Emilie on December 25 and 26, 1900.

A New Century

Walter Reed’s original letter to Emilie on New Year’s Eve is part of the Philip S. Hench Walter Reed Collection at the University of Virginia.

Blood

Details surrounding the blood inoculations came from two main sources: Truby provided some background information in his memoir, but the majority of the chapter came from John H. Andrus’s “I Became a Guinea Pig,” held in the Hench collection.

Instructions from the surgeon general came from letters exchanged between Sternberg and Reed in December 1900.

The description of Roger Post Ames was taken from Lambert’s account, as well as Paul Tate’s “Essay: Roger Post Ames,” written for Hench in 1954.

Reed’s letter to Sternberg expressing his concern for Andrus was written on January 31, 1901. Excerpts from that letter appear in Andrus’s own account, as well as the biography George M. Sternberg.

The Etiology of Yellow Fever

The account of Reed’s presentation to the Pan-American Medical Congress in Havana came from his own descriptions in family letters submitted to the Philip S. Hench collection by Blossom Reed.

The remark about Reed’s voice rising to a falsetto note when he emphasized important points was taken from Hench’s interview with Lawrence Reed on November 21, 1946. The quote about Reed as a teacher came from Captain J. Hamilton Stone’s remarks in Kelly’s book Walter Reed.

The Washington Post quote was from a clipping dated February 11, 1901, held in the Hench collection.

Retribution

Walter Reed was given military orders to report to Buffalo, New York, on September 5, 1901. Those original orders are held in the Philip S. Hench Walter Reed Collection.

The account of McKinley’s assassination came from a New York Times article published on September 7, 1901. The facts of the article were also checked against Encyclopaedia Britannica.

Proceedings from the 1901 American Public Health Association meeting are held in the Hench collection under the title Public Health Papers and Reports, Volume XXVII, Presented at the Twenty-ninth Annual Meeting of the American Public Health Association, Buffalo, NY, September 16-20, 1901.

The information about Wasdin’s theory of a poisoned bullet came from a New York Times article dated September 16, 1901.

Reed’s opinion of the Guitéras experiments came from a letter written by Reed to Gorgas, May 23, 1901. The letter is held in the Walter Reed Papers at the National Library of Medicine. Reed’s disappointment in hearing about the deaths resulting from the Guitéras experiments was found in another letter to Gorgas, dated September 2, 1901, also held at the National Library of Medicine.

The account of Clara Maass’s death during the experiments came from Philip S. Hench’s personal notes, as well as a New York Times article published on August 25, 1901. James Carroll’s experiments passing blood through the Berkefeld filter were outlined in his Report to the Surgeon General, August 18, 1906, held in the Hench collection.

Reed’s frustration in being passed over for surgeon general, as well as his statements about doing something for the real benefit of humanity, were expressed in a letter to Gorgas on July 21, 1902. The letter is part of the Walter Reed Papers at the National Library of Medicine.

The description of Keewaydin and the inscription above the fireplace was relayed in a “Biographical Sketch of Walter Reed” written by Emilie Lawrence Reed, held in the Hench collection.

The quote about Reed’s failing health and his frustration over having persons in high authority rob him of his just fame was taken from a letter from Henry Hurd, a friend of Reed’s, to Caroline Latimer on February 11, 1905. The letter can be found in the Hench collection. A similar reference, though with slightly different wording, can be found in Kelly’s book.

The statements by George M. Sternberg appeared in the July 1901 Popular Science Monthly. Reed’s anger at these remarks was expressed in a letter to Gorgas dated July 27, 1901, and held at the National Library of Medicine. Sternberg’s letter requesting a promotion to major general was dated January 25, 1901, and is held in the Sternberg papers at the National Library of Medicine.

The description of Reed’s final days and illness came from Emilie Lawrence Reed in notes held in the Hench collection, as well as “Notes on Reed and Carroll,” written by Philip S. Hench on January 10, 1942. Additional details were found in the Walter Reed Papers at the National Library of Medicine. The account of Reed’s death was taken from three sources: Kean’s letter to Howard Kelly on March 25, 1901, William Borden’s letter to Howard Kelly on March 16, 1905, and the Report: History of Doctor Walter Reed’s Illness from Appendicitis by William Borden, 1903. All three are held in the National Library of Medicine.

Details of Reed’s funeral were taken from Kean’s letter to Howard Kelly on March 25, 1901, Truby’s recollection, Hench’s interview with Lawrence and Blossom Reed on November 21, 1946, and a Biographical Sketch: Life and Letters of Dr. Walter Reed by HisDaughter. Welch’s remarks were found in the Message from the President of the United States Transmitting Certain Papers in regard to Experiments Conducted for the Purpose of Coping with Yellow Fever, by Theodore Roosevelt, December 5, 1906. Roosevelt’s quote about Reed’s contribution to the betterment of mankind came from Senate Document No. 10, Fifty-ninth Congress. All of the above are held in the Hench collection.

The list of names who contributed to the Walter Reed Memorial Association were found in Writer and Pierce’s Yellow Jack and Bean’s Walter Reed.

The Mosquito

Biographical information about Major William C. Gorgas came from Greer Williams’s book The Plague Hunters, as well as William Crawford Gorgas: His Life and Work.

In an interview with an anonymous source in Havana, I confirmed that the same method used in 1900 for monitoring mosquitoes is still in use today.

Part IV: United States, Present Day Epidemic

The introductory quote for Part IV was found in T. P. Monath’s “Yellow Fever: An Update,” published in Lancet Infectious Disease, 2001.

The account of Tom McCullough’s death from yellow fever came from the Centers for Disease Control and Prevention: “Fatal Yellow Fever in a Traveler Returning from Amazonas, Brazil, 2002,” Morbidity and Mortality Weekly Report. I also consulted another article, “Fatal Yellow Fever in a Traveler Returning from Venezuela, 1999,” in the Morbidity and Mortality Weekly Report for information about similar cases. Some of the more personal details about McCullough’s hospital stay and death were taken from two articles in the Corpus Christi Caller-Times, March 27, 2002, and May 14, 2004.

To describe what would happen in the case of an epidemic in the United States, I followed the CDC’s “Response to an Epidemic of Yellow Fever,” published in November 2005 specifically for Africa and the Americas. In the report, the CDC outlines the response of field investigators, armed forces, border officials, medical personnel, educational campaigns and vaccine usage.

For additional information about yellow fever vaccine production and stockpiling, I consulted the WHO’s “State of the World’s Vaccines and Immunizations” and the Global Alliance for Vaccines and Immunization. Prior to 2002, there was a global shortage of the yellow fever vaccine due to the lack of funds and too few labs producing the vaccine. Since then, the GAVI, with help from the Vaccine Fund, has been able to keep stockpiles of six million vaccines in the case of an epidemic, as well as an additional six million for yearly routine use in African and South American countries where yellow fever is endemic. According to the WHO report, there are four main manufacturers of the yellow fever vaccine, with a total global production capacity of 270 million.

A Return to Africa

Character development of Adrian Stokes came primarily from Greer Williams’s The Plague Killers, written in 1969. Some additional information about Stokes, as well as some of the details about the Rockefeller compound in Yaba, were found in Charles Bryan’s A Most Satisfactory Man: The Story of Theodore Brevard Hayne, Last Martyr of Yellow Fever.

Descriptions of the Rockefeller Foundation were gathered from Williams’s book and the website for the Rockefeller Foundation. John M. Barry’s Influenza also provided some material about the historical significance of the Rockefeller Institute and Rockefeller Foundation.

The two quotes cited in this chapter were taken from Laurie Garrett’s The Coming Plague, written in 1994, and Paul De Kruif’s Microbe Hunters, written in 1926.

The Vaccine

Biographical information about Max Theiler and his work with the 17-D yellow fever vaccine came from Greer Williams’s books The Virus Hunters and The Plague Killers. Williams was a contemporary of Theiler and was able to interview him personally for his book.

History Repeats Itself

The majority of updated information about yellow fever was taken from the World Health Organization.

Additional information about the attempts to eradicate Aedes aegypti from the United States was found in Andrew Spielman and Michael D’Antonio’s book Mosquito. The quote about America going to war with Spain, in part, because of yellow fever was taken from their book.

Information about the Asian tiger mosquito and its discovery in Memphis came from Paul Reiter and Richard Darsie’s “Aedes Albopictus in Memphis, Tennessee (USA): An Achievement of Modern Transportation,” published in Mosquito News, 1984. Reiter was the entomologist who found the tiger mosquito in Memphis, TN. Additional details came from Gary Taubes’s “Tales of a Bloodsucker—Asian Tiger Mosquitoes,” published in Discover, July 1998.

The recent study about the proteins on the surface of the yellow fever virus was published in an article in Virology, July 5, 2005. The study of the way a flavivirus interacts with interferon during an immune response was published in the Journal of Virology,September 2005.

The quote regarding A. aegypti mosquitoes established in urban areas was taken from the article “Yellow Fever: A Decade of Re-emergence,” by S. E. Robertson, et al, the Journal of the American Medical Association, 1996.

Epilogue: Elmwood

The majority of the descriptions of Elmwood were based on several visits there to look through their historical collections and an interview with superintendent Sunny Handback just before he retired in November 2005. The reference to the terms burial andcemetery were taken from the book Elmwood: In the Shadow of Elms. I also read through Elmwood’s ledger of burials for 1878-1879.