Chapter 24

We three left the yellow-fever hospital together that afternoon; I got down from the doherty-wagon where the road forks, going on to the Military Hospital, while Carroll and Lazear continued on their way to Camp Columbia. On the following day, Lazear telephoned to me in the evening, to say that Carroll was down with a chill after a sea bath taken at the beach, a mile and a half from Camp, and that they suspected he had malaria; we therefore made an appointment to examine his blood together the following morning.

When I reached Camp Columbia I found that Carroll had been examining his own blood early that morning, not finding any malarial parasites; he told me he thought he had "caught cold" at the beach: his suffused face, blood-shot eyes and general appearance, in spite of his efforts at gaiety and unconcern, shocked me beyond words. The possibility of his having yellow fever did not occur to him just then; when it did, two days later, he declared he must have caught it at my autopsy room in the Military Hospital, or at "Las Animas" Hospital, where he had been two days before taking sick. Although we insisted that he should go to bed in his quarters, we could only get him to rest upon a lounge, until the afternoon, when he felt too sick and had to take to his bed.

Lazear and I were almost panic-stricken when we realized that Carroll had yellow fever. We searched for all possibilities that might throw the blame for his infection upon any other source than the mosquito which bit him four days before; Lazear, poor fellow, in his desire to exculpate himself, as he related to me the details of Carroll's mosquito experiment, repeatedly mentioned the fact that he himself had been bitten two weeks before without any effect therefrom and finally, what seemed to relieve his mind to some extent, was the thought that Carroll offered himself to feed the mosquito and that he held the tube upon his own arm until the work was consummated.

I have mentioned before that, as Lazear and I, vaguely hoping to find malarial parasites in Carroll's blood, sat looking into our microscopes that morning, the idea that the mosquito was what brought him down gradually took hold of our minds, but as our colleague had been exposed to infection in other ways, by visiting the yellow fever hospital "Las Animas," as well as the infected city of Havana, it was necessary to subject that same mosquito to another test and hence the inoculation of Private Dean, which is described in the opening chapter of this history.

TERMINATION OF THE FIRST SERIES OF MOSQUITO EXPERIMENTS.

DEATH OF LAZEAR.

The month of September, 1900, was fraught with worry and anxiety: what with Carroll's and Private Dean's attacks of yellow fever and Major Reed's inability to return, Lazear and I were well-nigh on the verge of distraction. Private Dean was not married, but Carroll's wife and children, a thousand miles away, awaited in the greatest anguish the daily cablegram which told them the condition of the husband and father, who was fighting for life, sometimes the victim of the wildest delirium caused by consuming fever, at others almost about to collapse, until one day, the worst of the disease being over, the wires must have thrilled at our announcement, "Carroll out of danger."

Fortunately both he and Dean made an uninterrupted recovery, but we were still to undergo the severest trial, a sorrow compared to which the fearful days of Carroll's sickness lose all importance and dwindle almost into insignificance.

On the morning of the eighteenth my friend and classmate Lazear, whom in spite of our short intercourse I had learned to respect and in every way appreciate most highly, complained that he was feeling "out of sorts." He remained all day about the officers' quarters and that night suffered a moderate chill. I saw him the next day with all the signs of a severe attack of yellow fever.

Carroll was already walking about, though enfeebled by his late sickness, and we both plied Lazear with questions as to the origin of his trouble; I believe we affectionately chided him for not having taken better care of himself. Lazear assured us that he had not experimented upon himself, that is, that he had not been bitten by any of the purposely infected mosquitoes.

After the case of Dean so plainly demonstrated the certainty of mosquito infection, we had agreed not to tempt fate by trying any more upon ourselves, and even I determined that no mosquito should bite me if I could prevent it, since the subject of my immunity was one that could not be sustained on scientific grounds; at the same time, we felt that we had been called upon to accomplish such work as did not justify our taking risks which then seemed really unnecessary. This we impressed upon Major Reed when he joined us in October and for this reason he was never bitten by infected mosquitoes.

Lazear told us, however, that while at "Las Animas" Hospital the previous Thursday (five days before), as he was holding a test-tube with a mosquito upon a man's abdomen, some other insect which was flying about the room rested upon his hand; at first, he said, he was tempted to frighten it away, but, as it had settled before he had time to notice it, he decided to let it fill and then capture it; besides, he did not want to move in fear of disturbing the insect contained in his tube, which was feeding voraciously. Before Lazear could prevent it, the mosquito that bit him on the hand had flown away. He told us in his lucid moments, that, although Carroll's and Dean's cases had convinced him of the mosquito's role in transmitting yellow fever, the fact that no infection had resulted from his own inoculation the month before had led him to believe himself, to a certain extent, immune.

How can I describe the agony of suspense which racked our souls during those six days? It seemed to us as though a life was being offered in sacrifice for the thousands which it was to contribute in saving. Across the span of thirteen years the memory of the last moments comes to me most vividly and thrilling, when the light of reason left his brain and shut out of his mind the torturing thought of the loving wife and daughter far away, and of the unborn child who was to find itself fatherless on coming to the world.

Tuesday, the twenty-fifth of September saw the end of a life full of promise; one more name, that of Jesse W. Lazear, was graven upon the portals of immortality. And we may feel justly proud for having had it, in any way, associated with our own.

The state of mind in which this calamity left us may better be imagined than described. The arrival of Major Reed several days after in a great measure came to relieve the tensity of our nerves and render us a degree of moral support of which we were sorely in need.

Lazear's death naturally served to dampen our fruition at the success of the mosquito experiments, but, this notwithstanding, when the facts were known we were the subjects of much congratulation and the question whether the theory had been definitely demonstrated or not was the theme of conversation everywhere, about Havana and Camp Columbia particularly. We fully realized that three cases, two experimental and one accidental, were not sufficient proof, and that the medical world was sure to look with doubt upon any opinion based on such meager evidence; besides, in the case of Carroll, we had been unable to exclude the possibility of other means of infection, so that we really had but one case, Dean's, that we could present as clearly demonstrative and beyond question. In spite of this, we thought that the results warranted their presentation in the shape of a "Preliminary Note," and after all the data were carefully collected from Lazear's records and those at the Military Hospital, a short paper was prepared which the Major had the privilege to read at the meeting of the American Public Health Association, held on October 24, in the city of Indianapolis.

For this purpose Major Reed went to the States two weeks after his return to Cuba, and Carroll also took a short leave of absence so as to fully recuperate, in preparation for the second series of inoculations which we had arranged to undertake, after the Indianapolis meeting.

These inoculations, according to our program, were to be made upon volunteers who should consent to suffer a period of previous quarantine at some place to be selected in due time, away from any possibility of yellow fever.

It so happened then that I was left the only member of the board in Cuba and, under instructions from Major Reed, I began to breed mosquitoes and infect them, as Lazear used to do, wherever cases occurred, keeping them at my laboratory in the Military Hospital No. 1. Major Reed had also asked me to look about for a proper location wherein to continue the work upon his return.

ORIGIN AND DEVELOPMENT OF THE MOSQUITO THEORY

The possible agency of insects in the propagation of yellow fever was thought of by more than one observer, from a very early period in the history of this disease. For instance, Rush, of Philadelphia, in 1797, noticed the excessive abundance of mosquitoes during that awful epidemic. Subsequently, several others spoke of the coincidence of gnats or mosquitoes and yellow fever, but without ascribing any direct relation to the one regarding the other. Of course, man-to-man infection through the sole intervention of an insect was a thing entirely inconceivable and therefore unthought of until very recently, and in truth the discovery, as far as yellow fever is concerned, was the result of a slow process of evolution of the fundamental fact, taken in connection with similar findings, in other diseases.

The earliest direct reference is found in the writings of Dr. Nott, of Mobile, Ala., who in 1848 suggested that the dissemination of the yellow fever poison was evidently by means of some insect "that remained very close to the ground." But the first who positively pointed to the mosquito as the spreader of yellow fever, who showed that absence of mosquitoes precluded the existence of the disease and who prescribed the ready means to stamp it out, by fumigation and by preventing the bites of the insects, was Dr. Louis D. Beauperthuy, a French physician, then located in Venezuela. The writer has an original copy of his paper, published in 1853, where he fastens the guilt upon the domestic mosquitoes, believing, in accord with the prevailing teachings of medical science, that the mosquitoes infected themselves by contact or feeding upon the organic matter found in the stagnant waters where they are hatched, afterwards inoculating the victims by their sting. He recognized the fact that yellow fever is not contagious and therefore could not think of the possibility of man-to-man infection, as we know it to-day. The keenest observer was this man Beauperthuy, and, even at that benighted time in the history of tropical medicine, made most interesting studies of the blood and tissues, employing the microscope and the chemical reactions in his research. No one believed him, and a commission appointed to report upon his views said that they were inadmissible and all but declared him insane.

This field of investigation remained dormant for a comparatively long period of time. Meanwhile another medical writer, Dr. Greenville Dowell, mentions in 1876, that "if we compare the effect of heat and cold on gnats and mosquitoes with yellow fever, it will be difficult to believe it is of the same nature, as it is controlled by the same natural laws." Soon after this, in 1879, the first conclusive proof of the direct transmission of a disease from man-to-man was presented by the father of tropical medicine, Sir Patrick Manson, with regard to filaria, a blood infection that often causes the repulsive condition known as elephantiasis and which the mosquito takes from man and after a short time gives over to another subject. This discovery attracted world-wide attention and many looked again towards the innumerable species of biting insects that dwell in the Tropic Zone, as possible carriers of the obscure diseases which also prevail in those regions.

In 1881, Dr. Carlos Finlay, of Havana, in an exhaustive paper read before the Royal Academy of Sciences, gave as his opinion that yellow fever was spread by the bites of mosquitoes "directly contaminated by stinging a yellow fever patient (or perhaps by contact with or feeding from his discharge)." This latter view he held as late as 1900, which, although correct in the main fact of the transmission of the germ from a patient to a susceptible person by the mosquito, the modus operandi, as he conceived it, was entirely erroneous.

Dr. Finlay, unfortunately was unable to produce experimentally a single case of fever that could withstand the mildest criticism, so that at the time when the Army Board came to investigate the causes of yellow fever in Cuba, his theory, though practically the correct one, had been so much discredited, in a great measure by his own failures, that the best-known experts considered it as an ingenious, but wholly fanciful, one and many thought it a fit subject for humorous and sarcastic repartee. Finlay also believed, erroneously, that repeated bites of contaminated insects might protect against yellow fever and that the mosquitoes were capable of transmitting the germ to the next generation.

The wonderful discoveries of Theobald Smith, as to the agency of ticks in spreading Texas fever of cattle, and those of Ross and the Italian investigators who showed conclusively that malaria was transmitted by a species of mosquito, brought the knowledge of these various diseases to the point where the Army Board took up the investigation of yellow fever.

SECOND AND FINAL SERIES OF MOSQUITO EXPERIMENTS

Major Reed came back to Havana in the early part of November, Carroll following a week after.

During their absence, I had been applying mosquitoes to yellow fever patients at "Las Animas" Hospital, keeping them in my laboratory, as it was done at the beginning of the investigation; the season being more advanced, now and then a cold "norther" would blow and my insects suffered very much thereby, so that I had the greatest trouble in preventing their untimely death: to this may be added the difficulty met in feeding them blood, for now that I knew their sting was dangerous, unto death perhaps, I could not allow any indiscriminate biting, but had to select for the purpose individuals who had suffered an attack of the disease and were therefore immune.

The necessity for an experimental camp became more imperative as time passed, not only where proper quarantine and isolation could be established, but also where the insects intended for the inoculations might receive better care. This entailed considerable expense.

Fortunately for us, the military governor of the island at that time, Brigadier General Leonard Wood, was a man who had received a thorough medical training; broad and clear-minded, he fully appreciated the importance of what might be the outcome of our researches. We found in him the moral support which we so much needed and, further, he promptly placed at the disposal of the board sufficient funds with which to carry on the experiments to the end. I firmly believe that had other been the circumstances, had a more military and less scientific man been at the head of the government, the investigation would have terminated there and then, and many years would have passed, with hundreds of lives uselessly sacrificed, before we could have attained our present remarkable sanitary triumphs.

We immediately set about choosing a location for our camp. I had already looked over the ground, preferring the proximity of Camp Columbia, from where supplies could be easily obtained and because the Military Hospital there could be used for treating the cases that we intended to produce; I was therefore favorably impressed with the seclusion offered by a spot situated a short distance from the main road, in a farm, named San Jose, belonging to my friend Dr. Ignacio Rojas, of Havana. Major Reed decided upon this place after looking at many others in the neighborhood, so that on the twentieth of November we inaugurated our camp, which we named Camp Lazear, in honor to the memory of our dead colleague, consisting then of seven army tents, guarded by a military garrison, composed of men who had been carefully selected by virtue of their previous good record and their interest in the work to be undertaken.

Feeling that we had proved, to ourselves at least, the agency of the mosquito in yellow fever, it became our duty to disprove the theory, until then held as a certainty by many authorities, to the effect that the soiled bedding and clothing, the secretions and excreta of patients, were infectious and in some way carried the germ of the disease. We therefore designed a small wooden building, to be erected a short distance from the tense, with a capacity of 2,800 cubic feet. The walls and ceiling were absolutely tight, the windows and vestibuled door screened and all precautions taken to prevent the entrance of insects.

Into this, called the "infected clothing building," three beds and a stove, to maintain a high tropical temperature, were introduced; also mattresses and pillows, underwear, pajamas, towels, sheets, blankets, etc., soiled with blood and discharges from yellow fever cases: these articles were put on the beds, hung about the room and packed in a trunk and two boxes placed there for the purpose.

The building was finished and equipped on November 30. That Friday evening, Dr. Robert P. Cook, U. S. Army, with two other American volunteers, entered it and prepared to pass the night: they had instructions to unpack the boxes and trunk, to handle and shake the clothing and in every way to attempt to disseminate the yellow fever poison, in case it was contained in the various pieces. We watched the proceedings from the outside, through one of the windows. The foul conditions which developed upon opening the trunk were of such a character that the three men were seen to suddenly rush out of the building into the fresh air; one of them was so upset that his stomach rebelled; yet, after a few minutes, with a courage and determination worthy only of such a cause, they went back into the building and passed a more or less sleepless night, in the midst of indescribable filth and overwhelming stench.

For twenty consecutive nights these men went through the same performance; during the day they remained together, occupying a tent near their sleeping quarters. Dr. Cook, by voluntarily undergoing such a test, without remuneration whatsoever, proved his faith in the mosquito theory; his demonstration of the harmless character of so-called infected clothing, in yellow fever, has been of the greatest importance. The other six men (two of them with Dr. Cook) who were subjected to this test, received each a donation of one hundred dollars for his services.

Many days even before the establishment of the experimental camp, the board had heard that several men who knew of our work were willing to submit to the inoculations and thus aid in clearing up the mystery of yellow fever. Two of these require special mention, John R. Kissinger, a private in the Hospital Corps of the Army, was the first to offer himself most altruistically, for, as he expressed it, his offer was made without any desire for pecuniary or other consideration and solely "in the interest of humanity and the cause of science," the other, J. J. Moran, a civilian employee, also stipulated as a condition that he was to receive no pay for his services. Both these men, in due time, suffered from yellow fever and until very recently had never obtained any reward for the great risk which they ran so voluntarily and praiseworthily.

Kissinger, who after several years' service in the army became disabled, is receiving a pension from the government; Moran, I hope, is still well and in the employ of the Isthmian Canal Commission, justly enjoying the friendship and confidence of his superior officers. The names of Kissinger and Moran should figure upon the roll of honor of the U. S. Army.

On the day the camp was definitely organized, Kissinger, who had not gone outside the military reservation for more than a month, moved into Camp Lazear and received his first bite from a mosquito which evidently was not "loaded" for, again on November 23, he was stung by the same insect without result. On December 5, five mosquitoes were applied, which brought about a moderate infection in three days. Moran was also bitten by mosquitoes which were supposed to be infected on November 26 and 29, both times unsuccessfully. As will be seen, he was infected later on.

By this time we had decided, the weather having cooled considerably, that it was better to keep the mosquitoes at a higher temperature and nearer to the men who were to be inoculated; therefore it was planned to put up another small wooden structure, which was to be known as the "Mosquito Building" in which an artificial temperature could be maintained; at my suggestion, the building was so designed that it might serve to infect individuals; by liberating infected mosquitoes on the inside and exposing some person to their stings, we could try to reproduce the infection as we felt it occurred in nature. Another reason for the mosquito house was the need to obviate the transportation of the insects from the Military Hospital, where I kept them, to our camp, which could not be easily done without subjecting them to severe injury. Upon one occasion I was taking four infected mosquitoes in the pocket inside my blouse from the laboratory in Havana to the experimental camp, accompanied by my attendant Private Loud; the horse which pulled my buggy, a rather spirited animal, becoming frightened at a steam roller, as we went around the corner of Colon Cemetery, started to race down the hill towards the Almendares River: Loud was thrown out by the first cavortings of the horse, who stood on its hind legs and jumped several times before dashing away, while I held tightly to the tubes in my pocket, as the buggy upset and left me stranded upon a sand pile in the middle of the road; the mosquitoes were quite safe, however, and upon my arrival at Camp Lazear I turned them over to Carroll for his subsequent care.