WALTER REED 
From a photograph taken in 1901. rEtat 50 WALTER REED 
AND YELLOW FEVER 
By 
HOWARD A. KELLY, M. D. 
Third Edition Revised 
THE NORMAN, REMINGTON COMPANY 
BALTIMORE, MARYLAND Copyright, 1906, by 
HOWARD A. KELLY 
Copyright, 1923, by 
THE NORMAN, REMINGTON CO. 
PRINTED IN THE UNITED STATES OF AMERICA Affectionately inscribed 
to the memory of 
REED, CARROLL, and LAZEAR PREFACE TO THIRD EDITION 
It is now sixteen years since I wrote the life of 
Walter Reed, and much has transpired in the 
interim. We have lived to see Reed’s discovery 
tested out in a large territory under the control of 
that sanitary genius, General William C. Gorgas, 
to be still further extended under the beneficent 
fostering care of The Rockefeller Foundation. 
We have also beheld the placing of the capstone 
on the monument by Noguchi’s great discovery 
of the specific organism and the preventive serum 
until at last the goal of complete extermination of 
this age long enemy of our race, the slayer of 
countless millions, is almost reached. Thus ends 
the greatest battle ever fought for the health of 
the human race, and a new era dawns with the 
fair promise of other like successful battles with 
similar enemies. 
The present edition includes a life of General 
George M. Sternberg, the precursor of Reed, and 
a life of General Gorgas, the one who first put 
Reed’s work on a broad practical basis, adding 
enormously to its prestige and opening up new 
fpafns. 
Sternberg, Reed, Gorgas, Noguchi, a great 
quartette, none complete without the other, each 
a complementary part to the completed whole. 
‘‘Others have labored, ye have entered into their 
labors.” 
The revision of this present edition has been 
made in close cooperation with Miss Audrey W. 
Davis. 
October, 1922. 
VII PREFACE 
My pleasant self-imposed task is at an end. 
I had hoped at the beginning that I might be 
able to catch enough of that evanescent aura which 
we call a personality, to convey in written words 
some clear notion of the man to whom it was given 
to make the greatest American medical discovery. 
Alas, as I look upon my unfinished picture, I real- 
ise the impossibility of portraying that “animula 
blandula, vagula, hospes comesque corporis”— 
with us so short a time and then gone. The mo- 
mentous external activities in which the man was 
engaged are easily recited, but the real inner man 
must, I think perhaps in all such attempts, evade 
the crude methods of the biographer. Only He 
who gave it can really appreciate the spirit of a 
man, as only to Him who gave it does that spirit 
hold itself responsible for its activities during its 
earthly stewardship. The inspiration of Reed’s life 
lies to me in the fact that, though a man of war, he 
ravaged no distant lands, he destroyed no tens of 
thousands to make his reputation, but by quiet 
methods, when there was no strife, he saved count- 
IX X 
PREFACE 
less lives and swept away a hideous plague, which 
from time immemorial had periodically visited 
our shores, devastated our fair land, and too often 
snatched from the years of peace and plenty all 
their blessings. 
My personal interest, as I reviewed the his- 
tory of the various yellow fever epidemics in this 
country, was enhanced by the fact that my two 
paternal great-grandmothers lived through the 
Philadelphia epidemic of 1793. The terrible 
cries of the men who drove the dead-carts, 
“Bring out your deadl bring out your dead!” 
lingered long in the ears of my great-grand- 
mother, Mrs. Thomas Kelly. 
Acknowledgments for hearty cooperation are 
due to Mrs. Walter Reed, for her constant sym- 
pathy and ready aid given at every phase of the 
work. I am indebted to Dr. Reed’s sister, the late 
Mrs. J. H. Blincoe, as well as to his brother, Mr. 
Christopher Reed, for information relating to his 
childhood and youth. 
Dr. James Carroll, Dr. Reed’s friend and fel- 
low commissioner, has furnished me much valu- 
able information relative to the work of the Yellow 
Fever Commission; while Major J. R. Kean has 
given cheerful aid in securing data concerning his 
army life. 
I have to thank my friend, Dr. Mary Augusta PREFACE 
XI 
Scott, Professor of English in Smith College, for 
aid in reading and criticising manuscript. 
Dr. Henry M. Hurd, Superintendent of the 
Johns Hopkins Hospital, has proved a valuable 
friend and helper on this, as on similar occasions, 
in giving advice touching additions and altera- 
tions. 
Professor William H. Welch wrote the pages 
dealing with Dr. Reed’s work at the Johns Hop- 
kins Medical School. 
Professor George M. Kober furnished the 
photograph of the bust of Dr. Reed by Hans 
Schuler. 
There are other acknowledgments it would be 
pleasant to make, if space permitted. 
Dr. Caroline Latimer has been my constant 
associate throughout, throwing herself into the 
work with an inspiring interest and zeal, without 
which it would never have been completed. 
May> 1906 CONTENTS 
PAGE 
Chapter I: Birth and Childhood.—1851-1876 . 3 
Date of birth, 3—Members of family, 4—Child- 
hood and early education, 5—College life, 6— 
Graduation at University of Virginia, 7—Gradua- 
tion at Bellevue Hospital Medical School, 8— 
Practice of medicine in New York and Brooklyn, 9 
—Resolution to enter the United States Army, 12 
—Over-work in studying for examinations, 16— 
Engagement to Miss Lawrence, 19—Commission 
in Army, 19—Ordered to Arizona, 21—Interview 
with Surgeon-General, 22—Marriage, 23—Depar- 
ture for Arizona, 23. 
Chapter II: Frontier Life.—1876-1889 . . 24 
Journey with wife to Fort Lowell, Arizona, 24— 
Life in Arizona, 30—Journey to Fort Apache, 32— 
Difficulties of housekeeping on the frontier, 42— 
Life as Post-Surgeon, 49—Popularity with friendly 
Indians, 51—Struggle to maintain his authority, 52 
—Deer and turkey hunt, 53—Promotion to rank of 
captain, 56—Ordered to Fort McHenry, 57—Work 
in physiology at the Johns Hopkins University, 57 
—Ordered to Nebraska, 58—Ordered to Alabama, 
59—Efforts to undertake scientific work in the 
East, 60—Appointment to duty in Baltimore, 60. 
Chapter III: Beginning of Scientific Work.— 
1890-1899 62 
Work in pathology and bacteriology at the Johns 
XIII XIV 
CONTENTS 
PAGE 
Hopkins Hospital, described by Dr. William H. 
Welch, 62—Appointment to duty in Washington, 
67—Promotion to rank of major, 67—Foundations 
for scientific work laid by life on the frontier, 67— 
Interest in discovery of Klebs-Loeffler bacillus and 
diphtheria antitoxin, 70—Efforts to obtain posi- 
tion in charge of sick soldiers in Spanish-American 
War, 72—Opinion of injury done to Army Medical 
Corps by appointment of incompetent persons to 
responsible positions, 73—Made chairman of the 
Typhoid Fever Commission, 74—Extracts from 
published report of the Commission, 76-79. 
Chapter IV: History of Yellow Fever in 
the Past ...... 80 
Clinical description of yellow fever, 80—Synonyms, 
82—Earliest authentic accounts, 83—Occurrences 
and epidemics of yellow fever, 84—Discussion of 
contagion and non-contagion theories during the 
epidemic of 1793 in Philadelphia, 86—Contention 
for priority of publication of views of non-conta- 
gion, 87—Attitude of Dr. Benjamin Rush, 90— 
Contagionists divided into three parties, 90—Epi- 
demic of 1819 in Baltimore, 92—Publication of 
La Roche’s work on yellow fever in 1855, 93— 
Early theories as to cause and transmission of the 
disease, 94—Transmission by means of fomites 
first discussed, 95. 
Chapter V: Insects and Diseases ... 98 
Suggestions in literature as to transmission of dis- 
ease by’means of insects, 98—Experiments by Sir 
Patrick Manson upon the Filiaria sanguinis 
hominis, 100—Paper by Dr. A. F. A. King on 
“Insects and Disease,” 102—Manson’s views on 
the transmission of malaria by means of the mos- 
quito, 106—Experiments by Major Ronald Ross, 
proving that malaria is conveyed by the mosquito, CONTENTS 
PAGE 
of the genus Anopheles, 108—Confirmation of 
Ross’s experiments by other workers, 113—First 
suggestion that yellow fever is conveyed by the 
mosquito made by Dr. J. C. Nott, 114—Formula- 
tion of theory that yellow fever is conveyed by 
the Culex fasciatus made by Dr. Carlos J. Fin- 
lay, 115—Search for specific germ of yellow fever 
by different scientists, 119. 
Chapter VI: George Miller Sternberg.—1838— 
1915 122 
Birth and early training, 122—Commission in 
army, 124—Subsequent appointments, 124—Work 
in yellow fever, 126—Further experimentation 
and study, 127—Detailed on Havana Yellow Fever 
Commission of the National Board of Health, 128— 
Discovers Micrococcus pasteuri, 129—Researches 
in various laboratories, 129—Surgeon General of. 
the United States Army, 132—Establishment of 
the Army Medical School, 132—Physician to 
President Cleveland, 133—Work with Medical 
Corps, 133—Discovery of mode of spread of yel- 
low fever by Walter Reed and his party, 134—In- 
terest in sanitary dwellings, 135—Work in tu- 
berculosis, 137—Death, 137. 
Chapter VII: Work in Yellow Fever . . 138 
Controversy with Sanarelli, 138—Appointment of 
United States Army Yellow Fever Commission, 
141—Investigation of epidemic at Pinar del Rio, 
by Reed, 142—Reed’s reasons for accenting the 
mosquito theory as a working hypothesis, 145— 
Description of different species or Anopheles, 147 
—Description of Culex fasciatus> 148—Success- 
ful inoculation of Dr. James Carroll with an in- 
fected mosquito, 150—Death of Dr. Lazear from 
accidental inoculation, 152—Establishment of 
XV CONTENTS 
XVI 
PAGE 
Camp Lazear, 154—Volunteers for experimental 
inoculation, 157—Successful inoculation of Pri- 
vate John R. Kissinger, 158—Other successful 
inoculations and their results, 161—Experiments 
showing that infection from yellow fever is not 
conveyed by fomites, 163—Experiments showing 
that infection of houses proceeds from contami- 
nated mosquitoes, 168. 
Chapter VIII: Work in Yellow Fever 
(Continued) 172 
Gratifying reception of Reed’s results by the medi- 
cal profession in Havana, 172—Successful inocu- 
lation of Private Jernigan with blood of a yellow 
fever patient, 174—Experiments showing the 
length of time which must elapse between con- 
tamination of a mosquito and its being able to 
convey the disease, 175—Experiments showing 
the length of time for which the mosquito is able 
to transmit the disease, 176—Paper read by Reed 
before the Pan-American Congress in Havana, 
February, 1901, 179—Return of Reed and Carroll 
to the United States, 181—Prophecy by General 
Sternberg as to the nature of the specific germ of 
yellow fever, 182—Experiments of Loeffler and 
Frosch in the foot and mouth disease of cattle, 183 
—Carroll’s return to Cuba to continue experiments, 
184—Difficulties encountered, 185—Experiments 
showing that the specific germ of yellow fever is, 
in all probability, ultra-microscopic, 192—Obliga- 
tions of the Yellow Fever Commission and of the 
world at large to Major General Leonard Wood, 
Governor of Cuba, 198. 
Chapter IX: Practical Application of the 
Mosquito Theory ..... 200 
Extermination of yellow fever in Havana by 
Reed’s methods, 200—Extermination of yellow CONTENTS 
XVII 
PAGE 
fever in Laredo, Texas, by Reed’s methods, 206— 
Advisability of martial law during the extermi- 
nation of an epidemic, 213—Extermination of 
yellow fever in New Orleans in 1904, described 
by Dr. J. H. White, 214; by Mr. Rupert Boyce, 
220; Comparative table of deaths from yellow 
fever in New Orleans during different epidemics, 
222—Reed’s views on quarantine regulations 
against yellow fever, 223. 
Chapter X: Value of Reed’s Work to the World 228 
Epidemic of yellow fever at Philadelphia, in 1793, 
229; extract concerning it from published account 
by Mathew Carey, 230; extracts from published 
account by Dr. Benjamin Rush, 235—Epidemic 
of 1878 in Memphis, Tenn., 241; extracts concern- 
ing it from published account by J. M. Keating, 
242, 245—Generosity throughout the United 
States to the sufferers in Memphis, 248—Work of 
the Howard Association, 249—Epidemic of 1878 
in Grenada, Miss., described by Mrs. Lena 
Warner, 251—Epidemic of 1900 in Havana, de- 
scribed by Mrs. Warner, 253—Mortality during 
different epidemics, 256—Injury to national pros- 
perity, 257—Expense of quarantine regulations, 
259—Slow and imperfect appreciation of Reed’s 
services by the world at large, 260. 
Chapter XI: Life after Return from Cuba 
and Death.—1901-1902 .... 263 
Address before the Medical and Chirurgical Fac- 
ulty of Maryland, April, 1901, 263—Reed’s suc- 
cess as a teacher, 264—Summer home in Monte- 
rey, 267—Honorary degree from Harvard Uni- 
versity, 268—Letter to Dr. Theobald Smith, on 
Bacillus Icteroides and the hog-cholera bacillus, 
269—Honorary degree from the University of 
Michigan, 270—-Failing health, 270—Last illness, XVIII 
CONTENTS 
PAGE 
271—Operation for appendicitis, 272—Death, 274 
—Funeral services, 275—Monument at Arlington, 
275—Universal expression of grief, 276—Estab- 
lishment of Walter Reed Memorial Association, 
277. 
Chapter XII: Other Members of the Yellow 
Fever Commission . . . . . 280 
Life and work of Dr. Carroll, 280; extracts from 
published writings on yellow fever, 290-296; trib- 
ute to Dr. Carroll by Dr. Pilcher, 297; list of inde 
pendent publications on yellow fever, 299—Life 
and work of Dr. Lazear, 299; death from experi- 
mental yellow fever,302; tributes to his memory, 
303; tablet erected by his friends in the Johns 
Hopkins Hospital, 306—Life and work of Dr. 
Agramonte, 306; list of independent publications 
on yellow fever, 309. 
Chapter XIII: Reed’s Work made Effective, 
William Crawford Gorgas . . .310 
Life, 310—Death, 312—Memorials, 312—Gorgas’ 
application of Reed’s discovery in Havana, 313; 
in the Canal Zone, 325—Means of exterminating 
malaria in the Canal Zone, 329—Battle for eradi- 
cation of yellow fever from world undertaken by 
Noguchi, 341—Isolation of Leptospira icteroides 
and development of serum, 341—Subsequent work 
in elimination of yellow fever from world, 342— 
Fallacious statements of the efficacy of work 
done in the Canal Zone, 343. 
Conclusion ........ 346 
Bibliography ....... 353 LIST OF ILLUSTRATIONS 
MAJOR WALTER REED IN 1901 . .Frontispiece 
JEtat 50. 
Facing Page 
WALTER REED IN 1874 . . . . .10 
From a photograph taken in Murfreesboro, N. C. 
23. 
WALTER REED IN 1876 . . . . . 30 
From a photograph taken in Harrisonburg, Va. 
TEtat 25. 
WALTER REED IN 1882 ... . .58 
From a photograph taken in Washington, D. C. 
TEtat 31. 
MAJOR SIR RONALD ROSS . . . .108 
Professor of tropical medicine, University of 
Liverpool. 
DR. CARLOS J. FINLAY 116 
Who first promulgated the theory of the trans- 
mission of yellow fever by the mosquito. 
GEORGE MILLER STERNBERG . . .132 
CAMP LAZEAR . . . . . . .154 
Where the experiments with the yellow fever 
mosquito were first carried out, and the trans- 
mission of the disease by this means proven. 
CAMP LAZEAR . . . . . 164 
Building where the experiments were made which 
proved that yellow fever is not transmitted by 
means of infected clothing (fomites). 
JAMES CARROLL, M.D .184 
Member of the U. S. A. Yellow Fever Commis- 
sion. From a photograph taken in 1901. 
MOSQUITOES 208 
MAJOR WALTER REED . . . .276 
Bust by Hans Schuler. Now in the library of 
the Surgeon-General in Washington. 
JESSE W. LAZEAR, M.D .300 
Member of the U. S. A. Yellow Fever Commis- 
sion, who laid down his life on the field of service. 
ARISTIDES AGRAMONTE, M.D. . . . 306 
Member of the U. S. A. Yellow Fever Commis- 
sion. From a photograph taken in 1902. 
SURGEON GENERAL WILLIAM CRAWFORD 
GORGAS 312 
XIX WALTER REED AND YELLOW FEVER CHAPTER I 
BIRTH AND CHILDHOOD 
1851-1876 
When Nature has work to be done she creates a 
genius to do it.—Emerson. 
WALTER REED, to whom the nineteenth cen- 
tury owed the last of her goodly array of scientific 
discoveries, was born in Gloucester County, Vir- 
ginia, September 13, 1851. 
The Reed family were of English extraction, 
being descended, as they suppose, from Sir Chris- 
topher Reed, of Chipchase Castle, on the Tyne. A 
son of this Christopher was, at one time, Lord 
Lieutenant of Ireland. Walter Reed’s father, 
Lemuel Sutton Reed, was a North Carolinian by 
birth, though he passed nearly forty years of his 
life in Virginia, as a minister of the Methodist 
Church. His upright character together with his 
mental endowments procured him distinction in 
his profession, and he was for many years a 
member of the Bishop’s Council. His first wife, 
Walter’s mother, was Pharaba White, the daugh- 
ter of a North Carolina planter, who also came of 
a good English family. She was a loving, loyal- 
3 4 
WALTER REED AND YELLOW FEVER 
hearted woman, with great force of character, and 
her children owed much to her influence. 
The leading traits in Walter Reed’s ancestors 
on both sides were individuality of character and 
desire for knowledge, attributes which he, him- 
self, possessed in no common degree. 
Lemuel Reed and his wife Pharaba had five 
children, a daughter, Laura, who married Mr. J. 
W. Blincoe of Ashland, Virginia, and died in 
February, 1906, and four sons, James, Thomas, 
Christopher, and Walter. The first years of Wal- 
ter’s life were spent at Farmville, Prince Ed- 
ward County, and here when six years old he 
began his education at a small private school, 
kept by a Mrs. Booker. His personal appearance 
as a child was very attractive, and his manners 
were remarkable for their childish graciousness. 
He had the happy nature which finds pleasure in 
everything, but he began early to manifest the 
stronger qualities which distinguished him in after 
life, namely, force of character, self-control, a 
passionate love of knowledge, and a keen sense 
of honour. His brother tells the story of a boyish 
escapade, which illustrates some of these traits. 
Once, when still quite a small child, Walter, 
in company with some older boys, made the rounds 
of the tobacco warehouses, then very numerous 
in Farmville, tasting a little of the tobacco at BIRTH AND CHILDHOOD 
5 
each, until the inevitable result followed, and 
Walter, the youngest of the party, became so ill 
that his friends were obliged to carry him home 
as fast as they could. On the way the sick boy grew 
rapidly worse, and his friends, thinking he was 
going to die, became thoroughly frightened. In 
great alarm as to the judgment to come they said to 
him “Promise, Walter, that you will not tell, even 
if it kills you.” And Walter, firmly persuaded that 
his last hour was at hand, promised solemnly that, 
even if it killed him, the secret should be kept. 
When he was about ten years old the Civil War 
began, and in the year 1865 Sheridan’s raiders 
swept through the part of Virginia where the 
Reeds lived, carrying off with them all the live- 
stock available. Walter and his next brother, 
Christopher, together with some other boys in the 
neighbourhood, were sent by their parents to hide 
their horses. The boys found a suitable place in 
the bend of a river, far from any dwelling and 
completely hidden by trees, which seemed so se- 
cure that one fine morning, leaving the horses well 
tied, they went for a swim in the river. Suddenly, 
while they were thus occupied, a band of raiders, 
guided by a servant who had been considered per- 
fectly trustworthy, dashed into the hiding-place, 
seized the horses, and took the boys into custody. 
They were all too small to be worth keeping as 6 
WALTER REED AND YELLOW FEVER 
prisoners, and were, therefore, released, but not 
until their families had been greatly alarmed by 
reports of their seizure. The horses, of course, 
were gone forever. 
In 1866 the Reed family moved to Charlottes- 
ville, and there Walter, now fifteen years of age, 
was sent to a private school kept by a Mr. Abbott, 
a graduate of the University of Virginia. His 
education had been carried on without interrup- 
tion up to this time, except for one year during 
the Civil War, when all the schools in his neigh- 
bourhood were closed, and he was well advanced 
for his age, especially in history and literature; 
but, strange to say, he does not seem to have shown 
any marked aptitude or taste for science during 
his boyhood. He remained with Mr. Abbott for 
two sessions and then entered the university, by 
special dispensation, as he was only sixteen, which 
was under the required age. Notwithstanding his 
extreme youth, his work was always good and he 
held a high place in all his classes. It was his 
earnest wish to go through the university, but as 
two of his brothers were already studying there 
with that intention, and his father’s means were 
limited, he soon realised that it would be impossi- 
ble for him to take the entire course. He applied, 
therefore, in person to the faculty to be certificated 
in the studies he had pursued, but this request BIRTH AND CHILDHOOD 
7 
was refused on the ground that he was under age. 
He then inquired whether he would be allowed to 
take the degree of doctor of medicine if he could 
pass the examinations. To this the faculty silently 
assented, thinking (as one of them afterwards told 
Reed’s brother) that it was a safe promise, for 
the undertaking was an impossibility. Reed then 
turned to Dr. Maupin, the chairman, and said, 
“Doctor, you have heard what these gentlemen 
say. Will you see that I have my degree as M. D. 
if I make the required standard?” Dr. Maupin 
replied that he would, and Reed, bowing to the 
faculty said, “Gentlemen, I hold you to your 
promise,” and left the room. The friend who re- 
lated this incident to Christopher Reed said that 
Walter’s self-restraint and dignity, remarkable in 
a boy of sixteen, made a marked impression on 
those who were present. 
Reed at once began his medical studies and 
graduated nine months later, in the summer of 
1869, standing third in his class. Dr. Maupin, in 
presenting him his diploma, said that he was the 
youngest student ever graduated from the Medical 
School at Charlottesville, but that as he had ful- 
filled every requirement, the faculty were bound in 
honour to give him his degree. 
Dr. A. R. Buckmaster, recently professor of ob- 
stetrics and practical medicine at the University 8 
WALTER REED AND YELLOW FEVER 
of Virginia, writes me regarding Reed’s career at 
college as follows: 
Walter Reed was at the University of Virginia 
two sessions. In 1867 he took Latin, Greek, English 
literature, and another study in the academic depart- 
ment. In 1868 he studied medicine and was graduated 
after one year’s work. This in itself shows that he was 
an unusual man. There are quite a number of men 
who succeeded in the past in obtaining the degree of 
M. D. in one year, but in many of these cases they 
had studied one or two years before coming here. The 
standard was very high and no man could have reached 
it unless he was a very clever student. ... I do 
not think I exaggerate when I say that a large propor- 
tion of the men who won the degree after a single 
year’s work became physical wrecks. So you see that 
in earning his degree he proved himself above the 
average. 
Walter’s brother, Christopher, who was his 
roommate during this period of his life, testifies 
to the earnestness and enthusiasm with which he 
pursued his studies, at one time allowing himself 
only three or four hours’ sleep of the twenty- 
four. A few months after his graduation he went to 
New York and matriculated as a medical student 
at the Bellevue Hospital Medical College, where 
he received the degree of M. D. a year later. This 
was Reed’s first visit to a large city, and he made 
the most of his time in other ways than the study of medicine. His love of intellectual pursuits 
made him seize every opportunity to hear good 
speakers on literature, science, and even law, as 
well as to enjoy all that was best in music or the 
drama. 
After finishing his course in Bellevue, Dr. Reed 
was attached to several of the hospitals in New 
York and Brooklyn, amongst these the King’s 
County Hospital, where he was interne. He was 
also at the hospital on Randall’s Island, where 
he went especially to study children’s diseases. 
A little later he was appointed district physi- 
cian to one of the poorest districts in New 
York, and was thus brought into daily contact, 
for the first time, with all the misery arising 
from poverty and vice in a large city, a phase 
of life which affected him most deeply. His 
brother, Christopher, by this time practising law, 
was now again his roommate, and he relates how 
one night, when he was in bed, and apparently 
asleep, Walter returned late from some pro- 
fessional visits, and after standing for a time at 
the window looking down upon the great city be- 
low him, said slowly, as one unobserved and 
speaking to himself: “Woe unto thee, Chorazin, 
woe unto thee, Bethsaida, for if the mighty works 
which were done in you had been done in Tyre 
and Sidon, they would long ago have repented 
BIRTH AND CHILDHOOD 
9 10 
in sackcloth and ashes.” Then, kneeling down by 
the bedside, he repeated the Lord’s Prayer slowly 
and with deep emotion. Christopher Reed gave 
no sign of observing what passed, and the incident 
was never mentioned between the brothers. 
While at one of the Brooklyn hospitals Dr. 
Reed attracted the attention of Dr. Joseph C. 
Hutchison, then the leading physician and sur- 
geon of Brooklyn, and through his influence was 
appointed one of the five inspectors on the Brook- 
lyn Board of Health. At this time Reed was only 
twenty-two years of age, but he had already es- 
tablished his reputation as a young man of the 
highest talents, especially distinguished for his 
skill in surgery. When on the Board of Health 
he came home one day greatly depressed, and on 
his brother’s asking the reason, he replied, “To- 
day an elegant equipage with coachman and foot- 
man stopped in front of my office and a finely 
dressed gentleman came in, introducing himself 
as Dr. , and saying that he wished to report 
the death of a child. He was so grossly ignorant 
that he could not use medical nomenclature cor- 
rectly, nor even state symptoms. I then asked him 
if he did not think it was such a disease [using the 
Latin term], and he answered ‘Yes,’ repeating the 
word backward. Yet this man has the leading 
practice in this part of Brooklyn, although he is 
WALTER REED AND YELLOW FEVER WALTER REED IN 1874 
From a photograph taken in Murfreesboro, N. C. TEtat 23 BIRTH AND CHILDHOOD 
11 
a first-class quack. I am disgusted and I should 
like to give up my profession.” 
In June, 1874, Dr. Reed paid a visit to his 
father, who was then living in the little town 
of Murfreesboro, in North Carolina. Walter’s 
mother had died when he was a boy, and his father 
was now married again to a Mrs. Kyle, formerly 
Miss Mary Byrd, of Harrisonburg, Virginia. 
There was only one child of this second marriage, 
a daughter Annie, now Mrs. D. T. Elam of Farm- 
ville, Virginia. 
It was during this visit to Murfreesboro that 
Dr. Reed made the acquaintance of his future 
wife, Miss Emilie Lawrence. Miss Lawrence’s 
father, John Vaughan Lawrence, was a North 
Carolina planter of means and influence; he was 
descended from an English John Lawrence, who 
came to this country from the west of England in 
1636 and settled in Watertown, Massachusetts. 
Her mother, Hannah Rea, belonged to another 
good old English family, which settled in Salem, 
Massachusetts, in 1630. 
On Dr. Reed’s return to New York he began a 
correspondence with Miss Lawrence, which af- 
fords an interesting insight into his thoughts and 
actions at this period of his life. It was during 
this year, 1874, that he made up his mind to give 
up the idea of general practice and to enter the 12 
WALTER REED AND YELLOW FEVER 
army as a surgeon. His reasons for this determi- 
nation, as given to his brother, were that success 
in general practice depended largely on social con- 
nection, the possession of wealth, and influential 
friends; and that as he was unable to rely upon 
these sources for advancement, he believed he 
had better take up a line where his future was 
secure and he could pursue scientific research. 
Long afterward, however, he admitted to his wife 
that his resolution to abandon general practice 
and enter the army arose from his desire to possess 
an assured competency as soon as possible in order 
that he might feel justified in asking her to marry 
him, and, indeed, anyone who reads the following 
letter, which was one of the earliest he wrote her, 
will see plainly how much he was actuated by this 
motive. 
Brooklyn, July 18, 1874. 
I have been recently contemplating a departure 
from Brooklyn. My friends will consider me unwise 
in this, perhaps, but after due attention given to the 
matter I believe I will be justified in so doing. I have 
about made up my mind to make a strenuous effort to 
enter the Medical Corps of the United States Army. 
The Examining Board, which has not met before in 
six (6) years, assembles in New York City, August 4, 
next. I should not desire to remain longer than 3 or 
4 years at the outside. And now for reasons. In the 
first place, the Board of Health are requiring more BIRTH AND CHILDHOOD 
13 
work of the Inspectors every day and to such a degree 
that the idea of private practice cannot be thought of 
—in fact they desire that the whole of an Inspector’s 
time be devoted to the interest of the Health of his 
District. This is, doubtless, right enough in a strict 
interpretation, but it is such a “new departure’’ that I 
for one, fail to appreciate it. Secondly, these great 
cities have lost the fascination which formerly held me 
so fast. Four years ago, I would have remained here 
“though the heavens fall.” I gave my hopes and am- 
bitions a free rein and applied the whip and spur un- 
sparingly. To live in any other place than New York 
or Brooklyn never entered my head, and if a person 
had advised me to go to some small town, I would 
have certified to his insanity. To such an extent does 
our folly mislead us! But since then a few more 
springs have come and gone, and though no grey hairs 
adorn my head, I have become a little wiser, I hope. 
I have carefully noted the success or failure of those 
around me and I have watched them in their sorrows 
and joys. Yet, during this time I have been unable to 
discover the great advantages of living in Metro- 
politan cities, except it be in the “wear and tear.” It 
is true I never worked harder, but I can’t say that it 
has brought me an equal amount of comfort. I have 
still a third reason. Having entered my profession 
about 4 years earlier than is the custom, I have ex- 
perienced all the troubles of a youthful aspirant for 
honours. As long as my success depended upon actual 
knowledge and experience, I managed to overcome all 
obstacles, but the moment that I entered upon the race 
of life I at once found out the disadvantages of a 14 
WALTER REED AND YELLOW FEVER 
youthful appearance. It is a remarkable fact that a 
man’s success during the first decade depends more 
upon his beard than his brains. And inasmuch as I 
could boast of none of the former, and but an in- 
finitesimal quantity of the latter, I found “Jordan to 
be a hard road to travel.” Yet, notwithstanding these 
many drawbacks, my success has been greater than I 
expected, and unless I can obtain the sanction of home- 
folks, I will not leave. My stay in these cities has done 
me an incomparable good. By it I have obtained an ex- 
tensive hospital and sanitary experience which is worth 
to me more than I can now estimate. It has also given 
me a truer insight into human nature than I would have 
acquired in an equal number of years elsewhere, while it 
has added to my respect for truth and morality. So 
that I count myself more than fortunate so far. On 
the other hand, I had thought that as I have no 
anxiety to plunge at once into the cares of life, a few 
years spent in travelling from one part of the country 
to another would be of profit to me. Of course all 
depends upon my ability to pass the examination, which 
is a very rigid one (I must confess I dread it). If at 
the end of that time (3 or 4 years hence) I could 
find some fair damsel who was foolish enough to trust 
me, I think I would get married, and settle down 
to sober work for the rest of my days in some small 
city where one could enjoy the advantages of a city and 
at the same time not feel as if lost. For in what does 
life consist? What is its true philosophy? Is it to 
win the applause of the rabble, or to sit in high places? 
Do we not arrive nearer to true happiness in striving 
to accept what Divine Wisdom allots to us—doing all 
we can to assist our fellowmen in being happy and BIRTH AND CHILDHOOD 
15 
submitting uncomplainingly to the will of Him who 
gave us breath and life? Ever remembering that “he 
that humbleth himself shall be exalted.” 
Reed’s resolution once taken, he began immedi- 
ately to prepare for the necessary examination with 
characteristic thoughtfulness. A few years spent in 
active life without systematic application to study 
always renders the resumption of it difficult, and 
Reed’s case was no exception. He writes about the 
examination to Miss Lawrence as follows: 
Brooklyn, Aug. 12, 1874. 
If I appear amazingly stupid as I proceed, please 
remember that my mind has been racked during the 
past day or two with the “atomic theory” and the “law 
of equivalents” so that peradventure whatsoever I shall 
write will not contain one atom of news or be equiva- 
lent to your loss of time in reading it. From early 
morning till far into the hours of the night I must 
needs be plodding along through dry dusty details and 
charging my memory with a thousand items which may 
possibly prove useful to me in the coming ordeal. The 
truth is I was not aware of how much I had forgotten 
and in how many places the rust had accumulated till 
I began a careful review. The more I read, the greater 
the task looms up before me till I stand appalled at the 
work that must be done, and almost think all I ever 
knew has forsaken me. But one thing I will not per- 
mit to forsake me is my courage, and if effort will 
avail anything, it shall not fail me in this case. I went 
over to New York a few days ago and had a long 16 
WALTER REED AND YELLOW FEVER 
talk with the Recorder of the Examining Board. To 
my utter astonishment he informed me that candidates 
must stand an examination in Latin, Greek, mathe- 
matics, and history, in addition to medical subjects. 
Horror of Horrors! Imagine me conjugating an ir- 
regular verb, or telling what x+y equals, or what year 
Rome was founded, or the battle of Marathon fought. 
Why the thing is impossible, I shall utterly fail. Add 
to this that each applicant is examined five hours each 
day for six successive days—thirty hours’ questioning 
—and, to cap the climax, there are more than 500 ap- 
plicants for less than 30 vacancies. The very thought 
of it makes me dizzy. Think of my condition and 
pity me, for I need all the sympathy of all my friends. 
The strain of such close application soon told 
upon Reed’s health and spirits. He became much 
depressed, and about a month later he writes: 
Brooklyn, Sept. 17, 1874. 
I owe you an apology for my long delay in an- 
swering your last letter. I would have written you 
promptly had I not been debarred from doing so by 
severe sickness. During three long weeks I have been 
confined to my room and during the greater part of 
this time I was scarcely able to raise my head from 
the pillow. Hence I have, of necessity, been compelled 
to forego executing many plans which I had projected, 
no one of which gave me more reason for regret than 
my inability to write to you. Doubtless my own folly 
was the cause of my indisposition. I had been trying 
to do more than my strength could bear. It may be that I cannot do as much brainwork in the same length 
of time as I could do in my younger days; or, perhaps, 
a more correct statement would be that I have for so 
long a time abandoned the habit of hard, continuous 
application as to make it somewhat difficult, if not a 
matter attended with danger, to return into the traces 
quickly. I remember the time when I could safely study 
as much as 20 hours uninterruptedly day after day, 
and not experience any bad effect from it, but I presume 
that time shall return no more. . . . But, really, 
there is a charm in study which I fain must acknowledge. 
Let me become interested with what the author is say- 
ing, and it is a difficult matter to break the spell, nor do 
I cease to toil until my weary senses warn me that nature 
is well-nigh exhausted. . . . Perhaps I decide to 
dash aside the book and for once yield to refreshing 
sleep, but quicker than ever winged lightning cleaved 
heaven’s vault the thought flashes through my mind 
that there are a thousand things in that cast-aside vol- 
ume of which I am ignorant, a thousand unanswerable 
questions that may rise up against me in the day of my 
examination, to humble and mortify me. Wracked with 
a thousand fears, I tear open the book and eagerly scan 
its pages, determined to exhaust every effort, and, if 
need be, to suffer death rather than defeat. This is 
what I have done and the result is sickness and mental 
paralysis, and it is what I shall not dare to repeat. Too 
happy in having regained my strength, I will see to it 
that I do not precipitate myself into my former unhappy 
condition. This I can do the more easily as I have now 
abundance of time in which to review my studies. A few 
days ago I received a notice from the Pres. Army Exam- 
BIRTH AND CHILDHOOD 
17 18 
WALTER REED AND YELLOW FEVER 
ination Board that I would not have to stand my exam- 
ination till January 18th, 1875. Of course this suits me 
exactly.” 
In spite of the relief afforded by the postpone- 
ment of his examination, Reed continued, as his 
letters show, to be much oppressed by his work, 
and he writes again two months later: 
Brooklyn, Nov. 3rd, 1874. 
My second excuse for not writing is but a repeti- 
tion of the same old story—ill-health. Alas! I am so 
harassed. What to do surpasses the infinite of thought. 
I must study—not a moment to lose—and it is this 
same studying that has all along delayed my conva- 
lescence. Sick! Why, I haven’t drawn an unsound 
breath for years. But now, when I need all my 
strength, lo! it fails me. . . . Still I believe that 
when a person determines to accomplish an end, he 
should put forth all honest effort, nor turn aside, 
unless for the best of reasons; and if he meets with de- 
feat let him accept it like a man, remembering that 
many better men have found themselves in a like situa- 
tion. At all events I shall pursue my course until every 
prop is knocked away from under me. Sufficient to the 
day is the evil thereof. 
The morbid dread of failure arising from bodily 
weakness passed away as health returned, and in 
January, 1875, Reed writes cheerfully of his pros- 
pects. A month later, in February, 1875, after a second postponement, he passed his examinations 
brilliantly, and this event was shortly followed by 
his engagement to Miss Lawrence. In the follow- 
ing June he received his commission as Assistant 
Surgeon, with the rank of First Lieutenant. 
His first station was Willet’s Point, New York 
harbour, whence he writes to Miss Lawrence as 
follows: 
BIRTH AND CHILDHOOD 
19 
Willet’s Point, Sept. 15, 1875. 
Would you, could you believe that I would allow my 
twenty-fifth birthday to pass without so much as think- 
ing of it during the whole day? The very day on which 
I wrote you last I was twenty-four years old (just 
think of it), and yet I was totally ignorant of it. Of 
course I felt the weight of years more than usual on 
that day, but I could not account for it. Suddenly on 
Tuesday the 14, it occurred to me that I was one year 
older and immediately the cause of my fatigue flashed 
across my mind. It is too late for me to grow eloquent 
over the subject (for I had intended to say something 
suitable to such an occasion), since the champagne has 
lost its effervescence, but still I can not permit my birth- 
day to pass without some remarks. 
Alas, my twenty-fifth birthday has passed and what 
have I to show for it! What good deeds have I 
done that merit approbation! How negligent and 
wayward I have been! What golden moments of op- 
portunity have come and gone, all unheeded! As I 
look back over my past life to-night, but few thoughts 
occur to me such as cause my bosom to swell with 20 
honest pride. Ah, how many heart pangs have I not 
suffered during these few years of my life? Are there 
as many more in store for me in the future? No! 
I’ll not believe it. I know there will be griefs and 
disappointments, but will you not share them with 
me? . . . Do not think that I fail to appreciate 
the many sacrifices that you make in confiding your 
future to my care. The remembrance of them is 
daily present with me and serves to increase my dili- 
gence. 
WALTER REED AND YELLOW FEVER 
In the following December Miss Lawrence lost 
a little nephew to whom she was much attached, 
and in the letter written to her after hearing of the 
child’s death, Reed expresses his sympathy and 
makes mention of his religious faith with touching 
simplicity. The words referring to the possibili- 
ties of his own future assume a new significance 
now that the work then in store for him is ac- 
complished. 
Willet's Point, Dec. 20th, 1875. 
Your letter of the 16th is just at hand. I had 
hoped and prayed that when your next letter came it 
would bring me the glad tidings that your little nephew 
had been spared and restored to the love of his parents 
and friends. Alas, while I prayed that his life might 
be prolonged to many years of usefulness, he had al- 
ready departed for a better and a brighter home. 
Little pilgrim of a few days, what sad, sad 
hours you have escaped! God removed you ere you had experienced the cruel bufferings of this world and 
while thy heart knew no evil. And for this ought we 
not rather to bless His Holy Name than yield to un- 
availing grief? When I see the little lambs hastening 
home, I would not call them back, for though I have 
scarcely begun life, I have known what sorrow is and 
felt the weight of care. Do not think that I shrink 
from meeting life’s realities. No, no. That would 
display a lack of courage and a want of faith. Nor 
that I would not wish to live many years yet. It may 
be that God in his all-wise Providence has some wise 
purpose for me, humble as I am, to fulfil, and shall I 
shrink from it? 
BIRTH AND CHILDHOOD 
21 
In a letter shortly preceding this one, when 
speaking of the delight with which he looked for- 
ward to a visit to Murfreesboro, Dr. Reed writes: 
Think if anything should occur to interrupt my going, 
such for instance as my being ordered to the Far 
West before the time arrives. Uncle Sam couldn’t be 
so hard-hearted as to order a poor fellow away. He 
is too good-natured an old chap to do such an act. At 
least we will hope so. 
Uncle Sam justified this good opinion for the 
moment, but a little later Reed’s worst forebodings 
were fulfilled. In the spring of 1876, when his 
marriage was shortly to take place, and all ar- 
rangements for it were made, he was suddenly 
ordered to duty in Arizona. This was a great blow 22 
WALTER REED AND YELLOW FEVER 
to him. To postpone his marriage indefinitely was 
not to be thought of, yet he could not bear to take 
a young wife out to a rough, semi-civilised coun- 
try with which he was not even himself familiar. 
He decided to seek an interview with the Surgeon- 
General and to find out whether, if he went to Ari- 
zona at the time appointed, he would be able to 
obtain leave in the course of a few months to 
return for his marriage. This was a step that re- 
quired all his courage, for to a lieutenant in the 
Army Medical Corps his chief is an all-power- 
ful being, holding his subordinates entirely in his 
power, and able to exalt or debase them at his 
will. There was no help for it, however, and 
Reed went to Washington. 
His heart sank within him when he was ushered 
into the presence, and after introducing himself, 
was ordered in a peremptory manner to “Sit 
down.” Next came the abrupt question, “What 
do you want?” “I would like to know, General, 
if I can get a leave while I am in Arizona. I am 
engaged to be married and should want to re- 
turn.” The General’s voice became gruffer still 
and his face more stern as he replied, “Young 
man, if you don’t want to go to Arizona, resign 
from the service.” At this Reed’s spirit returned, 
he lost all timidity, and answered fearlessly as 
man to man, “General, I did not labour for my B1RTH AND CHILDHOOD 
commission with all the will which I did to throw 
it away hastily, nor can you deprive me of it till 
I act so unworthily as to cause dismissal.” The 
old man’s manner changed at once. He was evi- 
dently pleased by his young subordinate’s spirit, 
and he answered kindly, “Have a cigar, Dr. Reed, 
and let us talk it over.” At the end of the inter- 
view, he gave his ultimatum thus: “Don’t marry 
now. Go to Arizona. There is no doubt some 
officer will become insane before long. You can 
bring him East, and there will be the chance for 
your wedding.” In after years Dr. Reed often 
laughed at the patience he would have been called 
upon to exercise if he had followed the Surgeon- 
General’s advice, for he had been married thirteen 
years before he was ordered to Washington to 
escort an officer to St. Elizabeth’s Asylum. 
As no change in the situation could be hoped 
for, the arrangements for the wedding were has- 
tened, and it took place on April 25, 1876. Two 
weeks later Dr. Reed went to his command alone, 
wishing to ascertain what hardships would have 
to be faced, and also what arrangements could be 
made for his wife’s comfort before she joined him. 
23 CHAPTER II 
FRONTIER LIFE 
1876-1889 
Es bildet ein Talent sich in der Stille. 
—Goethe. 
IN May, 1876, Dr. Reed went to his post in Ari- 
zona, there to continue a garrison life which lasted 
eighteen years, the greater part of it being spent in 
the Far West. 
In the following October his wife set forth 
from Norfolk, Virginia, to join him. At that time, 
when facilities for travel were not what they are 
now, such a journey was a great undertaking for 
a girl of twenty, who had never travelled alone 
for any distance before. Mrs. Reed’s courage was, 
moreover, tried by several emergencies, such as a 
blizzard and a collision with a westward bound 
train. At the end of a week, however, she reached 
San Francisco, where Dr. Reed joined her, and 
they started for Fort Lowell, Arizona, a journey 
of twenty-two days, in an army waggon over the 
roughest kinds of roads, and among the most prim- 
itive conditions. Some idea of the difficulties 
which beset their way may be formed from the fol- 
24 FRONTIER LIFE 
lowing extract taken from a letter from Dr. Reed 
to his wife’s sister, Mrs. J. N. Harrell: 
25 
We left San Diego, November 15, ’76, at 2 P. M. 
My waggon, loaded with our baggage, had left at 1 
P. M. I had been told, on careful inquiry, that the dis- 
tance to the first station was 16 to 20 miles, which 
being the case, my waggon should have made it by 6 
P. M. and my ambulance by 5 P. M. But “the best laid 
plans of mice,” etc., etc. I soon found that the road 
was horribly rough and by 5 P. M. I had not made 
more than 10 miles, for I had to walk my team every 
step. By this time the sun was set and as there was 
no moon, it soon became so very dark that we could 
barely keep to the road. I had already overtaken and 
passed my waggon. By seven o’clock p. M. it had 
turned quite cold. I had Emilie put on her waterproof; 
I also had two overcoats, one of which I wrapped her 
feet snugly in and the other I had her put on, so that 
she was thoroughly prepared for the cold. I then told 
the driver to go very carefully, and to watch for any 
lights, so that we would be certain not to pass the sta- 
tion in the dark, for I thought it must be near by. On 
we went, keeping a good watch on each side, till my 
watch marked 9 P. M., and still no station. Emilie be- 
gan to ask “How much further have we got to go?” 
quite frequently, and I could only answer, “It can’t be 
far.” A few minutes later and we espied a light ahead 
and to the right of our road. I now told Emilie to 
pluck up her courage as we should soon reach the sta- 
tion. However, when we had gone about half a mile, 
we found that the road left the light to our right, and  WALTER REED AND YELLOW FEVER 
26 
hence I was much perplexed to know whether it was the 
station or not. I told the driver to go over and ascer- 
tain. He returned in about 20 minutes and stated that 
it was not the station ! He said that the owner was very 
anxious that we should stay over night with him, al- 
though his accommodations were not the best in the 
world. He had neither hay nor grain for my animals; 
in fact, he could not furnish us even a bed to sleep in, 
inasmuch as he and his old lady had had a “family 
jar” on that very day, which had ended in the old 
lady walking off with the bed and bedding and leaving 
him the house. I could but feel extremely grateful to 
this gentleman for his kind proffer, but nevertheless 
concluded to decline his hospitality till some future day. 
Our search thus fruitlessly terminated, we again 
began our weary march, Emilie, in the meantime, let- 
ting fall several very small tears. Bless her darling 
heart! I must give her credit for great bravery on 
this, her first night in an ambulance. I’m afraid, if 
there had been a stone wall near by I should have 
brought my head in violent contact with it. But there 
was nothing to be done but to go on. On, on, we 
plodded, so slow, so slow, for it was very dark and 
the road horribly rough. Several times it seemed as 
if the vehicle would certainly upset; several times the 
driver had to descend from his seat in order to find the 
road. Ten o’clock came, but no station or any sign 
of one! I had just examined my watch and found it 
11 o’clock, when on making a short curve in the road, 
we saw a smouldering fire but a short distance ahead. 
On reaching it, we found that it was a small camp of 
two waggons. I got out and awoke one of the sleepers 
(there were two of them), who sat up in his bed, but was not very communicative. He told me that the 
station was about two miles further, but added, “over 
the worst road in California.” I thanked him for this 
cheering intelligence, and was about to go on, when he 
told me that the last mile was through a very bad 
canon, and then lying down and pulling the bed-cloth- 
ing closely around him, he remarked to his companion, 
“He’ll have a devil of a time getting through that 
canon to-night!” which put me into such a good frame 
of mind that I gave the order, at once, “go ahead.” 
One mile and we had reached the mouth of this 
canon, and as we proceeded, step by step, the hills 
arose on either side high and dark. If before it had 
been dark, it was now the very blackness of darkness. 
The trees overhead cut off every ray of light. The 
mules seemed disinclined to venture on, even under the 
lash, and it began to look as if further progress was 
impossible. I got out to take a look, but all I could 
find out was that we were in the midst of rocks and 
deep sand and no sign of a road! What was to be 
done? Fortunately the driver had a lantern and a part 
of a candle. This we lit, and taking with me a soldier 
who was riding with the driver, I started ahead to 
show the way. By keeping just in front of the team 
and halloaing “Now to the right,” “Now to the left,” 
and “Now straight ahead,” we managed to make some 
progress. Poor E. all this time was in the ambulance 
alone, and calling out continually, “Where are you, Dr. 
Reed? Please come back and let the soldier carry the 
lantern,” but I told her I could trust no man living to 
point the way out of this horrible canon; and on I 
went in sand nearly up to my knees, calling to the 
driver all the time what course he should take. Not- 
FRONTIER LIFE 
27 28 
WALTER REED AND YELLOW FEVER 
withstanding the very great advantage the lantern af- 
forded and that I had an excellent driver, every fifty 
yards would find a wheel stopped by some great 
boulder. Oh ! the terrible difficulties of that night! But 
everything must have an ending, and after we had been 
working like beavers for an hour, success at last crowned 
our efforts. We had passed the canon and reached the 
station! (12.30 A. m.) Ah! I should like to tell you 
what a sigh of relief escaped my breast and how happy 
I felt when I saw the little house by the wayside. 
I soon aroused the station-keeper, who was a very 
rough-looking specimen of a frontiersman, but under 
all this roughness he concealed a kind heart, as you 
will see. 
But let me describe the station, called “Jamul” 
(pronounced “Harmool”). It consisted of a small 
house about 10 feet square, and a horse stable. The 
keeper’s residence (the same house above mentioned) 
was constructed of plain boards, with spaces of half 
an inch between the boards, possibly for ventilation, 
as the window was very small. A dirt roof and dirt 
floor. A piece of canvas stretched on a frame, which 
he called his “bed,” a small stool, a broken chair, a pine 
table and a cooking stove completed the furniture. 
Now to show you the kind heart that this rough fellow 
had, he no sooner found that I had my wife with me 
than he not only made a roaring fire, prepared us both 
a nice cup of hot tea (which with the lunch that we 
had, enabled us to make a good meal), but he also 
abandoned his “bed” for us, himself sleeping for the 
rest of the night in the stable! and for this kindness 
he not only did not charge a penny, but he would not 
take a cent although I insisted upon paying him! As soon as Emilie got within doors and saw the bright 
fire, her spirits rose accordingly, and when the tea 
was ready and we each had our cup, her humour was 
of the best. All her sprightliness returned and as she 
took a glance around the room and saw the various 
articles, she laughed heartily, and declared that she 
wouldn’t take anything for this experience. We talked 
of homefolks and wished that they could see us just 
as we were. The “bed” was especially an object of 
much merriment to Emilie. She declared that she 
could never rest on such a contrivance; but when I had 
arranged things a bit, had spread over the piece of 
canvas a blanket which I found in the room and had 
drawn my overcoats over us, we both soon fell asleep 
and did not wake till broad daylight. Thus passed 
Emilie’s first day and night on her trip to Camp 
Lowell! . . . 
FRONTIER LIFE 
29 
Forturfately both Dr. Reed and his wife pos- 
sessed a keen sense of humour, which helped them 
over many of their hardest experiences. The fol- 
lowing anecdote told me by Mrs. Reed shows how 
valuable a sense of the ludicrous was among such 
surroundings. 
Late one evening they drove up to a little shanty 
perched on the side of the mountain, where the 
country was so barren that there was not earth 
enough to drive their tent pegs, and they were 
forced to seek shelter for the night in the hut. Dr. 
Reed had stopped at this place on his way to San 
Francisco, and when he alighted he expected to find 30 
WALTER REED AND YELLOW FEVER 
the same friendly owner with whom he had made 
acquaintance three weeks before. To his surprise 
an entire stranger appeared, who told him that 
when roaming over the prairie a week or two be- 
fore, he had come across this hut uninhabited, 
while the body of the former owner lay outside 
with a bullet through his heart. When Dr. Reed 
asked whether they could have accommodation 
for the night, the man replied in the affirmative, 
but said, referring to the previous owner, “The 
kyotes [coyotes] have about finished him, and I 
hope the young lady will not be afeared of his 
arm bone. I use it to prop open the window.” 
And there, sure enough, was the bone in the win- 
dow just over the spot where the visitors were ex- 
pected to sleep! 
Thirty years ago Arizona seemed as remote 
from civilisation as the Philippines do now. Com- 
munication with the East was imperfect and ir- 
regular; at one time when Dr. Reed was stationed 
at Camp Apache, he was seven hundred miles 
from a railroad, the mail arrived only once a week, 
and letters from the East were often six weeks on 
the way. Life at these distant posts was always 
hard and often desolate, nor was the element of 
danger absent. Dr. Reed, it is true, was never in 
the field, but the unsettled condition of the coun- 
try and the presence of hostile Indians were a WALTER REED IN 1876 
From a photograph taken in Harrisonburg, Va. Hi tat 25 constant source of peril. On one occasion, when 
moving from Camp Lowell to Camp Apache, a 
journey of eleven days, Reed and his wife, with an 
escort of two soldiers, camped for the night on a 
quiet plain, which three days later was the battle- 
ground between two hostile tribes, who engaged 
in a bloody fight and left the peaceful spot a scene 
of frightful carnage. At another time when Dr. 
Reed had been relieved and was hastening to join 
his wife and child, a brother officer urged him to 
break the journey by stopping at his post, which 
was on the stage route, and Dr. Reed would have 
complied had it not been for his strong desire to 
join his wife without delay. He often said that 
his eagerness to push forward saved him from im- 
minent peril and perhaps death, for the stage on 
which he would have travelled had he been a day 
later, as suggested, was waylaid by the Navajoes 
and the driver killed. 
In the summer of 1877, after a year spent at 
Fort Lowell, Dr. Reed was transferred to Fort 
Apache, a journey which he and Mrs. Reed again 
performed in true frontier fashion. He himself 
gives a most graphic description of the difficulties 
which they encountered to his sister-in-law, Mrs. 
Harrell, and the account is so full of interest and 
of colour that I give the letter almost in full: 
FRONTIER LIFE 
31 32 
WALTER REED AND YELLOW FEVER 
Camp Apache, Arizona, 
October 25, 1877. 
In this territory, as, in fact, in all others, officers 
of the army, especially those who are married, travel 
by ambulance whenever they can get one. Now I 
know the word ambulance will at once recall to your 
mind a long, black, funereal-looking vehicle, such as 
you probably saw during the war. These army ambu- 
lances, however, are constructed on the same pattern 
as the ordinary stage, only a little smaller, have two 
seats capable of seating four, and are drawn by four 
to six mules. They are painted white so as to absorb 
the terrible heat of the climate as little as pos- 
sible. Such a vehicle you would have seen standing in 
front of our quarters at Camp Lowell at nine o’clock 
on the morning of August nth last. The waggon 
containing our baggage, to the extent of 1700 lbs., 
had started for Apache on the morning of the 10th, 
so that we had but few things to put i-n the ambulance. 
I will enumerate its contents as it stood ready for the 
words to be given, “go ahead.” Inside of the vehicle 
there were the following articles: On the back seat, 
Emilie, the dog Undina, and myself; under the back 
seat, a box of medicines for emergencies, a lunch 
basket, a jar of preserved ginger, a pair of boots, a 
blacking brush, a bag containing a saucepan, frying 
pan, tin pan, and coffee pot. On the front seat, two 
folding chairs, my valise, Emilie’s companion, a basket 
containing her work, a bundle of shawls, my overcoat, 
two double blankets, a feather pillow, a clothes brush, 
and four books of light literature; under the front seat, 
a mess-chest containing the necessary tableware for the 
journey, a box of provisions, and a large clothes basket containing everything from a hairpin to a pair of 
shoes. Suspended from various points of the roof 
were two hats, a sword, an umbrella, a pair of E.’s 
shoes, a carbine, a pistol, a belt full of cartridges, and 
two canteens filled with water. Now for the outside: 
underneath the driver’s seat in front were my private 
case of instruments weighing 50 lbs., a sack of grain, 
and the driver’s rations for ten days; on the seat be- 
hind, my trunk, and bedding consisting of a mattress, 
blankets, sheets, etc., done up in a canvas cover. 
There may have escaped my memory a few articles, 
but I believe I have mentioned all. If there was any- 
thing on top I did not see it. I have a lurking idea, 
however, that the driver concealed several chairs and 
boxes in odd places about the vehicle. I forgot to say 
that beside the driver there was a corporal on the seat 
with him, a very light man, weighing just two hun- 
dred lbs. 
Thus equipped, after bidding good-bye to our 
Lowell friends, we started for Camp Apache, external 
temperature iio°. As Undina had never before rid- 
den in a vehicle, she straightway set up a terrific bark- 
ing, which she kept up till she was so hoarse that she 
couldn’t hear herself, and then stopped. Our destina- 
tion for the first day was “Tres Al'imos” or “The 
Three Cottonwoods,” a small settlement 40 miles 
from Lowell. Aside from the heat, the day was not 
an unpleasant one for travelling. We passed our time 
in chatting and laughing at Undina’s queer freaks (who, 
by the way, wasn’t quiet in any one place for a minute 
at a time) till it was time for taking lunch. Perhaps 
you have never taken what is called a “flying lunch.” 
If not, let me tell you, you have missed a great deal 
FRONTIER LIFE 
33  WALTER REED AND YELLOW FEVER 
34 
of fun. Mind you, everything connected with the meal 
is done while the ambulance is in full progress—no 
stopping “five minutes for refreshments,” and as the 
road is most often very rough and rocky, and always 
so when you think it is about time to eat, and as the 
driver concludes to whip his horses up to their very 
best speed just at this time, whereas he had been per- 
sistently permitting them to walk for the last hour, 
why, the feat of getting anything into your mouth be- 
comes a matter of considerable uncertainty. . . 
It is needless for me to narrate at length all the trials 
of this meal; I could not, however, forbear showing 
you what you have missed by never partaking of a 
“flying lunch.” 
At sunset we reached our destination, “Tres 
Alimos.” When I had got Emilie into a very comfort- 
able and well-furnished room, I proceeded to unpack 
all those articles enumerated in the beginning of my let- 
ter, and when you take into consideration the fact that 
I had to unpack all of them every night and put them 
back every morning, you will know that it was quite 
a task. I would have had one of the men do the pack- 
ing for me, but it would have taken so long to teach 
him, for every article had to go in a certain place and 
nowhere else, that I thought it would be easier to do it 
myself. At 7 o’clock we had a very nice supper, con- 
sisting of fried spring chicken, good milk, butter, etc., 
and after I had seen about a lunch for the morrow, we 
retired, for we were to start the next morning at 4 
o’clock, so as to reach the next station, 30 miles distant, 
before noon and thus avoid the heat of the after- 
noon. 
At the aforesaid hour we were up and preparing FRONTIER LIFE 
35 
for our journey. A cup of tea and everything stowed 
away safely in the ambulance, not forgetting the little 
dog, and we were ready for our day’s trip. This day 
we had to pass what are called the “Lime Kilns,” a 
place where Indians (I mean hostile ones) have been 
often seen, and I must confess that I felt the least bit 
anxious. However, I said nothing to E. about it, but 
took good care to have all my weapons loaded and 
in good reach and kept my eyes well open. When I 
imagined that we were pretty near the “Kilns” I 
called to the driver and told him to let me know when 
he got there, whereupon, much to my satisfaction, he 
replied that we had already passed them. A ride of 
15 miles further and we had reached our station, called 
“The Point of the Mountain”; so named from the 
fact of the station being situated just where a mountain 
range abruptly ends on the plain. Looking across a 
plain, 20 miles in width, we can see the “Chiricahua 
Mountains,” well known in Arizona history as the 
home of the celebrated Indian Chief “Cochise” and 
his Chiricahua tribe, Indians that have killed more 
people in Arizona than all the other tribes put to- 
gether. We can follow with the eye the plain, white 
stage road as it stretches across the intervening coun- 
try and see it where it enters the mountains. Could 
the eye but follow it 4 miles further, we should see 
the spot where three mail-riders have recently fallen, 
pierced by the bullets of the savages. The last one was 
killed just a week before we commenced our journey. 
This night, as we had very good accommodations, 
we rested very well and awoke much refreshed. You 
would think it rather fatiguing, I guess, to have to 
ride 70 miles in two days. But there’s nothing like 36 
getting used to a thing, so that even frail little Emilie 
Lawrence Reed, although she had ridden and jolted 
over 70 miles of rough road in two days, stepped out 
of the station on the third morning as bright as a silver 
dollar and ready to ride 50 miles before sunset, if 
necessary. However, it was only 35 miles we had to 
go on the third day. Our journey lay along a very 
pretty green valley, bordered on either side with a 
range of blue mountains. The road was level and as 
smooth as could be desired. On our right across the 
valley, distant about 10 miles, we could distinguish 
“Camp Grant,” a military post in this Territory. We 
had first thought of going by way of Grant, so as to 
rest a day or two, but concluded to abandon the idea, 
as we would really have to receive and return so many 
calls that our rest would be of little use to us. This 
day’s ride was especially pleasant, as we saw plenty 
of green grass and liveoak trees, objects, especially the 
latter, that we had not seen for many a day. We 
passed through numerous herds of cattle, and saw 
many others scattered here and there over the valley, 
which added much to the beauty of the landscape. 
Toward afternoon the land became beautifully rolling 
and at 2 P. M. we alighted at “Eureka Springs,” the 
best station in Arizona. 
Here we found a large house, having 4 or 6 
rooms and the windows provided with real window- 
blinds, and green ones too. A servant took our bag- 
gage and we were ushered into as nicely furnished a 
room as one could ask for. A good carpet, bedstead, 
bureau, centre table, etc., etc. By the time we had 
freed ourselves of the dust of travel, we were sum- 
moned to a nice dinner of fat mutton, vegetables, but- 
WALTER REED AND YELLOW FEVER FRONTIER LIFE 
termilk, and all manner of good things. My! how we 
made the eatables fly! and such nice, cold, well water. 
Ah! this was a luxury which we could scarcely drink 
enough of. In a word, so charmed were we both with 
this station that we concluded, at once, to remain over 
a day, and rest and eat! We arrived on Monday and 
left on Wednesday. On the latter day we travelled 30 
miles to reach Camp Thomas, a military post. We 
stopped at Lieutenant Powell’s house, a bachelor ac- 
quaintance of mine. In fact there was only one married 
officer at the post and his wife was East. Emilie was 
the first lady ever at the post. She was such a curiosity 
that one little dog chancing to spy her, took to his heels 
for dear life, yelling at every jump. He soon returned 
reinforced by about 20 others and such a barking you 
never heard. None of them, though, had the courage 
to advance very close. At Thomas we were enter- 
tained just as hospitably as possible, as army officers 
always are when passing through a garrison. We re- 
mained over here a day also, in order to allow my 
waggon to precede me one day. 
We left Camp Thomas on Friday and came 33 
miles, part of the day over very rough roads. We 
passed through large orchards of “prickly pears,” a 
fruit which grows on the large-leaved cactus. The 
fruit is the size of a large pear, of a beautiful purple 
colour, and an acid, agreeable taste. Emilie insisted 
upon eating several, whereof she much repented before 
next morning. Our destination for the day was 
“Green’s Camp,” so called from the fact that Lieu- 
tenant Green, of the army, camped there many years 
ago. For the first time on our journey we had to camp 
out under the open heavens, as there is not a house be- 
37 38 
WALTER REED AND YELLOW FEVER 
tween Camp Thomas and Camp Apache. We arrived 
in camp about 3 P. M. Soon afterwards I saw an Indian 
on a hill opposite camp. He came over, sat down by 
the side of me, and laying down his gun, said “El 
campo Apache,” by which I knew that he was going to 
Apache. A minute later he said “pan,” at which I 
wasn’t surprised, for they are always ready to eat. I 
gave him a loaf that was as dry as ashes and as hard 
as a “nigger’s head,” and the way he demolished it was 
astonishing. Having filled his stomach, he picked up 
his gun, said “adios,” and a moment later was lost to 
sight. When I got to Apache our recognition was 
mutual. The Indian turned out to be the celebrated 
“Dead-shot,” so named because he never misses his 
game, whether man or otherwise. We had our supper 
under the “umbrageous foliage” of a cedar tree and 
about 6.30 P. M. prepared to retire. We had no tent, 
but slept in the ambulance. The seats were so con- 
structed that they could be slid together, forming a 
perfect floor. On this came our bedding and when we 
had made the curtains fast and tight, we were ready 
for hail or rain. Little Undina each night found a 
warm bed at our feet. 
We broke camp Saturday morning about 8 o’clock, 
as we only had 12 miles to go in order to reach water, 
for you must remember that in Arizona the length of 
a day’s travel depends upon the distance between 
watering places. There are no streams every few miles, 
as in the East. Sometimes you go forty or even sixty 
miles without seeing a drop of water, and you rarely 
have to travel less than 30 miles. “Ash Creek,” our 
camp this day, was reached by noon. I made a heroic 
effort to catch some fish here, but after broiling in the FRONTIER LIFE 
39 
sun an hour I only got one bite and that proved to be a 
plaguey turtle, to get which off my hook consumed 
another hour. I gave up fishing in disgust. “Ash 
Creek” is worth mentioning for this reason: about the 
time our dinner was well under way a terrific rain- 
storm came up, and as our bake-oven had no top our 
bread was soon afloat and the poor soldier, our cook, 
looked as if he had lost his best friend; but it was 
no use to try to make anything out of that bread, for 
it was so soaked that it weighed a pound to the square 
inch. 
We left our camp next morning bright and early, 
as we were this day to pass over the worst road in 
Arizona, yes, the worst road in the world. When we 
had gone about 4 miles we began to ascend very slowly 
and gradually the slope of the “White Mountains.” 
Soon we entered what is called “Rocky Canon” and 
no person who has been over this “Canon” once will 
ever forget it. It is useless for me to attempt to de- 
scribe this road to you. It is simply beyond language to 
describe its awful roughness. For a distance of about 
3 miles the ambulance scarcely touches “terra firma”; 
the wheels jump from rock to rock with a perfect 
crash at times. But this is the good part of the road, 
I assure you. When we had gone over this, which re- 
quired about 2 hours, we came to what is designated 
“Nautaumes Hill.” This is about three-quarters of a 
mile long to the summit. Standing at the foot of the 
hill and casting your eye upwards, you see nothing but 
solid stone, broken and tossed into all manner of 
shapes and positions. You would declare that no such 
thing as a waggon could ever go up or come down with- 
out being smashed into a thousand fragments. Im-  WALTER REED AND YELLOW FEVER 
40 
agine the steepest hill you ever saw, and then imagine 
its surface covered with stones the size of flour barrels, 
packed just as closely as possible, some on end, some 
on their sides, and some on their edges, and then you 
have not formed a conception of this hill. 
The first thing to be done was to make every- 
thing perfectly snug inside the ambulance, and then 
to fasten two strong ropes, one to each side of 
the vehicle. To each rope two strong men held and 
then the ambulance was ready to start. The idea of 
the ropes was to keep it from upsetting, as very fre- 
quently only two wheels are on the ground, or stones, 
I should say. After the mules have plunged as if they 
would break their necks, we get a start, every man 
holding on to the ropes for dear life, the vehicle rising 
and falling, swaying and creaking, as if it would cer- 
tainly go to pieces the next jump; fifty feet and we 
stop for breath; and it is a repetition of this from the 
foot to the top of the hill. It took just one hour and a 
half for my ambulance to make the three-quarters of a 
mile. As for my waggon, although I had only 1700 
pounds in it, yet the twelve mules that I had harnessed 
to it, with the help of my four ambulance mules, could 
not budge it when it reached the foot of this hill. I 
worked from 10 A. M. till 5 P. M. and at that time we 
had made just thirty feet by actual measurement! I 
saw that it was useless to worry my animals any longer, 
so that I ordered the men to unhitch and camp there 
for the night. As for myself, I came on about three 
miles further to “Camp Disappointment” and spent 
the night under the lofty pines. I had with me only 
the corporal and driver. Emilie was very much afraid 
of bears and Indians until we got a rousing fire started, FRONTIER LIFE 
and then her spirits rose and she ate quite a hearty sup- 
per, which I cooked, as we had left our cook back with 
the waggon. I had left orders to unpack the waggon and 
carry part of the load up the hill on the mules. This 
they did, and thus managed to get up next day and 
reach “Camp Disappointment.” 
I will describe briefly one more hill and then I am 
done with my letter. On this, the last day but one, 
we travel down “Black River” hill, the steepest hill I 
ever saw; so steep that it is necessary to lock the wheels 
and to drag behind the ambulance a large tree. Be- 
sides this, we fasten two ropes to the rear of the 
vehicle, to one of which the corporal swings and to the 
other my cook (who has overtaken us) and myself. 
The driver descends from his seat, for the danger is 
that the ambulance will go end over end. Having 
taken out the lead mules, we commence our downward 
progress slowly. We descend about sixty feet and then 
come to the “jumping-off” place, for it is a sheer 
descent of five feet, right over the face of a rock. 
Here we stop, examine every rope, every man braces 
himself for the struggle and the question is asked, 
“Are you ready?” The answer is “All ready, sir,” and 
the words given, “Let her go!” We pause a moment 
and then are jerked full twenty feet right over the 
rocks! So sudden was the leap and with such terrible 
force did I strike the ground that the very soles of my 
shoes were torn off! Suffice it to say that my ambu- 
lance landed safely and unbroken, and as the rest of 
our journey was smooth sailing, I will not inflict an 
account of the next day’s trip upon you. Forgive me, 
for I never wrote so disconnected a letter before in my 
life. If you will only promise to burn it as soon as read, 
41 42 
all right; it is on this sole condition that I send it. 
Emilie joins me in love to all. Pardon my abrupt 
ending, write soon, and believe me very affectionately, 
your brother, Walter Reed. 
WALTER REED AND YELLOW FEVER 
Camp Apache was at length reached in safety, 
and there the Reeds remained nearly four years, 
during which time their eldest child, Walter 
Lawrence Reed, was born, on December 4, 1877. 
Their life during these years was not lacking in 
the difficulties and privations with which existence 
on the frontier is always filled, but these were met 
by them in the brave and cheerful spirit which re- 
duces all troubles to a minimum. The following 
letter from Dr. Reed to Mrs. Harrell gives an 
amusing account of one variety of annoyance with 
which he and his wife had to contend. 
Camp Apache, Arizona, 
April 14, 1878. 
You know that in civilised life it is not allowable 
for an officer to have a soldier do his cooking, because 
he can easily get servants to do his work. But on the 
frontier, and especially in such a delectable country as 
“Arizony” where it is simply impossible to find hand- 
maidens, unless it be an occasional Chinaman, it is per- 
mitted to use soldiers as cooks, provided they are will- 
ing to cook. Of course it is at the option of the soldier 
whether he will do duty with his company or cook. I 
will premise by saying that nearly all soldiers can cook 
after a fashion, and some of'them very well, but most of them have a dislike to cooking for a married officer. 
The “pig under the fence” is the officer’s wife. Sol- 
diers will take any order and any amount of abuse from 
an officer without murmuring, but when it comes to re- 
ceiving orders or even suggestions from a lady, they 
rebel at once. . . . Another point to bear in mind 
is that soldiers, with but few exceptions, are very fond 
of their “toddy” and always get drunk after pay day, 
which comes every two months. 
You will remember that up to December last we 
messed with Mrs. Colonel Andrews, and hence had no 
trouble about cooks. On the first of December, how- 
ever, we went to housekeeping, for reasons which it is 
not necessary to state, being no less than the expected 
advent of a “kid,” and so I had to look about for a 
soldier to do my cooking. After much search I lit upon 
one James Anmach, a high private in the rear rank. 
Now this same private Anmach is a considerable per- 
sonage, having had no less than seven trades or pro- 
fessions, as follows: He is a natural born plasterer; 
in his early years he took up painting as a fine art; wax- 
ing stronger he devoted himself, his time and muscle 
to carpentering; finding that this occupation cramped 
his mental powers too much he turned his attention to 
brightening rusty knife blades and sharpening scissors, 
etc.; subsequently, circumstances over which he had no 
control forced him to become a plumber, for you know 
the greatest intellects must at times yield to the course 
of events; and finally, ruthless fortune converted him 
into a farmer. Now what he does not know about 
horses and cows is entirely superfluous knowledge. As 
an extractor of the “albine fluid” he has no equal. In- 
deed the cow herself is amazed at his dexterous per- 
FRONTIER LIFE 
43  WALTER REED AND YELLOW FEVER 
44 
formance. If the animal manifests any desire to run 
him through with her horns, he throws a lariat round 
the horns and fastens her head to a post; and then, if 
she makes too free with her posterior extremities, he 
simply ties them snugly together with a rope, and as 
he milks pays not the least attention to her frantic 
efforts to extricate herself. 
Such an one was James Anmach, my new cook, on 
the first day of December, 1877. I should state that he 
knew nothing about cooking whatever, but as he ex- 
pressed it “he would not mind learning to cook, as it 
might be useful to him one of these days.” I presume 
the real reason was because he had so few trades. Upon 
his assumption of the culinary dignity I had a brief 
interview with Mr. Anmach, in which I expressed to 
him my earnest desire that he would abstain from all 
intoxicating liquors, for a time at least. After the birth 
of the future President I again told him that I hoped 
while Mrs. Reed was sick he would keep sober, for 
should he get on a spree and absent himself for a week 
or so, I would have no one to cook but myself and 
would be placed in a most deplorable position. He de- 
clared that should he think of getting drunk under the 
circumstances he would consider himself no better than 
a “dog” and that I might place full confidence in 
his sobriety. 
Fortunately he turned out to be a very fair cook; a 
plain one, but he knew how to season food and could 
make pretty good bread and coffee, besides flannel cakes, 
etc. But he had the most curious ideas about crockery 
and its uses of any man I ever met. In the first place, 
he had a perfect mania for soup-plates. It made no 
difference what the dish was, whether beefsteak, FRONTIER LIFE 
chicken, tomatoes, corn, flannel cakes, or what not, he 
always brought it to table in a soup-plate and insisted 
on my eating out of the same kind of plate. I really 
believe he would have served the coffee in the same, 
if he could have found another one. Luckily we have 
only six soup-plates, and when he got these full he had 
to resort to something else. I gently remonstrated with 
him and pointed out the uses of a few utensils, but 
whether my explanations confused him or were too stu- 
pendous to grasp, I know not; I do know that the fol- 
lowing day at dinner he fairly knocked the breath out 
of me by serving the tomatoes in the slop-bowl, the 
potatoes in the soup-tureen, and the pickles in the gravy- 
boat. I ate my dinner in silence, and from that day I 
never made any suggestions to Mr. Anmach. He took 
a great deal of pains in preparing his dishes, but when 
once cooked his mission ended, and he served them re- 
gardless of all traditions. 
I cannot remember all the ingenious freaks of this 
man Anmach. On one occasion he served the soup in 
the cream pitcher, on another day on lifting the lid of 
the soup-tureen what should I find but half-a-dozen 
peach dumplings reposing therein. I think he intended 
this as a surprise, but I betrayed no astonishment what- 
ever. He could not have told from my face but that I 
nad been used to eating peach dumplings out of soup- 
tureens all my life. A few days after that when I at- 
tempted to fill my glass with water and found instead 
boiled potatoes in the pitcher, I may have betrayed 
some momentary surprise, but I think not. You may 
think I am falsifying, but I assure you that I am giv- 
ing stern facts. 
When I had lulled myself into the belief that private 
45 46 
WALTER REED AND YELLOW FEVER 
Anmach would cling to his early training and keep 
sober, it came to pass that that season of the year drew 
nigh which has been so beautifully described by Lord 
Macaulay in the words “Apple cider, cinnamon beer; 
Christmas comes but once a year.” Perhaps the recol- 
lection of other days came back to him and led him 
astray, for at any rate Christmas night I heard a noise 
in Anmach’s room about 11 o’clock and going in found 
him quite drunk and made him go to bed. I locked the 
door and put the key in my pocket, but to my surprise 
when I went to his room next morning about 7 o’clock, 
I found the bird had flown. I then went into the kitchen 
and found everything in confusion. As I stood there 
and cast my eye over the various frying-pans and tea- 
kettles, and especially the cold, ashy face of the old 
stove, I realised for the first time the true beauty of 
soldier cooks. 
I returned and told the mother of the future Presi- 
dent that our festive cook was gone, and took council 
with her as to how the dilemma was to be met. After 
a brief session of five minutes’ duration, it was decided 
that I should peel off my jacket and approach the 
pensive frying-pan. I cannot say that I essayed the task 
with songs of joy upon my lips, but still I was deter- 
mined that no one should cheat me out of my breakfast 
that morning. The bill of fare was as follows: Pan 
frescoy manteca, cafe calient e y huevos as ados. Now 
does not that sound like a city hotel? Reduced to plain 
English it is not quite so overpowering, but fresh bread, 
butter, hot coffee, and boiled eggs are at all times re- 
freshing. For three days and nights I saw nothing of 
my truant cook, and during this time I got up various 
unspeakable and uneatable dishes. Emilie, however, FRONTIER LIFE 
47 
lacked for nothing, for the ladies sent her meals regu- 
larly. On the morning of the fourth day a soft knock 
at the door announced the return of the wanderer. I 
had fully made up my mind to give him “rats,” but he 
ate such a quantity of humble pie that I could say noth- 
ing. He acknowledged his meanness in leaving me un- 
der the circumstances, calling himself a good-for-noth- 
ing “dog” and promising never to deceive me again. 
Everything now went on lovely, and as Emilie was 
out of bed by January 15 and able to direct affairs I 
had high hopes that we had passed the worst. Contrary 
to my advice, however, Emilie insisted that the vege- 
tables should go into the vegetable dishes, the soup 
in the tureen, and a lot of other nonsensical ideas 
which I felt convinced our man Friday would never 
submit to. And sure enough, just four days thereafter, 
January 19th, the man of many trades slid off again, 
this time on a drunk as before, and again I was elected 
cook. After waiting five days and finding that cooking 
was a trifle monotonous I employed another cook, pri- 
vate George Powers, the “meek-eyed.” He did very 
well, and as he was sober and learned willingly and 
quickly, Emilie was on the fair road to make him a first- 
class cook. But lo! there were breakers ahead! The 
Commanding Officer’s cook got on a rampage and was 
sent back to his company. Hence the Commanding 
Officer (as private Powers belonged to his company) 
found himself under the “painful necessity” (which, 
by the way, was all painful fiddlesticks) of taking our 
cook to cook for his family. So on March 1st we had 
to let him go and take as our bread-maker one private 
Bertrand Howard, the sullen, and, I may add, the lazy. 
He had the reputation of being an excellent cook, and 48 
WALTER REED AND YELLOW FEVER 
thought he knew everything. Pie could make excellent 
cakes for breakfast and pretty good pumpkin pies, but 
beyond this his cooking was a mess. He could not 
bear for Emilie to give him any suggestions, and as for 
her coming into the kitchen it made him very angry 
for a week. He thought he knew so much that he 
wouldn’t follow any receipt and in fact just cooked after 
his own style and liking. As we had had so much 
trouble I begged Emilie to put up with him, although 
she could hardly help throwing a frying-pan at his 
head. Mr. Howard was much inclined to laziness, so 
that when we began to move to our new house and he 
found he would have to do a little extra work in clean- 
ing the kitchen, he came to me and said he would like 
to go back to his company. I was so disgusted with the 
gentleman’s performance that I paid him and told him 
to report at once. Thus blooming April found us once 
more minus a cook, and that too while we were busy 
moving. I tried various soldiers, but could get no one 
to come. In fact there seemed to be a perfect dearth 
of cooks, and I knew not what to do, when a happy 
thought occurred to us. What do you suppose it was? 
It was E.’s suggestion. To take back to our hearts our 
old friend the plasterer, alias the painter, alias the car- 
penter, alias the cutler, alias the tinner, alias the farmer, 
alias the cook, alias James Anmach of the Horse 
Marines! 
And we did! We have the most beautiful contract 
drawn up imaginable, and it is as simple as it is beauti- 
ful. Private Anmach agrees to cook and do general 
work, such as milking, etc., to put the soup into its 
proper tureen, and not to put the potatoes in the water 
pitcher, provided he is permitted to have a week’s drunk FRONTIER LIFE 
after each pay day, or once in two months. Once more 
the God of day has chased away the clouds and we are 
happy. I am glad to say that under E.’s skilful general- 
ship he is doing amazingly, even going so far as to make 
a citron pudding after your latest receipt, which was 
mighty good and gave us indigestion like all the world. 
And this is all I know about cooks in general and 
soldier cooks in particular. Best love to all, in which 
E. and baby join. Write soon. 
Your affectionate brother, 
Walter Reed. 
P. S.—I am constrained to add a few lines which are 
so appropriate to the present occasion that I hope you 
will not consider me verbose. 
49 
“We may live without poetryf music, or art; 
We may live without conscience and live without 
heart; 
We may live without friends and live without 
books; 
But civilised man cannot live without cooks.” 
As a post surgeon Dr. Reed was greatly and 
deservedly beloved. At this time, as Dr. Walter 
D. McCaw says in his “Memoir of Walter Reed,” 
the young medical officer at an army post was gen- 
erally the only physician at the station, and was 
called upon by the settlers for miles around. With- 
out help and with only such instruments and 
medicines as could be hastily stuffed into his sad- 
dle bags, he would be summoned to attend a WALTER REED AND YELLOW FEVER 
50 
fractured thigh, a child choking to death with 
diphtheria, or, most trying of all, a difficult child- 
birth. At one time when Dr. Reed himself was 
ill with a fever and cared for by the hospital 
steward, he insisted on responding to any urgent 
call, would get up, ill as he was, sit down repeat- 
edly while dressing for lack of strength, and finally 
start out with the snow deep on the ground and 
the thermometer far below zero. It has more than 
once happened that on reaching the patient’s house 
he would have to lie down and recover himself 
before he could go upstairs. The more humble 
the patient, the greater was Dr. Reed’s devotion, 
for the impression made upon him by his experi- 
ence among the poor in his New York district was 
never effaced, and his heart always went out to 
the lowly and the ignorant. 
His devotion was especially strong to children, 
and often, if some little one’s life was in danger 
from ignorance and want of proper care, he would 
plead with his wife to let it be brought to his 
home in order that his injunctions could be carried 
out, a plan which she was forced to oppose, as 
their home life would have been destroyed if their 
house had been turned into a hospital. On one 
occasion he brought into the camp a little Indian 
girl of four or five, so horribly burned that her 
people had left her to die. This child he suc- ceeded in saving, and then brought her up in his 
own family as nurse to his children, in spite of a 
friendly warning from that keen old Indian 
fighter, General Crook. When this child was 
nearly a woman the savage Apache blood asserted 
itself and she ran away, after giving abundant 
evidence (so says Major Kean) that fifteen years 
of kindness, gentleness, and refinement had not 
modified the cruel and deceitful characteristics 
of her race. 
The friendly Indians settled near the post often 
sent for Dr Reed to prescribe for them, and he was 
as painstaking in their behalf as in that of any 
other patient, although he was well aware that 
the Medicine Man’s word had much more weight 
than his own, and that as soon as he was gone the 
drum and rattle of the latter would be persistently 
beaten at the patient’s bedside, even though he 
might have given a narcotic. The Indians, never- 
theless, were much attached to him, and often 
showed their regard by bringing him a haunch 
of venison. If no one was in the house to receive 
it, they would walk in stealthily and lay it on Mrs. 
Reed’s dressing table, or, perhaps, take a picture 
from the wall and hang the venison in its stead. 
With all Dr. Reed’s gentleness his sense of per- 
sonal dignity and justice was strong and he never 
allowed anyone, even a superior officer, to infringe 
FRONTIER LIFE 
51 52 
upon his rights, or to fail in treating him with the 
respect to which he was entitled. Several times 
during his garrison life he had reason to think that 
the commanding officer was usurping authority, 
and he at once appealed to the higher powers, 
knowing that he was in the right and that an un- 
biassed judgment would decide in his favour. 
Once, while a soldier was still on the sick list, 
the commanding officer saw him taking a walk 
and ordered him to duty, saying that if he was 
well enough to be out, he was well enough to 
work. Dr. Reed’s anger was justly aroused, but his 
temper was always under his control. Without al- 
lowing himself to speak, he sent a written com- 
munication through the commanding officer to 
Headquarters, asking whether such interference 
was allowed. The paper was promptly returned 
through the proper channels to the commanding 
officer, who read it and handed it to his adjutant 
to be forwarded to Dr. Reed, remarking, “D 
the doctors, Mr. Adjutant, we can never get ahead 
of them.” 
Dr. Reed took the greatest interest in his army 
hospitals and in the hospital corps. His influence 
over his men was very great and he inspired them 
with his own enthusiasm, so that order and neat- 
ness prevailed wherever he ruled. Cleanliness is 
next to Godliness was his motto. Drinking he 
WALTER REED AND YELLOW FEVER FRONTIER LIFE 
would not permit under any circumstances among 
the hospital attendants, and in subsequent years 
several of his former hospital stewards sought him 
out and thanked him for keeping them bound to 
a temperance pledge while in hospital service. 
His love for outdoor sports was very strong, and 
a Western life afforded him opportunities of 
hunting, which he greatly enjoyed. In 1879 his 
wife went back East to spend a year at home, and 
he writes to her as follows concerning a deer hunt 
in which he had been engaged: 
53 
Fort Apache, Arizona, 
December 23, 1879. 
My last letter was not a very long one for the 
reason that I was getting ready to go for a “big 
hunt” with Lieutenants Kingsbury and Cruse, al- 
though I did not mention it at the time. Well, we got 
away from the post about 8 o’clock on Wednesday 
morning, and away we hied to “Bonito Fork,” the 
scene of our former hunting expedition, on which occa- 
sion the deer we killed and the turkey we slew would 
not have furnished fresh meat for many days. On this 
occasion, however, besides four soldiers and four pack- 
ers, we had twenty of the Indian Company, so that 
when we arrived at our camp that afternoon we found 
four turkeys and a fine big deer awaiting us. 
Our little camp looked real pretty at night. We were 
on the extreme right, then came our soldiers’ camp 
about 30 feet away, then the packers’, and farther still  WALTER REED AND YELLOW FEVER 
54 
the 20 Indians, divided into two camps of io each, 
so that there were five camp fires burning brightly and 
stretched along in a line about 30 feet apart. We had 
a good tent for ourselves and one for the soldiers. You 
should have seen our beds. Lieutenant Cruse and I 
dug a small hole on each side of the tent large enough 
to admit our backbones, and then filled both of them 
with long dry grass which we cut from the mountain 
side, thus making a delightfully soft cushion for our 
bones—a sort of hair mattress with springs, as it were, 
over which we spread our blankets. I slept with 4 
blankets under me doubled over, and 8 over me with 
my night-cap and a good heavy comforter which Mrs. 
Harrison gave me around my neck, and I managed to 
exclude the cold pretty well. I forgot to say that I had 
Lieutenant Kingsbury’s dog sleeping on my feet to 
keep them warm, and pretty cold it was too. Next 
morning (Thursday) when we got up, bright and 
early, we found about half an inch of snow on the 
ground and the wind was singing merrily though the 
trees. The Indians had already skipped out for a day’s 
hunt, and while we ate our broiled venison for break- 
fast we now and then heard a sharp crack of a rifle, 
which we knew meant either a turkey or a deer. After 
breakfast was over (I am sorry to say that I did not 
wash my face that morning, it was so cold) Lieutenant 
Cruse and I took our guns and climbed a high hill 
which took the breath clean out of us and then away 
we went, tramping over the roughest country you al- 
most ever saw, and we kept our walk till 2 P. M., but 
we didn’t get anything, as the Indians were ahead of 
us and frightened all the game away. We got back at 
2 P. M. to camp, and such a dinner as we two ate would FRONTIER LIFE 
have supplied half a dozen hungry men. ... By 
the time we had finished the Indians began to come 
in with their game, and before the sun had sunk be- 
neath the western horizon we counted 13 deer and 10 
turkeys as the result of one day’s shooting. I attended 
to “drawing” the turkeys, in fact, did it all myself, 
and Lieutenant Kingsbury superintended cleaning the 
deer. Before night we had them all hung up on a rope 
stretched between two tall pines and by the light glim- 
mer of the camp fire the display of game was very 
fine. . . . Next morning we were up before the 
stars ceased shining, busy taking down our tent and 
bundling up our baggage ready for a day’s journey to 
another branch of Black River, about 7 miles farther 
away. We were there and in camp by 12 o’clock noon, 
and after camp was pitched we lay off on our backs, and 
snoozed and sang songs and had a jolly time generally. 
That afternoon the Indians brought in 5 turkeys and 
6 deer and reported that they had left hanging out in 
the trees, from 5 to 15 miles away, 13 more big deer 
so large that they couldn’t pack them on their backs. 
That night we had a glorious time broiling venison 
over the red-hot coals. We ate and ate and yet did not 
seem to have enough. We held a council of war that 
night and decided to send in to the post next morning 
16 deer and 17 turkeys as a gentle reminder to the 
folks at Apache that we were as good hunters as other 
people. After getting the party off to Apache early 
next morning (Saturday) we started in various direc- 
tions to get the deer that were hanging out. Sam Bow- 
man and I went out with two pack mules, and after 
travelling about 5 miles over mountains and canons 
we brought in 4 beautiful deer, but such a tramp as we 
55 56 
WALTER REED AND YELLOW FEVER 
had. The Indian who went to show us where the deer 
were said that it was only “poco logos” that is “a 
little far” (Dandy-Bill, our old friend, by the way, 
was the caballiero), and I never knew what upoco 
logos” was before, but I know now. It means about 
50 miles for a white man! I was so tired when I got 
back to camp that it took about 3 pounds of venison 
stew to refresh my drooping spirits! Saturday night it 
began to storm and rained all night, and continued so 
to do all day Sunday, so that no hunting could be done 
by the Indians. All day we lay in our tents with a roar- 
ing fire in front and did not have to go out, except for 
meals, which even the storm could not keep us from. 
. . . We concluded that night that our hunt was 
over, as the storm only increased in severity and we 
only waited for the return of the pack mules from 
Apache in order to pack up our duds and hie to the 
camp. They returned on Monday, too late for a start 
back on the same day. On Tuesday morning (yester- 
day), however, we started back again to Apache and 
faced a terrible storm till 2 P. M. . . . In all we 
killed 41 deer and 50 turkeys! This morning we dis- 
tributed the game and now everyone at the Post has 
enough fresh meat for their Christmas dinner. . . 
A thousand Happy New Years for my sweet wife and 
son! God bless and preserve you both is ever the 
prayer of your fond and devoted husband, 
Walter of Arizona. 
At the end of four years in Arizona, Dr. Reed 
was ordered East again, being promoted at the 
same time to the rank of captain. In 1881 he was FRONTIER LIFE 
stationed for a short time at Fort McHenry, Balti- 
more, and while there made use of the opportunity 
to study physiology at the Johns Hopkins Uni- 
versity. This work may really be considered his 
introduction to the world of modern scientific 
research, and it was during this period that he 
laid the foundations of his future distinction. 
In 1882 Dr. Reed was transferred to the De- 
partment of the Platte and stationed in Western 
Nebraska. It was during the next year, while he 
was living at Fort Omaha, that his second child, 
Emilie Lawrence Reed, was born, on July 12, 
1883. 
While serving in Nebraska, Dr. Reed was fre- 
quently called on to practice among the poor set- 
tlers known as “Grangers,” who eke out a 
wretched subsistence by trying to farm in a coun- 
try where the rainfall is barely sufficient for a 
good crop once in three years. In the winters he 
was often obliged to take journeys on horseback in 
the discharge of his professional duties that were 
really dangerous from the risk of being overtaken 
by one of those blizzards in which the most ex- 
perienced frontiersman cannot see his way and 
the staunchest horse turns tail, so that the lost 
traveller is in greater peril than he would be on a 
battlefield. A little incident occurred on one of 
these expeditions which Dr. Reed always referred 
57 58 
WALTER REED AND YELLOW FEVER 
to with amusement as an instance of the difference 
in man’s “point of view.” 
He was sent for while a blizzard was raging 
and the thermometer was below zero, to go a 
distance of twelve miles to see a sick woman. He 
started at sunset in a driving wind, out on to the 
open prairie, where nothing could be seen but a 
sheet of snow, stretching miles and miles ahead of 
him, without a landmark visible. It was not long 
before he lost his way, and wandered about aim- 
lessly until midnight, when suddenly, from behind 
a snowdrift, a little beacon of light appeared and 
he found the tiny cabin he was seeking. The 
woman was very ill, and he could not leave her 
till the next afternoon, during which time the 
husband did his best to entertain him. While they 
were sitting before a rickety three-legged stove, 
waiting for some coffee to boil, the old man 
drawled out, “Well, Doc, I often feels sorry for 
you folks at the post. I know you all must git 
powerful lonely sometimes.” The post consisted 
of four companies, with headquarters and the 
band; moreover, it was situated within sight of the 
railroad station; and Dr. Reed, with the recollec- 
tion of it in his mind, was at that very moment 
commiserating inwardly the utter isolation of this 
poor old pair in their remote cabin. 
In 1887, after five years in Nebraska, Dr. Reed WALTER REED IN 1882 
From a photograph taken in Washington, D. C. 31 was ordered to Mount Vernon Barracks, Ala- 
bama, and his delight in the change of surround- 
ings was intense. After the barren desolation and 
trying climate of Nebraska, to say nothing of the 
still worse condition of things in Arizona, the sun- 
shine, showers, and abundant vegetation of the 
South were a never-ending delight. His love for 
nature knew no bounds, and wherever he was 
stationed, even among the most untoward sur- 
roundings, he would manage to have a garden full 
of flowers for his friends and of fruit and vege- 
tables for his hospital. It was a familiar sight to 
see him returning from an early morning visit 
laden with flowers gathered on his homeward 
way. 
He had a great admiration for the magnolia tree, 
indigenous to southern Alabama, and once trans- 
planted a couple of them into the hospital yard; 
shortly afterwards, a countryman, observing them, 
came to him and entreated that they might be up- 
rooted, as it was a firm belief in that part of the 
country that if a transplanted tree lives, some mem- 
ber of the family owning it will die within the year. 
Dr. Reed, greatly amused, set to work immediately 
to scour the woods until he found a sufficient num- 
ber of small magnolia trees to set out a whole 
row, saying that he would teach the country peo- 
ple a lesson. The trees lived, and no member of 
FRONTIER LIFE 
59 60 
WALTER REED AND YELLOW FEVER 
the family died, but it is not known whether the 
superstition survived or not. 
In 1889 Dr. Reed began to feel keenly that he 
needed time and opportunity for study, in order 
to keep abreast of advances in medical reseach. 
He applied, therefore, for leave of absence, stat- 
ing his reasons for doing so and the advantages to 
himself and to others that he hoped to gain from it. 
The reply from headquarters was that if he would 
pay the salary of a contract surgeon to fill his 
place he might go. This was a bitter disappoint- 
ment, but fortunately it was only for a short time. 
The old order in Washington was just then giv- 
ing place to new, and with the change sufficient 
interest was manifested in his application to in- 
sure his appointment as Attending Surgeon and 
Examiner of Recruits in Baltimore, with permis- 
sion to pursue some line of professional work at 
the Johns Hopkins Hospital, at that time just 
opened to physicians for courses in clinical medi- 
cine, surgery, and laboratory work. Even then, 
however, he was not free to follow his own incli- 
nations without restriction. He consulted the 
superintendent of the hospital as to his best line 
of work, and was advised to take courses in pa- 
thology and bacteriology in addition to certain 
clinical work in general medicine and surgery. 
Dr. Reed showed great interest in the suggestion, FRONTIER LIFE 
61 
but answered with regret that the Surgeon-General 
had forbidden him to give any attention to labora- 
tory work and had informed him, curtly and 
pointedly, that the object of the Government in 
detailing him for service in Baltimore was that 
he might better familiarize himself with the care 
of sick soldiers; under the circumstances, he felt 
that he could not, in honour, pursue any laboratory 
courses. He began his work, therefore, exclu- 
sively on the clinical side of the hospital, but 
fortunately for himself and for the country'he was 
not obliged to remain there. Surgeon-General 
Baxter died suddenly a few weeks later, and the 
new Surgeon-General was much more in sympathy 
with scientific pursuits, so that after obtaining the 
necessary permission, Dr. Reed devoted himself 
largely to pathology and bacteriology, in which 
lines of work he soon became known as a worker 
of the utmost promise. The quiet years of practical 
work on the frontier had furnished an admirable 
soil for the development of his talents, and they 
were now ready to yield an abundant harvest. CHAPTER III 
BEGINNING OF SCIENTIFIC WORK 
1890-1899 
In all things sought to see the Whole, 
Brooked no disguise; 
And set his heart upon the goal, 
Not on the prize. 
—William Watson, Laleham Churchyard. 
THE winter of 1890-91 was one of the keenest en- 
joyment to Dr. Reed. After living for so many 
years at a distance from the scientific world and 
cut off from congenial companionship, he re- 
turned to both with delight. His work at the Johns 
Hopkins Hospital brought him into the society 
of cultivated, scientific men, with whom his own 
genial nature and charming manner made him 
universally popular. He made many warm friend- 
ships during this year of his life, among which 
he set special value on that of his beloved teacher, 
Professor William Welch. 
The following account of Dr. Reed’s work at 
the Johns Hopkins University and Hospital has 
been kindly supplied me by Dr. Welch: 
62 SCIENTIFIC WORK 
63 
Dr. Reed was sent to Baltimore in October, 1890, 
as Attending Surgeon and Examiner of Recruits, and 
he remained there until the following October. The 
Medical Department of the University was not opened 
until October, 1893, but the Hospital was in full opera- 
tion in 1889, and the Pathological Laboratory of the 
Hospital and the University had been equipped and 
opened for the reception of physicians and advanced 
students and for research since 1885. Here systematic 
laboratory courses were given in pathology and bac- 
teriology, and it was here that Dr. Reed received his 
fundamental training in these subjects. 
Dr. Reed began his work on the clinical side of the 
Hospital, but after a few weeks, a new Surgeon-Gen- 
eral having in the meantime been appointed, he was 
enabled to follow his own inclination and to enter the 
regular courses in pathology and bacteriology in the 
Pathological Laboratory. I well recall with what 
eagerness and enthusiasm he turned his attention to 
the new fields of scientific medicine thus first opened to 
him, which from that time until the end of his life be- 
came the centre of his professional interest and activity, 
and which he himself was destined to cultivate with 
such signal benefits to medical science and to the 
welfare of mankind. 
The decade preceding the time when Dr. Reed 
began his practical studies at the Johns Hopkins had 
been a period of marvellous progress in our knowledge 
of infectious diseases. Upon the basis of the discov- 
eries of Pasteur and of Koch, and particularly as a 
result of the new methods introduced by Koch for the 
cultivation and study of bacteria, there had followed 
in rapid succession within this period such important 64 
WALTER REED AND YELLOW FEVER 
discoveries as those of the specific germs causing tuber- 
culosis, cholera, leprosy, glanders, erysipelas, surgical 
infections, tetanus, pneumonia, typhoid fever, malaria, 
amoebic dysentery, cerebro-spinal meningitis, diph- 
theria, and a large number of animal diseases. Pasteur 
had discovered methods of rendering animals arti- 
fically immune from chicken-cholera and other dis- 
eases, and had devised his method of protective inoc- 
ulation against rabies, which has been the means of 
saving many human lives. A great impetus was given 
by these discoveries to the establishment of hygienic 
and other laboratories where the new science of bac- 
teriology was actively cultivated. Medicine, both as a 
science and an art, had entered upon a new era, already 
rich in achievement and still richer in promise of future 
good. 
While Dr. Reed took the regular courses in pathol- 
ogy given in the laboratory and was interested in the 
subject, his special object was bacteriology, which is 
included in the Department of Pathology. In the con- 
duct of these courses there were associated with me 
at that time, Drs. Councilman, Abbott, Nuttall, and 
Flexner; and among others then engaged in research 
work in the laboratory I call to mind, Drs. Halsted, 
Lafleur, H. M. Thomas, Berkeley, W. T. Howard, 
Jr., Barker, Robb, Ghriskey, Randolph, Clement, 
Blackstein, Gilchrist, and Thayer. 
Dr. Reed soon made a place for himself in this in- 
timate group of active workers. We early recognised 
that he possessed unusual aptitude for the work which 
he had undertaken, and that he combined with excel- 
lent endowment of mind a sincere, manly, and winning 
personality. The friendship formed with his teachers SCIENTIFIC WORK 
and co-workers at this period were strong and en- 
during. 
Dr. Reed applied himself with great energy to his 
work in the laboratory, devoting to it daily a large part 
of his time and carrying it much beyond the regular 
class exercises. After he had acquired familiarity with 
technical methods, he undertook advanced and inde- 
pendent work. He attended post-mortem examinations 
and sometimes conducted them; moreover, he was ac- 
customed to study for himself pathological material 
and cultures which he had obtained from autopsies. 
He followed and profited by the various investigations 
which were at that time in progress in the laboratory 
and the Hospital, and he was a regular attendant at 
the Hospital Medical Societies. Drs. Abbott, Flexner, 
and I were at that time engaged in the study of diph- 
theria, the toxin of which had been discovered two 
years previously, and the antitoxin of which was dis- 
covered by Behring in 1890. The investigations of 
hog-cholera made at this time by Dr. Clement and 
myself enabled Dr. Reed to become familiar with the 
hog-cholera bacillus, so that he had no difficulty later 
in recognizing the resemblance to this bacillus of the 
micro-organism erroneously claimed by Sanarelli to be 
the cause of yellow fever. He also followed with great 
interest the studies of Drs. Councilman and Lafleur on 
amoebic dysentery, as well as investigations in the 
Hospital on the malarial parasite. 
During the latter part of his stay in Baltimore Dr. 
Reed was assigned, at his own request, a special subject 
for research. This was the microscopical and experi- 
mental study of the so-called lymphoid nodules which 
are found in the liver in cases of typhoid fever. He 
65 66 
WALTER REED AND YELLOW FEVER 
succeeded in producing these nodules ‘experimentally 
and demonstrated that they originated as small foci of 
dead liver cells. His paper upon this subject, published 
in the Reports of the Johns Hopkins Hospital, is a 
valuable contribution, and it embodies the results of his 
first original scientific investigation.1. 
When Dr. Reed left Baltimore in October, 1891, he 
was well trained in pathological and bacteriological 
methods, he had acquired a consijjefable amount of ex- 
perience, and he was thoroughly fitted to make the best 
use of such opportunities as might present themselves 
to add to this experience and training, as well as to 
undertake original investigation. This was apparent to 
us at the time and was fully demonstrated by his sub- 
sequent career. 
In 1893, when Dr. Reed was assigned to duty as 
curator of the Army Medical Museum and professor 
of bacteriology and clinical microscopy in the Army 
Medical School, he at once re-established relations 
with the Pathological Laboratory in Baltimore. He 
was a frequent visitor, together with his associate, Dr. 
Carroll, at the laboratory, and he kept in touch with 
the men and the work there. He often came to the 
Hospital Medical Society, at which he occasionally 
made contributions. I was often consulted by him re- 
garding his own investigations, and his relations 
were likewise very intimate and cordial with Drs. Flex- 
ner, Abbott, and Thayer. He talked over with me the 
plan of the yellow fever work to be undertaken by the 
commission of which he was the head, and he kept me 
informed by letter and by conversation of the results 
of this work while it was in progress. 
1 Johns Hopkins Hosp. Rep., 1895, V, p. 379. SCIENTIFIC WORK 
67 
It is one of the greatest satisfactions and pleasures 
of my life to have enjoyed the relations of teacher and 
of friend with a man who has left a memory so re- 
spected and beloved, and who has conferred such 
inestimable benefits upon his country and upon mankind 
as Dr. Reed. 
In October, 1891, Reed was sent to Dakota, 
and remained there until 1893, when he was 
ordered to duty in the office of the Surgeon-Gen- 
eral in Washington. There he was made curator 
of the Army Medical Museum and professor of 
bacteriology and clinical microscopy in the 
United States Army Medical School, then just 
organised, and was at the same time promoted to 
be full surgeon with the rank of major. With 
this promotion his garrison life ended, after last- 
ing eighteen years and including fifteen changes 
of station. Its influence on his own life and 
character is best described in the words of friends 
who speak from personal knowledge of him and 
of his environment during this period. 
Dr. McCaw, in his excellent memoir of Dr. 
Reed, writes on the subject thus: 
For a man like Reed, already an earnest student, no 
better preparation for his future could perhaps have 
been made. His early army service must have singu- 
larly tended to develop in him the very qualities most 
necessary to his final success. To the end of his life it 
was noticeable that, even when he had long given up 68 
WALTER REED AND YELLOW FEVER 
the practice of medicine for the work of the labora- 
tory, he was, nevertheless, unexcelled at the bedside 
for unerring diagnosis and sound judgment in treat- 
ment. So also were the experiments which robbed 
yellow fever of its terrors especially remarkable for 
simplicity, accuracy, and completeness, or they would 
never have so quickly convinced the world of their 
truth. Too much reverence for accepted teaching and 
too little experience in grappling with difficulties unas- 
sisted, and they might never have been conceived. 
Major J. R. Kean spoke to the same effect as 
follows at the memorial services held in memory 
of Dr. Reed at Washington, in December, 1902: 
In speaking of Dr. Reed as a medical officer we 
should consider especially that part of his career with 
which the members are least familiar, namely, from 
his entrance into the army, in 1875, to his assignment 
to duty in Washington, in 1893. With the latter date 
began his career as a scientific man, although much of 
his time during the last decade was given to examining 
boards and other work of a military rather than a 
scientific character, and the race horse spent much time 
at the plough. These eighteen years of garrison duty 
were, we may be sure, not wasted, yet the official 
records tell us but little of them. . . . The work of 
young army surgeons claims little space in the gazettes 
or in the reports of military commanders, and in the 
seventies and eighties the life was certainly not stimu- 
lating to intellectual effort. 
The surgeon shared with his comrades of the line SCIENTIFIC WORK 
the tedium of marches and the monotonous sameness 
of Arizona summers and Dakota winters. And those 
with whom bonne camaraderie outweighed studious 
industry shared alike the afternoons of bottle-pool and 
beer, and the nightly seductions of draw-poker. But 
for medical officers it was redeemed by the study of 
our profession, which was then beginning to broaden 
out from ancient channels into the full flood of recent 
progress, and it was saved from triviality by those 
stern responsibilities of life and death which practice 
brings to all physicians. To lesser minds the limita- 
tions of such a life must have been narrowing, but for 
the eager industry and professional devotion of a Reed 
they made the roots strike deep; and when we are sur- 
prised at the rapid growth and splendid fruit of his 
career as a scientist, we must remember that in the 
post-surgeon’s unmarked life the seed was germinated 
and the roots firmly set. But for the opportunities 
given him by his position in the army, however dis- 
tinguished he might have become in other ways, it is 
safe to say that the work with which his fame will 
always be inseparably connected would never have been 
accomplished by him. During that long apprentice- 
ship he acquired, too, that perfect familiarity with the 
conditions and limitations of army life which, com- 
bined with the scientific knowledge and sound judg- 
ment, made him the best sanitary inspector in the army 
and the court of last resort on all sanitary questions. 
69 
Dr. Reed’s paper on “The Contagiousness of 
Erysipelas” was published in 1892, and from 
this time forward he was a constant contributor to 70 
medical periodicals, where his literary work shows 
the same excellence as everything else to which 
he put his hand. A full list of his publications is 
given at the end of this volume. They stand as 
witness to the indomitable energy and persever- 
ance of the man as well as to his unusual intel- 
lectual endowments, for it must be remembered, 
that not only were these papers written during 
a single decade, but that the scientific researches 
which they record were all executed during the 
same space of time. 
This discovery of the Klebs-Loeffler bacillus was 
a matter of extreme interest to Dr. Reed, and he 
used every means in his power to advance the 
practical benefits attendant on its demonstration. 
Early in 1894 he was invited by the Medical So- 
ciety of the District of Columbia to open the dis- 
cussion on a paper by Dr. Kinyoun, entitled, “The 
Prevention and Control of Diphtheria”; he con- 
ducted the debate with great earnestness and ad- 
mirable command of the subject. He firmly be- 
lieved that the Klebs-Loeffler bacillus was the 
cause of primary diphtheria, and that the disease 
was a local one, tending to become constitutional 
by the production of virulent toxins. A year later, 
January, 1895, m discussing diphtheria and its 
treatment by antitoxin, he said that he believed 
the production of antitoxin should be under mu- 
WALTER REED AND YELLOW FEVER nicipal control and the serum tested by disin- 
terested persons, so as to avoid imposition by 
unscrupulous men, actuated by the love of gain. 
On December 4, 1895, he struck the deathblow 
to the local opponents of antitoxin in a discussion 
on “The Clinical Aspects of Diphtheria” before 
the Medical Society in Washington. The presi- 
dent, Dr. S. S. Adams, thus describes the occasion: 
SCIENTIFIC WORK 
71 
A clinician of wide experience and recognised ability, 
while disclaiming any unfriendliness towards its use, 
had taken a decided stand against this serum, basing 
his remarks upon the statistics and arguments of a 
distinguished English laryngologist and a well-known 
American pediatrist. It seemed as if the pendulum 
were swinging toward the opposition when Walter 
Reed entered the forum—majestic, fearless, deter- 
mined to conquer. With keen eyes fixed on his princi- 
pal antagonist, he hurled his weapon of defence in un- 
mistakable language, when he said: “You are theo- 
rising, while we are dealing with facts. If another 
friend of antitoxin arises and deals it such blows as 
Doctor has given it, the antitoxin-serum will be 
slaughtered in the house of its friends.” In concluding 
his remarks came this appeal: “I myself almost feel 
like saying, with the reader of the paper, that the 
failure to use it in a case of human diphtheria is crimi- 
nal; and I beg of you, that if you have not yet done so, 
when next you stand by the bedside of your patient 
afflicted with this disease, you do not, through any fear 
of its peculiar action, withhold this invaluable remedy.”  WALTER REED AND YELLOW FEVER 
72 
In 1898, when the Spanish-American War 
broke out, Dr. Reed became extremely anxious to 
hold some responsible position in charge of sick 
soldiers. He knew that his experience peculiarly 
fitted him to do this work, since he was familiar 
with practical matters, such as the condition of the 
army, the routine of getting supplies, the manner 
of preserving the health of the soldiers, and all 
questions of general management, which were un- 
known to the civilian physicians and political 
doctors appointed to hold responsible positions 
over him. He made a strong effort to secure some 
such appointment, for which years of army work 
had so admirably fitted him, only to be chagrined 
and distressed when men with political influ- 
ence were preferred, while he and other army 
surgeons were relegated to other unimportant 
positions. The records of our camps during the 
Spanish-American War afford, indeed, a val- 
uable object lesson on the evils of allowing 
matters in which human safety depends upon 
technical knowledge and specialised training to 
be governed by political interest. For, not only 
is human life, under such conditions, at the mercy 
of ignorance, indifference, and greed, but the very 
men whose hands are tied by political usurpation 
of authority which should be theirs, are liable to 
undeserved blame for the evils they have striven SCIENTIFIC WORK 
to prevent, and our credit as a nation suffers in 
consequence. 
No one felt this injustice more keenly than Dr. 
Reed; and in a conversation with a friend -soon 
after the war was over, he spoke with extreme sad- 
ness of the fact that by such mismanagement on 
the part of the Secretary of War and others who 
should know better, the Army Medical Corps had 
been subjected to censure which it did not deserve. 
To use his own words, “The Army Medical Corps 
has received a black eye because of the neglect and 
incompetence of men who did not really belong 
to it.” 
The knowledge gained by our experience in 
Cuba and in our own Southern States shows only 
too plainly that there is but one remedy for such 
a state of things, and that a radical one, namely, 
the entire reorganisation of the Army Medical 
Corps with the object of investing it with au- 
thority necessary to carry out the measures and 
regulations which it enacts. So long as the Army 
Medical Corps is subject, in hygienic and sani- 
tary matters, to the will of ignorant, inefficient, or 
unprincipled military officials, no improvement 
can be expected. During our recent war the army 
surgeon could recommend proper sanitary regula- 
tions, but he had no authority to enforce his 
recommendations. The value of camp cleanliness, 
73 74 
pure water, and adequate sanitary arrangements 
might be appreciated by the medical authorities, 
but so long as the military officials refused to 
co-operate they were powerless to enforce the 
necessary regulations. If the military commander 
issued orders to enforce sanitary regulations they 
were carried out; but if not, they never went into 
effect, no matter how great the need for them 
might be. The mortality and suffering which re- 
sulted from this state of things would, it might be 
thought, have resulted in some measures for im- 
provement, but no steps towards it have as yet been 
taken. Nothing, indeed, but a complete reorgan- 
isation of all matters connected with the medical 
department of the United States Army can pro- 
duce any lasting benefit; and until this is done we 
are at the mercy, should war again be our fate, of 
the same ravages from disease which have already 
cost us so dearly. 
When, owing to the ignorance of untrained 
officials and the lack of organisation and method, 
typhoid fever broke out among the volunteer 
troops, Dr. Reed was made chairman of a com- 
mittee to study its causation and modes of propa- 
gation. The other members were, Dr. V. C. 
Vaughan of the University of Michigan and Dr. E. 
O. Shakespeare of Philadelphia. The investiga- 
tion, which covered more than a year, was re- 
WALTER REED AND YELLOW FEVER markable for the patience and skill with which a 
vast number of details were collected and studied, 
and it marks a great advance in our knowledge of 
the disease. The report of the committee, under 
the title “Report of the Origin and Spread of 
Typhoid Fever in the United States Military 
Camps during the Spanish-American War of 
1898,” has only recently been issued by Govern- 
ment, for its publication required not only a con- 
siderable amount of time and work in order that 
so vast an amount of data might be available to 
the profession at large, but also demanded a 
liberal expenditure of money. The labor required 
has been supplied by the sole surviving member 
of the board, Dr. Vaughan, and the appropriation 
by Congress of the necessary funds is due, in large 
measure, to the interest and appreciation of the 
former Secretary of War, Mr. Elihu Root. 
The report is issued in two large volumes, the 
first of which contains the reports on typhoid fever 
in all the different army divisions, with plots of 
distribution of regiments, regimental lists, tem- 
perature charts, and the conclusions reached after 
a careful study of the results; the second volume 
contains maps of the country over which typhoid 
fever was distributed. The book is a monumental 
work, which will always be of value as a basis of 
future study in the epidemiology of typhoid fever. 
SCIENTIFIC WORK 
75 76 
WALTER REED AND YELLOW FEVER 
The most original and interesting point in the in- 
vestigation is the proof that the infection of typhoid 
fever is spread in camps by the common fly and 
by contact with patients and infected articles, 
such as clothing, tentage, and utensils of all kinds, 
as well as by contaminated drinking water. Space 
forbids me to quote from it at length, but I give 
one or two extracts from the general statements 
and conclusions at its close. 
Section 27—Infected water was not an important 
factor in the spread of typhoid fever in the national 
encampments in 1898. 
There were probably local water supplies that be- 
came specifically infected with the typhoid fever bacil- 
lus, but infected water was not the great factor in the 
causation of this disease. It is possible that the piped 
water at Chicamauga became specifically contami- 
nated. . . . However, that even at Chicamauga in- 
fected water was not the chief factor in the spread of 
typhoid fever, is shown by the fact that regiments 
which did not drink piped water also became widely 
infected with the disease, and it is furthermore demon- 
strated by the fact that the spread of typhoid fever 
continued after the regiments had been moved to 
Knoxville, Tenn., and Lexington, Ky., at both which 
places the water supply was above suspicion. 
Section 28—Flies undoubtedly acted as carriers of 
the infection. 
Flies swarmed over the infected fecal matter in the 
pits, and then visited and fed upon the food prepared 
for the soldiers at the mess tents. In some instances where lime had been sprinkled over the contents of 
the pits flies with their feet whitened with lime were 
seen walking over the food. It is possible for the fly 
to carry the typhoid infection in two ways. In the first 
place, the fecal matter containing the germ may adhere 
to the fly and be mechanically transported. In the 
second place, it is possible that the typhoid bacillus 
may be deposited with its excrement. Since the above 
was written Hamilton has demonstrated that the 
house fly may, and does at times, transport the typhoid 
bacillus. . . . Fischer (Arch. f. Hygiene, Bd. 46, 
s. 274) has attempted to determine the duration of 
life of the typhoid bacillus in the bodies of flies fed on 
infected material, and places it at twenty-three days. 
Section 29—It is more than likely that men trans- 
ported infected material on their persons, or in their 
clothing, and thus disseminated the disease. 
We have condemned the method which was fol- 
lowed in many of the camps, of detailing men from the 
ranks to act as orderlies at the hospitals. In some of 
the commands it was customary to detail 100 or more 
men from the line every morning. The most of these 
men were wholly ignorant of the nature of infection 
and the methods of disinfection. In fact, at one of the 
division hospitals we saw orderlies of this kind go from 
the hospital and partake of their midday meal without 
even washing their hands. These men handled not 
only the food they ate, but passed articles to their 
neighbours. It seems to us that a more certain method 
for the dissemination of an infectious disease could 
hardly have been invented. 
Section 30—Typhoid fever, as it developed in the 
regimental organization, was characterised by a series 
SCIENTIFIC WORK 
77 78 
WALTER REED AND YELLOW FEVER 
of company epidemics, each one having more or less 
perfectly its own individual characteristics. 
The truth of this statement will be evident after the 
inspection of the charts showing the distribution of 
typhoid fever among the companies of the different 
regiments. . . . Certain tents were badly infected 
and the majority of all their inmates developed the 
disease, while other tents wholly escaped. Blankets 
and tentage became soiled with typhoid discharges, 
and in this way the disease was propagated and carried 
by the company wherever it went. We believe, there- 
fore, that personal contact was a very important factor, 
probably the most important, in the spread of the dis- 
ease. That the floors, furniture, and bedding of bar- 
racks may become infected with typhoid fever, and 
may continue to endanger the life and health of the 
occupants for a long time is abundantly shown in the 
records of military surgeons. . . . Our investiga- 
tions certainly demonstrate that typhoid fever is not 
only an infectious, but also a contagious disease; that 
it may be transmitted from one person to another by 
contact, and that the clothing, bedding, and rooms of 
typhoid patients should be disinfected with as much 
care as is now given to these matters in cases of diph- 
theria and scarlet fever. 
Section 31—It is probable that the infection was 
disseminated to some extent through the air in the form 
of dust. 
. . . The shell roads through the encampments at 
Jacksonville were ground by the heavy army wagons 
into an impalpable dust several inches thick. Along 
these roads scavengers carted in half barrels fecal 
matter containing the typhoid bacillus. The contents of SCIENTIFIC WORK 
79 
these tubs splashed and fell in the dust. On each side 
of these roads soldiers were encamped, and many din- 
ing tables were in close proximity to the roads. 
Local whirlwinds sometimes caught up large quantities 
of this dust and carried it considerable distances. After 
seeing these things we feel that we cannot exclude dust 
as a probable carrier of infection, notwithstanding the 
fact that it would probably be a very difficult thing to 
demonstrate scientifically that the disease was dissem- 
inated in this way. 
In 1899, when the work of the Typhoid Commis- 
sion was completed, Dr. Reed returned to Wash- 
ington. Shortly afterward he was called upon to 
undertake investigations which really represent 
the first stage of his work in yellow fever, but 
before we take up the consideration of this, the 
central event of his life, let us pause for a moment 
to review the history of yellow fever in the past, 
in order that we may form a just conception of the 
condition of knowledge regarding it at the time 
the Yellow Fever Commission began its work. CHAPTER IV 
HISTORY OF YELLOW FEVER IN THE PAST 
“Miserandaque venit 
. . . lues, et lethifer annus, 
Linquebant dulces animas, aut aegra trahebant corpora.” 
—Virgil, Aeneid, Book III. 
YELLOW FEVER was described by Osier in 1892 
as “an acute febrile disorder of tropical or sub- 
tropical climates, characterised by jaundice and 
hemorrhages, and due to the action of a specific 
virus, the nature of which is not yet known.”1 The 
course of the disease, according to the same au- 
thority, is distinguished by a sudden onset without 
previous symptoms. There is frequently an initial 
chill, associated with headache and pain in the back 
and limbs, nausea and vomiting, constipation, and 
diminished urinary secretion. This first, or febrile, 
stage lasts from a few hours to a few days, and may 
or may not be accompanied by the jaundice which 
gives the disease its name. It is followed by a re- 
mission, sometimes known as the stage of calm, dur- 
ing which the temperature falls, and the severity 
of the symptoms subsides. In favourable cases the 
disease now decreases and convalescence sets in. 
In other instances, the third stage, known as febrile 
reaction, begins. The temperature again rises, all 
the symptoms become aggravated, the jaundice 
1 “Practice of Medicine,” 1892, p. 125. 
80 HISTORY OF YELLOW FEVER 
81 
develops rapidly, and in many cases the symptom 
called “black vomit” takes place; this is the ejec- 
tion of blood and gastric mucus altered by the acid 
juices of the stomach. Black vomit is usually re- 
garded as a symptom belonging distinctively to 
yellow fever, but such is not the case, since material 
identical with it is brought up under other febrile 
conditions in which vomiting of blood occurs. It 
is not, therefore, necessarily a fatal symptom in 
yellow fever, though it is present only in the se- 
verer forms of the disease. Bleeding sometimes 
occurs from the gums and from the kidneys, while 
haemorrhages into the skin are not uncommon. 
The mortality in yellow fever is very high, having 
ranged in different countries from 15 to 85 per cent. 
Convalescence is slow or rapid, according to the 
severity of the disease, and, in most cases, one 
attack insures against another. 
In the treatment of yellow fever almost every 
known measure under the sun has been tried at dif- 
ferent times, with indifferent success. Even inocu- 
lation with the poison of the rattlesnake was em- 
ployed at Havana many years ago, and was as- 
serted by some persons to have been of considerable 
value in certain forms of the disease. But this 
question, once of vital interest, has become of sec- 
ondary importance now that the prevention or ex- 
tinction of the disease has been shown to be pos- 82 
WALTER REED AND YELLOW FEVER 
sible. The forms of treatment which our present 
knowledge shows to be most profitable are given in 
Chapter XIII with other records of Dr. Gorgas’ 
work. 
Some of the older writers have objected to the 
name “yellow fever” {fievre jaune in French and 
fiebre amarilla in Spanish) because the yellow tinge 
of the skin from which it is derived is present also in 
bilious fever. The name in common Use among the 
Spaniards, “el vomito negro” is, perhaps, a better 
term. 
At different periods in the earth’s history both 
the old world and the new have been scourged by 
epidemics of yellow fever, which have never been 
arrested by any of the means employed for the pur- 
pose. On every occasion the disease has run its 
course unhindered, the only fact clearly determined 
being that its abatement was always preceded by 
cooler weather. 
Some of the older writers claim that yellow fever 
was originally present in Africa, though Cortes 
found it in Mexico, where it was known as matzla- 
huatt. It was certainly unknown in Europe until 
after the discovery of America by Columbus. The 
earliest authentic instance of it is an epidemic in 
Central America, in 1596, concerning which Mr. J. 
M. Keating, in his account of the epidemic in 
Memphis in 1878, speaks as follows:2 
* ‘‘History of the Yellow Fever Epidemic of 1878,” J. M. 
Keating, 1879. HISTORY OF YELLOW FEVER 
83 
The first authentic record we have of the appear- 
ance of yellow fever is that which occurred in Cen- 
tral America, in 1596. Subsequently we hear of it 
in New England among the Indians, in 1618. After 
that in the Island of St. Lucia, in 1664, where it 
killed over 1411 out of a population of 1500 sold- 
iers, a ratio of 1 in 1.06 of the whole number. We 
next hear of it in the same place, in 1665, when, out 
of 500 sailors, 200 died, being 1 in 2.5, and again in 
1666, when every man, woman, and child of 5000 
died. New York was visited by it for the first time 
in 1668; Boston in 1691 and again in 1693;Philadel- 
phis was visited for the first time in 1695. In 1699 
it again visited the latter city, the mortality being 
220, which no doubt was very heavy, as the inhabi- 
taiits were few in numbers, the town being only 
seventeen years old. Charleston, S. C., was also 
visited for the first time in 1699, but what the mor- 
tality was we have no means of knowing. 
Between the years 1702 and 1800 yellow fever 
appeared in the United States, according to Keat- 
ing, thirty-five times, in localities varying from 
Pensacola to Nantucket Island, but showing a 
marked preference for the cities of the South. 
Among these visitations was the epidemic in Phila- 
delphia in 1793, when the death ratio was 1 in 10 of 
the population. Between the years 1800 and 1879, 
when Keating’s book was issued, yellow fever vis- 
ited the United States every year with two excep- 
tions, although it was epidemic on only a few occa- 
sions. The great epidemics during this period 84 
WALTER REED AND YELLOW FEVER 
were that of New Orleans in 1853, in which there 
were 29,020 cases with 8101 deaths, a case fatality 
of 27.91 per cent.; and that of Memphis in 1878, 
when there were 17,600 cases with 5150 deaths, a 
mortality of 1 in 3.3. In 1878 the disease also 
raged extensively throughout the Southern States 
in general, reaching as far north as Virginia. 
Dr. Charles Bolduan, of the United States 
Public Health Service, furnishes the following list 
of all occurrences of yellow fever in the United 
States from 1668 to 1705 and of all epidemics 
from 1705 to 1905, which is complete so far as 
information is available: 
1668, New York; 1691, Boston; 1693, Boston, 
Philadelphia, and Charleston (S. C.); 1695, Phila- 
delphia; 1697, Virginia; 1699, Philadelphia and 
Charleston (S. C.); 1702, New York and Biloxi 
(Miss.); 1703, Charleston (S. C.); 1705, Mobile; 
1732, Charleston (S. C.) and Philadelphia; 1741, 
Philadelphia; 1743, New York; 1745, Charleston 
(S. C.); 1747, Philadelphia; 1762, Philadelphia; 
1763, Nantucket; 1765, Pensacola; 1789, New 
York; 1791, New York; 1793, New Orleans and 
Philadelphia; 1794, New Orleans, Charleston (S. 
C.), and Philadelphia; 1795, New Orleans, New 
York, and Philadelphia; 1796, New Orleans; 1797, 
Providence (R. I.) and Philadelphia; 1798, 
Charleston (S. C.), Philadelphia, Chester (Pa.), 
Wilmington (Del.), New York, Boston, Salem 
(Mass.), Portsmouth (N. H.), and New London 
(Conn.); 1799, New Orleans, Charleston (S. C.), HISTORY OF YELLOW FEVER 
85 
Philadelphia, and New York; 1800, Charleston 
(S. C.) and Norfolk; 1802, Philadelphia, Charles- 
ton (S. C.), Wilmington (Del.), and Boston; 1803, 
Norfolk, Philadelphia, and New York; 1804, 
Charleston (S. C.); 1805, Philadelphia and New 
York; 1807, Charleston (S. C.); 1808, St. Mary’s 
(Ga.); /c?6>P, Brooklyn; 1817, New Orleans and 
Charleston (S. C.); /£/<?, Charleston (S. C.) and 
New Orleans; 1819, New Orleans, Mobile,Charles- 
ton (S. C.), New York, and Baltimore; 1820, 
Philadelphia; 1821, St. Augustine (Fla.); 1822, 
Pensacola, New Orleans, and New York; 
New Orleans and Charleston (S. C.); 1825, New 
Orleans; 1827, New Orleans; /<&?£, New Orleans 
and Charleston (S. C.); 1829, New Orleans and 
Mobile; /d’J#, Charleston (S. C.) and New Or- 
leans; New Orleans; 1834, New York and 
Charleston (S. C.); 1835, New Orleans; 1837, New 
Orleans and Mobile; Charleston (S. C.); 
1839, New Orleans, Galveston, Mobile, and 
Charleston (S. C.); 1841, New Orleans, St. Au- 
gustine, and Key West; 1842, New Orleans and 
Mobile; 1843, New Orleans and Mobile; 1844, 
Galveston and New Orleans; 1845, New Orleans; 
1846, New Orleans; 1847, Galveston and Mobile; 
1848, New Orleans and Mobile; 1849, New Or- 
leans, Mobile, and Charleston (S. C.); 1850, New 
Orleans; 1852, New Orleans and Charleston (S. 
C.); 1853, Galveston, New Orleans, Norfolk, Mo- 
bile, Key West, and Philadelphia; 1854, New Or- 
leans, Savannah, Charleston, and Galveston; 1855, 
Norfolk and Portsmouth (Va.); 1856, New Or- 
leans and Charleston; 1857, New Orleans; 1858, 86 
WALTER REED AND YELLOW FEVER 
Galveston, New Orleans, and Charleston (S. C.); 
1859, Galveston; 1862, Key West; 1864, Galves- 
ton and Newbern (N. C.); 1867, New Orleans, 
Pensacola, and Galveston; 1870, New Orleans; 
1871, Charleston and New Orleans; 1872, New 
Orleans; 1873, New Orleans and Pensacola; 1875, 
Barrancas (Fla.), Pascagoula (Miss.), and Key 
West; 1876, Brunswick; 1878, Memphis and all 
the Mississippi Valley to Cairo (111.); 1882, Pen- 
sacola; 1883, Brewton (Ala.); 1887, Key West; 
1888, Jacksonville (Fla.); 1893, Brunswick (Ga.) 
and adjacent islands; 1897, Louisiana, Missis- 
sippi, Alabama, and Tennessee; 1898, Louisiana 
and Mississippi; 1899, Key West, Miami, New 
Orleans, and Scattering; 1903, Laredo (Texas); 
1905, Pensacola, New Orleans, Lake Providence 
(La.), and Vicksburg (Miss.). 
Up to the time of the Philadelphia epidemic of 
1793 yellow fever seems to have been accepted 
without question as the visitation of God, and no 
theories in regard to its origin or mode of trans- 
mission were developed. In 1793, however, when 
the interest of the medical profession in Philadel- 
phia was focused on the disease, two hypotheses 
as to the manner in which it originated were 
brought forward. One of them was that of direct 
importation, probably from the West Indies, and 
this was supported by the College of Physicians. 
The other view, held by some of the best authori- 
ties in the city, and in particular by Dr. Benjamin HISTORY OF YELLOW FEVER 
Rush, was that of a local origin, that is to say, of 
spontaneous generation under appropriate condi- 
tions of filth, heat, and moisture. 
The manner by which the disease was propa- 
gated also became the subject of discussion, al- 
though definite theories in regard to this point 
were slow to develop. In 1793 the large ma- 
jority of physicians held that yellow fever was 
transmitted through direct contact with the in- 
fected individual, although there were a few who 
believed its extension was due to the diffusion, 
through the agency of the air, of morbid exhala- 
tions, themselves the offspring of organic decom- 
position. The latter doctrine gradually gained 
ground, until, at last, the physicians of Philadel- 
phia became divided into two hostile parties, and, 
says La Roche, from whom I quote, “From this 
moment may be dated the origin of the intermin- 
able dispute about contagion and non-contagion 
which has continued ever since to occupy the atten- 
tion of the medical profession in this and in other 
countries.” 3 
Priority in the publication of views on the non- 
contagion theory was for many years the subject of 
much discussion. La Roche tells us that Dr. Na- 
thaniel Potter, of Baltimore (died 1843), in an 
essay on contagion published some time after the 
Philadelphia epidemic, claims that in October, 
87 
8 “ Yellow Fever,” by R. La Roche, M. D., 1855. 88 
WALTER REED AND YELLOW FEVER 
1793, he had written to Dr. Rush emphasizing the 
domestic origin and the non-contagious character 
of the epidemic diseases of the Eastern Shore of 
Maryland, and had then expressed the opinion that 
fevers arising from vegetable decomposition are 
non-contagious, suggesting at the same time that 
the yellow fever epidemic raging in Philadelphia 
was also, as he expresses it, “devoid of that prop- 
erty.” Dr. Potter further states that in the summer 
of 1795, believing that he was at that time the only 
person in America who denied the contagious char- 
acter of the disease, and that his opinion could be 
sustained by facts, he proposed to embody his views 
in a thesis, but was dissuaded from doing so by Dr. 
Wistar. This claim to priority is explicit, but it is 
sustained only by a letter, not made public until 
1818, and however true it is that Dr. Potter enter- 
tained such views, his claim to priority must yield 
to that of others who were less tardy in making 
their opinions public. Other claimants to the dis- 
tinction of first formulating the doctrine of non- 
contagion are Dr. Davidge of Baltimore, in the 
Baltimore Federal Gazette of November 30, 1797, 
and Dr. Charles MacLean, an English authority, 
who unhesitatingly ascribes the belief in non-con- 
tagion, which appeared in Philadelphia about 
1798, to the influence of a dissertation by himself 
on the source of epidemic diseases, originally HISTORY OF YELLOW FEVER 
89 
issued in Calcutta, in 1796, and reprinted in Phila- 
delphia in 1797. 
According to La Roche, however, there can be 
no doubt that to Dr. Jean Deveze of Philadelphia 
belongs the distinction of first publicly enunciat- 
ing the non-contagion theory. Dr. Deveze arrived 
in Philadelphia from the West Indies at the be- 
ginning of the epidemic of 1793, and was soon 
after placed at the head of a hospital opened at 
Bush Hill, where he had ample means of observ- 
ing the disease. In 1794, a year before Dr. Potter 
proposed writing his thesis, Dr. Deveze published 
a description of the epidemic of 1793, and in this 
essay, which has never, in the opinion of La Roche, 
received the attention it deserves, he boldly pro- 
claims the non-contagious character of the disease, 
assigning facts analogous to those advanced by 
subsequent writers and adducing arguments simi- 
lar to theirs.4 
As the facts brought out by the epidemic of 1793 
in Philadelphia were gradually disseminated, a 
change became perceptible in the opinion of the 
leading physicians there and elsewhere as to the 
question of contagion. Dr. Rush, who in 1793 was 
4 “ An Inquiry into and Observations upon the Causes and 
Effects of the Epidemic which Raged in Philadelphia from the 
Month of August till toward the Middle of December, 1793.” 
By Jean Deveze, Philadelphia, 1794. 90 
himself a decided supporter of the contagion the- 
ory, modified his views in the partial epidemic 
of 1794, and some years later published a formal 
recantation of what he had come to consider an 
error, stating that although he was aware of the 
influence which changes in medical opinion have 
upon a physician’s reputation, he “should consider 
as small the total sacrifice of his own, could it avert 
the evils which are connected with a belief in the 
importation of pestilential diseases, and insure to 
the world the benefits which would necessarily 
flow from the establishment of the doctrines of 
non-contagion.” In a subsequent part of his work 
he even goes so far as to beg forgiveness from the 
friends of science and humanity if the publication 
of his opinion in favour of the contagion theory 
had exercised any influence in increasing the mis- 
ery and mortality attendant upon the disease, add- 
ing that such was the pain he felt in recollecting 
that he had entertained and propagated it, that “it 
would long, and perhaps always, deprive him of 
the pleasure he might otherwise have derived from 
a review of his attempts to fulfill the public duties 
of his situation.” 
Contagionists at this period were divided, ac- 
cording to La Roche, into three classes: first, those 
who believed the disease to be invariably conta- 
gious, the power of communication being more 
WALTER REED AND YELLOW FEVER HISTORY OF YELLOW FEVER 
91 
actively displayed in crowded, ill-ventilated, and 
filthy places; second, those who believed the dis- 
ease was naturally endowed with contagious prop- 
erties, but that these required an impure atmos- 
phere for their manifestation; third, those who 
considered that the disease had not naturally any 
contagious properties at all, but could acquire them 
through the influence of favourable conditions, 
such as filth and bad air or water. The third of 
these opinions, namely, that the disease becomes 
contagious only under unfavourable conditions, 
was upheld by many of the best physicians, includ- 
ing Dr. Rush, up to the time of his recantation, and 
all old writings on yellow fever contain constant 
references to the effect of heat, moisture, and 
organic decomposition on the spread of the disease. 
The doctrine of local origin gained ground at 
the same time as that of non-contagion; indeed, 
there seems to have been a general impression that 
direct importation implied contagion, while non- 
contagion assumed a local origin. 
As would naturally be expected, the occurrence 
of each epidemic by which some region of the 
country was swept stimulated men’s minds to inves- 
tigation of the problems involved in the disease, 
and, accordingly, we find epochs in the develop- 
ment of knowledge regarding it associated with the 
years marked by its most formidable outbreaks. WALTER REED AND YELLOW FEVER 
92 
With the Philadelphia epidemic of 1793 the non- 
contagion theory, as we have seen, found entrance, 
and the years immediately following it were fruit- 
ful in contributions to the support of that view. 
In 1819, an epidemic of yellow fever with 
350 deaths occurred in Baltimore, and we then 
find one of the citizens, consulted on the 
subject, writing to the mayor that: 
The very fact that individuals every way competent 
to judge of the matter are now found opposing the 
doctrine of contagion is in itself evidence of such high 
authority that nothing short of so overwhelming a 
truth could have removed their prejudices and changed 
their opinions. ... Of the hundreds and thou- 
sands who declare and believe yellow fever to be a 
contagious disease very few have ever seen it; and 
those who have ventured to look upon it came to the 
sight with all the horrors which must be felt in the 
field of battle, expecting every moment a shaft of con- 
tagion to transfix their liver; of course they were badly 
qualified to make a cool, dispassionate inquiry, whilst 
our distinguished non-contagionists have had rational 
cause to triumph over all their terrors and think like 
men.6 
The opinions which are quoted in this and other 
letters show that while the doctrine of contagion 
was still accepted by the uneducated and preju- 
5 Series of Letters and Other Documents Relating to the Late 
Epidemic of Yellow Fever. Baltimore, Second Dispensary, 1820. diced, it was generally discredited among those 
carrying authority. 
In 1853 occurred the great epidemic in New 
Orleans, and two years later, in 1855, La Roche 
published his monumental work on the history of 
yellow fever, which up to the present time has been 
the great authority on the subject and will always 
remain the most complete source of information 
as to it in the past. La Roche reviews all the 
ground covered by investigation from the time 
when the cause and propagation of yellow fever 
were first under discussion, and sums up the evi- 
dence in favor of local origin and non-contagion. 
A few years later the pendulum had begun to 
incline to the other side. In 1867 some mild epi- 
demics at New Orleans, Galveston, and Indianola 
induced the United States Government to send a 
commission to inquire into their cause and charac- 
ter. The official report of this commission states 
that the direct importation of the disease is, in its 
opinion, fully established, the source, in that 
particular instance, being Vera Cruz, Mexico, and 
Havana. The question of contagion is not dis- 
cussed, being apparently accepted as a matter of 
course. 
In 1878 occurred the great epidemic of Mem- 
phis, which belongs to the experience of the present 
generation; and in the next year an eye-witness, 
HISTORY OF YELLOW FEVER 
93 94 
WALTER REED AND YELLOW FEVER 
Mr. J. M. Keating, published the vivid and inter- 
esting account of it already mentioned, which con- 
tains a discussion of all the knowledge acquired in 
regard to the disease up to that date. He gives a 
number of different theories which had been ad- 
vanced during the years immediately preceding 
his work, some of which are very ingenious, not to 
say fantastic. 
Dr. J. M. Clements, of Louisville, attributed the 
yellow fever poison to some order of fungus plants 
indigenous to the tropics, but as yet undiscovered. 
Dr. Ford of St. Louis, believed in a principle of 
fermentation, by which yellow fever remained 
existent in the form of dry particles of dust every- 
where that it had once prevailed; cold, however, 
repressed the activity of these germs, in so far as 
cold rendered persons less receptive and prevented 
their bodies from being in a condition to induce 
the fermentation of the dry dust. Professor P. 
Stille, of Mobile, advanced a novel theory which 
attributed the disease to the influence of the Gulf 
Stream. Dr. Labadie favoured the “explosive the- 
ory,” namely, the theory that the disease was caused 
by a peculiar subtle poison which exploded in the 
air like an inflammable substance, and that per- 
sons who inhaled or swallowed it, in greater or less 
quantity, fell under its influence after a certain 
time. Dr. Warren Stone, of New Orleans, in com- HISTORY OF YELLOW FEVER 
95 
pany with many others, upheld the wave, or cycle 
theory. 
The best authorities, however, seem to have in- 
clined to the opinion that the disease was due to a 
specific germ, a view expressed in a somewhat 
indefinite manner by the medical experts appointed 
by Congress in December, 1878, to investigate the 
disease. In their report they state that: 
It (yellow fever) is a specific disease produced by 
the introduction into the human organism of a specific 
poison, and though this specific poison has never been 
chemically or microscopically demonstrated, nor in any 
way made evident to the human senses, we deem it safe 
to assume that it is material and particular, is endowed 
with ordinary properties, and is subject to the ordinary 
laws of material substance. We also hold that it is or- 
ganic—is endowed with the vital properties of growth 
and reproduction; that it is not malarial, but the con- 
currence of local conditions favourable to the evolu- 
tion of it seems to be necessary to the evolution of 
yellow fever epidemics. 
It is about this time that fomites, a term which 
for the next twenty years did constant service, 
begins to come into prominence. Dr. L. S. Tracy, 
in a number of the Popular Science Monthly about 
1878, says: 
Yellow fever occupies a singular position between 
the contagious and non-contagious diseases. The poi- 96 
WALTER REED AND YELLOW FEVER 
son is not like that of smallpox, directly communica- 
ble from a sick person to a well one; but, although 
the emanations of the sick are connected with the 
spread of the disease, they seem to require an appro- 
priate nidus in which to germinate and develop. This 
nidus must be warm and moist, and there the germs, 
whatever they are, lie and grow, or in some way de- 
velop until they are able to migrate. The germs are 
portable and may be conveyed in baggage or merchan- 
dise (fomites) for hundreds or thousands of miles. If 
not so conveyed the spread of the disease is very slow. 
In 1822, in New York, when it gained a foothold in 
Rector Street, it appeared to travel about 40 feet a 
day until killed by the frost. It often leaves a house 
or a block intact, going round it and attacking those 
beyond with no assignable reason. A thin board parti- 
tion seems to have stopped it on Governor’s Island, in 
1856, and an instance is related where it attacked the 
sailors in all the berths of one side of a ship before 
crossing to the other. Such apparent vagaries, in the 
present state of our knowledge, are inexplicable. 
From all these data it would appear that knowl- 
edge of yellow fever had at this period advanced 
very little beyond its status in 1793, if, indeed, it 
had not in some respects receded; for, although 
the contagion theory in its original sense was aban- 
doned, that is to say, the direct transmission of the 
disease from one person to another, after the fash- 
ion of smallpox and other eruptive fevers, was no HISTORY OF YELLOW FEVER 
longer accepted, the theory of its conveyance by 
means of fomites was now fully established. 
For twenty years after this, knowledge of yellow 
fever remained stationary, and, in 1898, the offi- 
cers of the United States Marine Hospital Service 
issued a report in which they sum up the status of 
knowledge at that period as follows: 
97 
While yellow fever is a communicable disease, it is 
not contagious in the ordinary acceptation of the term, 
but is spread by the infection of places and articles of 
bedding, clothing, and furniture. This is a process re- 
quiring several days (extrinsic infection), and during 
this period the yellow fever patient is as harmless as 
one suffering from a surgical complaint. . . . More 
recently the idea has been advanced that probably the 
germ of yellow fever enters the general circulation 
through the respiratory organs in some obscure man- 
ner, and incubating in the blood directly poisons this 
life-giving stream. However this may be, the present 
opinion is that one has not to contend with an organism 
or germ which may be taken into the body with food 
or drink, but with an almost inexplicable poison so 
insidious in its approach and entrance that no trace is 
left behind. 
This is practically the last official statement un- 
der the old order and the last defence of the old- 
fashioned theories on yellow fever. CHAPTER V 
INSECTS AND DISEASE 
“ Imo muscas 
turn infirmorum turn cadaverum succo saturatas, mox in alias 
domos vicinas transmigrantes dum sordibus suis comestibilia in- 
ficiunt hominibus iis vescentibus contagium attulisse Mercuri- 
alis refert.”—Athanasius Kircher, Scrutinium Physico- 
Medicum, etc., 1659, p. 247. 
EXPERIMENTAL evidence proving that insects 
play an important part in the transmission of dis- 
ease is of recent date, but suggestions to that effect 
are found scattered through literature for a num- 
ber of years. Indeed, the early history of almost 
every infectious or contagious disease contains some 
reference to its supposed transmission by means of 
flies or other insects. Anthrax, cholera, typhoid 
fever, malaria, tuberculosis, leprosy, the plague, 
yellow fever, and many other less well-known dis- 
eases have been associated by early writers with 
insects as a mode of transmission. Anyone inter- 
ested in the subject will find it exhaustively treated 
in Nuttall’s monograph in the Johns Hopkins Hos- 
pital Reports for 1899.1 
1 “ On the role of insects, arachnids, and myriapods, as car- 
riers in the spread of bacterial and parasitic diseases of man and 
98 INSECTS AND DISEASE 
99 
The earliest of all allusions, so far as I can dis- 
cover, is found in a treatise called “De Regimine 
Pestilentico,” which appeared in 1498, and is 
attributed to Bishop Knud of Aarhus, Denmark. 
Athanasius Kircher, a learned priest and naturalist 
of the seventeenth century, went farther, perhaps, 
than anyone towards a clear understanding of the 
part played by insects as carriers of disease. In 
his interesting work, “Scrutinium Physico-Med- 
icum,” etc., published at Rome in 1659, he says: 
“Flies carry the plague,” and again, “There can 
be no doubt that flies feed on the internal secre- 
tions of the diseased and dying, then flying away, 
they deposit their excretions on the food in neigh- 
bouring dwellings, and persons who eat it are thus 
infected.” 
Ambroise Pare, in his description of the battle- 
field of St. Quentin in 1557, strikes the same note 
when he says:2 “We saw more than half a league 
round us the earth all covered with the dead; and 
hardly stopped there, because of the stench of the 
dead men and their horses; and so many blue and 
green flies rose up from them, bred of the moisture 
of their bodies and the heat of the sun, that when 
animals.” A critical and historical study, by G. H. F. Nuttall, 
M. D., Ph. D., Johns Hopkins Hosp. Rep., 1899, VIII., p. 1. 
a “Ambrose Pare and his Times,” by Stephen Paget, 1897. 100 
WALTER REED AND YELLOW FEVER 
they were up in the air they hid the sun. It was 
wonderful to hear them buzzing; and where they 
settled, there they infected the air, and brought the 
plague with them;” and he adds, quaintly: “Mon 
petit maistre, I wish you had been with me, to ex- 
perience the smells and make report thereof to 
them that were not there.” 
The first person to establish the fact that insects 
act as carriers of disease on a scientific basis was 
Dr., now Sir, Patrick Manson, in 1880. He demon- 
strated that the mosquito acts as the intermediary 
host of the Filaria sanguinis hominis, and is thus 
directly instrumental in the production of chyluria, 
elephantiasis, lymph-scrotum, etc. Manson’s de- 
scription of the part played by the mosquito under 
these circumstances is as follows:3 
Should a certain species of mosquito which has fed 
on the blood of a filaria-infested individual be exam- 
ined immediately after feeding, the blood contained in 
the stomach of the insect will be found to contain 
large numbers of living filarise. If a second mosquito 
be examined three or four hours after it has similarly 
fed, it will be found that the blood corpuscles in its 
distended abdomen have, in great measure, parted 
with the haemoglobin and that the blood plasma has 
become thickened, though not coagulated. If attention 
be directed to the filariae in the thickened blood, it will 
3 “ Tropical Diseases. A Manual of the Diseases of Warm 
Climates,” 1898. INSECTS AND DISEASE 
101 
be seen that many of them are actively engaged in en- 
deavouring to escape from their sheaths. The diffused 
haemoglobin has so thickened the blood plasma that it 
has become viscid and holds, as it were, the sheath. 
This viscosity of the blood seems to prompt the filariae 
to endeavour to escape from their sheaths. They be- 
come restless and excited, alternately retiring toward 
the tail, and then rushing forward against the head end 
of the sheath in frantic efforts to escape. After a time 
the majority succeed in effecting a breach, and in wrig- 
gling themselves free from the sheaths which had 
hitherto enclosed them. The filariae now swim free in 
the blood and the character of their movements once 
more undergoes a remarkable change. Hitherto, though 
active enough in wriggling about, the parasite did not 
materially change its position on the slide, but now, hav- 
ing become free, it moves about from place to place— 
locomotes—in fact. If we dissect a mosquito at a 
somewhat later period after feeding, it will be found 
that the stomach of the insect, though still full of 
blood, contains very few filariae, although their empty 
sheaths can be seen in abundance. If, however, we 
break up with needles the thorax of the insect and 
tease out the muscular tissue, we shall find that the 
filariae after discarding their sheaths have quitted the 
stomach and entered the thoracic muscles of the insect, 
among which they can now be seen, moving languidly. 
By a course of serial dissections of filariated mosqui- 
toes, we can ascertain that in the thorax of the insect 
the parasite enters upon a metamorphosis which takes 
from six to seven days to complete—a metamorphosis 
eventuating in the formation of a mouth, of an ali- 
mentary canal, and of a peculiar trilobed tail, as well 102 
WALTER REED AND YELLOW FEVER 
as in an enormous increase in the size and activity of 
the young parasite. 
About a week after the time of feeding, the mos- 
quito, in the ordinary course of nature, lays her eggs 
on the surface of stagnant water, and thereafter dies, 
falling into the water. It is conjectured that the filaria, 
now a formidable-looking and a very active animal, 
about one-sixteenth of an inch in length, escapes from 
the dead body of the insect, and thus, in drinking water, 
it obtains a chance of gaining access to the stomach of a 
human host. It is believed that it bores its way through 
the wall of the stomach, through the intervening tissues, 
and finally enters the lymphatic trunks. Arrived in one 
of these, it attains sexual maturity, fecundation is 
effected, and in due course of time new generations of 
embryo filariae are poured into the lymph. These, 
passing through the glands—if such intervene—by way 
of the thoracic duct and left sub-clavian vein, or by the 
lymphatics of the upper part of the body, appear in 
the circulation. Such is the life-history of filaria noc- 
turna; man is its definitive host, the mosquito its inter- 
mediate host. It is manifest that filarial periodicity is 
an adaptation of the habits of the mosquito parasite to 
that of the mosquito. 
These conclusions of Manson’s were subse- 
quently confirmed by the experiments of Dr. Ban- 
croft, in Australia, and of Dr. J. R. Lewis, in India, 
as well as those of Dr. Sonsino, in Egypt. 
In 1883 an admirable paper by Dr. A. F. A. 
King on “Insects and Disease—Mosquitoes and 
Malaria,” appeared in the Popular Science INSECTS AND DISEASE 
103 
Monthly for September of that year. The o oje:t 
of this paper, it is stated, is “to present a series of 
facts with regard to the so-called malarial poison, 
and to show how they may be explicable by the 
supposition that the mosquito is the real source of 
diseases, rather than the inhalation or cutaneous ab- 
sorption of a marsh vapour.” The facts presented 
by Dr. King are evidently the result of close obser- 
vation and able reasoning, and they show an exten- 
sive acquaintance with the literature of the subject. 
He had no experimental evidence to adduce in 
support of his theory, but he handles his hypotheti- 
cal material in a masterly manner, and offers a 
stable foundation for further investigation. He 
shows that the distribution, spread, and general 
characteristics of malaria all correspond with the 
life-history of the mosquito; also that mosquitoes 
are common wherever malaria is prevalent; and 
the conclusions he draws as to the possibility of 
protection from malaria by destruction of mos- 
quitoes are just what subsequent experiments have 
demonstrated to be true. His own words are: 
“While the data to be presented cannot be held 
to prove the theory, they may go so far as to initiate 
and encourage experiments and observations by 
which the truth or fallacy of the views now held 
may be demonstrated.” 
Further suggestions on the subject were made by 104 
WALTER REED AND YELLOW FEVER 
se/eral observers, the most important of them being 
Ktch, in 1884, and Laveran (independently), in 
the same year. It is, however, first to Dr. Manson 
and then to Major Ronald Ross of the British 
Army that we are indebted for a clear and definite 
knowledge of the part played by mosquitoes in the 
transmission of malaria. 
The fact that the red blood corpuscles of verte- 
brates may contain within them certain parasites 
had been known for some time. These parasites 
are divided into three groups, one of which is found 
in reptiles, another in oxen (being the cause of 
Texas fever), and a third, which has received the 
name of h&mamcebidcB, in man. This third group 
includes the parasite of malarial fever, which 
exists under three varieties, corresponding to the 
three forms of the disease, tertian, quartan, and 
remittent. All the species have a close resemblance 
to each other and all contain the typical melanin 
of malarial fever. The youngest parasites are 
found as minute amoebulce, living within the red 
blood corpuscle, and generally containing granules 
of this melanin derived from the haemoglobin of 
the corpuscle. When these amcebulce reach ma- 
turity they reproduce themselves in the ordinary 
asexual manner by means of spores, but they also, 
at one time in their life-history, undergo sexual 
reproduction through the formation of gameto- INSECTS AND DISEASE 
105 
cytes, and it is in the life-history of these gameto- 
cytes that the solution of the malarial problem lies. 
Long before Manson’s time they were observed to 
circulate in the blood of their hosts without, appar- 
ently, performing any function whatever. As soon, 
however, as they are withdrawn from the circula- 
tion they are seen to swell up and liberate them- 
selves from the enclosing capsule, after which some 
of them emit a number of long motile filaments. 
These filaments can then be seen to struggle wildly 
and sometimes to break from the parent cell, dart- 
ing away among the corpuscles and leaving the 
residue of the gametocyte, with its melanin, an 
inert mass. A hot controversy concerning the na- 
ture of this phenomenon had been in existence ever 
since it was discovered. Laveran, who first ob- 
served it, considered that the motile filaments are 
living organs and constitute a stage in the life-his- 
tory of the parasite. Bignami, and others of the 
Italian school, held to the old theory that it is a 
retrogressive phenomenon, a distinct disintegration 
of the parasite due to its death in vitro. At this 
point the controversy rested for a time, except that 
Laveran and his followers thought that the motile 
filaments were meant to lead a saprophytic exist- 
ence, but they did not offer any explanation as to 
how they could escape from the body in order to 
do so. 106 
WALTER REED AND YELLOW FEVER 
Manson accepted the view that the gametocytes 
are living organisms, and he considered that the 
fact of their appearance only after the abstraction 
of the blood must have some definite purpose in 
the life scheme of the parasite. What this purpose 
was he set himself to discover. 
He had already pushed the method of inductive 
reasoning to a brilliantly successful issue in his dis- 
covery of the development of the filaria nocturna 
within the body of the mosquito, and he pursued 
the same plan here. It is, of course, evident that 
the malarial parasite, like all others, must pass 
from host to host, since all known parasites are 
capable not only of entering the host, but of leaving 
him, either themselves or by their progeny. Here, 
in Manson’s opinion, lay the explanation of the 
fact that the motile filaments appear only after 
abstraction of the blood. The phenomenon, though 
usually observed in a preparation for the micro- 
scope, is really meant to occur within the stomach 
cavity of some suctorial insect, and constitutes the 
first step in the life-history of the parasite outside 
the vertebrate host. Supposing this to be the case, 
the connection between malarial fever and low- 
lying areas in warm countries suggested that the 
suctorial insect must be the mosquito. This view 
proved to be correct, although Manson’s first idea 
that the motile filaments are spores which es- INSECTS AND DISEASE 
107 
cape from the gametocytes in the stomach cavity 
of the mosquito and then occupy and infest the tis- 
sues of the insect was afterwards disproved by the 
experiments of W. G. MacCallum. 
MacCallum showed that the motile filaments 
were not spores, but microgametes, i. e., bodies of 
the nature of spermatozoa. As soon as the gameto- 
cytes, which are sexual cells, male and female, are 
ingested by a suctorial insect they begin their 
proper functions: the male gametocyte emits a var- 
iable number of microgametes (the motile fila- 
ments), which wander to and fro in search of the 
female gametocytes. The female contains a single 
macrogamete, or ovum, which is fertilised by one 
of the microgametes, and becomes a zygote. As 
soon as this discovery of MacCallum’s was an- 
nounced Manson saw the importance of its bearing 
on the mosquito theory, for if the motile filaments 
did not infect the insect, it was probably the func- 
tion of the zygote to do so, and this view proved 
correct, although it was some time before it was 
established. 
Towards the end of the year 1894 Manson com- 
municated his theory concerning the mosquito to 
Major Ronald Ross, who at once set himself to 
investigate it in the malarial districts in India, 
where he was then stationed. 108 
WALTER REED AND YELLOW FEVER 
The task so lightly commenced [Ross says] was, 
as a matter of fact, one of so arduous a nature that 
we must attribute its accomplishment largely to good 
fortune. The method adopted—the only method which 
could be adopted—was to feed gnats 4 (mosquitoes) 
of various species on persons whose blood contained 
the gametocytes, and then to examine the insects care- 
fully for the parasites which by hypothesis the gameto- 
cytes were expected to develop into. This required not 
only familiarity with the histology of gnats, but a 
laborious search throughout the whole tissues of each 
individual insect examined—a work of at least two or 
three hours for each individual, but the serial labour 
involved was the smallest part of the difficulty. Both 
the form and appearance of the object I was in search 
of, and the species of gnat in which I might expect to 
find it, were absolutely unknown quantities. We could 
make no attempt to predict the appearance which the 
parasite would assume in the gnat; while, owing to 
the general distribution of malarial fever in India, the 
species of insect engaged in the propagation of the 
disease could scarcely be determined by a comparison 
of the prevalence of different kinds of gnats at different 
spots with the prevalence of the fever at those spots. 
In short, I was obliged to rely simply on the careful 
examination of hundred of gnats, first of one species 
and then of another, all fed on patients suffering from 
malarial fever—in the hope of one day finding the clue 
I was in search of. Needless to say that nothing but 
the most convincing theory, such as Manson’s theory 
4 Major Ross uses the word “ gnat ” for mosquito through- 
out the article. MAJOR SIR RONALD ROSS 
Professor of tropical medicine, University of Liverpool INSECTS AND DISEASE 
was, would have supported or justified so difficult an 
enterprise.5 
109 
For nearly two years and a half the search was 
almost entirely negative, and Major Ross had be- 
gun to despair, when fortune unexpectedly placed 
the clue in his hands. In a bottleful of larvae, 
brought by a native from an unknown source, there 
were a number of newly hatched mosquitoes, be- 
longing to a species with spotted wings and boat- 
shaped eggs, which Major Ross had only recently 
observed and of which he did not know the name. 
Eight of these mosquitoes were fed on a patient 
whose blood contained ucrescentic gametocytes>, 
and then examined; six of them were dissected 
prematurely, but the seventh when examined cell 
by cell gave the following results: 
The tissues of the stomach (which was now empty 
owing to the meal of malarial blood taken by the 
insect four days previously being digested) were re- 
served to the last. On turning to this organ I was 
struck by observing, scattered on its outer surface, cer- 
tain oval or round cells of about two to three times the 
diameter of a red blood corpuscle—cells which I had 
never before seen in any of the hundreds of mosquitoes 
examined by me. My surprise was complete when I 
next detected within each of these cells a few granules 
of the characteristic coal-black melanin of malarial 
6 “ Malaria and Mosquitoes.” Nature, 1900, LXI, p. 522. 110 
fever—a substance quite unlike anything usually found 
in mosquitoes. Next day the last of the remaining 
spotted-winged insects was dissected. It contained pre- 
cisely similar cells, each of which possessed the same 
melanin; only the cells in the second mosquito were 
somewhat larger than those in the first. . . . 
These fortunate observations solved the malarial 
problem. As a matter of fact the cells were the 
zygotes of the parasite of remittent fever growing 
in the tissues of the gnat; and the gnat with spot- 
ted wings and boat-shaped eggs in which I found 
them belonged (as I subsequently ascertained) to the 
genus Anopheles. Of course it was impossible abso- 
lutely to prove at the time, on the strength of these 
two observations alone, that the cells found by me in 
the gnats were indeed derived from hamamcebidre 
sucked up by the insects in the blood of the patients on 
whom they had fed;—this proof was obtained by sub- 
sequent investigations of mine; but . . . the clue 
was obtained: it was necessary only to follow it up— 
an easy matter. 
WALTER REED AND YELLOW FEVER 
The further experiments by means of which 
Major Ross established beyond any possibility of 
doubt that the cells containing the melanin of 
malaria are really zygotes will be found in the 
interesting article upon which I have already made 
such liberal demands. I must confine myself to 
abstracting from it a brief account of the life- 
history of the zygotes. 
After fertilisation of the macrogamete has taken INSECTS AND DISEASE 
place in the stomach cavity of the gnat, the ferti- 
lised parasite, or zygote, has the power of working 
its way through the mass of blood contained in the 
stomach, of penetrating the wall of the organ, and 
of affixing itself on, or just under, its outer coat. 
Here it first appears about thirty-six hours after 
the insect is fed, as a “pigmented cell,” that is, a 
little oval body about the size of a large red cor- 
puscle, which contains the granules of melanin pos- 
sessed by the parent gametocyte from which the 
macrogamete originally came. In this position it 
shows no sign of movement, but begins to grow rap- 
idly, to acquire a thickened capsule, and to project 
from the outer wall of the stomach to which it is 
attached into the body cavity of the insect host. At 
the end of six days, if the temperature of the body 
be sufficiently high (about 8o° F.), the diameter of 
the zygote has increased to about eight times what 
it was at first. If the stomach of an infected insect 
be extracted at this stage it can be seen by a low 
power of the microscope to be studded with a num- 
ber of attached spheres, which have something the 
appearance of warts on a finger. These are the 
large zygotes, which have now reached maturity. 
Every zygote now, as it increases in size, divides 
into meres, each of which next becomes a blasto- 
phore, carrying a number of blasts attached to its 
surface. Finally, the blastophore vanishes, leav- 
111 112 
WALTER REED AND YELLOW FEVER 
ing the thick capsule of the zygote packed with 
thousands of blasts. The capsule then ruptures and 
allows the blasts to escape into the body fluids of 
the insect. 
The question of importance which now arises is: 
How do the blasts which are the spores, and there- 
fore the progeny of the zygotes, carry on the life- 
history of the parasite to a further stage? What is 
their function? It is evident that a knowledge of 
the mode of infection in malarial fever depends on 
the answer to this question. The zygotes, as has 
been .raid, become ripe and rupture, scattering the 
blasts into the body cavity of the insect. Then, by 
some process, apparently owing to the circulation 
of the fluids of the insect’s body, the blasts find their 
way into every part of the mosquito. 
Beyond this it was difficult to go, but at last, after 
examining the head and thorax of one insect, I 
found a large gland consisting of a central duct sur- 
rounded by large grape-like cells. My astonishment 
was great when I found that many of these cells 
were closely packed with the blasts, which are not in 
the least like any normal structure found in the mos- 
quito. Now I did not, at this time, know what this 
gland is. It was speedily found, however, to be a large 
racemose gland consisting of six lobes, three lying in 
each side of the insect’s neck. The ducts of the lobes 
finally unite in the common channel which runs along 
the under surface of the head and enters the middle INSECTS AND DISEASE 
113 
stylet, or lancet, of the insect’s proboscis. It was im- 
possible to avoid the obvious conclusion. Observation 
after observation showed that the blasts collect within 
the cells of this gland. It is the salivary or poison gland 
of the insect, similar to the salivary gland found in 
many insects, the function of which in the gnat had 
already been discovered—although I was not aware of 
the fact. That function is to secrete the fluid which is 
injected by the insect when it punctures the skin, 
fluid which causes the well-known irritation of the 
puncture, and which is probably meant either to pre- 
vent the contraction of the torn capillaries or the 
coagulation of the ingested blood. . . . The blasts 
must evidently pass down the ducts of the salivary 
gland into the wound made by the proboscis of the in- 
sect, and thus cause infection in a fresh vertebrate host. 
For the experiments by which Major Ross con- 
firmed the truth of this observation I must again 
refer the reader to the original article. Suffice it to 
say that he was able to establish conclusively this 
last link in the chain, and thus in his own words, to 
“complete the original and fundamental observa- 
tions on the life-history of the h&mamcebidce in 
mosquitoes.” 
In 1899 the expedition sent to Sierra Leone by 
the Liverpool Tropical School of Medicine, of 
which Major Ross was a member, confirmed the 
results of his experiments in every respect, and his 
work has also received support from other sources, 
especially through the labours of Italian scientists. 114 
WALTER REED AND YELLOW FEVER 
The discovery of the connection between the mos- 
quito (of the genus Anopheles) and malaria was 
received with great interest not only by the scien- 
tific world, but by the laity, and it has been put to 
a practical test in the protection of towns and 
districts from malaria through the systematic de- 
struction of the mosquito. 
While there is no doubt that the establishment of 
a connection between the mosquito and malaria led 
directly to the discovery of the transmission of 
yellow fever by the same means, yet the first sug- 
gestion of a relation between the mosquito and yel- 
low fever preceded the investigation of the origin 
of malaria by a good many years, and in order to 
follow it from its inception we must retrace our 
steps. 
So far as I can find, the first person to suggest 
that insects play a part as carriers of yellow fever 
was Dr. J. C. Nott of Mobile, in 1848, in a paper 
entitled “On the Cause of Yellow Fever.” Nott 
first disputes the then accepted doctrine that mala- 
ria was disseminated by means of a gaseous or 
molecular emanation from the earth’s surface, dis- 
missing it as wholly inadequate. He refers to the 
theory of transmission of disease through insects 
as no novelty, and mentions Kircher, as well as 
others who supported it in the past, after which 
he reviews a number of facts characteristic of ma- INSECTS AND DISEASE 
115 
laria that are readily explicable on the hypothe- 
sis of insect transmission, but on no other. 
Nott then describes the characteristics of yellow 
fever and shows that they, as well as many of the 
pecularities noted in connection with it, such as 
its appearing on one side of the ship without in- 
fecting the other, are comprehensible, like those 
of malaria, only on the theory of insect transmis- 
sion. “With these facts before us,” he says, “how 
much more easily may we account for the spread of 
yellow fever from a focus, by the insect theory than 
by the malarial hypothesis.” He also argues that 
the insect theory of yellow fever explains many of 
the facts which then presented difficulties to both 
contagionists and non-contagionists. “It is prob- 
able,” he says, “that yellow fever is carried by an 
insect or animalcule bred on the ground, and in 
what manner it makes its impression on the system 
is but surmise—but unless the animalcule is, like 
that of psora, bred in the system, we could no more 
expect it to be contagious than the bite of a serpent. 
We may, therefore, easily understand that it can 
at the same time be transported in the form of a 
germ and yet not be contagious.” 
To Dr. Carlos J. Finlay of Havana, president 
of the Superior Board of Health of Cuba, belongs 
the credit of first formulating a definite theory as 
to the transmission of yellow fever by means of the 116 
WALTER REED AND YELLOW FEVER 
mosquito, which he embodied in a paper read be- 
fore the Royal Academy of Havana on August n, 
1881, under the title, “The Mosquito Hypotheti- 
cally Considered as the Agent of Transmission of 
Yellow Fever.” 
Dr. Finlay's theory as stated in this paper is as 
follows: 
Let us now consider by what means the mosquito 
might transmit the yellow fever, if that disease hap- 
pens to be really transmissible through the inoculation 
of blood. The first and most natural idea would be 
that the transmission might be effected by the virulent 
blood which the mosquito has sucked, amounting to 
5 to 7 cubic millimetres, and which, if the insect hap- 
pens to die before completing its digestion, would be 
in excellent condition to retain during a long period its 
infecting properties. It might also be supposed that 
the same blood that the mosquito discharges as excre- 
ment, after having bitten a yellow fever patient, might 
be dissolved in drinking water, whereby the infection 
might be conveyed, if the latter were susceptible of 
penetrating by the mouth. But the experiments of 
Ffirth and other considerations arising from my per- 
sonal ideas, regarding the pathogenesis of yellow fever, 
forbid my taking into account either of these modes 
of propagation. ... A valuable collection of micro- 
photographs from preparations made by our corre- 
sponding member, Surgeon-General Sternberg, showed 
what to me appeared to be a most striking feature, 
namely, that the red blood corpuscles are discharged 
unbroken in the haemorrhages of yellow fever. This DR. CARLOS J. FINLAY 
who first promulgated the theory of the transmission of yellow fever 
by the mosquito INSECTS AND DISEASE 
117 
fact, taken into consideration with the circumstance 
that these haemorrhages are often unattended with 
any perceptible break in the blood vessels, while, on 
the other hand, they constitute a most essential clini- 
cal symptom of the disease, led me to infer that 
the principal lesion of yellow fever should be sought 
for in the vascular endothelium. The disease is trans- 
missible, it attacks the same person but once, and al- 
ways presents in its phenomena a regular order compar- 
able with that observed in the eruptive fevers, all of 
which circumstances suggested to my mind the hypothe- 
sis that yellow fever should be considered a sort of 
eruptive fever in which the seat of the eruption is the 
vascular endothelium. The first period would corre- 
spond to the initial fever, the remission to the eruptive 
period, and the third period to that of desquamation. 
If the latter phase is accomplished under favourable 
conditions, the patient will only show evidence of an 
exaggerated transudation of some of the liquid ele- 
ments of the blood through the new endothelium; if 
the conditions are unfavourable, a defective endothe- 
lium will have been produced, incapable of checking the 
escape of the figured elements of the blood; passive 
haemorrhages will occur and the patient may find him- 
self in imminent danger. Finally, assimilating the dis- 
ease to smallpox and to vaccination, it occurred to me 
that in order to inoculate yellow fever it would be 
necessary to pick out the inoculable material from 
within the blood vessels of a yellow fever patient and 
to carry it likewise into the interior of a blood vessel 
of the person who was to be inoculated. All of which 
conditions the mosquito satisfies most admirably 
through its bite, in a manner which it would be almost 118 
WALTER REED AND YELLOW FEVER 
impossible for us to imitate, with the comparatively 
coarse instruments which the most skilful makers could 
produce. 
Three conditions will, therefore, be necessary in 
order that yellow fever may be propagated: (i) The 
existence of a yellow fever patient into whose capil- 
laries the mosquito is able to drive its sting and to im- 
pregnate it with the virulent particles, at an appro- 
priate stage of the disease. (2) That the life of the 
mosquito may be spared after its bite upon the patient 
until it has a chance of biting the person in whom the 
disease is to be reproduced. (3) The coincidence that 
some of the persons whom the same mosquito happens 
to bite thereafter shall be susceptible of contracting 
the disease. 
Dr. Finlay continued to keep the subject in view, 
and he made a number of valuable contributions 
to it during the next ten or fifteen years, although 
as time advanced his ideas underwent some modifi- 
cation. His original theory, based on the studies 
made by Theobald Smith on Texas fever, was that 
the specific poison adhered to the mosquito’s pro- 
boscis and was thus mechanically transferred to the 
individual next bitten, but he changed his view 
“so as to include the important circumstance that 
the faculty of transmitting the yellow fever germ 
need not be limited to the parent insect, directly 
contaminated by stinging a yellow fever patient, 
(or perhaps by constant contact with or feeding from its discharges ) but may be likewise inherited 
by the next generation of mosquitoes issued from 
the contaminated parent.” He also claimed, as 
time went on, that the specific cause of the disease 
was the Micrococcus tetragenus. 
During the years following Finlay’s first con- 
tribution the aetiology of yellow fever was much 
before the minds of scientists. After the brilliant 
results in the causation of disease obtained by Koch 
and Pasteur, bacteriologists naturally looked upon 
yellow fever as a promising field for exploration. 
In 1885 Dr. Domingo Freire of Rio de Janeiro 
claimed to have found its specific cause in an or- 
ganism which he named “Cryptococcus zantho- 
genicus” He obtained such favourable results 
from inoculating human beings with attenuated 
cultures of this organism for the purpose of con- 
ferring immunity that he received a grant from 
the state to enable him to continue his investiga- 
tions. The work attracted considerable attention, 
and he continued to report favourable results until 
1887, when Dr. Sternberg of the United States 
Army was sent to Rio de Janeiro for the purpose of 
investigating into and reporting upon the merits 
of the inoculations. Dr. Sternberg’s report, how- 
ever, was not encouraging, for he found that the 
cultures made over to him by Freire for examina- 
tion did not agree with the published descriptions 
INSECTS AND DISEASE 
119 120 
of his organism; moreover, the organism itself 
proved to be the common Staphylococcus pyogenes 
albus. 
Dr. Carmona y Valle of Mexico, in 1885, pub- 
lished the description of an organism which he 
considered to be the cause of yellow fever, but his 
claim, as well as that of Dr. Finlay for Xhz Micro- 
coccus tetragenus, were disposed of by Dr. Stern- 
berg, who showed that both these bacteria were 
common organisms that could be obtained from 
various sources. In 1888 Sternberg began an ex- 
amination of the blood in yellow fever cases in 
Havana, investigating both blood from different 
organs and the contents of the intestinal tract, but 
without result, for, in his final report, he stated 
that the specific agent of the disease had not been 
demonstrated. 
The aetiology of yellow fever remained, there- 
fore, an undiscovered country. The knowledge of 
the disease acquired during a century of its more 
or less disastrous visitations amounted to very little. 
The old idea that the disease was spontaneously 
generated from organic decomposition under fa- 
vorable conditions had, of course, died a natural 
death with the development of bacteriology as a 
science, and it was universally regarded as an im- 
portation. The old theory of contagion, which had 
been the subject of such heated controversy early 
WALTER REED AND YELLOW FEVER in the nineteenth century, appeared at its close 
under a new form. Direct transmission from one 
person to another through the emanations from the 
body was no longer accredited, but its place was 
taken by the doctrine of fomites, which was sup- 
posed to afford a full explanation of its means of 
conveyance and to account satisfactorily for its 
transmission over great distances. The idea of 
studying the disease from the standpoint of its 
transportal had as yet occurred to no one but Dr. 
Finlay, and the scientific world in general was oc- 
cupied in a search for the specific agent which, it 
was assumed, must be discovered before the nature 
of the disease could be satisfactorily investigated. 
INSECTS AND DISEASE 
121 CHAPTER VI 
GEORGE MILLER STERNBERG1 
1838-1915 
THE first man in the United States to take the 
yellow fever problem in hand and to attempt to 
reduce the vagaries of our ancestors to a scientific 
basis was George Miller Sternberg, Surgeon Gen- 
eral of the United States Army, an indefatigable 
worker in the field of bacteriology and reorganizer 
of the United States Army Medical Corps. Stern- 
berg set a fierce pace for his colleagues in the army 
by his burning zeal as an investigator and cleared 
the way for Reed’s and Carroll’s work by proving 
that sundry alleged discoveries were based on 
false claims. 
On June 8, 1838, at Hartwick Seminary, Ot- 
sego County, New York, George Miller Sternberg1 
was born. He was the eldest son of the Reverend 
Levi Sternberg, a descendant of an old Lutheran 
family of the Palatinate, which had settled in 
“‘George Miller Sternberg.” A Biography. By his wife, 
Martha L. Sternberg. Chicago, American Medical Associa- 
tion, 1920. 
*From The Johns Hopkins Hospital Bulletin, XXXII, 359. 
122 GEORGE MILLER STERNBERG 
123 
Schoharie and the Mohawk Valley,—one Lambert 
Sternberg (we are told) having been the first to 
sow wheat in Schoharie County in 1713. His 
mother, Margaret Levering Miller was an excellent 
linguist. When he was ten years old, George 
went to live with his grandmother at Hartwick, 
where two years later his father became principal 
of the Theological Seminary. 
At thirteen he took a situation in a book store, 
which he held for about a year, spending most of 
his spare time in reading fiction. At sixteen the 
res angusta domi of the clergyman’s family drove 
George to teaching school at $10 a month and 
board, some twelve miles from home. Later he 
secured a school at $20 where he taught for two 
years, his salary being gradually increased to $100 
a quarter. With money saved he returned to his 
studies at Hartwick, where he at the same time 
taught mathematics, chemistry, and natural phil- 
osophy. Having made up his mind to study med- 
icine, he began his preparatory work under Dr. 
Hiram Lathrop of Cooperstown, N. Y. He at- 
tended his first course of lectures in 1859-60 in 
Buffalo, N. Y., and later on went to the College of 
Physicians and Surgeons in New York City, grad- 
uating in the spring of 1860. He at once settled 
in Elizabeth City, N. J., and practised there 
until the Civil War broke out. 124 
WALTER REED AND YELLOW FEVER 
In May, 1861, he entered the Federal Army as 
Assistant Surgeon and was sent to the Army of 
the Potomac under General George Sykes. At 
Bull Run he was captured but escaped later and 
after sundry vicissitudes made his way to Wash- 
ington. He was with Sykes until August, 1862, 
when he suffered from an attack of typhoid fever. 
After his recovery, for a short time he held the 
position of executive of the U. S. General Hos- 
pital at Portsmouth Grove, R. I., a hospital of 
2200 beds. 
In November, 1862, he joined General Banks 
and served as Assistant to the Medical Director 
of the Department of the Gulf and with the Board 
of Health until January, 1864. He then became 
Assistant Medical Director at Columbus and later 
was put in charge of a large general hospital in 
Cleveland, Ohio, whence he was transferred to 
Jefferson Barracks in July, 1865. During the war 
he was brevetted Captain and later Major. 
In October, 1865, he married Miss Louise Rus- 
sell of Cooperstown, N. Y. 
From Jefferson barracks, in April, 1866, he was 
ordered to Fort Harker. Here cholera broke out 
in a colored regiment; it spread to the civil popu- 
lation and Mrs. Sternberg died of the disease 
July 15, 1867. The sanitary conditions in and 
around were deplorable, as was noted in Stern- GEORGE MILLER STERNBERG 
125 
berg’s report.3 His habits of close observation 
are already apparent in this early memorandum: 
In it he says: “There have been an unusual num- 
ber of flies and mosquitoes. Houses have been 
infested with a large fly which differs from the 
common house fly.” 
After being on leave from August to December, 
1867, he was ordered to Fort Riley as Post Sur- 
geon and on court martial duty. He saw some 
Indian campaign service under Major M. H. Kidd 
in 1868. 
In September, 1868, he was assigned as chief 
medical ofRcer to Col. A. Tulley’s expedition 
against hostile Indians about the Arkansas River, 
with bases near Fort Dodge, Fort Hayes, Kansas, 
and Camp Supply, I. T. 
In December, 1868, he joined Major General 
Sheridan in the field depot and headquarters, on 
the North Canadian River at the junction of 
Beaver Creek, I. T., dealing with hostile Chey- 
ennes and other tribes. Here he collected crania 
and fossils, some of which were sent to Joseph 
Leidy of Philadelphia and others to the Army 
Medical Museum. 
After being relieved from Sheridan’s command 
March 2, 1869, he was sent for a short while to 
Fort Hayes, Kansas, but in the same year re- 
3Surg.-Gen. Office Circular No. 1, pp. 29-30. 126 
WALTER REED AND YELLOW FEVER 
turned to Fort Riley. Here he had the advant- 
ages of a good post with a fine hospital and a 
thriving town, Junction City, two miles away, 
where he could obtain photographic materials. 
Here he married Martha L. Pattison, daughter of 
Thomas Thurston Nelson Pattison of Scotch- 
Irish ancestry, a pioneer in Indiana from theEast- 
ern Shore of Maryland, and of Huguenot descent 
on the side of her mother, Elizabeth Grant Mauzy. 
At Fort Riley Sternberg indulged his penchant for 
invention and devised and perfected an anero- 
meter, which, however, the patent office decided 
had been anticipated by a German. He also in- 
vented a practical heat regulator by which an 
even temperature could be maintained in the 
wards. Some years later he received $5000 for 
this device, which in principle is still in use. 
In June, 1870, Dr. and Mrs. Sternberg arrived 
at Governor’s Island, where in September an epi- 
demic of yellow fever broke out. During this 
trying period he rendered faithful service and be- 
gan his epochal studies of this disease. 
After a short service at Fort Hamilton and Fort 
Warren in July, 1872, he was sent to New Orleans 
where yellow fever was then prevalent. 
In September, 1872, he was assigned for duty 
to Fort Barrancas, nine miles from Pensacola, 
where he stayed for three years. Here, as every- GEORGE MILLER STERNBERG 
127 
where they went, Dr. and Mrs. Sternberg were 
interested in the botany of their immediate sur- 
roundings, and spent much of their spare time 
studying and collecting plants. 
In the summer of 1873 yellow fever broke out 
at Barrancas and as the only effectual (and in 
view of present knowledge the most sensible) rem- 
edy then known was to move from the infected 
area to fresh ground, the troops were at once 
transferred to a camp near old Fort Pickens 
across the bay, where they remained until the 
autumn frost. Again in the summer of 1874 an- 
other invasion claimed numerous victims. These 
epidemics were made the subject of a thorough, 
intensive study and the conclusion reached that 
the infection was brought by ship. As a result 
of these studies Sternberg became our leading 
authority on yellow fever. 
In his spare time he made a study of various 
shell heaps and mounds in this region and a 
fine collection of pottery was excavated and sent 
to a state museum. On this Sternberg made a 
report before the American Association for the 
Advancement of Science at Salem, Massachu- 
setts, in 1879. 
Another epidemic of yellow fever occurred in 
June, 1875, brought by the steamship Von Moltke 
from Havana, in spite of a strict quarantine. At 128 
WATLER REED AND YELLOW FEVER 
last, Sternberg himself was stricken, but recov- 
ered after a severe illness. This was followed by 
a rest of six months in Europe (1875-76), and 
promotion to the rank of major, to which he had 
been entitled since February, 1869. 
In May, 1876, he reported at Headquarters, 
Portland, Oregon, where he utilized an oppor- 
tunity to become proficient in French. 
In 1877 he went through the Lapwai Campaign; 
he was present at the battle of the Clearwater, 
and underwent many hardships. 
From 1878 to 1885 he was busy experimenting 
with commercial disinfectants, having only an im- 
provised equipment at his disposal, and pursuing 
studies in bacteriology, laying sound foundations 
for the future in these fields in this country. 
In 1879 he reported again at Washington, and 
was detailed for duty with the Havana Yellow 
Fever Commission of the National Board of 
Health. He was now able to spend time in in- 
tensive microscopic work, with high power lenses, 
and in making micro-photographs. 
In Cuba he became intimate with Carlos Finlay, 
who was fully convinced that yellow fever was 
propagated by the stegomyia mosquito. Stern- 
berg’s official instructions were to study sanitary 
conditions, to increase knowledge of pathology, 
and to investigate endemicity, with some hesitat- GEORGE MILLER STERNBERG 
129 
ing suggestions as to any elucidation of the funda- 
mental problem of the true nature of the disease. 
It being generally thought that the organism must 
be in the blood, Sternberg devoted his time to 
making micro-photographs and analyzing the re- 
cords of all patients. He made as many as 105 
from 41 clear cases, rigging up a heliostat to il- 
luminate a dark room. 
In 1880 he returned to Georgetown, D. C. 
Later in 1880 he went to New Orleans to investi- 
gate the micro-organisms of the air in their possible 
connection with malarial fever. A year before 
this, Klebs with Tommasi-Crudeli had announced 
the discovery of a bacillus as the causative factor 
in malaria; this Sternberg proved to be incorrect. 
In 1880 while working on the malaria problem 
in New Orleans he discovered, by inoculating a 
rabbit with his own sputum, the micrococcus 
which he named Micrococcus pasteuri and which 
was subsequently demonstrated by Sternberg and 
others to be the infectious agent in croupous pneu- 
monia. Mrs. Sternberg in her biography is in 
error in identifying this micro-organism with, the 
Friedlander bacillus. Sternberg was anticipated 
in publication by Pasteur. 
In August, 1881, he was assigned to Fort Mason; 
here at his own expense he established a laboratory 
for biological research, and demonstrated the tu- 130 
WALTER REED AND YELLOW FEVER 
bercle bacillus discovered by Koch in 1882. His 
original scientific work was done after the com- 
pletion of his round of post duties each day. 
On November 27, 1883, he wrote Surgeon Gen- 
eral Robert Murray summarizing his post work, 
and begging for better surroundings and facilities 
for scientific investigation. As a result in April, 
1884, he was transferred to the Department of the 
East, where he was appointed Attending Surgeon 
and Examiner of Recruits at Baltimore, and found 
laboratory facilities in Newell Martin’s laboratory 
of The Johns Hopkins University. Culture bouil- 
lon and media were made for him by Mrs. Stern- 
berg, who maintained throughout an active and 
intelligent interest in all his studies. 
In 1885 he went as Delegate for the United 
States to the International Sanitary Conference in 
Rome, where he was made honorary member of 
the Royal Academy of Medicine. 
Returning in March, 1885, he demonstrated, at 
The Johns Hopkins University, the living motile 
plasmodium of malaria discovered in 1880 by 
Laveran. 
In 1886 Dr. and Mrs. Sternberg went to Berlin, 
where they met Koch; on their return he received 
the Bausch and Lomb prize for his work on the 
practical value of disinfectants, begun in Walla 
Walla in 1878 and completed in the laboratory of GEORGE MILLER STERNBERG 
131 
The Johns Hopkins University, the culmination 
of a series of studies undertaken as chairman of a 
committee of the American Public Health Asso- 
ciation. 
In May, 1887, he and Mrs. Sternberg went to 
South America to investigate certain alleged dis- 
coveries relating to yellow fever, that of Dr. Freire 
of Rio de Janeiro and that of Dr. Carmona de 
Valle of Mexico City. The claims of both these 
workers were shown by Sternberg to have no sci- 
entific data to justify them. 
On his return from this mission he again located 
in Baltimore and resumed work with William H. 
Welch and Wm. T. Councilman in the pathological 
laboratory of The Johns Hopkins Hospital. 
In April, 1888, he asked to be sent to Havana 
to continue his yellow fever studies. In the course 
of these he was able to prove conclusively that 
Gibier’s organism was not the cause of yellow fever. 
The summer of 1889 saw him once more at work 
in Havana; this time his wide bacteriologic knowl- 
edge enabled him to show that Carlos Finlay’s or- 
ganism, Micrococcus tetragenus jebris flavae was 
merely a common non-pathogenic tetrad tropic 
skin coccus, which often accidentally contami- 
nated cultures. About this time he originated the 
alkaline treatment of yellow fever. 132 
WALTER REED AND YELLOW FEVER 
In 1890 he published his researches on the “Eti- 
ology and Prevention of Yellow Fever.” 
In October, 1890, he was again assigned to San 
Francisco, where he pursued his scientific studies, 
worked on his Manual of Bacteriology, and lec- 
tured on preventive medicine and sanitary condi- 
tions. 
In February, 1892, he returned to New York as 
Surgeon and Examiner of Recruits; it was at this 
time that Mrs. Sternberg isolated a new protozoon 
in Brooklyn which was named after Dr. Hoagland. 
In September, 1892, during the Hamburg chol- 
era epidemic, Dr. Sternberg was called as an au- 
thority into active and most successful coopera- 
tion in the quarantine service. His “Disinfection 
at Quarantine Stations, Especially against Chol- 
era,”4 and other papers written at this time were 
full of practical interest. 
On May 30, 1893, he was made Surgeon General 
of the United States Army. This high position 
of responsibility increased his powers for service, 
and one act taken promptly and with far-reaching 
consequences was to put Walter Reed in the path- 
ological laboratory of The Johns Hopkins Hospital 
for advanced study, preparing the way for his 
great work. At General Sternberg’s recommenda- 
tion the Army Medical School in Washington, D. 
4New York Medical Journal, 1893, XVII, 57. GEORGE MILLER STERNBERG GEORGE MILLER STERNBERG 
133 
C., was established June 24, 1893, designed to in- 
struct approved candidates for the Medical Corps 
of the army in their duties as medical officers. 
The faculty consisted of: 1. A president of the 
Faculty, lecturing on duties in war and peace; 2. 
A professor of Military Surgery; 3. A professor of 
Military Hygiene (Sanitary); 4. A professor of 
Clinical and Sanitary Microscopy. 
In 1893 he was appointed physician to President 
Cleveland when in Washington, vice his regular 
physician, Dr. Joseph D. Bryant of New York. 
As Surgeon General he made all possible efforts 
to advance the interests and standing of the Medi- 
cal Corps, and yet, with a strange lack of fore- 
sight, our House of Representatives in point of 
fact slaughtered his Medical Corps by reducing its 
numerical strength from 125 to 110, without mak- 
ing any provision for employing acting Assistant 
Surgeons. The sanitary atrocities of the trqop 
stations in the Spanish American War were due to 
the utter lack of preparation for war of “a proud 
country” [sic], and yet all the data needed for per- 
fect sanitary administration were in the hands of 
General Sternberg. Is it to be wondered at that 
he was unable to render them effective among the 
undisciplined troops served often by poor and ill- 
trained medical men, one of the best known of 134 
WALTER REED AND YELLOW FEVER 
whom scorned the value of carbolic acid and all 
antiseptics and the dangers of contamination? 
In 1900, it was due to Sternberg that a board 
of medical officers, including Dr. Rich and Pro- 
fessor Strong, was appointed to go to the Philip- 
pines to study tropical diseases, beriberi, the dys- 
enteries, and diseases caused by intestinal para- 
sites and malarial fevers. 
In 1900 the crowning event of Sternberg’s ad- 
ministration was the discovery of the mode of 
spread of yellow fever by Walter Reed and his 
party, established near Havana, Cuba, thus prov- 
ing conclusively Carlos Finlay’s hypothesis, and 
setting on foot the efficient methods for the exterm- 
ination of the disease, so brilliantly successful in 
the hands of that practical genius, Major Gorgas 
(later to be, in his turn, Surgeon General). These 
two pieces of work constitute the greatest achieve- 
ment of American medicine, an accomplishment, 
as a piece of applied scientific work, equal to any- 
thing the world has yet seen. Like Moses, who 
viewed the promised land from Mount Nebo, so 
Sternberg had worked and sweated over this great 
subject for the best part of his busy life; it was 
the one great prize he coveted, and he had held it 
as it were in his hand when he carefully discussed 
and rejected Carlos Finlay’s theory and inocula- 
tion experiments in 1891; but to enter the land of GEORGE MILLER STERNBERG 
135 
promise was given not to him but to a subordinate 
working as head of the commission which he 
appointed. 
So discouraged had Sternberg become with his 
negative results that when Reed discussed with 
him future work on the mosquito theory, he de- 
clared, “You may do it if you want to, but there 
is nothing in it.” Overbalancing the vast work 
he had accomplished in other lines lay his lack of 
success in achieving his great desire in this field, 
the tragedy of his life, pathetic to his friends in 
view of the great importance of Reed’s discovery 
at Havana that immediately overshadowed all 
efforts that had preceded it. 
In 1901 a tour of inspection of four months was 
made in the Philippine Islands, by order of Presi- 
dent McKinley, to determine health conditions 
for the army. 
On December 8, 1900, he addressed the Philo- 
sophical Society of Washington, under the au- 
spices of the Academy of Sciences, on malaria.5 
From May, 1893, to June 8, 1902, when he re- 
tired, his years were full of intensive work. 
In 1897 he became actively interested with Dr. 
Geo. M. Kober of Washington, in providing san- 
itary dwellings for people in moderate circum- 
stances, the design being to replace the wretched 
BSmithsonian Report for 1900. 136 
WALTER REED AND YELLOW FEVER 
alley homes. This was accomplished by first pro- 
viding improved homes for the better class of wage 
earners, whose vacated houses were then occupied 
by those lower down. In this way, standard sani- 
tary homes with individuality were secured at 
reasonable rentals, with a dividend profit of five 
per cent. 
General Sternberg also was interested in passing 
a law compelling the proper repair or removal of 
buildings unfit for dwellings. These activities 
stimulated extensive private enterprises in the 
erection of two-story sanitary flats. 
He was a charter member of the National Asso- 
ciation for the Study of Tuberculosis, and as 
President of the Society for the Prevention of 
Tuberculosis in the District of Columbia, from 
1908 to 1915, he hammered continuously at the 
disgraceful conditions tolerated in the national 
capital by indifferent incompetent congressmen. 
An opportunity of making an intensive practical 
application of his life-long work and studies in the 
field, was afforded him in his appointment by 
President Theodore Roosevelt with a commission 
of 14 on a “President’s Homes Commission.” 
The result was a pioneer report in industrial 
hygiene. 
At the International Congress on Tuberculosis, 
in Washington 1908, at the dinner to Robert GEORGE MILLER STERNBERG 
137 
Koch, he was dubbed affectionately by Koch, the 
“father of American bacteriology.” 
In part as a result of his tuberculosis work the 
death rate in Washington from this disease was 
reduced from 492 per hundred thousand in 1900, 
among the colored people, to 312 in 1917, and 
among the white from 188 to 93. 
On November 3, 1915, at the age of 77, General 
Sternberg peacefully passed away. In Arlington 
Cemetery there lies at rest the greatest of our 
Surgeon Generals, “America’s pioneer bacteriol- 
ogist” (Welch), a productive scientific investigator 
of disease, an accomplished sanitary expert, and an 
administrator who greatly improved the organi- 
zation and opportunities of the medical corps of 
the United States Army. CHAPTER VII 
WORK IN YELLOW FEVER 
1897-1901 
Dream not helm nor harness 
The sign of Valor true; 
Peace hath higher test of manhood 
Than battle ever knew. 
—Whittier. The Hero. 
THE British Medical Journal for July 3, 1897, 
contained the announcement that, during the pre- 
ceding year, the specific cause of yellow fever had 
been discovered by the Italian scientist, Dr. Giu- 
seppe Sanarelli, in the form of a bacillus named 
by him Bacillus icteroides. This statement was re- 
ceived with great interest by the scientific world, 
and by no one more gladly than by Reed, who 
expressed the hope that Sanarelli’s work would 
soon be confirmed by other observers. Shortly af- 
terwards Reed himself, together with Dr. James 
Carroll, U. S. A., was appointed by Surgeon-Gen- 
eral Sternberg to investigate Sanarelli’s bacillus 
and compare it with the Bacillus xy which Stern- 
berg had obtained from the bodies of yellow fever 
patients during the summer of 18 8 7. The investi- 
138 gation was begun with the desire on the part of the 
workers, as they themselves state, of confirming 
Sanarelli’s observations. Their work, however, as 
it proceeded, revealed such strong structural re- 
semblances between the Bacillus icteroides and the 
bacillus of hog-cholera that it was determined to 
institute a different line of research, which soon 
convinced them that Sanarelli’s bacillus was really 
a variety of the hog-cholera bacillus, and that if it 
was present in yellow fever at all, it must be re- 
garded as a secondary invader. 
The results of their investigation were formally 
expressed by Reed and Carroll in a “preliminary 
note,” published in the Medical News for April 29, 
1899;1 Sanarelli challenged it four months later 
in the same journal,2 denying the truth of the state- 
ments made by Reed and Carroll, explaining their 
failure to confirm his results by their employment 
of faulty methods, and even accusing them of lend- 
ing themselves to the support of a personal con- 
troversy between himself and General Sternberg. 
Reed and Carroll replied to this attack without 
loss of time, showing beyond any possibility of 
doubt that Sanarelli’s hostile criticisms of their 
WORK IN YELLOW FEVER 
139 
1 “ Bacillus icteroides and Bacillus cholerae suis—A Prelim- 
inary Note.” Med. News, April 29, 1899. 
2 “ Some Observations and Controversial Remarks on the 
Specific Cause of Yellow Fever.” Med. News, Aug. 12, 1899. 140 
WALTER REED AND YELLOW FEVER 
work were without foundation, and meeting his 
personal innuendoes with gentlemanly forbear- 
ance.3 In December, 1900, they were able to pub- 
lish the complete report of their investigations, 
which supplied overwhelming experimental proof 
that the Bacillus icteroides belongs to the hog- 
cholera group.4 
Before the appearance of this complete report, 
however, additional evidence in support of Reed 
and Carroll’s results had been supplied through 
the investigations of Dr. Aristides Agramonte, 
Assistant Surgeon, U. S. A., who, during 1898 had 
studied tht Bacillus icteroides and tht Bacillus x 
in Dr. Reed’s laboratory, and was then sent to 
Cuba, where he succeeded in isolating Sanarelli’s 
bacillus from about thirty-three per cent, of the 
yellow fever cases examined at Santiago, and also 
obtained it from cases that were not yellow fever. 
Early in the year 1900, yellow fever appeared 
among the American troops stationed at Havana, 
and became quite prevalent during the summer. 
In order to take advantage of this opportunity for 
investigating the aetiology of the disease, a com- 
3 “ The Specific Cause of Yellow Fever.” A Reply to Dr. 
G. Sanarelli. Med. News, Sept. 9, 1899. 
4 “ A Comparative Study of the Biological Characters and 
Pathogenesis of Bacillus x (Sternberg), Bacillus icteroides 
(Sanarelli), and the Hog-Cholera Bacillus (Salmon and 
Smith).” Jour. Exper. Med., 1900, vol. Y, p. 215. WORK IN YELLOW FEVER 
141 
mission of medical officers from the United States 
was appointed and ordered to meet at Havana for 
the purpose. The officers composing the board 
were: Dr. Walter Reed, Dr. James Carroll, and 
Dr. J esse W. Lazear, all non-immunes, and Dr. 
Aristides Agramonte, a Cuban immune. Dr. Agra- 
monte and Dr. Lazear were already in Cuba and 
Dr. Reed and Dr. Carroll joined them at Havana 
in June, 1900. 
The work of the Commission was divided among 
its members as follows: Dr. Reed, the chairman, 
was at the head of affairs; Dr. Carroll had charge 
of the bacteriological investigations; Dr. Lazear 
had the mosquito work, for he was, at that time, the 
only member of the board acquainted with the 
mosquito; and Dr. Agramonte was in charge of the 
autopsies and of the pathological work. 
The first efforts of the Commission were directed 
to a conclusive experiment on the true nature of 
the Bacillus icteroides. For this purpose cultures 
drawn during life from the blood of eighteen 
patients were carefully studied, but as the, Bacillus 
icteroides could not be obtained from any of them, 
nor from cultures made at eleven autopsies on 
yellow fever patients, it was considered established 
beyond all doubt that it might be excluded from 
further consideration. 
Two separate lines of work now presented them- 142 
WALTER REED AND YELLOW FEVER 
selves: one, the study of the bacterial flora of the 
intestine and anerobic cultures from the blood and 
various organs of yellow fever patients; the other, 
the transmission of the disease according to the 
theory of insect conveyance advanced by Dr. Fin- 
lay, in 1881. 
It happened that just at this time an opportunity 
was afforded Dr. Reed to investigate an epidemic 
of yellow fever prevailing at Pinar del Rio Bar- 
racks, about one hundred and two miles from Ha- 
vana. In company with Dr. Agramonte, Dr. Reed 
made a visit there on July 31, 1900, and performed 
an autopsy on a yellow fever patient that after- 
noon. . . . His own description of the visit and the 
conclusions he drew from it are as follows:6 
The lesions found were those of yellow fever. In- 
quiry showed that under the diagnosis of “remittent 
malarial fever,” or “pernicious malarial fever,” the 
disease had been prevailing for at least thirty-seven 
days prior to our arrival, July 31, and that about thirty- 
five cases had been under treatment in the post hospital, 
of which number eleven had died. As the true nature of 
the disease had not been suspected, no precautionary 
measures had been taken as regards the disinfection 
of bedding and clothing used by the patients, except 
that in case of death, the sheets and pillow slips were 
put into bichloride solution and the mattress and pillow 
6 “ The Propagation of Yellow Fever; Observations based 
on recent Researches.” Med. Rec., Aug. io, 1901. WORK IN YELLOW FEVER 
143 
exposed to sunlight. An order required that the excreta 
of all patients under treatment in this hospital should 
be carefully disinfected, and this was probably carried 
out fairly well. . . . Notwithstanding the omis- 
sion to disinfect the bulk of the contaminated articles 
of bedding and clothing, the disease had not been con- 
tracted by the nurses, nor by the three men who 
washed all of these articles. A little inquiry showed 
that contaminated clothing was in all of the eight bar- 
rack-rooms without apparent detriment to the occu- 
pants. Further investigation showed that a death from 
yellow fever had occurred in this garrison as early as 
May 16, 1900, and that the source of infection for this 
case, as well as for the present outbreak, was in the 
immediately adjacent town of Pinar del Rio, to which 
the soldiers had free access. 
An interesting observation was the sudden attack of 
yellow fever experienced on July 12, 1900, by a gen- 
eral prisoner who had been confined in a cell in the 
guard house since June 6, 1900. His death occurred 
at the post hospital on July 18, 1900. This cell 
was occupied, at the time, by eight other prisoners, 
none of whom contracted the disease, although one of 
them continued to occupy the bunk vacated by the sick 
man. As these nine prisoners had been kept under 
strict military guard, it was impossible that the in- 
dividual attacked could have acquired his infection in 
the town of Pinar del Rio. He was, as far as could 
be ascertained, exposed to no source of infection to 
which his companions had not been equally exposed, 
and yet he alone acquired the disease. It was conjec- 
tured at the time thatf perhaps, some insect capable of 144 
WALTER REED AND YELLOW FEVER 
conveying the infection, such as the mosquito, had em 
tered through the cell window, bitten this particular 
prisoner, and then passed out again. This, however, 
zvas only a supposition. 
Two instances of undoubted exposure to fomites 
involving four individuals came under my observation 
during this inspection. In the one case a box of cloth- 
ing belonging to a soldier who had died of yellow 
fever on July 3, and which had been packed by an 
enlisted man on July 4 and placed in the company 
store-room, was unpacked for the purpose of making 
an inventory of the articles, and carefully repacked on 
July 18 by two non-immune soldiers, who did not con- 
tract the disease by this exposure. In the other case, 
the very bed vacated on July 18 by the Commissary 
Sergeant, who was taken sick on July 17, and died on 
July 21, was occupied by a non-immune soldier on the 
night of the 19th and 20th of July. Although this 
individual was badly frightened when the true char- 
acter of the sergeant’s attack was announced, the com- 
bination of fright and exposure to fomites was not 
sufficient to produce an attack of yellow fever. 
It happened that Dr. Reed had been much im- 
pressed by the valuable observations made at Or- 
wood and Taylor, Mississippi, during the year 
1898 by Surgeon Henry R. Carter of the U. S. Ma- 
rine Hospital Service, on the interval between in- 
fecting and secondary cases of yellow fever.6 The 
circumstances under which Carter worked were 
favourable for recording the time between the 
6 New Orleans Med. Jour., May, 1900. WORK IN YELLOW FEVER 
arrival of infecting cases, in isolated farmhouses, 
and the occurrence of secondary cases in these 
houses. According to him, “The period from the 
first (infecting) case to the first group of cases in- 
fected at these houses is generally from two to three 
weeks. The houses having become infected, sus- 
ceptible individuals who visited them for a few 
hours fell sick with the disease in the usual period 
of incubation—one to seven days.” Observations 
made by the Commission confirmed Carter’s con- 
clusions,7 and pointed, in Dr. Reed’s opinion, to the 
presence of an intermediate host, such as the mos- 
quito, which having taken the parasite into its 
stomach soon after the entrance of the patient into 
a non-infected house, was able after a certain 
interval to reconvey the infecting agent to other 
individuals. This interval appeared to be from 
nine to sixteen days (allowing for the period of 
incubation). 
All these data induced Dr. Reed to form the fol- 
lowing opinion:8 
145 
At this stage of our investigation, it seemed to me, 
and I so expressed the opinion to my colleagues, that 
the time had arrived when the plan of our work should 
be radically changed and that the search for the spe- 
cific agent of yellow fever, while not abandoned, should 
7 Carter’s splendid work is admirably summarized by 
General Gorgas in his “ Sanitation in Panama,” D. Appleton 
and Company, 1915. 
8 “The Propagation of Yellow Fever: Observations Based 
on Recent Researches.” Loc. cit. 146 
WALTER REED AND YELLOW FEVER 
be given secondary consideration, until we had first 
definitely learned something about the way or ways in 
which the disease was propagated from the sick to the 
well. I felt well-nigh convinced that we could obtain 
no light whatever upon the task that had been set be- 
fore us, unless we substituted this line of work for the 
one we had been pursuing, and that in view of the 
splendid work of Ross, Bignami, and others with re- 
gard to the propagation of malarial fever, together 
with the well-known thermal influences intimately con- 
nected not only with the epidemiology of the disease 
in the United States, but also with its endemiology on 
the Island of Cuba, it was of the highest importance 
that the agency of an intermediate host, such as the 
mosquito, should either be proven or disproven. 
“Notwithstanding the fact,” Dr. Reed remarks 
elsewhere, “that Finlay had no results to show in 
support of his theory, and that the latter had been 
rejected by other investigators, the argument in 
favour of an intermediate host seemed so strong, 
as I have already said, that investigation along this 
line was determined upon.” 
The mosquito selected was that used by Finlay, 
and spoken of by him as Culex fasciatus. Culex, 
however, is an old genus, named by Linnaeus in 
1735, which for a long time contained all the mos- 
quitoes. But other genera have been erected, and 
now the mosquitoes are included in a family known 
as the Culicidae, which comprises several genera and very many species. Culex, however, is the 
typical genus and includes the commoner, most 
abundant, and most widespread kinds of mosqui- 
toes. The particular species of mosquito used by 
Dr. Finlay in his original experiments is the one 
referred to in this country as Culex fasciatus, 
Fabricius; but Mr. F. V. Theobald, who has been 
investigating the mosquitoes of the world, on behalf 
of the British Museum, and has made a morpho- 
logical study of these insects, has decided that Culex 
fasciatus is not to be contained in the genus Culex, 
but on account of scale structure and other struc- 
tural peculiarities it must be placed in another 
genus, which has received the name Stegomyia. 
It is the female of one particular species, Stegomyia 
fasciata, which Dr. Reed made use of in his experi- 
ments upon yellow fever, and which, as we shall 
presently see, he demonstrated to be the interme- 
diate host for the parasite of the disease. 
The malarial mosquito (see Chapter V., p. 114) 
belongs to another genus, namely, Anopheles, 
founded by Meigen in 1818. There are three spe- 
cies of anopheles in the United States: A.maculi- 
pennis Meigen, A. punctipennis Say, and A. 
crucians Wied. It is not known whether the insect 
was introduced from Europe to America or the re- 
verse. It is quite within the bounds of possibility 
that malaria was originally an European disease, 
WORK IN YELLOW FEVER 
147 148 
and that not only was the disease itself carried from 
there on sailing vessels, but the mosquito which 
propagated it as well—at any rate to America. 
The following description of Stegomyia fasciata, 
its appearance, habitat, and breeding places is 
abridged from Dr. Reed’s account of it: 
WALTER REED AND YELLOW FEVER 
This mosquito is rather a striking looking insect. It 
has conspicuous markings of a broad, semilunar, sil- 
very stripe on the lateral surface of the thorax, and 
white stripes at the bases of the tarsal joints. Four 
stripes of silvery scales seen on the posterior surface of 
the thorax distinguish this species from all others, ex- 
cept Stegomyia signifer. It has a widespread distribu- 
tion, being found in all the principal cities of Cuba, as 
well as in almost all the southern countries of Europe, 
and the Southern States of this country. Its breeding 
places are in rainwater barrels or sagging gutters con- 
taining water, and indeed in all places where stagnant 
water has collected. The female lays her eggs during 
the night, extruding them on the surface of the water 
in pairs, in groups of three or more, or singly. The 
number of eggs deposited varies from twenty to about 
seventy-five. They are jet black in colour and, to the 
naked eye, cylindrical in shape. Under a low power of 
the microscope the surface of the egg is seen to be 
marked by tolerably regular six-sided plates, each of 
which has a little round elevation in the centre, that 
gives the surface a roughened appearance. The eggs 
are singularly resistant to external influences. Dried 
eggs can be easily hatched at the end of three months WORK IN YELLOW FEVER 
and freezing does not destroy their fertility. The eggs 
are laid after a meal of blood after an interval varying 
from two to thirty days—as a rule within seven days— 
and under favourable conditions of warmth (/. e., a 
summer temperature) they begin to hatch on the third 
day. The larval stage occupies seven to eight days and 
the pupal stage about two days. The impregnated 
female bites at a temperature of 62° F. and above, but 
at a lower temperature even very hungry females will 
not bite; the unimpregnated female does not appear 
to bite at all. UnlikeCulexpungens, this mosquito bites 
by day as well as by night.9 
149 
The line of work being finally determined, there 
at once arose the tremendous responsibility in- 
volved in the use of human beings for experimental 
purposes. After careful consideration the Com- 
mission reached the conclusion that the results, if 
positive, would be of sufficient service to humanity 
to justify the procedure, provided, of course, that 
each individual subjected to experiment was fully 
informed of the risks he ran, and gave his free con- 
sent. The members of the Commission, however, 
agreed that it was their duty to run the risk in- 
volved themselves, before submitting anyone else 
to it. 
It became necessary just at this time for Dr. 
8 “ The Prevention of Yellow Fever.” Med. Rec., Oct. 26, 
1901. 150 
WALTER REED AND YELLOW FEVER 
Reed to return to this country, and the work was 
left in charge of Dr. Carroll. The experiments 
were begun by Dr. Lazear, who applied a number 
of infected mosquitoes, hatched from eggs fur- 
nished by Dr. Finlay, to several persons, himself 
included, without result. On the afternoon of Au- 
gust 27 a second attempt was made, in which Dr. 
Carroll submitted to the bite of an infected mos- 
quito, applied by Dr. Lazear. The description of 
this, the first successful experiment, is best given 
in Dr. Carroll’s own words.10 
The insect, which had been hatched and reared in 
the laboratory, had been caused to feed upon four cases 
of yellow fever, two of them severe and two mild. 
The first patient, a severe case, was bitten twelve days 
before, the second, third, and fourth patients had been 
bitten four, and two days previously, and their 
attacks were in character, mild, severe, and mild, re- 
spectively. In writing to Dr. Reed on the night after 
the incident I remarked jokingly that if there were 
anything in the mosquito theory I should have a good 
dose; and so it happened. After having slight pre- 
monitory symptoms for two days I was taken sick on 
August 31, and on September 1 I was carried to the 
yellow fever camp. My life was in the balance for 
three days, and my chart shows that on the fifth, sixth, 
10 “ A Brief Review of the Etiology of Yellow Fever.” N. Y. 
Med. Jour, and Phil. Med. Jour, (consol.), Feb 6 and 13, 
1004. and seventh days my urine contained eight-tenths and 
nine-tenths of moist albumen. The tests were made by 
Dr. Lazear. I mention this particularly because the re- 
sults obtained in this case do not agree with the twen- 
tieth conclusion of Marchoux, Salimbeni, and Simond, 
that the longer the interval that elapses after infec- 
tion of the mosquito the more dangerous he becomes. 
Twelve days, the period above cited, is the shortest 
time in which the mosquito has been proved to be 
capable of conveying the infection. It is my opinion 
that the susceptibility of the individual bitten is a much 
more potent factor in determining the severity of the 
attack than the duration of the infection in the mos- 
quito, or the number of mosquitoes applied. On the 
day that I was taken sick, August 31, 1900, Dr. La- 
zear applied the same mosquito, with three others, to 
another individual who suffered a comparatively mild 
attack, and was well before I left my bed. Thus it hap- 
pened that I was the first person to whom the mosquito 
was proved to convey the disease. On the eighteenth 
day of September, five days after I was permitted to 
leave my bed, Dr. Lazear was stricken and died in 
convulsions just one week later, after several days of 
delirium with black vomit. Such is yellow fever. 
WORK IN YELLOW FEVER 
151 
As soon as Dr. Carroll fell ill, Dr. Lazear ap- 
plied the insects which had bitten him, together 
with three others, to another subject mentioned in 
the report as X. Y., who also succumbed to the dis- 
ease after the usual period of incubation. In doing 
this Lazear was actuated by the scientific spirit, 152 
WALTER REED AND YELLOW FEVER 
for he confirmed the source of infection in Dr. 
Carroll’s case, while at the same time he secured 
additional proof regarding the transmission of the 
disease by the mosquito. The entire series of pre- 
liminary experiments consisted of eleven cases, 
nine of which were negative; it was felt, however, 
that the negative results might be attributed to the 
fact that the insects used in them had not been kept 
long enough after biting yellow fever patients. 
The two positive cases were therefore considered 
sufficiently encouraging to justify advancing along 
the line of investigation already proposed, espe- 
cially as the movements of both patients in the suc- 
cessful cases were known to the Commission for 
some weeks prior to their inoculation, and gave 
reasonable assurance that no other source of infec- 
tion had been possible. 
The death of Dr. Lazear, mentioned by Dr. 
Carroll, occurred in consequence of an accidental 
inoculation. He had been experimentally bitten, 
as I have said above, without any result, but a 
short time afterwards a mosquito settled on his 
hand while he was collecting blood from a yellow 
fever patient for purposes of investigation, and he 
allowed it to take its fill. It is believed that he 
did not particularly notice the species, for he 
said nothing about the occurrence to his asso- 
ciates. In due course of time, he was taken ill 
with yellow fever in its most virulent form, and WORK IN YELLOW FEVER 
153 
died within a week. His death was an irreparable 
loss to the Commission, but I will not pause here 
to dwell on his many claims to admiration and re- 
spect, for I shall speak of them at length in their 
own time and place (see Chapter XII). 
Dr. Reed returned to find the first series of ex- 
periments, upon which the utility of the mosquito 
theory as a working hypothesis must rest, already 
accomplished through the exertions of his col- 
leagues, and the Preliminary Note for publication 
was immediately begun. As Lazear’s infection was 
accidental, his case is not officially cited in the re- 
port, though it is mentioned incidentally; but, as 
the bite was received while he was actually in the 
yellow fever ward, the presumptive evidence in 
favor of his infection through the mosquito is very 
strong. The two positive cases, however, were con- 
sidered by the Commission sufficient evidence to 
justify them in stating before the Public Health 
Association at Indianapolis in October, 1900, that 
“The mosquito acts as the intermediate host for 
the parasite of yellow feverA11 
The first stage in the investigation thus com- 
pleted, it became evident that, if further experi- 
ments were to be of permanent value to humanity, 
some means must be provided by which perfect 
““The Etiology of Yellow Fever: A Preliminary Note.” 
Address before the American Health Assoc., Indianapolis, Oct., 
1900. 154 
WALTER REED AND YELLOW FEVER 
control could be exercised over the movements of 
the individuals subjected to inoculation, in order 
to exclude every possible source of infection ex- 
cept the mosquito. An experimental sanitary sta- 
tion was, therefore, established, in an open, uncul- 
tivated field, about one mile from the town of 
Quemados, Cuba, on a site which was well drained 
and freely exposed to both sun and wind. This 
station, which was named Camp Lazear in mem- 
ory of the deceased member of the Commission, 
was placed under Dr. Reed’s entire control, and 
he speaks of it thus:12 
Any location selected, provided it should be one mile 
from such a centre of infection and surrounded by 
proper safeguards, would be just as free from the oc- 
currence of yellow fever as if it were located ten miles 
from such a town. My own experience on the Island 
of Cuba had already taught me that yellow fever could 
be easily kept out of a military garrison, although pre- 
vailing in epidemic form in a town less than one mile 
distant. For this reason it was not considered advisa- 
ble to establish our experimental sanitary station at a 
greater distance than one mile from Quemados, Cuba. 
Thus Camp Lazear could easily be reached by the 
members of the Board and was conveniently located as 
regards its basis of supplies. 
The personnel of the camp, in addition to the 
three surviving members of the Commission, con- 
1J “ The Propagation of Yellow Fever.” Med. Record, Aug. 
io, 1901. CAMP LAZEAR 
where the experiments with the yellow fever mosquito were first carried 
out and the transmission of the disease by this means proven WORK IN YELLOW FEVER 
155 
sisted of Dr. Roger P. Ames, an immune, in im- 
mediate charge; Dr. Robert P. Cooke, a non-im- 
mune; one acting hospital steward, an immune; 
nine privates of the hospital corps, one of whom 
was an immune; and one immune ambulance 
driver. 
For the quartering of this detachment and of 
such non-immune individuals as should be received 
for experimentation, hospital tents, properly 
floored, were provided, placed at about twenty feet 
apart and numbered i to 7 respectively. Camp 
Lazear was established on November 20, 1900, and 
from this date was put under strict quarantine, no 
one being permitted to leave or enter camp, except 
the three immune members of the detachment. 
Supplies were drawn chiefly from Columbia Bar- 
racks, and for this purpose a conveyance under the 
control of the immune acting hospital steward, and 
having an immune driver, was used. A few Span- 
ish immigrants, recently arrived at Havana, were 
received from time to time, but a non-immune 
person having once left the camp was not permitted 
to return under any circumstances whatever. The 
temperature and pulse of all non-immune residents 
were carefully recorded three times daily, so that 
any infected individual entering the camp could 
be promptly detected and removed. No non-im- 
mune resident was subjected to inoculation who 156 
WALTER REED AND YELLOW FEVER 
had not passed in this camp the full period of incu- 
bation of yellow fever with one exception, for 
which there was a special reason.13 
It was now proposed [says Dr. Reed] to attempt 
the infection of non-immune individuals in three dif- 
ferent ways, namely, first, by the bites of mosquitoes 
which had previously bitten cases of yellow fever; 
second, by the injection of blood taken during the 
early stages from the general circulation of those suf- 
fering the disease; and third, by exposure to the most 
intimate contact with fomites. For this purpose, in 
addition to the seven tents provided for the quartering 
of the detachment, two frame buildings each 14x20 
feet in size were constructed. These buildings, having 
a capacity of 2800 feet, were exactly similar, except 
that one of them, known as the “Infected Mosquito 
Building,” was divided near the middle by a permanent 
wire screen partition and had good ventilation; while 
the other, designated as the “Infected Clothing Build- 
ing,” was purposely so constructed as to exclude any- 
thing like efficient ventilation. These houses were 
placed on opposite sides of a small valley, about eighty 
yards apart, and each seventy-five yards distant from 
the camp proper. Both houses were provided with wire 
screen windows and double wire screen doors, so that 
mosquitoes could be kept within or without the build- 
ings as the experimenters might desire.14 
13“ Etiology of Yellow Fever: An Additional Note.” Jour. 
Amer. Med. Assoc., Feb. 16, 1901. 
u “ Propagation of Yellow Fever.” Loc. cit. The subject of the first experiment was a young 
private from Ohio, named John R. Kissinger, who 
volunteered for the service, to use his own words, 
“solely in the interest of humanity and the cause 
of science. When it became known among the 
troops that subjects were needed for experimental 
purposes, Kissinger, in company with another 
young private named John J. Moran, also from 
Ohio, volunteered their services. Dr. Reed talked 
the matter over with them, explaining fully the 
danger and suffering involved in the experiment 
should it be successful, and then, seeing they were 
determined, he stated that a definite money com- 
pensation would be made them. Both young men 
declined to accept it, making it, indeed, their sole 
stipulation that they should receive no pecuniary 
reward, whereupon Major Reed touched his cap, 
saying respectfully, “Gentlemen, I salute you.” 
Reed’s own words in his published account of the 
experiment on Kissinger, are: “In my opinion 
this exhibition of moral courage has never been 
surpassed in the annals of the Army of the United 
States.” 
It should be mentioned to the credit of the 
United States Army that when men were needed 
for duty in different capacities at Camp Lazear, 
the number of volunteers was always in excess of 
the demand. Subjects for experiment by inocula- 
WORK IN YELLOW FEVER 
157 158 
WALTER REED AND YELLOW FEVER 
tion or by exposure to fomites were always forth- 
coming of their own choice, although no pains 
were spared by those in command to make them 
fully understand the risks they assumed. 
On December 5, 1900, at 2 P. M., five promising 
mosquitoes were selected, two of which had been 
contaminated fifteen days previously; one, nine- 
teen days; and two, twenty-two days. These were 
allowed, with his free consent, to bite the patient, 
John R. Kissinger; the result of the bites was per- 
fectly successful, for about midnight on December 
8, at the end of three days, nine and a half hours, 
the subject, who had been under strict quarantine 
during fifteen days, was seized with a chill that 
proved the beginning of a well-marked attack of 
yellow fever. 
Dr. Reed watched the progress of this case with 
intense interest, and wrote to his wife concerning 
it as follows: 
Columbia Barracks, Quemados, Cuba. 
Dec. 9, 1900. 
It is with a great deal of pleasure that I hasten to 
tell you that we have succeeded in producing a case of 
unmistakable yellow fever by the bite of the mosquito. 
Our first case in the experimental camp developed at 
11.30 last night, commencing with a sudden chill fol- 
lowed by fever. He had been bitten at 11.30,15 Dec. 
15 Probably a lapsus penncc for 2.30, which is the time stated 
in the published record. WORK IN YELLOW FEVER 
159 
5th, and hence his attack followed just three and a half 
days after the bite. As he had been in our camp 15 days 
before being inoculated and had had no other possible 
exposure, the case is as clear as the sun at noon-day, 
and sustains brilliantly and conclusively our conclu- 
sions. Thus, just 18 days from the time we began our 
experimental work we have succeeded in demonstrat- 
ing this mode of propagation of the disease, so that the 
most doubtful and sceptical must yield. Rejoice with 
me, sweetheart, as, aside from the antitoxin of diph- 
theria and Koch’s discovery of the tubercle bacillus, it 
will be regarded as the most important piece of work, 
scientifically, during the 19th century. I do not exag- 
gerate, and I could shout for very joy that heaven has 
permitted me to establish this wonderful way of 
propagating yellow fever. It was Finlay’s theory, and 
he deserves great credit for having suggested it, but as 
he did nothing to prove it, it was rejected by all, in- 
cluding General Sternberg. Now we have put it be- 
yond cavil, and its importance to Cuba and the United 
States cannot be estimated. Major Kean says that the 
discovery is worth more than the cost of the Spanish 
War, including lives lost and money expended. He is 
almost beside himself with joy and will tell General 
Wood when he goes to town in the morning. To-mor- 
row afternoon we will have the Havana Board of Ex- 
perts, Drs. Guiteras, Albertini, and Finlay, come out 
and diagnose the case. I shan’t tell them how the in- 
fection was acquired until after they have satisfied 
themselves concerning the character of the case, then I 
will let them know. I suppose that old Dr. Finlay will 
be delighted beyond bounds, as he will see his theory 
at last fully vindicated. 9.30 P. M. Since writing the 160 
WALTER REED AND YELLOW FEVER 
above our patient has been doing well. His tempera- 
ture, which was 102.50 at noon, has fallen to ioi° and 
his severe headache and backache have subsided consid- 
erably. Everything points, as far as it can at this stage, 
to a favourable termination, for which I feel so happy. 
Two days later he writes: 
Our patient, concerning whom I wrote you in my 
last, is doing very well. We had Dr. John Guiteras, 
Dr. Finlay, and Dr. Albertini out here to see him yes- 
terday afternoon. They were all immensely interested 
and Dr. Albertini did not hesitate to say “yellow 
fever.” The others too regarded the case as one of 
probable yellow fever, but desired to see how his tem- 
perature and pulse would run during the next few days. 
Dr. Amador, an expert in yellow fever, says the dis- 
ease is undoubtedly yellow fever. Of course, I can’t 
blame anyone from withholding a diagnosis until they 
are satisfied, but from my standpoint it is very amus- 
ing. The case is as plain as the nose on a man’s face, 
but as Dr. has pronounced in an interview our 
theory as being very “wild and improbable,” of course 
he wants to be “let down easy,” for he must surrender. 
He will come round in a few days. Dr. Gorgas also 
saw the patient and pronounced the case as so suspi- 
cious that had it occurred in Havana he would not 
have hesitated to send him to the yellow fever hospital. 
Ah! wonderful is nature, and I thank God that he has 
allowed poor unworthy me to look a little way into this 
secret. Six months ago, when we landed on this island, 
absolutely nothing was known concerning the propaga- 
tion and spread of yellow fever—it was all an unfath- WORK IN YELLOW FEVER 
161 
omable mystery—but to-day the curtain has been 
drawn—its mode of propagation is established and we 
know that a case minus mosquitoes is no more dan- 
gerous than one of chills and fever! Hurrah! I will 
write to Dr. in a few days about the case. Of 
course he will at once write an article to say that for 20 
years he has considered the mosquito as the most prob- 
able cause of yellow fever. That would be just in order 
for him to do. Dr. of the Marine Service has 
written a very discourteous reply to our Preliminary 
Note in the same Journal that our article appeared 
in. . . . Dr. Cobb, of the same service, has also writ- 
ten a very courteous and interesting answer to our 
paper, in which he proves to his own satisfaction that 
the mosquito can’t possibly propagate the disease, and 
says that it would be dreadful after all the years of dis- 
infection that his service has done if this theory should 
be what we have claimed for it. And so the ball rolls 
on! 
During the week following the onset of Kis- 
singer’s attack four other cases of yellow fever were 
produced by inoculation with mosquitoes, and this 
further confirmation of the mosquito theory had 
one somewhat amusing effect, which Dr. Reed 
describes thus:18 
It can readily be imagined that the occurrence of 
four cases of yellow fever in our small command of 
twelve non-immunes, within the space of one week, 
11 “ Propagation of Yellow Fever: Observations Based on 
Recent Researches.” Loc. cit. 162 
WALTER REED AND YELLOW FEVER 
while giving rise to feelings of exultation in the hearts 
of the experimenters, in view of the vast importance 
attaching to these results, might inspire quite other 
sentiments in the bosoms of those who had previously 
consented to submit themselves to the mosquito’s bite. 
In fact, several of our good-natured Spanish friends, 
who had jokingly compared our mosquitoes to “the 
little flies that buzzed harmlessly about their tables,” 
suddenly appeared to lose all interest in the progress 
of science, and forgetting for the moment even their 
own personal aggrandisement, incontinently severed 
their connection with Camp Lazear. Personally, while 
lamenting, to some extent, their departure, I could 
not but feel that in placing themselves beyond our 
control they were exercising the soundest judgment. 
In striking contrast to the want of confidence shown 
by these Andalusians, who had agreed to be bitten by 
the mosquitoes, was the conduct now displayed by 
the three young Americans who had consented to 
jeopardise their lives by exposure to fomites, and 
who, as a matter of fact, had already passed fifteen 
nights in a small ill-ventilated building, breathing in 
an atmosphere dreadfully contaminated by the soiled 
garments of yellow fever patients. With the occur- 
rence of these cases of mosquito infection the coun- 
tenances of these men, which had before borne the 
serious aspect of those who were bravely facing an 
unseen foe, suddenly took on the glad expression of 
school-boys let out for a holiday, and from this time 
their contempt for “ fomites ” could not find sufficient 
expression. Thus illustrating once more the old adage 
that familiarity, even with fomites, may breed con- 
tempt ! WORK IN YELLOW FEVER 
163 
The experiments regarding infection with fo- 
mites, here alluded to, formed an essential part 
of Dr. Reed’s work, since it was nearly as im- 
portant to establish the fact that yellow fever could 
not be conveyed in this way as to prove that it 
could be transmitted by the mosquito. To show 
that the mosquito was responsible for the transmis- 
sion of yellow fever, without disproving its con- 
veyance by fomites, would only have added to the 
confusion and dread with which the whole subject 
of the disease was surrounded. For many years it 
had been unhesitatingly accepted that the epidem- 
ics which devastated the country had their origin 
in the unpacking of boxes and trunks containing 
infected clothing; hence the efforts of the health 
authorities were constantly directed to the disin- 
fection of clothing and bedding from ports where 
yellow fever prevailed. 
To determine whether clothing contaminated by 
contact with yellow fever patients or their dis- 
charges really conveyed the disease from one 
person or one place to another became, therefore, 
a matter of vital importance. If the mosquito 
theory were true, the fomites theory had no founda- 
tion, but nothing short of actual demonstration of 
its futility could be relied on to induce conviction. 
One of the frame buildings erected at Camp 
Lazear had been designed for the special purpose 
of conducting this series of experiments. It con- 164 
WALTER REED AND YELLOW FEVER 
sisted of one room, 14 x 20 feet in size, with two 
tiny windows both facing south, and closed with 
wire screens, so that a thorough circulation of air 
was impossible; in addition there were glass sashes 
within and heavy wooden shutters without, the 
latter being intended for the purpose of excluding 
the sunlight. Entrance was through a small vesti- 
bule on the same side as the windows, protected 
without by a solid door and divided in the middle 
by a wire screen door. The inner entrance had also 
a screen door, and in this way the entrance of mos- 
quitoes was effectually prevented. This house was 
kept closed till long after sunset and was heated to 
a temperature of 920 to 950 F. with precautions to 
secure sufficient humidity. 
On November 30 [says Dr. Reed], the building 
being now ready for occupation, three large boxes filled 
with sheets, pillowslips, blankets, etc., contaminated by 
contact with cases of yellow fever and their discharges, 
were received and placed there. The majority of the 
articles had been taken from the beds of patients sick 
with yellow fever at Las Animas Hospital, Havana, or 
at Columbia Barracks. Many of them had been pur- 
posely soiled with a liberal quantity of black vomit, 
urine, and fecal matter. A dirty “comfortable” and 
much-soiled pair of blankets, removed from the bed of 
a patient sick with yellow fever in the town of Quema- 
dos, were contained in one of these boxes. The same 
day at 6 P. M. Dr. Robert P. Cooke, Acting Assistant CAMP LAZEAR 
Building where the experiments were made which proved that yellow 
fever is not transmitted by means of infected clothing (fomites). 
The figure on the left is Dr. Carroll. WORK IN YELLOW FEVER 
165 
Surgeon, U. S. A., and two privates of the hospital 
corps, Folk and Jernigan, all non-immune young Amer- 
icans, entered this building and deliberately unpacked 
these boxes, which had been tightly closed and locked 
for a period of two weeks. They were careful at the 
same time to give each article a thorough handling and 
shaking in order to disseminate through the air of the 
room the specific agent of yellow fever, if contained in 
these fomites. These soiled sheets, pillow-cases, and 
blankets were used in preparing the beds in which the 
members of the hospital corps slept. Various soiled 
articles were hung around the room and placed about 
the bed occupied by Dr. Cooke. 
From this date until December 19, a period of 
twenty days, this room was occupied each night by 
these three non-immunes. Each morning the various 
soiled articles were carefully packed in the aforesaid 
boxes, and at night again unpacked and distributed 
about the room. During the day the residents of this 
house were permitted to occupy a tent pitched in the 
immediate vicinity, but were kept in strict quarantine. 
December 12 a fourth box of clothing and bedding 
was received from Las Animas Hospital. These arti- 
cles had been used on the beds of yellow fever patients, 
but in addition had been purposely soiled with the 
bloody stools of a fatal case of the disease. As this box 
had been packed for a number of days, when it was 
opened and unpacked by Dr. Cooke and his assistants 
on December 12, the odour was so offensive as to com- 
pel them to retreat from the house. They pluckily re- 
turned, however, within a short time and spent the 
night as usual. 166 
WALTER REED AND YELLOW FEVER 
On December 19 these three non-immunes were 
placed in quarantine for five days, and then given the 
liberty of the camp. All had remained in perfect health, 
notwithstanding their stay of twenty nights amid such 
unwholesome surroundings.17 
This experiment was repeated on three subse- 
quent occasions, the only variation being that on 
several occasions the men actually slept in the gar- 
ments used by yellow fever patients, and notwith- 
standing this trying ordeal, they continued in per- 
fect health. There could be no doubt, therefore, 
that the attempt to convey the disease by means of 
fomites was a total failure, and if measures to con- 
vey disease, thus carried out, with every conceiv- 
able precaution against its entrance by other 
sources of infection and every conceivable facility 
for its admission by the sources under considera- 
tion came to no effect, the experiment might be 
accepted as unquestionable evidence that the dis- 
ease is not conveyed by fomites. Dr. Reed writes 
to his wife on the subject as follows: 
Columbia Barracks, 
Dec. 9, 1900. 
I have allowed the men who have spent 20 nights in 
our infected clothing house to come out and they are 
now in quarantine. Two other soldiers are now occu- 
15 “ The Etiology of Yellow Fever.” Loc cit. pying the house and sleeping not only in the same beds 
and between the same sheets on which our yellow fever 
patients have rested during their attacks, but they sleep 
in the very shirts that our patients wore through- 
out their entire illness! If anything should give them 
the disease this should succeed! Don’t you think so? 
Infected clothing and bedding have been a horrible 
nightmare during the past 300 years, but, methinks, 
it will die out very early in the next century! Yel- 
low fever can no more be transmitted in that way 
than intermittent fever. How General Sternberg and 
hosts of others could have believed in the contagious- 
ness of clothing and of the stools of yellow fever pa- 
tients I cannot possibly see. They were simply ac- 
cepting the statements of others who had nothing on 
which to base such statements. A little careful testing 
of this theory has served to knock it completely into 
smithereens. I thank God that I did not accept any- 
body’s opinion on this subject, but determined to put 
it to a thorough test with human beings in order to see 
what would happen. My own observations at Pinar 
del Rio convinced me that infected bedding was in- 
deed a myth. Actual trial has proven that I was right 
and that what the medical profession believed was 
wrong! 
WORK IN YELLOW FEVER 
167 
It seems but just that we should pause a moment 
here to commend the courageous spirit of the men 
who submitted to the fomites experiments. Dr. 
Cooke, in a private letter, disclaims any credit 
for bravery, in the modest spirit which has dis- 
tinguished all the men engaged in these researches; 168 
WALTER REED AND YELLOW FEVER 
but, while it is true that the risk of acquiring 
yellow fever in this way is absolutely nil, the fact 
was not established at the time the men began 
their sojourn in the infected clothing building. 
Apart, however, from any question of possible 
yellow fever, surely there can be no finer spirit 
of self-devotion to the cause of science and of 
humanity than that which voluntarily spends a 
considerable time amid such repulsive surround- 
ings. To pass twenty nights in a small, ill-venti- 
lated room, with the temperature over ninety, in 
close contact with the most loathsome articles of 
dress and furniture, in an atmosphere fetid from 
their presence, is an act of heroism which ought 
to command our highest admiration and our last- 
ing gratitude. 
The non-contagiousness of fomites being thus 
definitely settled, the question arose: How does a 
house become infected with yellow fever? and the 
next experiment undertaken was for the purpose 
of demonstrating that the essential factor in the 
infection of a building with yellow fever is the 
presence of mosquitoes that have bitten cases of 
the disease. 
Accordingly [says Dr. Reed],” at 11.55, Decem- 
ber 21, 1900, fifteen mosquitoes were freed in the 
larger room of the “Infected Mosquito Building” 
ia “ The Propagation of Yellow Fever,” etc. Loc cit. which, as I have said, was divided into two compart- 
ments by a wire-screen partition. The interval that had 
elapsed since the contamination of these insects was 
as follows: one, twenty-four days; three, twelve days; 
four, eight days; and seven, five days. The only articles 
of furniture in this building consisted of three beds, 
one being placed in the mosquito room and two beyond 
the wire screen, these latter intended to be occupied 
by two “control” non-immunes. The articles of bed- 
ding as well as the bedsteads had been carefully dis- 
infected by steam. At noon on the same day, five 
minutes after the mosquitoes had been placed therein, 
a plucky Ohio boy, Moran by name,19 clad only in his 
night-shirt and fresh from a bath, entered the room 
containing the mosquitoes, where he lay down for a 
period of thirty minutes. On the opposite side of the 
screen were the two “controls” and one other non- 
immune. Within two minutes after Moran’s entrance 
he was bitten about the face and hands by the insects 
that had promptly settled down upon him. Seven in all 
bit him at this visit. At 4.30 P. M. he again entered and 
remained twenty minutes, during which time five others 
bit him. The following day at 4.30 P. M. he again 
entered and remained fifteen minutes, during which 
three insects bit him, making the number fifteen that fed 
at these three visits. The building was then closed, ex- 
cept that the two non-immune “controls” continued to 
occupy the beds on the non-infected side of the screen. 
On Christmas morning at 11 A. M. this brave lad was 
WORK IN YELLOW FEVER 
169 
19 This young man, who volunteered at the same time as 
Kissinger, had already been the subject of one inoculation, 
immediately after that of Kissinger. The results in his case, 
however, had been negative. 170 
WALTER REED AND YELLOW FEVER 
stricken with yellow fever and had a sharp attack which 
he bore without a murmur. The period of incubation 
in this case was three days and twenty-three hours, 
counting from his first visit, or two days and seventeen 
and a half hours, if reckoned from his last visit. The 
two “controls” who had slept each night in this house, 
only protected by the wire screen, but breathing the 
common atmosphere of the building, had remained in 
good health. They continued to remain so, although 
required to sleep here for thirteen additional nights. 
As Moran had remained in strict quarantine for the 
period of thirty-two days prior to his attack, the source 
of his infection must be found in this house. 
With this experiment the work for the time be- 
ing came to a close. Dr. Reed’s own sentiments 
regarding the blessing it had conferred upon the 
human race are expressed in the following letter 
to his wife: 
Columbia Barracks, 
Quemados, Cuba, 
11.50 p. m., Dec. 31, 1900. 
Only ten minutes of the old century remain. Here 
have I been sitting, reading that most wonderful book, 
“La Roche on Yellow Fever,” written in 1853. Forty- 
seven years later it has been permitted to me and my 
assistants to lift the impenetrable veil that has sur- 
rounded the causation of this most wonderful, dread- 
ful pest of humanity and to put it on a rational and 
scientific basis. I thank God that this has been accom- 
plished during the latter days of the old century. May its cure be wrought out in the early days of the new! 
The prayer that has been mine for twenty years, that 
I might be permitted in some way or at some time to do 
something to alleviate human suffering has been 
granted! A thousand Happy New Years. 
Hark, there go the twenty-four buglers in concert, all 
sounding “Taps” for the old year. 
WORK IN YELLOW FEVER 
171 CHAPTER VIII 
WORK IN YELLOW FEVER (continued) 
Thine the victory, 
As the just Future measures gain. 
—James Russell Lowell. 
THE new year opened auspiciously for the work 
of the Yellow Fever Commission. The members 
felt themselves justified in stating publicly that 
they had proved the transmission of yellow fever 
by means of the mosquito, as well as the harmless- 
ness of fomites in conveying the disease; and they 
were gratified to find that the results were received 
with enthusiasm in Havana. Dr. Reed describes 
their reception in a letter to his wife, from which 
we have already quoted, as follows: 
Columbia Barracks, Cuba, 
Dec. 23, 1900. 
Last evening I attended quite a swell banquet in 
Havana given to Dr. Finlay by some seventy or eighty 
physicians of Havana. It was a very recherche affair 
and extremely enjoyable. Everything was in Spanish 
—the Governor General was there—the toasts were 
all in Spanish, and the speeches, while flattering to Dr. 
172 WORK IN YELLOW FEVER 
173 
Finlay for his conception of the theory, gave us full 
credit for the discovery. It is to me surprising and ex- 
tremely satisfactory to see how very quickly the pro- 
fession of Havana have accepted our results. 
The work of the Commission was now nearly 
completed, and on January i, 1901, Reed writes: 
I celebrated the day by writing to General Stern- 
berg, and requesting him to have the order for our re- 
turn issued so that we could leave here the night after 
the close of the Pan-American Congress. Six weeks 
from to-day I hope to be at home again. 
Before leaving Cuba, however, Dr. Reed wished 
to investigate some points of minor interest associ- 
ated with the problems of moment which he had 
just solved, namely, whether yellow fever could be 
transmitted by any other means than the bite of the 
mosquito, and what was the length of time during 
which the mosquito was capable of conveying the 
infection. In order to determine the first question 
it was decided to try inoculation with the blood of 
a yellow fever patient, the Commission regarding 
it as probable that yellow fever, like- the several 
types of malarial fever, 'might be produced by the 
injection of blood taken from a patient suffering 
with the disease. 
The subject of the experiment was a non-immune 
private, named Jernigan, who has already been 174 
WALTER REED AND YELLOW FEVER 
mentioned as one of those who slept in the “In- 
fected Clothing Building.” He had been bitten by 
an infected mosquito on December 28 and 29, 1900, 
with negative results, but it was thought that the 
failure of the experiment might possibly be due to 
some degree of natural immunity, or, more prob- 
ably to the fact that as most of the mosquitoes first 
used had been destroyed (presumably, by the small 
red ants which abounded), those by which Jernigan 
was bitten were only thirteen days old. While this 
matter was still under discussion, an opportunity 
to make a good inoculation presented itself, and 
as Jernigan was the only available subject in the 
camp, it was determined to make use of him for 
the purpose. He was accordingly inoculated sub- 
cutaneously on January 4, 1901, with two cubic 
centimetres of blood taken from the arm of a yel- 
low fever patient twenty-four hours after the onset 
of the disease; an attack of yellow fever developed 
in a little less than four days, showing that although 
the bite of the mosquito is the natural method for 
the transmission of the disease, it is not essential. 
It would also appear that the mosquito at certain 
periods of the disease may fail to obtain the para- 
site, a result not unlike that sometimes found when 
the blood is examined in malarial fever. This first 
experiment was confirmed by three others, in which 
the subcutaneous injection of blood gave positive WORK IN YELLOW FEVER 
175 
results, the amounts administered being 1.5, 6.5, 
and 1 cc., respectively. Dr. Reed’s remarks on 
these experiments are as follows:1 
The production of yellow fever in this way is of 
much scientific interest; first, as serving to confirm what 
the mosquito inoculation had already shown, viz., that 
the parasite is present in the general circulation; sec- 
ond, that passage through the body of the mosquito, 
although this would seem to be nature’s method, is 
not absolutely necessary in the life-history of this 
micro-organism; and third, that the period of incuba- 
tion of the disease, when thus produced, corresponds 
fairly closely to that occasioned by the mosquito’s bite. 
A point of considerable interest brought out by the 
blood injection was the absence from the blood, on 
careful'bacteriologic culture, of any bacterium which 
grows on our ordinary media by anerobic methods; 
thus excluding absolutely the Bacillus icteroides of 
Sanarelli from further claim as the specific agent of 
yellow fever. 
The second point of interest, that is, the number 
of days which must elapse after contamination of 
the mosquito before it can convey the disease to 
a second individual, was now taken up. 
After a quarantine period of nine days [Dr. Reed 
says],2 a man named Martinez visited the room (in 
1 “ The Propagation of Yellow Fever,” etc. Loc. cit. 
2 “ The Propagation of Local Fever.” Loc. cit. 176 
WALTER REED AND YELLOW FEVER 
which the mosquitoes were now kept in jars) and there, 
on December 17, 1900, was bitten by fourteen mos- 
quitoes, which four days before had fed upon the first 
case (Kissinger’s). The result was quite negative, and 
on December 24, or on the eleventh day after con- 
tamination, the subject was again bitten by seven of 
these insects, all that remained of the original fourteen. 
Again no infection took place. After six full days, or 
on December 30, at 11 o’clock A. M., Martinez was 
again bitten by the surviving four of the mosquitoes, 
i. e., on the seventeenth day after their contamination. 
On the fourth day thereafter, January 3, 1901, at 10.30 
A. M., he was seized with yellow fever, which ran a 
typical course. The period of incubation was three days 
twenty-two and one-half hours. Although we cannot 
say on what particular day these insects became capable 
of conveying the disease, we are able to state that they 
were incapable of infecting on the fourth or the 
eleventh day after contamination. These observations 
seem to indicate that after the parasite has been taken 
into the mosquito’s stomach a certain number of days 
must elapse before the insect is capable of reconveying 
it to a second individual. This period probably repre- 
sents the time required for the parasite to undergo 
its cycle of development and reach the mosquito’s 
salivary glands; and, as far as our experience goes, the 
length of time is about twelve days in summer weather, 
and most probably about eighteen or more days dur- 
ing cooler winter months. The experiment just given, 
therefore, does not support the opinion of Finlay that 
the bite of the contaminated mosquito confers immunity 
against a subsequent attack of the disease, since we have WORK IN YELLOW FEVER 
177 
seen that neither the bites of fourteen insects on the 
fourth day nor the bites of seven on the eleventh day 
after contamination, prevented, in the least, the con- 
veyance of the infection by the bites of four only of 
these mosquitoes on the seventeenth day. 
In the next case, the subject, an immune Ameri- 
can, was bitten by insects that had fed upon the 
first case (Kissinger’s) on the third day of his 
illness, that is, during the secondary fever, which in 
this case followed a complete intermission. These 
mosquitoes had been kept alive on sugar and water 
for a period of thirty-nine days before being ap- 
plied to the case in question. Of the original five 
insects that had bitten Kissinger on the third day, 
four were still alive on the thirty-ninth day after- 
ward, and three showed every evidence of good 
appetite. This particular subject, having passed 
twenty-one nights in the infected clothing build- 
ing, during which time he was exposed to the most 
intimate contact with fomites without apparent 
detriment to his health, had been kept in strict 
quarantine for yet thirty days longer at Camp La- 
zear. At the expiration of this time, on January 
19, 1901, at 4.30 P. M., he visited the mosquito- 
room, where he was bitten by these thirty-nine-day- 
old insects, three in number. This inoculation was 
followed by an attack of yellow fever of moderate 178 
WALTER REED AND YELLOW FEVER 
severity, which began at 4 P. M. January 23, the 
period of incubation being three days and twenty- 
three and one-half hours. 
The next case [says Dr. Reed] 3 is of equal interest, 
as the patient was infected in the same room by the 
bites of two of these same mosquitoes on the fifty-first 
day after their contamination, the period of incubation 
being three days and two and one-half hours, and the 
character of the attack mild; while still another case 
conclusively demonstrates that these identical insects, 
on the fifty-seventh day after their contamination, were 
not only capable of conveying the infection, but of 
producing an attack of such severity that the subject’s 
life hung in the balance for several days. I regret to 
have to state that the individual who had consented to 
be bitten by these insects on the sixty-second day after 
their contamination failed to fulfil his promise at the 
last moment; otherwise I cannot say to what old age 
these mosquitoes might have attained. Deprived of 
further opportunity to feed on human blood, one died 
on the sixty-ninth day and the other on the seventy- 
first day after their original contamination. The dura- 
tion of life in the case of these mosquitoes will readily 
explain how the poison of yellow fever can remain 
even in a depopulated area for a period of two and a 
half months, so that, as is well known, those who enter 
the infected area, even at the expiration of this period, 
are liable to acquire the disease. 
The last successful case of mosquito infection at 
Camp Lazear was bitten on February 7, 1901, after 
3 “ The Propagation of Yellow Fever.” Loc. cit. WORK IN YELLOW FEVER 
179 
a period of twenty-five days’ quarantine, by two mos- 
quitoes, on the sixteenth day after their contamina- 
tion, and was seized with an attack of yellow fever at 
noon on February 10, after an incubation period of 
two days and twenty-two hours. 
These experiments, confirming those already- 
mentioned by Carter in 1898, enabled Dr. Reed to 
state positively that at least twelve days must elapse 
between contamination of the mosquito by the 
blood of a yellow fever patient and the communi- 
cation of the disease, while the period may be as 
much as twenty-three. They also show that the 
mosquito is capable of conveying the disease for a 
period of fifty-seven days, and quite possibly 
longer. 
The Pan-American Congress met at Havana on 
February 4-7, 1901, and Dr. Reed submitted before 
it a paper describing his experiments and stating 
his results. The points which he felt himself justi- 
fied in publishing as proved are these:4 
(1) The mosquito, C. fasciatus, serves as the inter- 
mediate host for the parasite of yellow fever. 
(2) Yellow fever is transmitted to the non-immune 
individual by means of the bite of the mosquito that has 
previously fed on the blood of those sick of the disease. 
4 “ The Etiology of Yellow Fever: An Additional Note.” 
Jour. Amer. Med. Assoc., Feb. 16, 1901.  WALTER REED AND YELLOW FEVER 
180 
(3) An interval of about twelve days or more after 
contamination appears to be necessary before the mos- 
quito is capable of conveying the disease. 
(4) The bite of the mosquito at an earlier period 
after contamination does not appear to confer any im- 
munity against a subsequent attack. 
(5) Yellow fever can also be experimentally pro- 
duced by the subcutaneous injection of blood taken 
from the general circulation during the first and second 
days of this disease. 
(6) An attack of yellow fever, produced by the 
bite of the mosquito, confers immunity against the sub- 
sequent injection of the blood of an individual suffering 
from the non-experimental form of the disease. 
(7) The period of incubation in thirteen cases of 
experimental yellow fever has varied from forty-one 
hours to five days and seventeen hours. 
(8) Yellow fever is not conveyed by fomites, and 
hence disinfection of articles of clothing, bedding, or 
merchandise, supposedly contaminated by contact with 
those sick with this disease, is unnecessary. 
(9) A house may be said to be infected with yellow 
fever only when there are present within its walls con- 
taminated mosquitoes capable of conveying the para- 
site of this disease. 
(10) The spread of yellow fever can be most ef- 
fectually controlled by measures directed to the de- 
struction of mosquitoes and the protection of the sick 
against the bites of these insects. 
(11) While the mode of propagation of yellow 
fever has now been definitely determined, the specific 
cause of this disease remains to be discovered. WORK IN YELLOW FEVER 
181 
Dr. Reed’s paper met with a most gratifying 
reception, which he describes in a letter to his 
wife, just before he sailed for home, as follows: 
Columbia Barracks, 
Quemados, 
Feb. 6th, 1901. 
To-day the paper was read and met with a most 
favourable reception. The attention during the reading 
was all that I could have asked for and the applause 
at its conclusion long and hearty. A resolution expres- 
sive of the high appreciation in which our work was 
held, together with the thanks of the Congress, was 
unanimously adopted. I received dozens of the warm- 
est kind of handshakes from Cuban, Spanish, Mexi- 
can, South American, and North American physicians, 
men whom I had not even met. The hall was crowded 
and even the doors packed with listeners. It was in- 
deed a signal triumph for our work. 
When Dr. Reed returned early in February, 
Dr. Carroll remained behind in order to make 
some further observations upon the blood in yel- 
low fever and also, especially, upon the urine. The 
following letter was written him by Dr. Reed 
during this interval: 
Surgeon General’s Office, 
Washington, Feb. 26, 1901. 
My dear Doctor: I have yours of the 21st, and 
am afraid that this will not reach you before your de- 
parture. I want you to bring the reprints of our Prelimi- 182 
WALTER REED AND YELLOW FEVER 
nary Note, which I seem to have left behind uninten- 
tionally. There were about a dozen of them. . . . 
It is too bad that would not take the bite 
again, but I cannot blame him after ’s expe- 
rience. Still, 10 successes out of 13 attempts is a pretty 
good record. We must present the clinical side of these 
cases to the Association of American Physicians in May, 
if possible. Neale is on the sick list, temporarily, with a 
bad cold, and I am tied down to the Army Examining 
Board. Weather still beastly, with no immediate hope 
of a let-up. You made no mistake by remaining in Cuba 
till March, as February has been simply atrocious. 
Give my love to everybody and hurry back as fast 
as you can. Welch, Osier, and Thayer are very enthu- 
siastic over our work. Love to Agramonte when you 
see him. Sincerely yours, Reed. 
The specific germ of yellow fever, however, had 
not yet been found, and although its discovery was 
not a matter of such vital importance as the mode 
by which the disease is conveyed, there were some 
points connected with it which the Commission 
desired to investigate before they withdrew from 
their labours. 
Dr. Sternberg, who had always taken an intense 
interest in the subject, made the following pro- 
phetic suggestion concerning it, on page 531 of 
his “Manual of Bacteriology,” published in 1892: 
The possibility, of course, remains that the specific 
infectious agent in yellow fever may belong to an en- tirely different class of micro-organisms from the bac- 
teria, or that it may be ultra-microscopic, or not capable 
of demonstration in the tissues by the staining methods 
usually employed by bateriologists. 
WORK IN YELLOW FEVER 
183 
In the early summer of 1901 Dr. William H. 
Welch, of the Johns Hopkins University, called 
Dr. Reed’s attention to the experiments of Loeffler 
and Frosch, in which they had demonstrated that 
the specific infectious agent of foot and mouth dis- 
ease in cattle would pass through a porcelain filter 
and was, therefore, too small to be discovered by 
the microscope. According to Loeffler and Frosch, 
there were two possible explanations of this result: 
either the filtered lymph held in solution an ex- 
traordinarily active toxin, or the specific agent of 
the disease was so minute as to pass through the 
pores of a filter which prevents the passage of the 
smallest bacteria. They themselves accepted the 
latter explanation, since they were able in later 
experiments by means of the filtered lymph to 
convey the disease through a series of six animals, 
the last of which sickened just as promptly after 
the injection of the filtered lymph as the first of the 
series. Having thus determined that the micro- 
organisms might be considered ultra-microscopic, 
Loeffler and Frosch offered the suggestion that, 
perhaps, the specific agent of some of the acute 
infectious diseases of man and the animals, such 184 
WALTER REED AND YELLOW FEVER 
as smallpox, scarlet fever, measles, rinderpest, etc., 
might belong to the same category. The remain- 
ing members of the Army Commission, Reed and 
Carroll, considered that investigations carried out 
along the line just suggested might throw light 
upon the aetiology of yellow fever, and as an out- 
break of the disease at Santiago de las Vegas, near 
Havana, in the summer of 1901 offered an oppor- 
tunity of carrying on the necessary experiments, 
Dr. Carroll returned to Cuba for the purpose, 
landing at Havana on August 11, 1901. It was also 
decided, at Dr. Carroll’s suggestion, to test the 
effect of moderate temperature upon the infectious 
property of the serum. 
Some months before Dr. Carroll’s arrival an 
inoculation station had been established in connec- 
tion with Las Animas Hospital, under the charge 
of Dr. John Guiteras, for the purpose of carrying 
on inoculation experiments. These experiments 
had been instituted, to use Dr. Guiteras’ own 
words, “not with a view to control or confirm the 
conclusions of the United States Army Commis- 
sion, for anyone who has followed their work with 
unprejudiced attention must have concluded that 
their solution of the problem of the aetiology of 
yellow fever was final; but rather with the hope 
of propagating the disease in a controllable form 
and securing, among the recently arrived immi- JAMES CARROLL, M.D. 
Member of the U. S. A. Yellow Fever Commission. From a photo- 
graph taken in 1901 grants, immunisation, with the minimum amount 
of danger.” So far as immunisation was concerned, 
it may be said at once that the experiments did 
not fulfil the hopes which had been based upon 
them, the desired object, says Dr. Guiteras, “not 
being attainable by the present methods, without 
considerable risk to the individual.” 
Up to the time of Dr. Carroll’s arrival in Ha- 
vana, Dr. Guiteras had not succeeded in produc- 
ing a single case of experimental yellow fever, a 
fact which was beginning to cause him and his col- 
leagues some discouragement. Immediately after 
Dr. Carroll reached Las Animas Hospital, how- 
ever, an experimental case did develop, and two 
days later Dr. Carroll wrote to Dr. Reed describ- 
ing the situation as follows: 
WORK IN YELLOW FEVER 
185 
Las Animas Hospital, Havana, 
Aug. 13, 1901. 
Dear Doctor: I landed on Sunday morning after 
what would be called a very pleasant time as far as 
weather and sea were concerned, but I felt it all the 
same, and the company are several meals ahead. 
Drs. Finlay, Guiteras, and Gorgas were very much 
put out over their failures, but now they are all very 
much elated. On the evening of my arrival the first case 
came down on the fourth day from four 3/19 5 insects 
5 This was a formula by which it was understood that the 
mosquitoes had bitten a yellow fever patient on the third day 
of the disease, and had been kept nineteen days before biting a 
well subject. 186 
from a Santiago de las Vegas case. On the following 
day another man came down from similar insects from 
this case applied to both individuals at the same time. 
I made a dozen 200 cc. bouillon flasks at Las Animas 
and am making preparations to draw blood from one 
of these individuals to-morrow. . . . 
Everybody is very nice and I am hustling to get 
to work while the material is in sight. Guiteras has 
no more immunes in sight and some of his Spaniards 
have backed out. I shall telephone Colonel Havard to 
send me six subjects from Triscormia, and shall use 
three of them at once. In order to aid me in securing 
material with certainty, I have just asked for one thou- 
sand dollars. I spoke to Colonel Scott about it this 
morning and it will be all right. . . . 
Our friends Bellazaghi and Caldos are located at 
Camp Lazear, waiting an opportunity to demonstrate 
the value of their specific serum. I learned from Colonel 
Havard yesterday that they claim to have the specific 
organism, and they inoculate horses with it so as to ob- 
tain the serum. They find it in black vomit and in the 
intestine and they produce yellow fever with it in dogs! 
Evidently colon or lactis aerogenes. The colonel says 
that they are willing to describe the characteristics of 
their organism, but they have bound themselves to 
some commercial concern, so that they cannot furnish 
a culture. I remarked that such methods of procedure 
were mercenary and unscientific, and if they believed 
they had the specific organism they were in duty bound 
to give it to the world, in order that their claims might 
be substantiated and they receive the credit due to them 
for such a valuable piece of work. A few drops under 
the skin of a few individuals would settle the point, and 
WALTER REED AND YELLOW FEVER I believe they know it, but the test would be too crucial 
for them. I have not had the pleasure of meeting them 
yet, and I am not wasting my time in seeking them. 
Major Ross is exceedingly kind and asks to be re- 
membered. As soon as I get my results I shall write to 
you again. With regards to all. 
Very sincerely yours, 
James Carroll. 
WORK IN YELLOW FEVER 
187 
Dr. Guiteras’ satisfaction in his experimental 
cases was soon damped by the serious character 
that some of them assumed, and his anxiety mani- 
fested itself in extreme cautiousness as to permit- 
ting further experiments upon his patients, al- 
though Dr. Carroll had been sent to Cuba by the 
United States Government for that purpose and 
it was absolutely necessary to complete his final in- 
vestigations that he should make them. Dr. Car- 
roll’s next letter to Dr. Reed describes his disap- 
pointment at the turn affairs were taking. 
Las Animas Hospital, Havana, 
August 15, 1901. 
My dear Doctor : I have to record my first disap- 
pointment. When I last wrote you I was making prepa- 
rations to draw blood from Dr. Guiteras’ second case. 
It was a good one with a constant temperature of be- 
tween 103° and 104° F., and I expected to draw blood 
from him yesterday. Early in the morning Dr. Guiteras advised against it, for the reason that the moral effect 
upon the man might be bad. He admitted that the 
man’s general condition at the time was good, but he 
said that his promises to him did not include any such 
operation. The matter was decided by Major Ross, 
who has charge of the treatment of these cases and 
who, of course, sided with Guiteras. ... You can 
imagine my disappointment. . . . 
I have asked for three men to bite to-morrow with 
the same insects Dr. Guiteras used, for I must have 
some good cases. I expect to get Spaniards from Tris- 
cormia. I have also asked Colonel Havard for Ames 
or Amador to look after my patients while I am attend- 
ing to my experiments. . . . With this arrangement 
there will be no quibbling about the drawing of a small 
quantity of blood from my own patients. I obtained 
half a dozen insects from Ames to-day, which his 
steward has been raising, and I shall apply them in the 
morning to the third case, at the end of the second 
day. . . . 
I receive the fullest cooperation from General Scott. 
The allotment of $1,000 has been ordered and the 
per diem too. Mr. McCoy has also called to-day about 
my boxes, which have not arrived. I rely upon the 
Berkefeld filters and I have purchased hypodermic 
syringes here, so that I am equipped for work in the ex- 
pectation of using these cases. I am not deterred, how- 
ever, and shall go right ahead. . . . 
I saw Drs. Bellazaghi and Caldos to-day. They have 
injected two Spaniards with their protective serum, and 
two others are to be used as controls when the biting 
is done. They will first administer another injection of 
what they call their vaccine. They say the immunity 
188 
WALTER REED AND YELLOW FEVER WORK IN YELLOW FEVER 
189 
they confer lasts forty days. I learn this from Dr. 
Guiteras. ... 
With kind regards to everyone, 
Very sincerely, 
James Carroll. 
Dr. Reed replied to these two letters as follows: 
Blue Ridge Summit, Pa., 
Aug. 20,'1901. 
My dear Carroll: Yesterday I received your first 
letter, and to-day your second came. I am intensely 
gratified to hear that Guiteras and Finlay have been 
able at last to confirm our experiments, although very 
sorry to learn that two of their cases are so severe. It 
was disappointing not to be permitted to draw blood 
from such a typical case, but you must know how timid 
is about anything like a surgical case. . . . 
Sincerely yours, 
Walter Reed. 
A few days later Reed writes again: 
Blue Ridge Summit, Pa., 
Aug. 23, 1901. 
You were right in ignoring Caldos and Bellazaghi. 
Think of reputable physicians stooping to such unpro- 
fessional conduct! I am amazed that did not 
promptly inform the Surgeon General of the conduct 
of these men. 
The disappointment about the Las Animas cases 
occasioned some delay in Dr. Carroll’s observa- 
tions, for he was obliged to produce cases of ex- 190 
WALTER REED AND YELLOW FEVER 
perimental yellow fever by inoculation of Span- 
iards who volunteered for pecuniary reasons, and 
then draw blood for his further experiments from 
these, instead of obtaining it without loss of time, 
as he had expected to do, from Dr. Guiteras’ cases. 
I give a copy of the contract used between the 
United States Government and the men who vol- 
unteered as subjects. 
Las Animas Hospital, Havana, Cuba, 
Sept. 5, 1901. 
I, Jeremiah Tomlinson, born in Lincoln, Neb., de- 
clare that I am twenty-five years of age, and that I 
have no one dependent upon me for support. 
Desiring to become immune to yellow fever, and fully 
appreciating that in so doing I will probably contract 
the disease, I hereby give my full and free consent to 
the inoculation of my person through the bites of mos- 
quitoes. In consideration of which I am to receive the 
sum of seventy-five (75) dollars Am. Cy. if the inocu- 
lation fails, and two hundred (200) dollars if I con- 
tract yellow fever as a result of said inoculation. 
Jeremiah Tomlinson. 
[R. M. Kirby Smith, 
[ Charles Parker. 
Witnesses 
One of the difficulties encountered by Dr. Car- 
roll at this time was associated with the terms of 
this contract. The fact that a sum of money, no 
matter how small, was paid to volunteers, whether 
they contracted the disease or not, induced men WORK IN YELLOW FEVER 
191 
who had had yellow fever, and were, therefore, 
immune, to present themselves as subjects, and if 
no one but the man himself was in the secret he 
could do a little stroke of business without risk. 
In spite of all these hindrances, Dr. Carroll set 
to work with his customary zeal and enthusiasm 
to secure conditions necessary to the prosecution 
of his researches; as soon as suitable cases of yellow 
fever were produced, his experiments were con- 
ducted along the following lines: 
(i) Injection of the fresh blood taken from a 
vein at the bend of the elbow; (2) injection of 
unheated and partially defibrinated blood; (3) in- 
jection of partially defibrinated blood heated for 
ten minutes at 550 C.; (4) injection of diluted 
blood serum previously filtered through a Berke- 
field laboratory filter. 
The results of these experiments showed that of 
seven individuals who received subcutaneously the 
fresh or partially defibrinated blood in quantities 
of 0.3 to 5 cc., six (85.7 per cent.) developed an 
attack of yellow fever within the usual period of 
incubation of the disease, thus demonstrating that 
the specific agent of yellow fever is present in the 
blood, at least during the first, second, and third 
days of the attack, at which time the blood em- 
ployed in the experiments was abstracted. 
It also appeared that if, when blood had been 192 
WALTER REED AND YELLOW FEVER 
injected into the non-immune subject, additional 
blood was at once withdrawn in considerable quan- 
tity and transferred to tubes of nutritive bouillon, 
no organic growth could be obtained (except on 
one occasion Staphylococcus pyogenes citreus, a 
skin-contaminating organism common in Cuba) 
even when a much smaller amount injected into 
the individual as a control sufficed to produce a 
severe attack of yellow fever. 
It was further found that the specific agent con- 
tained in the blood was destroyed, or at any rate 
attenuated, by heating up to 550 C. for ten min- 
utes, so that the injection of 1.5 cubic centimetres 
of the heated defibrinated blood was harmless, 
although the injection of 0.75 cubic centimetres of 
the same defibrinated blood, unheated, sufficed to 
induce a prompt attack of yellow fever in a control 
individual. 
Of not less interest was the fact brought out by 
these experiments that yellow fever could be pro- 
duced by the injection of a small quantity of bac- 
teria—free filtrate, obtained by passing the diluted 
serum through a Berkefield filter. The writers 
conclude with the following remarks:6 
The production of yellow fever by the injection of 
blood serum that has previously been passed through 
““The Etiology of Yellow Fever: A Supplemental Note.” 
Amer. Med., Feb. 22, 1902. a filter capable of removing all test of bacteria is, we 
think, a matter of extreme importance and interest. 
The occurrence of the disease under such circumstances 
and within the usual period of incubation might be ex- 
plained in one of two ways, viz., first, upon the supposi- 
tion that the serum filtrate contains a toxin of consider- 
able potency; or, second, that the specific agent of yel- 
low fever is of such minute size as to pass readily 
through the pores of a Berkefeld filter. 
In favour of the supposition that in yellow fever an 
active toxin is present in the blood, may be cited the 
early and marked jaundice; the free haemorrhage from 
the mucous membrane of the mouth and stomach, 
doubtless due to profound changes in the capillary ves- 
sel-walls; the rapid progress of the disease to a fatal 
termination, the advanced fatty degeneration of the 
hepatic cells, as well as the marked parenchymatous 
changes found in the kidneys. If present in the blood, 
this toxin would in all likelihood be found in the serum 
filtrate obtained from the blood, and if injected in suf- 
ficient quantity might induce an attack of yellow fever 
in a susceptible individual after the usual period of in- 
cubation. In this respect it would bear analogy to the 
production of tetanus in the human being, after the 
usual period of incubation of this disease, by the sub- 
cutaneous injection of a very small quantity of tetanus 
toxin, as reported by Nicolas, in 1893, and more re- 
cently by Bolton, Fisch, and Walden. 
Against the view that a toxin is present in the serum 
filtrate, we invite attention to the innocuousness of the 
partially defibrinated blood when heated to 550 C. for 
ten minutes. . . . Here the toxin, which must have 
been present in just the same quantity as in the serum 
WORK IN YELLOW FEVER 
193  WALTER REED AND YELLOW FEVER 
194 
filtrate obtained from this blood, appears to have been 
completely destroyed by the temperature above men- 
tioned. Now, although certain bacteria are destroyed 
by this temperature, as yet we know of no bacteria toxin 
that is rendered inert by such a low degree of heat con- 
tinued for such a short time. . . . The tetanus toxin 
which has been found to be the most sensitive thus far, 
requires, according to Kitasato,7 a temperature of 6o° 
C. for twenty minutes, or 550 C. for one and one half 
hours, in order to destroy its activity. 
As a further test, and in order to determine whether 
the serum filtrate contained something more particu- 
late than a soluble toxin, we availed ourselves of the 
opportunity of observing the effect that would follow 
the transference to a third individual of blood drawn 
from one of the patients whose attack had been oc- 
casioned by the injection of 1.5 cc. of serum filtrate. If 
under these circumstances it should be found that the 
injection of a small amount of blood was followed by an 
attack of yellow fever in a third individual, the evidence 
would point in the strongest manner to the presence of 
the disease in such blood, since we can hardly believe 
that a toxin which had undergone so great dilution in 
the body of the second individual would still be capable 
of producing the disease. 
The patient who submitted to inoculation for 
the purpose of determining this crucial point was 
a young American non-immune, mentioned in the 
report simply as J. M. B. He was injected with 
7 The distinguished Japanese bacteriologist. WORK IN YELLOW FEVER 
195 
i.5 cc. of serum filtrate, and then, at the beginning 
of the eighth day after his first inoculation, was 
given a subcutaneous injection of 1.5 cc. of blood 
drawn from the venous circulation of a patient in 
whom the disease had followed the injection of 
3 cc. of serum filtrate, representing 1.5 cc. of the 
undiluted serum. At the time of the inoculation 
the subject’s condition was quite normal. After an 
inoculation of just twenty-four hours he developed 
a well-marked case of yellow fever, which ran a 
typical course and ended in prompt recovery. The 
incubation period of yellow fever in cases induced 
by the bite of the mosquito had been shown by 
Reed and by Guiteras to vary from six days one 
hour,in the longest case, to two days thirteen 
hours, in the shortest; while in cases produced by 
the injection of blood it varied from five days two 
hours to one day seventeen hours. “In view of these 
data,” Reed and Carroll remark, “we believe that 
we are justified in expressing the opinion that the 
source of infection in the case just described must 
be attributed to the injection of blood rather than 
to the injection of filtered serum derived from the 
blood, and, further, that the blood contained the 
specific agent of yellow fever, which had, there- 
fore, passed through the filter along with the fil- 
trate with which the individual in this case had 
been inoculated,” 196 
During the experiments conducted by Dr. Car- 
roll at this time an incident occurred which is an 
apt illustration of the disappointments and failures 
liable to overtake scientific investigators at all 
times, even though every source of disaster has, 
apparently, been guarded against. I give Dr. Car- 
roll’s account of it in full: 
WALTER REED AND YELLOW FEVER 
Las Animas Hospital, Havana, 
Sept. 24, 1901. 
My dear Doctor: I have a beautiful case now on 
hand, and if had obeyed orders the serum test 
would have been made. It is a pronounced case, but 
appears to be doing well. . . . 
Well, on Saturday morning I drove over to Santa 
Clara Battery, and arranged for my three men for this 
evening. From there I went to Quemados, drew more 
blood, made a few smears, examined fresh blood and 
urine, and applied mosquitoes. By 2 P. M. the serum 
had separated well (six hours), and was transferred 
with a pipette to a test-tube, both being sterile. After 
dinner at Las Animas I proceeded to the laboratory 
to filter it. My pump had been tested and found to 
work perfectly, and was directed to place it under 
lock and key and not to allow any person to interfere 
with it. A closet of large size was available, and only 
he and I had keys to it. 
It was already dark and I was working by gaslight, 
and as I had promised to come for the men at 7 P. M. 
I had no time to lose in order to inject the filtrate that 
night. I took it for granted that the pump had not been 
disturbed, but after the first few strokes the filter was forced out of the flask ( was holding both) with 
considerable force, fell on the table, and was broken, 
losing all the serum! The valve attachment of the pump 
had been reversed, so that a positive instead of a nega- 
tive pressure was obtained, with the result stated. The 
valve attachment was easily reversible, but I had made 
it a point never to change it since I saw it work in the 
store in New York. had evidently unscrewed the 
thing, and replaced it in the same position, as he 
thought. There was nothing on the outside to indicate 
the position of the pump valve, which he thought was 
in the plunger of the pump. Instead, it is screwed in as 
a separate piece between the nozzle and the barrel. As 
the heavy pressure tubing remained tied to the nozzle, 
there was no reason to suppose it had been disturbed, 
but I did notice that instead of taking the pump from 
the closet that was locked, he took it from the adjoin- 
ing one, which was not iocked. This leads me to believe 
that in his confidence in his mechanical ability he had 
taken the thing apart to show some one, and had neg- 
lected to return it to its proper compartment. 
I had tested the outfit a number of times, and it had 
never failed to work perfectly, generating a tremendous 
pressure. denies absolutely any knowledge of 
manipulation, but subsequent events prove him to be 
a ready liar. I had directed him a number of times to 
say nothing to any person about the work, or anything 
connected with it. This morning I met Dr. Guiteras, 
and told him I had a case at last. He replied: “Yes, so 
I hear. It was too bad that you had an accident with 
your serum. says that there was too much vaseline 
on the plunger, and it clogged the valve !” denied 
having spoken a word, but I convinced him that I knew 
WORK IN YELLOW FEVER 
197 198 
better, and advised him if he valued his job to keep his 
mouth closed. I have been keeping as dumb as an oyster 
while he has been keeping people posted on my work! 
WALTER REED AND YELLOW FEVER 
To this letter Reed replied: “I should have 
been tempted to have dynamited had I been 
there. It only goes to show that you cannot trust 
anybody!” 
With these experiments of Dr. Carroll’s at Las 
Animas the business of the Army Commission 
came to an end, and Dr. Reed’s own active work 
in yellow fever ceased, although his interest in the 
subject continued unchanged during the remain- 
der of his life. The results obtained by Dr. Carroll 
were embodied by the Commission in a paper pre- 
sented to the Society of American Bacteriologists 
when it met at Chicago at the close of the year 
1901, which was published in American Medicine 
for February 22, 1902, under the title, “The Eti- 
ology of Yellow Fever: A Supplemental Note.” 
This was the last publication issued in the name of 
the Commission, but some other interesting papers 
on the subject were published later by Dr. Carroll, 
and will be discussed elsewhere. 
Before concluding this chapter, a word must be 
said concerning the debt which the world owes to 
Major-General Leonard Wood, the Military Gov- 
ernor of Cuba, for his active and intelligent inter- est in the work of the Army Commission. When 
application was made to General Wood for per- 
mission to conduct experiments on non-immune 
persons, together with a request for a liberal sup- 
ply of money to be expended in rewarding volun- 
teers who should submit themselves to experiment, 
both money and authority were liberally granted. 
It was most fortunate for the work that General 
Wood was not only a man of sound judgment and 
extended sympathies, but that his scientific train- 
ing enabled him to comprehend the nature of the 
experiments which Dr. Reed proposed to under- 
take, and to appreciate their value to the world at 
large. 
Dr. Reed, in making acknowledgment of Gen- 
eral Wood’s kindness, says: “Without his ap- 
proval and assistance these observations could not 
have been carried out. But, even more than this: 
had the head of affairs in Cuba been a man of 
less intelligence, less breadth, or less knowledge, 
the work might, and probably would, have been 
far less fruitful of benefit to humanity. Wherever 
the recent discoveries concerning yellow fever are 
known, and protective measures based upon them 
are employed for the safety of communities, Gen- 
eral Wood’s hearty support of Major Reed and 
his colleagues should be remembered with respect 
and gratitude. 
WORK IN YELLOW FEVER 
199 CHAPTER IX 
PRACTICAL APPLICATION OF THE MOSQUITO 
THEORY OF YELLOW FEVER 
Disease and her ravening offspring, Pain with the thousand 
teeth, 
He drave into night primeval, the nethermost worlds beneath. 
—William Watson, The Dream of Man. 
LET us now consider for a moment the practical 
results of Dr. Reed’s discovery; in other words, let 
us ascertain whether a town or district can actually 
be freed from yellow fever, or protected against its 
invasion, by the use of methods based on the theory 
of mosquito inoculation. And, if so, what are these 
methods in detail? 
The best answer to the first of these questions 
will be found in Dr. Reed’s own account of the 
results of his theory when put into practice in the 
city of Havana, published in the Journal of Hy- 
giene for April, 1902: 
The importance of the discovery that yellow fever is 
transmitted by the bite of a certain species of mosquito 
did not fail to attract the prompt attention of the mili- 
tary governor of Cuba, himself a physician, and for- 
200 MOSQUITO THEORY OF YELLOW FEVER 
merly a distinguished member of the Medical Depart- 
ment of the United States Army. By his direction the 
theory was subjected to a practical test in the city of 
Havana, in which city yellow fever had not failed to 
make its yearly appearance during the past one hundred 
and forty years. 
Under the efficient management of the chief officer, 
Surgeon-Major William Gorgas, U. S. A., the sanitary 
regulations were so far modified as to require that 
every patient having yellow fever should not only be 
quarantined, but that his room should be promptly 
protected with wire screens, so as to prevent the pos- 
sibility of mosquitoes becoming infected by sucking the 
blood of the patient. As a second important measure, 
a systematic destruction of all mosquitoes in other 
rooms of the patient’s house, as well as in adjoin- 
ing houses, was at once begun, the fumes of pyre- 
thrum being relied upon to stupefy the insects, after 
which they were carefully swept up and buried. In 
other words, Surgeon-Major Gorgas, relying upon the 
well-known slow progress of yellow fever, sought to 
destroy all mosquitoes, infected or non-infected, within 
a given radius of each case, while at the same time 
he effectually excluded all mosquitoes from access to 
the sick. If a secondary case occurred, the same 
hygienic measures were vigorously enforced along the 
lines indicated. 
As an illustration of what has been accomplished by 
these newer sanitary regulations, I may say that, count- 
ing from the date when they were put into force, viz., 
February 15, 1901, Havana was freed from yellow 
fever within ninety days; so that from May 7 to July 
1, a period of fifty-four days, no cases occurred. Not- 
201  WALTER REED AND YELLOW FEVER 
202 
withstanding the fact that on the latter date and dur- 
ing the months of July, August, and September, the 
disease was repeatedly reintroduced into Havana from 
an inland town, no difficulty was encountered in 
promptly stamping it out by the same measures of sani- 
tation, intelligently applied, both in the city of Havana 
and in the town of Santiago de las Vegas, whence the 
disease was being brought into Havana. 
As a further illustration of the remarkable sanitary 
victory accomplished over a disease whose progress we 
have heretofore been powerless to arrest, I will close 
this paper by inviting the reader’s attention first to the 
accompanying Chart I., which shows the average mor- 
tality from yellow fever in Havana for the twenty 
years 1880—1899, inclusive, and also the mortality by 
month for the years 1900 and 1901. I will then ask 
him to examine Chart II., which shows the progress 
of yellow fever in Havana during the epidemic year 
ending March 1, 1901, when the sanitary authorities 
were putting forth every effort known at the time to 
sanitary science in order to control the march of the 
disease, and when he has satisfied himself that no effect 
whatever was produced upon the epidemic of that 
year, I will invite his attention to Chart III., which 
shows the occurrence of that disease in Havana for the 
epidemic year March 1, 1901, to March 1, 1902, dur- 
ing which year yellow fever was fought on the theory 
that the specific agent of this disease is transmitted 
solely by means of the bites of infected mosquitoes. 
By carefully comparing the figures both as to deaths 
and cases in these three charts, and recalling that be- 
tween the years 1853 and 1900 there have been re- 
corded in the city of Havana 35,952 deaths from yel- Chart I.—The unbroken line shows the average monthly mortality from yellow fever in 
Havana for the twenty years 1880-1899 inclusive; the broken line shows the mortality by 
month for the years 1900 and 1901. This was before the new era of the mosquito theory. 
203 204 
low fever, he will then be able more clearly to appre- 
ciate the value of the work accomplished by the Ameri- 
can Army Commission. 
WALTER REED AND YELLOW FEVER 
Chart II.—Shows the progress of yellow fever in Havana during 
the epidemic year ending March i, 1901, when the Sanitary authorities 
were putting forth every effort known to sanitary science in order 
to control the disease. The unbroken line shows the number of cases, 
while the broken line gives the mortality. This also was in the pre- 
mosquito period. MOSQUITO THEORY OF YELLOW FEVER 
205 
To this statement Major J. R. Kean, who used 
the paper in a somewhat abridged form after Dr. 
Reed’s death, adds the following footnote: 
Not a single case of yellow fever occurred in Ha- 
vana during the year 1902, nor, so far as known, in the 
Island of Cuba.—J. R. K. 
These facts speak for themselves, but a more 
detailed demonstration of the practical value of 
Chart III.—Shows the occurrence of yellow fever in Havana for 
the epidemic year March i, 1901, to March 1, 1902, during which year 
yellow fever was fought on the theory that the specific agent of the 
disease is transmitted by means of infected mosquitoes. Note the 
extraordinary contrast between Chart III, under the new regime, and 
Charts I and II, under the old. 
Dr. Reed’s theory is given in the results obtained 
by Dr. G. M. Guiteras, in 1903, at Laredo, Texas. 
Dr. Guiteras’ work also affords an interesting in- 
sight into the details of the method by which disin- 
fection based on the mosquito theory is carried out, 206 
WALTER REED AND YELLOW FEVER 
and shows that the desired end can be attained 
under adverse conditions, such as were present in 
Laredo, as well as under the favourable circum- 
stances which obtained in Havana. 
In 1903 Dr. Guiteras was appointed by the Sur- 
geon-General to investigate the epidemic at La- 
redo, a town of 18,000 inhabitants, and he arrived 
there on September 25, 1903, in company with 
Dr. George R. Tabor, State health officer of Texas. 
On their arrival they found that yellow fever had 
already obtained a firm foothold and was widely 
disseminated in a population consisting almost en- 
tirely of non-immunes; it was also firmly estab- 
lished in the little neighbouring town of Nuevo 
Laredo, containing about 8000 inhabitants, and 
separated from Laredo itself by the River Rio 
Grande, over which there are various avenues of 
communication. There was reason to believe that 
the disease had been imported directly from Mon- 
terey, having originally come from Tampico, Mex- 
ico, along the line of the Mexican National 
Railroad. 
On investigation it was found that the Stegomyia 
fasciata was present in enormous quantities and 
widely distributed, the conditions of the water sup- 
ply being such as to afford every facility for its 
active propagation. A private water-works com- 
pany supplied both towns, but as its rates were too MOSQUITO THEORY OF YELLOW FEVER 
207 
high for the poorer classes, the latter were in the 
habit of buying water from carts driven along the 
streets, which obtained their supply directly from 
the river. The water from both sources was so 
muddy that it was the universal custom to use bar- 
rels as receptacles, for the purpose of allowing the 
water to settle. Every house was supplied with 
from one to ten of these water-casks, which, as a 
matter of course, were kept in sheds or dark and 
shady corners. As Dr. Guiteras says, it would be 
difficult to improve on them as breeding places 
for mosquitoes. The houses of the poorer classes 
were of the worst type, many of them being simply 
adobe huts with thatched roofs, which consist of 
one room, and possibly a shed at the back, used for 
a kitchen. Others are made of lumber, with no 
attempt at apposition between the planks, and oth- 
ers again are partly or wholly constructed of tin or 
of iron, with just enough lumber to attach these 
thereto. 
On the 26th of September [says Dr. Guiteras],1 an 
office was established in the central part of the city for 
the transaction of business and on the following day the 
sanitary corps under my command was given a definite 
organisation. Four mosquito sections had been formed, 
with an acting assistant surgeon in charge of each, 
1 “ The Yellow Fever Epidemic of 1903, at Laredo, Texas.” 
Jour. Amer. Med. Assoc., July 9, 1904. 208 
WALTER REED AND YELLOW FEVER 
and Past Assistant-Surgeon Von Ezdorf given general 
supervision over the entire squad. Each section con- 
sisted of about eight men, one of whom was a car- 
penter, and another was designated as foreman and had 
charge of the material. Each section was supplied with 
a cart containing all the material necessary for the work, 
to wit: Sulphur and pyrethrum powder in sufficient 
quantity, twenty-five pots, twenty-five pans, five-gallon 
can of wood alcohol, roll of paper, shears, knives, 
bucket of paste, brushes, brooms, wall-brushes, mos- 
quito netting, a number of strips of lath, nails, hatchet, 
saw, ready-made screen doors and windows, ladder, 
five-gallon can of kerosene oil. 
Within a short time the above system was somewhat 
modified, with the object of gaining time and effective- 
ness. The carpenters were separated from the general 
disinfecting section and formed at first into two and 
later into three “screening” sections. These were com- 
posed each of two or three carpenters, supplied with 
a wagon carrying tools, lumber, mosquito bars, and 
mosquito netting. The modus operandi was then as 
follows: 
Immediately on a case (whether suspicious or posi- 
tive) being reported to us by the state board of health 
or by anyone having authority to do so, a screening sec- 
tion was at once sent out and the infected house 
“screened.” This “screening” varied according to cir- 
cumstances. Unnecessary doors and windows were shut 
tight. One window and a door of the patient’s room 
were left open for ventilation and to admit those caring 
for him, and both of these were fitted with wire screens. 
Often the conditions did not admit of this. The shacks 
or “jacals” of the poorer classes consisted of but one MOSQUITO THEORY OF YELLOW FEVER 
209 
room with innumerable openings in the walls and 
room. Screening was impracticable here, and the pa- 
tient was placed under a mosquito bar. Towards the 
end of the epidemic I had a portable mosquito house 
built, covered with wire gauze and with double doors, 
which was applicable to such cases. The patient being 
thus isolated and rendered as safe as possible against 
propagating the disease by infecting the mosquito, the 
disinfecting section would come along and disinfect the 
premises and surrounding houses to kill the insects 
already infected. It was also the duty of the disinfect- 
ing section to pour oil into all cisterns, barrels, or other 
receptacles of stagnant waters found on the premises 
disinfected. 
The details of the disinfecting process were as fol- 
lows : The room or house was made mosquito-tight. 
To accomplish this, all doors and windows were closed. 
Paper was then cut into strips and pasted over all cracks 
or openings through which mosquitoes might escape; 
the chimney was made secure. In many cases houses 
were in such bad condition that they had to be almost 
completely both inside and out, and large 
unprotected openings covered entirely with sheets of 
paper. In the meantime the pots were being filled with 
sulphur or pyrethrum, as the case might demand, and 
placed in position on pans filled with water. These 
water-pans served a double purpose, to prevent danger 
from fire and for the purpose of collecting mosquitoes, 
for experience had shown that after disinfection nearly 
all the dead mosquitoes within the room were found in 
the pans. . . . 
The pots and pans being in position, about fifty cubic 
centimetres of alcohol were poured on the sulphur, 210 
WALTER REED AND YELLOW FEVER 
or pyrethrum, as the case might be, and the contents 
ignited. Then, without loss of time, the disinfectors 
would retire, closing the last door of exit and pasting 
paper over any cracks that might be found in it. When 
the house admitted of it, all rooms except that of the 
patient were first disinfected, and he was then removed 
to one of the disinfected rooms, duly protected from 
mosquitoes, so as to permit of the disinfection of the 
room occupied by him. . . . For the purpose of mos- 
quito disinfection, sulphur was burned in the propor- 
tion of four pounds to the one thousand cubic feet, 
with four hours’ exposure; pyrethrum, six pounds to the 
one thousand cubic feet, with six hours’ exposure. On 
the termination of the disinfection the house was opened 
and the floors, walls, furniture, etc., carefully swept for 
the purpose of collecting all asphyxiated mosquitoes 
and immediately incinerating them. . . . 
The above plan was adhered to until the end of the 
epidemic, with the modification that the duties of oiling 
cisterns, barrels, and receptacles of all kinds assumed 
such proportions that on October 9 an oiling section 
was organised and set to work. This section was put in 
charge of Acting Assistant Surgeon Frick, with a wagon 
carrying the necessary material. Subsequently it was 
divided into two sections, one attending to the sprink- 
ling of the streets, pools, ponds, and other large bodies 
of standing water; the other looking after water-bar- 
rels, cisterns, pails, tin cans, and all other water con- 
tainers found in the neighbourhood of houses. 
Naturally much opposition arose against the oiling of 
the water-barrels, especially among the ignorant classes, 
who were led to believe that our object was to poison 
the water. On several occasions this opposition assumed MOSQUITO THEORY OF YELLOW FEVER 
211 
serious and menacing proportions, so much so that the 
lives of the officers and men engaged in the work were 
threatened. To obviate this difficulty it was decided to 
put wooden faucets into the barrels of drinking water, 
so that the water might be drawn from below, free from 
oil contamination. The oiling section was duly supplied 
with these faucets, with instructions to apply them to 
all barrels containing water for drinking purposes. This 
measure was very effective in allaying irritation and 
avoiding trouble with the people. . . . Within a 
short time the oiling section, under its efficient chief, 
became so apt in its duties that the entire city could be 
inspected and oiled in five or six days, so that within 
that time every water container and other deposit of 
standing water was inspected and treated, making it im- 
possible for the mosquito larvae to arrive at maturity. 
In spite of all these efforts the epidemic contin- 
ued to increase so alarmingly that disinfection of 
infected houses was not found sufficient, and a sys- 
tematic and complete disinfection of the entire city 
was begun. Two sections of disinfecting parties 
were started, therefore, one at the southeast and 
another at the northeast extremities of the town, 
working towards each other. Every house and 
building was included in this disinfection: schools, 
public buildings, and churches, no matter whether 
they had or had not been previously disinfected. 
The following table, published by Dr. Guiteras, 
gives an estimate of the work done from September 
26 to November 30: 212 
WALTER REED AND YELLOW FEVER 
Houses or rooms screened 304 
Patients screened under mosquito bars 115 
Houses disinfected 2,952 
Rooms disinfected 10,045 
It was estimated on careful calculation that there 
were at that time 2963 houses in Laredo, and of 
these 580, or 19.54 Per cenG were infected. 
Great difficulty was experienced in carrying out 
the work on account, especially, of the lack of 
authority to enforce the necessary procedures and 
the ignorant prejudice of the people. A large part 
of the inhabitants of Laredo were possessed of the 
idea that the physicians and the authorities were in 
a conspiracy to make money. They even went so 
far as to believe very generally that the physicians 
poisoned their patients to get rid of them and thus 
end the epidemic, and, incredible as it may appear, 
these opinions were supported by one or two 
(irresponsible) newspapers published in Laredo. 
Under these circumstances it is not surprising that 
all possible means were used to secrete cases of 
yellow fever from the physicians and inspectors. 
Patients very ill with the disease would hide them- 
selves or be hidden by their relatives, until at last 
it became necessary to institute a house-to-house 
inspection under the direction of the health officer, 
and, later, of volunteer inspectors, appointed by 
the Mayor. After a short time these efforts were MOSQUITO THEORY OF YELLOW FEVER 
213 
supplemented by the better class of citizens, who 
became interested in the work and offered their 
services. 
Lack of authority to carry out sanitary measures 
was, however, the most important obstacle to suc- 
cess, and it may be said here, once and for all, that 
the course of affairs in Laredo showed that results 
such as were obtained in Havana during the Amer- 
ican occupation cannot be achieved, if the disease 
is at all widespread, unless undisputed authority 
is placed in the hands of the sanitary authorities 
by government. The power exercised in Havana 
really amounted to martial law, and when it is 
considered what the shortening of an epidemic 
means in the saving of life, the reducing of expen- 
diture, and the conservation of commercial and 
railroad interests, it becomes, as Dr. Guiteras says: 
A serious question whether under such circumstances 
the establishment of martial law, or something equiva- 
lent to it, should not be the first step taken in the sup- 
pression of an outbreak of yellow fever, or, in fact, any 
of the epidemic diseases. ... In most epidemics 
the hardships endured by the people, the loss of life, 
the interruption of commerce, causing heavy financial 
losses, all are greater than in the case of riots or other 
financial disturbances of the peace for which ordinarily 
martial law is imposed. Such being the case, it is not 
clear why this efficient means of combating an epidemic 
should not be more strongly recommended, nor why so 214 
WALTER REED AND YELLOW FEVER 
much opposition should be aroused against it when it 
is suggested. 
Under martial law the Laredo epidemic could 
have been controlled, in Dr. Guiteras’ opinion, 
within three or four weeks after the disease had 
been officially declared, on September 25, while, 
as a matter of fact, the desired end was not attained 
for nearly two months, the quarantine against 
Laredo by the State of Texas not being raised until 
November 30. Even under all disadvantages, how- 
ever, the disease was completely eradicated. 
Further conclusive evidence of the practical 
value of Dr. Reed’s discovery has been given to the 
world since this memoir of him was begun, by the 
records of the epidemic in New Orleans in 1905. 
I have been so fortunate as to obtain, through 
the good offices of my friend, Dr. Rudolph Matas, 
a brief account of this epidemic from the pen of 
Dr. J. H. White, Surgeon of the United States 
Public Health and Marine Hospital Service, who 
was in command at New Orleans during the sum- 
mer of 1905: 
New Orleans, La., 
November 21, 1905. 
Dr. Rudolph Matas, 
My dear Doctor Matas : In compliance with your 
request, I submit the following statement with regard to the yellow fever epidemic of 1905, and am sorry 
that all the statements made cannot be exact, for the 
reason that the data have not as yet been worked up. 
From information at hand, it appears that the local 
Board of Health, being informed on the 12th day of 
July of the existence of yellow fever in the neighbour- 
hood of the French Market, undertook to stamp it 
out by the fumigation of infected houses, the empty- 
ing of water barrels, and the oiling of cisterns, etc., in 
accordance with modern ideas, but with untrained men 
and means entirely inadequate for the huge task which 
confronted them, it being probable that Dr. Kohnke’s 
estimate of 100 cases and 20 deaths up to July 20, 
was an under-, rather than an over-, estimate, and the 
number of concealed foci, therefore, in excess of what 
he had supposed. 
For two or three years prior to this time Dr. 
Kohnke, as City Health Officer, had endeavoured to 
inculcate the idea of mosquito transmission, and, al- 
though his efforts were apparently unsuccessful, there 
must have been some results accomplished, as shown 
by the readiness with which all classes of the people 
subscribed to this doctrine in July and August, there 
being practically no exception worthy of mention, out- 
side of the superstitious and ignorant alien popula- 
tion. 
The Citizens Volunteer Ward Organisation, under 
the command of the Rev. Dr. Beverley Warner, began 
on or about July 24 a general fight on the mosquito, 
which was of great value, as may be readily seen, it 
being beyond question that a great reduction in the 
number of mosquitoes took place as a result thereof, 
MOSQUITO THEORY OF YELLOW FEVER 
215 216 
WALTER REED AND YELLOW FEVER 
the number to be infected being necessarily reduced in 
like proportion. 
It is difficult to estimate how many cases existed on 
the 21 st day of July, when the presence of the epidemic 
became known to the world at large, my own estimate 
being 148 cases and 24 deaths as the minimum, and a 
mathematical calculation would lead back to about the 
middle of May, possibly earlier, as the date of the first 
case. 
On the 4th of August the citizens requested that the 
work of eliminating the disease be turned over to the 
Public Health and Marine Hospital Service, sending a 
message to this effect to the President, and the neces- 
sary orders were issued. 
The funds for all of the work, except the pay of the 
officers, were furnished by the citizens, the State, and 
the city; on August 8 the work was placed in charge 
of the Public Health and Marine Hospital Service, 
and on the next day organisation was begun. I wish 
to make it plain that there was one central organisa- 
tion prior to the time the Service took control, and 
that the division of the work and establishment of ward 
organisations was made by me because I believed the 
work too stupendous to be handled from one office. 
Seventeen sub-headquarters were therefore established. 
When the Service took hold of the work there 
had been 616 cases and 112 deaths by the record, and 
four days after this the maximum daily report was 
made, showing 105 cases on August 12. After this 
the number of cases per day declined, until the date 
in September shortly following drastic measures taken 
to ascertain concealed cases, which action was followed 
by a sharp rise in the number of cases, which, in turn, MOSQUITO THEORY OF YELLOW FEVER 
217 
was succeeded by a genuine decline that continued to 
the end. 
As previously stated, there* was practically no oppo- 
sition to the sanitary measures after the starting of the 
campaign of education by the medical profession and 
the Citizens Volunteer Ward Organisation, and it 
may be stated, broadly, that within one week there was 
no opposition worthy to be called such. 
I had never before had the pleasure of seeing a cos- 
mopolitan population, or even one of a homogeneous 
character, respond so readily to rational teaching and 
place so little obstruction in the way of the rational 
work which was necessary to be done. The gigantic 
natural difficulties in the way, the topography of the 
city lending itself to the breeding of mosquitoes, made 
the co-operation of the profession and of the people at 
large an absolutely essential pre-requisite to success, 
which co-operation, I am glad to say, was freely given 
and success attained. 
The work itself was done from the ward headquar- 
ters, seventeen in number, of which I have spoken 
above, and was performed entirely in accordance with 
the findings of Walter Reed, the first step in any case 
of known infection being to thoroughly screen the 
sick room and place a mosquito bar over the patient, 
following this as soon thereafter as possible with a 
total destruction of all mosquitoes, both in the sick 
room and in the house. All rooms were sealed with 
paper strips on the inside, in order to prevent the mos- 
quitoes from getting into cracks and thus escaping the 
fumigation. In every reported case, where opportu- 
nity was offered, an effort was made to trace its origin; 
namely, to ascertain at what house the patient had 218 
WALTER REED AND YELLOW FEVER 
visited during the six days preceding his illness, and in 
this way many hitherto unknown foci were discovered 
and blotted out. 
To give some idea of the vastness of such an under- 
taking in a city having a population of 325,000, with 
infection scattered from one end to the other, the fol- 
lowing facts should be borne in mind : 
The total area of this city occupied by dwellings 
and places of business is 44 square miles, although the 
geographical area is 196 square miles. There are, ap- 
proximately, 60,000 houses and 70,000 cisterns. 
During this period of our work we used a sufficient 
quantity of a five to ten per cent, solution of salt to salt 
75 miles of gutters, this requiring nearly 3,000,000 
pounds of rock salt. 
We made 300,000 house-to-house inspections; dis- 
infected 55,151 rooms, burning for this purpose, in 
round figures, 200 tons of sulphur and 5000 pounds of 
pyrethrum. We used about 60,000 gallons of oil in 
gutters and cisterns. 
There were employed in the work 25 commissioned 
officers, 42 acting assistant surgeons, and three pharma- 
cists, while the number of disinfectors, screeners, and 
ordinary labourers employed from time to time was 
over 4000, the largest number at any one time being 
1276. 
The cost of the campaign to the Public Health and 
Marine Hospital Service was about $50,000; and to 
the city, including the sums appropriated by the State, 
the city, and the citizens, $240,000, making a grand 
total of about $290,000. 
The last well-authenticated case of yellow fever was 
reported on the 5th day of November, and of cases MOSQUITO THEORY OF YELLOW FEVER 
219 
which obtained their infection in the city there have 
been practically none since the ist of November. 
At the present writing, November 21, there has been 
no frost nor any very near approach thereto. 
I wish to accentuate the fact that, accepting Reed’s 
findings in toto, and not in part, I did not quaran- 
tine against infected communities, but allowed people 
from such places to enter the city freely, simply watch- 
ing them in order that any developing case might be 
cared for. This involved a little trouble and expense, 
but no harm was done, and the additional expense thus 
incurred was not a tithe of what would have been 
necessary in an effort to quarantine the city. I cannot 
too strongly express my views on this point, and one 
of the prime objects I had in view from first to last 
was to illustrate to the people of New Orleans and to 
the world at large, that under rational methods there 
is no more necessity for quarantining a city against 
yellow fever than there would be to do so against 
typhoid fever. If the people and the profession will 
co-operate, there is absolutely no danger of a spread, 
and I believe it a duty incumbent upon the latter to 
preach this doctrine until it is universally accepted. It 
certainly was demonstrated here by allowing several 
hundred people to come into New Orleans from Pat- 
terson and other infected points, and to go freely wher- 
ever they would in the city, no harm resulting in any 
instance. Very sincerely yours, 
J. H. White. 
A strong proof of the assurance of safety afforded 
by the present methods of fighting yellow fever 
and of the confidence arising from them is shown 220 
WALTER REED AND YELLOW FEVER 
by the cheerful spirit with which the citizens of 
New Orleans encountered the epidemic of 1905, 
and the light-heartedness which pervaded the 
town, in marked contrast to the gloom that, in for- 
mer times, always hung like a pall over such scenes. 
Mr. Rupert Boyce, Dean of the Liverpool School 
of Tropical Diseases, who was sent to New Orleans 
by that association as envoy charged to investigate 
yellow fever, has described this state of things most 
graphically in the Southern Magazine for October, 
1905. 
In one respect New Orleans has set an example to all 
the world in the fight against yellow fever. Coming, 
as I did, a stranger, but a stranger who has seen many 
campaigns against similar diseases, the first impression 
that struck me was the complete organisation of the 
citizens, and the rational and reasonable way in which 
the fight has been conducted by them. When I alighted 
from the car the first thing that greeted my eyes was a 
placard—of which tens of thousands have been dis- 
tributed—bearing the words: 
WEAR A SMILE ON YOUR FACE 
AND A 
FLOWER IN YOUR BUTTONHOLE. 
Everywhere I went I saw these. The force with 
which such evidences of the light-hearted spirit in which 
the citizens of New Orleans sallied forth to win this 
fight strikes one who has been a witness to the pro- 
found gloom, distress, and woe that cloud every other 
epidemic city cannot be estimated. MOSQUITO THEORY OF YELLOW FEVER 
221 
That is the spirit which has led to victory. That is 
the light heart and gay song which nerves the warrior 
to invincibility. To go at the enemy laughing, and to 
fight with a jest, means always to overcome with a 
glorious victory. 
When I came, in the first part of September, I found 
the whole country organised. The municipality was 
organised by wards; the medical profession was organ- 
ised by flying squadrons; the State was organised by 
parishes. With a tangible enemy in view, the army of 
defence could begin to fight rationally and scientifically. 
Every individual citizen of every city and town, but 
especially of New Orleans, had taken to himself new 
heart of grace, because he knew what he had to fight. 
To me, coming as I did from many campaigns against 
tropical diseases in many an odd corner of the world, 
this organisation appealed more strongly than I can 
say. An example to the world has been set, an example 
to every city in the civilised world which shall hence- 
forth be attacked by similar diseases. 
And the work of the Marine Hospital Service struck 
the heart of the beholder with joy. Cleanly, swiftly, 
scientifically, the olive-green uniforms darted hither and 
thither, into dens of filth and obscurity, opening up 
every corner to the bright light of science, working 
heroically, and withal so swiftly that it was like watch- 
ing a huge machine, well oiled and efficacious, perform- 
ing a marvellous task with perfect show of ease. 
I subjoin a table, furnished me by Dr. L. O. 
Howard, of the United States Department of 
Agriculture, showing figures comparing the recent 
epidemic at New Orleans with those of previous 222 
WALTER REED AND YELLOW FEVER 
years. The table was drawn up for epidemics prior 
to 1905 by Dr. Stanford E. Chaille, the figures for 
1905 having been added by Dr. White or one of his 
assistants. The epidemics of 1867 and 1878 are 
those which should be compared with those of 
1905, and on doing so it will be seen that whereas 
there were 3107 deaths in 1867 and 4046 in 1878, 
there were only 452 in 1903, although the epidemic 
of the latter year promised in the beginning to be 
more severe than the others. It should also be 
noted that the Public Health and Marine Hospital 
Service did not begin its anti-mosquito work until 
August 12, of 1905. It is, as Dr. Howard says, an 
overwhelming proof of the efficacy of treatment on 
the mosquito basis. 
COMPARATIVE TABLE OF DEATHS FROM YELLOW FEVER 
IN NEW ORLEANS 
MONTHS 
1847 
1848 
1853 
1854 
1855 
1858 
1867 
1878 
1905 
May 
2 
June 
4 
31 
2 
5 
2 
3 
July 
74 
33 
1521 
29 
382 
132 
11 
26 
57 
August 
965 
200 
5133 
532 
1286 
1140 
255 
1025 
224 
September 
1100 
467 
982 
1234 
874 
2204 
1637 
1780 
in 
October 
198 
126 
I4i7 
490 
97 
”37 
1072 
1065 
56 
November 
12 
20 
28 
131 
19 
224 
103 
147 
4 
December 
10 
4 
7 
7 
i5 
26 
3 
Months unknown 
445 
22 
Totals 
2804 
872 
7848 
2425 
2670 
4854 
3107 
4046 
452 MOSQUITO THEORY OF YELLOW FEVER 
223 
The epidemics of 1848, 1854, and 1855 are least 
comparable for 1905, because they immediately 
succeeded severe epidemics to which were due very 
many immunes. 
Population of New Orleans by U. S. Census, 
130,565 in 1850; 168,675 in i860; 191,418 in 1870; 
216,090 in 1880; and 287,104 in 1900. 
Dr. White, it will be noticed, speaks strongly 
against unnecessary quarantine regulations, believ- 
ing that the struggle with yellow fever on Dr. 
Reed’s principles renders such regulations as pre- 
vailed in former times entirely superfluous, while 
the injury they inflict on commercial interests can 
hardly be estimated. I think that before leaving 
this subject some account of Dr. Reed’s own views 
on the subject of quarantine will be in place.2 
Under the admirable system of inspection and re- 
ports as carried out by the Marine Hospital Service, 
the appearance of yellow fever at any foreign port is 
promptly reported for the information of the health 
authorities of our several Atlantic ports. We may 
therefore, divide foreign ports within the so-called epi- 
demic zone into (1) infected and (2) non-infected 
ports. Heretofore no distinction has been made by the 
health officers of our Southern ports as regards quaran- 
tine regulations from April 1 to November 1 between 
infected and non-infected places. All ports within the 
2 “ The Prevention of Yellow Fever.” Med. Rec., Oct. 26, 
1901. 224 
WALTER REED AND YELLOW FEVER 
epidemic zone of yellow fever were considered as being 
infected places, and hence passengers and vessels were 
subjected to disinfection of both baggage and cargoes. 
With our present knowledge of the way in which 
yellow fever is propagated, we believe that in the treat- 
ment of passengers, as well as of cargoes, a sharp dis- 
tinction should be made, first, between infected and 
non-infected ports, and second, in the case of vessels 
sailing from infected ports, between those that have 
received their cargoes and passengers in mid-stream 
and those that have loaded at the wharf. We believe 
that no quarantine restrictions should be placed upon 
either passengers or cargo from non-infected ports. 
In the case of a vessel loading in mid-stream at an in- 
fected port by means of lighters, we believe that she 
can only receive infection in one way, i. e., by passen- 
gers who have been exposed to yellow fever on shore, 
and who, coming on board, may thereafter be seized 
with the disease. The possibility of infected mosqui- 
toes reaching the vessel either by flight or by means of 
lighters, may be considered as highly improbable. 
Vessels loaded under the foregoing circumstances, 
i. e., by lighters in mid-stream, and arriving at our 
ports without yellow fever developed en route should 
have their non-immune passengers quarantined for five 
days, counting the time consumed by the voyage as 
part of the quarantine period, and should be allowed 
to discharge their cargoes without delay. If the disease 
has developed en route among the crew or passengers, 
the sick should be promptly removed—the forecastle 
or staterooms, as the case may be, thoroughly disin- 
fected with sulphur or formaldehyde gas, and the ves- 
sel allowed to proceed to her wharf. MOSQUITO THEORY OF YELLOW FEVER 
225 
On the other hand, if the vessel has received her 
cargo at the wharf of an infected port, there is a pos- 
sibility that she may have received infection in one of 
three ways: first, either by contaminated mosquitoes 
that have bitten a case of yellow fever in the immediate 
vicinity on shore; second, by mosquitoes that have be- 
come infected from biting a yellow fever patient pres- 
ent on another vessel loading at the same or at an 
adjacent wharf; or, third, by some individual who has 
acquired an infection on shore and afterward taken 
passage on the vessel. 
In our opinion, however, the chances of infection of 
a vessel from contaminated mosquitoes coming aboard 
from a house or ship in close proximity are very slight, 
although such a possibility must be admitted, as well 
as the further possibility that recently infected mos- 
quitoes may have sought refuge on the vessel during the 
night preceding her departure. It is also possible that a 
case of mild, and hence undetected, yellow fever, may 
occur on board, and be the source for the infection of 
mosquitoes already present in the vessel. 
Under these circumstances, if a sufficient number of 
days have not elapsed between her port of departure 
and her port of arrival in the United States, i. e.f six- 
teen to twenty-one days, to demonstrate the presence 
of the infected mosquitoes by the occurrence of a case 
or cases of yellow fever en route, we know of no way 
of absolutely excluding the possibility of importation 
of the disease by such vessel, than by detention of 
all non-immune passengers for such number of days as 
will show their freedom from infection, and by careful 
disinfection of crew’s and passengers’ quarters. If 
more than twenty days have elapsed during the voyage 226 
WALTER REED AND YELLOW FEVER 
without the occurrence of yellow fever, we see no good 
reason why either passengers or vessel should be 
detained. 
We have said nothing about the disinfection of the 
vessel’s cargo for the reason that we do not consider 
this to be necessary. The only possible excuse for sub- 
jecting the cargo to disinfection would be the fear of 
the presence of infected mosquitoes in the vessel’s hold, 
provided she had loaded at the wharf of an infected 
port. In this instance, if the voyage has consumed five 
or more days, all mosquitoes contained in the hold will 
have died; for, Stegoviyia fasciata lives only two days 
if deprived of water. We cannot too strongly insist that 
the danger of importation of yellow fever into the 
United States lies, not in the cargo or personal baggage, 
but in the individual sick with the disease. With our 
present knowledge of its propagation, personal baggage 
should no longer be subjected to disinfection, and with 
our increased ability to prevent its spread by measures 
easy of application, instances should be few and ex- 
ceptional when a vessel coming from a yellow fever 
port should be delayed longer than will be necessary 
to remove her non-immune passengers who have not 
completed their period of five days since leaving the 
port of departure. 
The chief duty of quarantine officers hereafter will 
consist in the detection of mild, or very mild, cases of 
yellow fever. . . . While the exclusion of such cases is 
of the greatest importance, we doubt, however, whether, 
with our improved knowledge of how to prevent the 
spread of yellow fever, it would be advisable to place 
a greater burden upon ship’s passengers by extending 
the quarantine period to more than five days. It ap- MOSQUITO THEORY OF YELLOW FEVER 
pears to us rather, that, in view of the troublesome 
delays to which passengers and vessels from yellow 
fever ports have been subjected in the past, the time 
has now arrived when, standing upon more solid 
ground, we will be justified in seeking in every way to 
lessen as much as possible the restrictions placed by 
present quarantine regulations upon the ship’s cargo, 
while we are adding to those of the passengers. 
Anyone who reads the little volume of quaran- 
tine regulations issued in 1899 by Surgeon-General 
Walter Wyman, of the Public Health and Marine 
Hospital Service, from which I have extracted in 
the following chapter, will realise how great a 
difference in quarantine has been made by our 
present knowledge of yellow fever, in money, in 
time, in labour, in commercial injury, and in per- 
sonal annoyance. 
227 CHAPTER X 
THE VALUE OF DR. REED’S WORK TO 
THE WORLD 
And the king said, What honour and dignity hath been 
done to Mordecai for this? Then said the king’s servants that 
ministered to him, There is nothing done for him. 
—Esther vi. 3. 
NO consideration of Dr. Reed’s life and work 
would be complete which did not place in high 
relief the suffering and sorrow from which he has 
freed mankind. I make no apologies, therefore, for 
describing as graphically as possible the horrors 
which occurred during epidemics of former times, 
in order to emphasise the fact that, thanks to the 
labours of Dr. Reed and his colleagues, the country 
need never be visited by another. 
Between the years 1702 and 1878 yellow fever 
appeared in the United States, according to Keat- 
ing, one hundred and twelve times, its invasions 
being most frequent and most destructive in the 
Southern States, although they reached as far north 
as Nantucket Island, Mass., where 259 persons 
died of it in 1763, a mortality, which, considering 
228 VALUE OF DR. REED’S WORK 
229 
the small size of the island, must have represented 
a very high rate. 
The first epidemic concerning which we have 
reliable information is that which visited Philadel- 
phia in 1793. This has been vividly described by 
Dr. Benjamin Rush, and by Mr. Mathew Carey, a 
member of the citizens’ “Committee for Relieving 
the Sick and Distressed,” both writing immediately 
after its cessation; and by La Roche, writing in 
1855. 
The epidemic began in August with a few 
scattered cases, which Rush tells us were so mild 
as not to excite suspicion of their real character. 
The first patient which Dr. Rush attended was the 
child of his friend, Dr. Hodge, whom he saw on 
the 5th of August, when he made a diagnosis of 
bilious fever. His suspicions were aroused, how- 
ever, by several similar cases that followed, and on 
the 19th of the month he was called to a Mrs. Le 
Maigre of Water Street, whose symptoms con- 
vinced him of the real character of the disease now 
rapidly increasing in the city, and he, in conjunc- 
tion with certain other physicians, made known the 
condition of things to the College of Physicians. 
The first official notice of the disease took place on 
August 22, when the Mayor, Matthew Clark- 
son, wrote to the City Commissioners, giving the 
most peremptory orders as to the cleansing of the 230 
WALTER REED AND YELLOW FEVER 
streets, and on the 26th of the month the College 
of Physicians issued, through the medium of the 
newspapers, a list of precautions proper to be used 
against the spread of the disease. In the light of 
our present knowledge we see that these measures 
could have done nothing for the safety of the peo- 
ple, and we are not surprised to learn that the 
disease gained ground with the utmost rapidity, 
so that by the end of August the city was in all 
the horrors of an epidemic. 
Mathew Carey’s account of the period, entitled 
“A Short Account of the Malignant Fever Lately 
Prevalent in Philadelphia,” 1 is a valuable history 
of the epidemic. It contains a list, based on burial 
returns, of the dead between the first of August and 
the middle of September, which is probably the 
most complete on record, and numbers 4041. 
The consternation of the people of Philadelphia 
[writes Carey] at this period was carried beyond all 
bounds. Dismay and affright were visible in the counte- 
nance of almost every person. Of those who remained 
many shut themselves in their houses and were afraid 
to walk the streets. . . . 
The corpses of the most respectable citizens, even 
those who did not die of the epidemic, were carried to 
the grave on the shafts of a chair (chaise), the horse 
driven by a negro, unattended by a friend or relative, 
1 Published by the author, ist edition, Nov. 13, 1793. VALUE OF DR. REED’S WORK 
231 
and without any sort of ceremony. People hastily 
shifted their course at the sight of a hearse coming to- 
wards them. Many never walked on the footpath, but 
went into the middle of the streets, to avoid being in- 
fected in passing by houses wherein people had died. 
Acquaintances and friends avoided each other in the 
streets and only signified their regard by a cold nod. 
The old custom of shaking hands fell into such disuse 
that many shrunk back with affright at even the offer 
of the hand. A person with a crape, or any appearance 
of mourning, was shunned like a viper. And many 
valued themselves highly on the skill and address with 
which they got to the windward of every person they 
met. Indeed, it is not probable that London, at the last 
stage of the plague, exhibited stronger marks of terror 
than were to be seen in Philadelphia from the 24th or 
25th of August till pretty late in September. 
While affairs were in this deplorable state, and the 
people at the lowest ebb of despair, we cannot be as- 
tonished at the frightful scenes that were enacted, which 
seemed to indicate a total dissolution of the bonds of 
society in the nearest and dearest connections. Who, 
without horror, can reflect on a husband deserting his 
wife, united to him, perhaps, for twenty years, in the 
last agony—a wife unfeelingly abandoning her husband 
on his death-bed—parents forsaking their only children 
without remorse—children ungratefully flying from 
their parents and resigning them to chance, without an 
inquiry after their health or safety—masters hurrying 
off their faithful servants to Bush-Hill, even on suspi- 
cion of the disease, and that at a time when, like Tar- 
tarus, it was open to every visitant, but never returned 232 
WALTER REED AND YELLOW FEVER 
any—servants abandoning tender and humane masters, 
who only wanted a little care to restore them to health 
and usefulness—who, I say, can even now think of 
these things without horror? . . . 
A woman, whose husband and two children lay dead 
in the room with her, was seized with the pains of 
labour, without a mid-wife, or any other person to as- 
sist her. Her cries from the window brought up one of 
the carters employed by the committee for the relief of 
the sick. With his assistance she was delivered of a 
child, which died in a few minutes, as did the mother, 
who was utterly exhausted by her labour, by the dis- 
order, and by the dreadful spectacle before her. And 
thus lay in one room no less than five dead bodies, an 
entire family, carried off in an hour or two. 
In contrast to these painful scenes it should be 
mentioned that the city was never without many 
beautiful exhibitions of charity and humanity. One 
of these, which, although no greater than that of 
others, was perhaps more extensive in its results, 
was that of Stephen Girard, a native of France and 
a wealthy merchant of the city. He became so 
touched by the desolate condition of the patients 
in the public hospital at Bush-Hill that he offered 
to superintend the hospital management himself 
while the fever lasted, and a Pennsylvanian, Peter 
Helm, offered his services to the same end. No 
greater act of charity could have been shown, 
for the Bush-Hill Hospital was in a most de- VALUE OF DR. REED’S WORK 
233 
plorable condition described by Carey in vivid 
terms. 
A profligate, abandoned set of nurses and attendants 
(hardly any of good character could at that time be 
procured) rioted on the provisions and comforts pro- 
vided for the sick, who (unless at the hours when the 
doctors attended) were left almost entirely destitute of 
every assistance. The sick, the dying, and the dead were 
indiscriminately mingled together. Not the smallest ap- 
pearance of order or regularity existed. It was, in fact, 
a great human slaughter house, where numerous vic- 
tims were immolated at the altar of riot and intemper- 
ance. No wonder, then, that a general dread of the 
place prevailed through the city, and that a removal to 
it was considered as the seal of death. In consequence 
there were various instances of sick persons locking their 
rooms and resisting every effort to carry them away. At 
length the poor were so much afraid of being sent to 
Bush-Hill that they would not acknowledge their illness 
until it was no longer possible to conceal it. For it is 
to observed that the fear of contagion was so preva- 
lent that as soon as anyone was taken sick an alarm was 
spread among the neighbours and every effort was used 
to have the sick person hurried off to Bush-Hill, to 
avoid spreading the disorder. The cases of poor people 
forced in this way to the hospital, though labouring 
only under common colds and common fall fevers, are 
numerous and afflicting. . . . 
But the case was soon altered under the direc- 
tion of the managers, Girard and Helm. They in- 234 
WALTER REED AND YELLOW FEVER 
troduced such order and regularity and had the 
patients treated with so much care and tenderness 
that they retrieved the character of the hospital, 
and in the course of a week or two numbers of sick 
people, who had not at home proper persons to 
nurse them, applied to be sent to Bush-Hill. 
Some slight excuse for the condition of Bush- 
Hill may be found in the fact that soon after the 
epidemic began all of the guardians of the poor 
except three, namely, James Wilson, Jacob Tom- 
kins, and William Sansom, ceased the performance 
of their duties and nearly all of them moved out of 
the city. The whole care of the poor, therefore, the 
providing for Bush-Hill, the sending of the sick 
there, and the burying of the dead had devolved 
upon these three “faithful among the faithless 
found.” Two of them, James Wilson and Jacob 
Tomkins, both excellent and indefatigable young 
men, whose services were of the utmost value, fell 
victims to their devotion. The third William San- 
som, was likewise taken ill and brought to the brink 
of the grave, but fortunately escaped with his life. 
The number of the physicians in the city was, of 
course, quite inadequate to afford the necessary 
attendance upon the ill and dying, although nearly 
all of them were faithful to their post in danger 
and fulfilled their duties with the utmost courage. 
Some idea of the terrible strain imposed by the VALUE OF DR. REED’S WORK 
235 
circumstances upon the physician himself may be 
gathered from the graphic account given by Dr. 
Rush of his own experiences.2 
Between the 8th and 15th of September I visited and 
prescribed for between a hundred and a hundred and 
twenty patients a day. Several of my pupils visited a 
fourth or fifth of that number. For a while we refused 
no calls. In the short intervals of business, which I 
spent at my meals, my house was filled with patients, 
chiefly the poor, waiting for advice. For many weeks I 
seldom ate without prescribing for numbers as I sat at 
my table. . . . From my constant exposure to the 
sources of the disease my body became highly impreg- 
nated with miasmata. My eyes were yellow and some- 
times a yellow tinge was perceptible in my face. My 
pulse was preternaturally quick and my nights were 
rendered disagreeable, not only by sweats, but by the 
want of my usual sleep, produced in part by the frequent 
knocking at my door and in part by anxiety of mind 
and the stimulus of the miasmata upon my system. I 
went to bed in conformity to habit only, for it ceased 
to afford me rest or refreshment. When it was evening 
I wished for morning, and when it was morning the 
prospect of the labours of the day, at which I often 
shuddered, caused me to wish for the return of evening. 
The degree of my anxiety may be easily conceived when 
I say that I had at one time upwards of thirty heads 
of families under my care; among these were Mr. Josiah 
2 “ A Narrative of the State of the Body and Mind of the 
Author during the Prevalence of the Fever.” “ Medical Inqui- 
ries and Observations.” 3d edition, Philadelphia, 1809. 236 
WALTER REED AND YELLOW FEVER 
Coates, the father of eight, and Mr. Benjamin Scull 
and Mr. John Morell, both fathers of ten children. 
They were all in imminent danger, but it pleased God 
to make me the instrument of saving each of their lives. 
. . . Every moment in the intervals of my visits to 
the sick was employed in prescribing in my own house 
for the poor, or in sending answers to messages from my 
patients. Time was now too precious (October) to be 
spent in counting the number of persons who called 
upon me for advice. From circumstances I believe it 
was frequently 150, and seldom less than 50 a day for 
five or six weeks. The evening did not bring with it the 
least relaxation from my labours. I received letters 
every day from the country and from distant parts of 
the Union containing inquiries into the mode of treating 
the disease, and after the health and lives of persons 
who had remained in the city. The business of every 
evening was to answer these letters and also to write to 
my family. To these constant labours of body and mind 
were added distress from a variety of causes. Having 
found myself unable to comply with the numerous ap- 
plications that were made to me, I was obliged to refuse 
many every day. My sister counted forty-seven in one 
forenoon before eleven o’clock. Many of them left my 
door with tears, but they did not feel more distress than 
I did from refusing to follow them. ... In riding 
through the streets I was often forced to resist the 
entreaties of parents imploring a visit to their children, 
or of children to their parents. I recollect, and even yet 
with pain, that I tore myself away at one time from five 
persons in Moravian Alley who attempted to stop me, 
by suddenly whipping my horse and driving my chair 
as speedily as possible beyond the reach of their cries. VALUE OF DR. REED’S WORK 
237 
But I had other afflictions besides the distress which 
arose from the abortive sympathy which I have just 
described. On the nth of September my ingenuous 
pupil, Mr. Washington, fell a victim to his humanity. 
. . . Scarce had I recovered from the shock of the 
death of this amiable youth when I was called to weep 
for another pupil, Mr. Alston, who died in my neigh- 
bourhood the next day. ... At this time a third 
pupil, Mr Fisher, was ill in my house. On the 26th of 
the month Mr. Coxe, my only assistant, was seized with 
the fever and went to his grandfather’s. I followed him 
with a look which I feared would be the last in my 
house. At two o’clock my sister, who had complained 
for several days, yielded to the disease and retired to 
her bed. My mother followed her, much indisposed, 
early in the evening. My black servant man had been 
confined with the fever for several days, and had, on 
that day, for the first time quitted his bed. My little 
mulatto boy, of eleven years old, was the only person 
in my family who was able to afford me the least as- 
sistance. . . . 
On the 1st of October, at two o’clock, my sister died. 
I got into my carriage within an hour after she expired 
and spent the afternoon in visiting patients. According 
as a sense of duty or of grief has predominated in my 
mind I have approved of this act or not, ever since. 
She had borne a share in my labours. She had been my 
nurse in sickness, and my casuist in my choice of duties. 
My whole heart reposed itself in her friendship. . . . 
From this time I declined in health and strength. All 
motion was painful to me. My appetite began to fail. 
My night sweats continued. My short and imperfect 
sleep was disturbed with distressing or frightful dreams. 238 
WALTER REED AND YELLOW FEVER 
The scenes of them were derived altogether from sick 
rooms and graveyards. . . . For the first two weeks 
after I visited patients in the yellow fever I carried a 
rag wetted with vinegar and smelled it occasionally 
in sick rooms, but as I saw and felt the signs of the uni- 
versal presence of miasmata in my system I laid aside 
this and all other precautions. I rested myself on the 
bedsides of my patients, and I drank milk or ate fruit 
in their rooms. Besides being saturated with miasmata 
I had another security against being infected in sick 
rooms, and that was, I went into scarcely a house which 
was more infected than my own. Many of the poor 
people who called upon me for treatment were bled by 
my pupils in my shop and in the yard, which is between 
it and the street. From the want of a sufficient number 
of bowls to receive the blood it was sometimes suffered 
to flow and putrefy upon the ground. From this source 
streams of miasmata were constantly poured into my 
house and conveyed to my body by the air during every 
hour of the day and night. . . . My perception of 
the lapse of time was new to me. It was uncommonly 
slow. The ordinary business and pursuits of men ap- 
peared to me in a light that was equally new. The 
hearse and the grave mingled themselves with every 
view I took of human affairs. Under these impressions 
I recollect being as much struck with observing a num- 
ber of men employed in digging the cellar of a large 
house as I should have been at any other time in seeing 
preparations for building a palace upon a cake of ice. I 
recollect, further, being struck with surprise, about the 
first of October, in seeing a man busily employed in lay- 
ing in wood for the approaching winter. I should as VALUE OF DR. REED’S WORK 
239 
soon have thought of making provision for a dinner 
on the first day of the year 1800. 
After the loss of my health I received letters from 
friends in the country, pressing me in the strongest terms 
to leave the city. Such a step had become impracticable. 
My aged mother was too infirm to be removed, and I 
could not leave her. I was, moreover, part of a little 
circle of physicians who had associated themselves in 
support of the new remedies. This circle would have 
been broken up by my quitting the city. The weather 
varied the disease, and in the weakest state of the body 
I expected to be able, from the reports of my pupils, 
to assist my associates in detecting its changes and in 
accommodating our remedies to them. Under these cir- 
cumstances it pleased God to enable me to reply to one 
of the letters that urged my retreat from the city that 
I had resolved to stick to my principles, my practice, 
and my patients to the last extremity. 
From the 15th of October the disease gradually 
declined, and by December the city was free from 
the pestilence, so that the 12th of that month was 
observed as a day of thanksgiving. The total num- 
ber of deaths, reckoned from the burial lists, was 
4041, and as the city during the epidemic contained 
40,144 inhabitants, it was literally decimated. 
Much difference existed among physicians as to 
the manner in which the disease originated. To 
our enlightened minds it would appear to have 
been imported by some refugees from San Do- 240 
WALTER REED AND YELLOW FEVER 
mingo who arrived in Philadelphia during the 
latter part of July. It is true that no cases of yellow 
fever were reported as occurring among them, but 
then it is expressly stated that the first cases which 
came under notice were so mild as to escape recog- 
nition, and that their nature only became known 
after others of a well-marked character developed; 
it seems probable, therefore, that the imported 
cases were of the same indefinite character and 
their real nature was never known. The transmis- 
sion of the disease becomes perfectly intelligible 
when we read the remark, made casually by Dr. 
Rush, that “Moschetoes (the usual attendants of 
a sickly season) were uncommonly numerous.” 
Some excellent physicians held by the theory of 
importation, even though they do not seem to have 
focussed their suspicions upon the San Domingo 
refugees; there were not wanting, however, per- 
sons of high authority, of whom Dr. Rush himself 
was one, who insisted that the disease was gener- 
ated within the city, and Dr. Rush was of opinion 
that a large quantity of coffee which had been 
allowed to decay upon one of the wharves was the 
whole cause of the trouble. So convinced, indeed, 
was he that the disease arose from this cause that 
he published a short address in one of the daily 
papers, describing the exact spot where the coffee 
lay and warning all persons to avoid the locality. VALUE OF DR. REED’S WORK 
241 
I must not neglect to mention here one lay ac- 
count of this epidemic, which is of peculiar inter- 
est. The horrors of that frightful summer appealed 
to the weird imagination of the first American 
romancer, the precursor of Hawthorne, Charles 
Brockden Brown (1771-1810). The misery and 
death in the stricken city furnish a lurid back- 
ground for the happenings of his sombre story, 
“Arthur Mervyn.” The result is a work of fiction 
containing the most vivid description we have of 
the ravages of yellow fever in earlier times. 
During the next eighty years the United States 
was visited by yellow fever every year, with one 
exception, 1861, in which no deaths were reported 
from any quarter. During this period two great 
epidemics occurred, one in New Orleans in 1853, 
and another in Norfolk in 1835. I wiH not pause 
to dwell on these, but pass on to that terrible visita- 
tion which is within the memory of most of us, the 
epidemic of 1878 in Memphis and its vicinity. The 
history of this terrible pestilence has been written 
in the most graphic manner by Mr. J. M. Keating 
in a volume, now unfortunately out of print, en- 
titled “History of the Yellow Fever Epidemic of 
1878 in Memphis, Tenn.” 
The pestilence in this instance began as early 
as May, when a steamboat, the Sudder, entered 
Memphis with a case of yellow fever on board. 242 
WALTER REED AND YELLOW FEVER 
The disease spread slowly at first and created little 
alarm until August, but by the middle of that 
month the city was in a state of panic and everyone 
who could, began to escape. 
Men, women, and children [says Keating] poured 
out of the city by every possible avenue of escape. . . . 
Out by the country roads to the little hamlets and plan- 
tations, where many of them were welcome guests in 
happier days; out by every possible conveyance—by 
hacks, by carriages, buggies, waggons, furniture vans, 
and street-drays; away by bateaux, by anything that 
could float on the river; and by the railroads, the trains 
on which, especially on the Louisville road, were so 
packed as to make the trip to that city, or to Cincinnati, 
a positive torture to many delicate woman every mile of 
the way. The aisles of the cars were filled and the plat- 
forms packed. In vain the railroad officials pleaded, in 
vain they increased the accommodations. The stream 
of passengers seemed to be endless and they were as 
mad as they were many. The ordinary courtesies of 
life were ignored, politeness gave way to selfishness, 
and the desire for personal safety broke through all so- 
cial amenities. . . . To the cities of the far North and 
the far West they fled, too many of them to die on the 
way like dogs, neglected and shunned, as if cursed of 
God; or, to reach the wished-for goal, only to die, a 
plague to all about, carrying dismay to those who even 
then were busying themselves for the relief of the 
stricken cities of the South. In less than ten days, by 
the 24th of August, twenty-five thousand people had 
left the city and in two weeks after five thousand others VALUE OF DR. REED’S WORK 
243 
were in camp, leaving a little less than twenty thousand 
to face consequences they could not escape. . . . 
By the last week in August the panic was over in the 
city. All had fled who could, and all were in camp who 
would go. There were then, it was estimated, about 
three thousand cases of fever ... an appalling 
gloom hung over the doomed city. At night it was 
silent as the grave, by day it seemed desolate as the 
desert. There were hours, especially at night, when 
the solemn oppression of universal death bore upon 
the human mind, as if the day of judgment was about 
to dawn. Not a sound was to be heard; the silence 
was painfully profound. Death prevailed everywhere. 
Trade and traffic were suspended. The energies of all 
who remained were engaged in the struggle with death. 
The poor were reduced to beggary, and even the rich 
gladly accepted alms. . . . Even the animals felt 
the oppression and fled from the city. Rats, cats, or 
dogs were not to be seen. Death was everywhere tri- 
umphant. White women were seldom to be met with, 
children never. The voice of prayer was lifted up only 
at the bed of pain or death, or in some home circle 
where anguish was supreme and death threatened, as 
in a few cases he accomplished, total annihilation. Tears 
for one loved one were choked by the feeling of un- 
certainty provoked by the sad condition of another. In 
one case a family of four was found dead in one room, 
the bodies partially decomposed. There were no public 
evidences of sorrow. The wife was borne to the tomb 
while the husband was unconscious of his loss, and 
whole families were swept away in such quick succes- 
sion that not one had knowledge of the other’s de- 
parture. Death dealt kindly by these. . . . Neither 244 
cleanliness nor right living was a shield to stay the 
hand of the destroyer. He invaded the homes of the 
most chaste and the den of the vilest. He took inno- 
cence and infamy at the same moment and spread ter- 
ror everywhere. Where sorrow was so general there 
could be no parade of it. There were no funerals and 
but little demand for funeral services. The luxuries of 
woe were dispensed with. In most cases the driver of 
the hearse and an assistant composed the funeral party. 
Not infrequently many bodies were left in the cemetery 
unburied for a night, so hard pressed were the man- 
agers for labour, and so numerous were the demands 
upon what they had. . . . The churches were 
closed. The congregations dispersed. The members 
were far apart. Some were safe, many were dead. 
Only a few survived, and these were manifesting their 
faith by works. The police were cut down from forty- 
one to seven. Their ranks were recruited and again 
were thinned. They were a second and a third time 
filled up, and yet death was relentless. He was jealous 
of all sway but his own. 
WALTER REED AND YELLOW FEVER 
I have so far dwelt solely upon the misery and 
sorrow directly attendant on the march of the 
pestilence, but the worst horrors following in its 
train arose from the lawlessness and criminality 
which always come to light and run riot under 
such conditions, when human nature throws off all 
disguise and stands forth human. 
Petty thieving [says Keating] prevailed as an epi- 
demic. This was principally confined to food and cloth- VALUE OF DR. REED’S WORK 
245 
ing, and wood or coal, or both. A few who came to 
nurse died, leaving full trunks of silverware, bijou- 
terie, bric-a-brac, and clothes, to prove how indus- 
triously they could ply two trades and make one cover 
up and supply the deficiencies of the other. A few of 
them also made themselves notorious for lewdness and 
drunkenness. To these vices many deaths were due. 
They shocked decency and outraged humanity, they 
were no better than the beasts of the field. Male and 
female they herded together in vileness. They made of 
the epidemic a carnival. . . . One of these, a 
woman who would not or could not control her appe- 
tite for strong drink, while stupefied from wine and 
brandy allowed a poor woman to leave her bed, naked 
as when born, and wander out into the country one 
inclement night, calling as she went for the husband 
who had preceded her to the grave by a few days. . . . 
In the house of an ex-judge, whence a whole family 
had been borne to the grave, the victims of neglect, 
four such nurses died, and in the trunks of one, the 
worst of them, a woman of seeming refinement, there 
was found the family plate and wearing apparel of the 
judge’s wife, then absent in Ohio. This woman and 
her paramours fell victims to the fever which they in- 
vited by their debauchery and hastened by their ex- 
cesses. In the whole range of human depravity there 
are few parallels to these cases. They illustrate the ex- 
tremes of degradation; they sounded the lowest depths 
of vice and shamed even the standards of savage life. 
But it was not only among the lowest and vilest 
that the dark side of human nature was brought 246 
into evidence. The deterioration of character 
which takes place under the effect of terror and a 
temporary suspension of customary social restraints 
became manifest in the inhumanity exercised 
towards inhabitants of yellow fever districts by 
persons of good standing and character, whose 
business it was in many instances to do their utmost 
for the protection of these sufferers. 
Dr. George Armstrong, a Presbyterian minister, 
who wrote a brief account of the epidemic in Nor- 
folk, in 1855, mentions the following case of inhu- 
manity in quarantine regulations which appeared 
in one of the Norfolk daily papers: “The follow- 
ing order,” says Dr. Armstrong, “was adopted by 
the town authorities of Welden:—Ordered—That 
if any person or persons shall visit the town of Wel- 
den, within fifteen days after such person or persons 
shall have been in such infected cities, if white, he 
shall be fined one hundred dollars for every day 
he or she may remain in the town of Welden. And 
if a slave, the owner shall be fined fifty dollars (if 
within the knowledge of the owner), if not, nine- 
and-thirty lashes on his or her bare back. If free 
coloured, shall be fined fifty dollars, or shall re- 
ceive nine-and-thirty lashes.—That is, in substance, 
if any poor negro, likely to have the fever in his 
blood, shall enter our town of Welden, where God 
has laid his afflicting hand, we will strip him to the 
WALTER REED AND YELLOW FEVER VALUE OF DR. REED’S WORK 
247 
skin, lay on the lash, and then turn the fugitive out 
into the swamps to die.” 
Mathew Carey (1793), after citing numerous 
instances of the unkindness manifested by the dif- 
ferent States and cities in their quarantine regula- 
tions, gives the following almost incredible instance 
of cruelty: “Many travellers from the city,” he 
says, “exhausted with fatigue and with hunger, 
have been refused all shelter and all sustenance, 
and have fallen victims to the fears, not to the want 
of charity, of those to whom they applied for relief. 
Instances of this kind have occurred on almost 
every road leading from Philadelphia. People 
under suspicion of having this disorder have been 
forced by their fellow-travellers to quit the stage 
and perish in the woods without a possibility of 
procuring any assistance. At Milford, in Dela- 
ware State, a waggon-load of goods from Phila- 
delphia was actually burned; and a woman who 
came with it tarred and feathered ” 
But times of stress and danger, although they 
bring out everything brutal and selfish in human 
nature, also afford opportunity and supply stim- 
ulus to all its finer qualities. It is a relief to turn 
from such distressing scenes to the numerous in- 
stances of self-sacrifice and devotion which, to the 
credit of humanity, were plentiful in all these 
crises. We have already spoken of several which 248 
WALTER REED AND YELLOW FEVER 
took place in the epidemic of 1793, and I wish 
space permitted me to do justice to many others. 
In the pestilence of 1878 the whole country 
seemed to be moved with compassion. “The cry 
for food,” says Keating, “for clothing, for money, 
for doctors, for as many as a thousand coffins, went 
out by telegraph to the ends of the earth, and a 
prompt and generous response came back. By tele- 
graph, by express, through the banks, by private 
hands, money was forwarded by hundreds, by 
thousands of dollars—New York City alone send- 
ing altogether $43,800. . . . The people of 
the North were especially urgent; it seemed as 
though they could not do enough. ‘We send,’ they 
said, ‘what wre can; but you, who know what you 
need, must ask—“Ask and ye shall receive.” ’ The 
Republic in its remotest confines was moved as if 
by a divine impulse. The leading artists of the 
lyric as well as of the dramatic stage were es- 
pecially conspicuous in good gifts, in generous 
contributions. . . . The miner in the Nevada 
hills, the ranchero in far California, and the farmer 
in distant Oregon vied in dispensing a charity equal 
to the growing exigencies of the time, while the 
people of the older States of the East, where organ- 
isations existed in every city and village, were 
eagerly engaged in the good Samaritan’s work. 
. . . Hundreds of men and women volunteered VALUE OF DR. REED’S WORK 
249 
as nurses, who were destined to a speedy death. 
. . . A long line of graves in Elmwood Ceme- 
tery tells the story of their fidelity to a mission that 
was one purely of mercy and loving kindness.” 
Instances of individual self-sacrifice were as 
numerous as in former years and they were con- 
spicuous among those whose lives would have least 
suggested it. “One unfortunate ‘woman of the 
town,’ ” says Keating, “a phrase which only too 
well tells her trade, gave up her house to be used 
as a hospital, and herself, until she fell in the act, 
nursed the sick, and closed the eyes and covered the 
faces of the dead. Others, doomed like her to be- 
come a curse instead of a blessing to humanity, 
followed her example. One such came from a 
great city of the West, disguised as a widow, and 
faithfully and assiduously continued to do her duty, 
running the gauntlet of death every hour: even 
when all like her were denounced in her presence 
as irreclaimable and abandoned of God by an 
earnest Christian woman, whom she nursed to con- 
valescence.” 
A word must be said here of the good accom- 
plished by the organisation called the Howard 
Association, after the great philanthropist, John 
Howard. The first of these associations was es- 
tablished in Memphis during a comparatively 
mild epidemic of yellow fever which occurred 250 
WALTER REED AND YELLOW FEVER 
there in 1855, the object of the members being, in 
Keating’s words, “to devote themselves to the 
succor of the sick, the relief of the suffering, and 
the burial of the dead.” In subsequent epidemics 
these associations have been established in different 
cities by self-sacrificing men and women and have 
accomplished more than can ever be estimated in 
the relief of suffering. In Memphis, in 1878, eight 
members remained who had joined the association 
when there was special need in 1867, and these be- 
came the nucleus of a new association whose de- 
voted service will always remain, as ‘Keating says, 
“a monument of human love.” 
Yet even the Howard Association became a 
source of affliction in some cases. A number of 
tramps, thieves, and the scum of humanity in gen- 
eral invaded Memphis, and after stealing the 
badges of some of the Howard nurses, gained 
entrance into houses by representing themselves as 
members of the association, and then made use of 
the occasion to plunder the helpless inmates, most 
of whom were prostrated from the disease; they 
even in some cases committed murder. This atroc- 
ity was soon stopped in Memphis itself, but in some 
of the smaller towns where the disease was raging, 
these imposters did a great amount of injury. 
One of these smaller towns, Grenada, Missis- 
sippi, was the seat of the disease in a peculiarly VALUE OF DR. REED’S WORK 
251 
virulent form, the death-rate being the largest ever 
known to follow in the track of the disease. A 
trained nurse, Mrs. Lena Warner, who was an eye- 
witness of this terrible episode, has kindly given 
me an account of her experience, which I quote in 
her own words: 
My first great sorrow came to me through this ter- 
rible scourge, in 1878, in the town of Grenada, Missis- 
sippi, a place of 3000 inhabitants. History records this 
epidemic as the most terrible death-rate known. In my 
own family eight members were stricken, and myself 
and a child of nine years were the only ones to recover. 
I can recall very distinctly the terrible ordeal we had to 
undergo, while many noble men and women sacrificed 
their lives to relieve the helplessness of these unfor- 
tunate people. They came from all sections of the 
country, and as every occasion of this kind is burdened 
with human beasts of prey, robbing and pilfering the 
living, dying, and dead, so was this plague-stricken 
city. Men sent there who represented themselves as 
nurses from the Howard Benevolent Association were 
among the worst. My own father, while ill with the 
fever, was choked, robbed, and left alone to die; I was 
too ill even to cry out for help, but witnessed the entire 
affair. It was twenty hours before we were found in 
this condition. Burning tar, bonfires, and disinfectants 
of various kinds were placed on the corners of the 
streets, and yet that peculiar odour from yellow fever 
could be detected from every direction. The only signs 
of traffic were waggons hauling the dead; few caskets 
were seen, but in their stead plain boxes and sometimes 252 
dry goods boxes were utilised; they were piled one on 
top of the other and fastened with ropes to the bed of 
the waggons. Negroes were procured for this work; 
they were known to rob the dead and the vacant resi- 
dences. The following winter several visits were made 
to the cabins, where clothing, silver, and other valu- 
ables were found. On one occasion of this kind I was 
called by the town marshal to identify some things 
supposed to have been taken from our house; while 
looking down on a crowd of negroes I called the mar- 
shal’s attention to a negro man wearing my father’s 
hat. He proved to be a minister, and we found a wag- 
gon-load of various articles at his house. The negroes’ 
work as grave-diggers proved to be very poor, as six- 
teen inches was afterwards found to be the depth of 
any grave made during that time. 
WALTER REED AND YELLOW FEVER 
From a possible recurrence of horrors such as 
these we are now insured by the labours of Walter 
Reed and his colleagues, who risked their lives to 
ascertain the facts by which we are now protected. 
The reports of the Army Commission on yellow 
fever are so modest and self-restrained that they 
give little or no idea of the dangers to which the 
members were incessantly exposed, nor of the pain- 
ful scenes which they were daily called upon to wit- 
ness. I quote, therefore, again from Mrs. Warner’s 
letter, for it is due to both the living and the 
dead that the full extent of their efforts should be 
known. VALUE OF DR. REED’S WORK 
253 
From the date of a lecture I heard on yellow fever 
delivered by Dr. R. B. Maury and Dr. R. W. Mitchell, 
I was possessed of a great desire to come in contact 
with the disease. When our Government called for 
volunteer nurses to go to Cuba I availed myself of this 
opportunity. 
In August, 1900, I was ordered from Matanzas to 
Havana. The night before my transfer to Havana I 
was entertained at the quarters of the officers of the 
2nd Cavalry stationed at Matanzas; there I met 
a Major Cartwright, who informed me that he also 
had been ordered to Havana, as he was an immune, 
having had the fever in ’98 at Santiago. Two weeks 
after my arrival at the yellow fever camp the ambu- 
lance brought a patient from General Lee’s head- 
quarters, and as I stepped forward to give directions 
in regard to him I recognized Major Cartwright. 
After some conversation he stated that he could not 
possibly have yellow fever, as he certainly had a gen- 
uine case in ’98. However, on the sixth day after his 
arrival he died of black vomit. Major Peterson also 
thought that he had had the fever, but he was taken 
ill again with it, and his wife, hearing of his illness, 
two hours after his death, committed suicide by shoot- 
ing herself through the temple in our quarters at Las 
Animas. 
The only nurse with me who had yellow fever was 
one that claimed to be an immune; she was sent to 
Major Edmund’s residence at Quemados the night 
before his death; she returned to the camp and four 
days after was taken with a mild case. We had no 
mosquitoes in our camp. 254 
WALTER REED AND YELLOW FEVER 
Quarantine was very strict, but we continued to have 
yellow fever among the soldiers and officers; we were 
poorly equipped at Columbia Barracks Detention 
Camp, and yet the mortality was not so great as in this 
country. A few officers and privates from the Palace 
in Havana were taken to Las Animas, a Cuban hos- 
pital for civilians under Major Gorgas’ supervision; 
he called on our chief surgeon for help and I was or- 
dered there for ten days. At this place they were well 
equipped, the nurses being well cared for as well as 
the patients. We lost that week Major Peterson, Cap- 
tain Page, the quartermaster sergeant, one soldier, 
and one civilian employe. Major Gorgas was very 
successful in the treatment of the fever, and upon my 
return to Camp Columbia I determined to imitate his 
directions. 
In September I nursed Dr. James Carroll, a mem- 
ber of Major Reed’s staff of Commissioners, and 
he told me he experimented upon himself with the 
mosquito; while he had a severe case he did not have 
haemorrhages, but even to the whites of his eyes he was 
as yellow as saffron. A few days after Dr. Carroll’s 
chill Dr. Jesse Lazear was stricken with the fever. 
He also was a member of the board and was brought 
on a litter to our camp about eleven A. M. He knew 
what his illness was and informed me that he had his 
chill about six P. M.; he had not been in bed all night, 
as he was busy writing up their experiments in regard 
to yellow fever and the mosquito. His temperature 
was 103°, his pulse 80; he lived five days; the black 
vomit would spurt from his mouth up through the bar 
over his cot. I had just relieved the day nurse and gone 
on for the night; my efforts to keep him in bed failed VALUE OF DR. REED’S WORK 
255 
and I called for help, but before assistance reached 
me he had made several turns around the room in his 
efforts to get out. All night it took two men to hold 
him, and he died the next morning. 
In December I met Major Reed, and it was at this 
time that they had begun in earnest to erect buildings 
for the special experiments to prove that the mosquito 
was the only source of infection. Major Reed was an 
officer to whom we were all devoted; he liked best to 
be called “Doctor.” I was always glad on my daily 
visits to the laboratory to catch him there; he had won 
the friendship and esteem of the entire corps, having 
the most genial manners and was so considerate and 
kind to everyone. I do not feel that I could speak in 
too high terms of Major Reed. At all times he was so 
willing to go into details with any part of the experi- 
ment I did not comprehend, and was patient enough 
to give me a peep through the different microscopes 
and give a full explanation. I told him of our ’78 epi- 
demic, and he informed me that Surgeon-General 
Sternberg was in Memphis at that time. The experi- 
mental camp was called after Dr. Lazear. In a state- 
ment I heard Major Reed make, he said that Dr. 
Lazear’s efforts in this work had been of vast im- 
portance. Major Reed was strong in his friendships, 
as Dr. Carroll can readily testify. I recall an incident 
which gives an insight into the kind of man he was. 
On one occasion he moved his mess quarters because he 
heard his brother officers use language at the table 
which was very ungentlemanly. It was due to his inde- 
fatigable efforts that we owe our success with yellow 
fever at Camp Lazear, as we never lost a case experi- 
mented upon. 256 
WALTER REED AND YELLOW FEVER 
To give an idea of the frightful mortality of this 
disease in actual numbers, I turn to the paper 
issued by Reed and Carroll in 1901, on “The 
Prevention of Yellow Fever.” 3 
It would be difficult to determine with accuracy the 
loss of life occasioned by the ninety-five invasions of our 
territory by yellow fever during the past two hundred 
and eight years. We have endeavoured to collect from 
the most available sources the mortality caused by the 
disease, but have been unable to obtain any reliable 
data for the earlier epidemics. If we confine ourselves 
to the epidemics which have occurred since 1793, we 
find that there have not been less than 100,000 deaths 
from this cause. The greatest sufferer has been the city 
of New Orleans, with 41,348 deaths, followed by the 
city of Philadelphia with 10,038 deaths. The epidemics 
of 1855, 1873, 1878, and 1879 claimed 7759 victims 
in the city of Memphis, Tenn. From 1800 to 1876 
Charleston lost 4565 of its citizens by attacks of 
yellow fever. New York during the earlier and later 
invasions of this disease has had 3454 deaths, while 
the later epidemic of 1855 in Norfolk, Va., caused 
over 2000 deaths. During our brief occupation of the 
Island of Cuba (July, 1898—December, 1900), with 
every precaution brought into exercise to ward off the 
disease, there have occurred among the officers and 
men of our army 1575 cases of yellow fever, with 231 
deaths. If we reckon the average case fatality at 20 
per cent, there have not been less than 500,000 cases 
8 “ The Prevention of Yellow Fever.” Med. Rec., Oct. 
26, 1901. VALUE OF DR. REED’S WORK 
257 
of yellow fever in the United States during the period 
from 1793 to 1900. 
Yet the actual loss of life from the disease, ap- 
palling as it is, is but a part of the distress which 
it has occasioned to the country. The pecuniary 
loss, both direct and indirect, is a matter of serious 
moment. Estimates of the exact amount of money 
loss in epidemics are hard to arrive at, since 
account must be taken not only of actual expendi- 
tures in the relief or restriction of an epidemic, but 
also of the commercial loss resulting from the in- 
terruption of intercourse with the afflicted region 
and the maintenance of the necessary quarantine 
regulations. I have, however, collected an amount 
of information sufficient to demonstrate conclu- 
sively the heaviness of the loss, although it is some- 
what miscellaneous in character. 
Keating states that the amount contributed by 
the world at large for the relief of the stricken cities 
of the South in 1878 was $4,548,703. Dr. Horl- 
beck, chairman of the committee appointed in 
1897 to investigate the aetiology of yellow fever, 
states in his report that the total loss to the country 
in the 1878 epidemic was not less than $100,000,000. 
The loss to the city of New Orleans alone was 
over $10,000,000. Evidence given before a Con- 
gressional Committee in 1897 disclosed the fact 258 
WALTER REED AND YELLOW FEVER 
that the loss incurred by the Southern Pacific Rail- 
way Company in Texas and Louisiana during the 
epidemic of 1897 was in excess of one million of 
dollars. So strongly has our national prosperity 
always been affected through commercial losses 
occasioned by the disease that the probability of 
their arising from the introduction of yellow fever 
into our Southern States was in former years con- 
sidered a serious obstacle to the annexation of Cuba. 
In 1889 Dr. Benjamin Lee, then president of the 
State Board of Health of Louisiana, read before 
the association a paper with the title, “Do the 
Sanitary Interests of the United States Demand the 
Annexation of Cuba?” in which this sentence oc- 
curs: “A single widespread epidemic of yellow 
fever would cost the United States more in money, 
to say nothing of the grief and misery which it 
would entail, than the purchase of Cuba.” In 
forcible comparison with this statement are the 
words of General Leonard Wood, spoken at the 
memorial service in honour of Dr. Reed. “I know 
of no man,” he said, “who has done so much for 
humanity as Major Reed. His discovery results in 
the saving of more lives annually than were lost 
in the Cuban war and saves the commercial in- 
terests of the world a greater financial loss in each 
year than the cost of the entire Cuban war.” When 
we look back over our history in the immediate past and remember that our occupation of Cuba 
was (let us hope at least to some extent) actuated 
by dictates of humanity which forbade us to leave 
the people we had freed unprotected and undevel- 
oped, we realise that we have our reward, in our 
deliverance from the very evil which we were sup- 
posed to entail upon ourselves in thus fulfilling our 
duty to our neighbour. 
Another source of expense to the country against 
which we are now insured, is that involved in 
keeping up expensive quarantine regulations, now 
shown to be, to a large extent, unnecessary. I have 
no means of estimating the direct cost of these, but 
some idea of it may be formed from a little volume 
on United States Quarantine Regulations, issued 
in 1889 by Surgeon-General Walter Wyman. 
After considering the nature of yellow fever and 
stating directions for ordering life in the man- 
ner most likely to escape it, he proceeds to con- 
sider at length the following subjects: disinfec- 
tion of houses; disinfection of baggage; isolation 
of infected cases; detention camps; disinfection 
of premises; disinfection of freight; inspection of 
trains; regulation of traffic; disinfection of mail; 
inspection of mail; inspection of vessels; disin- 
fection of vessels; inspection of territory. When 
the cost of carrying out all these measures in detail 
is considered, it is plain that protection against 
VALUE OF DR. REED’S WORK 
259 260 
yellow fever, according to the old ideas, was a 
heavy expense to government. But nearly all 
of these procedures were instituted to meet the 
theory of infection by fomites, and now that this 
is disproved all expedients based upon it are un- 
necessary. The few precautions really essential are 
those given by Dr. Reed, which we have already 
quoted (see ChapterVIII), and we need only com- 
pare these with the long list of measures just cited 
to realise what a burden of expense and annoyance 
is removed from the shoulders of government. 
And now let us pause for a moment to ascertain 
what has been done by the world at large in ap- 
preciation of the man who has accomplished so 
much in the service of his fellow-creatures. Let 
us inquire, with the motto of this chapter, “What 
honour and dignity hath been bestowed upon Mor- 
decai for this?” 
The members of Dr. Reed’s own profession, as 
well as medical societies and learned bodies, both 
at home and abroad, have spared no exertions to 
show their satisfaction in the distinction he has 
conferred upon his profession; and his friends and 
acquaintances, both medical and lay, have shown 
a generous and loving spirit of appreciation in 
the Memorial Association established by them to 
secure that some practical return should be made 
for his services to mankind. But these demonstra- 
WALTER REED AND YELLOW FEVER VALUE OF DR. REED’S WORK 
261 
tions, right and fitting as they are, represent only 
a small part of what is due. Acknowledgment of 
Dr. Reed’s services to humanity should not be con- 
fined to his colleagues and friends. It is the nation 
which he has benefited and the government he has 
served from whom it is due; not as a favour, nor 
even as a recompense, but as a testimonial of en- 
during gratitude. 
“Yet popular appreciation of the value of the 
work of the yellow fever commission has been,” so 
says Major Kean, “singularly slow and imperfect. 
While nearly every educated person in the United 
States is familiar with the name and work of a 
distinguished Austrian surgeon who has recently 
demonstrated in this country an operation for the 
cure of a rather rare deformity in childhood, only 
a small fraction of them know anything of Walter 
Reed, the conqueror of the ‘yellow plague.’ ” 
“Precedents are abundant,” Major Kean con- 
tinues, “for State aid to public benefactors and 
their families. The English Government a century 
ago, when the purchasing value of money was far 
greater than at present, gave to Jenner, the dis- 
coverer of vaccination, grants amounting to i/30,- 
000. He also received £7383 from a subscription 
in India. Pasteur, the founder of the science of 
bacteriology, besides numerous honours and deco- 
rations and money donations from other sources, 262 
WALTER REED AND YELLOW FEVER 
received from the French Government a pension 
of 12,000 francs. Lister, the originator of anti- 
septic surgery, has, besides numerous honours and 
decorations, been successively knighted and ele- 
vated to the peerage. In this country a bill to 
donate $100,000 to the discoverer of anaesthesia was 
twice passed by the Senate (in 1853 and 1854), but 
failed in the House, probably only because of the 
uncertainty as to which of the rival claimants was 
entitled to the credit of the discovery.” 
It is Congress towards whom we naturally look 
to express a nation’s gratitude, and there is ample 
precedent, as we see, for its taking action; yet so 
far nothing has been done in the matter beyond the 
granting of a very modest pension to Dr. Reed’s 
widow. I cannot but believe that such a state of 
things is due to ignorance on the part of its mem- 
bers, not, of course, of the work accomplished, but 
of the real extent of the evils it has averted and of 
the practical benefits it insures to our national pros- 
perity. It is partly with the hope of aiding in the 
dissemination of the necessary knowledge that this 
little book is sent forth into the world, for I firmly 
believe that, if my countrymen only understand 
the subject in all its bearings, they will find some 
substantial means of testifying their gratitude to 
the man whose memory each and all of us should 
delight to honour. CHAPTER XI 
LIFE AFTER RETURN FROM CUBA, AND DEATH 
1901-1902 
Scarce had he need to cast his pride or slough the dross of earth. 
E’en as he walked that day to God, so walked he from his 
birth— 
In simpleness and gentleness and honour and clean mirth. 
—Rudyard Kipling, To Wolcott Balestier. 
DR. REED left Cuba, as I have said, in February, 
1901, and returned to his work in Washington. In 
the following April he delivered an address before 
the Medical and Chirurgical Faculty of Mary- 
land on the “Propagation of Yellow Fever,” 
which embodies the results of his labours in a 
peculiarly pleasing manner. It was received by 
the faculty with the greatest enthusiasm, and those 
who were present will long remember the ovation 
paid Dr. Reed on this occasion. The paper was 
subsequently published in the Medical Record for 
August 10, 1901, and of all the articles written by 
Dr. Reed on the subejct, this will best repay the 
non-professional reader who may wish to acquaint 
himself with the subject. 
It will be remembered that Dr. Reed held one 
263 264 
WALTER REED AND YELLOW FEVER 
appointment in Washington as professor of bacteri- 
ology and clinical microscopy in the Army Medical 
School and another as professor of pathology and 
bacteriology in the Columbian University. To his 
work in these institutions he now devoted the 
greater part of his time, and during the brief re- 
mainder of his life he was occupied mainly in 
teaching, a line of work for which his natural abil- 
ities seem to have been no less marked than they 
were elsewhere. 
Dr. A. F. A. King speaks of Dr. Reed’s success 
as a teacher thus: 
In the whole domain of knowledge there is probably 
no subject more difficult and intricate than that of pa- 
thology, especially when considered in relation with 
bacteriology, this latter being also a comparatively new 
departure, and therefore bristling with the unfamiliar 
terms of a new and laboured nomenclature, as every 
new science necessarily must be. 
Notwithstanding these difficulties, Professor Reed, 
with his well-trained mind and cultivated powers of 
observation, inspired, too, with the spirit of research 
and led on by the charm of discovering new principles 
and new facts, had devoted himself with so much 
ardour, earnestness, and industry to the study of his 
chosen sphere of thought that it may be said all diffi- 
culties had been trampled under his feet; that he rose, 
step by step, to higher and still higher planes of 
knowledge, until he reached an eminence where the 
whole subject became easily intelligible in one compre- LIFE AFTER RETURN FROM CUBA 
265 
hensive view and where he himself attained a complete 
mastery of his favourite theme. 
Having traversed the highways of knowledge him- 
self, he was fully able to lead his pupils along the same 
paths and perhaps point out to them many short cuts 
which were easier than the longer distances and more 
laborious journeys originally pursued by himself. It 
should be remembered also that many of these roads 
were not always the well-travelled avenues of old lines 
of thought, but, on the contrary, entirely new, strange, 
and perhaps lonely ways, far out on the prairies of 
investigation, where briars of speculation, weeds of 
error, and the ignes fatui of false theories were liable 
to obstruct and mislead the honest seeker for truth. It 
was under these circumstances that Professor Reed be- 
came a trusted guide and counsellor. In these track- 
less wastes of thought he could not easily get lost or 
take a wrong direction, for in many instances he was 
able to say: “I made these paths myself ” and he well 
knew whither they would lead. 
A pupil of his, Captain J. Hamilton Stone, As- 
sistant Surgeon, U. S. A., writes of him as follows: 
As a teacher Dr. Reed always seemed to me to be 
first of all, master of his theme. His information was 
so much his own—a part of him, as it were—that when 
it was given to others it flowed forth with unadulter- 
ated naturalness, and sparkled with a keen interest 
which his charming personality could not help but lend 
it. These qualities would not permit his words to fall 
upon deaf ears. His kindly and considerate mien, to- 
gether with his universally acknowledged high scien- 266 
WALTER REED AND YELLOW FEVER 
tific attainments, won for him both the respect and 
admiration of his students. His language was always 
interesting, eloquent, and well appointed. When at his 
best his voice would reach a high falsetto note, and this 
was his characteristic method of impressing important 
facts upon dull or indurate intellects. His students 
never feared him, but from the start regarded him with 
filial affection. Of patience, that special attribute of a 
good teacher, he possessed an abundance. He was con- 
stantly at the side of his pupil in the laboratory, ad- 
vising, consoling, encouraging, and above all, in- 
structing. 
Another student, Mr. H. H. Donnally, says: 
Dr. Reed’s lectures were models of order and sys- 
tem. A recital of the various views previously held in 
the different branches of pathology and bacteriology 
always led up to and served to emphasize the more 
recent and generally accepted theories. In these his- 
toric reviews the student was constantly surprised at 
Dr. Reed’s remarkable memory for dates and his fa- 
miliarity with the host of investigators and their 
several special lines of research, not only those in this 
country, but others in all parts of the civilised world. 
This method of unfolding the subject historically, with 
a final and forcible exposition of the latest current 
views, was keenly appreciated by the students, and gave 
them a broad and comprehensive picture of the whole 
subject, which was easily remembered and understood. 
The summers of 1901 and 1902, like many pre- 
vious ones, were spent by Dr. Reed at his cottage LIFE AFTER RETURN FROM CUBA 
267 
near Monterey, Pennsylvania, where out of a mere 
rocky field he had made a pleasant country resi- 
dence. This was his home, which the many years 
spent by him as a wanderer made him deeply ap- 
preciate. Here he could lay aside the cares and 
annoyances of his work; here he could pursue 
some of the various lines of out-door interest which 
his love for nature suggested; and here, above all, 
he could enjoy the happiness of unrestrained inter- 
course with his family. 
“Love ever at my fireside, 
And peace within my door” 
was the motto which he chose for his roof-tree, and 
those who were privileged to know him there, 
amidst the closet intimacies of his life, realised 
to the full the peculiar beauty of his character. 
As one who loved him says, “All that love, self- 
sacrifice, and devotion could bring, he laid upon 
the family altar and worshipped there.” 
But those who saw Doctor Reed during these last 
years of his life could not but be struck with the 
signs of fatigue and strain apparent in his face and 
manner. In addition to the cares and effort inci- 
dent upon his work, he suffered, as all who achieve 
distinction must suffer, from the injustice and un- 
kind judgment of some of those to whom he would 
naturally have looked for appreciation of his work. 268 
WALTER REED AND YELLOW FEVER 
A friend who saw him during the summer of 1902 
says: “He was very much worn by his scientific 
labours, and it was also evident that he felt most 
keenly the attempts which were being made by 
persons in authority to rob him of his just fame for 
the work which he had done.” To a nature so 
generous and affectionate as Dr. Reed’s, the hard- 
est part of such annoyances must have lain in the 
pain caused by the betrayal of those in whom his 
trusting nature placed entire confidence, and this 
was probably a harder trial to him than the risk 
of losing any part of the distinction he had earned, 
for, as his wife says, “When his great work was 
accomplished, the happiness which filled his soul 
was entirely for the suffering he would spare hu- 
manity. He rejoiced that he had not lived in vain, 
and that God had seen fit to make him an instru- 
ment of good.” 
But, although Dr. Reed had his share of mis- 
understanding to endure, his work was not without 
recognition of the most gratifying description. In 
the summer of 1902 Harvard University bestowed 
on him the honorary degree of M. A., conferred by 
President Eliot in these words: “Walter Reed, 
graduate of the University of Virginia, the army 
surgeon who planned and directed in Cuba the ex- 
periments which have given man control over that 
fearful scourge, yellow fever.” In this connection LIFE AFTER RETURN FROM CUBA 
269 
I give a letter of Dr. Reed’s to Dr Theobald 
Smith, then of Harvard, which shows in a simple, 
unaffected manner his pleasure in the distinction 
he had just received, and also gives evidence that 
his interest in the question of yellow fever was as 
keen as it had ever been. 
Surgeon-General’s Office, Washington, 
July 18, 1902. 
My Dear Dr. Smith: 
On returning to the city from a short outing, I find your 
kind favour of the 8th instant. I am, of course, extremely 
interested in what you tell me about the agglutinative reac- 
tions of B. icteroides and hog-cholera. Carroll and I, as 
you know, in testing the blood of yellow fever and hog- 
cholera had found that whenever a given specimen would 
clump icteroides, it would affect hog-cholera in like manner. 
With a culture of hog-cholera from Welch’s laboratory we 
got clumping with icteroides serum in less dilution than with 
B. icteroides. We only tested this particular serum with 
this one culture of hog-cholera. As to the significance of 
this clumping, I have not doubted the very close affinity 
of these micro-organisms ever since I found that B. icteroides 
(orig.) when fed to young swine would produce a fatal infec- 
tion with the acute lesions of hog-cholera. 
Concerning your inquiry whether there is virulent 
hog-cholera in Cuba, I think that I can safely answer, 
Yes. Agramonte and other physicians assured me that 
this disease was well known on the island and that, 
in certain years, it caused a high mortality among 
swine. I did not see the disease, as I made no attempt 270 
WALTER REED AND YELLOW FEVER 
to do so, but I think you can safely accept its presence 
there. The domestic relations between the lower classes 
and the swine are as intimate as can be found among 
dwellers in the same house and often in the same room. 
Whether B. icteroides produces a disease sui generis in 
the West Indies, I cannot say. It is probably responsi- 
ble for occasional fatal infections with continued fever. 
Thank you so much for your kind congratulations 
on the Harvard degree. Of course I didn’t deserve it, 
but I could not altogether repress a feeling of pride in 
finding myself in such distinguished company. 
Sincerely yours, 
Walter Reed. 
Shortly after this the degree of LL.D. was con- 
ferred on him by the University of Michigan. 
In October, 1902, when Dr. Reed returned to 
Washington for the winter, it became evident that 
his strength was much below par. Each evening 
he came home worn out with fatigue, the lines of 
exhaustion on his face telling plainly that the day’s 
work had been too much for his powers. All 
mental exertion became a painful effort to him, and 
he complained frequently to his wife of the diffi- 
culty he experienced in giving his accustomed 
lectures. One night, as he was leaving the house 
for the Columbia Lecture Hall, he glanced over 
his notes, and shaking his head, remarked, “I can- 
not realise that I ever delivered this lecture. It is 
utterly beyond my mental capacity now.” Before LIFE AFTER RETURN FROM CUBA 
271 
his friends and acquaintances he exerted himself 
to keep up his usual flow of spirits, but his wife, to 
whom he could express himself without restraint, 
was so shocked at the change wrought in him by a 
few short weeks that she became oppressed by the 
sense of an impending calamity. The faithful old 
messenger at the Museum was the only person 
besides his wife to whom he allowed himself to give 
way, and to him he said one day, “Beechner, I am 
a very sick man.” 
On Wednesday, the 12th of November, Dr. 
Reed returned from his office earlier than usual, 
and remarked to his wife that he must have eaten 
something at luncheon which had disagreed with 
him. He was so ill throughout the remainder of 
the day that he could not go to his lecture in the 
evening, and the next day he remained in bed most 
of the forenoon. Later he rose, dressed, and went 
out, although still complaining of abdominal pain 
which caused him to limp. On Friday, the 14th, 
he consulted his old friend and brother officer, 
Major W. C. Borden, stating that he himself 
thought the trouble was appendicitis. 
On examination, Major Borden found a tender 
spot, one-third of the way inward from the right 
anterior superior spine, with increased muscular 
tension in the neighbourhood. The temperature 
was then 99.40 and the pulse 77. Dr. Borden made 272 
WALTER REED AND YELLOW FEVER 
a diagnosis of appendicitis, but as Dr. Reed was 
much better next morning, it was hoped the worst 
was over. That night the temperature was 99.8° 
and the next morning it was 98°. Dr. Reed sat up 
in bed most of that day (Sunday, the 16th), begged 
for solid food, read his letters, talked of the im- 
provements to be made at his country home in the 
spring, saw some of his old friends, and was alto- 
gether so well and bright that he seemed on the 
high road to recovery. On Sunday evening, how- 
ever, his temperature rose to 100.4°, with some 
return of pain, and although the other symptoms 
were not worse, Dr. Borden advised operation as 
soon as possible the following day. Early the next 
morning, accordingly, Dr. Reed was taken to the 
Army Hospital Barracks, where Dr. Borden 
operated at eleven A. M. Just before the operation 
Dr. Reed said to his old friend, Major Kean, to 
whom he was much attached, “Kean, I am not 
afraid of the knife, but if anything should happen 
to me, I am leaving my wife and daughter so lit- 
tle;” and as he went under the influence of the 
ether he was heard to whisper, “So little, so little.” 
Some difficulty was encountered in finding the 
appendix, so that it was necessary to enlarge the 
incision, and when located, it proved to be very 
large and closely adherent to the caput coli. The 
organ was partly filled with pus and had perfo- LIFE AFTER RETURN FROM CUBA 
273 
rated at one point, but the pus had not escaped into 
the abdominal cavity on account of a thin wall of 
adhesions. During the separation of these adhe- 
sions pus escaped, but as it was carefully taken up 
with a dry sponge, Dr. Borden believed that none 
escaped into the abdomen. As the appendix was so 
necrotic at the base that no invagination of the 
stump was possible, it was simply ligated. Gauze 
drainage was inserted, the lower end of the drain 
being carefully packed over the stump down into 
the space between the posterior abdominal wall 
and lower end of the caecum where the pus had 
gravitated. The appendix, itself, on examination 
showed evidence of considerable previous inflam- 
mation, and it became plain that certain attacks of 
“indigestion” and “intestinal colic,” from which 
Dr. Reed had suffered occasionally for some years, 
had been, in reality, mild attacks of appendicitis. 
The overwork and anxiety which Dr. Reed had 
borne so cheerfully during previous years had their 
effect now. He reacted badly from the operation, 
the nausea continuing for nearly eighteen hours, 
and even after this was relieved he suffered from 
almost uncontrollable nervousness and great de- 
pression. 
His friend, Major Kean, who saw him every day 
during his illness, found him still anxious to a 
painful degree as to the future of his family. His 274 
son, Walter Lawrence Reed, a young man of 
twenty-four, had entered the United States Army 
as a profession, and was then beginning a success- 
ful career, but the provision for Mrs. Reed and 
her daughter in case of Dr. Reed’s death was sadly 
inadequate. While trying to cheer him, Major 
Kean told him that he knew, in confidence, that 
the Secretary of War had recommended his promo- 
tion to the rank of colonel in his annual report. 
Major Reed frowned, and then answered, “I care 
nothing for that now.” It was, as Major Kean 
says, the reply of Lancelot of the Lake, “Prize me 
no prizes, for my prize is death.” 
Dr. Borden had predicted at the operation that 
sloughing and a faecal fistula would almost in- 
evitably ensue, on account of the rigid and dis- 
coloured condition of the caecum, and when the first 
packing was removed on the fourth day this pre- 
diction was found to be fulfilled. On the fifth day 
symptoms of peritonitis appeared, indicating a 
rupture into the general peritoneal cavity, and 
from this time Dr. Reed sank rapidly and died 
peacefully in a state of unconsciousness on the sixth 
day after the operation, November 22, 1902. 
His funeral took place with military honours on 
Tuesday morning, November 25, from St. Thomas’ 
Church, Washington. The pall-bearers, all officers 
of the Medical Corps of the Army, were: General 
WALTER REED AND YELLOW FEVER LIFE AFTER RETURN FROM CUBA 
275 
Calvin DeWitt, Majors Louis A. LaGrade, W. B. 
Davis, W. D. McC/aw, J. R. Kean, and W. B. 
Banister. A large number of persons were present 
in spite of most inclement weather, among them 
the students, officers, and professors of the Army 
Medical School and Navy Medical School, in 
uniform; a number of general officers and their 
staffs; the professors and many students from the 
Columbian University, besides a large concourse 
of friends and many distinguished scientific men, 
among them Dr. Reed’s beloved teacher and 
friend, Professor William H. Welch. 
Dr. Reed’s remains are interred at Arlington, 
on a beautiful knoll, overlooking the city of Wash- 
ington, and here Mrs. Reed has erected a simple 
but striking monument to his memory. It is a shaft, 
five feet high, of dark Quincy granite, with an 
oblong bronze tablet, bearing this inscription, se- 
lected by the Surgeon-General and his staff: 
Walter Reed, M. D. of the University of Virginia, 
A. M. of Harvard University, 
LL.D. of the University of Michigan, 
Professor of Bacteriology, Army Medical School 
and 
Columbian University, Washington, D. C. 
“He gave to man control over that dreadful scourge, 
Yellow Fever.” 276 
WALTER REED AND YELLOW FEVER 
The quotation is taken from President Eliot’s 
address when he conferred upon Dr. Reed the 
Harvard honorary degree, a distinction in which 
Dr. Reed took such especial pleasure that it seems 
peculiarly fitting it should mark his last resting 
place. A very successful marble bust of Dr. Reed, 
by the scuptor, Hans Schuler, of Baltimore, has 
been placed in the Surgeon-General’s Library in 
Washington. 
The news of Dr. Reed’s untimely death was re- 
ceived by his profession and by the scientific world 
at large with poignant regret. The loss of such a 
man, at the zenith of his usefulness, with powers 
undimmed, and a future full of possibilities, was 
a bereavement which reached far beyond his own 
immediate circle and occasioned a national regret. 
Expressions of grief, and of sympathy for his 
family, came freely from every side, couched in 
terms of the most genuine feeling. 
The New York Academy of Medicine, the 
University of Virginia, Columbia University, the 
American Academy of Medicine, the International 
Congress of Medicine, and many other scientific 
bodies at home and abroad passed resolutions ex- 
pressing their sense of the loss sustained by the 
profession and their sympathy for Dr. Reed’s 
family. The Medical Society of the District of 
Columbia, of which Dr. Reed had been a distin- MAJOR WALTER REED 
Bust by Hans Schuler. Now in the library of the Surgeon-General in 
Washington guished member, held a memorial service on De- 
cember 31, 1902, at which some of his friends and 
brother officers spoke on different aspects of his 
life and work. I have already quoted largely from 
the addresses made on this occasion, and I will 
pause here only to emphasise one point which 
strikes the reader forcibly in all of them, namely, 
the note of personal feeling apparent under the 
most conventional forms of expression. It would 
seem as though no one could come in contact with 
Dr. Reed without experiencing the charm and 
force of his personality in a lasting manner, so that 
even those whose knowledge of him was limited 
to a passing acquaintance experienced a sense of 
individual loss on hearing he was gone. 
All of the leading medical journals published 
expressions of appreciation of Dr. Reed’s work 
and grief for his untimely end. One of these, in 
particular, by Dr. George Nuttall in the Journal 
of Hygiene for April, 1903, contains an interesting 
account of his work and a warm-hearted defence 
of his claims to distinction against his detractors. 
During the winter following Dr. Reed’s death 
a strong desire arose among his friends as to the 
establishment of some memorial in his honour. 
The project first assumed definite shape at a dinner 
given by Professor Alexander Graham Bell to a 
number of the members of the Association of 
LIFE AFTER RETURN FROM CUBA 
277 278 
American Scientists, and early in 1903, a certificate 
of incorporation was filed in Washington for the 
Walter Reed Memorial Association, in order that 
further steps might be taken on an organised basis. 
The officers of the Association were: Dr. D. C. Gil- 
man, president; General G. M. Sternberg, vice- 
president; Mr. Charles J. Bell, treasurer; General 
Calvin De Witt, secretary; with an executive 
committee consisting of Major J. R. Kean, Major 
W. D. McCaw, and Dr. A. F. A. King. The 
American Medical Association appointed a com- 
mittee to co-operate with the Memorial Associ- 
ation, of which Dr. W. W. Keen of Philadelphia 
was chairman, and the Association for the Advance- 
ment of Science did the same, with Dr. D. C. Gil- 
man as its head. 
On August 15, 1903, the various committees met 
at Bar Harbor, Maine, in order to confer as to 
the steps proper to be taken and to determine the 
nature of the memorial. Representative men from 
all parts of the country were present, and letters 
were received from various minor committees. It 
was then determined to make every effort to raise 
by subscription a fund of twenty-five thousand dol- 
lars, the income of which should be devoted to 
Dr. Reed’s widow and daughter during their lives, 
while at their decease the principal should be used 
either in the erection of a monument to Dr. Reed’s 
WALTER REED AND YELLOW FEVER LIFE AFTER RETURN FROM CUBA 
279 
memory or in the promotion of researches in his 
especial field of work. CHAPTER XII 
THE OTHER MEMBERS OF THE YELLOW 
FEVER COMMISSION 
And there some whom a thirst 
Ardent, unquenchable, fires, 
Not with the crowd to be spent, 
Not without aim to go round 
In an eddy of purposeless dust. 
Effort unmeaning and vain. 
—Matthew Arnold, Rugby Chapel. 
IT would not be fitting that this volume should 
close without special mention of the men associated 
with Dr. Reed in his experimental work. It is 
true that “his was the master mind and he the 
guiding spirit,” but his three associates gave them- 
selves to the cause with no less devotion than he; 
two of them suffered from the disease, and one lost 
his life by it. If the pestilence at our gates has been 
stayed by the efforts of the Commission, ought we 
not to honour these “brave soldiers in the Libera- 
tion War of Humanity,” by whom the victory has 
been gained, only less than their commander? 
JAMES CARROLL 
Dr. James Carroll was born at Woolwich, Eng- 
land, on June 5, 1854. He received a good com- 
280 YELLOW FEVER COMMISSION 
mon school education, and when he was fifteen 
emigrated to Canada, where for some years he 
lived the life of a backwoodsman. In 1874 he 
entered the United States Army and afterwards, 
while still a soldier, he began the study of medi- 
cine at the University of the City of New York, 
during the session of 1886-1887. After the break 
of a year he resumed his medical studies in Balti- 
more, at the University of Maryland, in 1889-1891, 
and received his degree from that institution. Dur- 
ing the winters of 1891-1892 and 1892-1893 he 
undertook some post-graduate work at the Johns 
Hopkins Hospital in pathology and bacteriology. 
His first association with Dr. Reed was in 1893, 
when he was assigned to duty at the Army Medical 
School in Washington, and they continued to be 
more or less connected during the next six years. 
In 1899, as I have related elsewhere, they were 
both appointed by Surgeon-General Sternberg to 
investigate the true nature of the Bacillus icter- 
oides, which Sanarelli asserted was the specific 
cause of yellow fever, and in 1890, when the Army 
Commission on yellow fever was appointed, Dr. 
Carroll was placed second in command. He sailed 
from New York in company with Dr. Reed on 
June 21, 1900, and reached Havana on the 23th. 
On August 4, when matters were in working train 
in Cuba, Dr. Reed returned to the United States 
281 282 
WALTER REED AND YELLOW FEVER 
for two months on official business, and Dr. Carroll 
remained at the head of affairs in Cuba. It was 
during this interval that he had the attack of yel- 
low fever, described as the first case produced 
experimentally by the bite of the mosquito. Dr. 
Carroll himself says that the proudest circum- 
stance of his life is the fact that he was the first 
person to succumb to mosquito inoculation, al- 
though, he adds, “with a wife and five young 
children at home, my thoughts during the serious 
part of my illness may be better imagined than 
described.” 
During Dr. Carroll’s convalescence an incident 
occurred which caused him a good deal of amuse- 
ment. One of his nurses, who came from Tennes- 
see, had had considerable experience with yellow 
fever, having, indeed, lost her husband and sev- 
eral children from it. One day early in his ill- 
ness, Dr. Carroll mentioned to her that he had 
contracted the disease through the bite of a mos- 
quito and noticed that she looked surprised. Some 
time later, when well enough to look over the daily 
records of his condition, he found this entry: 
“Says he got his illness through the bite of a 
mosquito—delirious!” 
Although Dr. Carroll made a rapid recovery 
from yellow fever, he did not entirely escape its 
effects. During the course of the illness he had a YELLOW FEVER COMMISSION 
sudden heart attack, the nature of which is best 
described in his own words: “From personal ex- 
perience I think more stress should be laid on the 
necessity for confining mustard foot-baths to the 
earliest stage, as laid down by Sternberg and 
nearly all writers. In my own case it was used for 
the first time on the third day, and I shall never 
forget the effect of it. Within half an hour after 
the removal of the foot-bath, and while I was 
oppressed with a weight of heavy grey blankets, 
I felt a sudden pain and embarrassment at the 
heart. The pain was very acute and accompanied 
with a feeling of distention, as if the organ was 
much distended and was being arrested in diastole. 
Happily, it lasted but a few moments. This was 
the only time I felt myself to be in imminent 
danger.” 1 Unfortunately, the effects of this attack 
were not so transitory as Dr. Carroll believed 
when he first wrote his account of it. Subsequent 
events have shown that this was, undoubtedly, an 
acute dilatation of the heart, which induced a per- 
manent valvular lesion that limited Dr. Carroll’s 
activity and caused his rejection by a life insurance 
company. 
Early in October, 1900, Dr. Reed returned to 
Cuba to collect material for the preliminary re- 
283 
1 “ The Treatment of Yellow Fever,” Jour. Amer. Med. 
Assoc., July 19, 1902. 284 
WALTER REED AND YELLOW FEVER 
port of the Commission. This occupied about ten 
days, after which he again went back to the United 
States, where he presented the first results of the 
work before the American Public Health Asso- 
ciation in Indianapolis, at the end of October. 
Shortly after the ist of November Dr. Reed was 
once more in Cuba, and resumed the personal 
supervision of the work. 
All the reports of the Commission bear Dr. 
Carroll’s name as well as that of Dr. Reed, and 
in reading them we should always bear in mind 
that, while the experiments were planned by the 
master mind of the chief, the accuracy with which 
they were carried out and the care by which all 
possible precautions were taken to exclude every 
source of error, are due to Dr. Carroll quite as 
much as to Dr. Reed. 
In February, 1901, when the work at Camp 
Lazear was finished, Dr. Reed returned to the 
United States, but Dr. Carroll remained for some 
weeks longer in order to investigate into the con- 
dition of the urine in yellow fever, as well as to 
ascertain how long the mosquito is capable of 
conveying the infection. He sailed for home on 
March 4, but the following August he returned 
to Cuba alone, having been sent by the United 
States Government for the purpose of performing 
the experiments in the inoculation of blood and serum described in Chapter VIII. These experi- 
ments have already been dwelt upon at some 
length, but the present seems to be the most ap- 
propriate place to relate an incident which shows 
how greatly the final success of the yellow fever 
work was due to Dr. Carroll’s force of character. 
The serious nature of the experimental cases at 
Las Animas Hospital and the occurrence of two 
deaths had alarmed Dr. Guiteras and Dr. Finlay 
and had occasioned no little excitement in the 
public mind. Such a condition of things would 
have deterred many men from further action, but 
Dr. Carroll was of a different fibre. To be driven 
from the field of battle just as the crowning suc- 
cess of his investigations was at hand was not a 
part of his plan; his continuance, however, was 
rendered somewhat difficult by the fact that Dr. 
Reed, disturbed by the exaggerated reports which 
reached him through the press, and hampered in 
his judgment by the disadvantage of being at a 
distance, wrote to advise against further experi- 
ments upon human beings, and Dr. Carroll was 
forced to stand alone. The correspondence be- 
tween them at this juncture makes it plain that the 
Yellow Fever Commission owes the completion of 
the final stage in its work at this particular time 
to Dr. Carroll’s wisdom and self-reliance. 
On August 18, Dr. Carroll wrote to Dr. Reed 
YELLOW FEVER COMMISSION 
285 286 
as follows concerning the serious character of the 
yellow fever cases then under Dr Guiteras’ care: 
WALTER REED AND YELLOW FEVER 
Las Animas Hospital, Havana, 
Aug. 18, 1901. 
My dear Doctor: The first fatal case of experi- 
mental fever is now on record. Dr. Guiteras’ second 
case died at 2 P. M. this morning, on the sixth day of 
the disease, after having had black vomit, with deli- 
rium, bloody stools, etc. . . . Guiteras declined to per- 
mit the case to be autopsied, for fear of its effect upon 
the Spaniards. The morgue is situated adjoining to and 
continuous with the laboratory, and is completely 
screened with slatted windows. Dr. Gorgas came out 
later and overcame the objections, so I made an autopsy 
in Dr. Guiteras’ presence, and with his assistance. . . . 
Their third case has black vomit, hiccough, convul- 
sive movements, delirium, and will die within twenty- 
four hours. The fourth and fifth cases are down, the 
former very mild, in the person of Dr G.’s laboratory 
assistant, and the latter, a Miss Maass, a nurse, came 
down to-day. So far she seems to be one of only mod- 
erate severity. ... In the third case there was no rise 
of temperature until within the first three hours of the 
sixth day of the disease. I was prepared to take blood 
from this individual on the second day, but Guiteras 
would not let me bite him with the six insects which I 
had ready for the purpose. To tell the truth, they ap- 
pear to be panic-stricken at the positive character of 
their results, and they think all biting should be stopped. 
Very sincerely yours, 
James Carroll. YELLOW FEVER COMMISSION 
287 
This letter crossed the following, coming from 
Dr. Reed to Dr. Carroll: 
Blue Ridge Summit, Pa., 
Aug. 23, 1901. 
My dear Doctor: Guiteras and my good friend 
Dr. Finlay must have been having a devil of a time 
with their patients, as far as I can judge by the ac- 
counts in the daily papers. I wonder what they think 
of the “mild” character of the attacks conveyed by 
these insects! There did not appear to be much “im- 
munity conveyed by these insects.” Really, this sacrifice 
of life was so unnecessary, in my opinion. I was certain 
that somebody was bound to be killed before the work 
was completed. 
You say “prospects favourable.” And this leads me 
to strongly advise against further experiments on hu- 
man beings. Our work has been too good to be marred 
now by a death. As much as I should like to know 
whether the filtrate will convey the disease, I should 
advise against it. Infect as many insects as you can for 
further sectioning, and get other information about the 
epidemic at Santiago de las Vegas, and send me as soon 
as you can. 
Please extend my sympathy to Drs. G. and Finlay, 
with my kindest regards. I return to Washington Sep- 
tember 1. 
Yours sincerely, 
Walter Reed. 
It will be remembered that in all the inocula- 
tion experiments carried on at Camp Lazear no 288 
fatal case of experimental yellow fever had oc- 
curred, and Dr. Carroll was convinced that it was 
entirely possible for him to continue the experi- 
ments necessary to the completion of his work 
without unjustifiable risk to life, the death at Las 
Animas being due, in his opinion, to special causes 
which it would be within his power to control. To 
abandon his researches simply because the public 
mind was unduly agitated was not to be thought 
of. Accordingly, during the interval between the 
despatch of his letter to Dr. Reed, and the receipt 
of the one which crossed it, he proceeded with 
the work along the proposed lines, writing again 
on August 22 to keep Dr. Reed informed of his 
proceedings. About a week later he received the 
following letter from Reed: 
WALTER REED AND YELLOW FEVER 
Blue Ridge Summit, Pa., 
Aug. 27, 1901. 
My dear Carroll: I have your letters of the 18th 
and the 23d, both of which reached me by this morn- 
ing’s mail. It is needless to say that both are of extreme 
interest. Certainly, Guiteras should now be satisfied 
with his proof of the mosquito theory. Six out of seven 
cases, with two fatal, is evidence that should convince 
even Wasdin. I wrote you a few days ago advising 
against further experiments on human beings, in view 
of these fatal cases. From the tenor of your last letter, 
however, I see that you have made all preparations to 
go ahead with the observations as determined by us at YELLOW FEVER COMMISSION 
289 
Washington, and I hardly know what to say. I will 
suggest that, inasmuch as the injection of the blood has 
given us four positive results, you limit your observa- 
tions to the injection of the serum without making con- 
trols injected with unfiltered blood. If the filtrate 
proves negative in, say, three or four cases, that would 
decide the point conclusively. 
Of course, since Guiteras denied you the chance to 
obtain the blood, I suppose you must obtain your first 
subject by means of the mosquito’s bite, unless there are 
cases at Havana. What could have been Guiteras’ ob- 
jection to your applying mosquitoes to his cases? . . . 
I shall await your results with the greatest interest. 
Please remember me kindly to Majors Havard and 
Gorgas, and to Agramonte when you see him. 
Sincerely yours, 
Walter Reed. 
This letter was written on August 27, and after 
writing it Dr. Reed made up his mind, on further 
reflection, that it would be unwise to interfere 
with Dr. Carroll’s plans, considering that since he 
was on the spot he was, after all, the best judge as 
to the propriety of making further experiments 
upon human beings. On August 29, therefore, he 
cabled to Dr. Carroll as follows: 
Washington, D. C., 
Aug. 29, 1901. 
Consult Havard. Use your best judgment in future. 
Reed. 290 
WALTER REED AND YELLOW FEVER 
This despatch was received by Dr. Carroll on 
the same day as the letter written on the 27th, and 
was a great relief to his mind. He had some diffi- 
culty at first in producing the necessary experi- 
mental cases; in spite of delay from this cause, 
however, as well as hindrances of various kinds, 
among them the action to the suction pump, 
already described, he persevered according to the 
proposed plans and completed the work in the 
latter part of October. Dr. Reed’s last letter to him 
before his return home shows emphatically how 
satisfactory were the results of his judgment at 
this final stage of the yellow fever work: 
Surgeon General's Office, 
Washington, D. C., Oct. 26, 1901. 
My dear Doctor: I have just received your letter 
of the 22d, and hasten to congratulate you on the 
thorough manner in which you have accomplished the 
task assigned you. The results could not be better, and 
throw a flood of light on the etiology of yellow fever. 
. . . We can now go ahead and submit a contri- 
bution on the etiology of yellow fever. This we must 
do promptly, after we have discussed all of the later 
results. . . . 
Again congratulations. Hoping to see you soon, 
Very sincerely yours, 
W. Reed. 
The published report of these experiments is the 
last paper issued under the joint names of Reed and Carroll. With its appearance the official pub- 
lications of the Commission ended, but Dr. Car- 
roll’s interest in the subject continued unabated, 
and he embodied the knowledge acquired during 
his unique experiences in several papers of the 
greatest interest. The first of these, on “The 
Treatment of Yellow Fever,” published in July, 
1902, is of special interest, because it is the 
first discussion of the therapeutics of the dis- 
ease since its aetiology has been correctly known. 
After reviewing all the methods of treatment em- 
ployed both in ancient and more modern times, 
Dr. Carroll lays down the following general 
principles:2 
YELLOW FEVER COMMISSION 
291 
In yellow fever we are dealing with a disease of 
short duration and one that tests severely the vital 
powers of the patient. I believe, however, that in 
previously healthy, non-debilitated subjects, free from 
organic lesions, the mortality can be reduced, practi- 
cally to zero, by careful and judicious treatment insti- 
tuted at the incipiency of the attack. On the other 
hand, if there be present debility from any cause, 
anaemia, organic lesions of the heart, liver, or kidneys, 
the outlook is always serious and recovery doubtful. 
The treatment must be essentially eliminative and sup- 
porting, with the incidental use of measures tending to 
reduce hyperpyrexia, relieve pain, and remove internal 
congestions. 
2 Jour. Amer. Med. Assoc., July 19, 1902. 292 
WALTER REED AND YELLOW FEVER 
“The lesions and symptoms,” he continues, “are 
produced by a powerful toxin circulating in the 
blood and tissue fluids. This poison appears to act 
with greatest intensity upon the liver, and next 
upon the kidneys.” After giving an able description 
of the conspicuous pathological lesions produced 
by the disease, Dr. Carroll proceeds as follows: 
The primary indication in the treatment of yellow 
fever is to remove the immediate cause of the condition 
present, viz., the toxin. This is best and most expedi- 
tiously effected through the normal channel, with the 
urinary secretion, aided by the moderately free action 
of the skin and moderate depletion of the digestive 
tract by the use of mild saline cathartics. With the 
evacuation of these fluids and the toxin they contain, 
the symptoms abate—speaking of the early stage— 
and the stomach will retain an increased amount of 
fluid to replace that which has been removed. Care 
should be taken to maintain one or more of these func- 
tions throughout the attack, sustaining the patient’s 
strength by the judicious use of appropriate stimulants. 
It is much to be regretted that we have no means of 
acting directly on the liver. 
After reviewing the various means of fulfilling 
these indications in detail, Dr. Carroll takes up 
the question of nutrition during the disease: 
The nutrition of the patient is a subject well worthy 
of consideration. Food is frequently withheld for vary- 
ing periods, from three to five days or a week; in my YELLOW FEVER COMMISSION 
293 
own case, I think for at least eight days nothing was 
allowed but water, Apollinaris, ice, and champagne. 
Now, during all this time certain cells of the body are 
functioning and using up their own protoplasm, for in 
conditions of anaemia or malnutrition and in the in- 
fectious diseases, we know that the cells of the vital 
organs undergo degeneration and often necrosis, from 
want of proper material. In specific fevers the func- 
tions of some of the cells are consumed in the perform- 
ance of these functions and converted into waste mate- 
rial and end-products which add to the general intoxica- 
tion. Physiologists teach us that there are certain foods 
that will prevent this by saving their proteid constit- 
uents. Among these are gelatine, fat, and non-proteid 
foods, the latter of which, in the form of olive oil, has 
been used with marked success by Spanish physicians in 
the treatment of yellow fever. . . . The rationale of 
this treatment appears to be that the oil is highly nutri- 
tious, a proteid saver, and is readily absorbed by the 
epithelial and endothelial cells of the capillaries. In this 
way the integrity of the latter is preserved and the haem- 
orrhage prevented. Pathology teaches us that when 
there is capillary blood stasis, haemorrhage soon takes 
place from deprivation of nourishment, the endothelial 
cells of the capillaries being nourished by the blood that 
circulates within the vessels. This suggests the early 
administration of olive oil in emulsion with lime water.' 
Finally, Dr. Carroll takes up the question of 
decrease in the elimination of urea as follows: 
The early involvement of the liver, as indicated by 
the early lesion in the duodenum, naturally suggests an 294 
WALTER REED AND YELLOW FEVER 
equally early defect in the functioning power of the 
liver in the elaboration of urea. This deficiency, which 
must sooner or later become marked, is manifested in 
the failure of the kidneys to secrete the normal amount 
of urine. As the rate of elimination by these organs 
increases normally with an increase in the urea in the 
blood, it would seem justifiable to supply the defect by 
the medicinal administration of urea, either through 
the stomach or by hypodermic injection as soon as the 
ordinary remedies cease to have the ordinary effect. 
The injection of urea into the blood soon evokes a very 
copious secretion of urine, even if previously to the in- 
jection the secretion had been at a standstill. We can 
hardly do better than follow Nature’s method of stimu- 
lating these organs to perform their normal functions. 
And the danger of an excessive accumulation of urea 
in the blood must be very slight in a condition where 
the substance is manifestly deficient. . . . 
In my opinion [he concludes], the services of trained 
female nurses are indispensable to secure the very best 
results. They should be under strict discipline, and the 
tour of duty with patients who are seriously ill should 
be eight hours in the twenty-four. 
In 1903 Dr. Carroll published two more papers. 
One of these, on the “History, Cause, and Mode 
of Transmission of Yellow Fever, and the Occur- 
rence of Similar Type of Fatal Fevers in Places 
where Yellow Fever is not Known to Have Ex- 
isted,” 3 contains an interesting review of the liter- 
3 Jour. Military Surg., 1903. YELLOW FEVER COMMISSION 
295 
ature of the disease which it will well repay any- 
one investigating the subject to read. 
The other paper is “The Transmission of Yel- 
low Fever.”4 In this article, when speaking of 
the possibility of controlling yellow fever, Dr. 
Carroll says: 
The greatest obstacle to the control of the disease 
is the failure to recognise the first cases, when they are 
not accompanied by black vomit. Some of these cases 
are so mild in character that no physician would dare 
to pronounce them yellow fever unless he knew the dis- 
ease to be prevailing at the time. Susceptible persons 
visiting at the house, or living in adjoining houses, 
would be bitten and develop the disease in near or 
distant localities several weeks later, forming second- 
ary foci of infection. From these secondary foci, terti- 
ary foci would in time develop. The diagnosis of bil- 
ious remittent fever, dengue, etc., would serve to cover 
the earlier cases until the appearance of black vomit, by 
which time the infection would have become more or 
less widely disseminated. Such is the history of many 
outbreaks. 
Another of Dr. Carroll’s later publications is 
entitled “A Brief Review of the Etiology of Yel- 
low Fever.” This paper has been very largely 
drawn upon for the material in some of the fore- 
going chapters, and I will not, therefore, stop to 
consider it here, except in one particular. In con- 
4 Jour. Amer. Med. Assoc., May 23d, 1903. 296 
WALTER REED AND YELLOW FEVER 
eluding, Dr. Carroll makes reference to some ex- 
periments, performed a hundred years ago, which 
have great historic interest in the light of our 
present knowledge. 
They were made by a student of the University of 
Pennsylvania, Stubbins Ffirth by name, who embodied 
a description of them in a graduation thesis presented 
on June 6, 1804. During the epidemics of 1802 and 
1803 in Philadelphia, Ffirth made numerous attempts 
to inoculate himself by depositing fresh black vomit 
and blood obtained from patients in the early stages 
of the disease into incisions made in his arms and legs. 
Besides numerous other experiments he inserted four 
drops of such serum into an incision in his leg. One 
must read this interesting treatise in order to appreciate 
fully the determination of the investigator, who admin- 
istered black vomit to animals, injected it into his own 
circulation, and deposited it in his own tissues. He in- 
haled the fumes of six ounces of this material which 
he heated over a sand-bath in a small room; the resi- 
due he made into pills and swallowed. Failing in this, 
he further tried to inoculate himself with blood serum, 
saliva, perspiration, bile, and urine, and finally concluded 
that yellow fever was neither infectious nor contagious. 
Since the French Commission has told us that O.i CC. 
of virulent serum is sufficient to infect, we can safely 
say that Stubbins Ffirth came very near to proving the 
inoculability of yellow fever more than a century ago. 
There are great possibilities for investigation 
as to the transmission of other diseases through the medium of insects, and the establishment 
of prophylaxis along lines suggested by such 
demonstrations. In this connection it was in- 
teresting to learn from Dr. Carroll that Dr. 
Reed firmly believed that smallpox is conveyed 
by a biting insect of some kind, and that he 
and Dr. Carroll made some (apparently inef- 
fectual) attempts to variolate calves by causing 
them to be bitten by bed-bugs that had previously 
been applied to patients suffering with small- 
pox. 
The organic heart lesion which resulted from 
his attack of yellow fever terminated fatally on 
September 16, 1907, after an illness of some 
months. 
I cannot close this little memoir of Dr. Carroll 
more suitably than by quoting from an address 
delivered by Dr. J. W. Pilcher, U. S. A., before 
the Association of Military Surgeons touching 
“The Duty of the Physician to the Public,” in 
which he alludes to Dr. Carroll as follows: 
YELLOW FEVER COMMISSION 
297 
“While stationed in the Far West some years ago, 
my attention was attracted by the unusual ability of a 
young soldier who had come under my command. Be- 
lieving that a higher fate might be in store for him 
than that of an enlisted man of the army, I began in- 
structing him in the art of medicine. He became very 298 
much interested in the subject, and under my direction 
pursued the work until he acquired the degree of 
Doctor of Medicine and ultimately became employed 
as assistant in the Army Medical Museum at Washing- 
ton. When the entrance of our army into Cuba made 
the conquest of yellow fever one of the most important 
forces to be accomplished, he and his chief, the late, 
lamented Walter Reed, determined to enter upon a 
series of investigations in that direction. The proper 
execution of the work demanded animal experimenta- 
tion of the highest type. Humanity must be the subject. 
No creature of a lower grade would suffice. In the 
grandeur of self-sacrifice this glorious fellow submitted 
himself to the bite of aStegomyia fasciata from the sick 
room of a yellow fever patient. The disease promptly 
developed in its most severe form. . . . Only the most 
intimate care of the ablest physicians based upon a con- 
stitution strengthened by correct living and good habits 
saved him from the fell destroyer. 
“From this experiment grew that wonderful series 
of studies upon which has been based the true theory 
of the control of yellow fever. I refer to the particular 
case because I am prouder than I can state that the re- 
sults of my teaching have brought into the profession 
a man so highly typical of the best in practice and in 
experimentation. That this example was followed by 
Jesse Lazear, in whom the experiment resulted fatally 
and whose brilliant young life was sacrificed for the 
benefit of the people of America, is but an additional 
demonstration of the great danger which this young 
physician incurred, without hope of reward, for the 
benefit of the human race.” 
WALTER REED AND YELLOW FEVER I subjoin a list of the articles which Dr. Carroll 
has published independently on the subject of 
yellow fever. 
YELLOW FEVER COMMISSION 
299 
list of dr. carroll's independent contributions 
TO THE LITERATURE OF YELLOW FEVER. 
“The Treatment of Yellow Fever.” Jour Amer. 
Med. Assoc., July 19, 1902. 
“The Transmission of Yellow Fever.” Jour. Amer. 
Med. Assoc., May 23, 1903. 
“The Etiology of Yellow Fever: an Addendum.” 
Jour. Amer. Med. Assoc., Nov. 28, 1903. 
“Remarks on the History, Cause, and Mode of 
Transmission of Yellow Fever, etc.” Jour. Assoc. Mili- 
tary Surgeons, 1903. 
“A Brief Review of the Etiology of Yellow Fever.” 
N. Y. Med. Jour, and Phil. Med. Jour, (consol.), 
Feb. 6 and 13, 1904. 
“Yellow Fever: a Popular Lecture.” Amer. Med., 
June 3, 1905. 
“Lessons to be Learned from the Present Outbreak 
of Yellow Fever.” Jour. Amer. Med. Assoc., Oct. 7, 
I9°5- 
“Remarks on the Epidemics of Yellow Fever in Bal- 
timore.” Old Maryland, Feb., 1906. 
“Without Mosquitoes There Can Be No Yellow 
Fever.” American Medicine, March 17, 1906. 
JESSE W. LAZEAR 
Dr. J esse W. Lazear, the third member of the 
Army Commission, was born in Baltimore on May 300 
2, 1866. His early education was received at Trin- 
ity Hall, a private school in Washington, Pennsyl- 
vania, from which he entered the Johns Hopkins 
University, graduating in 1889. He then studied 
medicine at Columbia University and was gradu- 
ated there in 1892, after which he served for two 
years at the Bellevue Hospital, New York. When 
his hospital service ended he spent a year in Eu- 
rope, part of which was passed at the Pasteur 
Institute, in Paris. On his return to this country he 
was appointed bacteriologist to the medical staff 
of the Johns Hopkins Hospital, and also held the 
position of assistant in clinical microscopy in the 
University. 
Much of Dr. Lazear’s time after he was gradu- 
ated in medicine was spent in research, and during 
his residence at Bellevue he succeeded in isolating, 
for the first time, the diplococcus of Neisser in 
pure culture from the circulating blood, in a case 
of ulcerative endocarditis; he followed up this dis- 
covery by investigations into problems connected 
with malarial parasites. He was the first person 
in this country to confirm and elaborate the studies 
of Romanovsky and others concerning the intimate 
structures of the hasmatozoa of malaria, although 
his work on the subject was, unfortunately, not 
published until after his death. He, together with 
Woolley and Thayer, was first in this country to 
WALTER REED AND YELLOW FEVER JESSE W. LAZEAR, M.D. 
Member of the U. S. A. Yellow Fever Commission, who laid down his 
life on the field of service YELLOW FEVER COMMISSION 
301 
confirm, in part, the work of Ross and the Italians 
on the mosquito cycle of the malarial parasite. 
The years spent in studies of this description 
had, of course, peculiarly fitted Dr. Lazear for the 
work which the Yellow Fever Commission was 
instituted to conduct, and he was appointed to it 
with the rank of acting assistant surgeon. When 
Dr. Reed, in company with Dr. Carroll, reached 
Cuba, Dr. Lazear had been on the island several 
months, during which time he had observed a 
number of cases of yellow fever, performing au- 
topsies, when opportunity afforded, and taking 
cultures. He had studied many films of blood from 
yellow fever patients, and was prepared to say 
with confidence that cultures and blood examina- 
tions promised nothing of special importance. 
Not long after the arrival of the other members 
of the Commission, Dr. Lazear applied to him- 
self a mosquito of the genus Stegomyia, which 
had bitten a yellow fever patient some days 
previously. The results, however, were nega- 
tive. About a month later, during Dr. Reed’s ab- 
sence in the United States, Dr. Lazear allowed a 
mosquito, which had chanced to alight on hishand, 
to take its fill. This occurred while working 
in the yellow fever ward of Las Animas Hospi- 
tal, in the suburbs of Havana, on September 13, 302 
WALTER REED AND YELLOW FEVER 
1900. At that time Dr. Lazear with others 
was skeptical as to the mosquito theory of 
transmission and, as previously stated, he neither 
paid special attention to the species of the 
mosquito nor did he report this occurrence to 
any of his colleagues. He merely took the 
chance of any visitor coming into the ward. 
Five days later, during the night of September 
18, he was seized with a chill, followed in a few 
hours by another. Dr. Carroll, who was at that 
time recovering from his own attack of yellow 
fever, examined Dr. Lazear’s blood twice for ma- 
larial parasites, and as the results were negative 
and the clinical symptoms made the diagnosis 
fairly secure, he was removed to the yellow fever 
isolation camp. Before his removal he made over 
to Dr. Carroll his notes covering all the attempts 
at mosquito inoculation, and told him of his per- 
sonal experience concerning which there was no 
record. For three days of his illness he held his 
own, but at the end of this time the dreaded black 
vomit made its appearance, a symptom the sig- 
nificance of which he himself knew only too well. 
“I shall never forget,” says Dr. Carroll in his 
published account of Dr. Lazear’s illness, “the 
expression of alarm in his eyes when I last saw 
him alive in the third or fourth day of his illness. 
The spasmodic contractions of his diaphragm in- YELLOW FEVER COMMISSION 
303 
dicated that black vomit was impending, and he 
fully appreciated their significance.” Four days 
later he died, leaving a widow and two little chil- 
dren, the younger of whom he had never seen. 
“Thus ended,” says Dr. Carroll, “a life of bril- 
liant promise at the early age of thirty-four. Dr. 
Lazear died that his fellow-men might live in com- 
fort and happiness. . . . It is no exaggeration 
to say that hundreds, nay perhaps thousands, in 
the Southern States owe their lives, certainly their 
prosperity, to the results of the work in which he 
was engaged, and for which he and his family 
have paid such a fearful penalty. The world lost 
in him a benefactor; the profession a man of high 
attainments, noble character, and lovable disposi- 
tion; words cannot measure the loss to his widow 
and orphans.” These words are taken from Dr. 
Carroll’s address at the unveiling of the memorial 
tablet to Dr. Lazear at the Johns Hopkins Hos- 
pital, and I ought not to close this tribute to his 
memory without quoting from the remarks of his 
friend and co-worker, Dr. W. B. Thayer. 
“I wish,” Dr. Thayer said, “especially for 
the younger men here, that I might be able to 
picture to you Lazear as a man and companion. 
Quiet, retiring, and modest almost to a fault, he 
was yet a manly man with a good, vigorous tem- 
per, well controlled, and a rare physical courage, 304 
WALTER REED AND YELLOW FEVER 
with a deep love of his profession, and an ardent 
desire to make adequate contributions to its ad- 
vance. . . . When the news of his sad death 
became known, there were those who blamed what 
they regarded as unjustified temerity; who felt that 
such risks were not for married men. With these I 
cannot agree. No man loved his family more than 
Lazear, but he was engaged in a great work—and 
he knew it—in a work where at the moment no 
substitute could take his place. Lazear saw his 
duty clearly, and where he saw his duty fear and 
doubt could not enter in. A few well-known lines 
of Emerson’s tell the story: 
Though love repine and reason chafe, 
There comes a voice without reply. 
’Tis man’s perdition to be safe, 
When for the truth he ought to die.” 
Dr. Lazear laid down his life before the Yellow 
Fever Commission had advanced very far with its 
work, so early in its career, indeed, that his name 
appears in only one of its published reports, the 
“Preliminary Note on the Etiology of Yellow 
Fever.” Nevertheless, although his untimely death 
deprived him of a full share in the brilliant re- 
sults they achieved, he did heroic service in the 
cause. I do not think I can close this brief memo- 
rial more appropriately than by citing the tribute 
paid him by his friend and colleague, Dr. Reed, YELLOW FEVER COMMISSION 
305 
when addressing the Medical and Chirurgical 
Faculty of Maryland in April, 1901. 
Before proceeding to the discussion of my subject, it 
is fitting that I should pay brief tribute to the memory 
of a former member of this Faculty, the late Dr. Jesse 
W. Lazear, United States Army. I can hardly trust 
myself to speak of my late colleague, since the mention 
of his name brings back such scenes of anxiety and de- 
pression as one recalls only with pain. Along with 
these sad memories, however, come other recollections 
of a manly and fearless devotion to duty such as I have 
never seen equalled. In the discharge of the latter, Dr. 
Lazear semed absolutely tireless and quite oblivious 
of self. Filled with an earnest enthusiasm for the ad- 
vancement of his profession and for the cause of sci- 
ence, he let no opportunity pass unimproved. Although 
the evening might find him discouraged over the diffi- 
culties at hand, with the morning’s return he again 
took up the task full of eagerness and hope. During 
a service of less than a year in Cuba he won the good- 
will and respect of his brother officers and the affection 
of his immediate associates. Almost at the beginning 
of what promised to be a life full of usefulness and 
good works he was suddenly stricken, and, dying, 
added one more name to that imperishable roll of 
honour in which none others belong than martyrs to 
the cause of humanity. It is my own earnest wish that, 
whatever credit may hereafter be given to the work 
of the American Commission in Cuba, during the past 
year, the name of my late colleague, Dr. Lazear, may 
be always associated therewith. 306 
WALTER REED AND YELLOW FEVER 
Dr. Lazear’s remains lie in the Loudon Park 
Cemetery at Baltimore. A memorial tablet, erected 
by his friends at the Johns Hopkins Hospital, bears 
this inscription, by President Eliot: 
In memory of 
JESSE WILLIAM LAZEAR, 
born May 2, 1866, at Baltimore, 
Graduated in Arts at 
the Johns Hopkins University in 1889; 
and in Medicine at Columbia University in 1892. 
In 1895-96 Assistant Resident Physician 
in the Johns Hopkins Hospital. 
Member of the Yellow Fever Commission in 1900 
with the rank of Acting Assistant Surgeon. 
He died of Yellow Fever at Quemados, Cuba, 
28 of September, 1900. 
With more than the courage and devotion of 
the soldier, he risked and lost his life to show 
how a fearful pestilence is communicated and 
how its ravages may be prevented. 
ARISTIDES AGRAMONTE 
Dr. Aristides Agramonte was bom in Puerto 
Principe, Cuba, on June 3, 1868. His father was 
the well-known insurgent, General Eduardo Agra- 
monte, who was killed in battle on March 8, 1872. 
After General Agramonte’s death his family emi- 
grated to the United States, where the son received ARISTIDES AGRAMONTE, M. D. 
Member of the U. S. A. Yellow Fever Commission. From a photograph 
taken in 1902 YELLOW FEVER COMMISSION 
307 
his education, first in the public schools and then 
in the College of the City of New York. He stud- 
ied medicine in the College of Physicians and 
Surgeons and graduated there with honour on 
June 8, 1890, receiving the third Harston prize 
for clinical reports. 
After obtaining his degree Dr. Agramonte held 
several appointments in the city of New York, two 
of which he obtained through competitive exam- 
ination. One of these was as sanitary inspector in 
the new health department, the other as assistant 
bacteriologist to the health department. 
In May, 1898, he was appointed acting assist- 
ant surgeon in the United States Army, and in 
that capacity he was sent to Santiago in July of 
the same year. In the following November he re- 
turned, and after presenting a report of the inves- 
tigations made by him at Santiago, he was sent to 
Havana, in December, to make studies in the bac- 
teriology of yellow fever; the results of which 
were published in the Medical News for Feb- 
ruary, 1900. 
In May, 1901, he was put in charge of the army 
laboratory of the Division of Cuba, a post which 
he retained till the end of his service on the island. 
At the same time he was also appointed a member 
of the Army Commission on yellow fever, with 
Dr. Reed, Dr. Carroll, and Dr. Lazear. 308 
WALTER REED AND YELLOW FEVER 
During the summer of 1900 Dr. Agramonte 
investigated an epidemic of yellow fever at Santa 
Clara, Cuba, as well as certain cases of so-called 
pernicious fever at Pinar del Rio. The latter 
proved to be an epidemic of yellow fever in a gar- 
rison of 800 troops, and as the cases were being 
treated for malaria by the medical officers in 
charge, Dr. Agramonte met with a great deal of 
opposition when he announced a contrary opinion. 
For his determined stand in carrying out his views 
in the face of obstacles and for the general excel- 
lence of his work he was publicly complimented 
by his commanding officer. 
Dr. Agramonte’s part in the work of the Yellow 
Fever Commission, as I have already said, was 
that of the pathological work and the autopsies; 
and he was associated with the .commission until 
the return of Reed and Carroll to the United 
States in February, 1901. 
In August, 1900, Dr. Agramonte received the 
degree of M. D. from the Medical Faculty of 
Havana, after passing incorporation examinations, 
and in the September following he obtained, by 
competitive examination, the chair of bacteriology 
and experimental pathology in the same institu- 
tion. 
The “Preliminary” and the “Additional 
Notes” in which the Army Commission published the results of their labours, as well as their paper 
on “Experimental Yellow Fever,” bear Dr. Agra- 
monte’s name, with those of the other members of 
the board. Dr. Agramonte has, moreover, pub- 
lished several valuable articles on the subject in- 
dependently, a list of which I give below. He has 
also issued a number of papers on subjects other 
than yellow fever, which I have not space to 
record. 
YELLOW FEVER COMMISSION 
309 
LIST OF DR. AGRAMONTE's INDEPENDENT CONTRIBU- 
TIONS TO THE LITERATURE OF YELLOW FEVER. 
“El Bac. Icteroides (Sanarelli) y el Bac. X (Stern- 
berg).” Ext. of an Official Report. Cronica Medico- 
Chirurgica, Havana, Oct., 1899. 
“La Relacion del Bacilo Icteroides con la Fiebre 
Amarilla.” El Progreso Med., Havana, March, 1900. 
“El Fracaso del Suero Sanarelli.” Revista de Med. 
y Chir., Havana, March, 1900. 
“Report of Bacteriological Investigations upon 
Yellow Fever.” The Med. News, February, 1900. 
“Paludismo y Fiebre Amarilla: Seis Casos Clin- 
icos.” El Progreso Med., Havana, Oct., 1900. 
“Anotaciones acera de la Etiologia de la Fiebre 
Amarilla.” Revista de Med. y Chir., Aug., 1901. 
“La Etiolgia de la Fiebre Amarilla.” Official Re- 
port to the N. Y. Quarantine Department, Revista de 
Med. Tropical, October 1, 1902. 
“The Supposed Parasite of Yellow Fever.” Revista 
Med., Cubana, October, 1902. CHAPTER XIII 
REED’S WORK MADE EFFECTIVE 
WILLIAM CRAWFORD GORGAS 
WILLIAM CRAWFORD GORGAS was born on 
October 3, 1854, in Mobile, Alabama, the state of 
which his maternal grandfather Quayle had been 
governor. He was the son of William Gorgas, a 
West Point graduate and a brigadier general in 
the confederate army, who, after the war, was 
made president of The University of the South at 
Sewanee, Tennessee, at which institution General 
Gorgas received his college education before study- 
ing medicine in New York at The Bellevue Medi- 
cal College. Following his medical course, Gorgas 
applied for a commission in the army and was sent 
to Fort Brown, Texas, as a lieutenant. At this 
post, it is said, he first became interested in com- 
batting yellow fever, after having fallen a victim 
to the disease. 
During the Spanish War, when in Cuba with 
the rank of major, and in the years immediately 
following, Gorgas achieved the remarkable suc- 
cess of cleaning up the Island, which made him 
310 REED’S WORK MADE EFFECTIVE 
311 
the inevitable and unquestioned choice of the 
Government in 1905 when it became necessary to 
make healthful the area about what is now the 
Panama Canal in order to render possible the en- 
gineering achievements of General Goethals. 
In 1913, Colonel Gorgas went to South Africa 
at the solicitation of the British Government to 
investigate conditions in the Rand mines where 
thousands of Kaffirs were dying from epidemics of 
pneumonia. The rank of Surgeon General was 
accorded him in 1914 and that of Major General 
in the following March. In 1915, he was elected 
a permanent director of The International Health 
Board of The Rockefeller Foundation and made 
for them, during the summer and autumn of 1916, 
a survey of the endemic foci of yellow fever in 
South America. 
Shortly after the United States entered the 
World War, General Gorgas began the work 
which assisted in reducing the rate of mortality for 
our army to six tenths of one per cent. While on 
duty in France in 1918, he reached the age limit 
and was retired from active service when the war 
was over. 
In 1919, as head of the Yellow Fever Commis- 
sion, organized by the Rockefeller Foundation, he 
directed the work carried on in the South American 
countries. 312 
WALTER REED AND YELLOW FEVER 
In May, 1921, General Gorgas arrived in Lon- 
don from New York, preparatory to investigating 
sanitary conditions in West Africa. The day after 
his arrival, he went to Brussels where he was dec- 
orated by King Albert. From Brussels, he jour- 
neyed to Coblenz, returning thence to London, 
where, on May 30, he was stricken with apoplexy 
and was removed to the Queen Alexandra Hospi- 
tal. The development of renal complications left 
little hope of his recovery, and with the dawning 
of the new day on the Fourth of July, he died, 
unable to recognize Mrs. Gorgas or Brigadier Gen- 
eral Noble, Assistant Surgeon General of the 
United States Army, the only Americans present 
at the end. 
General Gorgas has affectionately been called 
“the physician to the world,” a title which reflects 
the power and personality of this man of dreams 
and action far better than the military and civil 
honors conferred on him by many countries. It 
is, therefore, most fitting that his great memorial, 
designed to comprise two complementary institu- 
tions, be erected by all the nations of the world. 
One, “The Gorgas School of Sanitation” at Tus- 
caloosa, Alabama, the old home of General Gorgas, 
will train country health workers, sanitary en- 
gineers, and public health nurses, especially edu- 
cated to deal with problems peculiar to the south- SURGEON GENERAL WILLIAM CRAWFORD GORGAS REED’S WORK MADE EFFECTIVE 
313 
ern states. The other, “The Gorgas Institute of 
Tropical Diseases and Preventive Medicine” will 
be erected in Panama City and will provide lab- 
oratories and materials for research work in tropi- 
cal diseases for men from all over the world. 
Through President Porras, the Republic of Pan- 
ama has contributed the site for the Institute on 
the Bay, near the new Santo Tomas Hospital. 
To no one man is it ever given to make a great 
discovery and to exhaust the whole of its possi- 
bilities. 
Walter Reed’s discovery of the cause of yellow 
fever and its methods of propagation, manifestly 
not self-operative, challenged the world to find a 
great practical mind and a sanitary genius to 
make it effective in a community. The difficul- 
ties of applying the acquired knowledge even to a 
small community were obvious, and the complete 
stamping out of yellow fever seemed so distant a 
goal as hardly to be dreamed of. And yet the 
first of these ideals, the immediate application to 
a localized infected area, was speedily realized in 
the city of Havana; while the second, the purifi- 
cation of a large territory, constituted the dra- 
matic episode of Panama and the Canal Zone; 
and the third, the complete world-wide eradica- 
tion, is now nearly attained through the Rocke- 314 
WALTER REED AND YELLOW FEVER 
feller Foundation and its highly organized scien- 
tific board of workers. 
The latter tasks called for a man with gifts of a 
new order, as great on recent practical lines as 
those of Reed himself. Such a man was found in 
Major William Crawford Gorgas, later Chief Sani- 
tary Officer of the Panama Canal, Surgeon-General, 
and Major-General of the United States Army. 
As with Reed, so with Gorgas,—the man seemed 
fashioned for the emergency; nor have we been 
able in later years to point to another man in these 
United States so preeminently fitted by experi- 
ence, training, and native ability to direct the 
forces charged with the carrying out of this dif- 
ficult task as Major Gorgas, whose slogan was the 
annihilation of the mosquito. Reed’s was the 
rare and brilliant mind of the experimenter, the 
vir tenax propositi, who with test tubes, microscope, 
and media in the laboratory, in hospital, and on 
field patiently follows his problem step by step to 
its elucidation; while Gorgas’ mind was equipped 
for the larger arena in the field of service, also 
calling for rare imagination and an adaptability of 
means to ends. Let me urge the perusal of Gor- 
gas’ book “Sanitation in Panama,”1 a thrilling, 
modest, soldierly account of great services ren- 
dered, as well as the best brief and intimate ac- 
*D. Appleton and Company, 1915. REED’S WORK MADE EFFECTIVE 
315 
count of the work of his friend and predecessor, 
Walter Reed,—a true American epic. In this 
chapter I freely use Gorgas’ memoir for my facts. 
Carlos Finlay’s brilliantly conceived and ob- 
stinately reiterated conviction that a mosquito, 
and in particular the stegomyia mosquito, was 
responsible for the transmission of yellow fever 
from victim to victim, and not filth, fomes, or 
miasma, was now at length, as demonstrated in 
the preceding pages, clearly proven. The minor- 
ity of one had become the vast majority and now 
had all the suffrages. The next query was, have 
we really gotten anywhere? Can we apply this 
strange wisdom practically? Is not the peccant 
cause too elusive? Is not the extermination of 
the mosquito, that ubiquitous, ethereal tenant of 
the air, floating invisibly hither and thither on 
gossamer wings with every breeze, about as dif- 
ficult to accomplish as the evacuation of the very 
medium in which she navigates? General efforts 
at sanitation and city and household cleanliness, 
though promptly undertaken and most carefully 
and scientifically carried out, with the cooperation 
of such experts as Carlos Finlay and John Guiteras 
(a master mind in all these activities) had accom- 
plished nothing. 
“We arrived there (in Havana),” says Gorgas, 
“in 1898. The military authorities concluded 316 
WALTER REED AND YELLOW FEVER 
that this was the opportunity which the United 
States had been awaiting for the past two hundred 
years. Thinking that yellow fever was a filth dis- 
ease, they believed that if we could get Havana 
clean enough, we could free it from yellow fever,” 
and “if we could eliminate Havana as a focus of 
infection, the United States would cease to be 
subject to epidemics.” So they worked like Tro- 
jans on purification lines with the result, “I be- 
lieve Havana was cleaner than any other city 
had ever been up to that time. . . . But in 
spite of all this work and care, yellow fever had 
been steadily growing worse ever since we had 
taken possession of the city, and in 1900 there 
was a greater number of cases than there had 
been for several years. The Cubans twitted us 
with the fact that all our cleaning up and expendi- 
ture not only had not bettered things, but had 
even made them worse. They called our atten- 
tion to the fact that the very cleanest and best 
kept portions of the city were by far [the worst 
sufferers from yellow fever, and the evidence was 
so staringly before our eyes that we had to ac- 
knowledge the truth of what they said.” In this 
way was smashed the age-long theory that yellow 
fever was born of filth and carried by articles from 
the patient contaminated with the vomit, excre- REED’S WORK MADE EFFECTIVE 
317 
tions, or effluvia, and that by extreme cleanliness 
in the ordinary sense it might be controlled. 
These tests were not wanting ample funds 
granted by General Leonard Wood, who ever co- 
operated with hearty sympathy in marked con- 
trast to some officials of a later date at Panama. 
Major Gorgas, at first a laughing skeptic as to 
Finlay’s mosquito notion, was convicted and con- 
vinced by the work of Reed and Carroll, though 
it was not his fortune to help more directly than 
by furnishing clinical material from the Havana 
hospitals under his control. But when the proof 
was at hand, then his great work began, and he 
remarks that “neither the Reed Board nor any 
of its members had anything to do with the prac- 
tical working out of the methods whereby their 
theory was demonstrated and by means of which 
yellow fever was finally eliminated from Havana.” 
Two plans at once suggested themselves, (1) to 
destroy the mosquitoes, which seemed impossible, 
and (2) to immunize the patient by inoculation, 
hoping for only a mild attack. As this latter 
method was plausible, immunization was tried. 
In the first experiments referred to, during the 
winter of 1901, they had been able to carry but 
one specially infected mosquito through the rigors 
of the cooler Cuban season, and so precious was 
her life that she was guarded with a care amusingly 318 
WALTER REED AND YELLOW FEVER 
and graphically described by Gorgas up to her 
tragic end, her wings having become entangled in 
the gauze cover of her jar, when she had “a larger 
attendance of doctors and nurses around her table 
than had ever been present around the death bed 
of any mere human being in the city of Havana.” 
Vaccination as a solution of the problem became 
abhorrent when three of Guiteras’ eight inocu- 
lated cases died, and among them Miss Maass, a 
trained nurse, who sought immunization in this 
way. 
The first step taken in the new and right direc- 
tion was to segregate all yellow fever patients so 
far as possible, in order to prevent the access of 
mosquitoes, thus limiting the infection of healthy 
insects necessary in the transportation of the dis- 
ease. It was clear that if this one precaution 
could be carried out wherever yellow fever existed 
for one entire season, the chain would be broken 
and the disease would cease to exist. The plan 
of seclusion was to keep the patients inside well 
screened rooms either in Las Animas Hospital or 
in their homes and to put sanitary officers in 
charge, on eight hour shifts, to enforce regulations. 
It was also a known fact that the stegomyia mos- 
quito naturally remained in one house and was 
not a neighborhood wanderer. When, therefore, 
a case of fever was reported (and soon all were REED’S WORK MADE EFFECTIVE 
319 
reported promptly), there was an abundance of 
time to destroy all the mosquitoes in the house 
before they could become carriers of the disease 
or migrate. This vital fact had been demon- 
strated by Carter and confirmed and explained by 
Reed’s work. The necessary incubation period in 
the mosquito was nearly two weeks. As soon, 
therefore, as the disease had run its course (within 
one week), the house in which the patient lived 
was fumigated so effectively as to destroy all the 
mosquitoes. This was done by making it air- 
tight and burning sulphur, one pound to a thous- 
and cubic feet. The sulphur was set in a Dutch 
oven isolated in a box of sand and alcohol poured 
on and fired. The dense, deadly fumes of the sul- 
phur burning for several hours utterly destroyed 
all mosquitoes and, fortunately for a warm climate, 
all other vermin in the house as well. Enormous 
quantities of pyrethrum (“insect powder”) were 
also used in the same way, either with sulphur or 
alone. Pyrethrum only stupefies, so it is neces- 
sary afterwards to sweep up the mosquitoes and 
destroy them. In tobacco warehouses where sul- 
phur ruined the flavor of the weed, tobacco stems 
were burned, two pounds to the thousand cubic 
feet, and it was found that these stems fully rep- 
resented all the poisonous qualities of the leaves 320 
WALTER REED AND YELLOW FEVER 
themselves and were almost as effective as the 
penetrating noxious sulphur. 
From such significant beginnings the problem 
rapidly expanded into a general campaign against 
mosquito life in all its stages. She was attacked 
in every locality where she was wont to breed;she 
was prevented from laying her eggs;she yielded up 
her life in the larval water-wiggler stage; she was 
prevented from invading the house by the erection 
of bars, and, if she once got in, she was held back 
from the well and sick by barriers of netting; she 
was captured on the walls of the rooms where she 
sought obscurity; she was incontinently slaught- 
ered after infecting a victim when search was made 
with redoubled vigor; and she was sought out for 
annihilation in a general round up of all the neigh- 
boring houses. Great suddenly became the tribu- 
lations of the hitherto despised and neglected 
mosquito, for by these many effective measures 
was she speedily eradicated and her generation cut 
short, and so the wings were clipped from the 
angel of death who always hovered with her in- 
visible and awful presence wherever the stegomyia 
travelled. 
The attack against the mosquito breeding places, 
involving measures to prevent her from laying her 
eggs as well as to destroy the larvae or “wigglers” 
in the water, was a peculiarly difficult task in REED’S WORK MADE EFFECTIVE 
321 
Havana where pipe water was distributed over 
but a small area and the mass of the population 
stored its supplies of rain water in tanks, cisterns, 
and sundry and various receptacles, all of which 
harbored abundant nascent mosquitoes. One can- 
not avoid the obvious reflection upon this travesty 
of human life and mockery of man’s boasted per- 
spicacity, when we find him thus actually breed- 
ing beneath his own roof one of the smallest, most 
notoriously pestiferous, and yet most easily de- 
stroyed of all God’s creatures, only to batten on 
his blood and to slay the human race by countless 
millions, even depopulating large tracts. 
This absurd Brobdingnag-Liliputian war of man 
against the mosquito became, under Gorgas, the 
greatest life-saving conquest in the history of our 
race. It was set in order as a general campaign, 
by dividing the city into twenty inspection dis- 
tricts, each under a sanitary officer charged to 
visit every house in his district once a month, to 
search carefully for breeding places, and to fill out 
a report on a printed blank to be filed in the cen- 
tral office. An order in Council was promulgated, 
making it a sanitary nuisance for a householder to 
harbor mosquito larvae. If any were found the 
officer had authority to impose a fine collectable in 
the Cuban courts for the Cuban treasury, which 
fine could be remitted at any stage by the officer. 322 
WALTER REED AND YELLOW FEVER 
This happy clause saved the day with the people 
who, failing to grasp the significance of the absurd 
mosquito hunt and to understand why great men 
should demean themselves to make such a pother 
about a contemptible insect, looked upon the mos- 
quito fine as but a new and bizarre species of 
graft. When, however, these fines were unex- 
pectedly remitted by our authorities, they consid- 
ered that they had received a present of just so 
much money for such magnanimity had never 
been heard of in the annals of insular history. 
After such a genial act they became fast friends 
of the United States anti-mosquito protagonists. 
Speaking statistically, out of about twenty-five 
hundred fines imposed, only about fifty were act- 
ually collected from the contumacious. 
Water barrels were well screened above to keep 
mosquitoes from laying in them and were spigotted 
below to avoid the necessity of lifting the covers; 
stray cans were emptied and all pools were filled; 
roof gutters, a prolific source of trouble, were 
cleaned and drained; vessels in daily use were 
emptied each day; and cesspools were oiled. 
Among the worst breeding places were these cess- 
pools, which were constantly treated with a heavy 
dosage of oil. In the suburbs, draining, oiling, 
ditching, and burning trash were most effective, 
so in a surprisingly short time the mosquito ceased REED’S WORK MADE EFFECTIVE 
323 
even to sing an occasional vesper and to be a pest 
any longer, and pari passu yellow fever disap- 
peared! And like many other noble efforts under- 
taken in a spirit of altruism, not only was the 
blessing sought received, but an added blessing of 
incalculable benefit was also secured, one might 
say almost incidentally, namely, the wiping out 
of the dreadful age-long plague of malaria by the 
destruction of the anopheles mosquito accom- 
plished by the same measures. 
One more precaution had yet to be taken to 
prevent the importation of yellow fever from 
without,—that of a quarantine against incoming 
vessels. With this established a cordon was evi- 
dently thrown around all the sources of infection 
through which it seemed impossible to break. 
The steps then were, in brief review: 
1— Prompt reporting of all cases; 
2— Segregation of every case either at home or 
in the Las Animas Hospital, with a wire screen 
to prevent access of mosquitoes to the patient, 
thus steadily cutting down the number of disease 
carriers; 
3— Killing of all mosquitoes in infected areas, 
with immediate special attention to houses har- 
boring the sick; 
4— A general campaign against mosquito breed- 
ing places all over the city, with the power of law 
to enforce orders; 324 
WALTER REED AND YELLOW FEVER 
5— A suburban campaign against mosquitoes, 
destroying simultaneously breeding places of ano- 
pheles and exterminating malaria; 
6— Quarantine to prevent Importation of yellow 
fever from the outside, detaining non-immunes for 
six days and fumigating a ship when fever was 
found. 
For ten years preceding the American Army 
occupation there had been an average of more 
than five hundred deaths yearly from yellow fever, 
which had existed continuously (was endemic) 
since the year 1762, when Havana was besieged 
and taken by the English troops, largely made up 
of colonials never before exposed to it (non- 
immunes), who suffered severely. 
The measures described and summarized above 
became effective February, 1901, and with their 
enforcement the disease disappeared so rapidly 
that by September of that year the last case had 
occurred, and with a single exception Havana has 
remained free from that date. The extinction of 
malaria also meant the saving of from three to 
four hundred lives yearly, for in 1898 even as 
many as nineteen hundred had died from it. In 
1912, there were but four deaths from this cause! 
Major Gorgas, as it were, thus crowned Reed’s 
discovery; while by their beneficent joint efforts 
these two modern doughty warriors of the micro- REED’S WORK MADE EFFECTIVE 
325 
scope, the test tube, and the kerosene oil brigade, 
and their noble coadjutors, accomplished a work 
which is destined as time rolls on to save countless 
millions of lives, conferring upon humanity the 
greatest of all material blessings,—perpetual im- 
munity from a dreadful insidious foe capable in a 
short season of desolating vast tracts, and estab- 
lishing in its place peace, security, and prosperity 
with health to enjoy them. Gorgas saw prophet- 
ically the strategic value of his work to the pros- 
pective Panama Canal, clearly realizing that the 
application of Reed’s discovery, by means of his 
own methods just elaborated, would overcome the 
sanitary difficulties which had formed the one in- 
superable obstacle to the enterprise. He broached 
the matter to Surgeon General George M. Stern- 
berg, who was in entire sympathy with his views 
and ready to cooperate. 
During the latter part of March, 1904, therefore, 
Dr. Gorgas was appointed Chief Sanitary Officer 
to the Commission to Panama and left for the 
field with the regular Commission and with Medi- 
cal Director John W. Ross, of the Navy, Major 
Louis A. La Garde, Surgeon of the Army, and 
Major Cassius E. Gillette, of the Corps of Engin- 
eers, of the Army, associates in his prospective 
strenuous labors. It was evident, even from a 
superficial consideration, that should yellow fever 326 
WALTER REED AND YELLOW FEVER 
and malaria prevail in the Canal Zone, as in the 
days of the futile efforts of the French to cut the 
Isthmian waterway, it would be impossible to 
provide enough American men to finish the work. 
The project would then have to be abandoned in 
spite of any wages that might be offered, for the 
yearly toll would not be less than fifteen or sixteen 
hundred lives; indeed the ratio of losses sustained 
by the French, if maintained among our own lab- 
orers, would amount to not less than thirty five 
hundred lives per annum. 
Naturally the first thought of the Sanitary 
Board, on surveying their new field was that the 
yellow fever could be eliminated by fumigating 
all the houses in Panama and destroying the mos- 
quito, a problem simple enough as compared with 
the big city of Havana some twelve times larger. 
So fumigation was the carte dujour, and the town 
was raided by the fumigating squad, smoked with 
pyrethrum, and choked with sulphur. The pyre- 
thrum holocaust reached the unprecedented figure 
of one hundred and twenty tons (the entire supply 
of the whole United States); in addition, some 
three hundred tons of sulphur rolled up in fumes, 
and so the city was purified three times over, but 
still inexplicably, contumaciously, and vexatiously, 
cases of yellow fever continued to break out. The 
Canal Construction Commission, ignorant and REED’S WORK MADE EFFECTIVE 
327 
unsympathetic, became highly critical, excepting 
only General George W. Davis, the governor, who 
allowed for initial difficulties and continued his 
hearty support. The force of whites who were 
unacclimated was rapidly decimated, and the 
fever kept increasing during the year 1904 to 
1905. Then the Canal Commission was dis- 
charged and another came in its place, but the 
sanitary force labored all the while under the 
disability of being a subordinate body, lacking 
sufficient authority to force through its plans; while 
the regular commissioners for the most part looked 
askance at the Sanitary Corps as a horde of im- 
practical, wild, and visionary theorists,—and that 
too with the background of the splendid victory 
of Havana. When, however, in April, 1905, sev- 
eral of the higher officials themselves died of yel- 
low fever, there was a pretty complete demoral- 
ization among all the forces who now began to 
live from day to day in the gloom of an impending 
doom. “Finally, in June, 1905, the Governor 
and Chief Engineer, members of the Executive 
Committee of the Commission united in a recom- 
mendation to the Secretary of War that the Chief 
Sanitary Officer (Gorgas) and Dr. Henry R. Carter, 
and those who believed with them in the mosquito 
theory should be relieved, and men with more 
practical views be appointed in their stead . . . 328 
WALTER REED AND YELLOW FEVER 
Fortunately for the cause of sanitation, the then 
President of the United States had been in office 
when the work in Havana had been done by us. 
He told the Commission that the mosquito theory 
had been established beyond peradventure and 
that its application had been entirely successful 
at Havana, where yellow fever had existed for a 
longer time and had been more firmly established 
than at Panama. He declined to sanction the 
change recommended and directed that every 
possible support and assistance be extended to the 
sanitary officials.” Fortunately, too, at this junc- 
ture, Mr. John F. Stevens, being made Chief 
Engineer, at once gave the Sanitary Department 
his fullest support. A little later (a matter of 
vital import), the Sanitary Department was made 
an independent bureau, reporting directly to the 
Chairman of the Commission, and from this time 
on the work began to progress. Writing some ten 
years later, Gorgas says that these years 1905 and 
1906 were the halcyon days of the department’s 
work, the period in which the serious problems 
were solved. From that time on, the effort was 
to hold what had been gained. After May, 1905, 
not a case of yellow fever originated in the Isth- 
mian Zone. How near we came to losing out 
through the folly of some of our politician officials 
is evident, when we learn that had Dr. Gorgas REED’S WORK xMADE EFFECTIVE 
329 
been removed, a doctor opponent was slated for 
his place who had no faith in the mosquito theory 
but insisted on the old exploded mechanism of 
propagation by filth. As Gorgas naively remarks, 
“it seems singular that, after the demonstration at 
Havana, there should have been any doubt in the 
mind of any one with regard to the mosquito 
transmission of yellow fever.” 
By 1907, the work was complete, and the fight 
against the disease was won, for the last of yellow 
fever in Panama had been seen in November, 
1905. This gave the doctors great prestige not 
only locally, but throughout the world, and the 
lustre of their achievement is not dimmed but 
ever grows brighter with succeeding years. There 
was a single exception to the rule, and Gorgas 
notes, “One more case of yellow fever occurred in 
Colon during the following May, but since May, 
1906, now more than eight years, not a case of 
yellow fever has originated on the Isthmus.” 
The reputation of American scientific medicine 
had been at stake, and Gorgas, Carter, Ross, and 
Le Prince had saved it. Not content with this 
victory, this bold band of medical scientists next 
undertook to rid the Canal Zone of another pest 
almost as great, namely, malaria. 
As the problem is a kindred one, let me devote 
a few paragraphs to it for its educational value. 330 
WALTER REED AND YELLOW FEVER 
Malaria extermination, as declared above, re- 
solved itself into the destruction of the anopheles 
mosquito, which was more of a country problem, 
requiring the subdivision of the fifty miles of Pan- 
ama country district bordering the Canal into 
twenty-four sanitary zones with sub-hospitals, 
tributary to the main ones, at the ends of the line. 
In each district was an inspector with a force of 
from twenty to a hundred men, proportioned to 
the population. The zone was fifty miles long 
and ten miles wide. Aggressive sanitary work 
generally speaking was limited to an area within 
a mile or so of the Canal, and all brush and under- 
growth were cleared away within two hundred 
yards, the grass cut, and the ground carefully 
drained. In this way the Sanitary Commission 
was regnant over one hundred square miles out of 
the five hundred under the jurisdiction of the 
Isthmian Canal Commission. The two hundred 
yards intensive area was fixed for the following 
reasons,—“The anopheles is not a mosquito of 
strong flight; two hundred yards is in general a 
good flight for her. If there were trees and shrubs 
and bushes every few yards the anopheles might 
travel very long distances and not be much ex- 
posed to either the sun or the wind. But if an 
area of two hundred yards around each building 
is kept clear, she will not often be able to cross REED’S WORK MADE EFFECTIVE 
331 
such a zone without destruction, either by sun or 
wind. Clearing this zone exposes the ground to 
both sun and wind, and by these forces alone many 
of the smaller pools will be dried up and made 
unfit for mosquito breeding. I have often seen 
this measure alone . . . cause a swampy place 
which I had expected to drain to become dry and 
cease to breed mosquitoes.” The ditches them- 
selves naturally formed excellent breeding places 
for mosquitoes, so the plan was adopted of filling 
them with large stones and making them of con- 
crete, which prevented them from filling with 
weeds and becoming choked. A horse lawn-mower 
was used to keep down the grass and sub-soil, and 
tile drains were used. This involved the draining 
of a hundred square miles of territory, the con- 
struction of some five million feet of open ditches, 
some one and a half million feet of concrete ditch, 
some one million feet of rock filled ditch, and 
about a million feet of sub-soil tile drains. Crude 
kerosene oil as a spray was invaluable in caring for 
places not amenable to ditching, such as tempor- 
ary pools caused by the advancing construction 
work, at a cost of a little over two cents a gallon. 
The best natural enemies of the mosquito larvae 
are the small fish, in the larger waters where they 
can get at them. Wire netting was used to screen 
the houses, keeping out the pests, while the archi- 332 
WALTER REED AND YELLOW FEVER 
tect of the Commission planned houses with but 
one door, limiting the avenues of invasion by the 
enemy, and the house was screened in with ninety 
per cent, copper wire, sixteen strands to the inch. 
In this way the ventilation was not so seriously 
interfered with. Repair work was done con- 
stantly on broken netting, and when mosquitoes 
did gain an entrance they were caught by an ef- 
fective method devised by Mr. Le Prince, consist- 
ing of a test tube in which chloroform was poured 
on some ordinary rubber, with a little absorbent 
cotten to hold it in place. When this lethal vapor 
was held under a mosquito on the wall she speed- 
ily succumbed. In bad swampy regions, well 
screened box cars were used as sleeping quarters 
and prophylactic quinine was given regularly, and 
by routine visitations of the cars and daily hunting, 
the infected diptera were sure to be enmeshed 
sooner or later and always before reaching the 
ten day limit necessary to render them infectious. 
So much for the malaria which soon winged its 
pestiferous flight to climes not yet guarded by 
great practical scientists. 
It is a brilliant tribute to the efficiency and sci- 
entific skill of the management to be able to say 
that notwithstanding the large number of cases 
treated at the Ancon Hospital in the years, 1904 
and 1905, and in spite of the fact that in these REED’S WORK MADE EFFECTIVE 
333 
wards there was a considerable number of non- 
immune patients who did not have yellow fever, 
and that most of the doctors and nurses were not 
immune, not a single case of yellow fever devel- 
oped during the American control of that institu- 
tion. One exception must be made to this state- 
ment, that of a nurse who was clearly often in- 
veigled into visiting the infected part of the town. 
Soon after her recovery she married the doctor, 
her escort. This fact of the safety of the immunes 
in the very hospital where they had all taken it 
before, with so much loss of life, rightly made a 
great impression, demonstrating as it clearly did 
that some new principle was at work, and did 
much to subvert skeptics and to win warm adher- 
ents. Curiously enough by a strange perversity 
of fate, previous to Reed’s work and to Gorgas* 
discovery of the efficient means of its application, 
the French had done all that ingenuity could sug- 
gest to foster the propagation of yellow fever. 
While thousands of non-immunes were flowing 
into the country, everywhere about the very hos- 
pital designed to relieve and cure disease were to 
be found ideal mosquito breeding places in roof 
gutters, in rain-water barrels, and in discarded 
cans and bottles. The grounds, laid out with ex- 
quisite French taste, bore a great variety of trop- 
ical bushes carefully kept in plots. In that region 334 
WALTER REED AND YELLOW FEVER 
is found the umbrella ant which is most destructive 
to shrubs and plants, in a single night cutting off 
every leaf from a good sized orange tree. To 
guard against this vandal the trees were sur- 
rounded with a hollow pottery ring, always kept 
full of water, an ideal breeding place for the 
mosquitoes. Dr. Gorgas had all this shrubbery 
removed from the Ancon Hospital for a distance 
of two hundred yards. The Tivoli Hotel, about 
a quarter of a mile from the hospital, was practic- 
ally unscreened, and during the dry season was 
crowded with visitors; yet out of the tens of thous- 
ands no case of yellow fever developed. The 
one great difference between the now and the 
then is that the surroundings are well drained and 
pools eliminated so that no mosquitoes can breed. 
After the breeding places were all done away with, 
the shrubbery was restored, and the umbrella ants 
were laboriously eradicated by tracing them to 
their holes, where their extermination was ef- 
fected by pouring bisulphid of carbon into the ant 
hole, which, after vaporizing, was exploded, driv- 
ing the gas into all parts of the nest and destroying 
them. 
Let me cite an individual example of the bril- 
liant work of Dr. Gorgas and his staff,—the case 
of the warship Boston which spent several months 
in the Panama Bay during the fall of 1904. While REED’S WORK MADE EFFECTIVE 
335 
down the coast on gun practice in January, 1905, 
seven cases of yellow fever developed. She had 
been away from Panama so long that the doctor 
knew that the disease must have originated on 
board and that the ship must be infected. No 
account of any early misinterpreted mild case 
occurring on board could be found in the records; 
all the cases of fever were connected directly or 
indirectly with the ward room, three of those 
stricken being commissioned officers. Since there 
was some yellow fever at Panama, the crew had 
not been allowed to go ashore. A short time be- 
fore the ship left the harbor on New Year’s Eve, 
1904, a ball had been given aboard, which was at- 
tended by a large number of the citizens of Pan- 
ama. After excluding other causes, the conclu- 
sion was reached that some one of the visitors 
had been in the initial stages of a mild case of the 
fever and had been bitten by a stegomyia aboard, 
which at the end of two weeks became infectious 
and so spread the disease among the crew. Dr. 
G. A. Perry, of the Public Health Service, in im- 
mediate charge of the work, found a small flat tub 
on the ship under the steps going down to the ward 
room, in which stegomyias were breeding freely!! 
This was the only place on the ship where the lar- 
vae were found, and this one piece of carelessness 
was responsible for the epidemic. It was too late 336 
WALTER REED AND YELLOW FEVER 
to find out why the ward room steward had been 
so careless, since he, as well as the ship’s surgeon, 
had died. After careful fumigation under the 
supervision of Dr. Henry R. Carter no more cases 
occurred. 
In conclusion of this great second step extending 
the benefits of Reed’s discovery from a city to a 
large zone, let us briefly evaluate this vast under- 
taking—one of the greatest contributions ever yet 
made to practical medicine, using so far as possi- 
ble Dr. Gorgas’ words. “Our army in Cuba dur- 
ing the Santiago campaign had during the last 
two months of our stay a constant sick rate of 
over six hundred per thousand. Undoubtedly, 
the French rate approximated this during their 
period of active work, and we can safely calculate 
that their constant sick rate was at least three 
hundred and thirty-three per thousand, or one 
third their force. Our force during the ten years 
of construction averaged thirty-nine thousand 
men. If we had had a similar constant sick rate, 
we would have had thirteen thousand sick 
employees in our hospitals every day during the 
ten years of construction. As it was we had only 
twenty three per thousand sick each day; that is, 
we had about twelve thousand fewer men sick 
every day than had the French. This twelve 
thousand men per day saved from sickness must REED’S WORK MADE EFFECTIVE 
337 
be credited to the sanitary work done on the Isth- 
mus.” In a period of ten years there was a saving 
of 39,420,000 days of sickness; the saving in dol- 
lars amounted to no less than 339,420,000. 
In thus estimating the saving effected by such 
highly skilled medical care, one must also bear in 
mind the improved morale of the men, over that 
of a body constantly mulling over the many daily 
journeying in the direction of the hospitals and 
the constant complete disappearance of their 
.pals. Enormous wages would have had to be 
paid to hold such men to their work. Thus in 
ways not so apparent, a much larger sum was evi- 
dently saved than by the more obvious calcula- 
tions given above. During the ten years of con- 
struction we lost by death seventeen out of every 
thousand of our employees yearly; that is to say, 
from the whole force of 39,000 men, 663 died each 
year, or, 6,630 for the entire period. If, like the 
French, we had lost 200 out of each thousand 
yearly, the whole loss would have totalled 78,000 
for the ten years. The saving of 71,370 lives was, 
therefore, justly claimed for the work of the Sani- 
tary Department, not to appraise the added vast 
amount of invalidism, where the patient does not 
die but returns home a burden to his family and 
the community. 338 
WALTER REED AND YELLOW FEVER 
The value of the work of Reed and Gorgas is 
enormously enhanced by the immediate back- 
ground of the fearful conditions of sickness pre- 
vailing under the management of the French, in 
their attempt to construct the canal, which was 
defeated wholly by the anophles and stegomyia 
mosquitoes. While this is a matter of general 
knowledge, there are no full and satisfactory rec- 
ords of the daily course of events leading up to the 
ultimate debacle. Just such a record, however, 
is furnished by Neville B. Craig in his “Recollec- 
tions of an Ill-Fated Expedition (the well known 
Collins Expedition) to the Headwaters of the Ma- 
deira River in Brazil.”2 Here we follow in the 
careful statements of eye witnesses the disastrous 
course of events day by day until we behold the 
great expedition, wonderfully planned and under- 
taken with a large outlay of money, crumble un- 
der the attacks of insect pests. 
We of the medical profession will ever hold that 
Dr. Gorgas and his aids did as much to build the 
Panama Canal as did Goethals, of whom the 
country is so justly proud. We are certain too 
that the sanitary work was of far more lasting 
value to humanity, because of the practical means 
discovered and employed,—means which must be 
2J. B. Lippencott Company, Philadelphia and London, 
1907. REED’S WORK MADE .EFFECTIVE 
339 
adopted, mutatis mutandis, in all similar future 
enterprises. The engineering was a piece of ad- 
mirable work of local significance, while the dis- 
ease campaign was world-wide in its scope, des- 
tined to last so long as our race and its ailments. 
We now approach the third and final step in 
this drama of life and death,—the great question 
which at once obtrudes itself. If we can thus ex- 
tirpate this dread disease from a big city like Ha- 
vana, where it has festered and rampaged for gen- 
erations, and if we can also clean up so large an 
area as the Canal Zone, why can we not apply the 
same principles on a yet larger scale to all other 
tropical cities where the disease is endemic and so 
rid the world of yellow fever and, let us say, inci- 
dentally, of malaria? This would then do away 
with much of the labor of our quarantine systems. 
The answer is as simple and as brief as the ques- 
tion; nothing could be simpler IF only the various 
peoples would select intelligent, honest officials 
disposed to cooperate with men trained in modern 
science who stand ever ready to offer their lives 
to this end. If some one exclaims, “How stupid! 
Can there exist a people anywhere so dull as not 
to aid so beneficent a work!” alas, let us remember 
our own manifold shortcomings and the politi- 
cians’ efforts to eject Dr. Gorgas and his confreres 
from Panama; let us recall too that we still have 340 
WALTER REED AND YELLOW FEVER 
typhoid fever and tuberculosis (filth diseases) in 
our midst and that millions die of typhus due to 
the lice crawling over their heads—all equally 
controllable, and that we tolerate everywhere mil- 
lions of vermin, mice, and rats ready to bring in 
the dreaded bubonic plague, which also actually 
destroy property to the value of hundreds of mil- 
lions of dollars yearly. Can any stupidity equal 
this? All our difficulties in the final analysis are 
due to our own selfish indifference to the public 
weal and to placing vicious, selfish men, wearing a 
certain party stripe, in high offices. 
It is obviously the part of wisdom and a worthy 
goal for the highest human skill to devote one’s 
life to the extermination of yellow fever from the 
whole world, an accomplishment which Gorgas be- 
lieved to be possible since there are not many 
endemic foci. Once break but one link in the bale- 
ful chain connecting man with the mosquito in 
any locality, and the possibility of further infec- 
tion is gone if fresh importations are excluded by 
quarantine. Carry out this program in all other 
endemic areas, avoiding meantime mosquito mi- 
gration in ships and railways, and the grand ob- 
jective is achieved and the slayer of countless mil- 
lions of our race is forever laid low. Thus far more 
wonderful than the fairy tales of our youth are 
these of adult life in the field of scientific endeavor. REED’S WORK MADE EFFECTIVE 
341 
The Rockefeller Foundation has just this ob- 
jective, namely, the eradication of yellow fever 
from the world, and is moving unremittingly to- 
ward its accomplishment which involves the ster- 
ilization of certain ports about the Caribbean Sea 
and the Atlantic and the tropical Pacific Ocean, 
including portions of Mexico, Central and South 
America, and certain areas in Africa. 
A clear idea of the effective steps leading toward 
this admirable objective may be had by perusing 
a brief statement of the work by George E. Vin- 
cent, President of The Rockefeller Foundation, 
in a review of their public health activities and 
medical work in many lands for the year 1919. 
The first battle, beyond the bounds of Cuba and 
Panama, was waged at Guayaquil on the coast 
of Ecuador, where the fever had long been ende- 
mic and where cases could always be had for 
study. It began with the now successful efforts 
of Dr. Hideyo Noguchi of the Rockefeller staff, 
who, taking the blood of undoubted yellow fever 
patients, transmitted the disease through guinea 
pigs, dogs, and monkeys by inoculation. He also 
succeeded in cultivating a minute spiral organism, 
which is doubtless the essential factor in the dis- 
ease, which he calls Leptospira icteroides. The 
isolation of this organism has made possible the 
development of a serum by Dr. Noguchi, which, 342 
WALTER REED AND YELLOW FEVER 
it is believed, will materially reduce the mortality 
from yellow fever. This great step in the break- 
ing of the fatal chain binding the victim, man, to 
the mosquito thus brings us back to the first ef- 
forts of Reed, Guiteras, and Gorgas. 
It is refreshing to say that the American Com- 
mittee has had the hearty cooperation of the Ecua- 
dor government, and that the greater part of the 
work has been done by the skilled enthusiastic 
Ecuador physicians themselves. The Ecuador 
Press has also aided ideally, and with lectures, 
posters, bulletins, and splendid team work, the 
people have united in this common beneficent 
public enterprise as never before in their history. 
Two things were aimed at here, as in previous 
campaigns: (1) to discover all cases as early as 
possible and to isolate and screen them from mos- 
quitoes which can only absorb the poison in the 
first three days; and (2) to eliminate the stegomyia 
by preventing her access to breeding places. It 
was peculiarly difficult to enforce this latter pre- 
ventive measure in Guayaquil. Here the hy- 
drants run for only one hour and a half out of 
every twenty four, and considerable storage facil- 
ities for water are necessary. However, the re- 
ceptacles are easily protected, and drainage, filling 
in, oiling, and screening became the universal 
order of the day as of yore at Havana and Panama. REED’S WORK MADE EFFECTIVE 
343 
For some more difficult breeding places, after some 
efforts, a minnow was found with a good bump of 
self-protection, which devoured the mosquito lar- 
vae voraciously. While the average number of 
cases yearly had been not less than 259, with ex- 
acerbations, it was soon reduced to zero by these 
novel and skillfully guided efforts. 
In July, 1918, an outbreak in Guatemala drew 
the Commission thither, as well as later to Hon- 
duras, Salvador, and Nicaragua. It now remains 
to guard what has been gained in this territory, 
while purging other centers by the same measures, 
especially on the Yucatan Peninsula and at Me- 
rida and other parts of Mexico. The coast of 
Africa, where Sir Rupert Boyce worked so admir- 
ably, must be carefully considered in the program. 
Not only is just recognition of success often 
withheld, but maliciously destructive criticism 
frequently impairs a wonderful work. In the 
Panama “Star and Herald” on June 18, 1922, and 
subsequently, appeared articles, stating that an 
epidemic of malaria had developed among the 
Canal Zone employees; that the breeding places 
of mosquitoes, heretofore carefully sprayed with 
oil during the entire year, had been neglected, re- 
sulting in a larger number of mosquitoes on the 
Isthmus than had been known since the first ef- 
forts at sanitation; and that the Ancon Hospital 
was overcrowded with malaria patients. 344 
WALTER REED AND YELLOW FEVER 
These articles led to an indignant denial on the 
part of Dr. D. P. Curry, Acting Chief Health Of- 
ficer of the Canal Zone, who stated that there 
was no epidemic of malaria among the employees 
of the Panama Canal; that the breeding places 
were sprayed with oil as zealously as ever; that 
the number of mosquitoes on the Isthmus was far 
smaller than ever before; and that the Ancon Hos- 
pital had fewer malaria patients, relatively speak- 
ing, than in former years. On June 21, Governor 
Jay J. Morrow, of the Panama Canal, officially 
reiterated, “There is not a case of blackwater 
fever in any of the Panama Canal or other hospi- 
tals, nor has there been a case originating on the 
Isthmus for several years. The health depart- 
ment, however, has frequently issued warnings to 
the public of the danger of contracting malaria 
by visiting unsanitated areas after sundown, and 
this caution is again urged here.” 
In the New York Times of July 5, Mr. W. C. 
Hushing, the representative of the Canal Zone 
Union Workers at Washington, D. C., made even 
more fallacious statements, whereupon the gov- 
ernor branded Mr. Hushing’s statements as libel- 
ous and discharged him from the Panama Canal 
employ. 
It needs no deep insight to recognize that all 
these efforts to eliminate disease and to improve REED’S WORK MADE EFFECTIVE 
345 
the physical condition of our race are only possible 
in times of peace and with the intelligent, whole 
hearted cooperation of the various countries united 
as in a common brotherhood. Thus in a new and 
material sense do we realize the truth of the divine 
benediction, “Blessed are the peacemakers;” while 
we recognize that science without the cooperation 
of the higher faculties, residing in the heart of 
man, can hold in her hands no better gift than a 
cup of Tantalus. Thus, as we have seen in this 
great drama, part of the far-flung battlefield for 
human welfare and for a world-wide brotherhood, 
peace has her victories greater far than those of 
war, and peace, too, has her votaries, ready, nay 
eager to lay down their lives for their fellows, 
though knowing well that no laurels will be laid 
upon their graves. CONCLUSION 
I would the great world grew like thee 
Who grewest not alone in power 
And knowledge, but by year and hour 
In reverence and in charity. 
The flame is quenched that I foresaw, 
The head hath missed an earthly wreath; 
I curse not nature, no, nor death, 
For nothing is that errs from law. 
We pass; the path that each man trod 
Is dim, or will be dim with weeds; 
What fame is left for human deeds 
In endless ages rests with God. 
■Tennyson. In Memoriam. 
THIS little volume is my tribute to the memory 
of a great and good man. My own acquaintance 
with Dr. Reed was, I regret to say, but a brief one, 
yet it made upon me that lasting impression which 
was a characteristic of his personality, and which 
I count among the good things of my life. The fol- 
lowing letter I prize, not only because it is the only 
one I ever received from him, but because it con- 
tains a reference to his life-work. 
346 WALTER REED AND YELLOW FEVER 
347 
WAft OCAARTMCXT, 
|U«OEON GENERAL’S OFFICE* 
U«T MMH MbM ««• UMMTr. 
WASMWOTOH. 348 
CONCLUSION 
I have tried to set forth in these pages all the 
benefits which Dr. Reed’s talents and industry have 
accomplished for the world, but I must not lay 
down my pen without tracing some of the uncon- 
scious lessons which such a life holds for his fellow- 
men. 
The annals of Walter Reed’s early years are re- 
freshing in their simplicity. They record a natural, 
healthful life, with habits and interests in no wise 
different from those of thousands of American 
boys. Nothing in its circumstances or pursuits 
marked him out as different from his fellows, and 
his character was distinguished from theirs, not by 
flashes and premonitions of genius, but by a re- 
markable uprightness, earnestness of purpose, and 
tenderness of heart. Neither his youth nor his ma- 
ture years were characterised by any of those eccen- 
tricities which it is often the fashion to consider 
inseparably associated with genius; indeed, his 
whole life is a consistent witness to the falsity of 
the theory which exempts a man of unusual abili- 
ties from the laws governing mankind in general, 
on the ground that exceptional talent is in itself 
abnormal. The popular idea that the gifted few 
are not responsible for their actions, because they 
are themeslves a deviation from the normal, and 
that what are vices in their fellow-men are venial 
errors in them, finds no support in Walter Reed’s WALTER REED AND YELLOW FEVER 
349 
life. Sanity next to earnest Christian principle, 
was his distinguishing trait. 
Again, let those who complain of the cramping 
influence of uncongenial environment, and insist 
upon the necessity of opportunity and sympathetic 
surroundings to a full intellectual development, 
review the record of the forty years spent by Reed, 
first in his quiet Virginia home, and then on the far 
Western frontier. The foundations of his achieve- 
ments were not laid amidst a stimulating mental 
atmosphere, nor did he make success the one object 
in life to which all other aims were subordinated; 
on the contrary, the training which prepared him, 
quite unconsciously, to enter, fully equipped, upon 
the great work in store for him, was a constant, 
daily, unselfish devotion to the needs of others, 
often amid uncongenial surroundings. 
Yet no man appreciated the value of opportunity 
more than Dr. Reed. He put forth all his powers 
to improve every possible occasion that arose in 
his life, and here again we find a lesson. 
Formerly, it was unfortunately the fashion 
to fancy that a scientific training could not ap- 
proach perfection unless more or less time was 
spent in a foreign university. A man was not, 
according to some of the best authorities, fully 
equipped as a scientist if all his foundations 
were laid and his methods acquired in the 
United States. Americans owe a debt of grat- 350 
CONCLUSION 
itude to Dr. Reed for the evidence his career 
affords to the contrary. His medical education was 
received in Virginia and New York, and his train- 
ing in pathology and bacteriology, subjects not con- 
sidered in a medical curriculum in his undergrad- 
uate days, was acquired entirely at the Johns Hop- 
kins University and Hospital. He himself fully 
recognised and appreciated his obligations to the 
latter institutions, and when, after his return from 
Cuba in 1901, he delivered the annual address be- 
fore the Medical and Chirurgical Faculty of Bal- 
timore, he paused before entering upon his subject 
to pay a graceful tribute to the advantages afforded 
him by his training in that city, saying that it gave 
him pleasure to feel that he was bringing back to 
Baltimore, in the results of his work in Cuba, some 
return for all that he had received there. From 
first to last Reed was the product of his native coun- 
try, and those experiments which Dr. Welch de- 
clares “will always remain as models of scientific 
research,” were the fruit of knowledge acquired 
and methods perfected in the United States. 
But the greatest lesson of Dr. Reed’s life is that 
the secret of happiness and usefulness lies rather in 
giving what we can to life, than in getting what we 
can from it. It was his consistent adherence to this 
principle which raised him morally so far above 
his fellows. His constant prayer from early youth CONCLUSION 
351 
was that he might be permitted to alleviate in some 
degree the suffering of humanity, and all his efforts 
were spent in striving toward this goal, without a 
thought of self. 
The lives of Sternberg, Reed, and Gorgas show 
the value of a spirit of hearty cooperation in sci- 
entific work. Among the workers engaged in the 
same field there are always occasions for jealousy 
and friction, but the moment these appear the 
work itself is invariably hindered. The generous 
conviction that the work is greater than the worker 
and a spirit of humility with a desire to give credit 
to others, while oblivious of one’s own claims, are 
the rare high qualities of the true scientist. These 
attributes were stressed in the relationship of 
Charles Darwin and Alfred Russel Wallace in 1859, 
and they are also beautifully exemplified in the 
case of Reed and Gorgas, as well as in Sternberg’s 
readiness to permit Reed, his subordinate, to follow 
his own initiative in the investigation, taking a 
direction which he, Sternberg, thought was futile. 
The annals of medical science furnish no more con- 
spicious incident of such a beautiful spirit of hearty 
affectionate cooperation and self abnegation look- 
ing toward a great goal. 
Walter Reed’s work here is over; his humble, 
faithful use of the talents committed to his charge 
is at an end, and he has entered into his reward. 352 
WALTER REED AND YELLOW FEVER 
When we are tempted to mourn over his untimely 
death, and to regret all the possibilities which a 
further use of his abilities might have developed, 
we should remember the words of Bishop Law- 
rence of Massachusetts to Mrs. Reed, after her 
husband’s death: “Let us try to feel that the Mas- 
ter took him because he had other work for him to 
do.” Are not the talents, which to our feeble in- 
telligence seem so greatly needed by our present 
necessities, still employed in the Master’s service 
in ways beyond our finite understanding? 
“0 strong soul, by what shore 
Tarriest thou now? For that force, 
Surely, has not been left vain! 
Somewhere, surely, afar. 
In the sounding labour-house vast 
Of being, w practised that strength, 
Zealous, beneficent, firm!” BIBLIOGRAPHY* 
Reed, Walter. [1851-1902.] 
1892. —The contagiousness of erysipelas. Boston M. and S. J., v. 126. 
1893. —Remarks on the cholera spirillum. Northwest. Lancet, St. Paul. 
1894. —Association of Proteus vulgaris with Diplococcus lanceolatus in 
a case of croupous pneumonoa. Johns Hopkins Hosp. Bull., Baltimore, 
v. 5. 
1894.—The germicidal value of trikresol. St. Louis M. and S. J. (642), 
v. 66. 
1894.—Idem. Proc. Ass. Mil. Surg. U. S. (Washington), St. Louis, v. 4. 
1894. —A brief contribution to the identification of Streptococcus ery- 
sipelatos. Boston M. and S. J., v. 131. 
1895. —An investigation into the so-called lymphoid nodules of the liver 
in typhoid fever. Johns Hopkins Hosp. Rep., Baltimore, v. 5. 
1895.—An investigation into the so-called lymphoid nodules of the liver 
in abdominal typhus. Am. J. M. Sc., Philadelphia, n. s., v. 110. 
1895. —What credence should be given to the statements of those who 
claim to furnish vaccine lymph free of bacteria? [Read before the District 
of Columbia Md. Soc., June 5.] J. Pract. M., N. Y., v. 5. 
1896. —[The character, prevalence, and probable causation of the malarial 
fevers at Washington Barracks and Fort Myer.] Rep. Surg. Gen. Army, 
Wash. 
1896. —The parasite of malaria. J. Pract. M., N. Y., v. 6. 
1897. —Serum diagnosis in typhoid fever. Rep. Surg. Gen. Army, Wash. 
1897.—On the appearance of certain amoeboid bodies in the blood of 
vaccinated monkeys (Rhoesus) and children, and in the blood of variola. 
An experimental study. Tr. Ass. Am. Physicians, Phila., v. 12. 
1897.—On the appearance of certain amoeboid bodies in the blood of vac- 
cinated monkeys (Rhoesus) and children, and in the blood from cases of 
variola. An experimental study. J. Exper. M., N. Y., v. 2. 
1897.—Typhoid fever in the District of Columbia; diagnosis: The value 
of Widal’s test, the dried blood method. Nat. M. Rev., Wash., v. 7. 
♦This bibliography is adopted from that issued by the Medical Society of the District of 
Columbia in their published adcount of the Memorial Services to Dr. Reed, December 
31. 1902. 
353 354 
WALTER REED AND YELLOW FEVER 
1897. —[Experiments with Hollister’s formaldehyde generator.] Rep. 
Surg. Gen. Army, Wash. 
1898. —Splenic leukaemia. {Trans. Med. Soc. District of Columbia, Oct. 
27, 1897.] Nat. M. Rev., Wash. v. 7. 
1900.—Report on the practical use of electrozone as a disinfectant in the 
city of Havana, Cuba. Rep. Surg. Gen. Army, Wash. 
1901. —The propagation of yellow fever; observations based on recent 
researches. [Address before 103d Ann. Meeting Med. and Chir. Fac., 
State of Md., Bait., Apr. 24-27.] Med. Rec., N. Y. (1605), v. 60. 
"* 1901.—Idem. Rep. Surg. Gen. Army, Wash. 
1902. —Recent researches concerning the etiology, propagation and pre- 
vention of yellow fever, by the United States Army Commission. J. Hyg., 
Cambridge, Eng., v. 2. 
Reed, Walter, and Carroll, James. 
1899.—Bacillus icteroides and Bacillus cholerae suis. A preliminary 
note. Med. News, N. Y., v. 74. 
1899. —The specific cause of yellow fever. A reply to Dr. G. Sanarelli. 
Med. News, N. Y., v. 75. 
1900. —A comparative study of the biological characters and pathogene- 
sis of Bacillus x (Sternberg), Bacillus icteroides (Sanarelli), and the hog- 
cholera bacillus (Salmon and Smith). [Received for publication Feb. 25]. 
J. Exper. M. [Balt.], v. 5. 
1901. —The prevention of yellow fever. [Read at 29th Ann. Meeting, 
Am. Pub. Health Ass., Buffalo, Sept. 16-21]. Med. Rec., N. Y. (1616), v. 
60. 
1902. —The etiology of yellow fever. A supplemental note. [Read at 
3d Ann. Meeting, Soc. Am. Bacteriologists, Chicago, Dec. 31, 1901, and 
Jan. 1, 1902.] Am. Med., Phila., v. 3. 
Reed, Walter; Carroll, James; and Agramonte, Aristides. 
1901.—The etiology of yellow fever. An additional note. [Read at 
Pan-Am. Med. Cong., Havana, Cuba, Feb. 4-7.] J. Am. Med. Ass., 
Chicago, v. 36. 
1901.—Experimental yellow fever. Am. Med., Phila., v. 2. BIBLIOGRAPHY 
355 
Reed, Walter; Carroll, James; Agramonte, Aristides; and Lazear, 
Jesse W. 
1900.—The etiology of yellow fever. A preliminary note. [Read at 
Meeting of Am. Pub. Health Ass., Indianapolis, Ind., Oct. 22-26.] Phila. 
M. J. (148), v. 6. 
Reed, Walter, and Sternberg, George M. 
1895.—Report of immunity against vaccination conferred upon the mon- 
key by the use of the serum of the vaccinated calf and monkey. Tr. Ass. 
Am. Physicians, Phila., v. 10. 
1907.—Recollections of an ill-fated expedition to the headwaters of the 
Madeira River in Brazil, by Neville B. Craig. J. B. Lippincott Co., Phila. 
delphia and London. 
1907.—Problems of the Panama Canal, by Henry L. Abbot. The Mac- 
millan Co., New York. 
1913.—Panama and the Canal in picture and prose, by Willis J. Abbot. 
The Syndicate Publishing Co. 
1915.—Who built the Panama Canal? by W. Leon Pepperman. E. P. 
Dutton and Co., New York. 
1915.—Sanitation in Panama, by William Crawford Gorgas. D. Apple- 
ton and Co., New York and London. 
1920.—George Miller Sternberg, by Martha L. Sternberg. The Am' 
Med. Ass., Chicago.