U.S. Army Maj. Walter Reed

1893 - 1902

Walter Reed was born Sept. 13, 1851 in Gloucester County, Va., the son of a Methodist minister and his wife. After his basic education at a private school in Charlottesville, Va., Reed matriculated at the University of Virginia, where he completed the two-year medical course in only one year and received his degree in 1869 at the age of 17. He remains the youngest student ever to graduate from the medical school. Because the University of Virginia had no hospital attached, he took a second degree at Bellevue Hospital Medical College in New York in 1870.

He competed for and won a position as assistant physician at Infants' Hospital at Randall's Island in New York. He served his internship at Kings County Hospital in Brooklyn and also worked at the Brooklyn City Hospital. While interning at Kings County he was described as being "sociable and companionable with a special gift for conversation." After further hospital work at Brooklyn City Hospital with consultant status at Kings County, in 1873 at the age of 22 he was appointed one of the five inspectors on the Brooklyn Board of Health. He reportedly approached his duties with enthusiasm and optimism, traits which contributed immeasurably to his success, both social and professional. He attended concerts at the Hippodrome and the Academy of Music and lectures on literature and scientific subjects.

In 1874, having served on the boards of health in Brooklyn and New York, he traveled to North Carolina to visit his father, who was living in Murfreesboro. There he met his future wife, Emilie Lawrence, the daughter of a North Carolina planter. His letters to her revealed that he had decided to give up his civilian career and enter the U.S. Army as a surgeon. Because he felt the Army offered a good opportunity for travel, and also the financial security he felt he needed to marry his fiancée, he applied and was accepted for an appointment in the medical department of the Army. Reed passed the required examinations and on June 26, 1875 was appointed assistant surgeon with the rank of first lieutenant.

So began for the young couple 18 years of garrison life. After five years in Arizona at Fort Lowell and Fort Apache, where he served as a family doctor visiting patients in the wild country surrounding his posts, on June 26, 1880 he was promoted to captain, and soon thereafter was transferred to Fort McHenry in Baltimore. In his spare time he became a student of physiology at Johns Hopkins University during 1881 and 1882. After serving at Fort McHenry, Reed was again assigned to the western frontier at Forts Omaha, Sidney, and Robinson in Nebraska, and then to Mount Vernon Barracks in Alabama. One historian points out "one of the marvels of his life is that his relegation to frontier garrisons, unfavorable for intellectual contacts, did not ruin him."

Reed's career coincided with the great flowering of medical science that took place in the 1880s. The germ theory of infectious disease was starting to be accepted as postulated and proved by Louis Pasteur (he fought to convince surgeons that germs existed and carried diseases, and dirty instruments and hands spread germs and therefore disease) and Robert Koch (he founded modern medical bacteriology by isolating several disease-causing bacteria, including those of tuberculosis, and discovered the animal vectors of a number of major diseases). In the United States, George Miller Sternberg, who later became the Army Surgeon General, was one of the founders of bacteriology and developed a close professional relationship with Reed.

Reed returned to Baltimore in 1890 as an examiner of recruits. This assignment was quite welcome, because it provided him with the opportunity for further study. He became a student of bacteriology and pathology under the tutelage of Dr. William Henry Welch, head of the pathological laboratory at Johns Hopkins and one of the foremost pathologists and medical bacteriologists in the country. These subjects had not been previously taught as part of the medical curriculum. It was during this period that the mature scientific investigator began to be formed. He conducted his own individual research, much to the delight and satisfaction of Dr. Welch, who had been one of Pasteur's students. His ties with Dr. Welch were strengthened, and Dr. Welch's mutually admiring relationship with Sternberg was advantageous to Reed.

From 1891 to 1893, Reed spent his last western tour at Ft. Snelling, Minn. A man of character, religious by nature, prepared for practice and research, a soldier who had learned to endure hardships, a student and pathologist of the highest caliber, Reed was now ready for the great achievements of his lifetime. He would live for only 51 years, but between 1893 and 1901, a year before his death, he was engaged in some of the most important work in the history of medicine. This took the form of research into the etiology (cause) and epidemiology (spread) of typhoid and yellow fever.

In 1893, Reed was promoted to major and brought to Washington, D.C. by Sternberg, the new Army Surgeon General. He took his post as curator of the Army Medical Museum (now the National Museum of Health and Medicine, part of the Armed Forces Institute of Pathology) and professor of clinical microscopy in the Army Medical School (now the Walter Reed Army Institute of Research) opened in Washington that year by General Sternberg.

He later took on additional duties as professor of bacteriology at the Columbian University (now the George Washington University). He worked industriously for five years, teaching and working in his specialty -- bacteriology. His work, clinical and academic, was accurate and original. His long experience as a military doctor in the field gave him an excellent sense of judgment, valuable for investigating the causes of epidemic diseases and in making sanitary inspections at military posts. He was indeed needed as an instructor; because medicine was making rapid advances and military doctors had to be informed of the new techniques. An anti-toxin for diphtheria had been prepared and there was a race to find the specific agents responsible for communicable diseases. This was the beginning of truly an era of great discovery. But the work of Pasteur and Koch were not well enough known; Reed, as a professor at the Army Medical School, served in a vital capacity teaching the new science of bacteriology.

The rush of volunteers at the beginning of the Spanish-American War in early 1898 presented special problems for the Army Medical Department. These volunteers were sent to various training camps, mostly in the east and south. In these crowded camps typhoid became a terrible killer. In fact, many more young soldiers died of disease, mostly typhoid, than were killed by the enemy in Cuba. It became a national disgrace. Surgeon General Sternberg appointed a board of officers headed by Reed to investigate the problem of typhoid fever. The Typhoid Board performed its greatest service through the discovery that this deadly disease, prevalent at almost all U.S. Army encampments, was spread most commonly and disastrously by contact between persons and flies soiled with human excrement containing typhoid bacilli, by human carriers who shed bacilli by the billions, and by impure drinking water. This triumph for Army medicine demonstrated for the first time the effects of intestinal disease-producing agents. It also pointed out the failure of outdated diagnostic techniques. In some camps there were not even microscopes available for diagnostic purposes. The report of these findings passed with little notice, but it proved beyond all doubt that proper diagnosis required microscopic investigations and, in some cases, autopsies. Further, it served to dispel old notions that such diseases were caused by miasmas or foul emanations from swamps and rivers.

Diseases, including yellow fever, killed more men in the Spanish-American War than did the enemy. Yellow fever may have first appeared in Central America in 1596, probably imported from Africa by slave ships. It may have been the disease from which members of Columbus' second expedition suffered in 1495. Ninety epidemics struck the United States between 1596 and 1900. In 1793, an epidemic first hit Philadelphia, then the U.S. capital, causing the government to flee as 10 per cent of the population perished. Washington went to Mount Vernon while Jefferson fled the disorder caused by the onslaught of the disease. Because of frequent epidemics, which killed 90 per cent of his expeditionary forces in 1802, Napoleon was influenced to sell the Louisiana Territory to the United States. It was chiefly because of malaria and "yellow jack," as the disease was nicknamed from the pennant that was flown during quarantine, that the French were unable to complete construction of the Panama Canal. The danger of contaminating the southern states was considered to be a major factor in the annexation of Cuba.

The onset of yellow fever came with chills and a headache. This was followed by severe pains in the back, arms, and legs accompanied by high fever and vomiting. The feverish stage might last hours, days, or weeks. Jaundice, from which the fever derives its name, might then appear. Then came the so-called "stage of calm" when the severity of the symptoms subsided and the fever dropped. In less serious cases this stage indicated recovery. But usually this stage was followed by a return of the fever accompanied by internal bleeding that caused the dreaded "black vomit," when blood released into the stomach was ejected. Reed and his assistant, James Carroll, had estimated there were 300,000 cases in the United States between 1793 and 1900 that cost the nation almost $500 million, with a mortality rate usually at 40 per cent, but sometimes as high as 85 per cent. The scourge of yellow fever had plagued the southeastern United States for almost 200 years, but nowhere was it more prevalent than in Havana.

Following the end of the Spanish-American War, yellow fever loomed as a significant problem for the U.S. Army during its planned four-year occupation of Cuba. In 1899, Reed and Carroll published a paper refuting the claim of the respected Italian scientist Giuseppe Sanarelli that a bacterium he had discovered was the agent of yellow fever. Surgeon General Sternberg, the country's leading expert on yellow fever, agreed with them completely. In the late spring of 1900, as the yellow fever season approached and the sanitary measures taken to protect the forces in Cuba were clearly less than adequate, Sternberg appointed a group of Army physicians to study the issue in Cuba.

In May 1900, Reed was appointed president of the board "to study infectious diseases in Cuba paying particular attention to yellow fever." The other members of the board were Reed's friend Carroll, an acting assistant surgeon; and acting assistant surgeons Jesse W. Lazear and Aristides Agramonte of Havana. Reed organized the board in the following manner: he was in charge of the entire project; Carroll was in charge of bacteriology; Lazear was to do laboratory work, but fairly quickly took charge of the experimental mosquitoes; and Agramonte was in charge of pathology. As a result of the extraordinary work of this Yellow Fever Commission, few people living today have any knowledge of this dread disease.

Reed arrived at Columbia Barracks in Quemados about six miles from Havana on June 25, 1900. Reed visited the hospital where his friend, Maj. Jefferson R. Kean, chief surgeon of the Department of Western Cuba, was ill with yellow fever. It was the first active case Reed had ever seen, and fortunately Kean recovered. Despite the fact that Reed and Carroll had published results contrary to it, the commission members set out to see if they could validate Sanarelli's theory. By August 1900, however, they had found no causal relationship between Bacillus icteroides (it is actually a member of the hog-cholera group) and yellow fever.

The commission then decided that the best way to approach yellow fever was not by searching for a specific agent, but rather by identifying the means by which the fever was transmitted. They turned their attention to the theory of Dr. Carlos Juan Finlay and examined it more carefully. For 19 years this resident of Havana had contended that yellow fever was carried in the body of a common house mosquito, which at that time was called Culex fasciatus, later Stegomyia fasciata, and is now known as Aedes aegypti. This theory had been expounded even earlier, but it was Finlay who was its staunchest exponent. However, after some 100 experimental inoculations had failed to produce any clear cases of the disease under strict laboratory control, Finlay was scoffed at; people referred to him as the "mosquito man." There was evidence, however, that tended to lend credence to this theory, which even the commission, optimistic though it was, had doubted. First of all, the disease skipped erratically from house to house, jumping around corners. One member of a household might contract the disease while others in close contact never became ill or did so after a period of about two weeks had elapsed. This was unlike any other infectious disease except malaria, which had just recently been shown by Maj. Ronald Ross of the British Army to be spread by the Anopheles mosquito.

Although Reed was called back to Washington to finish the Typhoid Board report following the unexpected death of one of its members, the work of the Yellow Fever Commission went forward. Lazear had recently been working with malarial mosquitoes and attacked his duties with great enthusiasm in view of the information he had concerning the observations of Dr. Henry R. Carter of the Marine Hospital Service (now the Public Health Service). Carter, who was assigned in Cuba at the time, had observed that it took two or three weeks for the first case of yellow fever to produce the next case in a community. On the basis of this observation, he suspected that an insect might be the intermediary, because this would account for the delay in transmission. He called this the "extrinsic incubation period."

Finlay had given some of the mosquitoes' black, cigar-shaped eggs to the commission, and Lazear allowed them to hatch. In the warm summer months, it was not difficult to maintain a supply because the mosquitoes bred in any clean, still water. Several members of the research team (including Drs. Carroll and Lazear) then volunteered to be bitten, but initially without producing illness. Later Carroll was bitten again and promptly developed a successful case of yellow fever, but his case was experimentally defective because there may have been other sources of contamination. Despite a severe case, Carroll fortunately recovered and went on with his work in bacteriology. Next, Lazear asked Pvt. William Dean of Ohio if he would consent to be bitten. Answering that he wasn't "afraid of any little old gnat" Dean permitted the female Aedes aegypti to bite him. He developed the first unquestionable experimental case and survived.

Lazear himself came down with yellow fever and tragically died after several days of delirium and black vomit -- a true martyr to science. The exact details of how he acquired his illness will probably never be known, as he had several possible exposures, including possibly from self-experimentation.

With the Typhoid Report completed and word of Lazear's death, Reed quickly returned to Cuba. Although grieved at Lazear's death, he was excited at the prospect of successfully tracking down the secret of the fever. Lazear's notebook, found by Lt. Albert E. Truby, yielded the key. In it, through the carefully recorded controlled experiments, Reed found that in order for a mosquito to become infected, it had to bite a yellow fever patient during the first three days of his illness; only during that time was the agent present in the bloodstream. Further, it required at least 12 days for the agent to incubate in the female mosquito (only the female aegypti draws blood) before the fever could be passed to another person.

In October 1900, Reed was able to announce to the annual meeting of the American Public Health Association that "the mosquito serves as the intermediate host for the parasite of yellow fever." These two cases, although sufficient to convince the Yellow Fever Commission that they were at last experiencing some success, were not enough for the thorough scientific mind of Reed, nor would they be for a public that the press had instructed in the "foolishness" of the mosquito theory. With the express permission and financial support of Gen. Leonard Wood, Governor General of Cuba, Camp Lazear, named for their fallen comrade, became operational on Nov. 20, 1900.

Carroll had exhausted the list of experimental animals, rats, and the like normally used for scientific research, failing to find any susceptible to yellow fever. Human volunteers would be needed. General Wood also authorized the commission to use and pay American and Spanish volunteers to participate in the experiments.

In addition to the mosquito theory, Reed also desired to disprove the seemingly fallacious belief that yellow fever could be transmitted and induced from clothing and bedding soiled by the body fluids and excrement of yellow fever sufferers. These articles were known as fomites and were commonly thought to carry the disease. Just as "everybody knew" that the mosquito theory was foolish, so "everybody knew" that fomites were dangerous.

In November 1900, Camp Lazear was established one mile from Quemados and placed under strict quarantine. At this experimental station, Pvt. John R. Kissinger permitted himself to be bitten and developed the first case of controlled experimental yellow fever. This case has been deemed as important to medical science as Koch's discovery of the tubercle bacillus and the development of the diphtheria anti-toxin. Kissinger and John J. Moran (who was bitten, but did not develop yellow fever) had volunteered on condition that they would receive no gratuities, performing their service "solely in the interest of science and the cause of humanity." In a truly unprecedented step, the commission got informed consent from its research subjects, having them sign a consent form that was written in English and Spanish. This almost unrecognized contribution of the commission was a landmark event in the evolution of ethical human experimentation.

Then, in order to prove the theory for all time and to destroy the fomite myth, two specially constructed buildings were erected in Camp Lazear. Building No. 1, or the "Infected Clothing Building," was composed of one room, 14 x 20 feet heated by a stove to 95 degrees. For 20 nights Dr. Robert P. Cooke and Privates Folk and Jernegan hung offensive clothing and bedding around the walls. They slept on sheets and pillows befouled by the blood and vomit of yellow fever victims. Not one of the volunteers contracted the disease. On Dec. 19, 1900, they were relieved by Privates Hanberry and England who, in turn, were finally relieved by Privates Hildebrand and Andrus. From Nov. 30, 1900 to Jan. 31, 1901 the experiment ran to completion, disproving the fomite theory of transmission and thereby demonstrating the uselessness of destroying the personal effects of yellow fever victims, thus saving thousands of dollars in property.

The second building was similarly constructed and was called the "Infected Mosquito Building." It was divided into two parts separated by a screen with screens on the windows as well. Moran, a clerk in General Fitzhugh Lee's office, volunteered again, was bitten by 15 infected mosquitoes, developed the fever, and recovered. The other volunteers, who were separated and thereby protected by the screen, escaped infection.

In February 1901, Reed presented their results to the Pan-American Medical Congress in Havana. The results were readily accepted in Havana, but on his return to the United States there was not universal acceptance. Despite the acclaim he received, he remained modest and reserved. His constant hope of doing something to relieve the suffering of mankind had been fulfilled; his dedication to duty, sound judgment, and thorough scientific methods was an inspiration to the generations of medical researchers.

In the late summer of 1901, Carroll returned to Cuba and through further experiments proved that the specific agent of yellow fever was sub-microscopic and too small to be caught in the pores of the diatomaceous filter that retained bacteria. Thus the last key to the disease was found. Carroll had proved through a series of injections of filtered blood that a filterable agent (a virus) could cause disease in man.

Yellow fever was produced in 22 American and Spanish volunteers either by direct mosquito bites or by injections of infected blood or filtered blood. These injections proved that the specific agent of yellow fever is in the blood and that passage through the body of a mosquito is not necessary to its development. According to John Pierce and James Writer in "Yellow Jack: How Yellow Fever Ravaged America and Walter Reed Discovered Its Deadly Secret," "Neither the brilliance of their thoroughness nor the genius of their experimental design could have bequeathed the commission the extraordinary luck they had, for not a single one of their volunteers had died."

The courage of the volunteers is inestimable. A unique honor helps keep alive the memory of the gallant men who participated in these experiments. In 1929 Congress awarded a special gold medal to each man or his next of kin. In addition, their names are recorded in the Army Roll of Honor.

Had it not been for Reed's fair and thoroughly scientific approach to the problem and misconceptions concerning the disease, especially the whole contagion theory, yellow fever might have continued for years. As a result of the Yellow Fever Commission's success, Maj. William Crawford Gorgas, then chief sanitary officer for the Department of Cuba, rid the island of this longtime pestilence. Realizing that the mosquitoes never stray far from human dwelling places in order to get their meals of blood necessary for them to lay their eggs, Gorgas organized inspection parties to check all homes in Havana for possible breeding places, ensuring that the only standing water in the homes was needed for family use and properly screened. All other water receptacles were to be emptied. Yellow fever, which had ravaged Havana for 150 years, was essentially eradicated in 150 days. The whole world was astounded by the results.

As the mosquito clean-up campaign was starting, Gorgas was not convinced that it was going to be successful in controlling yellow fever. While he believed the validity of the commission's experiments, he felt that the disease was also transmitted by other means and that killing all the mosquitoes, if that was even possible, was not all that would be needed.

Gorgas and a Cuban yellow fever expert, Dr. Juan Guitéras, wanted to see if intentionally causing a mild case of yellow fever could be used as a way to "vaccinate" against the disease. They had been impressed that almost all yellow fever cases produced by the commission had been relatively mild. A separate Inoculation Station was established at the Las Animas Hospital outside Havana and Drs. Gorgas and Guitéras successfully produced a case of yellow fever by the bite of a loaded mosquito in February 1901. It was a mild case and the patient survived. During the next six months all subsequent attempts to produce cases were unsuccessful. In August 1901, they succeeded in infecting eight out of sixteen volunteers. Tragically, three of these eight cases turned out to be fatal.

The only American among the Gorgas and Guitéras volunteers was a 25-year-old nurse from New Jersey, Clara Maass. She had volunteered during the Spanish-American War in 1898 and had served at stateside camps and in Cuba. She worked as a contract nurse as there were no nurses on active duty at that time. Later she volunteered again and served in the Philippines, but returned home because of illness. After she recovered, she wrote Gorgas and asked if he need her help. Following his positive response, she returned to Cuba to work in the Las Animas Hospital. She volunteered for the Gorgas and Guitéras mosquito experiments and was bitten numerous times during March, May, and June without results. She was bitten one last time on Aug. 14, 1901. She became ill on the 18th and despite the best care possible, died on the 24th. Her death and the two others sent shock waves through the Army that reverberated all the way back to Washington and eventually lead to the cessation of human experimentation.

Several years later Gorgas, now a colonel, applied the same techniques in the Canal Zone, controlling yellow fever and malaria, permitting the United States to complete the Panama Canal so vital for commerce and deployment of the Pacific fleet. Thus the menace which had struck in the southern United States and Caribbean every year since 1648 was for all practical purposes eradicated.

The commission's discoveries were confirmed by the Board of Health of Havana and later a commission of the Pasteur Institute confirmed the agent's filterability. In 1927 it was found that certain species of monkeys were susceptible to the virus, thereby eliminating the need for human subjects. In 1937, a vaccine against yellow fever, called 17-D, was produced by scientists of the International Health Division of the Rockefeller Foundation. The use of this vaccine became routine in the U.S. Army in 1942. Because yellow fever is still endemic in the jungles of Central America and Africa where anti-mosquito measures are almost impossible, the fever still exists. A distinction is therefore made between "urban" yellow fever, which is under control, and the jungle variety, which persists. As yet there is no cure for the disease, only inoculation against it.

After his return to the United States in February 1901, Reed resumed his position as professor of bacteriology in the Army Medical School, and as professor of pathology and bacteriology at the Columbian (George Washington) University Medical School. In the summer of 1902 he was awarded two honorary degrees: a master of arts from Harvard University and a doctor of laws degree from the University of Michigan. He was appointed librarian of the Surgeon General's Library on Nov. 1, 1902.

Reed's health had appeared in decline for some time, and following an appendectomy he died of peritonitis on Nov. 23, 1902. He was buried in Arlington National Cemetery. On his simple monument is inscribed the following epitaph, taken from the remarks of President Eliot when Harvard University conferred the master of arts degree: "He gave to man control over that dreadful scourge, yellow fever."

Today, a hospital and medical center stand in tribute to Reed. Due to the efforts of Maj. William Cline Borden, who was the initiator, planner, and effective mover for the creation, location, and first Congressional support of the medical center, it is still referred to today as "Borden's Dream." Walter Reed General Hospital, as it was then known, opened its doors on May 1, 1909 to 10 patients. Fourteen years later, Gen. John J. Pershing signed the War Department Order creating the Army Medical Center. In September 1951, on the 100th anniversary of Reed's birth, the entire complex became known as Walter Reed Army Medical Center, in further tribute to this hero of medical science. In 1945, Reed was elected to the Hall of Fame of Great Americans at New York University, the first physician to be so honored. On Nov. 21, 1966, a memorial and bronze bust of Reed were unveiled by President Eisenhower on the grounds of Walter Reed Army Medical Center.

Resources

Henry, Robert. "The Armed Forces Institute of Pathology: Its First Century 1862-1962." Office of the Army Surgeon General Army, 1964.; Pierce, John and James Writer. "Yellow Jack: How Yellow Fever Ravaged America and Walter Reed Discovered Its Deadly Secret." John Wiley & Sons Inc., 2005.