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From April to August 1898, the United States fought Spanish forces during the Spanish-American War. But it wasn't bullets or bayonets that killed the most, it was disease. Dysentery, malaria, typhoid and yellow fever were far deadlier than conventional weapons of war. Yellow fever, while less prevalent among U.S. service members than typhoid fever, still infected more than 2,000 troops during the invasion of Cuba. By the time U.S. forces arrived in Cuba, yellow fever and other diseases had decimated the Spanish forces, leaving only 55,000 able-bodied troops out of an estimated 230,000 Spanish fighters. Yellow fever continued to plague U.S. armed forces even as the Spanish-American War ended.
Typhoid cases, ward in Spanish military hospital, Ponce, Puerto Rico, 1898," (OHA 313-030). OHA 313 Spanish-American War Photographs Collection.
By 1900, Army Surgeon General George Sternberg commissioned a study of yellow fever. Walter Reed, James Carroll, Jesse W. Lazear, and Aristides Agramonte formed a four-person board to lead the research. In June 1900, the commission began its work outside Havana, Cuba.
Yellow fever military tests, Cuba. Detachment of the Hospital Corps, on the steps of Camp Columbia's hospital in Cuba, in September 1900.," (OHA 309-001-00010). OHA 309 Sontag Collection.
At the same time, a young woman named Clara Louise Maass was working as a contract nurse in the Philippines. The eldest daughter of nine children, she was born to a poor German immigrant family in East Orange, New Jersey. Clara began working at an early age to help support her family, taking her first job while in grammar school. In high school, she worked as a "mother's helper," living with a wealthier family to assist with raising children and performing household chores. By age 15, she was employed at the Newark Orphan Asylum, earning $10 per month for seven days of work each week. At 17 she enrolled at the Christina Trefz Training School of Nurses at Newark German Hospital, and by 1898, at age 21, she had become the head nurse.
Portrait of Clara Louise Maass, 1895" (MIS 05-6619-1). OHA 233.05 Medical Illustration Service (MIS) Library Collection.
That same year, at the start of the Spanish-American War, she joined the war effort as a contract nurse (the U.S. Army and Navy Nurse Corps had not yet been established). There she witnessed firsthand the toll that typhoid and yellow fever took on U.S. troops. After the war, she took a new contract and traveled to the Philippines to nurse sick service members back to health. When she became sick, she was sent back to the United States. Not long after, she accepted another contract position — this time to assist with a concurrent study happening alongside the Yellow Fever Commission.
While Reed finished his experiments to confirm that the Aedes aegypti mosquito was the carrier of the disease, a further study at Las Animas Hospital was being carried out under the supervision of Dr. Juan Guiteras, Guiteras was interested in whether those bitten and infected by the virus delivered by the Aedes aegypti mosquito would become inoculated (gaining immunity to the disease through exposure to a small amount of the agent of yellow fever). Havana, meanwhile, was amid a severe yellow fever outbreak that killed roughly 1 in 10 people.
Illustration, Aedes (Stegomyia) aegypti Linnaeus, 1762, illustrated by Nelson Leandro Cerqueira, Serviço Nacional de Febre Amarela (National Yellow Fever Service), Brazil, 1948" (MIS 54-13280-2). OHA 233.05 Medical Illustration Service (MIS) Library Collection.
Maass, now employed by the Sanitary Department of Havana, was among the first to volunteer for the experiments, directed by Guiteras. Already working with infected patients, she believed that if inoculation worked, she could more safely carry out her work. She was the only woman and only American among the 19 volunteers. Maass volunteered in March of 1901 then again in May and June. In August 1901, she volunteered again to be bitten. and developed a severe case of the disease, leading to her death at age of 25.
News of Maass' death circulated widely in New York City newspapers. The New York Times eulogized her, writing, "The annals of medicine are full of the records of the noblest and most disinterested self-sacrifice for the sake of truth. No soldier in the late war placed his life in peril for better reasons than those which prompted this faithful nurse to risk hers." ("THE THIRD MOSQUITO VICTIM.; Miss Clara Maas Dies from Yellow Fever at Havana After Being Bitten by an Infected Insect." New York Times, Aug. 25, 1901).
Army Maj. Gen. William Gorgas (pictured here as a Major) looking at stagnant retention pond during the construction of the Panama Canal, a potential breeding ground for mosquitos," (Reeve 62703). OHA 80 Reeve Photograph Collection.
The Yellow Fever Commission was ordered to end shortly after her death. Maj. William Gorgas, who had recommended Maass' commission to the Sanitary Department of Havana, would continue the crusade against yellow fever, working throughout Cuba and Central America - including during the construction of the Panama Canal. Gorgas and Reed would go on to be credited with saving millions of lives thanks to their research and pest management efforts. The commission's work and Gutieras' experiments also pushed forward understanding of bacteriology and germ theory (a precursor to the modern medical field of virology).
Clara Maass and her sacrifice continue to be remembered as well. In 1951, commemorating the 50th anniversary of her death, Cuba issued a postage stamp with her likeness. The United States issued a similar commemorative stamp in 1976 marking the 100th anniversary of Maass' birth. She was the first American nurse to be commemorated on a U.S. stamp, and the first nurse to have a U.S. hospital named after her, the Clara Maass Medical Center in Belleville, New Jersey.
Resources
Guinther, L. (1932, February). "A nurse among the heroes of the yellow-fever conquest." American Journal of Nursing Vol. 32, No. 2 (1932, February), pp. 173-176.
Walter Reed – A Name for the Ages
Typhoid Mary/Mary Mallon: An Asymptomatic Carrier of Salmonella typhi
Reed, Walter, Victor A. Vaughan, and Edward O. Shakespeare. Origin and Spread of Typhoid Fever in U.S. Military Camps During the Spanish War of 1898, Volume 1. Washington DC: Government Printing Office, 1904.
OHA 177 Gorgas Hospital Autopsies and Pathology Reports
OHA 356 Walter Reed Yellow Fever Campaign Slide Set
