CORRESPONDENCE WITH DR. REED
As illustrating the way in which we looked at conditions at Havana
at the time that our mosquito work was first begun, I will quote
correspondence which took place between Dr. Reed and myself at this
time.
(1)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, May 16, 1901.
MY DEAR GORGAS:
Briefly speaking, how is the yellow-fever situation in Havana? I got
your report for April and noted, with much pleasure and satisfaction,
your enthusiasm in tackling C. fasciatus and her numerous cousins.
Later, I think on May 4th, I read of “a serious outbreak” in your
town, to the extent of two cases. Since then I have heard nothing
concerning the progress of your epidemic. How many cases have you at
the present writing, and what are your prospects of prognostications
for the future? I ask for this information particularly because Dr.
Durham, of the English Commission, in a letter recently received, has
proposed to join us in Cuba for the purpose of trying to reconcile
his work, or rather the results of his work, at Para, Brazil, with
our observations at Quemados, and as he will reach here during the
last week in May, it is barely within the bounds of possibility that
you may again see us back in our old haunts by July 1st. Everything
will depend upon Dr. Sternberg’s decision.... As much as I should
like to see you and other friends, I would prefer to spend the summer
in the United States. I hear that my friend, Kean, has been promoted
to be the head of Charities and Correction for the Island. Who, then,
is Post Surgeon at Columbia Barracks? How does Dr. Guiteras succeed
at his propagating station? I trust that your own and Mrs. Gorgas’
health is very good. Please remember me very kindly to the latter and
to Col. Havard and Glennan.
Sincerely yours,
WALTER REED.
(2)
Havana, Cuba, May 22, 1901.
MY DEAR REED:
Yours of the 16th received. I wrote you a day or two ago, but I have
forgotten whether or not I answered your question.
The fever situation is all that could be desired, I think. The last
death from yellow fever occurred on March 13th. Since that time we
have had a case April 21st; another on April 22d. We had no more
cases then till May 6th, when we had one; and on May 7th, three
more. Since that time, two weeks, we have had no more; and as the
conditions, as far as non-immunes are concerned, seem more favorable
for the spread of yellow fever, I am in high fettle.
I am inclined to attribute our freedom to the way in which we killed
the mosquitoes. We have fifty men at this work, oiling and draining
small collections of water in every house and putting oil in all
the sinks and closets so that it will run down into the cesspools.
During the winter and cool periods of the year, up to this time say,
the cesspools are the great places for breeding mosquitoes. All
the cesspools, so far, have larvæ in them; when water barrels and
cisterns in same yard have none. I am inclined to think that Dr.
Guiteras, and other mosquito breeders, would get much more vigorous
larvæ if they would use blood or some richer food than mere bread. We
have been trying them side by side and find that sewer water develops
much more hardy and large larvæ than rain water with bread alone in
it.
I have had all the little streams and ditches in the suburbs cleaned
and oiled; and we have killed a great number of larvæ.
You can go to any sewer mouth now and see the dead larvæ running
out in considerable numbers, coming principally, I think, from the
fosomauros, where they have been killed by the oil which would no
doubt remain upon them for several hours.
But we have evidently had some tough old infected fellows, who have
hibernated through the winter. For instance, on the two cases that
occurred on the 21st and 22d of April (in different parts of the
city, however), the mosquitoes were killed as thoroughly as we knew
how. Every room in the house was closed; and a pound of pyrethrum
powder burned to 1,000 cubic feet, and oil used everywhere, sewers
and everywhere else. Not only was this done in the infected house,
but in the fifteen or twenty contiguous houses. On each case we used
50 pounds of pyrethrum powder and something like 40 gallons of oil.
I think the results show that we probably got hold of the infected
mosquito or mosquitoes. We did the same thing on May 6th and 7th; and
it now looks as though we had gotten hold of the infected mosquito
there.
The prospect of getting infected mosquitoes now is poor. So far we
know of none in Las Animas; all the cases this year having been
exceedingly mild. It takes a Board with decided “amarylic” to
diagnose them.
Would like very much to see you, Durham and Carroll down this summer,
that is if you did not object to coming.
Dr. Gaylor, of the New York Pathological Laboratory, wants to take
a whack at yellow fever, after his success at cancer. He asked me
to let him know when I could get him some more autopsies of yellow
fever, and he would come down at once.
We have things nicely fixed at Las Animas now; and I think we would
do good work if we only had yellow fever; but of course we can do
nothing if we don’t have.
Mrs. Gorgas has just returned from the “States” and joins me in
kindest regards. I got weak in the knees and was afraid to keep our
small girl down here, even though we had no infected mosquitoes.
Very truly yours,
W. C. GORGAS.
(3)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, May 23, 1901.
MY DEAR GORGAS:
I had only just penned you a short note, inquiring into the
yellow-fever situation, when here comes your most welcome and
interesting letter of May 15th. I was so much interested in Guiteras’
results. One positive case in nine inoculations is better than we had
at first. We only succeeded with our _tenth_ individual. Of course,
you were biting often with non-contaminated mosquitoes, as your fever
cases were doubtful. Cases 3 and 6 should have failed. I expect
better results from your May-infected mosquitoes. I see that Finlay
and Guiteras continue to harp on the harmlessness of a _single_
mosquito’s bite, drawing the conclusion that ordinarily y. f. is due
to _multiple_ bites. After some poor devil dies, they may change
their minds. Carroll’s severe illness was due to a _single_ insect
and poor Lazear died from a _single_ bite. Why are not malarial
fevers generally double or multiple infections? We know that the
opposite—single infections, as shown by one group of parasites—is
the rule.... What’s the need for us to return, if you have no y. f.?
Havana should get a more accommodating Chief Sanitary Officer! Hurry
up your new infections.
Again thanking you for your letter and the copy of G.’s report, and
with best regards to your wife, believe me,
Sincerely yours,
W. REED.
(4)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, June 5, 1901.
MY DEAR GORGAS:
Your very kind letters of May 22d and 23d have both been received.
Please say to Dr. Finlay that I will send a copy of our last paper
just as soon as we can get it from “American Medicine.” It hasn’t
been published yet. I hope to have it soon. You shall certainly have
a Reprint. What you tell me about the y.-f. situation is certainly
very encouraging, _but_ were not the _results_ just as encouraging
in _1899_, at the same season? I will admit that you must have more
non-immunes in Havana now than in 1899. Of course, you understand, my
dear Doctor, that the control of yellow fever during this epidemic
season, is to me the all-absorbing and important question, and it is
on this very account that I am afraid that you and I might be led,
in our enthusiasm, to think that more should be attributed to the
sanitary measures now being carried out, than to the season, or
some other conditions of which we might be ignorant. It is simply
a delight to read that you are “in high fettle,” and I consider
the city fortunate in having a Health Officer who believes that he
can master the problem. I am astonished at the strength of your
mosquito-destroying sanitary squad. What you say about the cesspools
as breeding-places is intensely interesting. We got our first good
supply of larvæ from an old can containing some feces at Columbia
Barracks, and since then we have added a little fecal material to
our breeding jars and have found that larvæ thus fed grew much more
vigorously than those in ordinary water. Your experiments agree
fully with ours. You are certainly doing effective work toward
their destruction. I was astonished at the amount of pyrethrum that
you are burning to the 1,000 cubic feet. Is such a large amount
necessary, do you think? Won’t you soon exhaust the supply? At Mount
Vernon B’ks, where culex was very abundant, I used to find that
about 2 or 3 ounces would intoxicate every mosquito in a room of
some 3,500 cubic feet, so that I could sweep them up and burn them
before they “sobered up.” Certainly your plan of destroying insects
in the surrounding houses is worthy of all commendation. However,
be sure that your sanitary measures do not prove obnoxious to the
Cuban doctors and laymen, or otherwise they will certainly conceal
their milder cases. While the destruction of the mosquitoes is very
desirable, I consider the thorough protection of the patient against
their bites as of even greater importance. I cannot believe that
in so largo a city ... that you can possibly accomplish this. The
undertaking, to me, seems well-nigh impossible. They _will_ conceal
their cases, _do what you may_; and these cases will be the foci
for other cases. I can see no other alternative for this summer, at
least. Still, you will undoubtedly be able to control the spread of
the disease better than ever.... Pardon this long letter. Good luck
attend your well-conceived regulations. Health and happiness attend
you and yours.
Sincerely, your friend,
REED.
Dr. Reed here considers a squad of fifty men doing sanitary work
in a city of two hundred thousand inhabitants at large. Four years
afterwards, in the city of Panama, a place of twenty thousand
inhabitants, we had six hundred men doing the same work. Major Reed
is inclined to think fifty pounds of pyrethrum to a case a large
amount. In 1905 in Panama we used two hundred and forty thousand
pounds during the year. I call attention to this as showing how
little any of us appreciated the magnitude of the job when we first
started in.
(5)
Havana, Cuba, June 13, 1901.
MY DEAR REED:
Yours of June 5th received. I inclose you a copy of Dr. Guiteras’
report for May.
We see still no success from our inoculations in twenty-two cases,
but the great “but” comes in. I am not sure that any of the cases
bitten were yellow fever. One of the last, from Tampico, I thought
a pretty well marked case, though not dangerously ill, but his
mosquitoes, on the 20th day, did not infect. I am disappointed
beyond measure. I had hoped by this time to have Las Animas full to
overflowing with inoculated cases, and be turning out immunes at the
rate of some two hundred a month. But may be it is well as it is; in
our enthusiasm we might have infected the city.
No case of yellow fever since May 7th, and still none on hand.
The Board diagnosed one early in the month, but it turned out a
well-marked case of typhoid fever. Of course I agree with you that
nothing very definite can be deduced from our results this early
in the season, though personally I am very much impressed by them.
Our condition now is very much better than it was even in ’99, with
regard to yellow fever, and of course our liability to it is very
much better. ’98 and ’99, with regard to yellow fever, should be
left out, as in these years there were no non-immunes in Havana, and
they would not have had yellow fever no matter what the condition of
infection would have been. I except of course, the latter part of ’99.
From the 1st of March to the 16th of June in ’99 (and mind you this
has been far and away the best record Havana ever made), we had four
deaths from yellow fever. In the same period this year, we have had
one, which occurred March 16th. The deaths in ’99 occurred scattered
over this period. It seems to me that the present condition of
affairs indicates that we have been doing something that has had a
great effect upon infection; and of course the only thing we have
done this year that we did not do last year is the destruction of the
mosquito. We commenced this work about the middle of February, just
about the time that yellow fever practically disappears.
On the 12th of June, 1899, we had had for the month two cases of
yellow fever, and in 1900, six. If you consider the amount of work
there was to be done, to put oil in all the cesspools, all the
water barrels and all the cisterns, once a month, and then keep the
streams and pools in the suburbs drained, you will understand that
seventy-five men is not at all a large force. I think I could use to
advantage more. As you say, we could use less pyrethrum. We arrived
at the rate of a pound per 1,000 cubic feet by experiments at Las
Animas. We found that in this ratio we could kill mosquitoes in one
and a half hours. It would probably be just as well to intoxicate
them and sweep them up, and I shall probably cut down the quantity in
a short time. We have to sweep them up anyway. But feeling that it
may be possible that we have no infected mosquitoes in Havana I want
to do everything I can think of, when a case occurs, to increase the
chances of killing the infected mosquito in the neighborhood of where
the patient got his infection.
We are using now from one hundred to two hundred pounds to the
patient, killing the mosquitoes everywhere within half a dozen houses
of the patient’s home. There is less objection raised to this than
to the ordinary disinfection. It damages nothing, only keeps them out
of their room for an hour or two, and kills the mosquitoes. I think
there is much less opposition to us on this account than there was
last year.
I feel confident that there is very little concealment of cases, and
I do not feel much anxiety on this score. We cannot have many light
cases without having a death now and then, and deaths would almost
certainly be reported.
But what gives me the greatest confidence is that our non-immunes are
made up entirely of Spaniards and Americans. The Americans promptly
report themselves where there is anything suspicious, for the sake of
the better care that they get at Las Animas. The Spaniards are all
matriculated at one of the three “quintas,” and go there as soon as
they are sick from any cause. These “quintas” are all very anxious to
try and catch up to the record of Las Animas, and report every case
that they think, by any possibility, will pass the Board. And then,
too, I can control the “quintas” by frequent inspections. So it seems
to me that there is very little probability of cases being concealed
to any extent. Still, we can speak more definitely on this subject
about the 1st of December than we can now.
All well. With kindest regards, I remain,
Very sincerely yours,
W. C. GORGAS,
Maj. & Surg., U. S. A.
Chief Sanitary Officer.
To Maj. Walter Reed,
Washington, D. C.
(6)
Army Med. Museum, June 27, 1901.
MY DEAR GORGAS:
I thank you so much for your last kind and most interesting letter
of June 13th. Really, my dear Dr., in spite of a few disagreeable
things and people, when I think of the absence of yellow fever from
Havana for a period of fifty days, I begin to feel like rejoicing
that I ever was born! You are doing a splendid work for your corps
and profession in Havana.
* * * * *
Sincerely, your friend,
REED.
(7)
Army Med. Museum, Washington, July 29.
MY DEAR GORGAS:
I was on the eve of writing to you, when your kind favor of the 20th
inst. reached me. The news from Havana is simply delightful. I am
willing to confess that my fears that physicians would fail to report
cases of yellow fever to your office, and thus maintain foci of
infection, were groundless. It shows that your acquaintance with the
local conditions were much better than mine. That you have succeeded
in throttling the epidemic appears to be beyond question, and is to
your everlasting credit as an energetic Health Officer, who saw his
opportunity and grasped it. A man of less discretion, enthusiasm and
energy would have made a fiasco of it. Whereas, you, my dear Gorgas,
availing yourself of the results of the work at Camp Lazear, have
rid that pest hole, Havana, of her yellow plague! All honor to you
my dear boy! Thank God that the _Medical Department_ of the U. S.
Army, which got such “a black eye” during the Spanish-American war,
has during the past year accomplished work that will always remain to
its eternal credit! I had seen in the papers report of the cases at
Santiago de las Vegas. I am delighted that you have taken charge of
the suppression of this outbreak. Of course, you will soon stamp it
out, if you can enforce your regulations. I shall look forward with
the greatest interest to your work there. _Please keep me posted._ I
did not get your June Report, which I should like to have very much.
Apropos of the outbreak at Santiago de las Vegas, I have concluded
to have Carroll go to Havana, for the purpose, if he can get hold
of any cases of yellow fever, of making a few observations on human
beings, which will be a valuable guide to us at the present stage of
our search for the parasite. I sincerely hope that he can succeed in
getting hold of a few recently arrived immigrants for this purpose. I
especially ask your kind assistance in this matter. I see that Gen.
Wood has left Havana so that I am afraid that Carroll cannot get any
money with which to pay the subjects of experimentation. Have you any
funds with which they could be paid $1.00 per day? I think that you
said that subjects could be obtained at that price. Carroll would
like to do his work at Las Animas Hospital. Can that be arranged? He
must start on his return by Sept. 20th, if possible. So that he has
but little time in which to accomplish the task before. Still if he
can draw blood from a few undoubted cases and can get a few subjects,
it won’t take him long to decide the point. I wanted to come very
much, but I have work here which I feel that I should not neglect.
Else I should have certainly come down. I have been intending to ask
you whether, in dealing with y. f. in Havana, this year, you have
confined your work to simply protecting the sick against bites and
destruction of mosquitoes; and have _omitted_ all disinfection of
bedding and clothing. I sincerely hope that this is true. I shall
probably present, with Carroll, a paper to the next meeting of the
American Public Health Association on the management and prevention
of yellow fever, and I would so like to be able to say that the great
work in Havana was accomplished without the disinfection of any
bedding or clothing. Carroll leaves New York, with Pvt. Springer,
on Ward Line leaving on Wednesday, August 6th. Pardon this lengthy
letter. Please present my kindest regards to Mrs. Gorgas. Keep me
informed of your progress at S. de las Vegas.
Sincerely yours,
REED.
The parasite has not yet been discovered. Dr. Carroll proved by the
experiments which Dr. Reed here refers to that the parasite of yellow
fever is sub-microscopic.
(8)
Havana, Cuba, August 26, 1901.
MY DEAR REED:
Yours of July 29th received. You will see by the last report that
our conditions continue good. So far this month we have had only two
cases belonging to Havana, one of these a Cuban child twelve years
old who had never been out of Havana. Personally, I have not seen a
case since March, belonging to Havana, with which I was perfectly
satisfied as being yellow fever, but I am more confirmed in my
suspicions since we have had the Santiago de las Vegas cases.
You recollect we bit some thirty-four subjects at the time when I
last wrote you without being able to transmit the disease in a single
instance. These mosquitoes we tried to infect on some dozen of these
supposed Havana cases.
We all agreed that the Santiago de las Vegas cases were yellow fever.
While they were not severe, they were well-marked cases of yellow
fever. We bit one man with eleven mosquitoes. He was a well-marked
case, but not dangerously ill at any time. These eleven mosquitoes
have since bitten seven subjects, six of whom have gone down with
yellow fever. Three have recovered and three died. Carroll will no
doubt give you details in these cases, and Guiteras will publish the
matter in detail.
I am very much disappointed. I had hope that through the mosquito
we had a means of giving mild cases which would protect, but these
cases show that the severest form of yellow fever can be transmitted
by one or two mosquito bites.
I suppose I ought to be thankful for the immense good that the
discovery so far has done, and for the great success that our work
this year has had, but the death of these patients, just now, makes
all success taste of gall and wormwood, and casts a gloom over the
Sanitary Department.
From a practical standpoint though I am inclined to think that the
yellow-fever question is settled. The discovery that it is the
mosquito alone that conveys the disease will enable us to manage it.
I cannot but think that the freedom of Havana from yellow fever on
the 24th of August, a thing never before known, must be due to the
fact that we got the infected mosquito nearly every time. The disease
has been introduced freely from the outside, and yet has not spread
among our thirty thousand non-immunes. I believe that our system gets
them nearly every time. I think we will soon have Santiago de las
Vegas under control. We are inspecting and keeping track of all the
non-immune travelers coming to Havana. They are seen by one of our
doctors every three days of their stay in Havana, up to six. We have
gotten hold of several in this way, and the town is being regularly
gone over with the same system that we have in Havana.
We had a case on the 20th from Las Vegas, but it was from a part of
that town that had not been disinfected. I feel confident that we
will have no more cases from Las Vegas after September 1st. This
will be a very nice demonstration of what can be done by our system
of mosquito killing.
Heretofore we have disinfected exactly as last year, plus using
the pyrethrum powder and oil in the infected house and in all the
neighboring houses. Formaline was used in the infected room and
the clothing was sent to Las Animas Hospital, and the patient
quarantined. I did it because it could not decrease the effectiveness
of disinfection, and would relieve me from criticism in case we were
not able to control yellow fever, and had as much as we had last year.
I must confess that our results this year are entirely unexpected
to me, and if I had any idea how they were coming out I might have
discontinued the disinfection of clothing long ago. But in order
that the cases may be reported as generally as possible, I am doing
everything that I think I safely can to make the routine as little
burdensome to the people, as possible. In accordance with this, I
have this month issued an order that in yellow-fever cases the only
disinfection was to be with pyrethrum; that the clothing was not to
be taken to Las Animas, and that after the fifth day the patients
were not to be quarantined or screened.
I have been designated by the Military Governor to represent the
Department at the Public Health Association next month at Buffalo,
and also the Board of Health at the meeting at Niagara which is
scheduled to occur on the 13th. I hope to see you there if I go. If
things are as quiet as they are now, I will probably go; but if I
have any yellow fever on hand I would rather send somebody else.
Yes, I agree with you. I think this yellow fever work will reflect
great credit upon our corps. Certainly the work of proving the
mosquito to be the transmitter of yellow fever is as important a
piece of work as has been done since Jenner’s time, and as far as
the United States is concerned, probably of more importance; and as
yours was the guiding hand in the whole matter, I hope that some
suitable reward will come to you, more substantial than the general
professional recognition which you are now getting from all quarters.
I am very happy to shine in the more humble rôle of being the first
to put your discovery to extensive, practical application.
Mrs. Gorgas joins me in kindest regards.
Very sincerely yours,
W. C. GORGAS,
Major & Surgeon, U. S. A.,
Chief Sanitary Officer.
(9)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Sept. 2, 1901.
MY DEAR GORGAS:
Upon returning to town, from a two weeks’ rest in the mountains, I
find your very interesting letter of Aug. 26th. Of course, Carroll
had already written to me about the unfortunate termination of some
of Guiteras’ cases. I was very, very sorry to hear of Guiteras’ bad
luck and can appreciate fully his mental distress over this loss of
life. Perhaps, after all, the sacrifice of a few will lead to the
more effectual protection of the many. I think that we had best look
at the matter in this light. That eleven mosquitoes could and did
infect _six_ persons, causing the death of three, is indeed, very
strong confirmatory evidence of our observations of last fall and
winter. I have been particularly anxious to learn of your results
at Santiago de las Vegas, hoping to incorporate them in a paper on
the prevention of yellow fever, which I hope to read at Buffalo; but
since the good news comes that you will be there “in persona vera,”
you can give the figures better than anyone else. I will, however,
show by chart, the occurrence of yellow fever in Havana during the
present year, and would be so glad if you would give me your cases
and deaths for _August_. To Aug. 26th, you report only _two_ cases.
Were there any others? I have the cases and deaths for the other
months. Is not the record a _glorious_ one? But it would not have
been obtained by a less energetic and enthusiastic Health Officer.
You, therefore, my dear Gorgas, deserve all manner of praise for your
thorough work. I hope that Carroll is meeting with success. Please
let me hear from you by return mail, if possible, about your _August_
cases and deaths. A line will do. With kindest regards to Mrs. Gorgas,
Sincerely, your friend,
REED.
(10)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, October 3rd.
MY DEAR GORGAS:
I have been hoping to see you and Mrs. Gorgas in Washington and
wondered what you found at Buffalo to keep you so long; but a letter
from Carroll just received, mentions your return to Havana. So you
have, indeed, given us the “glad go-bye!” Well, as Columbia has just
_won_ from Shamrock, I’ll have to forgive you this time! But you
mustn’t do so any more, or there will be “trouble on the old man’s
mind.”
I trust that you found the yellow-fever situation satisfactory.
I wish that I could have known the No. of cases and deaths for
September, so that I could have included them in our paper, but it is
too late now. Don’t forget to keep me on your exchange list. I had
a letter from your brother in answer to one I wrote you for which
please give him my best thanks. You were saying, if I remember, that
you would like to have your former assistants, Lyster and Shockley,
back again. If you haven’t them, and still want somebody, I only
mention the fact that Asst. Surgeon Devereux, who has been on duty
with Borden at the Genl. Hospital here, leaves in a day or two for
Havana, to report for duty, and might suit you very well as an
assistant.... Borden says that he has made a very good assistant. You
might have your eye open for him. Give my kindest regards to Mrs.
Gorgas. Good-bye.
Sincerely, your friend,
REED.
(11)
Havana, Cuba, Oct. 8, 1901.
MY DEAR REED:
I was sorry that I did not see you before leaving Buffalo, and have
an opportunity of talking with you over your superb paper, and
arguments with Wadsin. Nothing could have been clearer, it seems
to me. I congratulate you upon being the First Vice-President; I
think you ought to have been President but that matter had been
arranged beforehand as going to the retiring Treasurer, who had held
that office so long. Other names as First Vice-President had been
proposed to the Committee, but when your name was mentioned, they
all voluntarily withdrew, and you were nominated without a single
dissenting voice.
You will see from the report how we are coming along. The record is
just as good; two deaths for September. We have had a little focus
about the “Mercado del Vapor,” but I think we have squashed it. Our
last case occurred Sept. 26th. Ten days without a case, this time
of the year, is pretty good. But our general death rate took a most
remarkable drop. We had only 339 deaths in September, a rate of 15.64
per thousand.
You had better move down to Havana with your family. I am getting so
that I am afraid to go back to the United States and run all the
risks of infection and bad hygiene that you are constantly subjected
to in cities such as Washington, New York, etc.
I looked into it carefully, and am positive that there is no error in
the figures. I don’t believe it is possible for a person to be buried
in Havana without my knowledge, and I know that these figures are
correct.
Carroll seems to be hard at work; looks very mysterious, and can’t
get him to tell anything. He had better hurry up; yellow fever in
Havana will soon be a thing of the past.
I left Mrs. Gorgas and Aileen in New York, but expect them to leave
for Havana, Wednesday, the 9th.
With kindest regards, I remain,
Yours very sincerely,
W. C. GORGAS,
Major & Surgeon, U. S. A.,
Chief Sanitary Officer.
Major Walter C. Reed,
Office of the Surgeon General,
Washington, D. C.
This case which I report on September 26, 1901, was really the last
which occurred in Havana. Of course we did not know it at the time,
but this case marked the first conquest of yellow fever in an endemic
center; the first application of the mosquito theory to practical
sanitary work in any disease.
(12)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Oct. 17, 1901.
MY DEAR GORGAS:
I have yours of the 8th inst., and appreciate very much your kind
words about my paper and my selection for First Vice-President of the
Association. The latter was a very great surprise, as I didn’t dream
that I would be considered as a candidate for any office.
* * * * *
I am indeed delighted to hear that you only had two deaths in
September. What could be more satisfactory? Certainly _five_ deaths
in _seven_ months is a good record for the city of Havana, in this
year of our Lord 1901! I hope that you no longer destroy fomites
but are careful to protect your cases until fever subsides or death
ensues. Good luck to you and your work! I really don’t blame you for
being a little nervous about your health when you come to the United
States, for you are certainly making Havana one of the healthiest
cities in the world. I think that I will take your advice, come down
and build me a house; that is, _after_ I retire! Remember me very
kindly to Mrs. Gorgas and your daughter.... I will be glad to get
your monthly report for September.
With best wishes,
Sincerely yours,
WALTER REED.
(13)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Dec. 21, 1901.
MY DEAR GORGAS:
Many thanks for your October report. The November report has not
been received yet, but hope to get it later. I got your kind
letter of Dec. 6th. Certainly the results for October and November
could hardly be beaten. I think that we should thank Heaven and be
satisfied. Another experimental case of yellow fever? Look here, Mr.
Sanitary Officer, if you don’t stop applying stegomyia to willing
Castilians, there will be trouble yet! Carroll fairly grinned all
over when I read it to him! He wishes to be very kindly remembered
to you. I am glad that Dr. Finlay still finds his Tetragenus. Please
remember me to him. What a splendid paper that was of Guiteras in
_American Medicine_! I was delighted with it. Make my best regards
to him, also, please. The weather here is so very cold that I long
for the balminess of the Cuban atmosphere. Why men and women will
persist in living in cold climates is something that I can’t possibly
understand. Stay where you are. Don’t permit even the evacuation of
the Island to bring you away. We need you as a defence against yellow
Jack! Well, the hour is five p. m. and all have long since left the
office. I must hurry home in an open street-car and thereby chill my
very marrow. My best regards to Mrs. Gorgas....
With all manner of greetings for a Merry Xmas and happy 1902, believe
me,
Sincerely, your friend,
REED.
(14)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Jan. 14, 1902.
MY DEAR GORGAS:
In response to your request just received, I have forwarded to you
a copy of each of our Reports which I will ask you to hand to the
French Consul with my compliments. I was just about to write to you,
to ask at what time during 1901 you omitted to disinfect bedding
or clothing. I think that you wrote that about August 15th, you no
longer required such disinfection, but I cannot find your letter.
Again: Can you not give me some of the data with regard to your
fight for control of the epidemic in Santiago de las Vegas? Did your
results show by the prompt suppression of the epidemic in that town
that you were adopting the right measures? I have just been asked to
write an article for the English _Journal of Hygiene_, setting forth
our observations, as well as the work of the Medical Department in
Cuba, and I should like to mention Santiago de las Vegas as well as
Havana, giving you, of course, full credit for the results obtained.
I haven’t your December report as yet. Please send me a copy of it.
I never was quite so busy in all of my life and sigh for the 3d of
April, when I can get this class off my hands. How is your epidemic
in Havana? How I would like to run away from my present surroundings
and go on a “toot” with you and Kean!
Please let me hear from you promptly, as I must prepare my paper by
the end of February. Remember me very kindly to Mrs. Gorgas....
Sincerely yours,
REED.
(15)
Havana, Cuba, January 22, 1902.
Major Walter Reed,
Surgeon General’s Office,
Washington, D. C.
MY DEAR REED:
Yours of January 14th received. The sending of clothing and bedding
for disinfection to Las Animas, in yellow-fever cases, was stopped
about (text missing). The official order was issued August 21, 1901.
We have a large disinfecting plant at Las Animas to which everything
of this kind is sent. When a house is disinfected for diphtheria or
any similar disease, the room itself is infected with formaline gas
and washed down with a bi-chloride solution “and all fabrics and
clothing of every kind are sent to the disinfection plant”. Up to
the time mentioned this had been done in the case of yellow fever,
but, having become convinced that the mosquito was the only way of
transmitting the disease and that no good could be obtained from this
process, we stopped this method.
From my experience here in municipal sanitation, I think this
is of the greatest importance, viz: to put people to as little
inconvenience and loss as possible by methods of disinfection. The
destruction of mosquitoes in a building can be accomplished with
very little annoyance to the inmates but the thorough destruction of
fomites causes a great deal of inconvenience and some loss.
The all important matter in yellow fever is to get your cases
reported as thoroughly as possible and this can only be done with the
co-operation of the people. I am therefore of the opinion that the
great element of our success was due to the fact that we did away
with the attempted destruction of fomites. You can readily see how
one unreported case might start an epidemic.
The Santiago de las Vegas case is a very good illustration of the
efficiency of our methods in stamping out a focus. Santiago de
las Vegas is practically a suburb of Havana, distant about twelve
miles with a considerable non-immune population, constantly having
communication with Havana. The infection of 1900 evidently remained
over. Some cases occurred in January, some in June and more in July.
The cases of July were taken and the houses all gone over, and
the mosquitoes killed, but it was evident that the infection had
gotten away from us by this method, so on the 24th of July we got
a considerable appropriation and started a brigade systematically
fumigating, block by block, around the infected areas. With this we
were successful and got rid of the focus. This was the most difficult
disinfection we have attempted. The infection had evidently got
pretty widely spread and new cases kept occurring outside of the area
in which we were working. I send you a few papers on the subject.
Please return them when you have finished as they form a part of our
records on the subject. Please excuse this hurried letter.
Sincerely yours,
W. C. GORGAS,
Major and Surgeon, U. S. A.
Chief Sanitary Officer.
(16)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Jan. 31st.
MY DEAR GORGAS:
Your kind letter of January 22d was received a few days ago. I am
very much obliged for the information concerning Santiago de las
Vegas. I have made a copy of several of the enclosed papers and
return them herewith with many thanks for the opportunity of seeing
them. I would like to know in how many cases of y. f. since July
1, 1900, you have omitted disinfection of clothing. How many cases
under observation in Havana since that time? There were five deaths I
notice after that date and these probably cover say twenty cases. Can
you give me the exact number of cases by months for 1900 and 1901? I
want to make a curve for these years of cases to accompany my next
article to be published in the _Journal of Hygiene_ (English)....
Another thing. Can you possibly obtain from Dr. Guiteras, some eggs
of stegomyia and send them to me dried on filter paper? I have no
insects nor eggs at present, and am so very anxious to obtain some as
soon as possible.
Remember me very kindly to Mrs. Gorgas. With best wishes,
Sincerely yours,
WALTER REED.
(17)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Feb. 4, 1902.
MY DEAR GORGAS:
Yours of January 31st is just to hand. The Army Examining Board of
which I am a member is not now in session, but undoubtedly will be
set at work just as soon as the school session ends, April 3d, and
I should venture the opinion that the Board will remain in session
until November 1st, except during a brief summer vacation in July
and August. I hope that your friend will appear. Give him a note to
me, or a general recommendation for the use of the Board, and I will
see if I can’t soften the hearts of some of the stoniest-hearted
members.... I hear that you are going to have a y. f. “picnic” down
in Havana this month. Talk “right from the shoulder” to those South
Americans, and make them begin the work of exterminating the disease
in their respective countries. I think that Mexico is alright on
this question.
* * * * *
Faithfully yours,
REED.
(18)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, Feb. 12, 1902.
MY DEAR GORGAS:
Just a line to say that I have your kind letter of Feb. 6th,
containing the information that I so much wanted. I thank you very
much for it. I am trying very hard to put together an article for the
_Journal of Hygiene_, as I wrote you, but between the class and other
work, it’s deuced hard to accomplish a half hour’s work on it daily.
Did you see Souchon’s reply to Carroll and myself in the Record for
January 8th?... If I can get a little time, after awhile, I may reply
to him.... This should reach you in the midst of the meeting of the
Congress. Do, pray, persuade them to accept the mosquito transmission
and change their sanitation accordingly. I trust to you, Havard, Kean
and Guiteras to do this. Make my kind regards to Mrs. Gorgas. I am so
glad that you are going to remain in Havana for awhile. You should
stay during the whole summer and fall....
Good-bye.
Sincerely yours,
REED.
(19)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, April 3, 1902.
MY DEAR GORGAS:
Yours of March 28th reached me yesterday....
I was simply delighted with your Annual Report. What a glorious
record! No wonder, my dear boy, that you should grow eloquent, as
you did, in your closing paragraph. It made my heart beat faster as
I read it. You have done a splendid work in Havana, my dear Gorgas,
one that should always give you the greatest pleasure to look back
upon. You have my sincere admiration and congratulations. _We will
really and truly have to go on that Toot when you land on your native
heath, once more!!_ But if I had my way, you would remain in charge
of sanitary matters in Havana for another summer! I have told Gen.
Sternberg so. It would be such a pity to have this splendid work all
undone, for the lack of an enlightened Health Official. Who will
succeed you? His position will be the most important on the Island....
Adios, my dear friend. May Heaven bless you.
Your friend,
REED.
(20)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, May 14, 1902.
MY DEAR GORGAS:
I received your reprints and was very much pleased with them and to
know that you are doing such good missionary work. Modification of
quarantine will come slowly but surely. Am delighted to know that you
will be here on your way from Saratoga....
So you have really applied stegomyia again to y. f.? Dear me! Haven’t
you had experience enough? If you are going to do this thing much
more, Carroll and I will join you on your way back to Havana. There
are several problems to be worked out, from a scientific point of
view.... Are you not a delegate to the Assoc. of Military Surgeons? I
though that you were. If you should arrive before May 28th, you could
join us in the dinner to Gen. and Mrs. Sternberg. Wish so much that
you could be here with Mrs. Gorgas, as I know that you would both
enjoy the occasion....
Sincerely yours,
REED.
(21)
War Department, Surgeon General’s Office,
Army Medical Museum and Library,
Washington, July 21, 1902.
MY DEAR GORGAS:
It was like the good fellow that you are to sit down and write me
that nice letter of congratulation. Harvard did indeed do me very
great honor in conferring the degree of Master of Arts, and the
audience was so very enthusiastic that I felt that Boston, at least,
had some appreciation of what the Army had done in Cuba.... The
University of Michigan, not to be outdone by Harvard, gave me the
following week the degree of L.L.D!...
There is another way in which to look at this matter. Instead of
simply being satisfied to make friends and draw your pay, it is worth
doing your duty, to the best of your ability, for duty’s sake; and in
doing this, while the indolent sleep, you may accomplish something
that will be of real benefit to humanity and worth more than all the
high places that could be bestowed by shrewd politicians. Nor you nor
I have reason to be ashamed of our work of the past two years, nor
would we think of exchanging places with any of the luckier members
of the Corps. “_Verbum sap._” I am having Mr. Meyers look up Panama
and Nicaragua literature. Do you want articles in German and French,
or only in English? How shall they be addressed?
With warmest regards to Mrs. Gorgas, ... believe me, always,
Your good friend,
REED.