A medical expert employed by the U.S. government who more than a century ago used data and experiments to help address a major public health crisis is the focus of today’s #stampoftheday. A 5-cent stamp issued in 1940, it portrays Major Walter Reed, a physician and researcher who did groundbreaking work on both yellow fever (and typhoid fever). The stamp was part of the 35-stamp series honoring “Famous Americans,” including five “scientists”: Reed, John James Audubon, Crawford Long (who developed surgical anesthesia), Luther Burbank, and, somewhat surprisingly, Jane Addams, the pioneer social worker who founded Hull House.
Reed, who was born on September 13, 1851, is, at age 18, the youngest person to receive medical degree from the University of Virginia. He joined the US Army Medical Corps in 1875 and spent many years at various outposts taking care of American military troops and their families as well many Native Americans. Working in these outposts, Reed witnessed unsanitary conditions and decided to study pathology and bacteriology, new fields that were emerging as the germ theory of infectious disease began to take hold. Thanks to a transfer to Baltimore, he was able to study with William Henry Welch, a leader in these fields and to meet George Miller Sternberg, another pioneering researcher in bacteriology who, after becoming Army’s Surgeon General in 1893 promoted Reed and made him a professor of clinical microscopy in the new Army Medical School (now the Walter Reed Army Institute of Research).
In his new post, Reed began conducting careful studies on infectious outbreaks among soldiers. In 1898, after outbreaks of typhoid fever among volunteers who signed up when the Spanish-American War began, Sternberg appointed a board of officers headed by Reed to investigate the problem. They found no basis for older notions that typhoid was by miasmas (foul emanations from swamps and rivers). Rather, they concluded, the deadly disease spread most commonly and disastrously from either contaminated water or when people were bitten by flies that had fed on excrement from people who had typhoid fever.
Yellow fever and other infectious diseases, particularly malaria, were a major problem for the American troops occupying Cuba.
In 1900, as the yellow fever season approached and the sanitary measures taken to protect the forces in Cuba were clearly less than adequate, Sternberg made Reed the head of a newly created board of Army physicians order to “study infectious diseases in Cuba paying particular attention to yellow fever.”
Reed and his assistant, James Carroll, were familiar with the disease, which, they estimated, had infected about 300,000 people in the US over the past century, typically killing about 40 percent, but sometimes killing as many as 85 percent of infected people in particularly hard-hit locales (which included Havana). 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 Carlos Juan Finlay, a Cuban doctor who for almost two decades had been arguing that yellow fever was carried in the body of a common house mosquito. Among the evidence in support of this idea was the fact that 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, researchers had recently learned, was also spread by mosquitos.
To test this, members of Reed’s team volunteered to be bitten; two were infected and one died. His late colleagues’ notebooks, however, revealed the key to transmission, which was in order for a mosquito to become infected, it had to bite a yellow fever patient during the first three days of his illness. Further, it required at least 12 days for the agent to incubate in the female mosquito (because only the female draws blood) before the fever could be passed to another person.
Based on these findings, in October 1900, Reed told the annual meeting of the American Public Health Association that “the mosquito serves as the intermediate host for the parasite of yellow fever.” His assertion was not well received; in fact the Washington Post called it “silly and nonsensical.” And Reed wanted more proof as well. So in November, with the permission of General Leonard Wood, governor general of Cuba, he created an isolated facility outside of Havana and began recruiting paid volunteers – both local residents and enlisted soldier – for a comprehensive experiment. The volunteers were separated into two groups that were isolated in separate buildings. One contained clothes, utensils, and furniture that belonged to people who had yellow fever. The other was sterilized, but contained infected mosquitoes that bit volunteers. None of the former volunteers contracted the disease; several the latter did as did some involved with later experiments. In total, 22 volunteers contracted yellow fever; fortunately they all survived.
Based on these findings, the Army began a concerted effort to eradicate the mosquitos in Havana, which almost completely eradicated the disease. A few years later, William C. Gorgas used a similar approach to reduce the incidence and prevalence of mosquito-borne diseases in Panama during the American effort to build the Panama Canal, a project that the French had previously abandoned when about 10 percent of their workforce had been killed by malaria and yellow fever. Tragically, Reed did not live to see the fruits of his work because in 1902 he died from peritonitis caused by a ruptured appendix. He was subsequently honored in many ways, most notably as the namesake of the well-known Walter Reed Army Medical Center in Washington, DC.
His legacy is important but in ways that are more subtle than I knew before writing this post. I grew up learning that he was the one who found the cause of yellow fever and how to eradicate it. This story is the basis “Yellow Jacket,” a 1933 hit Broadway play that was made into a move in 1936 and also was also the storyline in history books for juveniles.
The story, of course, is more nuanced and involved a host of other researchers. Reed himself often cited Finlay’s papers in his own articles and gave him credit for the discovery in his personal correspondence. Moreover, I hadn’t known that the research protocol itself was noteworthy, because it was one of the first, if not the first, to be based on “informed consent” by volunteers who were informed them about the risks they were taking. But, as Dr. Howard Markel, pointed out in an article about Reed on the PBS website, “the kudos afforded Reed are valid only to a point….Enlisted soldiers who were asked to participate in a potentially deadly experiment by their superior officers may have interpreted such requests as orders; vulnerable, [and] poor newcomers recruited with tempting offers not exactly giving their consent freely either.”
More broadly, and more timely, is the fact that Reed was a careful scientist committed to helping people. As he wrote to his wife in June 1900, “[I]t has been permitted to me and my assistants to lift the impenetrable veil that has surrounded the causation of this most dreadful pest of humanity and to put it on a rational and scientific basis.” Like many, I’m hoping – indeed praying – not only that there are similar scientists addressing the current “dreadful pest of humanity” but also that their superiors, particularly in government, will allow them to use a “rational and scientific basis” to do that work.
Be well, stay safe, fight for justice and work for peace.