Major Walter Reed, Medical Corps, U.S. Army

On September 13, 1851, one of the world's outstanding physicians and medical research scientists was born in Belroi, Gloucester County, Virginia, the son of a Methodist minister, Lemuel Sutton Reed, and his wife, Pharaba White Reed. At an early age, Walter Reed gave "evidence of the intellectual brilliancy and earnestness of purpose which distinguished him in later years."

After his basic education at a private school in Charlottesville, Virginia, Walter Reed matriculated at the famed 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 eighteen. He was the youngest student ever to graduate from the medical school. Since the University of Virginia had no hospital attached, he took a second degree at Bellevue Medical College in New York in 1870. During the subsequent five years he served his internship at Kings County Hospital in Brooklyn and at the Brooklyn City Hospital. While interning at Kings County he was described as being "sociable and companionable with a special gift for conversation." There too, he attracted the attention of Dir. Joseph P. Hutchinson, then the leading physician and surgeon in Brooklyn. After further internship at Brooklyn City Hospital with consultant status at Kings County, he was appointed one of the five inspectors on the Brooklyn Board of Health in 1873 at the age of twenty-two. He approached all his duties with enthusiasm and optimism, traits which contributed immeasurably to his success, both social and professional. The turmoil of city life excited and stimulated him. He attended concerts at the Hippodrome and the Academy of Music and good lectures on literature and scientific subjects. It was at this time that the young intern conducted his first research which was the basis of his first scholarly paper, published in 1892, called "The Contagiousness of Erysipelas."

Walter Reed Birthplace, Bellroi, VA, 1851
In 1874, having served on the Boards of Health in Brooklyn and New York, he returned to Virginia 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 Army as a surgeon. Because he felt the Army offered a good opportunity for research and also the financial security he felt he needed to marry his winsome fiancee, he applied and was accepted for an appointment in the Medical Department of the Army. He passed the required examinations and was appointed Assistant Surgeon with the rank of first lieutenant on June 26, 1875. So began an eighteen-year garrison life.

After five years at Fort Lowell and Fort Apache, Arizona, where he served as a beloved family doctor visiting patients in the wild country surrounding his posts, he was promoted to captain and soon thereafter was transferred to Fort McHenry in Baltimore. In this city he became a student of physiology at Johns Hopkins University in his spare time during 1881 and 1882.

After serving at Fort McHenry, Walter Reed was again assigned to southern and western posts at Fort Omaha, Nebraska, and Mount Vermon Barracks, Alabama. One Walter Reed historian points out that "one of the marvels of his life is that his relegation to frontier garrisons, unfavorable for intellectual contacts, did not ruin him."

Dr. Reed returned to Baltimore in 1890 as Attending Surgeon and examiner of recruits. This assignment was quite welcome since it provided him with the opportunity to do research. 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 foremost pathologist and medical bacteriologist in this country. These subjects were not taught as part of the medical curriculum of that day.

It is significant that Walter Reed's career coincided with the great flowering of medical science that took place in the 1880's. The germ theory of infectious disease was now accepted as postulated and proved by Pasteur, and Robert Koch had perfected a method for studying bacteria. In the United States George Miller Sternberg, later Army Surgeon General, with whom Walter Reed had a close professional relationship, was one of the founders of bacteriology.

The 1880's were critically important years in Walter Reed's life and in the destiny of the United States. It was during this period, all areas of the world were plagued by yellow fever, that the mature scientific investigator was 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 Surgeon General Sternberg was quite advantageous to Dr. Reed as an Army surgeon protege.

Walter Reed, then forty-two years old, was greeted with enthusiasm by an eager group of researchers at the Pathological Laboratory. Captain Reed - promoted on June 26, 1880 - learned the necessary research techniques and was soon working on his own project concerning typhoid fever.

A man of sterling 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, Walter Reed was now ready for the great achievements of his lifetime. He would live for only fifty-one years, but between 1892 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.

From 1891 to 1893 Walter Reed spent his last western tour in the Dakotas. He was promoted to major in 1893 and then took his post as curator of the Army Medical Museum (now 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) founded in Washington by Surgeon General Sternberg. At this same time he also held the chair in 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 experience at work in the School gave him an excellent sense of judgement valuable for investigating the causes of epidemic diseases and in making sanitary inspections at military posts. He was indeed needed as an instructor; 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 (bacteria or viruses) responsible for communicable diseases. This was the beginning of medicine as we know it today, an era of great discovery. But the work of Koch and Pasteur were not well enough known; Major Reed, as a professor at the Army Medical School, served in a vital capacity teaching the new science of bacteriology. At the time of the Spanish American War, however, he was casting about for a position in the field which would allow him to put his knowledge of Army routines and sanitation to use for the benefit of soldiers in Cuba.

It was not until mid-August in 1898 when the war was already over that he had an opportunity to perform this valuable service. General Sternberg was then able to secure a board of officers headed by Major Reed to investigate the spread of typhoid fever. The Typhoid Board performed its greatest service through the discovery that this dread 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 (pathogens). It also pointed out the failure of out-dated 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.

In May 1900 Major Reed was appointed president of a board whose purpose it was to study infectious diseases in Cuba paying particular attention to yellow fever. The other members of the board were Acting Assistant Surgeons Major James Carroll, Major Jesse W. Lazear and Major Aristides Agramonte of Havana. As a result of this Yellow fever Board, very few people living today have any knowledge of this dread disease.

Yellow fever killed more men in the Spanish-American War than did the enemy. It 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 ten 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 destroyed ninety per cent of his expeditionary forces in 1802, Napoleon was influenced to sell the Louisianna Territory. It was chiefly because of "yellow jack," as the disease was nicknamed from the penant which was flown during quarantine, that the French were unable to complete 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. Then followed 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 in the main, this stage was followed by a return of the fever accompanied by internal bleeding which caused the dreaded "black vomit" when blood released into the stomach was ejected.

Reed and Carroll had estimated that there were 300,000 cases in the United States between 1793 and 1900, which cost the nation almost $500,000,000 with a mortality rate usually at forty per cent but sometimes as high as eighty five per cent. The scourge of yellow fever had plagued the southeastern United States for two hundred years, but nowhere was it more prevalent than in Havana. Surgeon General George Miller Sternberg was this country's leading expert on yellow fever. Because neither he nor other researchers had been able to pinpoint the specific cause, he was astounded to hear the claim of Dr. Giuseppe Sanarelli, who in 1897 stated quite conclusively that the fever was caused by Bacillus icteroides.

On June 25, 1901 Walter Reed arrived at Columbia Barracks in Quemados about six miles from Havana. Major Reed attended Major Jefferson R. Kean, Chief Surgeon of the Department of Western Cuba, who had himself contracted the disease and fortunately recovered. Then Doctor James Carroll and Major Reed set out enthusiastically to prove Sanaraelli's theory. By August, 1900 however they had found no causal relationship between Bacillus icteroides, a member of the hog-cholera group, and yellow fever.

The Board then turned its attention to the theory of Dr. Carlos Juan Finlay and examined it more carefully. For nineteen 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 innoculations had failed to produce any 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 Yellow Fever Board, 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 quite unlike any other infectious disease except malaria which had already been shown to be spread by the Anopheles mosquito.

The Board then decided that the best way to study yellow fever was not by searching for a specific agent but rather by identifying the means by which the fever was transmitted. For this purpose Major Reed organized the Board in the following manner: Major Reed himself was in charge of the entire project; Dr. James Carroll was in charge of bacteriology; Dr. Jesse W. Lazear was in charge of the experimental mosquitoes; and Dr. Aristedes Agramonte was in charge of pathology.

Dr. Lazear had recently been working with malarial mosquitoes and attacked his duties with great enthusiasm in view of the information he read concerning the observations of Dr. Henry R. Carter of the Marine Hospital Service (now the Public Health Service). Dr. Carter 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 since this would account for the delay in transmission as the disease ripened in the mosquito. Dr. Finlay had given some of the black, cigar-shaped eggs to the Board, and Lazear allowed them to hatch. It wasn't difficult to maintain a supply since the mosquitoes bred in any clean, still water. Dr. Carroll then volunteered to be bitten and promptly developed a successful case of yellow fever which was experimentally defective since there may have been other sources of contamination. Carroll luckily recovered and went on with his work in bacteriology. Next, Lazear asked Private 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 dine on him. He developed the first successful case and recovered. Dr. Lazear allowed himself to be bitten and, after several days of delirium and black vomit, died - a true martyr to science. He had been working in Las Animas Hospital in Havana.

Major Reed, although grieved at Lazear's death, was excited at the prospect of successfully tracking down the secret of the fever. Dr. Lazear's notebook, found by Lieutenant Albert E. Truby (later Brigadier General), yielded the key. In it, through the carefully recorded controlled experiments, Walter 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 twelve days for the agent to ripen in the female mosquito (only the female aegypti draws blood) and migrate to her salivary glands before the fever could be passed to another person.

In October 1900, Major 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 Board that they were at last experiencing some success, were not enough for the thorough scientific mind of Walter Reed, nor would they be for a public which the press had instructed in the "foolishness" of the mosquito theory. With the express permission of General Leonard Wood, Governor General of Cuba, Camp Lazear, named for their fallen comrade, was established on November 20, 1900. Moreover, General Wood authorized the Board to use and pay American and Spanish volunteers for the experiments since at this time yellow fever was thought to be a disease afflicting only humans. Dr. Carroll had exhausted the list of experimental animals, rats and the like normally used for scientific research, failing to produce any cases of the fever in them. In addition to the mosquito theory, Dr. Reed also desired to disprove the seemingly fallacious belief that yellow fever could be transmitted and induced from clothing and bedding soiled by the 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 Private John R. Kissinger permitted himself to be bitten and promptly developed the first case of controlled experimental yellow fever. This case has been deemed as important to medical science as Robert Koch's discovery of the tubercle bacillus and the development of the diphtheria anti-toxin. Kissinger and John J. Moran had volunteered on condition that they would receive no gratuities, performing their service "solely in the interest of science and the cause of humanity."

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 Number One, or the "Infected Clothing Building," was composed of one room, 14 x 20 feet heated by a stove to ninety-five degrees. For twenty nights Dr. Robert P. Cooke and Privates Folk and Jernegan hung offensive clothing and beefing 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 December 19, 1900, they were relieved by Privates Hanberry and England who, in turn, were finally relieved by Privates Hildebrand and Andrus. From November 30, 1900 to January 10, 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. Mr. John Moran, a clerk in General Fitzhugh Lee's office, was bitten by fifteen infected mosquitoes, developed the fever and recovered. The other volunteers who were separated, and thereby protected by the screen, escaped infection. Ten cases were produced in this manner.

Yellow fever was produced in the bodies of twelve more American and Spanish volunteers either by direct mosquito bites or by injections of infected blood or blood serum. 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.

The courage of the volunteers is inestimable. A unique honor helps keep alive the memory of the twenty-four gallant men who participated in this experiment. In 1929 Congress awarded a special gold medal to each man or his next of kin. Had it not been for Major 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 Board's success, Colonel 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, Colonel Gorgas organized inspection parties to check all homes in Havana for possible breeding places, insuring that the only standing water in the homes was needed for family use and properly screened. All other water receptacles were to be emptied. Later he applied the same techniques in the Canal Zone, freeing it of fever, 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 the United States every year since 1648, from Pensacola to Nantucket Island, was eradicated. There would be no more epidemics such as that in Memphis in 1878 which cost the country one hundred million dollars.

In February, 1901 Walter Reed returned to the United States where he was an instant success in medical circles. All through the acclaim 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 deans of medical research.

In the summer of 1901, Dr. Carroll 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 innoculations that a filterable virus could cause disease in man. The Board'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 United States Army in 1942. Since 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 innoculation against it.

After his return to the United States in February, 1901, Dr. Reed served again as professor of pathology and bacteriology at the Columbian (George Washington) University Medical School and as professor of bacteriology in the Army Medical School (the present Walter Reed Army Institute of Research). In the summer of 1901 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 November 1, 1902. His duties sapped his strength and, following an appendectomy, he died of peritonitis on November 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 great hospital and medical center stand in constant tribute to Walter Reed. Due to the untiring efforts of Colonel 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 Army General Hospital, as it was then known, opened its doors on May 1, 1909 to ten patients. Fourteen years later, General John J. Pershing signed the War Department order creating the Army Medical Center. In September 1951, the entire complex of 100 rose-brick Georgian buildings became known as the Walter Reed Army Medical Center in further tribute to this hero of medical science. In 1945 he was elected to the Hall of Fame at New York University, the first physician to be so honored. On November 21, 1966, a bronze bust of Major Reed was unveiled at Walter Reed Army Medical Center by the Walter Reed Memorial Association, an organization which, since its inception in 1903, had resolved to erect a memorial in Washington to perpetuate his fame and memory.

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