CHAPTER VII. Correspondence With Dr. Reed

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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.