Epidemic Invasions: Yellow Fever and the Limits of Cuban Independence, 1878-1930

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He introduced a regulation that the period during which all personnel on board should be detained for quarantine should start from their last possible exposure to infection, being the date of disinfection of the vessel. The length of the period of quarantine that he recommended was seven days, being the two days of the disinfection procedure plus the five days of the incubation period.


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From he established such a practice for the disinfection of vessels leaving Cuba and Mexico, to be undertaken either at the port of departure or en route , and so to shorten any period of quarantine on arrival. These measures taken against the spread of yellow fever were not wholly successful. From to there were more than nine major epidemics of yellow fever in southern states of the United States.

Carter was actively engaged in the measures to control these epidemics, and in and he was in general charge of such work by the Marine Hospital Service. Invasions of yellow fever into the U. Orwood was an agricultural community consisting almost exclusively of people living on farms which were mostly one mile or more apart. Practically all the inhabitants were susceptible to yellow fever. Carter observed that when a case of yellow fever occurred in an isolated farmhouse, persons who visited the house at that time did not catch the disease, but any who arrived about two weeks later could become infected.

In Orwood, with the assistance of two local physicians, Carter recorded the dates of first occurrence of yellow fever infection in individuals, primary cases, and the dates of occurrence of the next infection in the same house, secondary cases. It was supposed that the secondary cases had contracted the disease from the environment, excluding fomites objects contaminated with the infectious agent. For a total of 12 households in Orwood and Taylor yielding data, the intervals between the observations of primary and secondary cases were mostly between two and three weeks, with one case of just 11 days and three cases of 21 or 23 days.

Carter postulated that an infection of yellow fever may be conveyed directly from one sick of that disease to their environment. He considered that the period between the appearance of an infecting case and the appearance of a secondary case consists of three parts: 1 the time from development of the infecting case to the time the environment is capable of developing infection in other persons, 2 the time another person is exposed to the environment before they develop the disease, plus 3 the time from the date of exhibiting the disease to its development in the person.

Reports of yellow fever transmission in ten shipping vessels, obtained from marine quarantine stations where good disinfection work was known to be done, revealed patterns of transmission similar to those occurring in houses Carter , Carter a , b. In a later study, he analysed many other cases of domestic transmission of yellow fever Carter c. Henry Carter's epidemiological investigations in the southern United States ended in late when he was ordered to Cuba, where yellow fever was still endemic, to serve as Chief Quarantine Officer for the Marine Hospital Service Schultz However, he visited Lazear in hospital in late September.

A discussion with Reed might have been held in Washington and after research had started in Camp Lazear Section 2.

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Carter's work took him to the Panama Canal Zone in , where he served for five years. He had a highly regarded career in the U. From about he became interested in the history of yellow fever research, and between then and his death in he assembled a collection of letters and other items concerning American activities in Cuba, which amounted to more than 7, items. Every item has been digitized for computer use and is searchable. These letters describe activities of the Yellow Fever Commission during the period when Reed was in the United States. Its items have not been digitized. Accounts of those interactions are given in Sections 2.

Henry Carter was an extremely modest man. His daughter, Laura Armistead Carter, described him as being very loath to talk about the influence of his work in determining the direction of the experiments of the Reed Board the Havana Yellow Fever Commission , because he would have had to admit to determining the direction of its work.

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He argued that the only allowable ambition for a man was that of achievement, and that it did not matter who got the credit so long as the work was done. As noted earlier in Section 1. It was later named The Yellow Fever Commission. Formal descriptions of the experimental activities and findings of the members of the Commission were published in medical journals in and Review articles were published later by Reed and Agramonte Close scrutiny of the articles published in , and reveals their limitations as historic documents Reed et al.

Fortunately, other sources of information from that period survive in the many letters written by those involved. Retrieval of accurate information from this source requires that as many letters as possible relating to a particular topic are read and compared. Carroll was second in charge. He attended medical lectures in different universities, earning an M.

Agramonte, born in Cuba, lost his father when he was killed in battle against the Spanish. Taken to the U.

Cuba's Latest Revolt (1933)

Jesse W. Lazear first studied in the U. After completing two years hospital service he spent a year in Europe, during part of which he worked at the Institut Pasteur in Paris.

From he was a physician at the Johns Hopkins Hospital. There he followed Ronald Ross's accomplishments with great interest and pursued field work and experimentation on Anopheles mosquitoes with William S.

History of the discovery of the mode of transmission of yellow fever virus

Thayer, a fellow scientist. The first meeting of the four members of the Commission in their new capacity was on 25 June at Columbia Barracks Hospital, near Quemados Figure 1 , when they discussed their response to instructions sent in a letter dated 29 May from the Surgeon General of the Army, George M.

Yellow Fever and the Limits of Cuban Independence, 1878-1930

As you are familiar with what has already been done by other bacteriologists in this field of investigation, I do not consider it necessary to give you any suggestions or detailed instructions. But it is evident that the most important question which will occupy your attention is that which relates to the etiology of this disease. In , an Italian bacteriologist, Giuseppe Sanarelli, claimed that he had isolated from yellow fever patients an organism which he named Bacillus icteroides , and currently members of the group were investigating whether B.

Carroll, bacteriological work, Dr. Agramonte, autopsies and gross pathology, Dr. Lazear, microscopical pathology.

Yellow fever - Wikipedia

No mosquito investigation was thought of at that time. Already during May , Lazear's notebook contained pathological observations on yellow fever cases, but without mention of mosquitoes. Other individuals in the U. Army in Cuba provided voluntary service to Major Reed in his medical experiments. Lazear's earliest work for the Commission was bacteriological, but during that period three occurrences led to its change. The first of these was his contact with Henry Rose Carter, who had arrived in Cuba in early March Two accounts of their meeting differ in detail.

From one it appears that Lazear met Carter on 25 June, and that on 26 June Carter sent him a printed copy of his article on his work in two Mississippi towns Carter In , in a discussion with two friends, details of which were recorded by Carter's daughter Laura, 8 8 Article, by Laura Armistead Carter, July [Enclosed in C]. Carter recalled his meeting with Lazear see also Section 2. Durham and W. Myers, when on their way to Brazil to study yellow fever. They arrived on about 17 July and left on 31 July Espinosa , quoting a note sent by Carter to Lazear on 26 June Their report largely concerned Carter's research published in May , which had demonstrated the interval of 14 to 21 days between the introduction of infecting cases of yellow fever to isolated properties and the onset of secondary cases, resulting from a change to the environment during that period due to an unknown infecting factor or some agent Section 2.

Other evidence pointed to the possibility of infection at a distance. In , as noted above, the Italian bacteriologist Giuseppe Sanarelli claimed that he had isolated Bacillus icteroides from yellow fever patients. The possible identity of B. However, because Lazear had previously received training in the investigation of mosquitoes with reference to malaria and other diseases, Reed recommended that he should now investigate mosquitoes as possible vectors of yellow fever.

A visit was soon made to Finlay. During the first week in August, Reed was recalled to Washington and could not return to Cuba until early October Reed et al. Lazear entered details of his experimental work in one or more carefully written notebooks, keeping the information to himself.

After Lazear's death on 25 September , Walter Reed took possession of a notebook, and almost one month later, on 24 October, he addressed the Annual Meeting of the American Public Health Association, held in Indianapolis, giving a detailed account of Lazear's experiments, which could only have come from Lazear's notebook.

Kelly, 23 June Lazear had conducted his experiments with mosquitoes provided by Finlay from the strain which he himself had used. Specimens that Lazear sent to the mosquito taxonomist L. Howard in Washington were identified as Culex fasciatus Fabricius. Of the nine uninfected cases, seven had been bitten by mosquitoes after 2 to 8 days extrinsic incubation in the infected donor.