Report received last night. My thanks are due for your prompt
action and confirmation of my suspicions.
STARK,
Chief Surgeon
Conditions in the hospital were such as to demand immediate action; the commander of the post refused to believe he had yellow fever among his 900 men and was loath to abandon his comfortable quarters for the tent life in the woods that I earnestly recommended. In answer to my telegram asking for official support, I received the following:
CHIEF SURGEON'S OFFICE,
HDQRS. DEPT. HAVANA AND PINAR DEL RIO,
QUEMADOS, CUBA, July 21, 1900
SURGEON AGRAMONTE,
Pillar del Rio Barracks,
Pinar del Rio, Cuba
Take charge of cases. Reed goes on morning train. Wire for anything wanted. Nurses will be sent. Instructions wired commanding officer. Other doctors should not attend cases. Establish strict quarantine at hospital. You will be relieved as soon as an immune can be sent to replace you. Report daily by wire. STARK, Chief Surgeon
When Major Reed came to Pinar del Rio (July 21) I had, the day before, established a separate yellow-fever hospital, under tents, attended by some of the men who had already passed an attack and were thus immune. The Major and I went over the ground very carefully, we studied the sick report for two months back, fruitlessly trying to place the blame upon the first case. I well remember how, as we stood in the men's sleeping quarters, surrounded by a hundred beds, from several of which fatal cases had been removed, we were struck by the fact that the later occupants had not developed the disease. In connection with this, and particularly interesting, was the case of a soldier prisoner who had been confined to the guard-house since June 6; he showed the first symptoms of yellow fever on the twelfth and died on the eighteenth; none of the other eight prisoners in the same cell caught the infection, though one of them continued to sleep in the same bunk previously occupied by his dead comrade. More than this; the three men who handled the clothing and washed the linen of those who had died during the last month were still in perfect health. Here we seemed to be in the presence of the same phenomenon remarked by Captain Stone in reference to his case at Santa Clara, and before that by several investigators of yellow fever epidemics; the infection at a distance, the harmless condition of bedding and clothing of the sick; the possibility that some insect might be concerned in spreading the disease deeply impressed us and Major Reed mentions the circumstance in his later writings. This was really the first time that the mosquito transmission theory was seriously considered by members of the board, and it was decided that, although discredited by the repeated failure of its most ardent supporter, Dr. Carlos J. Finlay, of Havana, to demonstrate it, the matter should be taken up by the board and thoroughly sifted.
The removal of the troops out of Pinar del Rio was the means of at once checking the propagation of the disease.
On the first day of August the board met and after due deliberation determined to investigate mosquitoes in connection with the spread of yellow fever. As Dr. Lazear was the only one of us who had had any experience in mosquito work, Major Reed thought proper that he should take charge of this part of the investigation in the beginning, while we, Carroll and I, continued with the other work on hand, at the same time gradually becoming familiar with the manipulations necessary in dealing with the insects.
A visit was now made to Dr. Finlay, who, much elated at the news that the board was about to investigate his pet theory, the transmission of yellow fever from man to man by mosquitoes, very kindly explained to us many points regarding the life of the one kind he thought most guilty and ended by furnishing us with a number of eggs which, laid by a female mosquito nearly a month before, had remained unhatched on the inside of a half empty bowl of water in his library.
Much to our disappointment and regret, during the first week of August, Major Reed was recalled to Washington that he might, in collaboration with Drs. Vaughan and Shakespeare, complete the report upon "Typhoid Fever in the Army." Thus we were deprived of his able counsel during the first part of the mosquito research. Major Reed was detained longer than he expected and could not return to Cuba until early in October, several days after Lazear's death.