Building No. 1 was built to test a belief, and the belief had a hundred years of law behind it. This piece sets out what the belief was, what it rested on, and what became of it.

What the ports did

The Board’s paper of February 1901 begins its account of the fomites hut with a description of the thing it was about to overturn. “We believe that the general consensus of opinion of both the medical profession and the laity is strongly in favor of the conveyance of yellow fever by fomites. The origin of epidemics, devastating in their course, has been frequently attributed to the unpacking of trunks and boxes that contained supposedly infected clothing; and hence the efforts of health authorities, both state and national, are being constantly directed to the thorough disinfection of all clothing and bedding shipped from ports where yellow fever prevails.” In the epidemic season, from April to November, everything a traveller carried from the Gulf and the Caribbean was disinfected, “sometimes both at the port of departure and at the port of arrival; and this has been done whether the articles have previously been contaminated by contact with yellow fever patients or not. The mere fact that the individual has resided, even for a day, in a city where yellow fever is present, has been sufficient cause to subject his baggage to rigid disinfection by the sanitary authorities.”

The Army did the same inside its own fences. At Columbia Barracks, where 1,400 non-immune Americans lived through the summer of 1900, every case of yellow fever was followed by “destruction by fire of matresses, the disinfection of bedding and clothing with 1 to 500 bichlorid solution, and the application of the same solution freely to the ceiling, walls, and floors, by means of a force pump.” Reed himself, on his way back to Cuba in October 1900, after Carroll and Lazear had both been infected by mosquitoes, worried in a letter about catching the disease from clothing and bedding.

The scale of the fear was the scale of the disease. Yellow fever came to the United States in 1693. In 1878 it entered 132 towns and killed 15,932 of more than 74,000 who caught it, and Gorgas, writing in 1902, put the money cost of that summer at a hundred million dollars, “and in years when there was no epidemic quarantines had to be kept up against the infected regions around the Gulf of Mexico, which stopped almost all travel and greatly interfered with commerce.” Reed and Carroll’s verdict on the medical side was that “the doctrine of the spread of yellow fever by fomites and by filth had taken such hold on the professional mind as completely to overshadow all other views, and to direct into false channels the work of those who were engaged in the investigation of this disease.”

The two stories

In an address of 1901 Reed picked two of the accounts on which the doctrine rested and went to the records.

The first was told by a Dr A. A. Baldwin of Jacksonville, Florida, “presumably from memory, some 13 years after the event,” and printed by Harvey Brown in 1872. Two children in Jacksonville “contracted the disease by being present at the opening of a trunk belonging to their uncle who, a few days before leaving Habana, had visited the yellow-fever hospital, where he passed by the beds of those who were throwing up black vomit; and this, notwithstanding the fact that his coat, the only woolen clothing he had on at the time, had been sponged with alcohol after his return from the hospital!” Reed let the exclamation mark do the work.

The second was recorded by Rochester as an example “of the wonderful tenacity with which fomites hold the pestiferous material.” In September 1856 an infected ship from Cuba lay at the quarantine anchorage off Staten Island. Passengers died; “the garments and bedding were thrown overboard.” A mile across the water lay Bay Ridge, on the Long Island shore, and “the wind and tide deposited a number of garments that had been thrown away on the beach which terminated the lawn of Col. Charles Prince, an old and respected resident. In taking his usual morning walk he discovered the clothing and examined it with his cane, not otherwise handling it. He had no suspicion that it came from quarantine and never saw it again. In four days he was taken ill and died in a week of yellow fever.” Reed then opened Elisha Harris’s official report of the same year and found that on that same shore, directly opposite the quarantine grounds, six cases of yellow fever and three deaths from black vomit had already occurred between 13 and 21 July 1856, and that “from the latter date the malady extended fearfully until it had visited nearly every dwelling on the shore of that beautiful Bay Ridge, 30 cases and 15 deaths having occurred in that district previous to August 1.” Colonel Prince’s bedding had arrived in a neighbourhood that had been dying of yellow fever for two months. “We lose our faith,” Reed said, “in this brine-soaked bedding.”

What La Roche had said

The Board did not claim to be the first to doubt. At the end of its account of Building No. 1 it quoted René La Roche’s two-volume Yellow Fever of 1855, “the classic work,” at length. “In relation to the yellow fever, we find so many instances establishing the fact of the non-transmissibility of the disease through the agency of articles of the kind mentioned, and of merchandise generally, that we can not but discredit the accounts of a contrary character assigned in medical writings, and still more to those presented on the strength of popular report solely. For if, in a large number of well authenticated cases, such articles have been handled and used with perfect impunity—and that, too, often under circumstances best calculated to insure the effect in question—we have every reason to conclude, that a contrary result will not be obtained in other instances of a similar kind; and that consequently the effect said to have been produced by exposure to those articles must—unless established beyond the possibility of doubt—be referred to some other agency.”

That was written forty-five years before the camp. It was the book Reed was reading at ten to midnight on the last night of 1900, when he wrote that it had been given to him and his assistants “to lift the impenetrable veil.” Observation had not been enough. The ports went on burning mattresses because a crowd of good observations does not outweigh one terrible story unless someone runs the test.

What the Board told the ports to do

In September 1901, at the meeting of the American Public Health Association that had heard the Preliminary Note a year before, Reed and Carroll read “The Prevention of Yellow Fever,” and it is the document in which the fomites hut becomes law. The problem of a city into which a case had been imported “resolves itself into the simple one of excluding mosquitoes from access to the sick individual and of destroying those insects that have already become infected. We can leave out of consideration any danger from wearing apparel or baggage, which, in our opinion, may be dismissed as harmless.”

They had also tested the fear that insects might travel in the luggage. “The fear that has been entertained that infected insects may be imported in boxes or trunks we believe to be absolutely groundless, and this for the simple reason, as shown by numerous observations made by us, that mosquitoes, when deprived of water, die within a few days. Even if allowed to fill themselves with blood immediately before the experiment is begun, and then deprived of water, practically all are dead by the expiration of the fifth or commencement of the sixth day.” Of a large number tried, one female had reached the sixth day, “and then in a feeble condition.” Add the knocks a frail insect takes among packed clothes, “and we see that infected mosquitoes can not be imported alive in baggage that has been five days en route.”

So the rule changed. “With our present knowledge of its propagation, personal baggage should no longer be subjected to disinfection,” and a ship from a yellow fever port should be held no longer than it took to land passengers who had not yet completed five days since leaving it. The danger that remained was the person, not the trunk: “the chief duty of quarantine officers hereafter will consist in the detection of mild or very mild cases of yellow fever.” Of the Board’s own experimental cases, a third had been mild or very mild, and in one in six the incubation period had run past the five days of quarantine. Reed and Carroll did not ask for a longer quarantine. They asked for a lighter one, “to lessen as much as possible the restrictions placed by present quarantine regulations upon the ship’s cargo, while we add nothing to those of the passenger.”

In Havana, Gorgas had already changed the regulations on 15 February 1901, nine days after Reed read the Additional Note: the sick were screened and the mosquitoes around them killed, and the disinfection of their things went on only as a habit. By September the city had no yellow fever for the first time since 1762. At Las Animas, Juan Guiteras ran his own inoculation station through 1901 and found, as Reed reported, that “in the hands of Guitéras fomites failed to exert any effect on non-immunes.” The trunk and the lawn were not mentioned again.

Sources

• Walter Reed, James Carroll and Aristides Agramonte, “The Etiology of Yellow Fever: An Additional Note,” Journal of the American Medical Association, 16 February 1901. The statement of the fomites belief, the disinfection at both ports, “even for a day,” and the La Roche quotation. archive.org
• Walter Reed, James Carroll, A. Agramonte and Jesse W. Lazear, “The Etiology of Yellow Fever: A Preliminary Note,” The Philadelphia Medical Journal, 27 October 1900. The disinfection squad at Columbia Barracks. archive.org
• Walter Reed, “The Propagation of Yellow Fever: Observations Based on Recent Researches,” 1901, and Walter Reed and James Carroll, “The Prevention of Yellow Fever,” September 1901, both reprinted in Yellow Fever: A Compilation of Various Publications, Senate Document No. 822, 61st Congress, 3rd session, 1911; with Gorgas’s report of 12 July 1902 in the same volume. Harvey Brown’s trunk, Rochester’s Colonel Prince, Elisha Harris’s report, “brine-soaked bedding,” the doctrine that “had taken such hold on the professional mind,” baggage “dismissed as harmless,” the mosquitoes deprived of water, the five days, the mild cases, and the hundred million dollars. archive.org
• Walter Reed, “Recent Researches Concerning the Etiology, Propagation and Prevention of Yellow Fever,” Journal of Hygiene, 1902. Gorgas’s regulations of 15 February 1901 and Guiteras’s fomites. archive.org
• Howard A. Kelly, Walter Reed and Yellow Fever, 1906. Reed’s letter of 31 December 1900 on La Roche. archive.org
• Arsene Eglis and the author’s reply, letters in American History on Lazear and Reed, reprinted by HistoryNet, for Reed’s letter of October 1900 about infected clothing and bedding, which is cited there at second hand from José del Regato’s article of 1971. historynet.com