“Henry Hanson, M.D., Florida State Health Officer, 1929-1935, 1942-1945” [1]

Henry Hanson was born July 4, 1877 in Glenwood, South Dakota and credits his father for passing down a “pioneer spirit” that led him to “scientific and medical research.”[3]  He received an A.B. in 1902 and an A.M. in chemistry in 1904 from the University of South Dakota. He then moved to Baltimore to pursue an M.D. at the Johns Hopkins University which he achieved in 1908. After briefly working in Milwaukee, in 1909, Hanson moved to Florida to become Director of the Division of Bacteriological Laboratories of the State Board of Health.[4]

Henry Hanson, WWI Service Card. Courtesy of State Archives of Florida.[5]

 When the U.S. entered World War I, Hanson joined the Army Medical Corps and was stationed in Panama for the duration. Hanson distinguished himself and was appointed Chief Sanitary Inspector of the Panama Canal Zone in 1918. When the Peruvian government recruited him in 1919, Hanson brought his family to Peru. He recounted their adventures in The Pied Piper of Peru: Dr. Henry Hanson’s Fight against “Yellow Jack” and Bubonic Plague in South America, 1919-1922 which was published posthumously in 1961 by the Florida Department of Public Health. Hanson also summarized this work in his diary, stating that there were almost 20,000 cases of yellow fever during this period and nearly two million house inspections and five million container inspections carried out in the massive campaign.[6]

Telegram from the International Health Board to Henry Hanson, December 26, 1923, Hench-Reed Collection.[8]

After the successes in Peru, Hanson went to Colombia under the auspices of the Rockefeller Foundation International Health Board and the Colombian government to continue work on eradicating yellow fever and other tropical diseases. Hanson’s wife, Jane, and their two children, Martha and Karl, stayed in Panama. Jane was expecting the couple’s third child (Virgil), and sadly passed away in childbirth. Hanson wrote in his diary on the anniversary of his wife’s death: “El dia mas triste de mi vida el 19 diciembre 1923.” (Translation: The saddest day of my life on December 19, 1923).[7] After their meeting in Peru, Hanson and Henry Rose Carter formed a close friendship with each other, and the two families often spent time together. The Carters sent the above telegram following Jane’s death on behalf of the International Health Board.

Dr. Henry Hanson, State Health Officer (1929-1935) at right, conducting rodent eradication in Florida, ca. 1930. Courtesy of State Archives of Florida.[12]

Hanson’s struggle in deciding to join the West Africa Yellow Fever Commission only a couple of years after his wife’s death is shown through letters to Dr. Carter: “While I am becoming somewhat reconciled to this individual existence puttering along with one specimen after another I still ‘feel the call of the wild’ and should like to be out fighting again.”[9] Hanson spent the majority of his time in Southwestern Nigeria focused on work with over 5,000 house visits in twenty-two months. After returning to the United States in 1927, Hanson and his family moved to Florida where he accepted a position with the Bureau of Communicable Diseases, State Board of Health of Florida. He became the State Health Officer in 1929 and served two terms from 1929-1935 and 1942-1945.[10]

State Board of Health staff photo in Jacksonville, Florida. Hanson is center front, September 15, 1945. Courtesy of State Archives of Florida.[13]

In the intervening years, Hanson worked as the traveling representative of the Pan-American Sanitary Bureau 1936-1942.[11] Dr. Hanson’s focus on public health issues included rodent eradication (perhaps recalling the “burning of Paita” when he burned houses to kill rats and thus end a bubonic plague outbreak in the Peruvian town of Pieta in 1920) and establishing statewide mosquito control efforts. After his very successful career, Dr. Hanson retired in 1945 and moved to Jacksonville, Florida. He passed away at age 76 on February 13, 1954. Five years later, in 1959, the Florida State Board of Health laboratory building in Jacksonville was named “The Henry Hanson Building” in his honor.[14]

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 Download Hanson’s Complete Diary (300Mb PDF File – Right Click to Save)

 Download 1925 and Monthly Summaries for 1926 – 1927 (22Mb PDF File – Right Click to Save)

Map of Africa. The Times Survey Atlas of the World (G1019.T5 1922). Special Collections, University of Virginia Library, plate 68.

Map of Nigeria showing Hanson’s travels. The Times Survey Atlas of the World. Special Collections, University of Virginia Library, plate 76.

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The post Dr. Henry Hanson’s Diary, October 4, 1925 to July 27, 1927, and Maps appeared first on Henry Hanson.

In 2004, Historical Collections & Services at the University of Virginia Claude Moore Health Sciences Library concluded the second phase of an immense project digitizing the Philip S. Hench Walter Reed Yellow Fever Collection, which resulted in over 94,000 images of historic documents being made available online.  More than 2,000 people are listed in its Who’s Who section. Some of these individuals’ stories are told in full as the “key players” through extensive letters, diaries, published materials, and newspapers; other individuals are only briefly, tangentially mentioned, flitting through the documents with the speed of a tiny mosquito.  Dr. Henry Hanson’s listing simply states, “Hanson, Henry | Physician; involved with public health work in Ecuador, Peru (1921).”

Of course, as is often the case with history, there is more to the story. Because of the generous donation of Dr. Hanson’s diary concerning his experiences as a fever fighter in West Africa by his granddaughter, Jane H. Monroe, the Claude Moore Health Sciences Library is able to tell more of his story. It is placed within the context of the battle against yellow fever which has continued for more than a century after Walter Reed as head of the United States Army Yellow Fever Commission wrote his wife about “lifting the impenetrable veil that has surrounded the causation of this most dreadful pest of humanity.”[2]

A special thanks to Jane H. Monroe for her generosity and to all medical professionals, past, present and future, who sacrifice their health and well-being to save lives through their work and research.

 Next: Henry Hanson: A Biographical Essay 

The post “Ready to Do My Bit”: Henry Hanson and Yellow Fever appeared first on Henry Hanson.

“The First Mountain to Be Removed.” Engraving in Harper’s Weekly, July 1905, by W.A. Rogers. Print acquired by Philip S. Hench from Bettmann Archive.

Dr. Hanson once stated in an article that he “shared the popular fear of this much dreaded disease.”[1] This dread disease, yellow fever, has had many names throughout history, including: Yellow Jack, Terror of the Western Hemisphere, and the Black Vomit.  Hanson described his own experience with yellow fever in Peru and mentioned many of the typical first stage symptoms of “fever, chills, severe headache, back pain, general body aches, nausea, and vomiting, fatigue, and weakness.”[2] Hanson cautioned that convalescing patients could have a “false sense of well being and a desire to get up too soon,” characteristics he applied to himself.[3] Hanson recovered from his bout with yellow fever, but not everyone does.

Roughly 15 percent of yellow fever cases progress to a dangerous stage with high fever, jaundice (yellowing of the skin or eyes, hence the disease’s name), bleeding, and the involvement of multiple organs.[4] Excessive internal bleeding can cause the victim to vomit blood (thus the name “black vomit”). Half of the patients who enter this more serious stage are dead within two weeks; the others recover with minimal or no long term damage.[5] Lifelong immunity is acquired by those who survive the disease and is highly prized as demonstrated by one account, which stated that those who had a certificate of immunity “could command double the wages that he could get before he had the disease.”[6]

“Dr. Walter Reed 5-cent postage stamp.” Courtesy of the Smithsonian National Postal Museum.[7]

Dr. Hanson published the article about his own yellow fever experience in 1926 and references in it the work of the United States Army Yellow Fever Commission in Cuba.  This Commission (popularly known as the “Reed Commission” after the officer-in-charge, Walter Reed) in 1900 discovered the vector for the transmission of yellow fever: the Aedes aegypti mosquito.  This discovery put an end to the controversy over the spread of yellow fever and provided irrefutable proof that the “fomites theory” which hypothesized that yellow fever spread by direct contact with infected objects (fomites) or infected persons was incorrect.  The Commission members became known as the conquerors of yellow fever.  As the engraving on Walter Reed’s tombstone states: “He gave to man control over that dreadful scourge, Yellow Fever.”  Two exhibits by Historical Collections & Services offer more extensive information on this Commission and its important work in the early twentieth century: the Philip S. Hench Walter Reed Yellow Fever Collection and Yellow Fever and the Reed Commission.  The Reed Commission launched a new era in the fight against yellow fever and led to successful eradication and sanitary campaigns in the Americas; however, there were still obstacles to overcome, including identifying the elusive yellow fever virus and finding a way to vaccinate against the disease.

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The original Rockefeller logo.[1]

In 1913, John D. Rockefeller, a man indoctrinated from his youth “to work, to save, and to give,”[2] established the Rockefeller Foundation, which ultimately became one of the most famous philanthropic institutions in the world. The Rockefeller Foundation and its International Health Commission (later Board in 1916 and then Division in 1927) ambitiously set out “to promote the well-being of mankind throughout the world.”[3] Under the leadership of Wickliffe Rose, the Foundation quickly achieved success in the United States with the hookworm campaign of the Rockefeller Sanitary Commission. Rose was soon looking for a new disease to “attack,” one which met the criteria of being “of global importance, little was being done about it and it could be prevented at a reasonable cost.”[4]

Rose’s 1914 report to the Foundation, “Yellow Fever: Feasibility of its Eradication,”[5] marked the beginning of the Yellow Fever program which lasted until 1951 when Dr. Max Theiler won the Nobel Prize for his yellow fever vaccine, and the Foundation’s annual report stated, “in all likelihood yellow fever will cease to be a public health menace.”[6] Rose worked on his feasibility report in collaboration with three medical doctors: William Crawford Gorgas, Henry Rose Carter, and Joseph Hill White.

“William Crawford Gorgas, Surgeon General US Army Washington, D.C., July 22, 1917,” Hench-Reed Collection.[7]

William Crawford Gorgas, M.D.,(1854-1920) attended college at the University of the South in Tennessee and medical school at Bellevue Medical College in New York City. He joined the Army Medical Corps in 1880, survived yellow fever at one of his Texas assignments, and was made a Surgeon General in 1914. He was credited with successfully eradicating yellow fever and controlling malaria in Panama as the chief sanitation officer during the construction of the Panama Canal which opened in 1914.  In an early meeting with Rose, Gorgas commented that the eradication of yellow fever, “would command the attention and the gratitude of the world.  And the thing can be done.”[8][9]

Henry R. Carter, Hench-Reed Collection.[10]

Henry Rose Carter, M.D.,(1852-1925) was an 1873 graduate in civil engineering from the University of Virginia. He did post-graduate work in math and applied chemistry before he decided to study medicine. He obtained his medical degree from the University of Maryland in 1879 and joined the Marine Hospital Service which became the United States Public Health Service. He rose through the ranks to become Assistant Surgeon General in 1915. He was a prominent epidemiologist and leading yellow fever expert who studied the disease for years. His discovery of the “extrinsic incubation period” of the transmission was crucial to the Reed Commission’s ability to prove that the vector of the yellow fever virus was the Aedes aegypti mosquito.[11]

“Joseph H. White, [192?].” Courtesy of the National Library of Medicine.[12]

Joseph Hill White, M.D.,(1859-1953) was born in Georgia and earned his medical degree from the Baltimore College of Physicians and Surgeons in 1883. He was an Assistant Surgeon General in the United States Public Health Service, called the Marine Hospital Service when he entered in 1884.[13] He used measures to eradicate mosquitoes to counter a yellow fever outbreak in Virginia in 1899 before the link between the two had been proven. His skillful handling of the 1905 yellow fever epidemic in New Orleans would prove valuable to the Rockefeller Foundation when he was loaned to them in 1914.[14]

In Wickliffe Rose’s report on the feasibility of eradicating yellow fever, six locations were given as “Known Foci of Yellow Fever” with the first five locations in South America and the final location being “an African focus or group of foci on the West Coast from Sierra Leone south to the Gulf of Guinea.”  Costs and length of time for eradicating the disease were also estimated in the report. With a “maximum cost at about $2.00 per capita for one year,” but only $1.50 a year when patient cases were excluded, the city of Guayaquil with a population of 80,000, was predicted to have an annual budget of $120,000.  Varying time estimates were mentioned to do the work, but it was concluded that “taking all contingencies into consideration two years would seem to be a safer estimate of the time limit.”[15] Carter was so confident that yellow fever could be wiped out that he wrote to Rose, “I think you have rather exaggerated the difficulty of getting rid of yellow fever when you put two years as the time required.  We know just what to do. There is no uncertainty in it.”[16]

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In 1916, the Rockefeller Foundation Yellow Fever Commission was formed, and work began in South America with studies conducted in Ecuador, Peru, Colombia, Venezuela, and Brazil.[1] Only Guayaquil, Ecuador was deemed an endemic center.  Locating and destroying endemic centers or “key-centers” was crucial to the attack plan.  As Wickcliffe Rose stated, “Endemic centers are the seed-beds without which there can be no epidemics.”[2] Despite the U.S. entry into World War I, a special commission to study yellow fever was appointed in 1918, and experts in clinical medicine, pathology, bacteriology, and chemistry were sent to Guayaquil to search for the causative agent of yellow fever. Interestingly, in 1918, an effort to eradicate mosquitoes in Guayaquil led to validation of Carter’s estimate of a time-frame for elimination. By the end of 1918 there were 25 anti-mosquito squads and by mid-1919, there were no reported cases of yellow fever with the result that for the first time in almost a century the city was free of the disease.[3]

“Dr. Hideyo Noguchi in his laboratory” published in an essay, “The Conquest of Yellow Fever” by James Edward Peabody, Hench-Reed collection.[4]

The Commission’s bacteriologist was a well-known Japanese scientist, Hideyo Noguchi, who had achieved fame at the Rockefeller Institute for Medical Research by successfully “growing the causative agent of syphilis: the spirochete Treponema pallidum (now known as Spirochaeta pallida).”[5]  While working in Guayaquil in 1918, Noguchi identified another spirochete, Leptospira icteroides (“slim spiral, the jaundice resembler”), as the cause of yellow fever.[6]

Noguchi’s claim that yellow fever was caused by a bacterium went directly against the discoveries made by the Walter Reed Commission, specifically by James Carroll, back in 1902. Carroll had determined that the agent that caused yellow fever could pass through a bacteria-proof filter and therefore was smaller than a bacterium.[7]

Following World War I, the Peruvian government recruited Dr. Henry Hanson, stationed with the Army Medical Corps in Panama, to “study sanitary conditions in [the] Province of Lima and the Rimac Valley, with special reference to malaria.”[8] Hanson’s time in Peru began when he was 42 in the fall of 1919 and ended in July 1922 and resulted in work not only on malaria, but also bubonic plague and yellow fever.  In Peru Dr. Hanson met the “Big Four,” as he described them, in yellow fever research: Henry Rose Carter, William C. Gorgas, Joseph Hill White, and Noguchi.[9] It was also in Peru that Hanson had two memorable experiences: he was stricken by yellow fever in Piura not long after arriving; and in spite of understandable, local opposition, he relocated 600 residents of Paita before burning down their rat-infested buildings, thus ending the bubonic plague outbreak.[10]

Just before the burning of Paita, Noguchi briefly visited the town and “decided to test the Pfeiffer phenomenon.” Hanson described the procedure: “To do this they took blood from a group of people who had had yellow fever within the last few months. The blood of such people is lytic to the bacterium or agent responsible for the diseases; which means that when a culture of the organism and blood from such a recovered case is mixed, it causes the etiologic organism to disintegrate, a phenomenon known as bacteriolysis.”[11] Noguchi mixed L. icteroides with blood from people who had been diagnosed with yellow fever and observed destruction of the L. icteroides.[12]

Although Noguchi cautioned in a 1920 article that more testing needed to be conducted and that L. icteroides could not yet be “certainly established” as the inciting agent of yellow fever, he created a vaccine and immune serum from his cultures.[13]

A December 10, 1920 New York Times article that encouraged travelers to South and Central America to get the “Noguchi vaccine” stated, “the efficacy of the vaccine seems to be thoroughly established … there is no ‘kick’ from the vaccine at all.”[14]

The Rockefeller Foundation’s 1921 Annual Report reported that the “experience with Noguchi’s vaccine and serum indicated that the former when properly administered affords a marked protection against attacks of yellow fever, and that the latter if it is used on or before the third day of the onset of the disease reduces the mortality in a striking way.”[15] By September of 1921 over 525 people had been inoculated with the Noguchi vaccine in Peru alone by Dr. Hanson or under his direction.[16]

Noguchi carried on his experiments and continued to have a positive Pfeiffer reaction. In June of 1923 he used serum from Hanson whose yellow fever infection had been four years earlier. In his paper, “The Pfeiffer Reaction in Yellow Fever” he stated that Dr. Hanson was one of the doctors performing the experiments and observations.[17]

In 1926 Max Theiler and Andrew Watson Sellards published an article that raised the possibility that L. Icteroides might not be the causative agent of yellow fever.[18] The Foundation quietly stopped distributing the Noguchi vaccine the same year.[19] Both Noguchi and Hanson would continue their work studying yellow fever in West Africa.

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African Localities Reporting Yellow Fever 1900 to 1931, Hench-Reed Collection.[1]

 The Yellow Fever Commission that worked in South American also recommended in 1916 that the West Africa coast be investigated.[2] West Africa had been identified in Wickliffe Rose’s 1914 report as a suspected endemic center, largely due to Henry Rose Carter’s long held belief in the origin of the disease. His posthumous work, Yellow Fever: An Epidemiological and Historical Study of Its Place of Origin, published in 1931,concluded that biological and historical evidence made a very strong argument for an African origin of yellow fever.[3]The spread of the disease was a major concern. At a conference held at the Rockefeller Institute, Dr. J.H. White stated “with positive conviction that the presence of the infection in Africa should be regarded as a serious menace as long as it exists; within his own experience he has had under observation a case of yellow fever brought from Africa across the Atlantic Ocean; it is quite possible for it to travel by easy stages from the present infected region in West Africa to Cape Town, up the East Coast and across to the Orient; once introduced into the dense, non-immune populations of the Orient, its control would be practically impossible and the loss of life one would not care to contemplate.”[4]

In 1918 following his four years of service as Surgeon General of the United States Army, General William Crawford Gorgas became the Director of the Yellow Fever Commission of Rockefeller’s International Health Board.[5] World War I delayed the implementation of work in Africa, but in June of 1920 the Commission sailed from New York with the objectives of investigating whether reported yellow fever in West Africa really was yellow fever, and if it was, determining the possibility of instituting control measures. Tragically, Gorgas died on the journey during a stop in London. Although the rest of the Commission’s members continued on to West Africa, their final report recommended, “that its report be accepted merely as a progress report and that another, more fully equipped commission be appointed to carry out a more extensive and prolonged investigation of the situation in West Africa, including a laboratory study of the suspected fevers of the region.”[6]

The African narrative intensified in the mid-1920s when the fight against yellow fever was “drawing to a close in the Americas,”[7] and health professionals, including Dr. Hanson, prepared to join in the “African venture.”  The Rockefeller Foundation’s International Health Division was eager to expand into Africa in its mission to remove “the fangs of yellow fever”[8] from the entire globe. The 1924 Annual Report stated “men are in training and equipment is being assembled for the long-anticipated attack upon its ultimate stronghold –West Africa.”[9]

As suggested by Rose in 1920, the 1925 West Africa Yellow Fever Commission included: “two epidemiologists, two bacteriologists, two laboratory assistants and a secretary.”[10] The Commission members were culled from the Rockefeller Foundation’s staff. One man who particularly wanted to be a member was Henry Rose Carter who wrote in September 1924 that he would give “everything I have, except my immortal soul, if I could spend the next 3 or even 2, years in the Gulf of Guinea- from the Gold Coast to the mouth of the Congo.”[11] Carter’s health prevented him from joining the Commission, but he was influential in encouraging many others to participate, including Dr. Henry Hanson who served from 1925 to 1927.

Hanson was one of the Commission members who kept a personal diary of his time in West Africa. (A diary by the Commission’s director, Dr. Henry Beeuwkes, is available at the Rockefeller Foundation Archives.[12]) On November 22, 1925, Dr. Hanson wrote that he was reading a book, West Africa: A Handbook of Practical Information for the Official, Planter, Miner, Financier & Trader by H. Osman Newland,[13] to familiarize himself with the area.  This book and the West African Pocket Book: A Guide for Newly Appointed Government Officers compiled by direction of the Secretary of State for the Colonies[14]offer glimpses into the British Empire and colonial government, and the preparations that Rockefeller staff undertook before traveling.  West Africa’s reputation as the “White Man’s Grave,” due to the high mortality rates among whites caused by lack of immunity to two diseases, yellow fever and malaria, influenced the Commission’s preparations. While preparing to ship “portable houses of asbestos cement” that would be tightly screened once they arrived in Lagos, Beeuwkes, also requested a coffin be sent. Rockefeller Director, Frederick F. Russell, denied the request.[15]

The British colonies in West Africa during the 1920s and 30s included “Sierra Leone, the Gambia, Nigeria (with the British Cameroons), and the Gold Coast (including Gold Coast crown colony, the Asante empire, the Northern Territories, and British Togoland).”[16] As Hanson discovered, the British governance of all the colonies followed a model (in effect since 1912) established by Frederick J.D. Lugard in Nigeria with the central government comprised of an appointed governor, an executive, and a legislative council. Hanson met many of the British district officers who served as a liaison between the traditional ruler and the colonial regime.[17] This model had an impact on the West Africa Yellow Fever Commission in getting approval from local officials who were seen as crucial for gaining native populations’ cooperation to enable actually carrying out the surveys. Hanson wrote multiple letters to local officials during the early months of 1926, often mentioning that the Commission had the approval of the Colonial Office in London and the full approval of the “Nigerian government” but that they also needed the cooperation of the “Native Administration” to actually start work and carry out the survey.

In one letter recorded in his diary, Hanson stated, “… in my opinion yellow fever is never absent from the larger centers of population such as, Ibadan, Abeokuta, Iwo, Ogbomosho, Ilorin Oshogbo, Ede, Oyo, or Lagos, etc.”[18] In another letter copied in his diary, he wrote to Dr. D. Alexander, the Director of Medical & Sanitary Services for Nigeria. Hanson sought approval and described his work, which would “consist of two divisions, a & b:
a.) A search for evidence of yellow fever among the natives and its relation to the cases, which have occurred among Europeans. This will necessitate a contact with the Native Administration to such an extent that we shall be able to see fever cases as they occur in the leading towns in the Southern Provinces.
b.) A study of the prevailing mosquitoes, more especially those breeding by preference in artificial containers, and in close proximity to human habitation. It has been reported that the Stegomyia, alias Aedes aegypti Linn., Aedes argenteus etc., have different breeding habits in Africa from those found on the Western Hemisphere. It is desired to have an opportunity to observe what these differences may be. These investigations can not be limited to any specific town or city, nor can one anticipate the time required; it might be a question of months or it might mean from 1 to 3 years work, depending on different factors. The process of the above mentioned work would be materially expedited if the Director of the Medical and Sanitary Services would send a note of approval to the authorities in the Districts concerned.”[19]

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The majority of the Commission members arrived in West Africa in July 1925 with four goals: “to learn the characteristics and epidemiology of yellow fever in West Africa and its relationship to the fever in the Western Hemisphere; to attempt the isolation of the organism that causes the disease; to discover the method of transmission; and to identify those areas in which the disease is continually present.”[1]

Dr. Henry Beeuwkes, a U.S. Army colonel who had achieved fame with his work battling typhoid and cholera outbreaks in Russia, was in charge of the West Africa Yellow Fever Commission.[2] Headquarters and a laboratory in Yaba, near the capital city of Lagos, were immediately established, and other locations were soon set up as well.[3]

“Animal Houses of the Yellow Fever Laboratory, Lagos, Nigeria,” January 20, 1933. Courtesy of the National Library of Medicine.[6]

A Rockefeller report described the Commission’s “outpost” in West Africa: “Five miles north of Lagos, in Nigeria, on the road to inland towns and cities, is a small settlement. On seven and a half acres are six main buildings – an office, a laboratory, an animal house, two dormitories, and a staff house. They are of the portable, sectional type, brought from America and set high on pillars of concrete. They are well equipped for scientific work and for living purposes.  There is running water and electric light. A tennis court has been laid out.  Modest landscape-gardening has been begun. Additional structures for kitchens, servants’ quarters, and storage have been built locally. Here live and work expert field directors, clinicians, laboratory men, assistants, and servants.”[4] The headquarters provided a central spot for what would become essentially a “field program with a rotating staff” among the Nigerian population of “approximately 99,000 Africans and 1,000 British.”[5]

“Laboratory building of the Yellow Fever Laboratory, Lagos, Nigeria,” January 20, 1933. Courtesy of the National Library of Medicine.[7]

The Commission’s goals would not be met until the late 1920s when a series of discoveries occurred in quick succession. In the summer of 1927, Dr. Alexander F. Mahaffy drew blood from a yellow fever victim, a 28 year old man named Asibi, from the Gold Coast, now Ghana. (This marked an historic moment in the fight against yellow fever as Asibi’s blood was eventually used to develop the first successful vaccine, 17D. Asibi survived and was given a pension in 1945.[8])

Dr. Mahaffy then returned to the lab in Accra where he injected Asibi’s blood into two different species of monkeys and two guinea pigs. The Macaus rhesus monkey became ill, and thus began the first successful transmission of yellow fever to animals. Then, the Commission showed that the “agent of yellow fever passed through a Berkefeld filter,” confirming the experiments of James Carroll from 1901. And finally, they produced a “convalescent serum from the severe cases of yellow fever” which “protected susceptible monkeys from the virus.”[9]

Hideyo Noguchi with C.B. Philip. Hench-Reed Collection.[11]

 These advances were not without cost as the Commission experienced its first tragedy in the death of Adrian Stokes, who contracted yellow fever and died on September 19, 1927. Publishing their findings, in the 1928 article, “Experimental Transmission of Yellow Fever Virus to Laboratory Animals,” the authors note, “no spirochetes, leptospira, or other forms of microorganism were found in tissues of infected animals stained by Giemsa and Levaditi methods.”[10]

In 1927, as Hanson was departing West Africa, Hideyo Noguchi arrived to investigate the claim that his discovery of the Leptospira as the causative agent of yellow fever was incorrect. The photo to the left was taken on May 11, 1928, on board a steamship in Lagos Harbor, Nigeria. This is the last photo of Noguchi who had a headache at this time and was taken the next day to a hospital. Tragically, Noguchi had contracted yellow fever which led to his death in Accra on May 21, 1928. Several days later his assistant, William A. Young, who performed Noguchi’s autopsy, also succumbed to the disease.

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Houses of Dr. Mahaffey and Dr. Beeuwkes, Lagos, Nigeria, January 20, 1933. Courtesy of NLM Profiles in Science.[2]	The West Africa Yellow Fever Commission operated from 1925 to 1934 and generally had eight members at a time with twenty-four members total over the nine-year period.[3]

• Dr. Henry Beeuwkes (1881-1956), Director, The John Hopkins School of Medicine, 1906
• Dr. Henry Hanson (1877-1954), Field Investigation – Inspector – Nigeria
• Dr. A.F. Mahaffy (1891-1962), Field Investigation – Inspector – Lagos
• Dr. A.M. Walcott (1884-1962), Field Investigation – Inspector – Gold Coast – Carter’s 1921 letter recommends Walcott[4]
• Dr. Israel J. Kligler (1888-1944), Bacteriologist, Director of the Hygiene and Bacteriology Department at the Hebrew University-Hadassah Medical School (Columbia University graduate)
• Dr. Oskar Klotz (1878-1936), Special Pathologist, Professor of Pathology and Bacteriology at the University of Toronto – Diary
• Dr. H.R. Muller, Pathologist and Bacteriologist
• Mr. Lawrence H. Dunn, Entomologist
• Mr. F.A. Bryant, Office Manager
• Mr. Frank P. Hogan, Secretary
• Mr. Wm. Glassounoff, Laboratory Technician
• Dr. Adrian Stokes (1887-1927), Pathologist, Guy’s Hospital, London, died of yellow fever
• Dr. Wilbur A. Sawyer (1879-1951), Interim Director for six months while Beeuwkes was on leave
• Dr. Johannes H. Bauer (1890-1961), Pathologist
• Dr. N. Paul Hudson, Pathologist and Bacteriologist
• Bryan R. Dyer, Survey assistant to Dr. Hanson
• Dr. Maurice Wakeman, Biochemistry and Internal Medicine
• Dr. C. Morrell, Biochemistry and Internal Medicine
• Mr. Philip, Entomology
• Dr. Hideyo Noguchi (1876-1928), Bacteriologist – Gold Coast, died of yellow fever
• Mr. Batchelder, Technician – Gold Coast
• Dr. Kumm, Clinician
• Dr. Theodore B. Hayne (1898-1930), Clinician, died of yellow fever
• Mr. Davis, Technician in Immunology
• Mr. C. Michaeloff, Assistant Secretary
• Dr. Ramsay, Statistician
• Dr. E.J. Scannell, Clinician

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“Aedes (Stegonyia) aegypti” mosquito. Courtesy of the National Library of Medicine.[1] (Translation: aëdes (place of refuge or rest / house) aegypti (of Egypt / Aegyptus, the mythical king of Egypt whose fifty sons married the fifty daughters of his twin brother Danaus.)[2]

“1918: Anti-Mosquito Methods Control Yellow Fever in Ecuador.” Courtesy of The College of Physicians of Philadelphia.[3]	Pesticides: Mosquito squads were employed to spray chemicals on rooftops and other surfaces as shown in this picture taken in Guayaquil, Ecuador which features one of 25 mosquito squads assigned to the work.

Cheesecloth over water cisterns in New Orleans, 1905 from Yellow Fever Prophylaxis in New Orleans 1905 by Robert Boyce, published in 1906.”[4]	Eliminate mosquito breeding: Community water tanks, household water containers, and any other object that would potentially hold standing water (a prime environment for the mosquito to lay eggs) were sealed. Various materials were utilized, such as the cheesecloth over the cisterns in this image taken during the 1905 New Orleans outbreak.

Larva as depicted in the West African Pocket Book, 1920.[5]	Weekly house inspections: As a field inspector in West Africa, Dr. Hanson used this method to detect and destroy mosquito larvae. Hanson made frequent references to the “household index,” which is the percentage of houses that were found to have Aedes aegypti mosquitoes. The goal was to achieve a percentage under two percent.[6]

One of the fish species used in Colombia’s fight against yellow fever, 1924.[7]	Larva-eating fish: Dr. Hanson implemented this method in large water containers with significant success in Peru. Over “three hundred thousand fish” were distributed as larvae consumers in the campaign.[8] Hanson documented his results in the report, A Study of Sanitary Conditions in Peru with Special Reference to the Incidence of Malaria, published in 1921 by Panama Canal Press.[9]

It’s Up to You: Dengue-Yellow Fever Control.[10]	Public health campaigns continued to employ the same methods of mosquito control for many decades after the campaigns in South America and West Africa, as demonstrated in this 1945 U.S. Public Health Service film, It’s Up to You: Dengue-Yellow Fever Control.

Transmission of the Yellow Fever Virus.[13]

Additional studies showed that mosquitoes other than Aedes aegypti contained the yellow fever virus: Haemagogus, Sabethine, and Aedes lencocelaenus in South America and Aedes africanus and Aedes simpsoni in Africa.[11]

Today researchers describe three transmission cycles for the yellow fever virus: jungle (sylvatic), inter­mediate (savannah), and urban as depicted in the graph created by the Centers for Disease Control and Prevention. The disease is transmitted in the jungle by mosquitoes between nonhuman primates; humans can get the virus when they visit the jungle. The infected person can then take the disease back to an urban area where the virus is generally transmitted from human to human by means of the Aedes aegypti. In Africa, the intermediate cycle involves yellow fever transmission from mosquitoes to humans who live or work in areas near the jungle border. The mosquitoes can be the disease vector from monkeys to humans or from humans to humans.[12]

Although, these discoveries led to the realization that total elimination of yellow fever vectors was not possible, fever fighters today still focus on the control of mosquito populations, as in the Florida Keys where the three basic methods are source reduction or reducing the number of habitat areas for larvae, larval control which targets the immature mosquitoes before they mature into biting adults, and the adult surveillance program which aims to count, collect, and control the adult mosquitoes. The technique of larvae-eating fish espoused by Dr. Hanson is still used.[14]

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