Clara Maass Volunteered to Be Bitten Again

ABSTRACT

Clara Louise Maass, a 25-year-old American nurse, died of yellow fever on August 24, 1901, following experimental inoculation by infected mosquitoes in Havana, Republic of cuba. The human xanthous fever experiments were initially conducted past MAJ Walter Reed, who starting time used written informed consent and proved the validity of Finlay'south mosquito-vector hypothesis. Despite informed consent class and an incentive of $100 in U.S. aureate, human subjects were exposed to a deadly virus. The deaths of Clara Maass and ii Castilian immigrants resulted in a public outcry and the immediate cessation of yellow fever human being experiments in Republic of cuba.

What I wish to urge is a true knowledge of your foes, not just of the bullets, but of the much more important enemy, the bacilli.

Sir William Osler, Bacilli and Bullets, 1914 ¹

To deliberately inject a poison of known high degree of virulency into a man being, unless you obtain that man's sanction, is not ridiculous, information technology is criminal.

William Osler, Trans Assoc Am Phys, 1898 ²

More than soldiers died during the Spanish–American War from infections than from battle wounds. ³ Co-ordinate to statistics provided by the Function of the Surgeon General, between Apr 21 and Baronial xvi, 1898 (118 days), 1,939 men died of disease and 369 were battle casualties (266 killed in boxing and 103 died of wounds). ³ The rapid increase from a U.S. Army peacetime strength of 28,183 officers and enlisted men in Apr to 265,629 in July, 1898, taxed the State of war Department, especially the wellness government. ³ Lack of recognition and enforcement of germ-free measures resulted in an outbreak of typhoid fever that raged from May to September 1898. ³ Typhoid was the major killer among American soldiers during the Spanish–American War. A full of xx,738 contracted typhoid fever (82% of all sick soldiers) and 1,590 (7.vii%) died. ⁴ ^, ^– ⁶ As Cirillo aptly summarized, more soldiers died from bacilli than from enemy bullets. ⁶

U.S. ARMY Man EXPERIMENTS

Concerned well-nigh the high morbidity and mortality from infectious diseases, GEN George S. Sternberg, U.Due south. Army Surgeon General and a leading bacteriologist, formed the U.S. Army Quaternary Xanthous Fever Commission (Board) on May 23, 1900, "for the purpose of pursuing scientific investigations with reference to the infectious diseases prevalent on the island of Cuba and especially xanthous fever." ⁷ MAJ Walter Reed and U.S. Army contract surgeons James Carroll, Arístides Agramonte, and Jesse Lazear were appointed members of the board. Each fellow member had specific duties: Reed, head of affairs; Carroll, bacteriological investigations; Agramonte, autopsies and pathological work; and Lazear, mosquito work. ⁸

The board began inoculating homo volunteers on August xi, 1900, using mosquitoes harvested from larvae provided by the Cuban physician Carlos Finlay, for the purpose of showing the musquito as the vector of yellow fever among humans. ^ix For the first fourth dimension in the modern era, written informed consent was obtained (both in English and Castilian). ¹⁰ Participants in the experiments received an incentive of $100 U.S. gold, and an boosted $100 U.S. gold, should the subject develop experimental yellow fever. ¹¹ ^, ¹² Between August 11 and August 25, nine inoculations past infected mosquitoes were unsuccessful and the members of the board were disillusioned by their inability to reproduce experimentally a single case of yellowish fever. ^nine However, on August 27 Carroll (who did not believe in the mosquito-vector hypothesis) inoculated himself with an infected mosquito and 5 days later came downward with a astringent example of yellowish fever from which he recovered only incompletely. ^nine ^, ^eleven A second case developed in a 24-year-old American volunteer, PVT William Dean, 5 days subsequently he was bitten past the same mosquito Carroll had previously practical to himself. ⁹ ^, ¹¹ Another member of the lath, Lazear, (who supported Finlay'due south musquito-vector hypothesis), reportedly was accidentally bitten on the back of his mitt by a stray mosquito at Las Animas Hospital on September 13 and also adult a severe case of xanthous fever. ⁹ Unfortunately, Lazear succumbed to the dreaded vómito negro (black vomit) 12 days later. ⁹ ^, ¹¹ Although despondent from the loss of his colleague, MAJ Reed realized the importance of these cases and obtained permission from his superiors to present a preliminary annotation on the results of human experiments at the annual meeting of the American Public Health Association held in Indianapolis, on October 22 to 26, 1900. ⁸ ^, ⁹ The news of this great discovery was enthusiastically received both nationally and abroad. Reed, Agramonte, and Finlay (Carroll did not nourish) celebrated the victory and savored their claim to immortality at a banquet offered by MG Leonard Wood in honor of Finlay at Havana's Delmonico, on December 22, 1900. ¹³ ^, ¹⁴ The collegiality that united those who collaborated in the initial studies on yellowish fever after would become marred by personal animosities involving Reed, Sternberg, Carroll, and Agramonte. ¹⁵

Six boosted cases of xanthous fever were induced by mosquito bites among American soldiers (ii cases) and Spanish immigrants (four cases) betwixt Dec 5, 1900, and January 2, 1901, without any further fatalities. ¹⁶ 4 more cases of yellow fever were produced by infected mosquito bites amid American volunteers between January 19 and February 7. ¹⁷ Iv cases of xanthous fever resulted from the subcutaneous injection of blood or filtered serum from yellow fever patients. ¹⁷ Additional human experiments were designed to dispel the popular notion that yellow fever could be transmitted by close contact with contaminated materials (fomites) from yellow fever victims. ¹⁷ 5 subjects volunteered for these experiments and none developed xanthous fever. Thus, between Dec 5, 1900, and February 7, 1901, a total of sixteen cases of xanthous fever were induced experimentally without whatever reported fatalities. These experiments were carried out at a quarantined site established on November 20, 1900, near Military camp Columbia at Los Quemados de Marianao, consisting initially of seven Army tents guarded past a war machine garrison, and named Campsite Lazear in honour of the fallen colleague. ^xviii ^, ¹⁹

CLARA MAAS AS A CONTRACT NURSE

The crucial function that female person nurses played in the care and recovery of American ill and wounded soldiers was not recognized by the U.Due south. Army until the Spanish–American War. Surgeon-General Sternberg initially declined nursing services by individuals and groups of women volunteers. ²⁰ As weather in the camps deteriorated, Sternberg realized that trained nurses were indispensable for the recovery of sick soldiers, despite the objections from medical officers commanding hospitals. Sternberg requested and obtained authorization from the Secretary of War to hire women contract nurses (paid employees without rank) in March 1898, at a salary of $30 per calendar month and one daily ration. ²⁰ Applicants were selected based on professional ability, proficient grapheme, and good wellness. ²⁰ The number of contract nurses serving in the U.S. Army during the Castilian–American War peaked at 1,158 on September 15, 1898. ⁵ ^, ²¹ By the end of 1898, a full of ane,563 female person contract nurses were hired. ²¹ Female nurses were well-trained in the importance of cleanliness, antisepsis, and proper treatment of contaminated excreta. ⁵ These qualifications converted the skeptics into advocates and the Army Nurse (Female person) Corps was formed on February two, 1901. ^five ^, ²¹ One of these contract nurses was Clara Louise Maass (Fig. 1).

FIGURE ane.

Clara Louise Maass. (Courtesy National Library of Medicine).

Clara Maass was born in East Orange, New Jersey, on June 28, 1876, the eldest of ix children to a family unit who came from Europe to form part of the German diaspora seeking religious freedom and meliorate opportunities. ²² Her father worked as a farmer, grocer, and hatter, only he was unable to support such a numerous progeny. Clara assumed early her responsibilities to provide for her family. At age ten, she lived in another home every bit "a mother's helper" without pay except for room and board and time allowed to go to schoolhouse. ²² ^, ²³ She was employed at age 15 at the Newark Orphan Aviary at a bacon of $10 a calendar month for working vii days a week feeding, dressing, and caring for the orphans. ²⁴

The options available at the time for a young woman to satisfy her aspirations and help her family were express. Clara, inspired by Florence Nightingale's dedication to serve others during the Crimean War, turned to nursing and at age 17 enrolled in the Christina Trefz Grooming School for Nurses at the Newark German Hospital in 1893. ²² ^, ²³ She graduated 2 years later on, and later 3 more years, became caput nurse at the same hospital. ²² ^, ²³ The immature nurse searched for opportunities to increment her earnings and was employed as a contract nurse by the U.S. Army during the Spanish–American War. ²⁴ She attended to the ill and wounded in Jacksonville, Florida; Savannah, Georgia; and Santiago, Republic of cuba. She returned home 4 months later Feb 1899, afterwards completing her obligations as a contract nurse. Clara volunteered over again and in November 1899 left for the Philippines and served at the Field Reserve Hospital in Manila, only was sent home 7 months later to recuperate from a prolonged bout of dengue. ²³ ^, ²⁴

After MAJ Gorgas was appointed Primary Sanitary Officer of Havana in Feb 1900, a call was made to recruit nurses needed to attend patients. ²⁵ Clara wrote to Gorgas and requested to be considered for employment. ²⁴ Gorgas replied past telegram on October 14, 1900, asking her to "come up at once" to Havana. ²⁴ Although she was engaged to be married to a businessman from New York, Clara answered the telephone call to duty and embarked for Republic of cuba. She was employed past the Germ-free Section of Havana headed by Gorgas, a part of the military government of Republic of cuba, and was paid for her services as a nurse at Las Animas Hospital with Cuban funds and non by the U.S. Army. ²⁶

LAS ANIMAS INOCULATION STATION

After discussing with MAJ Reed the possibility of making practical awarding of his discoveries, and "a great deal of thought given to the matter," MAJ Gorgas and other members of the Sanitary Department decided to adopt all measures that seemed likely to exist useful in the command of yellow fever. ²⁷ Based on the previous feel that most of the cases of yellowish fever induced by the Board had been low-cal, they concluded that the "strongest measure" would be vaccination, every bit effectively showed by Jenner for smallpox in 1796 and by Pasteur for rabies in 1885. ²⁷ Permission was obtained from BG Leonard Wood, Governor-General of Cuba, to establish at Las Animas Hospital an inoculation station for the purpose of inducing "lite cases" among nonimmunes using infected mosquitoes. ²⁷ ^, ²⁸ The inoculation station opened in February 1901, under the management of Juan Guiteras, a Cuban-born physician trained as a pathologist in Philadelphia and formerly a professor of pathology at the Academy of Pennsylvania. ²⁸

Las Animas Hospital was the master infirmary for yellow fever patients in Havana. Suspected cases of yellow fever in the city were reported to the Wellness Section and seen equally soon equally possible by members of the Havana Yellow Fever Commission (Gorgas, Finlay, Guiteras, and Díaz Albertini, a Cuban physician). ²⁷ ^, ²⁸ Once the diagnosis of yellow fever was confirmed, patients were transferred to Las Animas Hospital. Guiteras and Gorgas alternated monthly as visiting physicians at the hospital and, adhering to a strict therapeutic regimen, soon achieved the lowest bloodshed among yellow fever patients compared to different handling modalities used in other (including private) hospitals in Havana. ²⁷ ^, ²⁸

Handling of yellow fever consisted of complete bed residuum and the patient was placed in a recumbent position during the course of the illness. ²⁹ An "absolute" diet (no nutrient whatsoever) was strictly enforced during the active stage of the disease, except for water, ginger ale, various carbonated, distilled, and city "waters" (as preferred by the patient) and cracked ice were given ad libitum, for no more than than iv or five days. Phenacetin 5 grains or a similar analgesic was administered for headache or muscular pains, normally only within the first 3 days. Stomach "irritability" was treated with "external" applications, such as mustard plasters, and "internally" with cracked ice. No other medication was given. When urine output roughshod beneath 500 cc. per 24 hours, saline enemas were administered. If the temperature remained above 103°F for any length of time, the patient was sponged every 2 hours with cold water. This rigorous treatment program required constant bedside attention and authentic recordings of temperature, pulse, and urinary output. ²⁹ Aided by an excellent corps of American female nurses, mostly graduates of grooming schools, and a resident physician and an assistant, Gorgas believed that this method saved 12 to 15 more lives per 100 at Las Animas Hospital when compared to handling at other hospitals and facilities in Havana, including private care given at dwelling house. ²⁹

Between February 22 and August 24, 1901, 23 volunteers were inoculated 42 times with infected mosquitoes at Las Animas Infirmary. ²⁸ ^, ³⁰ Of the offset 28 inoculations supervised by Guiteras, only one developed a case of mild yellowish fever. Yet, vii of the subsequent xiv experiments proved positive and as a upshot 3 subjects died of yellowish fever: two Castilian immigrants, Antonio Carro and Cumpersino Campa, and Clara Maass. ²⁸ ^, ³⁰

Both Maass and Guiteras believed that she lacked amnesty to yellow fever, despite her repeated exposures to infected patients while stationed in Santiago. Eager to go allowed and supplement her income as well, Clara volunteered to be bitten by contaminated mosquitoes. She submitted herself five times to experimental inoculations on March 17, March 25, May 15, May 27, and June iv, but failed to develop whatsoever of the symptoms of yellow fever. ²⁸ ^, ^xxx All the same eager to larn immunity, Clara volunteered for the sixth time and was inoculated on August 14 with four mosquitoes infected by previous exposure to Juan Alvarez, a 13-year-old from Santiago who had experienced a markedly virulent class of yellow fever. ²⁸ The "Alvarez mosquitoes" would business relationship for all three deaths from experimental yellowish fever recorded at Las Animas Infirmary. ²⁸ Three days and 21 hours later, Clara developed the unmistakable clinical features of xanthous fever: chills, backache, and fever (Fig. two). The illness evolved rapidly with severe manifestation of black vomit and renal failure. Clara sensed the seriousness of her condition and wrote to her female parent: ²⁴

Goodbye, Mother,

Don't worry. God will accept intendance of me in the xanthous fever hospital the same as if I were at dwelling house.

I will transport you nearly all I earn, so exist good to yourself and the two little ones.

You know I am the homo of the family, but do pray for me.

FIGURE ii.

Fever chart of Clara Maass, with notations: "Bitten past 2 mosquitoes at 9 a.m." (August fourteen) and "Died at 6:30 p.m." (August 24). Solid line plots body temperature every 3 hours. (Adapted from Guiteras. ²⁸ ).

Gorgas sent telegrams informing Clara's family that she had come down with yellow fever. ²⁴ Despite receiving the best possible care from the most experienced doctors, she deteriorated chop-chop. Guiteras succinctly recorded her fulminating course:

She was taken sick on August xviii, at 6 a.m., without any premonitory symptoms. The temperature was beginning to rising when she felt some chilliness and headache. The case was an intensely hemorrhagic i, and terminated fatally on the seventh day. ²⁸

Gorgas notified her family in a cursory telegram on August 24: "Miss Maas[due south] died twenty fourth six xxx p.grand." ²⁴

Clara had convinced her sister, Sophia, to come up to Havana and relieve her equally a nurse at Las Animas Hospital and so she could return to the United States. Sophia arrived in Havana on Baronial 25, unaware of her sister'southward fatal illness. She gathered Clara'due south belongings at Las Animas Hospital and attended her funeral at Colon Cemetery in Havana before returning home. ²⁴

Several newspapers reported Clara Maass' expiry and denounced human experimentation. Amidst the sensationalized headlines were: "Girl Died for Mother"; "Miss Maass Braved Yellow Fever because the $100 was Needed"; and "Sold Her Life for $100." ²⁴ Clara's mother declared in an interview reported in the Newark Sunday News (September 1, 1901), "From what I know of the circumstances, my girl's death seems little brusque of murder." ³¹

The grief experienced past the Maass family was shared by Gorgas, Guiteras, and Agramonte. Guiteras may have been the nearly affected, equally he became despondent and refused thereafter to brand whatsoever comments about or to discuss Clara's demise in public. ³² His aversion to inoculation experiments followed him for the rest of his professional life and even when he became Chief Sanitary Officer in Havana, he refused to endorse obligatory childhood vaccination programs in Cuba. ³²

INFORMED CONSENT

MAJ Walter Reed remains as the main figure in yellow fever human experimentation. Every bit head of the U.S. Army 4th Yellowish Fever Lath formed by GEN Sternberg, Reed gave considerable thought and effort to the ethical responsibilities of the board members. ^thirteen Although the members of the board agreed to inoculate themselves with infected mosquitoes before whatsoever other subjects were enrolled in these experiments, Reed was the only eligible member who did not participate (Agramonte probably had yellowish fever previously and was thought to be immune). ^fifteen ^, ³³ ^, ³⁴ Lazear's death from yellow fever induced by the seize with teeth of a stray mosquito at Las Animas Hospital was lamented by the other members of the board, more then since Lazear had recently married and left a widow and her son with fiddling support (except for a $125 monthly alimony granted by Congress 30 years later). ^xi ^, ²⁸ The severity of the yellow fever attacks experienced by Carroll and Lazear may have contributed to Reed'southward reluctance to participate in the human experiments, considering his own "vulnerability" at the advanced age of 49 years. ^xv ^, ³⁴ ^, ³⁵

BG Leonard Forest, Governor-General of Cuba, supported the xanthous fever human experiments merely was explicit in the protection of homo beings. ²⁸ Although he fabricated available $x,000 to be used to reward volunteers, he prohibited the enrollment of enlisted soldiers and directed Reed to devise a written consent form. ³⁵ Ix days before he created the Yellow Fever Board, GEN Sternberg admonished Agramonte that he must showtime obtain the volunteer's "full knowledge and consent" earlier conveying such tests in humans. ³⁶ MAJ Reed was sufficiently concerned with the ideals of human experimentation to devise the beginning known modern written informed consent form. ¹³ This "contract" was typewritten both in English and in Castilian and signed by the experimental subjects, by and large nonenlisted American soldiers and Spanish immigrants. ¹⁰ Some of the U.Southward. Army volunteers were eager to help analyze the pathogenesis of yellow fever. Others signed-up convinced that the mosquito-vector hypothesis was incorrect and that participation involved lilliputian, if whatsoever, risk. ¹¹ Although the informed consent form devised by Reed explained in detail the risks attendant to participants, how much was really understood by the subjects is questionable: ^x

The undersigned understands perfectly well that in the case of the development of yellowish fever in him, that he endangers his life to a certain extent but it being entirely impossible for him to avoid the infection during his stay in the island, he prefers to take the hazard of contracting it intentionally in the conventionalities that he volition receive from the said Commission the greatest care and the most skillful medical service.

The attendant high mortality of yellowish fever is not mentioned in this document. It is doubtful that the explanation given equally justification for submitting volunteers to yellow fever inoculations would gain approval from whatever Institutional Review Board today. Some of the participants who acquired yellow fever experimentally did not completely recover. Carroll, who well-nigh died during the disease, suffered afterward from chronic neuralgia and was described by his colleagues as mentally and physically weakened past the attack. ³² Kissinger was considered an invalid and unable to work thereafter. ³⁵ In an attempt to justify the results of the yellow fever human experiments in Cuba, Guiteras subsequently reasoned that the "low" bloodshed resulting from intentional inoculations by the U.S. Army Commission and at the inoculation station (iii out of 24 cases, or 12.v%) was more favorable than the mortality (49 out of 144 cases, or 34%) of naturally occurring cases of yellowish fever recorded in Havana betwixt November 20, 1900 and August 31, 1901, thus giving "the patient the better chance of recovery." ²⁸ Both Reed and Gorgas, however, concluded that the three fatalities were unacceptable and the experimental inoculations at Las Animas Hospital terminated.

When criticized at a medical meeting for his function in the human experiments, Reed dedicated his actions past stating that these were necessary in the absence of an animal model and acknowledged the difficult position he institute himself in and the moral uncertainty that beset his path. ⁹ When 1 of the volunteers developed fever and albuminuria, Reed confided to Sternberg: ¹²

Should he die, I shall regret that I ever undertook this work. The responsibility for the life of a man being weighs upon me very heavily merely at nowadays, and I am dreadfully melancholic.

Reed was fortunate that, except for the accidental exposure that resulted in Lazear's death, none of the volunteers who participated in the U.S. Regular army Fourth Yellowish Fever Board experiments died from yellowish fever. The success of his experiments and consequent eradication of yellow fever from Havana for the offset fourth dimension in 150 years probably helped to exonerate him from whatever culpability in exposing subjects to such a deadly disease. Conversely, history has non been as kind to Giuseppe Sanarelli, who erroneously claimed to accept found the causative agent of yellow fever and reported inoculating five human subjects to prove his findings. ³⁷ Reed's untimely death from appendicitis, scarcely two years after the decision of these experiments, may take saved him considerable anguish from criticisms past antivivisectionists and other opponents of homo and animal experimentation.

The responsibility for Clara Maass' death cannot be directly attributed to Reed, since the human being experiments at Las Animas Infirmary were not supervised by the U.Southward. Army 4th Yellow Fever Lath. Instead, the inoculation experiments were implemented by Gorgas and Guiteras as members of the Sanitary Department of Havana. ²⁸ These inoculation studies were approved by BG Leonard Wood as a logical sequence in an effort to develop immunity to xanthous fever by a more controlled natural means. The 3 deaths among volunteer subjects resulted in a public outcry and immediate termination of the yellow fever experiments in Republic of cuba. ¹⁹ ^, ³⁸ Reed corresponded with Gorgas on August 26, 1901: "…the details of these patients, simply at present, makes all success gustatory modality of gall and wormwood and casts a gloom over the Germ-free Department." ³⁹

The validity of informed consent depends on how fully the patient has been informed and understands all of the risks involved. ⁴⁰ Beecher reviewed in 1966 a number of questionable clinical research studies conducted since Earth War II and emphasized the importance of a properly documented informed consent and the "presence of an intelligent, informed, conscientious, compassionate, [and] responsible investigator." ⁴⁰ Institutional Review Boards were created to safeguard the rights of patients and experimental subjects, following the principles established past the Annunciation of Helsinki and Good Clinical Practice Guidelines. Article 5 of the Declaration of Helsinki clearly stated that the field of study's welfare must e'er have precedence over the interests of club and scientific discipline, thus refuting a long-held belief that loftier-take chances experiments were justified if the results benefited humankind. ⁴¹

The Cuban authorities recognized Clara Maass' contribution and placed a bronze plaque in the yellow fever ward where she died at Las Animas Infirmary in Havana. Two years afterwards her interment in Havana, her remains were returned to the United States and buried in Newark's Fairmount Cemetery. ²⁴ In 1951, Cuba emitted a stamp in her honor on the fiftieth ceremony of her death. Twenty-five years later, the U.S. Postal Service issued in 1976 a stamp commemorating Clara Maass. Several articles and books accept variously described Clara Maass equally a volunteer, patriot, heroine, martyr, victim, etc. The almost advisable and lasting memorial, even so, remains the naming of the Newark German language Hospital where she trained and later became a caput nurse, as the Clara Maass Medical Center, relocated in 1952 to Belleville, New Jersey. A hospital museum and archive preserves letters, documents, photographs, and publications to accolade the retentivity of Clara Maass.

ACKNOWLEDGMENTS

I thank Reinaldo Chaves, Yulia Orlova Md, and Brenda Marcus MFA (Museum Curating), for facilitating access to museum documents at the Clara Maass Medical Center, Belleville, NJ.

REFERENCES

Osler

Bacilli and Bullets. An Accost to the Officers and Men in the Camps at Churn

Oxford Pamphlets

, p

ane

London

Oxford University Press

1914

Osler

Discussion of Sternberg GM: The Bacillus Icteroides (Sanarelli) and the Bacillus X (Sternberg)

Trans Assoc Am Physicians

1898

;

thirteen

–

Bayne-Jones

Southward

The Castilian-American State of war. Tropical preventive medicine (1898–1914)

. In:

The Evolution of Preventive Medicine in the U.s. Army (1607–1939)

, pp

123

–

Washington, DC

Function of the Surgeon General, Department of the Army

1968

iv.

Reed

Due west

Vaughan

Shakespeare

Report on the Origin and Spread of Typhoid Fever in the U.South. Military Camps During the Spanish War of 1898 (Vol. I)

, pp

674

–

half dozen

House of Representatives, Certificate No. 757

Washington, DC

Government Press Office

1904

Cirillo

Fever and reform: the typhoid epidemic in the Spanish-American State of war

J Hist Med

2000

;

363

–

Cirillo

Bullets and Bacilli. The Castilian-American War and Military Medicine

, pp

151

–

half-dozen

New Brunswick, NJ

Rutgers University Printing

2004

vii.

Armed services Orders for Walter Reed and James Carroll, The Surgeon General to the Adjutant General, May 23, 1900

Philip S. Hench Walter Reed Yellowish Fever Collection, Box 20, Folder 18, Document one

Charlottesville, VA

University of Virginia Claude Moore Health Sciences Library

[Reprinted in Mil Med 2001; 166(Suppl 1): 18.]

Kelly

Piece of work in yellowish fever 1897–1901

. In:

Walter Reed and Yellow Fever

, pp

120

–

New York

McLure, Phillips & Co

1906

Reed

Westward

Carroll

Agramonte

Lazear

The etiology of xanthous fever—a preliminary note

Philadelphia Med J

1900

;

half-dozen

790

–

iii

[Reprinted in Mil Med 2001; 166(Suppl I): 29–36.]

10.

Contract between Antonio Benigno and Yellow Fever Lath (English translation), Nov 26, 1900

Philip S. Hench Walter Reed Yellow Fever Collection, Box 70, Binder four, Document ane

University of Virginia Claude Moore Health Sciences Library

Charlottesville, VA

[Reprinted in Mil Med 2001; 166(Suppl I): 38–nine.]

xi.

Pierce

"In the interest of humanity and the crusade of science": the yellow fever volunteers

Mil Med

2003

;

168

857

–

12.

Bean

Walter Reed and the ordeal of human being experimentation. The Fielding H. Garrison Lecture

Balderdash Hist Med

1977

;

–

13.

Bean

Walter Reed. A Biography

, pp

156

–

viii

Charlottesville, VA

University Press of Virginia

1982

14.

Rodríguez Expósito

El Dr. Carlos J. Finlay

. In:

Obras Completas

(

vol. I

). Edited by

Finlay

Carlos J.

–

Havana

Academia de Ciencias de Cuba

1965

fifteen.

Altman

The myth of Walter Reed

. In:

Who Goes Starting time? The Story of Self-Experimentation in Medicine

, pp

129

–

New York

Random House

1987

xvi.

Reed

Carroll

Agramonte

The etiology of yellow fever: an additional note

J Am Med Assoc

1901

;

431

–

[Reprinted in Mil Med 2001; 166(Suppl I): 44–53.]

17.

Reed

West

Carroll

Agramonte

Experimental yellow fever

Am Medicine

1901

;

–

[Reprinted in Mil Med 2001; 166(Suppl I): 55–60.]

18.

Reed

Due west

Carroll

The etiology of yellow fever: a supplemental note

Am Medicine

1902

;

301

–

five

[Reprinted in Mil Med 2001; 166(Suppl I): 62–6.]

19.

Gillett

Public health in Cuba

. In:

The Regular army Medical Department

, pp

1865

–

917

Washington, D.C.

Center of Military History The states Ground forces

, pp

229

–

1995

20.

Starnecky

A History of the U.S. Army Nurse Corps

, pp

–

Philadelphia

Academy of Pennsylvania Press

1999

21.

Kallesch

Heroines of '98: female nurses in the Castilian-American state of war

Nursing Inquiry

1975

;

411

–

22.

Tengbom

No Greater Love. The Gripping Story of Nurse Clara Maass

, pp

–

159

St. Louis, MO

Concordia Publishing House

1978

23.

Wenzel

Binkowski

Clara Maass 1876–1901

. In:

More than petticoats. Remarkable New Bailiwick of jersey women

–

Guilford, CT

Twodot

2003

24.

Cunningham

Clara Maass. A nurse. A hospital. A spirit

, pp

–

Cedar Grove, NJ

Rae Publishing Co.

1968

25.

Truby

"A Yellow Fever Yr"—1900

, pp

–

. In:

Memoir of Walter Reed

New York

Paul B. Hoeber

1943

26.

LT COL Mary Chiliad. Phillips to Josiah C. Trent, March 22, 1945. 112 Surgeon General (Army), General Correspondence 1928–1937, 710 (Yellow Fever), Box 109, 7/78/40/iv

Washington, DC

National Archives and Records Administration

27.

Gorgas

Sanitation in Panama

, pp

–

New York

D. Appleton and Co.

1916

28.

Guiteras

Experimental yellow fever at the inoculation station of the Germ-free Section of Havana with a view to producing immunization

Am Med

1901

;

two

809

–

29.

Gorgas

Notes on the handling of yellow fever at Las Animas Hospital, the infirmary of the Sanitary Department, during the epidemic of 1900 at Havana, Cuba

J Assoc Mil Surg U.Southward.

1903

xiii

225

–

30.

Finlay

Confirmation past the U.S. Army Board

. In:

Carlos Finlay and Yellow Fever

, pp

–

112

New York

Oxford University Press

1940

31.

Paine

A martyr to science: Miss Clara Maas[s], of Eastward Orangish, falls a voluntary casualty to the yellow fever musquito

Newark Sunday News, September i, 1901

Newark Public Library

5 Washington St., Newark, NJ 07102

32.

Expósito Rodríguez

Dr. Juan Guiteras

, pp

220

–

Havana

Editorial "Cubanacan"

1947

33.

Agramonte

The inside story of a not bad medical discovery

Scientific Monthly

1915

;

209

–

[Reprinted in Mil Med 2001; 166(Suppl I) 68–78.]

34.

Lederer

"The sacred cord": doctors, patients, and medical enquiry

. In:

Subjected to Science. Human Experimentation in America Before the 2nd World War

, pp

–

Baltimore

The Johns Hopkins University Printing

1995

35.

Lederer

Heroes and martyrs: man experimentation in an age of medical progress

. In:

Subjected to Scientific discipline. Human Experimentation in America Before the Second World War

, pp

126

–

Baltimore

The Johns Hopkins Academy Press

1995

36.

Letter from George Miller Sternberg to Aristides Agramonte, May 14, 1900

Philip S. Hench Walter Reed Yellow Fever Collection, Box xx, Folder fifteen, Document 1 [02015001]

Academy of Virginia Claude Moore Health Sciences Library

Charlottesville, VA

37.

Sanarelli

A lecture on yellow fever, with a clarification of the Bacillus icteroides

Brit Med J

1897

;

–

38.

Sherk

Clara Louise Maass. The Ethics of Experimentation on Human Subjects

North J Med

2004

;

101

–

39.

Gorgas

Correspondence with Dr. Reed

. In:

Sanitation in Panama

, pp

–

109

New York

D. Appleton and Company

1915

40.

Beecher

Ethics and clinical research

New Engl J Med

1966

;

274

1354

–

41.

Declaration of Helsinki. Globe Medical Association, 1964, revised 1975, 1983, 1989

. In:

The Ethics of Research Involving Human Subjects: Facing the 21st Century

, pp

433

–

. Edited past

Vanderpool

Frederick, Maryland

University Publishing Grouping, Inc.

1996

taylorhavendecked.blogspot.com

Source: https://academic.oup.com/milmed/article/178/5/557/4222873

Clara Maass Volunteered to Be Bitten Again

ABSTRACT

U.S. ARMY Man EXPERIMENTS

CLARA MAAS AS A CONTRACT NURSE

LAS ANIMAS INOCULATION STATION

INFORMED CONSENT

ACKNOWLEDGMENTS

REFERENCES

0 Response to "Clara Maass Volunteered to Be Bitten Again"

Post a Comment

Iklan Atas Artikel

Iklan Tengah Artikel 1

Iklan Tengah Artikel 2

Iklan Bawah Artikel