Clara Maass: An American Heroine by Stanton E Cope

Figure 1: Clara Maass portrait, circa 1898. Figure 2: Clara Maass commemorative stamp, 1976.

The hypothesis that the bite of cal College in Philadelphia in Entomology’ began around an insect or other arthropod 1855 and moved back to Cuba, 1878, when Sir Patrick Manson, could somehow cause illness becoming a highly respected working in China, observed the or death to human beings has physician. He claimed, rightly development of the nema - been around for some time. This so it turned out, that the mos- tode Wuchereria bancrofti in theory was put forth by several quito Culex fasciatus, now known Culex quinquefasciatus. Shortly individuals during the second as Aedes aegypti, transmitted thereafter, in 1880, a French half of the 19th century, al - virus. However, he physician named Alphonse Lav- though it had been mentioned, had been unable to fully con- eran found the causal organism perhaps cryptically, in some vince the international scientific of living in the red blood earlier writings. community during many years cells of humans. of experiments. In most scientific GIANTS IN MEDICAL ENTOMOLOGY and medical circles, the idea In 1889, Theobald Smith, work- that an insect bite was danger- ing for the United States Depart- Prominent among these early ous was scoffed at, or at least ment of Agriculture, discovered advocates was Dr Carlos Juan disregarded as folly. the organism responsible for Finlay. Finlay, of French and Scot- causing Texas cattle fever, and tish descent and born in Cuba, What has been referred to as in 1893, Smith and F L Kilbourne graduated from Jefferson Medi- ‘The Golden Age of Medical clearly demonstrated that the

16 Summer 2011 Wing Beats cattle tick was the necessary WORK OF THE REED COMMISSION the great contributions to public developmental host to com- health and disease control. plete the pathogen’s life cycle. In May of 1900, a special com- mission consisting of Major Walter Dr William Gorgas, a sanitary Sir David Bruce, a Scottish pa- Reed, Dr James Carroll, Dr Aris- engineer for the Army working thologist and microbiologist, tides Agramonte, and Dr Jesse in Cuba, skillfully applied the established in 1895 that the Lazear was ordered to Cuba recommendations of the com- causative agent of nagana by the United States Army to mission in Cuba and within a few (animal African trypanosomia- investigate the cause and pre- short months yellow fever had sis) was conveyed from animal vention of yellow fever. Through been eliminated from Havana. to animal by bite of the tsetse a series of simple yet elegant Basically, it was a military-style fly. Sir Ronald Ross, a physician experiments, for the first time operation, going from house in the British Army working in using human volunteers with to house looking for mosquito India in 1897, reported discov- informed consent, the commis- larval sites and fumigating ering sexual stages of malarial sion showed conclusively that houses with sulfur. parasites in “dapple-winged yellow fever virus was spread mosquitoes,” which we now call only by mosquito bite and not by A hideous plague had been Anopheles. contaminated objects known as swept away. Without doubt, fomites, nor by poisoned air. thousands of lives eventually However, the main piece of were spared and millions of dol- scientific work that would, for Most significantly, the commis- lars were saved. This, however, the most part, convince the sion proposed that the spread was not the end of the story in world of the role of arthropods of yellow fever could be stopped Cuba, especially with respect in the transmission of pathogens through rigorous mosquito control to the use of human volunteers. causing human disease was yet methods coupled with patient What follows is the tragic but to be accomplished. isolation from mosquito bites. This moving and inspirational story finding turned out to be one of of Clara Maass.

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Wing Beats Summer 2011 17 AFTERMATH AND THEN TRAGEDY Cuba, Dr Juan Guiteras, a Cuban GROWING UP & EARLY CAREER physician, began a series of ex- sailed home from periments designed to immunize Clara Maass was born June 28, Cuba on February 9, 1901, humans by giving them a mild 1876 in East Orange, New Jersey. never to return. On board with case of yellow fever through Her parents were German immi- him were John Kissinger and mosquito bite. grants and she was the oldest of John Moran, two of his human nine children. Economic hard- volunteers, both of whom con- The hypothesis was simple: ship forced her to leave school tracted yellow fever during the allow mosquitoes to feed on a at age 15, when she went to experiments but declined the mild case of yellow fever, hold work in the Newark Orphan payments in gold offered to them in the laboratory until Asylum. In 1893, she entered the them. Major Gorgas, who re- they were ready to transmit the nursing program at what was mained in Cuba, believed in virus, then allow them to feed then known as Newark German the validity of the commission’s on susceptible (non-immune) Hospital, graduating in 1895. In experiments and findings, but he humans, who would theoreti- 1898, at age 21, she was named felt that in addition to controlling cally acquire a mild case of the the Head Nurse. Clara Maass mosquitoes, means would be disease, survive, and hence be was obviously very intelligent, needed to completely eliminate immunized for life. Well, we now highly motivated and had a yellow fever. know that yellow fever does not bright future. behave in this fashion! One such approach, ill-fated Also during 1898, Clara served as it turned out, involved im- Tragically, some of the cases as a contract nurse for the United munization, using infected produced in these experiments States Army during the Spanish- mosquitoes. With the advice were much more severe than American War. At that time, and consent of Major Gorgas expected. Three of the volun- nurses were not able to serve and Major General Leonard teers died, including Miss Clara as officers in the Army, as they Wood, the Military Governor of Maass. are today. She cared for soldiers

Figure 3: Clara Maass, standing on right, with friends in Jacksonville, Florida, circa 1898.

18 Summer 2011 Wing Beats in Jacksonville, FL; Savannah, New Jersey: “God will care for the American Nurses Association GA; and Santiago, Cuba, be- me in the yellow fever hospital Hall of Fame. In 1952 the Newark coming intimately familiar with the same as if I were home. I will German Hospital, where Clara typhoid fever, malaria, dengue send you nearly all I earn, so be had once been the Head Nurse, and yellow fever. After success- good to yourself and the two little was renamed the “Clara Maass ful service, she was discharged ones. You know I am the man of Memorial Hospital” in her honor, in February 1899 and returned the family, but do pray for me.” and it remains so to this day. home to New Jersey. The follow- ing November, however, Clara FALLOUT AND RECOGNITION POSTSCRIPT again boldly volunteered for service in the Philippines, where As might be expected, Clara’s The angel Clara Louise Maass the United States Army was fight- death, and the deaths of two lived and died a true American ing. After seven months she was other volunteers, sent shock heroine. Let those of us who toil sent home to recover from what waves through the Army, that in the fields of mosquito control was reported to be a case of reverberated all the way back to and public health resolved to ! the United States. The major New honor and cherish her name and York City newspapers carried the memory, and the names and OFF TO CUBA AGAIN story of her death on the front memories of so many others who page, and shortly thereafter all have made the ultimate sacri- Clara Maass must have been a human experimentation with fice for the sake of humanity. remarkable woman, for in Oc- yellow fever in Cuba ceased. tober of 1900, after most of the The New York Times reported Disclaimer: The views con - work of the Reed Commission that not only was Clara willing tained herein are solely those was complete, Clara again vol- to incur the risk of infection and of the author and do not nec- unteered to go to Cuba to assist disease, but she desired to make essarily reflect the views of the in the fight to control mosquitoes herself immune through infection Department of Defense or the and yellow fever. Upon receiving in order to better serve those Department of the Navy. an urgent message – “Come at suffering from yellow fever. once” – from Major Gorgas to The author thanks John T Cun- report, she did so. Upon return- With her sister Sophie present, ningham, author of Clara Maass ing to Cuba, Clara worked in Clara Maass was hastily buried – A Nurse, A Hospital, A Spirit for the Las Animas Hospital, caring in Havana, with full military permission to use photos from for victims of yellow fever. Also, honors. About six months later, his book. A special thank you she bravely volunteered for the her body was returned to the to my friend and colleague, Guiteras mosquito experiments, United States and reinterred on Dr Rich Robbins, Armed Forces sending nearly all her payment of February 20, 1902, in Fairmount Pest Management Board, for his $100 in gold home to her mother. Cemetery in Newark. Her plaque careful review of the manuscript. Of the 19 participants in these reads in part, “greater love hath studies, she was the only woman no man than this,” from the Book and the only American. She re- of John, chapter 15, verse 13. ceived numerous mosquito bites during May, June and July but Clara’s contributions and memory she did not contract yellow fever, have been honored in several not even a mild case as some ways. A Senate Committee find- historical documents claim. ing “...that the services of this Captain Stanton E Cope nurse can be accepted as of a Director Clara Maass was bitten for the military character at the time of Medical Service Corps last time on August 14, 1901. She her death...” resulted in the award United States Navy became ill on the 18th and even of a pension to her mother. Post- [email protected] with the best medical care avail- age stamps bearing her likeness Director able, she died on August 24. She were issued by Cuba in 1951 Armed Forces Pest was all of 25 years old. Dr Gorgas and by the United States in 1976, Management Board kept Clara’s family fully up to which served to help celebrate Defense Pest Management date by telegram of her illness her 100th birthday. Also in 1976, Silver Spring, MD 20901 and death. After Clara became Clara was inducted, along with 301-295-8306 ill, she wrote to her mother in 14 others, as a charter member in

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