Clio Medica, Vol. 12, No. 2/3, pp. 131-145, 1977 © B.M. Israel, Amsterdam, The Netherlands

Hideyo Noguchi (1876-1928) · His Final Effort*

CLAUDE E. DOLMAN

The centennial of Noguchi's birth was celebrated with much fanfare in Japan last year. The salient features of his life have been outlined recently1, but the background and circumstances of his death have been glossed over or distorted. The acknowledged facts are that he died in 1928 on the Gold Coast (now Ghana) from laboratory-acquired yellow fever; and that the last six months of his life had two main objectives: 1. To confirm or disprove the 1927 findings of the Rockefeller Foundation's second West African Yellow Fever Commission, implicating a virus as etiological agent. 2. To compare West African yellow fever with the Central and South American disease, which he had ascribed ten years before to a specific bacterium, Leptospira icteroides. In writing this account of Noguchi's mission to West Africa, the main motives have been those of the historian who desires not to sit in judgment, especially upon the dead, but to set the record straight with the aid of valid documents and reliable memories; to encourage intelligent curiosity and sound opinions where questions remain unanswered; and to promote international perspective without puncturing national pride wherever these may conflict over the issues involved. Soon after the Rockefeller Foundation was organized in 1913 for "the well• being of mankind throughout the world", Mr. Wickliffe Rose, Director of its International Health Commission, noted rising concern about the Panama Canal possibly serving to convey yellow fever to the Far East. Rose persuaded Surgeon• General Gorgas to direct a six-man Yellow Fever Commission, to eliminate all endemic foci of the disease. The Aedes population of these areas would be lowered until residual mosquitoes were pitted against a factor which Henry Carter (a member of Gorgas' team) had termed "failure of the human most", i.e. an envir• onment lacking sufficient infective sources and non-immune humans to permit stray Aedes to transmit the yellow fever agent.

* Based on a paper presented at the Twenty-fifth International Congress for the History of Medicine, Quebec, Canada, August 21-28, 1976.

131 132 Claude E. Dolman

LEPTOSPIRA ICTEROIDES

In 1916, the Commission concluded that the only active endemic centre of yellow fever in South America was Guayaquil, Ecuador, but that possible foci in Mexico and West Africa needed investigation. Since the work of Walter Reed's Commis• sion in Cuba at the turn of the century, mosquito eradication had been so success• ful in controlling yellow fever that studies of the actual transmissible agent had not been pursued. Before anti-mosquito techniques were applied in Guayaquil, another commission was appointed to study the microbiology of all endemic in• fections in the city (especially any that might be confused with yellow fever), under the chairmanship of AI. Kendall, Dean of Northwestern University Medical School, himself a bacteriologist. The team, which included Hideyo Noguchi, member of the Rockefeller Institute for Medical Research, dispersed after two months- all except Noguchi, who had experiments to complete. The International Health Board then began eradicating mosquitoes, and in six months freed the city of yellow fever for the first time in a century. In 1920 the long-standing quarantine against Guayaquil was lifted.2 These accomplishments were overshadowed by Noguchi's announcement that in several cases of yellow fever he had demonstrated a spiral bacterium, Lep• tospira icteroides, which he considered the causal organism. The Leptospira required special media for growth, but guinea pigs developed jaundice and severe visceral lesions, resembling those of yellow fever, when injected with a yellow fever patient's blood. Noguchi's claims, added to his ingratiating manners and attempts to speak Spanish, made him a popular figure, and he was given the rank of honorary colonel in the Ecuadorian army. His discovery of the yellow fever germ, on July 24, 1918, is still commemorated by a plaque at the National In• stitute of Hygiene, Guayaquil. During the next three years, Noguchi and his trainees obtained similar results in small outbreaks in Yucatan, Peru, and Brazil. The findings were published in fourteen reports headed "Etiology of Yell ow Fever" in the Journal of Experimental Medicine.a Prophylactic vaccines and therapeutic antisera prepared from Leptospira icteroides were distributed by the Rockefeller Institute for field and clinical trials in yellow fever until 1926. The director of the Institute, Simon Flexner, was also the Journal's editor. The origin of the bond between Noguchi and Flexner dates back to 1899, when Flexner led a Johns Hopkins University commission to study diseases of American soldiers in the Philippine Islands. Stopping off in Tokyo, Flexner sought permis• sion to visit Prof. Kitasato's Institute. A courteous invitation was brought to the hotel by a graduate from a little-known Tokyo medical school, now an assistant at the Institute, with scant prospect for advancement - Noguchi. The messenger soon conveyed his wish to study pathology and bacteriology in America, but the request received no particular encouragement. That autumn, however, soon after Flexner became professor of pathology at Philadelphia, Noguchi arrived, dressed