Walter Reed, Yellow Fever, and Informed Consent
Journal Article - Open Access
AMERICAN REGISTRY OF PATHOLOGY ROCKVILLE MD ROCKVILLE United States
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In May 1900, Surgeon General George M. Sternberg commissioned a board of Army research scientists to pursue scientific investigations with reference to the infectious diseases prevalent on the Island of Cuba, and, especially, yellow fever. Yellow fever was perhaps the most feared of epidemics its mortality rate was known to reach 85. It was unpredictable, catastrophically virulent, and there was no effective treatment. Despite years of research, all attempts to produce yellow fever in animals had failed. In July 1900, Walter Reed told Sternberg that human subject testing was the only option. The team also determined that they, too, would be put at risk the serious nature of the work was decided upon and the risks . . . were fully considered, and we all agreed as the best justification we could offer for experimentation upon others, was to submit the same risk of inoculation ourselves. Reed sought volunteers from the Spanish immigrant community who had not yet contracted yellow fever. Reed asked the Governor General of Cuba to seek approval from the Spanish consul he wanted them to know that volunteers would be of legal maturity, and that they would be provided the best medical care. Volunteers would receive payment of 100 in gold, and another 100 if they became ill. In a further unprecedented act, Reed developed a written consent document in Spanish Fig. 1, so subjects would be fully aware of the risks and would have signed documentation promising care and compensation. This was a time when prisoners, the indigent, the mentally ill, people of color, and children were routinely used as experimental subjects, sometimes without their knowledge and almost always without their consent. There were no government or military regulations that covered medical research. The U.S. Army Yellow Fever Board is considered the first research group in history to use consent forms.