The Great Influenza (29 page)

Royal Copeland, head of the New York City health department, and the port health officer jointly stated there was 'not the slightest danger of an epidemic' because the disease seldom attacks 'a well-nourished people.' (Even had he been right, a study by his own health department had just concluded that 20 percent of city schoolchildren were malnourished.) He took no action whatsoever to prevent the spread of infection.

A navy bulletin warned of two steamships from Norway and one from Sweden arriving in New York City with influenza cases aboard on August 14 and 15. On August 18, New York papers described outbreaks on board the
Rochambeau
and
Nieuw Amsterdam;
men from both ships had been taken to St. Vincent's Hospital.

On August 20 even Copeland conceded that influenza, though mild and (he claimed) certainly not in epidemic form, was present in the city. The lethal variant of the virus was finding its home in humans. Now, almost simultaneously, on three continents separated by thousands of miles of ocean (in Brest, in Freeport, Sierra Leone, and in Boston) the killing, rolling boil was about to begin.

* 

Nearly 40 percent of the two million American troops who arrived in France (791,000 men) disembarked at Brest, a deepwater port capable of handling dozens of ships simultaneously. Troops from all over the world disembarked there. Brest had already seen a burst of influenza in the spring as had many other cities, albeit as in most of those other places that influenza had been mild. The first outbreak with high mortality occurred in July, in a replacement detachment of American troops from Camp Pike, Arkansas. They occupied an isolated camp and the outbreak initially seemed contained. It was not. By August 10, the same day the British army declared the influenza epidemic over, so many French sailors stationed at Brest were hospitalized with influenza and pneumonia that they overwhelmed the naval hospital there - forcing it to close. And the death rate among them began soaring.

The August 19
New York Times
took note of another outbreak: 'A considerable number of American negroes, who have gone to France on horse transports, have contracted Spanish influenza on shore and died in French hospitals of pneumonia.'

Within another few weeks all the area around Brest was in flames. American troops continued pouring into and then out of the city, mixing with French troops also training in the vicinity. When soldiers of both armies left the vicinity, they dispersed the virus en masse.

* 

Freetown, Sierra Leone, was a major coaling center on the West African coast, servicing ships traveling from Europe to South Africa and the Orient. On August 15 the HMS
Mantua
arrived there with two hundred crew suffering from influenza. Sweating black men loaded tons of coal into her, guided by several crew.

When the laborers returned to their homes, they carried more than their wages. Soon influenza spread through the force of men who coaled the ships. And this influenza was not mild. On August 24, two natives died of pneumonia while many others were still sick.

On August 27, the HMS
Africa
pulled into port. She too needed coal, but five hundred of the six hundred laborers of the Sierra Leone Coaling Company did not report to work that day. Her crew helped coal her, working side by side with African laborers. She carried a crew of 779. Within a few weeks, nearly six hundred were sick. And fifty-one were dead - 7 percent of the entire crew died.

The transport HMS
Chepstow Castle,
carrying troops from New Zealand to the front, coaled at Freetown on August 26 and 27; within three weeks, out of her 1,150 men, influenza struck down nine hundred of them. The death toll on her was thirty-eight.

The
Tahiti
coaled at the same time; sixty-eight men aboard her died before she reached England, the same day as the
Chepstow Castle.
After docking, crew of the two ships suffered eight hundred more cases and 115 more deaths.

In Sierra Leone itself, officials soon after estimated that influenza killed 3 percent of the entire African population, nearly all of them dying within the next few weeks. More recent evidence suggests that the death toll was most likely considerably more than that, possibly double that figure - or higher.

* 

Across the Atlantic, at Commonwealth Pier in Boston, the navy operated a 'receiving ship.' The name was a misnomer. It was actually a barracks where as many as seven thousand sailors in transit ate and slept in what the navy itself called 'grossly overcrowded' quarters.

On August 27, two sailors reported to sick bay with influenza. On August 28, eight more sailors reported ill. On August 29, fifty-eight men were admitted.

As in Brest and Freetown and aboard ship, men began to die. Fifty of the men were quickly transferred to the Chelsea Naval Hospital, where Lieutenant Commander Milton Rosenau and his young assistant Lieutenant John J. Keegan, worked.

The sailors were in better than good hands. While Keegan would later become dean of the University of Nebraska Medical School, Rosenau was one of the giants of the day. Strong, solid, and thick-necked, he looked as intimidating and determined as a wrestler staring down an opponent. Yet he was uniformly polite and supportive, and people enjoyed working under him. A prime mover in creating the U.S. Public Health Service Hygienic Laboratory and later the president of the Society of American Bacteriologists, he was best known for his textbook,
Preventive Medicine and Hygiene,
which was referred to as 'The Bible' for both army and navy medical officers. Only a few weeks earlier, he had met with Welch, Gorgas, and Vaughan to discuss how to prevent or contain any new epidemic.
^*

Rosenau and Keegan immediately isolated the men and did everything possible to contain the disease, working backward from each victim to trace and isolate people with whom the patients had had contact. But the disease was too explosive. They turned their attention to bacteriological analysis, seeking the pathogen so they could prepare a vaccine or serum. Their findings did not satisfy them, and within a few weeks they began using human volunteers from the navy brig in the first experiments in the world to determine if a virus caused the disease.

Long before that any hopes of containing the disease had collapsed. On September 3 a civilian suffering from influenza was admitted to the Boston City Hospital. On September 4 students at the Navy Radio School at Harvard, in Cambridge across the Charles River from Boston proper, fell ill.

And then came Devens.

CHAPTER SIXTEEN

C
AMP
D
EVENS
sat on five thousand acres in rolling hills thirty-five miles northwest of Boston. It included fine farmland along the Nashua River, as well as what had been until recently heavily forested land cut down now to tree stumps. Like the other cantonments in the country it was thrown together with amazing speed, at the rate of 10.4 buildings a day. In August 1917 it opened with fifteen thousand men although the camp was incomplete - its sewage was still being discharged directly into the Nashua River.

Like most other camps, it had suffered from measles and pneumonia. The medical staff was first rate. An inspection of the Devens hospital had given it an excellent review down to its kitchen, noting, 'The mess officer is well informed and alert.'

In fact the Devens medical staff was so good that Frederick Russell was preparing to rely on it to launch several major new scientific investigations. One involved correlating the existence of streptococci in the mouths of healthy soldiers with streptococcal infections of the throat. Another sought an explanation for the far higher morbidity rates of pneumonia among blacks over whites. Still another involved measles. Late in the summer at Devens, Major Andrew Sellards had passed infectious material from a recent measles case through a porcelain filter to isolate the virus, had inoculated four monkeys with it, and on August 29 began inoculating a series of human volunteers.

The only problem at Devens was that it was built to hold a maximum of thirty-six thousand men. On September 6, Devens held just over forty-five thousand men. Still, the camp hospital could accommodate twelve hundred and it was caring for only eighty-four patients. With enough medical personnel to run several simultaneous research efforts, with a highly competent clinical staff, with a virtually empty hospital, Devens seemed ready for any emergency.

It wasn't.

* 

A week before any reported illness in the harbor, Boston public health authorities worried: 'A sudden and very significant increase reported the third week of August in the cases of pneumonia occurring in the army cantonment at Camp Devens in the district seems to justify a suspicion that an influenza epidemic may have started among the soldiers there.'

While the eruption at Devens might still have come from the Navy Commonwealth Pier facility, it might also have developed independently. It might even have spread to Boston from Devens. At any rate, on September 1, four more soldiers at Devens were diagnosed with pneumonia and admitted to the hospital. In the next six days, twenty-two more new cases of pneumonia were diagnosed. None of these, however, were considered to be influenza.

On September 7, a soldier from D Company, Forty-second Infantry, was sent to the hospital. He ached to the extent that he screamed when he was touched, and he was delirious. He was diagnosed as having meningitis.

The next day a dozen more men from his company were hospitalized and suspected of having meningitis. It was a reasonable diagnosis. Symptoms did not resemble those of influenza, and a few months earlier the camp had suffered a minor epidemic of meningitis, and the doctors (lacking any false pride) had even called Rosenau for help. He had come himself, along with six bacteriologists; they had worked nearly around the clock for five days, identifying and quarantining 179 carriers of the disease. Rosenau had left the camp impressed with army medicine; even though he and his staff had done much of the work, he had advised navy superiors that the same effort would not have been possible in the navy.

Now, over the next few days, other organizations began reporting cases of influenza-like disease. The medical staff, good as it was, did not at first connect these various cases to each other or to the outbreak on Commonwealth Pier. They made no attempt to quarantine cases. In the first few days no records of influenza cases were even kept because they 'were looked upon as being examples of the epidemic disease which attacked so many of the camps during the spring.' In the overcrowded barracks and mess halls, the men mixed. A day went by. Two days. Then, suddenly, noted an army report, 'Stated briefly, the influenza' occurred as an explosion.'

It exploded indeed. In a single day, 1,543 Camp Devens soldiers reported ill with influenza. On September 22, 19.6 percent of the entire camp was on sick report, and almost 75 percent of those on sick report had been hospitalized. By then the pneumonias, and the deaths, had begun.

On September 24 alone, 342 men were diagnosed with pneumonia. Devens normally had twenty-five physicians. Now, as army and civilian medical staff poured into the camp, more than two hundred and fifty physicians were treating patients. The doctors, the nurses, the orderlies went to work at 5:30
A.M.
and worked steadily until 9:30
P.M.
, slept, then went at it again. Yet on September 26 the medical staff was so overwhelmed, with doctors and nurses not only ill but dying, they decided to admit no more patients to the hospital, no matter how ill.

The Red Cross, itself by then overwhelmed by the spread of the disease to the civilian population, managed to find twelve more nurses to help and sent them. They were of little help. Eight of the twelve collapsed with influenza; two died.

For this was no ordinary pneumonia. Dr. Roy Grist, one of the army physicians at the hospital, wrote a colleague, 'These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most vicious type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white.'

Blood carrying oxygen in arteries is bright red; without oxygen in veins it is blue. Cyanosis occurs when a victim turns blue because the lungs cannot transfer oxygen into the blood. In 1918 cyanosis was so extreme, turning some victims so dark (the entire body could take on color resembling that of the veins on one's wrists) it sparked rumors that the disease was not influenza at all, but the Black Death.

Grist continued, 'It is only a matter of a few hours then until death comes' . It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies' We have been averaging about 100 deaths per day' . Pneumonia means in about all cases death' . We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce' . It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows' . Good By old Pal, God be with you till we meet again.'

* 

Welch, Cole, Victor Vaughan, and Fredrick Russell, all of them colonels now, had just finished a tour of southern army bases. It was not their first such tour, and as before, knowing that an army barracks offered explosive tinder, they had been inspecting camps to find and correct any practice that might allow an epidemic to gain a foothold. They also spent much time discussing pneumonia. After leaving Camp Macon in Georgia, they had retired for a few days of relaxation to Asheville, North Carolina, the most fashionable summer retreat in the South. The Vanderbilts had built one of the most elaborate estates in the country there, and not many miles away Welch's old colleague William Halsted had built a virtual castle in the mountains (today Halsted's home is a resort called the High Hamptons).