The Great Influenza (54 page)

They also all played to fear. 'How To Prevent Infection From Spanish Influenza' . The Surgeon General of the U.S. Army urges you to keep your mouth clean' . [use] a few drops of liquid SOZODONT.''Help your Health Board Conquer Spanish influenza By Disinfecting your Home' Lysol Disinfectant.' 'For GRIP' You are Safe When You Take Father John's Medicine.' 'Influ-BALM Prevents Spanish Flu.' 'Special Notice to the Public. Telephone inquiries from Minneapolis physicians and the laity and letters from many parts of America are coming into our office regarding the use of Benetol,' a powerful bulwark for the prevention and treatment of Spanish influenza' .' 'Spanish influenza - what it is and how it should be treated:' Always Call a Doctor/ No Occasion For Panic'. There is no occasion for panic - influenza itself has a very low percentage of fatalities' . Use Vicks VapoRub.'

* 

By the middle of October, vaccines prepared by the best scientists were appearing everywhere. On October 17 New York City Health Commissioner Royal Copeland announced that 'the influenza vaccine discovered by Dr. William H. Park, director of the City Laboratories, had been tested sufficiently to warrant its recommendation as a preventive agency.' Copeland assured the public that 'virtually all persons vaccinated with it [were] immune to the disease.'

In Philadelphia on October 19, Dr. C. Y. White, a bacteriologist with the municipal laboratory, delivered ten thousand dosages of a vaccine based on Paul Lewis's work, with tens of thousands of dosages more soon to come. It was 'multivalent,' made up of dead strains of several kinds of bacteria, including the influenza bacillus, two types of pneumococci, and several strains of other streptococci.

That same day a new issue of
JAMA
appeared. It was thick with information on influenza, including a preliminary evaluation of the experience with vaccines in Boston. George Whipple, another Welch product and later a Nobel laureate, concluded, 'The weight of such statistical evidence as we have been able to accumulate indicates that the use of the influenza vaccine which we have investigated is without therapeutic benefit.' By 'therapeutic' Whipple meant that the tested vaccines could not cure. But he continued, 'The statistical evidence, so far as it goes, indicates a probability that the use of this vaccine has some prophylactic value.'

He was hardly endorsing Copeland's statement, but at least he provided some hope.

The Public Health Service made no effort to produce or distribute any vaccine or treatment for civilians. It received requests enough. It had nothing to offer.

The Army Medical School (now the Armed Forces Institute of Pathology) in Washington did mount a massive effort to make a vaccine. They needed one. At the army's own Walter Reed Hospital in Washington, the death rate for those with complicating pneumonia had reached 52 percent. On October 25 the vaccine was ready. The surgeon general's office informed all camp physicians, 'The value of vaccination against certain of the more important organisms giving rise to pneumonia may be considered to be established' . The Army now has available for all officers, enlisted men, and civilian employees of the Army, a lipo vaccine containing pneumococcus Types I, II, and III.'

The army distributed two million doses of this vaccine in the next weeks. This marked an enormous production triumph. Earlier a prominent British scientist had pronounced it impossible for the British government to produce even forty thousand doses on short notice. But the vaccine still protected only against pneumonias caused by Types I and II pneumococci, and it came too late; by then the disease had already passed through nearly all cantonments. When civilian physicians from New York to California begged for the vaccine from the army, the reply came back that the army had in fact produced 'a vaccine for the prevention of pneumonia, but none is available for distribution.' The army feared a recrudescence among troops; it had good reason to fear one.

The Army Medical School had also produced a vaccine against
B. influenzae,
but of this Gorgas's office spoke more cautiously: 'In view of the possible etiologic importance of the bacillus influenzae in the present epidemic, a saline vaccine has been prepared by the Army and is available to all officers, enlisted men, and civilian employees of the Army. The effectiveness of bacillus influenzae vaccine' is still in the experimental stage.'

That army statement was not a public one. Nor really was a cautionary
JAMA
editorial: 'Unfortunately we as yet have no specific serum or other specific means for the cure of influenza, and no specific vaccine for its prevention. Such is the fact, all claims and propagandists in the newspapers and elsewhere to the contrary not with standing' . Consequently the physician must keep his head and not allow himself to make more promises than the facts warrant. This warning applies especially to health officers in their public relations.' Nearly every issue contained a similar warning: 'Nothing should be done by the medical profession that may arouse unwarranted hope among the public and be followed by disappointment and distrust of medical science and the medical profession.'

JAMA
represented the American Medical Association. AMA leaders had worked for decades to bring scientific standards and professionalism to medicine. They had only recently succeeded. They did not want to destroy the trust only recently established. They did not want medicine to become the mockery it had been not so long before.

In the meantime physicians continued to try the most desperate measures. Vaccines continued to be produced in great numbers - eighteen different kinds in Illinois alone. No one had any real idea whether any would work. They had only hope.

But the reality of the disease was expressed in a recitation of events during the epidemic at Camp Sherman, Ohio, the single camp with the highest death rate. Its doctors precisely followed the standard treatment for influenza Osler had recommended in the most recent edition of his textbook - aspirin, rest in bed, gargles, and 'Dover's powders,' which were a combination of ipecac to induce vomiting and opium to relieve pain and cough. For complicating but standard pneumonias they followed 'the usual recommendations for diet, fresh air, rest, mild purgation and elimination'. All cases were digitalized' (digitalis given in maximum possible dosages to stimulate the heart) 'and reliance placed on soluble caffeine salt for quick stimulation. Strychnin in large doses hypodermically had a distinct value in the existing asthenia.'

Then, however, they reported their helplessness in the far too common 'acute inflammatory pulmonary edema,' what today would be called ARDS. 'This presented a new problem in therapy. The principles of treatment employed in pulmonary edema incident to dilation of the heart, though seemingly not indicated by the condition in question, were employed. Digitalis, a double caffeine salt, morphin [
sic
], and venesection' (bleeding again) 'were without significant value' . Oxygen was of temporary value. Posture accomplished drainage but did not influence the end result. Pituitary solution, hypodermically, was suggested by the similarity of this condition to the results of gassing. No benefits were gained by its use.'

They tried everything, everything they could think of, until they finally took pity and stopped, abandoning some of the more brutal (and useless) treatments they had tried 'on account of [their] heroic character.' By then they had seen enough of heroism from dying soldiers. They were finally willing to let them go in peace. Against this condition they could only conclude, 'No especial measure was of avail.'

* 

No medicine and none of the vaccines developed then could prevent influenza. The masks worn by millions were useless as designed and could not prevent influenza. Only preventing exposure to the virus could. Nothing today can cure influenza, although vaccines can provide significant (but nowhere near complete) protection, and several antiviral drugs can mitigate its severity.

Places that isolated themselves (such as Gunnison, Colorado, and a few military installations on islands) escaped. But the closing orders that most cities issued could not prevent exposure; they were not extreme enough. Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer. Even where fear closed down businesses, where both store owners and customers refused to stand face-to-face and left orders on sidewalks, there was still too much interaction to break the chain of infection. The virus was too efficient, too explosive, too good at what it did. In the end the virus did its will around the world.

It was as if the virus were a hunter. It was hunting mankind. It found man in the cities easily, but it was not satisfied. It followed him into towns, then villages, then individual homes. It searched for him in the most distant corners of the earth. It hunted him in the forests, tracked him into jungles, pursued him onto the ice. And in those most distant corners of the earth, in those places so inhospitable that they barely allowed man to live, in those places where man was almost wholly innocent of civilization, man was not safer from the virus. He was more vulnerable.

In Alaska, whites in Fairbanks protected themselves. Sentries guarded all trails, and every person entering the city was quarantined for five days. Eskimos had no such luck. A senior Red Cross official warned that without 'immediate medical assistance the race' could become 'extinct.'

Neither Red Cross nor territorial government funds were available. The governor of Alaska came to Washington to beg Congress for $200,000 - compared to the $1 million given to the Public Health Service for the entire country. A senator asked why the territory couldn't spend any of the $600,000 in its treasury. The governor replied, 'The people of Alaska consider that the money raised by taxes from the white people of Alaska should be spent for the improvements of the Territory. They need the money in roads a great deal' . They want to have the Indians in Alaska placed more on a parity with the Indians of other parts of the United States, where they are taken care of by the United States government.'

He got $100,000. The navy provided the collier USS
Brutus
to carry a relief expedition. At Juneau the party divided and went in smaller boats to visit villages.

They found terrible things. Terrible things. In Nome, 176 of 300 Eskimos had died. But it would get worse. One doctor visited ten tiny villages and found 'three wiped out entirely; others average 85% deaths' . Survivors generally children' probably 25% this number frozen to death before help arrived.'

A later relief expedition followed, funded by the Red Cross, dividing itself in the Aleutian Islands into six groups of two doctors and two nurses each, then boarding other ships and dispersing.

The first group disembarked at a fishing village called Micknick. They arrived too late. Only half a dozen adults survived. Thirty-eight adults and twelve children had died. A small house had been turned into an orphanage for fifteen children. The group crossed the Naknek River to a village with a seafood cannery. Twenty-four adult Eskimos had lived there before the epidemic. Twenty-two had died; a twenty-third death occurred the day after the relief expedition arrived. Sixteen children, now orphans, survived. On Nushagak Bay the Peterson Packing Company had established a headquarters and warehouse. Nurses went hut to hut. 'The epidemic of influenza had been most severe at this place, few adults living. On making a search Drs. Healy and Reiley found a few natives bedfast'. The doctors worked most faithfully but help arrived too late and five of the patients died.'

There was worse. Another rescue team reported, 'Numerous villages were found but no sign of life about except for packs of half-starved, semi-wild dogs.' The Eskimos there lived in what was called a 'barabara.' Barabaras were circular structures two-thirds underground; they were built like that to withstand the shrieking winds that routinely blew at hurricane force, winds that ripped conventional structures apart. One rescuer described a barabara as 'roughed over with slabs of peat sod,' entrance to which is gained through a tunnel of from four to five feet in height, this tunnel being its only means of light and ventilation, in most cases; about the sides of these rooms are dug shelves and in these shelves, on mattresses of dried grasses and furs, the people sleep.'

Entire family groups, a dozen people or more, lived in this one room. 'On entering these barabaras, Dr. McGillicuddy's party found heaps of dead bodies on the shelves and floors, men, women, and children and the majority of the cases too far decomposed to be handled.'

The virus probably did not kill all of them directly. But it struck so suddenly, with such simultaneity, it left no one well enough to care for any others, no one to get food, no one to get water. And those who could have survived, surrounded by bodies, bodies of people they loved, might well have preferred to go where their family had gone, might well have wanted to no longer be alone.

And then the dogs would have come.

'It was quite impossible to estimate the number of dead as the starving dogs had dug their way into many huts and devoured the dead, a few bones and clothing left to tell the story.'

All the relief party could do was tie ropes around remains, drag them outside, and bury them.

* 

On the opposite edge of the continent the story was the same. In Labrador man clung to existence with tenacity but not much more permanency than seaweed drying on a rock, vulnerable to the crash of surf at high tide. The Reverend Henry Gordon left the village of Cartwright in late October and returned a few days later, on October 30. He found 'not a soul to be seen anywhere, and a strange, unusual silence.' Heading home, he met a Hudson's Bay Company man who told him 'sickness' has struck the place like a cyclone, two days after the Mail boat had left.' Gordon went from house to house. 'Whole households lay inanimate on their kitchen floors, unable even to feed themselves or look after the fire.'

Twenty-six of one hundred souls had died. Farther up the coast, it was worse.