The Great Influenza (30 page)

At the Grove Park Inn, one of the most elegant settings in the city, they listened to a concert. Welch lit a cigar. A bellboy promptly told him smoking was not allowed. He and Cole withdrew to the veranda and began talking. Another bellboy asked them to please be quiet during the concert. Welch left in disgust.

Meanwhile Russell wrote Flexner, 'We are all well. Welch, Vaughan, and Cole, and I have had a very profitable trip and have begun to believe that immunity' (in this he was referring to efforts to manipulate the immune system) 'is the most important thing in pneumonia, as in other infectious diseases. It makes a good working hypothesis and one we will try to follow up by working in the lab, wards, and in the field this fall and winter. Bonne chance.'

The group returned to Washington on a Sunday morning relaxed and in good spirits. But their mood changed abruptly as they stepped off the train. An escort had been waiting for them and his anxiety quickly communicated itself. He was taking them to the surgeon general's office - immediately. Gorgas himself was in Europe. His deputy barely looked up as they opened the door: 'You will proceed immediately to Devens. The Spanish influenza has struck that camp.'

* 

They arrived at Devens eight hours later in a cold and drizzling rain. The entire camp was in chaos, the hospital itself a battlefield. The war had come home indeed. As they entered the hospital, they watched a continuous line of men filing in from the barracks carrying their blankets or being themselves carried.

Vaughan recorded this sight: 'hundreds of young stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full and yet others crowd in. The faces wear a bluish cast; a distressing cough brings up the blood-stained sputum.'

Care was almost nonexistent. The base hospital, designed for twelve hundred, could accommodate at most (even with crowding 'beyond what is deemed permissible,' according to Welch) twenty-five hundred. It now held in excess of six thousand. All beds had long since been filled. Every corridor, every spare room, every porch was filled, crammed with cots occupied by the sick and dying. There was nothing antiseptic about the sight. And there were no nurses. When Welch arrived seventy out of two hundred nurses were already sick in bed themselves, with more falling ill each hour. Many of them would not recover. A stench filled the hospital as well. Bed linen and clothing were rank with urine and feces from men incapable of rising or cleaning themselves.

Blood was everywhere, on linens, clothes, pouring out of some men's nostrils and even ears while others coughed it up. Many of the soldiers, boys in their teens, men in their twenties (healthy, normally ruddy men) were turning blue. Their color would prove a deadly indicator.

The sight chilled even Welch and his colleagues. It was more chilling still to see corpses littering the hallways surrounding the morgue. Vaughan reported, 'In the morning the dead bodies are stacked about the morgue like cord wood.' As Cole recalled, 'They were placed on the floor without any order or system, and we had to step amongst them to get into the room where an autopsy was going on.'

In the autopsy room they saw the most chilling sights yet. On the table lay the corpse of a young man, not much more than a boy. When he was moved in the slightest degree fluid poured out of his nostrils. His chest was opened, his lungs removed, other organs examined carefully. It was immediately apparent this was no ordinary pneumonia. Several other autopsies yielded similar abnormalities.

Cole, Vaughan, Russell, the other members of this scientific team were puzzled, and felt an edge of fear. They turned to Welch.

He had studied with the greatest investigators in the world as a young man. He had inspired a generation of brilliant scientists in America. He had visited and seen diseases in China, the Philippines, and Japan that were unknown in the United States. He had read scientific journals in many languages for years, heard back-channel gossip from all the leading laboratories in the world. Surely he would be able to tell them something, have some idea.

He did not reassure. Cole stood beside him, thinking he had never seen Welch look nervous before, or excited in quite this way. In fact Cole was shaken: 'It was not surprising that the rest of us were disturbed but it shocked me to find that the situation, momentarily at least was too much for Dr. Welch.'

Then Welch said, 'This must be some new kind of infection or plague.'

* 

Welch walked out of the autopsy room and made three phone calls, to Boston, New York, and Washington. In Boston he spoke to Burt Wolbach, a Harvard professor and chief pathologist at the the great Boston hospital the Brigham, and asked him to perform autopsies. Perhaps there was a clue to this strange disease there.

But Welch also knew that any treatment or prevention for this would have to come from the laboratory. From the Rockefeller Institute in New York he summoned Oswald Avery. Avery had been refused a commission in the Rockefeller army unit because he was Canadian, but on August 1 he had become an American citizen. By coincidence, the same day Welch called him, Avery was promoted from private to captain. More importantly, he had already begun the investigations that would ultimately revolutionize the biological sciences; influenza would confirm him in this work.

Later that day both Avery and Wolbach arrived and immediately began their respective tasks.

The third call Welch made was to Washington, to Charles Richard, the acting army surgeon general while Gorgas was at the front. Welch gave a detailed description of the disease and his expectations of its course at Devens and elsewhere. For this was going to spread. He urged that 'immediate provision be made in every camp for the rapid expansion of hospital space.'

* 

Richard responded instantly, sending orders to all medical personnel to isolate and quarantine all cases and segregate soldiers from civilians outside the camps: 'It is important that the influenza be kept out of the camps, as far as practicable' . Epidemics of the disease can often be prevented, but once established they cannot well be stopped.' But he also conceded the difficulty: 'There are few diseases as infectious as influenza' . It is probable that patients become foci of infection before the active symptoms' . No disease which the army surgeon is likely to see in this war will tax more severely his judgement and initiative.'

He also warned both the army adjutant general and chief of staff, 'New men will almost surely contract the disease. In transferring men from Camp Devens a virulent form of the disease will almost surely be conveyed to other stations' . During the epidemic new men should not be sent to Camp Devens, nor should men be sent away from that camp.'

The next day, with reports already of outbreaks in other camps, Richard tried to impress upon the chief of staff the lethality of the disease, relating what Welch had told him: 'The deaths at Camp Devens will probably exceed 500' . The experience at Camp Devens may be fairly expected to occur at other large cantonments' . With few exceptions they are densely populated, a condition which tends to increase the chance for 'contact' infection and the virulence and mortality of the disease' . It may be expected to travel westward and involve successively military stations in its course.' And he urged that the transfer of personnel from one camp to another be all but eliminated except for the most 'urgent military necessities.'

Gorgas had fought his own war, to prevent epidemic disease from erupting in the camps. He had lost.

* 

On August 27, the same day the first sailors at Commonwealth Pier fell ill, the steamer
Harold Walker
had departed Boston, bound for New Orleans. En route fifteen crew members had fallen ill; in New Orleans the ship unloaded its cargo and put three crewmen ashore. The three men died. By then the
Harold Walker
had proceeded to Mexico.

On September 4, physicians at the New Orleans naval hospital made the first diagnosis of influenza in any military personnel in the city; the sailor had arrived in New Orleans from the Northeast. That same date a second patient also reported ill with influenza; he was serving in New Orleans. Forty of the next forty-two patients who entered the hospital had influenza or pneumonia.

On September 7 three hundred sailors from Boston arrived at the Philadelphia Navy Yard. Many of them, mixing with hundreds of other sailors, were almost immediately transferred to the navy base in Puget Sound. Others had already gone from Boston to north of Chicago to the Great Lakes Naval Training Station, the largest facility of its kind in the world.

On September 8 at the Newport Naval Base in Rhode Island, more than one hundred sailors reported sick.

The virus was reaching south along the coast, jumping inland to the Midwest, spanning the nation to the Pacific.

Meanwhile, at the Chelsea Naval Hospital, Rosenau and his team of physicians were also overwhelmed - and well aware of the larger implications. Even before Avery arrived, he and Keegan had begun the first effort in the country, and possibly in the world, to create an immune serum that would work against this new mortal enemy. Simultaneously Keegan sent off a description of the disease to the
Journal of the American Medical Association,
warning that it 'promises to spread rapidly across the entire country, attacking between 30 and 40 percent of the population, and running an acute course.'

* 

Keegan was incorrect only in that he limited his estimate to 'the entire country.' He should have said 'the entire world.'

This influenza virus, this 'mutant swarm,' this 'quasi species,' had always held within itself the potential to kill, and it had killed. Now, all over the world, the virus had gone through roughly the same number of passages through humans. All over the world, the virus was adapting to humans, achieving maximum efficiency. And all over the world, the virus was turning lethal.

Around the world from Boston, in Bombay, which like so many other cities had endured a mild epidemic in June, the lethal virus exploded almost simultaneously. There it quickly began killing at a rate more than double that of a serious epidemic of bubonic plague in 1900.

* 

As the virus moved, two parallel struggles emerged.

One encompassed all of the nation. Within each city, within each factory, within each family, into each store, onto each farm, along the length of the track of the railroads, along the rivers and roads, deep into the bowels of mines and high along the ridges of the mountains, the virus would find its way. In the next weeks, the virus would test society as a whole and each element within it. Society would have to gather itself to meet this test, or collapse.

The other struggle lay within one tight community of scientists. They, men like Welch, Flexner, Cole, Avery, Lewis, Rosenau, had been drafted against their will into a race. They knew what was required. They knew the puzzle they needed to solve. They were not helpless. They had some tools with which to work. They knew the cost if they failed.

But they had very little time indeed.

Part V

EXPLOSION

CHAPTER SEVENTEEN

O
N
S
EPTEMBER
7, three hundred sailors arrived from Boston at the Philadelphia Navy Yard. And what happened in Philadelphia from that point would prove (too often) to be a model for what would happen elsewhere.

Philadelphia was already typical in its war experiences. Every city was being flooded by people, and in Philadelphia shipbuilding alone had added tens of thousands of workers. In a few months a great marsh had been transformed into the Hog Island shipyard, the largest shipyard in the world, where thirty-five thousand workers toiled among furnaces and steel and machinery. Nearby the New York Shipbuilding yard worked eleven thousand five hundred men, and a dozen other shipyards each worked from three thousand to five thousand more. And the city was thick with other great industrial plants: several munitions factories each employed several thousands at a single location, the J. G. Brill Company turned out a streetcar an hour and employed four thousand, Midvale Steel had ten thousand workers, Baldwin Locomotive, twenty thousand.

Overcrowded before the war, with jobs sucking ever more workers into the city and the population swelling to 1.75 million, Philadelphia literally teemed with people. In 1918 a national publication for social workers judged living conditions in its slums, where most tenements still had outhouses servicing dozens of families, worse than on the Lower East Side of New York. Blacks endured even more squalid conditions and Philadelphia had the largest African American population of any northern city, including New York or Chicago.

Housing was so scarce that Boy Scouts canvassed the area seeking rooms for newly arrived women with war jobs. Two, three, and four entire families would cram themselves into a single two-or three-room apartment, with children and teenagers sharing a bed. In rooming houses laborers shared not just rooms but beds, often sleeping in shifts just as they worked in shifts. In those same tenements, the city's own health department had conceded that during the winter of 1917-18 'the death rate' has gone up owing to the high cost of living and scarcity of coal.'

The city offered the poor social services in the form of Philadelphia Hospital, known as 'Blockley,' a poorhouse, and an asylum. But it offered nothing else, not even an orphanage. The social elite and progressives ran whatever charitable activities that did exist. Even normal services such as schools were in short supply. Of the twenty largest cities in America, Philadelphia, the city of Benjamin Franklin and the University of Pennsylvania, spent less on education than all but one. In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934.

All this made Philadelphia fertile ground for epidemic disease. So did a city government incapable of responding to a crisis. Muckraker Lincoln Steffens called Philadelphia 'the worst-governed city in America.' He may well have been right.