The Great Influenza (47 page)

The virus had reached New Orleans on September 4; the Great Lakes Naval Training Station on September 7; New London, Connecticut, on September 12.

Not until September 13 did the Public Health Service make any public comment, when it said, 'Owing to disordered conditions in European countries, the bureau has no authoritative information as to the nature of the disease or its prevalence.' That same day Blue did issue a circular telling all quarantine stations to inspect arriving ships for influenza. But even that order only advised delaying infected vessels until 'the local health authorities have been notified.'

Later Blue defended himself for not taking more aggressive action.
This was influenza, only influenza,
he seemed to be saying, 'It would be manifestly unwarranted to enforce strict quarantine against' influenza.'

No quarantine of shipping could have succeeded anyway. The virus was already here. But Blue's circular indicated how little Blue had done (in fact he had done nothing) to prepare the Public Health Service, much less the country, for any onslaught.

The virus reached Puget Sound on September 17.

Not until September 18 did Blue even seek to learn which regions of the United States the disease had penetrated.

On Saturday, September 21, the first influenza death occurred in Washington, D.C. The dead man was John Ciore, a railroad brakeman who had been exposed to the disease in New York four days earlier. That same day Camp Lee outside Petersburg, Virginia, had six deaths, while Camp Dix in New Jersey saw thirteen soldiers and one nurse die.

Still Blue did little. On Sunday, September 22, the Washington newspapers reported that Camp Humphreys (now Fort Belvoir), just outside the city, had sixty-five cases.

Now, finally, in a box immediately adjacent to those reports, the local papers finally published the government's first warning of the disease:

Surgeon General's Advice to Avoid Influenza

Avoid needless crowding.

Smother your coughs and sneezes.

Your nose not your mouth was made to breathe thru.

Remember the 3 Cs - clean mouth, clean skin, and clean clothes.

Food will win the war. [H]elp by choosing and chewing your food well.

Wash your hands before eating.

Don't let the waste products of digestion accumulate.

Avoid tight clothes, tight shoes, tight gloves - seek to make nature your ally not your prisoner.

When the air is pure breathe all of it you can - breathe deeply.

Such generalizations hardly reassured a public that knew that the disease was marching from army camp to army camp, killing soldiers in large numbers. Three days later a second influenza death occurred in Washington; John Janes, like the first Washington victim, had contracted the disease in New York City. Also that day senior medical personnel of the army, navy, and Red Cross met in Washington to try to figure out how they could aid individual states. Neither Blue nor a representative of the Public Health Service attended the meeting. Twenty-six states were then reporting influenza cases.

Blue had still not laid plans for an organization to fight the disease. He had taken only two actions: publishing his advice on how to avoid the disease and asking the National Academy of Sciences to identify the pathogen, writing, 'In view of the importance which outbreaks of influenza will have on war production, the Bureau desires to leave nothing undone' . The Bureau would deem it a valuable service if the Research Council arrange for suitable laboratory studies' as to the nature of the infecting organism.'

Crowder canceled the draft. Blue still did not organize a response to the emergency. Instead, the senior Public Health Service officer in charge of the city of Washington reiterated to the press that there was no cause for alarm.

Perhaps Blue considered any further action outside the authority of the Public Health Service. Under him the service was a thoroughly bureaucratic institution, and bureaucratic in none of the good ways. Only a decade earlier he had been stationed in New Orleans, when the last yellow-fever epidemic to strike the United States had hit there, and the Public Health Service had required the city to pay $250,000 (in advance) to cover the federal government's expenses in helping to fight that epidemic. Only a few weeks earlier, he had rejected the request from the service's own chief scientist for money to research pneumonia in concert with Cole and Avery at the Rockefeller Institute.

But governors and mayors were demanding help, beseeching everyone in Washington for help. Massachusetts officials in particular were begging for help from outside the state, for doctors from outside, for nurses from outside, for laboratory assistance from outside. The death toll there had climbed into the thousands. Governor Samuel McCall had wired governors for any assistance they could offer, and on September 26 he formally requested help from the federal government.

Doctors and nurses were what was needed. Doctors and nurses. And especially nurses. As the disease spread, as warnings from Welch, Vaughan, Gorgas, dozens of private physicians, and, finally, at last, Blue poured in, Congress acted. Without the delay of hearings or debate, it appropriated $1 million for the Public Health Service. The money was enough for Blue to hire five thousand doctors for emergency duty for a month (if he could somehow find five thousand doctors worth hiring.

Each day (indeed, each hour) was showing the increasingly explosive spread of the virus and its lethality. Blue, as if suddenly frightened, now considered the money too little. He had not complained to Congress about the amount; no record exists of his having asked for more. But the same day Congress passed the appropriation, he privately appealed to the War Council of the Red Cross both for more money and for its help.

The Red Cross did not get government funds or direction, although it was working in close concert with the government. Nor was its charge to care for the public health. Yet even before Blue asked, it had already allocated money to fight the epidemic and had begun organizing its own effort to do so - and do so on a massive scale. Its nursing department had already begun mobilizing 'Home Defense Nurses,' fully professional nurses, all of them women, who could not serve in the military because of age, disability, or marriage. The Red Cross had divided the country into thirteen divisions, and the nursing committee chief of each one had already been told to find all people with any nursing training, not only professionals or those who had dropped out of nursing schools (for the Red Cross checked with all nursing schools) but down to and including anyone who had ever taken a Red Cross course in caring for the sick at home. It had already instructed each division to form at least one mobile strike force of nurses to be ready to go to areas most in need. And before anyone within the government sought aid, the War Council of the Red Cross had designated a 'contingent fund for the purpose of meeting the present needs in coping with the epidemic of Spanish influenza.' Now the council agreed instantly to authorize expenditure of far more money than was in the contingency fund.

Finally, Blue began to organize the Public Health Service as well. Doctors and nurses were what was needed, doctors and nurses. But by then the virus had spanned the country, establishing itself on the perimeter, on the coasts, and it was working its way into the interior, to Denver, Omaha, Minneapolis, Boise. It was penetrating Alaska. It had crossed the Pacific to Hawaii. It had surfaced in Puerto Rico. It was about to explode across Western Europe, across India, across China, across Africa as well.

Science,
then as now a journal written by scientists for their colleagues, warned, 'The epidemics now occurring appear with electric suddenness, and, acting like powerful, uncontrolled currents, produce violent and eccentric effects. The disease never spreads slowly and insidiously. Wherever it occurs its presence is startling.'

October, not April, would be the cruelest month.

CHAPTER TWENTY-SEVEN

N
OTHING COULD HAVE STOPPED
the sweep of influenza through either the United States or the rest of the world - but ruthless intervention and quarantines might have interrupted its progress and created occasional firebreaks.

Action as ruthless as that taken in 2003 to contain the outbreak of a new disease called severe acute respiratory disorder, SARS, could well have had effect.
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Influenza could not have been contained as SARS was - influenza is far more contagious. But any interruption in influenza's spread could have had significant impact. For the virus was growing weaker over time. Simply delaying its arrival in a community or slowing its spread once there (just such minor successes) would have saved many, many thousands of lives.

There was precedent for ruthless action. Only two years earlier several East Coast cities had fought a polio outbreak with the most stringent measures. Public health authorities wherever polio threatened had been relentless. But that was before the United States entered the war. There would be no comparable effort for influenza. Blue would not even attempt to intrude upon war work.

The Public Health Service and the Red Cross still had a single chance to accomplish something of consequence. By early October the first fall outbreaks and the memory of those in the spring had already suggested that the virus attacked in a cycle; it took roughly six weeks from the appearance of the first cases for the epidemic to peak and then abate in civilian areas, and from three to four weeks in a military camp with its highly concentrated population. After the epidemic abated, cases still occurred intermittently, but not in the huge numbers that overwhelmed all services. So Red Cross and Public Health Service planners expected the attack would be staggered just as the arrival of the virus was staggered, peaking in different parts of the country at different times. During the peak of the epidemic, individual communities would not be able to cope; no matter how well organized they were they would be utterly overwhelmed. But if the Red Cross and Public Health Service could concentrate doctors, nurses, and supplies in one community when most needed, they might be able to withdraw the aid as the disease ebbed and shift it to the next area in need, and the next.

To manage this, Blue and Frank Persons, director of civilian relief and head of the new influenza committee of the Red Cross, divided the labor. The Public Health Service would find, pay, and assign all physicians. It would decide when and where to send nurses and supplies, to whom nurses would report, and it would deal with state and local public health authorities.

The Red Cross would find and pay nurses, furnish emergency hospitals with medical supplies wherever local authorities could not, and take responsibility for virtually everything else that came up, including distributing information. The Red Cross did stipulate one limit on its responsibility: it would not meet requests from military camps. This stipulation was immediately forgotten; even the Red Cross soon gave the military precedence over civilians. Meanwhile, its War Council ordered each one of its 3,864 chapters to establish an influenza committee even (indeed, especially) where the disease had not yet hit. It gave instructions on the organization of those committees, and it stated 'each community should depend upon its own resources to the fullest extent.'

Persons had one model: Massachusetts. There James Jackson, the Red Cross division director for New England, had done an amazing job, especially considering that the region was struck without warning by what was originally an unknown disease. While chapters made gauze masks (the masks that would soon be seen everywhere and would become a symbol of the epidemic) Jackson first tried to supply nurses and doctors himself. When he failed, he formed an ad hoc umbrella organization including the state Council of National Defense, the U.S. Public Health Service, state and local public health authorities, and the Red Cross. These groups pooled their resources and allocated to towns as needed.

Jackson had brought in nurses from Providence, New Haven, New York, even from Halifax and Toronto. He had succeeded at least somewhat in alleviating the personnel shortage. But Massachusetts had been lucky. When the epidemic erupted there, no other locality needed help. In the fourth week of the epidemic, Jackson reported, 'We have not yet reached the point where any community has been able to transfer its nurses or supplies. In Camp Devens' forty nurses ill there with many cases of pneumonia.'

He also advised Red Cross headquarters in Washington: 'The most important thing in this crisis is more workers to go into the homes quickly and aid the family. Consequently I have telegraphed to all my chapters twice regarding the mobilization of women who have had First Aid and Home Nursing training or any others who are willing to volunteer their services.'

And he confided, 'The Federal public health service has been' unable to handle adequately the entire situation' . [They] have not been on the job.'

It was October when he sent that wire. By then everyone needed nurses, or they were about to, and they knew it. By then everyone needed doctors, or they were about to, and they knew it. And they needed resources. The biggest task remained finding doctors, nurses, and resources. They needed all three.

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Even in the face of this pandemic, doctors could help. They could save lives. If they were good enough, if they had the right resources, if they had the right help, if they had time.

True, no drug or therapy could alleviate the viral infection. Anyone who died directly from a violent infection of the influenza virus itself, from viral pneumonia progressing to ARDS, would have died anyway. In 1918, ARDS had virtually a 100 percent mortality rate.

But there were other causes of death. By far the most common was from pneumonia caused by secondary bacterial infections.