The Great Influenza (48 page)

Ten days, two weeks, sometimes even longer than two weeks after the initial attack by the virus, after victims had felt better, after recovery had seemed to begin, victims were suddenly getting seriously ill again. And they were dying. The virus was stripping their lungs all but naked of their immune system; recent research suggests that the virus made it easier for some kinds of bacteria to lodge in lung tissue as well. Bacteria were taking advantage, invading the lungs, and killing. People were learning, and doctors were advising, and newspapers were warning, that even when a patient seemed to recover, seemed to feel fine, normal, well enough to go back to work, still that patient should continue to rest, continue to stay in bed. Or else that patient was risking his or her life.

Half a dozen years earlier medicine had been helpless here, so helpless that Osler in his most recent edition of his classic text on the practice of medicine had still called for bleeding of patients with pneumonia. But now, for some of those who developed a secondary bacterial infection, something could be done. The most advanced medical practice, the best doctors, could help - if they had the resources and the time.

Avery, Cole, and others at the Rockefeller Institute had developed the vaccine that had showed such promising result in the test at Camp Upton in the spring, and the Army Medical School was producing this vaccine in mass quantities. Avery and Cole had also developed the serum that slashed the mortality for pneumonias caused by Types I and II pneumococcus, which accounted for two-thirds or more of lobar pneumonias in normal circumstances. These were not normal circumstances; bacteria that almost never caused pneumonia were now making their way unopposed into the lungs, growing there, and thriving there. But Types I and II pneumococci were still causing many of the pneumonias, and in those cases this serum could help.

Other investigators had developed other vaccines and sera as well. Some, like the one developed by E. C. Rosenow at the Mayo Clinic and used in Chicago, were useless. But others may have done some good.

Physicians also had other assets to call upon. Surgeons developed new techniques during the epidemic that are still in use to drain empyemas, pockets of pus and infection that formed in the lung and poisoned the body. And doctors had drugs that alleviated some symptoms or stimulated the heart; major hospitals had x rays that could aid in diagnosis and triage; and some hospitals had begun administering oxygen to help victims breathe - a practice neither widespread nor administered nearly as effectively as it would be, but worth something.

Yet for a doctor to use these resources, any of them, that doctor had to have them - and also had to have time. The physical resources were hard to come by, but time was harder. There was no time. For that Rockefeller serum needed to be administered with precision and in numerous doses. There was no time. Not with patients overflowing wards, filling cots in hallways and on porches, not with doctors themselves falling ill and filling those cots. Even if they had resources, they had no time.

And the doctors found by the Public Health Service had neither resources nor time. Nor was it simple to find the doctors themselves. The military had already taken at least one-fourth (in some areas one-third) of all the physicians and nurses. And the army, itself under violent attack from the virus, would lend none of its doctors to civilian communities no matter how desperate the circumstances.

That left approximately one hundred thousand doctors in a labor pool to draw from - but it was a pool limited in quality. The Council of National Defense had had local medical committees secretly grade colleagues; those committees had judged roughly seventy thousand unfit for military service. Most of that number were unfit because they were judged incompetent.

The government had had a plan to identify the best of those remaining. As part of the mobilization of the entire nation, in January 1918 the Council of National Defense had created the 'Volunteer Medical Service.' This service tried to enlist every doctor in the United States, but it particularly wanted to track the younger physicians who were women or had a physical disability - in other words, those mostly likely to be good doctors who were not subject to and rejected by the draft.

The mass targeting succeeded. Within eight months, 72,219 physicians had joined this service. They had joined, however, only to prove their patriotism, not as a commitment to do anything real - for membership required of them nothing concrete, and they received an attractive piece of paper suitable for framing and office display.

But the plan to identify and have access to good doctors within this group collapsed. The virus was penetrating everywhere, doctors were needed everywhere, and no responsible doctor would abandon his (or, in a few instances, her) own patients in need, in desperate need. In addition, the federal government was paying only $50 a week - no princely sum even in 1918. Out of one hundred thousand civilian doctors, seventy-two thousand of whom had joined the Volunteer Medical Service, only 1,045 physicians answered the pleas of the Public Health Service. While a few were good young doctors who had not yet developed a practice and were waiting to be drafted, many of this group were the least competent or poorest trained doctors in the country. Indeed, so few doctors worked for the PHS that Blue would later return $115,000 to the Treasury from the the $1 million appropriation he had considered so insufficient.

The Public Health Service sent these 1,045 doctors to places where there were no doctors at all, to places so completely devastated by the disease that any help, any help at all, was embraced. But they sent them with almost no resources, certainly without Rockefeller vaccines and serum or the training to make or administer them, certainly without x rays, certainly without oxygen and the means to administer it. The huge caseloads overwhelmed them, weighed them down, kept them moving.

They diagnosed. They treated with all manner of materia medica. Yet in reality they could do nothing but advise. The best advice was this: stay in bed. And then the doctors moved on to the next cot or the next village.

What could help, more than doctors, were nurses. Nursing could ease the strains on a patient, keep a patient hydrated, resting, calm, provide the best nutrition, cool the intense fevers. Nursing could give a victim of the disease the best possible chance to survive. Nursing could save lives.

But nurses were harder to find than doctors. There were one-quarter fewer to begin with. The earlier refusal of the women who controlled the nursing profession to allow the training of large numbers either of nursing aides or of what came to be called practical nurses prevented the creation of what might have been a large reserve force. The plan had been to produce thousands of such aides; instead the Army School of Nursing had been established. So far it had produced only 221 student nurses and not a single graduate nurse.

Then, just before the epidemic struck, combat had intensified in France and with it so had the army's need for nurses. The need had in fact become so desperate that on August 1, Gorgas, just to meet existing requirements, transferred one thousand nurses from cantonments in the United States to hospitals in France and simultaneously issued a call for 'one thousand nurses a week' for eight weeks.

The Red Cross was the route of supply for nurses to the military, especially the army. It had already been recruiting nurses for the military with vigor. After Gorgas's call, it launched an even more impassioned recruiting campaign. Each division, each chapter within a division, was given a quota. Red Cross professionals knew that their careers were at risk if they did not meet it. Already recruiters had a list of all nurses in the country, their jobs and locations. Those recruiters now pressured nurses to quit jobs and join the military, pressured doctors to let office nurses go, made wealthy patients who retained private nurses feel unpatriotic, pushed private hospitals to release nurses.

The drive was succeeding; it was removing from civilian life a huge proportion of those nurses mobile enough, unencumbered by family or other responsibilities, to leave their jobs. The drive was succeeding so well that it all but stripped hospitals of their workforce, leaving many private hospitals around the country so short-staffed that they closed, and remained closed until the war ended. One Red Cross recruiter wrote, 'The work at National Headquarters has never been so difficult and is now overwhelming us' .[We are searching] from one end of the United States to the other to rout out every possible nurse from her hiding place' . There will be no nurses left in civil life if we keep on at this rate.'

The recruiter wrote that on September 5, three days before the virus exploded at Camp Devens.

CHAPTER TWENTY-EIGHT

P
HILADELPHIA STAGGERED
under the influenza attack, isolated and alone. In Philadelphia no sign surfaced of any national Red Cross and Public Health Service effort to help. No doctors recruited by the Public Health Service were sent there. No nurses recruited by the Red Cross were sent there. Those institutions gave no help here.

Each day people discovered that friends and neighbors who had been perfectly healthy a week (or a day) earlier were dead.
What should I do?
People were panicked, desperate.
How long will it go on?

The mayor, arrested in the early days of the epidemic and then himself ill, had done absolutely nothing. A review of five daily newspapers, the
Press, Inquirer, Bulletin, Public Ledger,
and
North American,
did not find even a single statement about the crisis from the mayor. The entire city government had done nothing. Wilmer Krusen, head of the city health department, no longer had the confidence of anyone. Someone had to do
something
.

Paul Lewis felt the pressures, felt the death all about him. He had felt at least some pressure since the sailors from the
City of Exeter
had been dying what seemed so long ago. In early September, with the virus killing 5 percent of all Philadelphia navy personnel who showed any symptoms of influenza at all, that pressure had intensified. Since then he and everyone under him had hardly left their laboratories to go home. Finding
B. influenzae
had begun his real work, not concluded it.

Never had he been so consumed with the laboratory. He had started his experiments with the pneumococcus. He had begun to explore the possibility that a filterable virus caused influenza. He had continued to look at the influenza bacillus. He and others had developed a vaccine. He was trying to make a serum. All of these he did simultaneously. For the one thing he did not have was time. No one had time.

If Lewis had a scientific weakness, it was that he too willingly accepted guidance from those he respected. Once when he asked for more direction from Flexner, Flexner had rebuffed him, saying, 'I much prefer that you arrange plans' . I have not planned specifically for your time, but much prefer to leave the direction of it to you.' Lewis respected Flexner. He respected Richard Pfeiffer as well.

In the overwhelming majority of cases he was now finding Pfeiffer's
B. influenzae
in swabs from living patients, in autopsied lungs. He was not finding it alone, necessarily, or always. It was not certain proof, but more and more he was coming to believe that this bacterium did in fact cause disease. And, under the pressure of time, he abandoned his investigation into the possibility that a filterable virus caused influenza.

Yet he loved this. Although he hated the disease he loved this. He believed he had been born to do this. He loved working deep into the night amid rows of glassware, monitoring the growth of bacteria in a hundred flasks and petri dishes, running a dozen experiments in staggered fashion; coordinating them like the conductor of a symphony. He even loved the unexpected result that could throw everything off.

The only thing Lewis disliked about his position as head of an institute was charming the fine families of Philadelphia out of philanthropic donations, attending their parties and performing as their pet scientist. The laboratory was where he had always belonged. Now he was in it hours and hours each day. He believed he had spent too much time mixing with the fine families of Philadelphia.

In fact, those fine families of the city deserved more respect. They were about to take charge.

* 

The writer Christopher Morley once said that Philadelphia lies 'at the confluence of the Biddle and Drexel families.' In 1918 that description was not far wrong.

Of all the major cities in the United States, Philadelphia had a real claim to being the most 'American.' It certainly had the largest percentage of native-born Americans of major cities and, compared to New York, Chicago, Boston, Detroit, Buffalo, and similar cities, the lowest percentage of immigrants. Philadelphia was not unusual in that its oldest and wealthiest families controlled the charities, the social service organizations (including the local Red Cross) and the Pennsylvania Council of National Defense. But now, with the city government all but nonexistent, it was unusual in that these families considered it their duty to use the Council of National Defense to take charge.

Nationally that organization had been the vehicle through which, before the war, Wilson had laid plans to control the economy, using it to assemble data from across the country on factories, transportation, labor, and natural resources. But each state had its own council, which were often dominated by his political enemies. Once the war started, Wilson created new federal institutions, sidestepped this organization, and it lost power. The Pennsylvania council, however, retained extraordinary, although almost entirely unofficial, influence over everything from railroad schedules to profits and wages at every large company in the state even though it too was run by Wilson's enemies. It held this power chiefly because it was headed by George Wharton Pepper.

No one had better bloodlines. His great-great-grandfather had led the state militia in the Revolutionary War, his wife was a descendant of Benjamin Franklin, and a statue of his uncle William, who had worked closely with Welch to reform medical education and brought Flexner to the University of Pennsylvania, today sits astride the grand stairway of the Free Library in downtown Philadelphia. George Wharton Pepper had ability as well. An attorney who sat on the boards of half a dozen of the country's largest companies, he was not ruthless, but he knew how to command. An indication of his stature had come a few months earlier when he received one of three honorary degrees awarded by Trinity College in Hartford, Connecticut; his fellow honorees were J. P. Morgan and former president of the United States and soon-to-be chief justice of the Supreme Court William Howard Taft.