The Great Influenza (56 page)

Inside each camp the same thing held true. Soldiers struck down in the first ten days or two weeks died at much higher rates than soldiers in the same camp struck down late in the epidemic or after the epidemic actually ended.

Similarly, the first cities invaded by the virus (Boston, Baltimore, Pittsburgh, Philadelphia, Louisville, New York, New Orleans, and smaller cities hit at the same time) all suffered grievously. And in those same places, the people infected later in the epidemic were not becoming as ill, were not dying at the same rate, as those infected in the first two to three weeks.

Cities struck later in the epidemic also usually had lower mortality rates. In one of the most careful epidemiological studies of the epidemic in one state, the investigator noted that, in Connecticut, 'one factor that appeared to affect the mortality rate was proximity in time to the original outbreak at New London, the point at which the disease was first introduced into Connecticut' . The virus was most virulent or most readily communicable when it first reached the state, and thereafter became generally attenuated.'

The same pattern held true throughout the country and, for that matter, the world. It was not a rigid predictor. The virus was never completely consistent. But places hit later tended to be hit more easily. San Antonio suffered one of the highest attack rates but lowest death rates in the country; the virus there infected 53.5 percent of the population, and 98 percent of all homes in the city had at least one person sick with influenza. But there the virus had mutated toward mildness; only 0.8 percent of those who got influenza died. (This death rate was still double that of normal influenza.) The virus itself, more than any treatment provided, determined who lived and who died.

A decade after the pandemic, a careful and comprehensive scientific review of findings and statistics not only in the United States but around the world confirmed, 'In the later stages of the epidemic the supposedly characteristic influenza lesions were less frequently found, the share of secondary invaders was more plainly recognizable, and the differences of locality were sharply marked' . [I]n 1919 the 'water-logged' lungs' (those in which death came quickly from ARDS) 'were relatively rarely encountered.'

Despite aberrations, then, in general in youth the virus was violent and lethal; in maturity it mellowed. The later the epidemic struck a locality, and the later within that local epidemic someone got sick, the less lethal the influenza. The correlations are not perfect. Louisville suffered a violent attack in both spring and fall. The virus was unstable and always different. But a correlation does exist between the timing of the outbreak in a region and lethality. Even as the virus mellowed it still killed. It still killed often enough that in maturity it would have been, except for its own younger self, the most lethal influenza virus ever known. But timing mattered.

The East and South, hit earliest, were hit the hardest. The West Coast was hit less hard. And the middle of the country suffered the least. In Seattle, in Portland, in Los Angeles, in San Diego, the dead did not pile up as in the East. In St. Louis, in Chicago, in Indianapolis, the dead did not pile up as in the West. But if the dead did not pile up there as they had in Philadelphia and New Orleans, they did still pile up.

* 

By late November, with few exceptions the virus had made its way around the world. The second wave was over, and the world was exhausted. And man was about to become the hunter.

But the virus, even as it lost some of its virulence, was not yet finished. Only weeks after the disease seemed to have dissipated, when town after town had congratulated itself on surviving it (and in some places where people had had the hubris to believe they had defeated it) after health boards and emergency councils had canceled orders to close theaters, schools, and churches and to wear masks, a third wave broke over the earth.

The virus had mutated again. It had not become radically different. People who had gotten sick in the second wave had a fair amount of immunity to another attack, just as people sickened in the first wave had fared better than others in the second wave. But it mutated enough, its antigens drifted enough, to rekindle the epidemic.

Some places were not touched by the third wave at all. But many (in fact most) were. By December 11, Blue and the Public Health Service issued a bulletin warning that 'influenza has not passed and severe epidemic conditions exist in various parts of the country' . In California, increase; Iowa, a marked increase; Kentucky, decided recrudescence in Louisville and larger towns, and in contrast to earlier stage of epidemic disease now affects many schoolchildren; Louisiana, disease again increased in New Orleans, Shreveport, [in] Lake Charles height reached equalled last wave;' St. Louis 1,700 cases in three days; Nebraska very serious; Ohio recrudescences in Cincinnati, Cleveland, Columbus, Akron, Ashtabula, Salem, Medina' in Pennsylvania, conditions are worse than the original outbreak in Johnstown, Erie, Newcastle. The state of Washington shows a sharp increase' . West Virginia reports recrudescence in Charleston.'

By any standard except that of the second wave, this third wave was a lethal epidemic. And in a few isolated areas (such as Michigan) December and January were actually worse than October. In Phoenix for three days in a row in mid-January, the new cases set a record exceeding any in the fall. Quitman, Georgia, issued twenty-seven epidemic ordinances that took effect December 13, 1918, after the disease had seemingly passed. Savannah on January 15 ordered theaters and public gathering places closed (for a third time) with even more rigid restrictions than before. San Francisco had gotten off lightly in the fall wave, as had the rest of the West Coast, but the third wave struck hard.

In fact, of all the major cities in the country, San Francisco had confronted the fall wave most honestly and efficiently. That may have had something to do with its surviving, and rebuilding itself after, the massive earthquake of only a dozen years before. Now on September 21 public health director William Hassler quarantined all naval installations, even before any cases surfaced in them or in the city. He mobilized the entire city in advance, recruiting hundreds of drivers and volunteers and dividing the city into districts, each with its own medical personnel, phones, transport and supply, and emergency hospitals in schools and churches. He closed public places. And far from the usual assurances that the disease was ordinary 'la grippe,' on October 22 the mayor, Hassler, the Red Cross, the Chamber of Commerce, and the Labor Council jointly declared in a full-page newspaper ad, 'Wear a mask and save your life!' claiming that it was '99% proof against influenza.' By October 26, the Red Cross had distributed one hundred thousand masks. Simultaneously, while local facilities geared up to produce vaccine, thousands of doses of a vaccine made by a Tufts scientist were raced across the continent on the country's fastest train.

In San Francisco, people felt a sense of control. Instead of the paralyzing fear found in too many other communities, it seemed to inspire. Historian Alfred Crosby has provided a picture of the city under siege, and his picture shows citizens behaving with heroism, anxious and fearful but accepting their duty. When schools closed, teachers volunteered as nurses, orderlies, telephone operators. On November 21, every siren in the city signaled that masks could come off. San Francisco had (to that point) survived with far fewer deaths than had been feared, and citizens believed that the masks deserved the credit. But if anything helped, it would have been the organization Hassler had set in place in advance.

The next day the
Chronicle
crowed that in the city's history 'one of the most thrilling episodes will be the story of how gallantly the city of Saint Francis behaved when the black wings of war-bred pestilence hovered over the city.'

They thought that
they
had controlled it, that
they
had stopped it. They were mistaken. The masks were useless. The vaccine was useless. The city had simply been lucky. Two weeks later, the third wave struck. Although at its peak it killed only half as many as did the second wave, it made the final death rates for the city the worst on the West Coast.

* 

With the exception of a few small outposts that isolated themselves, there was by early in 1919 only one place the virus had missed.

Australia had escaped. It had escaped because of a stringent quarantine of incoming ships. Some ships arrived there with attack rates as high as 43 percent and fatality rates among
all
passengers as high as 7 percent. But the quarantine kept the virus out, kept the continent safe, until late December 1918 when, with influenza having receded around the world, a troopship carrying ninety ill soldiers arrived. Although they too were quarantined, the disease penetrated - apparently through medical personnel treating troops.

By then the strain had lost much of its lethality. In Australia the death rates from influenza were far less than in any other Westernized nation on earth, barely one-third that of the United States, not even one-quarter that of Italy. But it was lethal enough.

When it struck in January and February, the war had been over for more than two months. Censorship had ended with it. And so in Australia the newspapers were free to write what they wanted. And, more than in any other English-language newspaper, what they wrote of was terror.

'We are told by some that the influenza is a return of the old 'Black death,'' reported one Sydney newspaper. Another quoted the classic, Daniel Defoe's
Journal of the Plague Year
(a work of fiction) for advice on precautions to take to prevent 'the influenza plague.' And headlines of terror ran day after day after day after day: 'How They Fought Plagues in the Old Days,' 'The Pneumonic Plague,' 'Fighting the Plague,' 'Plagues in the Past,''The Pagans and the Plague,''Did the Plague Start in NSW?' 'Catholic Chaplains in Plague Stricken Camps,' 'Catholics as Plague Fighters.'

The pandemic itself (even in this its most mild incarnation in the developed world) was terrifying enough that those who lived through it as children remembered it not as influenza at all, but as plague. One Australian historian in the 1990s was recording oral histories. She was struck when people she interviewed mentioned 'Bubonic Plague,' and she explored the issue further.

One subject told her, 'I can recall the Bubonic Plague, people dying by the hundreds around us that was come back from the First World War.'

Another: 'We had to get vaccinated' . And I bear the scar today where I was inoculated against the Bubonic Plague.'

Another: 'I can remember the Plague. There were doctors going around in cabs with gowns and masks over their faces.'

Another: 'They all wore masks' after the war and how they used to be worried here in Sydney' about the Plague.'

Another: 'We were quarantined, our food was delivered to the front door' . We didn't read about the Bubonic Plague. We lived it.'

Another: '[T]hey called it the Bubonic Plague. But in France they called it bronchial pneumonia. See that's what they said my brother died from' .'

Another: 'The Plague. The Bubonic Plague. Yes, I can remember that' . I always understood it was the same kind of flu that swept Europe, the Black Death in the Middle Ages. I think it was the same kind of thing, it was carried by fleas on rats.'

Another: 'Bubonic Plague' I think it might have been called a form of influenza towards the finish' . The Bubonic Plague was a thing that stuck in my mind' '

Yet this was after all only influenza, and the influenza that struck Australia in 1919 was weaker than it was anywhere else in the world. Perhaps the measure of the extraordinary power of the 1918 virus was this: in Australia, without a censored press, the memory that stuck in the mind was not of influenza at all. It was of the Black Death.

* 

The virus was still not finished. All through the spring of 1919 a kind of rolling thunder moved above the earth, intermittent, unleashing sometimes a sudden localized storm, sometimes even a lightning bolt, and sometimes passing over with only a rumble of threatened violence in the distant and dark sky.

It remained violent enough to do one more thing.

CHAPTER THIRTY-TWO

T
HE OVERWHELMING MAJORITY
of victims, especially in the Western world, recovered quickly and fully. This was after all only influenza.

But the virus sometimes caused one final complication, one final sequela. The influenza virus affected the brain and nervous system. All high fevers cause delirium, but this was something else. An army physician at Walter Reed Hospital investigating serious mental disturbances and even psychoses that seemed to follow an attack of influenza specifically noted, 'Delirium occurring at the height of the disease and clearing with the cessation of fever is not considered in this report.'

The connection between influenza and various mental instabilities seemed clear. The evidence was almost entirely anecdotal, the worst and weakest kind of evidence, but it convinced the vast majority of contemporary observers that influenza could alter mental processes. What convinced them were observations such as these:

From Britain: '' profound mental inertia with intense physical prostration. Delirium has been very common' . It has varied from mere confusion of ideas through all grades of intensity up to maniacal excitement.'

From Italy: '' influenzal psychoses of the acute period' as a rule subside in two or three weeks. The psychosis, however, may pass into a state of mental collapse, with stupor which may persist and become actual dementia. In other cases' depression and restlessness' to [which] can be attributed the large number of suicides during the pandemic of influenza.'

From France: '' frequent and serious mental disturbances during convalescence from and as a result of influenza' . The mental disturbances sometimes took on the form of acute delirium with agitation, violence, fear and erotic excitation and at other times was of a depressive nature' fear of persecution.'