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January 9 - January 31, 2021
The Johns Hopkins would have rigor. It would have such rigor as no school in America had ever known. The Hopkins opened in 1876. Its medical school would not open until 1893, but it succeeded so brilliantly and quickly that, by the outbreak of World War I, American medical science had caught up to Europe and was about to surpass it.
Influenza is a viral disease. When it kills, it usually does so in one of two ways: either quickly and directly with a violent viral pneumonia so damaging that it has been compared to burning the lungs; or more slowly and indirectly by stripping the body of defenses, allowing bacteria to invade the lungs and cause a more common and slower-killing bacterial pneumonia.
The greatest challenge of science, its art, lies in asking an important question and framing it in a way that allows it to be broken into manageable pieces, into experiments that can be conducted that ultimately lead to answers. To do this requires a certain kind of genius, one that probes vertically and sees horizontally.
Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world.
There are three different types of influenza viruses: A, B, and C. Type C rarely causes disease in humans. Type B does cause disease, but not epidemics. Only influenza A viruses cause epidemics or pandemics, an epidemic being a local or national outbreak, a pandemic a worldwide one.
The overwhelming majority of influenza victims usually recover fully within ten days. Partly because of this, and partly because the disease is confused with the common cold, influenza is rarely viewed with concern.
the nature of the influenza virus makes it inevitable that new viruses emerge.
By entering the cell, as opposed to fusing with the cell on the cell membrane—which many other viruses do—the influenza virus hides from the immune system. The body’s defenses cannot find it and kill it.
INFECTION is an act of violence; it is an invasion, a rape, and the body reacts violently.
Antigen drift can create epidemics. One study found nineteen discrete, identifiable epidemics in the United States in a thirty-three-year period—more than one every other year. Each one caused between ten thousand and forty thousand “excess deaths” in the United States alone—an excess over and above the death toll usually caused by the disease. As a result influenza kills more people in the United States than any other infectious disease, including AIDS.
But as serious as antigen drift can be, as lethal an influenza as that phenomenon can create, it does not cause great pandemics.
Pandemics generally develop only when a radical change in the hemagglutinin, or the neuraminidase, or both, occurs.
When a new influenza virus emerges, it is highly competitive, even cannibalistic. It usually drives older types into extinction.
Throughout the wars in history more soldiers had often died of disease than in battle or of their wounds. And epidemic disease had routinely spread from armies to civilian populations.
Osler called pneumonia “the captain of the men of death.” Pneumonia was the leading cause of death around the world, greater than tuberculosis, greater than cancer, greater than heart disease, greater than plague. And, like measles, when influenza kills, it usually kills through pneumonia.
Influenza causes pneumonia either directly, by a massive viral invasion of the lungs, or indirectly—and more commonly—by destroying certain parts of the body’s defenses and allowing so-called secondary invaders, bacteria, to infest the lungs virtually unopposed.
IT IS IMPOSSIBLE to prove that someone from Haskell County, Kansas, carried the influenza virus to Camp Funston. But the circumstantial evidence is strong.
The disease soon became known as “Spanish influenza” or “Spanish flu,” very likely because only Spanish newspapers were publishing accounts of the spread of the disease that were picked up in other countries.
Despite the articles in medical journals about its generally benign nature, they had heard of some worrisome exceptions, some hints that perhaps this disease wasn’t always so benign after all, that when the disease did strike hard, it was unusually violent—more violent than measles.
Lethality lay within the genetic possibilities of this virus; this particular mutant swarm always had the potential to be more pestilential than other influenza viruses. Passage was sharpening its ferocity. As it smoldered in the roots, adapting itself, becoming increasingly efficient at reproducing itself in humans, passage was forging a killing inferno.
In 1918 all infectious disease was frightening. Americans had already learned that “Spanish influenza” was serious enough that it had slowed the German offensive.
Even while medical journals were commenting on the mild nature of the disease, all over the world hints of a malevolent outbreak were appearing.
The U.S. Public Health Service’s weekly Public Health Reports finally took notice, at last deeming the disease serious enough to warn the country’s public health officials that “an outbreak of epidemic influenza . . . has been reported at Birmingham, England. The disease is stated to be spreading rapidly and to be present in other locations.” And it warned of “fatal cases.”
Lack of oxygen was sometimes so severe that victims were becoming cyanotic—part or all of their bodies were turning blue, occasionally a very dark blue.
In 1918 cyanosis was so extreme, turning some victims so dark—the entire body could take on color resembling that of the veins on one’s wrists—it sparked rumors that the disease was not influenza at all, but the Black Death.
Pneumonia means in about all cases death.
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.
killing at a rate more than double that of a serious epidemic of bubonic plague in 1900.
Meanwhile the Evening Bulletin assured its readers that influenza posed no danger, was as old as history, and was usually accompanied by a great miasma, foul air, and plagues of insects, none of which were occurring in Philadelphia.
the Board feels strongly that if the general public will carefully and rigidly observe the recommendations [to] avoid contracting the influenza an epidemic can successfully be prevented.” The board’s advice: stay warm, keep the feet dry and the bowels open—this last piece of advice a remnant of the Hippocratic tradition. The board also advised people to avoid crowds.
The United States was waging total war.
the control of information mattered.
Total war requires sacrifice and good morale makes sacrifices acceptable, and therefore possible.
The preservation of morale itself became an aim. For if morale faltered, all else might as well. So free speech trembled.
Eugene Debs, who in the 1912 presidential election had received nearly one million votes, was sentenced to ten years in prison for opposing the war,
“Every person who refuses to subscribe or who takes the attitude of let the other fellow do it, is a friend of Germany and I would like nothing better than to tell it to him to his face. A man who can’t lend his govt $1.25 a week at the rate of 4% interest is not entitled to be an American citizen.”
Army camps had already become so overwhelmed by influenza that on September 26 Provost Marshal Enoch Crowder canceled the next scheduled draft call.
The incubation period of influenza is twenty-four to seventy-two hours. Two days after the parade, Krusen issued a somber statement: “The epidemic is now present in the civilian population and is assuming the type found in naval stations and cantonments.”
an innovation he had experimented with: the wearing of gauze masks by patients with respiratory disease. Welch called the mask “a great thing .
“This is a very important matter in connection with the prevention of pneumonia.”
he wanted Capps’s use of masks extended to all camps.
the masks so successful that after less than three weeks of experimenting he had abandoned testing and simply started using them as “a routine measure.” He also made the more general point that “one of the most vital measures in checking contagion” is eliminating crowding. “Increasing the space between beds in barracks, placing the head of one soldier opposite the feet of his neighbor, stretching tent flags between beds, and suspending a curtain down the center of the mess table, are all of proved value.”
recommendation to isolate transferred troops.
But Hagadorn believed that disease could be controlled.
And this was only influenza.
Guards enforced the orders strictly. But people infected with influenza can infect others before they feel any symptoms. It was already too late. Within forty-eight hours every organization in the camp was affected.
In six days the hospital went from 610 occupied beds to 4,102 occupied, almost five times more patients than it had ever cared for.
All training for war, for killing, ceased. Now men fought to stop the killing.
They left after the provost general had had the foresight to cancel the next draft. And they left after Gorgas’s office had urged that all movement of troops between infected and uninfected camps cease.
When the train arrived, over seven hundred men—nearly one-quarter of all the troops on the train—were taken directly to the base hospital, quickly followed by hundreds more; in total, two thousand of the 3,108 troops would be hospitalized with influenza. After 143 deaths among them the statistics merged into those of other troops from Camp Hancock—Hancock, to which this shipment of virus was sent—and became impossible to track. But it is likely that the death toll approached, and possibly exceeded, 10 percent of all the troops on the train.
