The Great Influenza: The Epic Story of the Deadliest Plague in History

by John M. Barry

he abruptly ordered the withholding of the names of all soldiers who died from influenza.

Influenza was indeed exploding in the city. Within seventy-two hours after the parade, every single bed in each of the city’s thirty-one hospitals was filled.

Medical care was making little difference anyway.

died twenty-four hours after her first symptoms.

began her shift in the morning, felt sick, and was dead t...

On October 3, only five days after Krusen had let the parade proceed, he banned all public meetings in the city—including, finally, further Liberty Loan gatherings—and closed all churches, schools, theaters. Even public funerals were prohibited. Only one public gathering place was allowed to remain open: the saloon, the key constituency of the Vare machine. The next day the state health commissioner closed them.

In ten days—ten days!—the epidemic had exploded from a few hundred civilian cases and one or two deaths a day to hundreds of thousands ill and hundreds of deaths each day.

Giant placards everywhere warned the public to avoid crowds and use handkerchiefs when sneezing or coughing. Other placards read “Spitting equals death.”

newspapers reported those deaths—on inside pages with other obituaries—even while continuing to minimize the epidemic.

Nearly two-thirds of the dead were under forty.

the most terrifying aspect of the epidemic was the piling up of bodies.

The war had come home.

Death could come from anyone, anytime. People moved away from others on the sidewalk, avoided conversation; if they did speak, they turned their faces away to avoid the other person’s breathing. People became isolated, increasing the fear. The impossibility of getting help compounded the isolation.

This new influenza virus, like most new influenza viruses, spread rapidly and widely.

But this was influenza, only influenza. The overwhelming majority of victims got well. They endured, sometimes a mild attack and sometimes a severe one, and they recovered.

During the course of the epidemic, 47 percent of all deaths in the United States,

the key figure is actually the “excess death” toll. Investigators today believe that in the United States the 1918–19 epidemic caused an excess death toll of about 675,000 people.

Influenza almost always selects the weakest in a society to kill, the very young and the very old. It kills opportunistically, like a bully. It almost always allows the most vigorous, the most healthy, to escape, including young adults as a group. Pneumonia was even known as “the old man’s friend” for killing particularly the elderly, and doing so in a relatively painless and peaceful fashion that even allowed time to say good-bye. There was no such grace about influenza in 1918. It killed the young and strong.

The virus was often so efficient at invading the lungs that the immune system had to mount a massive response to it. What was killing young adults a few days after the first symptom was not the virus. The killer was the massive immune response itself.

In 1918 the immune systems of young adults mounted massive responses to the virus. That immune response filled the lungs with fluid and debris, making it impossible for the exchange of oxygen to take place. The immune response killed.

Today the mortality rate for a bacterial pneumonia following influenza is still roughly 7 percent, and in some parts of the United States, 35 percent of pneumococcal infections are resistant to the antibiotic of choice.

One key to science is that work be reproducible.

expandable. One must be able to enlarge it, explore it, learn more from it, use it as a foundation to build structures upon.

How does one know when one knows? When one is on the edge, one cannot know. One can only test.

To have any chance in alleviating the devastation of the epidemic required organization, coordination, implementation. It required leadership and it required that institutions follow that leadership.

Yet institutions are human as well. They reflect the cumulative personalities of those within them, especially their leadership. They tend, unfortunately, to mirror less admirable human traits, developing and protecting self-interest and even ambition.

unlike in World War II, America was no arsenal of democracy.

He had created a vast propaganda machine, an internal spy network, a bond-selling apparatus extending to the level of residential city blocks. He had even succeeded in stifling speech,

Only on May 23, 1918, had Provost Marshal Enoch Crowder, who oversaw the draft, issued his “work or fight” order, stating that anyone not employed in an essential industry would be drafted—an order that caused major league baseball to shorten its season and sent many ballplayers scurrying for jobs that were “essential”—and

Wilson pressed, pressed with all his might—and that meant all the nation’s might—for total victory.

If Wilson and his government would not be turned from his end even by the prospect of peace, they would hardly be turned by a virus. And the reluctance, inability, or outright refusal of the American government to shift targets would contribute to the killing.

From neither the White House nor any other senior administration post would there come any leadership, any attempt to set priorities, any attempt to coordinate activities, any attempt to deliver resources.

the military would give no help to civilians.

warning had been relayed to the army chief of staff, urging that all transfers be frozen unless absolutely necessary and that under no circumstances transfers from infected camps be made: The deaths at Camp Devens will probably exceed 500. . . . The experience at Camp Devens may be fairly expected to occur at other large cantonments. . . . New men will almost surely contract the disease. Gorgas’s superiors ignored the warning.

Crowder had acted immediately and likely saved thousands of lives, but he did not cancel the draft to save lives. He did so because he recognized that the disease was utterly overwhelming and creating total chaos in the cantonments. There could be no training until the disease passed.

All the Allied powers were desperate for fresh American boys. The army had to decide whether to continue to transport soldiers to France during the epidemic. They had information about the costs. The army knew the costs well.

over the course of the next several weeks, other troopships would ferry approximately one hundred thousand troops to Europe. Their crossings became much like that of the train that carried three thousand one hundred soldiers from Camp Grant to Camp Hancock. They became death ships.

The transports became floating caskets.

In the last half of October during the Meuse-Argonne offensive, America’s largest of the war, more Third Division troops were evacuated from the front with influenza than with wounds.

Shipping more men who required medical care into this maelstrom made little sense. It is impossible to state how many soldiers the ocean voyages killed, especially when one tries to count those infected aboard ship who died later on shore. But for every death at least four or five men were ill enough to be incapacitated for weeks. These men were a burden rather than a help in Europe.

Wilson said, “General March, I have had representations sent to me by men whose ability and patriotism are unquestioned that I should stop the shipment of men to France until this epidemic of influenza is under control. . . . [Y]ou decline to stop these shipments.”

If American divisions stopped arriving in France, whatever the reason, German morale might soar.

The war would end in a little over a month. The epidemic had made virtually all training in cantonments impossible. A parliament—not the kaiser—had already taken over the German government and sent out peace feelers, while Germany’s allies had already collapsed, capitulated, or, in the case of Austria, asked for peace on any terms Wilson dictated. But March insisted, “The shipment of troops should not be stopped for any cause.”

If Wilson did nothing about influenza in the military but express concern about shipping troops to Europe, he did even less for civilians.

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.”

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.

Each day—indeed, each hour—was showing the increasingly explosive spread of the virus and its lethality.

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.

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.

While chapters made gauze masks—the masks that would soon be seen everywhere and would become a symbol of the epidemic—Jackson