The Great Influenza (35 page)

Symptoms were terrifying. Blood poured from noses, ears, eye sockets; some victims lay in agony; delirium took others away while living.

Routinely two people in a single family would die. Three deaths in a family were not uncommon. Sometimes a family suffered even more. David Sword lived at 2802 Jackson Street. On October 5 the sixth member of his family died of influenza, while the
North American
reported that three other family members in the hospital 'may also die of the plague.'

The plague.
In the streets people had been whispering the word. The word slipped, somehow, once, by accident, into that newspaper. The 'morale' issue, the self-censorship, the intent by editors to put every piece of news in the most positive possible context, all meant that no newspaper used that word again. Yet people did not need newspapers to speak of the Black Death. Some bodies were turning almost black. People had seen them, and they had lost faith in what they read anyway. One young medical student called in to treat hundreds of patients recalled, 'The cyanosis reached an intensity that I have never seen since. Indeed the rumor got about that the Black Death had returned.' The newspapers quoted Dr. Raymond Leopold, sounding reasonable: 'There is abundant reason for such a rumor' . It is true that many bodies have assumed a dark hue and have given off a pronounced odor after death.' But he gave his assurance, 'There is no truth in the black plague assertion.'

He was of course correct. But how many trusted the newspapers anymore? And even if the Black Death had not come, a plague had and, with it, so had terror.

The war had come home.

* 

Long before Hagadorn's suicide, long before the marchers in Philadelphia began to parade down the city streets, influenza had seeded itself along the edges of the nation.

On September 4 it had reached New Orleans, with the three seamen (who soon died) carried to the hospital off the
Harold Walker
from Boston. On September 7 it had reached the Great Lakes Naval Training Station, with sailors transferred from Boston. In the next few days ports and naval facilities on the Atlantic and Gulf Coasts (in Newport, New London, Norfolk, Mobile, and Biloxi) also reported this new influenza. On September 17, 1918, 'the extensive prevalence of an influenza-like disease' was reported in Petersburg, Virginia, outside Camp Lee. That same day, the several hundred sailors who had departed Philadelphia earlier for Puget Sound arrived; eleven men had to be carried from the ship on stretchers to a hospital, bringing the new virus to the Pacific.

The virus had spanned the country, establishing itself on the Atlantic, in the Gulf, on the Pacific, on the Great Lakes. It had not immediately erupted in epidemic form, but it had seeded itself. Then the seeds began to sprout into flowers of flame.

The virus followed rail and river into the interior of the continent, from New Orleans up the Mississippi River into the body of the nation, from Seattle to the East, from the Great Lakes training station to Chicago and from there along the railroad lines in many directions. From each original locus fingers reached out, unevenly, like sparks shooting out, often jumping over closer points to farther ones - from Boston to Newport, for example, and only then reaching backward to fill in Brockton and Providence and places in between.

On September 28, when the Liberty Loan paraders marched through Philadelphia streets, there were as yet only seven cases reported in Los Angeles, two in San Francisco. But the virus would get there soon enough.

* 

In Philadelphia meanwhile fear came and stayed. 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. Eight hundred fifty Philadelphia doctors and more nurses were away in the military. More than that number were sick. Philadelphia General Hospital had 126 nurses. Despite all precautions, despite wearing surgical masks and gowns, eight doctors and fifty-four nurses (43 percent of the staff) themselves required hospitalization. Ten nurses at this single hospital died. The Board of Health pleaded for help from retired nurses and doctors if they remembered 'even a little' of their profession.

When a nurse or doctor or policeman did actually come, they wore their ghostly surgical masks, and people fled them. In every home where someone was ill, people wondered if the person would die. And someone was ill in every home.

Philadelphia had five medical schools. Each one dismissed its classes, and third-and fourth-year students manned emergency hospitals being set up in schools and empty buildings all over the city. The Philadelphia College of Pharmacy closed as well, sending its students out to help druggists.

Before University of Pennsylvania medical students went out to man the hospitals, they listened to a lecture from Alfred Stengel, the expert on infectious diseases who had treated the crew of the
City of Exeter
what seemed so long ago. Stengel reviewed dozens of ideas that had been advanced in medical journals. Gargles of various disinfectants. Drugs. Immune sera. Typhoid vaccine. Diphtheria antitoxin. But Stengel's message was simple:
This doesn't work. That doesn't work. Nothing worked.

'His suggestion for treatment was negative,' Isaac Starr, one of those Penn students, who became an internationally known cardiologist, recalled. 'He had no confidence in any of the remedies that had been proposed.'

Stengel was correct. Nothing they were yet doing worked. Starr went to Emergency Hospital #2 at Eighteenth and Cherry Streets. He did have help, if it could be called that, from an elderly physician who had not practiced in years and who brought Starr into touch with the worst of heroic medicine. Starr wouldn't forget that, the ancient arts of purging, of venesection, the ancient art of opening a patient's vein. But for the most part he and the other students elsewhere were on their own, with little help even from nurses, who were so desperately needed that in each of ten emergency hospitals supplied by the Red Cross only a single qualified nurse was available to oversee whatever women came as volunteers. And often the volunteers reported for their duty once and, from either fear or exhaustion, did not come again.

Starr had charge of an entire floor of an emergency hospital. He thought at first his patients had 'what appeared to be a minor illness' with fever but little else. Unhappily the clinical features of many soon changed.' Most striking again was the cyanosis, his patients sometimes turning almost black. 'After gasping for several hours they became delirious and incontinent, and many died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth.'

Nearly one-quarter of all the patients in his hospital died
each day.
Starr would go home, and when he returned the next day, he would find that between one-quarter and one-fifth of the patients in the hospital had died, replaced by new ones.

Literally hundreds of thousands of people in Philadelphia were falling ill. Virtually all of them, along with their friends and relatives, were terrified that, no matter how mild the symptoms seemed at first, within them moved an alien force, a seething, spreading infection, a live thing with a will that was taking over their bodies - and could be killing them. And those who moved about them feared - feared both for the victims and for themselves.

The city was frozen with fear, frozen quite literally into stillness. Starr lived twelve miles from the hospital, in Chestnut Hill. The streets were silent on his drive home, silent. They were so silent he took to counting the cars he saw. One night he saw no cars at all. He thought, 'The life of the city had almost stopped.'

Part VI

THE PESTILENCE

CHAPTER TWENTY

T
HIS WAS INFLUENZA,
only influenza.

This new influenza virus, like most new influenza viruses, spread rapidly and widely. As a modern epidemiologist already quoted has observed,
Influenza is a special instance among infectious diseases. This virus is transmitted so effectively that it exhausts the supply of susceptible hosts.
This meant that the virus sickened tens of millions of people in the United States (in many cities more than half of all families had at least one victim ill with influenza; in San Antonio the virus made more than half the entire population ill) and hundreds of millions across the world.

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.

The virus passed through this vast majority in the same way influenza viruses usually did. Victims had an extremely unpleasant several days (the unpleasantness multiplied by terror that they would develop serious complications) and then recovered within ten days. The course of the disease in these millions actually convinced the medical profession that this was indeed only influenza.

But in a minority of cases, and not just in a tiny minority, the virus manifested itself in an influenza that did not follow normal patterns, that was unlike any influenza ever reported, that followed a course so different from the usual one for the disease that Welch himself had initially feared some new kind of infection or plague. If Welch feared it, those who suffered with the disease were terrified by it.

Generally in the Western world, the virus demonstrated extreme virulence or led to pneumonia in from 10 to 20 percent of all cases. In the United States, this translated into two to three million cases. In other parts of the world, chiefly in isolated areas where people had rarely been exposed to influenza viruses - in Eskimo settlements of Alaska, in jungle villages of Africa, in islands of the Pacific - the virus demonstrated extreme virulence in far more than 20 percent of cases. These numbers most likely translate into several hundred million severe cases around the world in a world with a population less than one-third that of today.

This was still influenza, only influenza. The most common symptoms then as now are well known. The mucosal membranes in the nose, pharynx, and throat become inflamed. The conjunctiva, the delicate membrane that lines the eyelids, becomes inflamed. Victims suffer headache, body aches, fever, often complete exhaustion, cough. As one leading clinician observed in 1918, the disease was 'ushered in by two groups of symptoms: in the first place the constitutional reactions of an acute febrile disease - headache, general aching, chills, fever, malaise, prostration, anorexia, nausea or vomiting; and in the second place, symptoms referable to an intense congestion of the mucous membranes of the nose, pharynx, larynx, trachea, and upper respiratory tract in general, and of the conjunctivae.' Another noted, 'The disease began with absolute exhaustion and chill, fever, headache, conjunctivitis, pain in back and limbs, flushing of face' . Cough was often constant. Upper air passages were clogged.' A third reported, 'In nonfatal cases' the temperature ranged from 100 to 103F. Nonfatal cases usually recovered after an illness of about a week.'

Then there were the cases in which the virus struck with violence.

* 

To those who suffered a violent attack, there was often pain, terrific pain, and the pain could come almost anywhere. The disease also separated them, pushed them into a solitary and concentrated place.

In Philadelphia, Clifford Adams said, 'I didn't think about anything' . I got to the point where I didn't care if I died or not. I just felt like that all my life was nothing but when I breathe.'

Bill Sardo in Washington, D.C., recalled, 'I wasn't expected to live, just like everybody else that had gotten it' . You were sick as a dog and you weren't in a coma but you were in a condition that at the height of the crisis you weren't thinking normally and you weren't reacting normally, you sort of had delusions.'

In Lincoln, Illinois, William Maxwell felt 'time was a blur as I was lying in that little upstairs room and I' had no sense of day or night, I felt sick and hollow inside and I knew from telephone calls my aunt had, I knew enough to be alarmed about my mother' . I heard her say, 'Will, oh no,' and then, 'if you want me to' ' The tears ran down her face so she didn't need to tell me.'

Josey Brown fell ill working as a nurse at the Great Lakes Naval Training Station and her 'heart was racing so hard and pounding that it was going to jump out' of her chest and with terrible fevers she was 'shaking so badly that the ice would rattle and would shake the chart attached to the end of the bed.'

Harvey Cushing, Halsted's protegé who had already attained prominence himself but had yet to make his full reputation, served in France. On October 8, 1918, he wrote in his journal, 'Something has happened to my hind legs and I wobble like a tabetic' (someone suffering from a long and wasting illness, like a person with AIDS who needs a cane) 'and can't feel the floor when I unsteadily get up in the morning' . So this is the sequence of the grippe. We may perhaps thank it for helping us win the war if it really hit the German Army thus hard [during their offensive].' In his case what seemed to be the complications were largely neurological. On October 31, after spending three weeks in bed with headache, double vision, and numbness of both legs, he observed, 'It's a curious business, unquestionably still progressing' with considerable muscular wasting' . I have a vague sense of familiarity with the sensation - as if I had met [it] somewhere in a dream.' Four days later: 'My hands now have caught up with my feet - so numb and clumsy that shaving's a danger and buttoning laborious. When the periphery is thus affected the brain too is benumbed and awkward.'

Cushing would never fully recover.

And across the lines lay Rudolph Binding, a German officer, who described his illness as 'something like typhoid, with ghastly symptoms of intestinal poisoning.' For weeks he was 'in the grip of the fever. Some days I am quite free; then again a weakness overcomes me so that I can barely drag myself in a cold perspiration onto my bed and blankets. Then pain, so that I don't care whether I am alive or dead.'