The Great Influenza (46 page)

The
Leviathan
and, 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.

Although the army had ignored most of the pleadings from its own medical corps, it did remove all men showing influenza symptoms before sailing. And to contain influenza on board, troops were quarantined. Military police carrying pistols enforced the quarantine (aboard the
Leviathan,
432 MPs did so) sealing soldiers into separate areas of the ship behind shut watertight doors, sardining them into cramped quarters where they had little to do but lie on stacked bunks or shoot craps or play poker in the creases of open space available. Fear of submarines forced the portholes shut at night, but even during the day the closed doors and the massive overcrowding made it impossible for the ventilation system to keep pace. Access to the decks and open air was limited. The sweat and smells of hundreds of men (each room generally held up to four hundred) in close quarters quickly became a stench. Sound echoed off the steel bunks, the steel floors, the steel walls, the steel ceiling. Living almost like caged animals, they grew increasingly claustrophobic and tense. But at least they were safe, they thought.

For the plan to keep men quarantined in isolated groups had a flaw. They had to eat. They went to mess one group at a time, but they breathed the same air, their hands went from mouths to the same tables and doors that other soldiers had touched only minutes before.

Despite the removal before departure of men showing influenza symptoms, within forty-eight hours after leaving port, soldiers and sailors struck down with influenza overwhelmed the sick bay, stacked one on top of the other in bunks, clogging every possible location, coughing, bleeding, delirious, displacing the healthy from one great room after another. Nurses themselves became sick. Then the horrors began.

Colonel Gibson, commander of the Fifty-seventh Vermont, wrote of his regiment's experience on the
Leviathan
: 'The ship was packed' [C]onditions were such that the influenza could breed and multiply with extraordinary swiftness' . The number of sick increased rapidly, Washington was apprised of the situation, but the call for men for the Allied armies was so great that we must go on at any cost' . Doctors and nurses were stricken. Every available doctor and nurse was utilized to the limit of endurance. The conditions during the night cannot be visualized by anyone who had not actually seen them' [G]roans and cries of the terrified added to the confusion of the applicants clamoring for treatment and altogether a true inferno reigned supreme.'

It was the same on other ships. Pools of blood from hemorrhaging patients lay on the floor and the healthy tracked the blood through the ship, making decks wet and slippery. Finally, with no room in sick bay, no room in the areas taken over for makeshift sick bays, corpsmen and nurses began laying men out on deck for days at a time. Robert Wallace aboard the
Briton
remembered lying on deck when a storm came, remembered the ship rolling, the ocean itself sweeping up the scuppers and over him and the others, drenching them, their clothes, their blankets, leaving them coughing and sputtering. And each morning orderlies carried away bodies.

At first the deaths of men were separated by a few hours: the log of the
Leviathan
noted, '12:45
P.M.
Thompson, Earl, Pvt 4252473, company unknown died on board' . 3:35
P.M.
Pvt O Reeder died on board of lobar pneumonia' .' But a week after leaving New York, the officer of the day was no longer bothering to note in the log 'died on board,' no longer bothering to identify the military organization to which the dead belonged, no longer bothering to note a cause of death; he was writing only a name and a time, two names at 2:00
A.M
., another at 2:02
A.M
., two more at 2:15
A.M
., like that all through the night, every notation in the log now a simple recitation of mortality, into the morning a death at 7:56
A.M
., at 8:10
A.M
., another at 8:10
A.M
., at 8:25
A.M
.

The burials at sea began. They quickly became sanitary exercises more than burials, bodies lying next to one another on deck, a few words and a name spoken, then one at a time a corpse slipped overboard into the sea. One soldier aboard the
Wilhelmina
watched across the waves as bodies dropped into the sea from another ship in his convoy, the
Grant
: 'I confess I was near to tears, and that there was tightening around my throat. It was death, death in one of its worst forms, to be consigned nameless to the sea.'

* 

The transports became floating caskets. Meanwhile, in France, by any standard except that of the cantonments at home, influenza was devastating troops. 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. (Roughly the same number of troops were in the United States and Europe, but influenza deaths in Europe were only half those in America. The likely explanation is that soldiers at the front had been exposed to the earlier mild wave of influenza and developed some immunity to it.) One army surgeon wrote in his diary on October 17 that because of the epidemic, 'Some hospitals are not even working. Evacuation 114 had no medical officer but hundreds of pneumonias,' dying by the score.'

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 had made no public statement about influenza. He would not shift his focus, not for an instant. Yet people he trusted spoke to him of the disease, spoke particularly of useless deaths on the transports. Chief among them was certainly Dr. Cary Grayson, a navy admiral and Wilson's personal physician, as he had been personal physician to Teddy Roosevelt and William Howard Taft when they were president. Highly competent and highly organized, Grayson had become a Wilson confidant who strayed into the role of adviser. (After Wilson's stroke in 1919, he would be accused of virtually running the country in concert with Wilson's wife.) He also had the confidence of and excellent relationships with Gorgas and Welch. It was likely that army medical staff had talked to Grayson, and Grayson had been urging army chief of staff General Peyton March to freeze the movement of troops to Europe. March had refused.

Grayson convinced Wilson to summon March to the White House on October 7 to discuss the issue. Late that night Wilson and March met. 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.'

March made no mention of any of the advice he had received from Gorgas's office. He insisted that every possible precaution was being taken. The troops were screened before embarking and the sick winnowed out. Some ships even put ashore in Halifax, Nova Scotia, those who fell seriously ill before the actual Atlantic crossing began. If American divisions stopped arriving in France, whatever the reason, German morale might soar. True, some men had died aboard ship, but, March said, 'Every such soldier who has died just as surely played his part as his comrade who died in France.'

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.'

March later wrote that Wilson turned in his chair, gazed out the window, his face very sad, then gave a faint sigh. In the end, only a single military activity would continue unaffected in the face of the epidemic. The army continued the voyages of troopships overseas.

* 

If Wilson did nothing about influenza in the military but express concern about shipping troops to Europe, he did even less for civilians. He continued to say nothing publicly. There is no indication that he ever said anything privately, that he so much as inquired of anyone in the civilian arm of the government as to its efforts to fight the disease.

Wilson had appointed strong men to his administration, powerful men, and they took decisive actions. They dominated the nation's thought, and they dominated the nation's economy. But none of those appointees had any real responsibility for health. Surgeon General Rupert Blue, head of the United States Public Health Service, did. And Blue was not a strong man.

A square-faced man with a square thick athletic body, an amateur boxer, Blue was physically strong all right, even deep into middle age. But he was not strong in ways that mattered, in leadership. In a field that was largely new when he entered it, a field in which colleagues were cutting new paths into the wild in dozens of directions, he had broken no ground, demonstrated no professional courage, nor had he even showed real zeal. If he was by no means unintelligent, he lacked either real intellectual rigor or the creativity to ask important questions, and he had never manifested any truly special talents in or insights into public health.

As far as scientific public health issues went, the real leaders of the medical profession considered him a lightweight. Welch and Vaughan had not even trusted him to name the Public Health Service's representative to the National Research Council, and so they themselves had picked a PHS scientist they respected. Cary Grayson thought so little of him that he began to build an alternative national public health organization. (He abandoned his effort when Tammany took over the New York City Department of Health.) Blue became surgeon general simply by carrying out assigned tasks well, proving himself an adept and diplomatic maneuverer, and seizing his main chance. That was all.

After finishing his medical studies in 1892, Blue had immediately joined the Public Health Service and remained there his entire professional life. His assignments had moved him from port to port, to Baltimore, Galveston, New Orleans, Portland, New York, Norfolk, where he worked in hospitals and quarantine stations and on sanitation issues. His opportunity came with an outbreak of bubonic plague in San Francisco in 1903. Another PHS officer, a highly regarded scientist, had engaged in a running battle with local government and business leaders, who denied plague existed in the city. Blue did not prove that it did (Simon Flexner did that, demonstrating the plague bacillus in the laboratory, as part of a scientific team brought in to settle the question) but Blue did win grudging cooperation from local authorities in efforts to control the disease. This was no easy task, and he both oversaw the killing of rats and kept, according to one laudatory report, 'all interests in the State' harmonized.'

This success won him powerful friends. (He was not successful enough, however, to prevent plague spreading from rats to wild rodent populations; today plague exists in squirrels, prairie dogs, and other animals in much of the Pacific Coast and inland to Arizona, New Mexico, and Colorado.) When plague resurfaced in San Francisco in 1907 he was called back. Another success won him more powerful friends. In 1912 he rose to surgeon general. That same year Congress expanded the Public Health Service's power. From that position he pushed for national medical insurance, which the medical profession then advocated, and in 1916 he became president of the American Medical Association. In his presidential address he declared, 'There are unmistakable signs that health insurance will constitute the next great step in social legislation.'

Wilson did not bother to choose a new surgeon general, but when the war began he did make the Public Health Service part of the military. It had consisted chiefly of several quarantine stations that inspected incoming ships, the Marine Hospital Service, which cared for merchant seamen and some federal workers, and the Hygienic Laboratory. Now it became responsible for protecting the nation's health, if only so the nation could produce more war matériel. Blue did not grow with the job.

In advance of the epidemic, Gorgas had used all means possible to protect the millions of soldiers from disease. His counterpart Navy Surgeon General William Braisted had done little to match Gorgas, but he was supporting work by such men as Rosenau in Boston and Lewis in Philadelphia.

Blue by contrast did, literally, less than nothing; he blocked relevant research. On July 28, 1918, Blue rejected a request from George McCoy, director of the Hygienic Laboratory, for $10,000 for pneumonia research designed to complement the efforts of the Rockefeller Institute. Although Congress in 1912 had given the agency authority to study 'diseases of man and conditions affecting the propagation thereof,' Blue determined that McCoy's 'investigation is not immediately necessary to the enforcement of the law.'

Blue knew of the possibility of influenza in the United States. On August 1, the
Memphis Medical Monthly
published comments by him warning of it. Yet he made no preparations whatsoever to try to contain it. Even after it began to show evidence of lethality, even after Rufus Cole prodded his office to collect data, neither he nor his office attempted to gather information about the disease anywhere in the world. And he made no effort whatsoever to prepare the Public Health Service for a crisis.

Many of those under him were no better. The Commonwealth Pier outbreak began late in August, and by September 9 newspapers were reporting that influenza victims filled 'all the hospital beds at the forts at Boston harbor,' Camp Devens had thirty-five hundred influenza cases, and Massachusetts hospitals were filling with civilians. Yet the local Public Health Service officer later insisted, 'The first knowledge of the existence of the disease reached this officer September 10th.'