Apparently, the disease overstimulated healthy immune systems, turning them against the body. In slightly more medical terms, the Spanish flu triggered what’s called a cytokine storm. Cytokine proteins exist in your body to modulate the release of immune cells when there is an infection. A healthy immune system has a lot of those little fellows. In a cytokine storm, too many immune cells flood the site of the infection, which causes inflammation around that site. If the site of the infection is in the lungs—as it could be in a respiratory disease like the Spanish flu—the inflamed lungs fill with fluids. Then you die.8
You would think that if there was a strange new disease killing young soldiers, everyone would be reading about it everywhere. Remember the recent ebola outbreak, which killed a grand total of two people in the United States? That dominated the American news cycle for months.
So it seems insane that a disease killing young heterosexual white men in the middle of America would just be overlooked. (I’m not saying that diseases affecting other groups should be ignored; simply that, historically, they have been.) Were newspaper reporters really dense one hundred years ago? No. They didn’t report on the outbreak because they did not want to go to jail.
A morale law had been passed in 1917 after the United States entered World War I. It stated you could receive twenty years in jail if you chose to “utter, print, write or publish any disloyal, profane, scurrilous, or abusive language about the government of the United States.”9 This law seems unconstitutional, but it was upheld by the Supreme Court ruling (Schenck v. United States) that you can’t say things that “represent to society a clear and present danger.” So you cannot scream “Fire!” in a crowded theater, and you can’t say that a terrifying disease is spreading through the populace and the government has no idea how to combat it.
The difference between the two is that the first one presupposes a fire does not actually exist. If there is a blaze in a crowded theater, you should still scream “Fire!” You should scream it loudly. People need to know so they can make decisions about what to do. An even better option would be to scream, “Fire! The exits are clearly lit! Proceed to them!” (You are an usher in this situation.) Similarly, you should also loudly let people know about the terrifying new disease sweeping through the country, hopefully with some helpful thoughts on how to proceed in the face of such a menace.
But American reporters really didn’t want to risk those twenty years of jail time.
The press in Britain was even more severely censored during World War I. There, the Defense of the Realm Act declared, “No person shall by word of mouth or in writing spread reports likely to cause disaffection or alarm among any of His Majesty’s forces or among the civilian population.”10 In Britain, “journalistic outlaws” were threatened with execution.
Newspapers in the United States were supposed to present the truth, but they were also supposed to report cheerful facts that made America look good. Whenever someone jaded by today’s news tells you that they want a newspaper that just shares good news, remind them that President Woodrow Wilson tried that approach. It did not work out so well. The writer Walter Lippmann, who—cool fact—later came up with the phrase Cold War, urged the president to create a publicity bureau that would publish only articles favorable to the United States. That is because Lippmann believed that most citizens were “mentally children or barbarians.” Wilson founded the department one day after receiving Lippmann’s memo, appointing George Creel to run it. The Committee on Public Information went on to distribute tens of thousands of articles about America’s greatness, which newspapers ran largely unedited. After all, given that editors were fearful of publishing anything that might be construed as anti-American, they were happy for some additional articles to fill up pages.11
Lippmann may have viewed the populace as children, but even kids were able to figure out what was going on with the flu. Before long, they had begun singing a schoolyard rhyme that went:
I had a little bird,
Its name was Enza.
I opened the window
and in flew Enza.
The Spanish flu worked fast. The epidemiologist Shirley Fannin reported: “If an individual with influenza were standing in front of a room full of people coughing, each cough would carry millions of particles with disease-causing organisms into the air. All the people breathing that air would have an opportunity to inhale a disease-causing organism. It doesn’t take very long for one case to become 10,000 cases.”12
The disease started moving with the soldiers to other army camps around the country and then overseas. People could be infected and then die within twenty-four hours. However, news reports, where they existed at all in the American media, insisted that everything was fine. That was more or less what they would keep reporting—ridiculous though it increasingly seemed—through the entirety of the epidemic.
Spain, however, was neutral during World War I. That meant the Spanish press could report on the flu and its growing number of fatalities without fear of being jailed or labeled unpatriotic. On May 22, 1918, Spanish newspapers ran an article about a new kind of illness that seemed to be sickening many citizens. Since May is a month with numerous festivals, at first it was thought the disease might be foodborne, as entire parties of people fell ill. By May 28, King Alfonso of Spain was sick. So were a staggering 8 million other Spaniards.13
By July, influenza had made its way to London, where in the first week it killed 287 people.14 In spite of this, English newspapers still claimed the disease was just “the general weakness of nerve-power known as war-weariness.”15 They were also skeptical of the spread of the disease in Spain. The British Journal of Medicine reported that influenza “appears to have been particularly widespread in Spain during the month of May; that there were 8 million cases of the disease in that country, as it was alleged by the French press at the time, is a statement requiring perhaps a grain of salt for deglutition, but certainly pointing to a very heavy incidence.”16 Look, that 8 million number might be overstated. We have no way of knowing. But we do know you should take newspapers trying to keep morale up during wartime with a whole canister of salt. The British army would carry that world weariness, or, as it later came to be called, “the Big Sneeze,”17 all over the globe, and cases were soon turning up in India and North Africa.18
By fall, conditions were worse. In John M. Barry’s words in The Great Influenza, the spread of the disease among so many people had turned it into “a better and more efficient killer.” The autumn of 1918 is often considered to be the “second wave” of the disease.19
As the outbreak grew more deadly, more American troops were needed overseas. That was at least in part because in some units up to 80 percent of the men had died of Spanish flu. Dr. Victor Vaughn, the former president of the American Medical Association, stated, “This infection, like war, kills the young, vigorous, robust adults. The husky male either made a speedy and rather abrupt recovery or was likely to die.”20 Soldiers traveled to Europe on troop ships. In those crowded conditions, anyone who had the disease would certainly pass it on to others. When President Woodrow Wilson agreed that more young soldiers—men who would be at the most likely age to die of the disease—would have to be sent overseas (around 250,000 in October),21 he reportedly turned to his aide and remarked, “I wonder if you have heard this limerick? ‘I had a little bird and his name was Enza…’”22
Hearing this, do you think Woodrow Wilson a monster? Because he seems to be doing a very good imitation of Donald Sutherland’s character in the movie trilogy The Hunger Games (2012–15). I’ll actually spoil that for you and say, at the very least, Wilson had moral failings as large as the moon. He believed that immigrants to the United States represented “sordid and hapless elements of their population.”23 He literally kept African Americans in cages when they had to work on the same floor as white people because he didn’t want them mingling (much to the outrage of their coworkers, some of whom they had worked with for decades). The civ
il rights leader W. E. B. Du Bois wrote to him about his general belief that “segregation was not humiliating but a benefit,” and, specifically, about his forcible attempts to segregate people of different colors from working together, asking, “Do you know that no other group of American citizens has ever been treated in this way and that no President of the United States ever dared to propose such treatment?”24 President Wilson, like Lippmann, fundamentally believed that all Americans were not equal. That surely made the idea of restricting the flow of information available to all Americans much more palatable.
Also, his face looked like a rich man’s pet bird.
So, yes, Wilson was not a good guy. Whether you find his decision regarding soldiers’ deployment justifiable—and it seems like a fun theoretical situation to consider—depends on whether you think winning World War I was worth it at any cost. Whoever takes on this project should keep in mind that Woodrow Wilson himself later contracted what is largely believed to be the Spanish flu, which prevented him from engaging fully in the Treaty of Versailles peace talks, the terms of which are often said to have so deeply penalized Germany that they led to World War II.25
Whatever your opinion of Wilson at this moment (he’s awful), we have the advantage of looking at his actions from a hundred years in the future. He was focused on the war at hand.
Everyone was focused on the war at hand.
It is almost impossible, living as we do in a time without morale laws, to imagine how glorious World War I was considered to be by the American people. Patriotism was so high that young men would have been clamoring to get on the troop ship. The culture was suffused with references to how great it was to go fight the Hun. Immensely popular songs like “Over There” encouraged young men to
Hurry right away, no delay, go today
Make your daddy glad to have had such a lad
Tell your sweetheart not to pine
to be proud her boy’s in line.26
while women at home would chant,
Tramp, tramp, tramp the boys are marching.
I spy Kaiser at the door.
And we’ll get a lemon pie and we’ll squash him in his eye
and there won’t be any Kaiser anymore.27
It seems the men got the better song. That lemon pie ditty was like a child’s take on how to end fascism if that child was also obsessed with Charlie Chaplin and baked goods. If you hit someone with a pie, that person just doesn’t disappear. If that were true, there would be no clowns.
As enthusiastic as men might have been about participating in the war, they probably would have been less enthused about the prospect of dying from flu on a ship. But newspapers weren’t going to tell them about that. The government wasn’t going to, either. Officials claimed that they had everything under control and that the soldiers and the populace had nothing to worry about. Royal Copeland, the health commissioner in New York, claimed, “You haven’t heard of our doughboys getting it, have you? You bet you haven’t, and you won’t … No need for our people to worry over the matter.”28
You should have heard about it. During World War I, forty thousand American soldiers were killed by Spanish flu. For perspective, that’s only seven thousand fewer American soldiers than were killed in combat in Vietnam. Dr. Vaughn later remarked, “The saddest part of my life was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do. At that moment I decided never again to prate about the great achievements of medical science and to humbly admit our dense ignorance in this case.”29
Hushing up the epidemic took more and more work by the press. As late as September 26, headlines in the El Paso Herald proclaimed “Vicious Rumors of Influenza Epidemic Will Be Combatted,” while sailors were told to write home and tell their relatives not to worry about the stories spreading about the disease.30
Meanwhile, in Philadelphia—one of the largest and most overcrowded cities in the United States at the time—the disease began to present among members of the navy gathering there in early September. By September 15, six hundred navy men were in the hospital. The navy hospital was overflowing. The sick had to be sent to civilian hospitals, where they would begin spreading the disease farther.
This would have been a great time for officials to adamantly start advising people to stay inside. Or maybe not move people with a highly contagious disease to a hospital where people with other ailments would be. We can all play “How many better solutions can we find to this situation than a massive cover-up?”
The answer is “a lot.”
However, officials in Philadelphia opted for the “massive cover-up” option. They continued to downplay the threat. The Board of Health advised people to keep warm, keep their feet dry, and avoid crowds. Perhaps if they had stressed the actual danger, Philadelphians wouldn’t have ignored that “avoid crowds” message. Surely, hundreds of thousands of them wouldn’t have come together for the Liberty Loan parade on September 28. Dr. Howard Anders—a public health expert who should stand out as one of the heroes in this book—begged a series of reporters to write about the danger posed by the parade. He had already written to the navy surgeon general, asking him to send in federal authorities to “insist upon safeguarding its men and, collaterally, the whole population of Philadelphia,”31 to no avail. He was correctly certain that congregating for a parade would spread influenza to thousands of civilians. All the newspapers refused his request—despite his description of the parade as “a ready-made inflammable mass for a conflagration,” which is a fancy way of saying that this disease would burn Philadelphia to the ground—because they didn’t want to hurt morale.32
None of those newspapers can be heroes in this book. Dr. Anders can. You may say, “Wait. He tried, but he did not succeed! There are no points for trying! Do or do not, there is no try!” To which I will say, “No, that’s silly. The world is not dictated by Yoda’s quips. Yoda is just a little monster who lives in a backpack. Of course there are points for trying.” Dr. Anders tried to warn people, and that was more than anyone else was doing. He did the right thing, at a time when it was certainly easier to stay silent. This is my book, and I say he is a hero for trying.
He did fail, though.
I hope that parade was fun, because its consequences were every bit as devastating as Dr. Anders predicted. At the end of September, the director of the Philadelphia Department of Public Health and Charities, Dr. Wilmer Krusen, noted, “The epidemic is now present in the civilian population.” This admission was a step in the right direction, so good work, Dr. Krusen. Unfortunately, by the time he finally spoke, hundreds of people were dying a day. Literally. On October 1, 117 people died of Spanish flu in Philadelphia. Still, on October 6, the Philadelphia Inquirer peppily reported that the best way to avoid the disease was to:
Live a clean life.
Do not even discuss influenza …
Worry is useless.
Talk of cheerful things instead of the disease.33
The newspaper went on to lament the very basic precautions of closing public gathering places like churches and movie theaters.34 The Inquirer asked on October 6, “What are the authorities trying to do? Scare everyone to death?”35 A blasé attitude, clean living, and cheerful thoughts didn’t stop the disease. On October 10, 759 people died.36
There was a weird period during the fall months when everyone seemed to know about the disease, but no one seemed to take it very seriously. In Katherine Anne Porter’s short story “Pale Horse, Pale Rider,” there is a scene in which the protagonist, a theater critic, is welcoming her love interest, a soldier who is temporarily home on leave. It runs:
“I wonder,” said Miranda, “How did you manage to get an extension of leave?”
“They just gave it,” said Adam, “For no reason. The men are dying like flies out there, anyway. This funny new disease. Simply knocks you into a cocked hat.”
“It seems to be a plague,” said Miranda, “something out of the middle ages. Did you see so m
any funerals, ever?”
“Never did. Well, let’s be strong minded and not have any of it … What a job you’ve got,” said Adam, “nothing to do but run from one dizzy amusement to another and then write a piece about it.”
“Yes, it’s too dizzy for words,” said Miranda. They stood while a funeral passed, and this time they watched it in silence.37
Despite death surrounding them, the fact that they could be affected by the disease still seemed to shock people, as it did the characters in Porter’s work. There was a decided focus on going about day-to-day business, cheerfully. Among the scant public health warnings about the Spanish flu were paper flyers that explained, “When obliged to cough or sneeze, always place a handkerchief, paper napkin, or fabric of some kind before the face.”38 This is good advice if you have a cold. A hanky is woefully insufficient to combat a highly infectious, deadly, airborne disease. Still, the headline on October 15 in the Inquirer cheerfully announced on one of its back pages, “Scientific Nursing Halting Epidemic … Officials Say Entire Situation Is Well in Hand.”39 That was not true. Despite the noble efforts of the nurses and physicians at the hospitals—and the nuns and various other volunteers who were working tirelessly—they were absolutely not halting the epidemic. They couldn’t even respond to all the people who needed hospitalization.40
Horse-drawn carriages rolled through the streets of Philadelphia collecting dead bodies that had been rotting on the sidewalks. Why, you might understandably ask, have we suddenly been transported back to the fourteenth century? Likely because, as is usually the case when pandemics strike, coffins were in such high demand that they had become expensive. People had taken to stealing them. Children’s corpses were stuffed into macaroni boxes. Yes, macaroni boxes used to be bigger, and no, the government clearly wasn’t subsidizing funerals, because Woodrow Wilson wasn’t as smart as Marcus Aurelius.41 Even if you could procure a coffin, undertakers wouldn’t touch dead bodies, so families had to bury their loved ones themselves. That is, if there was anyone healthy enough to do the burying. Philadelphia’s citizenry were left waiting on their porches for a charity corpse truck, driven by priests, to come and collect their dead. You would have seen open trucks filled with dead bodies driving through the streets.42 Those trucks would make a lot of rounds that month, because eleven thousand people died in Philadelphia that October.43
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