The Great Influenza
Page 22
Gorgas had fought his own war, to prevent epidemic disease from erupting in the camps. He had lost.
*
On August 27, the same day the first sailors at Commonwealth Pier fell ill, the steamer Harold Walker had departed Boston, bound for New Orleans. En route fifteen crew members had fallen ill; in New Orleans the ship unloaded its cargo and put three crewmen ashore. The three men died. By then the Harold Walker had proceeded to Mexico.
On September 4, physicians at the New Orleans naval hospital made the first diagnosis of influenza in any military personnel in the city; the sailor had arrived in New Orleans from the Northeast. That same date a second patient also reported ill with influenza; he was serving in New Orleans. Forty of the next forty-two patients who entered the hospital had influenza or pneumonia.
On September 7 three hundred sailors from Boston arrived at the Philadelphia Navy Yard. Many of them, mixing with hundreds of other sailors, were almost immediately transferred to the navy base in Puget Sound. Others had already gone from Boston to north of Chicago to the Great Lakes Naval Training Station, the largest facility of its kind in the world.
On September 8 at the Newport Naval Base in Rhode Island, more than one hundred sailors reported sick.
The virus was reaching south along the coast, jumping inland to the Midwest, spanning the nation to the Pacific.
Meanwhile, at the Chelsea Naval Hospital, Rosenau and his team of physicians were also overwhelmed - and well aware of the larger implications. Even before Avery arrived, he and Keegan had begun the first effort in the country, and possibly in the world, to create an immune serum that would work against this new mortal enemy. Simultaneously Keegan sent off a description of the disease to the Journal of the American Medical Association, warning that it 'promises to spread rapidly across the entire country, attacking between 30 and 40 percent of the population, and running an acute course.'
*
Keegan was incorrect only in that he limited his estimate to 'the entire country.' He should have said 'the entire world.'
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.
Around the world from Boston, in Bombay, which like so many other cities had endured a mild epidemic in June, the lethal virus exploded almost simultaneously. There it quickly began killing at a rate more than double that of a serious epidemic of bubonic plague in 1900.
*
As the virus moved, two parallel struggles emerged.
One encompassed all of the nation. Within each city, within each factory, within each family, into each store, onto each farm, along the length of the track of the railroads, along the rivers and roads, deep into the bowels of mines and high along the ridges of the mountains, the virus would find its way. In the next weeks, the virus would test society as a whole and each element within it. Society would have to gather itself to meet this test, or collapse.
The other struggle lay within one tight community of scientists. They, men like Welch, Flexner, Cole, Avery, Lewis, Rosenau, had been drafted against their will into a race. They knew what was required. They knew the puzzle they needed to solve. They were not helpless. They had some tools with which to work. They knew the cost if they failed.
But they had very little time indeed.
Part V
EXPLOSION
CHAPTER SEVENTEEN
ON SEPTEMBER 7, three hundred sailors arrived from Boston at the Philadelphia Navy Yard. And what happened in Philadelphia from that point would prove (too often) to be a model for what would happen elsewhere.
Philadelphia was already typical in its war experiences. Every city was being flooded by people, and in Philadelphia shipbuilding alone had added tens of thousands of workers. In a few months a great marsh had been transformed into the Hog Island shipyard, the largest shipyard in the world, where thirty-five thousand workers toiled among furnaces and steel and machinery. Nearby the New York Shipbuilding yard worked eleven thousand five hundred men, and a dozen other shipyards each worked from three thousand to five thousand more. And the city was thick with other great industrial plants: several munitions factories each employed several thousands at a single location, the J. G. Brill Company turned out a streetcar an hour and employed four thousand, Midvale Steel had ten thousand workers, Baldwin Locomotive, twenty thousand.
Overcrowded before the war, with jobs sucking ever more workers into the city and the population swelling to 1.75 million, Philadelphia literally teemed with people. In 1918 a national publication for social workers judged living conditions in its slums, where most tenements still had outhouses servicing dozens of families, worse than on the Lower East Side of New York. Blacks endured even more squalid conditions and Philadelphia had the largest African American population of any northern city, including New York or Chicago.
Housing was so scarce that Boy Scouts canvassed the area seeking rooms for newly arrived women with war jobs. Two, three, and four entire families would cram themselves into a single two-or three-room apartment, with children and teenagers sharing a bed. In rooming houses laborers shared not just rooms but beds, often sleeping in shifts just as they worked in shifts. In those same tenements, the city's own health department had conceded that during the winter of 1917-18 'the death rate' has gone up owing to the high cost of living and scarcity of coal.'
The city offered the poor social services in the form of Philadelphia Hospital, known as 'Blockley,' a poorhouse, and an asylum. But it offered nothing else, not even an orphanage. The social elite and progressives ran whatever charitable activities that did exist. Even normal services such as schools were in short supply. Of the twenty largest cities in America, Philadelphia, the city of Benjamin Franklin and the University of Pennsylvania, spent less on education than all but one. In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934.
All this made Philadelphia fertile ground for epidemic disease. So did a city government incapable of responding to a crisis. Muckraker Lincoln Steffens called Philadelphia 'the worst-governed city in America.' He may well have been right.
Even Tammany's use of power in New York was haphazard compared to that of the Philadelphia machine, which had returned to power in 1916 after a reformer's single term in office. Philadelphia's boss was Republican state senator Edwin Vare. He had bested and mocked people who considered themselves his betters, people who despised him, people with such names as Wharton, Biddle, and Wanamaker.
A short, thick-chested, and thick-bellied man (his nickname was 'the little fellow') Vare had his base in South Philadelphia. He had grown up there before the incursion of immigrants, on a pig farm in a then-rural area called 'the Neck.' He still lived there despite enormous wealth. The wealth came from politics.
All city workers kicked back a portion of their salary to Vare's machine. To make sure none ever missed a payment, city workers received their salary not where they worked or in City Hall (a classic and magnificent Victorian building, with curved shoulders and windows reminiscent of weeping willow trees) but across the street from City Hall in Republican Party headquarters. The mayor himself kicked back $1,000 from his pay.
Vare was also the city's biggest contractor, and his biggest contract was for street cleaning, a contract he had held for almost twenty years. At a time when a family could live in comfort on $3,000 a year, in 1917 he had received over $5 million for the job. Not all of that money stayed in Vare's pockets, but even the part that left passed through them and paid a toll. Yet the streets were notoriously filthy, especially in South Philadelphia - where the need was greatest, where everything but raw sewage, and sometimes even that, ran through the gutters, and where the machine was strongest.
The machine proved so lucrative that Edwin Vare and his brother William, a congressman, became philanthropists, giving so much to their church at Moyamensing Avenue and Morris Street that it was renamed the Abigail Vare Memorial Methodist Episcopal Church, after their mother. Not many churches are named after mere mortals, but this one was.
Yet nothing about the machine was saintly. On primary election day in 1917, several Vare workers blackjacked two leaders of an opposing faction, then beat to death a policeman who intervened. The incident outraged the city. Vare's chief lieutenant in 1918 was Mayor Thomas B. Smith. In his one term in office he would be indicted, although acquitted, on three entirely unrelated charges, including conspiracy to murder that policeman. That same election, however, gave Vare absolute control over both the Select and Common Councils, the city's legislature, and broad influence in the state legislature.
Director of the Philadelphia Department of Public Health and Charities was Dr. Wilmer Krusen, a political appointee who served at the mayor's pleasure and whose term automatically expired with the mayor's. Krusen, a decent man whose son would become a surgeon at the Mayo Clinic, was as good an appointment as the machine made. But he lacked background in, commitment to, or understanding of public health issues. And he was by nature someone who thought most problems disappeared on their own. He was not someone to rush into a thing.
He certainly would exert no pressure whatsoever on the machine to advance the public health. Although a gynecologist, he refused even to help the military in its massive national campaign against prostitution. Even New Orleans had succumbed to pressure to close Storyville, where prostitution was legal, but no pressure could make Philadelphia, where prostitution remained illegal, in any way hinder its flesh industry. So, according to a military report, the navy 'actually took control of police affairs' outside its installations.
The city government was choking on corruption, with lines of authority split among Vare, precinct captains-turned-entrepreneurs, and the mayor. It did not wish to act, nor could it if it chose to.
*
Four days after the arrival of the sailors from Boston at the Navy Yard, nineteen sailors reported ill with symptoms of influenza.
Lieutenant Commander R. W. Plummer, a physician and chief health officer for the Philadelphia naval district, was well aware of the epidemic's rage on Commonwealth Pier and at Devens and its spread to the civilian population in Massachusetts. Determined to contain the outbreak, he ordered the immediate quarantine of the men's barracks and the meticulous disinfecting of everything the men had touched.
In fact, the virus had already escaped, and not only into the city. One day earlier 334 sailors had left Philadelphia for Puget Sound; many would arrive there desperately ill.
Plummer also immediately called in Paul Lewis.
Lewis had been expecting such a call.
He loved the laboratory more than he loved anyone or anything, and he had the full confidence of Welch, Theobald Smith, and Flexner. Lewis had won their confidence by his extraordinary performance as a young scientist under each of them in turn. He had already achieved much, and he held the promise of much more. He also knew his own worth, not in the sense that it made him smug but in that it gave him responsibility, making his promise at least as much burden as ambition. Only an offer to become the founding head of the new Henry Phipps Institute (Phipps had made millions at U.S. Steel with Andrew Carnegie, then, like Carnegie, had become a prominent philanthropist) which was associated with the University of Pennsylvania, had lured him to Philadelphia from the Rockefeller Institute. He was modeling Phipps after the institute, although Phipps would focus much more narrowly on lung disease, particularly tuberculosis.
No one needed to tell Lewis the urgency of the situation. He knew the details of the British sailors who had died in early July, and he had very likely tried to culture bacteria from them and prepare a serum. Soon after learning that influenza had appeared in the Navy Yard, Lewis arrived there.
It was up to him to take charge of what would normally be the step-by-step, deliberate process of tracking down the pathogen and trying to develop a serum or vaccine. And there was no time for normal scientific procedures.
The next day eighty-seven sailors reported ill. By September 15, while Lewis and his assistants worked in labs at Penn and at the navy hospital, the virus had made six hundred sailors and marines sick enough to require hospitalization, and more men were reporting ill every few minutes. The navy hospital ran out of beds. The navy began sending ill sailors to the Pennsylvania Hospital at Eighth and Spruce.
On September 17, five doctors and fourteen nurses in that civilian hospital suddenly collapsed. None had exhibited any prior symptoms whatsoever. One moment they felt normal; the next, they were being carried in agony to hospital beds.
*
Navy personnel from Boston had been transferred elsewhere as well. As Philadelphia was erupting, so was the Great Lakes Naval Training Station, thirty-two miles above Chicago. Teddy Roosevelt had created the base in 1905, declaring that it would become the largest and best naval training station in the world. With forty-five thousand sailors it was the largest, and it had begun to generate a proud history. The 'Seabees' naval construction battalions were born there, and during the war Lieutenant John Philip Sousa created fourteen regimental bands there; sometimes all fifteen hundred musicians played en masse on Ross Field, spectacle for tens of thousands who flocked to hear them. As the influenza virus swept through the base, there would be no massing of anyone, musicians or otherwise. At this base, influenza ripped through the barracks very much like an explosion.
Robert St. John had just been inducted into the navy there when he became one of the early victims. Given a cot in a drill hall where soon thousands of men (in that one hall) would lie unattended, he later recalled, 'No one ever took our temperatures and I never even saw a doctor.' He did make his first friend in the navy, a boy on the next cot who was too ill to reach for water. St. John himself barely had the strength to help him drink from his canteen. The next morning an orderly pulled the blanket over his friend's head, and two sailors put the body on a stretcher and carried it away. By then the medical department had already reported that '33 caskets to Naval Medical Supply Depot required.' They would soon require far more than that.
One nurse at Great Lakes would later be haunted by nightmares. The wards had forty-two beds; boys lying on the floor on stretchers waited for the boy on the bed to die. Every morning the ambulances arrived and stretcher bearers carried sick sailors in and bodies out. She remembered that at the peak of the epidemic the nurses wrapped more than one living patient in winding sheets and put toe tags on the boys' left big toe. It saved time, and the nurses were utterly exhausted. The toe tags were shipping tags, listing the sailor's name, rank, and hometown. She remembered bodies 'stacked in the morgue from floor to ceiling like cord wood.' In her nightmares she wondered 'what it would feel like to be that boy who was at the bottom of the cord wood in the morgue.'
*
The epidemic was sweeping through the Philadelphia naval installations with comparable violence, as it had in Boston. Yet in Philadelphia, despite the news out of Boston, despite the Great Lakes situation, despite events at its own Navy Yard, Philadelphia public health director Wilmer Krusen had done absolutely nothing.
Not all the city's public health figures remained oblivious to the threat. The day after the first sailor fell ill, Dr. Howard Anders, a prominent public health expert who despised and had no faith in the Vare machine, wrote Navy Surgeon General William Braisted to ask would 'the navy (federal) authorities directly come in, under this threat of influenza invasion, and insi
st upon safeguarding its men and collaterally the whole population of Philadelphia' ?' (Braisted declined.)
Krusen publicly denied that influenza posed any threat to the city. He seemed to believe that, for he made no contingency plans in case of emergency, stockpiled no supplies, and compiled no lists of medical personnel who would be available in an emergency, even though 26 percent of Philadelphia's doctors and even a higher percentage of nurses were in the military. Indeed, despite building pressure from Lewis, from Anders, from physicians all over the city, from faculty at Penn and Thomas Jefferson Medical College (which refused to release six doctors who wanted to volunteer for military service just as the epidemic erupted) not until September 18, a full week after the disease appeared in the city, did Krusen even schedule a meeting with Plummer, Lewis, and several others.
In Krusen's fifth-floor office at City Hall they acquainted each other with the facts. In Massachusetts nearly one thousand had already died, with tens of thousands ill, and the Massachusetts governor had just issued a plea for doctors and nurses from neighboring regions. In Philadelphia hundreds of sailors were hospitalized. Few signs of disease had surfaced among civilians, but Lewis reported that as yet his research had not found an answer.
Even if Lewis succeeded in making a vaccine, it would take weeks to produce in sufficient quantities. Thus, only drastic action could prevent the spread of influenza throughout the city. Banning public meetings, closing businesses and schools, imposing an absolute quarantine on the Navy Yard and on civilian cases - all these things made sense. A recent precedent existed. Only three years earlier Krusen's predecessor (during the single term of the reform mayor) had imposed and enforced a strict quarantine when a polio epidemic had erupted, a disease Lewis knew more about than anyone in the world. Lewis certainly wanted a quarantine.