The Great Influenza

by John M. Barry

The need was not only for medical care, but for care itself. Entire families were ill and had no one to feed them. Krusen pleaded publicly; 'Every healthy woman in the city who can possibly be spared from her home can be used in fighting the epidemic.'

  But by now the city had heard enough pleas, and had turned into itself. There was no trust, no trust, and without trust all human relations were breaking down.

  The professionals had continued to do their duty. One physician at Philadelphia Hospital, a woman, had said she was certain she was going to die if she remained, and fled. But that was a rarity. Doctors died, and others kept working. Nurses died, and others kept working. Philadelphia Hospital had twenty student nurses from Vassar. Already two had died but the others 'have behaved splendidly' . They say they will work all the harder.'

  Other professionals did their jobs as well. The police performed with heroism. Before the epidemic they had too often acted like a private army that owed its allegiance to the Vare machine. They had stood almost alone in the country against the navy's crackdown on prostitution near military facilities. Yet when the police department was asked for four volunteers to 'remove bodies from beds, put them in coffins and load them in vehicles,' when the police knew that many of those bodies had decomposed, 118 officers responded.

  But citizens in general had largely stopped responding. Many women had reported to an emergency hospital for a single shift. They had never returned. Some had disappeared in the middle of a shift. On October 16 the chief nurse at the city's largest hospital told an advisory council, '[V]olunteers in the wards are useless' . [T]hey are afraid. Many people have volunteered and then refused to have anything to do with patients.'

  The attrition rate even where volunteers did not come into contact with the sick (in the kitchens, for example) was little better. Finally Mrs. Martin turned bitter and contemptuous: 'Hundreds of women who are content to sit back' had delightful dreams of themselves in the roles of angels of mercy, had the unfathomable vanity to imagine that they were capable of great spirit of sacrifice. Nothing seems to rouse them now. They have been told that there are families in which every member is ill, in which the children are actually starving because there is no one to give them food. The death rate is so high and they still hold back.'

  Susanna Turner, who did volunteer at an emergency hospital and stayed, who went there day after day, remembered, 'The fear in the hearts of the people just withered them' . They were afraid to go out, afraid to do anything' . You just lived from day to day, did what you had to do and not think about the future' . If you asked a neighbor for help, they wouldn't do so because they weren't taking any chances. If they didn't have it in their house, they weren't going to bring it in there' . You didn't have the same spirit of charity that you do with a regular time, when someone was sick you'd go and help them, but at that time they helped themselves. It was a horror-stricken time.'

  The professionals were heroes. The physicians and nurses and medical students and student nurses who were all dying in large numbers themselves held nothing of themselves back. And there were others. Ira Thomas played catcher for the Philadelphia Athletics. The baseball season had been shortened by Crowder's 'work or fight' order, since sport was deemed unnecessary labor. Thomas's wife was a six-foot-tall woman, large-boned, strong. They had no children. Day after day he carried the sick in his car to hospitals and she worked in an emergency hospital. Of course there were others. But they were few.

  'Help out?' said Susanna Turner. 'They weren't going to risk it, they just refused because they were so panic-stricken, they really were, they feared their relatives would die because so many did die (they just dropped dead.' No one could buy things. Commodities dealers, coal dealers, grocers closed 'because the people who dealt in them were either sick or afraid and they had reason to be afraid.'

  During the week of October 16 alone, 4,597 Philadelphians died from influenza or pneumonia, and influenza killed still more indirectly. That would be the worst week of the epidemic. But no one knew that at the time. Krusen had too often said the peak had passed. The press had too often spoken of triumph over disease.

  Even war industries, despite the massive propaganda campaigns telling workers victory depended upon their production, saw massive absences. Anna Lavin said, 'We didn't work. Couldn't go to work. Nobody came into work.' Even those who weren't sick 'stayed in. They were all afraid.'

  Between 20 and 40 percent of the workers at Baldwin Locomotive, at Midvale Steel, at Sun Shipbuilding, each plant employing thousands, were absent. At virtually every large employer, huge percentages of employees were absent. Thirty-eight hundred Pennsylvania Railroad workers were out. The Baltimore and Ohio Railroad set up its own emergency hospitals along its tracks. The entire transportation system for the mid-Atlantic region staggered and trembled, putting in jeopardy most of the nation's industrial output.

  The city was breaking apart. Orphans were already becoming a problem. Social service agencies that tried but fell short in their efforts to deliver food and transport people to hospitals began to plan for the orphans as well.

  CHAPTER TWENTY-NINE

  WHAT WAS HAPPENING in Philadelphia was happening everywhere. In that densely populated city, Isaac Starr had counted not a single other car on the road in his twelve-mile drive from the city center home. And on the other side of the world, the same experiences (the deaths, the terror, the reluctance to help, the silence) were replicated. Alfred Hollows was in Wellington, New Zealand: 'I was detailed to an emergency hospital in Abel Smith Street. It was a hall' staffed by women volunteers.' They had sixty beds. 'Our death rate was really quite appalling (something like a dozen a day) and the women volunteers just disappeared, and weren't seen again' . I stood in the middle of Wellington City at 2 P.M. on a weekday afternoon, and there was not a soul to be seen - no trams running, no shops open, and the only traffic was a van with a white sheet tied to the side, with a big red cross painted on it, serving as an ambulance or hearse. It was really a City of the Dead.'

  In New York City at Presbyterian Hospital, each morning on rounds Dr. Dana Atchley was astounded, and frightened, to see that, for what seemed to him an eternity, every single patient (every one) in the critical section had died overnight.

  The federal government was giving no guidance that a reasoning person could credit. Few local governments did better. They left a vacuum. Fear filled it.

  The government's very efforts to preserve 'morale' fostered the fear, for since the war began, morale (defined in the narrowest, most shortsighted fashion) had taken precedence in every public utterance. As California senator Hiram Johnson said in 1917, 'The first casualty when war comes is truth.'

  It was a time when the phrase 'brisk fighting' meant that more than 50 percent of a unit was killed or wounded; a time when the memoir of a nurse at the front, published in 1916, was withdrawn by her publisher after America entered the war because she told the truth about gruesome conditions; a time when newspapers insisted, 'There is plenty of gasoline and oil for automobile use,' even while gas stations were ordered to close 'voluntarily' at night and Sundays and a national campaign was being waged against driving on 'gasless Sundays' and police pulled over motorists who did not 'voluntarily' comply.

  Newspapers reported on the disease with the same mixture of truth and half-truth, truth and distortion, truth and lies with which they reported everything else. And no national official ever publicly acknowledged the danger of influenza.

  But in the medical community, deep concern had arisen. Welch of course had initially feared that it might be a new disease, although he soon recognized it as influenza. Many serious pathologists in Germany and Switzerland considered the possibility of plague. The director of the laboratory at Bellevue Hospital wondered in the Journal of the American Medical Association if 'the world is facing' not a pandemic of an extraordinarily lethal influenza but instead a mild version of plague, noting, 'The similarity of the two diseases is enforced by the clinical features, which are remarkably
alike in many respects, and by the pathology of certain tissues other than the lungs.'

  What pathologists said in medical journals physicians muttered to each other, while laymen and -women watched a husband or wife turning almost black. And a great chill settled over the land, a chill of fear.

  Meanwhile, William Park sat in his laboratory amid petri dishes, dissected mice, and cultures of pathogens, and quoted Daniel Defoe's Journal of the Plague Year: 'In the whole the face of things, as I say, was much altered; sorrow and sadness sat upon every face; and though some parts were not yet overwhelmed, yet all looked deeply concerned; and as we saw it apparently coming on, so every one looked on himself and his family as in the utmost danger.'

  *

  As terrifying as the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read. Uncertainty follows distrust, fear follows uncertainty, and, under conditions such as these, terror follows fear.

  When influenza struck in Massachusetts, the nearby Providence Journal reported; 'All the hospital beds at the forts at Boston harbor are occupied by influenza patients' . There are 3,500 cases at Camp Devens.' Yet the paper asserted, 'Such reports may actually be reassuring rather than alarming. The soldier or sailor goes to bed if he is told to, just as he goes on sentry duty. He may not think he is sick, and he may be right about it, but the military doctor is not to be argued with and at this time the autocrat is not permitting the young men under his charge to take any chance.'

  As the virus infested the Great Lakes Naval Training Station, the Associated Press reported, 'To dispel alarm caused throughout the country by exaggerated stories' Captain W. A. Moffat, commandant, gave out the statement today that while there are about 4,500 cases of the disease among the 45,000 blue jackets at the station, the situation in general is much improved. The death rate has been only one and one half per cent, which is below the death rate in the east.'

  That report was meant to reassure. It is unlikely that it did so, even though it omitted the fact that quarantines were being imposed upon the training station, the adjoining Great Lakes Aviation Camp, and the nearby Fort Sheridan army cantonment, which, combined, amounted to the largest military concentration in the country. And military authorities of course assured both civilians nearby as well as the country at large that 'the epidemic is on the wane.'

  Over and over in hundreds of newspapers, day after day, repeated in one form or another people read Rupert Blue's reassurance as well: 'There is no cause for alarm if precautions are observed.'

  They read the words of Colonel Philip Doane, the officer in charge of health at the country's shipyards, who told the Associated Press, 'The so-called Spanish influenza is nothing more or less than old fashioned grippe.'

  Those words, too, ran in hundreds of newspapers. But people could smell death in them. Then they came to know that death.

  Immediately outside Little Rock lay Camp Pike, where eight thousand cases were admitted to the hospital in four days and the camp commandant stopped releasing the names of the dead. 'You ought to see this hospital tonight,' wrote Francis Blake, one of four members of the army's pneumonia commission at Pike. 'Every corridor and there are miles of them with a double row of cots and every ward nearly with an extra row down the middle with influenza patients and lots of barracks about the camp turned into emergency infirmaries and the Camp closed' . There is only death and destruction.'

  The camp called upon Little Rock for nurses, doctors, linens, and coffins, all while within the city the Arkansas Gazette declared in headlines, 'Spanish influenza is plain la grippe - same old fever and chills.'

  Outside Des Moines, Iowa, at Camp Dodge, also, influenza was killing hundreds of young soldiers. Within the city a group called the Greater Des Moines Committee, businessmen and professionals who had taken charge during the emergency, included the city attorney who warned publishers (and his warning carried the sting of potential prosecution) 'I would recommend that if anything be printed in regard to the disease it be confined to simple preventive measures - something constructive rather than destructive.' Another committee member, a physician, said, 'There is no question that by a right attitude of the mind these people have kept themselves from illness. I have no doubt that many persons have contracted the disease through fear' . Fear is the first thing to be overcome, the first step in conquering this epidemic.'

  The Bronxville, New York, Review Press and Reporter simply said nothing at all about influenza, absolutely nothing, until October 4, when it reported that the 'scourge' had claimed its first victim there. It was as if the scourge had come from nowhere; yet even the paper recognized that, without its printing a word, everyone knew of it. And even as the epidemic rooted itself in Bronxville, the paper condemned 'alarmism' and warned, 'Fear kills more than the disease and the weak and timid often succumb first.'

  Fear, that was the enemy. Yes, fear. And the more officials tried to control it with half-truths and outright lies, the more the terror spread.

  *

  The Los Angeles public health director said, 'If ordinary precautions are observed there is no cause for alarm.' Forty-eight hours later he closed all places of public gatherings, including schools, churches, and theaters.

  The Illinois superintendent of public health had (privately, in a confidential meeting with other Illinois public health officials and Chicago politicians) suggested they close all places of business to save lives. Chicago Public Health Commissioner John Dill Robertson violently rejected that suggestion as unwarranted and very damaging to morale. In his official report on the epidemic, he bragged, 'Nothing was done to interfere with the morale of the community.' Later he explained to other public health professionals, 'It is our duty to keep the people from fear. Worry kills more people than the epidemic.'

  The mortality rate at Cook County Hospital for all influenza cases (not just those who developed pneumonia) was 39.8 percent.

  Literary Digest, one of the largest-circulation periodicals in the country, advised, 'Fear is our first enemy.'

  'Don't Get Scared!' was the advice printed in virtually every newspaper in the country, in large, blocked-off parts of pages labeled 'Advice on How to Avoid Influenza.'

  The Albuquerque Morning Journal issued instructions on 'How to Dodge 'Flu.'' The most prominent advice was the usual: 'Don't Get Scared.' Almost daily it repeated, 'Don't Let Flu Frighten You to Death,' 'Don't Panic.'

  In Phoenix the Arizona Republican monitored influenza from a distance. On September 22 it declared 'Dr. W. C. Woodward of the Boston Health Department assumed an optimistic attitude tonight' . Dr. Woodward said the increase in cases today was not alarming.' At Camp Dix 'the camp medical authorities asserted they have the epidemic under control.' And the paper noted the first influenza deaths in New Orleans two days before the New Orleans daily newspaper the Item mentioned any death in the city.

  But after the first case appeared in Phoenix itself, the Republican fell silent, utterly silent, saying nothing about influenza anyplace in the country until the news was such that it could no longer keep silent. Its competitor the Gazette competed in reassurances, quoting local physician Herman Randall saying, 'Ten people sit in the same draught, are exposed to the same microbes. Some will suffer and perhaps die, while the others go scot free' . The people during an epidemic who are most fearful are usually, on the testimony of physicians, the first ones to succumb to the disease.' And in Phoenix, even after the war ended, the 'Citizens' Committee' that had taken over the city during the emergency continued to impose silence, ordering that 'merchants of the city refrain from mentioning the influenza epidemic directly or indirectly in their advertising.'

  Meanwhile, Vicks VapoRub advertisements in hundreds of papers danced down the delicate line of reassurance while promising relief, calling the epidemic, 'Simply the Old-Fashioned Grip Masquerading Under a New Name.'

>   Some papers experimented in controlling fear by printing almost nothing at all. In Goldsboro, North Carolina, recalls a survivor, 'The papers didn't even want to publish the lists of names [of the dead]' . The information about who was dying had to come up through the grapevine, verbally, from one person to the other.'

  A historian studying Buffalo County, Nebraska, expressed puzzlement that '[t]he county newspapers manifested a curious reticence regarding the effects of influenza, perhaps most evident in the The Kearney Hub. It may be surmised that the editors played down the severity of the problem to discourage the onset of general panic in the face of what was a thoroughly frightening situation.' As late as December 14 that paper was telling people not to 'get panicky,' telling them city officials were 'not inclined to be as panicky as a great many citizens.'

  *

  How could one not get panicky? Even before people's neighbors began to die, before bodies began to pile up in each new community, every piece of information except the newspapers told the truth. Even while Blue recited his mantra (There is no cause for alarm if proper precautions are taken) he was calling upon local authorities to 'close all public gathering places, if their community is threatened with the epidemic. This will do much toward checking the spread of the disease.' Even if Colonel Doane had said Influenza is nothing more or less than old fashioned grippe, newspapers also quoted him saying, 'Every person who spits is helping the Kaiser.'

  And even while Blue and Doane, governors and mayors, and nearly all the newspapers insisted that this was influenza, only influenza, the Public Health Service was making a massive effort to distribute advice - nearly useless advice. It prepared ready-to-print plates and sent them to ten thousand newspapers, most of which did print them. It prepared (the Red Cross paid for printing and distribution) posters and pamphlets, including six million copies of a single circular. Teachers handed them out in schools; bosses stacked them in stores, post offices, and factories; Boy Scouts stuffed them into tens of thousands of doorways; ministers referred to them on Sundays; mailmen carried them to rural free delivery boxes; city workers pasted posters to walls.