The Great Influenza

by John M. Barry

  But a Public Health Service warning to avoid crowds came too late to do much good, and the only advice of any real use remained the same: that those who felt sick should go to bed immediately and stay there several days after all symptoms disappeared. Everything else in Blue's circulars was so general as to be pointless. Yet all over the country, newspapers printed again and again: 'Remember the 3 Cs, clean mouth, clean skin, and clean clothes' . Keep the bowels open' . Food will win the war' . [H]elp by choosing and chewing your food well.'

  The Journal of the American Medical Association knew better. It dismissed the public reassurances and warned, 'The danger to life from influenza in this epidemic is so grave that it is imperative to secure from the individual patient the most complete isolation.' And it attacked 'current advice and instructions to the public from the official and other sources' (Blue's advice, the advice from local public-health officials downplaying everything) as useless and dangerous.

  'Don't Get Scared!' said the newspapers.

  Meanwhile people read (those in the West seeing it before the virus reached them) the Red Cross appeals published in newspapers, often in half-page advertisements that said; 'The safety of this country demands that all patriotic available nurses, nurses' aids [sic] or anyone with experience in nursing place themselves at once under the disposal of the Government' . Physicians are urgently requested to release from attendance on chronic cases and all other cases which are not critically ill every nurse working under their direction who can possibly be spared for such duty. Graduate nurses, undergraduates, nurses' aids, and volunteers are urged to telegraph collect at once' to their local Red Cross chapter or Red Cross headquarters, Washington, D.C.'

  'Don't Get Scared!' said the papers.

  Be not afraid.

  But not everyone was ready to trust in God.

  *

  In 2001 a terrorist attack with anthrax killed five people and transfixed America. In 2002 an outbreak of West Nile virus killed 284 people nationally in six months and sparked headlines for weeks, along with enough fear to change people's behavior. In 2003 SARS killed over eight hundred people around the world, froze Asian economies, and frightened millions of people in Hong Kong, Singapore, and elsewhere into wearing masks on the streets.

  In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They could not control it because every true report had been diluted with lies. And the more the officials and newspapers reassured, the more they said, There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death.

  So people watched the virus approach, and feared, feeling as impotent as it moved toward them as if it were an inexorable oncoming cloud of poison gas. It was a thousand miles away, five hundred miles away, fifty miles away, twenty miles away.

  In late September they saw published reports, reports buried in back pages, reports in tiny paragraphs, but reports nonetheless: eight hundred cases among midshipmen at Annapolis' in New York State coughing or sneezing without covering the face was now punishable by a year in jail and a $500 fine' thirty cases of influenza among students at the University of Colorado - but, of course, the Associated Press reassured, 'None of the cases, it was said, is serious.'

  But then it was serious: four hundred dead in a day in Philadelphia' twenty dead in Colorado and New Mexico' four hundred now dead in Chicago' all social and amusement activities suspended in El Paso, where seven funerals for soldiers occurred in a single day (it would get much worse)' a terrible outbreak in Winslow, Arizona.

  It was like being bracketed by artillery, the barrage edging closer and closer.

  In Lincoln, Illinois, a small town thirty miles from Springfield, William Maxwell sensed it: 'My first intimations about the epidemic was that it was something happening to the troops. There didn't seem to be any reason to think it would ever have anything to do with us. And yet in a gradual remorseless way it kept moving closer and closer. Rumors of the alarming situation reached this very small town in the midwest' . It was like, almost like an entity moving closer.'

  In Meadow, Utah, one hundred miles from Provo, Lee Reay recalled, 'We were very concerned in our town because it was moving south down the highway, and we were next.' They watched it kill in Payson, then Santaguin, then Nephi, Levan, and Mills. They watched it come closer and closer. They put up a huge sign on the road that ordered people to keep going, not to stop in Meadow. But the mailman stopped anyway.

  Wherever one was in the country, it crept closer - it was in the next town, the next neighborhood, the next block, the next room. In Tucson the Arizona Daily Star warned readers not to catch 'Spanish hysteria!' 'Don't worry!' was the official and final piece of advice on how to avoid the disease from the Arizona Board of Health.

  Don't get scared! said the newspapers everywhere. Don't get scared! they said in Denver, in Seattle, in Detroit; in Burlington, Vermont, and Burlington, Iowa, and Burlington, North Carolina; in Greenville. Rhode Island, and Greenville, South Carolina, and Greenville, Mississippi. And every time the newspapers said, Don't get scared! they frightened.

  The virus had moved west and south from the East Coast by water and rail. It rose up in great crests to flood cities, rolled in great waves through the towns, broke into wild rivers to rage through villages, poured in swollen creeks through settlements, flowed in tiny rivulets into isolated homes. And as in a great flood it covered everything, varying in depth but covering everything, settling over the land in a great leveling.

  *

  Albert Camus wrote, 'What's true of all the evils in the world is true of plague as well. It helps men to rise above themselves.'

  One who rose was Dr. Ralph Marshall Ward, who had abandoned medicine for cattle ranching. Leaving medicine had not been a business decision.

  An intellectual, particularly interested in pharmacology, he was a prominent physician in Kansas City with an office and pharmacy in the Stockyard Exchange Building down by the bottoms. But Kansas City was a major railhead, with the yards near his office. Most of his practice involved treating railroad workers injured in accidents. He performed huge numbers of amputations, and seemed always to work on mangled men, men ripped into pieces by steel. To have a practice with so much human agony ripped him into pieces as well.

  He had too much of doctoring, and, from treating cowboys hurt on cattle drives north to Kansas City, he had learned enough about the cattle business that he decided shortly before the war to buy a small ranch more than a thousand miles away, near San Benito, Texas, close to the Mexican border. On the long trip south, he and his wife made a pact never to utter a word that he had been a doctor. But in October 1918, influenza reached him. Some ranch hands got ill. He began treating them. Word spread.

  A few days later his wife woke up to a disturbing and unrecognizable sound. She went outside and saw out there in the gloaming people, hundreds of people, on the horizon. They seemed to cover that horizon, and as they came closer, it was clear they were Mexicans, a few of them on mules, most on foot, women carrying babies, men carrying women, bedraggled, beaten down, a mass of humanity, a mass of horror and suffering. She yelled for her husband, and he came out and stood on the porch. 'Oh my God!' he said.

  The people had come with nothing. But they knew he was a doctor so they had come. The Wards later told their granddaughter it was like the hospital scene in Gone With the Wind, with rows of wounded and dying laid out on the ground in agony. These people had come with nothing, had nothing, and they were dying. The Wards took huge pots outside to boil water, used all their resources to feed them, treated them. Out on the empty harsh range near the Mexican border, they had no Red Cross to turn to for help, no Council of National Defense. They did what they could, and it ruined them. He went back to Kansas City; he had already gone back to being a doctor.


  *

  There were other men and women like the Wards. Physicians, nurses, scientists - did their jobs, and the virus killed them, killed them in such numbers that each week JAMA was filled with literally page after page after page after page after page of nothing but brief obituaries in tiny compressed type. Hundreds of doctors dying. Hundreds. Others helped too.

  But as Camus knew, evil and crises do not make all men rise above themselves. Crises only make them discover themselves. And some discover a less inspiring humanity.

  As the crest of the wave that broke over Philadelphia began its sweep across the rest of the country, it was accompanied by the same terror that had silenced the streets there. Most men and women sacrificed and risked their lives only for those they loved most deeply: a child, a wife, a husband. Others, loving chiefly themselves, fled in terror even from them.

  Still others fomented terror, believing that blaming the enemy (Germany) could help the war effort, or perhaps actually believing that Germany was responsible. Doane himself charged that 'German agents' from submarines' brought influenza to the United States. 'The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle to America.'

  Others around the country echoed him. Starkville, Mississippi, a town of three thousand in the Mississippi hill country, was built around a sawmill, cotton farms (not the rich, lush plantations of the Delta but harsh land) and Mississippi A&M College (now Mississippi State University). It served as headquarters for Dr. M. G. Parsons, the U.S. Public Health Service officer for northeastern Mississippi, who proudly informed Blue that he had succeeded in getting local newspapers to run stories he made up that 'aid in forming a proper frame of mind' in the public. That frame of mind was fear. Parsons wanted to create fear, believing it 'prepared the public mind to receive and act on our suggestions.'

  Parsons got the local press to say, 'The Hun resorts to unwanted murder of innocent noncombatants' . He has been tempted to spread sickness and death thru germs, and has done so in authenticated cases' . Communicable diseases are more strictly a weapon for use well back of the lines, over on French or British, or American land.' Blue neither reprimanded Parsons for fomenting fear nor suggested that he take another tack. Another story read, 'The Germs Are Coming. An epidemic of influenza is spreading or being spread, (we wonder which).''

  Those and similar charges created enough public sentiment to force Public Health Service laboratories to waste valuable time and energy investigating such possible agents of germ warfare as Bayer aspirin. Parsons's territory bordered on Alabama and there a traveling salesman from Philadelphia named H. M. Thomas was arrested on suspicion of being a German agent and spreading influenza. Thomas was released, but on October 17, the day after influenza had killed 759 people in Philadelphia, his body was found in a hotel room with his wrists cut - and his throat slit. Police ruled it suicide.

  *

  Everywhere, as in Philadelphia, two problems developed: caring for the sick, and maintaining some kind of order.

  In Cumberland, Maryland, a gritty railroad and industrial city in the heart of a coal-mining region (where one actually could throw a stone across the Potomac River into West Virginia) to prevent the spread of the disease schools and churches had already been closed, all public gathering places had been closed, and stores had been ordered to close early. Nonetheless, the epidemic exploded on October 5. At noon that day the local Red Cross chairman met with the treasurer of the Red Cross's War Fund and the head of the local Council of National Defense. Their conclusion: 'The matter seemed far beyond control' . Reports were spreading fast that 'this one' or 'that one' had died without doctor or nurse and it was a panic indeed.'

  They decided to convert two large buildings on Washington Street to emergency hospitals. From there a handful of women took over, meeting barely an hour after the men had. Each woman had a task: to gather linens, or bathroom supplies, or cooking utensils, or flour. They worked fast. The next morning the hospitals filled with patients.

  In Cumberland, 41 percent of the entire population got sick. But the emergency hospitals had only three nurses. The organizers begged for more: 'We notified the Bd of Health we must have more nurses if we were to go on' .[Nurses] promised. However this help never materialized and up to date' 93 admissions, 18 deaths. The question of orderlies is difficult. They are just not to be found.'

  Back in Starkville, Parsons met with the president of the college, the army commander of the students (all the students had been inducted into the army) and physicians. 'We had an open discussion of the dangers and best actions to take and they assured me everything possible would be done,' he wired Blue. He asked for and received fifteen thousand pamphlets, posters, and circulars, more than the combined population of Starkville, Columbus, and West Point. But he, and they, accomplished little. Of eighteen hundred students, well over half would get influenza. On October 9 Parsons 'found unbelievable conditions with everybody in power stunned.' At that moment eight hundred students were sick and 2 percent of all students had already died, with many deaths to come. Parsons found 'influenza is all thru the region, in town, hamlet, and single home. People are pretty well scared, with reason' .' In West Point, a town of five thousand, fifteen hundred were ill simultaneously. Parsons confessed, 'Panic incipient.'

  In El Paso a U.S. Public Health Service officer reported to Blue, 'I have the honor to inform you that from Oct 9th to date there have been 275 deaths from influenza in El Paso among civilians. This does not include civilians who are employed by the government and who died at the base hospital of Fort Bliss, nor does it include soldiers' [W]hole city in a panic.'

  In Colorado, towns in the San Juan Mountains did not panic. They turned grimly serious. They had time to prepare. Lake City guards kept the town entirely free of the disease, allowing no one to enter. Silverton, a town of two thousand, authorized closing businesses even before a single case surfaced. But the virus snuck in, with a vengeance. In a single week in Silverton, 125 died. The town of Ouray set up a 'shot gun quarantine,' hiring guards to keep miners from Silverton and Telluride out. But the virus reached Ouray as well.

  It had not reached Gunnison. Neither tiny nor isolated, Gunnison was a railroad town, a supply center for the west-central part of the state, the home of Western State Teachers College. In early October (far in advance of any cases of influenza) Gunnison and most neighboring towns issued a closing order and a ban on public gatherings. Then Gunnison decided to isolate itself entirely. Gunnison lawmen blocked all through roads. Train conductors warned all passengers that if they stepped foot on the platform in Gunnison to stretch their legs, they would be arrested and quarantined for five days. Two Nebraskans trying simply to drive through to a town in the next county ran the blockade and were thrown into jail. Meanwhile, the nearby town of Sargents suffered six deaths in a single day - out of a total population of 130.

  Early in the epidemic, back on September 27 (it seemed like years before) the Wisconsin newspaper the Jefferson County Union had reported the truth about the disease, and the general in charge of the Army Morale Branch decreed the report 'depressant to morale' and forwarded it to enforcement officials for 'any action which may be deemed appropriate,' including criminal prosecution. Now, weeks later, after weeks of dying and with the war over, the Gunnison News-Chronicle, unlike virtually every other newspaper in the country, played no games and warned, 'This disease is no joke, to be made light of, but a terrible calamity.'

  Gunnison escaped without a death.

  *

  In the United States, the war was something over there. The epidemic was here.

  'Even if there was war,' recalled Susanna Turner of Philadelphia, 'the war was removed from us, you know' on the other side' . This malignancy, it was right at our very doors.'

  People feared and hated this malignancy, this alien thing in their midst. They were willing to cut it out at any cost. In Goldsboro, North Carolina, Dan Tonkel recalled, 'We were actually almost afraid t
o breathe, the theaters were closed down so you didn't get into any crowds' . You felt like you were walking on eggshells, you were afraid even to go out. You couldn't play with your playmates, your classmates, your neighbors, you had to stay home and just be careful. The fear was so great people were actually afraid to leave their homes. People were actually afraid to talk to one another. It was almost like don't breathe in my face, don't look at me and breathe in my face' . You never knew from day to day who was going to be next on the death list' . That was the horrible part, people just died so quickly.'

  His father had a store. Four of eight salesgirls died. 'Farmers stopped farming and the merchants stopped selling merchandise and the country really more or less just shut down holding their breath. Everyone was holding their breath.' His uncle Benny was nineteen years old and had been living with him until he was drafted and went to Fort Bragg, which sent him home when he reported. The camp was refusing all new draftees. Tonkel recalls his parents not wanting to allow Benny back in the house. 'Benny we don't know what to do with you,' they said. 'Well, what can I tell you. I'm here,' his uncle replied. They let him in. 'We were frightened, yes absolutely, we were frightened.'

  In Washington, D.C., William Sardo said, 'It kept people apart' . It took away all your community life, you had no community life, you had no school life, you had no church life, you had nothing' . It completely destroyed all family and community life. People were afraid to kiss one another, people were afraid to eat with one another, they were afraid to have anything that made contact because that's how you got the flu' . It destroyed those contacts and destroyed the intimacy that existed amongst people' . You were constantly afraid, you were afraid because you saw so much death around you, you were surrounded by death' . When each day dawned you didn't know whether you would be there when the sun set that day. It wiped out entire families from the time that the day began in the morning to bedtime at night - entire families were gone completely, there wasn't any single soul left and that didn't happen just intermittently, it happened all the way across the neighborhoods, it was a terrifying experience. It justifiably should be called a plague because that's what it was' . You were quarantined, is what you were, from fear, it was so quick, so sudden' . There was an aura of a constant fear that you lived through from getting up in the morning to going to bed at night.'