The Great Influenza

by John M. Barry

  'hundreds of young stalwart men': Ibid., 383/84.

  in excess of six thousand: Vaughan and Welch to Gorgas, Sept. 27, 1918, entry 29, RG 112, NA.

  'dead bodies are stacked': Vaughan, A Doctor's Memories, 383/84.

  'step amongst them': Cole to Flexner, May 26, 1936, file 26, box 163, WP.

  'too much for Dr. Welch': Ibid.

  'influenza be kept out of the camps': 'Memo for Camp and Division Surgeons,' Sept. 24, 1918, entry 710, RG 112, NA.

  'New men will almost surely': Brigadier General Richard to adjutant general, Sept. 25, 1918, entry 710, RG 112, NA; see also Charles Richard to chief of staff, Sept. 26, 1918, entry 710, RG 112, NA.

  'spread rapidly across': J. J. Keegan, 'The Prevailing Epidemic of Influenza,' JAMA (Sept. 28, 1918), 1051.

  Around the world from Boston: I. D. Mills, 'The 1918/1919 Influenza Pandemic (The Indian Experience,' The Indian Economic and Social History Review (1986), 27, 35.

  Part V: Explosion

  CHAPTER SEVENTEEN

  three hundred sailors arrived: 'Sanitary Report for Fourth Naval District for the Month of September 1918,' entry 12, file 584, RG 52, NA.

  tenements still had outhouses: 'Philadelphia (How the Social Agencies Organized to Serve the Sick and Dying,' The Survey 76 (Oct. 19, 1918); oral history of Anna Lavin, July 14, 1982, courtesy of Charles Hardy, West Chester University.

  'death rate' has gone up': Mrs. Wilmer Krusen reports, Feb. 4, 1918, entries 13B-D2, RG 62.

  no high school until 1934: Allen Davis and Mark Haller, eds., The Peoples of Philadelphia: A History of Ethnic Groups and Lower-Class Life, 1790/1940 (1973), 256.

  'worst-governed city': Quoted in Russell Weigley, ed., Philadelphia: A 300-Year History (1982), 539.

  'took control of police': Major William Snow and Major Wilbur Sawyer, 'Venereal Disease Control in the Army,' JAMA (Aug. 10, 1918), 462.

  left Philadelphia for Puget Sound: Annual Report of the Surgeon General of the U.S. Navy for Fiscal Year 1918, Government Printing Office.

  put the body on a stretcher: Robert St. John, This Was My World (1953), 49/50, quoted in Dorothy Ann Pettit, 'A Cruel Wind: America Experiences the Pandemic Influenza, 1918/1920' (1976), 103.

  '33 caskets to Naval': 'Journal of the Medical Department, Great Lakes,' entry 22a, RG 52, NA.

  toe tags on the boys': Carla Morrisey, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 26, 1997.

  'what it would feel like': Ibid.

  'this threat of influenza invasion': Howard Anders to William Braisted, Sept. 12, 1918, RG 52, NA.

  refused to release six: Board of Trustees minutes, Sept. 9 and Sept. 30, 1918, Jefferson Medical College, Philadelphia.

  'When obliged to cough or sneeze': Philadelphia Inquirer, Sept. 19, 1918.

  'No concern whatever': The Evening Bulletin, Sept. 18, 1918.

  'can successfully be prevented': Department of Public Health and Charities minutes, Sept. 21 and Oct. 3, 1918.

  'ideas of whole populations': Quoted in Victoria De Grazia, 'The Selling of America, Bush Style,' New York Times (Aug. 25, 2002).

  'world lives by phrases': Quoted in Joan Hoff Wilson, Herbert Hoover: Forgotten Progressive (1974), 59.

  ''Every Scout to Save a Soldier'': Quoted in ibid., 105 fn.

  'If you find a disloyal': Gregg Wolper, 'The Origins of Public Diplomacy: Woodrow Wilson, George Creel, and the Committee on Public Information' (1991), 80.

  'The IWW agitators': Kennedy, Over Here, 73.

  'nobody can say we aren't loyal': Ellis Hawley, The Great War and the Search for a Modern Order: A History of the American People and Their Institutions, 1917/1933 (1979), 24.

  'In spite of excesses such as lynching': Ibid.

  'most powerful of human motives': William McAdoo, Crowded Years (1931), 374/79, quoted in David Kennedy, Over Here (1980), 105.

  'Every person who refuses': David Kennedy, Over Here, 106.

  'a ready-made inflammable mass': Howard Anders, letter to Public Ledger, Oct. 9, 1918, in which he cites his earlier opposition to the rally; quoted in Jeffrey Anderson, 'Influenza in Philadelphia 1918' (1998).

  CHAPTER EIGHTEEN

  'excellent chief of service': Frederick Russell and Rufus Cole, Camp Grant inspection diary, June 15/16, 1918, WP.

  'keep our eye on him': Welch to Dr. Christian Herter, treasurer, Rockefeller Institute for Medical Research, Jan. 13, 1902, WP.

  'different type of pneumonia': Ibid.

  'an important contribution': Richard Pearce to Major Joseph Capps, July 10, 1918, Camp Grant, influenza file, NAS.

  'a very important matter': Rufus Cole to Richard Pearce, July 24, 1918, influenza file, NAS.

  'vital measures in checking contagion': Joseph Capps, 'Measures for the Prevention and Control of Respiratory Disease,' JAMA (Aug. 10, 1918), 448.

  'one of the most brilliant': Chicago Tribune, Oct. 9, 1918.

  had issued warnings: George Soper, M.D., 'The Influenza Pandemic in the Camps,' undated draft report, entry 29, RG 112, NA.

  'None of these diseases': A. Kovinsky, Camp Grant epidemiologist, report to SG, Sept. 4, 1918, entry 31, RG 112, NA.

  'Until further notice': Quoted in Kovinsky, report to SG, Nov. 5, 1918, entry 29, RG 112, NA.

  'crowding of troops': Charles Hagadorn, Sept. 20, 1918, entry 29, box 383, RG 112, NA.

  'No visitors will be permitted': Kovinsky, report to SG, Nov. 5, 1918.

  the first soldier died: 'Bulletin of the Base Hospital,' Camp Grant, Sept. 28, 1918, RG 112, NA.

  'except under extraordinary circumstances': 'Bulletin of the Base Hospital,' Oct. 3 and Oct. 4, 1918, RG 112, NA.

  'formalin should be added': Ibid.

  'Devoting special personal care': 'Bulletin of the Base Hospital,' Oct. 6, 1918, RG 112, NA.

  escorts of the dead' be prohibited: Dr. H.M. Bracken, Executive Director, Minnesota State Board of Health, Oct. 1, 1918, entry 31, RG 112, NA.

  'No power on earth': Victor Vaughan, A Doctor's Memories, 425.

  'movements of officers and men': See telegram from adjutant general, Oct. 3, 1918, RG 92.

  two thousand of the 3,108 troops: 'Analysis of the Course and Intensity of the Epidemic in Army Camps,' unsigned, undated report, 4, entry 29, RG 112, NA.

  likely that the death toll: Camp Hancock, Georgia, entry 29, RG 112, NA.

  twenty-eight hundred troops would report ill: Soper, 'The Influenza-Pneumonia Pandemic in the American Army Camps, September and October 1918,' Science (Nov. 8, 1918), 451.

  'very carefully controlled': Stone to Warren Longcope, July 30, 1918, entry 29, RG 112, NA.

  only 16.7 percent died: Alfred Gray, 'Anti-pneumonia Serum (Kyes') in the Treatment of Pneumonia,' entry 29, RG 112, NA.

  Desperate efforts were being made: Maj. General Merritt W. Ireland, ed., Medical Department of the United States Army in the World War, v. 9, Communicable Diseases (1928), 448.

  'the duty of the Ward Surgeon': 'Bulletin of the Base Hospital,' Oct. 7 and 8, 1918, RG 112, NA.

  'friends of persons dying': 'Bulletin of the Base Hospital,' Oct. 3 and 4, 1918, RG 112, NA.

  'winning their fight': Chicago Tribune, Oct. 7, 1918.

  'verandas must be used': 'Bulletin of the Base Hospital,' Oct. 5, 1918, RG 112, NA.

  'too early to foretell': George Soper, 'The Influenza-Pneumonia Pandemic in the American Army Camps, September and October 1918,' Science (Nov. 8, 1918), 451.

  CHAPTER NINETEEN

  $100 bribes: Visiting Nurse Society minutes, Oct. and Nov., 1918, Center for the Study of the History of Nursing, University of Pennsylvania.

  'no doctors available': Selma Epp, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 28, 1997.

  average weekly death toll: Public Health Reports 33, part 2, (July 26, 1918), 1252.

  'Don't get frightened': Public Ledger, Oct. 8, 1918.

  'another crepe and another door': Anna Milani, transcript of unaired interview f
or 'Influenza 1918,' American Experience, Feb. 28, 1997.

  'People were dying like flies': Oral history of Clifford Adams, June 3, 1982, provided by Charles Hardy of West Chester University.

  'My uncle died there': Anna Lavin oral history, June 3, 1982, Charles Hardy oral history tapes.

  'caskets stacked up outside': Michael Donohue, transcript of unaired interview for 'Influenza 1918,' American Experience interview, Feb. 28, 1997.

  ''Let me get a macaroni box'': Louise Apuchase, June 3, 1982, Charles Hardy oral history tapes. June 24, 1982.

  'They couldn't bury them': Clifford Adams, Charles Hardy oral history tapes, June 3, 1982.

  'may also die of the plague': North American, Oct. 7, 1918.

  'cyanosis reached an intensity': Isaac Starr, 'Influenza in 1918: Recollections of the Epidemic in Philadelphia,' Annals of Internal Medicine (1976), 517.

  'no truth in the black plague assertion': Unidentified newspaper clipping in epidemic scrapbook, Dec. 29, 1918, College of Physicians Library, Philadelphia.

  ports and naval facilities: Public Health Reports, Sept. 13, 1918, 1554.

  'an influenza-like disease': Ibid., Sept. 20, 1918, 1599.

  did not come again: Charles Scott to William Walling, Oct. 1, 1918, RG 200, NA.

  'After gasping for several hours': Starr, 'Influenza in 1918,' 517.

  'the city had almost stopped': Ibid, 518.

  Part VI: The Pestilence

  CHAPTER TWENTY

  'two groups of symptoms': Edwin O. Jordan, Epidemic Influenza (1927), 260, 263.

  'In nonfatal cases': Maj. General Merritt W. Ireland, ed., Medical Department of the United States Army in the World War, v. 9, Communicable Diseases (1928), 159.

  'didn't care if I died': Clifford Adams, Charles Hardy oral history tapes, West Chester University, June 3, 1982.

  'sick as a dog': Bill Sardo, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 27, 1997.

  'time was a blur': William Maxwell, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 26, 1997.

  'ice would rattle': Carla Morrisey, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 26, 1997.

  'happened to my hind legs': John Fulton, Harvey Cushing (1946), 435.

  'something like typhoid': Dorothy Ann Pettit, 'A Cruel Wind: America Experiences the Pandemic Influenza, 1918/1920, A Social History' (1976), 91.

  'on a narrow ledge over a pit': Katherine Anne Porter, 'Pale Horse, Pale Rider' (1965), 310/12.

  'pain above the diaphragm': Richard Collier, The Plague of the Spanish Lady: The Influenza Pandemic of 1918/1919 (1974), 35.

  'Many had vomiting': Ireland, ed., Medical Department of the United States Army in the World War, v. 12, Pathology of the Acute Respiratory Diseases, and of Gas Gangrene Following War Wounds (1929), 13.

  In Paris, while some: Diane A. V. Puklin, 'Paris,' in Fred Van Hartesfeldt, ed., The 1918/1919 Pandemic of Influenza: The Urban Impact in the Western World (1992), 71.

  'general throughout Spain': Public Health Reports 33, part 2 (Sept. 27, 1918), 1667.

  'beginning in the neck': W. S. Thayer, 'Discussion of Influenza,' Proceedings of the Royal Society of Medicine (Nov. 1918), 61.

  bowl of rice crispies: Carla Morrisey, transcript of unaired interview for 'Influenza 1918,' American Experience, Feb. 26, 1997.

  'rupture of the drum membrane': Ireland, ed., Medical Department of the United States Army in the World War, v. 9, Communicable Diseases (1928), 448.

  'bulging eardrums': Ireland, Pathology of Acute Respiratory Diseases, 13.

  'destructive action on the drum': Burt Wolbach to Welch, Oct. 22, 1918, entry 29, RG 112, NA.

  eye involvement with special frequency: David Thomson and Robert Thomson, Annals of the Pickett-Thomson Research Laboratory, v. 10, Influenza (1934), 751.

  ability to smell: Ibid., 773.

  'symptoms of exceeding variety': Ireland, Pathology of Acute Respiratory Diseases, 13.

  'Intense cyanosis': Ibid., 56, 141/42.

  'even to an indigo blue': Ireland, Communicable Diseases, 159.

  Many mechanisms can cause bleeding: Interview with Dr. Alvin Schmaier, University of Michigan, Oct. 2, 2002; J. L. Mayer and D. S. Beardsley, 'Varicella-associated Thrombocytopenia: Autoantibodies Against Platelet Surface Glycoprotein V,' Pediatric Research (1996), 615/19.

  'suffered from epistaxis': Ireland, Pathology of Acute Respiratory Diseases, 13, 35.

  'pint of bright red blood': Jordan, Epidemic Influenza, 260.

  'died from loss of blood': Ireland, Pathology of Acute Respiratory Diseases, 13.

  'hemorrhages' interior of the eye': Thomson and Thomson, Influenza, v. 9, 753.

  'subconjunctional hemorrhage': Ireland, Pathology of Acute Respiratory Diseases, 13.

  'uterine mucosa': Ibid., 76.

  chief diagnostician' diagnosed: Jordan, Epidemic Influenza, 265.

  47 percent of all deaths: Thomson and Thomson, Influenza, v. 9, 165.

  average life expectancy: Jeffrey K. Taubenberger, 'Seeking the 1918 Spanish Influenza Virus,' American Society of Microbiology News 65, no. 3 (July 1999).

  South African cities: J. M. Katzenellenbogen, 'The 1918 Influenza Epidemic in Mamre,' South African Medical Journal (Oct. 1988), 362/64.

  In Chicago the deaths: Fred R. Van Hartesveldt, The 1918/1919 Pandemic of Influenza: The Urban Impact in the Western World (1992), 121.

  A Swiss physician: E. Bircher, 'Influenza Epidemic,' Correspondenz-Blatt fur Schweizer Aerzte, Basel (1918), 1338, quoted in JAMA 71, no. 23 (Dec. 7, 1918), 1946.

  'doubly dead in that': Sherwin Nuland, How We Die (1993), 202.

  from 23 percent to 71 percent: Jordan, Epidemic Influenza, 273.

  26 percent lost the child: John Harris, 'Influenza Occurring in Pregnant Women: A Statistical Study of 130 Cases,' JAMA (April 5, 1919), 978.

  'interesting pathological experience': Wolbach to Welch, Oct. 22, 1918, entry 29, RG 112, NA.

  'convolutions of the brain': Douglas Symmers, M.D. 'Pathologic Similarity Between Pneumonia of Bubonic Plague and of Pandemic Influenza,' JAMA (Nov. 2, 1918), 1482.

  'relaxed and flabby': Ireland, Pathology of Acute Respiratory Diseases, 79.

  damage to the kidneys: Ireland, Communicable Diseases, 160.

  'necrotic areas, frank hemorrage': Ireland, Pathology of Acute Respiratory Diseases, 392.

  'comparable findings' death from toxic gas': Ireland, Communicable Diseases, 149.

  'inhalation of poison gas': Edwin D. Kilbourne, M.D., Influenza (1987), 202.

  CHAPTER TWENTY-ONE

  'died within twelve hours': Transcript of influenza commission appointed by governor of New York, meeting at New York Academy of Medicine, Oct. 30, 1918, SLY.

  'One robust person': E. Bircher, 'Influenza Epidemic,' JAMA (Dec. 7, 1918), 1338.

  the conductor collapsed, dead: Collier, Plague of the Spanish Lady, 38.

  'a new disease': Jordan, Epidemic Influenza, 36.

  'Physical signs were confusing': Ireland, Communicable Diseases, 160.

  'old classification' was inappropriate': Ireland, Pathology of Acute Respiratory Diseases, 10.

  'little evidence of bacterial action': F. M. Burnet and Ellen Clark, Influenza: A Survey of the Last Fifty Years, (1942), 92.

  'lesion of characterization': Ireland, Communicable Diseases, 150.

  inhibits the release of interferon: Fields, Fields' Virology, 196.

  weakened immune responses: Thomson and Thomson, Influenza, v. 9, 604.

  'acute inflammatory injection': Ibid., 92.

  'not previously described': P. K. S. Chan et al., 'Pathology of Fatal Human Infection Associated with Avian Influenza A H5N1 Virus,' Journal of Medical Virology (March 2001), 242/46.

  had seen the same thing: Jordan, Epidemic Influenza, 266/68, passim.

  mortality rate for ARDS: Lorraine Ware and Michael Matthay, 'The Acute Respiratory Distress Syndrome,' New England Jou
rnal of Medicine (May 4, 2000), 1338.

  Recent research also suggests: J. A. McCullers and K. C. Bartmess, 'Role of Neuraminidase in Lethal Synergism Between Influenza Virus and Streptococcus Pneumoniae,' Journal of Infectious Diseases (March 15, 2003), 1000/1009.

  almost half the autopsies: Ireland, Communicable Diseases, 151.

  the same conclusion: Milton Charles Winternitz, The Pathology of Influenza, (1920).

  deaths came from complications: Frederick G. Hayden and Peter Palese, 'Influenza Virus' in Richman et al., Clinical Virology (1997), 926.

  still roughly 7 percent: Murphy and Werbster, 'Orthomyxoviruses,' in Fields, Fields' Virology, 1407.

  35 percent of pnemococcal infections: 'Pneumococcal Resistance,' Clinical Updates IV, issue 2, January 1998, National Foundation for Infectious Diseases, www.nfid.org/publications/clinicalupdates/id/pneumococcal.html.

  Part VII: The Race

  CHAPTER TWENTY-TWO

  Three Hopkins medical students: Dorothy Ann Pettit, 'A Cruel Wind: America Experiences the Pandemic Influenza, 1918/1920' (1976), 134.

  'could not have dreamed': Comments at USPHS conference on influenza, Jan. 10, 1929, file 11, box 116, WP.

  went to bed immediately: Welch to Walcott, Oct. 16, 1918, Frederic Collin Walcott papers, SLY.

  'the Flip-flap railroad': Simon Flexner and James Thomas Flexner, William Henry Welch and the Heroic Age of American Medicine (1941), 251.

  'temperature has been normal': Welch to Walcott, Oct. 16, 1918, Walcott papers.

  'astonishing numbers': Quoted in David Thomson and Robert Thomson, Annals of the Pickett-Thomson Research Laboratory, v. 9, Influenza (1934), 265.

  the cause of influenza: William Bulloch, The History of Bacteriology (1938), 407/8.

  'Surely there is a time': Quoted in Wade Oliver, The Man Who Lived for Tomorrow: A Biography of William Hallock Park, M.D., (1941), 218.

  'Everyone believed it': Saul Benison, Tom Rivers: Reflections on a Life in Medicine and Science, An Oral History Memoir (1967), 237/40, 298.

  'No influenza bacilli': A. Montefusco, Riforma Medica 34, no. 28 (July 13, 1918), quoted in JAMA 71, no. 10, 934.

  CHAPTER TWENTY-THREE

  'a new bronchopneumonia': Pettit, 'Cruel Wind,' 98.

  Copeland was sworn in: Ibid., 9: 555.

  his loyalty to Tammany: Ernest Eaton, 'A Tribute to Royal Copeland,' Journal of the Institute of Homeopathy 9: 554.