No Man’s Land: This U.S. soldier, entangled in barbed wire between rival trenches in northern Europe, was one of millions whose lives were claimed by war. (1917) Credit 35
Russia’s so-called betrayal allowed Germany to transfer veteran troops to the Western Front, far outnumbering the British and French. By then, America had entered the war and was preparing to send the first trained AEF units overseas. Before those units arrived in strength, the German high command decided to risk everything on an all-out effort to smash the Allies. When an officer asked General Erich Ludendorff (1865–1937), the German commander on the Western Front, what would happen if the offensive failed, the general fixed him with a cold stare. “Then Germany must perish,” Ludendorff snarled. Whether Germany won or lost, he knew the war would end before 1918 was out.37
Ludendorff struck on March 21, 1918, the first day of spring. After a massive artillery bombardment, “a storm of steel and fire,” his troops broke through the French lines. This was as close as Germany would come to winning the war. Though halted in fierce fighting, Ludendorff held the ground he had taken. From a distance of seventy-five miles, he unleashed “Big Bertha,” a giant cannon that hurled 1,800-pound shells into Paris.
The attack did not surprise Allied leaders; aerial photographs had revealed the massive enemy buildup, and they feared the worst. During the first week of March, Georges Clemenceau, the French prime minister, wrote to President Wilson. “A terrible blow is imminent,” he said. “Tell your Americans to come quickly.” Luckily, by then, every month would see American troops land at French seaports; 84,000 arrived in March alone. They arrived in the nick of time, but they did not travel alone.38
Tents at the New Zealand reinforcement camp in Étaples, France. (c. 1914–1918) Credit 36
Historians disagree on where and when the first influenza wave began. Some believe migrating birds flew south from Canadian lakes, as they had done throughout the ages. A duck, most likely, dropped virus-tainted feces into a pig wallow near Fort Riley. Perhaps a farmer carrying a human variety of Type A virus passed it to one of his pigs, and the viruses reassorted and then spread to people. This may explain why recruits at Camp Funston reported sick on March 11, ten days before the German offensive began in France. As troops from Fort Riley moved to other camps for additional training, or to join units bound for France, they brought the infection with them—and eventually across the Atlantic.39
Other historians think it a coincidence that the first wave struck Europe just as American troops arrived. They point to Étaples, a village near the seaport of Boulogne, France, as the likely place of origin. Étaples lies on the edge of vast salt marshes, stop-off places favored by flocks of birds on their way to nesting sites in Africa. Nearby lay farms that raised pigs, ducks, geese, and chickens—immense numbers of them. At Étaples, the British army had the largest base it ever built on foreign soil. A railway link served the base’s twenty-four hospitals, placed within easy walking distance of each other. The base also had a prisoner-of-war compound, and camps for fresh troops bound for the front and men returning from the trenches for rest and medical treatment. A historian notes: “Never before or since have so many men and microbes co-existed in the same place for so long.”40
Étaples was filled with men forced to live in canvas tents or flimsy wooden barracks in all seasons. Impossible to keep clean, the place was damp, depressing, and smelly. Étaples, English poet Wilfred Owen wrote his mother, “seemed neither France nor England, but a kind of paddock where beasts are kept days before the shambles [slaughter].” The troops had a strange look about them, Owen noted. “It was not despair, or terror, it was more terrible than terror, for it was a blindfold look, and without expression, like a dead rabbit’s.” On any given day, the base held at least 100,000 men, a supercrowd in terms of infectious diseases.41
Trench diseases ran riot at Étaples: trench foot, trench fever, dysentery, tetanus, typhus. Bleak hospital wards held victims of gas—poisons, we know today, that cause gene mutations, even cancer. In 1916 and 1917, doctors reported outbreaks of influenza at Étaples. Not only did the infection strike the base, but men returning to the trenches carried the virus to their comrades. Similarly, those on home leave or sent to hospitals in England brought it there, too. In the spring of 1918, the current strain of influenza, or one very much like it, drifted to the point where it erupted into an epidemic.
Wherever the first wave began, at Fort Riley or Étaples, influenza soon washed over the Western Front. The disease appears to have struck the British army first. British generals, sticklers for discipline, would hear no excuses: feverish troops must do their duty! Private Arthur Lapointe recalled how it felt to leave his trench to attack: “As I reach the top, my head swims [and] everything around me whirls….One man can no longer stand erect, and crawls on hands and knees. We leave him behind, with a comrade looking after him.” Edouard Froidure, a Belgian soldier, wrote his folks: “For two or three days, I was raving, drained or agitated depending on the moment.” Clearly, this was not the familiar seasonal flu.42
The virus easily crossed No Man’s Land, perhaps brought by Allied prisoners. It played havoc in the German trenches. “Influenza is now epidemic all along the German front,” the New York Times reported. “Special hospitals are being established in the rear areas dealing solely with this disease.”43
General Erich Ludendorff. (Date unknown) Credit 37
H1N1 threw a monkey wrench into General Ludendorff’s plans, while helping the Allies stall the German advance. “Our army suffered. Influenza was rampant,” Ludendorff wrote in his postwar memoirs. “It was a grievous business having to listen every morning to the chiefs of staffs’ recital of the number of influenza cases, and their complaints about the weakness of their troops….[Eventually] the number of influenza cases diminished, although it often left a greater weakness in its wake than the doctors realized.” By late summer, the flu had temporarily put half a million German soldiers out of action.44
In wartime, casualty rates, even from sickness, are military secrets because they may help opponents figure out each other’s strength. To keep the extent of the infection secret, the U.S. War Department flat out lied. “The American troops have at no time shown any form of the disease,” it announced. Press censorship, moreover, prevented Allied journalists from getting or publishing firsthand information about the extent of the epidemic.45
The public learned the truth anyhow. Spain remained neutral throughout the war, refusing to take sides. So it did not have press censorship, and its journalists on both sides of the Western Front knew the score. Besides, viruses do not respect national borders. In May 1918, influenza broke out in Madrid, Spain’s capital. Thousands, including King Alfonso XIII, took to their beds. As a result, the Spanish press printed articles about the disease at home and elsewhere in Europe. British and French newspapers reprinted the stories, angering the authorities, who could not plug the leaks. Though the disease did not originate in Spain, people nicknamed it the “Spanish flu,” the “Spanish Lady,” and the “Plague of the Spanish Lady.” Spaniards returned the favor, calling it the “French flu,” because they thought it originated in France.46
The first wave grew from an epidemic into a pandemic. By July, it had spread worldwide. It surged across oceans and continents, reaching Africa, the Middle East, Asia, the Philippines, Australia, New Zealand, and North and South America. In China, according to an official report, “it swept over the whole country like a tidal wave.”47
The decomposing body of a German soldier in No Man’s Land. (1917) Credit 38
No disease had ever traveled so far, so fast. Bubonic plague had moved overland at the speed of a walking person and a horse-drawn wagon and by sea aboard sailing ships battling winds, currents, and tides. The 1918 pandemic was a disease of the Industrial Age, when the world was more closely connected than at any time in the past. Nestled inside infected people, the H1N1 virus traveled hundreds of miles a day aboard automobiles, buses
, trucks, trains, and steamships.
Millions suffered during the first wave. Some compared a bout of influenza to a “punch-up,” a fistfight with a stronger opponent. An anonymous soldier-poet described his experience this way:
When your back is broke and your eyes are blurred,
And your shin bones knock and your tongue is furred;
And your tonsils squeak and your hair gets dry,
And you’re doggone sure that you’re going to die,
But you’re skeered you won’t and afraid you will,
Just drag to bed and have your chill,
And pray the Lord to see you through,
For you’ve got the Flu, boy,
You’ve got the Flu….
What is it like, this Spanish Flu?
Ask me, brother, I’ve been through.
It is by Misery out of Despair;
It pulls your teeth and curls your hair;
It thins your blood and brays your bones,
And fills your craw with moans and groans,
And sometimes, maybe, you get well,
Some call it Flu—I call it hell!48
Fighting men dubbed their affliction the “three-day fever” and “knock-me-down fever.” Mercifully, first-wave flu caused few deaths. Apparently, the virus had not mutated to the point where victims’ immune systems failed to detect it and fight back. Dr. Herbert French, of Britain’s Ministry of Health, reported that it caused no complications, which are conditions that worsen an existing infection. Treatment required “nothing special,” simply “rest in bed for three days and ordinary nursing without drugs.”49
By early August, new influenza cases had dwindled to nearly zero. A British medical journal reached the logical conclusion, declaring that the disease had “completely disappeared.”50
But it hadn’t.
A cartoon by Ernest Noble depicting influenza as a monster packing a wallop. (1918) Credit 39
It seemed that Nature gathered together all her strength and demonstrated to man how puny and insignificant he and his fellows are, with all his murderous machinery, in the destruction of his fellows.
—Victor C. Vaughan, 1922
BOSTON STRUCK
Somewhere in war-torn France—we will never know exactly where or when—the Type A H1N1 virus of the first wave shifted, mutating into a mass murderer of humans. Now better able to evade the immune system and cling to cell walls, it lodged deep in the lungs, starting its attack there rather than, as usual, in the throat. Swiftly and savagely, the devil virus sent the second influenza wave surging across the planet.
In mid-August 1918, seaports on three continents, separated over thousands of miles by the Atlantic Ocean, felt the fury of the disease. On August 15, health officials reported a deadly outbreak in the port city of Freetown, Sierra Leone, in West Africa. Exactly a week later, on August 22, flu erupted in Brest, a French seaport jammed with incoming American troop transports. A few days later, it appeared in Boston, Massachusetts. For now, we will focus on Boston, because U.S. army physicians there provided the first detailed accounts of the early stage of the second wave.
The troopship Mount Vernon lands Yankee Division troops at Commonwealth Pier in Boston. (1919) Credit 40
U.S. navy ships often sailed home from Brest. Many of them docked at the quarter-mile-long Commonwealth Pier in South Boston. Troops bound for the trenches and returning sailors awaiting other assignments both stayed at a “receiving ship” until their orders came through. This was not a ship at all, but a set of barracks on the pier that housed up to 7,000 men at a time. These barracks were “grossly overcrowded,” the navy admitted, cold, drafty, rat-ridden, and foul-smelling. Basic items like soap and toilet paper were scarce; faulty plumbing made toilets overflow. Hot water for a shower was a luxury.1
On August 27, two sailors turned up at the Commonwealth Pier’s sick bay. One said his illness, whatever it was, felt as if he “had been beaten over the head with a club.” The next day, eight other sailors appeared, joined by fifty-eight more the following day. Within a week, the sick bay was swarmed with influenza cases. Unable to handle them all, doctors transferred many to Chelsea Naval Hospital during the first week of September. This move, however, introduced the disease to that hospital—and to patients suffering from other illnesses. Once recovered and discharged, they, in turn, traveled aboard troop trains, often with three men crammed into seats designed to hold two.2
Like a spreading ink stain, the virus found its way into civilian communities. Boston reported its first cases on September 3. Bostonians did not take them seriously; the first wave had passed without doing serious harm, and so would this latest outbreak, they hoped. A local newspaper joked about the disease: “Girls of Boston Must Cut Out That Germy Kiss” read the headline. A poster advised:
Avoid the hug,
Avoid the lip,
Escape the bug
That gives the “grippe.”3
Camp Devens was an army training camp northwest of Boston. Built to house 30,000 recruits but with more than 45,000, it proved that influenza was no laughing matter. Events there showed how lethal the mutated virus had become.
Even before the flu appeared, recruits at Camp Devens were stressed out by the rigorous training program. Starting before sunrise, it went nonstop, with short breaks for hasty meals in the crowded mess halls. After meals, bellowing sergeants put recruits through grueling drills: marching, crawling in mud under machine-gun fire, and firing rifles at “all hours of the day while it was light enough to see a bullseye.”4
The first flu case at the camp turned up on September 7. The next day, a dozen recruits came to the camp hospital with flu symptoms. Before long, the second wave swamped the place. The hospital overflowed with influenza and pneumonia cases. By the end of October, the hospital counted 17,400 admissions for these diseases. This human deluge stunned Chief Nurse Jane Malloy. “Every inch of available space was used,” she recalled, “[so that] three miles of hospital corridors were lined on both sides with cots.” Patients’ fevers shot up to 104º F, and their bodies ached so that the slightest touch was painful. Deaths skyrocketed, averaging 100 a day. Private Ralph Smith remembered 374 patients dying in a single night. Another soldier exclaimed: “Men were dieing [sic] like flys [sic], with the flu.”5
How did they die?
Influenza can kill in two ways. In the first and most common way, deaths are due not to the virus directly but to bacteria that normally live in the noses and throats of healthy people. Such bacteria are harmless if they stay in their proper place. Yet, should the virus attack the cells lining the bronchial (breathing) tubes, the bacteria can move downward, into the lungs. Marvels of natural engineering, our lungs have a combined surface area more than twenty-five times that of our skin. Our lungs also contain 750 million alveoli, microscopic air sacs, each as thin and delicate as a soap bubble. When blood passes through the vessels in the lungs, the alveoli transfer oxygen to the red blood cells, which carry it to every cell in our body. Animals and plants need oxygen to stay alive.6
Bacterial invaders cause bacterial pneumonia. Pneumonia is an infection of the lungs in which the alveoli become inflamed and clogged with pus. As the alveoli fill up, they lose their ability to transfer oxygen to the blood, and the victim grows short of breath. If a person’s immune system fails to halt the infection, cyanosis develops—a pale blue, purple, or brown tint of the skin. Death, if it comes, does so in about seven to ten days. It comes gently, as the dwindling oxygen supply gradually causes the body to shut down. The victim slips into a coma, a state of deep unconsciousness (coma is from the Greek koma, meaning “deep sleep”). Sir William Osler, the English medical genius, thought of pneumonia as merciful. “Pneumonia may well be called the friend of the aged,” he wrote a century ago, for it shortens the suffering caused by other diseases, like cancer. In the early 1900s, as today, bacterial pneumonia was the chief killer of the elderly. Even since the discovery of antibiotics in the mid-twentieth century, it
claims more Americans of all ages than any other infectious disease—between 40,000 and 70,000 people each year.7
The second means of death, viral pneumonia, is nobody’s friend. In 1918, the mutated Type A H1N1 influenza virus struck in ways physicians had never seen before or thought possible.
At Camp Devens, an army doctor named Roy Grist wrote a fellow physician, describing an alarming new form of cyanosis. Recruits, Grist said, “very rapidly develop the most viscous [thick, sticky, gluey] type of pneumonia that has ever been seen. Two hours after admission they have…mahogany spots over the cheek bones, and a few hours later you can begin to see the cyanosis extending from their ears and spreading over the face, until it is hard to distinguish the colored men from the white.” This type of cyanosis was a sure death sentence; nobody with it recovered. “It is only a matter of hours,” Grist continued, “until death comes and it is simply a struggle for air until they suffocate. It is horrible. One can stand to see one, or two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves.”8
As the disease snuffed out more lives, Grist told his friend, “It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce; we used to go down to the morgue and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle….We eat it [influenza], sleep it, and dream it, to say nothing of breathing it 16 hours a day.”9
Shocked by reports from Massachusetts, the army surgeon general, William Gorgas, sent members of his elite medical team to investigate. “You will,” Gorgas ordered, “proceed immediately to Devens. The Spanish influenza has struck the camp.” The group included doctors we have already met: Victor Vaughan, William Welch, and Rufus Cole. They arrived on September 23, just sixteen days after the first case checked into the camp hospital.10
Very, Very, Very Dreadful Page 6