Deeply learned men, they were experienced in the ways of death. They thought they had seen it all; the study of infectious diseases was woven into the fabric of their adult lives. However, like Roy Grist, what they found at Camp Devens shook them to the core.
The experience burned itself into Victor Vaughan’s soul. Memories of that awful place, he wrote years later, were “ghastly ones which I would tear down and destroy were I able to do so, but this is beyond my power. They will be part of my being and will perish only when I die or lose my memory.” The doctor said he had haunting visions when he closed his eyes at night: “I see hundreds of young, stalwart men in uniform coming into the wards of the hospital in groups of ten or more….Every bed is full, yet others crowd in….In the morning the dead bodies are stacked about the morgue like cord wood.”11
Doctors perform an autopsy at the Kerhuon base hospital in Brest, France. Medical staff there treated more than 3,000 soldiers suffering from influenza and pneumonia, of whom 569 died. Autopsies revealed that influenza victims’ lungs appeared strangely blue or purple and were filled with fluid. (Date unknown) Credit 41
Worse scenes awaited the team in the autopsy room. An autopsy is a medical examination of a corpse to discover the cause and manner of death. Autopsies are never pleasant, but those of second-wave flu victims were uniquely horrifying. Just reaching the room was like walking through a nightmare. The team passed bodies laid out on the floor “without any order or system, and… had to step amongst them to get into the room.” While one doctor tried to move a corpse aside, “a foamy, blood-stained liquid” ran from its nose and mouth.12
Once inside the autopsy room, the doctors found the body of a young soldier lying naked on a wooden table, his head propped up by a wooden block. William Welch, at seventy-one the team’s senior member, began the autopsy by opening the chest cavity with a scalpel. When he exposed the lungs, everyone gasped, scarcely able to believe their eyes. Lungs are normally lightweight and billowy, but these were dense purple masses, heavy as slabs of raw liver. Frothy red fluid filled the alveoli; the soldier had drowned in his own blood. When placed in buckets of water during autopsies, lungs would ordinarily float; the virus-infected lungs sank to the bottom. Welch was by nature calm and not easily rattled. Now, Rufus Cole said, he turned pale as a bedsheet. “ ‘This must be some new kind of infection or plague,’ ” Welch said, “and he was quite excited and obviously very nervous….It was not surprising that the rest of us were disturbed, and it shocked me to find that the situation…was too much even for Dr. Welch.”13
But Welch was wrong: this was not a new kind of infection, but an old one turned vicious by a mutated virus, a thing nobody knew existed. That an expert like Welch should have suggested plague as a cause further highlights the huge gap in the medical profession’s knowledge. Though physicians saw influenza’s ravages in the autopsy room, they could not explain why or how these came about.
Scientists today believe the virus did its worst damage by triggering a cytokine storm, which turned victims’ own immune systems against them. Cytokines, we recall, are chemical messengers that alert the immune system and send aid to the site of an infection. However, there can be too much of a good thing. Sometimes cytokines send huge amounts of immune cells flooding into the lungs. Then, for reasons still unclear, the cytokines overreact, “ordering” uncontrolled amounts of these cells to fight the infection. As the overreaction intensifies, immune cells spread throughout the body, attacking every organ and causing sudden, violent death.
That is what happened in 1918. Influenza victims developed gruesome symptoms. We have reports of blood vessels leaking, causing blood to pour from noses, mouths, ears, and eye sockets. Coughing became pure agony. American author John Dos Passos, who barely survived, remembered, “I coughed in a manner to turn my throat inside out and then outside in again.” In some cases, violent coughing ruptured stomach muscles, tore apart the muscles of the rib cage, and broke ribs. Lungs collapsed, trapping air bubbles beneath the skin. “As we rolled the dead in winding sheets,” a nurse recalled, “their bodies crackled—an awful crackling noise which sounded like Rice Crispies [sic] when you pour milk over them.” Some doctors and nurses died the same way.14
Another strange aspect of the mutated virus was the ages of its victims. Graphs of age-related flu deaths usually follow the trend of a U-shaped curve, as shown by the dotted line on the graph below, with peaks for babies and toddlers under the age of five and for old people over the age of sixty-five. The reason is probably that the immune systems of the very young are not fully developed, and advancing age weakens the immune systems of the elderly. Normally, when young adults catch influenza, they recover. This pattern changed during the second wave. It created a spike in the middle, the crude W-shaped curve shown by the solid line, representing those between ages eighteen and thirty-five. In other words, people in the prime of life were now at grave risk. Their death rates were several times higher than usual, most likely because their immune systems, operating at peak strength, triggered cytokine storms.15
Credit 42
PANDEMIC
Influenza raged at Camp Devens until late October. But it did not stay there. As during the first wave, the constant movement of recruits carried the virus to every military base and training camp in the country. Replacements from Camp Devens, for example, brought it to Camp Upton on Long Island, New York, a jumping-off point for troopships bound for Europe. As flu blazed through the camp, Naomi Barnett of Brockton, Massachusetts, rushed to care for her fiancé, Jacob Julian, when she learned of his condition. They planned to be married before he shipped out for France, but the bride-to-be died of flu-related pneumonia two days after her arrival. The love of her life died a half hour later. “Relatives,” their hometown newspaper reported, “are planning a double funeral in Brockton.” Overwhelmed and feeling powerless against the disease, Colonel Charles B. Hagadorn, the camp commander, put a bullet into his brain.16
Because of the raging pandemic, medical personnel worked extended shifts. At the Great Lakes Naval Training Station north of Chicago, Josie Mabel Brown put in sixteen-hour days as a nurse, she told an interviewer in 1986, the year she turned 100. “There were so many patients we didn’t have time to treat them,” Brown said. “We didn’t take temperatures; we didn’t even have time to take blood pressure. We would give them a little hot whiskey toddy; that’s about all we had time to do. They would have terrific nosebleeds…[and] sometimes blood would just shoot across the room. You had to get out of the way or someone’s nose would bleed all over you.” With its hospitals overwhelmed, the army put flu patients in jam-packed gymnasiums. Hundreds of men lay in cots, just inches apart, coughing and sneezing, separated only by bedsheets draped across ropes.17
Upon seeing a patient with a purple face, Brown knew he bore the mark of death. Though alive when he arrived, he was a goner; he had only hours left, or a day at most. When death came, nurses wrapped the body in a winding sheet, Brown said, “and left nothing but the big toe on his left foot out with a shipping tag on it to tell the man’s rank, his nearest of kin, and hometown.” Death struck so quickly that “the morgues were packed almost to the ceiling with bodies stacked one on top of another.” She said she felt sorry for “the poor fellow at the bottom of the heap.”18
As influenza spread in 1919, any available space became an impromptu medical ward. Credit 43
“The Flu,” a poem by Private Josh Lee, captures the epidemic’s impact on an ordinary recruit:
It stalked into camp when the day was damp
And chilly and cold.
It crept by the guards
And murdered my pards
With a hand that was clammy and bony and bold;
And its breath was icy and mouldy and dank,
And it killed so speedy
And gloatingly greedy
That it took away men from each company rank.19
Nothing could check the viral rampage. In the United States, H1N
1 put no fewer than 675,000 civilians into graveyards. This is a staggering number, more than the nation’s total military deaths in World War I, World War II, the Korean War, and the Vietnam War combined. Our neighbor to the north, Canada, a vast but thinly populated country of 8.1 million, lost about 50,000 people. In Montreal in November, an eyewitness reported, “funerals became so numerous that cemetery officials could not dispose of the corpses fast enough.” That same month, the Reverend Henry Gordon made his rounds in Labrador, a rural province with remote logging camps and fishing villages. Gordon found villages where “whole households lay inanimate on their kitchen floors, unable to feed even themselves or look after the fire.”20
Sailors aboard cargo ships brought the infection to Latin America. Mexico saw influenza race through its towns and cities, all but crippling Mexico City, the capital. The virus struck peasant farmers, the poorest of the poor, and the masters of haciendas—sprawling ranches and estates with grand houses dating from Spanish colonial days. In the state of Chiapas, in the southeast on the border with Guatemala, 10 percent of the population died. By the time the second wave passed, the flu had claimed more than 300,000 Mexican lives.21
Next the virus found its way into British Guiana (now Guyana), a British colony on the northeast coast of South America. “The epidemic has been the most severe visitation within the memory of any colonist,” a public health officer reported. “The almost universal prevalence and high mortality rate have caused untold suffering.” The virus killed 12,000 out of a population of 310,000. Farther south, in Brazil, 350,000 died, including Francisco de Paula Rodrigues Alves, the nation’s president-elect.22
Central America and the islands of the Caribbean fared no better. Ships carried the infection to British Honduras (now Belize), a small country in Central America, bordered by Mexico on the north and the Caribbean Sea on the east. “The catastrophe,” a British newspaper observed, “came and went, a hurricane across the green fields of life.” A banana-boat crew brought the virus to the island of Jamaica; it killed 10,000 out of a population of 850,000. In all, influenza claimed the lives of around 100,000 people in the Caribbean region.23
Meanwhile, the mutated virus fastened its hold on Europe. No fewer than 250,000 people died in Great Britain. In the autumn of 1918, bacterial pneumonia and influenza carried away 18,000 Londoners. Their city had so many cases that the London Zoo in Regents Park enclosed its monkeys in glass cages to protect them from infected visitors. A young woman named Caroline Playne, an avid diary keeper, wrote: “In trains and trams, the depression shown on travelers’ faces was very noticeable and talk was all about specially sad cases of death from influenza. A sense of dread is very general.” And no wonder, because such an authority as Sir Bertrand Dawson, the king’s personal physician, admitted defeat. “I fail to see any explanation [for the disease],” the learned doctor said after examining patients.24
The disease easily crossed the Irish Sea from Great Britain to the Emerald Isle. Ireland’s official death toll was 23,288, but researchers believe the actual number was much higher. Molly Deery, from County Donegal, on the northwest coast, recalled the flu experience years later. The disease “hit hard and the people were very fearful and frightened of it. You see the people had no idea what caused it….It was terrible, terrible…and people were told to keep to one side of the road if someone in a house had it.” People in Dublin, the capital, believed the disease originated in the trenches of the Western Front. A press report said that a Dublin doctor, home on leave, “found within the past week several cases of ‘influenza’ in which the ‘symptoms’ are very similar to those observed in soldiers ‘gassed’ in the trenches.” He was right in one sense: victims of both gas poisoning and influenza often turned blue or purple.25
In continental Europe, influenza killed more than 240,000 French men and women; in Paris alone, 1,200 people died each week. Germany lost more than twice that number: 562,000. Hardly any German family escaped an encounter with the devil virus. “From our housekeeper,” a wealthy woman wrote, “I hear that the whole village is stricken with it, and the wretched people are lying on the floors of their cottages in woeful heaps, shivering with fever and with no [medicine] or any one to attend them.” Italy, which fought on the Allied side, lost slightly fewer than Germany: 544,000 during the pandemic. Neutral Spain counted over 260,000 deaths from flu and bacterial pneumonia.26
AFRICAN HOLOCAUST
The term holocaust means “total destruction by fire.” Nowadays, the Holocaust (with a capital H) refers to German dictator Adolf Hitler’s attempt to exterminate Europe’s Jews and other “racially inferior” groups as part of his plan for world conquest during the Second World War. It is not too much to say that, for Africa, the influenza pandemic was a natural holocaust because it took so many lives, especially of black people ruled by foreigners.
In 1918, the African continent had only one independent country: Ethiopia. During the half century before the First World War, Europeans carried out a wild “Scramble for Africa,” seizing all the lands south of the Sahara. Great Britain, France, Belgium, Italy, and Germany ruled colonies with millions of native people and untold natural resources. To make this vast area governable and profitable, the imperial powers linked their holdings with seaports and railroads. However, these facilities, so vital to the continent’s economic development, had an unforeseen effect. As one historian observed, it was as if “the colonial transportation network had been planned in preparation for the pandemic.” Africa, where the human race originated over a million years ago, had never seen anything like this monster.27
HMS Mantua. (1914) Credit 44
The trouble began in August 1918 in West Africa. The Mantua, a British warship, had docked at Freetown, Sierra Leone, to take on a supply of coal. But the Mantua was not a happy ship; a third of the crew, 124 sailors, lay in their hammocks, coughing and burning with fever. Rather than place the Mantua under strict quarantine, port authorities, afraid of hampering naval operations, ordered black dockworkers to load the coal. They fell ill almost immediately, carrying the devil virus to Freetown’s population. “The disease,” the British governor reported, “spread with devastating rapidity, disorganizing everything. Everybody was attacked almost at once.”28
From Freetown, H1N1 traveled along the coast and inland by way of ships, trains, and riverboats. Infected sailors aboard other British warships also brought it to Gambia, north of Sierra Leone. A traveler reported from the Gambian interior: “I found whole villages of 300 to 400 families completely wiped out, the houses having fallen in on the unburied dead, and the jungle having crept in within two months, obliterating whole settlements.” Survivors had become pitiful scarecrows, shadows of their former selves. A British medical officer wrote, “Individuals who prior to an attack were strong, burly, healthy persons, in a few days became emaciated wrecks of humanity, barely able to crawl, and unable to undertake the slightest amount of exertion.”29
To the east of Sierra Leone, Nigeria lay in the path of the infection. Nigerians called it lululuka (killing by a sudden stroke) and ajukale-arun (a disease that spreads everywhere). To ward it off, Muslims in Lagos, the capital, drank water in which pages from the Quran, Islam’s holy book, had been dipped. Nigeria had the largest population in black Africa. Of its 18.6 million people, the best estimate is that 455,000 died, the vast majority of them black.30
British ships brought the virus to South Africa in October. Located at the southern tip of the continent, it was a self-governing country within the British Empire. The richest and most highly developed area south of the Sahara, it held invaluable mineral resources: diamonds, gold, platinum, copper, coal, iron ore—all mined by black workers directed by white bosses.
South Africans, whatever their color, remember October 1918 as “Black October.” It was a dark time, the darkest ever recorded there. Influenza first struck Cape Town, the country’s largest city and main seaport. Native people called it kaapito hanga (it came fast as a bullet). Death
s rocketed to 500 a day, and within two weeks Cape Town “was like a city of the dead.” Its main streets, usually bustling and crowded, were all but deserted at midday. People stayed home, worrying, “and nothing [was] talked of or thought about other than influenza.”31
But this was just the beginning. Before long, the virus invaded the South African countryside. In rural areas, cows lowed in pain as their udders swelled with milk. “A solemn hush prevailed,” a white farmer scrawled in his diary. “No one to be seen, no one to be heard; no life on the farms, no work in the lands. Lord influenza and his followers have…the countryside in their grip.” His Lordship took the lives of at least 300,000 of South Africa’s 6.7 million people. Deaths from starvation soared, too, because farmers were too sick to harvest or plant their crops. Most starvation victims, however, were black people. White settlers could afford to buy expensive food imported from Europe.32
In early November, the virus reached East Africa by railroad, by sea, and in the bodies of migrant workers returning home. Advancing northward, it terrorized Tanganyika (today’s Tanzania), a German colony conquered by British forces. Though the number of dead is unclear, travelers reported the disease “strewing the road with dead and dying.” Things were no better in neighboring Kenya, where 150,000 perished. Nairobi, the capital of Kenya and the British colony’s largest white settlement, was then little more than a village set in the wilds. It was not unusual to see a herd of zebra running down its main street in broad daylight. One never knew what to expect at night. Occasionally, a lion wandered in from the plains, hungry for household pets and unwary townspeople. Yet flu proved deadlier than any big cat. Ditto for Kenya’s northern neighbor, Ethiopia. The emperor, known as the “Lion of Judah,” sat on his jeweled throne, helpless. Years afterward, residents recalled that the capital, Addis Ababa, “looked like a dead city.” Influenza made even the government shut down, and in 1918 and 1919, Ethiopia had more deaths than births.33
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