Meanwhile, back in Haskell County, the Santa Fe Monitor continued to report the minutiae of small-town life. Young Dean Nilson returned home on leave from the army and the paper concluded that ‘Dean looks like soldier life agrees with him.’9 At the same time as Dean arrived home, Ernest Elliott embarked on his journey to Camp Funston, Fort Riley, to visit his brother. This military reservation, 300 miles from Haskell County, was the same place that Dean Nilson had just left. When Ernest Elliott set off, his young son Mertin was unwell. While Ernest was away, the little boy’s condition deteriorated. The ever informative Sante Fe Monitor noted that ‘Mertin [sic], the young son of Ernest Elliot, is sick with pneumonia.’10 Mertin had contracted the potentially lethal strain of influenza, and his father, although not a victim, was clearly a carrier, bringing the contagion with him to Fort Riley. A few days later, Dean Nilson arrived back at the same camp. Both men unwittingly spread the virus; an unforeseen consequence of America’s entry into the war.
America in 1918 had become a nation at war. Led by President Woodrow Wilson, the United States had declared war on Germany the previous year, galvanizing the country with draft call-ups, troop shipments and bond drives. By spring 1918, the nation was poised to play a decisive role in the conflict. Over 4 million men from all backgrounds volunteered or were conscripted to serve their country in a climate of patriotic fervour. Recruited from rural backwaters and sprawling cities, from Midwest prairies and the depths of the South, these men found themselves quartered in army camps, undergoing the basic training that would enable them to fight on all fronts against a common enemy. Tragically, these were also the ideal conditions for an outbreak of disease, according to epidemiologist Dr Victor C. Vaughan, writing with hindsight in his 1936 memoirs:
The procedures followed in the mobilization of our soldiers in the World War brought into every cantonment every infection then existent in the areas from which the men came. Drafted men were assembled at some point in each state. They came from every community; they came in their ordinary clothing; some clean, some filthy. Each one brought many samples of the bacteria then abounding in his own neighborhood. They brought these organisms on and in their bodies and on and in their clothing. They were crowded together at the state rendezvous and held here for varying periods of time, long enough to pass through the stages of enlistment. Then they filled troop trains and were transferred to their respective cantonments.11
While Vaughan was referring to measles in this broadside, the same rules applied to the epidemics of influenza that broke out in army camps in 1918. But at the time, his words and those of fellow medics fell on deaf ears: ‘The dangers in the mobilization procedures followed by us in the World War were pointed out to the proper authorities before there was any assembly, but the answer was: “The purpose of mobilization is to convert civilians into trained soldiers as quickly as possible and not to make a demonstration in preventive medicine.”’12
But, of course, Vaughan stated, the worst place for an infection was an army camp: ‘The more densely people are packed together the more difficult it is to control the spread of infection. There are no other conditions under which men are so closely and so continuously in contact as in an army camp.’13
Camp Funston, Fort Riley, Texas, was just such a camp, a typical example of the camps that were rising up across the United States. Located on the Fort Riley military reservation near Junction City, Kansas, Camp Funston, named after Brigadier General Frederick Funston, was the largest of sixteen divisional cantonment training camps built during the First World War to house and train soldiers for military duty. Construction had begun in July 1917 and buildings were laid out uniformly in city block squares with main streets and side streets on either side. An estimated 2,800 to 4,000 buildings were constructed at the camp to accommodate more than 40,000 soldiers from the US Army’s 89th Division, who were stationed at the facility. The camp cost roughly $10 million to build.14
More like a city than an army camp, Camp Funston contained housing and training centres, general stores, theatres, social centres, infirmaries, libraries, schools, workshops and even a coffee roasting house. The sleeping barracks were 43 feet by 140 feet and two storeys high. In them was a kitchen, mess hall, company commander’s office, supply rooms and squad rooms or dormitories. There were 150 beds in each sleeping room, as that was the size of an infantry company in 1917.15
Camp Funston’s main purpose was to train soldiers drafted in Midwestern states to fight overseas. Men would spend their hours drilling and learning new military techniques, and many officers were brought in from other countries such as France and Britain to train the Midwest soldiers. In their free time soldiers could see a show at the theatres or visit one of the social centres, although many pined for life back home. James H. Dickson, who served in the 356th Infantry Regiment of the 89th Division, wrote to his friend: ‘Eunice don’t be to [sic] long about writing for news is scarce out in Kansas the wind blows it all away.’16 The reference to the wind is significant. Soldiers often complained about the inhospitable weather conditions at Camp Funston, the bone-chilling winters and sweltering summers. First Lt Elizabeth Harding, army nurse corps and the first chief nurse at Fort Riley, recalled that ‘I arrived at Fort Riley about the middle of October, 1917, in a snow storm! I spent the coldest winter of my life and the hottest summer that I can remember.’17 As if the climate were not enough to contend with, conditions were made worse by the blinding dust storms, which in turn were intensified by manure fires. Fort Riley was the centre of the US Cavalry and thousands of horses and mules were stationed there; soldiers learned the skills of horsemanship, from veterinary science to farriery to harness-making and saddlery. The future General George Patton was to be seen there, playing polo and show jumping at weekends.18 The horses produced around nine tons of manure a month, and burning was the accepted method of disposal. As a result, the dust, combined with the ash of burning manure, created a stinging, stinking yellow haze. The grains of fine grit aggravated lungs and bronchi, leaving men miserable and prone to asthma, bronchitis and pneumonia, while thick black smoke hugged the ground for hours and further irritated respiratory tracts.19
One of the biggest problems at any military camp was the spread of communicable disease. All soldiers were inoculated against ‘battlefield’ diseases such as cholera and dysentery upon entering the camp, and any men thought to have any communicable disease were immediately quarantined until they either recovered or were no longer considered contagious. In 1918, the commandant of the base hospital at Fort Riley was Colonel Edward Schreiner, a surgeon who had entered federal service as a contract surgeon, joined the regular medical corps and commanded the cantonment hospital on the Mexican border in 1916.20 Army nurses had arrived to bleak conditions just a year earlier. First Lieutenant Elizabeth Harding recalled that ‘barracks were being converted into hospitals. At first it was very primitive with no toilet or bath facilities except in the basement of the buildings. Hot water and heat were scarce.’21
On Saturday, 9 March 1918, Fort Riley endured a significant dust storm, one of the worst that the men could remember. It was said that the sun went black in Kansas that day. Trains had to halt on the tracks and Fort Riley was covered in soot and ash. Men were assigned to clean up the mess, but it did not occur to their commanding officers to issue them with masks. The following Monday, 11 March, company cook Private Albert Gitchell reported sick, suffering from a sore throat and a headache. The duty medical officer suspected Private Gitchell’s symptoms were caused by the dust storms and the after-effects of manure bonfires, but, since Private Gitchell was running a temperature of 40° C, he was confined to an isolation bed.22 Soon afterwards, Corporal Lee W. Drake and Sergeant Adolph Hurby presented themselves. At 41° C, Private Hurby’s temperature was even higher than Gitchell’s, and he suffered from an inflamed throat, nasal and bronchial passages. As a steady stream of sick men formed an orderly queue, the duty medical officer called in Colonel Schreiner for back-up. By noon, Col
onel Schreiner and his assistants had seen over 107 sick men; by the end of the week there were 522 cases at Camp Funston, and by the end of March, 1,100 men were sick, so many that a hangar had to be requisitioned as a ward.23 In paying attention to this outbreak of influenza, and fulfilling the duty of care to the men, Colonel Schreiner was being ultra-cautious following events of the previous year. In 1917, an army officer, John Dwyer, had been court martialled following the death of recruits from influenza. Dwyer was found guilty of neglect, having ordered one flu victim to take on additional duties despite the fact that he was severely ill. Dwyer was dismissed from the army.24
This outbreak was severe, but not unexpected. Outbreaks of contagious disease were common in barracks, where so many men were crushed in together, in cramped conditions. First Lieutenant Harding noted that ‘As usual in large groups as were housed together at Camp Funston, there were many epidemics. Many of the troops came from the farms where they had never come in contact with contagious diseases.’25 But this outbreak was different.
Colonel Schreiner’s initial diagnosis suggested that his patients had succumbed to influenza. Their symptoms resembled a classic case of influenza, with a chill followed by a high fever, headache and back pain. But some patients were too weak to stand, and their symptoms included violent coughing, projectile nosebleeds, and air-hunger, some choking to death. The death toll was unusually high: while most patients recovered within five days, forty-eight died of complications such as pneumonia and haemorrhages. As the virulent strain of influenza cut a swathe through Camp Funston, Colonel Schreiner telegraphed the US Army’s GHQ in Washington on 30 March: ‘Many deaths influenza following immediately two extremely severe dust storms.’26 The authorities treated Colonel Schreiner the same way they had treated Dr Loring Miner: they did not take his warnings seriously.
Dust storms were nothing new in Kansas; neither were outbreaks of contagious diseases in army camps. But put together, the two seemed to suggest some new and hitherto unknown menace. Dr Miner and Colonel Schreiner were both aware that plague, in the form of pneumonic plague, represented a real threat. Pneumonic plague, the ‘Black Death’ of medieval history, was transmitted by breath, just like influenza, and as noted in the previous chapter, there had been an outbreak of pneumonic plague in Manchuria. Some 200,000 labourers from North China had passed through North America, to work with the Allies in France. Had they brought pneumonic plague with them, which now, after modification by the new environment, was appearing as the new and deadly strain of influenza? This theory, of course, does not explain the outbreaks in the remote farmsteads witnessed by Dr Miner.
Colonel Schreiner seemed to believe that the dust storm itself had triggered the epidemic, but in hindsight there were other possibilities: had swine flu mutated from animals kept on the base, or had horse flu, known as ‘the Strangles’, mutated from the camp’s a thousand cavalry horses?27 It is entirely possible that some of those horses were suffering from a strain of flu, which was then spread across the camp by the burning of manure. In practical terms, while the dust cloud may not have caused the influenza, it certainly helped it on its way, leaving the soldiers breathless and wheezing for days, ideal conditions in which a flu virus might flourish.
And then, just as before in Haskell County, the influenza vanished as swiftly as it had begun, and was forgotten in the ferment of preparation for the war in Europe.
CHAPTER THREE
THE KILLER WITHOUT A NAME
AS THE AMERICAN war effort intensified in the spring of 1918, outbreaks of a particularly severe strain of influenza flared up across the military camps apparently simultaneously, from New York to Florida, California and Alabama. Although influenza was a regular hazard of army life, the consequence of overcrowding and insanitary quarters, a number of officers became alarmed about the rapidity and severity of the outbreaks. The new strain of deadly influenza also began to make inroads among the civilian population, targeting those places where people were gathered together at close quarters, such as schools and prisons. The following series of events indicates the arbitrary manner in which the ‘First Wave’ of Spanish flu, as it would become known, occurred across the United States.
In the US army, Colonel Edward Schreiner had already expressed unease about the outbreak of influenza at Camp Funston. Major General Hugh Scott, commander of the 78th Division at Camp Dix in New Jersey, soon became similarly concerned. In April 1918, Major General Hugh Scott wrote to US Surgeon General William Crawford Gorgas about the spread of disease at Camp Dix, in particular influenza, which was responsible for an increasing number of pneumonia cases. Major General Scott was at a loss to explain the cause for such an epidemic, as ‘the camp is as clean as a hound’s tooth’.1
In his letter to General Gorgas, Major General Scott described the sanitation measures he had ordered at Camp Dix and asked Gorgas to come and visit the camp and ‘give us the once over’.2 Major General Scott could not rest easy until he could be certain that he had done everything he could to prevent his men from becoming infected.
For his part, General Gorgas took Major General Scott’s plea very seriously, having conquered yellow fever in the American army. Yellow fever, so called because in its second, toxic, stage it causes jaundice, is a viral disease spread by infected female mosquitos. Gorgas had famously tackled the virus with a programme of sanitary precautions, and was eager to tackle an outbreak of pneumonia in the same ruthlessly energetic fashion. General Gorgas was convinced that one reason for this particularly virulent outbreak was overcrowding.
‘I haven’t the least doubt that if you, tomorrow, could give every man in Camp Dix his own individual hut, that pneumonia would ease at once,’3 he declared, explaining that this was his chosen method for fighting pneumonia among construction workers on the Panama Canal, adding that ‘we have a number of the best scientists in the United States studying this question of transmission of pneumonia and may be [sic] we will be as successful with pneumonia in this as we were with yellow fever and malaria in the Spanish-American War’.4
One victim of the outbreak at Camp Dix was Private Harry T. Pressley of the 15th US Cavalry. Pressley caught influenza during the spring epidemic at Camp Dix, but was not considered sick enough to be taken off duty. Fortunately for Private Pressley, he had an office job which limited his physical activity. Pressley’s buddy, Cid Allen, had also fallen sick, but he was ‘ordered to keep on drilling’ and was still sick when they shipped out to France in April 1918.5
It was only when further outbreaks of this particularly severe strain of influenza struck simultaneously that the US military conceded that there might be a problem. Outbreaks of influenza occurred at army camps in California, Florida, Virginia, Alabama, South Carolina and Georgia.6 General Gorgas reported epidemic influenza at Camps Oglethorpe, Gordon, Grant, Lewis, Doniphan, Fremont, Sherman, Logan, Hancock, Kearney, McClellan and others.7
Outbreaks were not restricted to the military. Back in Haskell County, source of the disturbing outbreak witnessed by Dr Miner, influenza hit Haskell County Indian School, where young Native Americans were trained for the workforce. Out of a population of 400 children, three died. Fatal cases of influenza also appeared in Chicago and Detroit, where a thousand workers at the Ford Motor Company came down with influenza in March 1918.8 The mystery disease was on the move, and it was travelling fast. While it was clear to doctors such as Colonel Schreiner that this lethal strain of influenza took a different form, they didn’t even have a new name for this old enemy. One army doctor did attempt to find a label, however. In H. Camp Kearney Division Surgeon’s Reports, the local term ‘Japanese influenza’ was erroneously given to the disease, believed to have been started by the arrival of a squadron of Japanese warships at San Diego during the first week of April with a number of cases of influenza.9
Lack of documentation made the outbreak difficult to track. While the military authorities were compelled to keep medical records of troops, their fitness to serve being critical to the
ir role in the army, no such records were available for the civilian population, as influenza was not a notifiable disease. The only acknowledgement of the lethal outbreak in this period is the brief mention of the outbreak at Haskell County in Public Health Reports, 5 April 1918.10
Influenza flourished inevitably in schools. One victim was sixteen-year-old John Steinbeck. The future author of The Grapes of Wrath returned home from his Californian school one day looking ‘pale and dizzy’11 and collapsed into bed, much to the horror of his mother, Olive. John’s temperature shot up and he became delirious. ‘I went down and down,’ he remembered, ‘until the wingtips of angels brushed my eyes.’12 A local surgeon, Dr Merganser, was called in, and promptly turned the master bedroom into an operating theatre.
He opened the teenager’s chest under ether, removing a rib to gain access to the infected lung, which was then drained of pleural pus. ‘We thought surely he would die on us,’ his sister says. ‘John looked horrible, horrible. We did everything we could for him. And then he had a relapse. It took a long time, but he was all right in the end. I must say, we were scared to death.’13
This drastic treatment worked, and John recovered sufficiently to attend the last three weeks of school before the summer recess, but he was left with lung problems for the rest of his life. The experience bestowed a strange psychological legacy, leaving Steinbeck with a profound sense of vulnerability which shaped him as a writer. ‘It seems to have given him a sense of himself as someone on the edge of life,’14 wrote his biographer, Jay Parini. Like so many other Spanish flu survivors who we will meet in the course of this book, Steinbeck was marked for life by the experience.
America’s prisons were prime targets for influenza, which spread rapidly between overcrowded prison populations. The 1918 outbreak at San Quentin, California, where 500 of the 1,900 prisoners were affected, was a notable example, the prisoners appearing to have been victims of a notorious medical experiment.
Pandemic 1918 Page 4
