After a hospital ship arrived in Karachi on 20 June the majority of the patients developed Spanish flu within forty-eight hours. Again it is not clear whether the influenza had been brought with them or acquired in Karachi, but it is more likely that it was imported from outside. Although the outbreak of Spanish flu in Bombay in June lasted only four weeks, it took 1,600 lives and ‘at least a million working days, an incalculable amount of discomfort, expense and inconvenience’.11 The epidemic was confined to those working indoors, in offices and factories. The sickness rate in offices and mills was Europeans 25 per cent, Indians 33 per cent, and children 55 per cent. This last figure may appear surprising but at the time children were regularly employed in factories. Turner’s description of the Spanish Lady is memorable. Whereas the causes of diseases such as cholera, smallpox and plague were known and their spread could be contained, Spanish flu came, he said, ‘like a thief in the night, its onset rapid, and insidious’.12
Frederick Brittain of the Royal Army Medical Corps provided a snapshot of conditions in India when his hospital ship, the Egypt, arrived at Bombay, in August 1918. On Saturday 24 August, Brittain recorded: ‘With Carter to Natunga Station and walked up to the sea front at Mahim. This part really seems like the India of the story books with its groves of beautiful banana trees and coconut palms, palm-thatched houses, etc.’13 But this vision was swiftly dispelled when: ‘We went on the beach at Mahim and walked along past a burning ghat where a body had just been burned. An Indian carried his bedstead down on his head, took it out into the sea and washed it. We thought how strange this would look at home!’14
From India, Spanish flu spread into Iran, then known as Persia. The disease, known to the Persians as ‘bad-e nazleh’, arrived in Persia at Bushehr, courtesy of the English and Indian soldiers stationed in Bushehr and Bandar-e Lengeh ports, then spread from Baghdad to Kermanshah in the west and Shiraz in the south. Although detailed information is scarce, the Spanish flu outbreak in Persia was estimated to have killed one million people, one-tenth of the country’s population. The writer Mohammad Ali Jamalzadeh (1892–1997) described the appalling conditions in Shiraz: ‘At the end of WWI, three lethal killers entered Shiraz; they were famine, cholera and the Spanish flu. Many people died and corpses were seen everywhere in the city. The Bazar and shops were closed. There was no doctor, no nurse, and no drug.’15
Influenza spread across the entire country, with rural areas more affected than urban regions. Ashair tribespeople, particularly the healthy men, died from it. The reported mortality rate in the nomadic Ghashghai tribe was as high as 30 per cent. In Shiraz, which had a population of 50,000, 5,000 died from Spanish flu. The mortality rate in Kermanshah was reported as 1 per cent, but in the villages as many as 20 per cent of the people were reported to have perished, a figure which seems exaggerated. In Tehran, during a three-month period, 50,000 people were reported to have died.16
In one respect, the mortality rate in Persia differed from that in other parts of the world. While in the majority of Spanish flu epidemics the victims were men and women aged between fifteen and forty-four, mortality rates in Persia were affected by other factors specific to the region such as famine, opium consumption, anaemia and malaria. While the total estimated deaths from the 1918 Spanish influenza epidemic in Persia was between 902,400 and 2,431,000, the real figure was probably somewhere between the two extremes.17
The Spanish Lady made a protracted and devastating visit to the African continent in August 1918, killing 50 million people over the course of six months and leaving a catastrophic effect on the demographic which lasted into successive generations. While North Africa, namely the Maghrib and Egypt, had already experienced the first, relatively mild wave of influenza and received some immunity, sub-Saharan Africa had not, and as a result found itself lethally exposed to the deadly second wave when infected ships arrived in Freetown, Sierra Leone, Cape Town, South Africa and Mombasa, Kenya. The South African experience of Spanish flu is the subject of a subsequent chapter of this book.
In Nairobi, East Africa, young Londoner Sidney Peirce ‘got a nice packet of “Flu”’ on 25 August, and felt ‘rotten’.18 The following day, he was ‘Still in bed with the Flu, a little better. Aug 27th – Still in bed with the doings, still feel jolly bad. Aug 28th – Had a walkabout to-day.’19
Sidney, who had been sent to Africa to train a ‘black army’, suffered a second attack the following month. ‘Sept 15th – Got another attack of Flu its [sic] pretty prevalent at Nairobi.’20
The unprecedented level of troop movements across the globe aided and abetted the Spanish Lady’s campaign of destruction. Hundreds of thousands of US troops huddled together in overcrowded army camps before being herded into trains travelling to ports, then packed into battleships. In June 1918, 279,000 Americans sailed for Europe; in July, the number was 300,000; in August, 286,000. In total, 1.5 million American soldiers landed in Europe during the last six months of the war.21
American troops were just one contingent among the many different populations circulating the globe. Ships from New Zealand refuelled in Sierra Leone, alongside British ships on their way to South Africa, India and Australia. Inevitably, Sierra Leone was soon riddled with Spanish flu. Allied ships headed towards Archangel through the White Sea in a bid to attack Germany from the rear, taking Spanish flu with them so that Russia too was soon engulfed. At Brest, France, five hundred men-of-war lay at anchor as 791,000 doughboys arrived at the Depot de la Marine to encounter the flu-ridden French soldiers. Worse was to come as ships arrived into American ports, bringing the deadly disease with them from Europe.22
On 22 July 1918, a depleted City of Exeter hobbled into Philadelphia from Liverpool. Among her passengers were twenty-seven Lascars and an English quartermaster ‘so desperately ill with pneumonia that they had to be taken to a hospital immediately’.23 On the same day, an Indian vessel, the Somali, ‘steamed into the Gulf of St Lawrence and put 89 of her crew, ill with influenza, ashore at Grosse Island’.24
On 12 August, the Norwegian ship Bergensfjord docked in New York harbour carrying two hundred cases of influenza. Three had died at sea.25 Eleven passengers were transferred to a hospital in Brooklyn. They were not placed in isolated wards. Health Commissioner Royal S. Copeland of New York City made the woefully over-confident announcement that the victims had pneumonia, not influenza, and claimed that Spanish flu rarely attacked the well-fed. ‘You haven’t heard of our doughboys getting it, have you? You bet you haven’t, and you won’t … No need for our people to worry over the matter.’26
On 27 August 1918, three sailors succumbed to Spanish flu on the Receiving Ship at Boston’s Commonwealth Pier. This ‘Receiving Ship’ was not actually a ship but a massive floating barracks.27 It was designed to hold around 3,700 men but some nights held around 7,000, so was ‘grossly overcrowded’ by the Navy’s own admission.28 The following day, eight new cases presented for treatment. The day after that, there were fifty-eight. On day four, eighty-one men fell ill; on day five, one hundred and six. One modern writer, Dennis Lehane, has compellingly recreated the chilling vision that met the eyes of onlookers when flu-stricken men were removed from their infected ship, describing their ‘Pinched skulls and caved-in cheeks, their sweat-drenched hair and vomit-encrusted lips, they’d looked dead already.’29 The deadly symptoms of heliotropic cyanosis were already present in three victims, who ‘bore a blue tint to their flesh, mouths peeled back, eyes wide and glaring’.30
These Spanish flu cases overwhelmed the medical facilities at Commonwealth Pier, so fifty patients were transferred to Chelsea Naval Hospital, across the Bay. Physicians took blood samples and throat cultures and within forty-eight hours two of them had become infected. The most significant feature of this outbreak was the speed of onset. Within a matter of hours, perfectly healthy men were in a state of complete prostration. ‘Fevers ran from 101° to 105°, and the sick complained of general weakness and severe aches in their muscles, joints, backs and heads. The suf
ferers commonly described themselves as feeling as if they “had been beaten all over with a club”.’31
Within two weeks of the first case, 2,000 men of the First Naval District were critically ill with influenza. While the majority of patients recovered within a matter of days, a further 5 to 10 per cent developed severe pneumonia. ‘As of September 11, 95 cases of influenza pneumonia had been or were being treated at Chelsea Naval Hospital. Thirty-five had died and another 15 or 20 were desperately ill. It seemed probable that the mortality rate for influenza pneumonia would be 60 to 70 percent.’32 Autopsies revealed lung tissue sodden with fluid; and while pathologists expected to find Pfeiffer’s bacillus, confirming to them that this was influenza, the bacillus was not always present. One physician at the hospital, Lieutenant Junior Grade J. J. Keegan, predicted that the disease ‘promises to spread rapidly across the entire country, attacking between 30 and 40 percent of the population, and running an acute course in from four to six weeks in each community’.33 He was right.
Despite this obvious public health emergency, it appeared as if military and civilian authorities were doing little to prevent the spread of Spanish flu. On 3 September, the first civilian casualty arrived at Boston City Hospital; instead of imposing strict quarantine, the city authorities permitted four thousand men to march through the streets of Boston in a freedom parade the very same day. As the American historian Albert Crosby has observed, this did not win the war but it did spread the influenza epidemic.
On 4 September, the first cases of influenza appeared at the Navy Radio School at Harvard, in Cambridge. On 5 September, the state department of health released news of the epidemic to the newspapers. Doctor John S. Hitchcock warned the Boston Globe that ‘unless precautions are taken the disease in all probability will spread to the civilian population of the city’.34 But no precautions were taken, and a day later, on 6 September, thousands of sailors and civilians packed into a drill hall to celebrate the opening of a new building at the Radio School.
The first three official deaths from Spanish flu in Boston occurred on 8 September: one navy death, one merchant marine, and the first civilian death since early summer. A week later, on 11 September, the navy announced that the pandemic had killed twenty-six sailors in and around Boston, and the first flu cases were recognized among navy personnel in Rhode Island, Connecticut, Pennsylvania, Virginia, South Carolina, Florida and Illinois.35 While concerned public health officials in Washington were telling reporters that they feared Spanish flu had arrived in the United States, a massive recruiting drive saw thirteen million men of precisely the ages most liable to die of Spanish influenza and its complications lined up all over the United States and crammed into city halls, post offices and school houses to register for the draft. It was a gala flag-waving affair everywhere, including Boston, where 96,000 registered and sneezed and coughed on one another.36 The public health officials were wasting their breath. Meanwhile, three more victims dropped dead on the sidewalks of Quincy, Massachusetts.37 The Spanish Lady was continuing her inexorable campaign against the United States.
On 8 September, Spanish flu appeared at Camp Devens, just four days after 1,400 fresh recruits had arrived from Massachusetts. Camp Devens, forty miles north of Boston, Massachusetts, was crammed to the rafters with over 45,000 men, preparing to ship out to France. On the same day, 2nd Lieutenant Alfred Tennyson had looked on as four of his men were threatened with a court martial for refusing to do the ‘bear-crawl’ during a training exercise.38 Tennyson immediately realized that his men were sick and attempted to intercede on their behalf. Little did he know that they were the first victims of a Spanish flu epidemic that would rip through Camp Devens, killing 787 men. As soon as the extent of the epidemic became obvious, Dr Victor Vaughan, suffering from a bad cold, was summoned to do what he could for the stricken recruits.
‘I went directly to the Surgeon General’s office, where General Richard was officiating, as General Gorgas was in Europe,’39 recalled Vaughan. ‘Scarcely looking up from his papers, the general said, as I entered the door: “You will proceed immediately to Devens. The Spanish influenza has struck that camp.” Then, laying aside his papers and looking into my suffused eyes, he said: “No, you will go home and go to bed.” I took the next train for Camp Devens and arrived early the next morning.’40
On his very first day at Camp Devens, Vaughan saw sixty-three soldiers die. Recalling the traumatic scenes in his memoir, Vaughan wrote:
I see hundreds of young, stalwart men in the uniform of their country coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full and yet others crowd in. The faces soon wear a bluish cast; a distressing cough brings up the blood-stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood. This picture was painted on my memory cells at the division hospital, Camp Devens, in 1918, when the deadly influenza demonstrated the inferiority of human inventions in the destruction of human life. Such are the grewsome [sic] pictures exhibited by the revolving memory cylinders in the brain of an old epidemiologist as he sits in front of the burning logs on the hearth of his ‘cottage in the woods.’ 41
Vaughan’s most chilling discovery was that this new strain of flu, like war itself, killed ‘the young, vigorous, robust adults … The husky male either made a speedy and rather abrupt recovery or was likely to die.’42 As a result Vaughan, for all his medical qualifications, felt completely helpless: ‘The saddest part of my life was when I witnessed the hundreds of deaths of the soldiers in the Army camps and did not know what to do. At that moment I decided never again to prate about the great achievements of medical science and to humbly admit our dense ignorance in this case.’43
The distressing scenes at Camp Devens shocked new doctors and hardened medics alike. One of Vaughan’s colleagues, Dr Roy Grist, left a graphic description of this new influenza in a letter to a friend:
These men start with what appears to be an ordinary attack of La Grippe or Influenza, and when brought to the Hosp. [sic] they very rapidly develop the most vicious type of Pneumonia that has ever been seen … and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white. It is only a matter of a few hours then until death comes … It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies … We have been averaging about 100 deaths per day … Pneumonia means in about all cases death … We have lost an outrageous number of Nurses and Drs. It takes special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce … It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double row.44
Working in these conditions was both depressing and exhausting, as Grist’s closing remarks indicate: ‘The men here are all good fellows but I get so damned sick of pneumonia we eat it live it sleep it and dream it to say nothing of breathing it 16 hours a day … Good By [sic] old Pal, God be with you till we meet again.’45
Grist’s letter, with its testimony to the horrors of Spanish flu, was discovered among a cache of papers in an old trunk in 1979. We have no idea whether Dr Grist survived the war, or perished along with his patients; medical staff were among those who died at Camp Devens at the rate of 100 deaths a day.
When the veteran pathologist Dr William Welch arrived at Camp Devens, he confirmed that the cause of death in the majority of cases was lung failure. Autopsies revealed blue, swollen lungs filled with a bloody fluid. A calm and dignified man, who had witnessed many terrible sights, Welch was visibly shaken by the scenes that met his eyes. His young colleague, Dr Rufus Cole, later commented that ‘it shocked me to find that the situation, momentarily at least, was too much even for Doctor Welch�
�.46
Welch, along with Vaughan and Cole, immediately informed General McCain that Camp Devens must go into quarantine, with no more troops arriving and leaving the camp. In addition, increased numbers of medical personnel must be drafted in as soon as possible. But McCain, with a war to win, ‘had to delay and hedge on implementing and even ignore the meagre suggestions they did make’.47
It was left to Welch to vocalize the doctors’ anxieties and the powerlessness of medical science in the face of this onslaught. Welch was not afraid to put his deepest fears into words: ‘This must be some new kind of infection,’ he said, and then, employing one of the few words in the medical lexicon that still has an aura of superstitious horror, ‘or plague’.48
As Spanish flu ran unchecked across the United States and Europe, some patriots claimed that Spanish flu was actually a form of biological warfare, the natural successor to the mustard gas being used at the Front. It was feared that the Germans were to blame, having created a form of poison gas which had been released by U-boats onto the beaches of the United States. As thousands of Bostonians fell sick, rumours whirled as fast as the Spanish Lady. Outside the scientific constraints of the medical profession, one conspiracy theory held that German spies had deliberately seeded Boston Harbour with influenza-sprouting germs. On 17 September 1918, Lt Col. Philip Doane, head of the Health and Sanitation Section of the Emergency Fleet Corporation, opined that the epidemic had been started by Germans put ashore from U-boats.49 ‘It would be quite easy for one of these German agents to turn loose influenza germs in a theatre or some other place where large numbers of persons are assembled. The Germans have started epidemics in Europe, and there is no reason why they should be particularly gentle with America.’50 Another wild rumour circulated that the Bayer brand of aspirin was impregnated with germs, because the Bayer patent was originally German. However ridiculous these allegations, the Public Health Service had to investigate. It was said that German spies had infiltrated the Army Medical Corps and spread Spanish flu through hypodermic shots, and that the spies had been discovered and executed by firing squad.51 This was despite denials from Brigadier General Charles Richard, Surgeon General of the Army, who announced that ‘There have been no medical officers or nurses or anyone else executed at camps in the United States.’52 Despite this, some Americans continued to blame the Germans for Spanish flu, one declared: ‘Let the curse be called the German plague. Let every child learn to associate what is accursed with the word German not in the spirit of hate but in the spirit of contempt born of the hateful truth which Germany has proved herself to be.’53
Pandemic 1918 Page 9
