The Great Influenza: The Epic Story of the Deadliest Plague in History - John M. Barry (2004)

Part V. EXPLOSION

Chapter 17

ON SEPTEMBER 7, three hundred sailors arrived from Boston at the Philadelphia Navy Yard. And what happened in Philadelphia from that point would prove—too often—to be a model for what would happen elsewhere.

Philadelphia was already typical in its war experiences. Every city was being flooded by people, and in Philadelphia shipbuilding alone had added tens of thousands of workers. In a few months a great marsh had been transformed into the Hog Island shipyard, the largest shipyard in the world, where thirty-five thousand workers toiled among furnaces and steel and machinery. Nearby the New York Shipbuilding yard worked eleven thousand five hundred men, and a dozen other shipyards each worked from three thousand to five thousand more. And the city was thick with other great industrial plants: several munitions factories each employed several thousands at a single location, the J. G. Brill Company turned out a streetcar an hour and employed four thousand, Midvale Steel had ten thousand workers, Baldwin Locomotive, twenty thousand.

Overcrowded before the war, with jobs sucking ever more workers into the city and the population swelling to 1.75 million, Philadelphia literally teemed with people. In 1918 a national publication for social workers judged living conditions in its slums, where most tenements still had outhouses servicing dozens of families, worse than on the Lower East Side of New York. Blacks endured even more squalid conditions and Philadelphia had the largest African American population of any northern city, including New York or Chicago.

Housing was so scarce that Boy Scouts canvassed the area seeking rooms for newly arrived women with war jobs. Two, three, and four entire families would cram themselves into a single two-or three-room apartment, with children and teenagers sharing a bed. In rooming houses laborers shared not just rooms but beds, often sleeping in shifts just as they worked in shifts. In those same tenements, the city’s own health department had conceded that during the winter of 1917–18 “the death rate…has gone up owing to the high cost of living and scarcity of coal.”

The city offered the poor social services in the form of Philadelphia Hospital, known as “Blockley,” a poorhouse, and an asylum. But it offered nothing else, not even an orphanage. The social elite and progressives ran whatever charitable activities that did exist. Even normal services such as schools were in short supply. Of the twenty largest cities in America, Philadelphia, the city of Benjamin Franklin and the University of Pennsylvania, spent less on education than all but one. In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934.

All this made Philadelphia fertile ground for epidemic disease. So did a city government incapable of responding to a crisis. Muckraker Lincoln Steffens called Philadelphia “the worst-governed city in America.” He may well have been right.

Even Tammany’s use of power in New York was haphazard compared to that of the Philadelphia machine, which had returned to power in 1916 after a reformer’s single term in office. Philadelphia’s boss was Republican state senator Edwin Vare. He had bested and mocked people who considered themselves his betters, people who despised him, people with such names as Wharton, Biddle, and Wanamaker.

A short, thick-chested, and thick-bellied man—his nickname was “the little fellow”—Vare had his base in South Philadelphia. He had grown up there before the incursion of immigrants, on a pig farm in a then-rural area called “the Neck.” He still lived there despite enormous wealth. The wealth came from politics.

All city workers kicked back a portion of their salary to Vare’s machine. To make sure none ever missed a payment, city workers received their salary not where they worked or in City Hall—a classic and magnificent Victorian building, with curved shoulders and windows reminiscent of weeping willow trees—but across the street from City Hall in Republican Party headquarters. The mayor himself kicked back $1,000 from his pay.

Vare was also the city’s biggest contractor, and his biggest contract was for street cleaning, a contract he had held for almost twenty years. At a time when a family could live in comfort on $3,000 a year, in 1917 he had received over $5 million for the job. Not all of that money stayed in Vare’s pockets, but even the part that left passed through them and paid a toll. Yet the streets were notoriously filthy, especially in South Philadelphia—where the need was greatest, where everything but raw sewage, and sometimes even that, ran through the gutters, and where the machine was strongest.

Ironically, the very lack of city services strengthened the machine since it provided what the city did not: food baskets to the poor, help with jobs and favors, and help with the police—the commissioner and many magistrates were in Vare’s pocket. People paid for the favors with votes which, like a medieval alchemist, he transmuted into money.

The machine proved so lucrative that Edwin Vare and his brother William, a congressman, became philanthropists, giving so much to their church at Moyamensing Avenue and Morris Street that it was renamed the Abigail Vare Memorial Methodist Episcopal Church, after their mother. Not many churches are named after mere mortals, but this one was.

Yet nothing about the machine was saintly. On primary election day in 1917, several Vare workers blackjacked two leaders of an opposing faction, then beat to death a policeman who intervened. The incident outraged the city. Vare’s chief lieutenant in 1918 was Mayor Thomas B. Smith. In his one term in office he would be indicted, although acquitted, on three entirely unrelated charges, including conspiracy to murder that policeman. That same election, however, gave Vare absolute control over both the Select and Common Councils, the city’s legislature, and broad influence in the state legislature.

Director of the Philadelphia Department of Public Health and Charities was Dr. Wilmer Krusen, a political appointee who served at the mayor’s pleasure and whose term automatically expired with the mayor’s. Krusen, a decent man whose son would become a surgeon at the Mayo Clinic, was as good an appointment as the machine made. But he lacked background in, commitment to, or understanding of public health issues. And he was by nature someone who thought most problems disappeared on their own. He was not someone to rush into a thing.

He certainly would exert no pressure whatsoever on the machine to advance the public health. Although a gynecologist, he refused even to help the military in its massive national campaign against prostitution. Even New Orleans had succumbed to pressure to close Storyville, where prostitution was legal, but no pressure could make Philadelphia, where prostitution remained illegal, in any way hinder its flesh industry. So, according to a military report, the navy “actually took control of police affairs” outside its installations.

The city government was choking on corruption, with lines of authority split among Vare, precinct captains–turned–entrepreneurs, and the mayor. It did not wish to act, nor could it if it chose to.

Four days after the arrival of the sailors from Boston at the Navy Yard, nineteen sailors reported ill with symptoms of influenza.

Lieutenant Commander R. W. Plummer, a physician and chief health officer for the Philadelphia naval district, was well aware of the epidemic’s rage on Commonwealth Pier and at Devens and its spread to the civilian population in Massachusetts. Determined to contain the outbreak, he ordered the immediate quarantine of the men’s barracks and the meticulous disinfecting of everything the men had touched.

In fact, the virus had already escaped, and not only into the city. One day earlier 334 sailors had left Philadelphia for Puget Sound; many would arrive there desperately ill.

Plummer also immediately called in Paul Lewis.

Lewis had been expecting such a call.

He loved the laboratory more than he loved anyone or anything, and he had the full confidence of Welch, Theobald Smith, and Flexner. Lewis had won their confidence by his extraordinary performance as a young scientist under each of them in turn. He had already achieved much, and he held the promise of much more. He also knew his own worth, not in the sense that it made him smug but in that it gave him responsibility, making his promise at least as much burden as ambition. Only an offer to become the founding head of the new Henry Phipps Institute—Phipps had made millions at U.S. Steel with Andrew Carnegie, then, like Carnegie, had become a prominent philanthropist—which was associated with the University of Pennsylvania, had lured him to Philadelphia from the Rockefeller Institute. He was modeling Phipps after the institute, although Phipps would focus much more narrowly on lung disease, particularly tuberculosis.

No one needed to tell Lewis the urgency of the situation. He knew the details of the British sailors who had died in early July, and he had very likely tried to culture bacteria from them and prepare a serum. Soon after learning that influenza had appeared in the Navy Yard, Lewis arrived there.

It was up to him to take charge of what would normally be the step-by-step, deliberate process of tracking down the pathogen and trying to develop a serum or vaccine. And there was no time for normal scientific procedures.

The next day eighty-seven sailors reported ill. By September 15, while Lewis and his assistants worked in labs at Penn and at the navy hospital, the virus had made six hundred sailors and marines sick enough to require hospitalization, and more men were reporting ill every few minutes. The navy hospital ran out of beds. The navy began sending ill sailors to the Pennsylvania Hospital at Eighth and Spruce.

On September 17, five doctors and fourteen nurses in that civilian hospital suddenly collapsed. None had exhibited any prior symptoms whatsoever. One moment they felt normal; the next, they were being carried in agony to hospital beds.

Navy personnel from Boston had been transferred elsewhere as well. As Philadelphia was erupting, so was the Great Lakes Naval Training Station, thirty-two miles above Chicago. Teddy Roosevelt had created the base in 1905, declaring that it would become the largest and best naval training station in the world. With forty-five thousand sailors it was the largest, and it had begun to generate a proud history. The “Seabees” naval construction battalions were born there, and during the war Lieutenant John Philip Sousa created fourteen regimental bands there; sometimes all fifteen hundred musicians played en masse on Ross Field, spectacle for tens of thousands who flocked to hear them. As the influenza virus swept through the base, there would be no massing of anyone, musicians or otherwise. At this base, influenza ripped through the barracks very much like an explosion.

Robert St. John had just been inducted into the navy there when he became one of the early victims. Given a cot in a drill hall where soon thousands of men—in that one hall—would lie unattended, he later recalled, “No one ever took our temperatures and I never even saw a doctor.” He did make his first friend in the navy, a boy on the next cot who was too ill to reach for water. St. John himself barely had the strength to help him drink from his canteen. The next morning an orderly pulled the blanket over his friend’s head, and two sailors put the body on a stretcher and carried it away. By then the medical department had already reported that “33 caskets to Naval Medical Supply Depot required.” They would soon require far more than that.

One nurse at Great Lakes would later be haunted by nightmares. The wards had forty-two beds; boys lying on the floor on stretchers waited for the boy on the bed to die. Every morning the ambulances arrived and stretcher bearers carried sick sailors in and bodies out. She remembered that at the peak of the epidemic the nurses wrapped more than one living patient in winding sheets and put toe tags on the boys’ left big toe. It saved time, and the nurses were utterly exhausted. The toe tags were shipping tags, listing the sailor’s name, rank, and hometown. She remembered bodies “stacked in the morgue from floor to ceiling like cord wood.” In her nightmares she wondered “what it would feel like to be that boy who was at the bottom of the cord wood in the morgue.”

The epidemic was sweeping through the Philadelphia naval installations with comparable violence, as it had in Boston. Yet in Philadelphia, despite the news out of Boston, despite the Great Lakes situation, despite events at its own Navy Yard, Philadelphia public health director Wilmer Krusen had done absolutely nothing.

Not all the city’s public health figures remained oblivious to the threat. The day after the first sailor fell ill, Dr. Howard Anders, a prominent public health expert who despised and had no faith in the Vare machine, wrote Navy Surgeon General William Braisted to ask would “the navy (federal) authorities directly come in, under this threat of influenza invasion, and insist upon safeguarding its men and collaterally the whole population of Philadelphia…?” (Braisted declined.)

Krusen publicly denied that influenza posed any threat to the city. He seemed to believe that, for he made no contingency plans in case of emergency, stockpiled no supplies, and compiled no lists of medical personnel who would be available in an emergency, even though 26 percent of Philadelphia’s doctors and even a higher percentage of nurses were in the military. Indeed, despite building pressure from Lewis, from Anders, from physicians all over the city, from faculty at Penn and Thomas Jefferson Medical College—which refused to release six doctors who wanted to volunteer for military service just as the epidemic erupted—not until September 18, a full week after the disease appeared in the city, did Krusen even schedule a meeting with Plummer, Lewis, and several others.

In Krusen’s fifth-floor office at City Hall they acquainted each other with the facts. In Massachusetts nearly one thousand had already died, with tens of thousands ill, and the Massachusetts governor had just issued a plea for doctors and nurses from neighboring regions. In Philadelphia hundreds of sailors were hospitalized. Few signs of disease had surfaced among civilians, but Lewis reported that as yet his research had not found an answer.

Even if Lewis succeeded in making a vaccine, it would take weeks to produce in sufficient quantities. Thus, only drastic action could prevent the spread of influenza throughout the city. Banning public meetings, closing businesses and schools, imposing an absolute quarantine on the Navy Yard and on civilian cases—all these things made sense. A recent precedent existed. Only three years earlier Krusen’s predecessor—during the single term of the reform mayor—had imposed and enforced a strict quarantine when a polio epidemic had erupted, a disease Lewis knew more about than anyone in the world. Lewis certainly wanted a quarantine.

But Plummer was Lewis’s commanding officer. He and Krusen wanted to wait. Both feared that taking any such steps might cause panic and interfere with the war effort. Keeping the public calm was their goal. Those polio restrictions had been imposed when the country wasn’t fighting a war.

The meeting ended with nothing decided except to monitor developments. Krusen did promise to start a mass publicity campaign against coughing, spitting, and sneezing. Even that would take days to organize. And it would conflict with the downplaying of danger by Krusen and navy officials.

In Washington, Gorgas, who likely had heard from Lewis, was unsatisfied with these developments. By then influenza had erupted in two more cantonments, Camp Dix in New Jersey and Camp Meade in Maryland, that sandwiched the city. Lewis was in very close contact with the Philadelphia Tuberculosis Society, and Gorgas asked it to print and distribute twenty thousand large posters warning of influenza and stating a simple precaution that might help in at least a small way: “When obliged to cough or sneeze, always place a handkerchief, paper napkin, or fabric of some kind before the face.”

Meanwhile the Evening Bulletin assured its readers that influenza posed no danger, was as old as history, and was usually accompanied by a great miasma, foul air, and plagues of insects, none of which were occurring in Philadelphia. Plummer assured reporters that he and Krusen would “confine this disease to its present limits, and in this we are sure to be successful. No fatalities have been recorded among Navy men. No concern whatever is felt by either the military and naval physicians or by the civil authorities.”

The next day two sailors died of influenza. Krusen opened the Municipal Hospital for Contagious Diseases to the navy, and Plummer declared, “The disease has about reached its crest. We believe the situation is well in hand. From now on the disease will decrease.”

Krusen insisted to reporters that the dead were not victims of an epidemic; he said that they had died of influenza but insisted it was only “old-fashioned influenza or grip.” The next day fourteen sailors died. So did the first civilian, “an unidentified Italian” at Philadelphia General Hospital at South Thirty-fourth and Pine.

The following day more than twenty victims of the virus went to a morgue. One was Emma Snyder. She was a nurse who had cared for the first sailors to come to Pennsylvania Hospital. She was twenty-three years old.

Krusen’s public face remained nothing but reassuring. He now conceded that there were “a few cases in the civilian population” and said that health inspectors were looking for cases among civilians “to nip the epidemic in the bud.” But he did not say how.

On Saturday, September 21, the Board of Health made influenza a “reportable” disease, requiring physicians to notify health officials of any cases they treated. This would provide information about its movement. For the board to act on a Saturday was extraordinary in itself, but the board nonetheless assured the city that it was “fully convinced that the statement issued by Director Krusen that no epidemic of influenza prevails in the civil population at the present time is absolutely correct. Moreover, the Board feels strongly that if the general public will carefully and rigidly observe the recommendations [to] avoid contracting the influenza an epidemic can successfully be prevented.”

The board’s advice: stay warm, keep the feet dry and the bowels open—this last piece of advice a remnant of the Hippocratic tradition. The board also advised people to avoid crowds.

Seven days later, on September 28, a great Liberty Loan parade, designed to sell millions of dollars of war bonds, was scheduled. Weeks of organizing had gone into the event, and it was to be the greatest parade in Philadelphia history, with thousands marching in it and hundreds of thousands expected to watch it.

These were unusual times. The Great War made them so. One cannot look at the influenza pandemic without understanding the context. Wilson had realized his aims. The United States was waging total war.

Already two million U.S. troops were in France; it was expected that at least two million more would be needed. Every element of the nation, from farmers to elementary school teachers, was willingly or otherwise enlisted in the war. To Wilson, to Creel, to his entire administration, and for that matter to allies and enemies alike, the control of information mattered. Advertising was about to emerge as an industry; J. Walter Thompson—his advertising agency was already national, and his deputy became a senior Creel aide—was theorizing that it could engineer behavior; after the war the industry would claim the ability to “sway the ideas of whole populations,” while Herbert Hoover said, “The world lives by phrases” and called public relations “an exact science.”

Total war requires sacrifice and good morale makes sacrifices acceptable, and therefore possible. The sacrifices included inconveniences in daily life. To contribute to the war effort, citizens across the country endured the “meatless days” during the week, the one “wheatless meal” every day. All these sacrifices were of course voluntary, completely voluntary—although Hoover’s Food Administration could effectively close businesses that did not “voluntarily” cooperate. And if someone chose to go for a drive in the country on a “gasless Sunday,” when people were “voluntarily” refraining from driving, that someone was pulled over by hostile police.

The Wilson administration intended to make the nation cohere. Wilson informed the head of the Boy Scouts that selling bonds would give “every Scout a wonderful opportunity to do his share for the country under the slogan, ‘Every Scout to Save a Soldier.’” Creel’s one hundred fifty thousand Four Minute Men, those speakers who opened virtually every public gathering including movie and vaudeville shows, inspired giving. And when inspiration alone failed, other pressures could be exerted.

The preservation of morale itself became an aim. For if morale faltered, all else might as well. So free speech trembled. More than in the McCarthy period, more than during World War II itself, more than in the Civil War—when Lincoln was routinely vilified by opponents—free speech trembled indeed. The government had the two hundred thousand members of the American Protective League, who reported to the Justice Department’s new internal security agency headed by J. Edgar Hoover and spied on neighbors and coworkers. Creel’s organization advised citizens, “Call the bluff of anyone who says he has ‘inside information.’ Tell him that it’s his patriotic duty to help you find the source of what he’s saying. If you find a disloyal person in your search, give his name to the Department of Justice in Washington and tell them where to find him.”

Socialists, German nationals, and especially the radical unionists in the International Workers of the World got far worse treatment. The New York Times declared, “The IWW agitators are in effect, and perhaps in fact, agents of Germany. The Federal authorities should make short work of these treasonable conspirators against the United States.” The government did just that, raiding union halls, convicting nearly two hundred union men at mass trials in Illinois, California, and Oregon, and applying relentless pressure against all opponents; in Philadelphia on the same day that Krusen first discussed influenza with navy officials, five men who worked for the city’s German-language paper Tageblatt were imprisoned.

What the government didn’t do, vigilantes did. There were the twelve hundred IWW members locked in boxcars in Arizona and left on a siding in the desert. There was IWW member Frank Little, tied to a car and dragged through streets in Butte, Montana, until his kneecaps were scraped off, then hung by the neck from a railroad trestle. There was Robert Prager, born in Germany but who had tried to enlist in the navy, attacked by a crowd outside St. Louis, beaten, stripped, bound in an American flag, and lynched because he uttered a positive word about his country of origin. And, after that mob’s leaders were acquitted, there was the juror’s shout, “I guess nobody can say we aren’t loyal now!” Meanwhile, a Washington Post editorial commented, “In spite of excesses such as lynching, it is a healthful and wholesome awakening in the interior of the country.”

Socialist Eugene Debs, who in the 1912 presidential election had received nearly one million votes, was sentenced to ten years in prison for opposing the war, and in an unrelated trial Wisconsin congressman Victor Berger was sentenced to twenty years for doing the same. The House of Representatives thereupon expelled him and when his constituents reelected him anyway the House refused to seat him. All this was to protect the American way of life.

Few elites in America enjoyed more luxuries than did Philadelphia society, with its Biddles and Whartons. Yet the Philadelphia Inquirer reported approvingly that at “a dinner on the Main Line a dozen men were gathered at the table, and there was some criticism of the way the government was handling things. The host rose and said, ‘Gentlemen, it is not my business to tell you what to say but there are four Secret Service agents here this evening.’ It was a tactful way of putting a stop to conversation for which he did not care.”

Meanwhile, Treasury Secretary William McAdoo believed that during the Civil War the government had made a “fundamental error” not selling bonds to average citizens: “Any great war must necessarily be a popular movement. It is a crusade; and, like all crusades, it sweeps along on a powerful stream of romanticism. [Lincoln’s treasury secretary Salmon] Chase did not attempt to capitalize the emotions of the people. We went direct to the people, and that means to everybody—to businessmen, workmen, farmers, bankers, millionaires, schoolteachers, laborers. We capitalized on the profound impulse called patriotism. It is the quality of coherence that holds a nation together; it is one of the deepest and most powerful of human motives.” He went still further and declared, “Every person who refuses to subscribe or who takes the attitude of let the other fellow do it, is a friend of Germany and I would like nothing better than to tell it to him to his face. A man who can’t lend his govt $1.25 a week at the rate of 4% interest is not entitled to be an American citizen.”

The Liberty Loan campaign would raise millions of dollars in Philadelphia alone. The city had a quota to meet. Central to meeting that quota was the parade scheduled for September 28.

Several doctors—practicing physicians, public health experts at medical schools, infectious disease experts—urged Krusen to cancel the parade. Howard Anders tried to generate public pressure to stop it, telling newspaper reporters the rally would spread influenza and kill. No newspaper quoted his warning—such a comment might after all hurt morale—so he demanded of at least one editor that the paper print his warning that the rally would bring together “a ready-made inflammable mass for a conflagration.” The editor refused.

Influenza was a disease spread in crowds. “Avoid crowds” was the advice Krusen and the Philadelphia Board of Health gave. To prevent crowding the Philadelphia Rapid Transit Company had just limited the number of passengers in streetcars.

Army camps had already become so overwhelmed by influenza that on September 26 Provost Marshal Enoch Crowder canceled the next scheduled draft call. That same day, Massachusetts governor Samuel McCall formally pleaded for federal help and for doctors, nurses, and supplies from neighboring states.

If influenza was only beginning its assault on Philadelphia, it was already roaring full speed through the Navy Yard. Fourteen hundred sailors were now hospitalized with the disease. The Red Cross was converting the United Service Center at Twenty-second and Walnut into a five-hundred-bed hospital for the sole use of the navy. Krusen saw those reports and heard from those who wanted to cancel the parade, all right, but he did not seem to be listening. All he did was forbid the entertainment of soldiers or sailors by any organization or private party in the city. But military personnel could still visit stores, ride streetcars, go to vaudeville shows or moving picture houses.

In Philadelphia on September 27, the day before the parade, hospitals admitted two hundred more people—123 of them civilians—suffering from influenza.

Krusen felt intense and increasing pressure to cancel the parade, pressure coming from colleagues in medicine, from the news out of Massachusetts, from the fact that the army had canceled the draft. The decision whether to proceed or not was likely entirely his own. Had he sought guidance from the mayor, he would have found none. For a magistrate had just issued an arrest warrant for the mayor, who was now closeted with his lawyer, distracted and impossible to reach. Earlier, for the good of the city and the war effort, an uneasy truce had been forged between the Vare machine and the city’s elite. Now Mrs. Edward Biddle, president of the Civic Club, married to a descendant of the founder of the Bank of the United States, resigned from a board the mayor had appointed her to, ending that truce, adding to the chaos in City Hall.

Krusen did hear some good news. Paul Lewis believed he was making progress in identifying the pathogen, the cause of influenza. If so, work on a serum and a vaccine could proceed rapidly. The press headlined this good news, although it did not report that Lewis, a careful scientist, was unsure of his findings.

Krusen declared that the Liberty Loan parade and associated rallies would proceed.

None of the anxiety of the moment was reported in any of the city’s five daily papers, and if any reporter questioned either Krusen or the Board of Health about the wisdom of the parade’s proceeding, no mention of it appeared in print.

On September 28, marchers in the greatest parade in the city’s history proudly stepped forward. The paraders stretched at least two miles, two miles of bands, flags, Boy Scouts, women’s auxiliaries, marines, sailors, and soldiers. Several hundred thousand people jammed the parade route, crushing against each other to get a better look, the ranks behind shouting encouragement over shoulders and past faces to the brave young men. It was a grand sight indeed.

Krusen had assured them they were in no danger.

The incubation period of influenza is twenty-four to seventy-two hours. Two days after the parade, Krusen issued a somber statement: “The epidemic is now present in the civilian population and is assuming the type found in naval stations and cantonments.”

To understand the full meaning of that statement, one must understand precisely what was occurring in the army camps.