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

Part V. EXPLOSION

Chapter 18

DEVENS HAD BEEN STRUCK by surprise. The other cantonments and navy bases were not. Gorgas’s office had issued immediate warnings of the disease, and medical staffs around the country took heed. Even so, the virus reached first and with most lethality into these military posts, invading the close cluster of young men in their barracks beds. Camp Grant was neither the worst hit, nor the least. Indeed, except for one particular and individual tragedy, it was quite typical.

The camp sprawled across rolling but mostly level country on the Rock River outside Rockford, Illinois. The soil there was rich and lush, and its first commandant had planted fifteen hundred acres on the base with sweet corn and “hog corn,” hay, wheat and winter wheat, potatoes, and oats. Most recruits there came from northern Illinois and Wisconsin, farm boys with straw-colored hair and flush cheeks who knew how to raise the crops and produced them in plenty.

It was a remarkably orderly place, given the haste with which it had been built. It had neat rows of wooden barracks, and more rows and rows of large barrack-tents, eighteen men to each. All the roads were dirt and in the late summer dust filled the air, except when rain turned the roads to mud. The hospital was situated at one end of the camp and had two thousand beds, although the most patients it had cared for at one time was 852; several infirmaries were also scattered throughout the base.

In June 1918, Welch, Cole, Russell, and Richard Pearce of the National Research Council—who rarely left Washington, usually being too busy coordinating research efforts—had inspected the camp and come away impressed. Welch judged Grant’s chief medical officer, Lieutenant Colonel H. C. Michie, “capable and energetic,” the hospital laboratory “excellent,” the pathologist “a good man,” while Joe Capps, a friend of Cole, was “of course an excellent chief of service” at the hospital itself. The veterinarian, who was responsible for several hundred horses and assorted livestock, had also impressed them favorably.

During that June visit they had all discussed pneumonia. Capps had started clinical experiments with a serum developed by Preston Kyes that differed from Cole’s. Kyes was a promising University of Chicago investigator of whom Welch had said, “It is worth while for us to keep our eye on him.” Capps and Cole exchanged information. Capps also spoke of seeing a disturbing trend toward a “different type of pneumonia…clinically more toxic and fatal…at autopsy often massive areas of consolidation…and also areas of hemorrhagic alveoli.”

Then he demonstrated for them an innovation he had experimented with: the wearing of gauze masks by patients with respiratory disease. Welch called the mask “a great thing…an important contribution in prevention of spray infections.” He encouraged Capps to write an article for the Journal of the American Medical Association and advised Pearce to conduct studies of the masks’ effectiveness. Cole agreed: “This is a very important matter in connection with the prevention of pneumonia.”

Welch also came away from that inspection, the last one of that tour, recommending two things. It confirmed in him his desire to have new arrivals at all camps assigned for three weeks to specially constructed detention camps; these men would eat, sleep, drill—and be quarantined—together to avoid any cross-infections with men already in camp. Second, he wanted Capps’s use of masks extended to all camps.

Capps did write the JAMA article. He reported finding the masks so successful that after less than three weeks of experimenting he had abandoned testing and simply started using them as “a routine measure.” He also made the more general point that “one of the most vital measures in checking contagion” is eliminating crowding. “Increasing the space between beds in barracks, placing the head of one soldier opposite the feet of his neighbor, stretching tent flags between beds, and suspending a curtain down the center of the mess table, are all of proved value.”

To prevent a few arriving individuals from infecting an entire camp, he also repeated Welch’s recommendation to isolate transferred troops. Grant had such a “depot brigade,” a separate quarantine barracks for new recruits and transfers. Its stairways were built on the outside so guards could enforce the quarantine. But officers did not stay in the depot brigade; only enlisted men did.

Capps’s article appeared in the August 10, 1918, issue of JAMA.

On August 8, Colonel Charles Hagadorn took command of Camp Grant. A short, brooding officer and a West Point graduate, still a bachelor at fifty-one years of age, he had devoted his life to the army and his men. He had also prepared for war all his life, studying it constantly and learning from experience as well as reading and analysis; one report “accredited [him] one of the most brilliant line experts of the regular army.” He had fought the Spanish in Cuba, fought guerrillas in the Philippines, and chased Pancho Villa in Mexico just a year before. Sometimes he gave what seemed impulsive and even inexplicable orders, but they had a curve of reason behind them. He was determined to teach his soldiers to survive, and to kill. Not to die. He cared about his troops and liked being surrounded by them.

One problem that confronted him seemed to have little to do with war. The camp was over capacity. Only thirty thousand troops had been present when Welch had visited in June. Now the strength was in excess of forty thousand with no expectation of any decrease. Many men were forced into tents and winter—winter in northern Illinois, one year after a record cold—was only a few weeks away.

Army regulations defined how much space each soldier had in the barracks. These regulations had little to do with comfort and much to do with public health. In mid-September Hagadorn decided to ignore the army regulations on overcrowding and move even more men from tents into barracks. Already the nights were cold, and they would be more comfortable there.

But by then Gorgas’s office had issued warnings about the epidemic and influenza had reached the Great Lakes Naval Training Station one hundred miles away. At Camp Grant, doctors watched for the first case. They even had an idea where it might occur. Dozens of officers had just arrived from Devens.

The camp senior medical staff confronted Hagadorn over his plan to increase crowding. Although no record exists of the meeting, these physicians were men whom Welch and Cole held in the highest regard, and in outstanding civilian careers they gave rather than took orders. The meeting had to have been contentious. For God’s sake, they would have warned him, scattered cases of influenza had already appeared in Rockford.

But Hagadorn believed that disease could be controlled. In addition to his combat record, he had been chief of staff in the Canal Zone and had seen Gorgas control even tropical diseases there. Besides, he had tremendous confidence in his medical staff. He had more confidence in his doctors than they had in themselves, perhaps reminding them they had avoided even the measles epidemic that had plagued so many cantonments. On September 4 the camp’s own epidemiologist had filed a report noting, “The epidemic diseases at this camp were at no time alarming…. Cases of Measles, Pneumonia, Scarlet fever, Diphtheria, Meningitis and the Smallpox occurred sporadically. None of these diseases ever assumed epidemic form.”

And this was only influenza. Still, Hagadorn made a few concessions. On September 20 he issued several orders to protect the camp’s health. To prevent the rise of dust, all roads would be oiled. And out of concern for influenza he agreed to a virtual quarantine: “Until further notice from these Headquarters, passes and permission to be absent from Camp…will not be granted to Officers or enlisted men, except from this office, and then only for the most urgent reasons.”

But he issued one more order that day as well. It must have been particularly galling for Michie and Capps to see him use their authority to justify it: “There must as a military necessity be a crowding of troops. The Camp Surgeon under the circumstances authorizes a crowding in barracks…beyond the authorized capacity…. This will be carried out at once as buildings are newly occupied.”

September 21, the day after Hagadorn issued his order, several men in the Infantry Central Officers Training School—the organization with officers from Devens—reported ill. They were immediately isolated in the base hospital.

It did little good. By midnight 108 men from the infantry school and the unit next to it were admitted to the hospital. There each patient had a gauze mask placed over his mouth and nose.

The two units were isolated from the rest of the camp, and men in the units were partly isolated from each other. Every bed had sheets hung around it, and twice a day each man was examined. All public gatherings—movies, YMCA functions, and the like—were canceled, and the men were ordered not “to mingle in any manner with men of other organizations at any time…. No visitors will be permitted in the area involved…. Any barracks from which several cases are reported will be quarantined; its occupants will not be permitted to mingle in any way with the occupants of other barracks in the same organization.”

Guards enforced the orders strictly. But people infected with influenza can infect others before they feel any symptoms. It was already too late. Within forty-eight hours every organization in the camp was affected.

The next day hospital admissions rose to 194, the next 371, the next 492. Four days after the first officer reported sick, the first soldier died. The next day two more men died, and 711 soldiers were admitted to the hospital. In six days the hospital went from 610 occupied beds to 4,102 occupied, almost five times more patients than it had ever cared for.

There were too few ambulances to carry the sick to the hospital, so mules pulled ambulance carts until the mules, exhausted, stopped working. There were too few sheets for the beds, so the Red Cross ordered six thousand from Chicago. There were too few beds, so several thousand cots were crammed into every square inch of corridor, storage area, meeting room, office, and veranda.

It wasn’t enough. Early on the medical detachment members had moved into tents so their own barracks could be transformed into a five-hundred-bed—or cot—hospital. Ten barracks scattered throughout the camp were also converted into hospitals. It still wasn’t enough.

All training for war, for killing, ceased. Now men fought to stop the killing.

Healthy soldiers were consumed with attending, in one way or another, the sick. Three hundred and twenty men were sent to the hospital as general support staff, then 260 more were added. Another 250 men did nothing but stuff sacks with straw to make mattresses. Several hundred others unloaded a stream of railroad cars full of medical supplies. Hundreds more helped transport the sick or cleaned laundry—washing sheets, making masks—or prepared food. Meanwhile, barely in advance of a threatening thunderstorm, one hundred carpenters worked to enclose thirty-nine verandas with roofing paper to keep the rain off the hundreds of patients exposed to the elements. The gauze masks Capps was so proud of, the masks Welch had praised, were no longer being made; Capps ran out of material and personnel to make them.

The medical staff itself was collapsing from overwork—and disease. Five days into the epidemic five physicians, thirty-five nurses, and fifty orderlies were sick. That number would grow, and the medical staff would have its own death toll.

Seven days into the epidemic soldiers still capable of work converted nine more barracks into hospitals. There were shortages of aspirin, atropine, digitalis, glacial acetic acid (a disinfectant), paper bags, sputum cups, and thermometers—and thermometers that were available were being broken by men in delirium.

Forty more nurses arrived for the emergency, giving the hospital 383. It needed still more. All visitors to the base and especially to the hospital had already been prohibited “except under extraordinary circumstances.” Now those extraordinary circumstances had become common, with visitors pouring in, Michie noted, “summoned by danger of death telegrams….” Four hundred thirty-eight telegrams had been handled the day before.

That number was still climbing, and rapidly. To handle what soon became thousands of telegrams and phone calls each day, the Red Cross erected a large tent, floored, heated, wired for electricity, with its own telephone exchange and rows of chairs that resembled an auditorium where relatives waited to see desperately ill soldiers. More personnel were needed to escort these visitors to the sick. More personnel and more laundry facilities were needed just to wash the gown and mask that every visitor donned.

The hospital staff could not keep pace. Endless rows of men coughing, lying in bloodstained linen, surrounded by flies—orders were issued that “formalin should be added to each sputum cup to keep the flies away”—and the grotesque smells of vomit, urine, and feces made the relatives in some ways more desperate than the patients. They offered bribes to whoever seemed healthy—doctor, nurse, or orderly—to ensure care for their sons and lovers. Indeed, visitors begged them to accept bribes.

Michie responded sternly: “Devoting special personal care to any one patient whose condition is not critical is prohibited and the ward personnel is instructed to report any civilian or other person to the commanding officer who makes a special request that a certain patient be given special attention.”

And there was something else, something still worse.

The same day that the first Camp Grant soldier died, 3,108 troops boarded a train leaving there for Camp Hancock outside Augusta, Georgia.

They left as a civilian health official several hundred miles away from Camp Grant demanded the quarantine of the entire camp, demanded that even escorts of the dead home be prohibited. They left with the memory of the trains carrying troops infected with measles, when Gorgas and Vaughan had protested uselessly that troops had “distributed its seeds at the encampment and on the train. No power on earth could stop the spread of measles under these conditions.” They left after the provost general had had the foresight to cancel the next draft. And they left after Gorgas’s office had urged that all movement of troops between infected and uninfected camps cease.

The army did order no “transfer of any influenza contacts” between camps or to bases under quarantine. But even that order came days later, at a time when each day’s delay could cost literally thousands of lives. And the order also stated that “movements of officers and men not contacts will be effected promptly as ordered.” Yet men could appear healthy while incubating influenza themselves, and they could also infect others before symptoms appeared.

The men leaving Grant on that train were jammed into the cars with little room to move about, layered and stacked as tightly as if on a submarine as they moved deliberately across 950 miles of the country. They would have been excited at first, for movement creates its own excitement, and then tedium would have set in, the minutes dragging out, the hours melding the passage into a self-contained world ten feet across and seven feet high, smelling of cigarette smoke and sweat, with hundreds of men in each car in far closer quarters than in any barracks, and with far less ventilation.

As the country rolled by men would have leaned out windows to suck in a wisp of air the way they sucked on cigarettes. And then one soldier would have broken into a coughing fit, another would have begun pouring out sweat, another would have suddenly had blood pouring out of his nose. Other men would have shrunk from them in fear, and then still others would have collapsed or erupted in fever or delirium or begun bleeding from their nose or possibly their ears. The train would have filled with panic. At stops for refueling and watering, men would have poured out of the train seeking any escape, mixed with workers and other civilians, obeyed reluctantly when officers ordered them back into the cars, into this rolling coffin.

When the train arrived, over seven hundred men—nearly one-quarter of all the troops on the train—were taken directly to the base hospital, quickly followed by hundreds more; in total, two thousand of the 3,108 troops would be hospitalized with influenza. After 143 deaths among them the statistics merged into those of other troops from Camp Hancock—Hancock, to which this shipment of virus was sent—and became impossible to track. But it is likely that the death toll approached, and possibly exceeded, 10 percent of all the troops on the train.

Hagadorn had become all but irrelevant to the running of the camp. Now he yielded on every point to the medical personnel, did everything they asked, made every resource available to them. Nothing seemed even to slow the disease.

On October 4, for the first time more than one hundred men at Camp Grant died in a single day. Nearly five thousand were ill, with hundreds more falling ill each day. And the graph of contagion still pointed nearly straight up.

Soon, in a single day, 1,810 soldiers would report ill. At some other army camps even more soldiers would collapse almost simultaneously; indeed, at Camp Custer outside Battle Creek, Michigan, twenty-eight hundred troops would report ill—in a single day.

Before the epidemic, Capps had begun testing Preston Kyes’s pneumonia serum, prepared from chickens. Kyes had reasoned that since chickens were not susceptible to the pneumococcus, infecting them with highly virulent pneumococci might produce a very powerful serum. Capps had planned a series of “very carefully controlled” experiments. But now, with nothing else to try, he administered the serum to all as it arrived—it was in short supply. It seemed to work. Two hundred and thirty-four men suffering from pneumonia received the serum; only 16.7 percent died, while more than half of those who did not receive it died. But it was in short supply.

Desperate efforts were being made to protect troops from the disease, or at least prevent complications. Germicidal solutions were sprayed into the mouths and noses of troops. Soldiers were ordered to use germicidal mouthwash and to gargle twice a day. Iodine in glycerine was tried in an attempt disinfect mouths. Vaseline containing menthol was used in nasal passages, mouths washed with liquid albolene.

Despite every effort, the death toll kept rising. It rose so high that staff grew weary, weary of paperwork, weary even of identifying the dead. Michie was forced to issue orders warning, “The remains are labeled by placing an adhesive plaster bearing the name, rank, organization around the middle of the left forearm. It is the duty of the Ward Surgeon to see that this is done before the remains leave the ward…. A great deal of difficulty has been experienced in reading names on death certificates…Either have these certificates typewritten or…plainly printed. Any neglect on the part of responsible persons will be interpreted as a neglect of duty.”

Michie also instructed all personnel, “The relatives and friends of persons dying at this hospital must not be sent to the base hospital morgue…. The handling of the effects of the deceased has grown into an enormous task.”

Simultaneously, in that important fight to sustain the country’s morale, the Chicago Tribune reported good news from Camp Grant. “Epidemic Broken!” blared the paper’s headlines. “The small army of expert workers under the command of Lt. Col. H. C. Michie has battled the pneumonia epidemic to a standstill…deaths occurred among the pneumonia patients, but more than 100 fighting men pulled through the crisis of their illness…175 patients have been released after winning their fight.”

At that point Grant’s death toll was 452. It showed no sign of slowing. Hoping to have some slight effect on it, hoping to prevent cross-infections, Michie and Capps reiterated their orders to place patients outside: “The crowding of patients in the wards must be reduced to the minimum…. The verandas must be used to the greatest advantage.”

Perhaps that reminded Hagadorn of his earlier order authorizing overcrowding. Perhaps then too he got word of the hundreds of young men who had died on the train to Georgia, which, like the barracks overcrowding, he had ordered because of “military necessity.” Perhaps these things caused him such personal pain that it explained why he abruptly ordered the withholding of the names of all soldiers who died from influenza. Perhaps somehow that allowed him to block the deaths from his mind.

A day later the death toll at the camp broke five hundred, with thousands more still desperately ill. “How far the pandemic will spread will apparently depend only upon the material which it can feed upon,” wrote one army physician. “It is too early to foretell the end or to measure the damage which will be done before the pandemic disappears.”

Many of the dead were more boys than men, eighteen years old, nineteen years old, twenty years old, twenty-one years old, boys filled with their lithe youth and sly smiles. Hagadorn, the bachelor, had made the army his home, his soldiers his family, the young men about him his life.

On October 8 Michie reported the latest death toll to Colonel Hagadorn in his headquarters office. The colonel heard the report, nodded, and, after an awkward moment, Michie rose to leave. Hagadorn told him to close the door.

Death was all about him, in the papers on his desk, in the reports he heard, literally in the air he breathed. It was an envelope sealing him in.

He picked up his phone and ordered his sergeant to leave the building and take with him all personnel in the headquarters and stand for inspection outside.

It was a bizarre order. The sergeant informed Captain Jisson and Lieutenant Rashel. They were puzzled but complied.

For half an hour they waited. The pistol shot, even from inside the building, came as a loud report.

Hagadorn was not listed as a casualty of the epidemic. Nor did his sacrifice stop it.