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

Part VIII. THE TOLLING OF THE BELL

Chapter 26

WHILE SCIENCE was confronting nature, society began to confront the effects of nature. For this went beyond the ability of any individual or group of individuals to respond to. To have any chance in alleviating the devastation of the epidemic required organization, coordination, implementation. It required leadership and it required that institutions follow that leadership.

Institutions are a strange mix of the mass and the individual. They abstract. They behave according to a set of rules that substitute both for individual judgments and for the emotional responses that occur whenever individuals interact. The act of creating an institution dehumanizes it, creates an arbitrary barrier between individuals.

Yet institutions are human as well. They reflect the cumulative personalities of those within them, especially their leadership. They tend, unfortunately, to mirror less admirable human traits, developing and protecting self-interest and even ambition. Institutions almost never sacrifice. Since they live by rules, they lack spontaneity. They try to order chaos not in the way an artist or scientist does, through a defining vision that creates structure and discipline, but by closing off and isolating themselves from that which does not fit. They become bureaucratic.

The best institutions avoid the worst aspects of bureaucracy in two ways. Some are not really institutions at all. They are simply a loose confederation of individuals, each of whom remains largely a free agent whose achievements are independent of the institution but who also shares and benefits from association with others. In these cases the institution simply provides an infrastructure that supports the individual, allowing him or her to flourish so that the whole often exceeds the sum of the parts. (The Rockefeller Institute was such an institution.) Other institutions avoid the worst elements of bureaucracy by concentrating on a clearly defined purpose. Their rules have little to do with such procedural issues as a chain of command; instead rules focus on how to achieve a particular result, in effect offering guidance based on experience. This kind of institution even at its best can still stultify creativity, but such institutions can execute, can do a routine thing efficiently. They resemble professionals trying to do their jobs and duty; they accomplish their tasks.

In 1918 the institution of the federal government had more force than it had ever had—and in some ways more force than it has had since. But it was aiming all that force, all its vital energy, in another direction.

The United States had entered the war with little preparation in April 1917, and mobilizing the country took time. By the summer of 1918, however, Wilson had injected the government into every facet of national life and had created great bureaucratic engines to focus all the nation’s attention and intent on the war.

He had created a Food Administration to control and distribute food, a Fuel Administration to ration coal and gasoline, a War Industries Board to oversee the entire economy. He had taken all but physical control over the railroads and had created a federally sponsored river barge line that brought commerce back to life on the Mississippi River, a commerce that had been killed by competition from those railroads. He had built many dozens of military installations, each of which held at least tens of thousands of soldiers or sailors. He had created industries that made America’s shipyards teem with hundreds of thousands of laborers launching hundreds of ships, dug new coal mines to produce coal for the factories that weaned America’s military from British and French weapons and munitions—for, unlike in World War II, America was no arsenal of democracy.

He had created a vast propaganda machine, an internal spy network, a bond-selling apparatus extending to the level of residential city blocks. He had even succeeded in stifling speech, in the summer of 1918 arresting and imprisoning—some for prison terms longer than ten years—not just radical labor leaders and editors of German-language newspapers but powerful men, even a congressman.

He had injected the government into American life in ways unlike any other in the nation’s history. And the final extension of federal power had come only in the spring of 1918, after the first wave of influenza had begun jumping from camp to camp, when the government expanded the draft from males between the ages of twenty-one and thirty to those between the ages of eighteen and forty-five. Only on May 23, 1918, had Provost Marshal Enoch Crowder, who oversaw the draft, issued his “work or fight” order, stating that anyone not employed in an essential industry would be drafted—an order that caused major league baseball to shorten its season and sent many ballplayers scurrying for jobs that were “essential”—and promising that “all men within the enlarged age would be called within a year.” All men, the government had said, with orders for an estimated thirteen million to register September 12. Crowder bragged about doing “in a day what the Prussian autocracy had been spending nearly fifty years to perfect.”

All this enormous and focused momentum would not be turned easily.

It would not be turned even by the prospect of peace. In mid-August, as the lethal wave of the epidemic was gathering itself, Austria had already inquired about peace terms, an inquiry that Wilson rebuffed utterly. And as the epidemic was gathering full momentum, peace was only weeks away. Bulgaria had signed an armistice on September 29. On September 30, Kaiser Wilhelm had granted parliamentary government to the German nation; that same day Ludendorff had warned his government that Germany must extend peace feelers or disaster—immediate disaster—would follow. German diplomats sent out those feelers. Wilson ignored them. The Central Powers, Germany and her allies, were simultaneously breaking off one from one another and disintegrating internally as well. In the first week of October, Austria and Germany separately sent peace feelers to the Allies, and on October 7, Austria delivered a diplomatic note to Wilson formally seeking peace on any terms Wilson chose. Ten days later—days of battle and deaths—the Austrian note remained unanswered.

Earlier Wilson had spoken of a “peace without victory,” believing only such a peace could last. But now he gave no indication that the war would soon be over. Although a rumor that the war had ended sent thrills through the nation, Wilson quickly renounced it. Nor would he relent. He was not now fighting to the death; he was fighting only to kill. To fight you must be brutal and ruthless, he had said. Force! he had demanded. Force to the utmost! Force without stint or limit! The righteous and triumphant Force which shall make Right the law of the world, and cast every selfish dominion down in the dust.

Reflecting his will, there was no letup in the ferocity and wrath of the Liberty Loan rallies, no letup in the frenzied pressure to produce in coal mines and shipyards, no letup among editorials or for that matter news stories exhorting people to insist upon total and complete German capitulation. Especially within the government itself, there was no letup. Instead Wilson pressed, pressed with all his might—and that meant all the nation’s might—for total victory.

If Wilson and his government would not be turned from his end even by the prospect of peace, they would hardly be turned by a virus. And the reluctance, inability, or outright refusal of the American government to shift targets would contribute to the killing. Wilson took no public note of the disease, and the thrust of the government was not diverted. The relief effort for influenza victims would find no assistance in the Food Administration or the Fuel Administration or the Railroad Administration. From neither the White House nor any other senior administration post would there come any leadership, any attempt to set priorities, any attempt to coordinate activities, any attempt to deliver resources.

The military, especially the army, would confront the virus directly. Gorgas had done all that he could have, all that anyone could have, to prepare for an emergency. But the military would give no help to civilians. Instead it would draw further upon civilian resources.

The same day that Welch had stepped out of the autopsy room at Devens and called Gorgas’s office, his warning had been relayed to the army chief of staff, urging that all transfers be frozen unless absolutely necessary and that under no circumstances transfers from infected camps be made: The deaths at Camp Devens will probably exceed 500…. The experience at Camp Devens may be fairly expected to occur at other large cantonments…. New men will almost surely contract the disease.

Gorgas’s superiors ignored the warning. There was no interruption of movement between camps whatsoever; not until weeks later, with the camps paralyzed and, literally, tens of thousands of soldiers dead or dying, did the army make any adjustments.

One man did act, however. On September 26, although many training camps had not yet seen any influenza cases at all, Provost Marshal Enoch Crowder canceled the next draft (he would also cancel the draft after this one). It had been scheduled to send one hundred forty-two thousand men to the cantonments.

It was a bold move, made despite the unquenched appetite of George Pershing, in charge of the American Expeditionary Force, for men. In France, Pershing was pressing forward, earlier that same day launching a major offensive in the Meuse-Argonne region. As the Americans charged out of their trenches, the Germans shredded their ranks. General Max von Gallwitz, the commander facing them, entered into his official record, “We [have] no more worries.”

Despite this, Crowder had acted immediately and likely saved thousands of lives, but he did not cancel the draft to save lives. He did so because he recognized that the disease was utterly overwhelming and creating total chaos in the cantonments. There could be no training until the disease passed. He believed that sending more draftees into this chaos would only magnify it and delay the restoration of order and the production of soldiers. In Murder in the Cathedral, T. S. Eliot could call it “the greatest treason: to do the right thing for the wrong reason.” The men who lived because of Crowder might disagree with the poet.

But Crowder’s decision and the efforts of the Gorgas-led army medical corps would be the only bright spots in the response of the federal government. Other army decisions were not such good ones. Pershing still demanded fresh troops, troops to replace those killed or wounded in battle, troops to replace those killed by or recovering from influenza, troops to replace those who simply needed relief from the line. All the Allied powers were desperate for fresh American boys.

The army had to decide whether to continue to transport soldiers to France during the epidemic. They had information about the costs. The army knew the costs well.

On September 19 the acting army surgeon general, Charles Richard—Gorgas was in Europe—wrote General Peyton March, the commander of the army, urging him that “organizations known to be infected, or exposed to the disease, be not permitted to embark for overseas service until the disease has run its course within the organization.”

March acknowledged the warning from Gorgas’s deputy but did nothing. The chief medical officer at the port of embarkation in Newport News, Virginia, rephrased—more emphatically—the same warning: “The condition [on a troopship] is almost that of a powder magazine with troops unprotected by previous [influenza] attack. The spark will be applied sooner or later. On the other hand with troops protected by previous attack the powder has been removed.” He too was ignored. Gorgas’s office urged quarantining troops heading overseas for one week before departure, or eliminating overcrowding on board. March did nothing.

Meanwhile the Leviathan was loading troops. Once the pride of the German passenger fleet, built as the Vaterland, she was the largest ship in the world and among the fastest in her class. She had been in New York when America entered the war, and her captain could not bring himself to sabotage or scuttle her. Alone among all German ships confiscated in the United States, she was taken undamaged. In mid-September, on her voyage back from France she had buried several crew and passengers at sea, dead of influenza. Others arrived in New York sick, including Assistant Secretary of the Navy Franklin Roosevelt, who was taken ashore on a stretcher, then by ambulance to his mother’s home on East Sixty-fifth Street, where he stayed for weeks too ill to speak with even his closest adviser, Louis Howe, who kept in almost hourly touch with his doctors.

The Leviathan and, over the course of the next several weeks, other troopships would ferry approximately one hundred thousand troops to Europe. Their crossings became much like that of the train that carried three thousand one hundred soldiers from Camp Grant to Camp Hancock. They became death ships.

Although the army had ignored most of the pleadings from its own medical corps, it did remove all men showing influenza symptoms before sailing. And to contain influenza on board, troops were quarantined. Military police carrying pistols enforced the quarantine—aboard the Leviathan, 432 MPs did so—sealing soldiers into separate areas of the ship behind shut watertight doors, sardining them into cramped quarters where they had little to do but lie on stacked bunks or shoot craps or play poker in the creases of open space available. Fear of submarines forced the portholes shut at night, but even during the day the closed doors and the massive overcrowding made it impossible for the ventilation system to keep pace. Access to the decks and open air was limited. The sweat and smells of hundreds of men—each room generally held up to four hundred—in close quarters quickly became a stench. Sound echoed off the steel bunks, the steel floors, the steel walls, the steel ceiling. Living almost like caged animals, they grew increasingly claustrophobic and tense. But at least they were safe, they thought.

For the plan to keep men quarantined in isolated groups had a flaw. They had to eat. They went to mess one group at a time, but they breathed the same air, their hands went from mouths to the same tables and doors that other soldiers had touched only minutes before.

Despite the removal before departure of men showing influenza symptoms, within forty-eight hours after leaving port, soldiers and sailors struck down with influenza overwhelmed the sick bay, stacked one on top of the other in bunks, clogging every possible location, coughing, bleeding, delirious, displacing the healthy from one great room after another. Nurses themselves became sick. Then the horrors began.

Colonel Gibson, commander of the Fifty-seventh Vermont, wrote of his regiment’s experience on the Leviathan: “The ship was packed…[C]onditions were such that the influenza could breed and multiply with extraordinary swiftness…. The number of sick increased rapidly, Washington was apprised of the situation, but the call for men for the Allied armies was so great that we must go on at any cost…. Doctors and nurses were stricken. Every available doctor and nurse was utilized to the limit of endurance. The conditions during the night cannot be visualized by anyone who had not actually seen them…[G]roans and cries of the terrified added to the confusion of the applicants clamoring for treatment and altogether a true inferno reigned supreme.”

It was the same on other ships. Pools of blood from hemorrhaging patients lay on the floor and the healthy tracked the blood through the ship, making decks wet and slippery. Finally, with no room in sick bay, no room in the areas taken over for makeshift sick bays, corpsmen and nurses began laying men out on deck for days at a time. Robert Wallace aboard the Briton remembered lying on deck when a storm came, remembered the ship rolling, the ocean itself sweeping up the scuppers and over him and the others, drenching them, their clothes, their blankets, leaving them coughing and sputtering. And each morning orderlies carried away bodies.

At first the deaths of men were separated by a few hours: the log of the Leviathan noted, “12:45 P.M. Thompson, Earl, Pvt 4252473, company unknown died on board…. 3:35 P.M. Pvt O Reeder died on board of lobar pneumonia….” But a week after leaving New York, the officer of the day was no longer bothering to note in the log “died on board,” no longer bothering to identify the military organization to which the dead belonged, no longer bothering to note a cause of death; he was writing only a name and a time, two names at 2:00 A.M., another at 2:02 A.M., two more at 2:15 A.M., like that all through the night, every notation in the log now a simple recitation of mortality, into the morning a death at 7:56 A.M., at 8:10 A.M., another at 8:10 A.M., at 8:25 A.M.

The burials at sea began. They quickly became sanitary exercises more than burials, bodies lying next to one another on deck, a few words and a name spoken, then one at a time a corpse slipped overboard into the sea. One soldier aboard the Wilhelmina watched across the waves as bodies dropped into the sea from another ship in his convoy, the Grant: “I confess I was near to tears, and that there was tightening around my throat. It was death, death in one of its worst forms, to be consigned nameless to the sea.”

The transports became floating caskets. Meanwhile, in France, by any standard except that of the cantonments at home, influenza was devastating troops. In the last half of October during the Meuse-Argonne offensive, America’s largest of the war, more Third Division troops were evacuated from the front with influenza than with wounds. (Roughly the same number of troops were in the United States and Europe, but influenza deaths in Europe were only half those in America. The likely explanation is that soldiers at the front had been exposed to the earlier mild wave of influenza and developed some immunity to it.) One army surgeon wrote in his diary on October 17 that because of the epidemic, “Some hospitals are not even working. Evacuation 114 had no medical officer but hundreds of pneumonias,…dying by the score.”

Shipping more men who required medical care into this maelstrom made little sense. It is impossible to state how many soldiers the ocean voyages killed, especially when one tries to count those infected aboard ship who died later on shore. But for every death at least four or five men were ill enough to be incapacitated for weeks. These men were a burden rather than a help in Europe.

Wilson had made no public statement about influenza. He would not shift his focus, not for an instant. Yet people he trusted spoke to him of the disease, spoke particularly of useless deaths on the transports. Chief among them was certainly Dr. Cary Grayson, a navy admiral and Wilson’s personal physician, as he had been personal physician to Teddy Roosevelt and William Howard Taft when they were president. Highly competent and highly organized, Grayson had become a Wilson confidant who strayed into the role of adviser. (After Wilson’s stroke in 1919, he would be accused of virtually running the country in concert with Wilson’s wife.) He also had the confidence of and excellent relationships with Gorgas and Welch. It was likely that army medical staff had talked to Grayson, and Grayson had been urging army chief of staff General Peyton March to freeze the movement of troops to Europe. March had refused.

Grayson convinced Wilson to summon March to the White House on October 7 to discuss the issue. Late that night Wilson and March met. Wilson said, “General March, I have had representations sent to me by men whose ability and patriotism are unquestioned that I should stop the shipment of men to France until this epidemic of influenza is under control…. [Y]ou decline to stop these shipments.”

March made no mention of any of the advice he had received from Gorgas’s office. He insisted that every possible precaution was being taken. The troops were screened before embarking and the sick winnowed out. Some ships even put ashore in Halifax, Nova Scotia, those who fell seriously ill before the actual Atlantic crossing began. If American divisions stopped arriving in France, whatever the reason, German morale might soar. True, some men had died aboard ship, but, March said, “Every such soldier who has died just as surely played his part as his comrade who died in France.”

The war would end in a little over a month. The epidemic had made virtually all training in cantonments impossible. A parliament—not the kaiser—had already taken over the German government and sent out peace feelers, while Germany’s allies had already collapsed, capitulated, or, in the case of Austria, asked for peace on any terms Wilson dictated. But March insisted, “The shipment of troops should not be stopped for any cause.”

March later wrote that Wilson turned in his chair, gazed out the window, his face very sad, then gave a faint sigh. In the end, only a single military activity would continue unaffected in the face of the epidemic. The army continued the voyages of troopships overseas.

If Wilson did nothing about influenza in the military but express concern about shipping troops to Europe, he did even less for civilians. He continued to say nothing publicly. There is no indication that he ever said anything privately, that he so much as inquired of anyone in the civilian arm of the government as to its efforts to fight the disease.

Wilson had appointed strong men to his administration, powerful men, and they took decisive actions. They dominated the nation’s thought, and they dominated the nation’s economy. But none of those appointees had any real responsibility for health. Surgeon General Rupert Blue, head of the United States Public Health Service, did. And Blue was not a strong man.

A square-faced man with a square thick athletic body, an amateur boxer, Blue was physically strong all right, even deep into middle age. But he was not strong in ways that mattered, in leadership. In a field that was largely new when he entered it, a field in which colleagues were cutting new paths into the wild in dozens of directions, he had broken no ground, demonstrated no professional courage, nor had he even showed real zeal. If he was by no means unintelligent, he lacked either real intellectual rigor or the creativity to ask important questions, and he had never manifested any truly special talents in or insights into public health.

As far as scientific public health issues went, the real leaders of the medical profession considered him a lightweight. Welch and Vaughan had not even trusted him to name the Public Health Service’s representative to the National Research Council, and so they themselves had picked a PHS scientist they respected. Cary Grayson thought so little of him that he began to build an alternative national public health organization. (He abandoned his effort when Tammany took over the New York City Department of Health.) Blue became surgeon general simply by carrying out assigned tasks well, proving himself an adept and diplomatic maneuverer, and seizing his main chance. That was all.

After finishing his medical studies in 1892, Blue had immediately joined the Public Health Service and remained there his entire professional life. His assignments had moved him from port to port, to Baltimore, Galveston, New Orleans, Portland, New York, Norfolk, where he worked in hospitals and quarantine stations and on sanitation issues. His opportunity came with an outbreak of bubonic plague in San Francisco in 1903. Another PHS officer, a highly regarded scientist, had engaged in a running battle with local government and business leaders, who denied plague existed in the city. Blue did not prove that it did—Simon Flexner did that, demonstrating the plague bacillus in the laboratory, as part of a scientific team brought in to settle the question—but Blue did win grudging cooperation from local authorities in efforts to control the disease. This was no easy task, and he both oversaw the killing of rats and kept, according to one laudatory report, “all interests in the State…harmonized.”

This success won him powerful friends. (He was not successful enough, however, to prevent plague spreading from rats to wild rodent populations; today plague exists in squirrels, prairie dogs, and other animals in much of the Pacific Coast and inland to Arizona, New Mexico, and Colorado.) When plague resurfaced in San Francisco in 1907 he was called back. Another success won him more powerful friends. In 1912 he rose to surgeon general. That same year Congress expanded the Public Health Service’s power. From that position he pushed for national medical insurance, which the medical profession then advocated, and in 1916 he became president of the American Medical Association. In his presidential address he declared, “There are unmistakable signs that health insurance will constitute the next great step in social legislation.”

Wilson did not bother to choose a new surgeon general, but when the war began he did make the Public Health Service part of the military. It had consisted chiefly of several quarantine stations that inspected incoming ships, the Marine Hospital Service, which cared for merchant seamen and some federal workers, and the Hygienic Laboratory. Now it became responsible for protecting the nation’s health, if only so the nation could produce more war matériel. Blue did not grow with the job.

In advance of the epidemic, Gorgas had used all means possible to protect the millions of soldiers from disease. His counterpart Navy Surgeon General William Braisted had done little to match Gorgas, but he was supporting work by such men as Rosenau in Boston and Lewis in Philadelphia.

Blue by contrast did, literally, less than nothing; he blocked relevant research. On July 28, 1918, Blue rejected a request from George McCoy, director of the Hygienic Laboratory, for $10,000 for pneumonia research designed to complement the efforts of the Rockefeller Institute. Although Congress in 1912 had given the agency authority to study “diseases of man and conditions affecting the propagation thereof,” Blue determined that McCoy’s “investigation is not immediately necessary to the enforcement of the law.”

Blue knew of the possibility of influenza in the United States. On August 1, the Memphis Medical Monthly published comments by him warning of it. Yet he made no preparations whatsoever to try to contain it. Even after it began to show evidence of lethality, even after Rufus Cole prodded his office to collect data, neither he nor his office attempted to gather information about the disease anywhere in the world. And he made no effort whatsoever to prepare the Public Health Service for a crisis.

Many of those under him were no better. The Commonwealth Pier outbreak began late in August, and by September 9 newspapers were reporting that influenza victims filled “all the hospital beds at the forts at Boston harbor,” Camp Devens had thirty-five hundred influenza cases, and Massachusetts hospitals were filling with civilians. Yet the local Public Health Service officer later insisted, “The first knowledge of the existence of the disease reached this officer September 10th.”

The virus had reached New Orleans on September 4; the Great Lakes Naval Training Station on September 7; New London, Connecticut, on September 12.

Not until September 13 did the Public Health Service make any public comment, when it said, “Owing to disordered conditions in European countries, the bureau has no authoritative information as to the nature of the disease or its prevalence.” That same day Blue did issue a circular telling all quarantine stations to inspect arriving ships for influenza. But even that order only advised delaying infected vessels until “the local health authorities have been notified.”

Later Blue defended himself for not taking more aggressive action. This was influenza, only influenza, he seemed to be saying, “It would be manifestly unwarranted to enforce strict quarantine against…influenza.”

No quarantine of shipping could have succeeded anyway. The virus was already here. But Blue’s circular indicated how little Blue had done—in fact he had done nothing—to prepare the Public Health Service, much less the country, for any onslaught.

The virus reached Puget Sound on September 17.

Not until September 18 did Blue even seek to learn which regions of the United States the disease had penetrated.

On Saturday, September 21, the first influenza death occurred in Washington, D.C. The dead man was John Ciore, a railroad brakeman who had been exposed to the disease in New York four days earlier. That same day Camp Lee outside Petersburg, Virginia, had six deaths, while Camp Dix in New Jersey saw thirteen soldiers and one nurse die.

Still Blue did little. On Sunday, September 22, the Washington newspapers reported that Camp Humphreys (now Fort Belvoir), just outside the city, had sixty-five cases.

Now, finally, in a box immediately adjacent to those reports, the local papers finally published the government’s first warning of the disease:

Surgeon General’s Advice to Avoid Influenza

Avoid needless crowding….

Smother your coughs and sneezes….

Your nose not your mouth was made to breathe thru….

Remember the 3 Cs, clean mouth, clean skin, and clean clothes….

Food will win the war…. [H]elp by choosing and chewing your food well….

Wash your hands before eating….

Don’t let the waste products of digestion accumulate….

Avoid tight clothes, tight shoes, tight gloves—seek to make nature your ally not your prisoner….

When the air is pure breathe all of it you can—breathe deeply.

Such generalizations hardly reassured a public that knew that the disease was marching from army camp to army camp, killing soldiers in large numbers. Three days later a second influenza death occurred in Washington; John Janes, like the first Washington victim, had contracted the disease in New York City. Also that day senior medical personnel of the army, navy, and Red Cross met in Washington to try to figure out how they could aid individual states. Neither Blue nor a representative of the Public Health Service attended the meeting. Twenty-six states were then reporting influenza cases.

Blue had still not laid plans for an organization to fight the disease. He had taken only two actions: publishing his advice on how to avoid the disease and asking the National Academy of Sciences to identify the pathogen, writing, “In view of the importance which outbreaks of influenza will have on war production, the Bureau desires to leave nothing undone…. The Bureau would deem it a valuable service if the Research Council arrange for suitable laboratory studies…as to the nature of the infecting organism.”

Crowder canceled the draft. Blue still did not organize a response to the emergency. Instead, the senior Public Health Service officer in charge of the city of Washington reiterated to the press that there was no cause for alarm.

Perhaps Blue considered any further action outside the authority of the Public Health Service. Under him the service was a thoroughly bureaucratic institution, and bureaucratic in none of the good ways. Only a decade earlier he had been stationed in New Orleans, when the last yellow-fever epidemic to strike the United States had hit there, and the Public Health Service had required the city to pay $250,000—in advance—to cover the federal government’s expenses in helping to fight that epidemic. Only a few weeks earlier, he had rejected the request from the service’s own chief scientist for money to research pneumonia in concert with Cole and Avery at the Rockefeller Institute.

But governors and mayors were demanding help, beseeching everyone in Washington for help. Massachusetts officials in particular were begging for help from outside the state, for doctors from outside, for nurses from outside, for laboratory assistance from outside. The death toll there had climbed into the thousands. Governor Samuel McCall had wired governors for any assistance they could offer, and on September 26 he formally requested help from the federal government.

Doctors and nurses were what was needed. Doctors and nurses. And especially nurses. As the disease spread, as warnings from Welch, Vaughan, Gorgas, dozens of private physicians, and, finally, at last, Blue poured in, Congress acted. Without the delay of hearings or debate, it appropriated $1 million for the Public Health Service. The money was enough for Blue to hire five thousand doctors for emergency duty for a month—if he could somehow find five thousand doctors worth hiring.

Each day—indeed, each hour—was showing the increasingly explosive spread of the virus and its lethality. Blue, as if suddenly frightened, now considered the money too little. He had not complained to Congress about the amount; no record exists of his having asked for more. But the same day Congress passed the appropriation, he privately appealed to the War Council of the Red Cross both for more money and for its help.

The Red Cross did not get government funds or direction, although it was working in close concert with the government. Nor was its charge to care for the public health. Yet even before Blue asked, it had already allocated money to fight the epidemic and had begun organizing its own effort to do so—and do so on a massive scale. Its nursing department had already begun mobilizing “Home Defense Nurses,” fully professional nurses, all of them women, who could not serve in the military because of age, disability, or marriage. The Red Cross had divided the country into thirteen divisions, and the nursing committee chief of each one had already been told to find all people with any nursing training, not only professionals or those who had dropped out of nursing schools—for the Red Cross checked with all nursing schools—but down to and including anyone who had ever taken a Red Cross course in caring for the sick at home. It had already instructed each division to form at least one mobile strike force of nurses to be ready to go to areas most in need. And before anyone within the government sought aid, the War Council of the Red Cross had designated a “contingent fund for the purpose of meeting the present needs in coping with the epidemic of Spanish influenza.” Now the council agreed instantly to authorize expenditure of far more money than was in the contingency fund.

Finally, Blue began to organize the Public Health Service as well. Doctors and nurses were what was needed, doctors and nurses. But by then the virus had spanned the country, establishing itself on the perimeter, on the coasts, and it was working its way into the interior, to Denver, Omaha, Minneapolis, Boise. It was penetrating Alaska. It had crossed the Pacific to Hawaii. It had surfaced in Puerto Rico. It was about to explode across Western Europe, across India, across China, across Africa as well.

Science, then as now a journal written by scientists for their colleagues, warned, “The epidemics now occurring appear with electric suddenness, and, acting like powerful, uncontrolled currents, produce violent and eccentric effects. The disease never spreads slowly and insidiously. Wherever it occurs its presence is startling.”

October, not April, would be the cruelest month.