The Great Influenza (53 page)

They were also of course not paid unless they came to work. But at dozens of shipyards in New England, the absentee records were striking. At the L. H. Shattuck Company, 45.9 percent of the workers stayed home. At the George A. Gilchrist yard, 54.3 percent stayed home. At Freeport Shipbuilding, 57 percent stayed home. At Groton Iron Works, 58.3 percent stayed home.

Twenty-six hundred miles away was Phoenix, Arizona. At the beginning of the epidemic its newspapers had behaved as did those everywhere else, saying little, reassuring, insisting that fear was more dangerous than the disease. But the virus took its time there, lingered longer than elsewhere, lingered until finally even the press expressed fear. On November 8 the
Arizona Republican
warned, 'The people of Phoenix are facing a crisis. The [epidemic] has reached such serious proportions that it is the first problem before the people' . Almost every home in the city has been stricken with the plague' . Fearless men and women [must] serve in the cause of humanity.'

The war was three days from ending, and several false peaces had been announced. Still, for that newspaper to call influenza 'the first problem' while the war continued was extraordinary. And finally the city formed a 'citizens' committee' to take charge.

In Arizona, citizens' committees were taken seriously. A year earlier fifteen hundred armed members of a 'Citizens Protective League' had put 1,221 striking miners into cattle and boxcars and abandoned them without food or water on a railroad siding in the desert, across the New Mexico line. In Phoenix another 'citizens' committee' had been going after 'bond slackers,' hanging them in effigy on main streets. One man refused to buy a bond because of religious reasons. Nonetheless he was hung in effigy with a placard reading, 'H. G. Saylor, yellow slacker' . Can, but won't buy a liberty bond!' Saylor was lucky. The committee also seized Charles Reas, a carpenter, tied his hands behind his back, painted his face yellow, put a noose around his neck, and dragged him through downtown Phoenix streets wearing a sign that read 'with this exception we are 100%.'

The influenza Citizens' Committee took similar initiatives. It deputized a special police force and also called upon all 'patriotic citizens' to enforce anti-influenza ordinances, including requiring every person in public to wear a mask, arresting anyone who spit or coughed without covering his mouth, dictating that businesses (those that remained open) give twelve hundred cubic feet of air space to each customer, and halting all traffic into the city and allowing only those with 'actual business here' to enter. Soon the
Republican
described 'a city of masked faces, a city as grotesque as a masked carnival.'

And yet (ironically) influenza touched Phoenix only lightly compared to elsewhere. The panic came anyway. Dogs told the story of terror, but not with their barking. Rumors spread that dogs carried influenza. The police began killing all dogs on the street. And people began killing their own dogs, dogs they loved, and if they had not the heart to kill them themselves, they gave them to the police to be killed. 'At this death rate from causes other than natural,' reported the
Gazette,
'Phoenix will soon be dogless.' Back in Philadelphia Mary Volz lived near a church. She had always 'loved to hear the church bells ringing, they were so jubilantly ringing.' But now every few minutes people carried a casket into the church, left, 'and there would be another casket.' Each time the bells rang. 'The bells were my joy and then this 'BONG! BONG! BONG!' I was terrified, lying sick in bed hearing 'BONG! BONG! BONG!' Is the bell going to bong for me?'

The war was over there. The epidemic was here. The war ended. The epidemic continued. Fear settled over the nation like a frozen blanket. 'Some say the world will end in fire,' wrote Robert Frost in 1920. 'Ice is also great / and would suffice.'

An internal American Red Cross report concluded, 'A fear and panic of the influenza, akin to the terror of the Middle Ages regarding the Black Plague, [has] been prevalent in many parts of the country.'

CHAPTER THIRTY

W
IRES POURED INTO
the Red Cross and the Public Health Service demanding, pleading, begging for help. From Portsmouth, Virginia: 'Urgently need two colored physicians wire prospects obtaining same.' From Carey, Kentucky: 'Federal coal mines request immediate aid influenza'. Immediately rush answer.' From Spokane, Washington; 'urgent need of four nurses to take charge other nurses furnished by local Red Cross chapter.'

The demands could not be met. Replies went back: 'No colored physicians available.' 'It is almost impossible to send nurses all being needed locally.' 'Call for local volunteers with intelligence and practical experience.'

The failure to meet demand was not from lack of trying. Red Cross workers went from house to house searching for anyone with nursing experience. And when they knew of a skilled nurse, the Red Cross tracked her down. Josey Brown was a nurse watching a movie in a St. Louis theater when the lights went on, the screen went blank, and a man appeared onstage announcing that anyone named Josey Brown should go to the ticket booth. There she found a telegram ordering her to the Great Lakes Naval Training Station.

The
Journal of the American Medical Association
repeatedly (sometimes twice in the same issue) published an 'urgent call on physicians for help in localities where the epidemic is unusually severe' . This service is just as definite a patriotic privilege as is that of serving in the Medical Corps of the Army or Navy' . As the call is immediate and urgent it is suggested that any physician who feels that he can do some of this work telegraph to the Surgeon General, USPHS, Washington, D.C.'

There were never enough.

Meanwhile, physicians attempted everything (
everything
) to save lives. They could relieve some symptoms. Doctors could address pain with everything from aspirin to morphine. They could control coughing at least somewhat with codeine and, said some, heroin. They gave atropine, digitalis, strychnine, and epinephrine as stimulants. They gave oxygen.

Some treatment attempts that went beyond symptomatic relief had solid science behind them, even if no one had ever applied that science to influenza. There was Redden's approach in Boston based on Lewis's experiments with polio. That approach, with variations, was tried over and over again around the world.

And there were treatments less grounded in science. They sounded logical. They were logical. But the reasoning was also desperate, the reasoning of a doctor ready to try anything, the reasoning that mixed wild ideas or thousands of years of practice and a few decades of scientific method. First-rate medical journals rejected articles about the most outlandish and ridiculous so-called therapies, but they published anything that at least seemed to make sense. There was no time for peer review, no time for careful analysis.

JAMA
published the work of a physician who claimed, 'Infection was prevented in practically 100% of cases when [my] treatment was properly used.' His approach had logic to it. By stimulating the flow of mucus, he hoped to help one of the first lines of defense of the body, to prevent any pathogen from attaching itself to any mucosal membrane. So he mixed irritating chemicals in powder form and blew them into the upper respiratory tract to generate large flows of mucus. The theory was sound; perhaps while mucus was actually flowing, it did some good.

One Philadelphia doctor had another idea, logical but more reaching, and wrote in
JAMA
that 'when the system is saturated with alkalis, there is poor soil for bacterial growth.' Therefore he tried to turn the entire body alkaline. 'I have uniformly employed, and always with good results, potassium citrate and sodium bicarbonate saturation by mouth, bowel and skin' . Patients must be willing to forego [
sic
] the seductive relief by acetylsalicylic acid [aspirin]' . My very successful experience in this epidemic cannot be dismissed as accidental or unique' . I urge its immediate trial empirically. Further investigation in laboratory or clinic may follow later.'

Physicians injected people with typhoid vaccine, thinking (or simply hoping) it might somehow boost the immune system in general even though the specificity of the immune response was well understood. Some claimed the treatment worked. Others poured every known vaccine into patients on the same theory. Quinine worked on one disease: malaria. Many physicians gave it for influenza with no better reasoning than desperation.

Others convinced themselves a treatment cured regardless of results. A Montana physician reported to the
New York Medical Journal
of his experimental treatment; 'The results have been favorable.' He tried the treatment on six people; two died. Still he insisted, 'In the four cases that recovered the results were immediate and certain.'

Two University of Pittsburgh researchers reasoned no better. They believed they had improved on the technique Redden had adopted from Flexner and Lewis. They treated forty-seven patients; twenty died. They subtracted seven deaths, arguing that the victims received the therapy too late. That still left thirteen dead out of forty-seven. Yet they claimed success.

One physician gave hydrogen peroxide intravenously to twenty-five patients in severe pulmonary distress, believing that it would get oxygen into the blood. Thirteen recovered; twelve died. This physician, too, claimed success: 'The anoxemia was often markedly benefited, and the toxemia appeared to be overcome in many cases.'

Many of his colleagues tried similarly outlandish treatments and likewise claimed success. Many of them believed it.

Homeopaths believed that the epidemic proved their superiority to 'allopathic' physicians. The
Journal of the American Institute for Homeopathy
claimed that influenza victims treated by regular physicians had a mortality rate of 28.2 percent (an absurdity: if that were so, the United States alone would have had several million deaths) while also claiming that twenty-six thousand patients treated by homeopaths, chiefly with the herbal drug gelsemium, had a mortality rate of 1.05 percent, with many homeopaths claiming no deaths whatsoever among thousands of patients. But the results were self-reported, making it far too easy to rationalize away those under their care who did die - to remove, for instance, from their sample any patient who, against their advice, took aspirin, which homeopaths considered a poison.

* 

It was no different elsewhere in the world. In Greece one physician used mustard plasters to create blisters on the skin of influenza victims, then drained them, mixed the fluid with morphine, strychnine, and caffeine and reinjected it. 'The effect was apparent at once, and in 36 to 48 or even 12 hours the temperature declined and improvement progressed.' But the mortality rate of his 234 patients was 6 percent.

It Italy one doctor gave intravenous injections of mercuric chloride. Another rubbed creosote, a disinfectant, into the axilla, where lymph nodes, outposts of white blood cells scattered through the body, lie beneath the skin. A third insisted that enemas of warm milk and one drop of creosote every twelve hours for every year of age prevented pneumonia.

In Britain the War Office published recommendations for therapy in
The Lancet
. They were far more specific than any guidance in the United States, and likely did relieve some symptoms. For sleep, twenty grains of bromide, opiates to relax cough, and oxygen for cyanosis. The recommendations warned that venesection was seldom beneficial, that alcohol was invaluable, but that little could be gained by giving food. For headache: antipyrin and salicylic acid (aspirin). To stimulate the heart: strychnine and digitalis.

In France, not until mid-October did the Ministry of War approach the Académie des Sciences for help. To prevent disease, some physicians and scientists advised masks. Others insisted arsenic prevented it. For treatment, the Pasteur Institute developed an antipneumococcus serum drawn as usual from horses, as well as a serum derived from the blood of patients who had recovered. (Comparisons proved the Cole and Avery serum far superior.) Anything that might lower fever was urged. Stimulants were recommended for the heart. So were 'revulsions' that purged the body. Methylene blue, a dye used to stain bacteria to make them more visible under the microscope, was tried despite its known toxicity in the hopes of killing bacteria. Other doctors injected metallic solutions into muscle, so the body absorbed them gradually, or intravenously. (One doctor who injected it intravenously conceded that the treatment was 'a little brutal.') Cupping was recommended - using a flame to absorb oxygen and thus create a vacuum in a glass container, then placing it on the body, in theory to draw out poisons. One prominent physician called for 'prompt bleeding' of more than pint of blood at the first signs of pulmonary edema and cyanosis, along with acetylsalicylic acid. He was hardly alone in prescribing bleeding. One physician who recommended a return to 'heroic medicine' explained that the more the doctor did, the more the body was stimulated to respond. In disease as in war, he said, the fighter must seize initiative.

* 

Across the world hundreds of millions (very likely tens of millions in the United States alone) saw no doctor, saw no nurse, but tried every kind of folk medicine or fraudulent remedy available or imaginable. Camphor balls and garlic hung around people's necks. Others gargled with disinfectants, let frigid air sweep through their homes, or sealed windows shut and overheated rooms.

Advertisements filled the newspapers, sometimes set in the same small type as (and difficult to distinguish from) news articles, and sometimes set in large fonts blaring across a page. The one thing they shared: they all declared with confidence there
was
a way to stop influenza, there
was
a way to survive. Some claims were as simple as a shoe store's advertising, 'One way to keep the flu away is to keep your feet dry.' Some were as complex as 'Making a Kolynos Gas Mask To Fight Spanish Influenza When Exposed to Infection.'