America's Forgotten Pandemic: The Influenza of 1918

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America's
Forgotten
Pandemic
The Influenza of 1918
Second Edition

ALFRED W. CROSBY
University of Texas, Austin

CAMBRIDGE
UNIVERSITY PRESS
PUBLISHED BY THE PRESS SYNDICATE OF THE UNIVERSITY OF CAMBRIDGE
The Pitt Building, Trumpington Street, Cambridge, United Kingdom

CAMBRIDGE UNIVERSITY PRESS

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© Alfred W Crosby 2003

© Cambridge University Press 1989

This book is in copyright. Subject to statutory exception

and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.

First published in 1976 as Epidemic and Peace: 1918 by Greenwood Press, Westport, Conn.
First published by Cambridge University Press 1989
Reprinted 1990,1997

Second edition first published 2003

Typefaces Caledonia 10/13 pt. and Optima System W$L2e [TB]

A catalog record for this book is available from the British Library.

Library of Congress Cataloging in Publication data available

ISBN 0 521 83394 9 hardback
ISBN 0 521 54175 1 paperback

Transferred to digital printing 2004

To Katherine Anne Porter, who survived
CONTENTS

List of Graphs and Tables page ix

Preface to the New Edition xi

PART I. An Abrupt Introduction to Spanish Influenza

1. The Great Shadow 3

PART II. Spanish Influenza: The First Wave—Spring
and Summer, 1918

2. The Advance of the Influenza Virus 17

3. Three Explosions—Africa, Europe, and America 37

PART III. The Second and Third Waves

4. The United States Begins to Take Note 45

5. Spanish Influenza Sweeps the Country 56
6. Flu in Philadelphia 70
7. Flu in San Francisco 91
8. Flu at Sea on the Voyage to France 121
9. Flu and the American Expeditionary Force 145
10. Flu and the Paris Peace Conference 111
PART IV. Measurements, Research, Conclusions,
and Confusions

11. Statistics, Definitions, and Speculation 202

12. Samoa and Alaska 227
13. Research, Frustration, and the Isolation of the Virus 264
14. Where Did the Flu of 1918 Go? 295
vii
Viii/ CONTENTS

PART V. Afterword

15. An Inquiry into the Peculiarities of Human Memory 311

Index 329
GRAPHS AND TABLES

Influenza Deaths, U.S., 1917 page 22

Pneumonia Deaths, U.S., 1917 23

Influenza and Pneumonia Deaths, Louisville, Kentucky, April, 1918 24

United States Naval Forces Ashore in the U.S., Deaths due to

Influenza and Pneumonia, Autumn, 1918 58

United States Army in the U.S., Deaths due to Influenza and

Pneumonia, Autumn, 1918 59

Deaths due to Influenza and Pneumonia in Cities in the U.S.,

Fall, 1918 and Winter, 1919 60

Chronological Map of the Influenza Epidemic of 1918 in the U.S. 65

Deaths due to Influenza and Pneumonia in Philadelphia 86

Cases of Influenza and Deaths due to Influenza and Pneumonia

in San Francisco 114
Influenza and Pneumonia Admissions and Deaths in Allied
Armies in France 159

Deaths in Paris due to Influenza, Pneumonia, and All Causes,

August, 1918-May, 1919 181

Mortality Figures, Influenza and Pneumonia in U.S., 1918-19 209

IX
PREFACE TO
THE NEW EDITION

In 1976 when this book was first published, it seemed to be a piece of medical
antiquarianism, informative and interesting, I hoped, but with little immedi-
ate relevancy to our then-current situation. In the advanced nations the chief
killers were no longer infections, not even renowned villains like tuberculosis,
much less influenza. Public health measures and penicillin and the other new
antibiotics had demoted all the major pathogens to minor threats. They had
been superseded by the degenerative diseases of middle and old age such
as cancer and arteriosclerosis. We weren't looking forward to these, but we
were confident that we would be around long enough to get old and die of
them.
In 1969 the Surgeon General of the United States, William H. Stewart,
assured us that we had left infectious disease behind in our dust. Three
years later, in the final edition of the classic Natural History of Infectious
Disease, author and Nobel laureate Macfarlane Burnet concluded that "the
most likely forecast about the future of infectious disease is that it will be very
dull."1
There was the swine flu scare of 1976 that for a few months contra-
dicted such optimism. The flu experts told us that we might be on the
brink of another experience like that of 1918, when life expectation in the
United States plunged by twenty years. But the strain of virus that triggered
the swine flu scare did not trigger a pandemic, and the millions of dollars
spent on the production and distribution of a new flu vaccine were wasted.
To many outsiders the whole affair seemed farcical, and the influenza ex-
perts and gloom purveyors emerged from the experience with bedraggled
reputations.
A less significant effect was that my study of the 1918 pandemic lost the
patina of contemporary relevancy it had possessed for a while. I didn't mourn
the loss: rooting for a medical disaster because it might help book sales would
certainly have qualified me for residency somewhere in the lower circles of
Dante's hell.

XI
Xii / PREFACE TO THE NEW EDITION

The first Cambridge University Press edition of my book came out in 1989,
by which time events had resuscitated the study of infection. AIDS had struck
like a thunderbolt, infected legions, and killed thousands—and there was no
cure or promise of one. For some of us, the malady recalled to memory what
the Surgeon General of the United States Army, Victor Vaughan, had written
about the peak of the 1918 pandemic: "At that moment I decided never again
to prate about the great achievements of science "2
But AIDS was a sexually transmitted disease and presented little danger
to anyone with a strong sense of self-preservation. To most it seemed an
exception that served to highlight the comfortable ordinary. The experts with
white coats and stethoscopes still had things under control, and we would last
until the degenerative maladies got us. For certain, the 1918 flu was ancient
history and no more pertinent to our lives than the Sweating Sickness of Tudor
England.
In 2003 that confidence is shaking in its boots. AIDS afflicts millions and
the white coats still cannot cure it, although they can prolong its victims'
lives for years. Tuberculosis, under control a generation ago, has made a
comeback with the surfacing of antibiotic-resistant strains. Thugs we never
heard of before, Lyme Disease and West Nile Fever, for example, stalk us
in our backyards and parks where we picnic, and jungle monsters like Ebola
threaten us from TV screens.
The latest fright is SARS (Severe Acute Respiratory Syndrome), at first
suspected of being a new strain of influenza.3 It isn't, but the disease is trans-
mitted by droplets in the breath like flu, that is to say, stealthily and swiftly.
As I write this, SARS has spread from southern China, allegedly its point of
origin, to other locations in eastern Asia and to North America and Europe.
It is well on its way to circling the globe in a matter of weeks.
SARS has flu-like symptoms: runny nose, sore throat, aches, and fever.
There doesn't seem to be any cure more effective than bed rest, as was so
with the 1918 flu. A careful and conservative estimate of those who died of
influenza in the World War I pandemic puts the number at a minimum of
thirty million, three times the number of combat casualties of that conflict.4
Today we have antibiotics to cure the deadly secondary infections that
so often followed on the heels of the 1918 flu, which should reduce the
death rate of any similar pandemic. We know vastly more about that flu
virus than we did that year or when I first wrote about it. Dr. Jeffrey
Taubenberger, Ann Reid, and their associates have examined tissue samples
preserved since 1918-19 by the U.S. Armed Forces Museum of Pathology in
 PREFACE TO THE NEW EDITION / xiii

Maryland and by the permafrost in Alaska and have reconstructed much of

the genome of the pandemic virus.5 We have vigilant worldwide surveillance
systems like Japans National Institute of Infectious Diseases, the United
States Centers for Disease Control, and the World Health Organization to
watch for new flu epidemics and new strains of viruses. We have institu-
tions to produce vaccines to counter any new strains. We are even mak-
ing some progress in at least ameliorating the effects of viral diseases like
influenza.
But we don't know yet what made the 1918 virus so dangerous, and so we
don't know yet what to do to stall the return of that or any similarly dangerous
flu virus. Furthermore, we live in a world that has become in some ways a
better place for nasty viruses and a worse place for us than it was in 1918.
The flu virus seems a poor choice for bioterrorism, but our "globalized" trans-
portation systems increase the probability of natural pandemics of influenza.
In 1918 the fastest way to cross oceans was by steamship. In 2003, thousands
of us daily and tens of millions of us annually make such trips in aircraft
at speeds not far short of that of sound, carrying with us in our lungs and
bowels, on our hands and in our hair, micro-organisms of all kinds, including
pathogens. We are all, so to speak, sitting in the waiting room of an enormous
clinic, elbow to elbow with the sick of the world.
The world's human population is more than three times greater than it was
in the last year of World War I, which increases the likelihood of the spread
of strains of any and all pathogens. The populations of the animals with which
we exchange flu viruses, the source of epidemic strains, are vastly larger than
they were in 1918. China, which tops the world in its numbers of humans,
aquatic birds, and pigs, has been the source of many new flu strains since
1918 and will be again.
The health problems of our giant cities are especially daunting. Consider
Mexico City, with a population of 19 million officially and several million
more than that in reality, that is to say, a population considerably greater than
those of Norway, Sweden, and Denmark added together. Such megalopoli are
sprouting rankly across the world, most spectacularly in the regions where
the facilities and income are insufficient to take the most effective measures
to control disease.

There is a bitter little pill of a joke currently circulating among infectious dis-
ease experts. It is short: The nineteenth century was followed by the twentieth
century, which was followed by the . . . nineteenth century.
Xiv/PREFACE TO THE NEW EDITION

The medical optimism circa 1976 is receding. America's Forgotten

Pandemic has at last attained contemporary relevancy.

Notes

1. Burnet, Macfarlane, and White, D. O., Natural History of Infectious Disease,

4th edition (Cambridge University Press, 1972); Porter, Roy, The Greatest Benefit
to Mankind: A Medical History ofHumanity from Antiquity to the Present (London:
Harper Collins, 1997), p. 491; Grob, Gerald N., The Deadly Truth: A History of
Disease in America (Cambridge: Harvard University Press, 2002), p. 272.
2. Robert Kenner Films, script of The American Experience: 1918, the Year of Dying
and Forgetting.
3. Cyranoski, David, "Health Labs Focus on Mystery Pneumonia," Nature, vol. 422
(20 March 2003), p. 247.
4. Patterson, K. David, and Pyle, Gerald F , "The Geography and Mortality of the 1918
Influenza Pandemic," Bulletin of the History of Medicine, vol. 65 (1991), pp. 4-21.
5. Kolata, Gina, Flu: The Story of the Great Influenza Pandemic of 1918 and the
Search for the Virus that Caused It (New York: Farrar, Straus and Giroux, 1999),
pp. 187-280.
part I
AN ABRUPT
INTRODUCTION TO
SPANISH INFLUENZA
1
THE GREAT SHADOW

William Henry Welch was the most distinguished pathologist, physi-

cian, and scientist in the United States in the early years of the
twentieth century. He was, at one time or another, president of the
American Medical Association and of the Association of American
Physicians, and his reknown among medical scientists was equaled
by his fame among all scientists, which won him the presidencies of
the American Association for the Advancement of Science, the
National Academy of Science, and the Board of Directors of the
Rockefeller Institute. Doyen of all the American sciences, his like in
that respect had not been seen since Benjamin Franklin.1
Despite the urgency of existing obligations, Dr. Welch left his post
at Johns Hopkins to answer President Wilson's call to fight "the war
to end all wars" and, along with millions of men a half and a third his
age, put on the olive drab of the United States Army. In 1918 his job
was trouble-shooting for the Army Surgeon General, traveling about
the nation inspecting the sanitary conditions in the camps so abruptly
gouged out of America's open spaces to provide its plowboys and
jitney drivers with places to leam the skills of trench warfare. The job
wasn't glorious, but it was a very important one because in all
previous wars more American soldiers had died of disease than in
combat, and history would surely repeat itself unless constant and
careful inspections of the camps were made. So the man whom the
medical profession knew as the nation's most prestigious pathologist
checked on the thoroughness with which prostitutes had been routed
out of cantonment neighborhoods, stared into latrine pits, tested the
temperature of mess hall dish water—and measurably assisted the
Medical Corps in holding the line against infectious disease.
The health of the army proved to be as good as any reasonable
4 / EPIDEMIC AND PEACE, 1918

doctor could expect and the procedures to preserve it so exemplary

that by the last month of summer 1918 the good grey physician was
ready to take off his uniform and return to his civilian duties. Then
something new in the way of a threat to that health appeared, first
striking at Camp Devens in Massachusetts, then spreading to camps
Upton, New York, and Lee, Virginia. The Surgeon General's office
dispatched Colonel Welch to Devens to find exactly what was the
cause of the hair-raising telegrams originating there. By the time he
arrived on September 23, the disease—it was being called "Spanish
influenza"—was reported among civilians from Maine to Virginia
and news of it was coming in from scattered locations all over the
nation. The number and quality of the medical experts converging on
Devens are a measure of the governments concern: included in the
group were Welch; Colonel Victor C. Vaughan, another ex-president
of the American Medical Association; Rufus Cole of the Rockefeller
Institute; and Simeon Walbach of the Harvard Medical School.2
Camp Devens, located about thirty miles west of Boston on a
well-drained plateau of meadows and woods, had only one charac-
teristic to qualify it for the traditional military epidemic: it was over-
crowded, with 45,000 men, 5,000 of them under canvas, jammed
into an encampment built for 35,000.3 The cantonment was over
capacity for the very good reason that the United States was involved
in a war several times more prodigal in its appetite for fighting men
than any previous war in history. Where General Grant had called for
hundreds of thousands of American soldiers, General Pershing and
his French superior, General Foch, called for millions. Thirty-five
thousand officers and men had already trained at Devens in the first
year of its existence, and almost all of them were already in France.
Now the training of the brand new Twelfth Infantry Division was
under way, to the distant thunder of America's first major offense of
the war, the battle of St. Mihiel.
The Twelfth's commander, Major General Henry P. McCain, had
arrived at Devens at 10:00 A.M. on August 20 and announced his firm
intention to have the division ready for embarkation to France in
fourteen weeks. Range-firing would be carried on "all hours of the
day while it is light enough to see a bullseye."4 Three weeks later he
found himself commander not of a division well on its way to becom-
ing the crack outfit of his dreams, but of a division which was very sick
 AN ABRUPT INTRODUCTION / 5

and possibly getting sicker faster than any other similar outfit in the
world.
Word of Spanish influenza was heard from Boston as early as the
very first days of September, but when the first Devens victim, a
soldier of Company B, 42nd Infantry, went on sick call on the
seventh, his illness was diagnosed as cerebrospinal meningitis. The
abruptness of the onset of the disease and the degree to which it
overwhelmed the patient—the technical descriptive term is "ful-
minating"—seemed far too extreme to be attributed to influenza of
any kind.5 After all, influenza, flu, grippe, grip—whatever you called
it or however you spelled it—was a homey, familiar kind of illness:
two or three days in bed feeling downright miserable, a week or so
feeling shaky, and then back to normal. Call it a bad cold or call it flu,
it was an annual occurrence in most families and not a thing of terror
like smallpox or typhoid or yellow fever. Epidemic maladies like the
latter were a danger, not just an inconvenience, and doctors were
legally obliged to report them to their boards of health, but few
health departments in the United States or the world thought enough
of influenza to make it a reportable disease.
The following day a dozen men of Company B showed up at the
hospital, apparently with the same sickness as their comrade, and
medical officers began to question the original diagnosis. The fever,
headache, prostration, and abruptness of onset of meningitis were
there, but the most obvious external symptoms were those of disease
of the upper respiratory tract: cough, drippy nose, sore throat. The
patients complained of aching backs and legs. On September 12 a
definite diagnosis of influenza was made. By September 16, 36
members of Company B had been sent to the hospital with influenza
and the disease had spread to other companies and regiments. Daily
hospital admissions, only 31 on the second day of the month, soared
to 142 on the tenth, and to a peak of 1,176 on the eighteenth. By that
day, 6,674 cases of influenza had been reported in Devens.
Influenza often spreads explosively—that is the most obvious sign
by which to differentiate between it and the usual run of bad colds—
but the 1918 flu was unique in one way, at least. No other influenza
before or since has had such a propensity for pneumonic complica-
tions. And pneumonia kills.
The news that greeted Welch when he arrived at Devens on
6 / EPIDEMIC AND PEACE, 1918

September 23 was that 12,604 cases of Spanish influenza had been

officially reported since the seventh of the month. How many more
mild cases were still in the barracks spreading the epidemic no one
could say, but at least the number of new cases of flu being reported
was falling off. That number was down 250 from the previous day and
had been dropping since the twentieth.
But the spread of pneumonia was accelerating. The hospital's
clerical system was breaking down under the volume of paper work
created by the epidemic, but Colonel Welch could be told that there
were at least 727 cases of pneumonia. When the clerks finally caught
up with the pneumonia statistics four days later, they discovered that
the hospital had 1,902 cases of pneumonia under its care and the
number was still rising. The Boston Globe reported that in the
twenty-four hours preceding 7:00 A.M. of September 23, 66 men,
all of them probably in the peak years of physical prowess, had
died.6
The statistics boggled Welch's mind: the sight of lines of sick men
shuffling through the cold, penetrating rain to the hospital gave him
no encouragement about the immediate future. He needed no
stethoscope to conclude that the problem for many of them was lung
failure. He could see that at a dozen paces: some of them, stumbling
along, the blankets over their shoulders soaking up the fine drizzle,
were turning blue and even purple.7
And when the sick reached the hospital, where was there room to
put them and how many physicians and nurses were there to care for
them? The hospital was typical of those thrown together by the army:
a maze of dozens of wooden buildings connected by what seemed
miles of corridors. One physician after the war looked back in bitter-
ness to comment: "A farmer who gave no more thought to the
planning of his milking barns than was given to the planning of Army
hospitals in World War I would go broke in a month."8
The Devens hospital normally accommodated 2,000; now 8,000
sick men needed shelter and treatment. The wards overflowed onto
the porches, and when those filled up, raw wooden drafty barracks
were commandeered to serve as supplemental hospitals—or, rather,
as places to bed down the sick until someone, anyone could get
around to caring for them.9
Nurses were more important than doctors because neither antibio-
 AN ABRUPT INTRODUCTION / 7

tics nor medical techniques existed to cure either influenza or

pneumonia. Warm food, warm blankets, fresh air, and what nurses
ironically call TLC—Tender Loving Care—to keep the patient alive
until the disease passed away: that was the miracle drug of 1918. The
Devens hospital had 300 regular nurses, not nearly enough to handle
the tidal wave of patients, and the nurses themselves were, of course,
especially susceptible to infection because they were exhausted and
constantly in contact with the ill. Welch found that scores of them
were down with influenza; at one time 90 of the 300 were incapaci-
tated.10
Welch and his colleagues made their inquiries, noted down the
appalling statistics (29.6 percent of the 13th Battalion sick, 17.3
percent of the 42nd Infantry sick, 24.6 percent of Trains and Military
Police sick), stopped at the hospital laboratory to try to derive some
wisdom from the confusion there, and glanced in at the wards with
their lines of cots and prostrated soldiers, whose linens were often
stained with bloody sputum and the sudden nosebleeds that were
symptoms of Spanish influenza. The soldiers with the tint of blue
were almost certainly dying. The tour was appalling; Colonel
Vaughan, who had gone through the Spanish-American War and had
seen thousands of cases of typhoid, admitted that he had never,
never seen anything so depressing as this.11 Little could be learned
from the sick and dying but that they were sick and dying. Enlighten-
ment, if there was any to be had, would be found in the autopsy
room. What, in the name of God, was happening inside the lungs of
these soldiers who a few days ago were prime specimens of possibly
the most robust generation of men the human race had yet produced?
Conditions in the morgue were chaotic. In an army camp, popu-
lated for the most part with recruits in their twenties, a dozen deaths
a week would be a serious matter. Sixty-three died on the day Welch
came to Devens. Presently, 90 would die in a day.12 Bodies the color
of slate were "stacked like cordwood" or lying about the morgue floor
in confusion, and the eminent physicians had to step around and over
them to get to the autopsy room. There Welch, who had presided
over the most famous teaching laboratory for pathology in America
for more years than most pathologists had practiced, labored to find
the cause of death.
In the open chest of a cadaver Welch saw the blue, swollen lungs of
8 / EPIDEMIC AND PEACE, 1918

a victim of Spanish influenza for the first time. Cause of death? That
at least was clear: what in a healthy man are the lightest parts of his
body, the lungs, were in this cadaver two sacks filled with a thin,
bloody, frothy fluid.13
The human body is a collocation of wonders, and none is more
wondrous than the lungs. Here, quite literally, the line dividing the
body from its environment is thinnest. Here the blood exchanges its
gaseous wastes for the oxygen that the body needs every moment of
its existence to stay alive, and here the human organism spreads itself
out to expose as thin and broad an area to the air as possible. In an
adult male the lungs contain 750 million of the tiny air sacks, the
alveoli, where the gaseous exchange takes place, and their combined
surface is more than 25 times the area of his skin. The capillaries of
their walls are barely wider than the diameter of a single red blood
cell, and the membranes of those capillaries are one-tenth of a
millionth of a meter thick. It is here in the lungs that the human body,
in order to renew itself with every breath, takes on almost the
delicacy of a soap bubble.14
The most minute tendency toward any grossness in the tissues of
the alveoli or of the structure that contains them, or any presence
within them of anything but air endangers the gaseous exchange. In
the common varieties of pneumonia, which were familiar to Colonel
Welch, the tissue of the lungs becomes gross, full of nodules, and
often degenerates into something more like liver than the soft, light,
elastic tissue of a healthy lung. Many of the dead at Devens had lungs
at least similar to the coarse, defiled lungs he had seen so many times
before in autopsy, but those were from men who had died ten days or
more after the onset of influenza and after major invasions by the
microorganisms commonly associated with pneumonia. The lungs of
those who had died quickly, sometimes only 48 hours after the first
ache and cough, were such as he had never seen before. There was
little or no consolidation of the lung tissue, yet the lungs were so
abnormal that pieces of them, which should have been as buoyant as a
child's balloon, sank when placed in water. Their most conspicuous
feature was the enormous quantity of thin, bloody fluid. It oozed out
of the lungs sectioned for examination, and in the large air passages
leading to the throat it mixed with air in a bloody froth. As rigor
 AN ABRUPT INTRODUCTION / 9

mortis set in, the fluid often poured from the nose and stained the
body wrappings.15.
Welch was little given to fits and starts; he was the most dignified
of men, as befitted a hugely successful and universally admired
Victorian physician. He was by personality the kind of man who
could, to paraphrase a writer of his generation, keep his head while
all about him were losing theirs. Furthermore, he was a pathologist
and by profession accustomed to a daily routine of horrors. If there
was anyone at Devens who could be depended upon as a pillar of
strength, it was this sage of Johns Hopkins. But, when he saw the wet
lungs of influenzal pneumonia in the fall of 1918, the pillar trembled.
"This must be some new kind of infection," he said, and then used
one of the few words in the lexicon of medicine that still have an aura
of superstitious horror, "or plague."
Two decades later, Doctor Cole remembered that he hadn't been
surprised that he and the other younger men had been disturbed,
"but it shocked me to find that the situation, momentarily at least,
was too much even for Doctor Welch."16
A number of medical men, on first brush with Spanish influenza,
thought it was something vastly more dangerous than any kind of flu
could be. A favorite guess was pneumonic plague, that form of the
Black Death of medieval history which is transmitted by breath, just
like influenza. Between 1910 and 1917 pneumonic plague had killed
people in wholesale lots in Manchuria and China, and in the latter
year some 200,000 laborers from North China had come round the
globe, many passing through North America, to work in France.
Maybe they had brought the plague, which, after modification by the
new environment, now was appearing as the so-called Spanish
influenza.17.
Other medical men associated Spanish influenza directly with the
war. Wherever his armies met in Europe, man was creating chemical
and biological cesspools in which any kind of disease might spawn.
Never before had such quantities of explosives been expended,
never before had so many men lived in such filth for so long, never
before had so many human corpses been left to rot above ground, and
never before had anything so fiendish as mustard gas been released
into the atmosphere in large amounts.
10 / EPIDEMIC AND PEACE, 1918

That was all theory, and the immediate problem was not the origin
of Spanish influenza but how to cure it and prevent its spread. If the
previous century of medical history was any measure, then the
doctors at Camp Devens and their colleagues throughout the world
were better prepared to deal with the problem of an epidemic than
any group of healers ever before. In that hundred years, more had
been learned about disease than had been learned in the thousands of
years preceding. Remedies for, vaccines against, or, at least,
methods of limiting the spread of smallpox, typhoid, malaria, yellow
fever, cholera, and diphtheria had been devised and proven success-
ful. Welch and his colleagues were the direct heirs of Jenner, Pas-
teur, Koch, and the great sanitationists, Chadwickand Shattuck, and
were contemporaries of Walter Reed and Paul Ehrlich. Welch's
superior, Army Surgeon General William Crawford Gorgas, had led
the forces that controlled and almost eliminated the scourge of the
Caribbean, yellow fever, from Cuba and the Panama Canal Zone. Yet
these doctors now stood nearly as helpless in the presence of this
epidemic of Spanish influenza as Hippocrates and Galen in the
presence of epidemics of their time. Welch, Vaughan, Cole, and all
the physicians of 1918 were participants in the greatest failure of
medical science in the twentieth century or, if absolute numbers of
dead are the measure, of all time.
There was no leisure for the doctors to muse on their inability to
protect humanity from the malevolence of nature. The machinery of
the army continued to function, despite the epidemic. Men, possibly
infected, were leaving Devens for other camps, and on September 25
a new lot of draftees arrived, many of them to become victims and
carriers of the disease.18
Welch, Vaughan, and Cole made their learned recommendations
to General McCain that same day. No more troops should be ordered
to Devens or dispatched to other camps from Devens; as soon as
possible, the number of troops at Devens should be reduced by
10,000; quarters for men and officers should be expanded to provide
50 square feet of floor space per individual; more doctors, nurses,
and hospital space should be obtained. If General McCain had
expected magic formulae, these heirs of Pasteur and Koch had none
to offer, and with shortages of everything, especially medical person-
nel, and a division to train and orders to obey and a war to