Pandemic Influenza 1918

Professor N. R. Grist (Glasgow) shares a copy of a letter written by a U.S. Army physician during the influenza pandemic of 1918 (British Medical Journal, December 22-29, 1979; 2(6205):1632-3).

Epidemic influenza remains the biggest and unconquered acute threat to human health, inflicting damage and death far beyond familiar notification data. The impact of influenza A is particularly severe during periodic pandemics owing to novel antigenic variants that override immunity from the experience of earlier subtypes. It is salutary to remember that we do not really understand why the devastating pandemic of 1918-19 was so severe, and that we cannot therefore be confident that our modern medical measures would succeed against a similar future challenge.

As a reminder of the grim reality of that pandemic, the following letter may be of interest. It was found in a trunk in Detroit among other medical papers handed to the Department of Epidemiology of the University of Michigan. A copy was given to me in 1959 by the late Dr. T. Francis, jun., and it is now published with the agreement of Dr. V. Hawthorne, his successor as head of the department.

—N. R. Grist

Copy of original letter found in Detroit, 1959

Camp Devens, Mass.
Surgical Ward No 16
29 September 1918
(Base Hospital)

My Dear Burt-

It is more than likely that you would be interested in the news of this place, for there is a possibility that you will be assigned here for duty, so having a minute between rounds I will try to tell you a little about the situation here as I have seen it in the last week.

As you know I have not seen much Pneumonia in the last few years in Detroit, so when I came here I was somewhat behind in the niceties of the Army way of intricate Diagnoses. Also to make it good, I have had for the last week an exacerbation of my old “Ear Rot” as Artie Ogle calls it, and could not use a Stethoscope at all, but had to get by on my ability to “spot” ‘ em thru my general knowledge of Pneumonias. I did well enough, and finally found an old Phonendoscope that I pieced together, and from then on was all right. You know the Army regulations require very close locations etc.

Camp Devens is near Boston, and has about 50,000 men, or did have before this epidemic broke loose. It also has the Base Hospital for the Div. of the N. East. This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed. All assembleges of soldiers taboo.

These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.

The normal number of resident Drs. here is about 25 and that has been increased to over 250, all of whom (of course excepting me) have temporary orders-“Return to your proper Station on completion of work”. Mine says “Permanent Duty”, but I have been in the Army just long enough to learn that it doesnt always mean what it says. So I dont know what will happen to me at the end of this.

We have lost an outrageous number of Nurses and Drs., and the little town of Ayer is a sight. It takes Special trains to carry away the dead. For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle. An extra long barracks has been vacated for the use of the Morgue, and it would make any man sit up and take notice to walk down the long lines of dead soldiers all dressed and laid out in double rows. We have no relief here, you get up in the morning at 5 .30 and work steady till about 9.30 P.M., sleep, then go at it again. Some of the men of course have been here all the time, and they are TIRED.

If this letter seems somewhat disconnected overlook it, for I have been called away from it a dozen times the last time just now by the Officer of the Day, who came in to tell me that they have not as yet found at any of the autopsies any case beyond the Red Hep. stage. It kills them before they get that far.

I dont wish you any hard luck Old Man but I do wish you were here for a while at least. Its more comfortable when one has a friend about. The men here are all good fellows, but I get so damned sick o Pneumonia that when I go to eat I want to find some fellow who will not “Talk Shop” but there aint none nohow. We eat it live it, sleep it, and dream it, to say nothing of breathing it 16 hours a day. I would be very grateful indeed if you would drop me a line or two once in a while, and I will promise you that if you ever get into a fix like this, I will do the same for you.

Each man here gets a ward with about 150 beds, (Mine has 168) and has an Asst. Chief to boss him, and you can imagine what the paper work alone is – fierce,– and the Govt. demands all paper work be kept up in good shape. I have only four day nurses and five night nurses (female) a ward-master, and four orderlies. So you can see that we are busy. I write this in piecemeal fashion. It may be a long time before I can get another letter to you, but will try.

This letter will give you an idea of the monthly report which has to be in Monday. I have mine most ready now. My Boss was in just now and gave me a lot more work to do so I will have to close this.

Good By old Pal,
“God be with you till we meet again”
Keep the Bouells open.
(Sgd) Roy.

REPORT #93

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