BrittanyL.

Mooney
th
December7
,2015

SocialHistoryHI217

ADoctornamedRoy
"
IHADALITTLEBIRD,ITSNAMEWASENZA.IOPENEDTHEWINDOW,AND
INFLUENZA."

Theinfluenzapandemicof19181919killedmorethan20millionpeopleworldwide.On
th
September29
,1918,amilitaryphysicianwrotealetterdescribingthehorrificillnessstriking

Boston.Thedeathtollrosearoundhimashetriedtocareforhispatientsduringthemostdeadly
mutationoftheinfluenza.

Fromtheyearsof1918to1919,theUnitedStatesexperiencedmorethanjustthetailend
ofWorldWarI.Adeadlyillness,whatisnowreferredtoasTheSpanishFlu,hadsweptthe
nation.TheAlliesofWWIlatercalledthepandemictheSpanishFlubecauseofthepress
attentiontheillnessreceivedbySpanishofficialswhenitstruckSpaininNovemberof19181.
Initially,theU.S.governmentandnewspaperstriedtodownplaytheseverityoftheillnesswhen
itstartedtoappearinthestatesinMarchof1918infearofpublicitynegativelyaffectingwar
morale.SpainwasnotinvolvedinWWIanddidnotimposewartimecensorshipinregardstothe
illness2.InAmerica,itwastheusualfluseasonandtheU.S.couldnotaffordtoslowdown
militarytraining.However,theU.S.couldnotoverlooktheseverityofthevirusindefinitelyas
thepandemicprogressed.Thepandemicof19181919occurredinthreewavesthefirstwave
hadoccurredinthelatespringandsummerof1918andwasmild,thesecondwaveoccurredin
thefallof1918andwasasevereoutbreakandthemostdeadlyofall,andthethirdwave
occurredinthespringof19193 .Throughouthistory,influenzavirusstrainshavemutatedand
causedepidemicsandevenglobalpandemics,butduringatimeofwar,resourceswerenotso
willinglydivertedtoprecautionarytacticsinpreparationtofightthenewenemytheinfluenza.
Killingmorethan20millionpeopleacrosstheworld,thisdiseaseleftmorepeopledead,
widowedandorphanedinlesstimethananyweaponcouldinallfouryearsofWWI4.
Intheyear1918,theUnitedStatesPublicHealthService(PHS)hadjustbeguntorequire
stateandlocalhealthdepartmentstoprovidereportstothegovernmentaboutdiseasesintheir

ChristineKreiser.1918SpanishInfluenzaOutbreak:TheEnemyWithin.HistoryNet:WhereHistoryComesAlive
WorldU.S.HistoryOnline.2008.
2
Ibid.
3
UnitedStatesDepartmentofHealthandHumanServices.TheLegacyofthePandemicFlu.gov.
2012.
4
MollyBillings.The1918InfluenzaPandemic.HumanVirologyatStanfordUniversity.

2013.

districts5.However,influenzawasntareportablediseaseonthelist.Despitethatbeingthecase,
inearlyMarchof1918,HaskellCountyofKansassubmittedatroublesomereporttoPHS.The
reportwastoinformthefederalgovernmentthat18casesofsevereinfluenzahadbeen
identifiedinmedicalfacilitiesinthejustthatonecounty.ByMay1918,thereweremorereports
oftheseverevirusspreadingintheUnitedStates,supposedlytricklinginfromsoldierscoming
backfromEurope 6.Theoriginofthisinfluenzavariantisnotpreciselyknown,butsome
speculatethatitmayhaveoriginatedinChinainararegeneticrecombinationoftheinfluenza
virus,whichcreatedanewstraintowhichmuchofthegeneralworldpopulationhadno
immunity7.Withinacoupleofmonths,thisfirstwaveofinfluenzahadspreadfromthemilitary
tothecivilianpopulationinEurope,thenoutwardtoAsia,Africa,SouthAmericaandbackagain
toNorthAmerica8.

InlateAugustof1918,theinfluenzaalmostcertainlymutatedagain.Inmomentumofits
virulence,theviruseruptedinportcitiesthatloadedandunloadedwarshipmentsofmachinery
andsupplies.CitieshithardestbythesecondwavewereFreetown(SierraLeone),Brest
(France),andBoston(Massachusetts)9.Peoplesufferedfromfevers,coughing,vomiting,and
muscleandjointpains.Peoplewerestrickensuddenlyonthestreetsoratworkinthefactories,
shipyardsandoffices.Deathoftenquicklyfollowedtheonsetofpneumonia10.Doctors,nurses,
expertsandotherpublichealthofficialshadlittletimetoregistertheseverityoftheoutbreakand
manywereinshockasthedeathtollskyrocketed.Withindays,thediseasespreadfromtheports
UnitedStatesDepartmentofHealthandHumanServices.TheLegacyofthePandemicFlu.gov.
2012.
Ibid.
7
MollyBillings.The1918InfluenzaPandemic.HumanVirologyatStanfordUniversity.

2013.
8
UnitedStatesDepartmentofHealthandHumanServices.TheLegacyofthePandemicFlu.gov.
2012.
9
Ibid.
10
ChristineKreiser.1918SpanishInfluenzaOutbreak:TheEnemyWithin.HistoryNet:WhereHistoryComesAlive
WorldU.S.HistoryOnline.2008.
5
6

ofBostonintotheinnercity.Bythemiddleofthemonth,theepidemictouchedtheedgesofthe
countryCalifornia,NorthDakota,Florida,andTexas11 .
HowtheillnessunfoldedinBostonduringtheseconddeadlywave,howphysiciansand
medicalprofessionalsunderstoodtheinfluenzain1918,andwhatitfeltliketobeacaretakerof
otherswhileadeadlyvirussweptAmericaandkilledanestimated675,000ofyourpeople(ten
timesasmanyAmericansthaninWWI)12canonlytrulybeunderstoodfromafirsthand
historicalaccount.35milesawayfromBoston,amilitaryphysiciannamedRoystationedat
SurgicalWardNo.16inCampDevens,Massachusettswrotealettertoafellowphysicianduring
thissecondwavedescribingtheconditionsofhislocation13.Hedescribedhowhetriedhisbest
toupholdhisoathasaphysiciantosavelives,butexpressedhisfrustrationduetotheuncertainty
ofwhatiscausingtheinsurmountablenumberofdeathsallaroundhim.Royswrittenaccountof
hisappallingexperiencegiveshistoryakeyprimarysourceofthissignificanteventduringthe
1918influenzapandemic.
th
TheletterwaswrittenonSeptember29
,1918attheBaseHospitalofCampDevens.In

hisletter,RoytoldafriendfromDetroit,Burt,aboutwhatisoccurringinAyer,Massachusetts.
HecommentedonhowtherehadnotbeenalotofpneumoniainDetroitinthepastfewyears.He
impliedthatwhatisnowknownasapandemicmustnotyetspreadsouthinAmericaatthistime.
Symptomsofthe1918influenzaweresobrutalthatmanyphysiciansmistookitformalaria,
cholera,dysentery,dengue,typhoidandeventheplague.Roywasaseasoneddoctor,who,
despitehavinghadanailmentoftheearthatlefthimunabletouseastethoscope,wasableto

UnitedStatesDepartmentofHealthandHumanServices.TheLegacyofthePandemicFlu.gov.
2012.
Ibid.
13
NormanRoyGrist.Pandemicinfluenza1918.BostonMedicalJournal,

Dec.1979.pg.16321633.
11
12

spot[symptomsof]pneumonias.Roydescribedtheearlydiagnosticprocessasdifficult
becausehispatientsdiefromsuffocationwithinhoursofsymptomonsetandhaveinconclusive
autopsies.Hehypothesizedthattheillnessislikelagrippeorinfluenza,butmorelikelyanew
mixedinfection,ofwhichhedidnotknowabout.Anotablesymptomhedescribedisthatof
mahoganyspotsovercheekbonesandcyanosisstartingfromtheearstoallovertheface.He
saidthatthesymptomsmakeitsoonecannottellthedifferencebetweenthefaceofacolored
manandawhiteman.Hedescribedhisdayasmostlyidentifyingdryandmoistralesinhis
patientschestswhichhenotesisasignofpneumoniaanddeath.

AnArmydoctorexaminesafluvictimatCampDevens,Massachusetts
Credit:TheU.S.Army14

RoyexplainedthatCampDevenshasabout50,000menandthatthenormalnumberof
doctorswas25atthecamp.Theepidemichadbeengoingonforfourweeksatthetime,reported

14

MartinHill.TheSpanishFluandWartimeSecrecy.MilitaryHistoryArchivesDecodedPast.2014.

Roy,andwasrapidlydeveloping.Thecamphadtemporarilyincreasedthenumberofdoctorsto
250.Hehadbeengivenpermanentdutyatthecamp,butexpressedtohisfriendthathehadbeen
intheArmylongenoughtoknowthatthingscouldalwayschange.
Royregularlyexpressedhisconcernoverthesheernumberofdeathsinhisletter.Hesaid
thatheexpectedmaybe20mentodie,butthatwasnotthecase.Henotedthatpeoplewere
droppinglikefliesandthatithadmadehimnervousthattheaveragedeathtolladaywas100.
Hereportedthatanoutrageousnumberofdoctorsandnurseshaddiedandthatthewholetown
ofAyerwasasight.Hedescribedsceneandsaidthatspecialvehicleshadcametotakeaway
thedeadoncetheyhadrunoutofcoffins.Themorguewasrightbehindhiswardandhesaidthat
thesightofthebodieslaidoutinlongrowswasworsethanabattlefieldinFrance.
Hesaidthatapartofhimwishesthathisfriendwastherewithhimbecausetherewasno
onetotalktoatthecampaboutanythingbutthesickness.Hesaidthatheworksfrom5:30amto
9:30pmeverydayandthatthetalkofthepneumoniaconsumeshim.Hesaidthathedidnot
wishhisfriendanyhardluckthoughanditisbetterthathestayedawayfromthisplace.Roy
gaveaninsideperspectivetothelifefordoctorsinsidethecamp,explaininghowsomanyof
themthathadbeentheresincethebeginningoftheoutbreakhadgrownwearyandtired.He
himselfwastiredbecausethegovernmenthaddemandedalotofpaperworkfromhimandhe
wasseverelyunderstaffedwithonlyfourdaynurses,fivenightnurses,awardmasterandfour
orderliestocareforallofthepatients.Toconcludehisletter,Royapologizedforthe
discontinuityofhiswritingashewassoverybusyandhadbeenpulledawayfromwritingmany
times.

th
November11
,1918markedtheendofWWIandAmericawaseagertoforgetthe

horrorsofthepandemic.PeoplecelebratedArmisticeDaywithparadesandlargeparties,despite
publichealthofficialsdiscouragingthismuchcontactwithothers15.Thefearsofpublichealth
officialswereconfirmedwheninthespringof1919,thethirdwavehit.Thousandswereinfected
anddied.Yearslater,scientistsanalyzedthestatisticaldataofthe19181919influenzadeaths
andfoundauniquevictimology.Theanalysisshowedthatthisinfluenzawasnotonlysignificant
inthenumberofpeoplewhodied,butwhodied.Whilemostinfluenzastrainstargettheimmune
systemsoftheelderlyorchildren,thisstrainprovedtobeverydifferentitravagedpreviously
healthy25to35yearoldadults16.Itisunknownwhythisagegroupwasmostvulnerable.A
viruswithaWcurvevulnerabilitytrend,asseeninthegraphbelow,isagreatsocialtragedy.
Althoughpeopletriedtoforgettheillnessthatarrivedquickly,flourishedandwasgone,we
cannotforgettheyoungpeoplewhodiedandthegenerationthathadyettomakeitsmajor
contributiontosociety.Itisimportanttohavefirsthandaccountsofpeoplewhosurvivedthis
sweepofillnesslongenoughatleasttogiveinsightintowhatitwasliketobethere,suchas
Roysaccountoftryingtosaveyoungpeopleslivesduringtheepidemic.Whilethisgraphic
presentationofdeathduringthepandemicisinformational,Royshorrifyingexperienceofbeing
adoctorwhowassupposedtobeabletosavelivesduringatimeofanillness(thatcouldkilla
healthypersoninamatterofhourswithnovaccinedeveloped)givesamorepersonalsnapshot
intolifeinthe1918influenzapandemic.

MollyBillings.The1918InfluenzaPandemic.HumanVirologyatStanfordUniversity.

2013.
MiloradRadusin.TheSpanishFluPartII:TheSecondandThirdWave.

HistoryofMedicine,Volume10.pg.919.
2013.
15
16


Theabovegraphicpresentationshowsthedifferenceintheagespecificdeathrateforinfluenzaand
pneumoniaper100,000personsineachagegroup,USA,intheinterpandemicyears(thedashedlinethe
Ucurve)andinthepandemicyear(solidlinetheWcurve) 17

ThismilitaryphysiciansignstheendofhisletterRoy.Thisname,theinformation
abouthisoccupation,hisstationinthemilitary,andhiswordsareallweknowaboutthisman
therestisamystery.Theletteritselfwaslostinhistoryforatimebeforeitwasdiscoveredina
trunkinDetroitamongothermedicaldocumentsandturnedintothedepartmentof
epidemiologyattheUniversityofMichigan.AcopywasgiventoDr.NormanRoyGrist,an
infectiousdiseasespecialistandprofessoroftheUniversityofGlasgow,Scotlandin195918.He
wasfirsttopublishthisletter,inagreementwithothers,intheBritishMedicalJournalin197919 .
Thisbeingsaid,manysourceshavemistakenlydescribedDr.N.R.Gristastheauthorofthis
letter.Dr.Grist,however,wasbornintheyear1918,theyearthisletterwaswritten.Itis
possiblethatthiscommonyearandthenameRoyiswhathasallowedforamistakein
authorshiptobemadeandthislettertobecreditedtothewrongperson.However,thisdoesnot

MiloradRadusin.TheSpanishFluPartII:TheSecondandThirdWave.

HistoryofMedicine,Volume10.pg.919.
2013.
18
NormanRoyGrist.Pandemicinfluenza1918.BostonMedicalJournal,

Dec.1979.pg.16321633.
19
Ibid.
17

detractfromtheutilityofthisletterinunderstandinghowphysicianswentaboutearly
diagnosticsoftheinfluenza,remindingusthatthestudiesofvirologyandmicrobiologywerein
theirinfancy,andgivinginsightintothefrighteningexperienceoffirstresponsemedical
officialsduringtheSpanishInfluenza,incomparisontowhichnootherepidemichasyetclaimed
asmanylives.


WorksCited

Billings,Molly.The1918InfluenzaPandemic.HumanVirologyatStanfordUniversity.

2013.

Grist,NormanRoy.Pandemicinfluenza1918.BostonMedicalJournal,

Dec.1979.pg.
16321633.

Hill,Martin.TheSpanishFluandWartimeSecrecy.MilitaryHistoryArchivesDecoded
Past.2014.

Kreiser,Christine.1918SpanishInfluenzaOutbreak:TheEnemyWithin.HistoryNet:Where
HistoryComesAliveWorldU.S.HistoryOnline.2008.

Radusin,Milorad.TheSpanishFluPartII:TheSecondandThirdWave.

HistoryofMedicine,
Volume10.pg.919.2013.

UnitedStatesDepartmentofHealthandHumanServices.TheLegacyofthePandemic
Flu.gov.
2012.