Camp Devens Letter

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Camp Devens Letter

Influenza Pandemic of 1918

Letter

By: Roy

Date: September 29, 1918

Source: "Camp Devens Letter." British Medical Journal (December 22-29, 1979).

About the Author: The writer of this letter, known only as "Roy," was an army physician assigned to Camp Devens, Massachusetts, during the influenza pandemic of 1918.

INTRODUCTION

The influenza pandemic of 1918 killed more people than any other epidemic in recorded history, including the bubonic plague pandemic of the fourteenth century known as the Black Death. Although it apparently originated in China as a variation of the influenza virus, the 1918 flu was generally known as the Spanish flu because of the large number of deaths it caused in Spain in early 1918.

The Spanish flu moved too quickly for public health authorities to adequately respond. The disease, nicknamed the "purple death," caused the skin to turn the color of wet ashes and sparked sudden nosebleeds. It struck suddenly—a healthy person could become deathly ill within one to two hours. The fever that accompanied this flu often reached 105°F. Aches also were characteristic of the disease with sufferers commonly describing themselves as feeling as if they had been bruised or beaten all over their bodies. A cough, dripping nose, and sore throat completed the diagnosis of influenza. Those in the grip of the disease were typically delirious and occasionally were found wandering in the streets. Pneumonia was a common complication of the Spanish flu and contributed to the high death rate. Many who survived the flu were so weakened by their illness that they fell prey to bronchitis and pleurisy. As the symptoms of the flu subsided, weakness and depression often lingered.

Although the viral strain responsible for the Spanish flu was a particularly virulent one, the worldwide impact of the disease was intensified by the fact that it broke out in the last year of World War I (1914–1918). The massive worldwide movements of troops and shifts of civilian populations during the conflict provided the best possible opportunity for the spread of airborne germs. In the United States, influenza first appeared in early 1918 in the chief embarkation port of New York City. The U.S. Army lost almost as many soldiers from the illness as they lost in combat, snarling attempts to reinforce divisions already in battle and significantly influencing the conduct of the war.

In both military and civilian life, hospital resources were strained by the sheer number of persons sick with influenza. Physicians and nurses were overwhelmed and in short supply. Quarantine measures were enacted, but did little to stem the spread of the disease. Mortuaries were overcrowded. One Army physician, known only as "Roy," documented his observations of the epidemic at the base hospital at Camp Devens, Massachusetts. The letter was found years later and now resides in the archives at the University of Michigan.

PRIMARY SOURCE

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 Diagnosis. 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 over-look 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. Hepatitis. 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.

SIGNIFICANCE

By the end of 1919, the influenza pandemic had run its course. However, influenza continues to be a serious disease, causing many deaths worldwide each year. Even in a year when only a mild form of influenza circulates and despite the availability of vaccines, an estimated one to one and one-half million people die from influenza infections or from complications related to the disease. Generally, the very old, the very young, and those with compromised immune systems are more vulnerable to complications from the flu. During the 1918 influenza pandemic, an exaggerated immune response to the virus occurred in otherwise young, healthy adults and led to the severe lung inflammation that caused death.

The influenza pandemic of 1918 killed more people—mostly otherwise healthy young adults—than any other disease of similar duration in world history. Exact numbers of those struck by influenza are unknown. In 1919, a U.S. Public Health Service survey of eleven cities and towns discovered that about 280 out of 1,000 persons had influenza during the pandemic, yielding an estimated national infection rate of over 25 million afflicted Americans in 1918–1919. Deaths worldwide were estimated at 30 million to 75 million, or about 2.5 to 5 percent of the world's population in 1918.

In 2005, scientists announced that they had sequenced the genetic structure of the virus responsible for the 1918 influenza pandemic. By analyzing tissue samples recovered from a 1918 flu victim found frozen in the Alaskan tundra, along with preserved lung tissue samples from affected World War I soldiers, scientists were able to determine that the virus is a variety of avian (bird) influenza, known as the H1N1 strain.

Influenza epidemics tend to occur about every thirty years, and recent events have significantly heightened concern among scientists that another deadly pandemic may be on the horizon. In 2005, the World Health Organization warned that the H5N1 avian influenza strain (commonly known as the "bird flu"), which recently emerged in Asia, may lead to the next global influenza pandemic. Evidence suggests that the H5N1 flu is genetically similar to the virus that caused the 1918 pandemic. Although it is difficult for the H5N1 flu virus to be spread from person to person, mutations in the virus could alter this disease-transmission picture. If the virus changes so that it can be easily spread in airborne droplets, such as from a cough or sneeze, a global pandemic could result. In 2005, the world's population totals about 6.5 billion people—more than three times greater than the 1918 population. An influenza pandemic with mortality rates similar to those seen in the 1918 epidemic could kill an estimated 150 million people.

Strategies to counter a future avian influenza pandemic include tracking wild birds that host avian flu viruses, culling infected domestic birds, quarantining birds and poultry in trade, producing more antiviral drugs, and developing a vaccine to target the H5N1 influenza virus.