Fever of War: The Influenza Epidemic in the US Army during WWI – Book Review

Fever of War: The Influenza Epidemic in the US Army during World War I
Carol R. Byerly
New York University Press, 2005

"The 1918 influenza virus was an unusual strain. Like the common flu, its morbidity rate (rate of sickness) was much higher than its mortality rate. But where the flu usually only kills the very weak in a population (the common U-shaped mortality curve), the 1918 virus was different. It produced a “terrible W” curve of high mortality for the young and old . . . with an unusual peak of mortality at its center. The 1918 flu was deadliest for young adults ages twenty to forty, killing not only the weak, but also the strongest in the population." (From the introduction).

Influenza. In the time before the advent of antibiotics and the discovery of the virus causing the malady (both in the 1930s), just the mention of the illness could spur panic and give rise to wildly inaccurate rumors. In contrast, the Army Medical Department, flush with confidence from their successful eradication of many tropical diseases – including dengue fever, typhus, malaria and yellow fever – felt confident that it could manage any outbreak or disease, so long as standards of cleanliness and sanitation were observed. Before the end of 1918, many physicians and epidemiologists were reduced to questioning their knowledge and abilities, and the populace doubting and questioning the competence and dedication of physicians and others in the medical field.

Professor Byerly sheds light on an episode common not just to the US Armed Forces or the US populace, but a pandemic; a literally worldwide epidemic that is believed to have claimed a death toll of nearly 50 million, with an estimate of 17 million in India alone. In sheer numbers, this catastrophe exceeds even the “Black Death” of the 14th Century. Prof. Byerly notes that there is little mention of this flu epidemic in official unit histories (including the Medical Department) and in personal memoirs. The powers-that-be seem unable or unwilling to record the path of an event that they were unable to adequately describe, and less able to defeat. Through exhaustive research, Prof. Byerly uncovers a nearly ninety year ‘conspiracy of silence’, through letters, journals, memoirs and the resources of the National Archives, various military archives and academic sources. A common current runs through many of the personal correspondence and the official notations of medical personnel treating afflicted soldiers, both in America and France. Many parents, wives, brothers, sisters, etc, expressed dismay at the occurrence of their loved-one’s death ‘. . . even before they have a chance to fight the Hun.’

Until the discovery of more pathogens, and the development of new procedures, immunizations and equipment, disease had always been a greater killer than combat (57,460 American soldiers died of disease, 50,280 of combat wounds) – but this was different. A modern, well-educated and dedicated medical community found themselves essentially helpless, watching their patients die right before their eyes. Among comments by doctors and epidemiologists were:

This was no ordinary flu – in these cases, the mortality rate from infleuenzal pneumonia was nearly 100 percent, involving all lobes of the lungs, and “extensive toxic changes occurred in the liver, spleen and kidneys.”

. . . patients bled from the nose and ears, and coughed up bloody sputum, which one report described as “foamy and bloody sometimes mixed so completely as to resemble tomato puree.” Many patients became incontinent and some nauseous. Cyanosis (blueness of skin from deficiency of oxygen in the lungs) was one of the most alarming symptoms.

The flu victims came to the hospital, “with what appears to be an ordinary attack of ‘La Grippe’ or Influenza”, which then developed into, “the most vicious type of Pneumonia that has ever been seen, . . . 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 colored men from the white.” Then, “it is only a matter of a few hours until death comes, and it is simply a struggle for air until they suffocate.”

Army pathologists were shocked by their findings of the flu’s impact inside a victim’s body. Autopsy reports often reported on the livid condition of the lungs – normally light and airy, now sodden and distended, filled with a frothy, bloody liquid.

Another issue relevant to diagnosis and treatment of influenza in the US Armed Forces (and likely in American society as well) was segregation of the services. Few black physicians and nurses were permitted to serve, and black troops were generally more poorly treated, including condition of tents and barracks, attitudes toward them (both in regards to susceptability to disease and in general regard), location of tents/barracks and type of work assigned (generally unskilled, menial work). In fact, rates of disease among black troops were lower than for white troops (15.8% vs 19.8%).

Whatever the reason or reasons for the US Army, especially the Medical Department, to let this traumatic event fade into history, Prof. Byerly’s superb research and writing bring to life an event that held the world in its terrible grasp for more than a year. Compelling and enlightening, Fever of War is well worth the reading.