Navy and 'Great Influenza' Changed the World

Review by Bill Doughty

One hundred years ago another wave of an influenza epidemic crashed on America's shores.

(Illustration from Penn Medicine News)

"By February 7, 1920, Influenza had returned with enough ferocity that the Red Cross declared, 'Owing to the rapid spread of influenza, the safety of the country demands, as a patriotic duty, that all available nurses or anyone with experience in nursing ... (offer) their services," according to John M. Barry, author of "The Great Influenza: The Epic Story of the Deadliest Plague in History" (Viking/Penguin, 2014).

Courage in the Face of Fear

Fortunately, the epidemic did not hit with the same deadly force throughout 1920 that it had in the previous two years. 

The epidemic of 1918 erupted with such speed and scope that it created worldwide fear and terror. This influenza seemed to target young, otherwise healthy, adults as well as people with vulnerable immune systems.

"In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They could not control it because every true report had been diluted with lies. And the more the officials and newspapers reassured, the more they said, 'There is no cause for alarm if proper precautions are taken,' ... the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death."

The misnamed "Spanish Flu" of 1918 (Barry makes a strong case that it originated in Kansas) took more American lives in the first year (675,000) than all the U.S. service members who died fighting in WWI, WWII, the Korean War and Vietnam War combined. In one week in October, 4,597 Philadelphians died of the disease.

Paul Lewis

On the front lines of the war against the killer influenza epidemic – in laboratories and medical facilities – U.S. Navy and other military and civilian researchers searched for the pathogen as well as a vaccine and a cure.

This book is dedicated, in part, to one of those Navy warriors, and opens with a scene about him: "The Great War had brought Paul Lewis into the navy in 1918 as a lieutenant commander ..." Lewis had previously helped prove that a virus caused polio, "a discovery still considered a landmark achievement in the history of virology."

Lewis saw the early signs of disease in sailors in Philadelphia, where the virus was killing five percent of Sailors who showed any symptoms of influenza. 

In Boston, another Navy medical warrior, Lieutenant Commander Milton Rosenau at the Chelsea Naval Hospital, mobilized to fight the epidemic.

(Photo from Bureau of Medicine and Surgery)

"Rosenau too was a scientist who had chosen to leave a Harvard professorship for the navy when the United States entered the war, and his textbook on public health was called 'The Bible' by both army and navy military doctors."

Other military doctors and researchers who raced against the disease included William Henry Welch, Simon Flexner, Victor Vaughn and William Gorgas. Oswald Avery went from Army private to captain; he would eventually make "the most profound discovery of all" in his search for the cause of the disease.

The enemy in 1918 was not only the epidemic of disease, but also a pandemic of fear. "Uncertainty follows distrust, fear follows uncertainty, and, under conditions such as these, terror follows fear." Truth matters.

Emergency hospital in Funston, Kansas.

A Maritime Component

Author-historian Barry profiles each of these courageous warriors as well as dozens of other people who faced the crisis. He reveals the strong maritime component to its global spread.

(Photo from Naval History and Heritage Command)

The pandemic of 1918-1920 was fueled by WWI fervor and war mobilization – in crowded barracks and aboard ships, including international steamers and U.S. Navy vessels. Dozens of shipyards were hit and had to close. Naval hospitals were overwhelmed. Navy brig prisoners volunteered as test subjects for Lt. Cmdr. Lewis and other scientists.

Sailors unintentionally brought deadly influenza to Great Lakes Naval Training Center and Newport Naval Base in Rhode Island; to New Orleans and Puget Sound; back-and-forth to Europe; as well as across the Pacific aboard USS Logan to Guam. Adm. Albert Gleaves and his captains dealt with effects of the pandemic, including aboard USS Leviathan.

Navy collier USS Brutus carried a relief expedition to Juneau, Alaska. "They found terrible things. Terrible things," Barry writes. "In Nome, 176 of 300 Eskimos had died. But it would get worse." Other Red Cross relief teams to the Aleutian Islands found devastation caused first by the disease, then by starvation and finally by starving dogs.

Nineteen U.S. Navy nurses died on active duty during the war, more than half from influenza. One of the survivors was the second superintendent of the Navy Nurse Corps, Chief Nurse Lenah H. Sutcliffe Higbee, recipient of the Navy Cross and namesake of the first USS Higbee, commissioned in 1945. The keel was laid for the future USS Lenah H Sutcliffe Higbee (DDG 123) in November 2017.



Changing the World

The epidemic of 1918-1920 occurred at a time when women increased demands for the right to vote, a right won 100 years ago. Women had supported the war effort in Europe, and they served on the front lines in the fight against the epidemic.

The nation and world changed in other ways too in those first decades of the 20th century. 

President Woodrow Wilson's physician, Navy Rear Adm. Cary Grayson (who had served as presidential physician to Presidents Teddy Roosevelt and William Howard Taft) accompanied Wilson to the peace conference in Paris in 1919. Both Wilson and Grayson, as well as Wilson's wife and others, contracted influenza while in Paris.

President Wilson and Rear Adm. Grayson

Barry contends that the disease caused physical weakness and some mental lapses in the commander-in-chief and may have led to his stroke four months later. But the devastating effects of Wilson's bout with influenza also may have led to his concessions to the allied enemies of Germany in order to save his League of Nations.

"Historians with virtual unanimity agree that the harshness toward Germany of the Paris peace treaty helped create the economic hardship, nationalistic reaction, and political chaos that fostered the rise of Adolf Hitler," Barry writes. Feelings of persecution and resentment in Nazi Germany led to another world war.

Other ways the epidemic changed the world but for the better: Science, as represented by medical centers and researchers, triumphed over superstition. Corrupt local authoritarian governments in Philadelphia (the Vare political machine) and New York (Tammany Hall) were exposed and impeached in the court of public opinion. Truth and ethics were shown to be supremely important in the face of fear and terror.

"The media and public officials helped create that terror – not by exaggerating the disease but by minimizing it, by trying to reassure.Terror rises in the dark of the mind, in the unknown beast tracking us in the jungle. The fear of the dark is an almost physical manifestation of that. Horror movies build upon the fear of the unknown, the uncertain threat that we cannot see and do not know and can find no safe haven from. But in every horror movie, once the monster appears, terror condenses into the concrete and diminishes. Fear remains. But the edge of panic created by the unknown dissipates. The power of the imagination dissipates."

Cmdr. Richard Shope

Meanwhile, researcher Paul Lewis had remained perpetually restless both during and after the epidemic. The microscope was his periscope searching for an enemy lurking in his laboratory – "the mysteries he embraced. He settled into them like a man casting off into an impenetrable ocean fog, a fog that made one feel both alone in and part of the world.

"Among the warriors against fear was Paul Lewis's protege and assistant, Richard Shope. 

Shope investigated swine flu in the 1920s and by 1931 published his papers showing his discoveries. He included Lewis's name as an author on one of his papers.

Shope's research was successful. "He had found the cause of influenza, at least in swine," Barry writes. "We now know that the virus he found in swine descended directly from the 1918 virus, the virus that made all the world a killing zone."

In 1928, in England, Alexander Fleming serendipitously discovered penicillin while researching influenza. Oswald Avery's work on influenza led directly to the discovery of DNA, further changing the world.

Applied Science: Coronaviruses

Barry provides more than a history of the epidemic. He also explains coronaviruses, Acute Respiratory Distress Syndrome, and the science of the influenza virus at the cellular level, including the difference between a slower mutating DNA virus and a faster mutating RNA virus.

"Influenza is an RNA virus. So is HIV and the coronavirus. And of all the RNA viruses, influenza and HIV are among those that mutate the fastest," Barry writes.

"[O]ne cannot leave this subject without speaking to other questions: the likelihood and potential danger of another influenza pandemic, what we can learn from the one of 1918-1919, and how we can apply those lessons to the emergence of a new pathogen, whether that pathogen is a weapon of terror or a new natural menace – such as Severe Acute Respiratory Syndrome, SARS, the disease which spread from animals to man in the spring of 2003 and threatened to become a major pandemic.The answer to the first question – the likelihood and potential danger of another influenza pandemic – is not very reassuring. Every expert on influenza agrees that the ability of the influenza virus to reassort genes means that another pandemic not only can happen. It almost certainly will happen."

Barry offers a special discussion of the coronavirus SARS – Severe Acute Respiratory Syndrome – that appeared in China in 2003 and spread quickly across borders bringing with it susceptibility to ARDS. The Navy forward deployed to the western Pacific was concerned about the possibility of SARS outbreaks in 2004. The Navy maintains a preventive medicine SARS webpage as part of Ready Navy. 

The Navy (Navy and Marine Corps Public Health Center), DoD and Centers for Disease Control are leaning forward to provide information and prevention tips regarding the newly emerged novel coronavirus (2019-nCoV) that reportedly originated in Wuhan, China.

Today, unlike 100-plus years ago, scientists throughout the world are able to communicate and collaborate within seconds. They can, if allowed, share information and assistance across borders. An informed public can make rational decisions and not succumb to fear. Medical scientists have more tools and information to fight against pandemics.

Read this book to see the fate of Paul Lewis after the war. 

Right up there with McCullough's sweeping history books, Barry's "The Great Influenza" is a masterpiece. This is a great Navy read.

Camp Lemonnier’s medical team gives influenza vaccinations to service members, Oct. 28-30, 2019. (U.S. Navy photo by MC2 Marquis Whitehead)