Philadelphia navy authorities had taken Rosenau's warnings seriously, especially since a detachment of sailors had just arrived from Boston, and they had made preparations to isolate any ill sailors should an outbreak occur. They had been confident that isolation would control it.
Yet four days after that Boston detachment arrived, nineteen sailors in Philadelphia were hospitalized with what looked like the same disease. Despite their immediate isolation and that of everyone with whom they had had contact, eighty-seven sailors were hospitalized the next day. They and their contacts were again isolated. But two days later, six hundred men were hospitalized with this strange disease. The hospital ran out of empty beds, and hospital staff began falling ill. The navy then began sending hundreds more sick sailors to a civilian hospital. And sailors and civilian workers were moving constantly between the city and navy facilities, as they had in Boston. Meanwhile, personnel from Boston, and now Philadelphia, had been and were being sent throughout the country as well.
That had to chill Lewis, too.
Lewis had visited the first patients, taken blood, urine, and sputum samples, done nasal washings, and swabbed their throats. Then he had come back again to repeat the process of collecting samples and to study the symptoms for any further clues. In his laboratory he and everyone under him poured their energies into growing and identifying whatever pathogen was making the men sick. He needed to find the pathogen. He needed to find the cause of the disease. And even more he needed to make a curative serum or a preventive vaccine.
Lewis loved the laboratory more than he loved anyone or anything. His work space was crammed; it looked like a thicket of icicles (test tubes in racks, stacked petri dishes, pipettes) but it warmed him, gave him as much and perhaps more comfort than did his home and family. But he did not love working like this. The pressure to find an answer did not bother him; much of his polio research had been conducted in the midst of an epidemic so extreme that New York City had required people to obtain passes to travel. What did bother him was the need to abandon good science. To succeed in preparing either a vaccine or serum, he would have to make a series of guesses based on at best inconclusive results, and each guess would have to be right.
He had already made one guess. If he did not yet know precisely what caused the disease, nor how or whether he could prevent it or cure it, he believed he knew what the disease was.
He believed it was influenza, although an influenza unlike any known before.
Lewis was correct. In 1918 an influenza virus emerged (probably in the United States) that would spread around the world, and one of its earliest appearances in lethal form came in Philadelphia. Before that worldwide pandemic faded away in 1920, it would kill more people than any other outbreak of disease in human history. Plague in the 1300s killed a far larger proportion of the population (more than one-quarter of Europe) but in raw numbers influenza killed more than plague then, more than AIDS today.
The lowest estimate of the pandemic's worldwide death toll is twenty-one million, in a world with a population less than one-third today's. That estimate comes from a contemporary study of the disease and newspapers have often cited it since, but it is almost certainly wrong. Epidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million.
Yet even that number understates the horror of the disease, a horror contained in other data. Normally influenza chiefly kills the elderly and infants, but in the 1918 pandemic roughly half of those who died were young men and women in the prime of their life, in their twenties and thirties. Harvey Cushing, then a brilliant young surgeon who would go on to great fame (and who himself fell desperately ill with influenza and never fully recovered from what was likely a complication) would call these victims "doubly dead in that they died so young."
Copyright John M Barry 2004. All rights reserved
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