Written By: Gustav Person
Each year, as the fall and winter months approach, many Americans become concerned with getting their annual flu shots to ward off the latest strains of influenza, a potentially deadly disease. In the summer and autumn of 1918, the Spanish influenza pandemic struck Europe and the Americas, killing millions of people during the closing stages of World War I. This article will examine how the flu struck Camp A.A. Humphreys (now Fort Belvoir), Virginia, in 1918 and how military authorities coped with its effects.
With the entry of America into World War I in April 1917, the Chief of Engineers, Major General William M. Black, realized that a larger cantonment would have to be established to train the thousands of engineer soldiers needed to fill the many new units being organized for the American Expeditionary Forces (AEF).
He focused his attention on the Belvoir peninsula along the Potomac River, about eighteen miles southwest of the District of Columbia in Virginia. Soldiers at the Engineer School at Washington Barracks (now Fort McNair) had been using that location for a number of years for marksmanship and tactical training during the summer months. That site derived its original name, Camp Belvoir, from the eighteenth century plantation of Colonel William Fairfax. By January 1918, work had begun in earnest at the new cantonment which was named after the distinguished Civil War general and Chief of Engineers (1866-79), Major General Andrew A. Humphreys.
Dorland’s Illustrated Medical Dictionary defines influenza as an acute viral infection of the respiratory tract which occurs in isolated cases, epidemics, or pandemics. It is caused by serologically different strains of viruses (Influenza designated A, B and C). It normally has a three-day incubation period, and usually lasts three to ten days. It is marked by inflammation of the nasal mucus membranes and pharynx, and is characterized by myalgia, fever, chills, and body temperatures as high as 104 degrees Fahrenheit.ndirectly, it affects many parts of the body, and even a mild infection can cause pain in muscles and joints, intense headaches, and prostration.
Patients can also suffer from bleeding from the nose and ears and a cough that includes bloody sputum. An earlier epidemic in 1889-90 had already been the most severe influenza pandemic in the previous three centuries. In 1918, serious complications of the flu were pneumonia, emphysema, meningitis, and tuberculosis, which normally accounted for many of the fatalities. The disease either killed very quickly by way of violent viral pneumonia, or slowly as it stripped the body of its defenses. Viral diseases were still very mysterious in 1918 since the causes could not be seen. Influenza normally kills the very young and the very old. The 1918 strain was unusual in that it killed a significant number of people in their twenties and thirties. Many victims would go from feeling healthy to dying in as little as twelve hours.
The overwhelming proportion of influenza victims usually recovered fully within ten days. However, across the United States approximately 675,000 people died. This amounted to roughly eight to ten percent of adults living in the country. Influenza killed enough people to depress the average life expectancy in the United States by more than ten years. People often called the disease, “The Three-Day Fever,” or “The Grippe.” As a result of the abuses in the Spanish-American War, the U.S. Army Medical Department had implemented an elaborate system of sanitation and preventive medicine that included vaccinations, mosquito mitigation, water purification, sanitary waste disposal, dietary requirements, and physical inspections and examinations.
The influenza pandemic of 1918 simply overwhelmed that system. The pandemic struck Europe and America in three waves. The rather mild first wave broke out among the AEF at Dijon in France on 15 April. After initial reports, the flu seemed to subside within the American forces and the mortality rates dropped appreciably. The second wave struck the East Coast of the United States on 8 September. It exploded in the AEF one week later. The third wave struck later in the winter of 1918-19.
The Army had made some early preparations to deal with pneuemonia, a potentially fatal complication of influenza. In early October 1917, the Surgeon General, Major General William Gorgas, had advised Army hospital commanders to expect the probability that pneumonia would be a serious disease among the troops. Later, a series of circulars, distributed by his office in late September 1918, directed that soldiers should only sit on one side of tables in the mess hall, or the occupants of the two sides should be separated by a screen of cheesecloth above the middle of the table. The circulars also recommended that recent arrivals in camp should be inspected twice daily for signs of illness. Congregation of personnel in and around the post exchanges was to be avoided. The Surgeon General also reminded commanders to coordinate closely with local and state health officials concerning the incidence of disease in the surrounding jurisdictions.
The case of what happened at Camp A.A. Humphreys was fairly indicative of what was going on at military installations across the United States. Hundreds of servicemen had already died from pneumonia, as a complication of measles, which struck many Army training camps during the winter and spring of 1918. The first wave of the influenza epidemic struck the French and British armies in France in mid-April. For military personnel in America, the influenza epidemic started at Camp Devens, Massachusetts, during the first week of September, and worked its way down the eastern seaboard before heading west. Camp Devens had been reported as seriously overcrowded, and 374 men died in one night. Officials were unsure whether the disease was transmitted there from ships arriving in nearby Boston Harbor, or had developed independently.
Massachusetts was also the first state to suffer large numbers of civilian deaths. Soon, other Army posts along the East Coast began to feel the effects of the epidemic. At Camp Meade outside Baltimore, twenty-seven percent of the 42,300 troops housed there were hospitalized. Beginning in early July 1918, medical officers at Camp A.A. Humphreys noted the increased incidence of “colds” among trainees in the 3d and 5th Training Regiments. There were nine training regiments at Camp A.A. Humphreys, plus a plethora of supporting units. The disease was documented as having started in the 3d Training Regiment on 18 August. There were also scattered cases among the African American units. Between 13 and 18 September, 134 cases of influenza were reported. It was assumed at the time that the epidemic hit Camp A.A. Humphreys in earnest beginning on 13 September, and ending on 13 October.
Medical officers throughout the command were notified of the impending epidemic throughout the nation and were directed to take special steps to prevent its spread. The first measure taken consisted of a circular dated 18 September and issued by the camp commandant, Brigadier General Charles Kutz, to all regimental and battalion surgeons. The circular directed their attention to the disease, and called for special reports each morning as to the number of cases. On that date, an informative article was prepared for inclusion in the Castle, the camp newspaper.
It was noted that influenza was a communicable disease which was normally transmitted through the medium of the fine spray thrown out from the nose or throat during coughing, sneezing, spitting, or even loud talking. It was anticipated that the camp would be visited by the epidemic due to the assemblage of large numbers of troops in poorly ventilated and congested areas; however, commanders initially anticipated that the spread could easily be controlled. Troops were directed to use a handkerchief or piece of newspaper when coughing, and to avoid spitting, especially indoors on the floor. Commanders tried using disposable paper spittoons for this occurrence.
Medical officers quickly discounted the weather as a cause of the disease, or the dusty conditions common during the late summer. Each soldier was ordered to erect a screen with his shelter-half around the left side of his bunk in the barracks to control the spread of germs. (Author’s note: This practice was still in effect during the author’s basic training at Fort Dix, New Jersey, during the winter of 1969-70.)
African American troops, quartered in large tepee-like Sibley tents, were issued sheeting to erect screens between each bunk. Finally, all the enlisted men of the camp were required to attend a series of lectures on the spread of the disease, and unit officers attended and supervised each lecture.
A later memorandum issued on 27 September directed all company commanders to personally supervise Reveille and Retreat formations to insure that all soldiers exhibiting symptoms of “colds” were identified and sent on sick call to the unit medical officers. It was further directed that all soldiers diagnosed with influenza were to be segregated in hospital wards, and that each man was to have 100 square feet of floor space. A few days later, additional instructions directed that all windows in the hundreds of temporary wooden barracks, offices, classrooms, administrative, and logistics buildings were to be kept open full-width from Reveille to Retreat.
Duty officers were responsible to conduct regular inspections during hours of darkness, and to submit written reports each day. Soldiers were prohibited from sitting in proximity to each other in the barracks, and bedding had to be aired out daily. Strenuous efforts were taken to control the large number of flies around the mess halls and to adequately sterilize dishes, utensils, and mess kits after use. Flypaper, fly traps, and swatters were in regular use, even if locally improvised. These activities were indicative of every conceivable method to control transmission.
Efforts were also made to prevent the soldiers from congregating in groups, especially indoors. Commanders received directions to keep their men training outdoors for as much time as possible, although they were cautioned to avoid strenuous exercise. It was noted that many barrack floors had been littered with dirt, and in some cases with unconsumed food. Extensive methods were ordered to address this situation, which included sweeping the floors with damp sawdust and burning the residue.
It was noted that at no time during the epidemic was Camp A.A. Humphreys under general quarantine conditions, although many other training camps around the country were effectively quarantined. Even concerned relatives and family members were prohibited from visiting some camps. Although the Young Men’s Christian Association (YMCA) voluntarily cancelled their usual evening entertainments, the soldiers were allowed to visit those buildings, and performances in the open-air theatres continued throughout. The camp surgeon visited the YMCA, the Knights of Columbus, and similar facilities to caution soldiers about the causes and incidence of the disease.
On 28 September 1918, Lieutenant Colonel Charles E. Doerr, Medical Corps, commanding officer at the Base Hospital, became seriously ill with pneumonia as a complication of influenza, and died on 3 October. Incidentally, the highest number of cases, 771, occurred on that day. During the first week of October, several other medical officers became ill. As the epidemic progressed, and the cases became too numerous to be handled at the Base Hospital, temporary hospital wards were opened in other parts of the camp. In the 3d Training Regiment area, a 500-bed hospital was established in some empty barracks buildings.
This hospital annex was quickly filled and remained in operation until 27 October. The opening of these additional wards actually occurred during the transfer of patients from the original temporary medical facility to the new Base Hospital in September, which numbered thirty-nine buildings. As the epidemic drew to a close, an additional forty-two hospital buildings were under construction under the direction of the constructing quartermaster. The transformation had resulted in an increase from less than 600 beds to more than 1,500. The total number of patients treated at the Base Hospital eventually numbered 6,037 during this period. It was often necessary to cordon off and erect cubicles in corridors and porch areas to house overflow cases.
At the height of the epidemic, the medical staff in the camp consisted of thirty-seven medical officers, five Sanitary Corps officers, two dental surgeons, one quartermaster, one chaplain, and eighty-four enlisted men. Medical personnel were ordered to wear protective gowns of fresh cotton and clean gauze masks. Patients were also to be masked while being moved. About 500 soldiers from the various engineer organizations were sent to the hospital for special duty as attendants. Besides stuffing mattresses with straw, they unloaded a stream of railroad cars full of medical supplies, cleaned laundry, and prepared food. They were later commended for their excellent work, and it was noted that their service did much for the care of the sick.
Until 30 September, there were no nurses on duty in the camp. On that date, ten nurses were assigned from Walter Reed General Hospital in Washington, DC. This number soon expanded to ninety-four Army Nurse Corps personnel, twenty-six student nurses, seventeen civilian graduate nurses, and forty-five civilian aides. Unfortunately, the new Base Hospital did not initially include any laboratory facilities. Any chemical or bacteriological work had to be done at the Army Medical School in Washington, DC, rather than at Camp A.A. Humphreys.
Additionally, the Red Cross began construction of a facility for the accommodation of convalescent patients and relatives of patients in the hospital. There was also a Red Cross rest house for nurses near the nurse quarters. The epidemic lasted about five weeks at Camp A.A. Humphreys, and reached its maximum incidence during the week ending 4 October, when fifty-two percent of the cases occurred. Of the 4,237 flu cases reported and treated throughout the camp, 1,171 developed pneumonia. The mortality rate was reported at 35.2 percent, which broke down to a mortality rate of 15.5 cases per 1,000 soldiers.
By 25 October, 22, 688 personnel were quartered at the camp. Some training regiments and the Engineer Officer Training School had a lower incidence of the disease, probably because of strenuous measures taken by the commanding and medical officers. It was also noted that some training regiments with a higher incidence of disease contained many recruits who had been in service for less than three months, and therefore were of low stamina or physical fitness. Because the death rate averaged around fifty-six soldiers per day at the height of the epidemic, the War Department contracted with a number of undertakers in nearby Alexandria to process the increasing numbers of deceased soldiers.
In this case, the base morgue was completely bypassed. Bodies were placed in pinewood coffins and shipped by truck to Alexandria, where they where transferred to railroad freight cars for shipment around the country to the soldiers’ home districts. Each truck could carry fourteen coffins. In 1918, it was generally considered that African Americans were more susceptible to diseases of the respiratory tract than Caucasians. To the bewilderment and surprise of medical officers, the results of the epidemic at Camp A.A. Humphreys showed the exact opposite.
The ten black service organizations in camp generally showed a decidedly lower rate than the white troops during the entire epidemic. Generally, black troops had an incidence rate of only forty-three percent that of whites. For example, in the 900-man 552d Engineer Service Battalion, only sixty-eight men were hospitalized, and another sixty quarantined. Three died from influenza and one from meningitis. While white troops were housed in crowded, two-story wooden barracks, black troops were generally quartered in spacious pyramidal tents with much better ventilation and less density, which decreased the transmission of the flu among the soldiers.
Each wooden barracks was designed to quarter approximately sixty-six men, while each tent housed only five or six soldiers. In many camps, health care for blacks was segregated and inferior to that of whites. In some camps, blacks were accused of being natural carriers, or that outbreaks of flu started in black units.
At about the time the flu epidemic was winding down at Camp A.A. Humphreys, Colonel Walter D. McGraw, Chief Surgeon of the AEF, issued a circular titled “Prevention and Management of Pneumonia, a Derivative of the Influenza Epidemic Afflicting the American Forces in France” on 12 October.
The epidemic of influenza was prevalent in many widely separated parts of France, and had one common feature—the occurrence of pneumonia as an incidence of the disease. He noted that the current mortality rate had been in the neighborhood of thirty percent throughout the forces, and as colder weather approached, he predicted an increase in the prevalence of the disease. McGraw identified the causes of respiratory infections in the field as overcrowding; exposure to cold and wet conditions; and fatigue, whether induced by overwork, a long journey, nervous exhaustion from worry, or the stress of combat.
In the pandemic, the great majority of the cases of pneumonia were secondary to influenza—the natural resistance of soldiers having first been broken down by this disease.
McGraw examined the three main causes of the disease, and noted that whenever possible, the floor space in barracks per enlisted man should be eighty square feet, and should never be less than sixty square feet. He remarked that cold, wet feet, from service in the trenches, usually “produced a general reaction in the body which predisposed it to infection.” He also recommended prompt removal and drying of wet clothing of soldiers, and “additional blankets at night must be insisted upon.”
Finally, greater attention paid by medical officers to the early discovery and detection of cases of colds, influenza, and other respiratory infections, prompt isolation and treatment of such cases was required.
Colonel McGraw noted, as the epidemic progressed, that cases of the disease in the earliest stages withstood transportation fairly well, but patients in the later stages of the disease, after they were hospitalized, were greatly injured by moving.
He cited cases of pneumonia patients being moved to make room for battle casualties, resulting in the early death of the pneumonia patients. Finally, he noted that recovery and return to duty would be slow. The final stages of recovery would best be provided for in convalescent camps. Keep in mind that in 1918, a vaccine had not been developed in time to combat the epidemic. In fact, pneumonia continued to maintain its position as the leading cause of death in the United States until 1936. Currently, the modern Centers for Disease Control estimate that even without epidemic conditions, influenza kills on average 36,000 people per year.
The only real treatment in 1918 consisted of segregating and immobilizing the patient. The Surgeon General had quickly decided to recommend halting the transfer of personnel between military installations. By mid-October, he decided that the Army could avoid or at least minimize the spread of influenza on troop ships going overseas by transporting men who already had the flu or been exposed to it and were therefore likely to be immune.
However, officials also had to deal with seriously overcrowded troopships. A variety of treatments to relieve the symptoms were tried with only limited success. Despite the high incidence of the epidemic, training and construction at Camp A.A. Humphreys went on as usual. At a time when the Army was actively training troops for the Western Front in France, the outbreak of the Spanish influenza pandemic must have posed a great distraction for the leaders, and for the soldiers who were unfortunately stricken.
