Wednesday, October 12, 2011

The Great Influenza by John M. Barry Part II

In Part III The Tinderbox, John Barry demonstrates how America's mobilization for war allowed for conditions that were conducive to the spread of viruses and the development of not only epidemics but also possibly a pandemic. America's entry into World War I brought about significant changes in all aspects of American society. Woodrow Wilson, President of the United States was not a man to do things by half measure. He claimed that the nation needed to be trained for war. He wanted to ensure that everyone supported the war effort. Speech was controlled, as well as the mail and a new Sedition Act was passed that made opposition to the government in any form unlawful. Much of national life was controlled.

Wilson decided to call up all men between the ages of 18 to 45. This meant that military barracks would see men crammed into buildings designed to hold far fewer men. It also meant the mass mobilization of workers into cities and lodgings which were often shared in shifts. Mobilization for war meant that America was stripped of its best and brightest medical professionals, often recruited directly from graduate schools. Barry writes that during this time, the quality of medical care for civilians deteriorated rapidly. By the end of the war, there were 38,000 physicians serving in the US military. The military also took as many nurses as it could find. There was no contingency plan for the general population; if the civilian population became ill there would not be enough medical professionals to care for them.

William Gorgas, Surgeon General of the Army was deeply concerned about the possiblity that mass mobilization would result in epidemics of disease from so many men living in close quarters. The deepest concern was with pneumonia which exists in endemic form (meaning it is always present in the general population). The Government ignored the warnings of medical professionals in placing so many men in close quarters.

"These circumstances not only brought huge numbers of men into this most intimate proximity but exposed farm boys to city boys from hundreds of miles away, each of them with entirely different disease immunities and vulnerabilities. Never before in American history -- and possibly never before in any country's history -- had so many men been brought together in such a way...
Gorga's nightmare was of an epidemic sweeping though those camps. Given the way troops moved from camp to camp, if an outbreak of infectious disease erupted in one, it would be extraordinarily difficult to isolate that camp and keep the disease from spreading to others. Thousands, possibly tens of thousands, could die."

Barry gives a fascinating account of how America mobilized for war and the enormous effect mobilization had on society. he also recounts how the US military grappled with so many men packed into cantonments. Measles epidemics raged through the army barracks and with it came pneumonia. Forty-six of all deaths were due to pneumonia as a complication of measles. A Canadian physician, Oswald Avery who worked at the now pre-eminent Rockefeller Institute was sent to work on this problem. Public health and military officials as well as physicians knew that it was pneumonia that would kill the majority of people if there were an epidemic of any kind.

John Barry also describes why researchers were so keen on learning all they could about pneumonia, often called the captain of death. Pneumonia is often a secondary illness that sets in after the initial infection has already weakened the immune system. It is still a leading cause of death today. Many people succumb to pneumonia after being sick with influenza.

"Influenza causes pneumonia either directly by a massive viral invasion of the lungs, or indirectly by destroying certain parts of the body's defenses and allowing secondary invaders, bacteria, to infest the lungs."

Since 1892, scientists have tried to find a cure for pneumonia by making a serum to treat it. Researchers began by discovering many types of pneumonia-causing bacteria. Oswald Avery, Rufus Cole and Alphonse Dochez studied this problem and had some success in treating patients with a serum. They categorized pneumonias into Type I, Type II, and  Type III which were the most common. Research into the use of a serum suggested that it could raise survival rates significantly. At this time, pneumonia was considered the "captain of death" and was largely untreatable.

 Outbreaks of influenza in early June 1918 were mild and were not as dangerous as the measles outbreaks in the military had been. Their concern over influenza was due to the fact that people died from complications due to pneumonia rather than from the influenza itself. To prevent the spread of illness due to influenza, Welch, Cole, Vaughan and Russell were convinced that special measures were needed. These included the creation of contagious-disease wards or separate contagion hospitals that dealt only with cases of the disease. They also felt that segregating all new troop arrivals in Europe for 10 to 14 days might contain the spread of any contagious disease to the new troops.

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