During the late stages of World War I, a new threat to the global community emerged: an influenza pandemic. Arriving in the United States in the spring of 1918, the disease quickly spread throughout the country. At the overcrowded Camp Devens in Massachusetts, thousands of US soldiers suddenly became ill in a matter of days. Nearly one thousand men died at this site alone. In a letter to a friend and fellow physician, a camp doctor known only by his first name, Roy, describes the scene and conditions at Camp Devens, where an average of one hundred men were dying each day during the pandemic. He cites rapidly appearing symptoms, followed by severe pneumonia and a “horrible,” suffocating death.

During the late stages of World War I, a new threat to the global community emerged: an influenza pandemic. Arriving in the United States in the spring of 1918, the disease quickly spread throughout the country. At the overcrowded Camp Devens in Massachusetts, thousands of US soldiers suddenly became ill in a matter of days. Nearly one thousand men died at this site alone. In a letter to a friend and fellow physician, a camp doctor known only by his first name, Roy, describes the scene and conditions at Camp Devens, where an average of one hundred men were dying each day during the pandemic. He cites rapidly appearing symptoms, followed by severe pneumonia and a “horrible,” suffocating death.

World War I (1914–18) was one of the most destructive conflicts in history. More than sixty-five million military personnel were mobilized by sixteen nations, including the United States, which mobilized nearly 4.4 million troops. More than twenty-one million soldiers, who were sent to the battlefield, were wounded, and more than eight million soldiers were killed. The battlefield was a harsh environment; in addition to gunfire and chemical attacks, troops were exposed to extremely unsanitary conditions in the cramped and damp foxholes and trenches.

When the Great War began to wind down, a new threat emerged from that environment: influenza. The disease was first reported in the United States in January 1918, cropping up mainly in military camps. Very little attention was paid to this first wave, as the US government was more focused on the ongoing war effort. In the fall of 1918, however, a second, more virulent wave of influenza could not be ignored. The widespread mobilization of troops across the world facilitated the spread of the disease. Merchant and military ships carrying troops and military hardware also brought influenza to ports all across the United States.

This letter by an anonymous physician provides a fascinating snapshot of the effects of the influenza pandemic at one Massachusetts military installation. Camp Devens, located about thirty miles northwest of Boston, was one of the main military hospitals and training installations in the Northeast. The camp (later renamed Fort Devens) was built to house up to thirty-five thousand people. However, by the summer of 1918, it had exceeded this capacity by some ten thousand men. Soldiers slept in cramped, crowded quarters that further facilitated the transmission of the disease.

Influenza began its rapid spread through Camp Devens by mid-September 1918. On September 22 alone, more than fifteen hundred soldiers went to the camp infirmary complaining of flu-like symptoms. That infirmary was only supposed to house about twelve hundred patients. Due to the overcrowding, the camp’s barracks became makeshift hospitals as well. One barracks even became a morgue, as the staggering death toll from the pandemic filled the existing morgue beyond its capacity. The military quarantined the camp, but locking it off from traveling soldiers took a great deal of time; by the time the camp was contained, far too many soldiers had been exposed for the quarantine to be effective. Meanwhile, there was a lack of medical personnel to treat the ill–far too many physicians were overseas assisting the war effort, leaving medical students and volunteers to treat the sick. More than one thousand people at Camp Devens died from what one doctor described as a powerful form of pneumonia that ultimately asphyxiated them. Writing to a fellow physician, “Roy,” as he signed his letter, illustrated how influenza had affected those at Camp Devens.

Camp Devens, one of the US military’s main training and hospital installations in the Northeast during the Great War, became a microcosm of the second wave of the 1918 influenza outbreak in the United States. Because of wartime censorship in the United States and Europe, little attention was paid to the first wave of influenza. In September 1918, however, the second wave was so powerful and devastating that it killed thousands within days. Troops died, as did civilians and even the health care workers assigned to treat them. In a letter to a friend named Burt, a doctor at Camp Devens described the scene–the deplorable conditions, the rapidity and intensity with which the contagion spread, and the horrific images of the dead being stored in and transported out of the camp.

According to Roy, the onset of the influenza pandemic at Camp Devens was extremely quick and more devastating than any weapon deployed on the battlefield. The doctor writes how he and his fellow physicians at the camp “used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle.” He tells his friend that there were nearly fifty thousand people at Camp Devens prior to the outbreak; within a matter of weeks, that figure was significantly reduced. Soldiers arrived at the infirmary complaining of respiratory ailments. The symptoms resembled those of “la grippe” (otherwise known as “Spanish flu”). However, he says, the strain that afflicted countless men at Camp Devens overtook the afflicted with far greater speed than was expected.

As soon as the men came to the infirmary, Roy says, they fell victim to “the most viscous type of pneumonia” he had ever seen. Within hours, the patients’ inability to breathe would lead to cyanosis, a condition in which the skin becomes discolored (purple or blue) due to a lack of oxygen. The cases the doctor recalls witnessing were so severe that patients’ entire faces became discolored, making it “hard to distinguish the coloured men from the white.” After the appearance of cyanosis, “it is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible.” As a physician in the early twentieth century, Roy could be expected to see a handful of such cases from time to time, but at Camp Devens, he witnessed hundreds of agonizing deaths over four weeks.

The doctor says that the hospital was normally staffed by only about twenty-five doctors, but saw its physician rolls increase to 250 during the epidemic. Nevertheless, these extra doctors and nurses were still overworked. He recalls how he worked sixteen-hour days, without rest, writing, “we have no relief here.” Such stressful demands continued for weeks.

He also offers a surreal picture of the nearby town of Ayer. The normally picturesque town, he says, became a central venue for the removal of the dead from Camp Devens. Bodies were not loaded onto trains in coffins, as there were none available. Instead, the bodies were simply piled one on top of the other, awaiting a special train to take them away from the area. Back in the camp, the morgue was completely full, as was an extra-long barracks that had been converted into a temporary morgue. The letter explains that such images were reminiscent of those on the battlefield, although he believed (rightly or wrongly) that what he witnessed at Devens was far more horrific than any scene at the front during the Great War.

Unlike many Americans, the doctor who wrote this letter knew of the first wave of influenza that had occurred a few months earlier, beginning in January 1918. When the second wave of influenza arrived at Camp Devens and other military installations, the doctor had a relatively informed understanding of the fact that it was the flu. However, the virus’s virulence far exceeded his expectations as a physician, and he remained at a loss as to how to treat his patients. In his letter, he notes, “There is no doubt in my mind that there is a new mixed infection here, but what I don’t know.” The letter simultaneously reveals the tremendous efforts of the physicians who assisted infected patients, as well as the significant limitations to their medical knowledge in containing and treating the influenza.

In his letter to a colleague, the doctor suggests that the strength and speed with which this form of influenza attacked the Devens population could not have been anticipated. Indeed, droves of men entered the hospital daily complaining of flu-like symptoms, only to be quickly overcome by cyanosis and die within hours of their admission. The doctor describes his efforts to identify the characteristic sign of the disease in his patients by listening to their breathing for rales, or abnormal breathing sounds, noting “they all mean but one thing here… and that means in about all cases death.” The high mortality rate he witnessed at Camp Devens was characteristic of the disease worldwide: Approximately ten to twenty percent of all persons who became infected with this strain of influenza died. In total, nearly one-third of the global population became infected and more than fifty million people died, making the influenza pandemic responsible for nearly as many deaths as the war itself.

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