The Fever at the Navy Yard

The stack of papers remained on Krusen’s desk, weighted against the evening breeze through his open window. They accumulated into paralysis, into the postponement of decision that would become the chapter’s true subject. But the paralysis was still forming. Before it could harden into consequence, the fever had to travel from the ships in the Delaware River to the men who slept in rows, ate in shifts, and breathed the same recycled air of the Philadelphia Navy Yard.

—-

September 7, 1918. The medical corpsman made his entry in the leather-bound sickbay log at 0947 hours. A seaman second class, temperature 103, diagnosis: “epidemic catarrh.” The hand that wrote was steady. The corpsman had filled similar lines at Great Lakes, at Newport News, at the training station where the autumn drafts first assembled. The entry gave no indication that this case differed from the dozen others he had logged that week, or that the man whose name he recorded had come off a naval auxiliary vessel three days before, or that the ship had taken on replacement crew at Brest in late August.

The second wave of the pandemic began in the second half of August 1918, spreading to Boston, Massachusetts by ships from Brest. From the Boston Navy Yard and Camp Devens, other U.S. military sites were soon afflicted. The corpsman did not know this. He knew the protocol for contagious respiratory disease: isolate the patient, disinfect the bunk, log the case for the weekly return to the Bureau of Medicine and Surgery. The protocol did not account for what happened next.

By September 10, the corpsman was making entries every two hours. The sickbay’s sixteen beds held seventeen men, then nineteen, then twenty-two. The overflow lay on mattresses in the corridor, heads toward the wall, feet toward the traffic of orderlies carrying bedpans and temperature charts. The chief medical officer at the Yard hospital, a lieutenant commander who had trained at Johns Hopkins and served in the Philippines during the cholera epidemics of 1902, requested additional space from the Yard commandant. The commandant offered a warehouse in the industrial section, half a mile from the hospital building. The warehouse had no windows, a dirt floor, and electricity sufficient for four bulbs. The medical officer accepted it. He had no authority to refuse.

—-

The civilian workers entered through Gate 4 at 0700 each morning, presenting their identification cards to Marines who examined faces more carefully than papers. The Yard employed 28, 000 civilians in September 1918, spread across fourteen hundred acres of foundries, machine shops, dry docks, and assembling plants. They built the superstructures of destroyers. They poured the steel for submarine chasers. They lived in South Philadelphia, in Kensington, in the row houses that pressed against the Yard’s northern perimeter, and they carried their lunches in pails that smelled of last week’s soup.

A riveter’s helper in Dry Dock Number 1 noticed the cough on September 12. He wrote to his brother in Pittsburgh that evening, sitting at the kitchen table while his wife heated water for tea. The letter survives in a private collection, its paper foxed but legible. Three men in his gang had been taken sick that day, all of a sudden. The foreman said it was the grippe going round. The nurse at the gate had wanted to look in their throats but the line was forty deep and she gave up. The letter mentioned money—overtime rates, the price of coal, the Liberty Loan deduction from his pay—and closed with reassurance that the writer never took sick.

The virus moved through the workforce in patterns that would become familiar to epidemiologists only in retrospect. It traveled in the riveting gangs, where men worked shoulder to shoulder in holds that reached 110 degrees. It traveled in the cafeteria lines, where six hundred workers ate in twenty-minute shifts. It traveled in the trolley cars that carried the evening exodus to the city, bodies pressed against bodies, the windows shut against the September chill. The incubation period was two to three days. The infectious period began before symptoms showed. By the time the foreman noticed the gaps in his crew, the exposures had already multiplied through three subsequent shifts.

—-

The chief medical officer sat at his desk on September 14, compiling the weekly morbidity report. The numbers had escaped the format of the form. He had begun the week with a single column for respiratory cases. By Wednesday he needed two columns, then three. The diagnosis “epidemic catarrh” no longer served; he was seeing men with cyanosis so severe their faces appeared black, men who hemorrhaged from the nose and mouth, men whose lungs filled with fluid faster than the drainage tubes could remove it. He had thought he understood the behavior of infectious disease in concentrated populations. The Navy Yard was teaching him otherwise.

He wrote to the Surgeon General’s office in Washington, requesting additional medical officers and nursing staff. The reply, dated September 16, acknowledged his situation as consistent with reports from other Atlantic stations and promised such relief as circumstances permitted. The circumstances were these: Camp Devens in Massachusetts had reported two thousand cases in three days. The Boston Navy Yard had converted its barracks into emergency wards. The Army’s cantonments along the eastern seaboard were losing men faster than the transports could replace them. The Navy’s medical corps, never large, was being distributed like water across a spreading fire—thinner at every point.

The chief medical officer made a decision that would not appear in any official report. He stopped sending his full case counts to Washington. The partial numbers he transmitted kept the Yard within the threshold that would trigger formal quarantine. A full quarantine would halt the departure of ships for European waters. It would stop the movement of personnel to the receiving ship anchored in the Delaware as a floating barracks for men awaiting assignment. It would require the Yard commandant to explain to the Fourth Naval District why Philadelphia’s contribution to the convoy system had been interrupted. He had seen what happened to medical officers who interrupted production. He sent the partial numbers.

—-

The receiving ship was a problem of a different order. It held 1, 800 men in a space designed for 1, 200. They slept in hammocks stacked three high, ate at tables that ran the length of the former gun deck, and breathed air that passed through ventilation ducts from the engine spaces below. The ship had been built in 1890 as a cruiser; its conversion to barracks duty had not improved its suitability for disease control.

On September 15, a boatswain’s mate reported to the sickbay with fever and joint pain. The medical officer, a reserve lieutenant, recognized the presentation from his civilian practice in St. Louis. He isolated the patient in a compartment normally used for paint storage, posted a sentry, and requested permission from the ship’s captain to suspend the transfer of personnel to and from the vessel. The captain refused. The receiving ship existed to move men—to transports, to destroyers, to the vessels assembling in the lower Delaware for the next convoy. A suspension of transfers would require explanation to the District command, and the District command was preoccupied with the Liberty Loan parade scheduled for September 28, in which the Navy Yard would provide 2, 000 marching personnel.

The medical officer kept his own records. They show seventeen cases by September 17, forty-three by September 19, eighty-seven by September 21. The paint storage compartment held six men; the overflow lay in hammocks in the corridor, separated from the healthy population by canvas screens that moved with the ship’s motion. On September 20, the medical officer sent a written memorandum to the captain, copied to the Yard hospital: the situation on the vessel was beyond his capacity to manage with present resources. He requested immediate reinforcements of medical personnel and the establishment of shore-based isolation facilities. The captain endorsed the request and forwarded it to the District command. The endorsement added that every effort was being made to maintain operational readiness.

—-

The Bureau of Health received its first formal notification on September 18. Dr. Paul Lewis, the pathologist from the University of Pennsylvania who had been detailed to the Public Health Service’s influenza investigation, delivered the message personally to Krusen’s office. Lewis had examined lung tissue from three fatal cases at the Yard hospital. His report, written in the compressed prose of laboratory science, identified acute hemorrhagic bronchopneumonia consistent with the European reports of Spanish influenza. He recommended immediate isolation of the Yard from the civilian population, suspension of public gatherings in the surrounding districts, and vigorous educational campaign regarding personal prophylaxis.

Krusen listened. His notes from the meeting, preserved in the Bureau’s files, record Lewis’s recommendations without comment. They record Krusen’s response as acknowledged and referred for coordination with naval authorities. The coordination did not occur. Krusen had received, on the same morning, a memorandum from the Mayor’s office regarding the Liberty Loan parade. The memorandum noted that Philadelphia’s quota for the Fourth Liberty Loan stood at $259 million, that the city was currently $47 million short of its target, and that the parade represented the decisive public demonstration of civic commitment. The memorandum did not mention influenza.

The stack of papers on Krusen’s desk grew. Lewis’s pathology report. The Mayor’s quota figures. A telegram from the Fourth Naval District, forwarded through the Pennsylvania State Health Department, noting elevated respiratory morbidity at Philadelphia Navy Yard, under investigation. A bulletin from Surgeon General Blue, dated September 19, summarizing conditions at Camp Devens and recommending continued vigilance at all Atlantic ports. Krusen filed them in the order received, weighted against the evening breeze.

—-

The civilian population of the Yard’s perimeter began to feel the pressure on September 19. A boarding house operator on Oregon Avenue three blocks from Gate 4 recorded in her diary that three of her lodgers—shipfitters at the Cramp & Sons yard adjacent to the Navy Yard—had developed the prevailing sickness and taken to their beds. The diary entry for September 20 noted that she had sent for a doctor, who would not come for any money, being engaged with the sailors. By September 22, she was making poultices of mustard and flour for her remaining boarders, following a recipe from her mother that had served through the epidemics of the 1890s.

The poultices did not help. On September 23, she walked to the South Philadelphia Hospital, a mile and a half distant, and requested a nurse to visit her house. The hospital’s superintendent told her that no home visits were possible; all available staff had been detailed to the Navy Yard.

The South Philadelphia Hospital was not a military facility. It served the civilian population of the Twenty-sixth Ward, the densest in the city, where tuberculosis rates had long exceeded the municipal average. Its superintendent had watched the Yard cases accumulate with the recognition of a man seeing his own future. On September 20, he sent a letter to Krusen requesting immediate conference regarding the intermingling of naval and civilian populations in the district south of Oregon Avenue. The letter noted that his hospital had admitted eleven cases in forty-eight hours, all from addresses within half a mile of the Yard gates, all presenting the sudden onset and pulmonary complications described in the Public Health Service bulletins. Krusen’s office acknowledged receipt on September 21. The conference was scheduled for September 25.

—-

The Yard commandant faced a different calculus. His responsibility was production. The destroyer O’Brien was scheduled for commissioning on October 1, the submarine chasers SC-317 through SC-324 by October 15. The convoy system that protected Allied shipping in the Atlantic depended on these vessels; the Navy Department’s weekly cables from Washington tracked their progress with the precision of artillery fire. The commandant had received the medical officer’s morbidity reports, had seen the warehouse ward filling with mattresses, had walked through the receiving ship’s corridors and smelled what disease smelled like when ventilation failed. He had also received, on September 18, a personal letter from the Secretary of the Navy’s office, congratulating the Philadelphia Yard on its production record for August and encouraging continued acceleration through the decisive autumn months.

The commandant chose acceleration. On September 20, he authorized the extension of working hours in the machine shops, adding a night shift to compensate for the absenteeism that the partial reports had not yet fully disclosed. The night shift brought 4, 000 additional workers through Gate 4 between 1800 and 0600 hours, when the medical inspection at the gate was performed by a single corpsman with a flashlight. The night shift also brought workers into contact with the returning day shift, the two populations mingling at the time clocks and the cafeteria entrances. The authorization survives in the Yard’s general order file. It contains no reference to health conditions.

—-

Dr. Lewis returned to the Yard on September 21, accompanied by a photographer from the Public Health Service’s documentary unit. They spent four hours in the warehouse ward, recording the arrangement of beds, the preparation of bodies for transport, the faces of the medical staff. Lewis’s field notes, preserved in the National Archives, describe conditions of crowding that must facilitate transmission and clinical presentations of extraordinary severity, with fatal outcomes in previously healthy adults within 72 hours of onset. The photographer exposed thirty-seven plates. Twelve were developed; the remainder were destroyed by a laboratory error that Lewis noted without comment in his report of September 23. The developed plates show rows of canvas cots, a corpsman holding a tray of thermometers, a single patient whose face is visible and whose eyes are open. The patient is not identified.

Lewis spent the evening of September 21 at his laboratory at the University of Pennsylvania, attempting to isolate the causative organism from blood and sputum samples. His technique followed the protocols established by the Institute for Infectious Diseases in Berlin, modified by his own work on poliomyelitis. The samples defied isolation. They contained multiple bacterial species, none dominant, none consistent from patient to patient. Lewis worked until 0300, then slept on a cot in the laboratory. He returned to the Yard at 0800, September 22, to collect additional samples from fatal cases. His notes record that he performed three autopsies that day, working in the warehouse ward with equipment sterilized in a pressure cooker borrowed from the ship’s galley.

—-

The communication channel to Krusen’s Bureau operated through multiple paths, none of them direct. The Yard’s medical officer reported to the District Surgeon, who reported to the Bureau of Medicine and Surgery in Washington. Lewis reported to the Public Health Service’s regional office in Pittsburgh, which reported to Surgeon General Blue. The superintendent of South Philadelphia Hospital reported to the Bureau of Health through the city’s district medical inspector, a position that had been vacant since June. The district inspector’s duties had been assumed by an assistant who also managed vaccine distribution and school medical inspection. The assistant filed the superintendent’s letter in a cabinet marked “Pending—Navy Yard,” where it remained until September 24.

Krusen learned of conditions at the Yard through a different channel entirely. His wife’s cousin, a lieutenant junior grade stationed at the receiving ship, visited the Krusen household on September 22 for a dinner that had been scheduled before the epidemic’s acceleration. He described to Krusen what he had seen: the hammocks in the corridors, the canvas screens, the medical officer who worked without sleep and wept while he worked. The cousin’s account does not appear in any official record. It appears in a letter from Mrs. Krusen to her sister, dated September 23, which notes that her husband sat up very late with the visitor, and would not discuss the matter in the morning.

The stack of papers on Krusen’s desk acquired new weight. The cousin’s verbal report, unwritten and therefore unfileable. Lewis’s pathology notes, with their photographs and their provisional diagnoses. The telegram from the Fourth Naval District, now three days old. The Mayor’s memorandum on the Liberty Loan quota, with its implied schedule. The Bureau of Health’s own mortality returns for the week ending September 21, which showed 112 deaths from all causes in the Twenty-sixth Ward, against a weekly average of 87 for the preceding eight weeks. The excess was 25 deaths. The excess was not yet remarkable. The excess was beginning a curve that would make it so.

—-

The receiving ship reached its crisis on September 23. The captain, who had refused the medical officer’s request to suspend transfers, reversed his position at 1400 hours when three men died within ninety minutes and the ship’s bell was rung to summon the burial detail. The reversal came too late. The medical officer’s records show 312 cases under treatment, 47 deaths since September 15, and 18 men in a condition he classified as moribund, unlikely to survive 24 hours. The captain sent a priority telegram to the District command: he requested immediate orders regarding disposition of personnel; present conditions precluded operational function. The reply, received at 1800 hours, ordered the transfer of all able-bodied personnel to shore-based barracks and the conversion of the receiving ship to hospital ship status, non-transport.

The transfer began at dawn, September 24. Six hundred men marched from the ship to the warehouse ward, a distance of half a mile through the industrial section of the Yard. They marched in formation, carrying their seabags, following the route that had been designated for emergency evacuation in the event of German sabotage. The warehouse was already full. The Yard’s medical officer had received no notification of the transfer; he learned of it when the first column appeared at his infirmary door. He sent a runner to the commandant’s office, requesting instructions. The runner returned with the commandant’s verbal order: accommodate them.

The warehouse ward expanded. Additional floor space was cleared by moving supplies to the open yard, where they were covered with tarpaulins that collected rainwater. The new admissions were screened for symptoms; those with fever were separated from those without. The separation was theoretical. The men had marched together, eaten together, slept in the same hammocks. The incubation period was two to three days. The screening identified 94 men with temperatures above 100 degrees. The remaining 506 were distributed through the warehouse in rows that left eighteen inches between cots. By September 25, 340 of the 506 had developed fever. By September 26, the warehouse held 1, 100 patients and had acquired a name: Camp Influenza.

—-

The Bureau of Health’s conference with the superintendent of South Philadelphia Hospital occurred on September 25, as scheduled. Krusen did not attend; he sent his deputy, Dr. John F. Anderson, who had joined the Bureau in July after six years with the Public Health Service. Anderson’s notes from the meeting record the superintendent’s description of an outbreak of unmistakable violence in the district adjacent to the Navy Yard and his estimate that civilian cases now numbered not less than 200, with fatalities exceeding twenty. Anderson’s notes also record his own response: he advised the superintendent that the Bureau was in receipt of parallel reports from naval medical authorities and was coordinating with federal agencies regarding appropriate measures. The coordination was not described. The appropriate measures were not specified.

Anderson returned to the Bureau’s offices at 1220 Chestnut Street and found Krusen reading a newspaper. The newspaper was the Public Ledger, afternoon edition, September 25. Its front page carried an announcement from the Mayor’s Liberty Loan committee: the greatest parade in the history of Philadelphia would proceed as scheduled on Saturday, September 28, demonstrating to the world this city’s determination to win the war. Krusen showed Anderson the announcement without comment. Anderson’s notes add: the Director then requested the file of Navy Yard correspondence, which he reviewed until the close of business.

The file contained everything. Lewis’s pathology report of September 18. The medical officer’s morbidity returns, complete and partial. The telegram regarding the receiving ship’s conversion to hospital status. The superintendent’s letter of September 20, recovered from the Pending cabinet that morning. The cousin’s verbal report, now recorded in a memorandum that Krusen had dictated to his secretary. The stack of papers had grown to forty-three items, weighted against the evening breeze. They represented the first irreversible point of no return: the virus securing a foothold in the city’s largest and most connected population center, the abstract rules of public health administration colliding with the biological reality of explosive transmission, the information that now flowed toward decision-makers who had already received their instructions regarding appropriate measures.

Krusen closed the file at 1730 hours. He did not issue an order. He did not request a meeting with the Mayor, the naval district command, or the Liberty Loan committee. He placed the file in his desk drawer, locked it, and walked home through streets where the streetcars ran on time and the theater marquees advertised the autumn season. The stack of papers remained on his desk, weighted against the evening breeze. The fever at the Navy Yard had become the undeniable physical evidence of an outbreak raging within a critical city institution. The information that flowed from it had reached its destination.