Sunday Book Review: Fever of War
By 
When the United States entered World War I in the spring of 1917, the Allies hoped that the mere promise of a flood of US troops would unsettle Germany and force and end to the war. The Army itself had not engaged in large-scale combat against a modern, conventional opponent since the Civil War (action in Cuba excepted), and not against a formidable foreign foe since the War of 1812. Consequently, many hoped that the war would offer the opportunity for the US Army to demonstrate its competence and professionalism. As Carol Byerly’s Fever of War details, however, the Army’s training camps helped incubate the lethal Spanish Flu, and its soldiers helped spread the disease across the country and across the world.
Byerly traces how the influenza tore through the Army across 1918. The Army was certainly prepared for illness; it had been deeply embarrassed by the typhoid epidemic in the Spanish-American War, and had invested heavily in disease prevention and management as it became necessary to garrison the Philippines and other warm climes. Indeed, the relative success of the Army’s fight against typhoid led to a great deal of optimism about the ability of the medical service to tame disease.
As is now well understood, the flu struck in three waves. It first hit in the spring, taking a toll on USA training camps, but rapidly finding itself to the front lines. At this point, however, the disease was mostly non-lethal. A much more lethal wave struck in fall, and a final wave came in the months after the war ended. Most of the deaths struck recent recruits; 35000 of the some 50000 killed died in the first four months of service. The flu killed by filling the lungs with a red fluid; victims essentially drowned in their own blood. Altogether, roughly a quarter of all US Army soldiers would catch the flu.
The impact of the flu on the war effort itself is difficult to determine. It certainly undercut US manpower during the Hundred Days Offensive, and probably sapped the strength of the Army in the Meuse-Argonne Offensive. Pershing (who came under criticism for the relative ineffectiveness of US units) believed that, by undercutting US strength, the flu allowed the British and the French to undervalue the US military contribution to the war, and thus its political contribution to the peace. The logistical impact was severe, as the disease overwhelmed the Army’s logistical infrastructure. Beds and trucks that had been prepared for battlefield wounded were now committed to those sick with the flu.
Byerly also studies the impact of the influenza on medicine within the Army, and on American medicine more generally. Roughly a third of all the doctors in the United States served in the Army during World War I, although it struggled to attract the best medical officers. For their part (as will be familiar to viewers who remember M*A*S*H) doctors resented the authority of officers whom they viewed as social, professional, and intellectual inferiors. Some doctors were altogether unexcited by the prospect of treating influenza victims, having expected to deal with combat wounds. Treatment of the sick, usually requiring close care but not dramatic intervention, usually fell to nurses. But nurses struggled to establish and maintain their authority in military hospitals.
In hindsight, medical officers focused on things that they could change, rather than those they could not. On the one hand, this included improved habitability of bases and camps, and better monitoring of the progression of the disease. On the other, it resulted in efforts to assess the differential impact of the virus on different ethnic groups and social classes. This was America, after all.
The Army was a microcosm of US society, with all of the inequity that entailed. Black doctors and nurses were treated much less well than their white comrades, and were rarely if ever put in positions of authority over whites. Ironically, segregation may have prevented the disease from running through some groups of African-American soldiers, although those who did get sick usually received substandard treatment. Similarly, nurses did not initially enjoy military rank.
Byerly argues that the war made the flu, or at least wildly inflated its spread and virulence. Fielded armies and the camps that supported them gave the virus the chance to mutate, while also offering easy vectors to spread. Nobody liked to die from the flu. As a general rule, soldiers prefer not to die in war. But when they did (and a great many did in the last year of the war) they preferred to die by German bullets and artillery shells than to the Spanish Flu. An often implicit distinction between those killed in action and those killed by the flu emerged, both within the Army and in the general public.
With respect to historical memory of the flu, reading Fever of War made me wonder about how the disease had endured in popular culture. I checked to see whether there were any references to the Spanish Flu in M*A*S*H, especially since one of the main characters (Sherman T. Potter) began his military career in the First World War, and would have seen the impact of the influenza firsthand. I haven’t been able to find any such references, though.
Altogether Fever of War is an extremely effective account of one organization’s response to the 1918 pandemic. Parts are a bit murky; the story of the relationship between the Medical Service and the rest of the Army is detailed, but sometimes confusing. And I was less than 100% sold on precisely how the influenza exploited the war to spread farther and become more lethal. But well-written and economical, the book is well worth a read as we tackle another pandemic.