When killer flu struck 1918

Raymond Rochelle Boyd, a sergeant and cook she married three days before Christmas of the previous year in a quick, wartime wedding, rushed home on emergency leave from an Army training camp on Long Island to be by his wife's side as she gave birth.

She was 19, a dark-eyed brunette on the verge of motherhood. He was 23, a ruddy, round-faced farmboy with a thin mustache, pinched by the high-collared tunic of a soldier and nervous about becoming a father.

Both were stalked by a stealthy killer that would dwarf the carnage of the Western Front and the other far-flung battlefields of World War I: the silent virus of the Spanish flu pandemic of 1918-19.

With a fast-striking and deadly reach that spanned the globe, the worst influenza outbreak of the 20th century is more than a sepia-toned and horrific sidebar of history. It is also a harbinger for a future influenza disaster that medical researchers say is inevitable and long overdue, a grisly example of the worst nature has to offer.

Raymond Boyd looked healthy when he stepped off the train and arrived at his parents' house. Fresh from one of the crowded military posts that served as ready incubators for a viral monster that wiped out millions, he was unaware he was already infected and highly contagious, said his daughter from a second marriage, Kathryn Hamill of Jackson.

As the flu suddenly struck and ravaged his bed-bound body, his young wife cared for him. Soon, the virus struck her down. In separate bedrooms of his parents' farmhouse, each struggled to live.

She died. So did their baby.

His parents, worried that word of his wife's death would kill him, sneaked her coffin out of the house, covering it with hay in the wagon they slipped past their son's bedroom window. They hid his wife's death from him until the day he climbed out of his sick bed and insisted on seeing her.

Grief-stricken, he spiraled into a relapse that almost killed him.

"He blamed himself for Mabel's death," Hamill said.

Mabel Allen Boyd was one of at least 13,703 North Carolinians killed by this hyper-lethal flu virus, a mutation that still baffles modern-day scientists. Eighty-eight years after her death, she is still the face of the Spanish flu pandemic for Leon Spencer, 101, who lives in the Whitaker Glen retirement community near Five Points in Raleigh.

Before she married Raymond Boyd, Mabel lived about a mile down the dirt road that ran in front of the Spencer family farm just east of the railside Northampton County town of Seaboard.

"I was kindly stunned because she was almost like a family member," said Spencer, who was 13 in that deadly fall of 1918. "I was sorry because I thought she was a pretty young woman. I was sad."

Until he married again, Raymond Boyd honored his young, dead wife by wearing a simple gold signet ring that bore her initials on his pinkie finger.

For almost every North Carolinian buried by this remorseless killer, there was a parent or orphan, a spouse or sibling -- a loved one left behind, stunned by immediate grief and saddled with the long-running guilt of a survivor.

Just like Raymond Boyd.

'Worst case'

In truth, no one knows for sure how many died during the three waves of a universal outbreak nearly eight decades gone, because record-keeping was rudimentary.

But most modern-day historians say the body count was vastly underplayed for a pandemic now believed by some to be more lethal than the Black Death, the plague that ravaged Europe in the Middle Ages -- or the AIDS virus. They peg the American death toll at 675,000 people and the worldwide estimate between 50 million and 100 million -- about half of them adults in their 20s and 30s with robust immune systems, a marked difference from the usual victims of seasonal flu: infants and the elderly. Unlike other worldwide outbreaks, this misnamed plague did its deadliest work in two dozen weeks, not decades or centuries.

Overshadowed by the carnage of World War I, the Spanish flu pandemic now serves as the "worst-case scenario" for state and federal public health and emergency management officials scrambling to prepare for a future global outbreak of influenza. If history were to repeat itself, federal health officials say more than 2 million Americans would die and 90 million would be infected -- an Armageddon of disease that would swamp hospital systems and quickly exhaust limited supplies of medicine and equipment.

For modern-day public health officials, the Spanish flu pandemic provides a graphic object lesson of the lethal price of not responding swiftly when a future global health disaster strikes. At the time, it was ignored or downplayed by public officials and military leaders who let rallies and massive troop movements take place well after they knew the disease was on the march, aiding its rapid spread.

The reason for this colossal blunder is rooted in the war fever that dominated the times -- it made officials in North Carolina and elsewhere fearful of being seen as unpatriotic slackers. As a result, Raleigh civic leaders didn't cancel a huge Sept. 30, 1918, Liberty Loan parade and rally or a big revival on the same day at Tabernacle Baptist Church, then on South Person Street -- even as flu deaths started to accelerate dramatically in the city.

There's a crucial reason to heed the warning of yesteryear's mistake.

When the next flu pandemic strikes, it will take up to six months to produce a vaccine that specifically targets this new virus. That will force public health officials to rely on the same old-school measures that weren't applied soon enough in 1918-19 -- isolation, quarantine and the quaintly named tactic of "social distancing," which includes the closing of schools, churches, shopping malls, theaters, concert halls and sports arenas.

Until a vaccine is developed, these time-worn tools will be the primary weapons in the battle to dampen the spread of this viral killer.

Still a mystery

For scientists, the pandemic of 1918-19 provides a tantalizingly chilling challenge because they still don't know what made this strain so lethal and lightning quick -- infamous for claiming victims who felt fine in the morning but were dead by nightfall. Nor do they know why this murderously efficient virus arose simultaneously in Asia, Europe and the Americas.

"It's always been something of a mystery why that flu pandemic was so much deadlier than other pandemics," said Dr. Richard Frothingham, an associate professor of medicine at Duke University who specializes in vaccine research. "It was not just that it was new, but was there something else going on in the structure of the virus itself that made it so deadly?"

Researchers are feverishly studying the protein and genetic structure of reconstructed versions of the 1918-19 virus, the biological grandfather of all Type A flu viruses circulating among humans, hoping to resolve these unanswered questions. They hope those answers will help them develop a new vaccine for a future pandemic.

"It's the most lethal pandemic we know about. ... Unfortunately, we're still so ignorant about how these viruses work," said Jeffery Taubenberger, a senior investigator at the National Institute of Allergy and Infectious Diseases who has isolated the 1918-19 virus from preserved tissue samples of the pandemic's victims.

The specter of the 1918-19 pandemic also haunts the scientific watchdogs monitoring the Asian bird flu virus they think is the most likely source of the next pandemic. It's known by its genetic call sign, H5N1, but has yet to mutate into a form that can be readily passed between humans.

As they nervously eye this virulent strain that is particularly deadly to the several hundred humans who have caught it, physicians and scientists are seeing some of the same quick-striking, lung-clogging symptoms that marked the 1918-19 virus. It turned its victims a deep blue-black color as blood and other bodily fluids choked off their oxygen supply.

This is the result of what scientists call a "cytokine storm," an out-of-control reaction by the body's immune system to an utterly alien virus, a stealthy invader able to penetrate deep into the lungs before detection.

That's why the 1918-19 strain claimed so many young adults as victims -- their vigorous immune systems responded so violently to the threat that the reaction helped kill the stricken patient. That's what makes the H5N1 avian virus so scary.

"It was horribly devastating, unbelievably lethal -- particularly among young adults," said Taubenberger of the virus that is the focal point of his studies. "And that was unprecedented."

Victims everywhere

The 1918-19 pandemic's relentless second wave slipped ashore in North Carolina in late September, probably carried into Wilmington by steamship -- possibly from Boston, site of the outbreak's first major attack in the United States, or Philadelphia, another port city where thousands eventually died and steam shovels dug trenches for mass graves.

On Sept. 21, 1918, Wilmington's first Spanish flu victim died -- William A. Wright, 28, a popular merchant and one of at least 223 New Hanover County residents killed by this deadly virus and at least 7,000 who became sick.

As September slid toward October, the pandemic quickly spread to the Piedmont and beyond, riding the rails and roads, carried by soldiers, sailors and salesmen. It fooled the best scientific minds of the times, men and women who thought they were dealing with a bacteria and wouldn't discover the pandemic's viral roots until the 1930s.

In the Tar Heel state, the prominent and the plebian were struck down by this ravaging virus and the deadly, bacterial helpmate that often followed in its wake -- pneumonia. Victims included Edward Kidder Graham, 42, president of the University of North Carolina, and his interim successor, Marvin Hendrix Stacy, also 42, who died in January 1919, struck during the pandemic's wintry third wave.

Like a scythe, it cut down Lucy Page, 37, and Eliza Riddick, 24, two Raleigh volunteers who tended flu-stricken students at N.C. State University. It also snuffed the life of Bessie Roper, 29, of Asheville, a volunteer who nursed flu-stricken students at UNC.

A water-fountain memorial was built in Riddick's and Page's names and once stood in front of the old Wake County courthouse. Riddick's 21-year-old brother, William, described in newspaper accounts as a well-known man-about-town nicknamed "Rout," died Oct. 8, 1918, a week before his sister did.

Another Raleigh volunteer, Ernest Royall Carroll, 41, died Nov. 15, 1918 -- two months after registering for the draft -- after serving in a soup line for flu-sickened refugees at his church, Tabernacle Baptist. Carroll, who formed one of Raleigh's first Boy Scout troops, was one of 30 church members killed by the pandemic, including four deacons and a former pastor, a history of the church notes.

Signs in obituaries

While the virus was killing scores of people in Raleigh, Winston-Salem, Charlotte, Wilmington and Fayetteville, the front pages of North Carolina newspapers were dominated by reports of American troops launching a bloody offensive in the Meuse-Argonne sector of the Western Front -- leavened by flu stories only on occasion.

As a result, the telltales of the pandemic's lethal assault in North Carolina are buried in the funeral notices of the society pages or relegated to inside stories that invariably emphasized the rosy belief of public officials who claimed the worst had passed.

Even this muted coverage is stark and sobering. Roxboro had more than 600 flu cases by Oct. 8, 1918, and 13 funerals for flu victims on a single Monday.

There were 32 flu deaths in Durham by Oct. 17; 36 deaths in Raleigh by Oct. 15, including at least five N.C. State students. Raleigh's death toll rose to 82 by Oct. 21 and 100 by Oct. 24, with a canvass of 3,561 homes revealing 1,380 flu cases.

In one house, canvassers found the body of a man whose wife was recovering in bed from the birth of their 4-day-old child, unable to find anybody to prepare her husband's corpse for burial. The dead in Raleigh included James E. Moore, 22, an engineer on the Seaboard Air Line railroad, and C.W. Robbins, a student at Shaw University -- like Wright of Wilmington, young victims who were the preferred demographic of this pandemic.

"We've almost forgotten the horror of the war in the seriousness of the influenza epidemic," wrote Ray Tillinghast in a letter archived at Duke University and written to her cousin Carrie, a young Fayetteville woman who was serving as a nurse in France with the American Expeditionary Force. "The country has never known anything like it."

The death toll of the Spanish flu pandemic is staggering, even by the crude statistical measures of the time. It was enough to carve a dozen years off America's average life expectancy; enough to cause North Carolina's 1918 influenza death rate to leap to a level 20 times higher than 1917.

Consider this: More Americans died during the Spanish flu pandemic than were killed in battle during all of America's wars -- from the Revolutionary War through the Civil War, both World Wars and the current conflict in Iraq.

And during World War I, 80 percent as many soldiers and sailors died of flu and pneumonia as those who died in combat, historians say. Military flu victims died by the thousands -- in troop ships crossing the Atlantic and base camps in France.

But training camps in America were the real killing ground for this ruthless virus. Tents and hastily constructed barracks were overcrowded with soldiers and sailors who shuttled across the country before shipping out to France as part of an unprecedented, worldwide migration of millions driven by the demands of war.

This was an ancient precursor to the global transportation network that spans the globe today and would guarantee the wildfire spread of a future pandemic.

Worse than war

The pandemic's onslaught fostered fear and isolation, wrote Samuel Lewis Morgan, pastor of First Baptist Church in hard-hit Henderson when the pandemic struck.

"The disease struck terror everywhere. ... Soon I learned the tragic loneliness of the people," Morgan wrote in memoirs archived at UNC-Chapel Hill.

Morgan, who also led churches in Creedmoor, Smithfield, Lillington and Ramseur during a 38-year career, tried to combat this isolation by visiting members of his church before they or their loved ones became gravely ill.

But the flu struck him down and doctors ordered him confined to his bed, isolated from the rest of his family. Only his wife, Isabelle, could enter the room -- and only if she wore a mask.

He listened to the church bells of Henderson celebrating the Nov. 11 end of World War I from his sickbed.

"The epidemic I remember with more horror than the war," Morgan wrote. "It killed some lovely people and pillars in the churches."

For Leon Spencer, who now lives in Raleigh at Whitaker Glen, the killing horror of the pandemic is captured in a farmboy's memory of his parents naming the dead, the dying and the suddenly stricken.

In the five autumn weeks that marked the worldwide outbreak's deadliest peak, Spencer and his siblings listened to a daily toll of friends and neighbors so routine, yet overwhelming, his parents forgot to shield their children from the unrelenting reality.

Spencer's grandmother, Mary Smith Spencer, died of pneumonia in March 1918 after a bout with the flu, a likely victim of the pandemic's relatively mild first wave.

But at a time when death seemed like the commonplace passage of fall into winter, Spencer remembers his grandmother's passing because her burial took place on his father's birthday -- not as a blood-close reminder of a global health catastrophe.

For Spencer, still sharp and active after more than a century of life, the pandemic he lived through in his teens was a time of shuttered churches and schools, a town doctor on the run from dawn until midnight and the names of the suddenly departed passed between his parents.

"There were a lot of people getting sick and my parents would talk about people dying," Spencer said. "That lingers with me. I didn't know them all personally, but I knew they were young."

Just as young as Mabel Allen Boyd