The Great Flu Crisis at Mare Island Navy Yard, and Vallejo, California
Capt. Thomas L. Snyder, MC, USNR (Ret.)
Mare Island Navy Yard, the oldest U.S. Navy base on the West Coast, was founded by CDR David Farragut in 1854. The Yard was located across the Napa River from Vallejo, CA.
From the founding of the Navy Yard, Vellejo was a "Navy town." The yard civilian work force largely populated the city. Yard workers dominated city political, economic, and social structure. A lively social life between Navy personnel and the civilians of the city flourished.1
The Spanish Influenza epidemicNext to HIV-AIDS, the 1918-19 epidemic was the worst public health disaster of the 20th century. Estimates put American influenza deaths at 675,000, mortal to more Americans, by far, than all the wars fought in that century.2
Several phenomena new to the 20th century contributed to the rapid spread of the contagion:
- Masses of personnel were being moved in multiple directions around the world as the Great War was being fought.
- Large groups of coughing and sneezing people attended war bond rallies and parades.
- Movies encouraged people to gather in groups, all the while promoting the transmission of the virus.
- In a Navy town like Vallejo, several dance halls provided the opportunity for the spread of contagion.
- A less virulent influenza epidemic in the spring of 1918 had but little impact on military or civilian personnel, thence on public health thinking.
Accordingly, when the much more virulent form attacked in the autumn, health officials did not take the occurrence very seriously, and were late to institute appropriate public health measures to slow the contagion.
Preparations on the Mare Island Navy Yard
On 23 September 1918, the senior medical officer at Mare Island received a letter from the Naval Training Center at Great Lakes, which reflected the Great Lakes experience: 20 percent of the yard's manpower complement would become infected, and of those afflicted, 10 percent would develop pneumonia.3 The Mare Island medical officer and his assistants quickly calculated that they should prepare to care for as many as 1,600 influenza victims and 160 pneumonia cases. They immediately began planning for two "emergency hospitals" to supplement the permanent 200-bed Navy hospital, which would care only for the most ill, those with pneumonia.4 Calls for additional corpsmen, nurses, and medical officers went out.
The Navy yard commandant published instructions on how to recognize the symptoms of disease and what to do if they occurred. Any person presenting with upper respiratory-like symptoms was to be hospitalized and quarantined.
Things were thus in readiness when the first case of influenza, a Navy corpsman returning from leave in Oklahoma, presented at sick call on 25 September 1918.
Conditions in Vallejo
The situation in the City of Vallejo was quite different. Not only had little or no advance planning occurred, but the solitary local hospital, a very small facility, was under quarantine because of a small pox outbreak there, and doctors were involved in a smallpox vaccination program.5
At the same time, just as the epidemic began to break out, the city was filled with patriotic fervor over the Fourth War Bond Drive, for which large groups of people frequently gathered.
Housing in the city, whose population had swelled by the influx of 8 to 10 thousand war workers, was crowded and inadequate. Some workers and their families were housed in quickly constructed shacks; others lived in tents thrown up in the backyards of established homes.6 Crowding and its attendant spread of contagion was inevitable.
Because there was nothing, early on, to differentiate this virulent strain of flue from the "ordinary influenza prevalent here at various times",7 no provision for quarantine was made.
The first civilian cases, two, occurred on 27 September, according to the yard medical officer report. The local press reported the outbreak on 4 October.
The Epidemic Runs Its Course at the Navy YardWith the diagnosis of influenza in the community, Navy authorities quickly responded. Liberty in the city was canceled and functions involving large groups of personnel were prohibited. On 5 October the emergency hospitals were opened. The peak of the epidemic among service people in the yard was around 13-15 October, and it was virtually ended by 30 October. There were 1,536 (1,600 predicted) service personnel treated for influenza. An emergency hospital for civilian employees of the yard opened on Navy yard grounds on 3 November and closed 30 November. Two hundred eighty-seven civilians received care.8
The Epidemic in Vallejo
As the first few influenza cases appeared in town, physicians, with assistance from three Navy surgeons, were vaccinating all school children against the local smallpox epidemic. Local press reports indicate that the vaccination program was successful; after 4 October no new smallpox cases were reported.9
Attention could now be directed to fighting influenza. On 4 October, the Vallejo Evening Times headlined "Fumigation of Public Buildings in Next 48 Hours." The Navy medical officer decried this procedure as a futile gesture and complained in his report to BUMED that local authorities were ignoring advice from naval authorities to institute effective public health strategies. However, on 8 October, by City Council resolution, public authorities did close all public buildings. Church services, while not prohibited, were moved out of doors in order to reduce crowding. The press noted though, that no efforts had been taken to prevent the influx of contagion from outside the city.
In an editorial on 9 October, the Evening Times was reassuring. "There is no cause for alarm. As far as can be learned, no Spanish influenza is prevalent here and the steps taken [the closure of public buildings] have been taken merely as a preventative." The next day, however, the headlines reported 12 civilian cases. On 11 October, local Red Cross officials met to prepare for the coming onslaught by formation of an "influenza unit" involving physicians and nurses working in a local building which would be converted into a hospital, "should the need arise."
The need quickly arose as headlines, just 4 days later, declared "between 60 and 70 cases are being treated,"10 in their homes. It is probable that each civilian doctor made at least 60 house calls a day during this period. The 17 October Vallejo Evening Chronicle headlined that a 60-bed unit was to be opened, but noted that ". . . While medical officers of the [Navy] station think that a 60-bed hospital is a good thing to start with, they also state that if Vallejo hopes to care for her sick she should have at least 300 beds ready."
"City Emergency Hospital"
On 21 October, under the auspices of the Vallejo Red Cross, the Emergency Hospital was opened in an annex of the Y.M.C.A., "in an effort to concentrate the patients [according to the Navy special report] and thus relieve the wild running about of physicians, conserve nursing facilities, and provide hospital care for the sick." The Evening Times had a different take on the purpose of the facility, reporting that red Cross workers would look after those afflicted who had no homes and who were not eligible for care at the Navy hospital, that is, people who were not civilian employees of the yard. There are no records to indicate how many people were hospitalized there.
By 23 October, 350 cases of influenza were reported in town. The Vallejo Evening Chronicle reported that the Emergency Hospital was staffed by a single nurse, who had been on duty for 48 hours without relief. The President of the Vallejo Board of Health tried, without success, to obtain help in the civilian community.11 On the same day, about 1 month into the epidemic, the City Council directed the use of gauze face masks by all citizens. Non-compliers faced stiff fines.
October 24th found 20 patients hospitalized in City Emergency Hospital, many seriously ill with pneumonia. Still unable to properly staff the hospital with civilian workers, the Red Cross made an urgent appeal for help from the Navy Yard. Navy authorities quickly ordered six hospital corpsmen to assist at the facility. They found that it was "a deplorable place for patients. It was unheated, low ceilinged, poorly ventilated, poorly provided with nursing personnel, commissary, and toilet facilities."12 There was no effective administration, and the lead corpsman, a Hospital Apprentice 2d Class "stepped in and practically ran the hospital." Each private physician admitted, attended, and discharged his own patients independently, which troubled the Navy medical officer, who reported: "[s]uch lack of management and system gave rise to untold confusion and largely defeated the object of the hospital, namely to conserve the time and strength of the doctors and afford proper care of desperately sick patients."
The Evening Times reported that physicians were too busy to report accurate numbers of sick, "but indications are that several hundred are suffering."
The Crisis WorsensBy 26 October, Navy yard officials became acutely aware of the loss of a large number of civilian shipyard workers to illness. Navy doctors working in town reported they had discovered whole families ill, with no one to care for or feed them. They found unmarried Navy yard workers sick and unattended in rooming houses; at night, uninfected workers from the Navy yard would return to these same rooming houses, to share poorly ventilated quarters with the sick. In poorer areas of town, people were simply unable to obtain the services of doctors and had to fend for themselves.
The Evening Times reported that local physicians were overwhelmed by the number of calls they received, and noted that "one physician received 15 calls in 2 hours" in the evening.
Conditions were so serious by 30 October that three representatives, the local Red Cross Director, a local physicians (and Navy reservist), and a Trades and Labor Council leader, met with the City Council to "demand . . . that some steps be taken to alleviate conditions existing here at the present time . . .",13 and to "have the entire situation placed under the command of CAPT Harry George [the Navy Yard Commandant] to be handled by his medical forces."14 An editorial in the Evening Times concluded that "The summoning of the naval hospital unit should have been carried out several days ago, or as soon as the disease was well in hand at Mare Island and the physicians and their aides were at liberty . . . To answer the call of the people of the community."
"Saint Vincent's Navy Hospital"The City Council acknowledged the inability of the city's resources to deal with the crisis, and requested the aid of the Commandant of the Navy Yard. At the same time, the local Dominican Order offered the use of a newly constructed school for another temporary hospital. The Commandant promptly authorized a 100-bed facility to be opened.15 The Navy provided 4 medical officers, 24 corpsmen, and 58 support personnel. Six Dominican sisters acted as nurses. This hospital opened on 2 November. Three days later it was caring for 71 patients.
The Epidemic Finally Wanes
No sooner was the new hospital opened than newspapers began to report a decline in the number of new cases of influenza in town. By the 6th of November the Evening Times editorialized that "reports of today on the influenza situation indicated that the epidemic at last is under control and on the decline." By 16 November the Emergency Hospital at the Y.M.C.A. annex was closed. The St. Vincent's unit still had 68 patients but was closed on 30 November. Its Navy staff and the Dominican sisters had cared for a total of 190 patients, including 80 women and 42 children.
A Brief Resurgence of InfectionIn January 1919 the epidemic recurred. While few cases occurred at the Navy Yard, local resources were again quickly overwhelmed. Mare Island Navy Yard employees telegraphed the Secretary of the Navy on 10 January: "Vallejo Calif calls for help. Your Mare Island Navy Yard civilian men are dying. Wives and children lay stricken without help. Hospitals full, no nurses. Doctors working day and night. Please advise Commandant Harry George of Mare Island Navy Yard to quarantine Vallejo and take full charge. Live up to your good record and show us some action. Yours for service."16
In a City Council meeting on the 11th, the major of Vallejo stated "there is no provision in the budget for any emergency." However, the Dominicans again offered the use of their school, and on 13 January "St. Vincent Navy Hospital" was reopened. Face masks were again required, and theaters closed once more.
That same day the Commandant of the Yard reported to the Secretary of the Navy by telegram:
"Influenza in Vallejo serious and fast becoming epidemic. St. Vincent's Catholic Church has placed school building at disposal Commandant as temporary hospital. Large majority of residents are Officers and enlisted men Navy and civil employees Navy yard and their families, and immediate steps should be taken to afford them medical assistance. Request authority to maintain temporary Naval Hospital at St. Vincent's school and to expend necessary funds. Consider project most urgent to safe life and protect Navy personnel and civil employees."17
The Vallejo Evening Chronicle (January 13) editorialized that "[the Navy Yard Commandant] was quick, as he has been in all things, and at all times, to see the necessity for checking and controlling the new trouble." By 22 January the Evening Times headlined "NO NEW CASES REPORTED" and reckoned the quick demise of the epidemic was ". . . due to the systematic way in which the epidemic was handled . . ."18 Public places were re-opened on 25 January, and the St. Vincent's unit closed on 28 January. A total of 55 patients had been hospitalized.
The Spanish influenza epidemic represented a public health emergency of the highest order.
Mare Island medical personnel properly prepared for the onslaught of expected influenza cases. They "got their Public Health right" in that all patients presenting with symptoms of influenza were promptly quarantined. Similarly, contacts with the community where infection was rife were curtailed early on. Civil health officials were not so well prepared. Nor were they open to suggestions from Navy medical personnel about how to organize their efforts. Because the U.S. is an "open society," however, local citizens successfully urged Navy intervention. Naval personnel performed magnificently, to the copious approbation of citizens and civic authorities alike.19
What of Today?Our current concerns about possible terrorist-induced epidemic, or another SARS-like outbreak, throw the experience of Mare Island Navy Yard and Vallejo into high relief. A very contagious, virulent virus could produce so large a volume of illness so quickly as to overwhelm local medical capabilities.
In California there is "no specific authority" for public health officials to "deputize" or otherwise organize local medical personnel to respond to an emergency. While quarantine can be ordered with judicial approval, medical response to a public health emergency is [still] based on a "gentleperson's agreement" among the various parties.20 Country health officials and local hospitals work together developing action plans to be instituted in the event of a large public contagion.
Clearly, there could be a large role for military medicine in some future contagion. This would call for civilian-military contingency planning for such an eventuality. Strategies for a public health response and for the management of large numbers of very sick people must be put in place now.
Lemmon, S. and Wichels, ED. Sidewheelers to Nuclear Power: A Pictorial Essay Covering 123 Years at the Mare Island Naval Shipyard. Annapolis, MD. Leeward Publications, 1977, Part II-People.
2 Armed Forces Institute of Pathology, The AFIP Letter. 1997; 155(2).
3 Neilson, JL. Influenza epidemic, Mare Island, Cal; special report on, from the medical Officer, Navy Yard, Mare Island, CA, to the (Navy) Bureau of Medicine and Surgery, February 28, 1919, page 4, paragraph 5.
4 Ibid, page 4, paragraph 4.
5 Vallejo Evening Times (VET), Wednesday October 2, 1918.
6 Neilson, page 3, paragraph 9.
7 VET, Friday October 4, 1918.
8 Neilson, page 19, paragraph 38.
9 Vallejo Evening Chronicle (VEC), Friday October 4, 1918.
10 The Vallejo Evening Times, in a page three article titled "Ways to Prevent Contraction of the Spanish Flu" emphasized: "THE SPECIAL PRECAUTIONS TO TAKE ARE: LOTS OF FRESH AIR, NUTRITIOUS DIET, AND AVOID THE EVILS OF OVERCROWDING."
11 VEC, Wednesday October 23, 1918.
12 Neilson, page 30, paragraph 57.
13 VET, Wednesday October 30, 1918.
15 VET headlines cried "NAVAL UNIT IS DETAILED TO HOSPITAL AT THE SCHOOL. Captain Harry George Answers Call of Health Officials to Protect Our People".
16 Telegram received Secretary of Navy 10 October 1919.
17 Telegram received at Navy Department 13 January 1919.
18 VET, Wednesday January 22, 1919.
19 Neilson, page 44, copy of letter from B.J. Klotz, M.D., President, Vallejo Board of Health.
20 Thomas Carron, MD, PhD, Medical Director, Solano County (California) Public Health Department, telephone conversation with author, 2 January 2003.
Snyder, Capt. Thomas L., MC, USNR (Ret.)
"The Great Flu Crisis at Mare Island Navy Yard, and Vallejo, California."
Navy Medicine 94, no. 5 (September-October 2003): 25-29.
Dr. Snyder was Chief of Urology at the Kaiser-Permanente Medical Center in Martinez, CA, for 10 years. He retired in April.