Influenza: A Century of Science and Public Health Response

Introduction: Wagers and Unexpected Outcomes

1 It all started with a bet.1 On 5 January 1976, the U.S. Army base at Fort Dix, in south-central New Jersey, rapidly filled with a mixture of new recruits, advanced recruits, and military and civilian personnel and dependents. The camp barracks and quarters—which had been nearly deserted over the Christmas and New Year’s break—quickly crowded with about 19,000 people. Quarters were tight, and none more so than those for the approximately 6,000 basic trainees. These new recruits were grouped into units of fifty and assigned to eight-person rooms. In addition to sharing a common mess hall and repeated training processes, the men were restricted to their barracks for the first two weeks and to the camp for the following two weeks. The combination of close proximity, physical exertion, sleep deprivation, and high stress prompted the rapid circulation of infectious disease, a phenomenon military leaders have long observed.2 To help forestall such infections, the U.S. military routinely inoculates new recruits against a host of diseases, including influenza, during their initial threeday stay at the reception center. Despite these precautions, the post’s medical officer, Colonel Joseph Bartley, anticipated a surge of illness reports, especially of respiratory problems, which readily spread among those housed in close quarters. Col. Bartley was particularly vigilant for adenovirus, which causes IntroductIon Wagers and Unexpected Outcomes • 2 wagers and unexpected outcomes mild flulike symptoms. The infection had been reported at a base in Missouri prior to the Christmas break and, more recently, at Fort Meade, just down the highway in Maryland. In the weeks following the repopulation of the camp, recruits began to complain of fevers and coughs, and a surprising number were put to bed in the camp hospital. In casual conversation with Martin Goldfield, chief epidemiologist for the state of New Jersey, Colonel Bartley reported the suspected outbreak of an adenovirus infection at the camp and warned Dr. Goldfield to watch out for it in the civilian population. Dr. Goldfield listened to the description of the symptoms and suspected that the sudden rise of cases, rapid onset, high fevers, and large number of hospitalized recruits signaled influenza rather than an adenovirus infection. In the course of their friendly banter, Dr. Goldfield wagered Col. Bartley that the illness was influenza. To settle the bet, Col. Bartley sent nineteen samples from sick recruits to the Division of Laboratories and Epidemilogy, New Jersey Department of Health for identification on 29 and 30 January. Eleven samples tested positive for influenza, winning Goldfield the wager. Of these eleven, seven readily reacted to antigens for the prevailing strain of influenza, A/Victoria.3 The other four positives appeared to be influenza, but of a type that the state laboratory could not identify. Standard procedure called for unidentified viral material to be sent to the Atlanta office of the Centers for Disease Control (CDC) for typing. Goldfield dutifully arranged to have the specimens sent to Atlanta by airplane on 6 February. Meanwhile, Fort Dix continued to undergo what was now identified as a mini–influenza epidemic. Even so, despite the increased numbers hospitalized on the base, the epidemic had proved to be of minor consequence. All the soldiers had recovered and reported back to duty. However, this status was about to change. Private David Lewis, a nineteen-year-old recruit from Ashley Falls, Massachusetts , had been fighting what he believed was a bad cold for about a week before he visited the camp dispensary on 3 February. He was given cold medicine and ordered to his bunk for the next forty-eight hours. The next morning —either feeling better or fearful of having to repeat basic training if he missed too much time—Lewis formed up with his unit for a five-mile march to the shooting range. After training all day, the unit reformed for the march back to camp. On the return march Lewis fell farther behind and collapsed, gasping for air. Sergeant Good, who was walking “drag” on the march, came to his aid. Lewis stopped breathing, and Sgt. Good administered mouth-tomouth resuscitation while the senior drill sergeant rushed Lewis to the base hospital by car. By the time they arrived at the hospital, Lewis was dead. Post- wagers and unexpected outcomes 3 mortem testing provided another sample of the unidentified influenza, and this specimen, too, was sped to Atlanta. The Lewis sample added...