The Great Influenza: The Epic Story of the Deadliest Plague in History

by John M. Barry

Lewis was a scientist. Although a physician he had never practiced on a patient. Instead, a member of the very first generation of American medical scientists, he had spent his life in the laboratory. He had already built an extraordinary career, an international reputation, and he was still young enough to be seen as just coming into his prime. A decade earlier, working with his mentor at the Rockefeller Institute in New York City, he had proved that a virus caused polio, a discovery still considered a landmark achievement in the history of virology.

For whatever was attacking these sailors was not only spreading, it was spreading explosively. And it was spreading despite a well-planned, concerted effort to contain it. This same disease had erupted ten days earlier at a navy facility in Boston.

four days after that Boston detachment arrived, nineteen sailors in Philadelphia were hospitalized with what looked like the same disease.

Normally influenza chiefly kills the elderly and infants, but in the 1918 pandemic roughly half of those who died were young men and women in the prime of their life, in their twenties and thirties.

For the influenza pandemic that erupted in 1918 was the first great collision between nature and modern science.

In every war in American history so far, disease had killed more soldiers than combat.

Many schools bestowed a medical degree upon students who simply attended lectures and passed examinations; in some, students could fail several courses, never touch a single patient, and still get a medical degree.

SEPTEMBER 12, 1876, the crowd overflowing the auditorium of Baltimore’s Academy of Music was in a mood of hopeful excitement, but excitement without frivolity. Indeed, despite an unusual number of women in attendance, many of them from the uppermost reaches of local society, a reporter noted, “There was no display of dress or fashion.” For this occasion had serious purpose. It was to mark the launching of the Johns Hopkins University, an institution whose leaders intended not simply to found a new university but to change all of American education;

The keynote speaker, the English scientist Thomas H. Huxley, personified their goals.

Voting returns had already begun to come in—there was no single national election day—and two months later Democrat Samuel Tilden would win the popular vote by a comfortable margin. But he would never take office as president. Instead the Republican secretary of war would threaten to “force a reversal” of the vote, federal troops with fixed bayonets would patrol Washington, and southerners would talk of reigniting the Civil War.

Perhaps only in the United States, a nation ever in the act of creating itself, could such an institution come into existence both so fully formed in concept and already so renowned, even before the foundation of a single building had been laid.

Huxley commended the bold goals of the Hopkins, expounded upon his own theories of education—theories that soon informed those of William James and John Dewey—and

The two most important questions in science are “What can I know?” and “How can I know it?”

Methodology subsumes, for example, Thomas Kuhn’s well-known theory of how science advances. Kuhn gave the word “paradigm” wide usage by arguing that at any given point in time, a particular paradigm, a kind of perceived truth, dominates the thinking in any science.

Their careful observations noted mucus discharges, menstrual bleeding, watery evacuations in dysentery, and they very likely observed blood left to stand, which over time separates into several layers, one nearly clear, one of somewhat yellowy serum, one of darker blood. Based on these observations, they hypothesized that there were four kinds of bodily fluids, or “humours”: blood, phlegm, bile, and black bile. (This terminology survives today in the phrase “humoral immunity,” which refers to elements of the immune system, such as antibodies, that circulate in the blood.)

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Galen’s works were translated into Arabic and underlay both Western and Islamic medicine for nearly fifteen hundred years before facing any significant challenge.

Sweating, urinating, defecating, and vomiting were all ways that could restore balance.

Such beliefs led physicians to recommend violent laxatives and other purgatives, as well as mustard plasters and other prescriptions that punished the body, that blistered it and theoretically restored balance.

Bleeding was among the most common therapies employed to treat all manner of disorders.

And a rival school of thought gradually developed within the Hippocratic-Galenic tradition that valued experience and empiricism and challenged the purely theoretical.

Paracelsus declared he would investigate nature “not by following that which those of old taught, but by our own observation of nature, confirmed by . . . experiment and by reasoning thereon.”

Vesalius dissected human corpses and concluded that Galen’s findings had come from animals

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Fracastorius, an astronomer, mathematician, botanist, and poet, meanwhile hypothesized that diseases had specific causes and that contagion “passes from one thing to another and is originally caused by infection of the imperceptible particle.”

Francis Bacon in Novum Organum attacked the purely deductive reasoning of logic,

In 1628 Harvey traced the circulation of the blood, arguably perhaps the single greatest achievement of medicine—and certainly the greatest achievement until the late 1800s.

David Hume, after this demonstration and following Locke, led a movement of “empiricism.”

bleeding—today called “phlebotomy”—can actually help in some rare diseases, such as polycythemia, a rare genetic disorder that causes people to make too much blood, or hemachromatosis, when the blood carries too much iron.

In 1800 medicine remained what one historian called “the withered arm of science.”

“the Paris clinical school.” One leader of the movement was Xavier Bichat, who dissected organs, found them composed of discrete types of material often found in layers, and called them “tissues”;

In the

1795 Alexander Gordon on childbed fever!

Criticism notwithstanding, the numerical system began winning convert after convert. In England in the 1840s and 1850s, John Snow began applying mathematics in a new way: as an epidemiologist. He had made meticulous observations of the patterns of a cholera outbreak,

In the case of infectious and other disease, however, physicians continued to attack the body with mustard plasters that blistered the body, along with arsenic, mercury, and other poisons.

After the Civil War, America continued to churn out prophets of new, simple, complete, and self-contained systems of healing, two of which, chiropractic and Christian Science, survive today. (Evidence does suggest that spinal manipulation can relieve musculoskeletal conditions, but no evidence supports chiropractic claims that disease is caused by misalignment of vertebrae.)

(He disdained Yale’s medical school; fifty years later he was asked to give a speech on Yale’s early contributions to medicine and replied that there hadn’t been any.)

Carl Ludwig,

Julius Cohnheim, another mentor, taught him a new kind of curiosity: “Cohnheim’s interest centers on the explanation of the fact.

proved that the emigration of the white blood-corpuscles is the origin of pus, a statement which produced a great revolution Freezing histology specimens

even before they emerged as arguably the two greatest medical scientists of the nineteenth or early twentieth

With smallpox Jenner started out by taking seriously the experiences of country folk inoculating themselves.

Louis Thuillier, the youngest member of the expedition, died of cholera.

Most leading physicians around the world, including in the United States, agreed with a prominent American public health expert who declared in 1885: “What was theory has become fact.”

He never married. Despite working with others in ways that so often bind people together as comrades, with the single possible exception of the great and strange surgeon William Halsted—and that exception only a rumored possibility*—he had no known intimate relationship, sexual or otherwise, with either man or woman. Although he would live in Baltimore for half a century, he would never own a home there nor even have his own apartment;

Paul Ehrlich,

Sternberg, an autodidact whom Welch called “the real pioneer of modern bacteriologic work in this country . . . [who] mastered the technique and literature by sheer persistence and native ability.”

His failing was this: in science as in the rest of his life, he lived upon the surface and did not root. His attention never settled upon one important or profound question.

The greatest challenge of science, its art, lies in asking an important question and framing it in a way that allows it to be broken into manageable pieces, into experiments that can be conducted that ultimately lead to answers. To do this requires a certain kind of genius, one that probes vertically and sees horizontally.

William Halsted, a surgeon who changed the way surgeons thought,

AMERICAN MEDICAL EDUCATION needed a revolution. When the Hopkins medical school did at last open in 1893, most American medical schools had still not established any affiliation with either a teaching hospital or a university, most faculty salaries were still paid by student fees, and students still often graduated without ever touching a patient.

George Whipple