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

by John M. Barry

blood cells concentrate. There these other white blood cells learn to recognize the antigen as a foreign invader and begin the process of producing huge numbers of antibodies and killer white cells that will attac...

Vaccinations expose people to an antigen and mobilize the immune system to respond to that disease.

influenza has a way to evade the immune system.

The chief antigens of the influenza virus are the hemagglutinin and neuraminidase protruding from its surface. But of all the parts of the influenza virus that mutate, the hemagglutinin and neuraminidase mutate the fastest. This makes it impossible for the immune system to keep pace.

Antigen drift can create epidemics. One study found nineteen discrete, identifiable epidemics in the United States in a thirty-three-year period—more than one every other year. Each one caused between ten thousand and forty thousand “excess deaths” in the United States alone—an excess over and above the death toll usually caused by the disease.

Pandemics generally develop only when a radical change in the hemagglutinin, or the neuraminidase, or both, occurs. When an entirely new gene coding for one or both replaces the old one, the shape of the new antigen bears little resemblance to the old one.

Some virologists theorize that pigs provide a perfect “mixing bowl,” because the sialic-acid receptors on their cells can bind to both bird

and human viruses.

In 1510 a pandemic of pulmonary disease came from Africa and “attacked at once and raged all over Europe not missing a family and scarce a person.” In 1580 another pandemic started in Asia, then spread to Africa, Europe, and America. It was so fierce “that in the space of six weeks it afflicted almost all the nations of Europe, of whom hardly the twentieth person was free of the disease,” and some Spanish cities were “nearly entirely depopulated by the disease.”

To prevent the 1997 Hong Kong virus, which killed six of eighteen people infected, from adapting to people, public health authorities had every single chicken then in Hong Kong, 1.2 million of them, slaughtered. An even greater slaughter of animals occurred in the spring of 2003 when a new H7N7 virus appeared in poultry farms in the Netherlands, Belgium, and Germany. This virus infected eighty-two people and killed one, and it also infected pigs. So public health authorities killed nearly thirty million poultry and some swine.

One more thing makes influenza unusual. When a new influenza virus emerges, it is highly competitive, even cannibalistic. It usually drives older types into extinction. This happens because infection stimulates the body’s immune system to generate all its defenses against all influenza viruses to which the body has ever been exposed. When older viruses attempt to infect someone, they cannot gain a foothold. They cease replicating. They die out.

America had never been and would never be so informed by the will of its chief executive, not during the Civil War with the suspension of habeas corpus, not during Korea and the McCarthy period, not even during World War II. He would turn the nation into a weapon, an explosive device.

The single largest ethnic group in the United States was German-American and a large German-language press had been sympathetic to Germany. Would German-Americans fight against Germany? The Irish Republican Army had launched an uprising against British rule on Easter, 1916. Would Irish-Americans fight to help Britain? The Midwest was isolationist. Would it send soldiers across an ocean when the United States had not been attacked? Populists opposed war,

Soon after the declaration of war, Wilson pushed the Espionage Act through a cooperative Congress, which balked only at legalizing outright

press censorship—despite Wilson’s calling it “an imperative necessity.” The bill gave Postmaster General Albert Sidney Burleson the right to refuse to deliver any periodical he deemed unpatriotic or critical of the administration. And, before television and radio, most of the political discourse in the country went through the mails. A southerner, a narrow man and a hater, nominally a populist but closer to the Pitchfork Ben Tillman wing of the party than to that of William Jennings Bryan, Burleson soon had the post office stop delivery of virtually all publications and any foreign-language publication that hinted at less-than-enthusiastic support of the war.

The administration got such a law. In 1798, Federalist President John Adams and his party, under pressure of undeclared war with France, passed the Sedition Act, which made it unlawful to “print, utter, or publish . . . any false, scandalous, or malicious writing” against the government. But that law inflamed controversy, contributed to Adams’s reelection defeat, and led to the only impeachment of a Supreme Court justice in history, when Samuel Chase both helped get grand jury indictments of critics and then sentenced these same critics to maximum terms.

One could go to jail for cursing the government, or criticizing it, even if what one said was true. Oliver Wendell Holmes wrote the Supreme Court opinion that found the act constitutional—after the war ended, upholding lengthy prison terms for the defendants—arguing that the First Amendment did not protect speech if “the words used . . . create a clear and present danger.”

a “flying squad” of league members and police trailed, harassed, and beat members of the Industrial Workers of the World. In Arizona, league members and vigilantes locked twelve hundred IWW

state line in New Mexico. In Rockford, Illinois, the army asked the league for help in gaining confessions

Typically, Lippmann later called society “too big, too complex” for the average person to comprehend, since most citizens were “mentally children or barbarians. . . .

Lippmann urged that self-rule be subordinated to “order,” “rights,” and “prosperity.”

People like that . . . through their vanity or curiosity or treason they are helping German propagandists sow the seeds of discontent. . . .” Creel demanded “100% Americanism”

In 1881 Clara Barton founded the American Red Cross, and the next year the United States accepted the guidelines of the convention.

The American Red Cross was a quasi-public institution whose titular president was (and is) the president of the United States.

Honorary chairman - appts chairman of board of governors and designating. Embers to serve on the board.

Johnstown flood

the American Red Cross began the Great War with only 107 local chapters. It finished with 3,864 chapters.

improve not just the hard sciences but theories of crowd behavior, of scientific management of the means of production, of what was thought of as the new science of public relations.

Wilson had been a graduate student at the Hopkins when Welch had first arrived there and immediately invited him, Hale, and a few others to the White House. There they proposed to establish a National Research Council to direct all war-related scientific work.

medicine, too, had become a weapon of war.

conspicuous by his absence was Rupert Blue, then the civilian surgeon general and head of the U.S. Public Health Service (USPHS). Welch and his colleagues so doubted his abilities and judgment that they not only blocked him from serving

Instead they picked a USPHS scientist they trusted. It was not a good sign that the head of the public health service was so little regarded.

Throughout the wars in history more soldiers had often died of disease than in battle or of their wounds. And epidemic disease had routinely spread from armies to civilian populations.

This was true not just in ancient times or in the American Civil War, in which two men died from disease for every battle-related death (counting both sides, one hundred eighty-five thousand troops died in combat or of their wounds, while three hundred seventy-three thousand died of disease).

The Spanish-American War deaths especially were entirely unnecessary. The army had expanded in a matter of months from twenty-eight thousand to two hundred seventy-five thousand, and Congress had appropriated $50 million for the military, but not a penny went to the army medical department; as a result, a camp of sixty thousand soldiers at Chickamauga had not a single microscope. Nor was army surgeon general Sternberg given any authority. Military engineers and line officers directly rejected his angry protests about a dangerously unsanitary camp design and water supply. Their stubbornness killed roughly five thousand American young men.

In the Franco-Prussian War in 1871, for example, measles killed 40 percent of those who fell ill during the siege of Paris, and a measles epidemic erupted in the U.S. Army in 1911, killing 5 percent of all the men who caught the disease.

On no subject where he had only science behind him, science without political weight, could he get even a hearing from army superiors. Even when an American researcher developed an antitoxin for gangrene, Gorgas could not convince them to fund testing at the front.

The war also consumed the supply of practicing physicians.

(Sometimes physicians, threatened by intelligent and educated nurses, waged a virtual guerrilla

war; in some hospitals physicians replaced labels on drug bottles with numbers so nurses could not question a prescription.)

The Red Cross and the army surrendered to her. No training of nursing aides commenced.

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In the meantime the military’s appetite for doctors and nurses only grew. Four million American men were under arms with more coming, and Gorgas was planning for three hundred thousand hospital beds. The number of trained medical staff he had simply could not handle that load. So the military suctioned more and more nurses and physicians into cantonments, aboard ships, into France,

Medical care for civilians deteriorated rapidly. The doctors who remained in civilian life were largely either incompetent young ones or those over forty-five years of age, the vast majority of whom had been trained in the old ways of medicine. The shortage of nurses would prove eve...

Gorgas was taking action, too. He saw to it that many of the new army doctors assigned to the cantonments were trained at the Rockefeller Institute by some of the best scientists in the world. He began stockpiling huge quantities of vaccines, antitoxins, and sera. He did not rely for these products on drug manufacturers; they were unreliable and often useless.

In 1917, in fact, New York State health commissioner Hermann Biggs tested commercial products for several diseases and found them so poor that he banned all sales from all drug manufacturers in New York State. So

In 1918 the Republican-controlled Senate held hearings on the Wilson administration’s mistakes in mobilizing the military. Republicans had despised Wilson since 1912, when he reached the White House despite winning only 41 percent of the vote.

And, like measles, when influenza kills, it usually kills through pneumonia.

Osler did not claim that bleeding cured pneumonia, only that it might relieve certain symptoms. He was wrong.

the paper still made a deep impression on Cole. It was

Avery