Previous
Prologue
Themes
Key
LitCharts assigns a color and icon to each theme in The Great Influenza, which you can use to track the themes throughout the work.
Leadership and Crisis
Truth, Free Press, and Propaganda
Science vs. Nature
Education, Research, and Institutions
Summary
Analysis
On September 12, 1872, people gathered for the launch of Johns Hopkins University, an institution where the leaders had the lofty goal of changing American education. Thomas H. Huxley was an English scientist and the keynote speaker.
Barry foregrounds the role of Johns Hopkins University in changing American medical education in order to show why it is important for people to found and maintain strong educational institutions. High-quality education and training will be of critical importance during crises like the 1918 pandemic.
Themes
In many ways, the United States was in conflict. The day of Johns Hopkins’s launch, the front pages of the press were decrying the “hostile Sioux” for “massacring” General Custer. Meanwhile, in the South, white Democrats and former Confederates were revolting against Reconstruction by intimidating, torturing, and murdering Republicans and Black people, in part to influence elections.
The conflicts mentioned in this passage help establish the historical period. Today, European settlers’ treatment of Native Americans is often considered a genocide, but phrases like “hostile Sioux” suggest that newspapers (and the American public) viewed Native Americans as the aggressors. At the same time, the idea of a nation in crisis, with people split between political parties, is still relevant in the modern day.
Themes
The 1872 presidential election almost caused a crisis with the Democrat Samuel Tilden winning the popular vote but the Republican Rutherford B. Hayes taking office after Republicans threw out results in three Southern states. As part of the compromise, Republicans also withdrew federal troops from the South, removing protections for Black residents.
When Barry initially wrote this book, George W. Bush had also recently won a U.S. presidential election while losing the popular vote, and subsequent editions came out after a similar situation occurred with Donald Trump. As such, there’s an implication that past events can echo into the present.
Themes
Meanwhile, a much quieter but still significant war between science and tradition was happening at Hopkins. Huxley was a big believer in human reason and a major advocate for the theory of evolution. That day at Hopkins, he lectured about how Hopkins would provide education free from political or religious “sectarianism.” By modern standards, the speech was tame, but at a time when most universities had strong religious connections, it was revolutionary that Huxley didn’t say the word God once in his speech.
Huxley plays only a small role in the story, but his ideals represent the same ideals that many of the scientists who worked through the 1918 pandemic shared. The fact that Huxley wanted Hopkins to be free of “sectarianism”—that is, affiliation with a particular religion or political party—suggests that creating a clear divide between personal opinions and scientific truth was becoming an increasingly important (though still radical) principle at this time.
Themes
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Both today and in the early days of medical science, two of the most important scientific questions are and were “What can I know?” and “How can I know it?” Unlike religion and philosophy, science is less concerned with the question of “Why?” In science, methodology is often most important of all. Thomas Kuhn, for example, advanced a well-known theory about how the prevailing “paradigm” at any given time often creates mental obstacles to discovering (and funding) new ideas.
Barry gives a brief overview of the history of medical science, since these developments provide important context about what transpired in the modern period. The scientific method played a crucial role in investigating and combating the 1918 influenza pandemic, and so Barry shows how scientists arrived at the idea of a scientific method in the first place.
Themes
Though the scientific method is well-known today, not everyone who has investigated nature has used it. While reason has guided science for millennia, in the case of medical science, reason actually hindered progress in some ways. The failures of early medicine can’t be blamed on religion or superstition but on an overreliance on pure reason.
Despite the importance of the scientific method, Barry notes that it is not the only way of investigating nature. The idea that reason can actually hinder medical science is central to the book, since it demonstrates that real medical science isn’t like a simple math equation to solve but, in fact, something with so many variables that it can resemble an art.
Themes
Hippocrates, born around 460 B.C., was part of a school of ancient Greeks who were looking for answers about medicine. They observed nature but didn’t disturb it—they never would’ve considered dissecting a human body. The Hippocratic texts (named after Hippocrates but written by a group of people) introduced the concept of four bodily fluids, aka “humors”: blood, phlegm, bile, and black bile.
The four humors were a cornerstone not only of medicine but also of culture and literature, with frequent references to them in Chaucer and Shakespeare’s writing. To an outsider, it might seem impossible that a scientifically inaccurate idea like this could live on for so many centuries. This is why Barry included the earlier paragraph about how a single-minded focus on reason can be detrimental to medical research, since it helps explain why the four humors theory endured for so long.
Themes
The four humors theory of medicine seemed to make sense from a logical perspective. For example, coughs are caused by phlegm flowing to the chest. It also matched up nicely with the way the Greeks saw nature (four seasons, four elements, etc.).
Though the four humors theory has been disproven, Barry tries to portray it in a way that shows how logical it must have seemed to people living in the past.
Themes
It took about 600 years for medicine’s next big advance. A man named Galen helped to make the four humors theory more systematic, augmenting his research with animal dissections and inspections of wounded gladiators. Galen’s work went on to influence both Western and Islamic medicine for nearly 1,500 years.
Though Hippocrates is by far the best-known of the first medical investigators, Barry shows that he wasn’t alone and that, in fact, it took successors like Galen to help standardize and popularize ancient theories like the four humors. A very similar process will play out with the 1918 pandemic and its aftermath.
Themes
One of Galen’s central ideas was that illness was the result of imbalance in the body. The way to cure this imbalance, according to him, was to flush it out, whether by sweating, urinating, vomiting, or even bleeding.
Galen’s ideas reflect the wisdom of someone who’s thinking logically but who hasn’t applied the rigor of the scientific method to his logic. This lack of rigor leads to “solutions” that in many cases actually make the problem worse.
Themes
Another major part of Galen’s theory was the idea that natural processes should not be interfered with. Pus, for example, was considered a natural part of healing and even referred to as “laudable pus.” Surgery was also considered an intrusive interference in nature’s process.
Again, Galen’s theories make a certain logical sense, but the results he arrived at were the exact opposite of what was actually happening (since pus is, in fact, a sign of infection rather than healing). This reinforces the idea that pure logic has its limits.
Themes
Other medical theories did exist outside of the Hippocratic-Galenic tradition. Paracelsus, Vesalius, and Fracastorius were three men from the early 1500s who played a role in challenging old ideas about the theory of medicine, although they had little immediate impact on the actual practice of medicine. Their work, however, laid the groundwork for others around the world to challenge medical tradition.
While it’s often only the biggest names that survive through history (like Hippocrates), in fact these big names were often working with colleagues and successors who made their own important contributions. This focus on metaphorical schools of medicine in the past connects to the importance of literal schools of medicine in more recent history.
Themes
Ultimately, these challenges to the Hippocratic-Galenic tradition culminated in the new concept of “heroic medicine,” of which the late 18th-century American scientist Benjamin Rush was a major advocate. Heroic medicine involved doctors taking a more proactive approach to treatment.
What distinguished “heroic medicine” from what came before it was that doctors were more willing to get their hands dirty and be active. While in many cases, they ended up making things worse for patients, Barry implies that this curiosity and initiative was a necessary step in medicine’s development and something that was missing from earlier medical education.
Themes
Why did reason work for solving Newtonian physics but not for medicine? Partially, it’s because the Hippocratic-Galenic tradition really did seem to work. In some rare cases, bleeding (today called “phlebotomy”) actually is an effective treatment. Even in cases when bleeding didn’t work, it might have looked like it worked, particularly because blood loss sometimes causes a euphoric feeling. The intricacies of the doctor-patient relationship also caused complications, since most doctors usually felt it was better to do something than nothing, even if there was little evidence for a treatment’s effectiveness.
This passage details how complicated it is to assess progress in medicine, which helps illustrate why doctors in the past struggled to make advances and often relied on treatments that have since been proven ineffective. Unlike many other people working in the sciences, doctors often interact directly with regular people as patients, and the emotions and personal investment involved complicate both treatment and research.
Themes
Another explanation for reason’s failure in medicine is that biology is much more chaotic than mathematics. It took the application of the modern scientific method to get rid of the old Hippocratic paradigm.
This passage circles back to the idea of paradigms to show how new techniques and methods in science are often a result or reflection of the times in which they arose.
Themes
In the year 1800, medicine still largely followed the Hippocratic-Galenic tradition and was considered one of the least prestigious sciences. Over the course of that century, however, classical medicine began to give way to the more effective modern medicine. Scientists like the Parisian Pierre Louis conducted autopsies and learned that diseases invade the body as a separate entity and aren’t just a corruption of something inside. Louis also helped introduce the “numerical system,” which involves using stethoscopes, checking body temperature, checking blood pressure, and making other measurements.
Stethoscopes and blood pressure tests are common in doctor’s office visits today; as such, their introduction in the early 19th century foreshadows how medical science was maturing into its modern form. The autopsies that Louis performed show that he was moving past the realm of theory and pure reason and into a more active role. His focus on the physical helped apply the scientific method to medicine and focus on what makes medicine unique as a discipline.
Themes
Medicine also began borrowing from other sciences, including physics and chemistry. Though little of this new knowledge was applied directly to treating diseases at first, it built a foundation for later advances. At times, however, pseudoscience also flourished, and anti-elitism (fostered by people like President Andrew Jackson) led some to question physicians’ wisdom. Loose requirements for claiming the title “doctor” helped reinforce the skepticism (since it meant that many “doctors” were unqualified).
While Barry emphasizes the unique aspects of medical science, he also shows how it developed in conjunction with other sciences and how these different disciplines connect to one another. His mention of pseudoscience and anti-elitism has modern-day resonance—at the time of the book’s first publication, there were whole industries devoted to unscientific home remedies. Moreover, in the epilogue, Barry touches on how these unscientific ideas apply to the COVID-19 pandemic.
Themes
Around the time of the Civil War, American medicine moved forward a little and gained some esteem. The discovery and use of anesthesia was a genuine advancement, and the Civil War helped American surgeons learn more about anatomy. Still, infectious diseases remained a problem, and the treatments of heroic medicine weren’t very effective against them.
Though the book examines medical history through a critical lens, this passage acknowledges that methods now seen as antiquated did sometimes lead to surprising successes. At the same time, however, these successes were not enough to offset the fundamental problems with the practice of heroic medicine.
Themes
In the aftermath of the Civil War, physicians had discovered that some drugs (like quinine, digitalis, and opium) provided benefits, but they prescribed them indiscriminately, including for many diseases where they weren’t effective.
This passage shows what happens when doctors experiment without following the rigor of the scientific method. Though they often reach surprising discoveries, it is difficult to reproduce the results and determine what really led to them.
Themes
By the 1870s, European medical schools were state-funded and gave rigorous scientific training. By contrast, most American schools were owned by faculty who made money through tuition—meaning that often, the only requirement for entry was being able to pay student fees.
The fact that European schools were state-funded means that they received strong support from the government. By contrast, Barry suggests that one of the reasons why 19th-century American medical schools were so unsophisticated was that they had little government leadership or support, and they often prioritized short-term profits over fostering high-quality, lasting institutions. Moreover, the fact that there were few barriers to entry means that American doctors were likely less skilled and qualified than European doctors at this time.
Themes
The best medical research in the U.S. in the late 1800s was generally done by people working outside institutions. Many looked to Europe since they couldn’t get institutional support in the U.S.
This passage suggests that even without strong support, some doctors found a way to thrive. In this case, the poor state of medical education in the U.S. forced promising students who could afford it to travel abroad to Europe.
Themes
In 1873, however, Johns Hopkins (the man) died and left behind a trust to found a university and hospital. The Quaker trustees of Hopkins’s estate moved fast. They wanted to revolutionize American medical education by looking at European models. Johns Hopkins University opened in 1876, with its medical school opening in 1893, just in time to prepare American medical science for the influenza outbreak of World War I.
Though Hopkins wasn’t alive for the opening of the university that bears his name, his role in medical history was essential. The founding of Johns Hopkins University was rooted in the idea that providing enough resources to talented people can help them build schools and institutions that have a major impact on training new generations of scientists.
Themes
