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Chapter 4
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
The founders of the Rockefeller Institute had a goal: no patient there would pay for treatment, but they would only accept patients suffering from the specific diseases being studied. Rufus Cole, the hospital’s headstrong first director, had his own plan. He wanted to make sure that the people caring for patients were also the ones doing research on them. This meant physicians treating patients had to do rigorous disease research that was different from the pure laboratory research going on elsewhere in the institute. This set the model still followed today for clinical research.
Unlike Hippocrates and other medical scientists who relied primarily on pure reason, Rufus Cole created a program where doctors were directly involved in both research and patient treatment. This elimination of boundaries suggests that modern doctors like Cole were beginning to better understand how medicine really worked and how earlier distinctions between research and treatment were often arbitrary.
Themes
The hospital of the Rockefeller Institute opened in 1910. Though medical science had improved in the U.S., there was still a large gap between the best (which could compete with Europe) and the average (which was still subpar). Reforming medical education was slow, even at elite schools, and reaching practicing doctors was even harder. The American Medical Association (AMA) put out a report condemning the practices of the worst schools, where many students graduated without ever seeing a cadaver. This report inspired reform, and many schools changed entrance requirements to mandate some college education.
Again, the fact that students graduated without seeing a cadaver shows how old systems of medical education focused too much on theory and not enough on practical skills. In addition to the Rockefeller Institute, the American Medical Association was another strong institution that represented how standardization and cooperation helped medicine to grow and reform at the beginning of its modern period.
Themes
In 1910, Flexner put out his own “Flexner Report,” which was even harsher, suggesting that over 120 of the 150 or so medical schools should be closed. In some ways, his report reflected the values of the Progressive Era, a period of time marked by increasing rationalization in the U.S., not just in the sciences, but also in businesses, which were trying to apply “scientific” values to management. Flexner’s report caused a sensation, allowing the AMA to begin rating schools; schools with bad “Class C” ratings quickly lost licensing recognition and had to close.
Barry mentions the Progressive Era to show how, while Simon Flexner’s report was a noteworthy event in the medical community, it was also part of larger historical trends in the United States. The Flexner Report showed how one individual can make a difference, while simultaneously highlighting the need for broader, structural reform.
Themes
By the 1920s, over 100 medical schools had closed or merged, and the number of medical students went down too, even as the population rose. For the schools that did survive, Hopkins was the model. Ironically, even though the Rockefeller Foundation remained the single largest donor to medical research, John D. Rockefeller continued to see a homeopathic physician.
The fact that John D. Rockefeller continued to see a homeopathic doctor (whose practices aren’t based on rigorous scientific standards) suggests that he was more interested in the personal benefits of institutional patronage than in the benefits of science. Nevertheless, his institute produced world-class research, showing how sometimes the motivations behind medical research could be surprisingly complicated.
Themes
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Just before the U.S.’s entry into World War I, Welch had a goal. He wanted a separate school to study public health in a scientific way. Though he faced some resistance, particularly since Baltimore wasn’t known for much in medicine outside of Hopkins, in 1918, the Johns Hopkins School of Hygiene and Public Health opened. Welch resigned as a professor at the med school to become the public health school’s dean. One of the school’s most important functions was studying epidemics, and it would soon face a major test.
The creation of public health as a discipline showed once again that doctors and investigators were beginning to look at medicine not as some discipline to be studied in a vacuum, but as a vital part of human society with connections to other disciplines, like politics and sociology. Perhaps more than anything else in medicine, epidemics highlight how all these different disciplines are connected, so Welch’s decision to focus on public health was very forward-thinking.
Themes
