The Great Influenza Quotes

The Great War had brought Paul Lewis into the navy in 1918 as a lieutenant commander, but he never seemed quite at ease when in his uniform. It never fit quite right, or to sit quite right, and he was often flustered and failed to respond properly when sailors saluted him.

On September 12, 1876, the crowed 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; indeed, they sought considerably more than that.

Ultimately, then, logic and observation failed to penetrate the workings of the body not because of the power of the Hippocratic hypothesis, the Hippocratic paradigm. Logic and observation failed because neither one tested the hypothesis rigorously.

Once investigators began to apply something akin to the modern scientific method, the old hypothesis collapsed.

Nothing about the boyhood or youth of William Henry Welch suggested his future.

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 university, most faculty salaries were still paid by student fees, and students still often graduated without ever touching a patient.

The Rockefeller Institute Hospital opened in 1910. By then the best of American medical science and education could compete with the best in the world. But an enormous gap existed in the United States between the best medical practice and the average, and an unbridgeable chasm separated the best from the worst.

Haskell County, Kansas, lies west of Dodge City, where cattle drives up from Texas reached a railhead, and belongs geographically to an, in 1918, not far in time from, the truly Wild West. The landscape was and is flat and treeless, and the county was, literally, of the earth.

In the days before antibiotics, an infection launched a race to the death between the pathogen and the immune system. Sometimes a victim would become desperately ill; then, suddenly and almost miraculously, the fever would break and the victim would recover. This “resolution by crisis” occurred when the immune system barely won the race, when it counterattacked massively and successfully.

But once the body survives an infection, it gains an advantage. For the immune system epitomizes the saying that that which does not kill you makes you stronger.

In the spring of 1918 death was no stranger to the world. Indeed, by then the bodies of more than five million soldiers had been fed into what was called the “sausage factory” by generals whose stupidity was matched only by their brutality.

Wilson had demanded that “the spirit of ruthless brutality. . . enter into the very fibre of national life.” To carry out that charge, Creel had wanted to create “one white-hot mass,” a mass driven by “deathless determination.” He was doing so. This was truly total war, and that totality truly included the medical profession.

The 1918 influenza pandemic, like many other influenza pandemics, came in waves. The first spring wave killed few, but the second wave would be lethal.

As the virus moved, two parallel struggles emerged.

One encompassed all the nation. Within each city, within each factory, within each family, into each store, onto each farm, along the length of the track of the railroads, along the rivers and roads, deep into the bowels of mines and high along the ridges of the mountains, the virus would find its way. In the next weeks, the virus would test society as a whole and each element within it. Society would have to gather itself to meet this test, or collapse.

The other struggle lay within one tight community of scientists. They—men like Welch, Flexner, Cole, Avery, Lewis, Rosenau—had been drafted against their will into a race.

The Liberty Loan campaign would raise millions of dollars in Philadelphia alone. The city had a quota to meet. Central to meeting that quota was a parade scheduled for September 28.

Two days after Philadelphia’s Liberty Loan parade, Wilmer Krusen had issued that somber statement, that the epidemic in the civilian population “was assuming the type found in naval stations and cantonments.”

This was influenza, only influenza.

In 1918 in particular, influenza struck so suddenly that many victims could remember the precise instant they knew they were sick, so suddenly that throughout the world news reports were common of people who toppled off horses, collapsed on the sidewalk.

Nature chose to rage in 1918, and it chose the form of the influenza virus in which to do it. This meant that nature first crept upon the world in familiar, almost comic, form. It came in masquerade. Then it pulled down its mask and showed its fleshless bone.

Lewis knew full well that little of what he was doing was good science. It was all, or nearly all, based on informed guesswork. He only worked harder.

As he worked, the society about him teetered on the edge of collapse.

While science was confronting nature, society began to confront the effects of nature. For this went beyond the ability of any individual or group of individuals to respond to. To have any chance in alleviating the devastation of the epidemic required organization, coordination, implementation. It required leadership and it required institutions follow that leadership.

As terrifying as the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read. Uncertainty follows distrust, fear follows uncertainty, and, under conditions such as these, terror follows fear.

Vaughan believed that the influenza virus came close to threatening the existence of civilization. In fact, some diseases depend upon civilization for their own existence.

The overwhelming majority of victims, especially in the Western world, recovered quickly and fully. This was, after all, only influenza.

But the virus sometimes caused one final complication, one final sequela. The influenza virus affected the brain and nervous system.

By World War I, the revolution in American medicine led by William Welch had triumphed. That revolution had radically transformed American medicine, forcing its teaching, research, art, and practice through the filter of science.

The greatest questions remained the simplest ones: What caused influenza? What was the pathogen? Was Pfeiffer right when he identified a cause and named it Bacillus influenzae? And if he was not right, then what did cause it? What was the killer?

So the final lesson of 1918, a simple one yet most difficult to execute, is that those who occupy positions of authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.