My rating: 4 of 5 stars
Finished November 3, 2017
I work at Oregon Health Health & Science University which is comprised of hospitals, medical schools, and research facilities. Each year we are encouraged to get our flu vaccines – even those of us with no clinical responsibilities. My physician also recommends I get a flu shot and I have for as long as I remember. As I was standing in line to receive my vaccine this year I got to wondering about influenza and remembered hearing about a deadly epidemic in 1918. I came across this comprehensive study of the disease. John Barry tells the story of the deadliest epidemic through three lenses: the development of modern medicine that was occurring at the time, the mechanics of the disease itself, and the impact of public health and public policy – or lack thereof.
The disease is popularly known as the Spanish Influenza but Barry argues that it may have come from Kansas. As World War I was ramping up, the draft pulled thousands of young men into overcrowded camps for training. A couple of men came from an area in Kansas where people complained of influenza symptoms. “On March 4 a private at [Camp] Funston, a cook, reported ill with influenza at sick call. Within three weeks more than eleven hundred soldiers were sick enough to be admitted to the hospital, and thousands more – the precise number was not recorded – needed treatment at infirmaries scattered around the base.” [Loc 1576]
Within a matter of weeks “like falling dominoes, other camps erupted with influenza. In total, twenty-four of the thirty-six largest army camps experienced an influenza outbreak that spring. Thirty of the fifty largest cities in the country, most of them adjacent to military facilities, also suffered an April spike in ‘excess mortality’ from influenza, although that did not become clear except in hindsight.” [Loc 2636]
This was the first wave of the disease. Overall, through three waves “[e]pidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million.”[Loc 149 ]
Barry covers the technical details of the virus which invades cells that have energy and then, like some alien puppet master, subverts them, takes them over, forces them to make thousands, and in some cases hundreds of thousands, of new viruses” [Loc 1606] The influenza virus is incredibly nimble mutating very quickly. It would soon turn more deadly. “When the 1918 virus jumped from animals to people and began to spread, it may have suffered a shock of its own as it adapted to a new species. Although it always retained hints of virulence, this shock may well have weakened it, making it relatively mild; then, as it became better and better at infections its new hose, it turned lethal” [Loc 2767]
It was up to humans to try to contain it. William Henry Welch led the charge. He was responsible for pulling medicine from the dark ages into the scientific era. “Welch had turned the Hopkins model into a force. He and colleagues at Michigan, at Penn, at Harvard, and at a handful of other schools had in effect first formed an elite group of senior officers of an army; then, in an amazingly brief time, they had revolutionized American medicine, created and expanded the officer corps, and begun training their army, an army of scientists and scientifically grounded physicians.” [Loc 1457]
Prior to modernization medical students did not perform autopsies or see patients; rather they took art of less than a year of lectures. [Loc 569]. Welch and his colleagues brought the scientific method to studying the disease. “It was the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds.” [Loc 168] This battle is the primary focus of the book; Barry does a wonderful job bringing these people to life.
Although they were not immediately successful in stopping influenza, they did know how to combat its spread. Here we look through Barry’s third lens on the disease. Caught up in war fever, the military and public officials paid no mind. Warned to quarantine transferring soldiers, the military changed nothing. This caused the spread of the disease to the camps and to the war in Europe.
Public officials did little either. Often these officials were products of political machines such as Tammany Hall in New York who achieved their post due to connections rather than any skill. At the same time information was not published in the press for morale reasons. As a result people were fearful – they knew the disease was in their midst but there was no information on what to do – even though the scientists and provided information. “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.” [Loc 5199]
The head of the Public Health Service – made part of the military by Woodrow Wilson – “had done nothing … to prepare the Public Health Service, much less the country for the onslaught.” [Loc 4804] Even though the military draft was suspended, “Blue still did not organize a response to the emergency. Instead, … [he] reiterated to the press that there was no cause for alarm.” [Loc 4825]
The second wave of the disease was much more lethal there were not enough doctors and nurses to treat the afflicted. Harriet Ferell recalled “an open truck came through the neighborhood and picked up the bodies. There was no place to put them, there was no room.” [Loc 5082]
Although the entire social system was on the verge of collapse and the industrial output of the country was in peril [Loc 5165] “no national official ever publicly acknowledged the danger of influenza.” [Loc 5188]
On the political front, Barry argues that Woodrow Wilson contracted influenza at the peace talks and his weakened condition caused him to give in to French demands for reparations thus setting the conditions for World War II. [Loc 6062]
Influenza is serious and though we have vaccines to combat certain strains it still has the potential to kill hundreds of thousands of people in the United States. The Center for Disease Control says that the worst case scenario 422,000 Americans would die. [Loc 7064]
John M. Barry deftly pulls together the three strands of history, the development of modern medicine, and the importance of public health policy to weave a fascinating story of this deadly period.
Barry blames public officials for their ineptness at handling this pandemic. “Those in 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. Lincoln said that first, and best. Leadership must make whatever horror exists concrete. Only then will people be able to break it apart.”[Loc 7230]
Let me stand up a little higher on my soap box here. It is clear that influenza is different from the common cold virus. It is deadly. I often hear people tell me that they got sick even though they got their flu shot. Well, they may have gotten a cold; but they probably didn’t get the flu. A few years ago I called the nurse advice line thinking I had the flu. The nurse asked if I could stand up; when I said “yes” she said, you don’t have the flu. If you had the flu you probably wouldn’t be able to make a phone call. Do yourself a favor; get the annual flu vaccine.
As long as this reading report is, you probably figure I’ve covered it all or even transposed it. But I’ve only scratched the surface. Although this is a narrow subject it is a fascinating read.