The Great Influenza: The Story of the Deadliest Plague in History by John M. Barry. Examining the 1918 Influenza, John addresses one of the worst pandemics in history. The 1918 pandemic surpasses COVID-19 in so many horrible ways.
As World War I raged across Europe, American soldiers unknowingly took influenza to the battlefields. Yet US military commanders well understood the risks before they ordered them abroad.
Barry’s work is a sobering reading. The 1918 flu killed 500 million people. John certainly begins strong for readers diving into the 1918 pandemic.
However, chapters three to thirteen review in great detail the history of medical education item United States, Germany, and France at the turn of the century. Do not lose interest. John’s lessons for COVID come into focus slowly.
Death itself could come so fast. Charles-Edward Winslow, a prominent epidemiologist and professor at Yale, noted, “We have had a number of cases where people were perfectly healthy and died within twelve hours.” The Journal of the American Medical Association carried reports of death within hours: “One robust person showed the first symptom at 4:00 P.M. and died by 10:00 A.M.”
Page 433
At the same time, Barry, history, and medical documentation can now identify the source. Yet, it would not be Madrid or Barcelona as the source. Epidemiological evidence confirms the influenza virus originated in Haskell County Kansas, where an army cook at Camp Funston took ill on March 4, 1918. The camp was built to train and deploy solider to France. The domino effect of sending soldiers to European battlefields would only accelerate a global spread that we fully understand today.
Certainly the nickname Spanish Flu took hold in history. Conversely, the suppression of American newspapers allowed this tragedy to be thought as a foreign born illness. Barry simply reveals newspapers in Spain were free to report on the pandemic within their country regardless of war. Coupled with American suppression across all newspapers, this allowed the false label to stick.
The lack of medical education
The Great Influenza documents the slow evolution of medical education across America. The country’s medical education needed quick modernization to address the Yellow Fever outbreak of 1793 and subsequent cholera outbreaks, let alone confront the upcoming pandemic:
Calls for reform had begun in the 1820s. Little had been accomplished outside a handful of elite schools. Even among elite schools change came slowly. Not until 1901 did Harvard, followed soon by Penn and Columbia, join the Hopkins in requiring medical students to have a college degree. But even the best schools failed to follow the Hopkins’s lead in recruiting quality faculty, instead choosing professors in clinical medicine from among local physicians. The official history of Penn’s medical school conceded, “Inbreeding of a faculty could hardly go farther.” Harvard’s clinical professors were actually selected by a group of doctors who had no status at Harvard and met at the Tavern Club to make their decisions, which were usually based on seniority. Not until 1912 would Harvard select a clinical professor from outside this group.
pp.147-148.
The American military certainly understood the impact of influenza upon the war effort. Above all, Barry has devoted plenty of effort to convey how the military could not stop shifting men between military bases known to house camps of infected soldiers. For the most part Colonel Charles Hagadorn played a key role is these decisions as he commanded Camp Grant outside Rockford Illinois with deadly results:
“Army regulations defined how much space each soldier had in the barracks. These regulations had little to do with comfort and much to do with public health. In mid-September Hagadorn decided to ignore the army regulations on overcrowding and move even more men from tents into barracks. Already the nights were cold, and they would be more comfortable there.”
pp. 377-378.
However, Hagadorn would fully understand his enormous errors misjudging the influenza resulting in the deaths of thousands of soldiers. Thereupon, after ordering all base soldiers to stand at attention on the camp grounds, he committed suicide in his office.
Political Echo Chamber
On the other hand, Wilmer Krusen was Director of the Philadelphia Department of Public Health and Charities. He was in fact, a political appointee by the mayor. For this purpose, John reveals in great detail the city’s Liberty Loan Parade would be a super spreader and fatal event for the city. Krusen did not heed the warnings:
Krusen declared that the Liberty Loan parade and associated rallies would proceed. None of the anxiety of the moment was reported in any of the city’s five daily papers, and if any reporter questioned either Krusen or the Board of Health about the wisdom of the parade’s proceeding, no mention of it appeared in print.
On September 28, marchers in the greatest parade in the city’s history proudly stepped forward. The paraders stretched at least two miles, two miles of bands, flags, Boy Scouts, women’s auxiliaries, marines, sailors, and soldiers. Several hundred thousand people jammed the parade route, crushing against each other to get a better look, the ranks behind shouting encouragement over shoulders and past faces to the brave young men. It was a grand sight indeed.
Krusen had assured them they were in no danger.
The incubation period of influenza is twenty-four to seventy-two hours. Two days after the parade, Krusen issued a somber statement: “The epidemic is now present in the civilian population and is assuming the type found in naval stations and cantonments.
To understand the full meaning of that statement, one must understand precisely what was occurring in the army camps.
pp.371-372.
In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934. All this made Philadelphia fertile ground for epidemic disease. So did a city government incapable of responding to a crisis. Muckraker Lincoln Steffens called Philadelphia “the worst-governed city in America.” He may well have been right.
pp. 353-354.
On the other hand, will we be spared today the more serious nature of the 1918 death toll? Indeed the 1918 influenza strains brought death within 12 hours of infection. In this situation could we even imagine this today?
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 reports were common of people who toppled off horses, collapsed on the sidewalk. Death itself could come so fast. Charles-Edward Winslow, a prominent epidemiologist and professor at Yale, noted, “We have had a number of cases where people were perfectly healthy and died within twelve hours.” The Journal of the American Medical Association carried reports of death within hours: “One robust person showed the first symptom at 4:00 P.M. and died by 10:00 A.M.” In Rio de Janeiro, a man asked medical student Ciro Viera Da Cunha, who was waiting for a streetcar, for information in a perfectly normal voice, then fell down, dead; in Cape Town, South Africa, Charles Lewis boarded a streetcar for a three-mile trip home when the conductor collapsed, dead. In the next three miles six people aboard the streetcar died, including the driver. Lewis stepped off the streetcar and walked home.
p.423
That passage is certainly shocking to read. It gets worse. Published in 2005, Barry certainly could never have predicted the political fallout of influenza could mimmic today’s presidential election:
Voting returns had already begun to come in—there was no single national election day—and two months later Democrat Samuel Tilden would win the popular vote by a comfortable margin. But he would never take office as president. Instead the Republican secretary of war would threaten to “force a reversal” of the vote, federal troops with fixed bayonets would patrol Washington, and southerners would talk of reigniting the Civil War. That crisis would ultimately be resolved through an extra-constitutional special committee and a political understanding: Republicans would discard the voting returns of three states—Louisiana, Florida, South Carolina—and seize a single disputed electoral vote in Oregon to keep the presidency in the person of Rutherford B. Hayes.
pp.495-496.
In conclusion, this book in some ways is a reflection of our current pandemic. There are more lessons to learn and behaviors to change in order to eradicate COVID-19.
CBS Sunday Morning | The story of the 1918 flu pandemic
Library of Congress | “The Great Influenza” John M. Barry
CNBC Television | ‘The Great Influenza’
The Great Courses Plus | John M Barry
Virginia Museum of History & Culture | The Great Influenza
FEMA | The Next Pandemic: Lessons from History