The Great Influenza

“The greatest challenge of science, its art, lies in asking an important question and framing it in a way that allows it to be broken into manageable pieces, into experiments that can be conducted that ultimately lead to answers. To do this requires a certain kind of genius, one that probes vertically and sees horizontally.” 

Barry pays special attention to William Welch, arguing that he is essentially the father of American medical research. However, he notes that Welch had one flaw: He was not a particularly good researcher. Instead, he was good at acquiring talented researchers and inspiring them. Those scientists could probe vertically—looking deeper into a topic to find new information—while also thinking horizontally—weaving together seemingly unrelated pieces of information. Science, according to Barry, is also about collaboration, so Welch’s role in creating teams is important, even if Welch himself never created new pathways of research or contributed direct scientific knowledge.

“The army which Welch had created was designed to attack, to seek out particular targets, if only targets of opportunity, and kill them. On October 1, 1918, the abilities of that army were about to be tested by the deadliest epidemic in human history.” 

This description of the researchers and scientists trained at Hopkins and the Rockefeller Institute uses two of Barry’s most commonly used writing devices: the metaphor and the cliffhanger. Throughout the book Barry uses military metaphors to describe the fight against the influenza pandemic. Here he envisions Welch as the general of an army, with all who were trained below him to kill diseases depicted as soldiers trained to kill an enemy. As this quotation ends Chapter 5 (and Part 1 of the book), it also serves as a cliffhanger, encouraging anticipation of the actual pandemic described in the next section.

“An infection is an act of violence; it is an invasion, a rape, and the body reacts violently.” 

Barry opens Chapter 8 with this description of an infection, again utilizing the war metaphor. Here he extends it from the “warrior” scientists who fought the pandemic to the individual response to any virus or disease in a human body. The immune system serves, in this metaphor, as the army fighting back the invader, and the violence of war is placed in the context of the human body, where violence begets violence (just as it does in most wars). This quotation also exemplifies how Barry attempts to explain complicated medical concepts in simpler ways.

“One way to conceptualize antigen drift is to think of a football player wearing a uniform with white pants, a green shirt, and a white helmet with a green V emblazoned on it. The immune system can recognize this uniform instantly and attack it. If the uniform changes slightly—if, for example, a green stripe is added to the white pants while everything else remains the same—the immune system will continue to recognize the virus with little difficulty. But if the uniform goes from green shirt and white pants to white shirt with green pants, the immune system may not recognize the virus so easily.” 

The actual science of antigen drift and antigen shift is very complicated and involves changes in a cell’s RNA. Barry makes those concepts easier to understand through this clever metaphor. While a football team might alter its uniform, the viewer (or opposing team) will still recognize that team. However, if a team changes colors too, they will be unrecognizable, especially given that football players are fully covered by uniforms and helmets. This explains why an antibody is less effective at combating a virus that has undergone a viral shift, like the influenza of 1918 almost certainly did.

“The full engagement of the nation would thus provide the great sausage machine with more than one way to grind a body up. It would grind away with the icy neutrality that technology and nature share, and it would not limit itself to the usual cannon fodder.” 

In Part 3 Barry argues that President Wilson sought to turn America into a weapon of total war. He also explains that World War I was an especially bloody war that created millions of unnecessary fatalities and came to be known as the “sausage factory.” The war involved mechanized weapons such as the machine gun and chemical gases, and Wilson’s total war ended up feeding American soldiers directly into those weapons. Worse, because of overcrowding in army camps and a failure to get credible information about influenza to American citizens, Wilson’s full engagement in the war ultimately created even more death through the pandemic, as the army became a superspreader of the virus, killing its own recruits, other soldiers, and citizens around the world, all of whom became cannon fodder for the war directly or indirectly.

“By 1918 humankind was fully modern, and fully scientific, but too busy fighting itself to aggress against nature. Nature, however, chooses its own moments. It chose this moment to aggress against man, and it did not do so prodding languidly. For the first time, modern humanity, a humanity practicing the modern scientific method, would confront nature in its fullest rage.” 

World War I was the first war to make extensive use of weapons as well as medical advances created by scientists (such as sera designed to prevent pneumonia). The war itself, then, provides an example of the double-edged sword of science: Science can be used to cure but also to kill. Barry juxtaposes it with the power of nature, as influenza was not created in a laboratory, yet it killed more people than any of the advanced weapons of war. Thus, even though The Great Influenza is a book about scientific advancement, Barry makes it clear that much of science is limited and that nature is ultimately stronger.

“The preservation of morale itself became an aim. For if morale faltered, all else might as well. So free speech trembled.”

One of the book’s themes is the danger of censorship. To help the war effort, Wilson created departments that censored news and popular entertainment. His Justice Department also created a new security agency led by J. Edgar Hoover that arrested anyone who spoke out against the government or the war. With neighbors encouraged to accuse neighbors of treason, the public learned to not say anything. Thus, when the pandemic hit, news agencies did not report it and government representatives downplayed it. Civil liberties such as freedom of speech dissipated in the name of the war effort. But this led to an erosion of public trust and the mass fear that would define the era. It also led to the virus spreading without check, since no one could safely talk or write about it.

“All training for war, for killing, ceased. Now men fought to stop the killing.” 

As the virus spread through army camps, the war effort took a back seat. But the virus had spread so rapidly because of army commanders’ unwillingness to stop training soldiers. This quotation (which again uses the language of the war to make its point) is a reference to Camp Grant, where Colonel Charles Hagadorn ignored the advice of the camp’s medical experts as the virus spread, only to start take their advice after it was too late. The irony is that, had he stopped training soldiers earlier or not overstacked the barracks, the virus might have been contained, and men could have continued training to kill rather than stopping to prevent their own deaths.

“But how many trusted the newspapers anymore? And even if the Black Death had not come, a plague had and, with it, so had terror. The war had come home.”

Due to censorship efforts by the federal government, newspapers did not report truthful information about the pandemic. This led to the pandemic itself worsening even while the public’s trust in the media and the government eroded. This quotation explores that reality—why trust the media’s message that all is well when your own eyes show you the horror in front of you? The quotation also points out the irony that censorship designed to protect the war effort merely brought the horrors of war to the United States directly.

“This was influenza, only influenza.” 

This recurring quotation is an example of understatement. While many dismissed the severity of the influenza pandemic as it was happening, Barry emphasizes that this influenza was not the seasonal “flu” we think of but something far more virulent. The sentiment that it was no big deal proliferated among military leaders like Colonel Hagadorn, who ignored the outbreak at Camp Grant, as well as the press corps who were afraid of publishing bad news. Barry repeats the quotation several times to show the prevalence of the false sentiment as well as its futility, while also showing the repetitiveness of the pandemic itself.

“The world looked black. Cyanosis turned it black. Patients might have few other symptoms at first, but if nurses and doctors noted cyanosis they began to treat such patients as terminal, as the walking dead.” 

In Part 6 Barry describes the varying symptoms of influenza and notes that, all too commonly, the symptoms led to death. This quotation captures the mood of the healthcare workers who treated the patients as well as the horror-esque imagery the influenza pandemic made common in American cities. Just as the world seemed its bleakest and treatment options seemed exhausted, patients began to look black and blue in color, like the living dead.

“The immune system can behave like a SWAT team that kills the hostage along with the hostage taker, or the army that destroys the village to save it.” 

Chapter 21 is mostly about how the immune system responds to “invasions” of pathogens like viruses and bacteria. Barry notes that in many cases, the patient does not die due to the foreign body but the immune system’s response to it. That seems to have been the case for many with influenza in 1918. As the virus attacked the respiratory system, the body responded by putting excess fluids in the lungs, ultimately destroying the patient’s ability to breathe.

“How does one know when one knows? When one is on the edge, one cannot know. One can only test.”

At many points in the text, Barry defines the traits of a good scientist. In this quotation he captures one of these traits: the need to know what one knows and appreciate what one does not know. Ultimately, Barry argues that much in science is fundamentally unknowable but also that much scientific knowledge can be improved upon so long as scientists admit that nothing is truly known. Thus, a good scientist is willing to test multiple theories and is not satisfied with saying a topic is already exhausted.

“If Wilson and his government would not be turned from his end even by the prospect of peace, they would hardly be turned by a virus. And the reluctance, inability, or outright refusal of the American government to shift targets would contribute to the killing. Wilson took no public notice of the disease, and the thrust of the government was not diverted.” 

America’s entry into World War I came quite late, and by September 1918, America was still mostly mobilizing for war even while the war was winding down. While Austria and Germany were attempting to negotiate peace, Wilson and the allied nations were ignoring their entreaties, even as Americans died in mass numbers due to influenza. All aspects of the war effort would be stalled by the pandemic, except for the transportation of troops across the Atlantic, which spread the virus to Europe. Given the end of the war, when Wilson failed to negotiate the peace treaty he wanted, Barry suggests that the entire war effort was futile and caused several unnecessary deaths both in battle and via influenza.

“But by now the city had heard enough pleas, and had withdrawn into itself. There was no trust, no trust, and without trust all human relations were breaking down.” 

As the virus spread, cities became places of fear and isolation. This quotation refers specifically to Philadelphia in October 1918, the height of the pandemic, but it may as well refer to all America. The distrust in officialdom had spread to include distrust of all citizens, as any citizen could be a carrier of the disease. Streets emptied, and cities resembled ghost towns in more ways than one. Barry emphasizes the lack of trust by repeating “no trust,” the repetition of which suggests distrust of both leaders and neighbors.

“What pathologists said in medical journals physicians muttered to one another, while laymen and women watched a husband or wife turning almost black. And a great chill settled over the land, a chill of fear.” 

Barry often seems to separate the scientists battling the virus with the citizens confronted with it. But in this quotation Barry connects the fear gripping both physicians and citizens, as no one knew what to make of the influenza. As the virus spread, it was clear that it was no ordinary influenza. Many worried it was either a new disease altogether or a new bout of the black plague. The symptoms of the virus puzzled researchers, and citizens recognized only the change in color as cyanosis developed in victims. The uncertainty only contributed to the fear.

“Everywhere, as in Philadelphia, two problems developed: caring for the sick and maintaining some kind of order.” 

Philadelphia is used as a fill-in for all cities impacted by the influenza. Philadelphia lacked social order due to corrupt city leaders and a breakdown of civic trust as bodies piled up in houses since the morgues were too full. But in Chapter 29, Barry also lists issues affecting towns like Cumberland, Maryland; Gunnison, Colorado; and El Paso, Texas. No town seemed safe from the pandemic at its worst, although not all cities were as poorly managed as Philadelphia was. Some even did a fairly good job of maintaining trust and order and managed to minimize the impact of the pandemic.

“In the United States, the war was something over there. The epidemic was here.” 

This quotation uses a pun to make its point. “Over There” was a popular patriotic song by George M. Cohan, and its lyrics emphasized that patriotic and brave American troops were going to Europe (“over there”) to fight until World War I was over. Indeed, the war was distant from most people’s realities beyond the draft, censorship, and rations, since the Atlantic Ocean prevented any real threat to America (which was one reason America did not enter World War I until it was nearly over). However, the pandemic, which spread in the United States and Europe, could not be ignored. The war, in a sense, had come home.

“But it mutated enough, its antigens drifted enough, to rekindle the epidemic.” 

In describing the changes the influenza virus underwent before the third wave, Barry uses the same metaphor he used to describe the first wave. Where the army had once created a “tinderbox” for the influenza’s “explosion,” the third wave was apparently strong enough to “rekindle” the spark. This reminds the reader that even though the virus peaked and crested in waves, like a smoldering fire, it was not fully extinguished between waves. The virus merely stopped being as deadly and as transmissible for a time.

“The world was still sick, sick to the heart. The war itself… The senseless deaths at home, on top of all else… Wilson’s betrayal of ideals at Versailles, a betrayal that penetrated the soul… The utter failure of science, the greatest achievement of modern man, in the face of the disease...” 

Barry’s use of stream of consciousness helps convey the overwhelming horror of influenza as well as the helplessness and futility caused by it and the war. By the end of the pandemic, one could see clearly that Wilson and other leaders had betrayed both US citizens and the soldiers serving in the war. That the war itself was so pointless and only lead to World War II makes those decisions seem even worse and more unjustifiable in hindsight. What’s more, Barry, a man who clearly admires science and scientists, notes that scientists did not help end the pandemic even while science contributed to rising death tolls in World War I through mustard gas, machine guns, and other innovations. The world remained a sick place in more ways than one.

“People write about war. They write about the Holocaust. They write about horrors that people inflict on people. Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant.” 

In Chapter 33 Barry notes how few authors wrote about the influenza pandemic even though so many great authors wrote about World War I. He makes frequent allusions to literature in the text, but the literature he quotes or alludes to is never actually about the flu (with the exception of one memoir, Pale Horse, Pale Rider, which is mentioned right before this quotation). This may be because the flu was too universal to write about, since authors are more frequently drawn to unusual experiences. Or it may be that authors were exhausted by the disease and did not want to think about it again. Or it may be, as Barry posits here, that humans cannot comprehend the force of nature on their lives. Regardless, it seems that one purpose of The Great Influenza is to fill the void of literature on the influenza and to bring the story of the pandemic to the forefront.

“The pursuit of this question is a classic case of how one does science, of how one finds an answer, of the complexity of nature, of how one builds a solid scientific structure.” 

The last two chapters concern the laboratory research done by Oswald Avery and Paul Lewis that originated due to influenza. Barry suggests that Avery’s research is an excellent example of the scientific method and the painstaking, methodical work that is necessary for scientists to make breakthroughs. Lewis, on the other hand, failed to follow this solid scientific structure and became disillusioned. Regardless, as much of the book is devoted to the history of laboratory research, it seems fitting to end with examples of the good science Barry advocates throughout the text.

“To him the laboratory presented a stone face, unyielding to his pleadings. And whether his death was a suicide or a true accident, his failure to win what he loved killed him. One could consider Lewis, in a way meaningful only to him, the last victim of the 1918 pandemic.” 

Barry is drawn to Lewis’s story, as he introduces Lewis in the Prologue and ends the book (not including the Afterword) with this eulogy to him. It seems Lewis did not appreciate the skills he had and preferred to chase dreams of the laboratory skills he lacked. In a book full of sadness and death, Barry ends with the doomed romantic figure of Lewis rather than the triumphant figure of Avery, a fitting choice given that the book is as much about the failures and limits of science as it is about its triumphs.