The Great Influenza 2: American medicine finally catches up

These are notes taken from John Barry’s excellent book The Great Influenza. It’s a fascinating study in what is still the worst pandemic in history to strike humans. There are so many comparisons one can make to what is happening now—although I see so many on social media drawing the wrong conclusions about pandemics and how to protect against their spread. The amazing thing about the Spanish flu of 1918 is how its arrival happened at a great confluence of science, medicine and personalities.

Barry writes that the revolution of modern science and medical science began as science focused on what to how. In other words, methodology, research, empirical evidence. For most of history investigators into science relied too much on reason, on their own minds. They could know something if their logic followed a sound premise. Their premises were based primarily on observation. For example, I recall reading in another book on medical history how infusing an irrational, out-of-control man with calf’s blood should make him calm, because a calf was gentle by nature. (Probably it calmed him, right to his death)

This belief in reason alone actually blinded us. For 2,500 years medicine made almost no progress. The Hippocratic texts relied on passive observation and active reasoning, not scientific testing method. Doctors believed that natural processes should not be interfered with.

But in 1798, experimentation and methodology started to take root. The English doctor Edward Jenner, after overhearing a milkmaid say that she couldn’t get smallpox because she had had the cowpox, experimented with cows, and found that exposure to cowpox immunized one. Though this had been known in China and India for years, what made this a stand-out was his methodology and rigorous testing.

But this was late to come to the US. Dr. Benjamin Rush in Philadelphia, one of our premier physicians, still applied the observation method. He was advocate of venesection! (Read: “bleeding”) Meanwhile Pierre Louis (of the French School 1800-1850) created for first time a database by comparing cases. Disease began to be seen as something that entered the body, and not as something wrong with the blood. We so take this for granted now, but then, this actually was not realized till the mid-1800s.

Paris was the medical Mecca then. In 1853 Dr. John Snow applied mathematics as an epidemiologist, observing the cholera outbreak in London, and gathering data by going door to door, and interviewing the families of the dead—and basically gave birth to public health. (He also used anesthesia on Queen Victoria, when she gave birth to her ninth and last child! And we know she is the carrier of the “Royal Disease” –aka hemophilia) Only in 1830, did physicians began using a microscope in Europe. The Germans used it the most. In fact, Dr. Jacob Henle was the first to formulate the modern germ theory.

Medicine was evolving and not soon enough. And not fast enough in America. We lagged behind Europe in all things medical. But that soon changed.

In 1873 Johns Hopkins, American entrepreneur died, and left a trust of a staggering $3.5 million to found a university and a hospital. He and his trustees were Quakers, and they decided to model the new institution after German universities. It opened in 1876 and by 1914 the American medical science caught up to Europe.

And it was just in time. A viral juggernaut was about to strike the US, and then, the rest of the world.

Next week: the Spanish flu starts in Kansas.

The Great Influenza

I always believe we can learn so much from history, and that’s one reason I enjoy reading about history so much, especially medical history. This is incredibly relevant now, as the pandemic dominates the news, and our lives.

A few years ago, I read a great book called “The Great Influenza,” by John M. Barry (Penguin Books, 2004). I decided to reread it, since so many people on social media are making comparisons to coronavirus and the Spanish influenza pandemic of 1918, particularly in how our government is handling it.

Tonight, I just want to set the stage for the pandemic. It’s incredible to see how far we have come medically since the early 1900s.

First, know that the Spanish flu to this day remains the worst disease in history. Nothing can compare, not HIV, not COVID-19. From just 1918 to 1920 from 21-50 million would die from it. It’s estimated that 8-10% of all young adults then living may have been killed by it.  

What I love about this book is that it’s also the story of science, and how our thinking changes in response to a medical crisis. We’re watching that in action even now, as politicians, physicians, the nightly news and even our own friends now social media battle it out for what are the right approaches to take.

First—and this is incredible–medicine was not held in high esteem in the US. Barry reports that as late as 1900 only 20% of medical schools required a high school diploma! Almost anyone could call themselves doctor. Most medical students attended lectures, took one test, and never even saw a patient until they started practicing.

Barry notes that when Union Surgeon William Hammond stopped the use of violent purgatives (to rid the patient of “bad humors” like bile), he was court martialed and condemned by American Medical Association! No institution supported any medical research, and at Harvard, one professor of surgery admitted most medical students could barely write! Harvard president Charles Eliot realized the entire medical system had to be updated and improved.

And so began a movement to improve the American medical system. To whom did we look? Europe. The best medical institutions in the world were in Germany and France.

And so on September 12.1876, Johns Hopkins University was founded to change the way medicine was researched, delivered, and taught in America. If you watch CNN, you’ll note in the right hand margin that its daily statistics on COVID-19, including number of cases and number of deaths, is from Johns Hopkins University.

During the opening celebration, keynote speaker and English scientist Thomas H. Huxley, said, “Sit down before a fact as a little child, be prepared to give up every preconceived notion. Follow humbly wherever and to whatever abysses nature leads, or you shall learn nothing.”

It’s unfortunately not what many people are doing these days: accusations of misleading the public for political gain are tossed around from the CDC to the White House to news outlets, leaving us confused and anxious. Huxley would rather we listen and learn with open minds. And we can learn from the Spanish flu pandemic. To be continued next Sunday…