The Great Influenza

by John M. Barry

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Part 1: The Warriors Summary

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Last Updated on June 8, 2022, by eNotes Editorial. Word Count: 1016

Chapter One 

This section begins with the launch of Johns Hopkins University in 1876, marked by a speech given by Professor Huxley. At the time, the US government was engaged in conflict with Indigenous peoples, and there was continued tension between the North and the South following the Civil War. The launch of “the Hopkins” was part of another type of war: the advancement of modern science and secularism. At the time, the United States “[lagged] behind the rest of the world… in its study of the life sciences and medicine.” The creation of the Hopkins was a significant step to revolutionize American medicine.

Barry notes that in the history of medicine, progress was halted for almost two thousand years. “One cannot blame religion or superstition for this lack of progress,” Barry writes. Instead, secular reason—a focus on observation and logic, rather than on probing nature—kept medicine from advancing. Hypotheses such as “humours,” and practices such as bleeding patients, seemed to make “perfect sense.” Results were not recorded, measurements were not taken, and hands-on exploration was not performed.

While reason was able to drive progress in other areas of science, it failed in the area of medicine for several reasons. Human interests sometimes intervened, such as those of doctors clutching for remedies to offer suffering patients. And many scientists felt that “biology is chaos” compared to other sciences.

In the nineteenth century, medicine finally began to change “with extraordinary rapidity.” Beginning in France and then expanding in Germany, breakthroughs were made as doctors began to apply scientific methods through measurements, careful record-keeping and dissections. The concept of disease as “an independent entity” rather than an imbalance in the body, the use of “the numerical system,” the application of chemistry concepts, the use of the microscope, and the conducting of experiments were all important steps. While medicine was able to prove the uselessness of many existing treatments, it was at first unable to offer any new solutions.

In the United States, however, medical schools and medical practice did not progress at the same pace. American doctors travelled to Europe if they wished to pursue quality training. In 1876, the Hopkins medical school opened with the goal of meeting this demand and changing American medicine. By World War I, the Hopkins had succeeded in meeting its goals, and “those trained directly or indirectly by the Hopkins [led] the world in investigating pneumonia.”

Chapter Two 

William Henry Welch lived “a revolutionary life” and played an important role in the “makeover of medicine.” Although Welch “had generated no brilliant insights, made no magnificent discoveries, asked no deep and original questions,” by the end of his life he was celebrated as “arguably the single most influential scientist in the world.”

As a young man, Welch became passionate about medical science. He travelled to Germany to study laboratory science, and “analyzed the means why which German science had achieved such stature.” He decided that it was due to three elements: the preparation required by medical students, the financing of medical schools, and the support of research.

Returning to the United States, Welch began teaching at a laboratory course at Bellevue medical school.

Chapter Three 

As Welch’s course gained popularity, breakthroughs such as the germ theory were occurring in medical science. In 1884, Welch began teaching at the Hopkins, where he was “expected to create an institution that would alter American medicine forever.” Although Welch himself never “settled upon one important or profound question” to investigate, he attracted accomplished scientists to join the Hopkins, and he inspired his students. While he did not forge deep personal attachments, he was able to create a culture of unity around a common mission at the Hopkins.

Chapter Four 

The medical school at Johns Hopkins University, opened in 1893, was distinctly different from other American medical schools. Faculty were paid by salary, not by student fees, and students needed to meet rigorous standards. Even as changes were made in other medical schools, the Hopkins was far ahead in its progress and results; graduates from the Hopkins became important figures in changing American medicine.

In addition to the success of the Hopkins, Welch also succeeded in reforming all medical education and flowing “tens of millions of dollars into laboratory research.” The cure for diphtheria, discovered by German scientists and the first cure to be offered by modern medicine, spurred on the work of American researchers. In 1901, the Rockefeller Institute for Medical Research was created. It was coordinated by William Welch and headed by Simon Flexner, one of Welch’s protégés.

Chapter Five 

While the creators of the Rockefeller Institute always planned to have an affiliated hospital for the study of infectious disease, the hospital’s first director, Rufus Cole, adjusted their original vision. Simon Flexner, the head of the Rockefeller Institute, wanted scientists to plan experiments and conduct laboratory research, with other doctors performing the actual care of patients. But Rufus Cole insisted that the same people caring for patients be the ones to perform the research. Cole persisted, ultimately “creating the model of clinical research.” In 1910, the Rockefeller Institute Hospital opened.

Although the best medicine in the United States was advancing, there was “an enormous gap” between “the best medicine practice and the average, and an unbridgeable chasm separated the best from the worst.” Although medical schools were moving toward reform, and the American Medical Association published a “blistering—but confidential—report”, progress was slow.

Abraham Flexner, Simon Flexner’s brother, published a ruthless report in 1910. Using the ideals of the Hopkins as a standard, Flexner suggested that 120 of the 150-plus medical schools in the United States and Canada should be closed. “The Flexner Report” created a sensation and achieved quick results. Medical schools became rated by their quality, and states began to refuse licensing to graduates of poor-quality schools.

After helping transform American medicine, “making it science-based,” Welch returned to another goal: establishing a separate school for the scientific study of public health. On October 1, 1918, the Johns Hopkins School of Hygiene and Public Health was scheduled to open, with William Welch as its first dean.

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Prologue Summary


Part 2: The Swarm Summary