The Great Influenza

by John M. Barry

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Part 3: The Tinderbox Summary

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Last Updated on June 8, 2022, by eNotes Editorial. Word Count: 1066

Chapter Nine 

By the spring of 1918, five million soldiers had already died under the direction of “generals whose stupidity was matched only by their brutality.” The slaughter of World War I was accompanied by horrific living conditions for the soldiers. 

The war had begun in 1914, but it was not until April 1917 that the United States, led by President Woodrow Wilson, entered the conflict. Although he had been reluctant to enter the war, Wilson aggressively mobilized the entire nation in the war effort. Armed with a strong belief “in his own righteousness,” Wilson’s total war measures “informed virtually everything that happened in the country.” Speech and press were censored to prevent any “less-than-enthusiastic support of the war.” The American Protective League, a volunteer group, encouraged Americans to spy on each other. Wilson created the Committee on Public Information (CPI), with George Creel as its head, to control information available to the public.

During the war, the American Red Cross also infiltrated every area of American life. Unlike groups like the American Protective League, however, the Red Cross unified the nation and provided effective ways for civilians to support the war effort.

To meet the demand for soldiers, the draft requirements for American men were expanded. In high schools and on college campuses, “the teaching of academic courses was to end, to be replaced by military training.”

The mobilization of America would “jam” millions of men into barracks, and millions of workers into city factories. It would give the government full control of “the flow of information.” Ironically, Wilson’s forceful measures would “intensify the attack of influenza” when the disease did strike.

Chapter Ten

Before the United States entered the war, American scientists watched as their European colleagues “tried to perfect killing devices.” Welch, along with several others, met with President Wilson. They “proposed to establish a National Research Council to direct all war-related scientific work,” and Wilson agreed.

At the time, an informal hierarchy had formed in American medicine. William Welch was at the top, and several of his contemporaries were on the rung below, including US Army Surgeon General William Gorgas, the Mayo brothers, and Victor Vaughan. The National Research Council and the Council of National Defense medical committees were controlled by these men, and they “focused on the biggest killer in war—not combat, but epidemic disease.”

Welch, Vaughan and Flexner all joined the army to ensure “that the best medical science be available to the military.” Despite Surgeon General Gorgas’ success at reducing yellow fever in Havana, and venereal disease among troops, he was given little real power from the army. In many ways, he and the other medical scientists were forced to act independently of the army.

Across the country, scientists were joining the army. The Rockefeller Institute, at Flexner’s suggestion, became incorporated into the military. The war also “consumed the supply of practicing physicians,” and demanded more nurses. Gorgas tried to meet this need by supplying the military with partially trained nurses, but this idea was resisted by nurses themselves. The shortage of doctors and nurses, especially among civilians, “would prove deadly” in the face of the influenza pandemic.

Chapter Eleven

As part of Woodrow Wilson’s total war plan and Creel’s strict censorship of public information, even medical journals insisted that medical science must become focused on the war effort.

Army Surgeon General Gorgas was focused on preventing his “nightmare” of an epidemic from becoming a reality. The US military “had exploded,” mixing millions of men from different regions together, in close quarters, in training camps.

By 1917, medical science “had achieved considerable success in manipulating the immune system.” Gorgas tried to leverage these achievements, training army doctors at the Rockefeller Institute and “stockpiling” vaccines, antitoxins and sera. He transformed railroad cars into laboratories and created a unit focused on preventing infectious disease.

Scientists Rufus Cole and Oswald Avery, focused on studying pneumonia, warned the army of the potential for a pneumonia outbreak. Their warning was ignored, and during the winter of 1917-18, measles spread amongst the troops, in many cases causing pneumonia.

Gorgas “lacerated” the War Department in the testimony that he gave to the Senate, when he “was summoned to explain the measles fiasco.” As a result, he was further isolated by the army. Witnessing the measles epidemic firsthand, Welch called upon the work of Oswald Avery, a scientist of the Rockefeller Institute who studied pneumonia.

Chapter Twelve

Pneumonia is “an inflammation of the lungs with consolidation,” and it is “almost always caused” by some kind of infection. Directly or indirectly, influenza causes pneumonia. The bacterium most commonly responsible for pneumonia is pneumococcus. Since 1892, scientists had tried to develop a serum to treat pneumonia, but various attempts had failed.

Because pneumonia was “the biggest killer” in America, Rufus Cole focused his efforts at the Rockefeller hospital on the treatment of pneumonia. Unlike other bacteria treated successfully at that point, pneumococcus came in different forms, with different antigens.

To assist in the study of pneumonia, Cole recruited Oswald Avery, an ambitious Canadian scientist obsessed with his laboratory. Soon after arriving at the Rockefeller Institute, Avery prematurely published two papers. After publicly being proven wrong, Avery “became extraordinarily careful,” only going “an inch at a time” in future research.

Scientists discovered three common strains of pneumococci. At the Rockefeller Institute, Avery, Cole, and fellow scientist Dochez developed an immune serum ready to be tested on people.

Chapter Thirteen 

Significantly, Avery and Cole discovered a serum that would “cut the death rate of Type I pneumonias by more than half.” Although it was not a cure, it was “a landmark work” that provided instructions to prepare the serum. Anticipating pneumonia outbreaks in the army, Avery and his colleagues taught serum therapy to military doctors. At the same time, they developed a vaccine to prevent pneumonia.

Gorgas wanted to create a board dedicated specifically to pneumonia; Welch and Flexner selected Rufus Cole as the chair. The board members included Oswald Avery, Lieutenant Thomas Rivers, Lieutenant Francis Blake, and Captain Eugene Opie.

After the measles epidemic, various military leaders and scientists met to discuss measures to minimize the risk of another infectious disease. They discussed the problems of cross-infection and overcrowding of troops.

By 1918 “humankind was fully modern, and fully scientific.” Although nature had “generally been languid in its response” to human domination, it was about to unleash “its fullest rage.”

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