The Great Influenza

by John M. Barry

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Part 8: The Tolling of the Bell Summary

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Last Updated on June 8, 2022, by eNotes Editorial. Word Count: 1183

Chapter Twenty-Six

As scientists wrestled toward solutions, society grappled with the effects of the pandemic. These efforts “required leadership and… that institutions follow that leadership.”

In 1918, the federal government “had more force than it had ever had” but was devoting that force to the war, not the pandemic. Since the United States had entered World War I, President Woodrow Wilson had “injected” the war effort into every area of life.

Despite the growing danger of influenza, and despite movements toward a peace agreement, Wilson remained focused on the war effort.

Ignoring the warnings of Gorgas and other medical professionals, the army continued to send troops to Europe on ships that “became death ships.” With thousands of soldiers packed in close proximity, eruptions of the virus on these ships were horrific. When the ships arrived in Europe, the troops they carried became “a burden rather than a help” to European army hospitals that were already being overwhelmed by influenza outbreaks there.

Wilson refrained from any public statement about influenza, but privately discussed stopping the shipment of troops to Europe with General Peyton March. In the end, the “army continued the voyages of troopships overseas.”

Of all the leaders Wilson had appointed for civilian life, the only one with “any real responsibility for health,” Surgeon General Rupert Blue, “was not a strong man.” He was considered “a lightweight” by medical scientists. Compared to Gorgas, who fought to protect as many as possible from the disease, Blue was comparatively ineffectual and often blocked research.

When the virus exploded in the United States, it became obvious that Blue had barely prepared for it. As the pandemic spread, Blue finally published official warnings in newspapers. The warnings were made up of generalized precautions that offered no real reassurance.

Blue organized the Public Health Service at a much slower pace than the Red Cross had mobilized. Finally, with money from Congress, the Public Health Service sought what was needed most: more doctors and nurses. By then, “the virus spanned the country.”

Chapter Twenty-Seven

The only thing that could have truly stopped the influenza outbreak was “ruthless intervention and quarantines,” but in the context of wartime, Rupert Blue refrained from impinging on military efforts.

Instead, the Public Health Service and the Red Cross worked together to shift doctors, nurses and supplies to different cities as the virus hit its peak in each region. While bringing in support from other cities had worked in Massachusetts, one of the first cities hit with the virus, by October 1918 “everyone” needed doctors, nurses, and resources. 

While doctors could not prevent deaths caused by the influenza virus or by ARDS, they could still prevent deaths caused by pneumonia following an influenza attack. By 1918, a “promising vaccine” existed that was capable of reducing the death rate for specific types of pneumonia. Other medical techniques and tools existed that would allow doctors to have some impact.

Yet, when the virus erupted, the United States was already facing a shortage of doctors due to the war effort. The Public Health Service was only able to recruit moderately and poorly trained doctors. These doctors were ill-equipped and overwhelmed by the numbers of patients.

Nurses could also save lives, “but nurses were harder to find than doctors.” Leaders in the nursing profession had refused to allow the training of “practical nurses,” and thousands of nurses had already been called to the front.

Chapter Twenty-Eight

In Philadelphia, the city “staggered under the influenza attack,” with no relief or direction from any institution. Paul Lewis became more “consumed with the laboratory” than ever. While he juggled different areas of inquiry, he abandoned “the possibility that a filterable virus caused influenza.” Instead, respecting the work of Richard Pfeiffer, he primarily focused on the influenza bacillus.

In the vacuum of leadership in Philadelphia, several elite families “considered it their duty… to take charge.” The upper-class women organized the distribution of everything “from medical care to food” and widened the search for nurses and doctors.

Wilmer Krusen, head of the city health department, “had been slow to act before” but by October became mobilized. He drew from city emergency funds, ceded control of city nurses, appealed to the government to postpone the drafting of Philadelphia doctors, and cleaned the streets.

Despite the work of policemen, seminary students, and priests, the bodies of the dead “were choking homes and lying in stacks.” The bodies were collected in trucks and wagons; families themselves dug graves, or mass graves were excavated.

Although the city had seen an “initial burst of energy” to meet the pandemic with “vigor and courage,” the disease still overwhelmed it. People were isolated and fearful. The need for nurses was desperate, and most of the calls for help went unanswered.

Fear and anger began to tear apart the community. The women searching for volunteers became discouraged by the lack of willing helpers. Indeed, most citizens were paralyzed by fear.

Chapter Twenty-Nine

Around the world, cities were being struck by the virus. Governments were leaving “a vacuum” that became filled by fear. In wartime, newspapers and government officials reported on the pandemic with a “mixture of truth and half-truth.”

Civilians and medical scientists alike began to wonder if the disease was actually a resurfacing of the plague. Meanwhile, newspapers fuelled people’s fears by “making little” of the disease. Media reports and government assurances stood in contrast to the reality people faced. Newspapers warned audiences not to become afraid, ironically spreading the terror through lack of reliable information. Government officials contradicted their own reassurances. The movement of the virus across the country also increased fear. People watched as the virus “crept closer,” moving from one town to the next. 

The virus encouraged some men and women to “rise above themselves,” and there are tales of heroism. In other cases, the virus sparked false rumors about Germans. It also broke down community life and relationships. Across the country, from Philadelphia to Phoenix, fear “settled over the nation like a frozen blanket.”

Chapter Thirty 

Despite every effort to find more doctors and nurses, the need could not be met. In desperation, “physicians attempted everything—everything—to save lives.” Across the world, doctors reached for any way possible—from the “logical” to the “outlandish”—to try to relieve symptoms and prevent more deaths. Meanwhile, “hundreds of millions” of people received no medical help and, left on their own, tried to treat themselves with all manner of remedies.

By mid-October, vaccines “were appearing everywhere.” Although they were prepared “by the best scientists,” there had not been enough time to properly establish their value. The American Medical Association, not wanting medicine to once again be the “mockery” it had been decades before, urged doctors not to “arouse unwarranted hope.”

In reality, the only thing that could halt the virus was to prevent exposure. The few places that successfully isolated themselves “escaped,” but otherwise the virus “[hunted] mankind.” The most remote places were the most vulnerable. From the Arctic to remote jungle villages, “populations whose immune systems were naïve” were often destroyed. Across the world, the pandemic brought overwhelming death.

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