The Great Influenza Quotes

Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years.

Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one.

You don't manage the truth. You tell the truth.

The foundation of morality is to have done, once and for all, with lying.

The two most important questions in science are “What can I know?” and “How can I know it?

The fear, not the disease, threatened to break the society apart.

What’s true of all the evils in the world is true of plague as well. It helps men to rise above themselves.

In fact, biology is chaos. Biological systems are the product not of logic but of evolution, an inelegant process. Life does not choose the logically best design to meet a new situation. It adapts what already exists...The result, unlike the clean straight lines of logic, is often irregular, messy.

Epidemiologists have computed that measles requires an unvaccinated population of at least half a million people living in fairly close contact to continue to exist.

looked up and found the Great Bear. I told her, In Italy, they used to blame the influence of the constellations for making them sick—that’s where influenza comes from. Bridie took that notion in stride. As if, when it’s your time, your star gives you a yank—

As terrifying the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured. People could not trust what they read. Uncertainty follows distrust, fear follow uncertainty, and, under conditions such as these, terror follows fear.

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.” He also believed that learning had purpose, stating, “The great end of life is not knowledge but action.

So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

a spider and a fly i heard a spider and a fly arguing wait said the fly do not eat me i serve a great purpose in the world you will have to show me said the spider i scurry around gutters and sewers and garbage cans said the fly and gather up the germs of typhoid influenza and pneumonia on my feet and wings then i carry these germs into households of men and give them diseases all the people who have lived the right sort of life recover from the diseases and the old soaks who have weakened their systems with liquor and iniquity succumb it is my mission to help rid the world of these wicked persons i am a vessel of righteousness scattering seeds of justice and serving the noblest uses it is true said the spider that you are more useful in a plodding material sort of way than i am but i do not serve the utilitarian deities i serve the gods of beauty look at the gossamer webs i weave they float in the sun like filaments of song if you get what i mean i do not work at anything i play all the time i am busy with the stuff of enchantment and the materials of fairyland my works transcend utility i am the artist a creator and demi god it is ridiculous to suppose that i should be denied the food i need in order to continue to create beauty i tell you plainly mister fly it is all damned nonsense for that food to rear up on its hind legs and say it should not be eaten you have convinced me said the fly say no more and shutting all his eyes he prepared himself for dinner and yet he said i could have made out a case for myself too if i had had a better line of talk of course you could said the spider clutching a sirloin from him but the end would have been just the same if neither of us had spoken at all boss i am afraid that what the spider said is true and it gives me to think furiously upon the futility of literature archy

biology is chaos. Biological systems are the product not of logic but of evolution, an inelegant process.

Emerson said that an institution is the lengthened shadow of one man,

He advised, “Whenever you fall, pick up something.

Yet institutions are human as well. They reflect the cumulative personalities of those within them, especially their leadership. They tend, unfortunately, to mirror less admirable human traits, developing and protecting self-interest and even ambition. Institutions almost never sacrifice. Since they live by rules, they lack spontaneity. They try to order chaos not in the way an artist or scientist does, through a defining vision that creates structure and discipline, but by closing off and isolating themselves from that which does not fit. They become bureaucratic.

Certainty creates strength. Certainty gives one something upon which to lean. Uncertainty creates weakness. Uncertainty makes one tentative if not fearful, and tentative steps, even when in the right direction, may not overcome significant obstacles.

All positive knowledge obtained . . . has resulted from the accurate observation of facts.

Huxley did not look the warrior. But he had a warrior’s ruthlessness. His dicta included the pronouncement: “The foundation of morality is to have done, once and for all, with lying.

Viruses are themselves an enigma that exist on the edges of life. They are not simply small bacteria. Bacteria consist of only one cell, but they are fully alive. Each has a metabolism, requires food, produces waste, and reproduces by division. Viruses do not eat or burn oxygen for energy. They do not engage in any process that could be considered metabolic. They do not produce waste. They do not have sex. They make no side products, by accident or design. They do not even reproduce independently. They are less than a fully living organism but more than an inert collection of chemicals.

No other disease, no war, no natural disaster, no famine comes close to the great pandemic. In the space of eighteen months in 1918–1919, about 500 million people, one-third of the human race at the time, came down with influenza. The exact total of lives lost will never be known. An early estimate, made in 1920, claimed 21.5 million died worldwide. Since then, researchers have been continually raising the number as they find new information. Today, the best estimate of flu deaths in 1918–1919 is between 50 million and 100 million worldwide, and probably closer to the latter figure. 7

Another explanation for the failure of logic and observation alone to advance medicine is that unlike, say, physics, which uses a form of logic - mathematics - as its natural language, biology does not lend itself to logic. Leo Szilard, a prominent physicist, made this point when he complained that after switching from physics to biology he never had a peaceful bath again. As a physicist he would soak in the warmth of a bathtub and contemplate a problem, turn it in his mind, reason his way through it. But once he became a biologist, he constantly had to climb out of the bathtub to look up a fact.

overstate to make a point—warned, civilization could have disappeared within a few more weeks. So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. A leader must make whatever horror exists concrete. Only then will people be able to break it apart.

Great Influenza:

looked up and found the Great Bear. I told her, In Italy, they used to blame the influence of the constellations for making them sick—that’s where influenza comes from.

The 1918 epidemic came in two waves, a mild flu in the spring of 1918 followed by the killer flu in the fall.

But even after European medicine changed, medicine in the United States did not. In research and education especially, American medicine lagged far behind, and that made practice lag as well.

All rather humbling, she added ruefully. Here we are in the golden age of medicine - making such great strides against rabies, typhoid fever, diphtheria - and a common or garden influenza is beating us hollow.

For the influenza pandemic that erupted in 1918 was the first great collision between nature and modern science. It was the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds.

Newspapers reported on the disease with the same mixture of truth and half-truth, truth and distortion, truth and lies with which they reported everything else. And no national official ever publicly acknowledged the danger of influenza.

In the United States, no government, institution, or philanthropist even began to approach a similar level of support. As the Hopkins medical school was opening, American theological schools enjoyed endowments of $18 million, while medical school endowments totaled $500,000.

Surgeon General’s Advice to Avoid Influenza Avoid needless crowding. . . . Smother your coughs and sneezes. . . . Your nose not your mouth was made to breathe thru. . . . Remember the 3 Cs, clean mouth, clean skin, and clean clothes. . . . Food will win the war. . . . [H]elp by choosing and chewing your food well. . . . Wash your hands before eating. . . . Don’t let the waste products of digestion accumulate. . . . Avoid tight clothes, tight shoes, tight gloves—seek to make nature your ally not your prisoner. . . . When the air is pure breathe all of it you can—breathe deeply.

Here we are in the golden age of medicine—making such great strides against rabies, typhoid fever, diphtheria—and a common or garden influenza is beating us hollow. No, you’re the ones who matter right now. Attentive nurses, I mean—tender loving care, that seems to be all that’s saving lives.

Oliver Wendell Holmes, the physician father of the Supreme Court justice, was not much overstating when he declared, “I firmly believe that if the whole materia medica, as now used, could be sunk to the bottom of the sea, it would be all the better for mankind—and all the worse for the fishes.

The same sense of hubris affects us today as affected the generation that was blindsided by the Spanish Influenza. A modern epidemic comparable with the great ones of the past is a thing more akin to science fiction to most people living today rather than something seen as a realistic possibility.

But as the program got going, the smallest details became issues, even the very name of the disease. Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey

It still can be. The same sense of hubris affects us today as affected the generation that was blindsided by the Spanish Influenza. A modern epidemic comparable with the great ones of the past is a thing more akin to science fiction to most people living today rather than something seen as a realistic possibility.

And yet Flexner too was kept distant. Flexner himself wrote that after Welch’s estrangement from Dennis, “Never again would he allow any person, woman or colleague, close…. The bachelor scientist moved on a high plane of loneliness that may have held the secret of some of his power.” For the rest of his life Welch would remain alone.

new influenza virus emerges, it is highly competitive, even cannibalistic. It usually drives older types into extinction. This happens because infection stimulates the body’s immune system to generate all its defenses against all influenza viruses to which the body has ever been exposed. When older viruses attempt to infect someone, they cannot gain a foothold. They cease replicating. They die out. So, unlike practically every other known virus, only one type—one swarm or quasi species—of influenza virus dominates at any given time. This itself helps prepare the way for a new pandemic, since the more time passes, the fewer people’s immune systems will recognize other antigens.

relationship with nature, modern humanity has generally been the aggressor, and a daring one at that, altering the flow of rivers, building upon geological faults, and, today, even engineering the genes of existing species. Nature has generally been languid in its response, although contentious once aroused and occasionally displaying a flair for violence. 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.

Hemingway, eager not to miss the big battle even though he was suffering from influenza, managed to reach Colonel Buck Lanham’s command post near Rodenbourg. The house had belonged to a priest suspected of being a German sympathizer. Hemingway took great delight in drinking a stock of communion wine and then refilling the bottles with his own urine. He claimed to have relabelled them ‘Schloss Hemingstein 1944’ and later drank from one by mistake.

In 1918 fear moved ahead of the virus like the bow wave before a ship. Fear drove the people, and the government and the press could not control it. They could not control it because every true report had been diluted with lies. And the more the officials and newspapers reassured, the more they said, There is no cause for alarm if proper precautions are taken, or Influenza is nothing more or less than old-fashioned grippe, the more people believed themselves cast adrift, adrift with no one to trust, adrift on an ocean of death.

No medicine and none of the vaccines developed then could prevent influenza. The masks worn by millions were useless as designed and could not prevent influenza. Only preventing exposure to the virus could. Nothing today can cure influenza, although vaccines can provide significant—but nowhere near complete—protection, and several antiviral drugs can mitigate its severity. Places that isolated themselves—such as Gunnison, Colorado, and a few military installations on islands—escaped. But the closing orders that most cities issued could not prevent exposure; they were not extreme enough. Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer. Even where fear closed down businesses, where both store owners and customers refused to stand face-to-face and left orders on sidewalks, there was still too much interaction to break the chain of infection. The virus was too efficient, too explosive, too good at what it did. In the end the virus did its will around the world.

Capps did write the JAMA article. He reported finding the masks so successful that after less than three weeks of experimenting he had abandoned testing and simply started using them as “a routine measure.” He also made the more general point that “one of the most vital measures in checking contagion” is eliminating crowding. “Increasing the space between beds in barracks, placing the head of one soldier opposite the feet of his neighbor, stretching tent flags between beds, and suspending a curtain down the center of the mess table, are all of proved value.” To prevent a few arriving individuals from infecting an entire camp, he also repeated Welch’s recommendation to isolate transferred troops.

As Einstein once said, “One of the strongest motives that lead persons to art or science is a flight from the everyday life. . . . With this negative motive goes a positive one. Man seeks to form for himself, in whatever manner is suitable for him, a simplified and lucid image of the world, and so to overcome the world of experience by striving to replace it to some extent by this image. This is what the painter does, and the poet, the speculative philosopher, the natural scientist, each in his own way. Into this image and its formation, he places the center of gravity of his emotional life, in order to attain the peace and serenity that he cannot find within the narrow confines of swirling personal experience.

From the President’s speech, delivered at 9 PM, EST, not seen in many areas. ‘ … a great nation such as this must do. We cannot afford to jump at shadows like small children in a dark room; but neither can we afford to take this serious outbreak of influenza lightly. My fellow Americans, I urge you to stay at home. If you feel ill, stay in bed, take aspirin, and drink plenty of clear liquids. Be confident that you will feel better in a week at most. Let me repeat what I said at the beginning of my talk to you this evening: There is no truth – no truth – to the rumor that this strain of flu is fatal. In the greatest majority of cases, the person afflicted can expect to be up and around and feeling fine within a week. Further –’ [a spasm of coughing]

One nurse at Great Lakes would later be haunted by nightmares. The wards had forty-two beds; boys lying on the floor on stretchers waited for the boy on the bed to die. Every morning the ambulances arrived and stretcher bearers carried sick sailors in and bodies out. She remembered that at the peak of the epidemic the nurses wrapped more than one living patient in winding sheets and put toe tags on the boys’ left big toe. It saved time, and the nurses were utterly exhausted. The toe tags were shipping tags, listing the sailor’s name, rank, and hometown. She remembered bodies “stacked in the morgue from floor to ceiling like cord wood.” In her nightmares she wondered “what it would feel like to be that boy who was at the bottom of the cord wood in the morgue.

Wasn’t it Pieter Stuyvesant who said that first boatload of Jews could stay in New Amsterdam only as long as they took care of their own and asked for nothing? So take care of ourselves we did. They always told us how lucky we were to grow up in the Orphaned Hebrews Home, schooling us in its illustrious history. Didn’t we weather the blizzard of 1888, kept warm by our own stockpile of coal, fed from the ovens of our own bakery? And while children all over the city succumbed to cholera at the turn of the century, didn’t we emerge unscathed, the city’s water filtered before it reached our lips? After the Great War, people fell to influenza by the tens of thousands, but in the Home not a single child died. No matter how impressive, though, our Home was a kind of ghetto, the scrape of metal as the gates swung shut the same sound in Manhattan as in Venice. I

It kept people apart. . . . It took away all your community life, you had no community life, you had no school life, you had no church life, you had nothing. . . . It completely destroyed all family and community life. People were afraid to kiss one another, people were afraid to eat with one another, they were afraid to have anything that made contact because that’s how you got the flu. . . . It destroyed those contacts and destroyed the intimacy that existed amongst people. . . . You were constantly afraid, you were afraid because you saw so much death around you, you were surrounded by death. . . . When each day dawned you didn’t know whether you would be there when the sun set that day. It wiped out entire families from the time that the day began in the morning to bedtime at night—entire families were gone completely, there wasn’t any single soul left, and that didn’t happen just intermittently, it happened all the way across the neighborhoods, it was a terrifying experience. It justifiably should be called a plague because that’s what it was. . . . You were quarantined, is what you were, from fear, it was so quick, so sudden. . . . There was an aura of a constant fear that you lived through from getting up in the morning to going to bed at night.

Early on it is clear that Addie has a rebellious streak, joining the library group and running away to Rockport Lodge. Is Addie right to disobey her parents? Where does she get her courage? 2. Addie’s mother refuses to see Celia’s death as anything but an accident, and Addie comments that “whenever I heard my mother’s version of what happened, I felt sick to my stomach.” Did Celia commit suicide? How might the guilt that Addie feels differ from the guilt her mother feels? 3. When Addie tries on pants for the first time, she feels emotionally as well as physically liberated, and confesses that she would like to go to college (page 108). How does the social significance of clothing and hairstyle differ for Addie, Gussie, and Filomena in the book? 4. Diamant fills her narrative with a number of historical events and figures, from the psychological effects of World War I and the pandemic outbreak of influenza in 1918 to child labor laws to the cultural impact of Betty Friedan. How do real-life people and events affect how we read Addie’s fictional story? 5. Gussie is one of the most forward-thinking characters in the novel; however, despite her law degree she has trouble finding a job as an attorney because “no one would hire a lady lawyer.” What other limitations do Addie and her friends face in the workforce? What limitations do women and minorities face today? 6. After distancing herself from Ernie when he suffers a nervous episode brought on by combat stress, Addie sees a community of war veterans come forward to assist him (page 155). What does the remorse that Addie later feels suggest about the challenges American soldiers face as they reintegrate into society? Do you think soldiers today face similar challenges? 7. Addie notices that the Rockport locals seem related to one another, and the cook Mrs. Morse confides in her sister that, although she is usually suspicious of immigrant boarders, “some of them are nicer than Americans.” How does tolerance of the immigrant population vary between city and town in the novel? For whom might Mrs. Morse reserve the term Americans? 8. Addie is initially drawn to Tessa Thorndike because she is a Boston Brahmin who isn’t afraid to poke fun at her own class on the women’s page of the newspaper. What strengths and weaknesses does Tessa’s character represent for educated women of the time? How does Addie’s description of Tessa bring her reliability into question? 9. Addie’s parents frequently admonish her for being ungrateful, but Addie feels she has earned her freedom to move into a boardinghouse when her parents move to Roxbury, in part because she contributed to the family income (page 185). How does the Baum family’s move to Roxbury show the ways Betty and Addie think differently from their parents about household roles? Why does their father take such offense at Herman Levine’s offer to house the family? 10. The last meaningful conversation between Addie and her mother turns out to be an apology her mother meant for Celia, and for a moment during her mother’s funeral Addie thinks, “She won’t be able to make me feel like there’s something wrong with me anymore.” Does Addie find any closure from her mother’s death? 11. Filomena draws a distinction between love and marriage when she spends time catching up with Addie before her wedding, but Addie disagrees with the assertion that “you only get one great love in a lifetime.” In what ways do the different romantic experiences of each woman inform the ideas each has about love? 12. Filomena and Addie share a deep friendship. Addie tells Ada that “sometimes friends grow apart. . . . But sometimes, it doesn’t matter how far apart you live or how little you talk—it’s still there.” What qualities do you think friends must share in order to have that kind of connection? Discuss your relationship with a best friend. Enhance

On Sunday, November 10, Kaiser Wilhelm II was dethroned, and he fled to Holland for his life. Britain’s King George V, who was his cousin, told his diary that Wilhelm was “the greatest criminal known for having plunged the world into this ghastly war,” having “utterly ruined his country and himself.” Keeping vigil at the White House, the President and First Lady learned by telephone, at three o’clock that morning, that the Germans had signed an armistice. As Edith later recalled, “We stood mute—unable to grasp the significance of the words.” From Paris, Colonel House, who had bargained for the armistice as Wilson’s envoy, wired the President, “Autocracy is dead. Long live democracy and its immortal leader. In this great hour my heart goes out to you in pride, admiration and love.” At 1:00 p.m., wearing a cutaway and gray trousers, Wilson faced a Joint Session of Congress, where he read out Germany’s surrender terms. He told the members that “this tragical war, whose consuming flames swept from one nation to another until all the world was on fire, is at an end,” and “it was the privilege of our own people to enter it at its most critical juncture.” He added that the war’s object, “upon which all free men had set their hearts,” had been achieved “with a sweeping completeness which even now we do not realize,” and Germany’s “illicit ambitions engulfed in black disaster.” This time, Senator La Follette clapped. Theodore Roosevelt and Senator Lodge complained that Wilson should have held out for unconditional German surrender. Driven down Capitol Hill, Wilson was cheered by joyous crowds on the streets. Eleanor Roosevelt recorded that Washington “went completely mad” as “bells rang, whistles blew, and people went up and down the streets throwing confetti.” Including those who had perished in theaters of conflict from influenza and other diseases, the nation’s nineteen-month intervention in the world war had levied a military death toll of more than 116,000 Americans, out of a total perhaps exceeding 8 million. There were rumors that Wilson planned to sail for France and horse-trade at the peace conference himself. No previous President had left the Americas during his term of office. The Boston Herald called this tradition “unwritten law.” Senator Key Pittman, Democrat from Nevada, told reporters that Wilson should go to Paris “because there is no man who is qualified to represent him.” The Knickerbocker Press of Albany, New York, was disturbed by the “evident desire of the President’s adulators to make this war his personal property.” The Free Press of Burlington, Vermont, said that Wilson’s presence in Paris would “not be seemly,” especially if the talks degenerated into “bitter controversies.” The Chattanooga Times called on Wilson to stay home, “where he could keep his own hand on the pulse of his own people” and “translate their wishes” into action by wireless and cable to his bargainers in Paris.

...literature does its best to maintain that its concern is with the mind ; that the body is a sheet of plain glass through which the soul looks straight and clear, and, save for one or two passions such as desire and greed, is null , negligible and nonexistent. On the contrary, the very opposite is true. All day, all night the body intervenes; blunts or sharpens, colours or discolours, turns to wax in the warmth of June, hardens to tallow in the murk of February. The creature within can only gaze through the pane—smudged or rosy; it cannot separate off from the body like the sheath of a knife or the pod of a pea for a single instant; it must go through the whole unending procession of changes, heat and cold, comfort and discomfort, hunger and satisfaction, health and illness, until there comes the inevitable catastrophe; the body smashes itself to smithereens, and the soul (it is said) escapes. But of all this daily drama of the body there is no record. People write always about the doings of the mind; the thoughts that come to it; its noble plans; how it has civilised the universe. They show it ignoring the body in the philosopher's turret; or kicking the body, like an old leather football, across leagues of snow and desert in the pursuit of conquest or discovery. Those great wars which it wages by itself, with the mind a slave to it, in the solitude of the bedroom against the assault of fever or the oncome of melancholia, are neglected. Nor is the reason far to seek. To look these things squarely in the face would need the courage of a lion tamer; a robust philosophy; a reason rooted in the bowels of the earth. Short of these, this monster, the body, this miracle, its pain, will soon make us taper into mysticism, or rise, with rapid beats of the wings, into the raptures of transcendentalism. More practically speaking, the public would say that a novel devoted to influenza lacked plot; they would complain that there was no love in it—wrongly however, for illness often takes on the disguise of love, and plays the same odd tricks, investing certain faces with divinity, setting us to wait, hour after hour, with pricked ears for the creaking of a stair, and wreathing the faces of the absent (plain enough in health, Heaven knows) with a new significance, while the mind concocts a thousand legends and romances about them for which it has neither time nor liberty in health.

literature does itsnbest to maintain that its concern is with the mind ; that the body is a sheet of plain glass through which the soul looks straight and clear, and, save for one or two passions such as desire and greed, is null , negligible and nonexistent. On the contrary, the very opposite is true. All day, all night the body intervenes; blunts or sharpens, colours or discolours, turns to wax in the warmth of June, hardens to tallow in the murk of February. The creature within can only gaze through the pane—smudged or rosy; it cannot separate off from the body like the sheath of a knife or the pod of a pea for a single instant; it must go through the whole unending procession of changes, heat and cold, comfort and discomfort, hunger and satisfaction, health and illness, until there comes the inevitable catastrophe; the body smashes itself to smithereens, and the soul (it is said) escapes. But of all this daily drama of the body there is no record. People write always about the doings of the mind; the thoughts that come to it; its noble plans; how it has civilised the universe. They show it ignoring the body in the philosopher's turret; or kicking the body, like an old leather football, across leagues of snow and desert in the pursuit of conquest or discovery. Those great wars which it wages by itself, with the mind a slave to it, in the solitude of the bedroom against the assault of fever or the oncome of melancholia, are neglected. Nor is the reason far to seek. To look these things squarely in the face would need the courage of a lion tamer; a robust philosophy; a reason rooted in the bowels of the earth. Short of these, this monster, the body, this miracle, its pain, will soon make us taper into mysticism, or rise, with rapid beats of the wings, into the raptures of transcendentalism. More practically speaking, the public would say that a novel devoted to influenza lacked plot; they would complain that there was no love in it—wrongly however, for illness often takes on the disguise of love, and plays the same odd tricks, investing certain faces with divinity, setting us to wait, hour after hour, with pricked ears for the creaking of a stair, and wreathing the faces of the absent (plain enough in health, Heaven knows) with a new significance, while the mind concocts a thousand legends and romances about them for which it has neither time nor liberty in health.

Today, such studies are illegal. Medical scientists cannot offer inducements like pardons to persuade prisoners to take part in their studies. Although they can award small cash payments to research subjects, they are forbidden from giving anyone so much money or such tempting favors that their compensations might constitute what ethicists term an inappropriate inducement, an irresistible temptation to join the study. Now, more than eighty years after the 1918 flu, people enter studies for several reasons—to get free medical care, to get an experimental drug that, they hope, might cure them of a disease like cancer or AIDS, or to help further scientific knowledge. In theory at least, study participants are supposed to be true volunteers, taking part in research of their own free will. But in 1918, such ethical arguments were rarely considered. Instead, the justification for a risky study with human beings was that it was better to subject a few to a great danger in order to save the many. Prisoners were thought to be the ideal study subjects. They could offer up their bodies for science and, if they survived, their pardons could be justified because they gave something back to society. The Navy inmates were perfect for another reason. Thirty-nine of them had never had influenza, as far as anyone knew. So they might be uniquely susceptible to the disease. If the doctors wanted to deliberately transmit the 1918 flu, what better subjects? Was influenza really so easily transmitted? the doctors asked. Why did some people get it and others not? Why did it kill the young and healthy? Could the wartime disruptions and movements of troops explain the spread of the flu? If it was as contagious as it seemed, how was it being spread? What kind of microorganism was causing the illness? The normal way to try to answer such questions would be to study the spread of the disease in animals. Give the disease to a few cages of laboratory rats, or perhaps to some white rabbits. Isolate whatever was causing the illness. Show how it spread and test ways to protect animals—and people—against the disease. But influenza, it seemed, was a uniquely human disease. No animal was known to be susceptible to it. Medical researchers felt they had no choice but to study influenza in people. Either the Navy doctors were uncommonly persuasive or the enticement of a pardon was overwhelmingly compelling. For whatever reason, the sixty-two men agreed to be subjects in the medical experiment. And so the study began. First the sailors were transferred to a quarantine station on Gallops Island in Boston Harbor. Then the Navy doctors did their best to give the men the flu. Influenza is a respiratory disease—it is spread from person to person, presumably carried on droplets of mucus sprayed in the air when sick people cough or sneeze, or carried on their hands and spread when the sick touch the healthy. Whatever was causing the flu should be present in mucus taken from the ill. The experiments, then, were straightforward. The Navy doctors collected mucus from men who were desperately ill with the flu, gathering thick viscous secretions from their noses and throats. They sprayed mucus from flu patients into the noses and throats of some men, and dropped it into other men’s eyes. In one attempt, they swabbed mucus from the back of the nose of a man with the flu and then directly swabbed that mucus into the back of a volunteer’s nose.

observing that America was “a country governed by public opinion,” Gregory intended to help Wilson rule opinion and, through opinion, the country.

The force of an idea lies in its inspirational value. It matters very little if it is true or false.

I am Public Opinion. All men fear me!

that fear was “an important element to be bred in the civilian population. It is difficult to unite a people by talking only on the highest ethical plane. To fight for an ideal, perhaps, must be coupled with thoughts of self-preservation.

Throughout the wars in history more soldiers had often died of disease than in battle or of their wounds. And epidemic disease had routinely spread from armies to civilian populations.

So the advances of science actually, and ironically, led to “therapeutic nihilism.” Physicians became disenchanted with traditional treatments, but they had nothing with which to replace them.

To a large degree, the extent of the devastation that the flu caused on American cities depended on how they reacted to it. Those that took prompt action and made good choices had more limited devastation than others.

During the course of the epidemic, 47 percent of all deaths in the United States, nearly half of all those who died from all causes combined—from cancer, from heart disease, from stroke, from tuberculosis, from accidents, from suicide, from murder, and from all other causes—resulted from influenza and its complications.

Investigators today believe that in the United States the 1918–19 epidemic caused an excess death toll of about 675,000 people.

In most life forms, genes are stretched out along the length of a filament-like molecule of DNA, deoxyribonucleic acid. But many viruses—including influenza, HIV, and the coronavirus that causes SARS (severe acute respiratory syndrome)—encode their genes in RNA, ribonucleic acid, an even simpler but less stable molecule.

Desperate efforts were being made to protect troops from the disease, or at least prevent complications. Germicidal solutions were sprayed into the mouths and noses of troops. Soldiers were ordered to use germicidal mouthwash and to gargle twice a day. Iodine in glycerin was tried in an attempt to disinfect mouths. Vaseline containing menthol was used in nasal passages, mouths washed with liquid albolene.

NATURE CHOSE to rage in 1918, and it chose the form of the influenza virus in which to do

Public health was and is where the largest numbers of lives are saved, usually by understanding the epidemiology of a disease—its patterns, where and how it emerges and spreads—and attacking it at its weak points. This usually means prevention. Science had first contained smallpox, then cholera, then typhoid, then plague, then yellow fever, all through large-scale public health measures, everything from filtering water to testing and killing rats to vaccination. Public health measures lack the drama of pulling someone back from the edge of death, but they save lives by the millions.

Perhaps, in some innocent encounter in China between a child and a bird, a new killer flu is on its way. Or perhaps, even now, a young man or a young woman has become infected with two different strains of flu viruses. They are mixing together in the person’s lungs, their genes reassorting. Emerging from that witches’ brew is a new virus, a chimera, that, like the 1918 flu virus, is perfectly suited for destruction. Perhaps, as we grow almost smug about influenza, that most quotidian of infections, a new plague is now gathering deadly force. Except this time we stand armed with a better understanding of the past to better survive the next pandemic.

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

Pig farmers complained to the Centers for Disease Control that the name “swine flu” might frighten people away from eating pork. They asked, to no avail, that the flu’s name be changed to “New Jersey flu.

knows exactly how serious this threat could be. Nevertheless, we cannot afford to take a chance with the health of our nation.” With that preamble, Ford announced that he was asking Congress to appropriate $135 million “for the production of sufficient vaccine to inoculate every man, woman, and child in the United States,” for a disease that no one could even prove to exist.

Man seeks to form for himself, in whatever manner is suitable for him, a simplified and lucid image of the world, and so to overcome the world of experience by striving to replace it to some extent by this image.

air cannot flow out of the room, only in. There they are bathed in blue ultraviolet light, which kills viruses. After that, they tug on

It was more chilling still to see corpses littering the hallways surrounding the morgue. Vaughan reported, “In the morning the dead bodies are stacked about the morgue like cord wood.” As Cole recalled, “They were placed on the floor without any order or system, and we had to step amongst them to get into the room where an autopsy was going on.

Influenza causes pneumonia either directly, by a massive viral invasion of the lungs, or indirectly—and more commonly—by destroying certain parts of the body’s defenses and allowing so-called secondary invaders, bacteria, to infest the lungs virtually unopposed.

In 1910 they distinguished between what they called “typical” pneumococci and “atypical” pneumococci.

institutions are human as well. They reflect the cumulative personalities of those within them, especially their leadership. They tend, unfortunately, to mirror less admirable human traits, developing and protecting self-interest and even ambition. Institutions almost never sacrifice. Since they live by rules, they lack spontaneity. They try to order chaos not in the way an artist or scientist does, through a defining vision that creates structure and discipline, but by closing off and isolating themselves from that which does not fit.

They try to order chaos not in the way an artist or scientist does, through a defining vision that creates structure and discipline, but by closing off and isolating themselves from that which does not fit. They become bureaucratic.

There are three different types of influenza viruses: A, B, and C. Type C rarely causes disease in humans. Type B does cause disease, but not epidemics. Only influenza A viruses cause epidemics or pandemics, an epidemic being a local or national outbreak, a pandemic a worldwide one.

WHILE SCIENCE was confronting nature, society began to confront the effects of nature. For this went beyond the ability of any individual or group of individuals to respond to. To have any chance in alleviating the devastation of the epidemic required organization, coordination, implementation. It required leadership and it required that institutions follow that leadership.

So the final lesson of 1918, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that. Those in authority must retain the public’s trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best.

striving to replace it to some extent by this image. This is what the painter does, and the poet, the speculative

They had not done the wild things that had no basis in their understanding of the workings of the body. They had not given quinine or typhoid vaccine to influenza victims in the wild hope that because it worked against malaria or typhoid it might work against influenza.

Uncertainty follows distrust, fear follows uncertainty, and, under conditions such as these, terror follows fear.

In a truly lethal pandemic, state and local authorities could take much more aggressive steps, such as closing theaters, bars, and even banning sports events—in 1919 even the Stanley Cup finals were canceled—and church services.

Capps’s article appeared in the August 10, 1918, issue of JAMA.

And the reluctance, inability, or outright refusal of the American government to shift targets would contribute to the killing. Wilson took no public note of the disease, and the thrust of the government was not diverted.

From neither the White House nor any other senior administration post would there come any leadership, any attempt to set priorities, any attempt to coordinate activities, any attempt to deliver resources.

Today’s world population is 6.3 billion. To give a sense of the impact in today’s world of the 1918 pandemic, one has to adjust for population. If one uses the lowest estimate of deaths—the 21 million figure—that means a comparable figure today would be 73 million dead. The higher estimates translate into between 175 and 350 million dead.

Donohue’s family operated a funeral home: “We had caskets stacked up outside the funeral home. We had to have guards kept on them because people were stealing the caskets. . . . You’d equate that to grave robbing.” There were soon no caskets left to steal. Louise Apuchase remembered most vividly the lack of coffins: “A neighbor boy about seven or eight died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon.

of how amidst near-utter chaos a few men sought the coolness of contemplation, the utter calm that precedes not philosophizing but grim, determined action.

Pandemics often come in waves, and the cumulative “morbidity” rate—the number of people who get sick in all the waves combined—often exceeds 50 percent.

Even normal services such as schools were in short supply. Of the twenty largest cities in America, Philadelphia, the city of Benjamin Franklin and the University of Pennsylvania, spent less on education than all but one. In all of South Philadelphia, home to hundreds of thousands of Italians and Jews, there would be no high school until 1934.

Royal Copeland, head of the New York City health department, and the port health officer jointly stated there was “not the slightest danger of an epidemic” because the disease seldom attacks “a well-nourished people.” (Even had he been right, a study by his own health department had just concluded that 20 percent of city schoolchildren were malnourished.) He took no action whatsoever to prevent the spread of infection.

This answer involves not simply academic pursuits; it affects how a society governs itself, its structure, how its citizens live. If a society does set Goethe’s “Word . . . supremely high,” if it believes that it knows the truth and that it need not question its beliefs, then that society is more likely to enforce rigid decrees, and less likely to change. If it leaves room for doubt about the truth, it is more likely to be free and

Nearly two-thirds of the dead were under forty.

People were dying like flies,

ARDS by no means accounts for all the influenza deaths in 1918 and 1919, or even for a majority of them. It explains only those who died in a few days, and it explains why so many young healthy people died. Although influenza almost certainly killed some people in ways that had little to do with the lungs—for example, someone whose already weak heart could not stand the additional strain of fighting the disease—the overwhelming majority of non-ARDS deaths came from bacterial pneumonias. The destruction of the epithelial cells eliminated the sweeping action that clears so much of the respiratory tract of bacteria, and the virus damaged or exhausted other parts of the immune system as well. That gave the normal bacterial flora of the mouth unimpeded entry into the lungs. Recent research also suggests that the neuraminidase on the influenza virus makes it easier for some bacteria to attach to lung tissue, creating a lethal synergy between the virus and these bacteria. And in the lungs, the bacteria began to grow.