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The Great Influenza: The Story of the Deadliest Pandemic in History

By John M. Barry

What you’ll learn

Until recently, the idea of a pandemic took most people’s imagination to Hollywood thrillers and the Black Plague that ravaged medieval Europe. But the most devastating plague to ever strike the human race took place a century ago, during the First World War. This story contains many lessons for how—and how not—to handle a pandemic. Barry’s tie-ins to our own day (most recent edition published in 2018) have an eerily prophetic ring to them in light of the corona virus that has recently swept the globe.

Read on for key insights from The Great Influenza: The Story of the Deadliest Pandemic in History.

1. The 1918 influenza virus targeted young adults, and killed far more than the Black Plague or AIDS.

It was in the fall of 1918 that a group of sailors from the United States began presenting never-before seen symptoms that baffled clinicians. The presenting symptoms were bleeding in the nose and ears, pounding headaches, painful body aches, deep coughs (sometimes deep enough to tear abdominal musculature), and, finally, skin turning blue.

The medical professionals called in Paul Lewis, a lieutenant commander and a medical doctor who was more familiar with death in all its varieties than just about anyone alive at the time. He was also brilliant. More than a few colleagues—accomplished scientists in their own rights—called Lewis the most brilliant man they’d ever met.

Lewis was highly accomplished and still young. When polio had ravaged New York, he was part of the group that proved a virus was the culprit. And then he developed a vaccine that proved 100 percent effective in animal trials. He’d also founded a research institute in affiliation with University of Pennsylvania. Though Lewis was an accomplished man of science and familiar with death and all its friends, he was still baffled by the bodies of dying, blue-skinned sailors. He’d seen something similar among British soldiers weeks earlier, something influenza-like, but he wasn’t sure.

Whatever it was that the sailors who came through Boston to Philadelphia had brought with them that fall, it spread. Despite the best attempts of medical personnel to contain the unknown disease, it spread from the 19 soldiers to 87, and then to 600 within just a few days. Hospitals ran out of beds quickly and had to involve other medical facilities to care for the sick sailors and the civilians with whom they’d come in contact. Simultaneously, the same symptoms began showing up all over the world. This wasn’t a passing rash of influenza going around as doctors in the United States and Europe had thought. It was actually the second wave of a mild influenza that had appeared months earlier in America’s heartland. It was not nearly as devastating then, in symptoms or spread. The second, far more pernicious infection was spreading like wildfire in the fall of 1918, affecting not just sailors in New England, but also soldiers in the British Raj in India, and everywhere in between.

And so, as the Great War continued to rage, another war had begun. It wasn’t just a fight of nation against nation, but also of nation against some unknown disease. It began in a small town in the United States in the spring of 1918, but had laid dormant. But between the fall of 1918 and 1920, millions died. Of those who contracted influenza and succumbed, their deaths were swift and painful.

Earlier estimates put the death toll at 21 million, but this is now considered a low ball. More widely accepted estimates from epidemiologists are between 50 and 100 million. The majority of these deaths took place within a half-year window, during the fall and winter of 1918. The disease killed more people in a year than ever died in the medieval Black Plague or from AIDS.

What made this pandemic even more tragic was that it was the young (people in their 20s and 30s) who were especially vulnerable to the pathogen. If the higher estimates are accurate, that means the 1918 influenza took out about 10 percent of young adults on the planet.

The 1918 outbreak marked a milestone in human history. It was the first time that modern medicine and nature had challenged each other in such a robust way. The virus that led to the infamous Bubonic Plague 700 years earlier was a far milder strain, but it still decimated Europe because science and infrastructure couldn’t put up any real fight. This time, it was different, and it was the individuals who retained poise and calm in the midst of dire circumstances who stopped the bleeding and kept the catastrophe from being any more grim than it already was.

2. Only a few scientists saw the world’s vulnerability to epidemics and began planning accordingly.

Around the time of the pandemic, there were a number of remarkable people who had helped bring medical practices and research to the cutting edge. There are some areas of study where, even a century later, medical practitioners remain indebted to these forebears’ expertise and the skills they developed in a time of influenza. Paul Lewis was one of those geniuses. Another was William Henry Welch, who founded the first academic program devoted to public health in 1916 at Johns Hopkins University in Baltimore.

Still, it took tremendous time and dedication to make medicine a modern, scientific pursuit. Until the late-1800s, the field of medicine had changed very little since the days of Hippocrates in ancient Greece. Even until 1900, only one medical school in five required a high school diploma in the United States, and only one medical school required a college degree for admission. Many applicants without any serious training in the physical sciences were admitted, simply by proving that they could pay tuition. Degrees were doled out to men (women were not admitted) simply for passing all the classes—even if they had never touched a body or seen a patient.

Eventually, medical practice began to improve and become more empirically verified, first in Europe and then in the United States. United States medical science was the worst in the developed world before it became the best.

William Henry Welch was a forerunner who helped bring the massive and much-needed changes to the United States’ medical education. Welch was a capable scientist, physician, and professor, but his strength lay in his ability to inspire. He was a charming and charismatic individual. The students he taught at Johns Hopkins adored him and would become the most coveted in the United States. These Welch protégés formed an army of elites who would become more desperately needed than they knew in 1918. Welch was a man who convinced people that improvements in the American medical field were horribly overdue, and he provided a road map for how to get there, as well as a prestigious group of medical professionals to navigate it.

Welch’s influence revolutionized medicine in the United States, but another thing that  made Welch singular was that he saw what most everyone else had missed: humanity’s vulnerability to epidemics. He had noticed the trend that every time the United States went to war, disease killed far more combatants than the opposing armies. Moreover, war had a way of spreading illness. These facts led Welch to predict that, with the Great War on, it was just a matter of time before some kind of epidemic broke out.

Welch had pushed Johns Hopkins for a public health program since the 1880s, and he finally got his wish in 1916 when the Johns Hopkins School of Hygiene and Public Health was founded. This was just two years before the influenza began to emerge. He saw that robust public health (of which epidemiology, or the study of disease, is a central feature) was the best way to save lives. He was right, and his intuition holds true to this day.

3. The 1918 influenza began in Kansas, but it was quickly exported to the rest of the world, infecting hundreds of millions.

The influenza outbreak of 1918 most likely began in Haskell County, Kansas. There are other theories that it began in China or Vietnam or France, but the United States is the most probable starting point, and there’s no earlier record than from Haskell County. The virus drifted from Haskell to a nearby military base, when it was still tame in comparison to what was to come. Not much more was said about the outbreak than a forgettable health notice about “influenza of severe type” the Midwest. From there, the virus worked its way through the ranks of soldiers and was then exported to other U.S. bases and the various war theaters across Afro-Eurasia. It came roaring back to America in the fall of 1918, in the previously mentioned New England cities.

What makes influenza dangerous is that it’s caused by viruses—not bacteria (a discovery that one of William Henry Welch’s many protégés made). It’s not quite an organism, but it’s not as lifeless as a chemical compound either. Its mission is to replicate, but it cannot do so apart from a host. It needs an organism’s cells in order to make thousands or even hundreds of thousands of self-copies.

What makes influenza viruses unique is that they are extremely infectious and competitive. Influenza viruses set off all the body’s warning bells, and the immune system sets up defenses based on what the body has already encountered. But a new variation of the virus is unknown to the body, and attacks a compromised and blind immune system. The body beats down any other viruses that might be present, and then, once all other familiar viruses have been eliminated, the new influenza virus begins its work.

The United States was unprepared for the pandemic for a variety of reasons.

For the rest of the post…

 

Pastor Niemöller spoke out against Nazism. In 1937 he was sent to the camps for “misusing the pulpit.”

By Doris Bergen
In the annals of the Holocaust, Martin Niemöller cuts an awkward figure. A celebrity in his day, the impulsive German pastor is now remembered, if at all, as the tag to the quote that begins, “First they came for the Communists, and I did not speak out—because I was not a Communist.” Though a political prisoner, he is sometimes called a martyr but did not die at Nazi hands. In fact, Niemöller remained alive for decades after the war, time he used to try to reckon what he had been part of—and frequently to put his foot in his mouth.

Niemöller’s only meeting with Adolf Hitler was a fiasco. It was January 1934, and Hitler had been in power for just under a year. The chancellor, obsessed with his image, was irritated about strife in the German Protestant church and the foreign press coverage it attracted. Disunity made him look weak. To manage the situation, Hitler summoned a dozen prominent clergymen to his presence. Among them was the Lutheran pastor and former submarine captain Martin Niemöller.

THEN THEY CAME FOR ME

By Matthew D. Hockenos
Basic, 322 pages, $30

Martin Niemöller (1892-1984), a U-boat officer during World War I, received the Iron Cross in 1917. PHOTO: ULLSTEIN BILD VIA GETTY IMAGES

A junior member of the group, Niemöller stood near the back. When Hermann Göring, head of the newly formed Gestapo, spoke he pulled a sheaf of papers from his briefcase and began to read the transcript of a phone call recorded that very morning. It was a conversation between Niemöller and a friend. Frozen with dread, the churchmen heard how a cocky Niemöller had promised that everything would be fine. Hitler would come to see that the people he considered opponents within the church were in fact loyal Germans. Anyway, President Hindenburg would take their side, Niemöller predicted gleefully, and by the end of the meeting the old man would be “administer[ing] the last rites” to the upstart Hitler.

The meeting thus torpedoed, the future of the outspoken Niemöller quivered in the balance. Would the devout Christian emerge a champion against the moral evil of Nazism? Or would the ardent nationalist, who voted for Hitler in 1924 and again in March 1933, redouble his efforts to prove that he could serve both his country and his faith and in the process become complicit in Nazi crimes? The answer, Matthew Hockenos reveals in a gripping biography, is “yes” and “yes,” or, more precisely, “yes but.” Niemöller was heroic but flawed, and his life and legacy challenge the popular notion of the individual hero as society’s best hope. In its place, “the pastor who defied the Nazis” offers two modest messages for those under threat in our own troubled times: help one another and don’t wait too long.

For the rest of the review…

Of the Bonhoeffer brothers, Dietrich, the youngest, was the one most drawn to try the Youth movement. His episode in the Boy Scouts was a first attempt advance to move beyond the sphere of family and school, and to discover his own areas of experience not shared by his brothers and sisters. Many of his classmates did the same thing, and he did not want to be different from them in everything. 

Eberhard BethgeDietrich Bonhoeffer: A Biography (Revised Edition); Chapter 1: Childhood and Youth: 1906-1923, 33.

In 1917 Karl-Friedrich and Walter were called up. Because of their numerous contacts, the Bonhoeffers could have influenced the course of their sons’ military career to some extent, but the boys insisted on enlisting in the infantry, where the need was greatest. They joined the Fifth Regiment of Guards at Spandau, with no intention of becoming officers. With a heavy heart their parents let them do so; they did not want “to try to play Providence.”

After a short time of training, they were sent to the front.

…Walter was wounded in the advance on 23 April 1918. (He died from injuries on April 28)

…His death seemed to break his mother’s spirit. She spent weeks in bed at time…

…Karl-Friedrich was wounded in the October battles of 1918, but his injuries proved to be slight.

Seventeen-year-old Klaus was also called up and, after a brief period of training, served as an orderly at General Headquarters in Spa.

Eberhard BethgeDietrich Bonhoeffer: A Biography (Revised Edition); Chapter 1: Childhood and Youth: 1906-1923, 27-28.

Gradually, however, the war began to have a grim impact on the Bonhoeffer family. In 1914 their uncle Otto Bonhoeffer in Dussedorf and their mother’s sister, Aunt Hanna Countess von der Goltz, received bad news, and the children heard of cousins killed or severely wounded in action. As the war dragged on, the older brothers, who were still in school, approached military age.

At the end of 1916 faint hopes clung to the possibility of peace. 

Eberhard BethgeDietrich Bonhoeffer: A Biography (Revised Edition); Chapter 1: Childhood and Youth: 1906-1923, 26.

Dietrich was eight and a half when the First World War broke out…For the younger (Bonhoeffer) children the outbreak of was was a time of great excitement. At the end of July (1914) they were hurriedly brought home after a month’s holiday in glorious weather in Friedrichsbrunn. When one of the girl’s dashed into the house shouting: “Hurrah, there’s a war,” her face was slapped. The first German successes filled Dietrich with boyish enthusiasm. When he was nine he wrote his parents from Friedrichsbrunn asking them to send him all the newspaper cuttings with news from the front; he had learned from his big brothers and at school how to stick colored pins into a map showing the advance of the front line. 

Eberhard BethgeDietrich Bonhoeffer: A Biography (Revised Edition); Chapter 1: Childhood and Youth: 1906-1923, 25-26.

Related image

From his earliest childhood Dietrich Bonhoeffer was accustomed to being privileged, not the underdog. Admittedly, this was true only up to a point in terms of his position among his siblings. This position had some significance for his development, and probably for his choice of career as well. As the three “little ones,” he and his sisters had all the advantages and disadvantages of youngest children. It was natural that the sturdy and gifted boy should sometimes try to rival or even surpass his big brothers and, indeed, in the field of music, he did surpass them. This secret rivalry helped to make theology attractive, since it offered something special of his own. The distance between the two groups of children was increased by the war, which confronted the older children with its terrible realities early, while the younger children remained at home. 

Eberhard BethgeDietrich Bonhoeffer: A Biography (Revised Edition); Chapter 1: Childhood and Youth: 1906-1923, 20.

 by Ed Stetzer
Monday May 27, 2013   

If you’ve been following along with me on Twitter this weekend, you’re well aware that I am in the midst of an extended family reunion in Florida with my (very loud, Irish extended family). And while my family is still proud of our Irish heritage (some of them maybe a little too much), we are also deeply thankful to share in the freedoms the United States offers.

For those of you reading this outside of the US, today is Memorial Day– a holiday celebrating those who died fighting for our country and her freedoms. These freedoms that my family enjoy came at a great cost. And that cost was not just monetary, but blood-bought in wars and conflicts, some name and some now.

For example:

  • American Revolutionary War – 25,000 deaths
  • War of 1812 – 20,000 deaths
  • Mexican-American War – 13,283 deaths
  • US Civil War – 625,000 deaths
  • Spanish-America War – 2,446 deaths
  • Philippine-American War – 4,196 deaths
  • World War 1 – 116,516 deaths
  • World War 2 – 405,399 deaths
  • Korean War – 36,516 deaths
  • Vietnam War – 58,209 deaths
  • Persian Gulf War – 258 deaths
  • Iraq – 4,486 deaths
  • Afghanistan – 2,145 deaths

These brave men and women gave all they had so that we could enjoy certain freedoms not available to all. For that, my fellow Americans and I are very thankful.That’s a lot to remember. That’s a lot of people who gave their lives for others.

I get that this is a picnic and barbecue day. Nothing wrong with that. But, in the midst of the summer kickoff, be sure to take some time to pray for the families of those who lost their loved ones– parents, children, siblings, and more.

And, contrary some of the comments you may see on social media, it’s OK to be thankful for those who are serving now (or have served) as well, as President Bush modeled in his 2007 Memorial Day speech, honoring the fallen and being thankful for those who serve today. He explained:

Good morning. This Memorial Day weekend, Americans honor those who have given their lives in service to our Nation. As we pay tribute to the brave men and women who died for our freedom, we also honor those who are defending our liberties around the world today.

Yet, the main focus should be on the “memorial,” remembering those who have fallen– who gave their lives for something greater than themselves, or just to serve along side a comrade.

At times like this, I’m always struck by the teaching of Jesus where he said, “Greater love hath no man than this, that a man lay down his life for his friends” (John 15:13).

For the rest of the post…

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