'The Great Influenza' (2004) by Barry

Quite a lot of the entire world's research funding for H1N1 was concentrated in the Rockefeller Institute.

They'd make for a good case study in ultra-effective philanthropy, though of course in this case, the worst case, they were too late, started from too primitive a basis.

• In every belligerent nation, months of censorship of the press for "morale", preventing social distancing.
• In every belligerent nation, diverting more than half of the medical staff, even after decimation of the domestic population.
• In every belligerent nation, massive troop movements to many corners of the planet, massive unprecedented spreading.
• In America, war bond parades and marches, millions and millions of community mixing contacts.
• Rejecting peace terms twice, prolonging the war and continuing to divert half the world's medical resources.

Barry's middle chapters are a frightening portrait of how rabidly un-American the US was in 1918. The laws were bad enough - for instance the ban on criticising the government. But then there's the unofficial "patriotic duties", punishable by beatings. State-sponsored atavism.

By the summer of 1918, however, Wilson had injected the government into every facet of national life and had created great bureaucratic engines to focus all the nation’s attention and intent on the war.

He had created a Food Administration to control and distribute food, a Fuel Administration to ration coal and gasoline, a War Industries Board to oversee the entire economy. He had taken all but physical control over the railroads and had created a federally sponsored river barge line that brought commerce back to life on the Mississippi River, a commerce that had been killed by competition from those railroads. He had built many dozens of military installations, each of which held at least tens of thousands of soldiers or sailors. He had created industries that made America’s shipyards teem with hundreds of thousands of laborers launching hundreds of ships, dug new coal mines to produce coal for the factories that weaned America’s military from British and French weapons and munitions—for, unlike in World War II, America was no arsenal of democracy.

He had created a vast propaganda machine, an internal spy network, a bond-selling apparatus... He had even succeeded in stifling speech, in the summer of 1918 arresting and imprisoning — some for prison terms longer than ten years —not just radical labor leaders and editors of German-language newspapers but powerful men, even a congressman.

He had injected the government into American life in ways unlike any other in the nation’s history. And the final extension of federal power had come only in the spring of 1918, after the first wave of influenza had begun jumping from camp to camp, when the government expanded the draft from males between the ages of twenty-one and thirty to those between the ages of eighteen and forty-five. Only on May 23, 1918, had Provost Marshal Enoch Crowder, who oversaw the draft, issued his “work or fight” order, stating that anyone not employed in an essential industry would be drafted...

Crowder bragged about doing “in a day what the Prussian autocracy had been spending nearly fifty years to perfect..."

In mid-August, as the lethal wave of the epidemic was gathering itself, Austria had already inquired about peace terms, an inquiry that Wilson rebuffed utterly. And as the epidemic was gathering full momentum, peace was only weeks away. Bulgaria had signed an armistice on September 29. On September 30, Kaiser Wilhelm had granted parliamentary government to the German nation; that same day Ludendorff had warned his government that Germany must extend peace feelers or disaster—immediate disaster—would follow. German diplomats sent out those feelers. Wilson ignored them. The Central Powers, Germany and her allies, were simultaneously breaking off one from one another and disintegrating internally as well. In the first week of October, Austria and Germany separately sent peace feelers to the Allies, and on October 7, Austria delivered a diplomatic note to Wilson formally seeking peace on any terms Wilson chose. Ten days later — days of battle and deaths — the Austrian note remained unanswered.

Earlier Wilson had spoken of a “peace without victory,” believing only such a peace could last. But now he gave no indication that the war would soon be over. Although a rumor that the war had ended sent thrills through the nation, Wilson quickly renounced it. Nor would he relent. He was not now fighting to the death; he was fighting only to kill...

If Wilson and his government would not be turned from his end even by the prospect of peace, they would hardly be turned by a virus. 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. The relief effort for influenza victims would find no assistance in the Food Administration or the Fuel Administration or the Railroad Administration. 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.

...the military would give no help to civilians. Instead it would draw further upon civilian resources. The same day that Welch had stepped out of the autopsy room at Devens and called Gorgas’s office, his warning had been relayed to the army chief of staff, urging that all transfers be frozen unless absolutely necessary and that under no circumstances transfers from infected camps be made... Gorgas’s superiors ignored the warning. There was no interruption of movement between camps whatsoever; not until weeks later, with the camps paralyzed and, literally, tens of thousands of soldiers dead or dying, did the army make any adjustments.

Because so much of the state was occupied in war, in places there was wholesale social collapse:

In Philadelphia meanwhile fear came and stayed. Death could come from anyone, anytime. People moved away from others on the sidewalk, avoided conversation; if they did speak, they turned their faces away to avoid the other person’s breathing.

The impossibility of getting help compounded the isolation. 850 Philadelphia doctors and more nurses were away in the military. More than that number were sick. Philadelphia General Hospital had 126 nurses. Despite all precautions, despite wearing surgical masks and gowns, eight doctors and fifty-four nurses — 43 percent of the staff—themselves required hospitalization. Ten nurses at this single hospital died. The Board of Health pleaded for help from retired nurses and doctors if they remembered “even a little” of their profession.

When a nurse or doctor or policeman did actually come, they wore their ghostly surgical masks, and people fled them. In every home where someone was ill, people wondered if the person would die. And someone was ill in every home...

Starr went to Emergency Hospital #2 at Eighteenth and Cherry Streets. He did have help, if it could be called that, from an elderly physician who had not practiced in years and who brought Starr into touch with the worst of heroic medicine. Starr wouldn’t forget that, the ancient arts of purging, of venesection, the ancient art of opening a patient’s vein. But for the most part he and the other students elsewhere were on their own, with little help even from nurses, who were so desperately needed that in each of ten emergency hospitals supplied by the Red Cross only a single qualified nurse was available to oversee whatever women came as volunteers. And often the volunteers reported for their duty once and, from either fear or exhaustion, did not come again.

Nearly 1/4 of all the patients in his hospital died each day. Starr would go home, and when he returned the next day, he would find that between one-quarter and one-fifth of the patients in the hospital had died, replaced by new ones... Virtually all of them, along with their friends and relatives, were terrified that, no matter how mild the symptoms seemed at first, within them moved an alien force, a seething, spreading infection, a live thing with a will that was taking over their bodies — and could be killing them...

The city was frozen with fear, frozen into stillness. Starr lived 12 miles from the hospital. The streets were silent on his drive home, silent. They were so silent he took to counting the cars he saw. One night he saw no cars at all. He thought, “The life of the city had almost stopped.”

Everyone can read the collapse of official power in Philadelphia as supporting their politics. Anarchists can point to the benevolent spontaneous order that arose after the corrupt local government failed to act; libertarians can note that this was entirely funded by the richest Philadelphians; statists can point out that, without authoritative co-ordination, the effort eventually failed, because people defected against each other in fear.

The corpses had backed up at undertakers’, filling every area of these establishments and pressing up into living quarters; in hospital morgues overflowing into corridors; in the city morgue overflowing into the street. And they had backed up in homes. They lay on porches, in closets, in corners of the floor, on beds. Children would sneak away from adults to stare at them, to touch them; a wife would lie next to a dead husband, unwilling to move him or leave him. The corpses, reminders of death and bringers of terror or grief, lay under ice at Indian-summer temperatures. Their presence was constant, a horror demoralizing the city; a horror that could not be escaped. Finally the city tried to catch up to them.

The police wore their ghostly surgical masks, and people fled them, but the masks had no effect on the viruses and by mid-October thirty-three policemen had died, with many more to follow...
More coffins came by rail, guarded by men with guns.

We're in luck: around the swine flu pandemic, a virologist gave many corrections to Barry's descriptions of the virus. They range from nitpicking to raising a real controversy Barry doesn't cover (adaptive virulence shifts). Spirited and somewhat convincing reply from Barry here.

Barry makes at least one big error: he's horrified by the medical schools of the time having "no standards for admission":

In research and education especially, American medicine lagged far behind [European medicine]... At least one hundred US medical schools would accept any man willing to pay tuition... and only a single medical school required its student to have a college degree...

the Johns Hopkins itself, not student fees, paid [its] faculty salaries, and it required medical students to have not only a college degree but fluency in French and German and a background of science courses.

But Barry's enthusiasm for Johns Hopkins' degree requirement is misplaced. Contemporary US doctors (who all have 3 years of pre-med, or even more, before they start medical training) are probably no better clinicians than undergraduate doctors in other countries, and are far further in debt. And the requirement is probably one reason the American system is so expensive: we require unbelievably expensive credentials of doctors, and they respond by demanding higher salaries.

Perhaps Barry is confusing the schools' open admissions with their appallingly low graduation standards, which were certainly one reason eC20th medicine sucked. (Many doctors had never looked down a microscope; never used a stethoscope on a patient; never seen a dissection.)

The book is in the epic mode throughout. (That's not only a compliment.)

Man might be defined as “modern” largely to the extent that he attempts to control nature. In this 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.

He goes for meditations on epistemology, the modern mind, the redemptive meaning of science for beasts like us. I liked it, but it dismays other readers.

Nonfiction book reviews by nonspecialists are hazardous. It is just not easy to detect pseudo-empirical bullshit without

1. immersion in the field and/or good priors for what makes for an extraordinary claim in it;


2. incredible amounts of fact-checking gruntwork, at least 5x the time it takes to just read something; or


3. incredible amounts of argument-checking, which doesn't need domain knowledge, but often involves a lot of interpretive work.

I always try to do (3) but surely often fail.


In this case, no good reason to trust me. Barry is just a science-adjacent historian, not a scientist, and in his struggle to make a narrative, he fills in quite a lot of emotional colour which is at best vaguely inferred from letters.

I was glad to see a virologist weigh in, above: his corrections are worrying, since they're pretty fundamental, but limited in scope to a few pages.