Chapter
One
'The Great Influenza'
By JOHN M. BARRY
Published: March 14, 2004
In
September 12, 1876, the crowd overflowing the
auditorium of Baltimore's Academy of Music
was in a mood of hopeful excitement, but excitement
without frivolity. Indeed, despite an unusual
number of women in attendance, many of them from
the uppermost reaches of local society, a reporter
noted, "There was no display of dress or
fashion." For this occasion had serious
purpose. It was to mark the launching of the
Johns Hopkins University, an institution whose
leaders intended not simply to found a new university
but to change all of American education; indeed,
they sought considerably more than that. They
planned to change the way in which Americans
tried to understand and grapple with nature.
The keynote speaker, the English scientist Thomas
H. Huxley, personified their goals.
The import was not lost on the nation. Many
newspapers, including the New York Times, had
reporters covering this event. After it, they
would print Huxley's address in full.
For the nation was then, as it so often has
been, at war with itself; in fact it was engaged
in different wars simultaneously, each being
waged on several fronts, wars that ran along
the fault lines of modern America.
One
involved expansion and race. In the Dakotas,
George Armstrong Custer had just led the Seventh
Cavalry to its destruction at the hands of primitive
savages resisting encroachment of the white man.
The day Huxley spoke, the front page of the Washington
Star reported that "the hostile Sioux, well
fed and well armed" had just carried out "a
massacre of miners."
In
the South a far more important but equally
savage war was being waged as white Democrats
sought "redemption" from Reconstruction
in anticipation of the presidential election.
Throughout the South "rifle clubs," "saber
clubs," and "rifle teams" of former
Confederates were being organized into infantry
and cavalry units. Already accounts of intimidation,
beatings, whippings, and murder directed against
Republicans and blacks had surfaced. After the
murder of three hundred black men in a single
Mississippi county, one man, convinced that words
from the Democrats' own mouths would convince
the world of their design, pleaded with the New
York Times, "For God's sake publish the
testimony of the Democrats before the Grand Jury."
Voting
returns had already begun to come in (there
was no single national election day) and two
months later Democrat Samuel Tilden would win
the popular vote by a comfortable margin. But
he would never take office as president. Instead
the Republican secretary of war would threaten
to "force a reversal" of the
vote, federal troops with fixed bayonets would
patrol Washington, and southerners would talk
of reigniting the Civil War. That crisis would
ultimately be resolved through an extraconstitutional
special committee and a political understanding:
Republicans would discard the voting returns
of three states (Louisiana, Florida, South Carolina)
and seize a single disputed electoral vote in
Oregon to keep the presidency in the person of
Rutherford B. Hayes. But they also would withdraw
all federal troops from the South and cease intervening
in southern affairs, leaving the Negroes there
to fend for themselves.
To
act upon the world himself, he became a proselytizer
for faith in human reason. By 1876 he had become
the world's foremost advocate of the theory of
evolution and of science itself. Indeed, H. L.
Mencken said that "it was he, more than
any other man, who worked that great change in
human thought which marked the Nineteenth Century." Now
President Gilman gave a brief and simple introduction.
Then Professor Huxley began to speak.
Normally he lectured on evolution, but today
he was speaking on a subject of even greater
magnitude. He was speaking about the process
of intellectual inquiry. The Hopkins was to be
unlike any other university in America. Aiming
almost exclusively at the education of graduate
students and the furtherance of science, it was
intended by its trustees to rival not Harvard
or Yale (neither of them considered worthy of
emulation) but the greatest institutions of Europe,
and particularly Germany. Perhaps only in the
United States, a nation ever in the act of creating
itself, could such an institution come into existence
both so fully formed in concept and already so
renowned, even before the foundation of a single
building had been laid.
"His voice was low, clear and distinct," reported
one listener. "The audience paid the closest
attention to every word which fell from the lecturer's
lips, occasionally manifesting their approval
by applause." Said another, "Professor
Huxley's method is slow, precise, and clear,
and he guards the positions which he takes with
astuteness and ability. He does not utter anything
in the reckless fashion which conviction sometimes
countenances and excuses, but rather with the
deliberation that research and close inquiry
foster."
Huxley
commended the bold goals of the Hopkins, expounded
upon his own theories of education (theories
that soon informed those of William James and
John Dewey) and extolled the fact that the
existence of the Hopkins meant "finally,
that neither political nor ecclesiastical sectarianism" would
interfere with the pursuit of the truth.
In truth, Huxley's speech, read a century and
a quarter later, seems remarkably tame. Yet Huxley
and the entire ceremony left an impression in
the country deep enough that Gilman would spend
years trying to edge away from it, even while
simultaneously trying to fulfill the goals Huxley
applauded.
For
the ceremony's most significant word was one
not spoken: not a single participant uttered
the word "God" or made any reference
to the Almighty. This spectacular omission scandalized
those who worried about or rejected a mechanistic
and necessarily godless view of the universe.
And it came in an era in which American universities
had nearly two hundred endowed chairs of theology
and fewer than five in medicine, an era in which
the president of Drew University had said that,
after much study and experience, he had concluded
that only ministers of the Gospel should be college
professors.
The omission also served as a declaration: the
Hopkins would pursue the truth, no matter to
what abyss it led.
In no area did the truth threaten so much as
in the study of life. In no area did the United
States lag behind the rest of the world so much
as in its study of the life sciences and medicine.
And in that area in particular the influence
of the Hopkins would be immense.
By 1918, as America marched into war, the nation
had come not only to rely upon the changes wrought
largely, though certainly not entirely, by men
associated with the Hopkins; the United States
Army had mobilized these men into a special force,
focused and disciplined, ready to hurl themselves
at an enemy.
The
two most important questions in science are "What can I know?" and "How
can I know it?"
Science
and religion in fact part ways over the first
question, what each can know. Religion, and
to some extent philosophy, believes it can
know, or at least address, the question, "Why?"
For most religions the answer to this question
ultimately comes down to the way God ordered
it. Religion is inherently conservative; even
one proposing a new God only creates a new order.
The
question "why" is too deep for
science. Science instead believes it can only
learn "how" something occurs.
The
revolution of modern science and especially
medical science began as science not only focused
on this answer to "What can I know?" but
more importantly, changed its method of inquiry,
changed its answer to "How can I know it?"
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 open.
In the narrower context of science, the answer
determines how individuals explore nature (how
one does science). And the way one goes about
answering a question, one's methodology, matters
as much as the question itself. For the method
of inquiry underlies knowledge and often determines
what one discovers: how one pursues a question
often dictates, or at least limits, the answer.
Indeed,
methodology matters more than anything else.
Methodology subsumes, for example, Thomas Kuhn's
well-known theory of how science advances.
Kuhn gave the word "paradigm" wide
usage by arguing that at any given point in time,
a particular paradigm, a kind of perceived truth,
dominates the thinking in any science. Others
have applied his concept to nonscientific fields
as well.
According
to Kuhn, the prevailing paradigm tends to freeze
progress, indirectly by creating a mental obstacle
to creative ideas and directly by, for example,
blocking research funds from going to truly
new ideas, especially if they conflict with
the paradigm. He argues that nonetheless researchers
eventually find what he calls "anomalies" that
do not fit the paradigm. Each one erodes the
foundation of the paradigm, and when enough accrue
to undermine it, the paradigm collapses. Scientists
then cast about for a new paradigm that explains
both the old and new facts.
But the process (and progress) of science is
more fluid than Kuhn's concept suggests. It moves
more like an amoeba, with soft and ill-defined
edges. More importantly, method matters. Kuhn's
own theory recognizes that the propelling force
behind the movement from one explanation to another
comes from the methodology, from what we call
the scientific method. But he takes as an axiom
that those who ask questions constantly test
existing hypotheses. In fact, with a methodology
that probes and tests hypotheses (regardless
of any paradigm)progress is inevitable. Without
such a methodology, progress becomes merely coincendental.
Yet the scientific method has not always been
used by those who inquire into nature. Through
most of known history, investigators trying to
penetrate the natural world, penetrate what we
call science, relied upon the mind alone, reason
alone. These investigators believed that they
could know a thing if their knowledge followed
logically from what they considered a sound premise.
In turn they based their premises chiefly on
observation.
This commitment to logic coupled with man's
ambition to see the entire world in a comprehensive
and cohesive way actually imposed blinders on
science in general and on medicine in particular.
The chief enemy of progress, ironically, became
pure reason. And for the bulk of two and a half
millennia (twenty-five hundred years) the actual
treatment of patients by physicians made almost
no progress at all.
One cannot blame religion or superstition for
this lack of progress. In the West, beginning
at least five hundred years before the birth
of Christ, medicine was largely secular. While
Hippocratic healers (the various Hippocratic
texts were written by different people) did run
temples and accept pluralistic explanations for
disease, they pushed for material explanations.
Hippocrates
himself was born in approximately 460 b.c.
On the Sacred Disease, one of the more famous
Hippocratic texts and one often attributed
to him directly, even mocked theories that
attributed epilepsy to the intervention of
gods. He and his followers advocated precise
observation, then theorizing. As the texts
stated, "For
a theory is a composite memory of things apprehended
with sense perception." "But conclusions
which are merely verbal cannot bear fruit." "I
approve of theorizing also if it lays its foundation
in incident, and deduces its conclusion in accordance
with phenomena."
But if such an approach sounds like that of
a modern investigator, a modern scientist, it
lacked two singularly important elements.
First, Hippocrates and his associates merely
observed nature. They did not probe it.
This failure to probe nature was to some extent
understandable. To dissect a human body then
was inconceivable. But the authors of the Hippocratic
texts did not test their conclusions and theories.
A theory must make a prediction to be useful
or scientific (ultimately it must say, If this,
then that) and testing that prediction is the
single most important element of modern methodology.
Once that prediction is tested, it must advance
another one for testing. It can never stand still.
Those
who wrote the Hippocratic texts, however, observed
passively and reasoned actively. Their careful
observations noted mucus discharges, menstrual
bleeding, watery evacuations in dysentery,
and they very likely observed blood left to
stand, which over time separates into several
layers, one nearly clear, one of somewhat yellowy
serum, one of darker blood. Based on these
observations, they hypothesized that there
were four kinds of bodily fluids, or "humours": blood,
phlegm, bile, and black bile. (This terminology
survives today in the phrase "humoral immunity," which
refers to elements of the immune system, such
as antibodies, that circulate in the blood.)
This hypothesis made sense, comported with observations,
and could explain many symptoms. It explained,
for example, that coughs were caused by the flow
of phlegm to the chest. Observations of people
coughing up phlegm certainly supported this conclusion.
The war involving the Hopkins was more muted
but no less profound. The outcome would help
define one element of the character of the nation:
the extent to which the nation would accept or
reject modern science and, to a lesser degree,
how secular it would become, how godly it would
remain.
Precisely at 11:00 a.m., a procession of people
advanced upon the stage. First came Daniel Coit
Gilman, president of the Hopkins, and on his
arm was Huxley. Following in single file came
the governor, the mayor, and other notables.
As they took their seats the conversations in
the audience quickly died away, replaced by expectancy
of a kind of declaration of war.
Of
medium height and middle age (though he already
had iron-gray hair and nearly white whiskers)
and possessed of what was described as "a
pleasant face," 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." A brilliant scientist,
later president of the Royal Society, he advised
investigators, "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." |
