I wish I had read Sinclair Lewis's Arrowsmith just after this book (rather than just before). Lewis's novel would have had a lot more meaning. This author explains how Lewis built the novel around contemporary events, including a cigarette relating to researcher Paul Lewis. Amazing overlaps. Including issues like anxious-to-publish institute leadership in conflict with go-slow, meticulous researchers.Some thoughts about story line one:
1. U.S. med schools were in the dark ages well into second half of 19th century (and, in many cases, early 20th century). John Hopkins University as an unlikely pioneering institution in Baltimore. Rockefeller Institute in NYC develops. And others.
2. Prior to the new standards - med school professors earn fees by tuition - which means pandering to (rather than challenging) students. No or few autopsies. No research or labs in almost all cases. Generally no requirement for an undergraduate degree as a condition of admission. Graduates often saw their first patients after graduation. 1910 Flexnor Report is catalyst for change.
3. Author devotes a lot of time to mini-biographies of key players. Not entirely sure why - no one came up with a "cure" for this influenza, it just had to play itself out - ongoing mutations regress virulence to the mean, or something.
As to the flu itself:
1. Appeared to commence in at army setting in Kansas. Overcrowded barracks and constant transfers enabled the spread in a way that wouldn't have happened in peacetime.
2. Astonishing worldwide spread - especially with the far more virulent phase 2. 20 million deaths in India alone?
3. Interesting discussions of the way these diseases mutate and flow within and among different population centers - quite reminiscent of this book. Isolated populations get wrecked - limited antibody development.
4. Killed young, healthy folks (flu normally attacks the young and old) - antibody system went into overdrive.
5. Staggering death tolls, staggering effect on cities. Oxygen deprivation created a deep blueness in corpses that caused folks to call this a recurrence of the black death. And there were horse-drawn carts in US cities with calls to "bring out your dead" - amazing in 20th century.
6. Disaster in Philadelphia.
7. 176 of 300 "Eskimos" dead in Nome when a relief ship arrived. 85%+ death tolls in surrounding villages. Grisly scenes where half-wild dogs devoured corpses when the few surviving natives were too weak to fight them off. (As I understand it, this had nothing to do with the 1925 Balto serum run - that involved a later diphtheria outbreak.)
8. The amazing-ness of flu and why outbreaks will continue. How it doesn't need continuous access to a large human population - can nestle in bird or pig or whatever populations and then jump to humans in new forms.
Another thing: this story brought home the pervasiveness of the repressive environment during WWI - Wilson wanted, and got, a total war environment. Sedition Act - amazing. Buy war bonds - or else. Shut up - or else. The frightening know-it-all-ness of Wilson and the Progressive movement - hooray for experts and top-down control! (Unfortunately, that part doesn't seem to change much.)
The flu became known as the "Spanish Flu" because Spanish newspapers - printed in a neutral country - actually reported on the disease. It had been rampant elsewhere for a long time, but censors in combatant countries suppressed the news.
Author thinks Wilson was affected by this flu during critical portions of Versailles negotiations during which Wilson seemed to fold on long-held principles;others have attributed to Wilson's weakening to some other disease. In any event he never was very healthy thereafter. (#1 adviser Colonel House already was out of commission prior to Versailles via the flu.)
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