The Wrong Lessons - The Monster at Our Door: The Global Threat of Avian Flu - page 12

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The Wrong Lessons
The projections are that this virus will kill one million Americans in 1976. 49
HEW Secretary David Mathews
The writer John Barry has characterized the 1918 pandemic as the “first great collision between nature and
modern science.” 50 Certainly it was a supreme test of the self-confidence that scientific medicine had ac-
quired in the generation following the epochal discoveries of Pasteur and Koch. Many of history's great
killers—cholera, rabies, typhoid, anthrax, diphtheria, tuberculosis, even plague—had been successfully un-
masked as species of bacteria; and although no one had yet seen one, viruses had been recognized in
concept as the cause of polio and other diseases. In the Caribbean U.S. Army doctors had driven back the
legendary scourge of yellow fever. Potent vaccines and antitoxins had been developed, and biochemistry
had taken giant steps; and in the great hospitals and laboratories of Berlin, London, Paris, New York, and
Baltimore, all the foundations seemingly had been laid for the defeat of infectious disease.
In addition, World War I mobilized an unprecedented medical effort. As Barry emphasizes, the world's
top researchers all anticipated that the Great War would unleash a major epidemic of some kind. But no one
anticipated that it would be influenza; indeed, before 1918 flu was not considered a serious killer. Global
outbreaks in 1889 and 1898 had, to be sure, raised mortality, but scarcely on the scale of the bubonic plague
pandemic of 1894-1918 which ultimately killed millions and briefly threatened to cause the collapse of
world commerce. Under grim wartime conditions, with millions of soldiers mired in the mud and filth of
trench warfare or overcrowded in squalid hospitals and training camps, pneumonia was a grave danger, but
influenza was considered to be merely one of its several causes, along with measles.
In the winter of 1916-17, the British Army experienced a vexing outbreak of acute pneumonia that was
accompanied by heliotrope cyanosis—the victims' faces turned blue as their lungs drowned in blood—at
its huge encampment at Etaples in France. British researchers have recently proposed that this incident was
the first “seeding” of the influenza subtype that became pandemic in the summer of 1918. Army doctors at
the time, however, diagnosed the outbreak as epidemic bronchitis and were shocked when the same terrify-
ing symptoms returned on an epic scale with clearly identifiable influenza eighteen months later. 51
Barry's much-praised topic, The Great Influenza, provides a gripping account of the desperate cam-
paign mounted by America's leading pulmonary specialists and epidemiologists to contain the disease as
the new plague sowed death and panic in the early fall of 1918. Like their European counterparts, they nev-
er came close to identifying the true pathogen or creating an effective vaccine, so in the end, public-health
officials everywhere fought influenza with the same ancient weapons that Renaissance city-states had used
to resist bubonic plague: quarantines and face masks. In a few exceptional cases—American Samoa and
Australia—draconian quarantines excluded the pandemic or at least delayed its arrival until its virulence
had subsided. Elsewhere the influenza firestorm raged on until it had simply burnt up all available human