A few years ago, an acquaintance gave me a book about a piece of history I had never heard of before.
The book is called “The Great Influenza,” written by John Barry and published in 2004. It’s about the influenza pandemic of 1918 that killed an estimated 50 million people. As a point of reference, World War I, raging in Europe at the very same time, claimed the lives of 16 million people.
I was browsing through my bookshelf some months ago and noted that I owned many books I had never read. I thought I should finally get around to reading that book on influenza, and so I did.
I might write a full review of the book later, but today I want to talk about a part of it that I found particularly interesting. Before reading this book, I was vaguely aware that medical science was fairly primitive until around the Industrial Revolution. In “The Great Influenza,” Barry spends a few chapters describing the rapid advances in epidemiology in the decades leading up to that horrible 1918 pandemic.
The medical world of 1918 was night and day different from what it had been just a century or two earlier. Humans’ understanding of anatomy and of disease had advanced little in the 2,000 years since the days of the Greek physician Hippocrates of the fourth century B.C., who believed that disease was the result of an imbalance in the four “humors” or substances that they believed comprise the body: blood, yellow bile, black bile and phlegm. Belief in the four humors continued until well into the 19th century.
I had always assumed that medicine was poor for so many years because the doctors of yesteryear lacked the technology to solve health problems. After all, how could they see microscopic organisms with no microscopes? While technological advancements certainly played a role, Barry argues that early advances can be credited to a changing attitude, a willingness among physicians to apply the scientific method to the medical field.
For instance, Barry writes about how, in the early 1800s, Frenchman Pierre Louis had begun tracking the results of patients treated differently for the same disease. No doctor had ever attempted creating such a database before.
“Physicians could have done this earlier,” Barry writes. “To do so required neither microscopes nor technological prowess; it required only taking careful notes.”
English epidemiologist John Snow was the first to discover in the 1850s that cholera was transmitted through water, and was not a product of bad air or “miasma” as it was known. Snow solved the mystery by keeping detailed records of the living conditions of both healthy people and those stricken with the disease. He concluded that people who got their water from the sewage-contaminated section of the Thames River running through London were more likely to contract cholera.
Barry writes that the work of Snow and others “reflected a new way of looking at the world, a new way of seeking explanations, a new methodology, a new use of mathematics as an analytic tool.”
Another thing I found interesting about this period in medicine is that the United States lagged behind Europe in adopting these mathematical and scientific techniques. For most of the 19th century, American medical schools had low standards for acceptance because administrators did not want to turn away a paying customer. The quality of their education was abysmal, as students needed merely to attend lectures without ever having to treat a flesh-and-blood patient.
Meanwhile, physicians in France and Germany were making all sorts of breakthroughs in their laboratories. French biologist Louis Pasteur proposed the germ theory of disease in 1861, and after a few decades and numerous experiments proving its validity, it became a widely accepted fact. Another titan of this era was German microbiologist Robert Koch, who was the first to link a microorganism with a particular disease (in this case, anthrax), lending support to Pasteur’s germ theory.
By the mid to late 1800s, young Americans who took their medical studies seriously traveled to Germany to learn from that country’s best doctors. In fact, some American medical institutions began requiring their students to learn French and German to follow the latest advances in the field.
Europe’s hegemony on medical knowledge was not permanent. By the turn of the century, the U.S. was starting to catch up, led by the founding of the Johns Hopkins University in Baltimore, Maryland, in 1876. Within a few decades, U.S. medical schools advanced by leaps and bounds, but first they would have to contend with the deadliest pandemic in world history. I’ll cover that in a later column.