Barry, John M. - The Great Influenza, Parts II and III

[oyceter]

This got much more interesting once Barry stopped talking about assorted scientists with very little context and finally starting providing actual context for the 1918 pandemic!

Part II, The Swarm, covers viruses in general and how they work, and the influenza virus in particular. The H and N in the various influenza virus names (H1N1, H5N1, etc.) are hemagglutinin and neuraminidase, the two antigens on the virus. They occur in a ton of different shapes, each with subtypes, and the influenza virus also mutates extremely quickly because it's an RNA virus. (The RNA means there is less double-checking than there would be if it used DNA to replicate itself.) Influenza viruses originate in birds, and they probably migrate to humans via intermediary animals like pigs. One theory is that pigs have some receptors that can bind to bird or human viruses, so they can be infected by both, and the viruses mix their parts together.

If you can't tell, I found this part much, much more interesting than the assortment of scientists from Part I. I did, however, want to know if you are immune to all H1N1 influenza types if you have gotten one. It sounded like even after the numbering of the Hs and the Ns, there were still subtypes, but I couldn't tell how distinct those subtypes were, or if the main difference was in which shape of H and N the virus has.

In "The Tinderbox," Barry gives an overview of the US's entrance into World War I and how it mobilized various civilians, medical experts, and etc. Herein Welch reenters the picture, although I still can't quite say what he did. It's particularly weird that Barry emphasizes all these great scientists, because I feel in a later part, he basically has to detail how they all go down the wrong path when trying to research influenza. The poor nurses only get a paragraph or two, and they get blamed for a shortage in nurses because they consistently refused to let some of the doctors enlist "practical nurses," who would have less training than "graduate nurses."

I feel there is a whole book here on doctors vs. nurses and the status and respect (or lack thereof) given to nurses, but clearly Barry is not interested. Boo.

There's also a lot about censorship in the name of the war effort, which will come into play later when the pandemic kicks off.

- rachelmanija's review of Parts II and III

Comments

[lilacsigil]

The doctors vs nurses and nurses' struggle for respect for their training is still going on today, in a very similar form! My mother was a lecturer in nursing at university and there was great outrage at the nursing degree being put in the Faculty of Medicine! Especially as the nurse lecturers proved to be good organisers (veterans of a decade or so of industrial action on pay and conditions and patient ratios) and got themselves onto the faculty boards and committees.

If you have antibodies to any particular strain of H1N1 (via illness or vaccination), you are more likely to be immune to other H1N1 strains, but it mutates so quickly that there's no guarantee (as in the swine flu H1N1 in 2009-10, which previous H1N1 vaccination did not affect, so they had to rush out a new additional vaccine). H3N2, the most common A-type influenza in humans, changes even faster. That's why every now and then there'll be an influenza that has little effect on a particular age cohort who have been previously exposed, while it hits people a decade younger hard. It's not that they've been exposed to this particular H1N1 necessarily, but that the version they had is close enough to the current one that it gives them some immunity.

[rachelmanija]

I agree, it gets way more interesting - the chapter on viruses was one of the best in the book (so far).

So, I'm further in and I just hit a part that makes me wonder even more why Welch gets the first chapter and so much emphasis. A crush is really the only possible explanation.

Oh, and I was also really interested in the nurses. They continue to get short shrift, alas.

[oursin]

In the UK there were massive issues going on during the War over the Voluntary Aid Detachment vs professional nurses (this may have had a different class dynamic in UK context, i.e. women who had made a career vs middle-class girls wanting to 'do their bit' and perhaps having a rather glamourised notion of what it was all about). Also there was the broader background of the Registration of Nurses (happened finally in 1919) - to provide a standard professional qualification rather than the certificates of individual hospital training school, which also had questions of 'elite London teaching hospital founded by Royalty' vs 'workhouse infirmary' embedded.

I.e. there was a lot of status anxiety going on within nursing quite apart from their problems vis a vis docs.

[gramarye1971]

If you're interested in a specific case study about influenza's effects on the U.S. military, a coworker of mine has written a really great article about it in Army History magazine: "The Deadliest Enemy" (starts on page 24). Some fascinating aspects in this article, including both the censorship you mention and also the effects of segregation on flu transmission.

[oracne]

Weren't there also class issues relating to upperclass women who were supposed to stick to volunteering and not get their hands all professional? Though I seem to recall ambulance drivers could be upperclass in some cases; have not read enough on them to know how common that was.

I would love to find out what that WWI hospital with the Scottish women doctors did during the pandemic.

[oracne]

Ooh. Thank you for the link.

[oursin]

I think with the ambulance driving, it was because only, or at least mostly, upper-class women were likely to have learnt to drive at that period.

There was certainly a thing of upper-class women opening up their stately homes as nursing homes for officers, without getting into the hands-on stuff themselves, but what VADs encountered was often a pretty brutal shock - Vera Brittain and Naomi Mitchison both wrote of what it was like for the sheltered and ignorant middle-class young woman suddenly plunged into war nursing.

On women doctors, there is a new book on the Endell Street Hospital just out, by Wendy Moore, which includes something on the flu epidemic phase. But not sure what happened with the women's hospital units in France, Serbia, etc.

[ckd]

Unsurprisingly (given world events), the e-book is somewhat popular at my local library: "Total Copies: 41 Available: 0 On Hold: 221".

I'm sure other systems have similar numbers.

[cynthia1960]

I am learning so much about how Woodrow Wilson was a horrible president. Not quite 45 or Bush43 level, but still really bad.

[oracne]

Ahhhhhhh, the driving suddenly makes much more sense. Also, since some drivers provided their own vehicles, money would be a factor.

[oyceter]

I suspected as much re: the struggle nurses have for respect! I remember reading that one of the difficulties in getting doctors at hospitals to wash their hands more was that the nurses were asking them to do it and they didn't like being told what to do by nurses, per one of Atul Gawande's books.

Thanks for the additional detail re: immunity! That was very interesting.

[oyceter]

Boo! I hope the other book on the 1918 pandemic has more detail about People Who Are Not (Supposedly) Great White Men. It's very frustrating feeling like there is a lot more story around the edges, if Barry would only write about it/pay attention.

[oyceter]

Oh, that's very interesting, thanks for the additional context!

[oyceter]

Awesome, thank you!

[oyceter]

Ahaha, yes, the newsletter from my public library notes that this book is one of the most popular right now.

[oyceter]

I kind of heard, given a recent campaign to take his name off of Princeton's school of international affairs, but I am only getting some details via this book... mostly about the censorship.