The Great Influenza (6 page)

But Charles Eliot, a Brahmin with a birth defect that deformed one side of his face (he never allowed a photograph to show that side) had become Harvard president in 1869. In his first report as president, he declared, 'The whole system of medical education in this country needs thorough reformation. The ignorance and general incompetency of the average graduate of the American medical Schools, at the time when he receives the degree which turns him loose upon the community, is something horrible to contemplate.'

Soon after this declaration, a newly minted Harvard physician killed three successive patients because he did not know the lethal dose of morphine. Even with the leverage of this scandal, Eliot could push through only modest reforms over a resistant faculty. Professor of Surgery Henry Bigelow, the most powerful faculty member, protested to the Harvard Board of Overseers, '[Eliot] actually proposes to have written examinations for the degree of doctor of medicine. I had to tell him that he knew nothing about the quality of the Harvard medical students. More than half of them can barely write. Of course they can't pass written examinations' . No medical school has thought it proper to risk large existing classes and large receipts by introducing more rigorous standards.'

Many American physicians were in fact enthralled by the laboratory advances being made in Europe. But they had to go to Europe to learn them. Upon their return they could do little or nothing with their knowledge. Not a single institution in the United States supported any medical research whatsoever.

As one American who had studied in Europe wrote, 'I was often asked in Germany how it is that no scientific work in medicine is done in this country, how it is that many good men who do well in Germany and show evident talent there are never heard of and never do any good work when they come back here. The answer is that there is no opportunity for, no appreciation of, no demand for that kind of work here' . The condition of medical education here is simply horrible.'

* 

In 1873, Johns Hopkins died, leaving behind a trust of $3.5 million to found a university and hospital. It was to that time the greatest gift ever to a university. Princeton's library collection was then an embarrassment of only a few books - and the library was open only one hour a week. Columbia was little better: its library opened for two hours each afternoon, but freshmen could not enter without a special permission slip. Only 10 percent of Harvard's professors had a Ph.D.

The trustees of Hopkins's estate were Quakers who moved deliberately but also decisively. Against the advice of Harvard president Charles Eliot, Yale president James Burril Angell, and Cornell president Andrew D. White, they decided to model the Johns Hopkins University after the greatest German universities, places thick with men consumed with creating new knowledge, not simply teaching what was believed.

The trustees made this decision precisely because there was no such university in America, and precisely because they recognized the need after doing the equivalent of market research. A board member later explained, 'There was a strong demand, among the young men of this country, for opportunities to study beyond the ordinary courses of a college or a scientific school' . The strongest evidence of this demand was the increased attendance of American students upon lectures of German universities.' The trustees decided that quality would sell. They intended to hire only eminent professors and provide opportunities for advanced study.

Their plan was in many ways an entirely American ambition: to create a revolution from nothing. For it made little sense to locate the new institution in Baltimore, a squalid industrial and port city. Unlike Philadelphia, Boston, or New York, it had no tradition of philanthropy, no social elite ready to lead, and certainly no intellectual tradition. Even the architecture of Baltimore seemed exceptionally dreary, long lines of row houses, each with three steps, crowding against the street and yet virtually no street life - the people of Baltimore seemed to live inward, in backyards and courtyards.

In fact, there was no base whatsoever upon which to build except the money, another American trait.

The trustees hired as president Daniel Coit Gilman, who left the presidency of the newly organized University of California after disputes with state legislators. Earlier he had helped create and had led the Sheffield Scientific School at Yale, which was distinct from Yale itself. Indeed, it was created partly because of Yale's reluctance to embrace science as part of its basic curriculum.

At the Hopkins, Gilman immediately recruited an internationally respected (and connected) faculty, which gave it instant credibility. In Europe, people like Huxley saw the Hopkins as combining the explosive energy and openness of America with the grit of science; the potential could shake the world.

To honor the Hopkins upon its beginnings, to honor this vision, to proselytize upon this new faith, Thomas Huxley came to America.

The Johns Hopkins would have rigor. It would have such rigor as no school in America had ever known.

The Hopkins opened in 1876. Its medical school would not open until 1893, but it succeeded so brilliantly and quickly that, by the outbreak of World War I, American medical science had caught up to Europe and was about to surpass it.

* 

Influenza is a viral disease. When it kills, it usually does so in one of two ways: either quickly and directly with a violent viral pneumonia so damaging that it has been compared to burning the lungs; or more slowly and indirectly by stripping the body of defenses, allowing bacteria to invade the lungs and cause a more common and slower-killing bacterial pneumonia.

By World War I, those trained directly or indirectly by the Hopkins already did lead the world in investigating pneumonia, a disease referred to as 'the captain of the men of death.' They could in some instances prevent it and cure it.

And their story begins with one man.

CHAPTER TWO

N
OTHING ABOUT
the boyhood or youth of William Henry Welch suggested his future.

So it is apt that the best biography of him begins not with his childhood but with an extraordinary eightieth-birthday celebration in 1930. Friends, colleagues, and admirers gathered for the event not only in Baltimore, where he lived, but in Boston, in New York, in Washington; in Chicago, Cincinnati, and Los Angeles; in Paris, London, Geneva, Tokyo, and Peking. Telegraph and radio linked the celebrations, and their starting times were staggered to allow as much overlap as time zones made possible. The many halls were thick with scientists in many fields, including Nobel laureates, and President Herbert Hoover's tribute to Welch at the Washington event was broadcast live over American radio networks.

The tribute was to a man who had become arguably the single most influential scientist in the world. He had served as president of the National Academy of Sciences, president of the American Association for the Advancement of Science, president of the American Medical Association, and president or dominant figure of literally dozens of other scientific groups. At a time when no government funds went to research, as both chairman of the Executive Committee of the Carnegie Institution of Washington and president (for thirty-two years) of the Board of Scientific Directors of the Rockefeller Institute for Medical Research (now Rockefeller University), he had also directed the flow of money from the two greatest philanthropic organizations in the country.

And yet Welch had been no great pioneer even in his own field of medical research - no Louis Pasteur, no Robert Koch, no Paul Ehrlich, no Theobald Smith. He had generated no brilliant insights, made no magnificent discoveries, asked no deep and original questions, and left no significant legacy in the laboratory or in scientific papers. He did little work (a reasonable judge might say he did no work) so profound as to merit even membership in, much less the presidency of, the National Academy of Sciences.

Nonetheless, these hundreds of the world's leading scientists had measured him as coldly and objectively as they measured everything and found him worthy. They had gathered to celebrate his life, if not for his science then for what he had done for science.

In his lifetime the world had changed radically, from horse and buggy to radio, airplanes, even the first television. Coca-Cola had been invented and rapidly spread across the country before 1900, by the 1920s Woolworth's had over fifteen hundred stores, and a technocratic makeover of America had accompanied the Progressive Age, culminating in 1930 in a White House conference on children that proclaimed the superiority of experts to parents in child raising, because 'it is beyond the capacity of an individual parent to train her child to fit into the intricate, interwoven, and interdependent social and economic system we have developed.'

Welch had of course played no role in those changes. But he had played a large and direct role in an equivalent makeover of medicine and especially American medicine.

He had served first as a kind of avatar, his own experience embodying and epitomizing that of many in his generation. Yet he was no simple symbol or representative. Like an Escher drawing, his life both represented that of others and simultaneously defined the lives of those who followed him, and those who followed them, and those who followed them, down to the present.

For if he did no revolutionary science, he lived a revolutionary life. He was personality and theater; he was impresario, creator, builder. Like an actor on a live stage, his life was a performance given once, leaving its impact upon his audience, and only through them echoing in time and place. He led the movement that created the greatest scientific medical enterprise, and possibly the greatest enterprise in any of the sciences, in the world. His legacy was not objectively measurable, but it was nonetheless real. It lay in his ability to stir other men's souls.

* 

Welch was born in 1850 in Norfolk, Connecticut, a small town in the northern part of the state that remains even today a hilly and wooded retreat. His grandfather, great-uncle, father, and four uncles were physicians. His father also served a term in Congress and in 1857 addressed the graduates of Yale Medical School. In that speech he demonstrated a significant grasp of the latest medical developments, including a technique that would not be mentioned at Harvard until 1868 and the striking new 'cell theory with its results in physiology and pathology,' a reference to the work of Rudolf Virchow, who had then published only in German-language journals. He also declared, 'All positive knowledge obtained' has resulted from the accurate observation of facts.'

Yet if it seemed foreordained that Welch would become a physician, this was not the case. Years later he told the great surgeon Harvey Cushing, a protegé, that in his youth medicine had filled him with repugnance.

Perhaps part of that repugnance came from his circumstances. Welch's mother died when he was six months old. His sister, three years older, was sent away, and his father was distant both emotionally and physically. Throughout Welch's life he would be closer to his sister than to any other living soul; over the years their correspondence revealed what intimacies he was willing to share.

His childhood was marked by what would become a pattern throughout his life: loneliness masked by social activity. At first he sought to fit in. He was not isolated. Neighbors included an uncle and cousins his age with whom he played routinely, but he longed for greater intimacy and begged his cousins to call him 'brother.' They refused. Elsewhere, too, he sought to fit in, to belong. At the age of fifteen, submitting to evangelical fervor, he formally committed himself to God.

He attended Yale where he found no conflict between his religious commitment and science. While the college had begun teaching such practical arts as engineering, it kept a measured distance from the scientific ferment of these years immediately following the Civil War, purposely setting itself up as a conservative, Congregationalist counterbalance to the Unitarian influence at Harvard. But if Welch's intellectual interests developed only after college, his personality had already formed. Three attributes in particular stood out. Their combination would prove powerful indeed.

His intelligence did shine through, and he graduated third in his class. But the impression left on others came not from his brilliance but from his personality. He had the unusual ability to simultaneously involve himself passionately in something yet retain perspective. One student described him as 'the only one who kept cool' during heated discussions, and he would carry this trait through the rest of his life.

There was something about him that made others want him to think well of them. Hazing of freshmen was brutal at the time, so brutal that a classmate was advised to keep a pistol in his room to prevent sophomores from abusing him. Yet Welch was left entirely alone. Skull and Bones, perhaps the single most secret society in the United States, which marks its members powerfully with the embrace of the establishment, inducted him, and he would remain deeply attached to Bones his entire life. Perhaps that satisfied his desire to belong. At any rate, his earlier desperation to fit in was replaced by a self-sufficiency. His roommate on parting left him an extraordinary note: 'I ought to try to express my great indebtedness for the kindness which you always manifested toward me, the pure example you set me,' I feel now more deeply the truth of what I often said to others if not to you - that I was utterly unworthy of such a chum as yourself. I often pitied you, to think that you had to room with me, your inferior in ability, dignity and every noble and good quality.'

It is the kind of note that a biographer might interpret as homoerotic. Perhaps it was. At least one other man would later devote himself to Welch with what could only be called ardor. Yet for the rest of Welch's life he also seemed somehow, in some indefinable way, to generate similar if less intense sentiments in others. He did so without effort. He charmed without effort. He inspired without effort. And he did so without his reciprocating any personal connection, much less attachment. A later age would call this 'charisma.'