American medicine up until the twentieth century was an unmitigated disaster. Or so argues (quite convincingly) John Barry in his fascinating book, The Great Influenza: The Story of the Deadliest Pandemic in History. The first two sections of the book cover a brief history of American medicine and medical research, and I’ve only just gotten to the outbreak of the pandemic that killed between 20 and 50 million people, according to the best estimates. For comparison’s sake, WWI claimed 16 million lives, and AIDS an estimated 33 million.
Barry highlights a strong link between war and disease, namely, the emergence of epidemics or even pandemics. I’ll return to a discussion of this thesis when I’ve finished the book, but for now, what has been most striking is the utter catastrophe that was American medicine up until relatively recently. While scientists and physicians in Europe, including Robert Koch, Pierre Louis, Louis Pasteur, and John Snow were pioneers in epidemiology, germ theory, and more, the study of medicine in America was stagnant, suggesting the importance of healthy academic and scientific competition on the European continent.
Evidence of the United States’ relative backwardness is abundant. Charles Eliot, who became president of Harvard in 1869, wrote in his first report as president that, “The ignorance and general incompetency of the average graduate of the American medical Schools, at a time when he receives his degree which turns him loose upon the community, is something horrible to contemplate.” When Eliot proposed reforms within Harvard, including examinations (of all things), Professor of Surgery Henry Bigelow, had this to say:
“[Eliot] actually proposes to have written examinations for the degree of doctor of medicine. I had to tell him that he knew nothing of the quality of Harvard medical students. More than half of them can hardly 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.”
At the end of the 19th century, Barry reports that American universities had “nearly two hundred endowed chairs of theology and fewer than five in medicine…” showing where both the money and the power lay. It was ultimately the initiative of a few individuals, combined with big money from illustrious families such as the Hopkins and Rockefellers, that turned the ship around.
The Great Influenza is an excellent read, and fodder for thought not only for those interested in medicine, epidemiology, and virology (guilty as charged), but also for those interested in the academy as an institution – how it evolves or stagnates, and the factors that generate innovation and massive leaps forward in our understanding of the world.