THIS BOOK was initially supposed to be a straightforward story of the deadliest epidemic in human history, told from the perspectives of both scientists who tried to fight it and political leaders who tried to respond to it. I thought it would take me two and a half years to write, three at the most.
That plan didn’t work. Instead this book took seven years to write. It has evolved (and, I hope, grown) into something rather different than originally conceived.
It took so long partly because it didn’t seem possible to write about the scientists without exploring the nature of American medicine at this time, for the scientists in this book did far more than laboratory research. They changed the very nature of medicine in the United States.
And, finding useful material on the epidemic proved remarkably difficult. It was easy enough to find stories of death, but my own interests have always focused on people who try to exercise some kind of control over events. Anyone doing so was far too busy, far too overwhelmed, to pay any attention to keeping records.
In the course of these seven years, many people helped me. Some shared with me their own research or helped me find material, others helped me understand the influenza virus and the disease it causes, and some offered advice on the manuscript. None of them, of course, is responsible for any errors of commission or omission, whether factual or of judgment, in the book. (Wouldn’t it be entertaining to once read an acknowledgment in which the author blames others for any mistakes?)
Two friends, Steven Rosenberg and Nicholas Restifo at the National Cancer Institute, helped me understand how a scientist approaches a problem and also read parts of the manuscript and offered comments. So did Peter Palese at Mount Sinai Medical Center in New York, one of the world’s leading experts on the influenza virus, who gave very generously of his time and expertise. Robert Webster, at St. Jude Medical Center, like Palese a world leader in influenza research, offered his insights and criticisms as well. Ronald French checked the manuscript for accuracy on the clinical course of the disease. Vincent Morelli introduced me to Warren Summers, who along with the entire pulmonary section of the Louisiana State University Health Sciences Center in New Orleans helped me understand much of what happens in the lung during an influenza attack; Warren was extremely patient and repeatedly helpful. Mitchell Freidman at the Tulane Medical School also explained events in the lung to me.
Jeffrey Taubenberger at the Armed Forces Institute of Pathology kept me abreast of his latest findings. John Yewdell at the National Institutes of Health also explained much about the virus. Robert Martensen at Tulane made valuable suggestions on the history of medicine. Alan Kraut at American University also read and commented on part of the manuscript.
I also particularly thank John MacLachlan of the Tulane-Xavier Center for Bioenvironmental Research, who very much helped make this book possible. William Steinmann, head of the Center for Clinical Effectiveness and Life Support at the Tulane Medical Center, gave generously of his office space, knowledge of disease, and friendship.
All of the above have M.D.s or Ph.D.s or both. Without their assistance I would have been lost trying to understand my own cytokine storm.
People who write books are always thanking librarians and archivists. They have good reason to. Virtually everyone at the Rudolph Matas Medical Library at Tulane University was extraordinarily helpful to me, but Patsy Copeland deserves truly special mention. So do Kathleen Puglia, Sue Dorsey, and Cindy Goldstein.
I also want to thank Mark Samels of WGBH’s American Experience, who made available all the material collected for its program on the pandemic; Janice Goldblum at the National Academy of Sciences, who did more than just her job; Gretchen Worden at the Mutter Museum in Philadelphia; Jeffrey Anderson, then a graduate student at Rutgers, and Gery Gernhart, then a graduate student at American University, both of whom generously offered me their own research; and Charles Hardy of West Chester University, who gave me oral histories he had collected; and Mitch Yockelson at the National Archives, who gave me the benefit of his knowledge. Eliot Kaplan, then the editor of Philadelphia Magazine, also supported the project. I also want to thank Pauline Miner and Catherine Hart in Kansas. For help with photos I want to especially thank Susan Robbins Watson at the American Red Cross, Lisa Pendergraff at the Dudley Township Library in Kansas, Andre Sobocinski and Jan Herman at the Bureau of Navy Medicine, Darwin Stapleton at the Rockefeller University archives, and Nancy McCall at the Alan Mason Chesney archives at Johns Hopkins. I also want to thank Pat Ward Friedman for her information about her grandfather.
Now we come to my editor, Wendy Wolf. Although this is only my fifth book, counting magazine articles I’ve worked with literally dozens of editors. Wendy Wolf very much stands out. She edits the old-fashioned way; she works at it. On this manuscript she worked particularly hard, and working with her has been a pleasure. It is a true statement to say that, for better or worse (and I hope better), this book wouldn’t exist without her. I’d also like to thank Hilary Redmon for her diligence, reliability, and just general assistance.
Thanks also to my agent Raphael Sagalyn, as good a professional as there is. I’ve had many editors but only one agent, a fact that speaks for itself.
Finally I thank my brilliant wife, Margaret Anne Hudgins, who helped me in too many ways to enumerate, including both in concept and in the particular—but chiefly by being herself. And then there are the cousins.