Abstract
Tracing the complex history of how the past, present, and future of influenza became ‘viral’ in first half of the twentieth century, this book is a study of the making of a new virological way of knowing and controlling influenza that was constructed in Britain from the end of the nineteenth century to middle part of the twentieth century. It frames this transformation as the viralisation of influenza, a concept that denotes the complex and uneven processes by which influenza virus was incorporated into and changed medicine and public health and consolidated the viral identity of ‘modern influenza’. Modern flu emerged not with the discovery of influenza virus in 1933 but through a conjunction of bacteriological, epidemiological, and clinical ideas and practices that developed from the 1890s and reconceptualised influenza as a specific infectious disease. While intimately connected to the increasingly important role of virus research in efforts to scientifically modernise medicine in Britain in the 1920s, success came so quickly in 1933 only because so much had been put in place in the decades before. Pandemics, wars, and the state were crucial. Pandemics in the 1890s and 1918–1919 presented novel conditions and opportunities for governments, public health bodies, and medical researchers to carry out large-scale studies on the most pressing questions concerning the identity of influenza and measures to control it. Failures to resolve such questions resulted in moments of epistemological crisis but were also translated into new opportunities that drove the development of medical research through the interwar period. State-sponsored and -organised virus research was integral to the development of virological ways of knowing and their integration into medicine and public health, which helped forge a new medical consensus on influenza’s viral identity. The First and Second World Wars were key contexts of experimentation, but, more importantly, wartime organisation of medical science fundamentally shaped strategies for tackling influenza, with priority given to identifying causative agents and mass-producing vaccines for military populations. These strategies would eventually come to fruition when mass immunisation became reality after 1945. At the same time, vaccination systems put a spotlight on a major practical problem—antigenic variation among influenza viruses. A novel solution came in the form of the World Influenza Programme, which linked vaccine programmes to a world-wide system of influenza virus surveillance. The viralisation of influenza was internationalised after 1945, but its potential benefits were not shared equitably.
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Notes
- 1.
Clifford Troke, ‘Can we beat flu?’, Picture Post (2 February 1946), 8.
- 2.
For the concept of ‘ways of knowing’, see John V. Pickstone, Ways of Knowing: A New History of Science, Technology and Medicine (Manchester: Manchester University Press, 2000).
- 3.
‘Virus disease’ was the general term used in English-language medical and scientific publications and textbooks from the turn of the centuty until the late 1940s, when ‘viral disease’ became more widely used.
- 4.
Andrew Cunningham has traced how the bacteriological transformation of the identity of plague involved a transformation of its history; a similar process occurred with the viralization of influenza. Andrew Cunningham, ‘Transforming Plague: the Laboratory and the Identity of Infectious Disease’, in A. Cunningham and P. Williams (Eds.), The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992), 209–244.
- 5.
P.P. Laidlaw, ‘Epidemic Influenza: A Virus Disease’, The Lancet (11 May 1935), 1123.
- 6.
F.M. Burnet and E. Clark, Influenza: A Survey of the Last 50 years in the Light of Modern Work on the Virus of Epidemic Influenza (Melbourne: Macmillan, 1942).
- 7.
Genomic studies suggest that influenza viruses have existed for hundreds of millions of years. See, M. Shi, X.D. Lin, X. Chen, J.H. Tian, et al., ‘The Evolutionary History of Vertebrate RNA Viruses’, Nature, 556 (2018), 197–202; J.K. Taubenberger and D.M. Morens, ‘1918 Influenza: The Mother of All Pandemics’, Emerging Infectious Diseases, 12 (2006), 15–22; C.W. Potter, ‘A History of Influenza’, Journal of Applied Microbiology, 91.4 (2001), 572–579; W.I.B. Beveridge, ‘The Chronicle of Influenza Epidemics’, History and Philosophy of the Life Sciences, 13.2 (1991), 223–234; Youri Ghendon, ‘Introduction to Pandemic Influenza Through History’, European Journal of Epidemiology, 10.4 (1994), 451–453.
- 8.
I follow Pickstone’s characterisation of ‘ways of knowing’ as also ‘ways of working’, in which concepts and practice operate together. John V. Pickstone, ‘A Brief Introduction to Ways of Knowing and Ways of Working’, History of Science, 49.3 (2011), 235–245.
- 9.
Retrospective diagnoses of past influenza outbreaks or epidemics tend to ignore two important historical contingencies: first, that virological concepts and tools have histories and carry certain assumptions about the identity of a disease and its causes; and second, earlier classifications of influenza referred to or included other diseases and their different causes. For discussions of the pitfalls and prospects of retrospective disease history, see: Adrian Wilson, ‘On the History of Disease-Concepts: The Case of Pleurisy’, History of Science, xxxviii (2000), 271–319; Andrew Cunningham, ‘Identifying Disease in the Past: Cutting the Gordian Knot’, Asclepio, LIV (2002), 13–34; John Arrizabalaga, ‘Problematizing Retrospective Diagnosis in the History of Disease’, Asclepio, LIV (2002), 51–70; Mark, Jackson, ‘Perspectives on the History of Disease’, in idem., The Routledge History of Disease (London: Routledge 2016), 1–18.
- 10.
For example, W.I.B. Beveridge, Influenza: The Last Great Plague, An Unfinished Story of Discovery (London: Heinemann, 1977); F.M. Burnet, ‘A Portrait of Influenza’, Intervirology, 2 (1979), 201–214; E.D. Kilbourne, ‘Pandora's Box and the History of the Respiratory Viruses: A Case Study of Serendipity in Research’, History and Philosophy of the Life Sciences, 14 (1992), 299–308; D.A.J. Tyrell, ‘Discovery of Influenza Viruses’, in K.G. Nicholson, R.G. Webster and A.J. Hay (Eds.), Textbook of Influenza (Oxford: Blackwell 1998), 19–26; T. Quinn, Flu: A Social History of Influenza (London: New Holland, 2008).
- 11.
Ludwick Fleck, Genesis and Development of a Scientific Fact (Chicago: University of Chicago Press, [1935], 1979). Ilana Löwy and her colleagues have done invaluable work to develop Fleckian analyses of (bio)medical knowledge production. Ilana Löwy, ‘Ludwik Fleck’s Epistemology of Medicine and Biomedical Sciences’, Studies in History and Philosophy of Biological and Biomedical Sciences, 35C (2004), 437–446; Ilana Löwy, ‘Ludwik Fleck on the Social Construction of Medical Knowledge’, Sociology of Health & Illness, 10.2 (1988), 133–155.
- 12.
Fleck, Genesis and Development of a Scientific Fact, 96.
- 13.
Fleck, Genesis and Development of a Scientific Fact, 76.
- 14.
For a summary of this process, see Jan Golinski Making of Natural Knowledge: Constructivism and the History of Science (Cambridge: Cambridge University Press, 1998), 32–45.
- 15.
Charles E. Rosenberg, ‘What Is Disease? In Memory of Owsei Temkin’, Bulletin of the History of Medicine, 77 (2003), 491–505; Keith Wailoo, ‘Introduction’, in idem., Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill: University of North Carolina Press, 2001), 1–24.
- 16.
Most contemporary accounts in the 1890s used the term ‘epidemic’ instead of ‘pandemic. The term ‘pandemic’ came into wide use in the early nineteenth century to characterise the spread of cholera. August Hirsch was among the first to apply the term to influenza, noting in his 1883 Handbook that influenza ‘always occurs as an epidemic or pandemic’. August Hirsch, Handbook of Geographical and Historical Pathology, Volume I. Trans. Charles Creighton (1883), 18. The term started to be generally applied to influenza in accounts of the 1918–1919 pandemic, and then retrospectively applied to earlier epidemics.
- 17.
W.F. Bynum, Science and the Practice of Medicine in the Nineteenth Century (Cambridge: Cambridge University Bynum 1994), 92–117; William Bynum, ‘Medicine in the Laboratory’, in idem., History of Medicine: A Very Short Introduction (Oxford: Oxford University Press, 2008), 73–74. For an overview, of the relation between science and medicine, see John Harley Warner, ‘The History of Science and the Sciences of Medicine’, Osiris, 10 (1995), 164–193.
- 18.
Michael Worboys, ‘Practice and the Science of Medicine in the Nineteenth Century’, Isis, 102.1 (2011), 109–115; William F. Bynum, ‘The Rise of Science in Medicine, 1850–1913’, in W.F. Bynum, A. Hardy, S. Jacyna, C. Lawrence and E.M. Tansey (Eds.), The Western Medical Tradition: 1800 to 2000 (Cambridge: Cambridge University Press 2006), 111–239; Christoph Gradmann, Laboratory Disease: Robert Koch's Medical Bacteriology. Trans. Elborg Forster (Baltimore: Johns Hopkins University Press, 2009).
- 19.
My analysis is allied with revisionist accounts of the so-called bacteriological revolution. Michael Worboys, ‘Was There a Bacteriological Revolution in Late Nineteenth Century Medicine?’ Studies in History and Philosophy of Biological and Biomedical Sciences 38 (2007), 20–42. However, I also draw on important studies that have historicised the bacteriological revolution. Bruno Latour, The Pasteurization of France (Cambridge, MA: Harvard University Press, 1988); Andrew Cunningham, ‘Transforming Plague: the Laboratory and the Identity of Infectious Disease’, in A. Cunningham and P. Williams (Eds.), The Laboratory Revolution in Medicine (Cambridge: Cambridge University Press, 1992), 209–244.
- 20.
For example, see Michael Worboys, Spreading Germs: Disease Theories and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000), 108–149; Christoph Gradmann, ‘Robert Koch and the Pressures of Scientific Research: Tuberculosis and Tuberculin’, Medical History, 45.1 (2001), 1–32. For failure in science and medicine more generally, see Jutta Schickore, ‘“Through Thousands of Errors We Reach the Truth”—But How? On the Epistemic Roles of Error in Scientific Practice’, Studies in History and Philosophy of Science, 36.3 (2005), 539–556; Thomas Schlich, ‘Making Mistakes in Science: Eduard Pflüger, His Scientific and Professional Concept of Physiology, and His Unsuccessful Theory of Diabetes (1903–1910)’, Studies in History and Philosophy of Science, 24 (1993), 411–441.
- 21.
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- 22.
Roger Cooter ‘Of War and Epidemics: Unnatural Couplings, Problematic Conceptions’, Social History of Medicine, 16 (2003), 283–302.
- 23.
Alfred Crosby, America’s Forgotten Pandemic—The Influenza of 1918 (Cambridge: Cambridge University Press, 1989), argued, in passing, that memories of the pandemic in America were largely preserved in private memoirs of survivors and of some medical researchers. Nancy Bristow has developed this observation, highlighting how doctors, nurses and survivors also remembered, memorialized and forgot the pandemic. Nancy K. Bristow, American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic (Oxford: Oxford University Press, 2012).
- 24.
Samuel K. Cohn has recently addressed this issue. Samuel K. Cohn, Epidemics: Hate and Compassion from the Plague of Athens to Aids (Oxford: Oxford University Press, 2018), 423–424.
- 25.
For a reassessment of the role of medicine and science in remembering the pandemic, see Guy Beiner, ‘The Great ‘Flu Between Remembering and Forgetting’, in idem. (Ed.), Pandemic Re-awakenings: The Forgotten and Unforgotten 'Spanish' Flu of 1918–1919 (Oxford: Oxford University Press, 2021), 14–18; Jeffrey S. Reznick, 'The Past, Present and Future of Memory: Medical Histories of the 1918–19 Influenza Epidemic in the United States', in Guy Beiner (Ed.), Pandemic Re-awakenings, 234–243.
- 26.
Joan Austoker and Linda Bryder, ‘The National Institute for Medical Research and Related Activities of the MRC’, in J. Austoker and L. Bryder (Eds.), Historical Perscpectives on the Role of the MRC: Essays in the History of the MRC of the United Kingdom and its Predecessor, the Medical Research Committee, 1913–1953 (Oxford: Oxford University Press, 1989) 39; A.L. Thomson, Half a Century of Medical Research. The Programme of the Medical Research Council (UK), Vol. 2 (London: HMSO, 1975), 114; Roger Cooter, ‘Keywords in the History of Medicine: “Teamwork”’, Lancet, 363.9416 (April 10, 2004), 1245; Andrew Hull, ‘Teamwork, Clinical Research, and the Development of Scientific Medicines in Interwar Britain: The “Glasgow School” Revisited’, Bulletin of the History of Medicine, 81 (2007), 569–593.
- 27.
Steve Sturdy, ‘War as Experiment: Physiology, Innovation and Administration in Britain, 1914–1918: The Case of Chemical Warfare’, in R. Cooter, M. Harrison and S. Sturdy (Eds.), War, Medicine and Modernity (London: Sutton), 79; Robert E. Kohler, ‘Walter Fletcher, F.G. Hopkins, and the Dunn Institute of Biochemistry: A Case Study in the Patronage of Science’, Isis, 69 (1978), 331–355.
- 28.
Christopher C. Lawrence, ‘Still Incommunicable: Clinical Holists and Medical Knowledge in Interwar Britain’, in C. Lawrence and G. Weisz (Eds.), Greater Than the Parts: Holism in Biomedicine, 1921–1950 (Oxford: Oxford University Press 1998), 94–111.
- 29.
Steve Sturdy, ‘The Political Economy of Scientific Medicine: Science, Education and the Transformation of Medical Practice in Sheffield, 1890–1922’, Medical History, 36 (1992), 125–159; Steve Sturdy and Roger Cooter, ‘Science, Scientific Management, and the Transformation of Medicine in Britain c. 1870–1950’, History of Science, 36 (1998), 421–466.
- 30.
For the centrality of collaboration in early twentieth century biomedicine, see Ilana Löwy, ‘Historiography of Biomedicine: ‘Bio,’ ‘Medicine,’ and In Between’, Isis, 102.1 (2011), 116–122; Viviane Quirke and Jean-Paul Gaudillière, ‘The Era of Biomedicine: Science, Medicine, and Public Health in Britain and France After the Second World War’, Medical History 52.4 (2008), 441–452; Jean-Paul Gaudillière, Inventer la biomédicine: La France, l’Amerique et la production des savoirs du vivant (Paris: La De ́couverte, 2002); Soraya de Chadarevian and Harmke Kamminga, eds., Molecularizing Biology and Medicine: New Practicesand Alliances, 1910s–1970s (Amsterdam: Harwood, 1998).
- 31.
For general details, see, Michael Bresalier and Michael Worboys. ‘Saving the Lives of Our Dogs: The Development of Canine Distemper Vaccine in Interwar Britain’, British Journal for the History of Science, 47 (2014), 305–334.
- 32.
For example, Sabina Clarke ‘Pure Science with a Practical Aim: The Meanings of Fundamental Research in Britain, Circa 1916–1950’, Isis, 101 (2010), 285–311; Viviane Quirke, Collaboration in the Pharmaceutical Industry: Changing Relationships in Britain and France, 1935–1965 (London: Routledge, 2007); John Liebenau, ‘The MRC and the Pharmaceutical Industry: The Model of Insulin’, in J. Austoker and L. Bryder (Eds.), Historical Perspectives on the Role of the MRC (Oxford: OUP, 1989); Christopher Lawrence, Rockefeller Money, the Laboratory, and Medicine in Edinburgh, 1919–1930: New Science in an Old Country (Rochester, NY: University of Rochester Press, 2005); Ilana Löwy and Patrick Zylberman, ‘The Rockefeller Foundation and the Biomedical Sciences’, Studies in History and Philosophy of Biological and Biomedical Sciences, 31c (2000), 365–509.
- 33.
Barbara Canavan, ‘Collaboration Across the Pound: Influenza Virus Research, Interwar United States and Britain’, Rockefeller Archive Center Research Reports Online, 31 December 2014; William H. Schneider, ed., Rockefeller Philanthropy and Modern Biomedicine: International Initiatives from World War I to the Cold War (Bloomington: University of Indiana Press, 2002).
- 34.
With the exception of Patrick Laidlaw, all of the members of the NIMR team that worked influenza in the 1930s had received training from or had visited Rockefeller Foundation institutions.
- 35.
The OED dates the first use of the term to 1839. Chambers Journal referred to the ‘flu season’ in 1911. General use became frequent in the 1920s and 1930s, especially in patent medicine advertising, and NIMR workers used it in the vernacular. Its medical use in the Lancet and BMJ began in the early 1940s.
- 36.
For example, Christopher Lawrence, ‘Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain, 1850–1914’, Journal of Contemporary History, 20 (1985), 503–520; J.D. Howell, Technology and the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995).
- 37.
Steve Sturdy, ‘Looking for Trouble: Medical Science and Clinical Practice in the Historiography of Modern Medicine’, Social History of Medicine, 24, 3 (2011), 739–757.
- 38.
For an overview, see Morten Hammerborg, ‘The Laboratory and the Clinic Revisited: The Introduction of Laboratory Medicine into the Bergen General Hospital, Norway’, Social History of Medicine, 24.3 (2011), 758–775.
- 39.
For general approaches to aligning different medical knowledge, see Ilana Löwy, ‘Medicine and change’, in I. Löwy and J.-P. Gaudillière (Eds.), Medicine and Change: Historical and Sociological Studies of Medical Innovation (Montrouge, France: John Libbey Eurotext, 1993), 1–19; Annemarie Mol, ‘Pathology and the Clinic: an Ethnographic Presentation of Two Atheroscleroses’, in M. Lock, A. Young and A. Cambrosio (Eds.), Living and Working with the New Medical Technologies. Intersections of Inquiry (Cambridge: University of Cambridge, 2000), 82–102.
- 40.
For the importance of alignment, see Joan H. Fujimura, ‘Constructing “Do-able” Problems in Cancer Research: Articulating Alignment’, Social Studies of Science, 17 (1987), 257–293.
- 41.
Similar dynamics have been identified in histories examining the relationship between the ‘bench’ and the ‘bedside’ in constructions of cardiac disease, cancer, aphasia, and allergy. See, for example Ilana Löwy, Between Bench and Bedside: Science, Healing and Interleukin-2 in a Cancer Ward (Cambridge, MA: Harvard University Press, 1997); L.S. Jacyna, Lost Words: Narratives of Language and the Brain, 1825–1926 (Princeton, NJ: Princeton University Press, 2000); Mark Jackson, ‘“A Private Line to Medicine”: The Clinical and Laboratory Contours of Allergy in the Early Twentieth Century’, in K. Kroker, J. Keelan and P.M.H. Mazumdar (Eds.), Crafting Immunity: Working Histories of Clinical Immunology (Aldershort: Ashgate, 2008), 55–76.
- 42.
Carlo Caduff, The Pandemic Perhaps: Dramatic Events in a Public Culture of Danger (Berkeley: University of California Press, 2015); Lorna Weir and Eric Mykhalovskiy, Global Public Health Vigilance: Creating a World on Alert (New York: Routledge, 2010).
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Bresalier, M. (2023). Historicising Flu: Viral Identities of Influenza. In: Modern Flu. Medicine and Biomedical Sciences in Modern History. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-33954-6_1
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