In the winter of 1918, at the height of WWI, history's most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as 100 million people worldwide. It killed more people in twenty-four weeks than AIDS has killed in twenty-four years, more in a year than the Black Death killed in a century. But this was not the Middle Ages, and 1918 marked the first collision of science and epidemic disease. Magisterial in its breadth of perspective and depth of research, John M. Barry's The Great Influenza weaves together multiple narratives, with characters ranging from William Welch (founder of Johns Hopkins Medical School) to John D. Rockefeller and Woodrow Wilson. Ultimately a tale of triumph amid tragedy, this crisis provides a precise and sobering model for our world as we confront AIDS, bioterrorism and other, as yet unknown, diseases.
Barry notes how, while a handful of physicians and scientists in the world, particularly in western Europe, knew of the germ and cellular theories, by enlarge, most of the medical community in the world still operated on a largely antiquated, inaccurate understanding of medicine and disease. He notes how, up until the late 19th century, almost anyone could get a medical degree and practice medicine, and only a handful of medical schools, like Harvard, and Johns Hopkins had a rigorously clinical model of medicine.
Barry traces the confluence of the developing understanding of disease and cellular theory in that day with the outbreak and rapid spread of the virulent influenza of 1918. Thousands of young adults were grouped together in very close quarters while training and preparing to deploy to World War I. This environment proved to be conducive to the rapid spread of a deadly strain of influenza that spread through military barracks, out to the surrounding community, on to much of the country, and eventually much of the western world in the course of a number of months.
As this alarming pattern of severe illness, and in many cases, death of the particularly young and old emerged, several medical leaders of the day, began to take action. This included the U.S. surgeon general and chief surgeon of the Army. Their proactive measures, including initiating quarantines, strict sanitation, and early, basic attempts at vaccination, while unable to prevent an epidemic, saved countless lives.
This was also a crucial turning point in American medicine, Barry points out, that led to a national and international movement to raise standards for medical training. An increased emphasis on clinical training and better understanding of cellular theory, viruses, and epidemiology also resulted. Medical care advanced by leaps and bounds as a result.
Still, the stories and chilling photos of hundreds upon hundreds of bodies being stacked in the streets and left in abandoned homes in major American cities at the height of the outbreak give one pause. In his epilogue, Barry also looks ahead to the next global pandemic from a perspective of not 'if' but rather 'when' it occurs. His predictions about the spread of virulent strains of flu, such as H151, as well as other multi-drug resistant organisms are eerily prescient given recent news of the increased prevalence of such viruses.
Overall Barry's book "The Great Influenza" is very readable, informative, engaging and an incredible work of historical and clinical scholarship. Very highly recommended!
Also, for some reason the author decided to tie the history of the epidemic to the history of US medicine in the period (and preceding 30 years). This would have made sense if the changes in medical practice and research had had any effect on the course of the epidemic, but it didn't. Researchers were helpless, doctors were helpless, and public health advice (to the limited extent that it would have been useful) was ignored because it would have been bad for morale in wartime. So we didn't really need to spend the first section of the book learning about the foundation of the Rockefeller Institute or the biographies of the researchers who weren't able to do anything about the disease.
Despite “The Great Influenza’s” girth, there is a thrilling story here. Barry traces the influenza’s origin to pig farms in Haskell County, Kansas, following its path to Fort Riley, Kansas and, from there, to the rest of the United States and the world. Barry’s main argument is that the confluence of a new and extremely virulent strain of “only influenza” with the waning months of World War I led to a far greater crisis in two ways. First, the Sedition Act of 1918 led most American newspapers to downplay the significance of the flu outbreak for fear of hurting troop and civilian morale. Most European countries did the same. In a surprising twist, Barry argues, this is the very reason the 1918 flu pandemic became known as the “Spanish Flu.” Spain was not hit particularly hard by the flu, but they had remained neutral during the war and, thus, still had a neutral press capable of reporting on the flu, especially the incredibly serious case of King Alfonso XIII. This refusal to acknowledge the extent of the crisis resulted in more people becoming infected and dying that would have had they been willing to treat the epidemic as a true medical emergency.
The second way in which World War I exacerbated the influenza outbreak was by requiring the movement of thousands of people throughout the world. Normally, influenza spreads more slowly than it did in 1918 because when people are sick, they stay home. In war, however, the sick brought off the battle lines to the hospital, infecting people all along the way. And with a strain as virulent as this was, that meant hundreds and thousands of people becoming unnecessarily infected.
When separated from the chaff, Barry’s narrative is well-constructed and well-told. Unfortunately, there is a lot of chaff. Barry seems to suffer from a terrible case of what William Badke terms “the bulge,” or an inability to admit that a piece of information which was well-researched and time-consuming to prepare does not fit with the greater whole. The worst example of this is Barry’s fascination with a relatively unimportant scientific researcher named Paul Lewis. Lewis is, perhaps, best known for incorrectly declaring that influenza was caused by bacillus bacteria. But Barry follows his career with intense interest, following every lab failure and contract offer (all declined) along with his many personal failings. Lewis was, apparently, a brilliant scientist who nonetheless could never make a true breakthrough. Barry follows his story relentlessly despite Lewis failing to contribute anything noteworthy (and correct) to the study of influenza, with the exception of his training of Richard Shope, the man who would eventually isolate the Influenza A virus two years after Lewis’s death. Yet Barry is fixated on this relatively meaningless man’s story, it seems, so he can follow him to his death from another disease he was studying, yellow fever, so he can come to the superficially poignant conclusion that Dr. Paul Lewis was “the last victim of the 1918 pandemic.”
Also largely irrelevant was Barry’s dissection of the 19th century history of American medicine which, while consuming the first 80 pages of the book, culminates in the discovery of a cure for diphtheria and the declaration that “scientific medicine had developed technologies that could both prevent and cure diseases that had previously killed in huge numbers, and killed gruesomely (p. 71). This might have been an important discussion had it related to the 1918 influenza but, as it turns out, scientists were completely unable to isolate the cause of the flu, much less prevent or cure it. None of this matters except to establish the institutions that would ultimately hire the scientists who tried to stop the Great Influenza.
There are really two different stories here: A thrilling narrative of the 1918 influenza and its impact on the world then and now and a history of American medicine from 1950-1940. The former is gripping and a must-read. The latter could be interesting and told well in its own way, but here only serves to keep the reader away from the far more compelling story being told. Unfortunately, Barry’s lack of focus keeps a good book from being great.
The title describes a very specific, narrow subject - the influenza pandemic of 1918 - but the book itself is sprawling and vast. It starts with the arrival of scientific medicine on American shores, chronicling the terrible state of medical education and practice here in the late nineteenth and early twentieth centuries, and delves into the personalities of the doctors who stepped in to turn things around.
The fledgling universities and researchers are tested with the arrival of the influenza. That context alone was amazing and fascinating. But John M. Barry traces the emergence of the disease, its arrival in military cantonments, the ways that World War I helped to spread the disease - not just because the soldiers moving between camps and overseas carried the virus from place to place but because the war ensured a shortage of doctors and nurses, because the war justified widespread censorship of the newspapers, because the war encouraged authority figures to quell panic rather than take necessary steps that could halt the spread of disease.
There is tons of local color here, and it can be pretty gruesome. Corpses in the streets, shortages of coffins, undertakers who wouldn't go anywhere near bodies. Hospitals strained beyond capacity, stubborn officials who hold parades after being warned not to, false advertisments - like from Vicks Vap-o-Rub - promising to cure influenza. The result isn't just a picture of a particularly virulent strain of influenza, it's also a snapshot of our country under stress, of people who respond heroically and others who act like cowards.
The final death toll is astonishing - upwards of 100 million people died around the world. And the afterword is full of warnings about the inevitability of a new influenza pandemic, and how totally unprepared we'd be.
The final chapters cover the post-mortem; the doctors who living and working during the pandemic never discovered its source because they were searching for a bacteria. It took years of subsequent investigation before influenza was identified as a virus.
I didn't like the narrator of the audiobook. His voice was too smooth and lulling. Barry repeats the phrase "only influenza" throughout the book, driving home what a mistake it is to dismiss or overlook the threat of influenza. It's an effective technique and I appreciated it, but I really got to dread the particular tone of voice with which the narrator would say "only influenza."
Part of my problem with the book may be that some of the material was a repeat for me (I read "Genius on the Edge," about a pioneering surgeon at Johns Hopkins when its medical school first opened), so much of the discussion about the history of medicine had been covered in previous reads. That being said, other books cover this history better than Barry did in "The Great Influenza." Further, other books have covered other, less far-reaching disease outbreaks than the 1918 flu epidemic (which devastated the globe), and still I found myself more enthralled with the writing in those other books than with this one. (Some examples: "Polio: An American Story," "The Barbary Plague," "Spitting Blood," etc.) This book starts slowly, picks up to an exciting pace, and then just when you think it's on the right track, it slows right back down again to a painful slog. I am not even opposed to covering scientific details in books, but I think there are ways to make the material more interesting to the layperson.
* metric based medicine was not taught in the US till John's Hopkins University was established in 1870. Till then, the best medical education was available mostly in Germany. Around that time, the President of Harvard suggested the 'Harvard Medical School' should require an achievement test prior to granting an M.D. degree--the Dean of the Harvard Medical School replied that it would be difficult since half of his students could not read or write.
*Remember the movies of the thirties which had so many references to orphans and orphanages? The 1918 epidemic did not attack the ill, elderly and babies, it attacked adults in the prime of life, leaving many children with neither parent, which created many thousands of orphans, compounding the effects of the death toll of WW I.
* The author postulates that the epidemic started in Kansas and spread to Europe via the 'Doughboys' sent to fight in France from the US. I always thought it started in the trenches and the soldiers brought it to the US.
This book highlights the relative infancy of medical science and how recently what we have come to know as 'medical science' emerged from the dark ages. Medicine was and remains a developing science and does not possess the same certainties as say thermodynamics or general physics which engineering uses all the time with great efficacy.
The author fills in the background of US medical, political and social structures leading up to the epidemic and I am struck by the rudimentary nature of the institutions tasked with dealing with this disaster. This is one of the best books of any kind I have ever read.
It tells the story but educates and broadens the understanding to allow the reader to comprehend the significance of the various aspects of the tragedy. This book provides a view of history and the 19th century I had not previously encountered while giving insight into medical science and education I found fascinating.
It certainly told me a lot about flu, the flu virus and made you very aware that a pandemic in the modern world would be extremely bad (our just-in-time production mentality for example means there is little slack in the system if large chunks of the workforce were to fall ill).
It also gives a good story of the triumph of scientific approaches to disease control (especially in the US, which went from being relatively backwards in the late 19th century, to being a world leader by the time of the first world war). How this scientific elite did (and didn't) respond to the flu pandemic, how the political leadership did (and didn't) help and how this played out are the main parts of this book, offset too against how they dealt with the USA's surprise entry into the First World War.
There are some interesting anecdotes (as well as some terrifying descriptions of the spread of the illness), including the suggestion that Woodrow Wilson may have suffered minor flu symptoms while negotiating the Versailles treaty in 1919, thus affecting his judgement.
A good solid read, but it did not grab me as much as I expected.
The particular value of Barry's book, in addition to tracing the actual courses of the global waves of infection (there were at least 3, with #2 being "the big one"), is that he puts the events in context: World War I was in high gear, requiring that lots of young bodies be in crowded conditions and that "morale" be upheld at all costs; Tammany Hall was in full swing, making public health appointments disastrously political; and no clinical research or drug regulatory infrastructure existed yet, leading people to sometimes work at cross-purposes at best.
The text does get bogged down in places, but you can skim without losing much of the narrative. It's just that the disease and its effects were so overwhelming: influenza killed up to 5% of the WORLD's population within a year. Even now, influenza and pneumonia kill >50,000 people in the U.S. alone each year--it's the 8th leading cause of death--and the incidence is not going down. All it takes is a little shift in the antigens, a jump from an animal to a human, and off we go again...
I was stupid enough to no get my flu shot last year. Never again.
I found The Great Influenza to be really interesting and very different from Flu: The Story of the Great Influenza Pandemic of 1918 by Kolata. This one focused on the period before and during the epidemic for the most part while Kolata focused her story on the search for the virus that caused it which has only recently succeeded. Also Barry, in his afterword, asks how we would handle another such pandemic and his answer isn't very encouraging. At any rate, I found both books to be worthwhile reads.
For the reader with an interest in the history of medicine and the scientific process, this is a nourishing meal. If you are certain you only want the particulars of the pandemic itself, perhaps there is a more stream-lined account. In the end, I enjoyed this more than I would have without the stuff I did not set out to read about!
Cheers to John Barry
I found the book quite interesting. I don't remember ever knowing about this pandemic and it's very scary that something similar could happen again, despite medical advances. With the way people travel around the world now, and viruses and bacteria constantly mutating, it is scary. The book did take a long time to read, and there were times where my mind wandered a little bit while reading, but overall, it was a very interesting read.
This book presents the science and the sociology of the pandemic in conjunction with the history of medical advancement leading up to it. The primary approach is that of the history of medical science; the influenza outbreak occurred shortly after American medicine had established itself in something like its current form and presented it with a severe test. The cast of characters is largely made up of important scientists, and discusses the advances they made before, during, and because of the disease.
Other aspects of the pandemic are also included. The parts that I found most interesting concerned the sociology of why and how the pandemic spread. The outbreak occurred just after the US had entered World War I, and troop movements, the lack of civilian doctors and nurses, war-time propaganda campaigns, and, of course, the pig-headedness of the officials in charge all played enormous rolls in the course of the disease.
Overall I found the book very good. The descriptions of the actual disease and conditions during the pandemic were suitably horrifying, and the discussion of causes and effects I found very interesting. I have a few academic quibbles with the author's representation, however. There were a few places where I felt he made rather serious and unsubstantiated claims seemingly to enhance the significance of the pandemic, and he had the annoying habit of comparing statistics that didn't match (deaths per week compared to deaths per day, that kind of thing), I think towards that same end. All of that derives from the author's intention to tell a coherent story (as opposed to representing a scholarly debate), but be aware of that if you read the book. Overall enjoyable, but definitely not a light read. 4 stars.
Only by reading this book do I understand the work going on now regarding our current H1N1 virus in public health groups around the world. While it is currently mild, the virus has crossed the important barrier of being able to move from person to person. All that remains is the relatively minor mutation to become more lethal. Scary stuff.
John Barry can write, but a tighter edit would have helped. He seemed to repeat himself in places, adding to the length of the book, never a good thing. I recommend this as a good introduction to a layman, like me, to epidemiology and the specific story of the 1918 flu.