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Health & Fitness. History. Science. Nonfiction. In the winter of 1918, at the height of World War I, 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 between modern science and epidemic disease. Magisterial in its breadth of perspective and depth of research, THE GREAT INFLUENZA weaves together multiple narratives, with characters ranging from William Welch, founder of the Johns Hopkins Medical School, to John D. Rockefeller and Woodrow Wilson. Ultimately a tale of triumph amid tragedy, this crisis provides us with a precise and sobering model as we confront the epidemics looming on our own horizon.… (more)
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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!
I must confess that, when I started the book, I was not sure why he spoke about the history of the John Hopkins Institute or the Rockefeller Institute. However, as the book progressed, this became quite clear.
The book then traces you through the possible
During the course of the book, he makes some excellent points on how leaders should act, and the lessons we could have drawn from the pandemic.
It is indeed strange that the Spanish Flu, and the deadly lessons that the pandemic gave us, have been forgotten. Indeed, very few of us were aware of the pandemic that killed more people than World War I did.
This is a very readable book. It had me hooked from start to finish.
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
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
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.
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.
At the very end of this book, the author quotes Abraham Lincoln—"A leader must make whatever horror exists concrete. Only then will people be able to break it apart." Truer words were never spoken.
I can understand how long it took to research and write this book because it is incredibly dense with facts backed up with an extensive bibliography and footnotes section. I have already picked out several other sources I would like to read.
Unfortunately the last few pages did not give me hope that our pandemic will be over any time soon.
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!
Within the pages of this book the 1918-1920 global H1N1 pandemic is indeed discussed. But that is not really what this book is about.
It is hard to assess exactly what this book is about. The primary theme seems to be a paean
The author does go through a very thorough medical/scientific analysis of influenza: what it is, why we speak of it in terms of H and N and numbers, how it attacks cells, what the immune system does about it, and how sometimes it is the immune system's response that causes a lot of the difficulty.
We also learn much about World War I, how America entered it, and how Wilson aggressively prosecuted the war effort with suppression of dissent. Even though the Army's chief medical officer was very concerned about pandemic illness, and vowed to try to make sure more men died on the battlefield than because of disease, the pandemic exploded anyway. This information is helpful because it explains why newspapers and the media of the day did not cover the pandemic very much and how many throughout the country attempted to suppress information about it and to provide false reassurance that all was well. The fear that was engendered in response is described in detail and for good reason.
The author does trace H1N1 from its likely origins in rural Kansas and the "first wave" in the spring of 1918, and then the development of the much deadlier "second wave" in the fall of 1918. The statistics he provides are stunning. So much death and devastation, and how.
The pandemic would roll in waves for another 2 years but lose its steam; the author tends to gloss over this period because he focuses on the scientists and their investigations. The book ends with relevant updates about what we know and how as well as pandemics that have come about ever since and the dangers of pandemics which exist to this day.
I was not expecting the shoutout to the hometown of Rockford, Illinois, and learning that the first use of masks was done at Camp Grant there, but hey, extra bonus. Seeing that many had terrible difficulties after H1N1 - especially in the case of Woodrow Wilson himself - was sobering, especially in light of COVID-19.
This book really is about two or three different books smashed into one. A book about the scientists and the laboratory work involved, another book about WWI and the situation that led to the pandemic, and a third book about the pandemic in more detail might have been nice.
And we have learned from the COVID-19 experience that we haven't learned a lot from what happened a century ago, or we forgot about it because it left living memory. Sad to see how history repeats itself.
* 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
*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.
His afterword, which he wrote in I think 2018, is downright chilling—he essentially says that the biggest challenge to the next great pandemic will be governmental cooperation and the honest dissemination of accurate information. Granted, Trump was president when he wrote that so he may have had a better idea of possible scenarios than he would have in, say, 2015. But I imagine if he saw it coming with that kind of accuracy, so did a lot of medical folks, scientists, and policy people. And THAT is scary.
Unfortunately I can’t sing the praises of this book in the same way my colleagues (and apparently every major newspaper) have.
The book is clearly impeccably researched. The author spent seven years on it, and admits in the acknowledgments that he set out to write a very different book initially. He also lets the reader know that there actually isn’t a lot written in terms of first-hand accounts of experiencing the pandemic. There is a lot of information on the work done by scientists, and the work done by the military and government at the higher levels, but he isn’t able to really get into the areas that I am most interested in: how cities dealt with the pandemic.
Basically, I feel like the author wrote three books and attempted to weave them all together. Others say he was very successful in doing this; I think he was not. First, there’s the story of the scientists trying to figure out what was causing the influenza (a virus? A bacteria?). This story includes providing 80 pages of history of medicine. That is … fine, and I suppose sort of sets the stage? But not really. It felt like it could have been pared down to 15 or 20 pages and still more than gotten the point across that by the time this pandemic hit in 1918, medicine was still really in the dark ages.
The second story is about the war and the military’s treatment of the pandemic. If the information in here is accurate, well, DAMN. Wilson was not a great president when it comes to caring for civilians. He apparently didn’t really even acknowledge the pandemic and the devastation it was causing throughout the country, and pushed for some decisions that clearly cost lives unnecessarily – namely continuing to allow such close quarters at military bases. This part of the book was getting more at what I thought I would be reading about, but even this was oddly fleshed out. It didn’t fit very well, and kept popping up.
And this gets me to the issues of organization. In “The Immortal Life of Henrietta Lacks,” the author jumps back and forth along a timeline. At the start of each chapter, that timeline is there, and she provides a consistent visual to let the reader know where we are going to be in this chapter – allows us to prepare ourselves to process what we’re going to read. I appreciate that some people prefer to be along for the ride – and I’ve enjoyed that when reading novels. But I found it utterly distracting in this book. Half the time I wasn’t sure where or when the chapter was taking place. The fall wave of the 1918 pandemic was not that long – it passed through cities in a matter of weeks – but other than the occasional date thrown out in the middle of a chapter, I didn’t really know how each component fit in with the whole.
Finally, there was the third, and very small, book, and sadly that was the book I thought I was reading. It was almost entirely contained in chapters 17, 18 and 19. Those chapters talk about what the city of Philadelphia did – or more accurately did not do – to inform and protect the public. That is the story I am most interested in, and those chapters were well-written. There just wasn’t enough of it.
I can’t say that I would recommend this book. Again, it appears to be very well-researched, and probably interesting to those who really want a history of the medical side. But not so great if you’re interested in learning about how individuals and cities prepared for and responded to the pandemic.
The title describes a very specific, narrow subject - the influenza pandemic of 1918 - but the book itself is sprawling and vast.
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."
Highly recommended.
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.
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.