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Tuesday, May 26, 2020

The Great Influenza by John M. Barry



The Great Influenza by John M. Barry is a chronicle of the 1918 influenza as it effected The United States. This outbreak killed more people then any other pandemic in history. I found this book to be an informative and interesting account of this event. The book is also a medical history through the time of this influenza. Obviously, as we are in the midst of the Covid -19 pandemic, this history has special relevance for our time. This book was first published in 2005.


The pandemic was known as the Spanish Flu, although it did not start in Spain. Total death statistics are imprecise but probably ranged from a staggering 50 to 100 million deaths. This book concentrates on the American experience. There were about 675,000 American deaths. The influenza spread like wildfire across the globe. Though most people who caught it recovered in week or two, the fatality rate was high as a percentage of people infected. Also, the disease was very contagious so the number of people who were eventually infected was enormous. These two factors led to the huge number of deaths. 

The book is not a worldwide history. Though global events are covered, the focus here is on the disease’s impact upon the United States. This pandemic was such a monumental, worldwide cataclysm that a book that attempted to cover the entire story would probably be very general. 

The first hundred pages or so of the book is a history of medical science and the medical profession leading up to 1918. In the fifty years prior to the pandemic professional medicine had taken great strides. Instead of relying upon tradition and unscientific cures, evidence - based medicine had come into its own. Vaccines for certain diseases had been devised. Some diseases, such as Diphtheria, had been cured. Much about the human body was beginning to be understood. Researchers had come to understand a lot about contagious disease. Barry is a writer who bases his history on biography. Many pages are devoted to mini - biographies of doctors and researchers who played a part in the history of medicine as well as those who participated in fighting and researching the pandemic. William Henry Welch is highlighted more than anyone else. He helped found, and for years administered, the newly established John Hopkins Hospital. The hospital became the American center for the revolution that was occurring in the medical profession. Many others are profiled including several women who, unusual for the time, were scientists. For instance, Anna Williams was one of the world’s foremost experts on bacteria. Barry does not just profile the professional accomplishments of the people that he profiles, he covers all aspects of their lives. 

The book then delves into both the history and the science behind the pandemic. Though there is some dispute about the sequence of events, the origins of the virus, and how it changed over time, many, including the author, believe that this influenza originated in remote part of Kansas. It had probably jumped from an animal to a person in early 1918. This was in the middle of World War I and there were enormous army bases all over the United States. It is believed that the disease spread to a base in Kansas and then traveled to Europe with American troops. It then spread all over the world. Interestingly, this was an extremely contagious but very mild form of influenza that spread around the globe in early 1918. Later in the year, the disease mutated and became extremely deadly. This deadly form of the influenza spread as soldiers and sailors from many nations traveled throughout the world. There are a few researchers who do not agree with the above version of events and there are alternate narratives. For instance, some believe that the mild virus that spread in the spring of 1918 was a completely unconnected strain of influenza.

Either way, the deadly form of the virus quickly spread throughout America and just about everywhere else in the world. Almost all areas of The United States were affected. American cities saw tens of thousands of dead. A few places like Philadelphia were hit particularly hard. There were places where the authorities could not keep up and bodies began to sit and pile up. One odd thing about the disease was this it killed young people in their prime at a greater rate than it did older people. This is unusual for such deadly viruses.

America and Europe were actually hit a lot less hard then most of the rest of the world. This was probably because most people from America and Europe had some immunity to influenza. Where influenza was previously rare or unknown, this disease had much higher fatality rates.

In America, bad news about the disease was considered detrimental to war morale so most the newspapers and many political leaders downplayed the seriousness of the crises and at times outright lied about the situation. The federal government also suppressed pandemic news as being bad for the war effort. The federal response was often nonexistent. Much of America went into quarantine. In several places like Philadelphia, corrupt local governments essentially failed to function. As a result, in some cities private groups or organizations took over from the government. Though the disease mostly disappeared in early 1919, several subsequent waves hit in ensuring years. The books takes the reader into the 1930s when the actual virus was finally isolated. 

The scientific parts of the book are fascinating. I learned a lot about viruses, influenza and pneumonia. Many of the influenza victims, and most of the people who died, got pneumonia as a result of this disease. I did not really understood pneumonia before reading this book. This work shed a lot of light on this ailment for me. The book goes into the differences between viral and bacterial pneumonia. Viral pneumonia was directly caused by the influenza itself and tended to kill fast. Many victims also contracted bacterial pneumonia. Influenza is a virus, but it sometimes weakens the immune system and the lungs so that bacteria moves in and infects and causes pneumonia in the lungs. Bacterial pneumonia tends to move slower but also can be deadly. Many of the deaths from this pandemic were caused by bacterial pneumonia. Doctors at the time actually had some treatments that helped against some of the bacterial pneumonias.

The author also explains how viruses work and how they infect people. He delves into influenza viruses specifically. Influenzas are great mutators. They change over time, more so than any other infectious virus. This is why we need a new flu shot every year. Contrast that measles; after two measles vaccinations a person is usually protected for life. The author goes into the science as to why this is the case. This disease probably started relatively severe when it broke out in Kansas, became mild as it spread throughout the world, then mutated into a form that was very deadly. In subsequent years it became mild again. 

Barry is also an eloquent writer. Here is describing something important about science as it related to the medical revolution that occurred before the outbreak,

All real scientists exist on the frontier. Even the least ambitious among them deal with the unknown, if only one step beyond the known. The best among them move deep into a wilderness region where they know almost nothing, where the very tools and techniques needed to clear the wilderness, to bring order to it, do not exist. There they probe in a disciplined way. There a single step can take them through the looking glass into a world that seems entirely different, and if they are at least partly correct their probing acts like a crystal to precipitate an order out of chaos, to create form, structure, and direction. A single step can also take one off a cliff.

One criticism that I have is the though Barry covers the science in an understandable way, he breaks up the technical parts and mixes the science in with the history and biography. This may seem like a good way to present technical material to lay readers, but this a makes the technical parts difficult to follow and at times the book seems disorganized. 

Obviously, this book has relevance to the Covid – 19 situation. I also try to read and listen to a fair amount of medical content relating to Covid – 19. I try read articles from medical experts. I also listen to Dr. Radio for about an hour and a half or so many days while I am working. That is a great resource for expert and detailed information. Putting this book and this information together, I think that I have come to a basic, layperson’s understanding of the of the similarities and differences between the two events. Of course, there are there similarities between the situation of today and that of 1918. Both diseases are viruses that usually affect the lower respiratory system. Both cause a lot of pneumonias. Both are extremely contagious and have a high level of fatalities. But there are important differences. Covid – 19 is a terrible disease that should never be minimized, but luckily, the levels of death are unlikely to come anywhere close to the 1918 pandemic. Many experts think that there will be a second wave of Covid – 19 in the fall. I have heard people try to draw parallels with the first two waves of the 1918 influenza outbreak. It may very well be true that there will be a second wave of Covid – 19, but the situation in 1918, with when a very mild wave of sickness hitting in the spring, seems not as relevant to our current situation. The 1918 Influenza, like all Influenzas, mutated dramatically and quickly. Covid – 19 is not an Influenza. Though there have been some conflicting news stories about it mutating, the majority of experts that I read and listen to believe that Covid – 19 will mutate, but not nearly as much as influenza does. One characteristic of the 1918 pandemic was that it tended to kill young, healthy people more than other groups. Covid – 19, like most fatal diseases, tends to cause the most deaths in older and more vulnerable people. 

I thought that this was an excellent book. It covered both the history and science of the 1918 pandemic as it effected The United States, thoroughly. The book is interesting and it is informative. I learned a lot from it. The book’s flaws are relatively mild. I would eventually like to read a history of this pandemic that is more global. However, as an American history, this is excellent.

50 comments:

mudpuddle said...

timely post and wonderful comment re how science works... maybe general opinion will come to a different conclusion about which form of life is dominant on planet Earth... viruses seem to have the best of everything and no enemies...

Brian Joseph said...

Hi Muddpuddle- That is a great quotation. Once in the body, our immune systems do go at viruses pretty hard.

Judith said...

We have had this book in our house for years. And I just started to read it a couple of weeks ago. Other books are competing for my attention, but it has kept its status on the pile.
I look forward to reading more of it.
It seems that almost all of my older relatives got that flu in 1918-1919. My grandmother was 22 or so at the time, and she said she and her family got it, "but it wasn't anything much." I remember being stupefied when she told me this, because I had learned that it was a very serious disease. Nobody died of it that she knew of, her whole family had it, etc. I think probably that when they contracted it, the mutation drifting through New Bedford, Massachusetts, might have been a milder form of it. They were not well to do at all, so that's not it.

Debra She Who Seeks said...

I saw a documentary on TV about the Spanish Flu pandemic and it also said that the USA, European nations and their allies, all censored and hid news of the pandemic when it started so as not to "harm morale" during World War I. Spain, which was neutral in that war, did not censor its media and carried coverage of it for its people. That's why it became known as the "Spanish flu" just by association.

Brian Joseph said...

Hi Judith - That is a really interesting story. Like Covid - 19, even when it was at its deadliest, most people got over it. But it also could have been a milder wave that they got hit with.

Brian Joseph said...

Hi Debrah - Yes, the Spanish actually told the truth about it and as a result got unfairly saddled with the name.

Kathy's Corner said...

Hi Brian, great review and it sounds like a book with lessons for today. These pandemics and how people coped and what was going on historically make for fascinating reading.

Dorothy Borders said...

I just today finished reading The End of October by Lawrence Wright, a fictional account of a pandemic that seems torn from today's headlines although it was written a few years ago. The most interesting parts of the book for me were the descriptions of viruses, their prevalence in the environment including the oceans, and how they work to replicate and spread. It really is a fascinating subject and it seems to have been well covered in the book you read. Perhaps I will add this one to my TBR list.

Brian Joseph said...

Thanks Kathy. Definitely some lessons for today.

Brian Joseph said...

Hi Dorothy- Virus, how they work and how our immune system fights them is a fascinating topic. The End of October sounds good.

CyberKitten said...

You beat me to it! [lol] This is HIGH on my Amazon Wish List - now higher thanks to your review. The 1918 pandemic is a fascinating event in its own right but even more so with the present situation with Covid-19. I have a few Pandemic related book posts coming up including a Science 'book blitz'. Like you I want/need to know more about Pandemics. Living through one tends to concentrate the mind somewhat!

Brian Joseph said...

Hi CyberKitten. Current events do tend to ramp up the interest in these events. I look forward to your future posts, especially if you read this.

Stephen said...

I read a book on the yellow fever epidemic afflicting Philly in the 1780s early during the corona crisis. It's interesting how similar the experiences have been -- and the similarities to the Spanish flu are even more so, with similar measures taken regarding the closing of schools/churches/etc and the use of masks.

Brian Joseph said...

Hi Stephen - This book talks a little about the Yellow Fever outbreak.

It is interesting how history repeats itself with these diseases.

Suko said...

This post is certainly timely! It's also well-written and informative. I've learned more about this flu due to the current Covid-19 pandemic. I hope and pray that a vaccine will be available before too long. Thank you for an excellent review, Brian Joseph!

Judy Krueger said...

Thank you, Brian, for reading this book and reviewing it. I feel I should read it but for right now, cannot. That is why I am thanking you!

thecuecard said...

Thanks for giving us a good understanding of the 1918 Spanish Flu per this book ... it seems the differences between the two pandemics are quite significant. And a bit strange that young people were more affected in the 1918 pandemic .... I guess more immunity in older folks? But Covid-19 has been brutal on the older populations this time .... My reading of the novel The End of October was also pretty interesting about scenarios on pandemics & facts about them.

Sharon Wilfong said...

I absolutely must get this book. It has everything I'm interested in. Medical history, disease history, mini-biographies. Thanks for your review and letting me know about this great book.

Brian Joseph said...

Thanks Sharon. I think that you would like this.

Brian Joseph said...

Thanks Suko. These things certainly have a way of educating people. I think that we will get a vaccine. Unfortunately it might be a year or so off.

Brian Joseph said...

Hi Judy - I can see how it might not be the best time for everyone to read this book.

Brian Joseph said...

Hi Sue - There are some big differences between the two diseases.

I think that there are two theories. One is that a similar but milder flu spread across the world decades earlier, giving the survivors immunity.

The other is that the flue caused a Cytokine storm in s lot of people and killed them. Cytokine storm Is an overreaction of the immune system. With some diseases, Cytokine storm is worse in young people. Covid - 19 also caused Cytokine storm, but it plays out differently.

I want to read The End of October.

The Liberty Belle said...

Not the sort of book that I would typically find interesting but I must say at a time such as this, it seems like a fascinating read. Good review.

Brian Joseph said...

Thanks Belle It is a very relevant book these days.

James said...

I read this book more than a decade ago and remember being impressed with it. I think that the differences in the level of health care available and the state of communications technology makes it hard to compare that experience with our current pandemic.
Another exceptional book about a health crisis more than a century earlier is Bring Out Your Dead by J. H. Powell. It is an account of Yellow Fever in Philadelphia in 1793.

Brian Joseph said...

Hi James - Indeed, we are in a very different position because of the state of medical care today.

I keep hearing good tings about Bring Out Your Dead.

JacquiWine said...

I don't think I could read this right now, but it does sound very informative. If you're interested in reading more on the topic, there's a Katherine Ann Porter story, Pale Rider, Pale Horse. It's fiction rather than a factual account, but enlightening nonetheless.

Brian Joseph said...

Hi Jacqui - A lot of folks have commented that this is not a good time to read this for them. It is understandable.

I have heard about Pale Rider Pale Horse. I might give it a try.

Sue Bursztynski said...

The time of the Spanish Flu was truly scary. In Melbourne, my home town, they set up a huge hospital in the Exhibition Buildings, which had been used for the first meeting of Australia’s Parliament and is now used for...well, exhibitions! They were planning to set up something similar in our current exhibition centre, known wryly as Jeff’s Shed, after the Premier who had it built but thankfully it hasn’t been needed for that so far.

Brian Joseph said...

Hi Sue - Here in New York we had a similar experience with Covid -19. Giant fried hospitals were constructed. If things had gotten any worse we would have needed them. Luckily we just fell short of needing them.

Himawan Sant said...

Do not think if a pandemic similar to the Spanish virus pandemic is currently repeated again on an international scale. I actually think it is more or less possible the spread of the virus as it is today is chemical engineering or not.

Brian Joseph said...

Hi Himawan - Things are really different from 1918.

I think that Covid - 19 jumped from animals to humans.

RT said...

Now you have me searching local libraries for a copy ... good reviews do that to me .... I suppose the virus has been upstaged by anarchy ....I wonder what book will help me make sense of our current chaos ...
Best wishes from the Gulf coast and my new blog address:
https://miscellaneousmusingsandreviews.blogspot.com/

Brian Joseph said...

Thanks RT You are correct, the virus has been upstaged by some terrible and crazy stuff

Susan Kane said...

This retelling how deadly both were and no vaccine was not/could not have been developed is a strong comparison. When my gr-kids are grown, they will be telling their stories.

The farm communities may have had it easier. My hometown of 4,800 have had 0 fatalities, and no reports of cases reported. Social distancing that has dated back over 100 years makes this a possibility.

My grandmother helped the local doctor with his patients. She did not come down with 1918 virus.

Brian Joseph said...

Hi Susan - Rural areas and small towns are indeed spared some of the worst of this stuff. Here on Long Island, which is mostly suburban, we have thousands of deaths. Rural areas in upstate New York, even when deaths are measured on a per capita basis was hit much less hard. We also had a lot of mismanagement here in the United States.

As per this book, researchers actually were trying for a cure or a vaccine back in 1918.

Felicity Grace Terry said...

This sounds like a book I'd find truly fascinating ... just not at the moment.

Whilst, yes, a book that could put our current situation into perspective, I'm just not convinced that I'm up to reading it at the present time. That said, definitely one for the Wanna Read list.

Brian Joseph said...

Hi Felicity - I can see how this would not be the timed or this book.

R's Rue said...

Sounds interesting, but I'll pass right now.
www.rsrue.blogspot.com

Whispering Gums said...

I am always interested in medical history, so I really enjoyed your description of this book, and sharing some of the information it contains.

Interesting re predictions about your fall. We have just finished autumn and managed to flatten the curve by the end of it. However, with the flu season upon us, there is a query regarding a second wave here in July. However, there have also been suggestions that our Covid-19 strain was a weaker one than some others have had. I haven't investigated that though, as I have too many issues on my plate right now.

Brian Joseph said...

Hi WG - From everything that I heard, Australia did a great job of controlling this. Here in Nee York, there is still a lot of it around and I think there still will be a fair amount of it around so that it will be easier to spark a second wave.

baili said...

perfect timing for this choice dear Brain

i am thankful to you for sharing stuff which seems important to know in such times

knowing history of pandemic through your blog felt great privilege as i never tried to dig this topic before honestly

except i learned difference between virus and bacteria from my eldest son may be year ago , his knowledge stimulate my curiosity when Covid came in and i read two articles about Covid 19 almost month back

i found this book informative and useful for people who want to know history and science behind these pandemics
what seems strikingly weird is that each virus seems to have ability to select target or age group
how is this possible ? is this just coincident or planned strategy? and by whom ,why ?

how viruses mutate ? is there any research or book about reason that causes mutation of a virus ?
i would like to know it either
thank you for enlightening us with your insightful reviews my friend! i really appreciate it
blessings!

The Padre said...

Yo Brother Man, Totally Excellent Book - The Science Behind The Book Is Remarkable - You Inspired Me To Track It Down And Have Another Read - Be Well

Cheers

Brian Joseph said...

Hi Padre - The science in this book was very educational and fascinating.

Carol said...

Thanks for such a thorough review, Brian. I too, would like to read something that covers the pandemic globally, for obvious reasons, but even reading about the USA outbreak would be very interesting. I didn’t know that it actually started in the USA.

Rachel said...

Great review. I've had this book on my shelves for quite a while. I'm not in a place in life right now where I can read heavy books, so it probably won't get read for a while. But it's good to know it's a good book!

Brian Joseph said...

Thanks Carol - A more international study would be interesting. I also did not know that it started in the United States.

Brian Joseph said...

Thanks Rachel. I would say that one should be ready to take on books such as these before digging into them.

the bookworm said...

This is a timely read, I watched something once on the Spanish flu and was surprised to see it didn't even start in Spain.
Fantastic post as usual.

Brian Joseph said...

Thanks Naida. I too was surprised that it started in Kansas.