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.