“The Great Influenza” by John M, Barry

The Great Influenza: The Story of the Deadliest Pandemic in History by John M. Barry was originally published in 2004 but re-released several times since then. This remarkable book describes not only the human disaster of the huge pandemic of 1918, but also the history of medicine and research in that era and the experiences of a number of prominent scientists. The edition I read was published before the Covid pandemic, so there are no comparisons, but of course I was constantly making comparisons in my mind as I read, and I was somewhat shocked at how much worse things were in 1918 than in 2020!

Medical sciences — both clinical and laboratory practices — were developing into their modern form at the time of the pandemic. Barry follows the work of several physicians and scientists, mostly in the United States at the Rockefeller Institute and at Johns Hopkins University. He also describes how medical schools and research institutions were then emerging into their modern form, and how medical theory and medical education were developing in the era from the 1890s until the First World War.

Here are five important things that I learned while reading about this painful and horrendous historic event:

1. The global death toll was at least 35 million and probably as high as 100 million people out of a world population much smaller than the current world population. (In the covid pandemic the current death toll according to the World Health Organization has been almost 7 million).
2. The initial explosion of vast numbers of cases of this highly contagious and gruesomely virulent disease took place in the late summer and autumn of 1918 at US military camps where tens of thousands of young men were being trained and prepared for the battlefields of World War I. The descriptions of the camps full of fatally sick and helpless youth, the stacks of bodies, the lines of cots between the prepared hospital beds, the lack of nurses and doctors, and the suffering of so many people is horrifying (and I can’t possibly begin to evoke the atmosphere that the detailed descriptions in the book create).
3. In some parts of the world, populations of entire villages and towns were 100% killed; for example, many Inuit towns in Alaska had no survivors. The death toll in many American cities was huge, but elsewhere it was much worse.
4. Researchers were only beginning to identify and define the existence of viruses at the time, and did not prove that the influenza cause was a virus until the pandemic was almost over. The details of the research were fascinating — desperately, the best of the scientists tried to find a cure or a vaccine to stop the epidemic, but they were totally unable to do so. Opportunistic bacteria caused secondary infections in a large number of victims, which amplified the death toll, and which also confounded the efforts to identify the infectious agent of the pandemic.
5. It’s well-known that the most devastated age group of the 1918 flu was young people from late adolescence through around age 40; in some parts of the US and Europe this group sustained death rates up to 9% of their cohort. Although common knowledge (as I’ve always heard it) believes that older people had immunity left over from a previous influenza epidemic, the author presents another, more convincing theory. This theory says that the extremely virulent virus caused an overwhelming immune response in many victims, which resulted in a “cytokine storm” when the body essentially overwhelms itself, especially destroying the lungs. (We heard of the same catastrophic result of the coronavirus in 2020.) Younger people have more vigorous immune systems, so were much more likely to succumb to this effect.

It’s often noted that the 1918 pandemic seems to be forgotten, considering how drastically it affected the entire world. Few memoirs and virtually no fiction (other than the story “Pale Horse, Pale Rider”) were written about it. It’s true that American newspapers of the time were heavily censored because of the war effort, but when the war was over, there still seemed to be little interest in the type of documentation and memory that usually follows earthshaking events. Barry discusses this a little, but in my opinion, he has no illuminating explanation for the amnesia that seems to have downplayed the impact of such a major event. It seems to me that this erasure of history isn’t happening in regard to the covid outbreak but it’s too soon to know anything.

The Great Influenza has a very similar set of topics to my recent reading of Foreign Bodies: Pandemics, Vaccines, and the Health of Nations by Simon Schama, which I wrote about a few days ago. I was telling a friend about the Schama book, and he recommended the book by Barry — and in fact, loaned me his copy. This explains why I read the two in quick succession!

Review © 2023 mae sander