The Great Influenza: The Epic Story of the Deadliest Plague in History
By John M. Barry
Viking, 546 pages, $29.95
Historians of medicine often face a somewhat sickening ethical dilemma. As citizens, they–like all of us–wish for the good health of their fellow human beings. As scholars, though, they–perhaps with a secret guilt–quietly rejoice when “their” diseases surface at the same time their books appear in print. For example, when I began to research smallpox 15 years ago, few members of the public cared about this supposedly eradicated disease. Because of increased fears about bioterrorism and the controversial–and ultimately unsuccessful–attempt by federal authorities to vaccinate key medical personnel, however, people’s attention to the pox has picked up. So, naturally, has my friends’ curiosity about my work on that brutal disease. And I’ll admit, their interest provides me a certain happiness, alongside the dread that any responsible citizen should have when contemplating the (admittedly remote) possibility of a smallpox outbreak.
I don’t know if John Barry feels guilty. Really, he shouldn’t. But he has certainly hit the history-of-medicine jackpot big-time, and with a big-time book. “The Great Influenza” is a monumental story of the 1918 influenza pandemic that became, in the words of Barry’s subtitle, the deadliest plague in history. (Unlike a mere epidemic, a pandemic spreads across a wide geographic area, in this case the entire globe.) Barry worked seven years on his self-styled epic. Of course, he did not intend for his book to appear in the midst of a global influenza crisis that has done much to shape the last few months’ front pages. Yet, ironically, the current flu emergency is his good fortune–and ours. For as unlucky as we are to have to worry about influenza once again, Barry’s book is not just a masterful narrative of the events of 1918 but also an authoritative and disturbing morality tale of science, politics and culture that diagnoses much of what continues to ail us in matters of epidemic disease.
It is difficult to underestimate the horror of the 1918 influenza pandemic. Barry is a master of the telling detail, and his multitude of anecdotes reeks of death. The most agonizing come from an unflinching look at bodies: bodies where lungs fill up with blood that bubbles out the mouth; bodies that are in unimaginable, racking pain (this influenza was no ordinary 24-hour bug); bodies that pile up in hospital hallways and in tenement apartments because public health officials are either too ill or too overwhelmed, or even too fearful, to handle their disposition. “The Great Influenza” is a painfully colorful, as well as powerfully intelligent, addition to historical scholarship on the 1918 pandemic, which includes such fine books as “America’s Forgotten Pandemic: The Influenza of 1918,” by Alfred Crosby, and Gina Kolata’s “Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It.”
But Barry does not just have a flair for deadly detail. He also understands influenza so well that he is able to offer crystal-clear explanations of the most basic, as well as the most difficult, biological workings of the disease. Along the way we learn much about principles of immunology, mutant swarms of transformed viruses and the “antigen drift” that causes influenza to appear each year in a new and often unexpected form, making it difficult even today for pharmaceutical companies to formulate the correct annual flu vaccine.
Barry also knows how to connect the cold abstractions of science with the sheer horror of the awful death tolls. Consider a single grim statistic: 759 people died in Philadelphia on one day in October 1918 (the city’s normal weekly mortality rate was 485). The final summing up of all deaths was a minimum of 675,000 in the U.S., and 20 million worldwide. The much more likely figure for the global total was 50 million to 100 million. While the 1918 flu’s claim on the unflattering title of “deadliest plague” in human history is suspect, given the role of several diseases in killing American Indians after their first contact with Europeans, the pandemic clearly killed more people than the black plague did in the Middle Ages or AIDS has in our own time.
One of the strengths of Barry’s book is that it goes well beyond these medical facts and figures. Barry also explores a wide variety of social and political subjects as he seeks to show how Americans came to grips with the influenza terror. He takes us regularly to Philadelphia to show how corrupt politicians and public health officials, in the supposed spirit of keeping up popular morale, refused to acknowledge the seriousness of the illness. This ultimately forced the city’s powerful first families to restore order. He takes us to the overcrowded and underheated World War I Army camps in the U.S. that served as the first kindling for the pandemic. And he takes us to the nearly totalitarian national-security state that President Woodrow Wilson created once he decided to commit the U.S. to the Great War. That state was a beast that would go to almost any lengths to fight a war to make America safe for democracy but that would go to almost no lengths to ensure the health of its own citizens. Indeed, there are plenty of contemporary echoes, muted but presumably intentional, in Barry’s account of wartime intolerance, press censorship and politicians’ abdication of responsibility and refusal to face the facts.
More than anywhere else, Barry takes us into the world of modern scientific medicine–the world of universities, laboratories, conferences and institutes. Indeed, Barry’s book is something of a twofer. We pay for our book on the 1918 influenza crisis and receive, at no extra charge, a treatise on the development of modern epidemiology and the new spirit of professionalization that “transformed American medicine from the most backward in the developed world into the best in the world.” Yet for those who never dreamt that the origins of Johns Hopkins University, the ambitions of the Rockefeller Institute, or the politics of the surgeon general’s office would be the stuff of popular history, Barry places front and center intelligent, charismatic and determined scientists such as William Welch, Oswald Avery, William Gorgas and Paul Lewis. We begin to care about these individuals not only because of the momentous achievements that occurred in their laboratories, but also because Barry provides us with at least some sense of their personal quirks and the reasons why they devoted themselves so single-mindedly to science.
Barry’s two books-within-a-book, both of them fascinating, unfortunately do not always work with a unified purpose. For example, it takes Barry an awfully long time before he even mentions influenza in much depth. Before then, he is too busy with the Greeks and other early medical philosophers, with the development of the scientific spirit in its struggle against religious and medical orthodoxy, and with the reconstruction of American medical education.
Yet Barry’s two books work against each other in an even more fundamental manner. Barry not only writes epic history, he writes old-fashioned epic history, in which larger-than-life characters seize their day, think the unthinkable and perform great feats of heroism. We are clearly meant to admire these giants of the earth, these “men of genius” who “amidst near-utter chaos . . . sought the coolness of contemplation, the utter calm that precedes not philosophizing but grim, determined action.”
It is not difficult to make the case for the significance, and at times even the heroism, of Welch and his colleagues. Barry does not, however, seem to recognize the irony of doing so within the context of the influenza pandemic. For while scientists spent untold hours desperately trying to force their laboratories to yield serums and vaccines to halt the march of death, they largely failed. The scientists themselves had no problems recognizing this. As one of the despairing medical detectives, Victor Vaughan, grumbled, ” ‘Doctors know no more about this flu than 14th century Florentine doctors had known about the Black Death.’ ” The pandemic of 1918, therefore, staggered dangerously into 1919 and 1920, simply killing a bit more gently than before. Medical officials kept up their fruitless search for a specific disease-causing agent as the flu viruses continued to mutate, burning up their stock of human containers and then burrowing underground, ready to strike again, and again. In the end, Barry’s attempt to make Welch and his colleagues the god-like figures of American medical success halts before the sticky fact of those 50 million deaths. Barry celebrates them as “warriors,” but the Johns Hopkins professors and the Rockefeller Institute researchers lost almost all of their battles. They certainly lost the larger war against influenza, and to this day the flu holds the upper hand.
Even when some of Barry’s arguments fail to persuade, though, he remains one of the liveliest historians around. (An earlier book of his, “Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America,” is an even grander tale of politics, race and nature.) Barry is a journalist with a sweeping style that consistently focuses on real human beings, and he cares deeply and unapologetically about morality and politics. There is neither a cheap pseudo-objectivity nor a cheap fashionable politics on display in “The Great Influenza.” Barry does overwrite at times; he forgets to control his italics, and his ellipses are . . . well . . . occasionally a bit too dramatic, as if a computer program slipped them in because an “epic” account demanded them.
That said, Barry has done a remarkable service in writing “The Great Influenza.”
First, he comes close to scaring the hell out of us, because he offers no simple reassurance that modern medicine will be able to keep future outbreaks of influenza under control. The implicit lesson is that we likely have to give up our dream of conquering many diseases, instead learning to live with them–and die by them.
Second, and despite his focus on “a handful of extraordinary people,” Barry reminds us that we will not be able to deal effectively with horrifying epidemic disease unless we have a strong political culture that demands honesty and hard choices from our leaders. Virtuous scientists, working heroically in their laboratories, of course have their place as we face an unknown multitude of coming plagues. Yet we must never become so scared that we relinquish our obligation as citizens to hold accountable those to whom we would ordinarily defer. The result of such an abdication, Barry makes clear, would not just be the death of democracy, but perhaps even the loss of our very lives.
