John M. Barry

Books: History | Medicine | Disease

The Great Influenza: The Story of the Deadliest Pandemic in History (2004/2009/2018)

I started this immediately after finishing Gina Kolata's book on the flu. Interestingly, these books work well together. This book looks at things up to and during the outbreak, Kolata’s book is during and after the outbreak.

This book covers a lot, and it’s hard to boil it down to a brief review.

It starts out looking at the state of medicine in the United States, which was … terrible.

In research and education especially, American medicine lagged far behind, and that made practice lag as well.

While for decades European medical schools had, for example, required students to have a solid background in chemistry, biology, and other sciences, as late as 1900, it was more difficult to get into a respectable American college than into an American medical school. At least one hundred U.S. medical schools would accept any man— but not woman— willing to pay tuition.

I do not love writing notes on my kindle screen. And it’s even more frustrating when I’m lying in bed in the almost dark reading. Yet I took the time to here.

American medicine became as wild and democratic as the frontier. In the 1700s Britain had relaxed licensing standards for physicians. Now several state legislatures did away with the licensing of physicians entirely.

So, my note, in it’s entirety, was, "Wut?" but I think that’s a perfect summation. There are even more horrific bits, but it certainly explains why people would actually have a (VALID) mistrust of the entire field of medicine in the US.

There is also a good deal about politics and how that affected the outbreak in the US.

So army regulations— written for health reasons— detailing how much space each man should have were violated, and men were stacked in bunks with insufficient clothing and bedding and inadequate heating. That forced them to huddle ever more closely together around stoves.

Royal Copeland, head of the New York City health department, and the port health officer jointly stated there was "not the slightest danger of an epidemic" because the disease seldom attacks "a well-nourished people." (Even had he been right, a study by his own health department had just concluded that 20 percent of city schoolchildren were malnourished.) He took no action whatsoever to prevent the spread of infection.

And then there was president Wilson. He has almost nothing good to say about Wilson.

And so the United States entered the war filled with a sense of selfless mission, believing glory still possible, and still keeping itself separate from what it regarded as the corrupt Old World. It fought alongside Britain, France, Italy, and Russia not as an "ally" but as an "Associated Power."

Anyone who believed that Wilson’s reluctant embrace of war meant that he would not prosecute it aggressively knew nothing of him. He was one of those rare men who believed almost to the point of mental illness in his own righteousness.

Wilson pushed the Espionage Act through a cooperative Congress, which balked only at legalizing outright press censorship— despite Wilson’s calling it "an imperative necessity."

There is science here, but rather basic science.

Influenza is an RNA virus. So are HIV and the coronavirus. And of all RNA viruses, influenza and HIV are among those that mutate the fastest. The influenza virus mutates so fast that 99 percent of the 100,000 to 1 million new viruses that burst out of a cell in the reproduction process are too defective to infect another cell and reproduce again. But that still leaves between 1,000 and 10,000 viruses that can infect another cell.

What is especially fascinating is that throughout the epidemic they knew the disease was influenza, but they did not know specifically what caused the disease–most researchers believed it was caused by a bacteria, rather than a virus. I find that fascinating, since it clarifies just how much of an unknown these doctors and researchers were battling.

And unsurprisingly, there were many passages that caused one to reflect upon where we are right now.

Closing saloons and theaters and churches meant nothing if significant numbers of people continued to climb onto streetcars, continued to go to work, continued to go to the grocer.

In a city or town, the cycle from first case to the end of a local epidemic in 1918 generally ran six to eight weeks. In the army camps, with the men packed so densely, the cycle took usually three to four weeks.

And here’s something else to scare you.

Contemporary observers also linked influenza to an increase in Parkinson’s disease a decade later. (Some have theorized that the patients in Oliver Sacks’s The Awakening were victims of the 1918 influenza pandemic.) … Menninger spoke of the "almost unequalled neurotoxicity of influenza" and noted that two-thirds of those diagnosed with schizophrenia after an attack of influenza had completely recovered five years later. Recovery from schizophrenia is extremely rare, suggesting that some reparable process had caused the initial symptoms.  …  In 1927 the American Medical Association’s review of hundreds of medical journal articles from around the world concluded: "There seems to be general agreement that influenza may act on the brain.  …  In 1992 an investigator studying the connection between suicide and the war instead concluded, "World War I did not influence suicide; the Great Influenza Epidemic caused it to increase."

I do want to briefly note some of the negatives of this story. He goes into a LOT of detail about the backstories and histories of the doctors and scientists who changed medicine and studied influenza. My apologizes to those men, but I don’t care. I wanted to know about the science and the medicine and the politics and how those created and contributed to the epidemic. I get they’re important, but I don’t really care. Sorry.

In short:

Don’t read this book if you want to feel better about how we are dealing with the COVID-19 epidemic. The parallels between the mistakes made then, and the mistakes being made now, are terrifying.

Publisher: Penguin Books  Rating: 7/10