Product Description

In the winter of 1918, at the height of WWI, history’s most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as 100 million people worldwide. It killed more people in twenty-four weeks than AIDS has killed in twenty-four years, more in a year than the Black Death killed in a century. But this was not the Middle Ages, and 1918 marked the first collision of science and epidemic disease. Magisterial in its breadth of perspective and depth of research, John M. Barry weaves together multiple narratives, with characters ranging from William Welch (founder of Johns Hopkins Medical School) to John D. Rockefeller and Woodrow Wilson. Ultimately a tale of triumph amid tragedy, this crisis provides a precise and sobering model for our world as we confront AIDS, bioterrorism, and other, as yet unknown, diseases.

Product Details

• Amazon Sales Rank: #30102 in Books
• Published on: 2004-02-01
• Format: Bargain Price
• Number of items: 1
• Binding: Hardcover
• 546 pages

From Publishers Weekly
In 1918, a plague swept across the world virtually without warning, killing healthy young adults as well as vulnerable infants and the elderly. Hospitals and morgues were quickly overwhelmed; in Philadelphia, 4,597 people died in one week alone and bodies piled up on the streets to be carted off to mass graves. But this was not the dreaded Black Death-it was "only influenza." In this sweeping history, Barry (Rising Tide) explores how the deadly confluence of biology (a swiftly mutating flu virus that can pass between animals and humans) and politics (President Wilson's all-out war effort in WWI) created conditions in which the virus thrived, killing more than 50 million worldwide and perhaps as many as 100 million in just a year. Overcrowded military camps and wide-ranging troop deployments allowed the highly contagious flu to spread quickly; transport ships became "floating caskets." Yet the U.S. government refused to shift priorities away from the war and, in effect, ignored the crisis. Shortages of doctors and nurses hurt military and civilian populations alike, and the ineptitude of public health officials exacerbated the death toll. In Philadelphia, the hardest-hit municipality in the U.S., "the entire city government had done nothing" to either contain the disease or assist afflicted families. Instead, official lies and misinformation, Barry argues, created a climate of "fear... [that] threatened to break the society apart." Barry captures the sense of panic and despair that overwhelmed stricken communities and hits hard at those who failed to use their power to protect the public good. He also describes the work of the dedicated researchers who rushed to find the cause of the disease and create vaccines. Flu shots are widely available today because of their heroic efforts, yet we remain vulnerable to a virus that can mutate to a deadly strain without warning. Society's ability to survive another devastating flu pandemic, Barry argues, is as much a political question as a medical one.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

From the New England Journal of Medicine, August 5, 2004
The connection among public health, epidemic disease, and politics can be seen throughout history, from the responses to the Black Death in Italian cities in 1348 to the response -- or lack thereof -- to the resurgence of tuberculosis on the part of the New York City Department of Health in the 1980s. John M. Barry spells out this connection in fascinating detail in The Great Influenza. In his meticulous description of the dire consequences that resulted when short-term political expediency trumped the health of the public during the 1918 influenza pandemic, Barry reminds his readers that the government response to an epidemic is all too often colored by the politics of the moment. Barry is neither a scientist nor a professional historian, and some of the details he gives on virology and immunology are clearly targeted at a nonmedical audience, but physicians and scientists will find this book engrossing nonetheless. The influenza pandemic of 1918, the worst pandemic in history, killed more people than died in World War I and more than the tens of millions who have died, to date, in the AIDS pandemic. Barry focuses only on what was occurring in the United States at the time, and he tries to place this unprecedented human disaster both against the background of American history and within the context of the history of medicine. He is right to try to acquaint the reader with the state of American medicine at the turn of the last century, focusing on the dismal status of medical education and laboratory research, particularly as compared with that in Europe at the same time. Much of his discussion centers on "great men" (and an occasional great woman), however, and the picture given of their lives and professional careers is superficial and occasionally repetitious, and it distracts from the main events. His point, presumably, is to convey the futility of all the efforts of these brilliant minds, and he begins and ends the book with anecdotes about Paul Lewis, a scientist who had helped to prove that poliomyelitis is caused by a virus and then developed a highly effective simian vaccine. Lewis is the symbol of the best and the brightest of the scientific establishment, and we follow him as he weaves in and out of the story. He, like all scientists of his time, failed to grasp the fact that influenza was caused by a virus, believing it to be caused by Pfeiffer's bacillus, and he was therefore unable to develop a successful vaccine or to halt the devastation. The book becomes riveting once Barry begins to describe the origins and early weeks of the epidemic. The fact that it was wartime and that hundreds of thousands of men were being called up, placed in overcrowded camps, and packed like sardines into ships to be delivered as efficiently as possible to Europe enabled influenza to spread rapidly among recruits. From the military camps, the virus spread into the civilian population in the United States and from the United States to France. Barry describes the first catastrophe at Camp Devens, in Massachusetts, in the late summer of 1918, where thousands of previously healthy men in their prime suddenly became critically ill, overwhelming the inadequate camp hospital, infecting the medical staff, and dying by the hundreds, apparently with acute respiratory distress syndrome. The smartest and most hardworking scientists, physicians, and nurses, both military and civilian, were stunned by the rapidity of the disease progression and the inexplicable death toll among the youngest and strongest. (Figure) Barry provides a fascinating picture of the response of the government -- both federal and local. The former was sluggish at best and secretive and dishonest at worst, desperate to keep the war effort going and the public calm and to minimize the severity of the disease. In one of the more gripping chapters, Barry focuses on Philadelphia and tells us of the backwardness of its social infrastructure, the lack of a functioning health department, and the power of the local political machine. Dr. Wilmer Krusen, a political appointee who was the director of the Philadelphia Department of Public Health and Charities, deliberately ignored warnings against allowing a Liberty Loan parade to proceed, even though influenza had devastated the local Navy Yard and begun to spread into the civilian population. Within 72 hours of the parade, every bed in Philadelphia's 31 hospitals was filled. Within 10 days the epidemic exploded from a few hundred civilian cases to hundreds of thousands and from a daily rate of one or two deaths to hundreds. The horror is most vivid in the dilemma surrounding the disposal of bodies. The city morgue had hundreds of bodies stacked up, which produced an unbearable stench, and undertakers rapidly ran out of coffins. Hundreds of bodies lay in homes exactly where they had been at the time of death; burial quickly became impossible, since there were not enough people to dig graves. Whether anything might have been done differently, and if it had, whether this would have made a difference, are questions that Barry leaves unanswered. His tone is often irritatingly and unnecessarily sensationalist. But his indictment of the public authorities for their dishonesty and deliberate minimization of the damage and dangers is particularly chilling in today's climate of bioterrorism, in the midst of a war whose damages and dangers have been similarly minimized. Barry makes it all too easy to imagine a similarly devastating epidemic with a similarly inadequate response. I highly recommend this book to all. Karen Brudney, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

From The Washington Post's Book World/washingtonpost.com

At the time of the influenza pandemic of 1918, the stately, plump William Henry Welch was one of the most famous doctors in the world, even though he had not touched a patient since 1884. And while he was a renowned expert in microbiology and pathology and apprised of every cutting-edge medical advance of the early 20th century, he rarely ventured into the laboratory, let alone made any discoveries that might win him the coveted Nobel Prize.

In fact, Welch's singularly greatest accomplishments were organizational. In 1889, he helped found the Johns Hopkins Hospital and, a few years later, its famed medical school. Under Welch's watch, "the Johns Hopkins" became the vanguard medical institution in the world. A rotund, balding, cigar-puffing, high-voiced man with a pointy Imperial beard, at one time or another he was president or director of just about every important national medical institution then in existence. "Popsy," as his students called him behind his back, was so powerful that he could make or break a budding young physician's career "almost by the flick of a wrist." So it was hardly surprising that President Woodrow Wilson asked him to orchestrate a medical response to an influenza epidemic spreading rapidly through army training camps, killing soldiers in droves before they ever had the chance to go overseas to fight in what we now call World War I.

When the newly commissioned Col. Welch and his medical team visited Camp Devins, just outside of Boston, in late September 1918, the sight was chilling. One colleague, the equally overweight dean of the University of Michigan Medical School, Victor Vaughan, reported that "dead bodies are stacked about the morgue like cord wood." In the autopsy suite, Welch turned pale at the sight of the cadavers' blue and swollen lungs. It was hardly the gruesome procedure of dissection that made Dr. Welch so queasy. In his long career, he had presided over tens of thousands of post-mortem examinations. Instead, he realized that he was witnessing evidence of a new and terrible plague. One long-time assistant later recalled that it was the only time he ever saw the imperturbable Welch really worried and disturbed.

Before the worldwide pandemic subsided, at least 40 million people died. And a miserable death it was: incendiary fevers followed by intense muscle aches, delirium, profuse bleeding and suffocating chest congestion. Roughly 10 percent of the dead were young adults. During the Renaissance, Italian physicians thought that a celestial "influence" caused influenza, hence its quaint name. In 1918, at the dawn of our scientific understanding of virology, scientists did not have a clue as to what made that year's strain so lethal. They still don't.

Although we have several other superb histories of the 1918 influenza pandemic, John M. Barry presents a fascinating look at how the epidemic spread and how physicians and researchers rallied to mobilize against a global health crisis. Barry also supplies useful profiles of the American microbe hunters who struggled to stem the tide -- and shows in turn how their work was shaped by the vast transformations in American medicine that began around 1900, most especially the increasing ability not only to treat dreaded diseases but to halt or prevent them entirely. By synthesizing the work of several accomplished historians of medicine, Barry produces a sharp account of the epidemic's sudden onset, as well as the no less dramatic (and sometimes panicked) responses that it inspired. Barry also underlines the dismaying speed with which many survivors forgot the great influenza outbreak almost as soon as it appeared to end.

At present, around the world, approximately 500,000 people die annually of influenza, most of them the elderly, infants or those with severe illnesses. Although this year's flu season seems to be winding down, many health officials stay awake at night worrying that eventually something will change in the virus's structure as it did in 1918 to create a devastating pandemic. As Barry describes, the influenza virus can rapidly disguise the very features that allow our bodies to fend it off -- and that, indeed, is why we all need a flu shot every season. It is also why virologists and vaccine manufacturers need to do a better job of predicting which strain of influenza will prevail each year and ensuring that there is enough vaccine to go around.

Paradoxically, the success we enjoyed during the 20th century in taming contagious diseases such as influenza often inspires a false confidence that we have conquered microbes. And this has prompted us to underfund public health programs designed to prevent new epidemics from occurring. But if we learn anything from the history of influenza, not to mention the lessons unfolding daily in an era of SARS, bird flu and other newly emerging infections, it should be that we never really conquer germs; we merely wrestle them to a draw.

Reviewed by Howard Markel

Copyright 2004, The Washington Post Co. All Rights Reserved.

Customer Reviews

Great history of medicine and the early 20th Century
Although I purchased this book a couple of years ago, I hadn't gotten to it until just now. I moved it to the top of my To Read list after finishing The Last Town on Earth, which is a fictionalized account of the 1918 flu. I wasn't expecting the detailed history of how our medical profession modernized, and the history of the origins of Johns Hopkins, although I was pleasantly surprised to find it here. I also found the general policies instituted by the Wilson administration, utterly suppressing free speech and any discord about the war very interesting. The only problem I had with the book was excessive repetiveness -- sometimes I wondered if I were somehow re-reading a page I had read before, as descriptions or quotations were restated verbatim in several parts of the book. There were also excessive descriptions of similar events in different towns that didn't truly add to the book's point -- the impact and experience of the 1918 flu. Certain parts were reminiscent of The Coming Plague (another book which I highly recommend), and if you enjoyed that book, you will enjoy this one as well. I am very glad to have the knowledge gained by reading this book, and the only reason I gave it 4 stars instead of 5 was the repetiveness of many of its points -- the book could have easily been 100 pages shorter with some good editing.

A Hot Read
A detailed look at the horrible influenza epidemic that decimated not only the United States but most of the world in 1918, killing tens of millions and sickening many more. An excellent job of explaining the biological and medical complexities of the disease, detailing the history of often shoddy medical education in the United States, and relating the Spanish flu's human and emotional toll through vivid anecdotes of personal hardship and horror. The book reads well as a medical detective story and history, and also presents a useful lesson on the falsehoods routinely issued by government leaders and newspapers in the United States in a misguided effort to keep morale "positive," theoretically to help the war effort.

The Great Influenza
I liked this book it is a big thick book that takes a long time to read. If you enjoy history and you know it repeats itself. It is an interesting book to buy.