Product Description

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 months than AIDS 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 and now revised to reflect the growing danger of the avian flu, The Great Influenza is ultimately a tale of triumph amid tragedy, which provides us with a precise and sobering model as we confront the epidemics looming on our own horizon. John M. Barry has written a new afterword for this edition that brings us up to speed on the terrible threat of the avian flu and suggest ways in which we might head off another flu pandemic.

Product Details

• Amazon Sales Rank: #7734 in Books
• Published on: 2005-10-04
• Original language: English
• Number of items: 1
• Binding: Paperback
• 546 pages

Features

• ISBN13: 9780143036494
• Condition: NEW
• Notes: Brand New from Publisher. No Remainder Mark.
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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
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

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

The Great Influenza: The American Experience
In The Great Influenza, John Barry has produced a massive and exhaustively researched description of one of the greatest disasters of human history. At least, from the American point of view. While there are a few glancing references to what was going on in the rest of the world, there is no serious discussion of any attempts to deal with the pandemic in other countries, even in other industrialized countries. On the other hand, Barry has chosen a very specific point of view: the transition of American medicine and medical training from folk wisdom to science. It's a compelling point on which to balance a long and exhaustive (there's that word again) study of how America and, specifically, American medicine confronted an epidemic in which people were dying faster than the technology of the time could handle, an epidemic in which society itself was nearly overwhelmed by death.

As other reviewers have noted, the book's weakness is a tendency towards melodrama, as in the far-too-often repeated tag line "This was influenza. Only influenza." After a while, you think to yourself, "Yes, we get it. Give it a rest."

On the other hand, the book has one of those quirky displays of real brilliance in the last two chapters in which Barry deals with how science is done well (in the case of Oswald Avery) or done poorly (in the case of Paul A. Lewis). These two chapters are so strong that they could stand on their own, and what they have to say about the process of scientific thought itself is fascinating. Avery's story is that of a man who was just relentessly focused, who kept digging deeper and deeper into a single issue until he discovered the source of heredity itself. Lewis's story, on the other hand, is that of a man who simply lost his way. Distracted by the need to administer an institute, the need constantly to raise money, to deal with the politics of science, the need to socialize and just plain hustle to support the work of others, Lewis lost the focus that Avery had and ending up flailing in a sea of theories and methodologies. In fact, if you don't read any other part of this book, read these two chapters.

There is no question about The Great Influenza being a monumental work. It's so good that you just have to overlook the bits of melodrama that pop up from time to time. The research is, well I obviously can't use "exhaustive" again, so let's say nearly encyclodedic. In fact, there's so much research, and so much documentation that Barry has used an odd method of footnoting. Instead of using footnote numbers that refer to the notes section at the end of the book, you have to turn to the notes section and find the specific page and text being referenced. Unfortunately, as a result you don't know while you're reading which bits have footnotes and which don't. I'd prefer actual footnote numbers. Ah, well. I'm sure it seemed like a good idea at the time.

In any case, Barry has produced a massive and important work of epidemiological history which is, at the same time, as readable as a thriller. In writing this review, I kept wavering between giving it four stars or five stars and finally decided on five based on the scope, the thoroughness, and what Aristotle would call the "point of attack," that is, the point at which the story really begins, which is, in this case, the birth of truly scientific medical education in America. All in all, it's a truly fascinating and immensely readable piece of history.

Sobering look at a deadly pandemic...
A book that recently caught my eye was one by John Barry titled The Great Influenza - The Epic Story Of The Deadliest Plague In History. Now, I generally have a phobia about needles, and have *never* received a flu vaccination, but I think that will change next year. This was scary stuff...

Barry details the Spanish influenza pandemic of 1918 in great detail. He starts by setting the stage of how American medicine was practiced at the end of the 19th century, and how there was little control or respect for the profession. And rightly so... Nearly anyone could call themselves a doctor and do nearly anything. But through the efforts of a few key people, John Hopkins university was formed to bring the medical education up to European standards. Most of this transformation was occuring when the flu pandemic started. This is where the book gets interesting... and frightening.

Because of World War 1, recruits were overcrowded into training facilities that were less than sanitary. When the flu first broke out in one of the army camps in the states, it was quickly transferred to other camps when soldiers transferred. From there, it easily jumped into major cities, decimating large numbers of people. And when these soldiers went overseas, the flu went with them. Being especially contagious, it swept the globe in short order and left, by some estimates, over 100 million dead. That is so hard to comprehend.

When you look at the struggle they had to even identify the cause of the illness, you understand how it could so easily run rampant. One would think that it couldn't happen today, but one would be wrong. SARS, AIDS... diseases that defy attempts to quickly identify the virus, and are resistant to attempts and efforts to treat them. It's not hard to imagine how a pandemic could start so much more quickly today due to the ease of worldwide travel.

Well worth reading to understand how precarious the general health of society could be...

Roughly half of this book is a "must read" -- the rest of it is terrible!
As an initial, rough draft, this manuscript shows amazing potential as an important look at a terrifying and prescient topic. As a finished work, it is the most poorly edited book I've ever read.

In the acknowledgments, Barry writes the most important thing that the reader needs to know about getting through this book: "This book was initially supposed to be a straightforward story of the deadliest epidemic in human history, told from the perspectives of both scientists who tried to fight it and political leaders who tried to respond to it....Instead....it didn't seem possible to write about the scientists without exploring the nature of American medicine...." He was wrong. Rather than the exploration of American medicine being essential, enlightening, or even remotely relevant, the result is two completely unrelated books in one. One book is a terrifying and page-turning "straightfoward story of the deadliest epidemic in human history." The other book is a mind-numbingly boring list of names of doctors and scientists, descriptions of university politics, and confusing explanations of experiments that have nothing to do with the influenza pandemic. In fact, on page 259 of the book, Barry says that the people who the first 89 pages are about had nothing to do with research or medical breakthroughs regarding the influenza epidemic in any way!

My favorite example of what Barry considered essential to include in this book about the 1918 pandemic is the story of a scientist named Lewis. Barry tracks Lewis's career almost to the minute. He describes the tuberculosis research that he did, talks about his job offers, how much he was offered, what contracts he declined, his marital problems, what his childrens names were, the gardening that he did in his spare time, job offers he turned down, what people said about him at lunch, more about job offers, how his tuberculosis reasearch never really went anywhere or produced any useful results and he lost the general respect and confidence of the scientists around him. Then, when the reader is waithing for how all of this incredibly boring detail somehow becomes relevant to the 1918 pandemic or influenza research, Barry describes how Lewis went to a Brazilian jungle to do yellow fever research, gave himself yellow fever and died. What does this have to do with the topic of the book? NOTHING!! What insight or perspective is to be gained from Lewis's tale? NONE!!

Including some perspective about the state of American medicine during the pandemic is crucial to the story of the pandemic, but that isn't what Barry does. He simply lists names of scientists and where they worked in a manner that is as informative and interesting as the parts of the Bible that list who begat who. His philosophy of this book is like some entertainment rag that feels it is crucial to a story about the Iraq War to list every celebrity who attended a party in Hollywood and what each of them wore. These portions of the book -- which comprise roughly half of it -- are unreadable and irrelevant.

And even the portions of the book that are incredibly fascinating and well-researched reveal a complete lack of editorial guidance. At times, Barry keeps repeating "this was after all only influenza" as some sort of misguided literary device. Repeating this over and over might seem like a good way to build gravitas to a freshman English student in a C- paper, but any competent editor would have recognized it as just irritating and pathetic and removed at least the last 1,000 instances of its use. (The number 1,000 may be a mild exaggeration.) The book also contains frequent grammatical mistakes and clumsy sentences that make me wonder if there even was an editor.

What's worse is that the book skims over incredibly interesting aspects of the pandemic. For example, the virus was called "Spanish Flu" despite that fact that Spain suffered from the flu much less than England, France, Germany or America; and despite that it probably originated in America. It became "Spanish Flu" because Spanish newspapers reported honestly about its effects while wartime censorship in England, France, Germany, and America caused the press to lie about its severity. Barry deserves credit for researching and writing a little bit about how local political corruption and grossly unconstitutional actions of the federal government aided the spread of the flu, and about how "staying the course" in WWI was partially responsible for making the pandemic so deadly. Unfortunately, he just flits over these extremely prescient and timely topics, skims the surface of icebergs, then dives back into telling the reader about what some fat guy named Welch had for dinner and that Lewis turned down an $8,000 a year job in Iowa.

Barry says that it took him seven years to write this book. My guess is that he did an extordinary amount of research in that period of time. Then, he realized that a lot of his research didn't really fit into the book and that writing it properly required doing a great deal more research into public records, government documents, and judicial opinions. This probably sounded daunting. So instead of writing the book that should have been written, he wrote half of it and filled another couple hundred pages with gibberish. And with a naked disrespect for the consumer, Penguin Books had the nerve to publish it in its current form.

I recommend buying this book used and reading the relevant portions of it. Some of the medical history is very interesting and a tiny little bit of it is relevant to the influenza pandemic. However, VERY little of the medical and scientific portions of the book are either interesting or relevant. The good news is that because these chapters have virtually nothing to do with the subject of the book, the reader can feel free to skim through them or skip some entirely without fear of missing information. I read every word of this book because I kept hoping that all of the gibberish eventually had a point. It doesn't, and I've written this review to try to save you from the same fate. In fact, if you value your time and have a low tolerance for boredom, just start reading at chapter six. From there, understand that Welch, Avery, Flexner, Lewis, etc. never emerge as having ANYTHING to do with the influenza pandemic.