BOOK REVIEW
THE GREAT INFLUENZA: THE STORY OF
THE DEADLIEST PANDEMIC IN HISTORY
AUTHOR: JOHN M. BARRY.
PUBLISHED: PENGUIN BOOKS (OCTOBER 4, 2005)
Reviewed by Goetz Kloecker, MD, MSPH
This very detailed and thoughtful
description of the world’s deadliest
pandemic, that began in 1918, gives
you the eerie sense of a Greek tragedy
that may foretell our near future.
You become increasingly fatalistic
as you read.
The H1N1 Influenza pandemic started at
the end of World War I and took between 35 and 100 million lives.
Considering the present world population of 8 billion, this would
be equivalent to 150 to 425 million deaths. A regular influenza
season kills 650,00 people worldwide. The 2007-2008 return of
the H1N1 flu killed at least 5 million and possibly up to 20 million
worldwide–estimates from different countries vary greatly.
This 546-page book was published in 2004, with a new afterword
added in 2018. It’s clearly prescient of the present pandemic. History
reminds us that all the recorded pandemics from 1889 on have
arrived in waves. The great influenza of 1918 came in three waves,
starting in June 1918, subsiding for two months, then violently
erupting for three months in fall 1918 and again in spring 1919.
The author stresses the importance of a good surveillance system,
since even a few weeks of delaying stopgap/lockdown interventions
can make all the difference, as the next wave attacks us.
A vaccine would be the ideal solution. We’ve been trying since
the virus was identified in 1931 by Richard Shope, based on Paul
Lewis’ work during a swine epidemic by the same virus. However,
a universal vaccine has been elusive for more than 70 years. The
virus never stays still; it’s a mutating target.
With resignation, the author notes that isolation and strict hygiene
help, but are not feasible for a very prolonged time. He points
out that masks are only helpful when worn properly. Will children
wear them? Will the public wear them for weeks and weeks, months
and months?
The book describes the response in 1918 by elected leaders,
the press, the public and scientists in fascinating and grim detail.
President Wilson, focused on WWI, never addressed the epidemic
in public. He fell ill at the time of the Versailles peace treaty–some
historians suspect from influenza. The author theorizes that without
Wilson’s illness, the treaty would have been more balanced, and
this may have avoided the disastrous consequences which set the
stage for WWII.
The author portrays the surgeon general from 1912-1920, Rupert
Blue, MD, as an example of the slow and casual response by the
federal administration, blocking publications and research on this
terrifying killer, as these could interfere with morale during war
times. This influenza strain killed quickly by releasing a cytokine
storm or later by a bacterial superinfection. Hemophilus influenza
was for the longest time thought to be the pathogen responsible,
ergo its misnomer.
This “new” strain of influenza had struck Camp Funston, Kansas,
first in March 1918. The 56,000 young troops had been drafted and
were attacked hard by the virus in their improvised, overcrowded
and cold quarters. Thousands were ill within weeks. The influenza
virus of 1918 was uniquely vicious affecting the young adults as
much as infants and the elderly. Many health care workers died.
From Camp Funston, the virus spread to other camps, and was
shipped with the young men out to the world. More died from the
virus than from the Great War itself.
6 LOUISVILLE MEDICINE