“It seemed now as if there had never been life before the epidemic. The disease informed every action of every person in the city.”
On the heels of The Great War—now better known as World War I—a much more rapacious killer swept the globe, leaving a death toll that dwarfed the war in its invisible wake. As the influenza pandemic raged, medical scientists practically took up residence in their laboratories, seeking the elusive pathogen that was piling up bodies on their doorsteps. Wave after wave broke over the globe, but still the cause, a treatment, a vaccine, remained just beyond grasp. Recently modernized, American medical science clashed with nature and fell short, despite the concerted efforts of investigators such as Paul A. Lewis, Oswald Avery, and the team of William H. Park and Anna Wessel Williams. John M. Barry combines war, disease, and history of medicine in this account of 1918 flu pandemic, which remains one of the deadliest in human history.
The Great Influenza is broadly interested in the history of medicine, and specifically the evolution of the American medical tradition, and how it came to be transformed and modernized, finally becoming a scientific endeavour. Barry goes so far back as the Hippocratic and Galenic medical traditions, tracing progress through Paracelsus and Vesalius before discussing the stagnation of medical progress, and America’s late arrival to the scientific medical revolution. He spends significant time on the establishment of Johns Hopkins in 1876, the first modern medical laboratory in the United States to be modeled after state of the art institutions in Europe. The hospital and medical school would be added later, and for the first time prospective doctors in the United States would be required to have a college degree, as well as be fluent in French and German for admission. The establishment and contributions of the Rockefeller Institute also receive significant attention, if not quite as much detail as Johns Hopkins. This contextualization takes up about the first quarter of the book before Barry turns his attention to the pandemic proper.
Barry begins in Kansas in January and February of 1918, following Dr. Loring Miner, who observed an unusually violent influenza among his rural patients that winter which may have been the forerunner of what is now thought of as the first spring wave of a pandemic that would ultimately take as many as 100 million lives. He then turns his attention to Camp Funston, also located in Kansas. Although he briefly acknowledges that the exact origin of the outbreak is not proven, he considers this the most likely, and proceeds from there. From army camp to laboratory to naval shipyard to community spread, Barry follows the pathogen, and the people who were trying to identify it, and create a treatment or vaccine. Barry’s account of the pandemic is largely Amerocentric. (For a book with a slightly more global perspective, I would recommend Pale Rider by Laura Spinney.) Late in the book Barry makes a brief circuit of the globe, with cursory accounts of the death tolls in various locales, but this is not the focus of the book. On the home front, he uses Philadelphia as a particular case study. The city was home to a naval shipyard, and held the Liberty Loan Parade to raise money for war bonds in late September of 1918, just as the deadly second wave was breaking upon the city. The results were catastrophic, almost apocalyptic.
At times Barry seems to wish he was writing a biography, with figures such as William Henry Welch, Paul A. Lewis, and—to a lesser degree—Oswald Avery occupying large amounts of his attention, even taking time to detail lulls in their careers when they were not making significant contributions. Welch, though not much of a laboratory scientist himself, was a key player in the transformation of the American medical establishment, and an important mentor and power broker in the field. Both Lewis and Avery spent the war and the years that followed in the laboratory investigating influenza, but neither would identify the virus, and their most signal scientific accomplishments would be in other areas. Lewis would be remembered largely for his work on polio, and Avery for his ground breaking discoveries regarding DNA. Both the war and the pandemic would pass, and it would be the 1930s before the virus was at last discovered. This receives only cursory attention in the final section.
A significant cautionary note that emerges from The Great Influenza is the danger of government misinformation and inaction. Because of the war, information about influenza was tightly repressed, as it was believed to have a negative influence on morale. As Barry puts it, “What officials and the press said bore no relationship to what people saw and touched and smelled and endured.” In practice, the cognitive dissonance of seeing friends and neighbours dying all around while the press and government continued to print reassurances that there was nothing to be concerned about proved significantly more destructive to the social fabric. Trust eroded, and in the absence of reliable information, people simply had to fend for themselves. Read in the current circumstances of the COVID-19 pandemic, this makes The Great Influenza a chilling combination of reassurance and despair. It—which is to say the disease itself—could be so much worse, and yet more than a hundred years later, we are still making so many of the same mistakes.
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