Book Review: The Great Influenza by John M. Barry

Here are the first three paragraphs of The Great Influenza by John M. Barry:

The Great War had brought Paul Lewis into the Navy in 1918 as a lieutenant commander, but he never seemed quite at ease when in his uniform. It never seemed to fit quite right, or to sit quite right, and he was often flustered and failed to respond properly when sailors saluted him.
Yet he was every bit a warrior, and he hunted death.
When he found it he confronted it, challenged it, tried to pin it in place like a lepidopterist pinning down a butterfly, so he could then dissect it piece by piece, analyze it, and find a way to confound it. He did so often enough that the risks he took became routine.

Sounds pretty nails, right? Later, Barry relates the gravity of the subject matter:

And they died with extraordinary ferocity and speed. Although the influenza pandemic stretched over two years, perhaps two-thirds of the deaths occurred in a period of twenty-four weeks, and more than half of those deaths occurred in even less time, from mid-September to early December 1918. Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years.

What. The. Fuck.

Events in the story of the great influenza of 1918 do not get better from there. But Barry’s writing conveys the tense and terrifying nature of what life must have been like then. To wit, from the situation in Philadelphia, things got so bad that people began to steal caskets. And then they got worse:

There were soon no caskets left to steal. Louise Apuchase remembered most vividly the lack of coffins: “A neighbor boy about seven or eight died and they used to just pick you up and wrap you up in a sheet and put you in a patrol wagon. So the mother and father screaming, ‘Let me get a macaroni box’ [for a coffin] – macaroni, any kind of pasta, used to come in this box, about 20 pounds of macaroni fit in it – ‘please please let me put him in the macaroni box, don’t take him away like that…’”

How I didn’t know about the 1918 influenza pandemic before reading this book is a mystery to me. Fortunately though, Barry’s book grounds the harrowing tales in an account of the politics, the society, and most importantly, the state of medicine at the time. This allows Barry to show that while humans were slaughtering each other in unprecedented ways in World War I, nature was doing just the same with much better results because nature’s battlefield was not limited to the fields of Europe.

The contrasts between the worlds of medicine, politics, and society on one side and the great influenza on the other is sharp, especially since the state of medicine in the decades leading up to the pandemic might be scarier than the influenza itself. In the United States, medical students did not even learn how to use microscopes. They spent eight months in medical school, graduated sometimes without grades or by passing only four of their nine courses, and were unleashed to “practice” medicine on society (since they certainly didn’t practice any of it in the university). The true power of these contrasting worlds, however, benefits the reader when Barry shows how the worlds of politics and society that we think we live in are subject to the terrors that nature occasionally wreaks.

Here is another sobering passage from the book, just in case you thought the terror was confined to Philadelphia:

During the course of the epidemic, 47 percent of all deaths in the United States, nearly half of all those who died from all causes combined – from cancer, from heart disease, from stroke, from tuberculosis, from accidents, from suicide, from murder, and from all other causes – resulted from influenza and its complications. And it killed enough to depress the average life expectancy in the United States by more than ten years.

All shock-and-awe stories aside, it is Barry’s writing style that makes this book an excellent read. He manages to balance be sober facts and the gravity of the situation with how important and intelligent the scientists fighting the flu were. And he is not afraid to adorn his prose with some philosophical lessons for our day:

Man might be defined as “modern” largely to the extent that he attempts to control, as opposed to adjust himself to, nature. In this relationship with nature, modern humanity has generally been the aggressor and a daring one at that, altering the flow of rivers, building upon geological faults, and, today, even engineering the genes of existing species. Nature has generally been languid in its response, although contentious once aroused and occasionally displaying a flair for violence.
By 1918 humankind was fully modern, and fully scientific, but too busy fighting itself to aggress against nature. Nature, however, chooses its own moments. It chose this moment to aggress against man, and it did not do so prodding languidly. For the first time, modern humanity, a humanity practicing the modern scientific method, would confront nature in its fullest rage.

The second reason I thoroughly enjoyed this book was its span. As I said earlier, in order to talk about the influenza epidemic of 1918, Barry is forced to discuss the history of medicine, the politics and society of the time, and how these relate to today. He addresses each in a clear and concise way that made it easy to balance them in my mind while following the story. They helped to inform the narrative, instead of impinge on it.

Finally, I enjoyed how relevant this topic is these days. I may not have heard about this particular flu epidemic (still not sure how that’s possible), but I have heard about another flu that has people excited. The H5N1 flu strain has people worried that Barry might soon be given enough material to write a sequel, especially since two groups of researchers have published how this strain might potentially infect humans on a large scale. If you haven’t heard of this, the always great Carl Zimmer has the run down here and here.

Barry’s book ends with a discussion of influenza today and H5N1 in particular. In the afterword to my 2005 edition, he asks three questions:

1. Will another influenza pandemic occur?
2. If so, how dangerous will it be and what threat does the H5N1 virus present?
3. How prepared are we for it and what can we do to better prepare?

The short answers to these are yes, best case: 2 – 7.4 million dead, and “at this writing, we are not prepared. At all.”

The afterword was a nice addition to help frame my thoughts on the issue. It made the book more than just a history. But if you read this book and you read the news, I don’t think you will be able to refrain from comparing the events of 1918 to today. And that is another reason I highly recommend this book.

 
 

Up next: A very lengthy review of James W. Pennebaker’s The Secret Life of Pronouns: What Our Words Say About Us.