Review of the Great Influenza: The Story of the Deadliest Pandemic in History

Written by John Barry, The Great Influenza not only tells the story of the so-called Spanish flu that knocked the world off its feet in 1918-19, it also gives the medical and social background of the events leading up to the pandemic. The last section of the book discusses the impact of the pandemic on political, cultural, and medical history. Thus, The Great Influenza is not just a book about the flu. It places the H1N1 Spanish flu into its historical context and demonstrates how a worldwide pandemic can leave ripples on the surface of human culture for decades.

The book opens with a detailed discussion of medical history, going all the way back to Hippocrates. Some readers may be put off by the level of detail, preferring to go straight to the facts about the pandemic. However, in my opinion it is well worth the time and energy to slog through the descriptions of medical pioneers and their discoveries, because the reader becomes aware of the relative newness of many medical practices. At the time of the pandemic, viruses were a new concept, a fact which partially prevented the understanding of the illness among researchers who expected a bacterial cause. Antibiotics had not yet been discovered either, and practices such as bloodletting were still used by many physicians.

The mortality of the H1N1 flu strain which began attacking U.S. soldiers in spring of 1918 was excessive as compared to ordinary seasonal influenza. The fact that most countries in the developed world were at war and therefore imposing strict censorship of the press kept people from realizing how serious the pandemic was until it was too late. In fact, the name of the disease ("Spanish" flu) probably resulted from the neutral stance of Spain and the lack of censorship there. Citizen morale was high priority in countries such as the United States, so publication of bad news was not permitted. According to Barry, some of the deaths could have been prevented if public health measures (such as quarantines) had been put into effect sooner, but these measures would have required admitting that there was a problem, and all such negativity was prohibited.

Barry discusses the background and personality of the major figures in medicine during the early 20th century, integrating this information into the overall puzzle presented by the pandemic. Although the book focuses on the United States, conditions in Europe and the rest of the world are included as well. One of the most astonishing facts about the Spanish flu was its spread throughout the world, even to the most remote islands, unless a given area imposed a strict quarantine with no one permitted to enter or leave, no exceptions. Few areas chose to be this strict, and inevitably influenza made its way in, sometimes all but destroying entire tribes and island civilizations.

After the third wave of the pandemic had passed and influenza mortality was reduced to its normal seasonal levels, medical researchers took what they had learned and carried it forward. The devastation of the flu undoubtedly inspired the rapid development of vaccines, antibiotics, antivirals, and other treatments as the century continued. Fleming discovered penicillin, the "wonder drug," and the structure of DNA was uncovered by Watson and Crick, both partly related to the impact of H1N1 Spanish flu.

Finally, Barry addresses the topic of biological warfare. Although it is unlikely that influenza itself would be used in a biological attack, the information gathered through study of the flu virus is important in our understanding of possible bioterror agents. Many of these agents are viruses like influenza; others are toxins which produce symptoms similar to the pneumonia of the Spanish flu (e.g. anthrax).

Basic knowledge of world history and biology is assumed in The Great Influenza, but Barry provides excellent explanations of the more technical details. I highly recommend this book to all college-educated readers. Individuals with interests in 20th century history or medicine will especially appreciate it.