Customer Reviews

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

5 star:		(112)
4 star:		(75)
3 star:		(37)
2 star:		(12)
1 star:		(9)

 

 

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.

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...

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.

A startling fact about a plague that devastated humanity --one which occurred within the lifespan of many still alive today-- is the collective amnesia that so often surrounds that event.

Few Americans realize that it's probable that they have a family member only a generation or two ago who fell prey to the deadly Spanish Flu pandemic; tales of when the cry "bring out your dead!" echoed along American streets were seldom passed from those who witnessed it to those of us who descended from the survivors. It takes a trip to virtually any cemetery to bring the death toll home to us, as marker after marker identifies the victims of the 1918 flu pandemic.

With THE GREAT INFLUENZA, author John Berry provides illumination on what is perhaps the most horrific epidemilogical holocaust in human history-- the deaths in 1918-1919 of at least 40 million humans, and very likely as many as 100 million, within a timespan measured in months.

Chillingly, Barry's examination of the Spanish Flu worldwide epidemic is timely indeed.

As I write this, an avian influenza virus not unlike that which triggered the 1918 pandemic, if forcing the mass slaughter of chickens and other birds throughout Asia. It is an attempt to forestall the very real possibility that the virus (which already has infected human victims through bird-to-human transmission, and currently has a 70 percent mortality rate among human victims) could acquire genes which would allow for human-to-human transmission.

During research for my own novel, FINAL EPIDEMIC, I interviewed dozens of medical researchers and epidemeologists. Without exception, each stated that their greatest fear was a resurgence of a influenza virus similar to the 1918 variant, which through incubation in humans mutated into a unprecedented killer of humanity. Based on the cyclic nature of flu pandemics, I was told, mankind was already overdue-- and, worse: woefully unprepared-- for such an emerging viral Shiva.

Barry's research is intense and impressively documented; he cites in detail the historical record so painstakingly compiled by such fellow medical historians as Alfred W. Crosby, author of the definitive AMERICA'S FORGOTTEN PANDEMIC: THE INFLUENZA OF 1918, and draws compellingly upon the news accounts and diaries written during as the lethal pandemic raged worldwide. His detailed account of the individuals who revolutionized medicine in the U.S. --in the process, fortitiously preparing medical science for the coming conflict with influenza-- provides a valuable perspective on the portrait Barry paints.

Barry writes in a style that is gripping yet avoids the tone of sensationalim he could so easily have fallen into, given the terrifying nature of his subject. Influenza was, and remains, a universal threat: As A.W. Crosby wrote in his own classic examination of the 1918 Spanish Flu, "I know how not to get AIDS. I don't know how not to get the flu."

THE GREAT INFLUENZA deserves to be ranked among the best medical-oriented histories in print today. It also deserves the attention of any who recognize that in the past lies the potential calamity of our future.

In John M. Barry's THE GREAT INFLUENZA, we see that lethal potential all too clearly.

--Earl Merkel
Author, FINAL EPIDEMIC (PenguinPutnam 2002)
and DIRTY FIRE (PenguinPutnam 2003)

Upon completion of this book, one is left with mixed feelings. Almost immediately it becomes apparent that an enormous effort went into researching and writing the story. At the same time one can't escape the sense that the author struggled in the beginning with how he envisioned the structure of the book. For the first quarter of the book (roughly 140 pages), the readers suffers thorough agonizing details about the conditions of the medical schools in America at the beginning of the nineteenth century. Page after page, line after line, tiresome details of political influence and academic struggles to build the best medical system in the world (for one who is interested only in the Influenza pandemic, this appeared intrusive and out of place. Part 1 through 4 reads like a PR campaign for Johns Hopkins University. The question lingers - Why? ).

To learn truly about the devastating effects of the disease, I highly recommend skipping to part 5 and reading all the way through part 10. This portion of the book tells a gruesome story and by far represents the most in-depth material I've been able to find on the spread of the infections, statistical numbers of the death toll, as well as the measures undertaken by public officials (or lack of) to protect the public.

Unfortunately, the remainder of the book dips into unnecessary biographical information of semi-successful researches hunting for the Influenza pathogen. If short on time, skip to the new Afterward, in which the author posses some critical questions regarding the current state of preparedness should another pandemic hit the world.

Overall, the book is good, but it drags in places. It is only worth for its research into the spread of the disease and its destructive effects.

-by Simon Cleveland

I found John M. Barry's book on the 1918 influenza pandemic riveting. I am a certified nurse-midwife, and I found the discussion of the scientists involved in the search for a cure especially fascinating. He brought these men and women alive for me. I could almost feel the pressure they must have felt to find some way to stop the mass dying.

His coverage of the government's (Woodrow Wilson, to be specific) mishandling of the crisis shocked me - it forever changed my concept of Woodrow Wilson as a man and as a president.

I am a real history lover, and I would recommend this book to anyone interested in the time-period, the subject matter or medical science in the early 20th century. It was excellent.

This book is that rare combination of interesting writing and thorough research. Indeed it was hard to put down until I reached the middle of the book, when ironically the discussion of the epidemic itself bogged down. I frankly could have done with just a tad less drama (...it was, after all, just the flu). You get the irony of that statement if you've read the book. But really, isn't this tragedy enough drama in itself?

One of the aspects that I quite enjoyed in this book was the in-depth history of American medical education and educators. I also liked learning about the people who were researching desperately trying to find answers.

I thoroughly enjoyed this book and am glad I spent both the money and the time.

After reading Barry's story of the flu epidemic of 1918, you'll think twice before dismissing stories of SARS, bird flu and the like as overblown. Barry starts with a fascinating discussion of the state of medicine in the late 19c., when what we think of today as the scientific method was virtually unknown in the US. Medicine was practiced based not on experimentation and observation but on so-called logic. Take bleeding for example--a patient with a fever is red and flushed--bleed him and the flush goes away. Logical? sure! Good medicine? No! It's hard for us to imagine that our grandparents survived in this environment. But early in the 20c. a few key leaders in medicine headed to Europe and learned what we think of today as standard experimental techniques. Research centers were formed, medical schools founded, philanthropists got interested.

But then WWI began, and the medical establishment was completely overwhelmed by the epidemic. Barry's story gets very interesting as he details how the federal government tried to hush up the mounting death toll in the name of preserving morale, how the military refused to stop transports of soldiers despite knowing how many would die before they even reached the field of battle, how political machines in several cities, especially Philadelphia and New York, failed to react. Ultimately medicine could do little, except wait for the virus to burn itself out.

As I write the genetic code for the virus of 1918 has just been published in the journal Nature. We now know it was a bird flu. At the same time we hear stories nearly every day as the new bird flu virus creeps westward from Asia into Europe. For the Western Hemisphere, it's probably only a matter of time.

And that's Barry's point--it can and will happen again.

Barry sometimes over-sensationalizes his tale, citing horror stories of people boarding the trolley at the end of the workday, only to die before their stop is reached. And his tales of mass graves and the ugly deaths some suffered are repeated over and over. But by and large his facts are correct. But could it happen again?

Yes and no, I think. There is no cure for a virus, only vaccines. We've all read of the logistical impossibility of creating and manufacturing a vaccine in quantities sufficient to stop such an epidemic. And this virus still has an amazing ability to cross species, mutate, and spread.

But. . .in 1918 the scientists didn't even know it was a virus, and endless effort was wasted trying to track the bacteria which most thought was the cause. In addition, in this age of instant communication, it's hard to imagine the government being able to block the news of an epidemic, especially with the amount of media attention it's already received. We do have antibiotics, which were unheard of back then, to cure some secondary infections. And our understanding of hygiene is far advanced.

But no one knows for sure, and that's what is a little scary about this story. I recommend it!

Taken as a complete work, this book is quite in-depth and well researched. Unfortunately, I found that I was almost "forcing" myself to sit down and read, not because the book didn't serve up a wealth of statistical data, dates, or overall information, but because I felt as though it read rather like a textbook. I began reading this book with the hope that I would get a definitive picture of the state of medical science at the time, the various political actions,and the general living conditions that contributed to the development, spread and eventual world-wide explosion of the influenza outbreak...and I did. Unfortunately, the work comes off as sterile, cold and academic instead of evoking the "Oh my God! How horrible it must have been" reaction I was expecting to experience. I came away with a host of information, but no real appreciation of the emotion of the time period. I had hoped to reach the end of this book with a feeling as though I had just lived through and experienced this epidemic but, unfortunately, that was not my strongest feeling. I, in fact, was MOST thankful that I'd simply made it to the end of the book!

Secondly, I certainly went into this book well prepared, being familiar with laboratory and medical techniques and terminology secondary to a 20 year nursing career. The interested reader that is unfamiliar with these aspects could easily have been soon put off from the book as Mr. Barry quickly defines medical/scientific terms for the reader in some instances and, in others, leaves them hanging for several paragraphs before providing that key information...or worse yet, never providing it at all!

Lastly, this book became irritating in the sense of deja vu that you get while reading it. Mr. Barry's incredibly distracting habit of repeating himself really diminishes from the quality of this work. The further I read into the book, the more I realized that I was reading short paragraphs that I had encountered in previous chapters. It became so distracting to me that I actually found myself more interested in going back in the book to find where I'd read a certain paragraph the FIRST time, than I was in continuing to read on. I also noted one particular phrase that was repeated over and over and over and over (you get the idea) in this book, "This was influenza, only influenza". I understand that this statement is a device to express that, due to the fact that this illness was "only influenza", it's effects were completely underestimated and, therefore, inadequately handled on all fronts. The purpose of the statement is NOT what I take exception to. It was quite effective the first time it appeared. What I DO take exception to is the sheer number of times this one statement recurs in this book. Again, it was quite distracting to this reader and detracts from the overall quality of the writing.

In summary, I think this book DOES have a lot to offer, but for the reader that is looking for a more historical or political perspective on the causes and effects of the influenza pandemic of 1918-19. For the reader that is interested equally in the historical, political and MEDICAL effects of diseases/epidemics, they are much better advised to reach for a copy of Richard Preston's, The Hot Zone...and prepare for a terrifying ride!

This book covers a lot of ground and Barry has done some great research. What Barry does not do is maintain a consistently engaging narrative. As others have noted, the book could have used some judicious editing. It probably could have lost 100 pages in my view.

The first part of the book where Barry describes the evolution of medical practice and research is quite interesting, as is the story of the initial outbreak of influenza in the U.S. and its spread through military camps. However, after that, the book loses its way, as Barry often provides more detail than is necessary and skips around too often, which appears to be a result of his trying to cover too much ground. When giving examples of things (e.g. stories of deaths) Barry often provides a dozen examples when a few would do. He skips from city to city in the U.S., discussions of scientists, their research and their personal lives, WWI stories, local government responses, etc. As a reader, I wanted to follow more of a timeline as the epidemic spread and people reacted or didn't react, the epidemic died down, then resurged in a second wave, etc. As a result of Barry flitting from topic topic, the timeline is lost.

The book does provide some very interesting historical information on the influenza epidemic as well as some excellent backround on the epidemiology of viruses that a layman can understand. Worth reading for the interesting parts, but I recommend skimming much of the middle part of the book.