Influenza 1918 (Hardcover)

by Lynette Izzoni (Author)

Editorial Reviews

From The New England Journal of Medicine
By conservative estimates, the influenza pandemic of 1918 killed 21 million to 40 million people around the world, 675,000 of them in the United States. After only 17 months, the mortality was half that attributed to the 4-year span of the Black Death in 14th-century Europe and Asia. To many, "Spanish" influenza ranks as the deadliest plague to afflict human beings in recorded history. Its origins were obscure, its pathologic features unique, and its consequences, coming in the midst of the American entry into World War I, almost unendurable. In the panic that ensued, churches and schools were closed, the Army canceled the draft, corpses overflowed mass graves in Philadelphia, and black wreaths hung from virtually every door. Influenza 1918 recounts these statistics with the clarity of a tocsin.

Even more affecting are the stories of children, now in their 80s and 90s, whose pastoral reminiscences about Sunday picnics and Thrift stamps darken at the memory of lost friends, parents, siblings, and entire families. This book, adapted in part from the information televised in The American Experience, examines with a documentarian's eye the portraits of individual Americans against the canvas of the global pandemic.

The tracing of the nearly simultaneous eruptions of influenza in coastal Spain (in February 1918) and Fort Riley, Kansas (in March 1918), is complicated by the disease's wildfire proliferation across Europe as troops in trenches, hospitals, and overloaded transports spread the infection. In April and May 1918, the disease spread through Spain and the rest of Europe, but it remained quiescent in the United States until September, when explosive illness ravaged the East Coast. Continental epidemics in Africa, South America, India, and Australia followed. A time line summarizing these outbreaks might have been helpful to the reader; although they make for an effective journalistic portrayal of the simultaneity of foci, the book's rapid-fire shifts from Europe to the United States, then to India and Australia may be confusing to some readers. The book reads like a modern newscast, with rapid cutting from one scene to the next and brief but memorable sound bites from witnesses.

However, many of the scientific questions that would occur to the lay reader, not to mention the medical expert, are left unanswered. For example, what was the origin of the virus? The book breathes mystery: "A chance encounter occurred. Perhaps between a duck and a pig. Perhaps between a duck and a man, woman, or child. Perhaps between a pig and a man." But scientific evidence has demonstrated that partial sequences from 5 of the virus's 10 genes and the entire hemagglutinin sequence are much more akin to mammalian than to avian clades (J.K. Taubenberger, et al. Initial Genetic Characterization of the 1918 "Spanish" Influenza Virus. Science 1997;275:1793-6; and A.H. Reid, et al. Origin and Evolution of the 1918 "Spanish" Influenza Virus Hemagglutinin Gene. Proceedings of the National Academy of Sciences 1999;96:1651-6). Some of this work is summarized in the epilogue, but at times a tendency toward sensationalism displaces fact.

Other readers might wish to know more about the manifestations of illness, which were described as horrifying, even in contemporaneous medical reviews. Much is made of the awful premonitions that heralded imminent collapse, of the cutaneous, genital, and pulmonary hemorrhages that appalled medical personnel, and of the astounding rapidity of death, but no extracts from medical reports published at the time are provided. In other examples, we are told variously that workers in gas and cordite factories, blacks in the South, and those with tuberculosis were mysteriously spared, but without precise footnoting, these statements appear undocumented.

Finally, almost all readers will ask, "Can this happen again?" No facts are presented to dispel this very reasonable concern. A brief discussion of international surveillance organizations -- even without mention of the nearly immediate identification of the avian variant of the Hong Kong flu in 1998 -- would have been appropriate.

The book vividly evokes the fear and terror sparked by the pandemic but discusses its clinical, epidemiologic, and virologic correlates cursorily. This is a great read for those attracted to the "you are there" approach, but in the end a dissatisfying one for those who want to know why, how, and whether again.

Reviewed by Margaret K. Hostetter, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Product Details

• Hardcover: 256 pages
• Publisher: TV Books; 1 edition (March 1999)
• Language: English
• ISBN-10: 157500108X
• ISBN-13: 978-1575001081
• Product Dimensions: 9.2 x 6.2 x 0.8 inches
• Shipping Weight: 1.1 pounds
• Average Customer Review: 3.4 out of 5 stars See all reviews (11 customer reviews)
• Amazon.com Sales Rank: #1,816,171 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

27 of 29 people found the following review helpful:

2.0 out of 5 stars Poorly organized coverage of a fascinating topic, November 4, 1999

By A Customer

It does astound me that an epidemic of this magnitude affected the world, but no one ever hears anything about it. Is it because the people who were alive then are dying out? I became interested in this topic in the course of genealogical research. I found that three family members, who were in their late teens & twenties, all died of the flu and pneumonia in September 1918. I found it difficult to locate a book on the subject, but I was happy to find this book, which had to be good since it was based on a PBS documentary. I'm sorry to say that I found this book to be so poorly organized and repetitive that I almost could not finish it. I was hoping for a book that started at the beginning, developed the theme, and ended with the end of the epidemic and a discussion of all the medical issues involved. Instead, the author talks about the war, then women in the fight against flu, then the funerals, then the war, then women again, then a few statistics, etc. Each of these topics could have been treated in separate chapters. I will try to find other books in Amazon about the flu that are more coherent.

15 of 15 people found the following review helpful:

2.0 out of 5 stars Left me wanting more., August 9, 1999

By A Customer

While I think this is a good overview of the pandemic, I wish better use had been made of the extensive interviews done for the American Experience episode upon which it was based. Even the addition of an appendix of full interviews would have been helpful. Influenza 1918 seems to have been written with the attention span of television viewers in mind -- rather than as an extension of the excellent script upon which it was based. The PBS version focused more upon the sociological effects of the flu and left me wondering if perhaps the breakdown of the American family began with the fear of exposure to the deadly virus and not with the introduction of the "glass teat." The book, on the other hand, left me wanting more history and less assumption that that the reader doesn't want to READ. Influenza 1918 is simply the latest in the trend of PBS book tie-ins that doesn't deliver the goods on a promising subject.

5 of 5 people found the following review helpful:

5.0 out of 5 stars A striking account, January 16, 2001

By	Midwest Book Review (Oregon, WI USA) - See all my reviews

This review is from: Influenza 1918 (The American Experience) (Paperback)

Influenza 1918 provides a striking account of one of the worst seasons of death in American history, exploring the actions of public officials, a panicked public, and those 675,000 who died. Influenza 1918 is more than just a historical narrative; it examines the medical community's response and the elements which made the flu so deadly on so many levels.