- Hardcover: 560 pages
- Publisher: Viking Adult; 1 edition (February 9, 2004)
- Language: English
- ISBN-10: 0670894737
- ISBN-13: 978-0670894734
- Product Dimensions: 6.4 x 1.7 x 9.6 inches
- Shipping Weight: 2 pounds (View shipping rates and policies)
- Average Customer Review: 562 customer reviews
- Amazon Best Sellers Rank: #618,584 in Books (See Top 100 in Books)
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The Great Influenza: The Epic Story of the Deadliest Plague in History 1st Edition
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From Publishers Weekly
In 1918, a plague swept across the world virtually without warning, killing healthy young adults as well as vulnerable infants and the elderly. Hospitals and morgues were quickly overwhelmed; in Philadelphia, 4,597 people died in one week alone and bodies piled up on the streets to be carted off to mass graves. But this was not the dreaded Black Death-it was "only influenza." In this sweeping history, Barry (Rising Tide) explores how the deadly confluence of biology (a swiftly mutating flu virus that can pass between animals and humans) and politics (President Wilson's all-out war effort in WWI) created conditions in which the virus thrived, killing more than 50 million worldwide and perhaps as many as 100 million in just a year. Overcrowded military camps and wide-ranging troop deployments allowed the highly contagious flu to spread quickly; transport ships became "floating caskets." Yet the U.S. government refused to shift priorities away from the war and, in effect, ignored the crisis. Shortages of doctors and nurses hurt military and civilian populations alike, and the ineptitude of public health officials exacerbated the death toll. In Philadelphia, the hardest-hit municipality in the U.S., "the entire city government had done nothing" to either contain the disease or assist afflicted families. Instead, official lies and misinformation, Barry argues, created a climate of "fear... [that] threatened to break the society apart." Barry captures the sense of panic and despair that overwhelmed stricken communities and hits hard at those who failed to use their power to protect the public good. He also describes the work of the dedicated researchers who rushed to find the cause of the disease and create vaccines. Flu shots are widely available today because of their heroic efforts, yet we remain vulnerable to a virus that can mutate to a deadly strain without warning. Society's ability to survive another devastating flu pandemic, Barry argues, is as much a political question as a medical one.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
From The New England Journal of Medicine
The connection among public health, epidemic disease, and politics can be seen throughout history, from the responses to the Black Death in Italian cities in 1348 to the response -- or lack thereof -- to the resurgence of tuberculosis on the part of the New York City Department of Health in the 1980s. John M. Barry spells out this connection in fascinating detail in The Great Influenza. In his meticulous description of the dire consequences that resulted when short-term political expediency trumped the health of the public during the 1918 influenza pandemic, Barry reminds his readers that the government response to an epidemic is all too often colored by the politics of the moment. Barry is neither a scientist nor a professional historian, and some of the details he gives on virology and immunology are clearly targeted at a nonmedical audience, but physicians and scientists will find this book engrossing nonetheless. The influenza pandemic of 1918, the worst pandemic in history, killed more people than died in World War I and more than the tens of millions who have died, to date, in the AIDS pandemic. Barry focuses only on what was occurring in the United States at the time, and he tries to place this unprecedented human disaster both against the background of American history and within the context of the history of medicine. He is right to try to acquaint the reader with the state of American medicine at the turn of the last century, focusing on the dismal status of medical education and laboratory research, particularly as compared with that in Europe at the same time. Much of his discussion centers on "great men" (and an occasional great woman), however, and the picture given of their lives and professional careers is superficial and occasionally repetitious, and it distracts from the main events. His point, presumably, is to convey the futility of all the efforts of these brilliant minds, and he begins and ends the book with anecdotes about Paul Lewis, a scientist who had helped to prove that poliomyelitis is caused by a virus and then developed a highly effective simian vaccine. Lewis is the symbol of the best and the brightest of the scientific establishment, and we follow him as he weaves in and out of the story. He, like all scientists of his time, failed to grasp the fact that influenza was caused by a virus, believing it to be caused by Pfeiffer's bacillus, and he was therefore unable to develop a successful vaccine or to halt the devastation. The book becomes riveting once Barry begins to describe the origins and early weeks of the epidemic. The fact that it was wartime and that hundreds of thousands of men were being called up, placed in overcrowded camps, and packed like sardines into ships to be delivered as efficiently as possible to Europe enabled influenza to spread rapidly among recruits. From the military camps, the virus spread into the civilian population in the United States and from the United States to France. Barry describes the first catastrophe at Camp Devens, in Massachusetts, in the late summer of 1918, where thousands of previously healthy men in their prime suddenly became critically ill, overwhelming the inadequate camp hospital, infecting the medical staff, and dying by the hundreds, apparently with acute respiratory distress syndrome. The smartest and most hardworking scientists, physicians, and nurses, both military and civilian, were stunned by the rapidity of the disease progression and the inexplicable death toll among the youngest and strongest. (Figure) Barry provides a fascinating picture of the response of the government -- both federal and local. The former was sluggish at best and secretive and dishonest at worst, desperate to keep the war effort going and the public calm and to minimize the severity of the disease. In one of the more gripping chapters, Barry focuses on Philadelphia and tells us of the backwardness of its social infrastructure, the lack of a functioning health department, and the power of the local political machine. Dr. Wilmer Krusen, a political appointee who was the director of the Philadelphia Department of Public Health and Charities, deliberately ignored warnings against allowing a Liberty Loan parade to proceed, even though influenza had devastated the local Navy Yard and begun to spread into the civilian population. Within 72 hours of the parade, every bed in Philadelphia's 31 hospitals was filled. Within 10 days the epidemic exploded from a few hundred civilian cases to hundreds of thousands and from a daily rate of one or two deaths to hundreds. The horror is most vivid in the dilemma surrounding the disposal of bodies. The city morgue had hundreds of bodies stacked up, which produced an unbearable stench, and undertakers rapidly ran out of coffins. Hundreds of bodies lay in homes exactly where they had been at the time of death; burial quickly became impossible, since there were not enough people to dig graves. Whether anything might have been done differently, and if it had, whether this would have made a difference, are questions that Barry leaves unanswered. His tone is often irritatingly and unnecessarily sensationalist. But his indictment of the public authorities for their dishonesty and deliberate minimization of the damage and dangers is particularly chilling in today's climate of bioterrorism, in the midst of a war whose damages and dangers have been similarly minimized. Barry makes it all too easy to imagine a similarly devastating epidemic with a similarly inadequate response. I highly recommend this book to all. Karen Brudney, M.D.
Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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The book is well researched, yet the key element that makes the book readable is the narrative about the state of medical science, medical schools and their evolution at the start of the 20th century. Then the historical context is set up for the events that followed. There is also a detailed account of why the pandemic took such a toll on the world.
Every year we are told to get vaccinated against the flu. After reading this book and having lost my son to the flu, the book gave me a deeper understanding of the forces at work and why sometimes the outcome can be so deadly.
I highly recommend this book.
The disease is popularly known as the Spanish Influenza but Barry argues that it may have come from Kansas. As World War I was ramping up, the draft pulled thousands of young men into overcrowded camps for training. A couple of men came from an area in Kansas where people complained of influenza symptoms. "On March 4 a private at [Camp] Funston, a cook, reported ill with influenza at sick call. Within three weeks more than eleven hundred soldiers were sick enough to be admitted to the hospital, and thousands more - the precise number was not recorded - needed treatment at infirmaries scattered around the base." [Loc 1576]
Within a matter of weeks "like falling dominoes, other camps erupted with influenza. In total, twenty-four of the thirty-six largest army camps experienced an influenza outbreak that spring. Thirty of the fifty largest cities in the country, most of them adjacent to military facilities, also suffered an April spike in 'excess mortality' from influenza, although that did not become clear except in hindsight." [Loc 2636]
This was the first wave of the disease. Overall, through three waves "[e]pidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million."[Loc 149 ]
Barry covers the technical details of the virus which invades cells that have energy and then, like some alien puppet master, subverts them, takes them over, forces them to make thousands, and in some cases hundreds of thousands, of new viruses" [Loc 1606] The influenza virus is incredibly nimble mutating very quickly. It would soon turn more deadly. "When the 1918 virus jumped from animals to people and began to spread, it may have suffered a shock of its own as it adapted to a new species. Although it always retained hints of virulence, this shock may well have weakened it, making it relatively mild; then, as it became better and better at infections its new hose, it turned lethal" [Loc 2767]
It was up to humans to try to contain it. William Henry Welch led the charge. He was responsible for pulling medicine from the dark ages into the scientific era. "Welch had turned the Hopkins model into a force. He and colleagues at Michigan, at Penn, at Harvard, and at a handful of other schools had in effect first formed an elite group of senior officers of an army; then, in an amazingly brief time, they had revolutionized American medicine, created and expanded the officer corps, and begun training their army, an army of scientists and scientifically grounded physicians." [Loc 1457]
Prior to modernization medical students did not perform autopsies or see patients; rather they took art of less than a year of lectures. [Loc 569]. Welch and his colleagues brought the scientific method to studying the disease. "It was the first great collision between a natural force and a society that included individuals who refused either to submit to that force or to simply call upon divine intervention to save themselves from it, individuals who instead were determined to confront this force directly, with a developing technology and with their minds." [Loc 168] This battle is the primary focus of the book; Barry does a wonderful job bringing these people to life.
Although they were not immediately successful in stopping influenza, they did know how to combat its spread. Here we look through Barry's third lens on the disease. Caught up in war fever, the military and public officials paid no mind. Warned to quarantine transferring soldiers, the military changed nothing. This caused the spread of the disease to the camps and to the war in Europe.
Public officials did little either. Often these officials were products of political machines such as Tammany Hall in New York who achieved their post due to connections rather than any skill. At the same time information was not published in the press for morale reasons. As a result people were fearful - they knew the disease was in their midst but there was no information on what to do - even though the scientists and provided information. "As terrifying as the disease was, the press made it more so. They terrified by making little of it, for what officials and the press said bore no relationship to what people saw and touched and smelled and endured." [Loc 5199]
The head of the Public Health Service - made part of the military by Woodrow Wilson - "had done nothing ... to prepare the Public Health Service, much less the country for the onslaught." [Loc 4804] Even though the military draft was suspended, "Blue still did not organize a response to the emergency. Instead, ... [he] reiterated to the press that there was no cause for alarm." [Loc 4825]
The second wave of the disease was much more lethal there were not enough doctors and nurses to treat the afflicted. Harriet Ferell recalled "an open truck came through the neighborhood and picked up the bodies. There was no place to put them, there was no room." [Loc 5082]
Although the entire social system was on the verge of collapse and the industrial output of the country was in peril [Loc 5165] "no national official ever publicly acknowledged the danger of influenza." [Loc 5188]
On the political front, Barry argues that Woodrow Wilson contracted influenza at the peace talks and his weakened condition caused him to give in to French demands for reparations thus setting the conditions for World War II. [Loc 6062]
Influenza is serious and though we have vaccines to combat certain strains it still has the potential to kill hundreds of thousands of people in the United States. The Center for Disease Control says that the worst case scenario 422,000 Americans would die. [Loc 7064]
John M. Barry deftly pulls together the three strands of history, the development of modern medicine, and the importance of public health policy to weave a fascinating story of this deadly period.
Barry blames public officials for their ineptness at handling this pandemic. "Those in authority must retain the public's trust. The way to do that is to distort nothing, to put the best face on nothing, to try to manipulate no one. Lincoln said that first, and best. Leadership must make whatever horror exists concrete. Only then will people be able to break it apart."[Loc 7230]
Let me stand up a little higher on my soap box here. It is clear that influenza is different from the common cold virus. It is deadly. I often hear people tell me that they got sick even though they got their flu shot. Well, they may have gotten a cold; but they probably didn't get the flu. A few years ago I called the nurse advice line thinking I had the flu. The nurse asked if I could stand up; when I said "yes" she said, you don't have the flu. If you had the flu you probably wouldn't be able to make a phone call. Do yourself a favor; get the annual flu vaccine.
As long as this reading report is, you probably figure I've covered it all or even transposed it. But I've only scratched the surface. Although this is a narrow subject it is a fascinating read.