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It was influenza, only influenza....
on March 23, 2004
This book is a sobering wake-up call to those of us who fret about exotic diseases like smallpox and the Ebola virus when we should be worrying instead about "only" influenza. Barry does an excellent job of describing why and how the 1918 influenza epidemic was so lethal, and he does not shy away from the disquieting conclusion that another lethal epidemic is inevitable. Moreover, it is clear that the greater mobility and density of modern life will work to our disadvantage when the next epidemic hits.
This book was extremely well-researched, exhaustive, and well-written. However, it was not without its disappointments. First and foremost, the book got off to an extremely slow start, devoting approximately the first third to a detailed (and largely unnecessary) history of medicine throughout classical times and, in particular, the 19th century in the United States. Particularly grating was the author's rather gushing portrayal of the establishment of the Johns Hopkins University, a fine institution to be sure, but not quite deserving of the idolatry displayed by Barry.
More generally, I was disappointed that so much of the book was devoted to institutional reactions to the epidemic, and less time and space was devoted to the human aspects of the story. The parts of the book I enjoyed the most were when Barry presented people's individual experiences with the epidemic, as revealed in letters, books, and interviews. These anecdotes conveyed much more vividly what it must have been like to live through the fear and panic wreaked by the epidemic. Alas, this kind of detail was in the minority in this very long book, which tended to stress instead the system-level reactions to the epidemic, for example, the (irritatingly apathetic) response of the military.
Do these criticisms mean that the book is bad? No, not at all; it just means that it is a more scholarly work, intended to place the epidemic within a larger historical context, rather than provide an oral history of what it was like to live through the epidemic. Thus it is probably unfair of me to criticize it for not being something it did not intend to be; I'm just saying that readers who want primarily the more sensationalized, personalized story of the epidemic may very well be bored and frustrated by this book.
I also wish the author had devoted more time than the brief chapter he included on discussing what lessons we can learn from the 1918 epidemic in helping us to cope with the (inevitable) next influenza epidemic. To me, the most interesting and provocative finding of the book was the author's description of how a very few communities were able to escape the epidemic virtually unscathed, and this was through a rapid response to the encroaching epidemic accompanied by a drastic and total closing of city borders. Quite simply, the areas that did not lose any lives to the epidemics were the towns that did not allow anybody to come in. This policy was effective where no other measures (wearing masks, shutting down public meetings, making spitting a crime) were, but the legal and logistical implications of such isolationism are staggering, and I wish Barry had explored them in depth. I wish this because--even though it is only influenza--we will probably in our lifetimes be confronted with such a crisis. Barry's book does an excellent job of explaining why we should be terrified at this prospect, but it falls short in telling us what we can do to minimize it.