Jump to ratings and reviews
Rate this book

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

Rate this book
At the height of WWI, history’s most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as 100 million people worldwide. It killed more people in twenty-four months than AIDS killed in twenty-four years, more in a year than the Black Death killed in a century. But this was not the Middle Ages, and 1918 marked the first collision of science and epidemic disease. Magisterial in its breadth of perspective and depth of research and now revised to reflect the growing danger of the avian flu, The Great Influenza is ultimately a tale of triumph amid tragedy, which provides us with a precise and sobering model as we confront the epidemics looming on our own horizon. John M. Barry has written a new afterword for this edition that brings us up to speed on the terrible threat of the avian flu and suggest ways in which we might head off another flu pandemic.

546 pages, Paperback

First published February 9, 2004

Loading interface...
Loading interface...

About the author

John M. Barry

15 books320 followers
John M. Barry is an American author and historian, perhaps best known for his books on the Great Mississippi Flood of 1927 the influenza pandemic of 1918 and his book on the development of the modern form of the ideas of separation of church and state and individual liberty. His most recent book is Roger Williams and the Creation of the American Soul: Church, State, and the Birth of Liberty (Viking 2012).

Barry's 1997 book Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America appeared on the New York Times Best Seller list and won the 1998 Francis Parkman Prize from the Society of American Historians for the year's best book on American history. His work on water-related issues was recognized by the National Academies of Sciences in its invitation to give the 2006 Abel Wolman Distinguished Lecture on Water Resources; he is the only non-scientist ever to give that lecture.

His 2004 book The Great Influenza: The Epic Story of the Greatest Plague in History was also a New York Times Best Seller, and won the 2005 Keck Communications Award from the United States National Academies of Science for the year's outstanding book on science or medicine. In 2005 he also won the "September 11th Award" from the Center for Biodefense and Emerging Pathogens at Brown University. He has served on a federal government's Infectious Disease Board of Experts, on the advisory board of MIT's Center for Engineering Fundamentals, and on the advisory committee at Johns Hopkins Bloomberg School of Public Health for its Center for Refugee and Disaster Response.

The expertise he developed in these two areas has involved him in policy-making, risk communication and disaster management strategies, and developing resilient communities, and this work resulted in his induction into Delta Omega, the academic honorary society for public health. More specifically, he has advised the private sector and local, state, national, and international government officials about preparing for another influenza pandemic. He has also both advised officials and taken a direct role in preparing for water-related disasters. A resident of New Orleans, after Hurricane Katrina he was also named to both the Southeast Louisiana Flood Protection Authority, which is the levee board overseeing several separate levee districts in the New Orleans area, and the state's Coastal Protection and Restoration Authority, which is responsible for hurricane protection for the entire state.

His first book, The Ambition and the Power: A true story of Washington, appeared in 1989 and explored the operation of the U.S. Congress, the use of power by Speaker of the House Jim Wright, and the rise of future Speaker Newt Gingrich. In 1995 the New York Times named it one of the eleven best books ever written on Congress and Washington.

With Steven Rosenberg, MD, Ph.D., chief of the Surgery Branch at the National Cancer Institute and a pioneer in the development of "immunotherapy" for cancer—stimulating the immune system to attack cancer—Barry co-authored his second book, The Transformed Cell: Unlocking the Mysteries of Cancer, which was published in 12 languages.

Barry has written for The New York Times, Time Magazine, Fortune, The Washington Post, Esquire, and other publications and frequently appears as a guest commentator on broadcast media.

He has also coached high school and college football, and his first published article was about blocking assignments for offensive linemen and appeared in a professional journal for coaches, Scholastic Coach.

Ratings & Reviews

What do you think?
Rate this book

Friends & Following

Create a free account to discover what your friends think of this book!

Community Reviews

5 stars
13,123 (33%)
4 stars
15,651 (39%)
3 stars
8,207 (20%)
2 stars
1,907 (4%)
1 star
582 (1%)
Displaying 1 - 30 of 4,847 reviews
Profile Image for Stephen.
13 reviews36 followers
November 8, 2007
I am really surprised at the number of positive reviews this book got, both professional and consumer. I am currently a little more than halfway through and feel the need to write something in case I don't finish it and lose the desire.

Before critiquing Barry and his writing style, or lack thereof, his editor, Wendy Wolf deserves special mention. This is the first book I have ever read in which I have made special note of the editor and will refuse to read anything she works on in the future. I was sorely tempted to tally the number of repetitions of key phrases, pieces of information and entire narrative sequences. Perhaps editing this book was too daunting a task to do it well and still preserve the intent and message, but if so, I would have quit. Wendy gets 1 star.

Before she edited it though, he wrote it. As I understand it, the 1918 Influenza outbreak, with its undercurrents of concurrent revolutions in medical science, oppressive (and at times seemingly unconstitutional) governmental policy, sheer human agony, and internationality, is replete with its own inherent drama. No additional tear-jerkers are necessary - the reporting of how 50 million people died worldwide would be plenty. Barry decides that manufactured melodrama is the most effective vehicle to convey this, however. How can one assume how people felt during a worldwide pandemic? After assuming it, how can one essentially write fiction in a non-fiction book as it is described?

In addition to his atrocious writing style, Barry seems to thread 3 or 4 books into one, and doesn't even separate them with definitive breaks in his book. In a text which is nominally about an historical event, we read biographical sketches of several men who weren't even involved in fighting the disease.

I recommend this to no one. Read the wikipedia article on '1918 Influenza'. It's probably far less annoying.

UPDATE: After getting through 300 out of 460 pages of this poorly organized, melodramatic, poor excuse for historiography, I realized I was not only wasting my time reading it, but I was also wasting my time complaining about it to my friends and family. Thats a TRIPLE waste of time. Barry is not worth this investment. I caution every one of you. Unless you want to boost your self esteem and have a John Irving moment of "Wow, I could seriously do way better than this... and this guy got published!" DO NOT READ THIS BOOK. I hope you read this, Barry, and send me an apology.

I've never written a review this bitter. Mostly because I've never been this bitter about a book.
Profile Image for Matt.
935 reviews28.6k followers
April 4, 2020
“Epidemiological evidence suggest that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe. Later it began its sweep through North America, through Europe, through South America, through Asia and Africa, through isolated islands in the Pacific, through all the wide world. In its wake followed a keening sound that rose from the throats of mourners like the wind…”
- John M. Barry, The Great Influenza

This book is what happens when I combine a smart phone, Amazon’s one-click shopping, and my low-key binge drinking.

I had just sat down in my favorite chair for my weekly wine-drunk. No sooner had I dropped some ice cubes into a pint-glass full of club soda and cheap chardonnay, than Steven Soderbergh’s Contagion began playing on HBO.

I never intended to watch the movie. Based on the trailers, I had decided that it was too much like the movie Outbreak, except with fewer monkeys and 100% less helicopter chases involving Dustin Hoffman and Cuba Gooding, Jr. Still, people who drink Yellow Tail out of pint glasses can’t be choosers, so I let the film unspool.

Like all of Soderbergh’s works, Contagion was slick, engaging, and sharply edited. As the all-star cast began dying from a mysterious and highly contagious disease, and as I started to get a buzz from that pint of cheap wine, it occurred to me that I was suddenly, desperately interested in infectious diseases.

So I bought John M. Barry’s The Great Influenza, about the so-called Spanish flu of 1918 that killed as many as 100 million people. Unlike influenza, my interest in the topic quickly wore off. It was only several months later that I finally got around to reading it.

Totally worth the drunken purchase!

Barry’s epic is a work of incredible scope and depth. It combines accessible science/medical writing, perceptive character sketches, and telling human anecdotes to corral a story – a global pandemic – that doesn’t necessarily lend itself to the written word.

(Film is the more obvious medium for pandemic stories. All you need is a computerized map of the world in a neutral color. Then, have that map start to turn red while someone intones, “24 hours…48 hours…72 hours…”).

In Barry’s words, the 1918 influenza pandemic “was the first great collision between nature and modern science.” To that end, he begins the book with a brisk, wide-ranging, and fascinating history of medicine, gradually narrowing his focus to the state of American medicine at the turn of the century. It was, in a word, deplorable. There was no consistency in education, no overarching standards, no pursuit of progress. While American doctors were still pondering the leech, Europeans were making the advances:

In Europe, governments, universities, and wealthy donors helped support medical research. In the United States, no government, institution, or philanthropist even began to approach a similar level of support. As the Hopkins medical school was opening, American theological schools enjoyed endowments of $18 million, while medical school endowments totaled $500,000…

The future of American medicine got a bit brighter with William Welch and the founding of the Johns Hopkins Medical School. Welch is one of the titanic figures in American science, a stethoscope-wearing J. Robert Oppenheimer – not necessarily a great scientist or discoverer, but a manager nonpareil. It was Welch who would lead the U.S. response to the influenza outbreak.

The Great Influenza attempts to tell a huge story. An outbreak is hard to contain in a book (and also, obviously, in real life). It is not a singular event, but a worldwide phenomenon; it does not happen in a single place, to a single person, but to everyplace, and millions of persons. Accordingly, the narrative diffuses once Barry begins the story of the flu itself (ground zero of the pandemic is hotly debated; Barry pinpoints Haskell County, Kansas, as the originating spot).

Of necessity, the story begins to hop around a lot, to locations all over the globe. There are a lot of staggering numbers (x numbers infected, y numbers dead) interspersed with illustrative stories that provide a micro view of a global disaster. For instance, Barry relates the story of an Army camp commander (World War I was the mechanism by which this disease spread so far and wide) who committed suicide after failing to take proper steps to protect and quarantine his troops.

One of Barry’s real gifts is to explain medicine and biology to a part-time drunk, full-time nonscientist such as myself. I am a concrete thinker, a literalist. My ability to imagine things I can’t see – such as biological processes – is surpassed only by my ability to do one-armed pushups while shaving. Using metaphor and analogy, Barry does a wonderful job of providing both the hard science and a simple explanation to interpret it. For instance, Barry explains how the immune response to influenza ultimately made healthy young adults the flu’s greatest victim:

Macrophages and “natural killer” cells – two kinds of white blood cells that seek and destroy all foreign invaders… – patrol the entirety of the respiratory tract and lungs. Cells in the respiratory tracts secrete enzymes that attack bacteria and some viruses (including influenza) or block them from attaching to tissue beneath the mucus, and these secretions also bring more white cells and antibacterial enzymes into a counterattack; if a virus is the invader, white blood cells also secrete interferon, which can block viral infection.

All these defenses work so well that the lungs themselves, although directly exposed to the outside air, are normally sterile.

But when the lungs do become infected, other defenses, lethal and violent defenses, come into play. For the immune system is at its core a killing machine. It targets infecting organisms, attacks with a complex arsenal of weapons – some of them savage weapons – and neutralizes or kills the invader.

The balance, however, between kill and overkill, response and overresponse, is a delicate one. The immune system can behave like a SWAT team that kills the hostage along with the hostage taker, or the army that destroys a village to save it.

The 1918 influenza pandemic killed between 21 million (according to a 1927 AMA study) and 100 million people (according to Nobel laureate and influenza researcher Macfarlane Burnet). That meant that about 5% of the population of the world died.

It is a terrifying proposition. Using today’s population numbers, the fatalities would be between 70 and 300 million people.

With all the different flu scares we’ve had, Barry was eventually obligated (perhaps by his publishers, at gunpoint) to update his book to remind us how we’re all going to die. Like all “new afterwords,” the one included at the end of The Great Influenza feels halfhearted and unnecessary. If you’ve paid attention at all to the hundreds of preceding pages, it is not difficult to extrapolate what might happen during a present-day outbreak of an infectious disease or out-of-control virus.

The thing about The Great Influenza is that it is almost always relevant. Always, there is a disease, somewhere in the world, read to spring forth. In the years since this was first published in 2004, we’ve had Ebola, SARS, and Zika to terrify us. It’s hard to know what will crop up next, and whether this will be the one to turn the map all red.

Ultimately, I don’t think I was half as terrified as I was supposed to be, mainly because I have a lot of other existential threats to worry about: cancer; heart disease; wine poisoning. Thus, I rate my chance of dying in a deadly pandemic as relatively low. I also feel that the world is more attune to these things than ever before. We no longer believe in miasma theory or the humors of our bodies. Conversely, we believe in quarantining, washing hands, and reverse-engineering both pathogens and the journeys they travel.

Still, we are living – you might have noticed – in an extremely knitted-together world. All it takes is a handful of people leaving an uncontrolled hot zone, hopping on an airplane, and starting an exponential event that only Hollywood could love, and no one can halt.

(Update, March 31, 2020: As I write this, I am in the third week of self-quarantine, following a shelter-in-place order necessitated by the spread of Covid-19. The coronavirus has definitely made the penultimate paragraph of my original review look like the work of a prize fool. Turns out, I should have been more worried about dying in a pandemic. Certainly, being stuck at home has drastically increased my risk of wine poisoning. Of course, when I wrote about the advanced state of science - back in 2013 - I had no idea how many people on this earth didn't believe in science. More to the point, I did not know that there were so many people so militantly anti-science that they would go to a hospital in the midst of a pandemic to take videos, all in an attempt to disprove a deadly, worldwide virus as some massive hoax. On second thought, maybe I was right. Maybe the virus isn't the real danger. Maybe the thing we should all fear is ourselves).
Profile Image for Mario the lone bookwolf.
805 reviews3,850 followers
June 6, 2020
Pandemics recur, just as history repeats itself, and it´s all simply a question of how much can be learned from it and how far technology has marched on.

They were at war, so they couldn´t tell that there were outbreaks, only the neutral Spain could say it without the danger of demotivating the population. Today there are mostly just trade wars anymore, but the rules have stayed the same and looking at the potential immense economical damage, the intuition of those trying to hide outbreaks was right.

The influence of such pandemics on human, primate, mammal, and rodent evolution must have been immense, as wiping out huge parts of the population or even the whole population until extinction, and might have happened many times. Without samples and more advanced technology to detect virus DNA and RNA in archeology, or to find the right fossils, it will long stay unclear how massive the impact on the development of higher life forms on the planet might have been.

The differences between 1920 and 2020 are so immense that it takes time to realize how real and ever more realistic this danger is, because we tend to believe that it can´t get so bad:
Medicine was very primitive, but we didn´t really come so much closer to a solution in preventing outbreaks and finding cures.
They didn´t have cars, planes, anything to spread it worldwide or just in a nation with such a speed as today. No freeways, just trains and some roads with horses on them. As long as the horses didn't get it, the spread was very slow.
Fewer people having not so much contact with another.
Just telephones to communicate, nothing to coordinate the efforts of a state or even a whole continent.

A large question is what population group is most affected and if, when the virus has found its prime target, it won´t mutate again and switch the victim again.

The book is not just about the Spanish flu, but also about the doctors and researches that tried to deal with it with methods that seem medieval compared to nowadays standards and by mixing the historical facts with these protagonists, it becomes very vivid for a nonfiction title. It has a bit much redundancy and it would be a five star if the author had put more focus on not repeating himself and telling very similar stories, wildly jumping between geography, personal stories, and the medicine of those days, making it all a bit blurry and unnecessary complicated to follow.

Even if nowadays governments wouldn´t be incompetent, the human factor alone is highly disturbing. Just some people who are immune to rudimentary hygiene rules and logical arguments are enough, and guess what one little piglet that refuses to wash hands, sneeze in the crook of the arm, etc. could do for spreading diseases. Not to speak of antisocial psychos who do it on purpose, try to get it, and spread it.

We didn´t write our own history, nature in the form of plagues did a lot of it and it would be arrogant and dangerous to believe that we are now so highly advanced and have so much fancy technology (and it´s a techno optimist who is saying that) that we are invulnerable, as if we already had nanobots patrolling each body and sending signals to produce individualized vaccines as soon as any invader is detected.
But we aren´t there and the incompetence, arrogance, and idiocy of the Western governments will cost many lives now and in the future, until technology will eradicate the last plagues, what is just a question of time, not of if.

There might even be already the potential for producing and developing new vaccines, testing methods, and preventive measures. But the pharma companies make no money with developing cures for plagues that might never occur and the state has no interest in investing in protecting its citizens, although this could even be seen as military research where a bit of money is invested in general. Why it´s even not possible to produce enough test kits or establish a global network of testing stations that monitor the world or to have intelligent plans for pandemics or to listen to experts or to not worsen the situation with polemics and fake news or to quarantine early enough or…
but, as said, the politicians are like: „Lalalala…..ignoring experts…..yada yada yada…. Stupid decision stupid decision stupid decision“, while unnecessary piles of corpses are exponentially growing.

Some links dealing with the current pandemic:

CNN live updates

John Hopkins CSSE world map

Youtube statistics

A wiki walk can be as refreshing to the mind as a walk through nature in this completely overrated real life outside books:
Profile Image for Dr. Appu Sasidharan (Dasfill).
1,265 reviews2,439 followers
February 26, 2023
History is not only learning about the past but also learning from the past to shape our present and the future. This book, in such a way, is not only a compendium about the Spanish flu (1918 - 1920) but also a vivid description of the pattern of the current pandemic Covid-19 (Barry wrote this book in 2004) and also the pandemic that might happen in the future. Spanish flu is something every Medico might have studied during their Med school days. Still, this book gave me so much new information which I haven’t found anywhere else.

As Bill Gates said, “Barry will teach you almost everything you need to know about one of the deadliest outbreaks in human history through this book.” Just like the striking resemblances during the repeated outbreaks of Ebola in Africa, there is a striking resemblance between the Spanish flu and the current COVID-19 outbreak (even though the former occurred a century ago)

One IMMENSE tragedy might help us to save ourselves from a more significant catastrophe in the future. We can see multiple examples of these in both pandemics. I will cite an example here.

San Francisco
After suffering from one of the worst earthquakes in the history of the United States in 1906, San Francisco was recouping when the pandemic hit the USA in 1918. According to Barry, of all the major cities in America, San Francisco confronted the fall wave most honestly and efficiently. That may have had something to do with surviving and rebuilding after the major earthquake.
Well begun is half done. Even though it is true, it doesn’t give us the liberty to be complacent or overconfident after a good beginning. It seems that it is what happened in San Francisco later during the third wave. Dr. William Hassler, Chief of San Francisco’s Board of Health, was an early advocate of taking strong preventative measures against the flu. He, however, seemed to curb his concern and went so far as to predict that influenza would not even reach San Francisco. San Franciscans had to pay very severely for it, and the third wave hit San Francisco severely.

Racism and influenza
This book also says about the vital relationship between racism and influenza. According to Barry, “The 1918 pandemic did not, in general, follow any pattern of race and class antagonism. In epidemiological terms, there was a correlation between population density and hence class and deaths. But the disease struck down everywhere and everyone almost similarly.”

Leaders in times of Crisis and Lost trust
This is a crucial topic we all are facing, especially during this pandemic. Barry says, “Whoever held power, whether it is city Government or some private gathering of the locals, generally failed to keep the community together. They failed because they lost trust. They lost trust because they lied. It is impossible to quantify how many deaths the lies caused. San Francisco was a rare exception. Its leader told the truth and the city responded heroically during the fall wave. Those in authority everywhere else reassured the people that it was just influenza, only influenza. Some people have believed them. Some people must have been exposed to the virus in ways they would not have otherwise. At least some of these people must have died who would have otherwise lived.”
Leadership is as important as the infrastructure when we are dealing with a crisis like a pandemic. The countries with excellent infrastructure suffered severely in the 1918 and 2020 pandemics due to poor leadership.

Around 5% of the world, the population was wiped out from this world within two years, with most of the deaths occurring in a span of 12 weeks. This shows how severe was the 1918 pandemic. Among the developed countries, Italy and America suffered the worst, while India suffered the worst among the developing countries in both pandemics.

Barry, in 2004, while finishing this book, said,” It’s time to start spending serious money on influenza.”

Unfortunately, we human beings didn’t do it. We had to suffer for it in 2020. We can hope that, at least by now, we have learned a lesson and we will spend an adequate amount of money to ensure that such severe outbreaks won’t happen in the future.

People are of different opinions on whether we could have prevented the current pandemic or not. But there is no doubt amongst anyone that all of us could have responded to it in a better way.
30 reviews17 followers
October 19, 2007
This book had promise, and is good in spots - but the overall product suffers greatly from lack of direction and editorial control. If I could rate the best third of the book, I would give it five stars. The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative. And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.

In the afterword, it becomes quite obvious that the author made a bad assumption at the start of his endeavor. After spending seven years researching the book, he concluded that he could not tell the story of the epidemic without covering the history medical science leading up until that time. He also wanted to write the book from the perspective of the scientists and politicians who reacted to the influenza outbreak; he seemed more interested in covering their actions than the virus itself.

These assumptions are incorrect. The most interesting and relevant portion of the book is the history of the virus itself. If Barry had simply explained how the virus worked, how it may have come into being, and then followed each wave of the epidemic in chronological order, this book would have been much more enjoyable and much shorter. Instead, he covers material which is not relevant - and by focusing on this material he breaks up his coverage of the virus, thereby rendering the best part of the book less enjoyable.

The first third of the book is dedicated to the history of modern medical science. Some of the material is of interest, but this history is not necessary for any discussion of the influenza virus. It has absolutely no impact on the remainder of the book. The reader could simply skip the first 30% of the book and would not notice it. I actually found this information to be interesting, that that does not warrant their inclusion in a 450 page book with a supposed focus on the 1918 epidemic.

The second portion of the book is the most direct discussion of the virus in the book, and it is quite good. Barry provides a brief explanation of how the virus works and why it is so successful. He then discusses the impact of the disease, rivaling any horror story while doing so. The amount of chaos and suffering caused by the outbreak is quite sobering.

During this time, Barry also discusses the prevailing political climate. As this outbreak occurred during WWI. President Wilson's desire to turn the entire country into a weapon required news of the virus to be controlled rather tightly. This was exacerbated by a good deal of corruption at lower levels of government. The result was a climate in which misinformation and inaction killed tens of thousands of Americans. This material is entirely relevant, and I actually might have liked for him to focus more on it.

The last portion of the book covers the scientific community's attempts to control the virus. This is really a misguided effort, as there is no significant discovery to work towards. While the scientists Barry introduces the reader to are all very accomplished, none of them are able to make any headway with their influenza work. The book becomes a spastic collection of various experiments carried out by a handful of scientists. The text is hard to follow as it is all over the map, and after you finish it you realized that the last third of the book is about as relevant as the first third, only less interesting. It is almost comical; one of the scientists he covers during the entire book is Paul Lewis. Towards the end of the book, after discussing Paul Lewis' troubled family life ad nauseam, and filling the reader in on all sorts of work Lewis did with tuberculosis (which had no impact on any influenza research), Barry goes on to tell us how Lewis died while working with the yellow fever in Brazil. So essentially, any mention of Paul Lewis in the book was completely superfluous.
Profile Image for Matt.
3,817 reviews12.8k followers
April 15, 2020
As the world is wrapped up in the COVID-19 pandemic, I thought that I would try to educate myself a little more on the general topic while forced to isolate with books. I have often wanted to know a little more about the Spanish Influenza of 1918-19, which was said to be one of the worst pandemics in modern times. As we are in something similar at present, I turned to John M. Barry’s book to permit me to speak with ease as it relates to the spread of infection and the reactions by the public and politicians alike. Barry opens with a jaw-dropping tale of the emergence of medical schools and their lax entrance requirements, making the moniker ‘doctor’ seem less impressive. It was only students studying in Baltimore at Johns Hopkins who were put through the motions of a significant medical education and who earned the title with some confidence. From there, the narrative moves to offer some backstory on the emergence of the influenza, citing that its ‘Spanish’ name came not from the origins, but that Spanish newspapers offered frank discussion of events taking place, not censored during the Great War. Talk of an influenza with many deaths filled the headlines, which hit the newswires and the name stuck. Barry explores the origins, based on his own research, as well as how infection ran rampant throughout Europe and soldiers from all countries involved brought it back to their homelands during troop replenishments or retreats. With the only way to travel back to America being the ship, close-quartered troops passed the infection between one another with ease, beginning an explosion of cases once troops made their way across the country. Barry examines how health officials sought to contain things and pushed for hygiene campaigns, which were only somewhat effective. Public Health officials pushed isolation, cleanliness, and the need to take precautions, as the spread ran through the country and left medical officials scrambling to contain the spread. How things seem to parallel what is taking place now, to a differing degree.

Barry offers the scientific analysis of the topic as well, discussing frankly about how viruses develop and leap from animals to humans, including how immunity develops. The novice reader can learn much about this and how medicines can help occasionally, as well as what makes the virus able to overpower the human body. There is also a great discussion about how the virus attaches itself to the body through the lungs and other air passages. This discussion not only educates the reader into how infection takes place—perhaps justifying the precautions like washing, masks, and gloves—and the speed at which things can progress. Barry pulls no punches, using early 20th century medical technology to explain how things spread with ease and what could be done to eradicate any further spread. Fitting this medical and scientific knowledge with the narrative about the historical happenings, the reader has a better understanding of the situation. While this may not arm the reader to understand the intricacies of World Health Organisation documents or the high-level analysis done by leading politicians in their briefings, Barry gives the reader a better understanding of how things were during this world scare and what parallels can be drawn to the current COVID-19 pandemic.

Peppered amongst these two major narratives is the handful of scientists who studied the influenza and sought to find cures. The interested reader will discover a great deal about immunology and how scientists must use vigorous techniques, as well as exhausting their tests on animals and humans alike, in order to eradicate what was fast becoming a horrible disease that was growing exponentially. Barry follows the work of these essential scientists throughout, from their early focus on how the influenza infected humans through the various tests and microscopic analyses. Thereafter, it was infecting and watching the results in animals that permitted scientists to come up with something that could be used to stop the spread of the influenza. This is a solid teachable moment for the reader about immunisation and its importance to keep disease away from the population. Whatever the reader feels about needles and how their children react, Barry makes a blunt plea to eradicate new strains of long dormant diseases with some simple precautionary measures. Whether these cause autism is something to COVID-19 conspiracists can bring up when fashioning tin-foil hats at their upcoming social distancing picnics.

Whether the reader is a strong believer in the health crisis COVID-19 is unleashing on the world or feels that this is a political conspiracy drummed up to hide bigger issues (I have heard people on both sides share their sentiments with me), John M. Barry’s book is highly educational and fits perfectly into how things are playing out at present. Barry offers a great deal of background on so many interesting topics, all of which are interconnected to the issues at hand. The exploration of viruses and how their emergence in other mammals can ‘leap’ to humans with relative ease explains some of the new and odd influenzas and infections that are seen across the world today. Barry does not dilute the discussion, but his explanations are digestible by most readers with a general understanding of basic medical and scientific terminology. Paired with the thorough discussion of the historical goings-on in Europe and, eventually, America, the story is more complete and the policies enacted make a great deal of sense. The reader attuned with news reports may find parallels with what was done in 1918-19 to the present reaction in the United States, though it is sure that Woodrow Wilson allowed local governments and health officials to complete their work unimpeded with false hopes and unreasonable timelines. In a number of well-documented chapters, Barry illustrates just how vast the influenza infection and battle became in America, as well as how deeply felt the deaths were to many who had no idea what was going on. The empathetic reader will likely feel some heart pain for the orphans, the families who lost loved ones overnight, and the emotional battle of giving up the bodies of those they loved, sure that mass graves would leave them unidentifiable in the future. Barry’s book is surely a great one for those who are cooped up and want to get some context, as well as the curious reader, such as myself, who wonder how reactions to past calamities compare to today’s overly dramatic delivery in the 24-hour news cycle.

Kudos, Mr Barry, for this enlightening look at an event in world history that surely has some connections to the events in today’s COVID-19 world!

This book fulfils Topic #7: Catastrophe, of the Equinox #10 Reading Challenge.

Love/hate the review? An ever-growing collection of others appears at:

A Book for All Seasons, a different sort of Book Challenge: https://www.goodreads.com/group/show/...
Profile Image for Liz.
2,141 reviews2,759 followers
October 4, 2020
This book was so much more than I expected. It provides a history of American medicine, especially the development of modern day medical schools, an explanation of viruses, histories of other epidemics. At times, the book reads like a science text. Don’t go into this expecting a light read. But kudos to Barry for making complicated subjects easy to understand.
The book walks the reader through the lead up to the Influenza, especially how the war contributed to the problems. Somethings were apparent, such as large populations from diverse areas of the country being housed together. But others, such as doctor and nurses shortages left behind in the US were less obvious. Also of note was the impact of the political machines that ran governments, from city to national and their unwillingness to alert people. Our politicians are following a long line of liars, promising no worries, no danger, things are clearing up, ok to gather together, etc. “There was terror afoot in 1918, real terror. The randomness of death brought the terror home. So did it’s speed...But as horrific as the disease itself was, public officials and the media helped create the terror - not by exaggerating the disease but by minimizing it, by trying to reassure.”
One of the main focuses of the book is on the scientists that tried to find a way to cure the influenza. Barry gives us meaningful portraits of these people, not just their attempts during this time period. Of course, as we know now, all their efforts were for naught as the flu is caused by viruses, not bacteria.
I learned a lot reading this book, especially concerning the number of waves that the flu had. I thought it was basically a one year phenomenon but it continued through 1920. According to the last chapter, the five largest flu epidemics all had five waves. Most interesting point made - Even a 99% shutdown of borders would only delay a virus by a month.
While many people don’t want to be involved in anything dealing with another influenza as we grapple with Covid-19, I felt this was the perfect time to read this. I was engrossed by where science has made progress and where we haven’t. And how human nature hasn’t changed in the slightest.
Profile Image for Lilo.
131 reviews368 followers
May 30, 2021
I read The Great Influenza last winter when the covid-19 pandemic started. I didn’t have time to write a review when I finished reading the book, and I also don’t have time to write a review now. But I want to urge everyone to get this book asap and turn right to chapter 6, where the documentation of the influenza of 1918 (also known as the “Spanish Flu”) starts. (You can read the first 5 chapters about the history of medicine later.)

Learning about the development of this pandemic will give you an idea of what might happen with covid-19 this coming winter if people continue to fail taking necessary precautions, such as wearing masks, practicing social distancing, and avoiding all unnecessary mass gatherings. It will let your hair stand up straight, not only because of the horrible disease but also because of the catastrophic mishandling of a pandemic. No, Donald Trump is not the first American president to mishandle a pandemic. Woodrow Wilson actions were just as reckless and irresponsible, even though Wilson’s motives were less selfish than Trump’s.

Btw, did you know that Woodrow Wilson’s well-known mental decline was an aftermath of his influenza infection, which he came down with while he was in Paris for negotiating WWI peace treaty conditions? Thus, the French would succeed in pushing through their ideas, which resulted in the not so very savvy Treaty of Versailles, which again laid the base for Hitler’s rise to power.

It will be difficult for later historians to evaluate whether or not Trump’s behavior after his covid-19-infection might have anything to do with the coronavirus going to his brain. Yes, his behavior is quite irrational and erratic now, but was it any different before his infection?

OMG! It is 2 a.m.! Bedtime. I told you I didn’t have time to review this book today. I just wanted to make sure you start reading about the 1918 influenza asap, so that you will take the covid-19 pandemic seriously and neither fall ill yourself nor spread the virus to other people.


Did I tell you that with all the mishandling of the influenza pandemic (and not only by Woodrow Wilson), this pandemic eventually caused somewhere between 50 and 100 million people dead worldwide (and if I remember correctly, some 685,000 in the U.S.). Most of these deaths occurred in the fall of 1918, but the pandemic continued into 1919 and 1920, and it wasn’t until around 1925 that no more new infections occurred.

So let’s do everything to get covid-19 under control. Wash your hands, wear a mask, keep distance from other people, forgo this year’s Thanksgiving family reunion and Christmas dinner with your in-laws, and by all means, vote!

VOTE FOR a decent, responsible, and competent man (and here I mean Biden) who listens to scientists and has the survival and well-being of ALL Americans in mind. DO NOT VOTE FOR an unethical, irresponsible, incompetent, immensely egoistic, power- and money-greedy wannabe-dictator (and here I mean Trump), who won’t listen to scientists or any other experts. This man is already responsible for some 200,000 avoidable covid-deaths in our country (with this figure rising every day), and I suspect him not to mind at all when the old and the frail die, as he is likely to consider them as nothing but a burden to the economy and thus “unwertes Leben” (“life unworthy of life”). The PRO-LIFE slogan of his evangelical supporters only seems to apply to unwanted fetuses and embryos and not to anyone past age 65 or anyone younger with pre-conditions.

So I can only say to those who lean to the political Right: Wake up conservative America! Don’t vote for your own death, the death of your older loved ones, or the death of your not-100%-healthy child grandchild!

As far as those who lean to the political Left are concerned, I don’t have to say any more to them, as I'd only be preaching to the choir.

Friday, October 30, 2020: P.P.S.:

I just watched the news on CNN. There was a news clip copied from Fox News of this morning. It showed Donald Trump jr. Let me quote what I heard him say: “I went through the CDC. I kept hearing about new infections. So why aren’t they talking about deaths? Oh, oh, THE NUMBER IS ALMOST NOTHING.” I am not quite sure whether he intended to misquote the CDC or whether he just spit out his own lie. Either way, if 229,293 people dead in our country since the onset of this pandemic (and almost 3,000 only during the past 3 days) is “almost nothing”, then why did anyone ever get upset about the almost 3,000 people who died in 9/11?

Saturday, Dec. 18, 2020: P.P.P.S.:

This review is, meanwhile, a bit outdated, as huge parts of the population have disregarded all warnings, and millions have traveled for Thanksgiving and continued to spread the virus. So we are presently at the "almost nothing" of 314,305 deaths. I would like to shout to all these people who have been acting irresponsibly and recklessly , "I TOLD YOU SO", but this would not help much either. Some people will never learn. Christmas is coming and, and I am sure it will be another super-spreader event. So I can only say "Froehliche Weihnachten!", which is German and means "Merry Christmas!" but is in German language also used in a sarcastic way. I am about to despair. Armageddon is likely to be brought on by human stupidity.

Saturday, May 29, 2021: P.P.P.P.S.:

Today, almost half a year and some 300,000 more U.S. covid deaths later, I just noticed that I have failed to rate this book. Must have happened, as I had had trouble to decide.--Well, IMO, the writing style and the left-to-be-desired structure of the book deserves no more than 2 stars. However, the information provided in this book is so very important, especially during the present covid pandemic, that I would give this book 6 stars for its biological and historical contents. And since 2 plus 6 is 8, divided by 2 is 4, I think 4 stars is a fair rating for this book, which I consider an absolute MUST-READ despite of its flaws.
Profile Image for Diane.
1,081 reviews2,719 followers
June 1, 2020
This was a fascinating read about the 1918 flu pandemic, and a good overview of the history of medicine in America. I don't remember learning much about this topic in school — teachers seemed to treat it like more of a footnote to World War I, which was itself treated as a footnote to all the coverage of World War II.

But a friend had recommended this book to me more than a decade ago (he was always recommending big works of nonfiction), and it took the coronavirus outbreak for me to finally get it from the library and dedicate myself to reading it. Here is a good introductory section from the Prologue:

In 1918 an influenza virus emerged — probably in the United States — that would spread around the world, and one of its earliest appearances in lethal form came in Philadelphia. Before that worldwide pandemic faded away in 1920, it would kill more people than any other outbreak of disease in human history. Plague in the 1300s killed a far larger proportion of the population — more than one-quarter of Europe — but in raw numbers influenza killed more than plague then, more than AIDS today ...

And they died with extraordinary ferocity and speed. Although the influenza pandemic stretched over two years, perhaps two-thirds of the deaths occurred in a period of twenty-four weeks, and more than half of those deaths occurred in even less time, from mid-September to early December 2018. Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS has killed in twenty-four years.

Barry has a gift for writing narrative nonfiction; I was engrossed in this book, even though parts of it were a bit technical and required extra focus to follow along. I listened to this on audio, narrated by Scott Brick, who gave an excellent performance. I appreciated this book so much I looked up Barry's other works and intend to read them as well.

While a lot has changed in 100 years, a lot has also stayed the same, including how selfish and stubborn people can be, how elected officials often fail to lead during a crisis, and that some people get angry when scientists and experts tell them things they don't want to hear. Here is a good quote from the Afterword that has stayed with me:

In 1918 the lies of officials and of the press never allowed the terror to condense into the concrete. The public could trust nothing and so they knew nothing. So a terror seeped into the society that prevented one woman from caring for her sister, that prevented volunteers from bringing food to families too ill to feed themselves and who starved to death because of it, that prevented trained nurses from responding to the most urgent calls for their services. The fear, not the disease, threatened to break the society apart. As Victor Vaughan — a careful man, a measured man, a man who did not overstate to make a point — warned, "Civilization could have disappeared within a few more weeks."

So the final lesson, a simple one yet one most difficult to execute, is that those who occupy positions of authority must lessen the panic that can alienate all within a society. Society cannot function if it is every man for himself. By definition, civilization cannot survive that.

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.
Profile Image for Paul.
716 reviews66 followers
December 18, 2017
It was a book, only a book.

I have to keep telling myself this because even though author John M. Barry apparently felt like he was writing the tome to end all tomes about this chapter in world history – including the hideous phrase, "It was influenza, just influenza" over and over and over again – in the end, what he created was a terrific 200-page story of the world's deadliest pandemic wrapped in 250 pages of overwritten irrelevance.

Barry spent seven years working on this book, and it shows. By which I mean it's meticulously researched, thoroughly detailed – and very poorly edited. It's clear he was too invested in his work and failed utterly at even the most basic test of what was relevant to his thesis. Thus we have short books about the history of Johns Hopkins University and modern medicine, about the failed response of the scientific community to the flu pandemic, and about the flu pandemic itself and the political and military decisions that exacerbated it. This latter is a five-star book – tightly written, cogent, fascinating and novel-like in its intensity while still lucidly explaining the mechanism of influenza infection and the immune system's response – but the rest should have been excised.

In addition to the massive editing failure this book represents, Barry seems to understand on some level that his work is all head, no heart. It's about scientists and science, and cares very little for the actual people who got sick and died during the pandemic. The result, however, is to overwrite his descriptions of the flu's effects on cities like Philadelphia. He finds a rhetorical trick and hammers it home well past the point of overuse. He constantly uses "for" instead of "because," which trips up the reader.

By the end of the book, I was skimming pretty heavily. Despite flashes of brilliance, The Great Influenza is a book, only a book, and not one worth the time required to invest in it.
Profile Image for Debbie W..
760 reviews569 followers
August 28, 2021
Overall, an informative and well-researched microhistory about the deadliest pandemic in human history - the so-called "Spanish flu". I appreciated the information on where medical science was prior to 1918, as well as the explanation of how the flu virus works in layman's terms. The author often used literary devices such as analogies, metaphors and personification to describe complicated concepts. His afterword spells out what must be done to avoid another influenza pandemic from reoccurring. Although this book was about the deadliest pandemic, I found it focused too much on American scientists and how the flu decimated the American population. Even though mention was made of how this flu affected other countries, I felt it was insignificant, considering that this was a pandemic, not just an American epidemic.
Profile Image for Mara.
1,636 reviews3,884 followers
August 16, 2020
4.5 stars -- Interestingly enough, the strongest part of this book in my opinion is the table setting that Barry does to describe the progress of American medical science and practice in the lead up to WWI. Learning about the transition from the heroic age of medicine to the early modern age of what we would recognize as a professionalized force of doctors and nurses was totally fascinating and gives a helpful window into how and why American attitudes towards doctors developed. That said, of course the description of the pandemic itself and the way it unfolded amidst the chaos of WWI was fascinating and incredibly relevant. The afterword is particularly harrowing to read in light of the events of 2020. All around, super strong historical non-fiction that is sadly applicable to our current world
Profile Image for Tim.
146 reviews70 followers
April 19, 2022
This was not very pleasant reading, but it was a great book to read to get some historical perspective on what is happening now.

It seems to be forgotten how devastating the 1918 pandemic was. Estimates are between 50 and 100 million deaths. As terrible as the Coronavirus has been, we are at about 3M deaths as of April 2021, and the world’s population is now about 4 times larger. Barry describes in haunting detail what this meant. One visual that stuck with me was of homes having crepe ribbon hung to signify deaths from residents – and if you walked around town you would see most homes with at least one ribbon.

The book is great to read to ponder historical parallels. I never realized how infectious diseases ravaged society back then, especially during wars. During the Civil War, more people died of infectious diseases than of battle. 2/3rds of hospital visits at army bases were due to Venereal disease. More generally, pandemics were rather common and an understood part of life. It seems like the Coronavirus, by contrast, caught a lot of us by surprise. It’s as if we believed that in today’s society, with our technology and understanding of science, this kind of thing just shouldn’t be possible.

But there are also similarities, and sometimes they are almost too uncanny to believe. An unwillingness to listen to experts and believe this is really happening. Attempts by leaders to downplay and lie about the threat. Scapegoating of foreigners for causing the outbreak (back then it was Germany instead of China). The President himself contracting the disease!*

Barry only touches on this lightly, but it is also interesting to think about why the 1918 Pandemic did not impact culture and historical memory as much as you would think. For instance, you do not see it described in the setting of a lot of literature or movies of the time. Part of the answer to this is just how terrible it was – no one really wanted to remember it or think about it. But that is not the entire story. Wars do not have the same effect of getting erased from our memories. I think there is something especially devastating about it coming from an “invisible killer” that was not really understood. There was not a clear enemy you could face up to and challenge. It must have just been terrifying how incomprehensible it was.

Barry mentions this poem by Robert Frost that was written in 1920 and was popular at the time. I’m not sure if the poem was inspired at all by the influenza, but the tone does remind me of some of the dark humor you see today on social media about how terrible everything is right now.

Fire and Ice
Some say the world will end in fire,
Some say in ice.
From what I’ve tasted of desire
I hold with those who favor fire.
But if it had to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.

*Barry argues that Wilson’s illness during the Versailles negotiations was the Influenza, but other historians disagree.
Profile Image for Mike.
1,138 reviews151 followers
October 21, 2016
I read many of the reviews of The Great Influenza: The Epic Story of the Deadliest Plague in History. Many reviews are on target, the book just doesn't meet expectations for what should be a powerful tale. Unless you already have the book, I wouldn't rush to get it. How can I characterize it? Pompous, pretentious, repetitive, bloated,...? It seems he is trying to write like Simon Winchester, bringing in various threads to make a colorful tapestry. Except it is threadbare, strained, frayed. Just didn't work for me. A real shame because the story deserves a powerful telling.

There was one part that was outstanding. His description of Woodrow Wilson's administration and the Progressive hell that enveloped the US leading up to and during WWI was absolutely chilling and precise. The Espionage Act, the American Protective League, the associated American Vigilance Patrol, the Four-minute men, the Committee on Public Information… I don’t know if Barry intended to paint such a chilling picture of the rise of propaganda, censorship and government force but he does an excellent job.

Just 2 Stars for me. Darn it, was hoping it would be amazing.
Profile Image for Mike.
188 reviews17 followers
January 25, 2009
This book took me a long time to read, for several reasons. First, it really is two books in one. The first book is a history of the men and women and institutions involved in the change to scientific medicine in this country around the turn of the century. The second is the story of the influenza plague of 1918-1922 itself, the horrors of it, the death rate, the physical symptoms, the psychological effects, and the rather interesting fact that it seems to have been largely forgotten as the history of the 20th century wore on.

Barry bookends the second book with the first book, and you get the impression of an author who has researched the bejeesus out of his subject and time period, and is just brimming over with information that he needs to get down on paper. But the book on scientific medicine really needs to be edited out of the book about the flu plague, because the interaction of the two stories is bizarrely very small - when the plague comes, the scientists and researchers he has spent so much time describing have very little, almost no, impact on the progression of the disease itself. When the flu passes, the researchers continue to work on it, frantically, but nearly everyone is wrong about the cause of the disease for years and year. Other scientific discoveries are made in studies of other diseases, and finally a study of infected pigs sheds light onto the causative agent.

The organization of the telling of the influenza epidemic also needs editing, as Barry tells the story roughly chronologically but then diverts around geographically, sometimes telling the same kinds of stories again and again. So by the end of the book, you've read several horrifying stories of deaths by neglect, several accounts of the desperate medicinal efforts made, several accounts of rapid movement of the virus through populations. All of this loose organization makes the book a bit of a slog.

The second reason the book took me so long to read is just how painful the descriptions of the virus, the horrible effects it had on the bodies of its victims, the families of its victims, the communities of its victims, the mindsets of its victims and those who lived with the epidemic, were . . . it was horrifying in its scope and scale. The author certainly succeeds in one of his objectives, and that is to let everyone know that FLU CAN KILL, and even though everyone treats it with nonchalance, it is only through luck that we haven't encountered a very virulent and lethal strain lately. Reading this book would be an important thing to do for people who routinely skip their flu shot every year, and will spur the reader to think about what they would do with sick family members if the healthcare system was completely overwhelmed.

The most interesting part of the book was a chapter on the psychological damage the virus wrought on some people, and trying to link Woodrow Wilson's actions during the Paris peace conference of 1919 with changes brought on by a bought of the flu in April of that year. I think he proves his case that Wilson was changed mentally by the illness. What is less clear is whether the outcome of the Peace Conference would have been different because of it - the Germans were delusional about the end of WWI in any case, so it is a bit hard to lay Hitler and WWII at the feet of the flu.

I still would recommend this to nearly everyone. It is important to realize what we might have to deal with during any given flu season, and this book should be enough to scare anyone straight with regard to that. The author does a great job of describing the science of the pathology and doesn't make any big mistakes with the molecular biology that I caught.
Profile Image for Dave Schaafsma.
Author 6 books31.5k followers
August 10, 2020
“Oh, it’s just influenza”--millions of people, some of them quoted in this book

So now during this 2020 pandemic I have not just read Great Novels and comics, but have delved for almost the first time into non-fiction books about medical history. I read Crisis in the Red Zone by Richard Preston about the 2014 Ebola Crisis centered in West Africa; I read the novelistic account of the medieval plague, A Journal of My Plague Year by Daniel DeFoe, I reread the fictional but moving The Plague by Camus, and now this (though I may also read David Quammen’s Spillover still before I am done).

My main take-away from this book: I will never ever glibly decide not to get a flu shot ever ever again. My basic argument against getting one historically was that the vaccine make-up seemed to me, a non-scientist, a kind of guesswork,as it covers only some random strains (and I just have never liked getting shots).

This book reminded me that anywhere from 50-100 million died from particular strains of Influenza 1918-1919. The numbers are sketchy because a lot of people were dying at the time, public health (and medicine, epidemiology, science research) was less developed, and people didn’t have our (very.very useful, trust me) obsession with counting the dead and dying we have today. But now we know it was at least 50 million and probably closer to 100 million, but let’s just say it was 50, in comparison to today’s population, that would be like 72 million had died in the last year and a half. Though we are still not yet into the second wave, really, so our worldwide numbers of deaths could well exceed a million (or many more).

This book is really two books. A generous way of thinking of it is that it puts the “Spanish Flu” pandemic in the context of medical history, which is to say that it is as much about the still fledgling fields of scientific research and medicine we need to help us survive as a human race as it is a history of that particular pandemic. Barry romanticizes people like William Welch for playing a key role in modernizing the field of medicine in the US, and he names other key players in the development of various related fields needed to prepare us for surviving future pandemics, but none of these folks figure in all that much in the story of the pandemic itself, as they didn’t discover a cure or really impact the massive death rate. The book does give us a sense of how we need to fund science research in the area of pandemics because Covid-19 is by no means the last one we will see.

This argument happens in the last third of the book,which returns us to the development of medical research, which is as I said pretty disconnected from the middle of the book, the second whole book, on the history of the pandemic as it occurred mainly in the US. This book reveals the political contexts in which the disease took place and shows us how the disaster could have happened. What can we learn from it?!

Some other fun facts:

*It killed more people in twenty-four months than AIDS killed in twenty-five years, more in a year than the Black Death killed in a century.”

*The main way to beat a Pandemic is isolation, avoiding crowds, avoiding driving your Harley to Sturgis, SD with 300K other bikers to party and then superspreading it across the country and globe. Only in America? Well, in Brazil and in other macho-oriented cultures it seems to be happening, too. Anyway, why was there no death in Gunnison, Colorado? They stayed inside and kept visitors out until things were safe. Same with a private girl’s school in Maryland. No deaths. The countries that did that had fewer casualties, big surprise,

*Arizona, now a red state, got the idea then to wear masks and so their infection and death rate was much lower than other states. Sure, because this is America and you know, Live Free and Die, there was an Anti-Mask League then, but some people really did begin to figure out what to do and not to do.

*The Great Influenza, Barry says, started here, in Kansas, and spread to almost every corner of the world.

*One key reason for the spread is the inaction, half-truths and lies by politicians and lazy or ignorant public health officials supported by various co-opted media. MIs-information abounds. Not much was known about what to do about the flu, initially, but this did not prevent people from spreading lies and proposing unfounded solutions. “It’s almost over, it’s not that bad, it’s only the flu!”

*The state of medical education by the beginning of the twentieth century was terrible. You didn’t even need any college coursework to be a doctor, you didn’t have to see a single patient or do any medical research to become a doctor. Doctors and nurses were way underpaid, and so necessary, but there was a severe shortage when this hit and the health care system was overwhelmed.

*As with our current pandemic people focused on whether you live or die, but long term neurological and other effects may have been as serious as the number of deaths..

*The Red Cross was terrific even when government public health sucked.

*Over time, over waves of infection, as people, increasingly terrified, began to take it seriously and stop hanging out in large crowds together, as businesses and schools closed and people stayed inside, the pandemic sort of mutated and went away (though it could come back at any time)

*Ebola, SARS, Avian Flu, and on and on, are definitely changing life as we knew it; ignore this at your peril. A vaccine might help, but isolation is the best strategy for saving your and others’ lives. Humans: Develop a little discipline and willingness to self-sacrifice and get over your anti-science arrogance and let’s come together to do the right thing. How--as of today has New Zealand had new cases in six weeks? Guess! Fairy dust, right!

*There was WWI taking place, so President Woodrow Wilson made a decision to put all our resources into winning the war rather than saving people’s lives at home. And many many soldiers died, too, and Wilson and the military took most of the doctors and nurses to the front and lied to the American public that it wasn’t that bad and insisted people only say positive things in spite of the obvious rising death totals.

*Wilson also got the flu, which was kept secret for a long time, but we now know it affected him neurologically; in other words, decisions he made were flu-influenced. He died of a stroke that was likely brought on by the flu he largely tried to ignore.

*More people die of disease in wars than from guns, and very little money ever goes to military medicine. But you already know more money goes to the defense budget than public health.

*The book focuses on the US instead of the whole world but it is already 460 pages so i guess that can pass, but if it just focused on the pandemic it could have looked at things more globally.

*A lot of novelists wrote about The Great War, but why is so little written about the far greater killer, The Great Influenza? Note to self: Reread Katherine Anne Porter’s Pale Horse, Pale Rider. She writes a novella about her experience with it and obviously not dying from it.

*Barry in 2004 while finishing this book said, “It’s time to start spending serious money on influenza.” We didn’t do it. In fact the current POTUS defunded the Pandemic organization that might have helped us prepare better for these events. And broke off the US from the WHO!

This book is a good book, but it should just be one book, the history of the pandemic, rather than two books. It is obviously based on a lot of research, but it is not as well written as the other books I mention at the outset. It needs editing, The medical history goes on too long, he romanticizes science researchers and adds some melodramatic effects in places that distracted me. Why spend so much time on, for instance, Paul Lewis and others who were “original,” “brilliant,” but didn’t come up with a vaccine and had almost no impact on the progression of the disease itself. But I still learned a lot from it, from both of the books, truthfully.
Profile Image for CoachJim.
173 reviews103 followers
October 11, 2021
Don’t be lax, Vax!

When you read a history of the World War you read about military issues. When you read a history of Woodrow Wilson you read about political issues. When you read a history of the Reconstruction period you read about race issues. This book is a history of The Great Influenza of 1918 so you will read about medical issues. You will read about the differences between bacteria and a virus. You will read plenty about pneumonia, and find out the difference between bacterial pneumonia and viral pneumonia. You will read about the immune system and the respiratory system which is the first line of defense against invading viruses. You will also read about the struggles and efforts of various medical scientists trying to isolate and identify the bacteria causing the influenza. This effort went on long after the epidemic had ended. The search eventually leads to the discovery of DNA.

The book opens with a description of the state of medicine prior to the Twentieth Century and it is not a pretty picture. Doctors were still treating illnesses as an imbalance of the body’s humours. This led to the view that a poison in the body could be removed by evacuation, sweating, urinating, defecating, and vomiting. Bleeding was among the most common therapies employed to treat all manners of disorders. (Page 18)

The Great Influenza rolled over the country and the world in four waves between 1918 and 1920. Each wave was successively less lethal as people exposed to the virus in the earlier waves gained immunity. However, the waves led in some cases to a false sense of security. In San Francisco, for instance, which did a super job containing the virus early, declared an early victory which then led to disaster as the subsequent waves hit the city.

Evidence suggests the the influenza virus originated in Haskell County, Kansas in early 1918. The United States was in the process of creating a huge Army to send to Europe to fight in the World War. Recruits from Haskell County were sent to Camp Funston, a hastily built army camp. In an appropriately named section “The Tinderbox” it describes how recruits from various parts of the country were brought together. Because of the disparity in immunity in the country, especially at that time, this led to outbreaks of measles and other diseases. Thus a potential “breeding ground” for the influenza was created. Then as these troops were transferred around the country and eventually overseas, they took the virus with them.

Due to the heavy censorship of the news by the countries fighting in the World War there was no reporting of the deaths from The Great Influenza. However, Spain was not involved in the war and therefore did not need to censor its news and reported the number of people dying from the influenza. This led to people calling it the Spanish Flu.

Generally influenza attacks the weakest members of a population — the very young or the very old. We saw that in our current pandemic where 80% of the Covid deaths were over the age of sixty-five.* However, The Great Influenza attacked primarily the age group from twenty to thirty-five. This might be explained by the fact the influenza incubated in military camps full of men in that age group. It is also explained that in the late stages the influenza became a viral pneumonia, which triggered an immune response, which in younger people is so strong it attacked the lungs killing even good cells. The most vulnerable group were pregnant women.

There is extensive reporting, sometimes by day, of the deaths during the Great Influenza in various military camps, cities, hospitals, and military transports. The death toll was tremendous. It is generally thought that the U.S. death toll during the Great Influenza was 675,000. This resulted in the average life-expectancy in the U.S. to drop by 10 years. To put that in perspective, given todays U.S. population, a similar effect would mean a U.S. death toll of 1,750,000.

There was a great deal of fear from the disease as the bodies of the dead accumulated. People were afraid to go work or even to go out. In some cases people were living in a house with a dead body. Children were starving because the adults were all sick or dead. Neighbors refused to help for fear of catching the disease. There was a drastic need for nurses and doctors, in part because the war effort had demanded their services.

Then as now there were elected government officials who refused to acknowledge the disease. In many cases this was the result of Wilson’s total war effort that also involved censorship of the news. But again as currently there were mayors and governors who said the disease was nothing to be concerned about. In many cases measures like quarantines or other steps to reduce the spread were not implemented for economic or political reasons. As citizens watched the death toll rise around them they lost trust in these government officials. They lost trust because of the lies. There is no accounting of how many lives were lost because of these lies and the refusal to take the advice of medical experts.

Some of the more appalling stories were of military operations which had men crowded onto ships or trains and forced to travel for many days with others with the disease. Government and military officials refused suggestions to eliminate any diseased men from the transport. These men had to endure the torture of the stench of the dead and dying during the trip.

The Great Influenza left in its wake many health problems. In addition to the general emptiness over the loss of loved ones, it also left many families in poverty and distress. “[The] havoc was wide spread, reaching all parts of the United States and all classes of people.” (Page 392) It was also reported that very few victims escaped without some pathological changes. The most notable problem was the prevalence of Parkinson’s disease years later.

This book, which was published in 2004, would have been a good read 10 years ago, but with our current experience with a pandemic it becomes even more interesting and relevant. The author admits that nothing could have stopped the sweep of influenza through the country and the world. But an effort at intervention and quarantines would have delayed its spread, saving many thousands of lives. He discusses the role that leadership and institutions would have to play in such an effort. Then, as happened now, the less admirable human traits of self-interest and ambition spoiled that effort. In 1918 Wilson directed every effort of the government in the war effort. This resulted in the loss of many lives so that the military could send American soldiers to die in Europe from the meat-grinder that the war had become, and crowded them aboard ships to expose many to the virus.

Many questions recently have been asked about how long our current Covid pandemic will last and how will it end. These are the questions which made this book so interesting and relevant. For The Great Influenza it seems to die out in the mid 1920s after starting in March of 1918. The author states the mathematical theory of “regression towards the mean” as an explanation for the virus, which continued to mutate, to become less deadly. There is also evidence that because of its widespread uncontrolled impact that some “herd immunity” took over the resistance to this virus.

The Great Influenza of 1918 represented a war by nature against humanity. The country found itself inadequately prepared to meet this challenge. Funding was not available for the research necessary to find a vaccine. There was a shortage of hospitals beds, nurses and doctors. There was a shortage of the supply of personal protection equipment. There was also, and perhaps more importantly, a shortage of leadership.

A pandemic is an immense challenge, but “the biggest problem lies in the relationship between government and the truth” (Page 459). The lies told by government officials led to distrust in anything they said. “[A]s trust broke down, people became alienated not only from those in authority, but from each other” (Page 461).

Alas, we have learned nothing.

*(The Plague Year by Lawrence Wright (pages 128-129)).
Profile Image for Roy Lotz.
Author 1 book8,277 followers
May 1, 2020
People write about war. They write about the Holocaust. They write about the horrors that people inflict on people. Apparently they forget the horrors that nature inflicts on people, the horrors that make humans least significant.

Like so many people nowadays, I have been scrambling to wrap my mind around the current pandemic. This led me, naturally, to the last major worldwide outbreak: the 1918 influenza. I have a distant connection to this disease. My great-grandfather (after whom I was named) was drafted out of Cornell’s veterinary school to work as a nurse in a temporary hospital set up for flu victims. I read the letters he sent to his mother, describing the experience.

John Barry’s account of this virulent flu is sobering to say the least. In a matter of months, the flu spread across the world and caused between 50 and 100 million deaths. More American soldiers died from this flu than from the entire Vietnam War. In most places the mortality rate hovered around two percent, but it struck much more fiercely elsewhere. In the Fiji Islands, 14 percent of its population succumbed; in Western Samoa, twenty-two percent; and in Labrador, a third of the population died. And because the disease mainly struck young people—people in their twenties and thirties—thousands were left orphans.

Barry’s book is not, however, simply a record of deaths. He sets the historical scene by giving a brief overview of contemporary medicine. In the early 1900s, modern medicine was just coming into its own. After centuries in which it was thought that bad air (“miasma”) caused illness, and in which bleeding was the most popular “cure,” researchers were beginning to discover viruses and bacteria, and were beginning to understand how the immune system combats these germs. Major public health initiatives were just getting underway. The John Hopkins School of Public Health had been founded, and the Rockefeller Institute was making new types of research possible. It was not the Dark Ages.

The other major piece of historical context is, of course, the First World War. Undoubtedly this played a major role in the epidemic. Not only did troop movements help to spread the disease, but press censorship virtually guaranteed that communities were unprepared. Barry notes how newspapers all across the country consistently downplayed the danger, which ironically only further increased panic. (The pandemic is sometimes called the “Spanish flu,” because the press in neutral Spain was uncensored, and so reported freely on the disease.) The war effort overrode all of the warnings of disease experts; and by the time the disease struck many communities, most of the available doctors and nurses had been sent to the military.

Barry’s narration mainly focuses on the United States. Partly this is because this is where he believes the disease originated (there are several competing theories), partly this is because the disease’s impact in Europe was overshadowed by the war, and partly this is simply because of the amount of easily available sources. I did wish he had spent more time on other countries—especially on India, which suffered horribly. The sections on science—both on the history of science, and summarizing what we know now about flu viruses—were in general quite strong. What was lacking, for me, were sections on the cultural impact of the disease.

But perhaps there are not so many. As Barry notes, no major novelist of the time—Hemingway, Fitzgerald, Lawrence—mentioned the pandemic in their works. I have noticed the same thing myself. I cannot recall a single mention of this flu in biographies and autobiographies of people who lived through the pandemic, such as John Maynard Keynes or even John D. Rockefeller (who personally funded research on the disease). This is perhaps understandable in Europe, where the deaths from the pandemic were swallowed up in news of the war; but it seems odd elsewhere. What is more, the pandemic did not seem to exacerbate existing racial or class tensions. In many ways the virus seems to have swept through communities and then disappeared from memory.

(Barry does have one fairly controversial claim in the book: that Woodrow Wilson contracted the flu while negotiating the treaty of Versailles, and that it caused him to capitulate to Clemenceau’s demands. If this is true, it would be a major historical consequence.)

It is illuminating to compare the 1918 pandemic to the current crisis. There are many similarities. Both are caused by easily transmissible viruses, and both spread around the world. The H1N1 flu virus and the SARS-CoV-2 virus both infect the respiratory system, causing fever, coughing, and in severe cases pneumonia and ARDS (acute respiratory distress syndrome). In both cases, no vaccine is available and no known treatment is effective. As in 1918, doctors are turning desperately to other therapies and medicines—those developed for other, unrelated diseases like malaria—and as in 1918, researchers are publishing at a frantic pace, with no time for peer review. Police are again wearing masks, hospitals are again overrun, and officials are struggling to catch up with the progress of the virus.

But of course, there are many important differences, too. One is the disease itself. The 1918 flu was almost certainly worse than the novel coronavirus. It was more deadly in general, and it killed younger people in far greater numbers—which resulted in a much bigger dip in life expectancy. (Young people died because their immune systems overreacted in what is called a “cytokine storm.”) The H1N1 flu also had a far shorter incubation period. This meant that the gap between infection and the first symptoms was short—often within 24 hours—and patients deteriorated far more quickly. Barry describes people being struck down within mere hours of showing their first symptoms. The challenge of the SARS-CoV-2 virus, however, is the very long incubation period—potentially up to two weeks—in which people may be infectious and yet not show symptoms. This makes it very difficult to keep track of who has it.

The explanation for this difference lies in the nature of the virus. A virus is basically a free-floating piece of genetic code incased in a protein shell. It needs to highjack animal cells in order to reproduce; and it infiltrates cells using proteins that link up with structures on the cells’ surface. Once inside, the virus begins to replicate until the cell literally bursts, spilling virus into adjacent cells, which in turn get infected, and which in turn burst. Each burst can release thousands of copies. The rate at which the virus replicates within the cells determine the incubation period (between first infection and first symptoms), and coronaviruses replicate significantly more slowly in animal cells, thus explaining the slower onset of symptoms. Their greater speed also means that flu viruses change faster, undergoing antigenic drift and antigenic shift, meaning that new strains of the virus are inevitable. The novel coronavirus is (likely) more stable.

Another potential difference is seasonality. Flu viruses come in seasonal waves. The 1918 virus struck first in spring, receded in summer, and then returned in autumn and one last time in the winter of 1919. Every wave hit very quickly—and then left just as quickly. Most cities experienced a sharp drop-off in cases after about six weeks of the first patients. The seasonality of the 1918 flu was partly a result of the genetic drift just mentioned, as the different waves of this flu were all at least subtly different strains of the virus. Atmospheric conditions—humidity and temperature—also presumably make some difference in the flu virus’s spread. COVID-19 may exhibit a very different pattern. It may, perhaps, be less affected by atmospheric conditions; and if it mutates and reproduces more slowly, it may linger around for one long wave rather than several short ones. This is just my speculation.

Well, so much for the virus. How about us? The world has changed a lot since 1918. However, not all of those changes have made us better prepared. Fast and cheap air travel allowed the virus to spread more quickly. And economic globalization did not help, either, as both medicines and medical equipment are often produced overseas and then imported, thus rendering countries more vulnerable to supply-chain disruption than in the past. As we witness countries and states compete for supplies, this vulnerability is very apparent.

But of course we have many advantages, too. Many of the deaths caused by the flu and the coronavirus are not from the virus infection itself, but because the virus renders us vulnerable to secondary infections by bacteria, causing pneumonia. Antibiotics (which did not exist in 1918) can save many lives. Another advantage is medical care. The most severe patients of both epidemics were struck with ARDS, a condition with an almost 100% mortality rate for those who do not receive intensive medical care (using a ventilator machine). In 1918 they were able to administer oxygen, but far less effectively than we can. Even so, even with the best intensive care, the survival rate of ARDS is between 40-60%. And our ability to administer intensive care is quite limited. The ventilator shortage has become a global emergency in itself, as hospitals are overrun.

Medical science has also advanced considerably. Now we can isolate the virus (which they could not do in 1918), test individuals for it, and work on a vaccine. However, testing has so far been unable to keep up with the virus. And the most optimistic estimate of an available vaccine is in a year. Arguably a much bigger advantage is information technology. The press is not censored—so citizens have a much better idea of the risks involved—and experts can communicate with each other in real time. We can coordinate large-scale societal responses to the pandemic, and can potentially even use technology to track individual cases. As we come to better understand the virus, we will be able to use more sophisticated statistical methods to understand its progress. None of this was possible in 1918.

One thing that we will have to contend with—something that is hardly even mentioned in Barry’s book—is the economic toll that this virus will take. Even in the ugliest days of the 1918 pandemic, governments did not require businesses or restaurants to close. War preparations went on unabated. (In 1918, after years of slaughter and at the height of the war, life was simply cheaper than it is now.) Our societal response will likely mitigate the health crisis but will create a secondary economic crisis that may ultimately be more difficult to solve. The solutions to this crisis could be our most lasting legacies. Already Spain’s government is talking of adopting universal basic income. Though of course it is far too early to predict anything with confidence.

Comparisons with 1918 are partly depressing, and partly uplifting. Depressing, because we knew this was possible and did not prepare. Depressing, because so many governments have gone through the same cycle of early denial and disorganized response as they did back then. Uplifting, because we do know much more than we did. Uplifting, because—after our early fumbles—we are finally coordinating as a global community to deal with the crisis. Perhaps most uplifting of all, despite some ugly stories here and there, the crisis has revealed a basic sense of solidarity in the face of a universal threat. Hopefully, unlike 1918, we will not do our best to forget about this one.
Profile Image for Deborah.
736 reviews54 followers
July 23, 2021
This is a thoroughly well researched book on the Influenza epidemic of 1918 - 1920. I was surprised to learn that possibly and according to a local country doctor, Dr. Loring Miner, that the influenza might have originated in Haskell County, Kansas in early 1918. Although remote and little populated, it could have spread as a soldier came home on leave from Camp Funston, a man visited his brother in a town just after his child became ill, and a new recruit went to his basic training at Camp Funston from that town.

The influenza became known as the Spanish Influenza, because during World War I, Spain was neutral, the government did not censor the press, and there were many accounts published of the disease spreading, especially when its king became seriously ill.

Viruses constantly mutate. Unfortunately, the constant mutations of the influenza, which were normal and inevitable, were becoming more lethal. Quoting a modern epidemiologist, “Influenza is a special instance among infectious diseases. This virus is transmitted so effectively that it exhausts the supply of susceptible hosts.” This influenza “spread rapidly and widely.” “This meant that the virus sickened tens of millions of people in the United States – in many cities more than half of all families had at least one victim ill with influenza; in San Antonio the virus made more than half the entire population ill – and hundreds of millions across the world. But this was influenza, only influenza. The overwhelming majority of the victims got well.”

Because of the range of symptoms that were previously unknown, many feared it was a new disease or the plague. Lungs ruptured. Ears perforated. Headaches and body aches occurred. Smell disappeared. Blood poured from the nose, eyes, and orifices. Some died within hours of exhibiting symptoms. Patients were misdiagnosed with many different types of diseases. The disease, death, and fear spread quickly. Fear permeated bringing businesses to a standstill. Fear, also, killed many who desperately needed care, because those who could assist were too terrified to help.

Influenza hit the army bases hard where one camp reported 2800 soldiers in one day. Supplies, beds, and medical personnel were depleted. Some died within hours. The dead were not being identified due to exhaustion. The virus spread like wildfire among the army and navy camps and along rail and water routes. The military deaths were senseless and easily preventable if the transfers were stopped, the crowding eliminated, and the men isolated. The army ignored the warnings to keep newly recruited men separate and eliminate crowding. The 1917 - 1918 winter was harsh and bases were overcrowded and the army failed to provide the men with warm clothing or heat and adequate bathrooms. The camps were poorly administered and poorly designed. During World War I, “deaths from disease did exceed combats death.”

“In the United States [influenza] killed fifteen times as many civilians as military.” 47% of all deaths during the epidemic were from influenza or its complications. “Investigators today believe that in the United States the 1918-1919 epidemic caused an excess death toll of about 675,000 people. The nation then had a population of between 105 and 110 million, compared to 285 million in 2004. So a comparable figure today would be approximately 1,750,000 deaths.”

The chapter on Philadelphia was horrifying. When influenza appeared on its shores and despite pleas from doctors, Philadelphia because of political corruption did nothing, and then delayed claiming panic would interfere with the war efforts. Then they continued by denying and spinning false facts even as the deaths began increasing. Weeks of organization had spearheaded what was to believed to be Philadelphia’s greatest parade to “sell millions of dollars of war bonds.” On September 28, 1918 thousands marched and hundreds of thousands watched Philadelphia’s Liberty Loan parade. “Within seventy-two hours after the parade, every single bed in each of the city’s thirty-one hospitals was filled. And people began dying.” In ten days there were “hundreds of thousands ill and hundreds of deaths each day.” Courts closed. Physicians were dying. In one hospital, one quarter of the patients died daily to be replaced by new patients. Patients were still being turned back as there was no room. Yet the media and politicians were minimizing the dangers. The dead were everywhere. Rotting bodies piled up in homes and beds with no place to go. “The life of the city had almost stopped.”

Isolation and quarantine were necessary to stop the spread. Too many government officials and media lied or ignored the increasing dangers, because of corruption, the propaganda of the war effort, it was bad for the economy, or disbelief that it was only influenza. “As California senator Hiram Johnson said in 1917, “The first casualty when war comes is truth.” “[N]o national official ever publicly acknowledged the danger of influenza.” The United States was at war at the beginning of the epidemic. Two million soldiers were in Europe and that total was expected to double. “Total war requires sacrifice and good morale makes sacrifices acceptable, and therefore possible. The sacrifices included inconveniences in daily life.” As a consequence, free speech suffered. Despite entering a war, I was still shocked at how aggressively President Woodrow Wilson imposed restrictions on those who appeared disloyal or critical of the administration even without proof.

President Woodrow Wilson came down with influenza in Paris during the peace negotiations in January 1919. The influenza weakened him mentally and likely caused him to betray his ideals and to concede to demands contrary to his beliefs when he signed the Versailles Treaty. Unfortunately, its failure led to the rise of Hitler.

The influenza in 1918 “killed the young and the strong.” More than half that died were between the ages of 21 to 30. “In South African cities, those between the ages of twenty and forty accounted for 60 percent of the deaths. In Chicago the deaths among those aged twenty to forty almost quintupled deaths of those aged forty-one to sixty.” In various studies of hospitalized pregnant women, 23 - 71% died and of those who survived, 26% lost their child. “In eight weeks in early 1920, eleven thousand influenza related deaths occurred in just New York City and Chicago, and in New York City more cases would be reported on a single day than on any other day in 1918.” 21,000 children in New York City were orphans even before the epidemic ended. In Alaska, some Eskimo villages were wiped out leaving mainly children or half-starved dogs. Many Native Americans, Pacific Islanders, and Africans were decimated. In Frankfort, Germany 27.3% of those hospitalized with influenza died. Italy lost approximately one percent of its population with Mexico conservatively at 2.3%. “In Buenos Aires, Argentina, the virus attacked nearly 55 percent of the population. In Japan it attacked more than one-third of the population. The virus would kill 7 percent of the entire population in much of Russia and Iran. In Guam, 10 percent of the population would die.” “Huge but unknown numbers died in China.” “Throughout the Indian subcontinent, there was only death. Trains left one station with the living. They arrived with the dead and dying, the corpses removed as the trains pulled into stations.” “In the Indian subcontinent alone, it is likely that close to twenty million died and quite possibly the death toll exceeded that number.” It is believed that more than 5% of the world population of approximately 1.8 billion with the worse in 12 weeks in the Fall of 1918 died. “In 1918 the world’s population was 1.8 billion, less than one-third today’s. Yet the 1918 influenza virus killed a likely 50 million and possibly as many as 100 million.” “[M]ost of the deaths occurred in less than twenty-four weeks.” All of these statistics are merely estimates as the deaths and sickness spread so rapidly that record keeping was a low priority. In the U.S. only large cities and 24 states kept records. “Many who died never saw a doctor or nurse.” However, many countries failed to keep accurate or any records, especially in China, Africa, South America, and in rural areas of India. The Soviet Union was in the middle of a revolution.

Now when I read books set in 1918 - 1920, I will look to see if influenza is mentioned as it was a worldwide catastrophe. The author wrote that literature from that era barely mentioned the pandemic. Yet Poet Robert Frost was sick and John Dos Pasos was very ill with influenza. Author Mary McCarthy lost both of her parents. Writer and novelist William Maxwell’s mother died of it. However, Hemingway, Faulkner, and Fitzgerald did not appear to address it. Why? Katherine Anne Porter was so ill that she almost died, unfortunately her financé did. I want to read her novella, Pale Horse, Pale Rider, about the experience. Christopher Isherwood compared the Nazis’ takeover of Germany in 1933 like influenza.

I learned a lot from this book and recommend. However, my one major gripe is that the book is about influenza epidemic from 1918 to 1920, but the author purposely spent an inordinate amount of time about the history of medical scientists and prominent figures. He should have used another subtitle.

It has been almost a year since the COVID-19 pandemic began and I started working remotely and using Zoom for work. I have severely limited my socializing except for a very few people to Zoom get-togethers, outdoor dining, social distancing from others, and virtual kisses and hugs, and wearing masks when I venture outside or to offices or stores or using Amazon or other businesses to deliver packages. In the U.S. as more people are getting vaccinations or politicians are making decisions, restrictions are being eased. However, this should not be rushed as the pandemic over 100 years ago though less deadly in its subsequent mutations still lasted two years and killed.

Published in 2004, the author predicted that we would certainly have another epidemic as influenza is one of the most contagious diseases and easily spreads between people before symptoms develop and people even know that they are sick. As the world knows that is what happened in 2020 and we are still living with it one year later. This books reminds us of the importance of reading history. So much is not new. History repeats itself.
Profile Image for Joy D.
2,065 reviews239 followers
February 23, 2020
Comprehensive look at the influenza pandemic of 1918-1920 that resulted in the deaths of an estimated 50 million people worldwide. The author starts with a history of medical science, describing the common thoughts of the time immediately preceding the pandemic, and documenting the improvements made by notable institutions and scientists of the day. He traces the origins of the disease, likely in Kansas, and the spread of the disease through transfer and deployment of American military personnel in WWI.

A good portion of the book is devoted to the science of viruses (what they look like under a microscope, how they mutate, and how they infect a host), research methodology, and the many ways people tried to curtail the proliferation of the disease. He takes politicians and newspaper representatives to task for failing to tell citizens the truth. In fact, it ended up being called “Spanish flu” due to the fact that “only the Spanish newspapers were publishing accounts of the spread of the disease that were picked up in other countries.” He analyzes how society reacted to the overwhelming challenges created by the pandemic, and what lessons can be learned from it. Leadership is important, especially during a crisis, and it was sorely lacking in many instances.

The portion of the book focused in the influenza outbreak is the most effective. Barry paints a disturbing picture of the horrors created by the rapid contagion: “But the most terrifying aspect of the epidemic was the piling up of bodies. Undertakers, themselves sick, were overwhelmed. They had no place to put bodies. Gravediggers either were sick or refused to bury influenza victims. The director of the city jail offered to have prisoners dig graves, then rescinded the offer because he had no healthy guards to watch them. With no gravediggers, bodies could not be buried. Undertakers’ work areas were overflowing, they stacked caskets in halls, in their living quarters—many lived above their businesses.”

This book gives highlights the contributions of a number of scientists that may not be familiar to many readers. It points out some of the discoveries that came out of research dedicated to isolating the source of this virulent version of influenza, such as how DNA carries genetic code. I am impressed by the amount of research that went into this book, as documented in the extensive footnotes and bibliography.

At times, it gets a bit scattered and repetitive, and the author digresses into areas not directly related to the influenza epidemic, but overall it provides a detailed analysis of what happened and cautions us not to become complacent. If anyone wants motivation to get the annual flu vaccine, this book will provide plenty of rationale. It will appeal to those with an interest in science or the history of medicine. If reading it for the historical significance, be prepared for lots of scientific details.
Profile Image for Jim.
1,167 reviews73 followers
September 14, 2022
The bodies were piling up. The undertakers, themselves falling sick, were overwhelmed. There was no place to put the bodies. Gravediggers were either sick or refused to bury the influenza victims. Caskets were stacking up...then they ran short of caskets. The city morgue filled up. The stench was terrible...this was Philadelphia, October 1918, the time of the so-called "Spanish flu."
Barry gives us a panoramic view of the most lethal influenza outbreak in history which occurred in 1918-1919. Today we believe that the death toll in the United States was 675,000 out of a population of 105 million. As many as 100 million died worldwide out of a global population of 1.8 billion, more than 5% of the world's population.
Barry follows the movement of the flu virus across the world, starting in rural Kansas, where somehow the virus crossed the animal-human barrier (from chickens?). It erupted in an Army camp in Kansas and moved east with the soldiers and then went on the troopships with them to Europe...It came in three waves, that first wave that hit the soldiers in the spring of 1918 was rather mild. But then in the fall, there was the second wave that was much more virulent--that's when most of the deaths occurred. Then the virus mutated again and there was a third wave which hit places like Australia--which had not been hit so hard by the second wave.
Much of the book is involved with the story of the scientists battling the virus. Barry goes into some detail about this and focuses on some key figures. As he explains, a revolution had occurred in American medicine where labs had been organized and work was going on with the expectation that disease could be conquered by modern science. When it came to the great influenza, science failed. We are still living with the consequences of that.
The book was published in 2004 and, in it, Barry warns that we will face another pandemic. It's only a question of when. He states that we are NOT prepared for a pandemic. The events of this year of 2020 show that he was right.
Profile Image for Indra Nooyi.
Author 4 books19.5k followers
June 10, 2021
I recently read The Great Influenza by John M. Barry, which tells the story and reminds us of the tragic toll of the 1918 Spanish flu pandemic. This book was an incredible walk through history, and there are profound sections that I have read and re-read over the past few weeks. This quote in particular struck a chord with me throughout my involvement with the Reopen Connecticut Advisory Group:

"To have any chance in alleviating the devastation of the epidemic required organization, coordination, implementation."

I’d highly recommend this book and hope it provides you a lens through which to see the current COVID-19 crisis and the ways we get through it, as it did for me.

Profile Image for Sara W.
204 reviews40 followers
June 21, 2009
Getting a little boring, so I'm taking a break from it. I think I expected a social history (how everyday people dealt with the flu, how it affected communities, etc.), and instead it's a very detailed history of medicine at the time (and well, well before the time of the flu!). I think I made it through a good 1/4 to 1/3 of the book (or more) before the Spanish flu began to get mentioned. The focus is on the medicine and doctors (individuals and as a profession - you get the whole history of U.S. medical schools) at the time. While interesting in its own right, it's not what I expected. The title is a little misleading considering how much of this book does not cover the Great Influenza. In addition, the book seems to jump around weirdly, so it's a little hard to keep track of things. I agree with the other reviews which mention the poor editing. I'm planning on finishing the book at some point (at least skimming it) because portions of it are interesting and what I was looking for.
Profile Image for Paul Weiss.
1,251 reviews232 followers
February 6, 2023
A terrifying vision of our possible future!

Barry's THE GREAT INFLUENZA is the story of the influenza pandemic of 1918, the worst pandemic in history. With upper estimates of the global death toll topping an astonishing 100 million people, the Spanish flu outbreak of 1918 made the Black Death of the Middle Ages, for example, look like a family outbreak of a cold that was difficult to shake over the weekend. The Spanish Flu 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. While his focus was primarily on the USA, Barry tries to tell us about the general context of history in 1918 and the specific state of medicine of the day, the madly rushed epidemiological research that took place as a result of the illness, the successes and failures of the efforts that were taken to stem the inexorable progress of the virus as it marched around the world claiming its victims and the heroism of the front line medical staff that attempted to deal with the immediacy of the dying and the dead that filled the halls of the hospitals and overflowed into the streets.

Interesting? Unquestionably. Frightening? You bet ... and down to your very toes. THE GREAT INFLUENZA tells us in all too graphic terms about the extent to which we are currently susceptible to a repeated global pandemic as a result of some new deadly strain of a mutated virus. But was it compelling page turning reading or great writing? I'm afraid not. Writing great history is a very special skill that requires an author to turn dates, facts and events into something that reads like a suspense novel. Pierre Berton can do it. Simon Winchester can do it. Ken McGoogan can do it. For my money, the list of authors that can achieve this feat is really quite short and, sadly, John Barry didn't make the cut. Barry's research was clearly extensive and his tale of the events were exhaustive but it was also, frankly, quite exhausting.

Highly recommended for the information value of its content but it was neither fun nor easy to read.

Paul Weiss
Profile Image for Sherry Sharpnack.
851 reviews20 followers
July 12, 2018
As an immunizing pharmacist who lived through the craziness of the early onset (October) of the swine flu pandemic of 2009, I have long been interested in the great influenza pandemic of 1918-19. What were the circumstances? Why did so many young people die, when usually it’s infants and the elderly?

I was hoping this book would answer those questions, and in part, it did. However, I really did not need a history of medicine in general (back to Galen?!), laboratory medicine in particular, and medical colleges in America. This took up almost the first third of the book and IMHO was really unnecessary. Synopses of the main physicians trying to isolate the organism that caused the pandemic would have been sufficient. For this reason, the book only gets 4 stars.

When we do get to the history of the pandemic, the statistics just get mind-boggling: as many as 8 to 10 percent of all young adults alive at the time succumbed to the flu. Approximately two-thirds of the deaths occurred in a 24-week period. People who awoke healthy were often dead within two to four days, some within 12 HOURS. The flu “killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in twenty-four weeks than AIDS...killed in twenty-four years.” Priests drove down the street in Philadelphia calling out for people to bring out their dead, just like the Middle Ages. Many cities came to absolute standstills.

Even after reading this book, I can’t wrap my head around how awful the Great Influenza was, and can only worry about our preparedness for the next time the virus mutates into an unrecognizable form.

Profile Image for ALLEN.
553 reviews121 followers
February 16, 2022
There are still aspects to the 1918/19 "Spanish" flu pandemic that elude us. It likely originated in Kansas, not Spain. It killed more civilians than soldiers and was the 20th Century's most lethal pandemic except for AIDS. Even today, we are still dealing with its after-effects as it mutates and returns to attack human beings every few years, making vaccines only partially effective.

THE GREAT INFLUENZA is a fascinating book, not lacking in detail. It is unlikely that the death count would have been so high if not for the massive population shifts brought on by World War One, the overcrowding of soldiers, and President Woodrow Wilson's intransigence in insisting on total victory despite the fact that the Central Powers were on the verge of collapse.

The only real gripe I have with this book is that it's awfully long -- 546 pages -- with antecedents in other plagues and epidemics in Europe's prior centuries. You'll also learn a lot about how bacteria and viruses function, and how the great 20th Century epidemiologists set out to tame them. Try to get this revision (2018) of the book, which is right on the money about topics that still plague us: whether schools should be closed in a pandemic, and whether the USA keeps on hand enough personal protective equipment to protect the population (no, the author avers). In an age of Covid-19, we should all have listened.
Profile Image for A.L. Sowards.
Author 20 books1,084 followers
December 24, 2018
I thought this would be a history of the misnamed Spanish flu of 1918 (it originated in the US, but since Spain was one of the few countries not at war and not censoring information, it took that country’s name). This book included information about the epidemic, but also extensive details about the founding of Johns Hopkins and the Rockefeller Institute and the men (and at least one woman) involved in those organizations. I had been hoping for the story of the epidemic all over the world, but this account was focused on the US with only minimal attention for other regions. I thought the parts about the epidemic were interesting, but I found the writing style repetitive and long-winded. Rounding up to 3 stars.
Profile Image for Mike (the Paladin).
3,144 reviews1,847 followers
December 4, 2012
I hesitate to go 3 starts on this book, but for what it is it's a good book. The thing is (and I've seen other reviewers here say the same thing) it's not what I would call "primarily" about the 1918/1919 Influenza pandemic. That's what I was "primarily" interested in.

My grandparents and great grandparents lived through this time. My grand-aunt lived into her 90s and close to 100. She was one of those people (and most of us have known them) who seemed to have a "cast iron constitution". She was seldom sick and when she was she generally didn't slow down much for it. She wouldn't speak about a lot of her past and that included the flu epidemic (that generation seemed to be big on stoicism). When we asked she spoke about it a little. She was a young woman/older girl and was the one who ended up taking care of her whole family. She spoke of the bodies and how they couldn't all be buried and were stacked about.

I got this book because I wanted to know more about the epidemic. This book however is more about the state of medical science in the 18th, 19th and early 20th century. It covers the changes and the discoveries these changes drove science to. About halfway through the book we get to some direct text on the pandemic itself but the author is more interested in the state of medicine in general. The story of the book carries on well past the epidemic but not primarily about the effects of the pandemic itself but the effect on medical science and the doctors who were involved in research.

So it was fairly interesting and it tells the story that it tells very well. I would like however to find a book more concerned about the pandemic itself. We do get some information of that type here, don't let me mislead you. I'd say maybe 25% of the book is concerned with the flu, how it spread and the idiotic bureaucratic mistakes that added to it's spread. The facts of life for the people who lived with it, the situations like small cities that simply set out armed guards and cut themselves off from the outside. It's here but not the primary focus. I guess I'll keep looking.

Three stars but good for what it is.
Profile Image for Joel.
161 reviews29 followers
May 29, 2007
Like a poorly crafted pop song, this book is full of occasional flashes of intelligence and brilliance, but is brought down to the level of the two star by it's repetitive nature and bogged down by details.

Okay, the metaphor doesn't really work with the "bogged down by details" part, but other than that, it's apt.

In attempts to create a rhythm, and strike a melodic note with his writing, Barry uses phrases he thinks are poignant to the point of annoyance. It's honestly like that Debbie Gibson song "Shake Your Love." Well, John M. Barry, you're not shaking my love anymore.

He does Shake My Love during the best parts of the book: the graphic details of the disease itself. But when it comes to relaying the nature of it's affects on various cities and people, it certainly unshakes my love. Unshakes my love with a passion.

The subject matter tends to be so new and fascinating that it keeps you reading, and the 2nd third of the book is worth the time spent on the rest. All told, let's just say I hope there isn't another devestating influenza like the one of 1918-1919 so we don't have to sit through another John M. Barry retelling of it.

Oh, and also 'cause the 50+ million deaths sounds pretty shitty.
Profile Image for Paul Haspel.
563 reviews83 followers
June 3, 2021
The greatness of this book about the H1N1 influenza pandemic of 1918 lies partly, but only partly, in the applicability of its ideas and insights for the COVID-19 pandemic of today. John Barry’s 2003 book The Great Influenza is a magisterial work of history – one that garnered a great deal of critical praise in its own time, back when the idea of a novel coronavirus causing a worldwide pandemic would have seemed to many people like nothing more than a scenario for a science-fiction movie. In the light of more current events, of course, it reminds us of that well-known historians’ truism that what is past is prologue.

The influenza epidemic of 1918-20 sickened and killed people all over the world, in numbers that still stagger the imagination: “Epidemiologists today estimate that influenza likely caused at least fifty million deaths worldwide, and possibly as many as one hundred million….Influenza killed more people in a year than the Black Death of the Middle Ages killed in a century; it killed more people in 24 weeks than AIDS has killed in 24 years” (p. 4). And with such sobering statistics vividly impressed upon the reader’s mind, Barry recounts the entire grim history of the pandemic – a story that will resonate with special power for any reader who has lived through the time of COVID-19.

Author Barry is not only a distinguished historian – the author of thoroughly researched and mellifluously written histories like The Ambition and the Power: A True Story of Washington (1989) – but also a professor of tropical medicine at Tulane University. Accordingly, he is ideally situated to recount The Story of the Deadliest Pandemic in History (the book’s subtitle).

Writing for a lay audience rather than a readership of medical specialists (though I wouldn't be at all surprised if this book gets assigned in some pre-med college courses), Barry provides helpful information regarding the workings of influenza, pointing out that “Influenza is a viral disease. When it kills, it usually does so in one of two ways: either quickly and directly, with a violent viral pneumonia so damaging that it has been compared to burning the lungs; or more slowly and indirectly, by stripping the body of defenses, allowing bacteria to invade the lungs and cause a more common and slower-killing bacterial pneumonia” (p. 35).

In the process, one also learns what made the 1918 influenza so deadly to young people. Unlike COVID-19, a disease that is most devastating when it strikes older adults or people with compromised immune systems, the 1918 influenza hit hardest among young people in their 20’s and 30’s. These were people in their peak of life, health, and vigor, whose immune systems theoretically should have been most able to repel the influenza virus. Yet the 1918 influenza caused the immune system to overreact – the stronger one’s immune system, the more severe the system’s response to the virus – until the overreaction of the immune system was what actually led to the patient’s demise. Barry even evokes the metaphor of an army that uses devastating weapons to kill all the enemy soldiers in a village – but destroys the entire village, and kills all its friendly civilians, in the process.

And forget what you’ve heard about the “Spanish flu.” The reason why it came to be called the “Spanish flu” is quite simple: the outbreak occurred during the First World War, and all the combatant countries – Great Britain, France, the United States of America; Germany, Austria-Hungary, the Ottoman Empire – practiced rigid press censorship. Neutral Spain, by contrast, reported freely on the flu outbreak, particularly when the country’s king became ill with the disease. And all those warring countries, concerned only with winning the war, were all too happy to let the blame for the outbreak of a global flu pandemic fall upon Spain.

So where did the 1918 pandemic originate? It seems to have been a bit closer to home (for Americans) than Spain: “Epidemiological evidence suggests that a new influenza virus originated in Haskell County, Kansas, early in 1918. Evidence further suggests that this virus traveled east across the state to a huge army base, and from there to Europe” (p. 92).

Evidently it was an American flu, a Kansas flu, rather than a “Spanish flu”; and the fact of its breaking out in the midst of a total war effort that brought large numbers of people together in military camps only facilitated its spread. But what matters more than where it began is how quickly it spread and how many people it killed. While it took some time for the virus to take hold, Barry emphasizes well the devastating toll that it came to inflict, always with an eye on the engaging human detail that gives the story life and pathos:

One nurse at Great Lakes [a naval station near Chicago] would later be haunted by nightmares. The wards had forty-two beds; boys lying on the floor on stretchers waited for the boy on the bed to die. Every morning the ambulances arrived and stretcher bearers carried sick sailors in and bodies out. She remembered that at the peak of the epidemic the nurses wrapped more than one living patient in winding sheets and put toe tags on the boys’ left big toe. It saved time, and the nurses were utterly exhausted. The toe tags were shipping tags, listing the sailor’s name, rank, and hometown. She remembered bodies “stacked in the morgue from floor to ceiling like cord wood.” In her nightmares she wondered “what it would feel like to be that boy who was at the bottom of the cord wood in the morgue.” (p. 202)

As it was with the Trump administration’s response to the COVID-19 pandemic in 2020, so it was with Woodrow Wilson’s presidential administration and the H1N1 pandemic in 1918: political calculations got in the way of public-health considerations, and many people died unnecessarily as a result. In the case of the Wilson Administration and the 1918 pandemic, those political calculations related to the First World War: Wilson had committed the United States to a policy of absolute victory through total war, and nothing – not peace feelers put forth by the imperial German government, and not even a pandemic disease that struck people of all nations with impartiality – was going to be allowed to interfere with that policy.

U.S. soldiers were crammed onto troop transport ships, confined together in close quarters, and the results, while tragic, are unsurprising. Barry describes how “Pools of blood from hemorrhaging patients lay on the floor and the healthy tracked the blood through the ship, making decks wet and slippery. Finally, with no room in sick bay, no room in the areas taken over for makeshift sick bays, corpsmen and nurses began laying men out on deck for days at a time” (p. 305). And while “The transports became floating caskets”, the Meuse-Argonne battlefields toward which those U.S. soldiers were being conveyed became places where influenza casualties outnumbered those inflicted by battle, to the extent that those soldiers became “a burden rather than a help in Europe” (p. 306)

But if The Great Influenza is a grim story of disease and death, it is also a hopeful story of what modern medical science can do in response when a new illness presents itself. The influenza pandemic drew the attention of a remarkable group of talented scientists who “recognized that whatever each other’s flaws might be, each of them also had strengths, remarkable strengths. Their work was good enough that, even if in error, one could often find in that error something new, something important, something to build upon” (p. 402). There were indeed errors and false steps – for quite a while, a number of scientists erroneously thought that a bacterium called Haemophilus influenzae had caused the pandemic, where in fact the cause was an H1N1 virus – but over time, the necessary lessons were learned to help the world bring the pandemic under control.

The reader should be sure to seek out the 2018 republication of this 2003 book – because, for that edition, author Barry provided an eerily prescient look ahead to what a new disease like COVID-19 could do. He provides his sense of the efficacy of measures like telecommuting, “social distancing,” and closing national borders. He suggests that “In a truly lethal pandemic, state and local authorities could take…aggressive steps, such as closing theaters, bars, and even banning sports events…and church services.” He brings up school closings, while pointing out that “closing schools places a burden on working parents because it…has to be sustained for weeks” (p. 457).

Perhaps most importantly, Barry looks back at how lies and misinformation from politicians in many countries contributed to the spread of the the 1918 pandemic, and suggests that “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” (p. 460). Within just a couple of years of Barry’s writing those words, the world saw the way in which COVID-19 could be contained when politicians told the truth and forged a sense of common purpose among their citizens – as in New Zealand – as well as the way the disease spread faster, with more people becoming seriously ill and more people dying, when politicians lied, or bent the truth, or engaged in “spin,” or exacerbated divisions among their people, or denied or minimized the seriousness of the COVID-19 pandemic – as in Brazil, India, and the United States.

That amazingly prescient afterword is only one of many factors that make Barry’s The Great Influenza a singularly important book for our times. I feel that I learned a great deal about this public-health crisis of our own era by reading this study of a disease outbreak that took place more than a century ago.
Displaying 1 - 30 of 4,847 reviews

Can't find what you're looking for?

Get help and learn more about the design.