A Focus on KP HealthConnect
••Fall 2004/Vol. 8, No. 4

Book Reviews

The Great Influenza: The Epic Story of the Deadliest Plague in History | pdf >> By John M barry Book review by T L Max McMillen New York: Penguin Viking, 2004. ISBN: 0670894737. 546 pages. $29.95

In 1918, during the nascent years of modern medical science, nature chose to rage. More devastating than the 1906 San Francisco earthquake and with more quiet ferocity than the most devastating hurricane, storm, tornado--or even World War I--nature chose to demonstrate its simple, awesome, and ultimate power in the form of influenza. Unlike any ever seen before, this influenza demanded as much from a world just embracing science as the AIDS pandemic demands today but in a far shorter time period and with far more immediate results.

The Great Influenza chronicles the beginning of our modern medical world--a world rooted in scientific method, education, and analytic rigor. The founding of Johns Hopkins and the Rockefeller Institute just a few decades earlier than the onset of the 1918 influenza pandemic set the stage, and these institutions had become the "West Point" and "Annapolis" of the American medical forces by launching a defense against the bacteriologic horrors of nature. The first immunizations were being developed, a beginning of understanding of disease and the role of bacteriology was blooming, and disease was beginning to be understood as this most daunting of events was unfolding. Science was poised to understand this field but not to conquer it.

By tracing the scientific lives of the major researchers working at the beginning of the 20th century, John M Barry parallels the story of the pandemic and gives full voice to the naive notion that "this was only the flu." Supporting the argument that the pandemic began in a small town in middle America, Mr Barry explores the science used to decipher this illness, which expressed itself in such diverse and devastating ways. He discusses the sudden onset of influenza and the rapid death of its victims and the efforts to find staphylococci, streptococci, and pneumococci in the victims' lungs; the development of acute respiratory distress syndrome (ARDS); observation of patients' skin turning blue, then purple, then black; and Ebola-like symptoms of bleeding from eyes, ears, and nose. Mr Barry relates stories of people who went to work feeling well and dropped dead on the job with no warning. These stories caused researchers to doubt their theories of this illness and to reevaluate their research findings over and over again.

Richard Pfeiffer, following the influenza epidemic of 1889-1890, discovered the influenza bacillus (Hemophilus influenzae) that many people believed was the cause of the 1918 illness. This belief was supported by finding the bacteria in the mucous membranes of some, but not all, influenza victims. Not until 1931 was the cause of the 1918 pandemic discovered to be a virus with Hemophilus influenzae as a secondary invader.

Over a two-year period, an estimated 50 to 100 million people died worldwide from influenza, but most of the deaths occurred within a 12-week period. Adjusted to today's population, the 1918 figure would equal 175 to 300 million dead. Although medicine has made great strides in treating influenza and its complications, widespread immunization is hampered by the long length of vaccine production times and by inefficiency of distribution methods of vaccines. Medical advances are also offset by modern travel patterns, which can spread the influenza virus far more quickly than in geographically stable populations. Even now, the proper mutation of the influenza virus easily could overwhelm hospitals, cities, towns, and medical science.

Mr Barry states that he "... started this book intending to explore not only the 1918 pandemic itself, but ... how the larger society reacted to an immense challenge ... [and] ... how an investigator should do science ...."¹ His thoughtful and insightful exploration into the lives and motives of such researchers as William Park, Oswald Avery, and Paul Lewis examines the world of research in the early 20th century in a personal and intimate way. Finally, the author connects the 1918 influenza pandemic to us today by relating it to the HIV/AIDS epidemic, to SARS, to bioterrorism, and to the potential for another devastating mutation of the influenza virus. Among the many lessons to be learned from this study is that saying, "It's only the flu" is a singularly inept adage.

Reference

1. Barry JM. The great influenza: the epic story of the deadliest plague in history. New York: Viking Penguin; 2004.

T L Max McMillen is Assistant Editor and Writer for The Permanente Journal. E-mail: max.l.mcmillen@kp.org.

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