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A-Great InfluenzaIf you lived in American Samoa or a remote part of Alaska in 1918, you were probably safe. Safe, that is, from the Spanish flu that claimed more lives than any other outbreak of disease in human history. It killed more people than the Black Death in the Middle Ages and more people than AIDS has in 24 years. In the United States, one-fourth of the nation's population fell ill. Nearly 675,000 died, seven times more than those who perished in the Great War. Unlike most flu strains, this one disproportionately attacked healthy young adults. Victims turned blue, bled from their lungs, ears, and noses, and collapsed. Across the nation, undertakers piled bodies and dug mass graves.

Barry explores how a deadly intersection of biology, culture, and politics precipitated this global crisis. He first recounts the heroic efforts of scientists and physicians to modernize late 19th-century medicine. At Johns Hopkins, a dedicated research team gained valuable knowledge, if not answers, about viruses. When the flu hit in 1918, "a humanity practicing the modern scientific method, [confronted] nature in its fullest rage"Ñbut with mixed results. The 1918 strain, which probably originated in sick farm animals in Kansas, quickly spread to soldiers, who transformed cramped, European-bound ships into "floating caskets." Once overseas, the virus mutated, exploded, and rapidly became lethal. Yet, Barry argues, its deadly effects could have been mitigated had President Wilson's fervid war effort not obstructed public health warnings. Instead, government officials created a climate of fear that "threatened to break the society apart." The great lesson for today, Barry concludes, is that a deadly flu could strike again. But how far it spreads is, as history illustrates, both a medical and a political question.
Viking. 546 pages. $29.95.

Critical Themes

The pitfalls of patriotism. Barry claims that the government's war effort, including propaganda, newspaper censorship, and plain fear, precipitated a medical catastrophe. A crowd-filled Philadelphia Liberty Bond parade proceeded despite medical expert warnings. Within a week, the flu finished off 4,597 locals. Likewise, President Wilson could have delayed the shipment of infected troops to FranceÑbut didn't. As a piece of social history, the book is "invaluable." It shows how people and institutions, "captive to the ethos of the time, can rise to the occasion or abjectly fail" (Seattle Times).

The victims. The pandemic also altered the course of world history. Arriving when it did, it struck world leaders in the throes of war. The Germany Army chief of staff claimed that the flu, by debilitating his springtime offensive, accelerated the war's end. And fever hit President Wilson during the Versailles Peace Conference, hindering his effectiveness at the table. Even "peace and postwar security were victims," notes the Providence Journal. But did the disease, as Barry suggests, ultimately lead to the rise of Hitler and World War II? A more dubious claim.

Leadership will save the day. The "final lesson,"Barry writes, "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." It's a timely message. Although the surviving masses promptly forget the 1918 pandemic, the 1957 Asian flu, 1968 and 1997 Hong Kong Flu, and, most recently, SARS, have brought the great influenza "back into our minds" (Los Angeles Times).

Charlotte Observer 4 of 5 Stars
"Sometimes the book reads like a detective novel; other times it reads like science fiction. ... Readers of The Great Influenza will come away with greater knowledge of an important historical event, a new respect for modern medicine and a deeper understanding of and appreciation for the protective armies inside their own bodies." Pat MacEnulty

Chicago Tribune 4 of 5 Stars
"Barry's book is not just a masterful narrative of the events of 1918 but also an authoritative and disturbing morality tale of science, politics and culture that diagnoses much of what continues to ail us in matters of epidemic disease." Robert D. Johnston

Los Angeles Times 4 of 5 Stars
"Barry puts the pandemic into a context of medical, national and world history, reminding us that our world treats illness much differently than our ancestors' did. ... His special contribution in The Great Influenza is that he informs readers about the science of the subject, in 1918 as compared with 2004, intelligibly and without oversimplification." Alfred Crosby

San Diego Union-Trib 4 of 5 Stars
"...a compelling and scary read. ... [The] more tedious portions are necessary to explain the wartime mindset, in which health and political leaders minimized rather than spoke candidly about what everyone could see was an evolving disaster." Cheryl Clark

SF Chronicle 4 of 5 Stars
"Barry has a gift for evoking the horror of the time." Blair Campbell

Seattle Times 4 of 5 Stars
"He describes how the influenza virus attacks the body, how it mutates, how it is capable of recombining with other strains to create ever newer and more deadlier versionsÑwith a clarity that lays the conceptual groundwork for the horrors that would ensue. ... The massive dying begins to numb; a good 100 pages of this 545 page book could have been cut." Mary Ann Gwinn

Washington Post 4 of 5 Stars
"Although we have several other superb histories of the 1918 influenza pandemic, John M. Barry presents a fascinating look at how the epidemic spread and how physicians and researchers rallied to mobilize against a global health crisis." Howard Markel

Boston Globe 3.5 of 5 Stars
"One of Barry's great strengths is showing the interrelatedness of seemingly disparate aspects of social endeavor and economic interest." Katherine A. Powers

NY Times Book Review 3.5 of 5 Stars
"The Great Influenza is easily our fullest, richest, most panoramic history of the subject. ... Unfortunately, Barry is a teacher who doesn't know when to stopÑor start." Barry Gewen

Critical Summary

What happens when science, politics, and human nature collide in deadly conflict? Blood, death, and possibly some lessons for today. Barry, author of Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America, is a master at fashioning morality tales out of tragedy. Here, Barry explores how early 20th-century advances in epidemiology and the efforts of heroic health professionals left lasting legacies for today, but failed in the face of their own era's political, institutional, and cultural obstacles. The book, notes the Providence Journal, "stands solidly and eloquently on its own as a work of history and a cautionary tale."

Although other books have guided readers through the 1918 pandemic, The Great Influenza places this tiny lethal virus within a context of international, social, and medical history. Barry offers lucid (if at times complicated) biological and chemical explanations for the infection and spread of the influenza virus. Sections on microbiology, immunology, and epidemiology provide valuable background for Barry's larger story. Critics note that the narrative, which focuses both on the development of modern medicine in the United States and the government's crippled response to the outbreak, doesn't always hang together. But where it does, it's a gripping tale, enhanced by Barry's gift for evoking the gory details of victims' rapid deaths. Blood, gore, fear, death? It's all there, in vivid detail. At times, Barry's penchant for sharing his extensive knowledge slows down the narrative. Do we really need to begin with Hippocrates and the history of medicine or want to know every detail about his leading scientists' lives? Despite these quibbles, the book resounds powerfully with recent attempts to squelch influenza outbreaks and "the power of fear to paralyze a population" (Chicago Tribune). It's a topic that is as fascinating as it is deadly. You'll be the first in line for flu shots next fall.