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the great influenza

31 December 2004

John M. Barry calls The Great Influenza "the epic story of the deadliest plague in history," but his book is somewhat more idiosyncratic than epic and in any case is not as interested in the 1918 influenza pandemic as in the careers of those American medical researchers who studied the disease. To tell their stories, Barry finds it necessary to go back to the 1870s and recount the development of the profession of medical research in the United States. The story swells to epic length because of a copious use of epic digression.

The 1918 influenza was worldwide, killing more people than any other single outbreak of disease in history. Barry accepts the theory that the disease began in remote rural Kansas. In most other years this deadly new mutation in an influenza virus would have run its course and died out in rural Kansas. But 1918 saw an unprecedented mobilization of the American military, with tens of thousands of young men being crammed together in ill-prepared camps across the nation. Once a few of the Kansas ill joined the cantonment at Camp Funston (part of the modern Fort Riley), the influenza was on its way to spreading across the continent and the world.

The influenza, highly communicable, struck hardest at concentrations of population: military units and large cities. It devastated Philadelphia especially, but almost no city in rapidly urbanizing and developing America was unhit. (My grandmother told me stories of her mother feeding the children kerosene in Chicago that fall to prevent influenza. None of them got sick, so Great-grandma may have been on to something.)

Medical science was thrown for a loop by the influenza. Doctors and nurses, already stressed by the demands of military service, saw their ranks decimated by the disease. And many researchers had no better idea how to fight the illness than my great-grandmother did.

The accepted cause of influenza in 1918 was a bacillus known as B. influenzae. The little critter is now known to be a cause of secondary infections, not the influenza itself (which is viral). The combination of an elusive pathogen and a bunch of secondary invaders masquerading as the culprit stymied researchers at the time and kept them busy for decades afterwards.

Barry's focus is almost entirely on the United States and largely on American researchers. Here, in his efforts to carve individual human dramas from the great mass of the pandemic, he often loses the thread. In order to explain the nature of medical research in America, he centers on the post-Civil-War experiences of William Welch, the driving force behind the creation of the Johns Hopkins medical research labs. We expect Welch to become a leading figure in the battle against the influenza, but all Welch did in 1918 was get sick and then get better, sidelining him for the duration of the epidemic, whereupon he disappears from Barry's story.

Ultimately, Barry has two heroes: Oswald Avery and Paul Lewis. Both became nearly obsessed with research on the influenza pathogen. Neither solved many of its mysteries. Avery digressed into a completely different line of work that led to his discovery that DNA plays the key role in genetics. Lewis became disheartened, and his research career dwindled after a brilliant start; he ended up sacrificing his own life in an attempt many years later to fight a yellow-fever outbreak in Brazil.

These are interesting stories, but have almost nothing to do with the 1918 influenza. As a study of medical professionals stirred into desultory and serendipitous action by a great inciting event, The Great Influenza has some interest; as an epic of the 1918 pandemic, it has much less.

Barry, John M. The Great Influenza: The epic story of the deadliest plague in history. New York: Viking, 2004.