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Sunday, February 15, 2004 - Page updated at 12:00 A.M.

Book Review
Chronicle of the devastating flu epidemic of 1918 is frightening, readable

By Mary Ann Gwinn
Seattle Times book editor

Seattle, like many other places, became a masked city. All police wore them, as shown in this photo from "The Great Influenza."
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John M. Barry's magisterial new book about the 1918 influenza epidemic is a tale of how a tiny virus and the fear of its lethal effects swept over the Earth, and how the foundations of a civilized, open society fell before its onslaught.

Barry is the author of 1997's "Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America," which won the Francis Parkman Prize for American history. In "The Great Influenza" he presents a multistranded narrative account of the most devastating pandemic the world has ever known, as well as a history of early 20th-century science and medicine, an analysis of that era's social institutions and an explanation of why flu was, and remains, so dangerous.

It's a lot to absorb — perhaps too much. But it is one signal lesson in what happens when science, catastrophic illness and human nature collide.

First, a primer: In fall 1918, the most virulent strain of influenza known to history killed between 50 million and 100 million people worldwide. (Accurate counts of the dead were difficult to come by in an era where many affected regions, such as China, remained in isolation.) "It would kill more people than any other outbreak of disease in human history," Barry writes. It would kill more people than the plagues of the Middle Ages, more than AIDS today.

"The Great Influenza: The Epic Story of the Deadliest Plague in History"

by John M. Barry
Viking, $29.95
Barry begins his story with the scientists and physicians of the time, men (and a few women) struggling to transform the practice of medicine into a rational, science-based enterprise. He ably sketches their dedication, their monomania and the primitive state of medicine as late as the 19th century. Documenting the beginnings of laboratory-based research at Johns Hopkins, Barry writes that one research assistant kept medical investigators "supplied with organs by riding his tricycle to other hospitals, retrieving the organs, and carrying them back in buckets suspended from the handlebars."

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 versions — with a clarity that lays the conceptual groundwork for the horrors that would ensue.

The outbreak began in spring 1918 in Haskell County, Kan. Five million soldiers had already died in the trenches of World War I, and America was in the thick of the war. Young recruits from Haskell headed for military cantonments in Kansas, taking influenza with them. From there the disease traveled to Europe, infecting French troops a mere two months after its Haskell County debut.

The spring outbreak was an earlier, less virulent phase of the epidemic. By the time the virus traveled back to America in early fall of 1918, it had mutated to lethal effect. It ripped through East Coast military bases and into the civilian population.

Perhaps most instructive of the outbreaks described is the story of Philadelphia, where a corrupt administration did nothing to quarantine early influenza victims. The director of the city health department refused to halt a Liberty Bond parade, despite doctors' warnings that the virus would spread through the crowd. Physicians fared no better with the newspapers: One doctor demanded that an editor print his warning that the bond rally "would bring together 'a ready-made inflammable mass for a conflagration.' The editor refused."

The population was left to suffer and die. Half a million residents may have fallen sick; 759 died in one day. In the week of Oct. 16, 4,597 Philadelphians died of pneumonia, a secondary infection that frequently finished off flu victims. (The disease would spread to Puget Sound when 334 sailors left Philadelphia to come here; "many would arrive there desperately ill.")

Barry spares no detail in painting the mounting horror. As fear and illness spread, there was no one left to pick up the dead: "Corpses were wrapped in sheets, pushed into corners, left there sometimes for days, the horror of it sinking in deeper each hour ... while the living lived with them, were horrified by them, and perhaps most horribly, became accustomed to them."

The influenza epidemic of 1918 originated in Kansas, where this photo of an emergency hospital at a military camp was taken.

Fear froze the city. " 'The fear in the hearts of people just withered them,' " said Susanna Turner, a hospital volunteer. " 'They were afraid to go out, afraid to do anything ... If you asked a neighbor for help, they wouldn't do so because they weren't taking any chances.' "

Nationally, fear and censorship clogged efforts to contain the virus. In the grip of war fever, Woodrow Wilson had instituted measures to repress dissent that make today's Patriot Act strictures look like mild-mannered requests: "He had created a vast propaganda machine, an internal spy network. ... He had even succeeded in stifling speech, in the summer of 1918 arresting and imprisoning — some for prison terms longer than ten years — not just radical labor leaders and editors of German-language newspapers but powerful men, even a congressman."

In consequence, newspapers were afraid to print anything that might affect national morale. As the virus jumped from the East Coast to the West Coast, then moved into the interior, most newspapers simply refused to cover the story, other than to print government-approved cautionary lists filled with ludicrous advice: "Avoid tight clothes, tight shoes, tight gloves — seek to make nature your ally not your prisoner."

The military had already recruited the nation's most competent doctors and nurses. Those left ministered to a panicked population who had witnessed friends and relatives drop dead within three or four days of exposure.

As influenza spread worldwide, it attacked remote regions where the populations, unexposed to any flu virus, were immunologically vulnerable. Entire native villages in Alaska were wiped out. In the remote Canadian province of Labrador, a third of the population died.

And then, suddenly, the virus ran its course, leaving scientists without any clear idea of what had caused it.

Barry devotes the latter part of "The Great Influenza" to the scientists he introduced at the narrative's beginning, documenting their grueling search for the flu's cause and cure. This account doesn't provide much closure. Though flu-related research would yield many other scientific discoveries, no definite conclusions were drawn until many years later.

In researching his story, Barry acknowledges that he was hampered by a phenomenon peculiar to massive sudden death: those grappling with it were too busy to write about it. In the acknowledgements, he notes, "It was easy enough to find stories of death, but my own interests have always focused on people who try to exercise some kind of larger power over events. Anyone doing so was far too busy, far to overwhelmed, to pay any attention to keeping records."

Only a few writers, notably Katherine Anne Porter in her novel, "Pale Horse, Pale Rider," described the brutal snuffing of young lives (the disease disproportionately killed young adults.). Few vivid first-person accounts survive, though one comes from Seattle: The writer Mary McCarthy got on a train in Seattle on Oct. 30, 1918, with her family. They all fell ill. Her father, who had pulled out a gun when a conductor tried to put them off the train, died in Minneapolis on Nov. 6. Her mother died Nov. 7.

The massive dying begins to numb; a good 100 pages of this 545 page book could have been cut.

But it remains an immensely readable book. And as a piece of social history, "The Great Influenza" is invaluable. It shows the courage and cowardice of individuals under great pressure; it shows how institutions, captive to the ethos of the time, can rise to the occasion or abjectly fail.

Most of all, it shows the power of fear to paralyze a population. Fear froze the government's response to the great influenza. Fear that caring for others would lead to illness and death devastated cities and towns almost as much as the disease itself. It's a lesson to ponder in our times, when threats of disease and terrorism have so changed our routines, our attitudes toward strangers, even our world view. As Barry writes: "The fear, not the disease, threatened to break the society apart."

Mary Ann Gwinn: 206-464-2357 or


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