From Publishers Weekly
In 1918, a plague swept across the world virtually without warning, killing healthy young adults as well as vulnerable infants and the elderly. Hospitals and morgues were quickly overwhelmed; in Philadelphia, 4,597 people died in one week alone and bodies piled up on the streets to be carted off to mass graves. But this was not the dreaded Black Death-it was "only influenza." In this sweeping history, Barry (Rising Tide) explores how the deadly confluence of biology (a swiftly mutating flu virus that can pass between animals and humans) and politics (President Wilson's all-out war effort in WWI) created conditions in which the virus thrived, killing more than 50 million worldwide and perhaps as many as 100 million in just a year. Overcrowded military camps and wide-ranging troop deployments allowed the highly contagious flu to spread quickly; transport ships became "floating caskets." Yet the U.S. government refused to shift priorities away from the war and, in effect, ignored the crisis. Shortages of doctors and nurses hurt military and civilian populations alike, and the ineptitude of public health officials exacerbated the death toll. In Philadelphia, the hardest-hit municipality in the U.S., "the entire city government had done nothing" to either contain the disease or assist afflicted families. Instead, official lies and misinformation, Barry argues, created a climate of "fear... [that] threatened to break the society apart." Barry captures the sense of panic and despair that overwhelmed stricken communities and hits hard at those who failed to use their power to protect the public good. He also describes the work of the dedicated researchers who rushed to find the cause of the disease and create vaccines. Flu shots are widely available today because of their heroic efforts, yet we remain vulnerable to a virus that can mutate to a deadly strain without warning. Society's ability to survive another devastating flu pandemic, Barry argues, is as much a political question as a medical one. Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.


From the New England Journal of Medicine, August 5, 2004
The connection among public health, epidemic disease, and politics can be seen throughout history, from the responses to the Black Death in Italian cities in 1348 to the response -- or lack thereof -- to the resurgence of tuberculosis on the part of the New York City Department of Health in the 1980s. John M. Barry spells out this connection in fascinating detail in The Great Influenza. In his meticulous description of the dire consequences that resulted when short-term political expediency trumped the health of the public during the 1918 influenza pandemic, Barry reminds his readers that the government response to an epidemic is all too often colored by the politics of the moment. Barry is neither a scientist nor a professional historian, and some of the details he gives on virology and immunology are clearly targeted at a nonmedical audience, but physicians and scientists will find this book engrossing nonetheless. The influenza pandemic of 1918, the worst pandemic in history, 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. Barry focuses only on what was occurring in the United States at the time, and he tries to place this unprecedented human disaster both against the background of American history and within the context of the history of medicine. He is right to try to acquaint the reader with the state of American medicine at the turn of the last century, focusing on the dismal status of medical education and laboratory research, particularly as compared with that in Europe at the same time. Much of his discussion centers on "great men" (and an occasional great woman), however, and the picture given of their lives and professional careers is superficial and occasionally repetitious, and it distracts from the main events. His point, presumably, is to convey the futility of all the efforts of these brilliant minds, and he begins and ends the book with anecdotes about Paul Lewis, a scientist who had helped to prove that poliomyelitis is caused by a virus and then developed a highly effective simian vaccine. Lewis is the symbol of the best and the brightest of the scientific establishment, and we follow him as he weaves in and out of the story. He, like all scientists of his time, failed to grasp the fact that influenza was caused by a virus, believing it to be caused by Pfeiffer's bacillus, and he was therefore unable to develop a successful vaccine or to halt the devastation. The book becomes riveting once Barry begins to describe the origins and early weeks of the epidemic. The fact that it was wartime and that hundreds of thousands of men were being called up, placed in overcrowded camps, and packed like sardines into ships to be delivered as efficiently as possible to Europe enabled influenza to spread rapidly among recruits. From the military camps, the virus spread into the civilian population in the United States and from the United States to France. Barry describes the first catastrophe at Camp Devens, in Massachusetts, in the late summer of 1918, where thousands of previously healthy men in their prime suddenly became critically ill, overwhelming the inadequate camp hospital, infecting the medical staff, and dying by the hundreds, apparently with acute respiratory distress syndrome. The smartest and most hardworking scientists, physicians, and nurses, both military and civilian, were stunned by the rapidity of the disease progression and the inexplicable death toll among the youngest and strongest. (Figure) Barry provides a fascinating picture of the response of the government -- both federal and local. The former was sluggish at best and secretive and dishonest at worst, desperate to keep the war effort going and the public calm and to minimize the severity of the disease. In one of the more gripping chapters, Barry focuses on Philadelphia and tells us of the backwardness of its social infrastructure, the lack of a functioning health department, and the power of the local political machine. Dr. Wilmer Krusen, a political appointee who was the director of the Philadelphia Department of Public Health and Charities, deliberately ignored warnings against allowing a Liberty Loan parade to proceed, even though influenza had devastated the local Navy Yard and begun to spread into the civilian population. Within 72 hours of the parade, every bed in Philadelphia's 31 hospitals was filled. Within 10 days the epidemic exploded from a few hundred civilian cases to hundreds of thousands and from a daily rate of one or two deaths to hundreds. The horror is most vivid in the dilemma surrounding the disposal of bodies. The city morgue had hundreds of bodies stacked up, which produced an unbearable stench, and undertakers rapidly ran out of coffins. Hundreds of bodies lay in homes exactly where they had been at the time of death; burial quickly became impossible, since there were not enough people to dig graves. Whether anything might have been done differently, and if it had, whether this would have made a difference, are questions that Barry leaves unanswered. His tone is often irritatingly and unnecessarily sensationalist. But his indictment of the public authorities for their dishonesty and deliberate minimization of the damage and dangers is particularly chilling in today's climate of bioterrorism, in the midst of a war whose damages and dangers have been similarly minimized. Barry makes it all too easy to imagine a similarly devastating epidemic with a similarly inadequate response. I highly recommend this book to all. Karen Brudney, M.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


From The Washington Post's Book World/washingtonpost.com
At the time of the influenza pandemic of 1918, the stately, plump William Henry Welch was one of the most famous doctors in the world, even though he had not touched a patient since 1884. And while he was a renowned expert in microbiology and pathology and apprised of every cutting-edge medical advance of the early 20th century, he rarely ventured into the laboratory, let alone made any discoveries that might win him the coveted Nobel Prize. In fact, Welch's singularly greatest accomplishments were organizational. In 1889, he helped found the Johns Hopkins Hospital and, a few years later, its famed medical school. Under Welch's watch, "the Johns Hopkins" became the vanguard medical institution in the world. A rotund, balding, cigar-puffing, high-voiced man with a pointy Imperial beard, at one time or another he was president or director of just about every important national medical institution then in existence. "Popsy," as his students called him behind his back, was so powerful that he could make or break a budding young physician's career "almost by the flick of a wrist." So it was hardly surprising that President Woodrow Wilson asked him to orchestrate a medical response to an influenza epidemic spreading rapidly through army training camps, killing soldiers in droves before they ever had the chance to go overseas to fight in what we now call World War I. When the newly commissioned Col. Welch and his medical team visited Camp Devins, just outside of Boston, in late September 1918, the sight was chilling. One colleague, the equally overweight dean of the University of Michigan Medical School, Victor Vaughan, reported that "dead bodies are stacked about the morgue like cord wood." In the autopsy suite, Welch turned pale at the sight of the cadavers' blue and swollen lungs. It was hardly the gruesome procedure of dissection that made Dr. Welch so queasy. In his long career, he had presided over tens of thousands of post-mortem examinations. Instead, he realized that he was witnessing evidence of a new and terrible plague. One long-time assistant later recalled that it was the only time he ever saw the imperturbable Welch really worried and disturbed. Before the worldwide pandemic subsided, at least 40 million people died. And a miserable death it was: incendiary fevers followed by intense muscle aches, delirium, profuse bleeding and suffocating chest congestion. Roughly 10 percent of the dead were young adults. During the Renaissance, Italian physicians thought that a celestial "influence" caused influenza, hence its quaint name. In 1918, at the dawn of our scientific understanding of virology, scientists did not have a clue as to what made that year's strain so lethal. They still don't. 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. Barry also supplies useful profiles of the American microbe hunters who struggled to stem the tide -- and shows in turn how their work was shaped by the vast transformations in American medicine that began around 1900, most especially the increasing ability not only to treat dreaded diseases but to halt or prevent them entirely. By synthesizing the work of several accomplished historians of medicine, Barry produces a sharp account of the epidemic's sudden onset, as well as the no less dramatic (and sometimes panicked) responses that it inspired. Barry also underlines the dismaying speed with which many survivors forgot the great influenza outbreak almost as soon as it appeared to end. At present, around the world, approximately 500,000 people die annually of influenza, most of them the elderly, infants or those with severe illnesses. Although this year's flu season seems to be winding down, many health officials stay awake at night worrying that eventually something will change in the virus's structure as it did in 1918 to create a devastating pandemic. As Barry describes, the influenza virus can rapidly disguise the very features that allow our bodies to fend it off -- and that, indeed, is why we all need a flu shot every season. It is also why virologists and vaccine manufacturers need to do a better job of predicting which strain of influenza will prevail each year and ensuring that there is enough vaccine to go around. Paradoxically, the success we enjoyed during the 20th century in taming contagious diseases such as influenza often inspires a false confidence that we have conquered microbes. And this has prompted us to underfund public health programs designed to prevent new epidemics from occurring. But if we learn anything from the history of influenza, not to mention the lessons unfolding daily in an era of SARS, bird flu and other newly emerging infections, it should be that we never really conquer germs; we merely wrestle them to a draw. Reviewed by Howard MarkelCopyright 2004, The Washington Post Co. All Rights Reserved.


From Bookmarks Magazine
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--or two stories. 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. Copyright © 2004 Phillips & Nelson Media, Inc.


From Booklist
Late in this history of the 1918 influenza pandemic, Barry observes that the event "has survived in memory more than in any literature." Apparently, people would rather not record horrors that make them feel insignificant. Fortunately, there are deep-digging historians. Barry presents the pandemic as the first great challenge to the modern American medical establishment, whose response, although it was overwhelmed, demonstrated what medical science applied to public health practice might do, and as a test of national, state, and municipal political responsiveness to domestic crisis. Medicine, though far too lightly equipped, rose to the occasion, but politicians, from President Wilson on down, refused to acknowledge any crisis except the war in Europe and thwarted medicine's best preventive efforts. To portray the forces that met the crisis, Barry first tells the story of scientific medicine in America, begun by the shaping of Johns Hopkins Hospital and University under William Welch into the model for all other U.S. physicians' training and medical research institutions. The researchers who directly engaged the great flu were Welch proteges, and though they failed at the time, the continued research of one culminated in discovering the significance of DNA. Meanwhile, the death and panic, national and worldwide--the flu most probably started in Kansas, and troop movements that the army continued against its surgeon general's advice spread it cross-country and to Europe--were appalling. For readers, however, they are the somber underscoring of an enthralling symphony of a book, whose every page compels attention. Ray Olson
Copyright © American Library Association. All rights reserved


Los Angeles Times
[a] well-researched, well-written account Ö


The New York Times Book Review
Praise for Rising Tide: "Extraordinary . . . an accomplished and important social history."


Booklist, Starred review
an enthralling symphony of a book, whose every page compels attention.


Kirkus, Starred review
Majestic, spellbinding treatment of a mass killer.


Boston Globe
a sobering account of the 1918 flu epidemic, compelling and timely.


San Diego Union-Tribune
...spellbinding...The Great Influenza is a compelling and scary read.


Book Description
No disease the world has ever known even remotely resembles the great influenza epidemic of 1918. Presumed to have begun when sick farm animals infected soldiers in Kansas, spreading and mutating into a lethal strain as troops carried it to Europe, it exploded across the world with unequaled ferocity and speed. It killed more people in twenty weeks than AIDS has killed in twenty years; it killed more people in a year than the plagues of the Middle Ages killed in a century. Victims bled from the ears and nose, turned blue from lack of oxygen, suffered aches that felt like bones being broken, and died. In the United States, where bodies were stacked without coffins on trucks, nearly seven times as many people died of influenza as in the First World War. In his powerful new book, award-winning historian John M. Barry unfolds a tale that is magisterial in its breadth and in the depth of its research, and spellbinding as he weaves multiple narrative strands together. In this first great collision between science and epidemic disease, even as society approached collapse, a handful of heroic researchers stepped forward, risking their lives to confront this strange disease. Titans like William Welch at the newly formed Johns Hopkins Medical School and colleagues at Rockefeller University and others from around the country revolutionized American science and public health, and their work in this crisis led to crucial discoveries that we are still using and learning from today. The Washington Post’s Jonathan Yardley said Barry’s last book can "change the way we think." The Great Influenza may also change the way we see the world.


About the Author
John M. Barry is the author of four previous works of history, including the highly acclaimed Rising Tide: The Great Mississippi Flood of 1927. He is a Distinguished Visiting Scholar at the Center for Bioenvironmental Research of Tulane and Xavier universities.

FROM THE PUBLISHER

In the winter of 1918, the coldest the American Midwest had ever endured, history's most lethal influenza virus was born. Over the next year it flourished, killing as many as 100 million people. It killed more people in twenty-four weeks than AIDS has killed in twenty-four years, more people in a year than the Black Death of the Middle Ages killed in a century. There were many echoes of the Middle Ages in 1918: victims turned blue-black and priests in some of the world's most modern cities drove horse-drawn carts down the streets, calling upon people to bring out their dead.

But 1918 was not the Middle Ages, and the story of this epidemic is not simply one of death, suffering, and terror; it is the story of one war imposed upon the background of another. For the first time in history, science collided with epidemic disease, and great scientists - pioneers who defined modern American medicine - pitted themselves against a pestilence. The politicians and military commanders of World War I, focusing upon a different type of enemy, ignored warnings from these scientists and so fostered conditions that helped the virus kill. The strain of these two wars put society itself under almost unimaginable pressure. Even as scientists began to make progress, the larger society around them began to crack.

Yet ultimately this is a story of triumph amidst tragedy, illuminating human courage as well as science. In particular, this courage led a tenacious investigator directly to one of the greatest scientific discoveries of the twentieth century - a discovery that has spawned many Nobel prizes and even now is shaping our future.

FROM THE CRITICS

The New York Times

The Great Influenza is easily our fullest, richest, most panoramic history of the subject. Barry, who in the past has written about both cancer and the Mississippi flood of 1927, ranges widely, from the physiology of viruses to the development of the American Red Cross. — Barry Gewen

The Washington Post

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. Barry also supplies useful profiles of the American microbe hunters who struggled to stem the tide -- and shows in turn how their work was shaped by the vast transformations in American medicine that began around 1900, most especially the increasing ability not only to treat dreaded diseases but to halt or prevent them entirely. By synthesizing the work of several accomplished historians of medicine, Barry produces a sharp account of the epidemic's sudden onset, as well as the no less dramatic (and sometimes panicked) responses that it inspired. Barry also underlines the dismaying speed with which many survivors forgot the great influenza outbreak almost as soon as it appeared to end. — Howard Markel

Publishers Weekly

In 1918, a plague swept across the world virtually without warning, killing healthy young adults as well as vulnerable infants and the elderly. Hospitals and morgues were quickly overwhelmed; in Philadelphia, 4,597 people died in one week alone and bodies piled up on the streets to be carted off to mass graves. But this was not the dreaded Black Death-it was "only influenza." In this sweeping history, Barry (Rising Tide) explores how the deadly confluence of biology (a swiftly mutating flu virus that can pass between animals and humans) and politics (President Wilson's all-out war effort in WWI) created conditions in which the virus thrived, killing more than 50 million worldwide and perhaps as many as 100 million in just a year. Overcrowded military camps and wide-ranging troop deployments allowed the highly contagious flu to spread quickly; transport ships became "floating caskets." Yet the U.S. government refused to shift priorities away from the war and, in effect, ignored the crisis. Shortages of doctors and nurses hurt military and civilian populations alike, and the ineptitude of public health officials exacerbated the death toll. In Philadelphia, the hardest-hit municipality in the U.S., "the entire city government had done nothing" to either contain the disease or assist afflicted families. Instead, official lies and misinformation, Barry argues, created a climate of "fear... [that] threatened to break the society apart." Barry captures the sense of panic and despair that overwhelmed stricken communities and hits hard at those who failed to use their power to protect the public good. He also describes the work of the dedicated researchers who rushed to find the cause of the disease and create vaccines. Flu shots are widely available today because of their heroic efforts, yet we remain vulnerable to a virus that can mutate to a deadly strain without warning. Society's ability to survive another devastating flu pandemic, Barry argues, is as much a political question as a medical one. (Feb. 9) Forecast: Judging by the coverage on the news, we are in for a bad flu season this year, and with SARS barely behind us, this subject will always be topical. Copyright 2003 Reed Business Information.

Library Journal

The author of Rising Tide chronicles a disease that killed more people in 20 weeks than AIDS has killed in 20 years. Copyright 2003 Reed Business Information.

Kirkus Reviews