“The 1918 influenza epidemic is one of history’s great conundrums,” Gina Kolata writes in introducing the fascinating medical and scientific stories gathered together in her new book. As the subtitle explains, they are about the flu of 1918, and about recent efforts “to resurrect the virus’s genetic code,” which she believes may soon provide
a key clue in a medical mystery story that is as astonishing as the 1918 influenza itself. It involves science and politics, at their most confused, and at their finest. It involves a virus that is one of the worst killers ever known. And it involves researchers who became obsessed with tracking the virus down. Like all good mystery stories, it also has elements of serendipity and surprise.
It is a story that begged to be told, both for the sheer drama of the tale and for its implications. The resolution of the mystery could help scientists save humanity if that terrible virus or another like it stalks the earth again.
Allowing for a bit of enthusiastic exaggeration, the book delivers everything she promises. Artfully (indeed archly) constructed as a detective story, it tells how heroes and heroines of science, working in obscurity and on their own, encountered not wicked but pompous, misguided, or perhaps merely jealous scientific colleagues, and prevailed in the end. Or perhaps not, since the sequence of only one of the 1918 flu virus’s eight genes had been discovered when she finished her book. Nor had her heroes yet found any distinctive difference between it and other flu viruses that would explain its unusual lethal effects and permit the manufacture of a vaccine that would be fully effective in preventing its recurrence.
The book begins with a sketch of what happened in 1918: how an epidemic that took the medical establishment completely aback first came to public attention in Spain, largely because that country was neutral in World War I and allowed news of the infection to get out, whereas elsewhere military censors kept initial outbreaks secret. But in fact the “Spanish flu” seems to have broken out at almost the same time in many different parts of the world. The United States, Central and South America, remote Eskimo villages in Alaska, as well as Europe and Asia were all affected, and it was in Asia that by far the heaviest loss of life occurred. Expert, but always unreliable, estimates of flu deaths in India alone rise as high as 20 million, and for the world as a whole anywhere between 40 and 100 million are believed to have died.
In the United States, Kolata declares, 28 percent of the entire population fell ill and 2.5 percent of those infected died. But accurate figures for American deaths from the flu of 1918 do not exist, partly because pneumonia often followed the flu and was often listed as cause of death, and partly because at the height of the epidemic in locality after locality record keeping in general and medical administration in particular briefly broke down. But there is no doubt that far more people died from the flu than from combat in World War I; and, according to Kolata, General Erich von Ludendorff subsequently blamed the flu for the failure of the German offensive in July 1918, which “nearly won the war for Germany.”
At the time, viruses were as yet undetected, and for a while many American doctors jumped to the conclusion that a recently identified organism named Pfeiffer’s bacillus, which often appeared in the lungs of flu casualties, was responsible for the flu. When the epidemic was still in its early stages, this mistaken assumption allowed the Philadelphia Inquirer to announce that the medical profession now had “absolute knowledge on which to base its campaign against this disease.” But frantic efforts to vaccinate against the flu, using preparations made from Pfeiffer’s bacillus, as well as other prophylactic gestures, all proved futile.
As a result, the infection simply ran its natural course, almost unaffected by medical intervention. And as private family recollections still attest, when local infection peaked doctors and nurses succumbed in such numbers that most professional medical services ground to a halt. (I myself was thirteen months old when the flu paralyzed Chicago. My parents and I came down with the flu at the same time, and while severely ill my mother gave birth prematurely to a sister whose first months of life were precarious as a result of how she came into the world. It was an experience so searing that my parents almost never spoke of it afterward.)
When the epidemic faded away, medical men, popular memory, and professional historians agreed with my parents and tried to forget the whole thing. No one had much to be proud of. Suffering was over, and even though deaths of innumerable young men and women in the prime of life were privately mourned there was nothing useful to do or say about it. So, like other inexplicable infectious disasters of the more distant past, the flu of 1918 disappeared from the world and from public memory.
Kolata is puzzled by this reaction, failing to realize that in 1918 anyone over thirty-five years of age remembered a time when sudden death from infectious disease, especially in infancy, was an entirely normal human experience. The germ theory had been decisively established only after 1884, when Robert Koch announced his discovery of the cholera bacillus. But many doctors resisted the idea at first, and decades passed before sanitary engineering made the water supplies of American cities more or less germ-free. This, together with other forms of medical prophylaxis against germs, had begun to diminish deaths from infections significantly by 1918, so that, before the flu came, medical authorities of the American army were, in Kolata’s words, “flush with the success of the public health effort that seemed to have made disease in the military almost a thing of the past.” But unexpected death from infection was still a vivid memory for most adults. For them the flu was remarkable only for the number of persons it affected. Once it was over, the wish to forget the epidemic was wholly normal and natural.
The really unusual fact is that in the second half of the twentieth century, public experience of disease altered so radically that in retrospect the epidemic of 1918 began to seem as horrendous as Kolata makes it out to be. Beginning with DDT, atabrin, sulfa drugs, and penicillin, all of which first became widely available during World War II, new chemical compounds and organized, large-scale inoculations made infections preventable or curable as never before. Additional successes came thick and fast. More and more powerful antibiotics were discovered one after another; and in 1955 a vaccine against poliomyelitis brought the last widespread, publicly dreaded infection under control. The World Health Organization even managed to eliminate smallpoxâ€”the most lethal viral disease afflicting humankindâ€”from the entire world in 1976. Optimistic medical men and a grateful public jumped to the conclusion that infectious diseases had been permanently conquered, or at least reduced to triviality.
Flu remained an exception. Global but comparatively mild epidemics of flu recurred, decade after decade, most notably in 1946, 1957, 1968, and (abortively) 1976 and 1997. It was against this background that in 1976 a pioneering historian, Alfred W. Crosby, resurrected the story of the flu of 1918 in his book Epidemic and Peace: 1918.* In 1995, a handful of medical outsiders, emboldened by recent advances in molecular biology and partly inspired by Crosby’s book, decided to try to decipher the genetic code of the 1918 flu virus in the hope of becoming able to forestall any recurrence of such a lethal form of the familiar infection. The story of that extraordinary undertaking, together with accounts of the bureaucratic fiasco of an official effort to prevent an expected epidemic of “swine flu” in 1976 and a drastic but successful effort to stop a new, lethal form of flu in Hong Kong in 1997, make up the rest of the book.
But first Kolata devotes a hasty chapter to comparing the flu of 1918 with a few well-known earlier epidemicsâ€”the plague of Athens in 429 BC, the Black Death in the fourteenth century, and the spread of cholera and TB in the nineteenth century. This is the weakest part of the book. As a science reporter for The New York Times she knows a lot about recent and contemporary medical affairs but did not take time to learn much about the deeper past, and so makes mistakes. For example, despite the well-known fact that pious Europeans established numerous leprosariums and other hospitals in the thirteenth century, she says that “Europe had been relatively free of disease for three centuries” before the Black Death appeared in 1347. She also dates the first recorded flu epidemic, in China, to 1888, instead of 1558-1569, when detailed descriptions of symptoms clearly indicate that flu ravaged England (provoking, by one count, an amazingly high 20 percent mortality there) as well as breaking out in the Americas and in Japan (and very probably elsewhere).
Kolata then turns to episodes from the post-1918 scientific effort to decipher what caused influenza and why it was so infectious. As a skilled journalist and storyteller, Kolata concentrates on aspects of these studies that are relevant for the stories that are to follow. Accordingly, she has little to say about the mainstream of flu research and prevention, referring only in passing to the initial identification of the virus in 1933, and devotes only three brisk sentences to the fact that American health officials inaugurated annual immunization campaigns against flu in 1944, and helped to set up a worldwide watch for new forms of the flu virus in 1947. The central accomplishment of recent research on flu appears only briefly near the end of the book, where she devotes a page and a half to explaining how flu viruses are now believed to mutate by circulating among birds, pigs, and human beings, most notably in southern China, where all three hosts live intimately together and where recent flu epidemics all appear to have first emerged.
As a result, anyone wishing to discover how experts learned to decipher the secret of flu’s ever-renewed infectiousness will not find much help in this book. That was not Kolata’s intention. Instead, she has tales to tell of scientific adventure and misadventure, and her skillful presentation of the work of particular scientists and their derring-do makes her book delightful to read. Successive chapters move back and forth between her chosen characters, beginning with a stirring chapter about how Johan V. Hultin, a Swedish-born graduate student at Iowa, organized an expedition to Alaska in 1951 and discovered a grave where Eskimo victims of the 1918 flu epidemic had been buried in permafrost. He was hoping to recover intact viruses from the frozen bodies and succeeded in securing some still-frozen lung tissue. But using the best techniques available at the time, he was unable to isolate or replicate the 1918 flu virus from his samples and had to give up the quest. He then became a medical pathologist in California, without ever forgetting or quite giving up on the idea behind his youthful adventure.
Greenwood Press; reissued by Cambridge University Press in 1989 as America's Forgotten Pandemic.↩
Greenwood Press; reissued by Cambridge University Press in 1989 as America’s Forgotten Pandemic.↩