John Barry’s lively, artful, and very well informed account of the flu epidemic in 1918–1919, which killed more people than the guns and bayonets of World War I, ought to attract unusual interest in a year when a lethal form of “avian flu” has begun to spread from birds to people in East Asia, and may (or may not) be about to spread as widely around the world as its predecessor did. If that happens, the medical profession and public health authorities will be far better prepared than anyone was in 1918, since they now know how to immunize human populations against a flu virus, whereas in 1918 no one knew what caused the flu and efforts to find a cure proved ineffective. Yet despite all the expert knowledge and skills accumulated since 1918, it is far from sure that our contemporary medical establishment could deliver enough of the necessary vaccine in time to forestall another march of illness and death comparable to what occurred eighty-six years ago.
The story of the 1918 plague and how a few American doctors mounted frantic yet futile efforts to find a cure for it are the themes of Barry’s book. Chapters shift back and forth between evocative accounts of local outbreaks in the United States and the laboratory efforts of a handful of experts who sought to find the germ that caused the disease and hoped to develop a vaccine against it. In the end, the epidemic subsided of its own accord—or more accurately, through age-old ecological processes, as levels of resistance in human bloodstreams rose and genetic mutation deprived the virus of its initial lethality.
None of that was understood at the time, but Barry’s account profits from subsequent discoveries and his own impressively up-to-date understanding of the dynamics of infection and epidemic. This imparts a magisterial detachment to his portrait of the career of the virus and of a few of the doctors and public health officials who tried to counter its ravages. For in those far-off times, the parasitical virus and the human host still interacted in the natural fashion, and the process was little affected by anything that anyone could do. Nonetheless, current levels of scientific understanding allow Barry plausibly to reconstruct the course of the infection, while admiring the effort and recognizing the mistakes of the doctors and administrators who tried to cope with it.
Barry tells us that it took him seven years to write The Great Influenza, more than twice as long as he had expected. Partly that was because he expanded his theme by deciding to explore the sorry state of American medicine before 1918 in order to better understand the situation that medical scientists faced when the flu struck. But he was also delayed because
finding useful material on the epidemic proved remarkably difficult. 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 …