The first chapter of this deeply researched, scholarly documentary reads like an advertisement for Johns Hopkins Hospital and University; the second and third provide equal boosterism for William Henry Welsh who is praised as a godlike idol. We do not hear of influenza at all in Part 1(87 pages).
Part II is a very good but basic 25 page primer in general virology for non medical readers. In Part III we finally get a detailed discussion of the factors facilitating the spread and lethality of the 1918 influenza strain, from overcrowding and unhygienic conditions in hastily constructed military bases and munitions factories to a very dysfunctional public heath system in the U.S. (The somewhat parochial focus on the U.S. population, troops, researchers, and politicians gets a bit annoying.)
The liberty-limiting and fact-denying measures of the Wilson administration to whip up belated support for the war effort were as draconian and dangerous as anything Trump has dreamed up and give me some hope that the latter’s damage can also be reversed. Named Spanish flue only because the news of its devastation was not censored in neutral Spain unlike in most of the war-engaged countries, the overwhelming evidence is that the outbreak started in a sparsely populated community in Kansas and spread quickly because of the massive movement of military personnel, overcrowded barracks, and national leaders determination to ignore everything except the preparations for war. The constant mutation of the virus also contributed to its variable virulence in different parts of the world and in different waves.
A digression. In my now-dated book, Medicine Outside The Box, I pointed out that any pathogen that kills a high proportion of its host population is unlikely to itself survive, but neglected to note that there are pathogens which thrive in many host species and could thrive with one fewer host species. This is something worth considering with respect to Covid-19, which along with influenza viruses has other natural host species. To borrow a military euphemism, the future extinction of Homo sapiens might be just nature’s ‘collateral damage’ in a war between two or more other species. But if so neither I nor anyone else would be around to recognize my prediction.
In Parts IV through VII, the full global devastation of the pandemic is described in nauseating detail. There were debates about avoiding crowds, distancing oneself from others on the street, cancelling public functions, closing schools, churches and factories, and the use of face masks. Medical and nursing students and retired doctors were recruited to deal with the sick and dying, and uncontrolled drug treatment trials were carried out, often in overcrowded, unsanitary makeshift hospital wards. Sound familiar? And there circulated serious conspiracy theories that the virus was deliberately released by Germany as a biological weapon. Also sound familiar?
In later chapters Barry describes in minute unnecessary detail the panic and devastation in cities, towns, and rural communities, mostly in the U.S. or the U.S. contingent of soldiers in France. One cannot wonder if his description was not from biased reports and diaries selected for dramatic effect. The strong evidence that lasting brain effects of Woodrow Wilson’s encounter with influenza at Versailles lead to his acceptance of the very faulty treaty makes the virus a key player in 20th century history.
The lengthy digressions into the personalities and personal lives of researchers, public health officials and politicians are clearly separated into praise or vitriolic damnation with little in between. And they contribute little of vital importance to the theme of the book. The author seems very anxious to pass judgement on everyone, whether he has met them or talked to them or not. If you get to page 398, skip to page 447, as there is nothing about influenza in between.
There are at least two obvious errors in this account. By definition, symptoms are subjective experiences of the ill, but here they are twice said to be detected only at autopsy. In a superficial and confusing discussion of pulmonary anatomy, physiology, and pathology, Barry states that “The respiratory tract serves a single purpose: to transfer oxygen from the air into red blood cells.” Really? What about transferring carbon dioxide in the opposite direction? And like many others, he uses the words statistics and data interchangeably although they mean very different things,a pet peeve of mine.
This is a very informative and timely account, but it is also unnecessarily long, dry, and pedantic. It would be much better to have written a short book on influenza and a longer one on the history of early 20th century medicine and biological sciences. It is worth reading selective parts as we struggle to cope with Covid19.
Thanks, Andra.
The Passionate Reader 