"The Great Influenza" by John M. Barry

The COVID-19 pandemic created a surge of interest in previous pandemics, including what's generally acknowledged as the biggest and deadliest one of all (at least, until now) -- the "Spanish flu" epidemic of 1918-1920.  (Which wasn't actually Spanish at all -- but, I digress...) After watching a PBS documentary about it, soon after COVID began in early 2020, I added "A book about the Spanish flu" to my "priority TBR list" -- but I only just got around to actually reading one now.  There are several such books out there, many well-rated and reviewed (and I may eventually read some of them too), but I wound up choosing "The Great Influenza" by John M. Barry. The book was first published in 2004, and the edition I read was an e-version, published in 2018.  

After a promising Preface, in which doctors are confronted with the first cases of the mysterious virus, the book began with several long and somewhat boring chapters (the first five chapters/10% of the book) on the history of modern medicine and modern medical education in the U.S., followed by a couple more chapters explaining the immune system and viruses in great detail. Once we (finally!) got around to World War I (the U.S.'s entry in 1917, anyway) and the actual pandemic, things picked up and got more interesting.  (And the earlier chapters made more sense as I reached the end of the book, which circled back to some of the people and questions raised there.) 

Barry believes the pandemic began with a particularly virulent outbreak of influenza first recorded in the early months of 1918 in Haskell County, Kansas, which was then brought to an army training site at Camp Funston (Fort Riley) by several local recruits. The winter of 1917-18 was the coldest on record;  conditions at the training camps were crowded, bringing together young men from small towns and large cities all over the country.  Even before the influenza pandemic began, measles and pneumonia were killing thousands of young soldiers in these camps. (See below for a personal note.)  These soldiers carried the virus with them to Europe, where it morphed into an even more vicious and frightening variant -- and then returned with the soldiers to the U.S. aboard ships, causing explosions of illness in camps and cities across the country in the fall of 1918. Complicating matters, hundreds of thousands of doctors and nurses had been enlisted into military service, creating critical shortages in towns and cities across the country when the pandemic began affecting civilians. 

There is so much in here that, from our 2022 perspective, is an eerie precursor to the current covid-19 pandemic (as the French say, plus ca change, plus ca meme chose... do we never learn from history??):  head-in-the-sand politicians, public officials and military leaders;  ignoring common-sense public health measures (crowding ever-more soldiers into already-crowded camps, going ahead with a major bond drive parade in Philadelphia despite strong advice to cancel);  overworked medical staff collapsing from exhaustion and falling ill themselves;  shortages of hospital beds, linens, gauze masks and medical supplies; orders for precautionary measures that came too little, too late...  Like our current struggle with covid-19, this pandemic came in waves that seemed like they would never end. The 1918 pandemic lasted more than two years, through 1920, before finally petering out in the early years of the new decade. 

This earlier pandemic was lethal in a way that even the current pandemic, bad as it has been, is not, and made an impact that is still felt today, medically, culturally and otherwise. This was an era before antibiotics, before the widespread use of oxygen, when vaccines were still being developed for many common illnesses. Masks were used (and mandated in many places -- and yes, there were protests!), but were mostly made of gauze (!), which likely provided little real protection against the virus. The pandemic is curiously absent in the literature of the times, however, and was downplayed in the press for fears that the truth would panic the population and hamper morale and the war effort.  One of the first (and few) places where the virus was covered more openly was Spain -- hence, the virus became known as "the Spanish flu."  

The Afterword -- in which Barry speculates what a modern pandemic on the scale of the 1918 edition might look like and how it might unfold -- is probably worth the price of the book alone. (Many of his thoughts and predictions, for better and for worse, have come to pass.)  I'd love to see an eventual updated version! 

3.5 stars on Goodreads, rounded down to 3. There's a lot of interesting stuff here for anyone wanting to learn more about he 1918 pandemic, and I am glad I slogged my way through to the end -- the good stuff is pretty good -- but it WAS a slog at times.  (If anyone has read any other books about the 1918 pandemic that you would recommend, let me know!) 

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On a personal note:  I had an extra reason for being interested in this book and in the 1918 pandemic. My grandmother's first cousin, from the same town in northwestern Minnesota where she lived and where my mother was born, enlisted in the U.S. Army in December 1917, and died a month later, on January 19th, 1918, at Jefferson Barracks in St. Louis, Missouri. He was 23 years old, and had been living with his 80-year-old grandmother (my great-great grandmother). His mother died when he was 4 years old;  when he was 13, his father (the brother of my great-grandfather) headed west and was never heard from again. 

My grandmother was not quite 4 years old when her cousin died.  He is buried in a family plot in his hometown in Minnesota, and the local branch of the American Legion is named after him. His death certificate lists pneumonia as the cause of death, but his Find a Grave entry says he died of "Spanish flu."  

Barry's book traces the origins of the pandemic to Kansas in the early months of 1918, and to Camp Funston by March. Could the strange new influenza have spread to St. Louis in January, in time for Grandma's cousin to take ill, develop pneumonia and die on the 19th? Kansas and Missouri are next door to each other -- Camp Funston and Jefferson Barracks are just a few hundred miles apart -- so I suppose it's not impossible that (as Find a Grave would have us believe) he could have been an early victim of the pandemic. Or did his death happen so close to the pandemic outbreak that, over time, it just got lumped in with all the other deaths that came afterwards?  I suspect that was probably the case, but we'll likely never know for sure.   

From Chapter 11: 

"In the six months from September 1917 to March 1918, before the influenza epidemic struck, pneumonia struck down 30,784 soldiers on American soil. It killed 5,741 of them. Nearly all of these pneumonia cases developed as complications of measles... The average death rate from pneumonia in twenty-nine cantonments was twelve times that of civilian men of the same age."

There was a major outbreak of influenza at Jefferson Barracks in St. Louis in October 1918, with many deaths recorded then.  

This was Book #18 read to date in 2022 (and Book #2 finished in April), bringing me to 40% of my 2022 Goodreads Reading Challenge goal of 45 books. I am (for the moment, anyway...!) 6 books ahead of schedule. :)  You can find reviews of all my books read to date in 2022 tagged as "2022 books."