Review by Robert McCool
This is a big book on a big topic. 745 pages plus 181 pages (large print) of references and bibliography covering two years of research and attempts for a cure to the worst pandemic we've ever had.

“The Great Influenza of 1918” (Random House, ISBN 978-0-593-34646-4) from author John M. Barry is extensively researched and well written enough to keep you reading all those pages. I can say I liked it, mostly because of the similarity to today's pandemic. And our response to it, which is so much like the response in 1918. We grew to fear, just like in 1918.

 It was the peak of World War I. It quickly became the peak of the deadliest outbreak of the biggest killer the world has known. It killed more in a year than the Black Death did in a century. More in twenty-four weeks than AIDS did during twenty-four years. It killed all ages and financial statuses.  It killed as many as 100 million people worldwide.

It started in Kansas, near an army base, and it spread world-wide through the armed services as they moved soldiers and sailors back and forth for the war effort. Close quarters made it spread like a fire out of control. And that's what it was- out-of-control.

At a naval base where soldiers boarded ships to Germany, and in the shipbuilding industry, perhaps nowhere was hit as hard as Philadelphia. Overcrowding and close quarters killed indiscriminately. At one point bodies were stacked like cord-wood, with nobody to collect those bodies and nowhere to put them. Mass graves were dug and filled. Fear ran high. You couldn't even pay people enough to touch the bodies in order to move them out of the houses and streets.

But that was the enemy. This book is about the heroes who worked tirelessly in labs and in the field to try to find a cure, or even better, a vaccine.

The book is divided into sections. Section One gives the history of medicine from Hippocrates to 1918. Section Two is titled “The Warriors”, and introduces the movers and shakers of medicine and their initial efforts. Section Two, “The Swarm”details doctors coming together and their organizations. With titles like “The Tinderbox,” “Explosion,” “The Pestilence,” and “The Tolling of the Bell” the book chronicles the advances and setbacks the doctors experienced in their labs.

The disease was initially incorrectly diagnosed as bacterial pneumonia. A bad case of the flu because the labs didn't have the equipment to discern between bacteria and a virus. It continued to be labeled and treated as pneumonia,. With the expected results. Nothing could effect this plague.

With the giants of public health, like William Welch, who was chosen to lead the battle in the labs and hospitals, and  a new John Hopkins Medical School aiding the many institutions supporting the effort for a cure. Many doctors worked in public health, hoping to get their name into the annuals of medicine. All of them failed, except for a couple of labs with the means to fund seriously dedicated doctors who worked with all of their souls.

Some things don't change with age. There were the deniers in the huge bureaucracy who assured the public there was nothing to worry about, and the government made its typical moves to downplay the seriousness of the situation in order to control the uncontrollable mass of the public. There was the military with many soldiers dying daily because there was no way to separate the troops. The best thing the military did was to eventually mandate troops wear a mask.

Did we find a cure or vaccine? No. Not at that time. The pandemic moved around the globe until it began to die out on its own. It had turned into a milder, more common flu, and found that the body could develop a better immune  response to it.

Again, the flu of 1918 was so much like today's, except for the numbers of dead. Except for the now advanced medical care available. And the ability to develop a vaccine in record time. Amazing.

The author of the book says we were due for a new coronavirus, and here it is. This time we were lucky to respond so quickly. And the science has improved. Who knows where the public health departments will go from here to prepare for something worse than today's plague.