Once upon a time I read The Hot Zone: A Terrifying True Story, a book about emergent viruses like ebola, then read Stephen King's The Stand, which painted a graphic picture of life during and after a deadly plague. I thought this was the most terrifying combination of books I could read. I was wrong.

The Great Influenza is more blood-curdling than all that. And John Barry keeps repeating "and it was just influenza."

If we count every single AIDS fatality and add to them every single person infected with HIV, the count (summed over nearly a quarter century) is still less than the body count of the 1918 influenza epidemic.

Barry paints horrifying pictures of the suffering, but also develops the history of scientific medicine in the late 19th and early 20th Centuries.

He connects a lot of interesting dots, too, although he makes clear what is speculative. Had it not been for the influenza pandemic, there is a reasonably good chance that the German offensive during the summer of 1918 would have succeeded, and WWI would have been a bloody draw. Woodrow Wilson suffered from influenza (influenza can cause brain damage) and then reversed himself on holding out for a just peace (thereby laying the foundation for WWII).

One of the doctors who was trying to discover the cause of the flu epidemic kept digging away at perplexing problems. His research began in 1918 and culminated in the early 1940s with the discovery that desoxyribonucleic acid was responsible for transmitting genetic traits. He was up for a lifetime achievement Nobel in 1944, but that was retracted because this research was so controversial. Not until 1955 did Watson and Crick get the Nobel for describing the structure of DNA - which they could not have done without Avery's tireless and meticulous research.

It was a great read. It's also the last of my books carried over from last year. One thing's for dang sure, I'm gonna be getting my flu shots each year!!!

Although I purchased this book a couple of years ago, I hadn't gotten to it until just now. I moved it to the top of my To Read list after finishing The Last Town on Earth, which is a fictionalized account of the 1918 flu. I wasn't expecting the detailed history of how our medical profession modernized, and the history of the origins of Johns Hopkins, although I was pleasantly surprised to find it here. I also found the general policies instituted by the Wilson administration, utterly suppressing free speech and any discord about the war very interesting. The only problem I had with the book was excessive repetiveness -- sometimes I wondered if I were somehow re-reading a page I had read before, as descriptions or quotations were restated verbatim in several parts of the book. There were also excessive descriptions of similar events in different towns that didn't truly add to the book's point -- the impact and experience of the 1918 flu. Certain parts were reminiscent of The Coming Plague (another book which I highly recommend), and if you enjoyed that book, you will enjoy this one as well. I am very glad to have the knowledge gained by reading this book, and the only reason I gave it 4 stars instead of 5 was the repetiveness of many of its points -- the book could have easily been 100 pages shorter with some good editing.

A detailed look at the horrible influenza epidemic that decimated not only the United States but most of the world in 1918, killing tens of millions and sickening many more. An excellent job of explaining the biological and medical complexities of the disease, detailing the history of often shoddy medical education in the United States, and relating the Spanish flu's human and emotional toll through vivid anecdotes of personal hardship and horror. The book reads well as a medical detective story and history, and also presents a useful lesson on the falsehoods routinely issued by government leaders and newspapers in the United States in a misguided effort to keep morale "positive," theoretically to help the war effort.

I liked this book it is a big thick book that takes a long time to read. If you enjoy history and you know it repeats itself. It is an interesting book to buy.

This book contains some excellent information, but i would recommend the abridged version. I don't feel the personal lives & quirks of all of the scientists involved in the story added any insight to this pandemic.

To me, this book really represented a missed opportunity to tell a potentially fascinating story. I found *The Great Influenza* long, overwritten, repetitive, and, most important (as several have noted) telling only the American side of a worldwide pandemic. Sometimes, the author seemed to be so in love with a particular theme or trope that he strained the narrative beyond all reason to fit it in. One of the more egregious examples was the long tale, at the book's end, of the career decline and death of biologist Paul Lewis -- whose work at the time, in fact, was generally unrelated to influenza -- apparently solely so he could end the main text by metaphorically declaring Lewis (who actually died in Brazil of yellow fever) "the last victim of the great influenza."

While certain sections -- notably the ones focused on the actual operation of the virus and the factors underlying its virulence -- were well handled and interesting, and while clearly prodigious research was involved, in general I'm afraid I found the book shaggy, poorly organized, too narrowly focused on the American viewpoint, and ultimately unrewarding.

There are a lot of good reviews describing this book, so I will just say I thoroughly enjoyed it. It was difficult at times to track with the story because it weaves back and forth on itself so that you understand the whole story. Worth reading.

In "The Great Influenza," John Barry provides a fascinating, thorough, informative and accessible window into the great flu pandemic of 1918 that ravaged the United States and much of the western world. Barry deftly sets the background leading up to the outbreak. This includes the major figures and state of medicine during that pioneering era nearly 100 years ago.

Barry notes how, while a handful of physicians and scientists in the world, particularly in western Europe, knew of the germ and cellular theories, by enlarge, most of the medical community in the world still operated on a largely antiquated, inaccurate understanding of medicine and disease. He notes how, up until the late 19th century, almost anyone could get a medical degree and practice medicine, and only a handful of medical schools, like Harvard, and Johns Hopkins had a rigorously clinical model of medicine.

Barry traces the confluence of the developing understanding of disease and cellular theory in that day with the outbreak and rapid spread of the virulent influenza of 1918. Thousands of young adults were grouped together in very close quarters while training and preparing to deploy to World War I. This environment proved to be conducive to the rapid spread of a deadly strain of influenza that spread through military barracks, out to the surrounding community, on to much of the country, and eventually much of the western world in the course of a number of months.

As this alarming pattern of severe illness, and in many cases, death of the particularly young and old emerged, several medical leaders of the day, began to take action. This included the U.S. surgeon general and chief surgeon of the Army. Their proactive measures, including initiating quarantines, strict sanitation, and early, basic attempts at vaccination, while unable to prevent an epidemic, saved countless lives.

This was also a crucial turning point in American medicine, Barry points out, that led to a national and international movement to raise standards for medical training. An increased emphasis on clinical training and better understanding of cellular theory, viruses, and epidemiology also resulted. Medical care advanced by leaps and bounds as a result.

Still, the stories and chilling photos of hundreds upon hundreds of bodies being stacked in the streets and left in abandoned homes in major American cities at the height of the outbreak give one pause. In his epilogue, Barry also looks ahead to the next global pandemic from a perspective of not 'if' but rather 'when' it occurs. His predictions about the spread of virulent strains of flu, such as H151, as well as other multi-drug resistant organisms are eerily prescient given recent news of the increased prevalence of such viruses.

Overall Barry's book "The Great Influenza" is very readable, informative, engaging and an incredible work of historical and clinical scholarship. Very highly recommended!

I loved this book. I loved it because it is a work of non-fiction, yet reads like fiction. This is the story of a deadly virus that killed over 100 million people worldwide in 1918. But like Hollywood horror movies, the evil entity somehow survives at the end of the movie. The influenza virus is still with us, and it can strike back at any time. We already had a taste of its deadly force. The recent SARS and avian flu epidemics that were stopped in time were just a reminder of the risk we are in of another influenza pandemic similar to that of 1918. If the influenza pandemic of 1918 killed at least 100 million people (and some estimates go more than 200 million people) when the population was merely 2 billion, today a similar pandemic will kill over 600 million people worldwide! (Note: The influenza epidemic of 1918 is more precisely called a pandemic because it affected populations throughout the world).

The author does a great job tracing the rise of medical practice in the United States. In the late 1800s and early 1900s, doctors were still trained by the Hippocratic and other old medical practices. The body was said to be out of balance when a person was ill, and the doctor's job was to bring the body back in balance, or harmony. Homeopathy was widespread, but ineffective. There was widespread use of bleeding to get rid of the impurities in the body. Viruses were still unknown. But medical science was slowly progressing. The need for medical research was a hot subject in the early 1900s before the influenza outbreak. Great men founded great medical research institutions, such as the Mayo Clinic, the John Hopkins institute, and the Rockefeller foundation. When the influenza pandemic finally hit in 1918, there were well trained men ready to confront this deadly disease.

Interestingly, when the John Hopkins research institute was founded, the speech given at the inauguration did not mention God. God was no longer viewed as the cause of and healer of disease. Man was solely responsible for healing himself. Man was the healer, not God. The message the speech was giving is that old thoughts needed to change. According to the author, it is precisely this very change in thought that prepared great medical researchers to confront the influenza pandemic of 1918. Doctors and nurses trained after 1911 were much better qualified and knowledgeable about the treatment of disease than did their predecessors.

There is debate as to where the influenza pandemic first started. Some believe that it started in Spain, and for that reason it is sometimes called the Spanish Influenza. Indeed the influenza virus did hit Spain, but in a mild form. It became "Spanish Flu" because Spanish newspapers reported honestly about its effects while wartime censorship in England, France, Germany, and America caused the press to lie about its severity.

It is highly likely that the lethal influenza virus first erupted in an army camp in Kansas, and then moved east to Europe with American troops during World War I. The author explains in detail what it was like for American troops to be stuck on ships infected with the virus. Ships arriving back to the United States were quarantined, and most sailors died on the ships. Many of the American troops died on their journey to Europe from the influenza virus. Living in such close proximity to each other, the virus spread quickly on a ship. At some point, it was feared that more American troops were dying of the virus than in the trenches of Europe.

I found it very interesting how rats were dealt with in the trenches. According to the author, rats were eating the dead bodies of the soldiers. This was viewed as good by the generals of both sides, for the bodies of the dead soldiers did not need to be removed from the battle field, thus putting more soldiers at risk from enemy fire. Also, the time that would have been spent burying the dead was better used on the frontline. Rats of course spread the virus, and when this was brought up to the attention of the generals, nothing was done. Bodies were still left for rats to eat.

Because so many troops were dying of the virus, the army decided to take all the newly trained nurses and doctors. Most joined the army, leaving only a handful of doctors and nurses for civilians, and these were mostly over the age of 45 and trained before 1911 with the old teachings of Hippocrates. They were therefore not qualified to attend to patients inflicted with the influenza virus. As a result, civilians suffered heavy casualties from this deadly disease.

Many mistakes were made that helped spread the virus. Even though it was known that close proximity spread the virus, troops were still being sent to Europe. Many were infected by the virus by the time the ships arrived in Europe. Many arrived dead. The US government also downplayed the severity of the pandemic, claiming that there was no pandemic. Newspapers were not allowed to talk about the pandemic, or mention the word pandemic. We saw this today in China during the SARS and bird flu epidemic, where China hid those cases from the rest of the world. If the virus was able to mutate and spread from person to person, we would have had today a pandemic that would have dwarfed that of 1918. By not telling the world of the reported cases, China left the world unprepared to deal with the pandemic, and above all, for the world to place quarantines to stop the spread of the virus. It seems the same mistakes of 1918 will be repeated during the next influenza outbreak. History indeed repeats itself!

At very conservative estimates, the influenza pandemic of 1918 killed more than 100 million worldwide. It killed more people in twenty-four weeks than AIDS has killed in twenty-four years (estimates are at around 25 million), and more in a year than the Black Death killed in a century. How many will die today should the bird influenza succeed in mutating and spreading from person to person?

The author goes in detail through the trials and errors medical researchers went through in order to find and isolate the virus in order to find a cure against it. For example, many researchers believed that the virus responsible for the pandemic was not the flu virus, but a brand new virus. Those sections of the book read like a medical thriller. I really recommend this book.

Some of the negative feedback by other reviewers:

"Given that American medical research was in its infancy in 1918, there were obviously dozens of physicians and scientists in England, Germany, France, and elsewhere who were similarly involved in the frantic search for a cure. Their stories and identities are not mentioned, even briefly, in this book. Perhaps the book should have been subtitled, "The American Response to the Plague."

"It was quite obvious in the beginning of his book that he attributes the medical innovations of the last century to a separation of God and institutionalized curriculum. In short, he tries to show that when people began thinking for themselves and not relying upon God, medical breakthroughs flourished. As a Christian, I disagreed with his conclusion but was able to look beyond this."

I gave this book an average three stars because that's an average of how this book progresses.
It starts off very slowly with a description of the state of the medical art in the early 1900s , and biographies of the chief players involved in fighting the flu.
All is this is very slow reading, although the author's description of how the flu virus functions is fascinating.
But when the flu takes off, so does the book, and by the time I readed the end it was a page-turner, and I couldn't put it down. I was especially intrigued by the idea that the Spanish Flu set the stage for World War II.
If you can make it through the first half of the book, it is a fascinating history of the 1918 Spanish Flu epidemic.

This book celebrates some of the greatest intellects in American medical history, but fails utterly as a history of the 1918 influenza pandemic. Despite the death of over 50 million souls outside the US, "The Great Influenza" limits its international commentary to 3 pages of hasty statistics. The author thereby implies that the rest of the world was sitting on its hands waiting for America to come to its rescue, like a scene from "Independence Day."

Given that American medical research was in its infancy in 1918, there were obviously dozens of physicians and scientists in England, Germany, France and elsewhere who were similarly involved in the frantic search for a cure. Their stories and identities are not mentioned, even briefly, in this book.

Perhaps the book should have been subtitled, "The American Response to the Plague."

I appreciated the information in this book but it appears that Mr. Barry has never diagramed a sentence in his entire life. The sentence structure is very poor and there are far too many sentences overall. It is extremely repetative when trying to make different points about the same subject. The entire book could have been cut in half if Mr. Barry knew how to write.

Where were the editors on this one? They certainly missed their opportunities.

Also, in Chapter 28, page 323, he refers to a Mrs. George Wharton Pepper as being a descendant of Benjamin Franklin, which, in reality is rather a difficult thing to be since Mr. Franklin had no children.

Fascinating, well written and researched account of the 1918 Flu Pandemic. Even for someone with a weak science background but a strong interest in history, this is an exciting, horrifying book that was difficult to put down. The profiles of the doctors and scientists involved in this terrible plague were surperb and the science was made clear and easily understood. An excellent book on the subject that is haunting and frightening.

John M. Barry's book, THE GREAT INFLUENZA, spotlights the government flaws in 1918 as the USA tried to cope with the flu pandemic. Things are no better today as the Bush administration has mishandled Katrina, denies that global warming exists, and refuses to listen to scientists regarding evolution, a key to studying diseases.

Barry says cronies ran the USA Public Health Department in 1918, thereby not issuing proper directions to stop the flu. Today, Bush neocon cronies staff important positions in health, the FCC and in the airline business. Bush cronies messed up the Iraq War and Katrina relief. They'll make a bigger mess out of a flu pandemic.

In 1918, WWI was raging and our army needed soldiers badly, sending them to Europe even when they would spread the flu. The US Army sent them anyway, to their deaths from flu and infecting thousands of others. The Bush cronies now need more and more troops and money for the Iraq War. They are breaking the budget, leaving little money for battling a flu pandemic.

Barry's book is a huge warning to the USA and to Bush's cronies: set up a plan for flu now. It's going to happen soon.

by Larry Rochelle, author of TEN MILE CREEK, DANCE WITH THE PONY and DEATH AND DEVOTION

I really enjoyed this book as it showed in real life how fast a flu epidemic can spread. One has to realize that this epidemic took place in basically horse and buggy days, people did not travel as much. If you look into your family history, as I did, you may find a relative who died during this time period. After I read this book I discovered a graveyard for a turn of the century orphanage. There were so many children that died, all they could do is put numbers on the gravestones. It made me think how fast a flu epidemic could travel today. The references and facts were an eye opener.

This book will definitely really make you reconsider the vulnerability of society to an epidemic. What really surprised me was how this single epidemic really kick-started the modern health care system. I had no idea that 100 years ago, it was easier to get certified to be a doctor than it was to go to college - quite literally one could go through a correspondence course. It also traces the development and speaks to the foundation of institutions who, our time, are revered for their stature in modern medicine, such as John Hopkins. It covers a great many aspects of medicine and epidemiology. What this book does best, and is truly refreshing for a history book, is provide insight into the thinking of the time - what role politics and political decisions made in the outbreaks in certain cities. What is truly horrifying is how really vulnerable populations are to influenza. Although we understand it better, actual treatment is still quite limited (prevention seems to be the best hope). A small mutation in the virus could again hammer populations around the world. I took on this book because my grandfather's family was so badly devastated by it. I never really asked enough about it before he passed away and now I wish I had. I recommend this book to anyone interested in epidemiology, medicine, particularly how medicine has advanced in the last 100 years, particularly in the US, or if, like me, your family history may have been effected by this. The most frightening aspect is the astounding speed with which this virus spread and the corresponding mortality rate that it brought with it. Tie that in with its extreme, and I mean extreme contagiousness and one finds a really frightening scenario. I can't imagine a world where people are dying so fast they can't even bury the bodies, doctors and nurses are afflicted so badly that they die almost as fast as the patients, that almost nobody really understands how the contagion is spread and people shun one another - neighbors, even family members. What is even more frightening is that this happened less than one hundred years ago. It really makes you think. It really makes you consider how truly vulnerable we all are.

First, with all the fearmongering about pandemics in the last couple of years, it is nice to read about the most deadly epidemic the world has ever known. It's not real comforting, but it is better than the fear Fox News was pandering at Rita/Katrina and the bird flu. It's a great book, one that should have been written, though it could have used a better editor. The book does jump around and there is a lot that probably could have been cut, but it is a great book dealing with a complex subject.

A facinating window into a horrifying period that we've almost intentionally downplayed in our histories. It's especially worthwhile given the recent concerns about an inevitable pandemic. We are better equipped in some ways to deal with a worldwide pandemic, but in many others we are even more fragile. Viruses, like trade, move much more quickly now.

I learned a vast amount about disease, the medical system, and medecine in general. One of the best and most informative books I have ever read. Well-researched and easy to read.

As someone who has a minor hobby of reading everything available about the 1918 Influenza pandemic, I was glad to get a thorough, fairly neutral telling of the tale that included a wealth of detail about the people and places as they were before and after the epidemic. This book presents one of the most complete pictures of the epidemic available and does a good job contextualizing the outbreak in terms of the development of modern medicine and also the public health movement.

The problem with this book is the tone, which reminded me very unpleasantly of a breathless gossip columnist. The language was hyperbolic in a way that was unnecessary and distracting. Barry would have been far more successful in laying out the framework and the story of the epidemic itself had he adopted a more straightforward tone instead of having to herald and forebode with every other sentence.

Still, this is an improvement over the lesser work of Gina Kolata and the few other authors who have dealt with the most deadly epidemic in history.

My husband is a science teacher, and he says when he asks his students if they've heard of AIDS, of polio, of all sorts of epidemic diseases, they always say "yes." But when he asks if they've heard of the 1918 flu epidemic that killed somewhere from 2% to 5% of the total world population, they look at him blankly.

That's why John M. Barry's "The Great Influenza" is such a compelling book, and such a necessary one. This scourge may have been responsible for the deaths of up to 100 million people worldwide, yet we hear so little about it today. This doesn't bode well for our understanding of how epidemics and pandemics work, and it says scary things about our preparedness for another flu pandemic--especially when you consider that it's generally agreed another flu pandemic is coming, and it's only a matter of when---not if---it hits.

One of Barry's great achievements in this book (and there are many) is to focus on the small number of American research scientists and doctors who were working frantically to try to stem the tide of the illness that sprang up in an Army barracks in Kansas. In putting us inside the minds of Army Surgeon William Gorgas, Oswald Avery (who figured out that DNA carried genetic material many years before Watson and Crick came on the scene), and Paul Lewis, we see their human fear of the disease combined with their dispassionate interest in it as a subject for research. Their goal of coming up with a vaccine alone would make its own stunning thriller of a book.

Barry also teaches his readers about the horrific state of American medical education in the century or so leading up to 1918. Few American medical schools required a college education of their students. Fewer still required that their students have a basic understanding of human anatomy, or that they do hospital rounds in order to acquaint themselves with the fundamentals of a variety of illnesses and medical complaints.

In fact, before William Henry Welch came on the scene, most American doctors saw their first patients when they opened up their practices after medical school. Welch was the medical titan who decided to clamp down on sub-standard medical education, and follow the lead of the more sophisticated and demanding medical programs abroad. In instituting these more rigorous demands of medical schools and subsequently of their students and faculty, Welch oversaw the collapse and mergers of a number of American medical schools. He also was instrumental in the founding of Johns Hopkins, which became the gold standard for all American medical training to follow.

The disease was frightening from the very beginning. As America decided to join in the World War I fight, barracks and military camps were being thrown up with haste in order to get soldiers and sailors trained and shipped overseas to the action. The birth of this particular influenza virus was aided by the unusually crowded conditions of these new military installations, and by the subsequent travel of American military personnel to different points all over the world. The disease spread with radical efficiency due to these ground-level conditions.

Throughout the book, Barry refers to bodies being stacked like cordwood---there were too many to bury efficiently. The military and large metropolitan areas (Philadelphia was particularly hard-hit, with as many as 5,000 dead in a single week at one point) resorted to hasty mass burials. Barry tells a heartbreaking tale of a child being carried out of his home with his Italian parents trying to press a large macaroni container on the workers, saying they didn't want their boy buried without a proper casket. The scenes he evokes of New York and Philadelphia and Boston becoming virtual ghost towns---not to mention the smaller, less-well-known villages and towns throughout the country---are viscerally frightening.

This is a page-turner and an education of the highest order, and I can't recommend it too highly to anyone who wants to learn more about an extraordinary chapter of world history which is too little taught today.

John Barry has written a very thorough and compelling book about the 1918-19 flu pandemic. I have to say that my expectations for this book were quite different from the approach Barry took. This did not diminish my enjoyment of the story, however, it took me 50 or so pages to reset myself and why I was interested in this book in the first place -- to learn more about what is often a small footnote in history that coincided with WWI.

The story is not an outbreak thriller as some others suggest. It is first and foremost a history about the transformation of medicine and the medical profession in the United States. In the late 19th century and early 20th century, the profession of medicine in the United States was woefully behind Europe -- Barry notes with some hyperbole (although he is not that far off) that the profession had not advanced much from the days of Hippocrates.

Secondarily, Barry focuses on the inadequacy of public health in the US during this time and how that likely contributed to a greater death toll. Against this backdrop, we are introduced to some of the early American medical giants and their race to find a cure to stop the dying.

About 300 pages through, I thought the book began to drag a bit. About every other chapter kept me engaged and half of the rest of the chapters. Overall, Barry deserves credit for a well-written, multi-dimensional view of this epidemic -- certainly valuable reading as we prepare for the inevitable epidemic we'll face globally, either from influenza or another yet to be identified virus.

This provides and exceptional history of the Influenza Epidemic of 1919 (The "Spanish Flu"). It is written for the layman. It is not a short review or 'overview'. It is a thorough, in-depth presentation of the events spanning about 2 years. Yet the narration still flows smoothly, keeping the reader interested by interspersing personal stories within the basic information structure, providing a much needed human, personal face to the events.



All aspects of the disease are covered: the changes in medicine as a science, the social developments due to the times and the on-going World War I, the government's (in)ability to manage things. The terrifying part was the ease with which the disease went from a national epidemic to a world-wide pandemic in such a short time.



This history follows a group of people who had the greatest impact on public health in the United States in the early 20th Century. Reading the many stories and anectdoes about these people leaves one hoping that the current cadre of physicians and public health professionals will be up to the task to cope with the next world-wide disease. This demonstrates the fact that "globalization" is not a new event and, more relevantly, one could argue that this period in history, the combination of world war one and the concurrent Influenza pandemic was the first step towards globalization - it was the entire world's participation in the war which led to the spread of the disease, forcing us to realize today that our public health has long been interdependent upon other countries.



It was after reading this, when I was recommending it to my mother, that I discovered both of her grandfathers died from this epidemic. The tragedy was my calculation that her parents (my grandparents) had been 12 years old when they lost their fathers amidst a terrifying time of uncertainty.



A must read for anyone interested in either Public Health and its history or just general early 20th Century history.

Sure it was. Just a tiny outbreak of the flu in rural Kansas. Who was to know that this new strain of influenza, which struck brutally and violently and had no mercy, would lead to a pandemic that would haunt the world to this very day?

Barry makes a good point in this book: we talk about the horrors that people inflict upon each other, but not the horrors that nature inflicts upon us. The 1918 pandemic is often forgotten, when placed against the background of World War I. Yet it remains a haunting two-year period, a time of death and discovery, that would affect everything from daily life to world politics. Barry does a superb job of emphasizing both the glories and tragedies that arose from this period; the personal suffering of those fighting the disease; the world-wide impact this ever-evolving virus had on the history of the world. "The Great Influenza" starts with a summation of the rise of American medicine, and ends with a cautionary tale ripped from the latest headlines. This is a must read for everyone interested in medicine, in tragedy, or for those who simply love an engrossing true story.

John M Barry (JMB) has done a fine job of taking this story and delivering a linear discussion of how it spread and the men and woman who fought to try to stop it. Nothing that Man did seemed to have had any effect and in the end, it stopped itself. What Barry has done is to explain (sometimes in painstaking detail) what Influenza is, how it reproduces, how it attacks the body and how the body fights back, and what science and medicine did to try to mitigate the effects.

Like any good story, from time to time JMB goes into the backstory of the scientists and their organizations, how they came about and what they were trying to do before, during and after the pandemic. Mostly we are witnesses to the failures of medical science to make a dent in the morbidity and mortality rates (in the end the only way to prevent an outbreak was to quarantine the areas where people were healthy, and keep everyone else out).

What JMB brings to light is the swiftness in which the epidemic killed those who were the healthiest of the population over a twelve week period. The greatest number of deaths occurred among those 25 to 40, who should have had the easiest time fighting off the disease, while those over 60 (who should have been the weakest) had the lowest mortality rates. At its' worst, the people with the strongest immune response to the disease found that their systems overreacted to the disease and ended up killing the hosts (individual people).

My only criticism of the book is that many times JMB repeats himself or overstates an issue by citing multiple sources to the point of ad nauseum. He seems to suffer from "Mitchneritis", by which I mean that every piece of information that he discovered in his research had to end up in the book (in addition the notes fill almost 50 pages, and the bibliography is over twenty).

All in all though, I found the biographical information on the scientists, their organizations and the governmental response to be of high quality and interesting.

It always shocks me to see the flu of 1918-19 as a minor footnote to history. This is the flue that managed to kill more people in the world in 20 weeks then the AIDS virus has killed in 20 years. At times I'll admit it can be a bit too technical but there is a method to the madness of the detail. Barry is not exaggerating at all here; if you think we've got problems with infectious disease in the world today? Avian Flu? SARS? Big problems right? Buddy you don't even know the half of it. Healthy people knelled over dead sometimes in a week and sometimes in matter of hours. It also brought the economy of the United States to a standstill. Everyone needs to read this excellent book

The things I learned reading The Great Influenza: The Story of the Deadliest Plague in History I can only begin to relate. It was such a startling book, but it was two books truth be told. Two books written in two different ways.

The first book was a history of the stark, remarkable transformation of medicine and science in America from backwoods charlatanry to modern laboratory investigation in less than a generation. The second book was a page-turning drama about how the Spanish Flu traversed the nation and the world leaving nothing unaffected in its wake. The thread that ties these two stories together was that the flu was the first real test of a modern scientific establishment.

As a chronicle of the transformation of medicine from pigheaded instinct to deliberate science, the book succeeded by following the key figures in that movement. In no small part, the founding of Johns Hopkins University and the Rockefeller Center were the defining organizations that changed America from a backwater to a leader nearly overnight. But this chronicle isn't the book's strength and the founders of the scientific establishment in America weren't key players in what was to come. Sure, they trained the scientists and clinicians that were to become center to the dangerous plague, but the true story was the flu.

And devastating it was. In a year, and in three waves, it killed more people than anything else before or since. Upwards of 100 Million by modern estimates. Between 2.5% and 5% of the human population on planet earth. It was a ruthless, relentless killer, and it changed the nature of human interaction in its wake. It killed so brutally that people literally coughed their ribs to splinters. It ravaged the immune system and the circulatory system so thoroughly that people were black before death. It preyed on humanity so efficiently that diagnosis in many cases wasn't even possible until decay started. People would board a train healthy and die before their destination, not in isolated cases but by the dozens, and the hundreds.

In it there's an obvious lesson - it could happen again. It could happen again because our health care system, while more advanced, is poorly prepared to handle millions of sick at once. We've developed a Just-in-Time system with inadequate bed capacity and poorly stocked serum reserves with almost no way to produce needed medications in quantity in the time allowed by a ravaging worldwide disease. Flu deaths are up every year, not down. Illness is more potent, not less. Medicine is playing a bluffing game and eventually Mother Nature is going to call that bluff.

It's a good two books, but the one about flu is far superior to the history of medical science.

- CV Rick

This book was different than I expected in that it has a very thorough and mind-boggling look into the medical profession, politics of the day, and the effect of war on the epidemic. MUCH more information than I had expected. While it is testing my poor little brain with a vernacular that is largely foreign, it is incredible in that it paints a picture of society at large, not just the flu. I lost my great-grandmother in this epidemic, and had hoped to catch a glimpse of the experience...what I got was a history lesson unlike anything that I have ever read, and a deeper understanding of how she lived, not just how she died.

This book was different than I expected in that it has a very thorough and mind-boggling look into the medical profession, politics of the day, and the effect of war on the epidemic. MUCH more information than I had expected. While it is testing my poor little brain with a vernacular that is largely foreign, it is incredible in that it paints a picture of society at large, not just the flu. I lost my great-grandmother in this epidemic, and had hoped to catch a glimpse of the experience...what I got was a history lesson unlike anything that I have ever read, and a deeper understanding of how she lived, not just how she died.

A third of the way into this book, I was prepared to write a review praising John M. Barry for his decision to avoid the obvious - an Outbreak-style thriller (which would have been fine) - and to try something more ambitious: a look at how a handful of brilliant scientists reformed American medicine just in time to confront the 1918 Spanish flu pandemic. Unfortunately, Barry's grand scheme - and my high hopes - collapsed before the final pages. The reason is simple: Barry sets up a showdown that never arrives. Brilliant as they were, the scientists Barry admires so much were virtually helpless to stop "the deadliest plague in history.'' After killing millions, Spanish flu just mutated into something milder and faded away. "The Great Influenza'' was the wrong vehicle for telling the story about the rise of American medical science at the end of the 19th century and the beginning of the 20th. Which is unfortunate because both are fascinating stories, and Barry brings a lot of talent to the project. Despite his tendency to overwrite and to repeat himself, the book is full of gems: clear descriptions of how influenza kills; examples of bureaucratic stupidity in the face of disease; well-researched profiles of scientific giants such as William Welch and Simon Flexner, profiles that reveal their brilliance but also their human frailties. Before I read this book, I didn't know how backward American medicine was in the 19th century and how a few determined men hauled it into the modern world. Nor did I realize the extent to which Woodrow Wilson imposed a Big Brother state after entering America into World War I. So "The Great Influenza'' has redeeming qualities - but the book is a disappointment overall, done in by a flawed master plan.

The Great Influenza: The Epic Story of the Deadliest Plague in History
--By John M. Barry Reviewed by Philip W. Henry


In his monumental history of the (mis-named) Spanish Flu Pandemic of 1918, John M. Barry takes a critical look at American medical education, the role of public health supervision, and the relationship between health care policy and politics.
What is generally known is that the Flu Pandemic of 1918 killed more people in a few months than the Black Plague killed between 1347-1352. It decimated US Troops in World War I; killed as many as 5,000 in a week in Philadelphia, and pitted the interests of public health against the political considerations of the First World War.

As he did in "Rising Tide: The Great Mississippi Flood of 1927 and How it Changed America," Barry has made extensive use of primary sources, including records of morbidity, hospital admission records, census figures, and the private correspondence of many of the people involved. Barry begins the story with the dismal status of American Medical Education at the end of the 19th Century, and its relationship to Johns Hopkins University. Another reviewer has criticized Barry's extensive treatment of the history of medical education as irrelevant; but I find it relates directly to the quality of medical care during the epidemic and the quest to find a solution.
What is most maddening was the "head in the sand" attitude of public health officials. In an effort to prevent panic, they distributed handbills and posters urging people to cover their mouths when they coughed or sneezed and to close their windows against the "miasma" or night air which was thought to be dangerous. An example was the reaction of Philadelphia officials: "...City authorities and newspapers continued to minimize the danger. The Public Ledger claimed nonsensically that (the) order banning all public gatherings was "not a public health measure" and reiterated, "There is no cause for panic or alarm."On October 5th, doctors reported that 254 people had died that day from the epidemic, and the papers quoted public health authorities as saying " the peak of the Influenza epidemic has been reached." When289 people died the next day, the papers said:
"Believing that the peak of the epidemic has passed." In each of the next two days more than 300 people died, ...the next day 428 people died...and the daily death toll would keep climbing for many days yet...approaching even double that number." (P.2 22)
At times, the P.R. Machine almost made sense; it became unpatriotic to develop the Flu during a War.(a War which, ironically, ended with no resolution -- simply an "Armistice" on the llth hour of the llth day of the llth month of the year 1918)


Barry gets tedious after a while with the massive detail, but on the whole "The Great Influenza" is an excellent study of the relationship between public health policy and society. I agree with another reviewer who remarked that this book needed more editorial control and selective weeding out of unnecessary material.

**** (Four and a half stars) -- By Philip Henry

The Great Influenza: The Epic Story of the Deadliest Plague in History
--By John M. Barry Reviewed by Philip W. Henry


In his monumental history of the (mis-named) Spanish Flu Pandemic of 1918, John M. Barry takes a critical look at American medical education, the role of public health supervision, and the relationship between health care policy and politics.
What is generally known is that the Flu Pandemic of 1918 killed more people in a few months than the Black Plague killed between 1347-1352. It decimated US Troops in World War I; killed as many as 5,000 in a week in Philadelphia, and pitted the interests of public health against the political considerations of the First World War.

As he did in "Rising Tide: The Great Mississippi Flood of 1927 and How it Changed America," Barry has made extensive use of primary sources, including records of morbidity, hospital admission records, census figures, and the private correspondence of many of the people involved. Barry begins the story with the dismal status of American Medical Education at the end of the 19th Century, and its relationship to Johns Hopkins University .He says the epidemic did not materialize suddenly, although there were warnings.

What is most maddening was the "head in the sand" attitude of public health officials. In an effort to prevent panic, they distributed handbills and posters urging people to cover their mouths when they coughed or sneezed and to close their windows against the "miasma" or night air which was thought to be dangerous. An example was the reaction of Philadelphia officials: "...City authorities and newspapers continued to minimize the danger. The Public Ledger claimed nonsensically that (the) order banning all public gatherings was "not a public health measure" and reiterated, "There is no cause for panic or alarm."On October 5th, doctors reported that 254 people had died that day from the epidemic, and the papers quoted public health authorities as saying " the peak of the Influenza epidemic has been reached." When289 people died the next day, the papers said:
"Believing that the peak of the epidemic has passed." In each of the next two days more than 300 people died, ...the next day 428 people died...and the daily death toll would keep climbing for many days yet...approaching even double that number." (P.2 22)
At times, the P.R. Machine almost made sense; it became unpatriotic to develop the Flu during a War.(a War which, ironically, ended with no resolution -- simply an "Armistice" on the llth hour of the llth day of the llth month of the year 1918)


Barry gets tedious after a while with the massive detail, but on the whole "The Great Influenza" is an excellent study of the relationship between public health policy and society. I agree with another reviewer who remarked that this book needed more editorial control and selective weeding out of unnecessary material.

**** (Four and a half stars) -- By Philip Henry

A great read that covers a global hallmark that has all too soon evaporated from our consciousness.

As many have said ... it's not if ... it's when. Gives everything from macro to personal solutions to 'our' future health.

This book had promise, and is good in spots - but the overall product suffers greatly from lack of direction and editorial control. If I could rate the best third of the book, I would give it five stars. The other two thirds of the book suffers substantially from a lack of focus, inclusion of unnecessary information, and overly dramatic narrative. And, to add insult to injury, the footnotes are handled in such a fashion that they become nearly useless.

In the afterword, it becomes quite obvious that the author made a bad assumption at the start of his endeavor. After spending seven years researching the book, he concluded that he could not tell the story of the epidemic without covering the history medical science leading up until that time. He also wanted to write the book from the perspective of the scientists and politicians who reacted to the influenza outbreak; he seemed more interested in covering their actions than the virus itself.

These assumptions are incorrect. The most interesting and relevant portion of the book is the history of the virus itself. If Barry had simply explained how the virus worked, how it may have come into being, and then followed each wave of the epidemic in chronological order, this book would have been much more enjoyable and much shorter. Instead, he covers material which is not relevant - and by focusing on this material he breaks up his coverage of the virus, thereby rendering the best part of the book less enjoyable.

The first third of the book is dedicated to the history of modern medical science. Some of the material is of interest, but this history is not necessary for any discussion of the influenza virus. It has absolutely no impact on the remainder of the book. The reader could simply skip the first 30% of the book and would not notice it. I actually found this information to be interesting, that that does not warrant their inclusion in a 450 page book with a supposed focus on the 1918 epidemic.

The second portion of the book is the most direct discussion of the virus in the book, and it is quite good. Barry provides a brief explanation of how the virus works and why it is so successful. He then discusses the impact of the disease, rivaling any horror story while doing so. The amount of chaos and suffering caused by the outbreak is quite sobering.

During this time, Barry also discusses the prevailing political climate. As this outbreak occurred during WWI. President Wilson's desire to turn the entire country into a weapon required news of the virus to be controlled rather tightly. This was exacerbated by a good deal of corruption at lower levels of government. The result was a climate in which misinformation and inaction killed tens of thousands of Americans. This material is entirely relevant, and I actually might have liked for him to focus more on it.

Towards the end of the book, Barry discusses how the virus might have impacted negotiations over the Treaty of Versailles. This seems like a huge point that doesn't get the amount of time it deserves (especially compared to how freely the author discusses the family lives of scientists who had no impact on the epidemic). Still, it is one of the more salient points I took away from the book.

The last portion of the book covers the scientific community's attempts to control the virus. This is really a misguided effort, as there is no significant discovery to work towards. While the scientists Barry introduces the reader to are all very accomplished, none of them are able to make any headway with their influenza work. The book becomes a spastic collection of various experiments carried out by a handful of scientists. The text is hard to follow as it is all over the map, and after you finish it you realized that the last third of the book is about as relevant as the first third, only less interesting. It is almost comical; one of the scientists he covers during the entire book is Paul Lewis. Towards the end of the book, after discussing Paul Lewis' troubled family life ad nauseam, and filling the reader in on all sorts of work Lewis did with tuberculosis (which had no impact on any influenza research), Barry goes on to tell us how Lewis died while working with the yellow fever in Brazil. So essentially, any mention of Paul Lewis in the book was completely superfluous.

Some other gripes - this must be the most overly dramatic book I have ever read. It never adds brevity to the book; and at times almost induces giggles. Barry closes many paragraphs with the statement: "But this was influenza. Only influenza". With no exaggeration, I might have read it more than 100 times in the book. Along the same lines, at many times Barry provides the reader with some statistics to help provide some scale. However, where 2 or 3 statistics would do fine (number of bodies, number of hospital beds, etc), Barry provides us with every fact and number he can get his hands on. You get the impression that he felt compelled to use every fact he dug up during his research, even if it hurt the readability of the book.

Lastly, the footnotes are implemented in the most useless manner I have seen. Actually, there are no footnotes; instead there is an appendix at the back of the book with all of the author's notes. However, there is no notation in the book to indicate that there is a note in the appendix for a particular sentence. Instead, the notes exists in the appendix independently. Each note indicates the last few words of the sentence it relates to, and the page number. So for you to match a citation to the text it is related to, you would need to go to the appendix, find a citation, see the page number it is on along with the last few words of the sentence is relates to, turn to that page, and then scan for the sentence that ends in those few words. They should have saved some money by simply leaving the appendix out.

I imagine a good deal of what is wrong with this book might have been cleaned up by an editor. Unfortunately, it reads as if there was no editor. It is too long, it is not focused, and the writing suffers at times. I can recommend about 1/3 of this book, which is good despite some of the overarching issues discussed above. The rest of the book should be skipped.

The Great Influenza is much more than a book on the 1918 pandemic responsible for an estimated 20 million to 100 million deaths. It is also a history of American medicine. As late as WWI, physicians mired in ignorance were still bleeding patients for various maladies, doctor's certification could be had merely by attending a series of lectures, and funding of medical research was virtually nil. Fortunately for America, heroes such as William Welch worked tirelessly to learn the advanced practices and research methodologies of Europe and bring them to the United States. Thus, America was somewhat more prepared than it might have been for the killing machine which lashed out from Haskell County, Kansas and rapidly spread worldwide. But, "somewhat more prepared" could not begin to address a pandemic worse than any in history with 600,000 Americans dead at a time when the nation's population was one-third of today's.

Barry's book is a page-turner which palpably relates the terror, the dread, the utter helplessness of millions in need of competent medical attention. He chronicles the race to understand the cause of influenza and the brilliant researchers who fought that battle. Barry errs when continuously inserting the comparative phrase "this was influenza, only influenza" for the phrase migrates from one of impact to one of annoyance in no time flat. This, and a seemingly arbitrary penchant for registering his pacifist views may be the only weaknesses in an otherwise excellent text which kept me keenly interested from start to finish. The Great Influenza: The Epic Story of the Deadliest Plague In History is history done well and clearly deserving of 4+ stars.

It killed more people in 6 months than the Black Death killed in a century. People who were young and strong were the most likely to die. In the US, 650,000 people died. The average life expectancy in the US went down by 10 years. Worldwide, perhaps 100 million people died. And yet, it was only the flu. Even today, 90 years after the epidemic, it kills 36,000 Americans in a typical year and we are hardly more prepared to face another epidemic.

John M. Barry has written a fascinating account of the influenza epidemic of 1918. But the book is a lot more than just a review of the flu. Barry starts out by examining the state of the American health system at the time of the epidemic and how it reached that state. He explores the revolutionary changes to medicine that occurred in the late 19th and early 20th century and the people who led those changes. He shows us why, even today, a cure for influenza is beyond our reach, explaining in layman's terms how the influenza virus changes to become deadly and changes again to lose that deadliness. He explains how an endemic virus can lead to an epidemic of unimagined proportions.

Barry also shows how the demands of World War I on troop movements, the propaganda campaigns to keep morale high, and the failure of leaders to listen to the doctors and researchers led to a killing field of historic size. His account tends to concentrate on Philadelphia because the city was hit extremely hard and much of the research going on was near that city but he does cover other areas around the world hit hard by the virus, although his coverage of the flu outside of the US is sketchy at best. He gives us writings from diaries and newspaper articles to show what was actually happening and how the media tried to downplay the epidemic. He gives us detailed accounts of the research (and the researchers) that was done to fight the epidemic, explains why this research was mostly unsuccessful, and does it all in a way that is easy to understand even if you don't have a medical degree.

Barry likes to use foreshadowing, hints of what is to come, to keep the reader's interest and it does work, even if it is a bit melodramatic. Even the chapter titles, "The Tinderbox", "It Begins", The Race", provide some melodrama to the story. The book mostly moves at a good pace and I found myself having trouble putting it down. Barry has written a book that everyone should read, whether you are familiar with the epidemic or not. It is a fascinating, terrifying, detailed, and extremely important book.

On a recent flight I read a good book called, "The Great Influenza - The Epic Story of the Deadliest Plague in History" by John M. Barry. This is probably not the best book to read on a plane where people are coughing.

From the slip cover: In the winter of 1918, history's most lethal influenza of viruses was born. Over the next year it flourished killing as many as 100 million people.

It took me almost 100 pages to get into the book because of medical jargon, a large number of characters, technical research, and historical footnotes. After that I could not put it down for the next 350 pages.

The book not only tells the story of this great flu but it tells of the social impact and how isolated people became and how communities were no longer helping each other.

It is particularly interesting in light of one of the books I am listening to on CD called, "Social Intelligence" by Daniel Goleman that talks of the importance of social interaction on health and well being.

In some communities, 60% or 70% of the population was wiped out.

Medical researchers were not well connected and did not collaborate well during the crisis and medicine was way behind where it is today. (Although I do not think it is as far ahead as we would like to think.) In that day, in some cases they still bled people to try to help them get better.

The book made me think of my own mortality (something that I tend to fight, hence the exercise, etc.). It also made me think of the social system that we have.

The book is extremely well researched with 50 pages of footnotes.

Although this is not a business book, it was certainly interesting and I learned a lot. I do think that businesses need to think about what happens in the next pandemic. We all need a plan.

This book sheds light on the worst epidemic in recorded history, the viral influenza that ravaged populations during WWI. It gives insights into the politics and sociology. It also summarizes much of modern medical history. All making this a really great read for someone interested in these topics.

I often think the media blows the flu season way out of proportion. After reading this book, I feel they might not be even doing enough to warn people. This book blew my mind in many ways. From learning about the history of medicine in our country - to how influenza works, this book was very informational.

It is packed with tons of information - I would not call it a thriller, but more of a chiller. It is chilling to think about a pandemic that could occur at any time and kill 10% of the world's population. We need to pay attention to this book - and support medical research for flu-vaccines.

JVD

This book a a very detailed history of the influenza pandemic of 1918 (a part of history not often discussed or that well known). It is very interesting because of that, but is not very well structured or organized. The story doesn't really have a focus. The author tries to cover too much territory. It would have been better if he had narrowed the focus a bit and concentrated more on a particular aspect of the pandemic. The book tends to wander a bit and is often very repetative. He often uses upward of 10 or so examples to make a point when one or two would do. You find yourself cruising past certain pages to get back to the more core part of the story. Good history, interesting information, facts and characters, but a slow, winding read.

I bought The Great Influenza to find out more about the pandemic that killed my maternal grandmother. I was not expecting a book that read more like a John Grisham novel than an historical text. Barry writes a compelling tale, humanizing the past by focusing on individuals who played key roles in the story of this disease outbreak. He brings the medical and political background to a level that the lay person can not only understand, but also find fascinating. The parallels he draws to today make the book a must read for anyone interested in global health and the politics and science that drive it.

very informative and interesting. Great read for the medical and non-medical person who wants to learn more about how this counrty made medical discoveries in the early 20th century.

God forbid we should ever be faced and have to go through another pandemic, flu or otherwise. This information may help, if we listen, prevent another catastrophe.

If you want to understand how devastating the flu can be this is a great book. Another bonus is the history of John Hopkins and medical research in the United States. The flu spread quickly from an army medical camp in Kansas to infect and harm much of the world. In an age before penicillin the death rate was catastrophic and added to the death of the world war. This book reads like a mystery of how to figure out what was killing people across the world. This is among the best books on health history and the best book on the plague. It is highly recommended for anyone involved in health history or those looking for a defining moment in US history.

This book reads like a great detective story, hard to put it down! Although this is a story of the development and spread of the Great Influenza during WWI, it is much more a story of the state of medical science and a whole host of other factors and personalities that contributed to both the spread and the attempts to learn-about and counter the Great Influenza. Topics touched-on include politics, Woodrow Wilson's leadership, censorship, American society and culture, the media, America's great educational and research institutions, and the experience of military recruits as they prepared to fight in the Great War (WWI). I found the author's discussions on the government's focus on winning the war (to the exclusion of all other considerations and issues) to be very enlightening, and a real revelation as to what life was like at the time.

Although many personalities were involved, the author does an excellent job of getting inside the lives and thoughts of the leaders and medical experts who worked hard to detect and contain the flu, and those wishful thinkers and incompetents who contributed to its spread. The pages come to life with his graphic and engrossing descriptions of what life was like at the time, and how Americans in cities and towns all across the country experienced & dealt with its intrusion into their communities and lives.

The one negative in the book (although I found it did not distract from the overall narrative) is that so many people are mentioned, that it was hard to keep all the names straight. However, by the end of the book, it was clear who was who, and how they contributed (or detracted from) America's response to the Influenza.

I highly recommend this book, definitely one you'll enjoy reading on a quiet evening (or two or three), and probably one you'll want to re-read again!

As a college student, planning