Amidst the media's frenzied coverage of the Ebola disease and the more recent viruses including H1N1 and SARS, exists a part of history that is now little mentioned or perhaps forgotten--the Great Influenza of 1918. Indeed there are perennial lessons that physicians, public officials and the press, can learn from the global pandemic that is estimated to have infected 500 million people and taken up to 100 million lives.
John Barry's book The Great Influenza: the epic story of the deadliest plague in history (2004, New York, Viking) provides an in-depth look at this dark chapter of U.S. history by ingeniously incorporating the development of research and science and medicine against the backdrop of World War I. Barry focuses on the period of time that the disease emerges through the scientific manhunt to decode the disease and combat it with vaccine.
Barry's book recently celebrated its 10th anniversary since first publication in 2004, but the themes that it contains are evergreen especially as we examine the role of the press and public officials during the crisis of infectious diseases. Long before the emergence of the Internet or Google, the press apparently played a significant role in the dissemination of news to public.
But first Barry's book is not solely about a deadly virus nor is it a piece of medical or science journalism, instead it uses influenza as a lens to dig deep into better understanding a special time period in the U.S. Influenza sits in the forefront against the backdrop of World War I. The U.S. enters World War I in April 1917 and influenza, also known as "the Spanish flu" or "La Grippe," takes hold slowly and surely in 1918.
Barry gracefully writes about the disease against the backdrop of a critical time in history, and eloquently illustrates the synergy between disease and war, and its impact on society on the international, national and municipal levels. The book is a tapestry of history and mystery, and pendulums from dark and depressing to one of hope and solutions.
One of the strengths of the book is that it offers an engaging and comprehensive look at the rather recent rapid development of science, research and the medical field in the U.S. To be sure, around the Civil War period remedies related to infectious diseases included attacking the body with mustard plastics, and it isn't until the late 1800s that medical schools emerge, and Rockefeller University the premier university in scientific research opens.
Barry brings history to life by also introducing us to an entourage of top scientists and researchers. He uses people and characters as the common thread to tie the narrative together from beginning to end. The book paints a detailed portrait of a likeable and yet seemingly brilliant but odd cast of characters involved in the Influenza manhunt including William Henry Welch, Simon Flexner, Oswald Avery, William Park, Anna Williams, Rufus Cole and Paul Lewis.
There is rich detail on the various facets of their lives outside of the laboratory. Welch is a loner who consciously shies away from attachments. Williams, a wild and creative vaccine therapy expert, with a love of aviation, is also a loner. "I was told today that it was quite pathetic that I had no one particular friend," Williams is quoted as writing (272).
He also brilliantly weaves the history of the disease and World War I, along with the history of cities and municipalities. For example, he uses Philadelphia as a case study in illustrating the impact of influenza on public health. Along with this there is the age old question of individual and civil liberties and the welfare of public society during times of national crisis.
For example, a Liberty Loan parade is planned for September 28, 1918 in Philadelphia, but there's serious talk of cancelling it as the disease is known to easily spread in crowds. The parade went on but the disease infiltrates the crowds. Philadelphia's economy further takes a hit when workers such as those in the city's transportation department fall ill, and social service agencies are overwhelmed.
Barry also sheds light on the role of press coverage during this period in time throughout the book, thus acknowledging the importance of the media as an important vehicle for disseminating information.
Despite for example the staggering number of deaths in Philadelphia (on October 10, the epidemic killed 759 people in Philadelphia, and during the week of October 16, 4,597 Philadelphians died from influenza or pneumonia), the press underreported the realities of the disease. The five newspapers in Philadelphia, (Press, Inquirer, Bulletin, Public Ledger and North American) didn't even "find a single statement about the crisis from the mayor (321)."
The problems that emerge from under coverage or no coverage are as follows: there is a gap between what is being reported and what the public is actually seeing or experiencing, and as a result a mistrust of the press. "Uncertainty follows distrust, fear follows uncertainty, and under conditions such as these, terror follows fear," Barry writes.
Both public officials and the press are late in reporting the truth in the situation. It is not until November 8th that most newspapers start to report about the fear and the fallout. The impact and power of the press is seen with the change. The newspaper North American in referred to influenza as the "plague," leading "people in the street to whisper the word."
The repeated examples of the underreporting in newspapers and a muted press, leaves questions ripe for research and exploration. Was the press following in the heels of public officials who don't acknowledge it publicly either? Less clear and apparent is why? Why didn't the press serve as watchdog during this particular time and instance in history?
A potential theoretical framework that addresses these questions is W. Lance Bennett's indexing theory, which argues that the range of debate on public affairs appearing in the news is indexed to the range of debate present in mainstream government discourse. Essentially the lack of debate and consensus on influenza as a public issue was reflected within a muted press.
Structure-wise the book is smart, informative and engaging; it is written with a tone of mystery that builds with the emergence of the virus, and then an intense manhunt to capture the disease. The narrative is further focused as Barry primarily focuses on the year 1918.
Where the book falls short at times is over-dramatizing moments during history. There are the cliffhanger sentences that end chapters and remind one of a spy novel: "As he worked, the society about him teetered on the edge of collapse," or this sentence "In the meanwhile, the killing continued" ends the chapter, which describes Oswald Avery's efforts to isolate influenza. At other times the book is tiresome and repetitive in the way Barry almost beats to death the descriptive horror of influenza and leaves the reader thinking, "OK, we get it."
There is description of the spread of the virus inside the military vessel Leviathan. "Nurses themselves became sick. Then the horrors began," Barry writes. "Pools of blood from hemorrhaging patients lay on the floor and the health tracked the blood through the ship, making decks wet and slippery."
Despite its flaws, Barry's book is rich with knowledge, and for making a case that this is an event and a period of history that is significant. The book poses questions that the public, government officials and especially the press should consider as new infectious diseases emerge. How are the stories of these diseases told within the context of the present, and what are the lasting lessons can be learned from 1918? This still awaits to be seen.