The Great Influenza Review

NB: I initally wrote this with the goal of submitting to SlateStarCodex however things are on hold with that site so I thought I would just post here instead.

As I get older, I find that I am less willing to tolerate bad books. In the past, out of a strange sense of guilt, I would force myself to keep reading books even though I did not enjoy them. Nowadays, if I am starting to get bored with a book I will stop reading as early as possible and move on to other books. The Great Influenza by John M. Berry challenged this mantra immensely.

This was a book I had heard quite a bit about over the past few years and had long been interested in reading it. I have a background in public health, attended Johns Hopkins University and I wanted to learn more about influenza outbreaks - all of which made me excited to finally sit down and read this book.

This book starts off by making two compelling arguments - the first is that the US medical education system was incredibly weak in 1918 and most medical doctors had no real expertise or training upon graduation and the second argument is that the outbreak began at an army camp in Kansas. Both of these arguments are methodically presented with extensive background by the author. About halfway through the book, as the influenza epidemic continues to grow larger, the author abandons both of these arguments and shifts to more of a focus on how different communities and the US Government responded to the outbreak. The author argues that the Johns Hopkins School of Medicine was intented to improve medical education in the US and was based on the medical education system in German Universities. Many of the early founders of the Johns Hopkins School of Medicine are extensively profiled, only to completely disappear from the book entirely over the course of the book. This is not uncommon, many individuals are introduced, given a thorough background and then never mentioned again.

In the Afterword, the author says he had hoped this book would take only 1-2 years to complete and it ended up taking him seven years to complete. This is evident as there are many examples of the author describing events and people in excessive detail only for the event or person never to never be mentioned again. For example “Cincinnati’s public health agencies had examined 7,058 influenza victims since the epidemic had ended and found that 5,264 needed some medical assistance; 643 of them had heart problems, and an extraordinary number of prominent citizens who had influenza had died suddenly early in 1919.” (p. 392) This is the first time in the book that Cincinnati is mentioned in the book and it is unclear what exactly these statistical counts add to the narrative as Cincinnati is never mentioned again.

This book is sorely in need of an editor to prune some of the superfluous text. For example:

“It also seemed - although this was not scientifically established - that those who went to bed the earliest, stayed there the longest, and had the best care survived at the highest rates. Those findings meant of course that the poor died in larger numbers than the rich.” (p. 408)

Some basic run on sentences:

“Ten days, two weeks, sometimes even longer than two weeks after the initial attack by the virus, after victims had felt better, after recovery had seemed to begin, victims were suddenly getting seriously ill again. And they were dying.” (p. 317)

Reading page after page of this is exhausting.

This is not to say the book is all bad. There are some interesting parallels between today and the 1918 outbreak that are worth exploring. For example in 1918, President Wilson did not mention the outbreak at all in public and very rarely if at all in private with his staff. The US Surgeon General at the time, Rupert Blue, was extremely slow to even ask for influenza infection counts and instead focused on extolling patriotism by the virtues of Liberty Loans. In Phoenix and Philadelphia, “Citizens Committees” were created by private citizen groups who took it upon themselves to act to enforce quarantine and sanitation ordinances.

Finally, I was cautiously optimistic about the Afterword, written ten years after publication in 2018, and I hoped it would be a breath of fresh air. Sadly it is not. The author rants in the Afterword by claiming that wearing face masks is useless and that the only thing that might get society through a similar epidemic is belief in our elected leaders.

In many ways, reading this book is like performing a science experiment in the sense that there is an interesting story present but to get to it one must sift through a great deal of noise. The book as a whole was moderately interesting but far, far too long. For additional background I would also suggest reading the excellent Wikipedia page about the 1918 Flu instead.