Blogs > HNN > E. James Lieberman: Review of John Barry's The Great Influenza (Viking, 2004)

Apr 27, 2009 10:12 pm

E. James Lieberman: Review of John Barry's The Great Influenza (Viking, 2004)

[Dr. Lieberman is clinical professor of psychiatry, George Washington University School of Medicine.]

Epidemic influenza resembles a terrorist. Its virus camps among pigs and birds, inflitrates innocent people, mutates until a lethal variant trumps the immune system defense and takes over the human host as a weapon of mass destruction. Unlike anthrax, influenza spreads from person to person; unlike plague and HIV/AIDS, there is no effective drug.

Prevention and public health take a back seat to curative medicine in our tech-happy society. Politically we hunt down bad guys; pathogens are bad guys to be punished, but our aim is scattershot, our strategy biased toward pharmaceutical enrichment and poverty of prevention (only two suppliers of flu vaccine, this year and one fell down). The axiom about people, "What doesn't kill you makes you stronger" applies to microorganisms. Antibiotics have been used as placebos, wasted on colds, producing bacterial monsters that plague our hospitals and streets.

Knowing all this, Historian John Barry, prize-winning author of Rising Tide: The Great Mississippi Flood of 1927 and three other books, shows how exceptional science, humanitarian impulses, honest reporting, and courageous leadership contend with wishful thinking, dishonesty, and fear. His narrative pulls ahead, explanations light the way, tension grows about what comes next. The story of the influenza pandemic--"the deadliest plague in history"—has three starting places: Kansas, 1918, for the probable first outbreak; Baltimore, 1876, for the launching of Johns Hopkins University; and Greece, 460 B.C., where Hippocrates first investigated disease in a scientific way. Barry gives an stimulating precis of medical history and scientific method, that, sad to say, is lacking in most medicals schools today.

That history comes to a focus on the slow, painful transfer of European sophistication to the wasteland of American medicine at the turn of the 20th century. It was easier to get into medical school than college then, and the 150 proprietary schools graduated men most of whom had not witnessed an autopsy, done a chemistry experiment, used a microscope, or examined a patient. Just a century ago medical ignorance and quackery were the rule, not the exception.

Reports of the outbreak of what became the epidemic were suppressed by politicians and the press to keep people calm. Venality prevailed in Philadelphia when the mayor and his medical adviser allowed the biggest parade in the city's history to take place despite warnings about contagion. Soon the hospitals were full, the morgues overflowed, mass graves had to be dug. What had been "just influenza" now made many think of the plague. Ultimately 675,000 Americans died, most in the last three months of 1918. Around the world the total can only be estimated: 50 to 100 million. The population then was about one-third what it is now; less than one percent of Americans died but in areas and in whole countries with little prior exposure to influenza and less resistance the death rate was four percent or more. Unlike the influenze we know, this one took its greatest toll among young adults (21 – 45) probably because the elderly retained some immunity from earlier, milder epidemics.

Woodrow Wilson appears as a fanatical crusader once he decided to enter World War I in 1917. He had a weak Surgeon General and ignored better doctors' pleas to stop the transport of troops in crowded ships. Thousands died needlessly in what became "floating caskets" even as the surrender of Germany and its allies was imminent. Only in late September 1918 did newspapers urge people to avoid crowds, cover up coughs and sneezes, wash hands, etc. Doctors and nurses were dying too, and panic was widespread. People died on trains. Corpses riddled tenements. New orphans were cooped up with dead parents with no one to feed or even find them .

The crackdown came too late, e.g. a law in New York state punishing the failure to cover a cough with a year in jail and a big fine (after the horse gets out--like banning penknives from airplanes after 9/11). Bacteria were believed to be the primary cause of influenza, and often did attack its victims. Lab scientists found the viral connection over the next 25 years, which included the epochal discovery of the role of DNA, all thoroughly covered by Barry. The book is dedicated to Paul Lewis, a dedicated researcher who died while studying another viral disease, yellow fever; he is one of many key players humanized by Barry with details of personality and family.

In an afterword Barry looks ahead. The WHO says 43 different infectious organisms could be used as weapons, not including influenza. That would change if someone discovered how to make a dangerous mutant. "A weaponized influenza virus could be the equivalent of a worldwide nuclear holocaust." Publishing such information would enable terrorists to make the virus while also providing information on how to block it: an ethical dilemma for scientists and journalists.

The book ends with a powerful comment on the danger of panic, and the importance of a government and press that earn and keep the public trust. "Leadership must make whatever horror exists concrete. Only then will people be able to break it apart."

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