A Hypochondriac’s Nightmare: Discussing John M. Barry’s The Great Influenza

Another Thrift Store Find pick for this season is John M. Barry’s The Great Influenza. A hefty doorstop of a nonfiction book, Jennifer was originally intrigued because she’s always been interested in epidemiology, and with the chosen topic of the deadly 1918 influenza pandemic, this combined with her love of history as well. Turns out Paige and Jennifer are basically the same person because Paige is also interested in diseases, so this was a fortuitous pick. The 1918 pandemic, more commonly known – and mislabeled – as the Spanish flu, was the kind of disease that nightmares are made of. Modern medical science had just come into its own in the early twentieth century, with amazing discoveries being made at an incredible pace after the general acceptance of germ theory among the most educated medical professionals and researchers. However, despite this enormous step forward in medicine, the 1918 flu could not have hit at a worse time. A small conflict called World War I happened to be in full swing and in a time before commercial flying was available to the general population, the war necessitated an unprecedented amount of travel and contact between people from across the globe. The flu, possibly originating in America, would follow troop movements across the Atlantic, cross enemy lines, and eventually spread over the entire globe to disastrous consequences that modern medical science could only attempt to contain at the time. The sheer scale of this crisis was overwhelming. With the current threat of coronavirus constantly in the news, who knew months ago when BBE visited a Goodwill bookstore that this pick would become so relevant!

John M. Barry is a highly decorated author of nonfiction, but has worn many hats over the years: football coach, journalist, activist. Barry began studying for a PhD in history at the University of Rochester, but would drop out of the program after receiving his MA. This background in historical research and theory is clearly evident in the complexity, depth, and overall scholarly rigor of his work. Though the PhD route may not have been for him, Barry had a successful career coaching football, even rising to the position of assistant coach at Tulane University. Later Barry would move to Washington D.C. and write for publications such as The Washington Post before turning to nonfiction books. The Great Influenza is not the only book Barry has written on a scientific topic, and his efforts have been recognized by those in the scientific and policy-making communities.

Wow was there a lot to fit into a single episode this week. Jennifer did her best to cram in as much information from the book as possible, but despite an extra long recording session so much remained to be discussed! If you are expecting a book solely about the events of the pandemic of 1918 to 1920, forget about it. Jennifer was surprised to find that Barry takes the reader wayyyyy back. Back to Hippocrates and Galen, in fact, to discuss the foundation of Western medicine. While this may seem like quite a jump, and Jennifer was frustrated at times by the meandering path Barry took to 1918, providing the wealth of contextual material for the pandemic is A+ historical work. In case you were lacking a scientific background, never fear because Barry provides that as well. Jennifer learned how the flu virus acts differently from other viruses, what causes pneumonia, what makes pneumonia a deadly secondary infection, and what the H’s and N’s stand for in H1N1. The real heart of the story, though, are the individuals involved in fighting the disease. Barry is clearly invested in the stories of the scientists and researchers drawn into the flu pandemic, and by the end, chances are you will be invested in their stories, too. While some of the more speculative prose on the emotions or thoughts these individuals may have been experiencing at the time is a little outside the realm of academic history, Jennifer overall believes this technique really brings the story to life, inviting the reader into the lives of William Henry Welch, or Oswald Avery. You may not recognize either of these names in the slightest, but reading The Great Influenza, you’ll walk away seeing them as heroes.

Once Barry does finish setting up the political, social, and scientific background for the 1918 pandemic, the book starts to get rough. We don’t mean that Barry’s writing starts to flounder or the story loses coherence, we mean it is tough to read about the path of destruction that the 1918 virus (H1N1, coincidentally) wrought across the globe. The story of this pandemic is not for the faint of heart, the squeamish, or hypochondriacs (Jennifer is one, unfortunately). The descriptions of the horrific conditions that people faced in cities such as Philadelphia, New York, or Boston are better suited to a sci-fi horror movie than to real life. At least that is how it appears to us today in our mostly sterile and disease-free existence, where imagining bodies piling up in houses because the sick are too weak to remove them is so far outside our experience. Reading about the suffering and fear people across the world faced, and the heroism that emerged despite dire circumstances, brings home how privileged most of us in industrialized countries are today. But it also reveals how fragile and tenuous that privilege truly is. While the virus itself was lethal above and beyond normal limits, the scale and the speed of the 1918 pandemic were what broke societies down completely. Faced with the new threat of coronavirus today, how will we respond if it escapes containment? Just some big questions that neither Paige nor Jennifer have answers for.

In conclusion, The Great Influenza is a hypochondriac’s nightmare. Barry’s afterword is particularly sobering as he assesses our preparedness for the next pandemic. Unfortunately, we are woefully ill-equipped to deal with anything like the magnitude of the 1918 flu. In 1918, the federal government was very nearly criminally negligent in its apathetic response to the flu. The incompetence of government officials was compounded with their reluctance to listen to medical professionals and a president focused only on the war effort. The lack of centralized support as well as scarce resources were critical factors contributing to overall death toll. We will not have the luxury of this response again. Barry is emphatic in his assertion that government needs to seriously reconsider how much money is currently being spent on medical research, particularly the flu. It is also hard to comprehend the harshness of measures that might need to be taken to prevent a pathogen’s spread. The communities that fared best in 1918 were those who instituted strict quarantines, because in reality it is highly unlikely that during an epidemic help will come from a newly created vaccine. The best way to prevent deaths is to prevent infection. So while China’s steps taken to prevent movement in and out of the Wuhan epicenter may seem extreme, in reality this will save many lives as long as we continue to keep the coronavirus contained.

Despite the doom and gloom, what Barry has been able to accomplish through the weaving together of individual storylines with larger political and social developments is masterful. Even though The Great Influenza did not quite follow the path Jennifer had at first anticipated, it was a pleasant surprise. Despite some disagreements over stylistic choices Barry made with his writing, Jennifer gives this read 4.5 out of 5 stars and would recommend it to anyone interested in the history of disease, epidemiology, or the American medical profession.

Don’t miss out on the links mentioned in this week’s episode:

• The CDC has a small online exhibit about the 1918 pandemic, complete with links out to more resources.
• To learn more about the four humors theory of medicine, but also about other systems of medicine in the ancient and medieval period, check out this Crash Course History video. Also, you should just check out Crash Course in general, they make awesome content.
• Heinrich Hermann Robert Koch was the German scientist who was a founder of modern bacteriology and who’s name Jennifer couldn’t remember in the episode. And I mean with three first names, who is going to keep that straight?
• To learn more about viruses in a digestible format, Jennifer has rounded up some relevant YouTube vids: general virus info, the flu specifically, and where viruses came from. The last video is produced by PBS Eons, an awesome channel if you are interested in paleontology, geology, or other early earth science stuff. Basically, it’s nerd heaven!
• To keep up with the latest coronavirus news, check out CNN’s live updates.
• Don’t miss out on the drama over Barry’s science in The Great Influenza. It is fascinating to see others in the scientific community weighing in on whether or not this book is accurate, whether or not it needs to be entirely accurate when portraying scientific ideas to the public, and more.
• Visit John M. Barry’s personal website to see more of his works and read this excellent NYT article on Barry’s work as an activist suing Exxon over destruction of Louisiana coastline.

Tune in next Monday for Episode 1.6. If you’re enjoying the podcast so far, please consider giving us a review. Follow us on social medial if that is your thing (links above), and be sure to check out our Patreon for extra BBE content, including bonus episodes!