The Great Influenza

The Epic Story of the Deadliest Plague in History

By: John M. Barry

Narrated by: Scott Brick

In the winter of 1918, at the height of World War I, history's most lethal influenza virus erupted in an army camp in Kansas, moved east with American troops, then exploded, killing as many as 100 million people worldwide. It killed more people in twenty-four weeks than AIDS has killed in twenty-four years, more in a year than the Black Death killed in a century. But this was not the Middle Ages, and 1918 marked the first collision between modern science and epidemic disease. Magisterial in its breadth of perspective and depth of research, THE GREAT INFLUENZA weaves together multiple narratives, with characters ranging from William Welch, founder of the Johns Hopkins Medical School, to John D. Rockefeller and Woodrow Wilson. Ultimately a tale of triumph amid tragedy, this crisis provides us with a precise and sobering model as we confront the epidemics looming on our own horizon.©2004, 2005 John M. Barry; (P)2006 Penguin Audio, a division of Penguin Group (USA) Inc., and Books on Tape. All Rights Reserved.

Critic reviews

Over a year on The New York Times bestseller list

"Monumental... powerfully intelligent... not just a masterful narrative... but also an authoritative and disturbing morality tale." —Chicago Tribune

"Easily our fullest, richest, most panoramic history of the subject." —The New York Times Book Review

"Hypnotizing, horrifying, energetic, lucid prose..." —Providence Observer

"A sobering account of the 1918 flu epidemic, compelling and timely. —The Boston Globe

"History brilliantly written... The Great Influenza is a masterpiece." —Baton Rouge Advocate

the great book

I thought that the history of the flu needed the detailed discussion of the history of the disease, the governments, and the researchers. I didn't think any of it un-necessary. The author and the reader were excellent. I usually enjoy Scott Brick-he makes most books a better listen than a read.

Fascinating Account, Relevant Today

As I write this review in the fall of 2009, I am struck by the relevance of what happened 90 years ago to the swine flu pandemic of today. I learned from this book that the H1N1 virus that is threatening us today is the same virus from the Spanish flu back then (the author also explains how the Spanish flu got its name). The relevance of this book may be diminished by next spring, should the swine flu pandemic this winter turn out to be a false alarm. But listening to this book will hopefully help prepare the reader in taking precautions to prevent infection. Medicine has made huge advances since the Great Influenza. Whether those advances can prevent humans suffering a repeat of the tragedies of 1918 remains to be seen.

The book is quite lengthy, so if you have minimal patience and want to skip over the background of medical history to get to the influenza outbreak, I suggest you skip ahead to the 2nd part of the audio book. While you will be missing some interesting historical information, such information is not vital to the understanding of the influenza outbreak. The most important part of the book is how deadly the H1N1 virus is and what steps should be taken to prevent its spread. This information could be very important in the winter of 2009-2010.

Deja vu all over again...

H1N1 has been here before.
This is a totally engaging approach to the "Spanish Flu" history.
Not 5 stars because of the narration...not Mr. Brick's best work. The cadence of the reading is monotonous at times.

Narrator may need to tone it down

Brilliant! Important! I found this an excellent discussion of scientific method, and process. It's also a wonderful and disturbing piece of history. I do think we've been so lucky in the Western world to have not seen anything on the scale of the 1918 Influenza Pandemic in most of our lifetimes. While it's easy to take comfort with modern medical advances, I might point out that in the 1930's, St. Francis, Kansas (you may have trouble finding it on a map) had 2 doctors if my sources are right. While now they have no doctor at all. We got scared with Avian Flu, we got scared with SARS, we are scared about Ebola. This is what a Pandemic can look like. This also deals well with the political issues of the time which influenced decision making in ways which negatively impacted many people. The afterword is also very important. He makes important points about a market driven health care economy. To make money, we need to keep utilization high, which means that we don't keep a lot of excess capacity in the system for important items like Emergency Room beds. You may not have noticed but it's not all the uncommon for Hospital Emergency rooms to become overwhelmed during Flu season and to no longer accept transfers, or close outright. I listened to this as an audiobook, and I did think the narrators style at times felt a bit too dramatic. I've heard him narrate Ayn Rand novels, and those are sufficient hyperbolic to be well adapted to that style, but it felt out of place here.

I learned a lot, I didn't know.

Where does The Great Influenza rank among all the audiobooks you’ve listened to so far?

I would put it in the upper middle, good but not the best. I still enjoyed it a lot. I would recommend it to anyone to finds the subject matter interesting.

What was one of the most memorable moments of The Great Influenza?

The amount of mistakes the country's leaders made in under estimating the strength of the flu. Their thoughts were on the WW1 and how to win it. They went and had a 2 mile long War Bond parade when people were already dropping dead from the flu. This made it spread so much faster.

Have you listened to any of Scott Brick’s other performances before? How does this one compare?

no, I have not.

Did you have an extreme reaction to this book? Did it make you laugh or cry?

The hopelessness, some people were so sick themselves that they could not carry their loved ones corpses out of their NY apts and they were forced to lay in the same room as the dead. The scary thing is this could so easily happen again and spread so much quicker. We have no really major way to fight it.

Got The Sniffles

As I write this, I'm getting over the sniffles, even though I got the flu shot. I could not put "The Great Influenza" down, because it was so interesting. If you want to know on how the Influenza virus got started and how we finally got control of it, after millions of deaths, then you are in for a treat. Just get ready to be frightened as you cough and feel sick because who hasn't gotten sick from the flu..

Great history on medicine and how the medical field drastically improved because of the flu virus.

Even a fictional writer, such as Stephen King couldn't write this horrified story that plague the States in 1918 and almost demolished the existing of man.

At the time, the flu pandemic was a war that reached all boarders and still does..

Even today, the flu virus is adapting and changing and killing more and more of its victims.

I might be a tad bit paranoid, but another plague is coming and it is just a matter of time.

Lessons Not Learned

This is the book that moved President George W. Bush to make a speech in November 2005 to set up plans for the federal government to prepare for a future pandemic. The 1918 influenza pandemic was just the flu, but it spread throughout the world with rapid speed and came in waves not fading out for almost 2 years. And, though it was “just the flu,” it was an especially virulent strain much worse than any kind of flu we’ve faced since. It could kill within 12 hours of first symptoms in its most virulent form, though it was usually 24-48 hours. People could wake up in the morning just feeling a little uncomfortable and suddenly collapse while walking, fall off a horse, or collapse at the wheel of a streetcar. The lungs were destroyed so rapidly that people turned blue or even black from lack of oxygen in the blood. Sometimes it reached the brain and, even in survivors, left many with reduced mental ability. And, like any influenza, it mutates rapidly so that in any year, the type of flu at the end of the flu season will not be exactly the same as the strain at the beginning of the season. The 1918 epidemic killed more people than any other epidemic in history in numbers (though not in percentage of population), including the plagues of the middle ages. And, though it was commonly called “The Spanish Flu,” it most likely started, not in Spain but in Kansas. The first outbreak was severe, but still relatively mild compared to the second and third waves. 

It could have been worse. In the decade after the Civil War, medicine in the US was far behind its European counterpart. Almost no medical schools were connected to a university. Most were privately owned and students graduated without ever touching a patient or cadaver. The requirements to enter medical school were more lenient than getting into most high schools. The only standard was whether the student could pay tuition (and faculty salaries came from the students in their class, not from the school). Students didn’t even have to pass a medical exam to graduate. No medical schools had any research program or laboratory. While the scientific method was being applied to medical research in Europe, there was huge resistance to applying science to the study of disease in America. When the President of Harvard in 1876 criticized the dismal and horrible state of medical education in the US, he was widely criticized and was unable to make any reforms. But, in 1873 Johns Hopkins left a $7 million trust in his will to found a university and half of that was to go to founding a hospital connected to the university. The university opened in 1876, but it was the opening of its medical school in 1893 that was most significant. Its first dean was William Welch and he determined that it would focus on research and apply the scientific method to understanding the causes of disease. Many of his students would go on to found other medical schools and research laboratories funded by Rockefeller, Carnegie, and other philanthropists. By 1918, the quality of medical care and the research being done in America had caught up with and surpassed many Europe’s most prominent institutions. As soon as the reports of a new disease started appearing (and most believed that this couldn’t be “just the flu”), teams of researchers in American and Europe immediately got down to the task. The basics of what to do to slow the spread were learned early, but finding the cause and coming up with a cure was much slower and more difficult. The virus pathogen was not discovered until a decade later and research related to this helped us in many more areas and led to the discovery that DNA is the blueprint for each living thing.

It also could have been much better. The earliest major outbreaks were in military training camps (the US had just entered WW I) and the Army had one of the best epidemiologists of the time, (Alabamian, Dr. William Gorgas) who brought Yellow Fever and Malaria under control during the construction of the Panama Canal). Dr. Gorgas repeatedly urged quarantine of the affected camps, separation of the infected and those exposed to them, more distance between beds, some sort of barrier between beds, masks, etc. Those were sometimes followed but often ignored. But, the first outbreaks were very virulent and rapid spreading, but seldom lethal, so that led many to just believe that it was too costly to implement these measures and that they should just let it run its course. When it did start to become much more lethal, it was then harder to change people’s minds. In addition, the Wilson administration instituted censorship to a level previously unseen in America, and passed laws allowing prosecution with severe penalties on anyone who criticized the government in any way in order to avoid affecting morale during the war. European governments were doing the same thing, so that the first time most people heard about a flu epidemic was coming from Spanish newspapers (Spain was neutral and without censorship) which is why it came to be known as the Spanish Flu. Even as it became obvious that people were dying at alarming rates, the message from the government was that it was under control, that a cure was coming soon, that it was just in a few localized areas, etc. Researchers and medical professionals continued to push for people to stay indoors, to quarantine those exposed, to wear masks, to keep some distance between people, to avoid handshakes, etc., most government leaders ignored their advice. Even as the war was ending, the military and the government was unwilling to make any adjustments. Men were crowded onto troop ships with no quarantine or waiting times despite desperate pleas from medical authorities resulting in hundreds of burials at sea during the short trip across the Atlantic. It’s interesting though that in places where the seriousness of the epidemic was communicated with people, the death toll was much less than those places where it was hidden or minimized. And, where the messages were more rosy, people began to lose trust in the government and in each other. People refused to take in orphans or bring food to families that were sick. Children starved because parents were unable to get out of bed and eventually died. The numbers were mind-numbing in some places. In Philadelphia, almost 5,000 died in one week at the height of the pandemic. If the same percentages applied to today, it would like 200-400 million people dying worldwide. 

The book does a great job of explaining things in terms a layman can understand. It deals with the disease, the research, the politics, and the effects it had on the world afterwards. Even President Wilson got the disease during peace talks in Europe at the end of the war, leaving him out of important negotiations near the end and resulting in him almost completely giving up on the principles that he had originally said were non-negotiable and resulting in the heavy reparations on Germany that led to the next world war. At the end of the book is a chilling afterward in which the author warns that another pandemic was inevitable and that the world was currently unprepared for it (the book was published in 2004). Almost to the letter, every recommendation is one of the things that we are searching for today. It recommends that government should stockpile certain things like ventilators, face masks, protective gear, etc., and then at the first hint of an outbreak appoint a commission to oversee distribution of supplies to where it is most needed. It recommends a research group to continuously oversee research animal viruses that could be upcoming pandemic candidates (which Bush did, and Trump dismantled) as well as a watchdog group to watch for and give advance warning of any outbreak around the world (also part of the group dismantled by Trump). 

At the same time, it was encouraging and made me feel grateful. We are currently facing the Covid-19 pandemic (a virus of a completely different type than the influenza virus), and no projection has it becoming as serious as the 1918 pandemic. We are extremely fortunate, but hopefully this time we will not only learn about the disease itself, but learn that we cannot relax our guard and that it’s worth spending money on prevention and even that when a potential epidemic turns out to be not so serious, it’s not an indication that our precautions were wasted but that they succeeded. I recommend this book not to scare people but to encourage them. 

trust science and speak truth, make America great

Trust science and speak truth. Make America Great Again. Dump the orange egomaniac before he kills us all!!!!!

Detailed Medical history

I am still listening to this book. It’s pretty detailed on the history of American medicine, then how viruses, influenza, inoculation, etc. infects. I don’t know that I would ready this book. The information is valuable and informative. It’s great to listen to while I work at home.

Hauntingly Prophetic

1918 or 2020? The last chapter puts it all in focus. The detailed history is amazing.