of consciousness. The disease moved inexorably through the body, the course of its progress ranging from just hours to days. As the end neared, the faces of victims would turn a deep brownish purple. They began coughing up blood. Their feet went black. Breathing would become more difficult, until death finally came from suffocation. Autopsies revealed lungs clogged with a bloody fluid.

In the United States alone, more than 25 percent of the population became ill. A half million Americans died. A type of disease that normally produced a mortality of just one-tenth of 1 percent killed 2.5 percent of its victims. The death toll was such that in 1918 the average life span in the United States dropped by twelve years. To compare, a similar outbreak at the end of the twentieth century would kill one and a half million Americans, a winnowing greater than the number of lives claimed in a year by the combined efforts of heart disease, cancers, strokes, chronic pulmonary diseases, AIDS, and Alzheimer’s disease.

Kolata writes effectively about the horrors of 1918. A great pall of fear fell over the world as the disease ran its course. In America and Europe, the flu intensified the loss of life of World War I. Medical researchers labored in vain to control the epidemic. The germ theory of disease was well known, and doctors recognized the existence of a virus. Unfortunately, they did not possess the means to see and study a virus. They could not begin to create an effective vaccine. In 1918 they even lacked antibiotics. Therefore, doctors were reduced to treating the symptoms of the flu and watching their patients die. Drastic measures were taken to try to contain the disease. Public gatherings were canceled and people went about wearing gauze masks over their faces. In the end, it was nature, and not humanity, that brought the plague to a conclusion.

Kolata spends only a part of her book describing the crisis of 1918. She is more concerned with exploring the long-term impact of this devastating pandemic. Ironically, one of the great mysteries of the 1918 flu outbreak is the way in which it has disappeared from the public consciousness. Despite its astounding mortality, there have been very few books about this pandemic. If covered at all in history textbooks, it rarely receives more than a sentence or two. Even the memoirs of doctors who wrestled with the flu are unexpectedly reticent on the subject. In part, this forgetfulness is due to timing. The Spanish influenza struck during the closing months of World War I, and the suffering it inflicted tended to blur into the miseries wrought by that catastrophic war. The flu became just one more calamity to add to those already wracking the world. As a natural disaster, the flu was also something beyond human control. Unable to affect its course, there was little people could do but simply be thankful when the virus finally passed. Undoubtedly, humanity’s collective amnesia about the flu was, in part, deliberate. Something so fearful and powerful, so threatening to the normal order of things, was best not thought about as people moved on with their lives.

On the other hand, the shock this plague gave to the medical community has never entirely dissipated. The questions it raised about the vulnerability of modern civilization to unexpected outbreaks of deadly diseases continue to haunt public health officials. Fortunately, for most people’s peace of mind, these fears have largely been confined to the professionals.

Yet Kolata chronicles two dramatic occasions when the medical community’s memory of the 1918 flu became major news stories. In February, 1976, a young Army private at Fort Dix, New Jersey, suddenly fell ill and died. His doctors concluded that he had been killed by influenza, complicated by pneumonia. Further testing determined that he had perished from a strain of swine flu virus. Some researchers believed that a swine flu was implicated in the 1918 epidemic. Many flu experts believed that the world was primed for another major eruption of influenza. The unusual death of a healthy young man evoked images of 1918. Public heath officials began to worry that the next annual visitation of the flu might bring a return of a killer virus. They found themselves in a quandary. Was the soldier’s death an isolated incident, or was it the harbinger of worse to come? Mesmerized by the past, they were unwilling to risk the possibility of a deadly virus reappearing, especially in an election year. Therefore, the American government set in motion a massive campaign to vaccinate the entire population against the swine flu. In any event, a killer strain of the flu never surfaced, and the swine flu vaccine came to be perceived as more toxic than the flu it was engineered to combat. A number of people blamed the vaccine for a variety of neurological disorders. By 1980, 3,917 suits had been lodged in the courts asking for more than three and a half billion dollars in damages.

Another scare came in August, 1997, when a healthy three-year- old boy died in Hong Kong of a respiratory infection that turned into viral pneumonia. Followup tests determined that he had died of a bird flu, a prospect that frightened doctors because humans do not have natural immunities to such influenza strains. Intense investigation could not determine the source of the boy’s infection. In the absence of other victims, the medical authorities began to breathe easy. Then in November and December, more cases appeared, and six people died. Simultaneously, scientists discovered that chickens imported from China were suffering from the flu. As a result, every chicken in Hong Kong was destroyed in a massive effort to block the spread of the infection. No more humans fell ill, and public health officials congratulated themselves on preventing what could have become a tragic epidemic.

Kolata devotes much of her book to the scientists who have labored over the years to identify the 1918 flu virus. One of the earliest of these was Richard Shope, a researcher at the Rockefeller Institute in the 1920’s and 1930’s. Shope first established a connection between the 1918 flu and a simultaneous outbreak of flu among swine. The exact nature of the Spanish flu virus, however, continued to elude researchers.

In 1951, Johan Hultin, a young Swedish microbiologist studying in the United States, attempted to capture the original virus itself. He traveled to Alaska and took tissue samples from the frozen bodies of Eskimos who had died in 1918. He successfully transported his samples back to a laboratory, but with the technology available to him, learned nothing useful.

Over four decades later, Jeffery Taubenberger of the Armed Forces Institute of Pathology in Washington, D.C., decided to tackle the problem. Ever since the Civil War, samples of diseased tissue sealed in wax have been stockpiled at the institute. In 1918, Army pathologists had sent in slices of infected lung tissue. Taubenberger and his assistant Ann Reid made use of new techniques in molecular biology to try to catch the flu virus. After more than a year of effort, they succeeded in reconstituting part of the virus, thus raising the possibility of revealing the virus’s genetic code.

To be certain that he had the right virus and not a passive interloper, Taubenberger needed more tissue. In stepped Kristy Duncan, a Canadian professor of geography. Independently interested in the 1918 pandemic, Duncan believed that samples of the virus could be found in the bodies of Norwegian miners who died on the Arctic island of Spitsbergen. She organized a large and expensive expedition, which would be attended by six television crews. For all its elaborate preparations, the Duncan expedition proved a bust. The bodies of the miners had thawed.

In the meantime, Johan Hultin, now a retired pathologist, had learned of Taubenberger’s project. He contacted Taubenberger and then traveled alone to Alaska and the site of his previous attempt. With the help of the locals, he secured a tissue sample, which he sent to Taubenberger. The sample matched the others Taubenberger possessed. Modern science had captured the 1918 flu virus.

This does not end the story. Scientists still do not know why this particular virus was so deadly. Kolata’s timely book reminds readers that humans have much to learn before they are fully secure from another visitation like that of the flu pandemic of 1918.

Sources for Further Study

Library Journal 124 (November 1, 1999): 116.

The New York Times, November 26, 1999, p. B48.

The New York Times Book Review 104 (November 21, 1999): 11.

Publishers Weekly 246 (October 25, 1999): 62.

Time 154 (December 13, 1999): 105.

The Wall Street Journal, December 10, 1999, p. W12.