The Great Influenza

by John M. Barry

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The Great Influenza Summary

The Great Influenza by John M. Barry is a 2004 book of historical nonfiction about the 1918 influenza pandemic that focuses in particular on the disease's impact on American society.

  • Barry traces the spread of the influenza virus, from its suspected origins in Haskell County, Kansas, to army bases to Europe and on to the rest of the world.
  • Barry examines the virus's origins, nature, and impact on the human body.
  • The medical research establishment had shifted greatly at the end of the nineteenth century, preparing it for a through study of influenza. Barry follows the key American scientists involved in the effort.


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Last Updated on February 25, 2021, by eNotes Editorial. Word Count: 1302

Author John M. Barry begins The Great Influenza by giving an overview of the influenza pandemic that ravaged the world in 1918–19. For Barry, the pandemic is a story of struggle between modern science and nature. At the center of this narrative is a group of individual scientists involved in the pandemic.

In part 1, Barry traces the massive shift in American medicine that occurred in the decades before World War I. For centuries, the study of medicine was guided by somewhat abstract reasoning. In the nineteenth century, medicine shifted toward a more empirical, scientific approach. The United States lagged behind, and in 1876, the Johns Hopkins University opened with the goal of revolutionizing American medicine.

A key member of this revolution would be William Welch. Under Welch’s guidance, the Johns Hopkins medical school would stand apart. Later, Welch succeeded in changing all of American medical education and in securing funds for medical research.

In 1901, the Rockefeller Institute for Medical Research was created, with Simon Flexner as its director. The institute opened its own hospital for the study of contagious disease. Under Rufus Cole, its first director, the hospital became “the model for clinical research.” By World War I, American medicine had become “science-based.”

In part 2, Barry introduces the leading hypothesis that the influenza pandemic of 1918–19 began in Haskell County, Kansas, spreading from there to a nearby army base and eventually around the world. To understand how this happened, Barry explains what viruses do in the body and how they interact with the immune system. Influenza viruses have an ability to adapt quickly. This quality makes it easier for an influenza virus to spread from animals to humans, to change as it spreads from human to human, and to outpace the immune system’s efforts to recognize it.

In part 3, Barry describes the context of the pandemic. Although America had been reluctant to enter World War I, when it finally did, the entire nation became focused on the war effort. Millions of men were recruited and trained at huge army bases, civilians flocked to cities to work in factories, and information was censored to preserve morale.

The world of medicine also became mobilized for the war effort. Doctors and nurses served the military, leaving a shortage for civilians. Military medical research focused on a key goal: to contain the spread of infectious disease.

In part 4, Barry describes how, in the spring of 1918, the first wave of influenza spread across the world. While its spread was alarming, the disease itself was mild. Later, in the fall of the same year, the second wave broke and this time the virus was lethal. One of the first places that the virus emerged was at Camp Devens, an American army base. A group of leading medical scientists began their study of the frightening new disease.

In part 5, Barry tracks the “explosion” of the second wave of the influenza virus. He begins with Philadelphia, one of the first cities hit by the virus and a city that would become “a model for what would happen elsewhere.” Next, he describes the influenza outbreaks in army bases, focusing on Camp Grant as an example of the typical experience. Barry shifts the narrative back to Philadelphia, where desperation, fear and death overwhelmed the city.

In part 6, Barry focuses on exactly how the disease attacked and affected victims. The virus manifested in many different symptoms—some of them typical to influenza, some of them never seen before. Strangely, the virus also targeted young adults. These young adults could become violently ill and die with terrifying speed; their lungs confused doctors and scientists when inspected during autopsies.

The reason that many young adults died during the pandemic—and the reason that their lungs were strikingly different from those of other victims—is because they were not actually killed by the virus itself. And unlike others who died, they were not even killed by “second invaders”—other bacteria that followed the influenza attack. Instead, they were killed by their own immune systems.

In part 7, Barry describes the “race” between medical scientists and the disease spreading around the world. In order to find the cure to the disease, scientists needed to identify the pathogen that caused it. Many scientists believed that the pathogen was Bacillus influenza.

In the United States, the key individuals in the study of influenza were: William Park and Anna Williams, working in New York; Paul Lewis, working in Philadelphia; and Oswald Avery, working at the Rockefeller Institute.

In part 8, Barry shows how in American society as a whole, the war effort continued to take precedence over the danger of influenza. In some cases, this led to decisions that actually spread the virus. Public health officials were slow to act and hesitant to interrupt the war effort. To preserve morale, newspapers avoided or downplayed the virus. Counterproductively, this actually fuelled the terror. Across the country, cities became overwhelmed by the disease and by a lack of resources. Communities were torn apart by fear and isolation. In desperation, doctors reached for any cure that could offer a shred of hope.

Despite any efforts to control it, the virus spread to almost every corner of the globe.

Part 9 traces how the virus was eventually slowed by the process of immunity and its own mutation back to a less lethal form. When a third wave spread in early 1919, the virus was less dangerous but still inflicted horrific damage.

The impacts of the pandemic were incalculable. Even after people survived an influenza attack, in many cases their nervous system and mental function was permanently altered. This would have widespread political consequences, because it is likely—though not certain —that President Woodrow Wilson was suffering from influenza-related mental instability during the decisive Paris peace conferences following the war.

Around the world, countries suffered staggering death tolls. After the virus subsided, they were left to care for the many orphans who had been left behind. On many levels, society was scarred by the mental and social consequences of the pandemic.

In part 10, Barry discusses the pandemic’s “chief legacy”: its long-term impact on medical science. During the pandemic, American scientists joined together to map a course of action against the disease. At the center of much inquiry and dispute was the Bacillus influenza pathogen. Although William Park and Anna Williams had once believed the bacteria to be the pathogen, they later reversed their position. Scientists at the Rockefeller Institute, including Paul Lewis, maintained that Bacillus influenza was indeed the cause of the disease.

While Oswald Avery focused his research on influenza during the pandemic, in the years afterward he returned to his study of pneumococcus, the bacteria causing pneumonia. By relentlessly following this line of inquiry, he ultimately made a discovery that “would revolutionize all biology”: he discovered that DNA carries genetic information.

Paul Lewis, in contrast, would end his scientific career in tragedy. Despite his powerful intellect and seemingly limitless potential, Lewis’ career became marked by restlessness and failure. Rejecting the offers of universities, Lewis eventually spent years working in a division of the Rockefeller Institute. His work was “sterile,” and his failures seemed to lead nowhere. Eventually, Lewis died mysteriously while studying yellow fever in Brazil. Shortly after his death, one of the scientists in his lab published ground-breaking research correctly linking the influenza virus of 1918 to a virus found in pigs.

In the afterword, Barry argues that the lessons and warnings to be found in the 1918–19 influenza pandemic are “more relevant than ever.” Examining the characteristics of pandemics and existing public health measures and vaccine technology, Barry speculates about what might happen in a future pandemic. Above all, he writes, it is important that leaders tell the truth. By doing so, they preserve the trust that holds society together and dismantle the terror of the unknown.

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