Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It (review)

Gina Kolata. Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York: Farrar, Straus and Giroux, 1999. xi + 330 pp. Ill. $24.00.

Although intended for a general audience, this book should interest many historians. The story of the 1918 influenza epidemic is an important one, and this work reviews it well. But the book also offers interesting insights into what our concept of an epidemic is. Historians have recently written much about epidemics in an effort to understand and explain the impact of AIDS. This book, focusing on the story of another epidemic disease, is a wonderful example of the twentieth-century consensus about the nature of epidemics.

There are three characteristic themes that Kolata repeatedly associates with the epidemic nature of the 1918 flu. First, it was powerful--fast, big, and dangerous. It traveled across the United States in weeks, the entire globe in only a few months, and it could have a terrifyingly rapid course, progressing from early symptoms to death in a day. It affected more than 25% of the U.S. population, and perhaps 20% of people worldwide. Estimates of deaths due to influenza worldwide, obviously very inexact, are quoted as from 20 to 100 million persons. And its case fatality rate--the percentage of deaths among all cases of flu--was estimated at 2.5%, as compared with the 0.1% ascribed to the more usual outbreaks of influenza.

But beyond its raw power, the epidemic had two other crucial characteristics. It was lawless, not respecting any of the epidemiologic rules taught by former influenza outbreaks--ignoring such well-known risk factors as age, or occurring simultaneously at several widely separated sites, rather than tracing a recognizable epidemic "trail" from place to place. And it had a quality of unreality. Its symptoms were gruesome: "Your face turns a dark brownish purple. You start to cough up blood. Your feet turn black. . . . A blood-tinged saliva bubbles out of your mouth. You die--by drowning" (p. 4). It was a mystery--with no known origin, no known etiology, and no treatment.

From its extraordinary ability to reach into "everyday life in every nation" (p. 7) to the "special trains to carry away the dead" (p. 14), the epidemic is presented as a story of mythic proportions, a Paul Bunyan gone mad. And, along with these colossal attributes, it is also given, in popular thought, the power of agency. It is personalized. The very first chapter of Flu begins with a quotation from a pathologist involved in identifying the 1918 flu strain: "This is a detective story. Here was a mass murderer . . . who's never been brought to justice. And what we're trying to do is find the murderer" (p. 3).

The narrative goes beyond the 1918 epidemic, describing the challenge presented by "swine flu" in 1976, and telling the story of efforts to recover the genome of the 1918 virus from bodies buried in the Arctic permafrost and bits of tissue preserved in paraffin. Kolata is a talented journalist, and this is a great story, but despite the enormous amount of research she has obviously done, too much of this book is a retelling of other people's conclusions. While the distinguished scholarship of people like Crosby, Neustadt and Fineberg, and Silverstein is essential to any intelligent analysis of the 1918 flu and its historical consequences, it surprised me that this experienced and very capable journalist-author never offers a critique of the particular perspectives of, and in some cases the selective approaches taken by, these and other writers, which have both helped to shape and been shaped by the popular mythology of the epidemic. Instead, Kolata generally accepts and retells the conventional...