College Quarterly
Spring 2004 - Volume 7 Number 2
Notes The Great Influenza: The Epic Story of the Deadliest Plague in History.
John M. Barry
New York: Viking, 2003

Reviewed by Howard A. Doughty

It is not surprising that the medical speciality of epidemiology has not advanced to the point that it can confidently predict the spread of disease. Modern medicine is barely a century and a half old, if we consider its starting point to be the development of a microbial theory of the causes of illness. Add to that the difficulties of gathering and analysing data in the quantities necessary to meet the standards of empirical inquiry and the frequency of unanticipated epidemics becomes less surprising. Today, the matter seems quite out of hand when we understand how global transportation facilitates the almost instantaneous world-wide spread of once localized and containable bacterial and viral mutations. The regional epidemic is now the global pandemic.

Even in the absence of scientific medical theory and practice, however, the Arawak Indians must have conjectured that something evil was upon them. Aside from the fact that many of their number were enslaved, murdered, hunted for sport, worked to death in mines, burned at the stake for heresy, beheaded for insurrection or simply starved into non-existence, the fate of these people whom Bartolomé de Las Casas, in his book The Devastation of the Indies, described as "the most guileless, the most devoid of wickedness and duplicity of all the infinite universe of humanity," was sealed by disease. In 1492, ethnologists estimate their numbers in Hispaniola alone to have been about 300,000. By 1496, they were reduced by one-third. In 1508, a census revealed only 60,000. In 1548, Fernández de Oviedo y Valdés, the official Spanish historian of conquest, doubted whether 500 Indians remained.

The main cause of this hideous depopulation was sickness. Europeans had brought the gifts of typhoid fever, diphtheria, smallpox and measles against which the Arawak had no immunity. If not the first instance of a global pandemic, it was certainly among the most devastating.

Canadians can be forgiven if they are particularly sensitive to threats of exotic disease. In the past year, SARS, West Nile virus, "Mad Cow Disease," avian flu, new robust forms of tuberculosis, to say nothing of AIDS, have given us fearful epidemics and epidemics of fear. Elsewhere, however, matters are much worse. As Barry Gewen had written, there is ample evidence that we live on "a contaminated, disease-ridden planet, populated by microbes that constantly evolve and take advantage of any new opportunity. AIDS, tuberculosis and malaria combine to produce 500 million illnesses and six million deaths per annum. Every year, 100 million people contract dengue fever, and eight hundred thousand die of measles. Half of the deaths in underdeveloped countries are the result of infectious diseases, many of which could be treated with pharmaceuticals or prevented in the first place by minimal hygienic standards and basic nutrition.

The phenomenal advances in transportation mean that there is no longer an opportunity for any significant human population centre to remain isolated and thus exempt from contact with travellers, visitors and migrants who globalize infectious disease. Strangely, although we may vaguely recall the devastation done to ancient aboriginals and are assuredly attuned to contemporary threats to our well-being, we are social amnesiacs when it comes to the influenza outbreak of 1918 that killed more people in twenty-four weeks than AIDS has killed in twenty-four years. John Barry's book, The Great Influenza, tells the detailed and dramatic story of this pandemic that was earlier thought to have resulted in twenty million deaths. That estimate is now considered wildly low and best guesses indicate that such a number may have died in India alone, while the world-wide mortality rose to as high as one hundred million people.

To redress this grievous gap in our knowledge, Barry has produced an almost encyclopaedic (some say rambling) account that takes the lay reader safely through the sciences of microbiology and immunology with knowledge newly in hand and self-esteem barely troubled.

The heroic stories of "front line" medical workers are told with energy. The grotesque tales of human stupidity and mendacity are repeated with a generous understanding of the horror people were facing. Ethnic tensions grew as recent immigrant communities, domestic animals and even the Bayer pharmaceutical company were targeted for blame.

Medicine was reduced to the status it enjoyed at the turn of the nineteenth century when Daniel Drake, M.D. (1785-1852) offered as its definition "the art or science of amusing a sick man with frivolous speculations about his disorder, and of tampering ingeniously, till nature either kills or cures him."

Three lessons can be learned from this book.

First is the obvious warning that such devastation could easily (perhaps will ineluctably) come again unless something is done rather speedily. Since we cannot and should not try to close our borders, we must devote time and resources to solving problems before they arise. Scarcely thirty years ago, complacency reigned as we foolishly imagined infectious diseases had been conquered (in 1972, Nobel laureate in medicine, Macfarlane Burnet opined that "that most likely forecast about the future of infectious disease is that it will be dull.") They have not been. They have become more virulent, more widespread and more difficult to control.

Second is the recognition that our paradigm of medical practice may have become almost as malign as the diseases it seeks to defeat. Fascinated by high technology and eager for ever more invasive treatments of already existing illnesses, we conceive of medicine as a bag of unrelated tricks while failing to appreciate the most elementary precepts of holistic, preventative medicine which remains generally cheaper and more effective except in cases of trauma.

Third is the now only opaque perception that medical diseases are largely social diseases. MRIs, CAT-scans and all the other abbreviated research and diagnostic toys that enchant us today are uneconomical and ineffective if the objective of medicine is the prolongation and enhancement of human health. Don't get me wrong. I am not opposed to medical technology; in its absence, I would probably have died at seventeen and would certain have been dead at fifty-five. My personal good fortune notwithstanding, more is to be gained for more people through simple devices such as water purifiers than through the expenditure of billions on surgical innovations and lifestyle drugs from Valium to Vioxx to Viagra.

The next pandemic, it is almost certain, can be deflected as much by proactive decisions in the domain of political economy as by reactive medical treatment which, as in 1918, might not exist anyway.

Howard A. Doughty teaches in the Faculty of Applied Arts and Health Sciences at Seneca College, King City. His email address is


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2004 - The College Quarterly, Seneca College of Applied Arts and Technology