First, Barry establishes the setting: a country where doctors are barely trained and frequently incompetent, at least until William Welch begins collecting talented physicians and researchers for the opening of the Johns Hopkins in 1893. The institution revolutionized medical education and produced brilliant scientists who would play key roles in fighting the 1918 pandemic: Oswald Avery at the Rockefeller Institute, William Park and Anna Williams at the New York City Department of Public Health, and Paul Lewis at the University of Pennsylvania, to name a few. By chronicling the remarkable speed of the transformation of US medicine in the late 19th and early 20th century, Barry illustrates both the strengths and the limitations that American physician-scientists brought to the table once the virus begins its attack.
And what a virus it is! Influenza is the villain in the book, with its cellular biology and mechanisms explained in great detail to highlight how it can be almost unbeatable. (Although this virologist posted some corrections.) Under its onslaught, victims multiplied rapidly, coughed up blood, turned black, and died very, very quickly. The suffering that accompanied the deaths was similarly horrific: people too sick to care for themselves starved to death, medical personnel also expired in droves, and entire cities ground to a standstill as isolation became the norm. And all this happened during World War I, so the country's resources were geared towards the military--which, as Barry notes, was likely the starting point of the outbreak, with soldiers suffering high casualties.
Barry adds two secondary villains to his tale: misinformation and poor leadership. He describes how major newspapers minimized the dangers and risks, choosing to blare about hand washing and not spitting in public. He makes the case that fear of the unknown is the worst, so first we need to make things known, and then the fear can be stopped. The author also points to many political leaders who reacted too slowly to the virus, despite being warned ahead of time about its potency and likely effects on areas under their governance. Barry even suggests that President Woodrow Wilson was a victim of the great influenza, contrasting his firm stance against the demands of the French to his capitulation to the Treaty of Versailles after he gets sick. Apparently, that particular strain of the flu could have had neurological side effects as well, in which case it contributed to post-WWI Germany and the rise of fascism!
In any case, effective villains require great heroes, and here Barry supplies readers with a host of medical professionals who worked frantically to identify the virus and concoct vaccines. Again, Barrys' writing is terrific when describing the application of science: of how the virus is injected into animals, how serum is created, the many attempts to isolate the correct pathogen, etc. The personal stories of the scientists are also woven seamlessly into their struggles. The American Red Cross and even high society play their own critical roles in directing supplies and assets to the affected. These are tight, tense chapters.
However, there's a tendency toward purple prose (e.g. the overdone repetition of "this was influenza, only influenza") at some points, which is jarringly different from the clear, enjoyable narrative flow that makes up the rest of the book. This attempt at drama is most obvious when Barry focuses on Lewis, a highly respected researcher who he contends is the last victim of the pandemic when he died of yellow fever in 1929. Lewis' output diminished after the pandemic, he was antisocial, and his marriage was troubled, but it's still unclear how the influenza pandemic, which Lewis studied--like hundreds of others--led to his death. Barry seems to be reaching here?
In conclusion, The Great Influenza is well researched and combines a number of different elements to craft a compelling history of a virus, those who fell to it, and those who fought valiantly against it. It's instructive, interesting, and a page-turner! It also shows that some things never change; two words: nursing shortage.
TL;DR: Get your flu shot.
This post brought to you by subzero temperatures!