Review: Lessons of the pandemic, 1918-1919

March 11, 2021

The influenza pandemic of 1918-1919 struck the world as a few medical researchers were transforming U.S. medicine into a science-based profession, and as President Woodrow Wilson sent four million young men to fight in World War I, implementing social control measures which undermined public health practices. No available treatments could stem the virulence which killed 50-100 million people world-wide, almost half of them between 20 and 40, with a mean age of 28.

A major theme of The Great Influenza: The Story of the Deadliest Pandemic in History, by John M. Barry (Penguin Books, 2018) is the effort of the scientists who desperately worked on therapies for the disease. Barry provides insights from modern virology to help readers understand how influenza viruses invade and take over human body cells, how the body fights back, and why this influenza strain was so deadly. Nevertheless, lack of this knowledge in 1918 only partly explains the devastation.

In April 1917, the U.S. entered the “Great War.” Public policy and social institutions were geared to unite the country for the war effort. A Sedition Act was ruled constitutional—Supreme Court Justice Oliver Wendell Holmes argued that the First Amendment did not protect speech if “the words used…create a clear and present danger.” The Sedition Act specified 20 years imprisonment to “‘utter, write or publish any disloyal, profane, scurrilous…language about the government…’”


A 200,000-member volunteer American Protective League harassed and beat up members of the Industrial Workers of the World, targeting “seditious street oratory” and pressuring people to buy Liberty Bonds. The army and factories jammed millions of young people into extremely close quarters. The government Committee for Public Information played down news about the pandemic on the grounds it would harm morale.

An emergency hospital at Camp Funston, Kansas, 1918. (New Contributed Photographs Collection / otis historical Archives / National Museum of Health and Medicine).

A new, deadly strain of influenza emerged in February 1918 in Haskell County, Kansas. Barry concludes that it might have run its course in isolated Haskell County, except that soldiers called up from there reported to Camp Funston, Kansas. Barracks at Camp Funston were overcrowded against the advice of army doctors. The disease continued to spread with the movement of troops. The rapidly-mutating virus become even more deadly in its second wave in the fall of 1918.

Philadelphia refused to limit social interaction and experienced the worst outbreak in the U.S. Despite government’s belated attempts to “shape” news reports, total mistrust ensued. People stopped caring for each other. Families too sick to procure food starved to death. The dead piled up in houses, on streets and in mass graves.


Barry’s “Afterword” written in 2018 is a guidebook for managing the COVID-19 pandemic. Despite medical advances, “a severe influenza pandemic would hit like a tsunami…Hospitals… have gotten more efficient by cutting costs, which means virtually no excess capacity…Disease impact would ripple through the economy to disastrous effect.” He supports universal vaccination, but could be describing our current world problems getting “shots into arms.” As for public health measures, “Success depends on rigor, emphasis and discipline.” Finally, “public officials and the media helped create…terror, not by exaggerating the disease but by minimizing it.”

On many levels, this book is a valuable contribution to understanding pandemics, yesterday, today and tomorrow. It should be required reading for all public health workers and politicians.

—Susan Van Gelder

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