A Cruel Wind: Pandemic Flu in America 1918-1920 [Paperback]

A careful, well-written and thoroughly documented academic study of the flu pandemic that ravaged America from 1918 to 1920. Includes numerous illustrations, tables and photographs, chapter notes, an extensive classified bibliography, and an excellent index.

Taking a much-different approach than the several other books available on the 1918 Influenza Pandemic, the authors -- Pettit, a former Medical Technologist with a Ph.D. in American History, and Bailie, holding a Ph.D. in Biochemistry -- take a "social history" approach and weave the stories of individuals who lived and died during this harrowing time, in with informed scientific discussion of the virus and clinical perspectives of the healthcare professionals who tried to save them.

The numbers are shocking -- Pettit and Bailie cite pandemic influenza data indicating that "25%-30% of the world's population" had "clinically apparent illnesses" with a resulting "mortality rate of 2.5 % to 5 %." And, though the pandemic is usually only briefly mentioned in -- or, often even left out of many world and/or American history books -- it was truly a catastrophic event. The authors estimate that somewhere between 50,000,000 and 100,000,000 people died of this particular, virulent strain of the flu worldwide during those two years.

In the opening chapter, "The Riddle of Influenza," we're introduced to the distinguished neurosurgeon, Harvey Cushing, of Johns Hopkins University, who describes his battles with influenza in 1906 and 1918. The authors then discuss how the virus was typically diagnosed at the time, describes the viral invasion, replication and the body's attempts to defend itself; then, goes on to discuss bacterial complications, and traces the disease through the history of mankind. Closes the chapter with a discussion of research conducted by Simon Flexner of the Rockefeller Institute on epidemic encephalitis and Richard E. Shope's work on Hog Flu and the peculiar characteristics of this particular strain, noting that: "About fifty percent of those who died were between twenty and forty years of age. [And,] influenza and pneumonia death rates for 15 to 34 year-olds were more than 20 times higher in 1918 than in previous years; they were people in the prime of life, a group that usually has a very low death rate from influenza."

Chapter two, "The Silent Foe," focuses on the impact of the flu pandemic on the millions of American soldiers mobilized to fight in France during World War I. Describes efforts by Secretary of War Newton D. Baker, Army Surgeon General William C. Gorgas and others to improve sanitary conditions in the training camps, to identify and weed-out unfit doctors, and their unsuccessful efforts to prevent the spread of the flu to major cities. Offers useful data that describes this spread by date and city location (46 cities), through the Navy ships and shipyards, through the Army camps and over into France, China and around the world. Focuses on descriptions of the virus in China and closes with a brief discussion of the impact on Austrian-German forces.

Chapter 3, "A Kind of Plague," focuses on the impact of the Flu on the allied forces in France, discusses the establishment of the Pneumonia Commission in the United States during July 1918 and describes their work at Camp Pike in Arkansas, Camp Funston in Kansas, and Camp Devens in Massachusetts. Closes the chapter with discussion of the plight of specific individuals, the horrific death rates, the shortages of coffins in major cities, the effect on the political elections, and bans on gatherings.

Chapter 4, "One War Ends," discusses the economic impact of the flu pandemic during September-October, 1918 through the stories of individuals involved, how the pandemic "was a boon to the life insurance industry," the shortages of healthcare personnel, U.S. Public Health Service efforts to help communities fight the disease, how pandemic-related poverty cases overwhelmed the social agencies of the time, and the misery of the many thousands of children who had lost one or both parents.

Chapter 5, "The Paris Cold," focuses on the impact on the work of the Diplomatic Corps in Paris who fought influenza virus while trying -- at the same time -- to address and write the peace treaty and associated documents to end the war. Refers to cases of one prominent individual after another -- Dr. Raymond Pearl with the U.S. Food Administration, Willard Straight who was an investment banker and founder of New Republic Magazine, Joseph Grew of the State Department, economist Clive Day, Colonel Edward M. House, and finally the battle to save the life of the President himself, Woodrow Wilson, are all narrated and implications on the American Peace Delegation are drawn.

Chapter 6, "The Aftermath (1919)," offers an assessment of the impact of the pandemic on both individual lives and on America's public institutions. Suggests that it: forced the U.S. Government to offer financial support for medical research; pointed out to social workers, how essential it is for communities to offer services to safeguard the health of citizens; how health is as much a public concern as it is a private concern; forced a reassessment of the mission and role of the American Red Cross, the New York City Health Commission and the growth of Public Health Nursing; and, promoted efforts by bacteriologists and other noted scientists of the day to find the cause of the infection and spread of influenza.

Chapter 7, "A Tired Nation (1920)," describes the continued impacts of the pandemic on the American public. Discusses the deaths of more prominent individuals, efforts to limit the spread, the hoarding and profiteering that took place, the resulting mental disorders of many of the victims, and how the nation struggled during this "sad and sickly" time.

Chapter 8, the closing chapter, "The Battle Continues," concludes that the flu pandemic of 1918 was a truly "humbling experience." Discusses how the great strides that scientists had made in bacteriology during the previous 50 year had given many a "false sense of security." Cites the pandemic as kindling a vigorous crusade against the disease, with the Rockefeller Institute spending hundreds of millions of dollars in post-pandemic research and being instrumental in creating focus and interest on public and community health and preventative medicine. Offers a detailed discussion of the theories of origin of the pandemic, followed by a wide-ranging discussion of the research and findings of a number of present-day researcher, including: Jeffrey Taubenberger, Terrence Tumpey, Johan Hultin, Mark J. Gibbs, Adrian J. Gibbs, Neil M. Ferguson, Ira Longini, Jr., Pascale Wortley, and David Morens.

Bottom line of the authors? "We must treat this microscopic mass murderer with the utmost respect and never doubt its exceptional ability to adapt, take advantage of permissive conditions where it can, and overcome adverse conditions to develop resistance to treatments [designed] to destroy it when it must."

And, as stated on the back cover: "Because many experts believe that it is not a matter of IF the world will encounter another 1918-like flu pandemic, but WHEN...[this] should be considered essential reading for those interested in learning what worked -- and didn't--during that grim time."

Highly recommended; this book belongs in the collection of EVERY college, university and public library. It should also be seriously considered for inclusion in secondary school collections where students are encouraged to write term papers.

In addition, medical and public health decision-makers in government office worldwide, and individuals practicing in the fields of nursing, public health, medicine, and teaching in the history of medicine and in the life-sciences will find it thought-provoking and useful reading.

A Cruel Wind: Pandemic Flu in America, 1918-1920,
Dorothy Pettit, Ph.D, and Janice Bailie,Ph.D., Timberlane Press, 2007
Reviewer: Chris Holmes, M.D., M.S.P.H.

Why should we worry about the flu? It's just a minor, 3-day illness, right? Well, not exactly. For 15% of the world's citizens (500,000 U.S.) who get sick from it each year, or the 250-300,000 (30,000 U.S.) who die from it, it's not "minor." Nor is its economic impact: $167 billion annually in the U.S., which includes the cost of 70 million doses of vaccine. If you multiply these numbers by about 200, you approach the rates for the 1918 pandemic. So maybe we should be a little worried.

In this well written and thoroughly researched book, the authors -- a biochemist and an historian -- trace in detail the American course of this outbreak and its impact on every aspect of U.S. life: economic, political, military and public health. Even the entertainment industry was affected: movie theaters closed, stages darkened. The epidemic also highlighted America's woefully inadequate health care system. The book's numerous illustrations, tables and figures, and extensive references and bibliography ground, illuminate and clarify the viral and historical concepts.

The story begins with a review of basic influenza virology and immunologic classification. The concepts of antigen drift (minor surface antigen changes requiring a new vaccine annually) and antigen shift (major, 10 year-or-so changes which signal the start of pandemics like the 1957 Asian flu (2 million deaths worldwide) and the 1968 Hong Kong flu (700,000 deaths).

The authors then confront several vexing questions about the 1918 pandemic: First, where did it originate. Two competing theories have emerged: that it spontaneously erupted in Europe, Asia and North America; or it began in U.S. Army recruit camps in Kansas then spread to Europe as soldiers headed for WW I. Neither theory emerges a winner. But it seems plausible, wherever it began, that this particular strain also infected animals (swine). Another intriguing question is why this epidemic was so deadly (mortality close to 30% overall), especially in healthy young adults (50% mortalty in 20-40 year-olds). The authors find no definitive answer to this question either, though they examine all sides clearly.

Finally come the most important questions: How likely is the 1918 outbreak to happen again? And are we prepared for it if it does. The Influenza virus can cross the species barrier (as it appears to have done in 1918), and in 2006-2007 275 human cases of avian influenza (H5N1) were documented in Asia, a majority in Thailand. The great worry is that if a human host is infected with both the H5N1strain and a human influenza strain at the same time, he or she could become a mixing bowl for the reassortment and emergence of a new, deadly strain. That thought should scare the collective pants off us!

I highly recommend this book to students and researchers interested in the history of medicine and science, to practitioners and academic professionals (including university and public libraries) in medicine, nursing, public health and infectious disease, as well as to the general interested reader. There is no better example than this book of why we must learn history or are doomed to repeat it.

Previous reviewers have already presented very competent overviews of the contents of Pettit and Bailie's introduction to the horrific influenza pandemic that overwhelmed medical knowledge and American resources beginning in spring of 1918. The book is clearly written and coherently presented. The style might be considered a sort of relaxed academic prose; easy to read and assimilate, yet, perhaps, not as enlivening as some readers might prefer.

For anyone unfamiliar with the enveloping tide of the 1918 pandemic, this work provides a balanced overview of the enormous difficulties involved for those trying to stop or ameliorate the suffering, of a number of consequences of that suffering, of the nature of the disease and its likely recurrence; all related within a broad historical snapshot of an American society brought to its knees by disease just as WW I was ending.

The well researched story unfolds chronologically and includes numerous anecdotes which offer an interesting variety of the human details. But, with a few well developed historical and scientific issues left unanswered, and due to its topical nature as a survey, the book leaves a feeling of incompleteness in the end.

This is the second book I've read on the subject. I certainly respect this offering much more than the repetitious, overly-dramatized, 'popular' treatment I earlier reviewed. As an introduction to the pandemic, this intelligently conceived book is recommended for most readers.

› Go to Amazon.com to see all 6 reviews  4.0 out of 5 stars