Pandemic 1918
by Catharine Arnold
St. Martin’s, 2018

As historian Catharine Arnold reminds readers in her new book Pandemic 1918, the numbers associated with the world-wide outbreak of the so-called “Spanish flu” in 1918 still have the power to shock. US deaths reached at least 550,000, five times the country’s military deaths during the war that had just ended; the death-toll across Europe exceeded two million; over 17 million died in India; 2 percent of the entire population of Africa fell to the disease; exact numbers will never be known, but roughly a third of world’s population died in that first rampaging outbreak of the disease, “leading historians to refer to Spanish flu as the greatest medical holocaust in history,” Arnold writes, “killing more than the Black Death.”

It was a catastrophe that changed the nature of an entire generation, and it’s generated many first-rate histories over the years, from Gina Kolata’s Flu in 1999 to John Barry’s The Great Influenza in 2004 to Laura Spinney’s Pale Rider in 2017. In clear, engaging prose, Arnold takes readers through the horrifying familiar details again: the rapid spread of the disease as infected populations were shifted in the wake of the war, the vicious nature of the “second wave” of the disease, when victims who’d felt perfectly healthy at breakfast could collapse on the street hours later and be dead by sundown, and the widespread social reactions, as ineffective protective face masks became chic fashion accessories and morbid ditties about the disease became best-selling songs.

The strongest element of Pandemic 1918 is its virtually cinematic use of contemporary reactions to it all, from famous sources like Robert Graves or Vera Brittain to the unknown medical foot soldiers on the front lines of fighting the disease and helping the sick. In April of 1918, American nurse Shirley Millard confided in her diary:

We are swamped with influenza cases. I thought influenza was a bad cold, something like the grippe, but this is much worse than that. These men run a high temperature, so high that we can’t believe it’s true, and often take it again to be sure ... When they die, as about half of them do, they turn a ghastly dark grey and are taken out at once and cremated.

And in London, Dr. Basil Hood, medical superintendent of the Marylebone Infirmary, recorded even more vivid and disturbing memories:

One poor nurse I remember with a terribly acute influenza/pneumonia. She could not stay in bed and insisted on being propped up against the wall by her bed until she was finally drowned in her profuse, thin blood-stained sputum constantly bubbling froth.

I knew she was doomed and that her end was near so we did as she desired in making her as comfortable as possible. This epidemic was certainly the worst and most distressing of my professional life. In the first week of December 1918 the total patients reached 779 in one day, the nursing staff total under 100.

All books like Pandemic 1918 come freighted with an implicit warning that authors need hardly stress; no 2018 reader taking in the details of what happened a century ago will fail to wonder: what would happen if a similarly virulent and easily-contagious disease broke out today? For reasons that are still unclear, the Spanish flu pandemic ended abruptly in the autumn of 1918, but a roughly similar pathogen, something easily communicated and fast-acting, striking human population centers in the modern era of far greater personal mobility, could produce a nightmare on the same scale as the one that enveloped the world 100 years ago. Pandemic 1918 is among other things a strikingly effective portrait of everyday courage in the face of the unthinkable. Readers dreading a repeat of the disaster can only hope for a repeat of the responses.

Steve Donoghue was a founding editor of Open Letters Monthly. His book criticism has appeared in the Boston Globe, the Wall Street Journal, and the American Conservative. He writes regularly for the National, the Washington Post, the Vineyard Gazette, and the Christian Science Monitor. His website is http://www.stevedonoghue.com.