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Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It FREE TO VIEW

Lee K. Brown
Chest. 2003;123(6):2165-2166. doi:10.1378/chest.123.6.2165
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By Gina Kolata. New York, NY: Simon & Schuster, 1999, 352 pp; $14

Medical topics are common fodder for books aimed at a general audience, and sometimes such tomes will contain sufficient medical information and fresh insight as to reward the physician reader with an entertaining and educational “read.” Books by Berton Roueché (Eleven Blue Men) and Oliver Sacks (The Man Who Mistook His Wife for a Hat and Other Clinical Tales) come to mind in this regard, and Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It is yet another in that same tradition. In addition, this is a book that highlights some of the strengths of modern medical inquiry, but also points out the potential for hubris on the part of our academic institutions, especially when they interact with the political world.

The influenza pandemic that enveloped the world in the early 20th century receives surprisingly little attention in medical education compared with the recurring and ongoing threats of tuberculosis, HIV, Ebola virus, and anthrax. However, as Gina Kolata (a science writer for the New York Times) makes clear in the first chapter, this was an epidemic directly comparable to the catastrophic plagues of history such as bubonic plague and smallpox. In terms of mortality, estimates of deaths attributable to the pandemic range from 20 to 200 million; in terms of attack rate, it is estimated that > 25% of the US population acquired the disease. For the lay public, the story of the 1918 influenza epidemic perhaps was forgotten due to the overwhelming calamity of World War I, or because the brevity of this particular plague minimized collective recall. However, the medical significance of the pandemic carried enough weight to strongly influence the thinking of those scientists who conceived of, and lobbied for, the “swine flu” immunization program many years later.

The first portion of the book recounts some of the major epidemics in the history of humanity in order to put the influenza pandemic in context, and then sketches the history of the outbreak and the geography of its spread. The search for the etiologic agent is covered in detail. The discovery of the first human virus (yellow fever) had taken place < 20 years previously, and most investigators suspected that a bacterial organism was responsible since a variety of these (such as Haemophilus influenzae) could be found in the respiratory secretions of the victims. Unfortunately, none of these organisms could be passed on to a volunteer and replicate the disease. As Kolata relates, the discovery of several animal models (a concurrent swine influenza epidemic and successful influenza transmission to ferrets) resulted in the discovery of the influenza virus and a rudimentary understanding of influenza immunity. The concurrent presence of influenza in pigs also caused some investigators to question whether animals could function as a reservoir for viral development, periodically exposing the human population to new forms of influenza. However, most of the scientific exploration pertaining to influenza in the middle years of the 20th century involved the search for a method to culture influenza (successfully performed in chick embryos), the identification of various viral antigens (eg, hemagglutinin and neuraminidase), and the development of an influenza vaccine. Efforts to identify the specific virus involved in the 1918 pandemic occurred sporadically during the second half of the 20th century. As Kolata reports, these ranged from the exhumation of influenza victims buried in permafrost in order to obtain intact virus, to serologic studies of specimens retained in the Armed Forces Institute of Pathology. The dénouement of this tale of scientific detective work did not occur until the successful isolation of a 1918 influenza viral product by polymerase chain reaction in 1996, and even then the report of this finding was initially rejected by the journals Nature and Science!

Two other aspects related to the 1918 influenza story comprise most of the remainder of Kolata’s book. As alluded to earlier, she recounts the 1976 discovery of a new strain of influenza afflicting US military recruits at Fort Dix that prompted the subsequent development of the swine flu immunization program. The influenza spreading at Fort Dix proved to be a strain of swine influenza; since the 1918 pandemic was thought to be a related strain (although not actually identified until 1996), the specter was raised of a reprise of the 1918 experience. The academic and political machinations that resulted in the swine flu immunization program, the subsequent failure of any epidemic to develop, and the emergence of Guillain Barré syndrome as a complication of vaccination are described in fascinating detail. The swine flu story is even more compelling given the events in Hong Kong of 1997, when it appeared that a strain of avian influenza with considerable virulence began to spread to the human population. Furthermore, even as I write this review, the World Health Organization is disseminating the news of a condition termed severe acute respiratory syndrome, which seems to be emanating from Asia and bears some resemblance to fulminating influenza pneumonia.

When judged as a book written for the enlightened layman, no significant weaknesses can be identified in Kolata’s work. As a physician particularly interested in how neurologic disease effects respiration, I was disappointed by the dearth of information concerning von Economo’s encephalitis, the emergence of which appeared to coincide with the 1918 influenza pandemic, produced a number of interesting reports of abnormalities in respiratory control, and subsequently disappeared along with the influenza outbreak. Be that as it may, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It provides an entertaining, diverting reading experience for the scientifically minded layman and any physician interested in the history of medical science.




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