I had only vaguely heard about the influenza epidemic of 1918 due to a historical novel, but don't remember ever hearing about it in school as part of World War I history or anything along those lines, despite the death rates it caused. This book is very extensive as Barry covers a multitude of topics to explain the situation during which the epidemic occurred - this means discussing the state of science, medicine and the government at the time and in the years leading up to the flu. I also have to say he did a good job of explaining himself enough for a laymen to understand, and sometimes repeating a few explanations from chapter to chapter for the non-scientist readers.
Medical science in the United States was a disgrace in the mid to late 19th century. It was easier to get a medical degree than a college degree, and doctors believed in many cures that didn't work, and in fact hurt the patient, such as bleeding. There were a few scientifically minded people that went to Europe to study medicine which had made great medical advances beyond the United States. It was this environment that lead to the founding of John Hopkins, intended to be a premiere medical institute in the United States under the lead of a group of scientifically minded physicians. While John Hopkins made great strides, and slowly began improving medical standards throughout the whole country, by the time the influenza struck there were still not as many good doctors as one may have wanted - there were still holdovers practicing from the earlier period. However, the men of John Hopkins had quickly made advancements in science and as an instituion was comparable if not better than ones in Europe. Basically, when the influenza hit there was a small cadre of brilliant men to lead the fight, but they didn't have an army of doctors to lead. As Barry put it, they had generals and were missing the sergeants.
Of course it didn't help the civilian population that a large percentage of the doctors approved by the medical association were part of the military as well as many nurses. As a result, many of the cities were completely overwhelmed and suffered a shortage of medical personnel when the influenza epidemic swept the nation (the military was overwhelmed as well - the camps were all overcrowded, beyond medical recommendations which helped spread the virus more quickly). The war led to a few other things as well: Wilson was completely focused on the war and didn't even address or discuss the influenza once. Soldiers kept getting moved around despite warnings, leading to the spread of the illness from one barracks to another, from one camp to another, and across the ocean. Wilson had mobilized the nation in his war effort, and the level of self-censorship and real censorship was amazing. Anything slightly critical of the government or the war could lead to imprisonment, people were ostracized for not buying war bonds - the nation had one focus, and that was to win the war. Newspapers saw it as their jobs to keep morale up, not to report the truth. This led to several issues when it came to the flu. First, the newspapers kept downplaying the epidemic instead of warning people. Even with the scientist racing to find solutions, there were none to be found. There were no cures, the only prevention that seemed to work was complete quarantine which is almost impossible to do, but it still would have been at least somewhat helpful to encourage people to limit their daily contacts earlier rather than later. The other problem is that even while the newspapers were downplaying the issues, the populace saw how bad the influenza was so they no longer trusted the papers. In fact their lack of knowledge made them even more fearful because they built the flu up to something that was even more horrific. As a result, in many cities people didn't help each other from fear of being infected. Barry states that San Francisco alone gave out true details, and they had a terrific response from the community. While many of the deaths may not have been preventable, in some cases, the people didn't die of the flu itself but due to the fact that they were too incapacitated to take care of themselves and get water or food. These types of death could have been prevented if there had been a larger corps of civilian volunteers.
In the end, the scientists didn't find the answers or a cure - the virus itself simply mutated enough that it became less dangerous, and the survivors developed resistance. It was only years later that scientists were able to answer the question of what had caused the epidemic accurately after having pursued some false steps during the crisis. One person's work on the flu led him to focus in on smaller and smaller details until he discovered the importance of DNA and genes (DNA had been discovered previously but not its purpose).
Overall, this book was very well done. He doesn't exactly stay very linear in the middle portion during the influenza outbreak, instead taking a topic and focusing on it, then jumping back in time and referring to earlier issues as part of another discussion. It works, but it is something to be aware of to avoid confusion. As I said earlier, for the most part, the parts where he repeats himself were helpful for me, especially the more scientific facts, but there were a few other points and ancedotes that he repeated that weren't necessary. However, given the topic I think I preferred having one or two things referenced more often than I needed than three or four things less often. The politics and the government's response or lack thereof were definitely illuminating, and it was crazy to see just how much the nation as a whole bought into the war. While today it seems crazy that a nation can have its military at war without the whole or at least part of the nation being involved, the extent to which it defined live in the American community during World War I is extreme. It is suprising that this isn't mentioned more than it is in history - we all still know about the plagues in Europe and depending on the numbers this flu may have caused similar death rates. Of course, coming on the tail end of a war that disillusioned a generation, it is perhaps no surprise that it would be glossed over due to all the other significant historical events that had preceeded and followed the epidemic.