human history. From there, Spinney reveals
how infectious diseases have made fools of
history’s best doctors and used trade and war
to travel freely throughout the world.
One of the first officially recorded outbreaks of Spanish influenza occurred in
March 1918 at a U.S. Army infirmary in Kansas. (According to Spinney, the historical
misnomer was agreed upon by
the Allies at the expense of neutral
Spain.) In May of that year, the flu
appeared on the Western Front, in
North Africa, and in India. By the
end of July, both China and Australia were reporting cases. The
initial outbreak quickly subsided,
and many assumed the worst was
over. However, in August, it reappeared, and this time it was more
lethal. Overall, there were three
waves, and the death toll, still in
dispute, varies between 50 and
100 million worldwide.
“La grippe espagnole,” “
is-panka,” “die Spanische Grippe”—by whatever
name, it brought medieval darkness to the
modern age. Doubling in many countries as
both plague and curse, it sickened and bewildered generals, governors, doctors, and
clergymen. Cures and rituals were concocted
to halt its spread. Jewish communities in
Odessa held “black weddings” in cemeteries, assigning the roles of bride and groom
to beggars who were then showered with
gifts, an ancient practice intended to stave off
Between 1918 and 1920, the Spanish flu infected a third of the global popula- tion. It claimed more lives than either World War I or World War II. Nearly a century later, we are still strug- gling to understand the extent of this
pandemic. It crops up from time
to time in popular science and
history (1, 2), but no one has yet
to take as wide-sweeping an approach as Laura Spinney does in
her new book, Pale Rider.
Spinney, a Paris-based British
journalist and novelist, is a storyteller with a science writer’s cabinet of facts. Retracing influenza’s
death trail over nine continents,
she attempts to show how the
flu affected not only the war-torn
West but also remote communities in South Africa, China, and
Brazil. The book reveals how desperately and differently people reacted and
how gravely the flu influenced the modern
world, touching everything from medicine to
business and from politics to poetry.
The story begins in 412 BCE with Hippocrates and the “Cough of Perinthus,” an
outbreak of upper respiratory tract infections
widely cited as the first influenza epidemic in
The legacy of the Spanish flu
BOOKS et al.
The reviewer is a freelance writer based in Catskill, New York,
USA. Email: email@example.com
The Spanish Flu
of 1918 and How It
Changed the World
epidemics. In Persia, people strapped prayers
written on paper to their arms, in hope of
warding off infection.
In the West, the whole pharmaceutical
sink was thrown at the flu, with disastrous
side effects and few results. Mistakenly believing that Pfeiffer’s bacillus was the cause,
governments poured money into vaccines
that were all but useless.
Misunderstanding is a major theme in
Spinney’s story; perspective is another. Although the flu struck the poor and the rich
alike, people fared differently depending on
where they lived and where they stood on the
socioeconomic ladder. America and Britain
lost 0.5 percent of their populations, but in
India the loss was 10 times higher. Poor city
neighborhoods were more vulnerable than
richer ones, although cities in general were
worse off than rural areas.
How did the Spanish flu change the world?
Orphanages were overwhelmed. Religious
leaders struggled to explain a calamity that
struck believers and nonbelievers alike, and
the science community was humbled. The
U.S. life insurance industry paid out almost
$100 million in claims, the equivalent today
of $20 billion. The idea of universal health
care took off in Germany, Russia, and, to a
lesser extent, Britain. So did smoking, which
was promoted to soldiers as a flu prophylactic. Daringly, Spinney argues that the flu
even pushed India toward independence and
South Africa toward banning apartheid.
Although the Spanish flu was the worst
disaster in human history, it is unlikely to
be the last. The world population has quadrupled since 1918, and we now travel faster
and farther than ever before.
Unlike a century ago, we have the ability to
make flu vaccines and are always on the lookout for viral strains of pandemic potential. In
2005, the H1N1 strain that caused the Spanish flu was brought back to life in the laboratory. Spinney describes how researchers were
able to determine that the virus evolved into
such a virulent strain, by “restitching” viral
Today, we have health care workers trained
in speedy response. But is this enough? One
lesson that can be learned from the Spanish flu is that public awareness, policy, and
education are also important weapons with
which to curtail pandemics. j
1. D. Oshinsky, Bellevue: Three Centuries of Medicine and
Mayhem at America’s Most Storied Hospital (Doubleday,
New York, 2016).
2. J. Barry, The Great Influenza: The Epic Story of the
Deadliest Plague in History (Viking, New York, 2004).
Nearly a century after it killed millions, a journalist reflects
on how a pandemic changed the world
By Suzanne Shablovsky
A medical demonstration is conducted at a Red Cross
Emergency Ambulance Station in 1918.