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Pale Rider:

The Spanish Flu of 1918 and How it Changed the World

Laura Spinney


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BY EARLY 1920, nearly two years after the end of the first world war and the first outbreak of Spanish flu, the disease had killed as many as 100m people— more than both world wars combined. Yet few would name it as the biggest disaster of the 20th century. Some call it the 'forgotten flu'. Almost a century on,'Pale Rider', a scientific and historic account of Spanish flu, addresses this collective amnesia.

Influenza, like all viruses, is a parasite. Laura Spinney traces its long shadow over human history; records are patchy and uncertain, but Hippocrates's 'Cough of Perinthus' in 412BC may be its first written description. Influenza-shaped footprints can be traced down the centuries: the epidemic that struck during Rome's siege of Syracuse in 212BC; the febris italica that plagued Charlemagne's troops in the ninth century. The word 'influenza' started being used towards the end of the Middle Ages from the Italian for 'influence' - the influence of the stars. That was the state of knowledge then; in some ways at the start of the 20th century it was little better.

Ms Spinney, an occasional contributor to The Economist, recreates the world that Spanish flu came into. At the beginning of the 20th century science was on the rise. Scientists had switched miasma theory of disease for germ theory: they understood that many diseases were caused not by 'bad airs', but by microscopic organisms like bacteria. This led to improvements in hygiene and sanitation, as well as the development of vaccines. But viruses were almost unknown. The magnification of optical microscopes was too weak to show them up. People could spot bacteria, but not viruses, which are smaller than the wavelength of visible light. Until the electron microscope was invented in the 1930s, influenza was, like the Higgs boson before 2012, a theoretical entity: its existence was deduced from its effects. In the face of such uncertainty, public faith in medicine wavered. People reverted to superstition: sugar lumps soaked in kerosene, and aromatic fires to clear 'miasmas'.

Even so, Spanish flu was exceptionally deadly - about 25 times more so than seasonal flu. No one fully understands why. Ms Spinney ties the virulence of Spanish flu to its genetic irregularities and does a good job of explaining containment strategies through epidemiology. She draws on contemporary research, too, including the recent controversy about recreating the strain responsible for the pandemic. Ms Spinney is sanguine about the risks of such experiments: influenza appears to have all the ingredients for another catastrophic pandemic and scientists, using caution, should probably do all they can to learn more about it.

Perhaps the most valuable aspect of this book, though, is its global perspective, tracing the course of the disease in Brazil, India, South Africa and Australia, among other places. In Europe and North America the first world war killed more than Spanish flu; everywhere else the reverse is true. Yet most narratives focus on the West, and only partly because that is where the best records are. Ms Spinney's book goes some way to redress the balance.

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