Even today, there are conflicting estimates of how many deaths the great influenza pandemic of 1918 caused worldwide. In 1927, an American Medical Association study set the total at a conservative 21 million. Some say it was closer to 100 million. In the U.S. alone, where the disease is generally believed to have originated, approximately 675,000 citizens died.

This natural horror coincided with the last months of carnage of World War I, but as John M. Barry points out in The Great Influenza: The Epic Story of the Deadliest Plague in History, the disease was even more devastating than the battles. “In the American military alone,” the author reports, “influenza-related deaths totaled just over the number of Americans killed in combat in Vietnam [47,420]. One in every sixty-seven soldiers in the army died of influenza and its complications, nearly all of them in a ten-week period beginning in mid-September [1918].” Unlike pneumonia, which tended to kill infants, the old and the weak, this virulent strain seemed to target those who were young, strong and in the prime of their lives.

Barry, whose other books include Rising Tide: The Great Mississippi Flood of 1927, tells three separate but intertwined stories here. The first traces the history of American medicine from its primitive beginning to the start of the war; the second chronicles the spreading tentacles of the pandemic; and the third follows the medical community’s efforts to analyze and treat the disease and search for a cure.

Throughout his account, Barry criticizes President Woodrow Wilson and his administration for creating an unquestioning, suppressive pro-war climate that kept the public from recognizing and reacting sensibly to the disease. Time and again, medical precautions were ignored and vital news withheld for fear of damaging the war effort. Barry’s heroes are such valiant and foresighted doctors as William Welch, Simon Flexner and William Gorgas, who were rigorous in their attempts to cap the outbreak.

Believed to have originated in Haskell County, Kansas, in early 1918, the influenza spread across the country in two waves. The first one, in spring, was relatively mild. The second one was a rolling slaughterhouse. That fall, in the Camp Devens army encampment near Boston, deaths from the flu rose to an average of nearly 100 a day. Doctors and nurses began dying too. In Philadelphia, one of the cities hardest hit, the daily death toll soared briefly to around 800. There were neither enough coffins nor enough gravediggers to handle the onslaught. Entire families became sick and often had to wait for days for their dead to be taken away. Still, a cowed and “patriotic” press ignored or played down the city’s plight.

While medical and public health advances were made as it raged on, the plague essentially burned itself out, subsiding in America almost as quickly as it arose. Barry’s book is afflicted with a textbookish excess of detail at least for the general reader but it serves as a clear warning that governments must be open with their people and generous in their application of resources if they are to contain such present menaces as AIDS and SARS and slow the progress of epidemics yet to come.