-Caveat Lector-
New York Times
November 26, 1999
BOOKS OF THE TIMES
`Flu': Medical Sleuths Stalk One of History's Great Killers
By HELEN FISHER
In September 1918 a mass murderer was on the loose. Europeans,
Americans, Asians, Africans, Eskimos, Polynesians, men and women
from the Arctic to Australia died in hours from this killer. In
Ottawa streetcars were largely empty, theaters and movie houses
were dark. In Reading, England, schools turned into hospitals, and
morgues. In Cape Town coffins became so scarce that many of the
dead were buried in mass graves. More Americans died by this mighty
hand than were killed in all the battles of World War I, World War
II, the Korean War and the Vietnam War: half a million in all.
In the corridors of some city morgues in the United States, bodies
were stacked four feet deep. American baseball players and their
fans wore gauze masks. They feared the 1918 influenza, which came
to be known as the Spanish flu. Its cause: a mystery. Its cure:
none. Doctors recommended food, fresh air and tender loving care.
They had no treatment, and no vaccine. Some 20 percent of victims
recovered without incident; many more died within days.
The virologist John Oxford has called it "the biggest outbreak of
any infectious disease ever known, bigger than the Black Death."
Epidemiologists have estimated that 20 million to 100 million
people died worldwide. Then the pestilence vanished as mysteriously
as it had appeared. In "Flu," Gina Kolata, a science reporter for
The New York Times, writes of this 1918 pandemic with verve,
clarity and nightmarish detail.
The symptoms, for example, were not pretty: a dull headache,
burning eyes, chills, fevers, coughing up blood, shortness of
breath and death as the lungs deteriorated.
Most of Ms. Kolata's book concerns the scientists who have searched
to find and identify the 1918 influenza virus in hopes of
preventing its horror from revisiting humankind. It is a
fascinating tale.
As it turns out the major clues were found in the remains of two
U.S. Army privates and an Eskimo woman. Pvt. Roscoe Vaughan was a
strapping 21-year-old who checked into Camp Jackson near Columbia,
S.C., in 1918 and fell sick on Sept. 19. A week later he died.
Subsequently a small slice of his lung tissue was saturated with
formaldehyde, sunk in a chunk of candle wax smaller than a penny
and sent to the archives at the Armed Forces Institute of Pathology
in Washington.
As Vaughan lay dying, Pvt. James Downs got chills at Camp Upton,
N.Y. On Sept. 26 he succumbed, too. A snippet of his diseased lung
was sent to the same archive.
Then in mid-November an obese young Eskimo woman left her igloo in
a tiny settlement on the Seward Peninsula of Alaska to join a
village feast of reindeer meat, hot cakes and blueberries soaked in
seal oil. She was welcoming two visitors who had come 90 miles by
dog sled from Nome. Then she, too, suddenly began to shudder with
fever. Within days her body was placed along with the other
infected corpses in a trench in the permafrost. The freezing
temperature and her body fat preserved much of her remains,
including traces of the dead virus.
These three victims would provide a biological "Rosetta stone" for
this macabre illness, and those who sought to decipher its clues
are interesting characters themselves.
One is the retired pathologist Johan V. Hultin, who exhumed the
Eskimo woman's corpse, recovering bits of the virus. Another is the
dogged virologist Jeffery Taubenberger, who rummaged among the
millions of body parts stored in the Armed Forces archive, found
the remains of Privates Vaughan and Downs, and gradually pieced
together much of the genetic structure of this killer virus.
The stories of the men and women who struggled to find the virus,
make their reputations, assuage their curiosity and possibly save
the world from another disaster are compelling.
But I found some of the still-unsolved questions about this
epidemic to be even more intriguing. For example, no one knows why
this virus had such unprecedented virulence. The answer may lie in
an earlier epidemic: the 1890 flu. As one theory goes, people who
caught the 1890 flu produced copious quantities of antibodies and
then, if the 1918 flu virus had a similar protein on its surface,
the antibodies to the 1890 flu might well have turned to fight it,
perhaps too strenuously.
As Ms. Kolata puts it: "In a gross overresponse to the 1918 virus,
armies of white blood cells and fluids could rush to the lungs of
flu patients. The healthier people were, and the better their
immune systems, the more likely they would be to die when they were
infected with the 1918 virus." She adds that the only way to
confirm this theory is to find the 1890 flu virus, in the same
Armed Forces archive.
As Ms. Kolata spins out this remarkable scientific detective story,
the reader comes to understand a good deal about the biological
structure of viruses. For example, influenza viruses attack only
the lungs because only the lung cells have a particular enzyme that
the influenza virus needs to replicate. We also are given
excursions into the history of scientific inquiry, the science of
epidemiology and the role of disease in human history. Thucydides,
for example, suggested that the plague that struck Athens in 431
B.C. so traumatized its citizens that the Athenians were
subsequently unable to defeat Sparta and the Peloponnesian League.
This forceful book ends with some chilling information. Scientists
have discovered much of the genetic sequence of this virus, but
they still do not know exactly where it came from, why it was so
deadly or if this virus, or some version of it, may return. Even
today influenza remains "largely untreatable." "Flu" made me think
in new ways about viruses, epidemics, the course of history and the
future, including my own. I think I am off to get a flu shot.
PUBLICATION NOTES:
'Flu: The Story of the Great Influenza Pandemic of 1918 and the
Search for the Virus That Caused It'
By Gina Kolata
Illustrated. 330 pages. Farrar, Straus and Giroux. $25.
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