New York: Public Affairs, 2017332 pp., hardback, $28.00
The year 1918 is remembered for the ending of World War I, also known as the Great War. Very few people realize that this year saw the beginning of another global catastrophe that would claim more lives than both World War I and World War II combined. Throughout the world, the 1918 Spanish flu pandemic infected one-third of all humans and claimed an estimated 50 to 100 million lives. In addition, very few know that the first recorded case of the 1918 Spanish flu did not occur in Spain but closer to the American heartland in Kansas. The 100th anniversary of this event is rapidly approaching, and yet the Spanish flu epidemic has almost been forgotten by history.
Pale Rider discusses the history of flu outbreaks, including the Spanish flu, starting from the first probable recorded episode of influenza described by Hippocrates in 412 bc up to the present time. The book describes the epidemiology and personal accounts of Spanish flu occurring throughout the world along with several theories on the origin of this catastrophic event. Other deadly historical epidemics and pandemics that have ravaged the world are also discussed, including the Black Death, smallpox, and typhus.
The book does an excellent job at analyzing the conditions necessary to allow such a global pandemic to develop and affect the world. What is terrifying to note is that these same conditions exist today and are even more prevalent. They may be what caused the recent global AIDS pandemic and West Africa Ebola virus epidemic. Influenza is a zoonotic disease, one that originates in another animal and is transmitted to humans. We now know that the HIV-1 virus, responsible for the current HIV and AIDS pandemic, is thought to have mutated from the simian immunodeficiency virus found in West African chimpanzees.
The author points out how important events were shaped by the Spanish flu. These events include helping end the hostilities of World War I, strengthening the independence movement in India and apartheid in South Africa, and implementing universal health care. It is interesting to note that the H1N1 flu strain that caused the 1918 Spanish flu pandemic was extinct until very recently. This strain has been recently resurrected to allow for its scientific study and is closely guarded in a containment facility in Atlanta, Georgia. This strain was unusual in that it affected not only children and the elderly but also a large number of young adults, and it was deadlier than previous flu epidemics.
The 1918 Spanish flu was one of the greatest catastrophes to affect the world, claiming more lives than any other flu pandemic. Could another global flu pandemic occur? The time and conditions seem right. In the last 2 decades, several lives have been claimed by influenza subtype H5N1, which has a mortality rate of about 60%. Pale Rider provides an important lesson in history from which we need to learn to help identify and possibly avert another global pandemic disaster.
Biography
The reviewer, Jesus Flores, MD, is a colon and rectal specialist affiliated with Medical City Hospital, Dallas, Texas (e-mail: jflores725@hotmail.com).