Pale Rider

Science journalist Laura Spinney presents the 1918 influenza pandemic as the deadliest single event of the twentieth century, one that infected a third of the global population, killed between 50 and 100 million people, and yet remains largely absent from collective memory. She opens with the death of French poet Guillaume Apollinaire from the flu on 9 November 1918, the same day Kaiser Wilhelm of Germany abdicated. Apollinaire's funeral procession four days later, two days after the armistice was signed, was overtaken by celebrations, illustrating how the war swallowed the pandemic. There is no cenotaph for the Spanish flu, Spinney observes; it is "remembered personally, not collectively."

To explain how influenza became a human disease, Spinney traces its origins to the farming revolution roughly 12,000 years ago. When humans domesticated livestock, especially pigs and ducks, and began living in dense settlements, they created conditions for "crowd diseases" such as measles, smallpox, and influenza to jump from animal reservoirs to people. Wild waterbirds are influenza's natural reservoir, with pigs as possible intermediaries. Spinney tracks probable outbreaks through history, from ancient Greece and Rome to the "Russian flu" of 1889, which killed roughly a million people and displayed features echoed in 1918: multiple waves, pneumonia, and nervous complications including depression.

Spinney sketches the state of the world in 1918. Germ theory had produced real advances since the 1850s, fueling optimism that science would conquer infectious diseases, yet viruses remained mysterious. In 1892, Robert Koch's student Richard Pfeiffer identified a bacterium he claimed caused influenza, later called "Pfeiffer's bacillus," which was incorrect but went unchallenged for decades. Eugenics, which held that disease among the poor proved their constitutional inferiority, was mainstream and would shape responses to the pandemic. Life expectancy in Europe and America did not exceed fifty, and infectious diseases remained the leading cause of ill health.

The pandemic's conventionally accepted start is 4 March 1918, when Albert Gitchell, a mess cook at Camp Funston in Kansas, reported to the infirmary. The first wave spread from the American Midwest to France via U.S. troops sent to fight in Europe, then across North Africa, India, China, and Japan by summer. Though mild, it debilitated soldiers on both sides and contributed to the failure of Germany's spring offensive. The lethal second wave erupted in August 1918 from three points around the Atlantic and raced around the globe in weeks. Victims developed "heliotrope cyanosis," a terrifying discoloration advancing from the extremities inward as the lungs filled with fluid. A person could be infectious before showing symptoms. A milder third wave struck in early 1919, and the pandemic lingered in the southern hemisphere into 1920.

Spinney anchors the horror in the story of Pedro Nava, a fifteen-year-old who witnessed Rio de Janeiro's descent into chaos as corpses lay unburied. She examines why the disease was so difficult to identify and contain. Without knowing flu was caused by a virus, doctors confused it with plague, typhus, and cholera. In Chile, authorities assumed the epidemic was typhus and sent sanitary brigades to torch workers' homes. In Zamora, Spain, Bishop Antonio Álvaro y Ballano ordered large religious gatherings despite health warnings, framing the epidemic as divine punishment; Zamora's death rate reached about 3 per cent, twice the Spanish average.

Spinney contrasts containment experiences across the world. In New York, Health Commissioner Royal S. Copeland staggered factory opening times, established 150 emergency health centers, and kept schools open on the advice of child hygiene chief Josephine Baker, who argued children were easier to monitor and feed there. In Mashed, Persia, a city in the grip of famine, public health measures came too late to contain an airborne disease, and the death rate was roughly ten times New York's. In Odessa, a cosmopolitan Black Sea port, bacteriologist Yakov Bardakh lectured the public in cinemas, theaters, and synagogues. In Bristol Bay, Alaska, the Yupik, an Indigenous people of the region, lost roughly 40 per cent of their population.

Three theories of the pandemic's origin remain unresolved: a respiratory outbreak in Shansi (Shanxi), China, possibly carried westward by the Chinese Labour Corps; a disease at the British Army camp at Étaples, France; and an outbreak in Haskell County, Kansas. Counting the dead proved almost as difficult. Early estimates held at 21.6 million for decades before historians Niall Johnson and Jürgen Müller revised the figure to 50 million in 1998, noting it could be "as much as 100 per cent understated."

Spinney traces the scientific effort to understand the virus. In October 1918, French army scientist René Dujarric de la Rivière concluded that flu was caused by a "filterable virus," something smaller than a bacterium. Confirmation did not come until 1931 in pigs and 1933 in humans. In the 1990s, pathologist Jeffery Taubenberger began extracting viral RNA from preserved lung tissue of a soldier who died in 1918. With additional tissue sent by retired doctor Johan Hultin from an Alaskan mass grave, Taubenberger published the complete viral sequence in 2005. The reconstructed virus proved devastatingly lethal, provoking a massive inflammatory "cytokine storm" that turned robust immune systems against their hosts, helping explain why the pandemic disproportionately killed people in the prime of life.

The pandemic's aftermath reshaped the world. Fertility rates rebounded, but babies exposed to the flu in the womb showed diminished health and life prospects. Post-viral depression and a mysterious neurological condition, encephalitis lethargica, swept many countries. In South Africa, Nontetha Nkwenkwe, a woman of the Xhosa, a Black South African ethnic group, recounted fever dreams instructing her to lead her people toward self-rule; she was arrested and institutionalized until her death in 1935. Politically, the flu may have tipped the war against Germany and its wartime allies, the Central Powers. At the Paris peace conference, U.S. President Woodrow Wilson fell ill. His biographer contends Wilson largely achieved his aims apart from conceding Shantung to Japan, but the flu likely contributed to Wilson's massive stroke months later, leaving him unable to secure ratification of the Treaty of Versailles. In India, the colonial authorities' failure to address an epidemic that killed an estimated 13 to 18 million people fueled the independence movement and helped make Mohandas Gandhi its undisputed leader.

The pandemic accelerated the development of universal healthcare, the growth of epidemiology, and the creation of international health organizations culminating in the World Health Organization (WHO). It triggered a backlash against conventional medicine and a surge in alternative practices. In the arts, Spinney argues, the 1920s rupture, usually attributed solely to the war, was surely deepened by the flu. Disease moved from metaphor to center stage in literature, from Virginia Woolf to the Indian poet Nirala, who lost his family to the pandemic and wrote with unsentimental clarity about suffering.

Spinney concludes that another flu pandemic is inevitable. Scientists monitor circulating strains and work toward a universal vaccine. Researchers study what is known as the "friendship paradox," monitoring well-connected individuals who tend to fall ill earlier than average to detect outbreaks sooner. The lessons of 1918 remain urgent: Voluntary compliance with public health measures works best when built on trust, accurate information, and community engagement. The collective memory of the Spanish flu, Spinney argues, is not forgotten but still forming, a slow-developing recognition of the greatest demographic catastrophe of the modern era.