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Book review: Living with Enza

Michael Sargent

The Spanish Influenza pandemic of 1918 was the severest test that public health administrations had faced in their first fifty years. The arrival of this strain of influenza was dramatic and frightening. In some communities, one-third caught flu in a short period and five percent died; those who died went purple, drowned by fluid in their lungs. Two days after the Armistice, as the pandemic peaked, the British Chief Medical Officer had to admit that “he knew of no measure that could resist the influenza”. Mark Honigsbaum’s book is a vivid account of the pandemic in Britain and a reflection on what could have been done to ameliorate the disaster. Face masks and restrictions on public congregation might have helped but were scarcely credible as the army began to demobilise. Lessons were learnt, though, and eventually a profound knowledge of the disease emerged.

This book went to press before last year’s Swine flu outbreak, with Honigsbaum thinking Britain might not manage any better than it did eighty years ago in a pandemic of equivalent severity. He suspects the huge demand for medical services would be crippling and that absenteeism from work would disrupt the economy disastrously because of our dependence on remote providers of power, food, transport and communications. Gloomily, he supposes modern Britain would lack the grace and stoicism that helped people through the crisis of 1918.

Considering progress since 1918, he grudgingly recognises that our knowledge of the virus is an important advantage. He also acknowledges the effectiveness of the international surveillance system that did so well during the 2003 epidemic of severe acute respiratory syndrome (SARS). Today we have antibiotics that will cure secondary bacterial infections and anti-flu drugs that can reduce the intensity of the disease if taken early. He recognises the need for more research; for drugs to control infection and severe reactions to influenza and for the development of better vaccines and mass immunisation procedures.

The title of this very readable book reminds us how British children of the 1920s extracted a little gaiety from unpromising circumstances with a skipping rhyme:

I had a little bird
its name was Enza
I opened the window
and in-flu-enza.

Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918 by Mark Honigsbaum is published by Palgrave Macmillan, 2008

This essay was published in the Mill Hill Essays 2010

ISBN: 978-0-9546302-8-9

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