Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. By Gina Kolata. NY: Farrar, Straus and Giroux, 1999. 330 pages. $25.

Reviewed by Margaret Black

With Gina Kolata's Flu, all us closet hypochondriacs get two, quite different but equally gripping, well-written medical tales for the price of one. The first story describes ten ghastly months in 1918-19 when an extraordinarily lethal strain of influenza swept the globe; the second recounts the stumbling detective work involved in finding and understanding the cause.

The 1918 flu infected well over a quarter of all Americans, unexpectedly exterminating healthy, young adults in preference to small children or the very old. More died of the flu than were killed in all our twentieth-century wars -- World War I, World War II, Korea, Vietnam. Coffins were stacked on streetcars in Philadelphia, steamshovels dug mass graves, small towns were emptied. World wide, the disease not only cut down the troops huddled in French trenches, it stalked every continent, reaching from Arctic villages to Samoan beaches. Over 100 million people died. Even the horrific Black Death, the archetypal plague of European history, did not destroy at this rate. Phenomenally contagious, this virulent strain of a commonplace infection failed to kill even more because in 1919 it simply disappeared.

The author's deft recall of prior plagues in history shows that people reacted in a most unusual way. Perhaps World War I had already produced too much mythic horror, but whatever the reason, when the disease was gone, it plunged into oblivion. Everyone had lost family members, hordes of children were orphaned, but no one talked about it. Historians ignored it. Despite study as a microbiologist and years covering disease and medicine for The New York Times, the author did not learn of the pandemic until 1997, when she read a scientific paper about trying to recover genetic material from the virus.

Filling what she thought was a incredible void, Kolata produced a brief, at times gruesomely graphic account of the 1918 flu. But as often happens when one gets a good idea, other writers did too. PBS recently produced a documentary and companion volume, Influenza 1918, and an earlier account by Alfred Crosby, America's Forgotten Pandemic, also examines 1918 quite extensively. Nevertheless, Kolata holds her own, and readers may even appreciate her succinctness. In any case, the real strength of her book actually lies in the second story -- the search for the cause and possible future prevention.

This drama teems with fascinating characters, heartstopping experiments, professional rivalries, ethnic and gender narrowmindedness, political errors, and lucky accidents. There is even comedy, as when we watch a team of British scientists valiantly trying to coat the throats of their most successful test animals -- vile-tempered, sharp-toothed, squirming ferrets. Political buffs will enjoy Kolata's excruciating day-by-day examination of the swine flu vaccine disaster of 1976. By the time she's hung everybody out to dry, we actually pity the politicians, stuck as they are in a lose-lose situation, to say nothing of the scientists who had to persuade the public that some people dropped stone dead after a vaccination because they would have anyway.

With a light hand, Kolata sketches clear explanations of complex scientific problems and experiments. She helps us comprehend which pieces of a flu virus are important to follow and why. She constantly reminds us that the one thing following another does not necessarily make it an effect of the first. By taking us down several investigatory dead ends, she replicates briefly the perennial frustrations most researchers experience. But most of all, she excels at personal histories -- of doctors, researchers and even certain individual victims, who, long after their deaths, made advances in research possible.

Without doubt, the prince of this book is Johan V. Hultin, a Swedish-born American pathologist. Twice he plays a key role in locating and retrieving actual 1918 flu virus samples. Both times we see him trekking with little money through the wilds of Alaska to dig up victims buried so deep in permafrost they may still have frozen flu virus in their lungs. No special equipment for Hultin, our author notes with positive glee, but his amazing ability to invent on-the-spot solutions to intractable problems, endure personal discomfort, and make friends with just about anyone. Hultin leaves on his first trip suddenly because he discovers that the US Army has stolen his idea from a grant application he has made to the National Institutes of Health. (NIH holds up his grant while the Army outfits its own—needless to say, classified—expedition. Kolata beautifully contrasts Hultin's second foray, 40 years later, with another vast, but this time enormously publicity-conscious expedition to dig up seven flu victims in Norway.

At the end of Kolata's book, despite all the breakthroughs and discoveries, the mystery is still not solved. Although the killer virus appears to be in custody, and genetic decoding is under way, huge gaps still exist in understanding why that particular mutation proved so lethal or how we can prevent a future recurrence. So all us disease junkies can keep the flu virus in our nightmare collections along with Ebola, anthrax, AIDS, whatever. It's not over yet.