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Nearly a century after it killed millions, a journalist reflects on how the Spanish flu changed the world

Pale Rider: The Spanish Flu of 1918 and How It Changed the World

Laura Spinney
345 pp.
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Between 1918 and 1920, the Spanish flu infected a third of the global population. It claimed more lives than either World War I or World War II. Nearly a century later, we are still struggling to understand the extent of this pandemic. It crops up from time to time in popular science and history (1, 2), but no one has yet to take as wide-sweeping an approach as Laura Spinney does in her new book, Pale Rider.

Spinney, a Paris-based British journalist and novelist, is a storyteller with a science writer’s cabinet of facts. Retracing influenza’s death trail over nine continents, she attempts to show how the flu affected not only the war-torn West but also remote communities in South Africa, China, and Brazil. The book reveals how desperately and differently people reacted and how gravely the flu influenced the modern world, touching everything from medicine to business and from politics to poetry.

The story begins in 412 BCE with Hippocrates and the “Cough of Perinthus,” an outbreak of upper respiratory tract infections widely cited as the first influenza epidemic in human history. From there, Spinney reveals how infectious diseases have made fools of history’s best doctors and used trade and war to travel freely throughout the world.

One of the first officially recorded outbreaks of Spanish influenza occurred in March 1918 at a U.S. Army infirmary in Kansas. (According to Spinney, the historical misnomer was agreed upon by the Allies at the expense of neutral Spain.) In May of that year, the flu appeared on the Western Front, in North Africa, and in India. By the end of July, both China and Australia were reporting cases. The initial outbreak quickly subsided, and many assumed the worst was over. However, in August, it reappeared, and this time it was more lethal. Overall, there were three waves, and the death toll, still in dispute, varies between 50 and 100 million worldwide.

“La grippe espagnole,” “ispanka,” “die Spanische Grippe”—by whatever name, it brought medieval darkness to the modern age. Doubling in many countries as both plague and curse, it sickened and bewildered generals, governors, doctors, and clergymen. Cures and rituals were concocted to halt its spread. Jewish communities in Odessa held “black weddings” in cemeteries, assigning the roles of bride and groom to beggars who were then showered with gifts, an ancient practice intended to stave off epidemics. In Persia, people strapped prayers written on paper to their arms, in hope of warding off infection.

In the West, the whole pharmaceutical sink was thrown at the flu, with disastrous side effects and few results. Mistakenly believing that Pfeiffer’s bacillus was the cause, governments poured money into vaccines that were all but useless.


A medical demonstration is conducted at a Red Cross Emergency Ambulance Station in 1918.

Misunderstanding is a major theme in Spinney’s story; perspective is another. Although the flu struck the poor and the rich alike, people fared differently depending on where they lived and where they stood on the socioeconomic ladder. America and Britain lost 0.5 percent of their populations, but in India the loss was 10 times higher. Poor city neighborhoods were more vulnerable than richer ones, although cities in general were worse off than rural areas.

How did the Spanish flu change the world? Orphanages were overwhelmed. Religious leaders struggled to explain a calamity that struck believers and nonbelievers alike, and the science community was humbled. The U.S. life insurance industry paid out almost $100 million in claims, the equivalent today of $20 billion. The idea of universal health care took off in Germany, Russia, and, to a lesser extent, Britain. So did smoking, which was promoted to soldiers as a flu prophylactic. Daringly, Spinney argues that the flu even pushed India toward independence and South Africa toward banning apartheid.

Although the Spanish flu was the worst disaster in human history, it is unlikely to be the last. The world population has quad-rupled since 1918, and we now travel faster and farther than ever before.

Unlike a century ago, we have the ability to make flu vaccines and are always on the lookout for viral strains of pandemic potential. In 2005, the H1N1 strain that caused the Spanish flu was brought back to life in the laboratory. Spinney describes how researchers were able to determine that the virus evolved into such a virulent strain, by “restitching” viral RNA sequences.

Today, we have health care workers trained in speedy response. But is this enough? One lesson that can be learned from the Spanish flu is that public awareness, policy, and education are also important weapons with which to curtail pandemics.


  1. D. Oshinsky, Bellevue: Three Centuries of Medicine and Mayhem at America’s Most Storied Hospital (Doubleday, New York, 2016)

  2. J. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (Viking, New York, 2004)

About the author

The reviewer is a freelance writer based in Catskill, New York, USA.