The 1918 flu pandemic killed between 25 and 50 million people around the globe. The "Spanish flu,"; or "Spanish Lady,"; as it was also known, was thought to be worse than the Black Plague of the Middle Ages. There was no defence against it-no vaccine or wonder drug to combat the fast-moving, vicious strain that filled hospitals and hastily set-up isolation wards. Before it was over, people were dying within hours of showing the first symptoms. No part of Canada or the world escaped. The American death toll was about half a million, more than 10 times that of its losses in World War One. Canadian deaths numbered over 50,000-4,400 in British Columbia. Starting in Quebec City, the Spanish Lady spread steadily west to the Vancouver domain of public health officer Dr. Fred Underhill.

As the flu spread, so did fear of the unknown and the fact that there was no effective treatment. This was in the days before penicillin and sulfa drugs, and aspirin had only recently been on the market. The pandemic of 1918 killed some 8,000 in Ontario, 25,000 to 50,000 in all of Canada and anywhere from 25 to 50 million people around the globe at a time when accurate casualty figures were sketchy. People died within hours of showing the first symptoms, with a 40-per-cent death rate if pneumonia developed. Patients died a pain-wracked death.

Starting in China, the illness devastated much of Asia and Europe, including the armies battling the First World War, before jumping the Atlantic and striking North America. Ironically, infected troops coming home in the fall of 1918 brought it with them. Ships returned to ports in Quebec after many burials at sea of those who died en route. Then servicemen traveled across the country to their hometowns on westbound trains. No part of Canada or the world escaped the "Spanish flu,"; or "Spanish Lady"; as it also was known, a name derived from the first major newspaper reports about the disease published in Spain. One of the puzzling aspects was that unlike the usual flu, the main victims were not the old and young but rather adults between 20 and 45 and mostly males.

With their proven record of investigative writing, O'Keefe and Macdonald celebrate the public-health achievements of one man, while giving contemporary meaning to an 85-year-old mystery; the flu surprisingly killed not the old and very young, but rather adults between 20 and 45, mostly male.

Dr. Fred documents Dr. Underhill's yeoman service in dedicating himself the fighting the pandemic, a medical challenge unique in our history. O'Keefe and Macdonald's book comes a century after Underhill's appointment as Vancouver's first medical health officer. In light of recent avian-flu scares and the lingering shadow of SARS, it is an ominous indicator of how vulnerable we remain to new viral diseases. This compelling read will both educate and scare the hell out of you.