The influenza epidemic of 1918-19 has a lot to teach us, but we have to remember it before we can learn from it. In American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic Nancy K Bristow points out that here in America, although our family memories of the suffering are still alive, as a nation we have tended to forget what happened and to whom. The book foregrounds this situation, as the author puts it, in an appalling lapse into academese.
This story is very personal for the author whose great-grandparents died in the epidemic, leaving her 15-year old grandfather an orphan who had to grow up very quickly. He was not the only child in such a situation nor was he the only American whose life was changed forever by the suffering and death they witnessed. The suffering didn't stop when the last flu death was recorded.
Almost immediately, however, the country reworked the story of the epidemic (it was, of course, really a pandemic) into one of optimism and redemption. This is what Americans do with tragedy, especially when we feel powerless - we turn our backs on the past and look to the future. We pick ourselves up and dust ourselves off, we put things behind us, we find "closure." It's a big part of what makes us Americans and it accounts for some of our success as a country. But as a historian the author warns that if we ignore history we cannot learn from it.
In recent years there have been some first-rate histories of the epidemic, primarily John M Barry's 2004 book, The Great Influenza, the definitive book on the topic (for the moment at least) and Gina Kolata's excellent Flu (1999.) It's unfortunate that the title The Forgotten Plague is taken (by Frank Ryan's 1993 book), because it would be the perfect title for Bristow's work.
The author is a remarkable historian. There cannot be a corner of the country whose experience of the flu she doesn't know about, and she is especially interested in the experience of the Pacific Northwest. (She teaches at The University of Puget Sound in Tacoma, WA.) There are 196 pages of text in his book and 81 pages of notes and bibliography - all in unusually small type. Which is what makes it surprising how readable most of the book is.
This is not a popular history, but once she got going the author couldn't help herself - she mostly dropped the academic hooey and wrote a readable book full of stories that illustrate her thesis but also tear at the heart of the reader. Her interest is with the poor, blacks, recent immigrants, and others who did not have the middle-class benefits that made the experience of so much sickness and death a little easier. But this was an experience in which, more than in most catastrophies, race and poverty and other circumstances didn't matter. People died in the same numbers whether they lived on the lower East Side or on Park Avenue. The flu was a great leveler.
Bristow points out how different the experience was for nurses vs doctors. The goal for nurses was to care for patients. They were successful in doing that. Professionally trained nurses, the Red Cross, and even the volunteers who worked in the hospitals or as visiting care-givers did what they set out to do, making things a little easier for the sick. The mostly male doctors had a different goal: save lives. They saw the pandemic as a fight, a war. Indeed, the entire experience was spoken of in military terms, partly because it happened during and after World War I when the country was thinking in martial terms.
Doctors and public health professionals were almost powerless to stop the flu from invading every town and city in the country and they were unable to "cure" people who became ill. This was a time of great advances in medicine with the recognition of the germ theory of infection and the identification of the bacteria that caused many wide-spread diseases of the time. Not knowing what caused this illness or what to do about it made doctors feel defeated. Nurses came away from the experience feeling they had succeeded; doctors felt they had failed.
This is was heyday of the Progressive Era, a time when old politically corrupt machine politics was being swept away in many places by reformers who leaned on professionals who had ideas about how to solve social problems. (The Profressives were especially effective in California.) People were receptive to government rules that they thought would forestall the epidemic. But before long, as is usual in America, people became restive under so much government control (which verged on fascist at times - see John Barry's book) and began to balk at requirements that forced schools and churches to close and everyone to wear a face mask. And so the public health professionals, who were a new class of medical personnel at the time, experienced a double sense of failure.
What good came of all this "therapeutic chaos"? Nurses were increasingly recognized and appreciated for their work and they became more well-trained and professional. The public health experts learned that even when they cannot stop a pandemic they can keep records that help them send resources - the few that they had during the war - where they were most needed. They put more emphasis on public education about disease. And doctors, recognizing the need for more research - a lot more research - into communicable disease, encouraged government funding that eventually became the National Institutes of Health and the CDC. Health departments became common in most municipalities.
This is not the book to read if you don't know RNA from DNA, antigenic drift from antigenic shift, or contagious from infectious. John Barry's and Gina Kolata's are the books to go to for the bones of the story of the great pandemic. But if you know the story, this book will flesh out the personal experiences of both health professionals and victims.
For an excellent interview with the author, go here to Robin Lindley's article in History News Network.
2012 No 93