American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic by Nancy K. Bristow (review)

“Every, nearly every porch, every porch that I’d look at had—would have a casket box sittin’ on it.” Interviewed in 1987, Teamus Bartley, a ninety-five year-old retired Kentucky coal miner, still vividly recalled the influenza pandemic of 1918, when the mines closed, the work stopped, and “people went to dyin’.” It remains the deadliest pandemic on record: the so-called “Spanish influenza” of 1918 infected a third of the world’s people, killing some 50 million. The pandemic infected 25 million Americans, leaving more than half a million dead. For the untold millions who lost loved ones in this horrific global health crisis—which greatly compounded the suffering of a world at war—the pandemic sowed misery beyond words. Bartley reckoned, “It was the saddest lookin’ time then that ever you saw in your life.”¹

Nancy K. Bristow, a professor of history at the University of Puget Sound, has written a prodigiously researched and often affecting history of the American domestic experience with the 1918 pandemic. Bristow reports that her own grandfather lost both of his parents to the disease, making him one of the era’s thousands of influenza orphans. In American Pandemic, Bristow narrates the pandemic in two very different registers. The first is a relatively straightforward social history of the epidemic: the waves of infection, the locally variant responses of public health leaders and the medical profession, the public reaction, and the private experiences of patients and their families. The second, less successful, strand of the narrative involves Bristow’s attempt to make sense of what she describes as an outbreak of “national amnesia” (191) that trailed in the pandemic’s wake. Why had so many Americans moved so swiftly to put this event behind them, erasing the influenza pandemic from the American story?

The particular viral strain of 1918, Bristow explains, caused “[a] horrifying disease that bore little resemblance to the common yearly influenza” (8). The disease had a mortality rate of 2.5 percent, compared with more typical forms of influenza that killed roughly .1 percent of the infected. In 1918, the afflicted suffered a sudden onset of high fever, severe headache, and extreme discomfort. As the Journal of the American Medical Association reported, “The patient feels as though he had been beaten all over with a club” (45). But the signature symptom of this new influenza, was acute pulmonary edema, which led many physicians to diagnose it as pneumonia. The disease filled patients’ lungs with bloody fluid, turning many of them blue as they drowned in their beds. The 1918 influenza produced an unusual “W”-shaped mortality graph. Whereas an ordinary outbreak of yearly influenza could be expected to hit children and the elderly the hardest (producing a classic “U”-shaped curve when mortality was plotted against age), nearly half of the 1918 fatalities were adults between the ages of 20 and 40. Families lost breadwinners, and children lost parents. By November 1918, some 31,000 children in New York City had lost one or both of their parents to the influenza.

Bristow constructs her social history of the U.S. epidemic from a wide source base that includes dozens of archival collections as well as public health reports, medical journals, and local newspapers. Even pandemics of global scope are normally experienced on the local level. Bristow shows that as influenza ripped through American communities the disease tended to reinforce, rather than upend, the status quo. As Bristow observes, with a narrative restraint all too rare in the popular historical literature on epidemics, “the influenza crisis remade individual lives but not Americans’ communal life” (9). Predictably, native-born whites blamed immigrants and African Americans. Somewhat surprisingly, the public generally cooperated with the public health officials’ demands—the closing of churches, schools, and pool halls; the mandated restrictions on mobility; the orders imposed (in some locales) to wear protective masks in public. Bristow...