Influenza and Inequality: One Town's Tragic Response to the Great Epidemic of 1918

Conclusion

5 conclusion The 1918 influenza pandemic was one of the most deadly disease occurrences in medical history. It cost between 20 and 30 million lives and affected over half of the world’s population, all in less than a year. The United States alone lost well over 500,000 residents. As one historian put it, “Nothing else—no infection, no war, no famine—has ever killed so many in as short a period.”1 This brevity makes the influenza pandemic an excellent case study in epidemic behavior. Its onset was sudden and frightening, reactions immediate and visceral. It was an epidemic episode condensed, the sociological characteristics of epidemic behavior heightened by the shortness of its duration. Within the town of Norwood, Massachusetts, the foreign-born population suffered a disproportionate loss of life during the epidemic . Seventy-five percent of the adults who died during the virulent autumn wave of influenza were foreign-born, and the deaths were congregated primarily in the ethnic neighborhoods. A close examination indicates that prior to the outbreak, these residents were socially, geographically, and culturally isolated. The foreign-born population in South Norwood, where more than half the deaths occurred , was particularly marginalized and stigmatized. These people had arrived in this country from nations where they had been persecuted and poverty-stricken. Terrorized by government medical inspectors upon entry into the United States, they had been relegated to a crowded, poorly serviced section of town. As low-paid manual laborers, they had been harassed and taken advantage of by police, disenfranchised by political reformers, and ignored by most uptown citizens. Once the war began, foreign-born residents were further menaced by officials who kept their places of employment and recreation under close political surveillance. Ostracized for their language, 117 118 conclusion customs, and political beliefs, they lived, worked, worshiped, and socialized on the margins of the larger community, retreating into ethnic enclaves where they had little contact with established institutions or informational networks. This tendency toward isolation and distrust was particularly prevalent among certain ethnic groups in the early twentieth century. For example, in 1921, only three years after the epidemic, Michael Davis published the results of a large study on immigrant attitudes toward health and medical services which found that Italian, Russian, and Polish immigrants were afraid to go to a hospital under any circumstances , believing that “to go to the hospital is to die.”2 Italians in particular had a cultural distrust of authority figures, including medical personnel, and interpreted the actions of public health officials as intrusive and threatening. According to Alan Kraut, Italian behavior with regard to medical services “turned them inward to their families , cutting them off from whatever benefits turn-of-the-century medicine offered.”3 Many immigrants were genuinely afraid, and with good reason, perhaps. Hospitalization meant that they would be placed in unfamiliar surroundings, spoken to in a foreign language , treated by strangers, and often even kept from the reassuring presence of friends or relatives.4 Historian Alfred Crosby noted this pattern of ignorance and fear during 1918: “Many foreign immigrants had knowledge neither of public health principles nor English and had little confidence in Protestant, Anglo-Saxon officials, political or medical.”5 If they did become ill, many immigrants could not or would not seek assistance. Economic, linguistic, social, and political barriers combined to deny these groups life-saving knowledge and medical treatment. As the 1918 flu epidemic struck Norwood, many immigrants did not understand what was happening, and little was effectively explained to them. Most people could not afford to remain home from work despite illness or quarantine. They failed to report illness, undoubtedly expecting official sanctions or retribution, which caused the situation to escalate. They found their homes invaded and searched, and their ill loved ones taken away—to a hospital, where, many believed, people went to die. Certainly the attitudes and behavior of the Norwood authorities and citizenry up to this point had conclusion 119 not fostered any particular level of trust. Now the immigrants were faced with an organized, official response to very personal, tragic circumstances . Analysts have shown that “bureaucratic and emotionally neutral professionalism” during a disaster can create misunderstanding and cultural conflicts as “the relief . . . activities may arouse old class antagonisms or value conflicts.”6 While the town’s newspaper reports and committee minutes suggested that unsanitary living conditions and deficient personal hygiene were the cause of the spread...