[00:00:06] Narrator Dear Louise, as many as 90 people here die every day of the flu. Soldiers too are dying by the dozens. Catherine and I returned from Camp Humphreys where we volunteered to help nurse soldiers sick with influenza. The first one who died sure unnerved me. I had to go to the nurse’s quarters and cry it out. Orderlies carried the dead soldiers out on stretchers at the rate of two every three hours for the two days we were there. Two German spies posing as doctors were caught giving these influenza germs to the soldiers and they were shot last Saturday morning at sunrise. It is a horrible thing. It is hard to believe. And yet such things happen almost every day in Washington. That was a collection of excerpts from a letter written by a nurse to her friend in October, 1918. She was describing her experience nursing soldiers who had contracted what she refers to as the flu or influenza, which would come to be known as the Spanish flu. A misleading name, the earliest cases were recorded in Haskell County, Kansas. And within two years, nearly a third of the global population had been infected leading to the deaths of anywhere between 17 to 50 million people. Welcome to Countermeasures. This season, we’re looking back at historic public health outbreaks and bioterrorism events. From the Black Plague to the 2001 anthrax attacks, we are looking across the span of time to uncover how we have responded to health threats, what we’ve learned and what we still have to do. As the First World War drew to a close, a second catastrophe was already underway. The Spanish flu swept across the globe with devastating speed, striking hardest among adults in their 20s, 30s, and 40s, a generation still reeling from the war. By the time it was over, the pandemic had killed more people than the war itself. And yet in the century since, it has largely faded from public memory. Historian John M. Barry, author of The Great Influenza, describes what daily life looked like for ordinary Americans as the pandemic took hold, and how the wartime culture of silence that shaped that era helped ensure that one of history’s deadliest events would become one of its least remembered.
[00:02:42] John M. Barry Well, the government attempted to control thought in a way that it was new and had never been attempted before or since. They were very concerned with morale on the home front. As a result, they passed a law that made it illegal, punishable by 20 years in prison, to quote, utter, rwrite, print or publish any disloyal end quote in scurrilous language about the government or form of government in the United States. And they were quite serious about enforcing this. And any bad news was considered disloyal. They were banning songs from military camps like, I wonder who’s kissing her now. Early in the pandemic in 1918 when a Wisconsin newspaper actually started printing the truth about the pandemic. The prosecution of the editors started, although it was dropped as the pandemic proceeded. So it was really unlike any other time in American history from that perspective. Spain was not at war and didn’t censor its press. They had a pretty severe spring outbreak, not in terms of deaths, because the spring tended to be much milder, but it was still explosive in Spain, and not to mention the king got sick which created more publicity.
[00:04:10] Narrator Despite the government’s silence, there was still lots of action underway in order to manage the influenza. At the time, the best physicians in the country were in the military.
[00:04:21] John M. Barry Well, basically, the best scientists in America were in the military. What is now Rockefeller University was then called Rockefeller Institute of Medical Research. That entire institution was incorporated into the Army. You know, all those scientists became officers. The dean of the University of Michigan Medical School became the colonel who was head of the Division of Communicable Diseases in the Army, So the leadership was very concerned well in advance of the pandemic about infectious disease and explosive spreaded disease. You know there wasn’t a lot that they could do as early as late September. They the military, actually, they canceled the draft. I think it was September 26, September 28, because the camps were already overrun. Number one, they didn’t want to bring any disease in from the outside for the few camps that by then hadn’t already been attacked. Number two, they couldn’t handle the numbers of people who were sick. You know, that was one response. There was a lot of scientific work that was being done on pneumonia. Some of which actually led in sort of a straight line development to the pneumonia vaccine that people get today. But again, there, you know, there were efforts, but there was nothing they could do. The vaccines were all aiming at bacteria. And of course, it was a virus that was causing it. So the vaccines would have, could have had some impact on secondary bacterial infections which were quite dangerous if you were lucky enough to get a vaccine against that particular bacteria, but obviously they’re not gonna have any impact against the virus.
[00:06:19] Narrator Nancy Bristow is a retired professor of history at the University of Puget Sound and is the author of American Pandemic, The Lost Worlds of the 1918 Influenza Epidemic. Her research relies on letters to uncover what the pandemic was like outside of the official records.
[00:06:37] Nancy Bristow With the influenza pandemic, there are plenty of official records and they can give you all the information you need on how many people died, how many were infected, though even those statistics are problematic at best. But they don’t get anywhere near giving you the social experience of the illness and of the pandemic itself, the sense of chaos on the ground as it is breaking out the anxiety around not knowing what will happen. And the trauma really of those who are ill and those who were losing loved ones alongside them, without diaries and letters, you really lose the human side of it. And I think that’s really important to retain in order to to really understand the meaning of these massive events like pandemics. So the idea of a mother whose son is away at a military camp reminds you, oh, this was happening in the midst of World War I. So people, families were often divided and having to rely not on the internet, not on emails, not on texts, but on letters that could take weeks. So by the time you’re realizing your son is ill at an army camp and you rush there by train, they may have passed five days earlier by the time a mother arrives there. A wife who’s losing the male breadwinner in a family and suddenly has six children and no money coming in, or the situation of a child who is, like my grandfather was orphaned over the course of less than one week. Those are the kinds of real experiences that a pandemic involves that you simply cannot get from official records. Other thing that I think was really powerful for me was the account by Katherine Anne Porter, very famous novella, one of the only really well-known pieces written about the pandemic. She was a young journalist in Denver at the time when she was stricken with the flu, and while she was out with it, her boyfriend’s beloved man died while she was out with the flu. And when she comes to, realizes that this piece of her life has been shattered and she wrote a personal account of that as a novella, but heavily, heavily autobiographical, and she does a remarkable job of capturing both the trauma of loss, but also the trauma for the individual who goes through the illness and then comes back to life as expected to sort of step right back into life and may not be feeling that.
[00:08:54] Narrator As John mentioned previously, the public health response to this life-changing event was highly moderated by the government.
[00:09:01] John M. Barry There was certainly misinformation, which was coming directly from the government. Again, because we were at war, there was an effort to keep morale up. As a result, you had national public health leaders saying things like, this is ordinary influenza by another name. And when you see people, you know, 25 years old, dropping dead, sometimes with horrific symptoms, you know, bleeding from their ears, even bleeding from their eyes, you know, it’s not ordinary influenza by another name. The result of the lies that were being told was, you know, they were counterproductive. They increased fear because people recognize they couldn’t believe anything they were being told. Very alienating. Get the sense that you’re in it by yourself. As a result, You know, personally, I think society ultimately is based on trust. When trust dissolves, society begins to dissolve as well. Victor Vaughan was the, before the war, he was dean of the University of Michigan Medical School. He was head of communicable diseases for the army during the war. A sober, serious scientist. Yet, he wrote, if the current rate of acceleration continues for a few more weeks, civilization could disappear from the face of the earth. That’s how bad things were being perceived as, and were. I mean, people in some places were starving to death, not because there was any lack of food, but because others were afraid to bring them food. You know, there are, you know, several reports of that in the Red Cross records, for example. And I think that was directly related to the failure of public health leaders and national leaders to tell the truth. You know, Wilson, President Woodrow Wilson never made a public statement of any kind about the pandemic. Zero.
[00:11:15] Narrator The pandemic also exposed the deep cracks that existed in American society before a public health and welfare system existed.
[00:11:22] Nancy Bristow Pandemic really does expose social vulnerabilities in the country. On the simplest level, access to healthcare was completely inequitable. In a way, this was slightly less consequential in 1918 because this is an era before there is anything to do besides palliative sort of symptom care. There was no way to combat the illness because we didn’t yet have antibiotics for secondary infections. There were no ventilators yet. But that said, access to a caring situation where one could make sure that they were kept warm, that they were able to eat, that were kept hydrated was inequitable. And so depending on one’s class status, one’s racial status, one’s status as a recently arrived immigrant who doesn’t speak English versus somebody who’s fully established, people’s access to the most basic caregiving, the meeting of the most basic necessities in one’s life was inequitible. And not again, nothing surprising in that, given that this is a world before a social safety net as well. That’s what’s really consequential. Is not only is healthcare inequitable, but access to basic necessities is completely inequitable and there is no established governmental safety net. And so if a family has a breadwinner, let’s say two breadwinners in the family, a mother and a father, one of them goes out with the illness, doesn’t even die, but just is out of work for two weeks. There’s no insurance that they get their job back. So they’re now not getting a paycheck, which means they go to the store and they cannot get food. They have no coal to heat their home and the pandemic’s happening over the course of winter, the late fall and winter. So everything from access to food, access to housing, access to warmth is very endangered for those with less. The more marginalized communities, in particular around race, but again, also around class, so that this was already the case, but suddenly the smallest change, somebody out for a week or far worse, the loss of one or even two parents or breadwinners in a household, could put people into not only food insecurity, but home insecurity, homelessness.
[00:13:37] John M. Barry The 1918 pandemic, unlike COVID, tended to kill the very young and children under the age of 10. They were probably the most vulnerable and particularly under the age of five. And then it dropped down in terms of fatalities and then peaked again in the 20s. I think another peak was around age 28. The elderly in 1918 escaped relatively untouched. I think well over 90 percent of the excess mortality from the 1918 pandemic actually was people younger than 65, so that was the exact opposite of COVID. So if you’re, you know, in your mid-20s, your 30s, and your next door neighbor is dropping dead sometimes very rapidly, sometimes, you know less than 24 hours after the first symptoms. The level of fear in the community is quite a bit different from anything that we felt in COVID.
[00:14:46] Narrator That fear didn’t fall equally across society. For those already living at the margins, recent immigrants, the poor, communities of color, the pandemic didn’t just bring illness, it brought the threat of destitution. And as Nancy Bristow found in her research, even accessing help came with conditions.
[00:15:06] Nancy Bristow So the reality was that people had to rely, in many cases, on what we today would call charity, or even if there were, in some cases, a more progressive city policy, for instance, that had did provide some sort of safety net, because this is during the Progressive Era. Even if that was in place, those who requested aid would be investigated first. And as you read the records, for instance in Minneapolis, there’s a wonderful collection at the University of Minnesota. At their social welfare collection, and the investigators will talk about, you know, well, the home was not well kept or there was evidence that someone had consumed alcohol or these two people are not married, so until the man leaves the household, we’re not going to give any aid to this mother. So, the people had to be conforming to a kind of white. Middle-class Protestant way of living. No non-traditional family units, no consumption of alcohol, no sex outside of marriage, the ability to keep a home in the way that is far more accessible if someone is home full-time doing the keeping of a household. So people were deemed more or less worthy of aid depending on their ability to conform to certain social standards.
[00:16:25] Narrator The inequities the pandemic exposed didn’t disappear when the flu did. But in the years that followed, something happened. The pandemic itself largely disappeared from public consciousness. Nancy Bristow calls this public amnesia, and she has a theory about why it happened.
[00:16:43] Nancy Bristow The nation has really proven itself as a player in the world. And so the narrative about the country is this narrative of success, of pride, of strength, of power. The pandemic story doesn’t fit with that. The pandemic is in some ways, I won’t call it a failure, but it was experienced for some as a failure. Modern medicine couldn’t stop this thing. Nurses could prove valuable. So again, there are people for whom it’s a successful pandemic. But for the nation as a whole, this is something that led to huge numbers of deaths at a time when the nation felt not only powerful internationally, but there was also the sense, because of the bacteriological revolution of the 19th century, that we were getting control over infectious disease, right? We were developing vaccines for some of the worst illnesses out there. They had discovered the causal agents for everything from diphtheria to yellow fever. So this was not fitting with the storyline. Like, wait a minute. You just told us that infectious disease was soon to be a thing of the past, but now we have this pandemic.
[00:17:50] Narrator That silence wasn’t accidental. It was reflected everywhere. In the press, in public life, and in the almost complete absence of memorials or commemorations.
[00:18:01] Nancy Bristow And so in the public sphere, there’s very little accounting. There are not commemorations held. There are no memorials built. Lots of memorials about the First World War. And those would sometimes include a kind of, a whisper about the pandemic because sometimes they would include people who had died of influenza because they were serving in the military at the time. But in general, it would not be recognized. Even in something like the New York Times or in the daily newspapers across the country. Fairly quickly the stories disappear. You go from accounts of how many people died to very quickly these very positive stories about look how we’re back on our feet. Look at the business we’re doing in New York. Look how we won the war. Let’s talk about how we are really on our way. And so there’s just a kind of silencing in the public sphere around the story. And the problem with a public amnesia is the reality that people who have suffered trauma don’t forget. Right? And they were given no space for that recognition. And the consequences of that, I think, are difficult to account for. But one thing we know through research on trauma is the best way to rebuild one’s life in the wake of traumatic experiences is having the opportunity to tell your story, to have it heard, and to be believed about it. That was not an opportunity that people had in the wake of this pandemic. I think here of my own grandfather. He lost his parents in the course of a week in the fourth wave of the pandemic in early 1920. Literally in less than a week, he went from having two healthy parents to being orphaned. I never heard him speak of it. And it wasn’t until long after he had passed away that I learned that’s how he became an orphan.
[00:19:46] Narrator And it wasn’t just public memory that went quiet. The writers and artists who lived through it largely turned away too.
[00:19:53] John M. Barry Some people wrote about the disease, but you would have thought there would have been a lot more commentary by writers after it. You know, there are isolated cases, but John Dos Passos, one of my favorite writers, actually got sick with influenza on a troop ship going to Europe, which is one of the worst places you possibly could get it. And he wrote about two lines about it in his entire body of work. Which is kind of striking. So in terms of scholarship, it’s almost more understandable than the lack of fiction, at least serious fiction about it. After my book came out, which is now quite a while ago, some people did tell me that there was a lot of, you know, dime novel type fiction about the pandemic, which I did not know. Assuming that’s the case, but there’s very little serious fiction. There’s been oddly enough more about COVID in the last few years than there was after 1918.
[00:21:11] Narrator The 1918 pandemic left behind no monuments, no national days of remembrance. For decades, the people who lived through it carried their grief largely alone in letters and diaries that sat in archives. What historians like Nancy Bristow and John Barry have given us is something long overdue, a reckoning with what happened and with what was lost. But remembering is only part of the work. The pandemic revealed truths about public health that remain as relevant today as they were in 1918, that inequity determines who suffers most, that misinformation costs lives, and that the trust between governments and the people they serve is fragile and hard to rebuild once broken. Progress since 1918 has been real. We have better tools, better science, and a deeper understanding of how disease moves through a population. But the social conditions that shaped who lived and died in 1918 did not disappear with the pandemic. Perhaps the most important lesson it offers is this, that public health is not just about medicine, it is about the kind of society we choose to build. Thank you for listening to Countermeasures. If you enjoy the show, please consider leaving us a rating or review. Thank you to our guests for taking the time to share their insights. If you found this episode insightful, please share it with colleagues and friends. And don’t forget to subscribe so you don’t miss future conversations.