Fighting the Flu

BRIAN: It’s flu season and this year it’s a serious one with fatalities being reported across the country. But a century ago in 1918, America and the world was in the grip of a flu pandemic. By the time it ended, the number of deaths were estimated at between 50 and 100 billion people worldwide.

NATHAN: Today, we’re looking at the Spanish flu, tracking the impact it had on communities in the United States and across the world, hearing how some people fought back against the disease, which ravaged whole cities, and asking a disturbing question, could such a devastating flu pandemic ever happen again?

JOANNE: But first, we’re going to return to our conversation with Nancy Bristow. We’ll hear more from virologist John Oxford later in the program.

BRIAN: Scholars estimate 675,000 Americans died from the Spanish flu and that a quarter of the population was infected. This put a huge strain on the country’s medical resources and on its medical personnel who were desperate to stop the spread of this disease.

NANCY BRISTOW: On the local level, the actual fighting that takes place is at the local public health boards, so that you have in cities and towns across the country, these public health experts who are trying to impose restrictions on the behaviors of their people.

BRIAN: So what were some of the specific measures that local health boards took?

NANCY BRISTOW: Well, they started with the easiest ones, and these always make my audience smile. They outlawed spitting in public and they took away what was called the shared or public drinking cup. So today we imagine a water fountain with a stream of water. In the old days you just grabbed the same cup the person behind you and the person in front of you would use. So those are the easy things. That’s the low hanging fruit.

BRIAN: And did they actually organize shopping on different days for different people?

NANCY BRISTOW: In some communities they would have staggered work hours. They would have staggered shopping hours. What that means literally is just that if you had things open at different times, it would keep the public transportation less crowded for instance. So the purpose is just to establish sort of a calendar across the day, so that people would be in smaller numbers, so that you could stretch the public hour across the hours of the day, rather than having everybody doing the same things at the same moment.

But gradually they would impose much more interventionist measures. So they might at first just ban public meetings. And then they might move on to closing down bars and closing down public amusements. And then they might decide that even the schools and churches needed to be closed. And then they might impose a public masking where everyone in public had to wear a gauze mask, and might also engage with quarantining. Those would be the most interventionist and the most highly resisted actions that they would take.

BRIAN: Did people come to any conclusions about the effectiveness of those efforts, something like quarantine? There were places that did use it. Did they fare better in the long run?

NANCY BRISTOW: They did fare better in the long run. I’m not certain that at the time they could tell that. We know today though that quarantining and public distancing measures were really helpful. And the cities that had the earliest and longest restrictions on their publics had the best long term results. They had the lowest death rates.

BRIAN: Now, what did people do to fight the flu? And was there anything that could be done to treat this?

NANCY BRISTOW: There is nothing that can be done to treat it. In other words, you cannot address the illness itself. You can only treat the symptoms. And so they are taking good care. The nurses in particular are taking good care of the patients, not simply fluffing pillows, but keeping somebody warm, keeping them dry, keeping them clean, keeping them hydrated to the extent possible, giving them pain medication. Those were all useful things to do.

BRIAN: And I’m guessing that health care was very gendered. I’m guessing that the docs were guys an the disproportionate number of nurses were women.

NANCY BRISTOW: That’s exactly right. And it’s certainly what people expected even when there were exceptions to it. So as you read press accounts, they talk about the nurses as angels in white. And they talk about physicians and their strength and their expertise and their capacities to do the sort of manly things. But that’s a set up for trouble.

BRIAN: Yeah. How did that work out when by your description, the guys, the experts are not being terribly successful in their approach.

NANCY BRISTOW: For nurses who were primarily women, the pandemic was a positive experience of sorts. In letters and diaries and yearbooks, they write about how horrific it was to observe these illnesses, but how fulfilled they felt, how empowered they were, even the kind of camaraderie and joy they found in doing good service together. And this is a real boon to nursing as a profession. For the physicians, you can read letters and diaries casting first that horrific vision of how awful it was to see this and then the kind of defeat that this felt, the kind of meaning this carried for one’s professional identity and the kind of not embarrassment, but kind of pain of loss in their capacity to believe in what was possible.

BRIAN: And this comes on the heels of quite a bit of medical and public health optimism. Is that correct?

NANCY BRISTOW: That’s absolutely right. And I think that’s another piece of what makes this so frightening. People were unprepared. Just as we’ve said, they’re used to influenza, but they also thought that they were in an era in which infectious disease was on its way out, that medicine and public health was advancing so rapidly that they would be able to eliminate things like the yearly flu.

BRIAN: And why did they believe that? What was happening?

NANCY BRISTOW: The bacteriological revolution takes place in the late 19th century, where people in Europe, those famous doctors like Pasteur and Koch are doing the work of discovering bacteria. They can finally, for the first time identify the causal agent of illnesses.

BRIAN: Now, did people understand that the flu was not bacterial or did they figure that out?

NANCY BRISTOW: No. So there is a theory about something that’s even smaller than the bacteria they’re able to see. There are people who are aware that that is existing, but they can’t see it. They just can’t see it yet. The technology is not available. So they can only operate on a theory. And this is one of the problems that I think the scientists and the physicians are facing during the pandemic. And people write about, I will never again talk about my profession being capable of doing everything and anything.

Victor Vaughn who was a very important distinguished leader of American medicine. He was Dean of the University of Michigan Medical School. He had already completed a term as the president of the American Medical Association. And he writes in his memoir in 1926 this about his experience during the pandemic, the saddest part of my life was when I witnessed the hundreds of deaths of soldiers in the army camps and did not know what to do. At that moment I decided never again to parade about the great achievements of medical science and to humbly admit our dense ignorance in this case.

BRIAN: That’s unbelievably horrible.

NANCY BRISTOW: It is.

BRIAN: If we step back a little bit and look at the optimism about stamping out infectious diseases at the turn of the 20th century, there’s a real parallel there. And the parallel is to the optimism, believe it or not, of stamping out great wars. People believed very strongly that better transportation, more trade was bringing the world together. Do you see any parallels between the optimism on the war front and the disease front and then in fact what World War I and this pandemic led to?

NANCY BRISTOW: I do. What’s interesting for me is the way it plays in the aftermath, which is that in the aftermath of both the flu and the war, the nation is able to retain its optimism. And it retains it, I think, because of that war and what it does. So that in the public sphere, Americans feel bigger, stronger, and more important in the aftermath of the war, despite the disappointment and the disillusionment that the war brought. We see it in the 1920s with the explosion of the American economy and a great deal of belief that the way we are doing things is the way we should do things, and the withdrawal in fact from government activism, for instance. But in the aftermath of the pandemic, it’s much harder to draw kind of optimistic picture.

BRIAN: Does that mean that the war eclipses the pandemic quite quickly in people’s memory?

NANCY BRISTOW: That’s exactly what happens. The pandemic, as you know, is referred to by many and most famously by Alfred Crosby, the great historian, as the forgotten pandemic. And there are a number of reasons that that happens. But certainly the war eclipses it, and in part because the war is a better story. The pandemic is the wrong story for where the nation sees itself in the aftermath of World War I. And I think it’s much easier to subsume it under this glorious victory of the war. And as a result, to simply forget it in terms of its place in the public eye. There are no memorials. There are no anniversaries held for those who died or for those who quote, fought the pandemic. It just disappears.

BRIAN: Nancy Bristow is a historian at the University of Puget Sound, and the author of American Pandemic– the Lost Worlds of the 1918 Influenza Epidemic.