Pale Rider: The Spanish Flu of 1918 and How It Changed the World

by Laura Spinney

  Many heeded the restrictions. This was a time, before civil rights movements, when authorities had more licence to intervene in private citizens’ lives, and measures that would be perceived as invasive or intrusive today were more acceptable–especially in the patriotic atmosphere fostered by the war. In America, for example, it wasn’t just conscientious objectors who were denigrated as ‘slackers’ in the autumn of 1918, but those who refused to comply with anti-contagion measures too.

  Among those marginalised groups who had been targeted by such measures before, however, there were suspicions of another Trojan Horse, and many quietly rebelled. Vaccination programmes instigated in South Africa from November 1918 were widely boycotted. Both blacks and whites had a slippery grasp of germ theory, such that a contributor to the Transkeian Gazette was able to write that many thousands ‘smile secretly when they are told that an inoculation dose contains so many millions of germs and humour the physician by pretending to believe’. But on top of that, blacks had to ask themselves why whites were suddenly so concerned about their health. There were rumours that white men were trying to kill them, with their long needles which–according to the rumour-mongers–they inserted into the jugular.

  As time went on, fatigue set in even among those who had complied to begin with. Not only were the measures preventing them from going about their normal lives, but their efficacy appeared to be patchy at best. Role models forgot themselves. The mayor of San Francisco let his face mask dangle while watching a parade to celebrate the armistice. And the logic behind the restrictions was sometimes hard to follow. Father Bandeaux, a Catholic priest in New Orleans, protested the closing of churches in that city, when stores had been allowed to stay open. Such disparities, and the complaints they elicited, were duly reported in the newspapers.8

  Newspapers were the main means of communicating with the public in 1918, and they played a critical role in shaping compliance–or the failure of it. They often took a lead in educating their readers about germ theory and passed on public health messages, but not without expressing opinions on them, and different newspapers expressed different opinions, sowing confusion. Their attitude, like that of doctors and the authorities, was paternalistic. Even in countries that weren’t subject to wartime censorship, they rarely passed on information regarding the true scale of the pandemic, believing that the public couldn’t be trusted with it. The concept of the ‘mindless mob’ was much more powerful then, and they were afraid of triggering panic. The masses were hard enough to ‘steer’ anyway–a widespread attitude that was summed up by the British newspaper the Guardian a few years later: ‘But of what use is it to advise a modern urban population to avoid travelling on trains or trams, to ask the rising generation to abandon the pictures, or to warn the unemployed to take plenty of nourishing food and avoid worry?’9

  The major Italian newspaper the Corriere della Sera took an original stance in reporting daily death tolls from flu, until civil authorities forced it to stop doing so on the grounds that it was stirring up anxiety among the citizenry.10 The authorities don’t seem to have realised that the paper’s ensuing silence on the matter bred even greater anxiety. After all, people could see the exodus of dead bodies from their streets and villages. As time went on, and reporters, printers, truck drivers and newsboys fell sick, the news began to censor itself, and compliance dropped off even further. People drifted back to their churches, sought distraction in illicit race meetings, and left their masks at home. At that point the public health infrastructure–ambulances, hospitals, gravediggers–began to totter and collapse.

  IMPERIAL METROPOLIS

  New York in 1918 was the epitome of the atomised modern city. With a population of 5.6 million, it vied with London for the title of world’s largest metropolis, and would overtake it within a few years. The reason for its rapid expansion was immigration. More than 20 million people arrived in the United States between 1880 and 1920, in search of a better life, and New York was their main port of entry. The vast majority came from southern and eastern Europe, and as with any immigrants far from home, it took them time to assimilate. New York in 1918 was many worlds within one world.

  It was therefore a thoroughly modern challenge that faced the city’s health commissioner, Royal S. Copeland, when the second wave of the epidemic declared itself in July: to elicit a collective response from a jumble of different communities who, though they overlapped in space, often had no common language and little shared identity. And that wasn’t his only challenge. New York was the main embarkation point for troops heading for Europe, a role that ruled out the possibility of imposing an effective quarantine on the city.

  Copeland was an eye surgeon and a homeopath–a less surprising combination in the days before homeopathy was labelled ‘alternative’–and he had only been appointed to the commissioner’s post in April of that year. A ‘quintessentially optimistic, Bible-quoting, self-improving, platitude-sprouting American boy’ from Michigan, he was seen as a practical man who got things done, yet that summer and early autumn, he dragged his feet.11 The harbour authorities increased their surveillance of incoming ships from July, but when the thoroughly infected Norwegian vessel the Bergensfjord arrived on 12 August, and eleven of its passengers were taken to hospital in Brooklyn, they were not isolated. It was only on 17 September, by which time the epidemic was well underway, that influenza and pneumonia were made reportable in the city, and for the rest of that month Copeland played down the danger. By the time he officially acknowledged the epidemic, on 4 October, infected troopships including the Leviathan had long been ploughing backwards and forwards across the Atlantic, distributing their deadly cargo.

  Copeland must have realised he was impotent where troop movements were concerned–President Woodrow Wilson had followed the advice of senior military officers, and overruled that of military doctors, in insisting that the transports continue–and he may have delayed declaring the epidemic so as not to impede them. Having declared it, however, he took three potentially life-saving decisions. First, he eliminated rush hour by staggering the opening times of factories, shops and cinemas. Second, he established a clearing-house system under which 150 emergency health centres were set up across the city to coordinate the care and reporting of the sick. And third and most controversially, he kept the schools open.12

  Initially he had intended to close all public schools, as had happened in the neighbouring states of Massachusetts and New Jersey. But the pioneering head of the health department’s child hygiene division, Josephine Baker, persuaded him not to. She argued that children would be easier to survey in school, and to treat should they show signs. They could be fed properly, which wasn’t always the case at home, and used to transmit important public health information back to their families. ‘I want to see if I can’t keep the six-to-fifteen-year age group in this city away from danger of the “flu”,’ she told him. ‘I don’t know that I can do it, but I would awfully well like to have a chance.’13 Copeland gave her that chance, and in doing so he brought bitter recriminations down on his head, including from the Red Cross and former health commissioners. But he and Baker would be vindicated: the flu was practically absent from school-age children that fall.

  Copeland’s campaign was repeatedly trumped by the demands of patriotism and the war effort. By 12 October, as the epidemic neared its peak, hospitals were seriously overcrowded, surgical wards were being turned into flu wards, and gymnasia and the city’s first homeless shelter had been transformed to accommodate the overflow. But 12 October was Columbus Day, and to mark the occasion President Wilson led a parade of 25,000 down the ‘Avenue of the Allies’, as Fifth Avenue had been temporarily re-baptised.

  Copeland also had to negotiate with local businessmen. Unlike health commissioners in other cities, he didn’t close places of entertainment, though he did impose strict regulations on them–barring children, for example. When Charlie Chaplin’s film Shoulder Arms–in which a tramp kidnaps the kaiser–was released on
20 October, the manager of the Strand Theatre, Harold Edel, praised his customers for their impressive turnout: ‘We think it a most wonderful appreciation of Shoulder Arms that people should veritably take their lives in their hands to see it.’14 Unfortunately, Edel died a week before his words were published, of Spanish flu.

  In Copeland’s favour, however, New York was practised in the art of public health campaigns, having declared war on TB–and particularly on the habit of spitting in public–twenty years earlier. By the end of September, the city was papered in advice on how to prevent and treat influenza. But the advice was printed in English, and it was only in the latter half of October, when the worst was already over, that boy scouts were sent scurrying through the tenements of Manhattan’s Lower East Side to distribute pamphlets in other languages.

  Of all the immigrant groups living in the city in 1918, the newest, poorest and fastest growing were the Italians. Around 4.5 million of them arrived in the four decades from 1880, and many of them never left. They gravitated to the ‘Little Italies’–the Lower East Side, the area of Brooklyn around the navy dockyards, and East Harlem. They worked in factories and sweatshops, in construction or on the railroads, and they moved into crowded and substandard tenements, making New York the second most populous Italian city in the world after Naples.

  Mainly contadini or peasants from rural southern Italy, these immigrants were unused to city life and particularly vulnerable to respiratory disease. We know this thanks to Antonio Stella, a doctor and respiratory disease specialist who was of Italian origin himself–having become naturalised in 1909–and who went on to champion the Italian-American cause. When he wasn’t seeing patients at the Italian Hospital on West 110th Street, or in his own consulting rooms, he was seeking them out in the parts of the city where they clustered. Sometimes he was accompanied by his younger brother, the artist Joseph Stella, who sketched what he saw and compared New York to ‘an immense prison where the ambitions of Europe sicken and languish’.15

  Long before the pandemic, Stella had noted the high rates of respiratory disease–especially TB–in the Little Italies, and the fact that the Italians had the highest mortality of any descendants of immigrant stock in the city. His forays into the notorious ‘Lung Block’ in Lower Manhattan, so-called because it was riddled with TB, convinced him that the problem was greatly under-reported–the true number of cases being perhaps twenty times that of which the city’s health department was aware. ‘Six months of life in the tenements are sufficient to turn the sturdy youth from Calabria, the brawny fisherman of Sicily, the robust women from Abruzzo and Basilicata, into the pale, flabby, undersized creatures we see, dragging along the streets of New York,’ he wrote.16

  Stella was acutely aware that disease could be used to further stigmatise already marginalised groups, and this was a time when much xenophobic feeling was directed against Italians. Considered unclean, slovenly and ruled by their passions, they were disproportionately blamed for crime, alcoholism, communism and a host of other social ills. For this respected and cultivated doctor, who collected antiques and damasks in his spare time, and who counted the rich and famous–including the celebrated tenor Enrico Caruso–among his patients, assimilation was the best protection against prejudice. His adopted city had demonstrated it repeatedly. Each new wave of immigration had been associated, not only with certain racial stereotypes, but also with specific diseases. In the 1830s, cholera was blamed on poor Irish immigrants. Towards the end of that century, TB became known as the ‘Jewish disease’ or the ‘tailor’s disease’. And when polio broke out in East Coast cities in 1916, the Italians were blamed. Visiting nurses disdained their practice of kissing the dead, and the Italians slammed their doors in the nurses’ faces.

  It was clear to Stella that the immigrants acquired most of their health problems in America–rather than bringing them with them, as nativists liked to say–and that the underlying problem was crowding in the tenements. In the worst cases he recorded, the density of human beings reached 120,000 per square kilometre, or nearly 500 per acre–higher than that of the most densely populated European cities at the time, and not far off that of Dharavi, the Mumbai slum considered one of the most densely populated places on earth today. In parts of East 13th Street, a Sicilian stronghold, he counted ten people, on average, living in a single room. But he was also aware that they exacerbated their own vulnerability with their backward ways. Many were illiterate and spoke no English. They were superstitious, clannish and mistrustful of authority. Their folk cures had undergone some modification, now that wolf bones were no longer available, but they found substitutes in the city’s interstices, or cultivated them in window boxes. They continued to believe in witches and in the healing grace of the Virgin, and they spat to ward off the evil eye.

  Most dangerously of all, to Stella’s mind, these urban peasants believed in letting diseases run their course, in pazienza and what will be will be. They regarded doctors with the same suspicion they had priests and landowners in Italy, and considered hospital a place to die. Describing Manhattan’s Bellevue Hospital (where Stella consulted) in his novel The Fortunate Pilgrim (1965), Mario Puzo wrote that ‘The pious poor crossed themselves when they entered those gates.’ In fact, Stella might have been the model for Puzo’s Dr Barbato: ‘Oh, he knew very well how they felt behind the respectful, honeyed Signore Dottore this and Signore Dottore that. He fed on their misfortunes; their pain was his profit; he came in their dire need and fear of death, demanding monies to succour them. In some primitive way they felt the art of healing to be magic, divine, not to be bought and sold.’ The modern practice of paying for a doctor’s services was foreign to them.

  The main Italian-language daily newspaper in New York at that time was Il Progresso Italo-Americano. It sold close to 100,000 copies a day, and it was read as newspapers are, in communities with high levels of illiteracy: at the end of the working day, one semi-literate worker would read it many times, with great difficulty, then convey what he had understood to others, who would share and comment on it as they thronged the subway on their journey home. The writers of Il Progresso knew that their readers bound potato slices to their wrists to reduce fever, and kept their windows closed at night against evil spirits, and during the epidemic they took a stick-and-carrot approach to luring them away from such practices towards more ‘orthodox’ ones. The carrot was friendly advice: ‘One should never kiss children on the mouth and should avoid kissing them as much as possible.’ The stick was the law: ‘Very strict orders have been issued against those who do not scrupulously follow hygienic measures or don’t use a handkerchief when they expectorate. These infractions will be punished with both fines and jail time.’

  Il Progresso was one of the few to voice approval when Copeland announced his decision to keep the schools open. Italian families tended to keep their children close–bringing them home for lunch, for example–but as the paper pointed out, children liberated from the classroom often went unsupervised in the streets, while in school teachers watched over them, and could spot the first signs. ‘Moreover, in the schools hygiene and ventilation are better cared for than in many houses,’ it added. In fact Copeland may have had the Italians in mind when he gave Baker’s plan his blessing. Defending his father’s decision years later, Copeland’s son explained that, in one part of the Lower East Side, people ‘were crowded ten to fifteen persons in two rooms and a bath. The tub was used to store coal. Hot water was non-existent and cold water was often lacking. People had to sleep in shifts. To close the schools would mean even greater exposure.’

  Copeland himself caught the flu around the end of October, according to his son, but told no one and carried on managing the crisis. He declared the epidemic over on 5 November, though there would be a recrudescence in early 1919. When asked later why he thought the city had been affected less severely than other East Coast metropolises, he replied that New York was blessed with a solid foundation in public health, thanks to its twenty-year w
ar on TB.17 Most New Yorkers were familiar with the principles of hygiene, even if they didn’t know how flu spread, and they were used to the authorities intervening in matters of their health. Another potentially protective factor, that he didn’t mention, was the city’s early and possibly prolonged spring wave of flu, that may have conferred some immunity on the population.18

  The feared backlash against the Italians never came, and no other immigrant group was blamed for the flu either.19 It has been suggested that the epidemic simply passed through too rapidly for people to start pointing fingers, but there may have been another reason too. Though everyone had been vulnerable to the flu, the Italians had been more vulnerable than most–and this was in the public record. The censors Copeland sent into the tenements when he made flu reportable–not only doctors, but also inspectors from non-medical agencies and laypeople–often arrived only in time to count the dead and arrange for their burial. Two weeks after he mobilised them, he gave them an extra task: to describe the sanitary conditions in which they found the patients. This added vivid detail to the sketchy picture of immigrant life the authorities had had to work with until then, and afforded better-off New Yorkers an unprecedented glimpse of the TB-ridden slums.

  Il Progresso played its part in drawing attention to the Italian lot. In late October, it recounted the pitiful tale of Raffaele De Simone, who had been unable to find an undertaker to furnish him with a coffin for his one-year-old baby. The little corpse had lain unburied at home for several days, until the desperate father, anxious for his four other children, had appealed for help: if any suitable box could be found, he would put his dead child in it, take it to the cemetery and even dig the grave himself if necessary (several days later, the paper reported that he had finally bought some wood and, in despair, fashioned a coffin with his own hands).