Pandemic influenza has recently been in the air, both literally and figuratively. Almost exactly as I sat down to read Dorothy A. Pettit and Janice Bailie's excellent A Cruel Wind: Pandemic Flu in America, 1918-1920, the World Health Organization held a press conference in Geneva to announce that it was upgrading the recent outbreak of H1N1 influenza, more commonly known as "swine flu," to a global pandemic.
Although the designation comes from the increasing spread and not increasing severity of the disease, the announcement is understandably worrying. The world has not experienced a full-blown pandemic since the relatively mild 1968 outbreak, which still killed nearly one million people worldwide.
An even more worrying memory is the 1918 pandemic, which likely killed a staggering 50 to 100 million around the world and an estimated half-million Americans. The 1918 flu seemed even more cruel because it came just as World War I drew to a close, and while the Great War has been memorialized ever since, the flu was lost to a collective amnesia through much of the 20th century.
The 1918 flu has been rescued from obscurity by recent events, including the SARS outbreak, avian flu and now H1N1. Many readers will thus be familiar with the general outline of the story of the 1918 influenza, from its nebulous beginnings in either Asia or North America, to its petering out in 1919. Pettit and Bailie's book is organized roughly chronologically, they follow the pandemic from its early, elusive days in the spring of 1918 through its conclusion in 1919. They describe, in serious but not alarmist terms, the growth of the pandemic to its crescendo in October. They vividly paint the picture of world in which public masks were common, anti-influenza propaganda existed alongside the anti-German, and the healthiest young adults, those between 18 and 40, were most likely to die of influenza.
The greatest strength of this book is the intimate portraits that Petit and Bailie give of life during the pandemic. These include the stories of prominent figures, such as poet Robert Frost, and also the less well-known, such as children Bridget and Mary McG., who recovered from the illness but lost their father Timothy to it because he had worked through his illness in an attempt to support his family. Particularly interesting are the first and second chapters that cover the early days of the pandemic at home and in the field. Petit and Bailie illustrate how life at home, where the government kept the disease closely under wraps through censorship and deliberate under reporting, differed greatly from the front lines, where it was unavoidable.
Pettit and Bailie tease out the many implications of the outbreak. They are good at the big consequences: the possibility that Woodrow Wilson was ill when attempting to negotiate the treaty of Versailles, the effect of high levels of illness among troops on war planning, the economic consequences of the number of people off work. They evoke the frightening scenes of bodies stacked in morgues. They also discuss changes in understanding of the disease and of its treatment. Pettit and Bailie even illustrate how the experience of the pandemic helped ease the way for the entry of the government into medical and life insurance.
They also highlight the less obvious effects. Pettit and Bailie illustrate the dramatic impact that the influenza panic had on American theatre attendance and the World Series. They discuss how Ringling Brother's circus was forced to close due to lack of performers and audience members.
Pettit and Bailie back up their anecdotal stories with plenty of charts and graphs for the more statistically inclined. These figures clearly lay out the major influenza pandemics of the past century, death rates, morbidity rates and a host of other figures. For the more pictorially inclined a number of pictures are included. They have discovered a number of local images that do not appear widely in the available pandemic literature. The image of Seattle police wearing masks in 1918, featured page 102, is particularly striking, illustrating how the mundane was changed by the disease.
The book suffers from some small organizational problems. The first is the introductory chapter on influenza. The dense and detailed biological discussion of the influenza virus seems out of place in a book that is otherwise so accessible. A less specialized account would have served as a better introduction and been more in keeping with the tone of the book. Another slight problem is the break of chronology. The book jumps several times from wartime conditions to the post-influenza peace and back again, making it difficult for the reader to judge how the two events affected each other. The confusion is particularly striking because otherwise the narrative is so gripping and clear.
A Cruel Wind does a valuable service to our understanding of both this illness and the context in which it raged. No other recent work surveys the event with such attention to the political and social environment of the period of the entire country. They have integrated both compelling local studies and the growing international literature on the subject. Despite this breadth of background, they have never lost sight of the human experience of the story.
Many scientists are hopeful that the current pandemic will look more like the relatively mild 1957 or 1968 pandemics than 1918 for epidemiological and sociological reasons. Even still, A Cruel Wind may provide some insight. Historians are notoriously bad prophets, but Pettit and Bailie's book should bring some comfort for its illustrations of the compassion and humanity that were as widespread as the 1918 pandemic. One hesitates, especially under the current circumstances, to call a book about a pandemic enjoyable. However, if such a label can be applied, Pettit and Bailie's book deserves it.