The epidemic is seldom mentioned, and most Americans have apparently forgotten it. This is not surprising. The human mind always tries to expunge the intolerable from memory, just as it tries to conceal it while current.

— H.L. Mencken on the 1918 influenza pandemic

The toll was staggering. From 1918 to 1920, influenza killed more that 50 million people as it spread around the world in the worst pandemic in recorded history. 

In the United States, the flu infected a quarter of the population and killed 675,000 people — more than ten times the number of American combat deaths in World War I.  And this unusual form of influenza proved especially lethal to healthy young adults. The epidemic shook the confidence of medical professionals who were unable to determine the cause of the flu or develop a cure.

The epidemic devastated the United States, yet it soon became a forgotten moment in American history. In her new book American Pandemic: The Lost Worlds of the 1918 Influenza Pandemic (Oxford), Tacoma historian and professor Dr. Nancy K. Bristow delves into the social and cultural world of Americans during the pandemic and traces the ensuing national amnesia.

Bristow recounts this desperate time from the perspective of flu patients and their families to medical professionals and community leaders based on her extensive study of primary sources including letters, diaries, oral histories, memoirs, novels, newspapers, magazines, photographs, government documents, and medical literature.

Coupled with being a teacher of American history with an emphasis on race and social change at the University of Puget Sound in Tacoma, Bristow is the author of Making Men Moral: Social Engineering during the Great War and was the Washington State Professor of the Year in 2007. Incidentally, she is the great-granddaughter of two of the pandemic's fatalities.

Bristow recently talked by telephone about her study of the influenza pandemic and her passion for history from her home on Vashon Island.

Robin Lindley:  Did your family story about the deaths of your great grandparents during the influenza epidemic spark your interest in the pandemic?

Dr. Nancy Bristow:  It did. I was backpacking with my father, and during one of those trail conversations it became clear to me that my great grandparents had died during the pandemic. From the very beginning, I sought to make sense of what happened to these people — relatives I had never known. They had been immigrants from Ireland, people without a lot of resources who didn’t leave a record when they died. They just disappeared for us. So this was an effort to build the world in which they lived and died, and in which my grandfather was left an orphan.

Lindley:  Didn’t your great grandparents die within a few days of each other?

Bristow:  We don’t know for sure. The family lore suggests that Elizabeth Bristow died and, immediately following her funeral, John Bristow began feeling ill and then passed away in a couple of days. Within a week, according to this narrative, my grandfather lost his mother and his father. 

Lindley: Where did the United States fit into the story of the worldwide pandemic?

Bristow:  It was an enormous international event. Demographers are still trying to estimate [the casualties] because so many countries then did not have public health recordkeeping. Fifty million [deaths worldwide] is a good guess. The United States was very much in the center of the pandemic. The first wave in the spring of 1918 goes largely unnoticed, mistaken for the usual flu coming through. It’s only in retrospect that we see the connection to the major pandemic. It erupts in a second wave in late August in the United States, France and Sierra Leone almost simultaneously. From there it rages around the world.

The United States suffered in ways similar to the rest of the world. We had the advantages and disadvantages of being an industrialized nation. Influenza traveled fast for us because the virus could travel at the speed of railroads.  But we had some of the advantages of modernized public health and health care as well. 

Lindley: What were the symptoms of the flu?

Bristow: There was some variation, but the basics are pretty straightforward. Some people had a sore throat and felt crummy as we all do [with] the flu. But for most people it came without warning, and people were sickened in just a few hours. Some people would go from being perfectly healthy to dead in less than a day. A high fever from 101 to 105 degrees was common. There were terrible headaches and weakness and a feeling of being very sick.   

Many times, there was serious pain in the joints or in the back and muscles. One report said, “The patient felt as though he’d been beaten all over by a club.”  Frequently people would become very drowsy and those who got really sick would pass into delirium and unconsciousness.

The most unusual symptom of this influenza, though, was intense congestion when the lungs would hemorrhage and fill. That would lead to breathing difficulty, nosebleeds and coughing of blood and sputum. Sometimes the extremities would turn blue because the sick were literally drowning from fluid in the lungs. On autopsy they’d [describe} the “lungs of the drowned.”  

And then it was the wrong people who were sick and dying. A strange feature of this disease was that the young and healthy died in the largest numbers, which is very uncommon for influenza. One theory is that for those who were young and healthy, their strong immune response [caused] what happened in the lungs as the body tried to fight the influenza but instead fought itself.

Lindley:  Didn’t more American soldiers die of flu than died in combat in World War I?

Bristow: Yes, and that story wasn’t really told. One of the consequences of the way Americans remembered the pandemic was that there was a real tendency not to talk about all of the deaths. That was true of the military as well. Carol Byerly wrote a tremendous book Fever of War: The Influenza Epidemic in the U. S. Army during World War I.  According to War Department figures she cites, 50,280 soldiers died of combat wounds and 57,460 soldiers died of influenza.

Lindley: You note that the flu was a mystery that confounded medical professionals who, before this epidemic, were confident about addressing any infectious illness with new treatments.

Bristow: That’s right. There were real triumphs in the development of medicine in the late nineteenth century. They had figured out germs [and] they were able to cure some diseases and, more important, they were successful in preventing serious infectious diseases. The epidemic came as a terrible shock, then, because the medical profession hoped it was past the point when something this horrific could occur. They worked very hard, but had an awareness that there was little they could do, and that nursing was the most important ingredient in patient care during the pandemic. It wasn’t until the 1930s that the flu virus was first seen.

Lindley: You focus on how the epidemic affected the poor, women, and minorities.  You write that “the economic circumstances framed the impact of the disease.”