Pettit, Dorothy A., and Janice Bailie. A Cruel Wind: Pandemic Flu in America, 1918-1920. Murfreesboro, Tenn.: Timberlane Books, 2008. RC 150.5 .A2 P48 2008
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We all know – or think we know – much about the “Great Epidemic” of flu that struck in 1918. But in this extensively researched and well-written account of the full outbreak (1918-1920), Dorothy Pettit and Janice Bailie have given us the complete story, which has implications for public health, medical research and even politics in our time.
With medical and health sciences backgrounds (as well as a Ph.D. in History and in Biochemistry), the authors bring a wealth of knowledge to their subject, resulting in a work that is technical but nonetheless accessible. Their knowledge shows in their writing; they draw from a wide cross-section of research to support their ideas. But sprinkled throughout are personal reflections and stories which further illustrate the impact of the epidemic, without distracting from the subject.
The book begins with an in-depth definition of pandemic, and influenza, as well as the symptoms, theories and causes. Throughout, detailed graphs, charts and the occasional illustration draw out explicit conclusions from the text. The links between 1918 and the present (and even the past) are also clearly detailed. What we now know is encouraging, but we still have far to go, in terms of both public health and management of the disease (including vaccination) and medical science.
Chapter 1 (“Riddle of Influenza”) grounds the reader, in the science and public health situation of the time, and explains why the 1918 epidemic was so stunning in its effects. Chapter 2 (“The Silent Foe”) highlights the beginnings of the outbreak in the spring of 1918, and focuses on the political and military backdrop against which the flu played out, as well as the spread of the disease worldwide, and the relationship of the different strains. Sanitary conditions, for example, were in some cases not much better than they had been at the end of the Civil War, and military and political leaders seemed to spend more time passing blame on each other than on improving conditions. One quote exemplifies the situation: “…each day a [nurse] came around with a dose of castor oil, using the same utensil for patient after patient.” (p. 68)
Chapter 3 (“A Kind of Plague”) details the overwhelming nature of the epidemic, illustrated by specific instances. The situation at Presbyterian Hospital in New York, for instance, was horrible: “For what seemed like an eternity, each morning when the doctors made their rounds, all of the men in the critical section would be gone, all having died during the night.” (p. 95) The role of the press in the public health situation is discussed: was it helpful, for instance, for the Washington Post to print the names and ages of the victims daily? The discussion of the closing of schools, theaters and other public places as well as the shortage of caskets give the reader an idea of the vastness of this epidemic.
Chapter 4 (“One War Ends”) continues the public health discussion, detailing how the closings impacted jobs, and how, immediately prior to Prohibition, there was a sharp uptake in the increase of alcohol (particularly whiskey) for ‘health’ purposes. The contrast between the optimism at the end of the war and the discouragement of the ongoing flu epidemic is striking, as a second wave of infections made its way around the world. Chapter 5 (“Paris Cold”) focuses on the evolution of the disease, as well as the effects of the flu on the peace treaty in Paris. The precarious health of many of the participants in the negotiations, including Colonel House (the President’s chief advisor) and the President himself, made them extremely difficult.
Chapter 6 (“The Aftermath”) details the lingering (and devastating) effects of the illness on post-war recovery, and shows how this period was, in effect, the beginning of “Public Health” as we know it:
The pandemic had a noticeable impact on both individual lives and on human institutions. It forced the government to take up the questions of support for medical research and of the relationship between public health and private medicine. There was a remarkable institutional response to the pandemic, which will be examined in this chapter. But the institutional response grew out of the desperate needs of individual victims of the pandemic. Social workers and others began to see how essential it was that communities provide certain minimum services necessary to safeguard the health of their citizens. Health matters would have to become a public rather than a private concern. (p. 177)
Chapter 7 (“A Tired Nation”) continues discussing the broader impacts of the flu. For example, the health of various Senators and Congressmen was affected, as were Native Americans; even prices for various remedies (such as lemons) increased dramatically as demand soared. (The flu’s impact on the family of poet Robert Frost is illustrative, and quotes from their letters are used throughout the book to illustrate the phases of the pandemic.) Chapter 8 (“The Battle Continues”) discusses how we know what we know today about the flu of 1918, and how it has been studied. The development of antiviral drugs (such as Tamiflu) and other remedies through specific clinical trials is also detailed.
Finally, extensive notes, bibliography and a well-done index make this book an ideal source for anyone studying the medical or public health impacts of the 1918 outbreak or, indeed, any pandemic disease.
