She applied the “Page 99 Test” to her new book, American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic, and reported the following:
American Pandemic explores the American people as they weathered the worst health crisis in recorded history, the 1918 influenza pandemic. Focused especially on the range of Americans as they confronted the catastrophe—doctors, nurses, public health officials, patients, and the families and communities that surrounded them—the book attempts to give voice to the diversity of their experiences while acknowledging the powerful role played by social identity in shaping them. Men and women viewed the events through gendered lenses and responded in ways that fit with expectations about their masculine or feminine identity, a tendency that had a profound impact on the perspective of health care professionals, volunteers, families and patients. Race and class hierarchies, in turn, shaped the behaviors of those who most benefited from them, ensuring that some people in the country suffered from not only influenza but also the indignities and inequalities of the American caste system.Learn more about American Pandemic at the Oxford University Press website.
Page 99 entirely misses this theme, but picks up, instead, on another important subject, the conundrum public health experts encountered as they faced the pandemic—how to mobilize the citizenry to observe new hygienic standards and public health restrictions while keeping them calm. The influenza scourge had proven a shock to Americans, both because influenza had been domesticated by its familiarity and because of the growing belief among the populace that medical and public health experts could protect them from outbreaks of infectious disease. Such a circumstance called for care on the part of public health officials. As I explain on page 99,
It is clear that the effort to minimize public fear was a central feature of public health work during the epidemic. In their educational work, health leaders balanced the need to alert citizens with a determination to avoid frightening them. This strategy is very clear in the USPHS pamphlet “Spanish Influenza” “Three-Day Fever” “The Flu.” The pamphlet began by asking simply, “What is Spanish Influenza?” The answer was at once familiar and direct: “The disease now occurring . . . resembles a very contagious kind of ‘cold’ accompanied by fever, pains in the head, eyes, ears, back or other parts of the body, and a feeling of severe sickness.” Having compared the epidemic disease to the common cold, the pamphlet went on to describe a sickness little different from the yearly flu. “He [the patient] feels weak, has pains in the eyes, ears, head or back, and may be sore all over,” it noted.“Many patients feel dizzy, some vomit. Most of the patients complain of feeling chilly, and with this comes a fever in which the temperature rises to 100 to 104.”Put simply, “The patient looks and feels very sick.” The USPHS conceded, too, “in some places the outbreak has been severe and deaths have been numerous.”At the same time, the pamphlet carefully introduced such potentially frightening information alongside descriptions of a more pedestrian outcome. “Ordinarily,” it suggested, “the fever lasts from three to four days and the patient recovers.”And further, “When death occurs it is usually the result of a complication.” The pamphlet reassured readers that epidemic influenza was nothing new and had “visited this country since 1647,” in “numerous epidemics of the disease.” While these descriptions made clear that this was a potentially dangerous disease and epidemic, they also adopted the traditional strategy of domesticating influenza.As the example of the USPHS pamphlet makes clear, in their efforts to prevent panic the public health forces sometimes erred on the side of caution. This unwillingness to admit the scale of the pandemic had dramatic consequences. Some communities and citizens were slow to recognize the extent of the danger influenza posed to them, a disaster given that quick and comprehensive action proved the only possible, if limited, protection. As significant, perhaps, the tendency to understate the power of the pandemic persisted well after its passing. In the aftermath of the tragedy, American public culture quickly forgot the scourge, a dynamic encouraged by medical, nursing and public health officials anxious to restore the chorus of scientific dominance they had sung prior to the outbreak. This public amnesia only heightened the suffering of those who had experienced the trauma of loss, forcing them to live quietly and alone with their private pain.