With the luxury of hindsight, it is easy to understand why the public health strategies adopted in 1918 failed. As George A. Soper noted in a 1919 article titled “The Lessons of the Pandemic,” authorities thought “.. . the influenza could be stopped by the employment of methods which it was assumed would stop the other respiratory diseases.” In reality, “this double assumption proved to be a weak reed to lean upon.” Throughout the epidemic, public health authorities found themselves having to explain why the standard “lessons” of disease control were not working to contain the Spanish influenza.16
Due to a vastly expanded mass-media network, this questioning process got played out in a very public way. In the preceding two decades, new forms of communication, print technology, and advertising practice had given rise to a highly competitive news industry that greatly expanded the scope of what was considered “fit to print.” By World War I, newspaper reading in the United States had reached an all-time high.17 Editors had already learned from previous events, such as the rabies vaccine's introduction in 188518 and the cholera pandemic of 1892–1893, that disease stories sold papers.13 In this media-rich context, coverage of the 1918–1919 epidemic unfolded with an unprecedented degree of speed and detail, making the Spanish influenza a truly mass-mediated pandemic. As Edwin O. Jordan remarked in 1927, “Rarely if ever before in the annals of medicine has a manifestation of epidemic disease been studied by numerous observers with so much ardor and reported with so much fullness as was the epidemic. .. of 1918.”19
To be sure, influenza's importance was magnified by its association with the Great War, an event that still dominated the front pages. Yet even as a secondary issue, the pandemic earned an extraordinary amount of newspaper coverage. For months between the spring of 1918 and the winter of 1919, readers were provided a detailed commentary on the unfolding epidemic, including discussions about the nature of the disease, the best methods of containing it, and the growing frustration over managing it. Specialized newspapers such as Variety, a weekly devoted to the entertainment industry, carried extensive coverage of the pandemic. Monthly periodicals and magazines offered additional stories, albeit at a slower rate due to their less frequent publication.
Price's December 1918 article in the Survey, perhaps the most influential social science journal of this era, was a case in point. Writing for a presumably more educated audience, he made no effort to sugarcoat his observations. Despite the great advances of bacteriology, “.. . we are in the dark as to the invisible germ causing the disease,” he wrote, and “.. . might as well admit it and call it the ‘x' germ for want of a better name.” While the exact identity of the x germ was unclear, experts agreed that influenza was “.. . a hand-to-mouth infection which travels by direct contact from person to person. .. spread by droplets diffused by sneezing and coughing.” Hence, the best way to interrupt the chain of infection was to isolate flu victims, or as a Massachusetts physician expressed it more colorfully, “.. . put each diseased person in a diver's suit and provide him with a pair of handcuffs.”1 But what E.O. Jordan later referred to as “perfect” isolation proved no easier to implement in the face of influenza than it had been for either polio or pulmonary TB.19
To explain what made influenza so hard to control, public health commentators found the concept of a “crowd disease” increasingly useful. Of course, the idea that cities, crowding, and epidemics went together was by no means new in the early 1900s; for centuries, observers had noted that where many people packed in together, diseases often followed. Yet in size and complexity, the new industrial cities of the early 20th century posed an extreme challenge. The scale and scope of public gathering places increased dramatically between 1890 and 1918. The second industrial revolution directly or indirectly led to a vastly expanded public school system, huge factories and office buildings, extensive public entertainments (amusement parks, nickelodeons, dance halls), and, last but not least, mass transportation systems that connected all these elements together. By the early 1900s, the interlinking of public spaces created a vast highway along which the deadly germs could quickly travel.6