On October 6, 1918, a newspaper spread appeared in cities across the United States that conflated science, painting, nationalism, and war. The layout mingled scientific diagrams of the human respiratory system with a reproduction of a ca.-1900 painting of a bubonic plague victim by the British artist John Maler Collier, a late follower of the Pre-Raphaelite Brotherhood. This lurid work, shown at the 1902 Royal Academy exhibition, features a finely dressed woman collapsed on the floor of a luxurious interior, bathed in the oblique light of a large, multi-paned window. A lamp rolls across the floor as if it has just been dropped, and a man in the background, also sumptuously garbed, backs away from the scene, steadying himself against a large tapestry. The woman, beautiful and unmarred, looks as though she has simply fainted rather than fallen victim to contagion. This image of a swooning maiden sanitizes the grotesque reality of death by plague, which was rapid, violent, and anything but visually pleasing.
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Accompanying an article about the 1918 influenza pandemic by the physician Gordon Henry Hirshberg, Collier’s painting was used expressly to reassure readers; the caption reads “Such Epidemics as [the Plague] Which Ravaged England and Almost All of Europe in the Seventeenth and Earlier Centuries Are Now Impossible, Modern Medical Science Having Devised Infallible Means of Coping with Them. The Influenza, Bad as It Is, Is a Slight Disorder Compared to Ancient Pestilences That Followed Wars.”¹ Lacking the telltale signs of the plague—ugly swollen nodules called “buboes”—the attractive woman’s body more readily calls to mind tuberculosis (highly romanticized at the time as an illness of poetic souls) or the neuropathic diseases of the nineteenth century, all of them more palatable than influenza. The use of such a painting in place of a true image of the effects of the pandemic was clearly intended to contain and neutralize public fear, safely encapsulating the uncontrollable disease among scientific diagrams and relegating it to the distant past. Published nearly one month before the conclusion of World War One, the article nevertheless provides a glimpse of the human costs of a terrifying illness sweeping rapidly across the globe, testing the limits of turn-of-the-century medicine and the efficacy of public health initiatives in increasingly crowded cities.
Today, we are ourselves witnessing how the outbreak of a virulent disease fundamentally changes the way people interact with the urban environment, affecting not only cultural institutions but everyday visual experience. Within days of the World Health Organization declaring COVID-19 a pandemic on March 11, 2020, New York City’s museums, galleries, and theaters closed in rapid succession, followed by the cancellation of city schools, the suspension of all nonessential businesses in the state, and a plea from Governor Andrew Cuomo for all citizens to stay at home. Medical “war” terminology came into common use, and the National Guard was deployed to enforce a containment area in New Rochelle and safeguard essential supplies in New York. Soon, the Army Corps of Engineers was erecting emergency health-care facilities throughout the city, and a Navy hospital ship was docked on the West Side of Manhattan. And yet, as of May 11, COVID-19 had claimed over 14,000 lives in the city, contributing to a global total of approximately 284,000.
A century earlier, in the face of the far deadlier influenza pandemic, New York had refused to go anywhere near this far or this fast in its public-health response. In 1918–19, between 50 million and 100 million people died worldwide (out of roughly 500 million infected) from a vicious strain of influenza that came to be known as the Spanish flu.² Mortality was especially high among those between the ages of twenty and forty—unlike the pattern with COVID-19, which is deadliest for those over sixty-five.³ Yet the Metropolitan Museum of Art, for example, made no move to close its doors or even to reduce programming during the epidemic. Schools remained open.
In place of a shutdown, New York launched a public education campaign, flooding the city with circulars, newspaper spreads such as that featuring Hirshberg’s story, magazine articles, posters, and brochures, placing the onus on citizens to halt the spread of the disease. Some 10,000 placards were deployed in public spaces and throughout the transportation system.4 The posters highlighted the link between influenza and pneumonia, prohibited spitting, and advised citizens to cover coughs and sneezes; one read: “To prevent the spread of Spanish influenza, sneeze, cough, or expectorate (if you must) in your handkerchief. You are in no danger if everyone heeds this warning.”5 This declaration now sounds hollow, given that the most severe period of the pandemic would last until mid-November, resulting in a New York City death toll of around 30,000, out of a population of 5.6 million.6
The Health Commissioner of New York, Royal S. Copeland, refused to close entertainment centers (as Los Angeles, in contrast, did on October 11, 1918), particularly those “big modern sanitary theatres.”7 They remained open both for the morale of the city and for the additional opportunity to spread information about public health. As Copeland pointed out in a New York Times article, theatrical productions were preceded by announcements explaining how influenza spread and measures audience members could take to protect themselves, while similar announcements were “flashed on screens” in movie theaters. “My purpose in doing it all in this way, without issuing general closing orders and making a public flurry over the situation, was to keep down the danger of panic,” Copeland stated. “I felt that one of my prime duties was to keep this city from going mad on the subject of influenza.”8
Were he alive today, Copeland might contend that New York City, with its full spring 2020 lockdown, has—by his standards—indeed “gone mad” on the subject of COVID-19. In the nineteenth and early twentieth centuries, experts posited a direct link between a person’s psychological state and their susceptibility to bodily disease.9 Those who gave in to melancholy or anxiety were thought to be more vulnerable; Copeland wrote that keeping theaters open would “protect the public from a condition of mind which would predispose it to physical ills.”10 He was one of many who viewed cultural institutions and activities as a preventive medication that would directly guard against the spread of influenza by maintaining the psychological health of the population. The 2020 mandate, conversely, is to prevent physical interaction at all costs, and so museums and theaters have transferred many of their programs to digital spaces—also in the name of lifting the spirits and calming the minds of a troubled population. Culture is still thought to heal, although it now ranks below anti-contagion efforts prompted by a more thoroughly understood germ theory.
Pictorial records of the Spanish flu, relatively scant by today’s standards, suggest a public vacillation between bravado and horror. To grapple with the visual record of the influenza pandemic is to understand the psychological precarity Copeland witnessed. For all the didactic efforts of the department of health in 1918, New York City did not escape devastation by the fast-moving virus. Corpses piled up as the infection spread through tenements, just as in other cities. Philadelphia was one of the hardest hit, with more than 17,500 dead out of a population of 1.7 million, due in part to the city’s decision to proceed with a Liberty Loan parade on September 28, 1918.11 Newspaper photographs depict overflowing morgues, the digging of temporary graves, and rows of dead bodies, evidence that the public health system was thoroughly overwhelmed. The grim scenes were akin to images of war.
San Francisco was among the strictest of American cities in its response to the pandemic, and yet still saw 3,000 deaths in a population of 500,000. One archival photograph shows a tent hospital supplementing the permanent architecture of the city, a tool of military triage staffed by military personnel in a tableau that evokes the concurrent war. Unlike New York, San Francisco closed schools, cultural institutions, and government spaces. Many civic and religious events that ordinarily would have taken place inside its monumental buildings were instead held outdoors.12 Walls and ceilings were deemed a threat to public health as officials attempted to halt the spread of the pandemic by urging the populace outside—a stark difference from policy today.
While enabling some of the rapid military-style triage that was implemented in American cities, WWI is also to blame for the spread of the virus and, later, for the collective forgetting that took place once the pandemic was over. Across the globe, countries at war were reluctant to admit the impact of influenza on their military readiness, and so suppressed information about the outbreak, remaining in denial. The American government was unwilling to restrict troop movements or cancel parades such as that in Philadelphia, causing the disease to spread rapidly, particularly among soldiers.13 At least 26 percent of the entire army was afflicted, and in the European theater, more U.S. troops were killed by the flu than by enemy fire.14
A firsthand account from a military doctor at Camp Devens, Massachusetts, written on September 29, 1918, provides a graphic visualization of the virus’s ultimate effects:
These men start with what appears to be an ordinary attack of La Grippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. . . . For several days there were no coffins and the bodies piled up something fierce, we used to go down to the morgue (which is just back of my ward) and look at the boys laid out in long rows. It beats any sight they ever had in France after a battle.”15
Illustrations of cyanosis—the bluing of the patient’s skin from lack of oxygen at the end stages of influenza—are rare. Three watercolors by British medical artist W. Thornton Shiells show a progressive deepening to purple, while the accompanying captions indicate a bleak prognosis at each stage, including “almost hopeless.” This is no Collier painting; the end stages of influenza were visually horrifying. The doctor’s comment about cyanosis obscuring race is particularly telling. While reflecting the wide, indiscriminate reach of the pandemic, it also calls to mind the inequality of its impact on historically underserved populations. In Philadelphia, emergency clinics set up by the board of health barred black patients; eventually one of the city’s two African American hospitals set up an additional clinic for flu patients at a local school.16 In New York, personnel from Visiting Nurse Services entered the tenements, bringing care to immigrant communities otherwise demonized or forgotten.
During the worst days of the Spanish flu in America, the war was a constant parallel. Adopting a battlefield paradigm gave government agencies and the press a way to address the staggering mortality rate of the disease. Once metaphors of microbial invasion took hold, the language of warfare could apply to the pandemic as a whole.17 In his October 6 article, Hirshberg made a startling but apparently widely believed charge. “The physicians and scientists of the Allied countries are seriously considering whether or not the germs of this disease have been intentionally disseminated by the German Government with the intention of weakening their opponents,” he said. “No definite conclusion has been reached on this point, but the charge cannot be hastily dismissed, as the German Government has already been convicted of employing disease germs against civilians in Rumania.”18
A cartoon published in October 1918 in the Rio de Janeiro newspaper A Careta shows the flu, personified as a skeleton, peeking out from a German submarine. The image is captioned “Bacillomarine. One more ally for the central empires.”19 Conveniently, this biowarfare theory provided the US government with a clear enemy, a singular element to be eliminated in order to ensure the survival of American citizens. Such thinking was revived, early on in the current crisis, in President Trump’s pointed reference to a “Chinese virus” and later in his excoriation of Chinese officials and the World Health Organization for letting the coronavirus escape Wuhan. In Illness as Metaphor (1978) and AIDS and Its Metaphors (1989), Susan Sontag exposed the insidious power of figurative language in medical and civic discourse, specifying how its misuse debilitates both individual bodies and the body politic.
While images of the Spanish flu itself are almost completely nonexistent in art outside of medical illustration, in the few examples that exist, romanticism finds a foothold. One oft-cited example is a pair of paintings by Edvard Munch: Self-Portrait with the Spanish Flu and Self-Portrait after the Spanish Flu (both 1919). With their queasy colors and undulating lines, their hollowed-out faces and undefined or unfocused eyes, these pictures are arguably more about Munch’s psychology and self-mythologizing than the painful experience of the flu itself.20 No cyanosis is visible, no implements of care are seen; indeed, one would not know that Munch was infected were it not for the titles.
More compelling is a quick portrait sketch that Egon Schiele made of his wife, Edith, the day before she died of the Spanish flu (and a few days before the artist’s own death of the same, at age twenty-eight).21 Edith’s face is gaunt and drawn, the shading of her cheeks and lips perhaps a sign of cyanosis. Yet again, while the pictorial treatment is slightly less romanticized than Munch’s, the young woman’s soulful eyes and chaotic strands of hair signal that this is a psychological portrait rather than a clinical reflection of a rapidly debilitating disease. One might substitute any cause of suffering, much as “plague” replaced influenza in Collier’s painting.