Immigration, ethnicity, and the pandemic.

La grippe was the foreign-sounding name for a disease that was neither fearful nor a stranger to most Americans at the turn of the last century. This name for the influenza virus that swept through cities and towns, sickening many thousands annually, was familiar. Most of the time victims of la grippe recovered. The United States Public Health Service did not see fit to make it a reportable disease. When many Americans pondered health menaces from abroad, it was not la grippe that sprang to mind, but the millions of immigrants who had been flowing through the nation's ports and across its borders, perhaps bringing with them more serious diseases such as tuberculosis, typhus, cholera, or trachoma. Moreover, Americans feared that newcomers weakened by illness might be unable to support themselves, becoming dependent upon state and local resources or the charity of their new neighbors. All that changed in 1918. In 1918, the United States was in the midst of the largest wave of immigration in its history. Between 1880 and the 1920s, 23.5 million newcomers arrived in the United States, most of them from Southern and Eastern Europe, but also from China, Japan, Canada, and Mexico.1 (p. 52) The virulent strain of la grippe that was killing millions across the globe, known to many as the Spanish influenza, inspired fear in natives and newcomers alike. The influenza virus responsible for the pandemic of 1918 killed an estimated 20 million and perhaps as many as 100 million people worldwide. In the United States, approximately 550,000 died, an estimate derived from reporting that was incomplete and uneven at best.2–4 And, unlike other epidemics, this one took the lives of many young adults between 29 and 34 years of age, not the very young and very old who had been typical victims of other epidemics.5,6 In 1918, the United States was also a nation at war. Many of the young men who died were in the armed services. America's armed forces were hit hard: 32,165 died in U.S. military camps and another 18,136 in Europe.7,8 The flu did not respect borders and boundaries. Those felled by the disease in their home countries suffered and often died and so, too, did migrants who had wandered far from home.1,9–12 However, while the former wrestled with the disease in familiar places, surrounded by family and familiar institutions, migrants sought to regain their health and cope with their mortality among strangers. Some died of influenza among friends who stood powerless to cure the victim and could only show friendship and respect in how they mourned his passing. One such victim of “the cruel disease of influenza” was Frank Potesto, an Italian-born Denver police officer who succumbed in November 1918. His death was reported in Denver's Italian-language newspaper, Il Roma. Potesto was given a big funeral, “a true testament of the love that the colony [Italian community] wished to bestow on the poor deceased.”13 Others died tragically and alone. And still others died of the very fear that the sight of the suffering engendered. A resident of Hamden, Connecticut, 30-year-old Italian immigrant Maria Brava, acted in plays produced by the local Italian theater company. Brava poisoned herself “because of her worry that she would contract it [the flu].. .. Fearful of the suffering the distraught young woman took her own life.”14 How did native-born Americans view newcomers in the midst of this public health debacle? And how did various immigrant communities respond to the 1918 Spanish influenza epidemic? The presence of immigrants certainly complicated public health officials' battle against the epidemic. Government medical personnel needed to communicate advice and regulations to newly arrived, non-English-speaking immigrants. It was difficult, at times, to secure the compliance of the foreign-born with American standards of sanitation and hygiene, and public health regulations that seemed to them alien to their own beliefs about disease, prevention, and therapy. Foreign-born physicians, ethnic community leaders, and the foreign-language press were important mediators between public health officials and immigrants. They labored to diminish fears of the native-born that newcomers might be responsible for the epidemic. Institutions organized by the ethnic groups to which the newcomers belonged provided much-needed assistance to their own and to others during the crisis.