Hektoen International

A Journal of Medical Humanities

Katherine Anne Porter and the 1918 influenza epidemic

Cristóbal S. Berry-Cabán
Fort Bragg, North Carolina, United States


Fig 1. Katherine Anne Porter. Photograph taken in Mexico, 1930.

In Pale Horse, Pale Rider, Katherine Anne Porter weaves the horrors of the Great War, the 1918 influenza pandemic, and the near-death experience of a young woman in love with a doomed American soldier into a memorable novella.1

Porter was born on May 15, 1890, in the small Texan town of Indian Creek and died ninety years later on September 18, 1980, in a nursing home in Silver Spring, Maryland. Her literary canon is small, consisting of several collections of short stories, a collection of three “short novels,” the novel Ship of Fools, and miscellaneous articles and criticism. Much of her later life was spent lecturing at various colleges and universities, traveling and playing the role of grande dame of American letters.1-3

Most reports say that she was almost certainly not a nice person. She often lied, and many details of her life remain clouded.4-6 Peripatetic, Porter knew everyone and was involved in the cultural life of wherever she happened to be. In revolutionary Mexico in the 1920s she coped with a drunken Hart Crane; in Germany in the 1930s she argued about race with Hermann Goering. She drank gin out of teacups in speakeasies with Elinor Wylie. Literary luminaries Robert Penn Warren, Eudora Welty, Edith Sitwell, Wallace Stegner, and Archibald MacLeish were friends.

In the fall of 1918 Porter was a twenty-eight-year-old reporter for The Rocky Mountain News when she and a young army lieutenant both fell ill with the flu. Her death seemed imminent; the newspaper had her obituary set in type. Her fever was so severe that her hair turned white and fell out. The first time she tried to sit up after her illness she fell and broke her arm; she developed phlebitis in one leg and was told she would never walk again. Six months later her lungs were healthy, her arm and leg healed or were healing, and her hair had started growing back. The lieutenant died.

Events surrounding this illness form the backdrop for Pale Horse, Pale Rider. It is the story of Miranda, a twenty-four-year-old reporter in love with Second Lieutenant Adam Barclay, an army engineer on leave awaiting orders to be shipped out to Europe. The title, with its implication of impending doom, is taken from a Negro Spiritual that in turn is taken from the Book of Revelation.7

The story is a mosaic of Miranda’s dreams, conversations with co-workers, her relationship with Adam, and her descent into illness that results in a near-death experience.

It is the last year of the Great War. In the opening sequence Miranda dreams of a frightening horse race with death. Miranda refuses to accompany the pale rider of the title and orders him to “ride on.” As she awakens “inch by inch out of the pit of sleep” she returns to the ever-present war.

Fig 2. The Influenza Pandemic of 1918 in Colorado. 

Later that evening she attends the theatre on assignment for work with Adam. Before the third act begins, a “local dollar-a-year man” appears on stage to pitch Liberty Bonds to the audience. Beginning to feel the initial effects of influenza, Miranda whisperingly asks Adam why the pitchman will not cease his painful tirade.

The following day while walking to work with Adam, funeral processions pass regularly through the streets. Meanwhile, Miranda is falling in love and determined not to disturb “the radiance which played and darted about the simple and lovely miracle of being two persons named Adam and Miranda … alive and on earth at the same moment.”

But, as persistent as the pale rider of her dreams, there is always the constant presence of “the war, the war, the War to end War, war for Democracy, for humanity, a safe world forever and ever…. The worst of the war is the fear and suspicion,” Miranda tells Adam. The people who look as if they had “pulled down the shutters over their minds and their hearts … ready to leap if you make one gesture or say one word they do not understand instantly … It’s the skulking about, and the lying. It’s what war does to the mind and the heart…”

Miranda feels increasingly ill as they continue walking, telling Adam that her sickness must be more than just the weather and the war. “Don’t catch cold,” said Adam; “my leave is nearly up and it will be the last, the very last.”

At work a co-worker shares her thoughts on the flu epidemic: “They say that it is really caused by germs brought by a German ship to Boston,” she tells Miranda. “Somebody reported seeing a strange, thick, greasy-looking cloud float up out of Boston Harbor.”

Several days later, Miranda’s illness has worsened and she begins falling in and out of consciousness. Fearing the increased severity of her illness, she wonders if she should be sent home since “it’s a respectable old custom to inflict your death on the family.”

Awakening from another nightmare, Miranda discovers her landlady shouting at Adam, guarding the door to her room. The landlady threatens to “put her on the sidewalk” if an ambulance does not arrive for her soon. Adam reassures the landlady that he will get Miranda to a hospital as soon as a bed is available. Adam solemnly tells Miranda just how serious the epidemic has become: all of the public places, theatres, businesses and restaurants have closed and the streets are full of ambulances and funerals; “It’s as bad as anything can be.”

Liberally plied with ineffective medication, she swallowed two cherry-colored pills, promptly vomiting them up. “There are two more kinds yet,” said Adam. “You’ve hardly begun. And I’ve got other things, like orange juice and ice cream—they told me to feed you ice cream—and coffee in a thermos bottle, and a thermometer.”

Miranda is finally hospitalized. As she falls into delirium, the gruesome reality of the war merges into nightmarish fantasy. In this illness-induced confusion, Miranda imagines that her German surnamed doctor, Hildesheim, is a Hun child murderer. In her fevered state the healer becomes a killer who bayonets naked infants and poisons the earth with blood and death.

Momentarily returning to consciousness Miranda attempts to apologize Dr. Hildesheim, but slips back into sleep descending “through deeps under deeps of darkness” until she finds herself petrified, totally incapable of experiencing any of the five physical senses, “no longer aware of the members of her own body … yet alive with a peculiar lucidity and coherence.”

Abandoning “the stubborn will to live,” she becomes aware of a radiant light that gradually spreads out into a rainbow, beyond which she can see an alluring landscape of meadow, sand, and sea. Enraptured by the scene, Miranda runs through the gates of the rainbow into this “promised land.” Here she meets “a great company of human beings . . . all the living she had known.” Although no one speaks, each is aware of the other. As she lies with arms under her head luxuriating in the warmth both of the landscape and the loving company, Miranda feels “without warning a vague tremor of apprehension, some small flick of distrust in her joy.” She realizes that she has “left something unfinished,” that “somebody is missing,” that she has left something or someone behind and reluctantly realizes, “Oh, I must go back.”

Returning to the world of the living, she awakens to the sound of loud horns and shrill whistles, people shouting and lights exploding outside her hospital room window. Miranda has awakened to the sounds of the Armistice.

The war is over. Yet she remains hospitalized. “Her letters lay in a heap in her lap and beside her chair,” unopened. A nurse said, “Read your letters, my dear, I’ll open them for you.”

“Standing beside the bed, she slit them cleanly with a paper knife. Miranda, cornered, picked and chose until she found a thin one in an unfamiliar handwriting.” The letter in an unfamiliar handwriting was from a stranger at the camp where Adam had been stationed, telling her that Adam had died of influenza in the camp hospital. Adam had asked him, in case anything happened, to be sure to let her know. It had happened—she looked at the date—more than a month ago.

“I’ve been here a long time, haven’t I?” she asked the nurse, who was folding letters and putting and putting them back in their proper envelopes. “Oh, quite a while,” said the nurse, “but you’ll be ready to go soon now.”

Miranda goes forth into the new world, a world of “no more war, no more plague,” a place where “now there would be time for everything.”

Paul Fussell observes in The Great War and Modern Memory that World War I has had a powerful hold on cultural memory.8 The “Spanish Influenza,” however, made for a less compelling story. Alfred Crosby points out its conspicuous absence from the oeuvres of the great American writers of the 1920s.9 John Dos Passos and F. Scott Fitzgerald were doughboys in the fall of 1918; Ernest Hemingway and Gertrude Stein drove ambulances in Italy and France during the pandemic—yet none of these authors treated the flu in any detail in their work. “It is especially puzzling,” says Crosby, “that among those Americans who let the pandemic slip their minds were many members of that group of supposedly hypersensitive young people who were to create some of the greatest masterpieces of American literature, i.e. the ‘lost generation’ for so many of whom World War I, the other great killer of the era, was the central experience of their lives.”9

Katherine Anne Porter’s Pale Horse, Pale Rider ranks among the finest works of twentieth-century medical fiction. In this small masterpiece, Porter confronts three phenomena that have haunted humanity—the tragedy of war, the horror of a viral plague that literally threatened human existence, and the almost indescribable event of experiencing death only to return to the living—woven into the doomed love story of Miranda and Adam.



The views expressed herein are those of the author(s) and do not reflect the official policy or position of The US Army Medical Department, Department of the Army, Department of Defense, or the US government.



Figure 1. Katherine Anne Porter. Photograph taken in Mexico, 1930. Found: https://en.wikipedia.org/wiki/Katherine_Anne_Porter#/media/File:Katherine_Anne_Porter.jpg.
Figure 2. The Influenza Pandemic of 1918 in Colorado. Found: https://history.denverlibrary.org/sites/history/files/01290v.jpg.



  1. Porter KA. Pale horse, pale rider: three short novels. New York: Harcourt, Brace and Company; 1939.
  2. Porter KA. Ship of fools. Boston,: Little; 1962.
  3. Porter KA, Givner J. Katherine Anne Porter: conversations. Jackson: University Press of Mississippi; 1987.
  4. Bloom H. Katherine Anne Porter. New York: Chelsea House Publishers; 1986.
  5. Givner J. Katherine Anne Porter: a life. 2nd ed. Athens: University of Georgia Press; 1991.
  6. Unrue DH. Katherine Anne Porter: the life of an artist. 1st ed. Jackson: University Press of Mississippi; 2005.
  7. Stor J. Pale Horse and rider … Negro spiritual. Choral for mixed voices. Handy Brothers Music Co; 1936.
  8. Fussell P. The Great War and modern memory. New York: Oxford University Press; 1975.
  9. Crosby AW. America’s forgotten pandemic: the influenza of 1918. New York: Cambridge University Press; 1989.



CRISTÓBAL S BERRY-CABÁN, PhD, is a graduate of the University of Wisconsin-Milwaukee and has 30 years’ experience conducting research in health. He is an epidemiologist at Womack Army Medical Center and associate professor at Campbell University. He is the author of nearly 100 research articles including articles on the history of medicine.


Highlighted in Frontispiece Volume 10, Issue 1 – Winter 2018
Summer 2017  |  Sections  |  Women in Medicine

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.