Rachel Conrad Bracken
Rootstown, Ohio, United States
The “D.I.Y. Bragg Apple Cider Drink,” a mixture of water, vinegar, and a natural sweetener, like honey, is “important to the Bragg Healthy Lifestyle.”
The publication of Karen Hesse’s young adult novel, A Time of Angels (1997), coincides with a renewed interest in the history of the 1918–1919 “Spanish flu” pandemic and a proliferation of multidisciplinary studies of contagion and culture.i Yet A Time of Angels is also a novel about food and folk medicine at a moment in American medical history when, as millions were dying from an unorthodox strain of influenza, physicians and public health authorities could do little to prevent or cure the sickness. By 1918, the advent of salvarsan and diphtheria antitoxin, coupled with comprehensive public health regulations and extensive vaccination campaigns, offered hope for the treatment and prevention of many of the previous century’s scourges, including cholera, typhoid, syphilis, and smallpox. Breakthroughs in the fields of bacteriology and epidemiology endowed the practice of medicine and public health with scientific authority and professional prestige.ii Nevertheless, despite tremendous advances in pathology and diagnostic technology throughout the nineteenth century, medicine’s therapeutic capabilities remained tragically limited in the face of pandemic influenza.iii Preventative measures proved fruitless and bacteriologists’ search for the microbial cause of influenza infection, the first step in developing an effective vaccine, were unsuccessful; indeed, the viral origins of influenza remained undiscovered until 1933. Physicians and public health authorities were utterly overwhelmed by a strain of influenza far deadlier than common, seasonal variations and this, in turn, undermined the public’s trust in the medical profession. A Time of Angels chronicles this hopelessness, but also celebrates alternative healing practices that center on food and folk cures. Although ostensibly a children’s novel, A Time of Angels thereby presents a sophisticated critique of the tragic limitations of allopathic medicine in the early twentieth century.
Between February 1918 and May 1919, influenza killed as many as 50–100 million people worldwide; all told, one in four Americans were infected with the deadly virus and anywhere between 500,000 and 675,000 succumbed to the disease.iv Yet the pandemic was rather famously “forgotten” in the literature of era.v Although a number of prominent, early twentieth-century American authors had firsthand experience of the devastation wrought by the flu in the final months of World War I — Gertrude Stein, Ernest Hemingway, and John Dos Passos all drove ambulances for the Allied forces, witnessing both the horrors of trench warfare and the dangers posed by influenza in crowded army barracks — few wrote about it at length. Except among virologists and public health authorities, the 1918–1919 pandemic remained relatively obscure until late in the twentieth century, when advances in immunology and the emergence of AIDS, Ebola, and particularly virulent strains of zoonotic influenza reawakened interest in the flu among scholars of literature and culture, as well as of bioscience and medicine. Amid fears of the next global pandemic, scientists sequenced the unprecedentedly lethal virus and investigated its origins while historians and policy analysts evaluated the effectiveness of early twentieth-century public health precautions, all with an eye to better preparing for the next outbreak—or, better yet, preventing it altogether. Similarly, epidemics of SARS and swine flu in the early 2000s inspired a rash of historical fiction that, like Hesse’s A Time of Angels, bore witness to the 1918–1919 pandemic’s unparalleled ruin while also playing host to timeless tropes of “plague” writing: fear of corruption and exploitation, distrust of the Other, and the many ethical dilemmas, large and small, occasioned by social interconnectedness.[vi] In many ways, the tropes and themes explored in this historical fiction of the early 2000s mirror the larger scholarly and cultural fascination with outbreak and contagion in an increasingly global society. For Hesse, though, the history of pandemic influenza exposes the importance of food to American folk medicine traditions, as well.
A Time of Angels begins on September 10, 1918 — just as the second wave of influenza struck east coast cities in the US and began its calamitous move westward — and in its opening lines signals the central role both food and folk medicine will play in this fictional account of the pandemic. Returning to the apartment she shares with her sisters, her aunt, and her aunt’s roommate, Vashti, fourteen-year-old Hannah, “pushe[s] open the front door of [the] tenement and race[s] down the steps. Hesitating a moment in the dark stairwell, [she] breathe[s] in the odors from the other apartments. Ham. Bacon. Smells that made [her] mouth swim with hope.” But in Hannah’s apartment there is “only the foul stink of weeds” that Vashti, an unlicensed healer, transforms into herbal remedies.[vii] These lines immediately call attention to the inextricability of food and folk medicine, which closely regulates diet and relies on naturally derived, often food-based cures. As the chapter continues, it follows Hannah and her sisters, the children of Russian Jewish immigrants, as they traverse Boston’s bustling immigrant neighborhoods on their way to and from school and classes at the settlement house. From the smells of ham and bacon — foods forbidden by Jewish dietary law — to garlicky pickles, Italian cheese and salami, lemon cookies, kugel, and an orange bought from a street vendor, the girls’ daily commute offers a culinary tour of a multiethnic city. Here, families and communities are knit together by the buying and selling, making and sharing of traditional foods, just as they are united by a shared susceptibility to infectious disease made visible by the outbreak of influenza in later chapters.
The novel’s first mention of flu comes only after Hannah acknowledges the cooking smells that blanket her home, when she tells Vashti about an article in the day’s paper reporting “a hundred sailors, sick with influenza” (3). In just two weeks, the flu will entirely overrun Boston; the schools close and Vashti hardly sleeps as she tends to sick families around the city. Like countless others, Hannah and her sisters fall ill and, despite Vashti’s meticulous care, their aunt dies. In a feverish delirium, Hannah boards a train to Brattleboro, Vermont, where she is nursed by a kind, elderly farmer named Klaus. Like Vashti, this old farmer concocts natural remedies from “weeds”— he dresses a cut with “spruce sap and cattail juice,” which “stops the bleeding [and] keeps out infection” (179) — and swears by the limitless curative powers of apple cider vinegar. “As long as you’re here with me,” he instructs Hannah, “you’ll start every day with apple cider vinegar and you’ll end every day the same way” (105). Hannah’s recovery is slow, but steady, coaxed on by Klaus’s home cooking and stolid faith in Vermont folk cures.
A Time of Angels is historically accurate, both in its illustration of the speed and severity with which the 1918–1919 pandemic ravaged towns and cities around the globe — Hesse depicts overtaxed hospitals and coffin shortages — and in its depiction of food-based folk cures and home remedies. Klaus insists “it’s vinegar saved [Hannah],” and the nurses in Brattleboro’s emergency hospital agree: “it must have been. I don’t know what else could have” (79). In truth, attentive nursing care was the best doctors could offer flu patients in the fall of 1918 and vinegar was likely as effective as any “scientifically”-based medicines. Moreover, for many Americans who, like Klaus, lived in isolated, rural spaces without ready access to a physician or, like the immigrant families Vashti treats with her “weedy cures” (3), could not afford the doctor’s fees, home remedies such as apple cider vinegar were essential to managing health.
Of course, healthcare looks very different today. The sectarian feuds of the nineteenth century have long been settled and “regular,” allopathic physicians no longer jockey with Eclectic and homeopathic practitioners for patients and prestige.viii Furthermore, legislation has prevented the sale of dangerous “patent medicines” since the early twentieth century.ix Yet allegiance to health foods, “natural” cures, and home remedies remains strong in the US; as a matter of fact, self-proclaimed “health crusader” Patricia Bragg carries on her family’s business, founded in 1912, by touting the health benefits of unfiltered, organic apple cider vinegar.x And while Bragg does not claim that cider vinegar will either prevent or cure the flu, recent studies suggest that “various forms of vinegar,” including apple cider vinegar, may “potentially alleviate obesity, diabetes, cardiovascular, cancer, and other health complications.”xi More than a reminder of “America’s forgotten pandemic,” then, A Time of Angels also serves as a reminder of America’s long folk medicine tradition — one that continues to shape the consumption of health foods and “natural” remedies in the current moment, as well.
- Whether approaching it, in the biomedical sense, as the potential for an infectious disease to spread among populations and across the globe or, in the metaphorical sense, as the circulation of ideas and behaviors within and across communities, scholars of contagion and culture emphasize our inability to contain contagious disease within socially constructed borders and, thus, the power of infectious disease to make visible otherwise unrealized cross-cultural contact. See Alison Bashford and Claire Hooker, eds., Contagion: Historical and Cultural Studies (London and New York: Routlege, 2001); Priscilla Wald, Nancy Tomes, and Lisa Lynch, “Introduction: Contagion and Culture,” in “Contagion and Culture,” ed. Priscilla Wald, Nancy Tomes, and Lisa Lynch, special issue, American Literary History 14.4 (Winter 2002): 617–24; Kirsten Ostherr, Cinematic Prophylaxis: Globalization and Contagion in the Discourse of World Health (Durham and London: Duke Univ. Press, 2005); and Wald, Contagious: Cultures, Carriers, and the Outbreak Narrative (Durham and London: Duke Univ. Press, 2008).
- For an historical accounting of advances in allopathic medicine, see Paul Starr, The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic Books, 1982), esp. pp.79–144; David Rosner, “‘Spanish Flu, Or Whatever It Is…’: The Paradox of Public Health in a Time of Crisis,” Public Health Reports vol. 125, supplement 3 (2010): 38–47; and Nancy K. Bristow, “‘It’s as Bad as Anything Can Be’: Patients, Identity, and the Influenza Pandemic,” Public Health Reports vol. 125, supplement 3 (2010): 134–44.
- Concerning the medical profession’s inability to prevent, contain, or cure the flu, see Sarah Frances Vanneste, (“Medical Progress and the Influenza Pandemic of 1918,” Michigan Academician 41 (2012): 68–91; and Nancy Tomes, “‘Destroyer and Teacher’: Managing the Masses During the 1918-1919 Influenza Pandemic,” Public Health Reports vol. 125, supplement 3 (2010): 48–62.
- Because the flu so thoroughly overwhelmed local officials, and because the outbreak coincided with the end of WWI, extant records likely underestimate the death toll; see Monica Schoch-Spana (“‘Hospital’s Full Up’: The 1918 Influenza Pandemic,” Public Health Reports vol. 116, supplement 2 : 32–3, 32) and Richard J. Hatchett, Charles E. Mecher, and Marc Lipstitch (“Public Health Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” PNAS 104.18 (May 2007): 7582–7, 7582) for morbidity and mortality statistics from the 1918–1919 influenza pandemic.
- Remarking upon this rather unexpected absence of influenza in the literary and historical records, historian Alfred W. Crosby notoriously dubbed the outbreak “America’s Forgotten Pandemic,” ultimately choosing this as the title for his 1989 history of influenza. See esp. America’s Forgotten Pandemic: The Influenza of 1918, second edition (Cambridge and New York: Cambridge Univ. Press, 1989, 2003), 314–17; Caroline Hovanec, “Of Bodies, Families, and Communities: Refiguring the 1918 Influenza Pandemic,” Literature and Medicine 29.1 (Spring 2011): 161–81, 161–3; and Elizabeth Outka “‘Wood for the Coffins Ran Out’: Modernism and the Shadowed Afterlife of the Influenza Pandemic,” Modernism/Modernity 21.4 (Nov. 2014): 937–60, 938 concerning the general lack of attention paid to pandemic influenza in early twentieth-century American literature.
- Consider, for example, four historical novels published in 2006 alone: Myla Goldberg’s Wickett’s Remedy, Thomas Mullen’s The Last Town on Earth, J. R. Rada’s October Mourning, and Reina James’ This Time of Dying. Other notable retrospectives include Ellen Bryant Voigt’s 1995 sonnet collection, Kyrie, which gives voice to the myriad dead and forgotten in the wake of the pandemic and, most recently, Susan Meissner’s As Bright as Heaven (2018).
- Karen Hesse, A Time of Angels (New York: Hyperion, 1997), 3. All subsequent references to A Time of Angels will be cited parenthetically.
- For an overview of nineteenth-century medical sects, see Starr, The Social Transformation of American Medicine, 102–12.
- John Parascandola, “Patent Medicines and the Public’s Health,” Public Health Reports 114.1 (1999): 318–21.
- “About Bragg,” n.d. https://bragg.com/about/about.html. Accessed September 10, 2018.
- Anuar Samad, Azrina Azlan, and Aman Ismail, “Therapeutic Effects of Vinegar: A Review,” Current Opinion in Food and Science 8 (2016): 56–61, 59. http://dx.doi.org/10.1016/j.cofs.2016.03.001.
RACHEL CONRAD BRACKEN is Assistant Professor of Family and Community Medicine at Northeast Ohio Medical University. She received her PhD in literature from Rice University in Houston, Texas. As a scholar of American literature and the health humanities, Bracken explores the intersections of literature and public health history from the late nineteenth and early twentieth centuries. Her work also engages with contemporary debates over big data in healthcare and the rhetoric surrounding pediatric vaccination. Bracken’s research appears in Big Data and Society, English Language Notes (ELN), and the collection Transforming Contagion: Risky Contacts among Bodies, Disciplines, and Nations (Rutgers UP, 2018).