The American Red Cross and local response to the 1918 influenza pandemic: a four-city case study.

The role of the American Red Cross in the U.S. response to the 1918-1919 influenza pandemic holds important lessons for current-day pandemic response. This article, which examines local ARC responses in Boston, Pittsburgh, St. Louis, and Richmond, Virginia, demonstrates how the ARC coordinated nursing for military and civilian cases; produced and procured medical supplies and food; transported patients, health workers, and bodies; and aided influenza victims' families. But the organization's effectiveness varied widely among localities. These findings illustrate the persistently local character of pandemic response, and demonstrate the importance of close, timely, and sustained coordination among local and state public health authorities and voluntary organizations before and during public health emergencies. They further illustrate the persistently local character of these emergencies, while underscoring the centrality and limits of voluntarism in American public health.