Pale Horse, Pale Rider describes the effects of the influenza epidemic of 1918, sometimes referred to as the Spanish Flu. For the first part of the story, the disease is a distant concern. The characters discuss the illness as though it’s a far-away phenomenon, something that only affects people in Europe. Early descriptions of the illness symbolize the xenophobia of wartime. The characters in the US associate the illness with the strange, horrific war taking place in a distant land. The illness is a symbolic outgrowth of the horrors of war, associated with foreign places and not considered something that could ever affect the American people. When the characters do discuss whether the illness might arrive in America, they do so in terms of a German plot, suggesting that the foreign enemy is using the foreign illness to hurt Americans, bringing the foreign horrors to the home front. To the characters, this strange illness symbolizes the malign, foreign influence of the enemy. In the context of the story, the characters’ interpretation of the illness represents the xenophobic influence of state propaganda and the way that war can change people’s perceptions of something like a disease.

Eventually, the illness takes root in the US, and people become sick.