How did "gesundheit" work its way into common American usage?

According to etymonline.com:

gesundheit 1914, from Ger. Gesundheit, lit. "health!" Also in toast auf ihre Gesundheit "to your health" (see sound (adj.)). Lith. aciu, echoic of the sound of a sneeze, has come to mean "good luck, God bless you." See also God.

The United States has a large population of German immigrants and heritage speakers. Take that into consideration, along with the fact that a lot of Americans spent a lot of time fighting in two World Wars in Germany, and that many military personel are still stationed there.

From Wikipedia:

In German, Gesundheit ([to your] "Health") is said after a sneeze. This is sometimes used in the United States. The expression arrived in America with early German immigrants, such as the Pennsylvania Dutch, and doubtless passed into local English usage in areas with substantial German-speaking populations.1 The expression is first widely attested in American English as of 1910, about the time when large numbers of Yiddish-speaking Ashkenazi Jews immigrated to the United States.

Why Do We Say Gesundheit After Someone Has Sneezed?

Answering the question of why North Americans use ‘gesundheit’ post-sneeze also requires us to go back in time though not nearly as far as the days of Pope Gregory and the bubonic plague. The after sneeze use of ‘gesundheit’ can be attributed to German and Yiddish speaking immigrants entering the United States and other parts of North America in the early twentieth century. Like many phrases used prominently now in North American English gesundheit came from humble immigrant beginnings and is now used so often that the average speaker may not even know the translation etymology or literal meaning of what they’re saying when they utter this odd sounding German word. It’s interesting that the word is used so commonly now that there have been a few intervening generations since the wave of immigrants that brought ‘gesundheit’ to North America. It’s even more interesting to think that the origins of the use of ‘bless you’ to soothe someone who has sneezed are so dark. What will you say the next time someone sneezes?

Instances of 'Gesundheit' in U.S. newspapers, 1882–1918

A perusal of matches for the word Gesundheit in the Library of Congress's Chronicling America database of historical newspapers suggests that the word (meaning "Your health") may have been understood in the United States as a toast or greeting before it became associated specifically with a response to a sneeze.

Three of the earliest matches for Gesundheit in English-language newspapers involve the celebrated doctor Anton Reclam [or Recklam] of Leipzig and his reports published in a periodical called Gesundheit. From [The [Bloomsburg, Pennsylvania] Columbian] (September 1, 1882):

The famous Leipsic physician, Professor Reclam, in a late number of the Gesundheit, has ventured to say a good word on behalf of newly baked bread. The majority of old people, dyspeptics and hypochondriacs, he observes, say that they can only eat stale bread; they find new bread too indigestible. The virtue, he tells them, is not in the staleness of the bread, but in the care and thoroughness with which they are compelled to masticate it, on account of its hardness.

From the San Antonio [Texas] Light (April 7, 1883):

Dr. Recklam, in a recent number of the Gesundheit, says that the headache, restlessness, etc. which are sometimes caused by keeping flowers in bedrooms do not result from any special properties of the flowers themselves, but from the continued strain brought to bear upon the olfactory nerves.

And from the [Ravenna, Ohio] Democratic Press (August 2, 1883):

In an article recently contributed to the Gesundheit—a paper, as its name imports, devoted to sanitary subjects—Professor Reclam, a German Gelehrter, makes some timely and useful observations on the subject of baldness. ... He does not think, as is sometimes said, that loss of hair i the result either of impaired health or of much study. The strongest men are often bareheaded and German professors, who are nothing if not studious, are distinguished above all men by the profusion of their locks. ... Herr Reclam draws the conclusion that baldness comes chiefly of the artificial determination of blood to the head, and to the heat and perspiration thence arising. The result is a relaxed condition of the scalp and loss of hair.

Also from the 1880s onward, U.S. audiences were exposed to one or more very popular German songs titled "Gesundheit," either sung or played as purely instrumental music at band concerts.

Another early occurrence is from the [Honolulu, Hawaii] Daily Bulletin (July 18, 1885):

While Kaiser Wilhelm was receiving Minister Pendleton a slight draft of air caused his Imperial Majesty to sneeze. "Gesundheit!" cried Mr. Pendleton, promptly. The Emperor was so pleased that he took Bismarck aside and told him that at last the United States Government was represented by a real statesman.

But other early matches involves Gesundheit used in an American setting as an affectionate salute. From a burlesque poem titled "Elegy in a Leaky Wigwam" in the St. Paul [Minnesota] Daily Globe (July 3, 1892):

Nor you, ye proud, impute to these the fault,

If memory o'er their tomb no trophies raise,

Where thro' the long-drawn glass and cool beer vault

The word "Gesundheit!" swells the toast of praise.

From the [Washington, D.C.] Evening Star (October 19, 1895):

Milwaukee [Wisconsin] has just entered the fifty-first year of its career as a municipality. There is scarcely a city in the country which does not join in wishing her gesundheit.

And from the Jamestown [Dakota Territory] Weekly Alert (December 5, 1895):

Gesundheit!

A fine fat deer weighing 170 pounds was received Monday from Bismarck by The Alert with the compliments of Hon R. E. Wallace, who also remembers his friends Senator Fuller, Dr. Archibald and others in this handsome manner. The benedictions of those remembered go out in full measure to Robert with the added desire that he may live long and be happy.

Beer advertisements are another major source of use of the term in the late nineteenth and early twentieth centuries. An ad for "Bock Beer Day" from the Ferd Heim Brewing Company in the Kansas City Journal (April 9, 1898), featuring a drawing of a young woman with long braided pigtails; she sits on the back of a goat and holds up a glass of beer, and the caption beneath the drawing says simply "Gesundheit!"

An advertisement for Renner's bottled beer in the Akron [Ohio] Daily Democrat (September 24, 1900) uses the same salutation:

Gesundheit!

Health and happiness to you, my friend? You see how well I look? Don't look as if I were dying, do I? Well, I drink Renner's bottled beer—and there you are! You can do the same by simply dropping a line to Renner's and you'll get the goods at your door, cheap, too. Is it pure? Well, I guess yes.

And then there's this rather odd item from the Indianapolis [Indiana] Journal (June 3, 1896):

Gesundheit.

Gesundheit means health. It is not found in impure water, but in the pure invigorating brews of the Home Brewing Company. No family should be without their "Extract of Malt" or "Columbia." They are equally beneficial to adults an children. Order some in bottles.

A joke item in the Bismarck [North Dakota] Daily Tribune (November 17, 1900), published eleven days after the 1900 presidential election, reported various offers for employment that the losing candidate, William Jennings Bryan, has supposedly received in the interim:

Chicago, Nov. 16.—Otto Krautpretzel, the millionaire brewer, offers Mr. Bryan $1,000 a day if he will stand in front of the brewery with a life sized schooner and say "Gesundheit" to passers by. Mr. Bryan has not yet signified his assent. Krautpretzel believes there are millions in the scheme.

From the Minneapolis [Minnesota] Journal (November 13, 1901):

The governor of South Dakota called on the governor of Minnesota yesterday, but did not make the traditional allusion to liquid refreshments that id expected when governors meet. Governor Herried had a few minutes, and just ran in to see Governor Van Sant long enough for a mutual "gesundheit."

An advertisement for Fisher Beer in the Salt Lake [City, Utah] Herald (May 8, 1907) discusses German and U.S. English usage of the term:

"GESUNDHEIT"

The German word for "health" is the popular toast of Germans over beer.

In America, too, where also, beer has become the national beverage, the word "gesundheit" is a common greeting, and a most fitting one it is when the glasses are filled with Fisher Beer[.]

There is nothing more appropriate for a toast when Fisher beer is the beverage.

An item in the Calumet [Michigan] News (August 5, 1911) presents an even more vivid picture of early U.S. usage of the term:

What's in a Name? Fun, Says Gesundheit.

Chicago, Aug. 5. — "Gesundheit, Gesundheit, M. Gesundheit," droned a bellboy as he walked through the lobby of the Auditorium Hotel. Guests puzzled over his call until Mr. Gesundheit, a traveling man registered from New York, was found. "I have some fun with my name," he said. "Also some trouble when inquiring for small packages. When I step up and say 'Gesundheit' the reply is 'Same to you, but what's the name?'".

And from a short story, "The Specter of Our Unrest" by H.D. Couzens, in the [Washington, D.C.] Evening Star (October 15, 1911):

He dropped into a bamboo chair, and noting his covert glance at the tabouret I made haste to bring another tall glassful of ice. He took it cheerfully and poured himself a modest drink of the yellow spirit. I had looked to see him take the generous portion known as a "second mate's fid" and was somewhat surprised. He held up the glass of effervescing liquid. "To your very good health, Sir. A la votre sante, Gesundheit, or Aloha nui, as you choose."

It's tempting to see the confusion of the narrator of the following item—from the Indianapolis [Indiana] Journal (May 4, 1902)—as arising primarily from the connection of Gesundheit with drinking beer and offering toasts:

An Embarrassing Situation

Philadelphia Record.

"You may talk all you please about the embarrassing situations absentmindedness brings one into," said a pretty girl to her companion, in Broad-street Station yesterday, "but I think force of habit is just as bad sometimes. You know mamma is of German extraction and taught us at home always to say 'gesundheit' when one of the others would sneeze, until it became second nature with us. Well, day before yesterday I was in the elevated in New York, deeply absorbed in my book, when someone next to me sneezed heartily. Mechanically, and without looking up from my book I blurted out 'gesundheit.' The snickers of several persons near me brought me out of my trance, and looking around to see what the cause of the laugh might be, I found several pairs of eyes fastened upon me in amazement. In a second I had glanced at my reflection in the window to see if my hat was on straight, you know, felt the ribbon at my neck and looked don at my skirt, but everything appeared to be all right, and while wondering what there was about me to cause all this commotion, I happened to face a gentleman on my right who at the instant smiled, raised his hat and said politely, 'Thank you.' Well, it dawned on me then what I had done and I can tell you I felt pretty cheap. I didn't wait for the train to come to a full stop at the next station before I was off. I'll try and have my wits about me hereafter."

but her embarrassment seems more likely to have arisen from the young woman's having said anything—in any language—to a male stranger.

The demise of "Gesundheit" as a cheerful greeting in the United States may be tied to the vilification of all things German during the period of U.S. involvement in World War I. One instance of anti-German feeling in this period occurs in this item from the Harrisburg [Pennsylvania] Telegraph (May 2, 1918):

Ban Put on "Gesundheit;" "Have a Smile" Instead

Philadelphia, May 2.—"Gesundheit" is "verboten" in the Art Club.

"Have a smile" may be substituted, or, if the speaker prefers, "The top of the morning to you."

Everything with the enemy's taint—even his language—is barred at the Art Club, as the first step to banning German from club circles.

Notices have been posted in the club and sent to members prohibiting "the use of the German language within the club or the language of any of Germany's allies." This action bars Turkish, Bulgarian, Czech and Slovak.

Various newspapers in 1917 repeat a (presumably apocryphal) story in which a German immigrant in the United Sates, after promising his wife not to say anything that will reveal his ethnicity, ventures into public and gets beaten up after saying "Gesundheit" when a stranger sneezes.

Reported meaning of 'Gesundheit' in Merriam-Webster Collegiate dictionaries

The earliest Webster's Collegiate Dictionary to include Gesundheit as an anglicized term is the Fifth Collegiate (1936), which has this entry:

Gesundheit n. {G.} (To your) health; — a salutation as when drinking.

But the Sixth Collegiate (1949) begins to move away from the toasting situation and toward the sneezing one:

Gesundheit n. {G.} (To your) health; — a salutation as when drinking, or after a sneeze.

And the Seventh Collegiate (1963) takes the transition a step farther:

gesundheit interj {G, lit, health} —used to wish good health esp. to one who has just sneezed

This remains the definition in the Eleventh Collegiate Dictionary (2003), with a first occurrence date of 1914. I don't recall ever having heard "Gesundheit!" used in spoken English in the United States in any context other than as a response to a sneeze.

Conclusion

Perhaps the oddest thing about the aggressively anti-German feeling in the United States during and after World War I is the differential effect it seems to have had on usage and understanding of the word Gesundheit. Before the war, it was used as a friendly salutation, as a drinking toast, and as a response to someone's sneezing.

After World War I, Gesundheit as a response to someone's sneezing seems to have recovered rather quickly, and Webster's Fifth Collegiate Dictionary (1936) suggests that it may have rebounded somewhat as a toast, too. But its use as a greeting seems not to have recovered; and in the aftermath of World War II, Gesundheit as a jolly toast among American drinkers seems to have fallen almost entirely out of favor, too.

As a response to sneezing, however, it remains alive and well today in the United States—a frequent alternative to "Bless you" that strangers feel no embarrassment in saying when the occasion arises. It's an interesting and skewed survival, and I suspect that U.S. usage of Gesundheit would have played out differently if not for the two wars that the United States fought against Germany in the first half of the twentieth century.