In Journal of the Plague Year by Daniel Defoe, the narrator speaks ominously of a coming sickness: “In the whole face of things, as I say, was much altered: sorrow and sadness sat upon every face; and though some parts were not yet overwhelmed, yet all looked deeply concerned; and as we saw it apparently coming on, so every one looked on himself and his family as in the utmost danger.” A fictional account of the plague that struck London in 1665, the book has received increased attention in recent months, perhaps most notably serving as namesake to the project dedicated to documenting the current pandemic: A Journal of the Plague Year: An Archive of COVID 19.
Defoe’s narrator also speaks to the same kind of fear that crept into America’s cities during the Influenza Epidemic of 1918 and is documented at the online archive, The Influenza Encyclopedia. The website explores the pandemic through government documents, postcards, images, and newspapers articles across fifty US cities. Additionally, for each metropolis an essay detailing the municipality’s struggle with the disease provides great detail in understanding how local authorities responded and residents endured. We discussed the impetus for the archive, its relevance to today, and why there has never been a Hollywood film on the topic despite a plethora of movies documenting fictional pandemics with one of the archive’s co-founders, Alex J. Navarro, Assistant Director at the Center for the History of Science at the University of Michigan.
You completed the Influenza Encyclopedia in 2012 and updated it four years later, two years ahead of the centennial. In the introduction to the first edition of the site, you write, “Contrary to the popular imagination, the history of the 1918 influenza epidemic is hardly a monolithic one and can be best characterized as many tales of multiple places and people.” Was this the impetus behind the larger project and, to your point, how has building the encyclopedia revealed this multiplicity of experiences you describe?
This was definitely a large part of the impetus behind the creation of influenzaarchive.org. The standard history of the 1918 epidemic is that the epidemic swept across the United States, devastating communities that were powerless to react. Over the years, various myths have been added, including that health officers lied to the public about the seriousness of influenza and that massive censorship prevented citizens from being fully informed. Through our research, we discovered that this simply was not true. Cities and states across the nation implemented a host of community mitigation measures, which, as our 2007 JAMA paper shows, were successful when implemented early, in a layered fashion, and kept in place for as long as possible.
Newspapers featured daily articles on the epidemic, often with front-page and above-the-fold coverage. It is true that many federal, state, and local health officers initially downplayed the seriousness of the epidemic. This was not out of a purposeful desire to misinform the public, however. It was simply a result of the knowledge gap that existed about influenza at the time. The prevailing theory at the time was that influenza was a bacterial disease and that previous epidemics, as well as bad seasonal outbreaks, had come and gone. With no understanding that the 1918 epidemic was being caused by a novel strain of a virus for which no one had immunity, and with a bit of resignation that epidemics could not really be controlled, health officers were simply reacting with the medical information they had at hand. In each city we studied, we noticed a similar pattern: health officers who were initially unconcerned quickly realized that the epidemic was much more serious than first imagined, and then they reacted accordingly. While many cities and states reacted with a similar slate of public health measures, each city definitely had its own unique epidemic as well as response. In some cities, visionary public health officers and mayors were decisive in their leadership. In others, officials catered to businesses and tailored – and sometimes weakened – closure orders to placate those interests. In others still, elected officials challenged public health officers at the state and local level. Many cities had truly wonderful stories that came out of the epidemic, especially concerning the massive effort undertaken by citizen volunteers to act as nurses, to care for sick neighbors, to take in children orphaned by the epidemic, etc.
Our work grew out of an initial project conducted for the Defense Threat Reduction Agency. From there, we launched a collaborative research project with the Centers for Disease Control and Prevention on the use of non-pharmaceutical interventions (NPI) used in 43 American cities during the 1918 pandemic. That study, however, was a quantitative one. As part of our year-long research effort, we had gathered thousands of pages of newspaper articles, state and municipal health reports, scholarly articles from the period, correspondence, meeting minutes, and other documents. In these documents were incredible stories of the day-to-day history of how the pandemic unfolded in American cities. We therefore decided to create a digital archive of this trove of material so that other researchers, students, public health officials, and even lay people could easily access it. But we also realized that we needed to help contextualize the material. We therefore expanded our list of cities to 50 and crafted essays on how each community responded to their epidemic. With the tremendous help of the staff of M-Publishing (part of the University of Michigan Library) and a great web designer, we were able to create our digital encyclopedia.
According to historians such as John Barry and Alfred Crosby, Jr., record keeping during the pandemic was poor. You’ve uploaded newspaper articles, letters, images, reports, and other materials from the era. How hard was it to find documentation of the epidemic and what determinations did you have to make regarding the selection of the primary documents? Did you use mostly digital archives or did it require travel to archives in order to digitize materials?
From the outset we realized that the most important source of information would be newspaper articles. We selected two newspapers with the widest circulation for each city and then went about capturing every article that mentioned the pandemic or tangential information for the period from late-August 1918 through March 1919. This was well before most of these newspapers were digitized and accessible online. We had to go through the microfilm reel by reel. It was a laborious process, but it gave us detailed, day-by-day information on each city’s epidemic. Newspapers were absolutely critical to our research.
We also knew that state and municipal annual health reports and monthly bulletins would be essential sources as well. These documents can be very difficult to find, but we managed to track down copies for nearly every city in our study for the years between 1917 and 1920. In many cases these health reports offer rather perfunctory summations of the epidemic. A few cities – Chicago, for example – published lengthy and incredibly rich retrospectives on their epidemic, full of detailed information that helped clarify some of the confusing newspaper reports that had been generated in real time.
Whenever possible, we also traveled to archival repositories to obtain copies of items such as meeting minutes of local and state boards of health and education, mayor’s and governor’s papers, correspondence from officials, and records of the American Red Cross, the Navy’s Bureau of Medicine and Surgery, and the Army’s Medical Department.
For our initial study on the use of NPI, the most critical set of documents we located was the U.S. Census Bureau’s “Weekly Health Index.” These are typewritten documents that tracked overall mortality for the largest American cities. During the pandemic, the Census Bureau also included the data for influenza and pneumonia deaths for these cities. While case and death data were frequently reported by local health officers to newspaper reporters, the “Weekly Health Index” reports gave us a standardized dataset for the cities. And it was incredibly difficult to locate! We eventually found an old microfilm copy at the Science, Industry and Business Library branch of the New York Public Library. I was conducting research at the Library of Congress and National Archives when we located the microfilm. I woke up early one morning, took the train to New York, made paper copies of the reports, and took the evening train back to Washington, DC. It was like we struck gold.
Overall, we made every attempt we could to locate, copy, and incorporate every document related to the influenza epidemic in our fifty cities. Naturally there will be material we missed. But we visited dozens upon dozens of archives and special collections repositories to obtain as much information as possible.
Up until recently, historical memory of the 1918 Influenza Pandemic has been somewhat elusive. The general narrative seems to be that the war overshadowed everything and dominated newspaper reporting as well as people’s memories; from your experience constructing the archive, how true do you find that explanation? How does a nation forget 675,000 dead in nine months?
America’s involvement in The Great War (WWI) definitely overshadowed many other events at the time. However, it would be misleading to say that people were not concerned with the epidemic. As I noted above, there was widespread media coverage of the pandemic. Newspaper circulation and readership was generally high in 1918, and it is fair to say that the vast majority of Americans had easy access to such information and were well informed.
The answer to how the 1918 pandemic could so rapidly become a forgotten part of the nation’s history is more complicated. Certainly, involvement in the war played a very large role, and headlines about the war effort dominated newspaper reporting. After the war, the nation quickly turned to other matters. The Wilson administration was busy trying to establish the League of Nations. The House and Senate, both of which had been won by Republican majorities in the midterm election of 1918, were busy opposing it. The summer after the pandemic saw the rise of American radicalism and federal attempts to quash it. It was the infamous “Red Scare” of 1919. After that came the Roaring Twenties, with a focus on prosperity and conspicuous consumption.
Underscoring these historical trends was the fact that Americans were generally more resigned to experiencing the loss of loved ones to disease. It is, of course, impossible to quantify this. But generally speaking, contagious diseases were a much larger fact of life – and death – in 1918 than they are today. Families certainly grieved the loss of loved ones to the epidemic, but that grief was largely expressed privately.
However, it should be noted that we have tended to forget other epidemics and disease outbreaks as well. Collectively, there is very little discussion of the recurrent and quite serious polio outbreaks of the first half of the twentieth century, for example. The influenza pandemics of 1957 and 1968 killed over 100,000 Americans each, yet both of those events have been completely forgotten by the nation. It remains to be seen how the current COVID-19 pandemic will be remembered in the years and decades to come, but I suspect it will follow the same pattern.
Barry suggests that the pandemic went understudied for much of the twentieth century, yet over the past three decades, public health researchers and historians seem to have filled in significant gaps, your archive serves as one example. What explains the lag in research?
I think the discrepancy is between what historians and other researchers know and study as compared to the understanding that non-historians have. Historians have always known about the 1918 pandemic, particularly its impact on World War I. Public health researchers, particularly those working on influenza or on outbreaks and epidemics, have likewise explored the 1918 pandemic. To be sure, there has been greater attention paid to the deadly influenza pandemic in the last few decades, especially after the discovery of influenza A(H5/N1) and the fear that it could lead to another major pandemic. That greater attention has brought more focus on the specific details of the 1918 pandemic.
One of the draws of your archive for urban historians are the essays discussing the disease’s effect on fifty different cities. They became the basis for a supplemental issue of Public Health Reports on the pandemic. First, how did you go about writing the essays, and second, how did the issue of Public Health Reports become a reality?
Writing the essays first required processing all of the information we had gathered for each city. The first step was to go through each of the newspaper articles for a city and to abstract the pertinent information. Then we added in information from municipal health reports. That gave us a more manageable outline of how the epidemic unfolded in each city. From there, we incorporated details from the other sources we had gathered, such as various pieces of correspondence, or meeting minutes. In some cases, we conducted extra research in order to flesh-out a particular story from a city. Then I sat down and systematically drafted essays for each of the fifty cities in our project. It was a long but very rewarding process.
Just as our 2007 JAMA paper did not describe the narrative of each city’s handling of their epidemic, our city essays also necessarily leave out much of the story. Because of the sources available, they tend to be top-down histories. Although impossible to explore for every city we researched, we thought it was important to at least provide a thematic overview for some aspects of the pandemic left out of our city essays. For example, what was the impact on immigrant communities? On African Americans? What role did nurses play? What was the state of bacteriology and vaccine development in the fall of 1918? To answer these questions, we gathered a group of historians of medicine and asked if they would like to help us craft thematic essays on the pandemic. We had already pitched the idea to the editors of Public Health Reports, and they were excited about the project. Our colleagues drafted their essays, which were then workshopped at a group meeting, revised based on feedback the group gave the authors, and then submitted for publication. The result is the April 2010 special supplemental issue of Public Health Reports.
Considering the world’s current situation, and in particular, circumstances in the United States, the archive seems to have taken on greater relevance. What’s it like to create an archive about something one hundred years ago, that in many ways, speaks to our moment now in very distressing ways?
As much as I dislike using the word “surreal,” I think it is appropriate here. Everyone involved in any aspect of epidemic research – history, epidemiology, virology, vaccinology, etc. – fully understands that it is always a matter of “when” and not “if” another epidemic strikes. Still, you go about your life thinking that the next one is not going to happen any time soon. Then it happens, and you are still left feeling a bit blindsided.
Moreover, many of the same issues that occurred in 1918 are again happening today. About half of the cities we studied removed their public health interventions too soon and faced a second spike of cases and deaths, sometimes worse than the first. I fear that we might be making the same mistake today in some parts of the country. In cities that enacted mandatory face mask ordinances, such as San Francisco and Denver, pushback was widespread enough that hundreds were arrested. The San Francisco ordinance was so despised that 2,000 people formed the “Anti-Mask League” to protest it as an unconstitutional infringement of their civil liberties and as epidemiologically useless. Members included several prominent physicians and a member of the county Board of Supervisors. I see strikingly similar acts of defiance today. Despite changes in the historical backdrops between 1918 and 2020, human nature is perhaps more static than we like to admit.
We’ve had Outbreak, Contagion, World War Z, and even the last iteration of Planet of the Apes movies, all featuring frightening (fictional) pandemics. Why did we never get a film about 1918 and will we?
That is an excellent question. It would certainly make a great period piece, set against the backdrop of World War I and the pandemic. I have no insight into how Hollywood works, or how some (bad) movies get greenlit while other (potentially great) ideas are dismissed. But if a movie about the 1918 pandemic is ever made, my vote is for a screen adaptation of Katherine Anne Porter’s short novel Pale Horse, Pale Rider.
Featured image (at top): The 39th Regiment marches down Second Avenue with their flu masks on, passing Cheasty’s Haberdashery, ca. October/November 1918. The National Archives and Records Administration, The Influenza Encyclopedia.