Historians, journalists, and the public at large have long been interested in the 1918 “Spanish flu” epidemic, a dramatic chapter in American life that has spawned an impressive body of books, articles, and multimedia. The memory of the 1918 epidemic also has left a lasting mark on public health policy, planning, and practice. Indeed, for each influenza epidemic that followed in its wake – in 1957, 1968, and most, recently in 2009 – the events of 1918 have served both as a reference point and a severe if not “worst case” scenario.
It was within this context that, in 2006-2007, the Center for the History of Medicine collaborated with the United States Centers for Disease Control and Prevention (CDC) on a study of the use of non-pharmaceutical interventions (NPI) in American cities during the 1918-1919 influenza epidemic. Unlike in 1918, today we have the ability to develop vaccines against specific strains of influenza in circulation. The process is a lengthy one, however, requiring numerous steps and several months before a vaccine can be produced and distributed in bulk. Realizing that it would take approximately five to six months for the first supplies of vaccine to become available in the event of a new influenza pandemic, and with the possibility of a H5N1 “avian” influenza epidemic looming, public health officials at the CDC were interested to know what lessons could be gleaned from 1918. How did American cities respond in the fall of 1918? Were their efforts successful? Could these methods be used effectively today?
After an intense, year-long examination of the public health response of 43 American cities during the 1918-1919 epidemic, researchers at the Center for the History of Medicine and the CDC concluded that those cities that used social distancing measures and other non-pharmaceutical interventions in 1918 fared better than those that did not. More specifically, we found a strong association between early, sustained, and layered use of NPI and mitigating the consequences of the epidemic. Our results were published in Journal of the American Medical Association in August 2007 (freely available at http://jama.jamanetwork.com/article.aspx?articleid=208354), and subsequently became the basis for the Department of Health and Human Services’ community mitigation guidelines for pandemic influenza.
Even with a growing literature on the historical, epidemiological, and public health aspects of the 1918 influenza epidemic in the United States, significant gaps remained in our social and cultural understanding of this cataclysmic event. Although influenza infected and affected nearly every community across the nation, each experienced the epidemic in markedly different ways. 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. Consequently, narratives that capture the human dimension of epidemic response often can best be told from the local and personal perspective. At the same time, over-generalizations can discredit or distort the stories of the participants, the varying nature of community responses, and diminish the lessons that we can glean from studying the past.
For this reason, we continued our study of the 1918-1919 influenza epidemic. We expanded our list of American cities to fifty. We visited hundreds of libraries and archival repositories across the nation, gathering thousands of pages of newspapers, public health reports and bulletins, and other documents. Using these materials, we crafted a detailed narrative essay for each city, exploring the story of influenza’s arrival in each community and the havoc it caused, but also documenting the civic response, the political and economic ramifications, and, in every community, the heroism and courageousness of doctors, nurses, and countless volunteers who gave their all to fighting the epidemic. Realizing that even this work would not allow us to tell the complete story, in 2009 we invited renowned historians of public health and experts on influenza virology to write original articles on various thematic aspects of the epidemic, including the science of influenza, public health in the early-20th century, and the institutional and community responses to the disease. Those essays became the basis for a special supplemental issue of Public Health Reports, sponsored by the U.S. Centers for Disease Control and Prevention and the University of Michigan Center for the History of Medicine, and published in April 2010 (freely accessible at http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=125&Issue=9).
Together, we believe that our anthology of city essays and the thousands of historical documents we gathered while conducting our research constitutes the largest digital collection of materials relating to the 1918-1919 influenza epidemic. It has been a true labor of love to produce, and we hope that you find this resource both useful and enjoyable as you browse, explore, and learn about this tragic event in history.
J. Alex Navarro, PhD
Alexandra Stern, PhD
Howard Markel, MD, PhD
The American Influenza Epidemic of 1918-1919: A Digital Encyclopedia
We could not have completed this project without the support and help of a host of institutions and people. We would like to thank Harvey Fineberg, David Morens, Jeffrey Taubenberger, the late Harvey Lipman, David Rosner, Daniel Fox, Richard Goodman, Charles Rosenberg, David Mechanic, Cynthia Church, Lynn Rogut, Maria Bonn, Paul Courant, Vicki Ruiz, and Francis Blouin for their kind support of and intellectual contributions to our project.
We would like to thank our colleagues at Michigan Publishing for their technical support and for hosting the site. Generous funding came from the U.S. Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation, and the National Endowment for the Humanities. In the course of our research, we visited over 130 archives, libraries, and special collections repositories across the nation. We thank the kind staff at each of them who helped us locate this wonderful trove of materials.
De Paul Provincial House, Daughters of Charity Northeast Province Archives (no link available)
University of California-Los Angeles
University of Louisville
University of Michigan
University of Minnesota
University of Texas-San Antonio
Washington University in St. Louis