March 8, 2021 • 43 mins
Now that we’ve lived through a year of a global pandemic, our approach to looking at the 1918 flu pandemic had shifted. We’re revisiting the events of 1918 with new perspective, comparing then to now.
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Episode Transcript
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Fry. We're coming
up on the one year anniversary of the World Health
Organization's announcement that COVID nineteen could be characterized as a pandemic.
(00:25):
That happened on March eleven, and then a couple of
weeks after that, Holly and I talked on the show
about what it was like to be living through such
a massive and worldwide, clearly historic event while also hosting
a history podcast, and we re aired our previous episode
on the flu pandemic as a Saturday classic because it
(00:48):
seemed relevant what was happening. I don't think either of
us really foresaw that we might be in a place
to do kind of a one year later episode, not
even a little like. I have a friend who was
a nurse at Boston area hospitals. I mean, Boston was
one of the early hard hit places, and she talked
(01:09):
about getting a briefing at work saying that we were
probably looking at eighteen months to two years of pandemic.
But like, there's a big difference between intellectually having that
possibility in your mind and actually living through it. So
I researched and wrote our episode on the eighteen flu
(01:33):
pandemic that we aired as a Saturday Classic after the
COVID nineteen pandemic started. I wrote that back in and
over the last year, I have wandered over and over
is this what it was like in night? And how
would I have approached that episode differently if I were
working on it today instead of seven years ago. Uh.
(01:58):
We don't typically revisit older episodes in this way, but
the last year has just profoundly reshaped the way I
have thought about that earlier pandemic. To me, it's a
really good example of how your own perceptions and your
own knowledge and experiences influence your understanding of history. Uh.
(02:19):
So we're going to take another look at the flu pandemic. Um.
I do want to note here that theeen flu pandemic
was global, and so is the COVID nineteen pandemic. But
a big part of today's episode is how my own
lived experience has shifted my my understanding of that earlier
(02:40):
event and drawn my attention to totally different parts of
the eighteen pandemic. Then, we're on my mind back in
so by definition this gives things a more US centric focus.
I cannot tell you how how a person's lived experience
in another place would have changed their understanding. UM. I
also didn't start out thinking this was going to be
a two part episode, but it is turned out there
(03:05):
was a lot to talk about that we did not
touch on back much or at all. Okay, so we're
going to do a quick review here as we lead in.
The nineteen eighteen flu pandemic stretched from early nineteen eighteen
into the spring of nineteen twenty, although the largest peak
was between October of nineteen eighteen and January of nineteen nineteen,
(03:27):
with a smaller but still significant peak between February and
April of nineteen nineteen. It's estimated that one third of
the world's population contracted the flu during this pandemic. About
six hundred seventy five thousand people died in the United States,
worldwide estimates very considerably. At the time, the global death
(03:48):
toll was estimated at twenty million people, but today's estimates
are more like thirty million to fifty million people, and
sometimes even more so. Illnesses like the f are often
particularly lethal for the very old and the very young,
and that was true of the nineteen eighteen flu. But
then in addition to that, it also disproportionately killed young,
(04:11):
otherwise healthy adults, people who were in their twenties and thirties.
And since this pandemic took place in the last months
of World War One, its effects on troops were extreme.
The virus just moved through entire ships and entire military
units in waves. For example, in June and July of
nineteen eighteen, more than two hundred thousand of the two
(04:33):
million British troops in France all got too sick to
report to duty. In our earlier episode on this pandemic,
we talked about how in nineteen eighteen the world had
the germ theory of disease, but not antibiotics. We knew
which specific micro organisms caused some diseases, including tuberculosis, malaria,
(04:54):
and cholera, but not influenza. We had vaccines for some
diseases as well, including smallpox, rabies, cholera, and typhoid, but
again not influenza. It wasn't just that researchers didn't know
which specific pathogen caused influenza. They were also headed down
the wrong track on that. The prevailing theory before the
(05:17):
pandemic was a bacterium known as Phifer's bacillus that was
named after its discover Richard Friedrich Phifer. During the nineteen
eighteen pandemic, it became clear that this bacillus was not
the cause of the flu. A huge number of people
became ill, but they had no sign of this bacillus
and their cultures. Today, this basilus is actually called Hemophilius influenzae,
(05:41):
and while it does not cause influenza, it's not the fluvirus.
It does cause things like pneumonia, cellulitis, and meningitis. We
also talked about nineteen eighteens public health recommendations like stay
home if you're sick, avoid crowds, cover coughs and sneezes,
wash those hands thoroughly and often. In other words, a
(06:03):
lot of the exact same things that we've all been
hearing for the last year, most of which are also
what everyone should still be doing even when there is
not a pandemic. Yeah, I have a lot of feelings
about handwashing because I used to work in in like
food safety education. Uh and when things started um trending
(06:26):
towards pandemic in February and March of last year. I
definitely noticed when I would be in a public restroom,
suddenly people were at the sink for as long as
I was, and I was like, wow, this is let's
keep the cleep up this habit for the rest of
our lives. Uh. There were, though some notable differences in
the public health recommendations in en though at least in
(06:49):
terms of US culture, the idea that spitting on the
ground is rude and unsanitary was really fairly new in
nineteen eighteen. The first anti bidding campaigns had gotten underway
just a couple of decades before that to try to
prevent the spread of tuberculosis. Common drinking cups and shared
(07:09):
towels were also frequently found in public places, so back
in eighteen, in addition to those recommendations that feel pretty
familiar today, there were also slogans like spit spreads death
and advisories to avoid those common cups and towels. Public
health officials also advised people to wear masks, in which
(07:30):
brings us to the biggest, most obvious thing we'd approach
way differently now versus back in our treatment of masks
in the earlier episode is essentially just a sentence. We
said that public health authorities recommended that people wear them,
and that in some places they were even required by law,
but that this was not effective. We described that lack
(07:53):
of efficacy coming from virus particles being too small to
be blocked by simple fabric, which is true and which
actually came from a US Department of Health and Human
Services website that was written about the nineteen eighteen pandemic.
But as has been discussed at length in the last year,
well fitting masks made of tightly woven cloth can stop
(08:15):
respiratory droplets that are carrying those virus particles. That is
not necessarily true of the masks that were being worn
in nineteen eighteen, though those were typically made of gauze,
which is a very thin fabric with an open weave.
Some of them were made from cheese cloth, which also
has a similar open weave. Even with multiple layers, these
(08:39):
fabrics might leave you with a relatively porous mask. If
you look at photos from the nine eight pandemics, sometimes
you'll see people's facial features through their masks pretty clearly.
Sometimes you can see the gauzy holes in the material.
Sometimes people also cut holes in their masks to smoke,
or if they didn't have gauze or cheese claw, they
(09:00):
made masks out of materials that were way too thin
to do any good at all. They almost looked like
wearing a translucent veil instead of a mask. Like I
saw one photo of Red Cross nurses and it was
literally only attached over the bridge of their nose and
had this filmy, diaphanous quality, and I was just like,
(09:20):
that's not helping. No, what's interesting too, because I mean,
even then, cheesecloth was being used in kitchens to strain things,
so you knew stuff could go right through it, so
it's an interesting choice. UM. A publication called an Experimental
(09:41):
Study of the Efficacy of Gauze Masks, which was published
in the American Journal of Public Health in nineteen twenty,
looked at whether the masks themselves were effective, and the
authors concluded that a gauze mask that had enough layers
to actually block respiratory droplets was also very hard to
breathe through, and a person's exhaled breath just escaped around
(10:02):
the sides of the mask instead. So if you're hearing
a stock about this and you're thinking Wait a minute.
Didn't you talk about gauze masks being effective in that
episode on Wullie and Dah and the pneumonic plague. That
answer is yes, but those masks had a layer of
cotton wool in the middle of all that gauze. Pneumonic
plague is also caused by bacteria. Bacteria are much larger
(10:26):
than viruses, and those masks efficacy was really clearest among
healthcare professionals who would have been wearing the masks in
addition to other precautions, and probably also with better mask
discipline and more thorough hygiene steps than the general public
would have had. Back to that paper, the author cited
(10:47):
five reasons why mask mandates did not seem to slow
the spread of the disease in the pandemic quote. First,
the large number of improperly made masks that were used,
set and faulty wearing of masks, which included the use
of masks that were too small, the covering of only
the nose or only the mouth, smoking while wearing, etcetera. Third,
(11:11):
wearing masks at improper times when applied compulsorily, masks were
universally worn in public on the streets in automobiles, etcetera,
where they were not needed, but where arrest would follow
if not worn, and they were very generally laid aside
when the wearer was no longer subject to observation by
the police, such as in private offices and small gatherings
(11:33):
of all kinds. This type of gathering with the attendant
social intercourse between friends and office associates seems to afford
particular facility for the transfer of the virus. Another study
in ninety one concluded that quote the face mask as
used was a failure. The important bit there is the
(11:54):
as used, and that included things like the stuff we
just talked about and people re wearing the same masks
until they were just filthy. The general advice on mask
cleanliness back in was to boil them regularly, in some
cases daily. This study also notes that the masks did
nothing to protect the eyes, and that the tear ducks
(12:15):
had been pinpointed as a possible way that the virus
could get into a person's respiratory tract. We also did
not talk about resistance to mask mandates in that earlier episode.
We sure will after we first pause for a little
sponsor break. The most famous group of mask resisters during
(12:40):
the nineteen eighteen pandemic was the San Francisco Anti Mask League.
San Francisco had actually been the first city in the
United States to implement a mask mandate. It was a
four week mandatory mask law that started on October nineteen eighteen,
and it ended on November twenty one of that year.
Of full page ad ran in the San Francisco Chronicle
(13:03):
that read, quote wear a mask and savior life. This
ad was signed by the mayor, as well as civic
and business leaders and health officials. The Red Cross distributed
about a hundred thousand masks to residents of San Francisco
over the course of about a week. People who were
seen in public without a mask were fined five or
(13:24):
ten dollars or imprisoned for up to ten days. There
were a lot of arrests, although many were because the
person hadn't known about the mask law or just didn't
have a mask, but that was not the case for everyone.
On October, health officer Henry D. Miller escorted James Whisser
(13:44):
to a pharmacy to purchase a mask. The details here
are a little bit fuzzy, but Whisser refused to either
buy or where one UH. It's not clear which thing
happened first, but these two things happened. Whizzer struck Miller
with a sack of silver dollars, and Miller fired his
gun in the air. Miller kept firing as Whisser beat
(14:05):
him up in the street. Miller's shots hit Whisser and
two bystanders, and Whisser and Miller both faced charges after
this altercation. Some of the mentions of this that have
floated around in UH in the last year have sort
of made it sound like Miller just unprompted shot somebody
(14:26):
for refusing to wear a mask. They kind of leave
out the fact that that person hit him with a
sack of silver dollars and was beating him up in
the street, which sounds painful. Yes, yes, not that any
of that is okay, but it definitely is not as
simple as like this guy shot somebody for refusing to
wear a mask. So, as we've said before, this was
(14:48):
at the very end of World War One, and a
lot of the messaging around this first mass mandate in
San Francisco was framed around wartime patriotism and the idea
that stopping the disease would help protect the troops. So
when the armistice was signed on November eleventh, of night,
that stopped most of the active fighting and mask compliance
(15:11):
in San Francisco started to drop. Then, when the mask
order expired at noon on the twenty one, there were
bells and whistles that were sounded all around the city.
People gleefully ripped off their masks. They were very happy
to be done with this mass situation. Some people set
their masks on fire. The mask law in San Francisco
was just one part of the city strategy to control
(15:32):
the flu. Other steps included closing dance halls and ordering
street cars to keep their windows open unless it was raining,
and eventually banning public gatherings and closing the schools. Churches
were advised to move their services outdoors. Judges held court
sessions outside as well, and all this together seems to
(15:54):
have reduced the rate of infection in San Francisco during
the pandemic's worst spike in the fall of eighteen eighteen.
But when flu cases started spiking again in San Francisco
at the end of nineteen eighteen and early nineteen nineteen,
the city's tried to reinstate this mask mandate, and that
is when the Anti Mask League formed in response. They
(16:16):
were also called masks slackers thanks to a Red Cross
poster about masking which read quote the man, or woman
or child who will not wear a mask now is
a dangerous slacker. The Anti Mask League really politicized the
idea of mask wearing, and they held a rally that
was attended by two thousand people at the Dreamland Rink.
(16:40):
The city eventually repealed the second attempt at a mask
mandate under pressure from the Anti Mask League, and then overall,
San Francisco's response to this later wave of the flu
was not as effective as the earlier one had been,
so this example is just from San Francisco, but a
similar pattern played out in other cities as well. Most
(17:01):
of the U S cities that mandated mask wearing during
the nineteen eighteen pandemic were in the western part of
the country. Compliance with the mandates was often spotty at best,
but resistance tended to be more along the lines of
that's ridiculous or how silly, rather than forming an organized
group to push back against it. And a lot of
(17:22):
the complaints about the masks will probably sound pretty familiar.
People found them uncomfortable to wear and hard to breathe through,
and as we noted earlier, if you actually had enough
gauze layers to be effective, that probably was really hard
to breathe through. Public health officials also worried that the
appearance of masked people out and about would lead to panic,
(17:45):
or that wearing a mask might lead people to be
less vigilant in other ways. That's an argument we have
heard in the last year. It was clear then as
it is now that masking really needed to be combined
with other steps like so distancing and staying away from crowds.
But there are lots of pictures from nineteen eighteen of
huge groups of masked people standing shoulder to shoulder. Another
(18:11):
recurring question that Tracy has had over the last year
was the US response to the nineteen eighteen pandemic. Such
a chaotic and ineffective patchwork, with different cities and states
taking totally different steps to try to control the spread,
and with a bunch of contradictory and confusing messaging about
all of it. Basically a big old mess, because I think,
(18:32):
um to most of us, that's what this has seemed
to be. Sure feels like a big old mess to me. Yeah,
The short answer to all of Tracy's questions and probably yours.
I think most of us have had a similar was
the last before The answer is yes, yeah. So the
US response to the nineteen eighteen pandemic was almost completely decentralized.
(18:54):
The Centers for Disease Control had not been established yet.
That happened in nineteen forty six, and the World Health
Organization was established two years after that, so it did
not exist either. US Surgeon General Rupert Blue, who was
also head of the Public Health Service, also did very
little to try to curb the pandemic. He directed the
(19:15):
National Academy of Sciences to try to identify the pathogen
that was at work, but then he also denied funding
requests for research into that very thing. Blues efforts to
organize a federal response were essentially non existent until September,
when the illness had been circulating for months and cases
and deaths were increasing rapidly. Cities and states repeatedly asked
(19:39):
the federal government for direction and help, and they got
very little. Although the Public Health Service did eventually print
about six million posters, articles, and signs, it was well
into the pandemic before this happened, and as we're going
to talk about it just a little bit. A lot
of the information that they contained really wasn't exactly use. All.
(20:00):
Presidential press briefings were not nearly as common in nineteen
eighteen as they are today. But President Woodrow Wilson never
gave any kind of public statement about the pandemic or
took any steps to try to direct a federal response
to mitigate it. His focus was really on the war,
and this was true even as White House staffers started
(20:23):
to get sick. Donald Frey, who was an aid with
the US delegation to the Paris Peace Conference, died of
the pandemic flu, and Wilson himself contracted the flu and
was seriously ill during the Paris peace Conference. The social
safety net that has been providing at least some relief
in the US during the COVID nineteen pandemic also did
(20:47):
not exist yet at this time. The Supplemental Nutrition Assistance Program,
or SNAP, is a monthly benefit to help low income
US citizens by nutritious foods, and this grew out of
the government's first food stamp program, but that was not
established until nineteen thirty nine. There were union workers who
had some kind of unemployment compensation as part of their
(21:09):
union contracts in nineteen eighteen, but in general, unemployment insurance
did not exist yet. The first of many state unemployment
bills was introduced in Massachusetts in nineteen sixteen, but all
of these bills failed until Wisconsin finally passed one in
nineteen thirty two. Unemployment insurance didn't really become widespread in
(21:32):
the US until after that point. During and after the
Great Depression, Medicare and Medicaid also did not come into
existence until nineteen sixty five. Congress did approve a one
million dollar budget for the Public Health Service in nineteen
eighteen to try to address a serious shortage of doctors
and nurses. Many had been called up or had volunteered
(21:54):
for military service before the pandemic started, and the military
still didn't have nearly enough medical personnel, and regardless of
whether they were doing military or civilian work, medical professionals
were hard hit by the pandemic, terribly understaffed, working in
close proximity to people with a contagious respiratory illness, and
(22:14):
wearing often ineffective protective equipment. Every week, the Journal of
the American Medical Association printed pages and pages of obituaries
so this million dollar Public Health Service budget was meant
to help fill this gap by recruiting a thousand doctors
and seven hundred nurses. The Public Health Service worked on
(22:37):
this in conjunction with the Red Cross. The Red Cross
already had a coordinated national plan for recruiting nurses before
the government even got involved with this. Really, in the US,
the vast majority of aid during the pandemic was coming
from charities and religious organizations and private citizens, not from
(22:59):
the government. Passing this legislation was a challenge. So many
representatives were ill or otherwise absent that the House didn't
have a quorum. With fewer than fifty representatives actually there,
the two parties worked out a unanimous consent agreement to
push this legislation through. The final bill was approved by
(23:20):
both the Houses and Senate on October. Surgeon General Blue
had not asked for funding before this, but after the
bill passed, he protested that one million dollars would not
be enough. Even so, the Public Health Service ultimately returned
one and fifteen thousand to the Treasury because it simply
did not recruit enough people to use all of the
(23:42):
allocated money. So we mentioned a moment ago that Some
of the communication around the pandemic was also not particularly
effective in the US, and we will get to that
after a sponsor break. Because of the war, US officials
(24:03):
were generally more focused on maintaining morale and avoiding panic
in nineteen eighteen than they were on fighting the pandemic.
In the US, as well as in many parts of
Europe and Asia, the news was also subject to wartime censorship,
and this is why this pandemic was nicknamed the Spanish Flu.
Spain was neutral in the war and it wasn't really
(24:26):
censoring its news about the flu, so to some people
it seemed like this disease had come from Spain, when
really Spain was just the place that was being most
transparent about what was happening in the United States. This
also tapped into isolationism and xenophobia, branding a deadly illness
as having come from somewhere else and stigmatizing people who
(24:48):
got sick as somehow connected to this supposedly foreign invader.
And obviously, this type of mothering nickname is not unique
to the nineteen eighteen pandemic. The nineteen sixty eight flu
pandemic was known as Hong Kong Flu. The worldwide HIV
epidemics started out as gay related immune deficiency, and the
(25:10):
racist nickname China virus has stuck around long after the
current pandemic. Disease was officially named COVID nineteen. Since there
was no centralized agency formalizing public health advice in nineteen eighteen,
people were also hearing a lot of contradictory information about
what to do and how to protect themselves, and in
(25:31):
most parts of the US, they were also hearing that
things weren't that bad, that everything was under control, and
that nobody needed to be alarmed. It was just the
flu more direct and assertive public health messaging that we
talked about in San Francisco back before the break that
was far less common than messaging that really minimized the threat.
(25:52):
For example, Surgeon General blues first public communication about the
pandemic was published on September twenty second of nine eight
It ran under the title Surgeon General's Advice to avoid Influenza,
and it was full of very basic health advice like
avoiding crowds, covering coughs and sneezes, choosing and chewing your
(26:15):
food well, avoiding tight clothes, and quote don't let the
waste products of digestion accumulate. Okay, basically, don't leave crap
lying around basic sanitation and extremely basic sanitation and health steps. Then,
on October sevent as cases and deaths were really climbing dramatically,
(26:39):
Blue issued more of a question and answer statement that
was more specifically about the pandemic. He described this flu
as quote, a very contagious type of cold accompanied by fever,
pains in the head, eyes, ears, back or other parts
of the body, and a feeling of severe sickness. And
most of the cases these symptoms appear after three or
(27:01):
four days. The patient then rapidly recovering. Some of the patients, however,
developed pneumonia or inflammation of the ear or meningitis, and
many of these complicated cases die. He also put a
lot of focus on how many other epidemics there had
been before and how quote, the proportion of deaths in
(27:21):
the present epidemic has generally been low. In this piece,
Blue recommended that if a person was having to care
for both sick and healthy family members, they should wear
a mask and an apron or gown while with the
sick person and remove all of that before coming into
contact with the rest of the family, and he recommended
that everyone eat a good diet, get plenty of rest,
(27:44):
keep windows open, reduce overcrowding in their homes, and avoid
crowds while out in public. The overall tone of this
whole thing was far more reassuring and again pretty basic,
than it was urgent. As another example, Philadelphia Public Health
Director William Kruzen repeatedly suggested to residents of Philadelphia that
(28:05):
everything was under control and that the number of infections
had peaked. In September of nineteen eighteen, he decided not
to cancel a liberty loan parade that was to promote
war bonds. That parade had been scheduled for the twenty
eight and he carried on with it, even though an
outbreak had started at the Philadelphia Navy Yard just nine
(28:27):
days before that. Within seventy two hours after the parade,
every hospital bed in Philadelphia was full and sick patients
were being turned away. Meanwhile, Cruisin kept up the refrain
that everything was under control and the worst was over.
As the daily deaths in Philadelphia climbed to two hundred
(28:47):
and then three hundred, and then peaked at more than
seven hundred. Teams were dispatched to collect bodies from homes
and literally could not keep up with the deaths. Cruising
banned public meetings, and close churches, schools, and theaters only
after Philadelphia was experiencing hundreds of deaths today. And it
wasn't just government officials who were down playing the pandemic.
(29:11):
A lot of newspapers carried daily or weekly updates of
how many new cases and deaths had occurred, along with
news about how there were shortages of doctors and nurses,
and shortages of coffins and other obviously serious problems. But
at the same time, they also repeated this refrain that
this pandemic was just the flu, or, to use a
(29:33):
term of the day, it was just the grip, that
people didn't need to be alarmed. That Surgeon General's advice
to avoid influenza that included like the world's most rudimentary
Basic Sanitation information UH that ran next to newspaper reports
about outbreaks and deaths. Lists of precautions often framed things
(29:55):
as preventing the spread of colds, tuberculosis, pneumonia, and the flu,
sort of lumping the pandemic in with these other illnesses
as though it was nothing unusual. Even Philadelphia's news coverage
framed Cruisin's ban on public gatherings as not being for
public health reasons or any cause for alarm that one
(30:15):
is particularly weird like then then why by then if
it wasn't for public health reasons. So this effort to
avoid panic by downplaying the severity of the pandemic was
not effective. People's friends and family members were dying. Morgues
were past capacity, there were not enough coffins. People were
(30:35):
being buried in mass graves. And in the face of
all this, people naturally were not calm, and they also
stopped trusting what they were hearing from official sources because
those sources were clearly not being honest with them. Historian
John M. Berry, author of The Great Influenza, The Epic
story of the deadliest plague in history, has written on
(30:57):
this phenomenon a lot, and was a subject matter expert
in two thousand five and two thousand six when the
CDC was putting together an influenza pandemic plan. In article
in The Washington Post, he's described as telling a reporter
that he felt like his job was to bang on
the tell the truth, Tell the Truth drum because lying
(31:18):
to the public for the sake of keeping calm and
maintaining order in nineteen eighteen not only did not work,
but it actually had the opposite effect. Minimizing the pandemic
also meant that there was a big range and how
serious people thought it was, especially if they were lucky
enough that they didn't personally know anyone who had died.
(31:39):
And you can see some of this in some of
the popular media of the day. One example is the
popular syndicated newspaper comic The Outbursts of Everett True. This
is a two panel comic, with the first panel being
the setup and the second panel being the punch line,
often literally, because usually Everett would hit somebody. In one
(32:01):
strip from the nine Pandemic, amasked, Everett says, quote, I
think it's everybody's duty to help combat the spread of
the contagion. And then another man says, quote, well, I
don't think these muzzles do any good. If a person
is going to get it, he's going to get it,
and I'm going to take my chances. And in the
second frame, Everett, having punched the other man's face in,
(32:23):
says well, then take a tip from me, where one
and improve the looks of that face, you owe that
much to the community. In another strip, someone sneezes on
Everett in the first panel, and in the second Everett
has him trapped under a giant box and has sent
someone to fetch the fumigating squad from the Board of Health.
Somebody shared these comics and a group chat that I'm
(32:45):
in and our response was all like, are you sure
these are not from today? He's in the newspaper this morning.
So apart from what people were hearing from the media
and government sources and all of that, the actual measures
being taken also really varied from place to place. We
(33:06):
mentioned in that earlier episode we did on the pandemic
that some cities shut down their public transportation systems and
movie theaters, or they closed schools and churches, but we
didn't mention that these closures often went on for weeks,
or that because of the it's just the flu messaging.
There were a lot of people who thought that this
was an unnecessary and ridiculous overreaction. However, there were also
(33:31):
business owners who supported these shutdowns. For example, in San Francisco,
movie theater owners had already seen a huge drop in
attendance before the city closed the theaters, and they were
really hoping that this temporary total closure would get things
under control faster. One paper that looked at this was
non Pharmaceutical Interventions implemented by US cities during the nineteen
(33:54):
eighteen and nineteen nineteen influenza pandemic. The paper was published
in two thousand seven, and it looked at the steps
taken by forty three cities between September eighteenth, nine eighteen
and February twenty second, nineteen nineteen, that period that covered
the pandemic's largest peak in the United States. All of
these cities had populations of more than one hundred thousand
(34:16):
people and were among the sixty six most populous cities
in the United States at the time. The cities among
those sixty six that weren't included in this study just
didn't have accurate enough data to use. They looked specifically
and information about school closures, the canceling of public gatherings,
and the isolation and quarantine of sick people in their
(34:38):
close contacts, and all the cities that they looked at
did at least one of these. Most of them did
more than one. The most common combination was closing schools
and also canceling public gatherings within that September to February window.
The median length for these closures was four weeks, but
in some cases they went on much longer. So of
(35:00):
the cities had at least some kind of non pharmaceutical
intervention in place for twenty weeks or more. And this
paper also concluded that these steps were generally effective at
slowing the spread of disease, especially when cities took a
layered strategy of taking multiple steps at once. The effect
was greatest when restrictions went into effect earlier, before infections
(35:23):
and deaths really started to climb, rather than afterward in
response to those increases. For example, St. Louis, Missouri, put
multiple steps in place early in the pandemic and fared
much better than most of the other cities. Overall, cities
that took multiple steps took longer to reach peak mortality,
and they had lower peak mortality and lower total mortality
(35:46):
rates than cities that did not. Various cities took other
steps as well, beyond the cancelations, closures, and quarantines that
were part of that study. We talked about San Francisco's
multipart response earlier. For example, some other examples. In Portland, Oregon,
the public library was closed, but then it reopened for
(36:07):
book circulation only, with the chairs taken out of the
circulation room and patrons being required to wait five feet
apart from each other. Many cities shut down their bars
and their pubs. At this point. The eighteenth Amendment to
the Constitution, which prohibited the manufacturer, sale, and transportation of
intoxicating liquors, had been passed, but it had not been
(36:29):
ratified by the states. That didn't happen until January of
n So in general, the nine eighteen bar and pub
closures made prohibitionists really happy, but in some places, steps
that were taken really didn't make any sense. In St. Paul, Minnesota,
for example, buildings under six floors were prohibited from using
(36:50):
their elevators because of the lack of fresh air. There
was a lot of resistance to this, and some of
it was definitely justified. Like shutting down the elevators made
the buildings inaccessible for disabled people and discouraged people from
going outside into the fresh air, which was believed to
be necessary for health. Ultimately, the elevators were put back
(37:12):
into operation and they had a limit of one person
per five square feet of space to quote a two
thousand seven article in Public Health Reports that discussed the
nineteen eighteen response in Minneapolis and St. Paul. Quote, because
clear orders were not being given to public health officials,
the public in turn was not receiving transparent and consistent
(37:35):
advice and information. Should the public wear masks? Why was
it allowable to be next to someone in a street
car and not in an elevator? Why were church services
closed while Red Cross workers gathered in crowded conditions in
those very same churches? Was influenza a life threatening condition?
Or was the panic the most dangerous element of the
(37:56):
influenza pandemic? And Minneapolis and St. Paul, there was no
single message on any of these issues. In many cases,
the public had to decide for itself, in which case
the effect of the messages that were communicated only serves
to contradict each other. I read that and was like,
is this about today? So we have talked mainly about
(38:19):
cities here, but in nineteen eighteen, almost half of the U.
S population was living in more rural areas, and the
pandemic was devastating in those areas as well. Smaller communities
were taking many of the same non pharmaceutical steps that
big cities were, but in rural areas, people in general
had even less access to medical care and fewer resources.
(38:41):
It was particularly bad in places that were outside of
cities but also densely populated, like in coal mines. So
we have spent this episode mostly talking about masks and
the generally scattered, chaotic response to the nineteen eighteen pandemic
in the United States. Now next time we were going
to dive into some more focused topics, which is honestly
(39:04):
what I thought this episode was going to be like
when I started on it, Like, for example, was anything
happening with vaccines in nineteen eighteen, were there the kinds
of food and supply shortages that we have seen through
some of this pandemic, and were there any places that
managed to actually get things under control? Uh? While we
ruminate on all of this, Tracy D of listener Mail,
(39:26):
how do I have listener mail that has a connection
in that it discusses some of the medical stuff that
we have talked about lately, but it's not about the pandemic.
This is from Megan. Uh. Megan says, Hi, Holly and Tracy,
I hope that this email finds you well. First of all,
I want to thank you for all the great work
you do. You definitely make my car drives, housework, and
(39:47):
projects that I've been doing during the pandemic more interesting.
I'm writing to you as I've just finished your most
recent podcasts on the Mississippi Freedom Summer and w Montague Cobb.
When listening to your episode on Freedom Summer, you mentioned
the Mississippi Burning case. I immediately thought to myself, why
do I feel like I know much more about this
case than I would have learned in school. When you
(40:08):
mentioned the other bodies found, it clicked for me. Another
podcast that I've discovered during the pandemic is called Someone
Knows Something That takes a hard look at unsolved crimes.
The third season of that show was on the murder
of two of the bodies that were discovered when trying
to find Cheney, Goodman and Schwerner. What struck me most
(40:28):
about this podcast was that it made me realize that
for some people, this is not history. One of the victims, brother,
who the show followed, was still very frightened to look
into this case and even returned to that part of
Mississippi as he felt it was still unsafe for racial minorities.
It was definitely a check your privilege moment for myself.
I would recommend it to any of your listeners who
(40:48):
enjoy true crime. The second reason I am writing to
you is that I am a nursing student, so I
highly enjoy any of your podcasts about medical history. This
latest podcast about Dr Cobb was not any differ rent.
As you mentioned in your podcast, he focused a lot
on the disparities and healthcare for non whites. I've come
across a book and my attempt to better serve my
patients that I think any of your listeners and health
(41:10):
care might be interested in, called Mind the Gap, a
handbook of clinical signs in black and brown skin. It
was written by a black medical student in London that
realized that he was only learning the white symptoms in
school and wanted to better educate his spellow students as
well as better serve his community. I hope that your
listeners will look into this and we can continue to
(41:31):
correct the disparities and our healthcare system. Again, thank you
for all that you do bringing the more obscure and
less talked about parts of history to light. Megan uh
Megan also sent dog pictures. Thank you so much for
the dog pictures and for this email. I spent a
moment looking at this UM at the Mind the Gap handbook. UM.
(41:52):
There's a whole website for it online and some of
it has uh like photographs of things like skin conditions
that look very different depending on the coloring of a
person's skin. UM. One of the ways that I know
this has come up with the COVID nineteen pandemic is
the oxygen monitors that go on your fingers, reading people's
oxygen saturation very differently if they are black or brown. UM.
(42:16):
So it's a there's a whole, huge and immediate relevance
to this, So thank you again for this email. If
you would like to write to us about this or
anither podcast, we're at history Podcasts that I heart radio
dot com. And we're also all over social media at
miss in History. So you'll find our Facebook, Twitter, Pinterest,
and Instagram, and you can subscribe to our show on
(42:37):
the I heart radio app and Apple podcasts and anywhere
else to get your podcasts. Stuff you missed in History
Class is a production of I heart Radio. For more
podcasts from I heart Radio, visit the iHeart Radio app,
Apple podcasts, or wherever you listen to your favorite shows.
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Fry. We're coming
up on the one year anniversary of the World Health
Organization's announcement that COVID nineteen could be characterized as a pandemic.
(00:25):
That happened on March eleven, and then a couple of
weeks after that, Holly and I talked on the show
about what it was like to be living through such
a massive and worldwide, clearly historic event while also hosting
a history podcast, and we re aired our previous episode
on the flu pandemic as a Saturday classic because it
(00:48):
seemed relevant what was happening. I don't think either of
us really foresaw that we might be in a place
to do kind of a one year later episode, not
even a little like. I have a friend who was
a nurse at Boston area hospitals. I mean, Boston was
one of the early hard hit places, and she talked
(01:09):
about getting a briefing at work saying that we were
probably looking at eighteen months to two years of pandemic.
But like, there's a big difference between intellectually having that
possibility in your mind and actually living through it. So
I researched and wrote our episode on the eighteen flu
(01:33):
pandemic that we aired as a Saturday Classic after the
COVID nineteen pandemic started. I wrote that back in and
over the last year, I have wandered over and over
is this what it was like in night? And how
would I have approached that episode differently if I were
working on it today instead of seven years ago. Uh.
(01:58):
We don't typically revisit older episodes in this way, but
the last year has just profoundly reshaped the way I
have thought about that earlier pandemic. To me, it's a
really good example of how your own perceptions and your
own knowledge and experiences influence your understanding of history. Uh.
(02:19):
So we're going to take another look at the flu pandemic. Um.
I do want to note here that theeen flu pandemic
was global, and so is the COVID nineteen pandemic. But
a big part of today's episode is how my own
lived experience has shifted my my understanding of that earlier
(02:40):
event and drawn my attention to totally different parts of
the eighteen pandemic. Then, we're on my mind back in
so by definition this gives things a more US centric focus.
I cannot tell you how how a person's lived experience
in another place would have changed their understanding. UM. I
also didn't start out thinking this was going to be
a two part episode, but it is turned out there
(03:05):
was a lot to talk about that we did not
touch on back much or at all. Okay, so we're
going to do a quick review here as we lead in.
The nineteen eighteen flu pandemic stretched from early nineteen eighteen
into the spring of nineteen twenty, although the largest peak
was between October of nineteen eighteen and January of nineteen nineteen,
(03:27):
with a smaller but still significant peak between February and
April of nineteen nineteen. It's estimated that one third of
the world's population contracted the flu during this pandemic. About
six hundred seventy five thousand people died in the United States,
worldwide estimates very considerably. At the time, the global death
(03:48):
toll was estimated at twenty million people, but today's estimates
are more like thirty million to fifty million people, and
sometimes even more so. Illnesses like the f are often
particularly lethal for the very old and the very young,
and that was true of the nineteen eighteen flu. But
then in addition to that, it also disproportionately killed young,
(04:11):
otherwise healthy adults, people who were in their twenties and thirties.
And since this pandemic took place in the last months
of World War One, its effects on troops were extreme.
The virus just moved through entire ships and entire military
units in waves. For example, in June and July of
nineteen eighteen, more than two hundred thousand of the two
(04:33):
million British troops in France all got too sick to
report to duty. In our earlier episode on this pandemic,
we talked about how in nineteen eighteen the world had
the germ theory of disease, but not antibiotics. We knew
which specific micro organisms caused some diseases, including tuberculosis, malaria,
(04:54):
and cholera, but not influenza. We had vaccines for some
diseases as well, including smallpox, rabies, cholera, and typhoid, but
again not influenza. It wasn't just that researchers didn't know
which specific pathogen caused influenza. They were also headed down
the wrong track on that. The prevailing theory before the
(05:17):
pandemic was a bacterium known as Phifer's bacillus that was
named after its discover Richard Friedrich Phifer. During the nineteen
eighteen pandemic, it became clear that this bacillus was not
the cause of the flu. A huge number of people
became ill, but they had no sign of this bacillus
and their cultures. Today, this basilus is actually called Hemophilius influenzae,
(05:41):
and while it does not cause influenza, it's not the fluvirus.
It does cause things like pneumonia, cellulitis, and meningitis. We
also talked about nineteen eighteens public health recommendations like stay
home if you're sick, avoid crowds, cover coughs and sneezes,
wash those hands thoroughly and often. In other words, a
(06:03):
lot of the exact same things that we've all been
hearing for the last year, most of which are also
what everyone should still be doing even when there is
not a pandemic. Yeah, I have a lot of feelings
about handwashing because I used to work in in like
food safety education. Uh and when things started um trending
(06:26):
towards pandemic in February and March of last year. I
definitely noticed when I would be in a public restroom,
suddenly people were at the sink for as long as
I was, and I was like, wow, this is let's
keep the cleep up this habit for the rest of
our lives. Uh. There were, though some notable differences in
the public health recommendations in en though at least in
(06:49):
terms of US culture, the idea that spitting on the
ground is rude and unsanitary was really fairly new in
nineteen eighteen. The first anti bidding campaigns had gotten underway
just a couple of decades before that to try to
prevent the spread of tuberculosis. Common drinking cups and shared
(07:09):
towels were also frequently found in public places, so back
in eighteen, in addition to those recommendations that feel pretty
familiar today, there were also slogans like spit spreads death
and advisories to avoid those common cups and towels. Public
health officials also advised people to wear masks, in which
(07:30):
brings us to the biggest, most obvious thing we'd approach
way differently now versus back in our treatment of masks
in the earlier episode is essentially just a sentence. We
said that public health authorities recommended that people wear them,
and that in some places they were even required by law,
but that this was not effective. We described that lack
(07:53):
of efficacy coming from virus particles being too small to
be blocked by simple fabric, which is true and which
actually came from a US Department of Health and Human
Services website that was written about the nineteen eighteen pandemic.
But as has been discussed at length in the last year,
well fitting masks made of tightly woven cloth can stop
(08:15):
respiratory droplets that are carrying those virus particles. That is
not necessarily true of the masks that were being worn
in nineteen eighteen, though those were typically made of gauze,
which is a very thin fabric with an open weave.
Some of them were made from cheese cloth, which also
has a similar open weave. Even with multiple layers, these
(08:39):
fabrics might leave you with a relatively porous mask. If
you look at photos from the nine eight pandemics, sometimes
you'll see people's facial features through their masks pretty clearly.
Sometimes you can see the gauzy holes in the material.
Sometimes people also cut holes in their masks to smoke,
or if they didn't have gauze or cheese claw, they
(09:00):
made masks out of materials that were way too thin
to do any good at all. They almost looked like
wearing a translucent veil instead of a mask. Like I
saw one photo of Red Cross nurses and it was
literally only attached over the bridge of their nose and
had this filmy, diaphanous quality, and I was just like,
(09:20):
that's not helping. No, what's interesting too, because I mean,
even then, cheesecloth was being used in kitchens to strain things,
so you knew stuff could go right through it, so
it's an interesting choice. UM. A publication called an Experimental
(09:41):
Study of the Efficacy of Gauze Masks, which was published
in the American Journal of Public Health in nineteen twenty,
looked at whether the masks themselves were effective, and the
authors concluded that a gauze mask that had enough layers
to actually block respiratory droplets was also very hard to
breathe through, and a person's exhaled breath just escaped around
(10:02):
the sides of the mask instead. So if you're hearing
a stock about this and you're thinking Wait a minute.
Didn't you talk about gauze masks being effective in that
episode on Wullie and Dah and the pneumonic plague. That
answer is yes, but those masks had a layer of
cotton wool in the middle of all that gauze. Pneumonic
plague is also caused by bacteria. Bacteria are much larger
(10:26):
than viruses, and those masks efficacy was really clearest among
healthcare professionals who would have been wearing the masks in
addition to other precautions, and probably also with better mask
discipline and more thorough hygiene steps than the general public
would have had. Back to that paper, the author cited
(10:47):
five reasons why mask mandates did not seem to slow
the spread of the disease in the pandemic quote. First,
the large number of improperly made masks that were used,
set and faulty wearing of masks, which included the use
of masks that were too small, the covering of only
the nose or only the mouth, smoking while wearing, etcetera. Third,
(11:11):
wearing masks at improper times when applied compulsorily, masks were
universally worn in public on the streets in automobiles, etcetera,
where they were not needed, but where arrest would follow
if not worn, and they were very generally laid aside
when the wearer was no longer subject to observation by
the police, such as in private offices and small gatherings
(11:33):
of all kinds. This type of gathering with the attendant
social intercourse between friends and office associates seems to afford
particular facility for the transfer of the virus. Another study
in ninety one concluded that quote the face mask as
used was a failure. The important bit there is the
(11:54):
as used, and that included things like the stuff we
just talked about and people re wearing the same masks
until they were just filthy. The general advice on mask
cleanliness back in was to boil them regularly, in some
cases daily. This study also notes that the masks did
nothing to protect the eyes, and that the tear ducks
(12:15):
had been pinpointed as a possible way that the virus
could get into a person's respiratory tract. We also did
not talk about resistance to mask mandates in that earlier episode.
We sure will after we first pause for a little
sponsor break. The most famous group of mask resisters during
(12:40):
the nineteen eighteen pandemic was the San Francisco Anti Mask League.
San Francisco had actually been the first city in the
United States to implement a mask mandate. It was a
four week mandatory mask law that started on October nineteen eighteen,
and it ended on November twenty one of that year.
Of full page ad ran in the San Francisco Chronicle
(13:03):
that read, quote wear a mask and savior life. This
ad was signed by the mayor, as well as civic
and business leaders and health officials. The Red Cross distributed
about a hundred thousand masks to residents of San Francisco
over the course of about a week. People who were
seen in public without a mask were fined five or
(13:24):
ten dollars or imprisoned for up to ten days. There
were a lot of arrests, although many were because the
person hadn't known about the mask law or just didn't
have a mask, but that was not the case for everyone.
On October, health officer Henry D. Miller escorted James Whisser
(13:44):
to a pharmacy to purchase a mask. The details here
are a little bit fuzzy, but Whisser refused to either
buy or where one UH. It's not clear which thing
happened first, but these two things happened. Whizzer struck Miller
with a sack of silver dollars, and Miller fired his
gun in the air. Miller kept firing as Whisser beat
(14:05):
him up in the street. Miller's shots hit Whisser and
two bystanders, and Whisser and Miller both faced charges after
this altercation. Some of the mentions of this that have
floated around in UH in the last year have sort
of made it sound like Miller just unprompted shot somebody
(14:26):
for refusing to wear a mask. They kind of leave
out the fact that that person hit him with a
sack of silver dollars and was beating him up in
the street, which sounds painful. Yes, yes, not that any
of that is okay, but it definitely is not as
simple as like this guy shot somebody for refusing to
wear a mask. So, as we've said before, this was
(14:48):
at the very end of World War One, and a
lot of the messaging around this first mass mandate in
San Francisco was framed around wartime patriotism and the idea
that stopping the disease would help protect the troops. So
when the armistice was signed on November eleventh, of night,
that stopped most of the active fighting and mask compliance
(15:11):
in San Francisco started to drop. Then, when the mask
order expired at noon on the twenty one, there were
bells and whistles that were sounded all around the city.
People gleefully ripped off their masks. They were very happy
to be done with this mass situation. Some people set
their masks on fire. The mask law in San Francisco
was just one part of the city strategy to control
(15:32):
the flu. Other steps included closing dance halls and ordering
street cars to keep their windows open unless it was raining,
and eventually banning public gatherings and closing the schools. Churches
were advised to move their services outdoors. Judges held court
sessions outside as well, and all this together seems to
(15:54):
have reduced the rate of infection in San Francisco during
the pandemic's worst spike in the fall of eighteen eighteen.
But when flu cases started spiking again in San Francisco
at the end of nineteen eighteen and early nineteen nineteen,
the city's tried to reinstate this mask mandate, and that
is when the Anti Mask League formed in response. They
(16:16):
were also called masks slackers thanks to a Red Cross
poster about masking which read quote the man, or woman
or child who will not wear a mask now is
a dangerous slacker. The Anti Mask League really politicized the
idea of mask wearing, and they held a rally that
was attended by two thousand people at the Dreamland Rink.
(16:40):
The city eventually repealed the second attempt at a mask
mandate under pressure from the Anti Mask League, and then overall,
San Francisco's response to this later wave of the flu
was not as effective as the earlier one had been,
so this example is just from San Francisco, but a
similar pattern played out in other cities as well. Most
(17:01):
of the U S cities that mandated mask wearing during
the nineteen eighteen pandemic were in the western part of
the country. Compliance with the mandates was often spotty at best,
but resistance tended to be more along the lines of
that's ridiculous or how silly, rather than forming an organized
group to push back against it. And a lot of
(17:22):
the complaints about the masks will probably sound pretty familiar.
People found them uncomfortable to wear and hard to breathe through,
and as we noted earlier, if you actually had enough
gauze layers to be effective, that probably was really hard
to breathe through. Public health officials also worried that the
appearance of masked people out and about would lead to panic,
(17:45):
or that wearing a mask might lead people to be
less vigilant in other ways. That's an argument we have
heard in the last year. It was clear then as
it is now that masking really needed to be combined
with other steps like so distancing and staying away from crowds.
But there are lots of pictures from nineteen eighteen of
huge groups of masked people standing shoulder to shoulder. Another
(18:11):
recurring question that Tracy has had over the last year
was the US response to the nineteen eighteen pandemic. Such
a chaotic and ineffective patchwork, with different cities and states
taking totally different steps to try to control the spread,
and with a bunch of contradictory and confusing messaging about
all of it. Basically a big old mess, because I think,
(18:32):
um to most of us, that's what this has seemed
to be. Sure feels like a big old mess to me. Yeah,
The short answer to all of Tracy's questions and probably yours.
I think most of us have had a similar was
the last before The answer is yes, yeah. So the
US response to the nineteen eighteen pandemic was almost completely decentralized.
(18:54):
The Centers for Disease Control had not been established yet.
That happened in nineteen forty six, and the World Health
Organization was established two years after that, so it did
not exist either. US Surgeon General Rupert Blue, who was
also head of the Public Health Service, also did very
little to try to curb the pandemic. He directed the
(19:15):
National Academy of Sciences to try to identify the pathogen
that was at work, but then he also denied funding
requests for research into that very thing. Blues efforts to
organize a federal response were essentially non existent until September,
when the illness had been circulating for months and cases
and deaths were increasing rapidly. Cities and states repeatedly asked
(19:39):
the federal government for direction and help, and they got
very little. Although the Public Health Service did eventually print
about six million posters, articles, and signs, it was well
into the pandemic before this happened, and as we're going
to talk about it just a little bit. A lot
of the information that they contained really wasn't exactly use. All.
(20:00):
Presidential press briefings were not nearly as common in nineteen
eighteen as they are today. But President Woodrow Wilson never
gave any kind of public statement about the pandemic or
took any steps to try to direct a federal response
to mitigate it. His focus was really on the war,
and this was true even as White House staffers started
(20:23):
to get sick. Donald Frey, who was an aid with
the US delegation to the Paris Peace Conference, died of
the pandemic flu, and Wilson himself contracted the flu and
was seriously ill during the Paris peace Conference. The social
safety net that has been providing at least some relief
in the US during the COVID nineteen pandemic also did
(20:47):
not exist yet at this time. The Supplemental Nutrition Assistance Program,
or SNAP, is a monthly benefit to help low income
US citizens by nutritious foods, and this grew out of
the government's first food stamp program, but that was not
established until nineteen thirty nine. There were union workers who
had some kind of unemployment compensation as part of their
(21:09):
union contracts in nineteen eighteen, but in general, unemployment insurance
did not exist yet. The first of many state unemployment
bills was introduced in Massachusetts in nineteen sixteen, but all
of these bills failed until Wisconsin finally passed one in
nineteen thirty two. Unemployment insurance didn't really become widespread in
(21:32):
the US until after that point. During and after the
Great Depression, Medicare and Medicaid also did not come into
existence until nineteen sixty five. Congress did approve a one
million dollar budget for the Public Health Service in nineteen
eighteen to try to address a serious shortage of doctors
and nurses. Many had been called up or had volunteered
(21:54):
for military service before the pandemic started, and the military
still didn't have nearly enough medical personnel, and regardless of
whether they were doing military or civilian work, medical professionals
were hard hit by the pandemic, terribly understaffed, working in
close proximity to people with a contagious respiratory illness, and
(22:14):
wearing often ineffective protective equipment. Every week, the Journal of
the American Medical Association printed pages and pages of obituaries
so this million dollar Public Health Service budget was meant
to help fill this gap by recruiting a thousand doctors
and seven hundred nurses. The Public Health Service worked on
(22:37):
this in conjunction with the Red Cross. The Red Cross
already had a coordinated national plan for recruiting nurses before
the government even got involved with this. Really, in the US,
the vast majority of aid during the pandemic was coming
from charities and religious organizations and private citizens, not from
(22:59):
the government. Passing this legislation was a challenge. So many
representatives were ill or otherwise absent that the House didn't
have a quorum. With fewer than fifty representatives actually there,
the two parties worked out a unanimous consent agreement to
push this legislation through. The final bill was approved by
(23:20):
both the Houses and Senate on October. Surgeon General Blue
had not asked for funding before this, but after the
bill passed, he protested that one million dollars would not
be enough. Even so, the Public Health Service ultimately returned
one and fifteen thousand to the Treasury because it simply
did not recruit enough people to use all of the
(23:42):
allocated money. So we mentioned a moment ago that Some
of the communication around the pandemic was also not particularly
effective in the US, and we will get to that
after a sponsor break. Because of the war, US officials
(24:03):
were generally more focused on maintaining morale and avoiding panic
in nineteen eighteen than they were on fighting the pandemic.
In the US, as well as in many parts of
Europe and Asia, the news was also subject to wartime censorship,
and this is why this pandemic was nicknamed the Spanish Flu.
Spain was neutral in the war and it wasn't really
(24:26):
censoring its news about the flu, so to some people
it seemed like this disease had come from Spain, when
really Spain was just the place that was being most
transparent about what was happening in the United States. This
also tapped into isolationism and xenophobia, branding a deadly illness
as having come from somewhere else and stigmatizing people who
(24:48):
got sick as somehow connected to this supposedly foreign invader.
And obviously, this type of mothering nickname is not unique
to the nineteen eighteen pandemic. The nineteen sixty eight flu
pandemic was known as Hong Kong Flu. The worldwide HIV
epidemics started out as gay related immune deficiency, and the
(25:10):
racist nickname China virus has stuck around long after the
current pandemic. Disease was officially named COVID nineteen. Since there
was no centralized agency formalizing public health advice in nineteen eighteen,
people were also hearing a lot of contradictory information about
what to do and how to protect themselves, and in
(25:31):
most parts of the US, they were also hearing that
things weren't that bad, that everything was under control, and
that nobody needed to be alarmed. It was just the
flu more direct and assertive public health messaging that we
talked about in San Francisco back before the break that
was far less common than messaging that really minimized the threat.
(25:52):
For example, Surgeon General blues first public communication about the
pandemic was published on September twenty second of nine eight
It ran under the title Surgeon General's Advice to avoid Influenza,
and it was full of very basic health advice like
avoiding crowds, covering coughs and sneezes, choosing and chewing your
(26:15):
food well, avoiding tight clothes, and quote don't let the
waste products of digestion accumulate. Okay, basically, don't leave crap
lying around basic sanitation and extremely basic sanitation and health steps. Then,
on October sevent as cases and deaths were really climbing dramatically,
(26:39):
Blue issued more of a question and answer statement that
was more specifically about the pandemic. He described this flu
as quote, a very contagious type of cold accompanied by fever,
pains in the head, eyes, ears, back or other parts
of the body, and a feeling of severe sickness. And
most of the cases these symptoms appear after three or
(27:01):
four days. The patient then rapidly recovering. Some of the patients, however,
developed pneumonia or inflammation of the ear or meningitis, and
many of these complicated cases die. He also put a
lot of focus on how many other epidemics there had
been before and how quote, the proportion of deaths in
(27:21):
the present epidemic has generally been low. In this piece,
Blue recommended that if a person was having to care
for both sick and healthy family members, they should wear
a mask and an apron or gown while with the
sick person and remove all of that before coming into
contact with the rest of the family, and he recommended
that everyone eat a good diet, get plenty of rest,
(27:44):
keep windows open, reduce overcrowding in their homes, and avoid
crowds while out in public. The overall tone of this
whole thing was far more reassuring and again pretty basic,
than it was urgent. As another example, Philadelphia Public Health
Director William Kruzen repeatedly suggested to residents of Philadelphia that
(28:05):
everything was under control and that the number of infections
had peaked. In September of nineteen eighteen, he decided not
to cancel a liberty loan parade that was to promote
war bonds. That parade had been scheduled for the twenty
eight and he carried on with it, even though an
outbreak had started at the Philadelphia Navy Yard just nine
(28:27):
days before that. Within seventy two hours after the parade,
every hospital bed in Philadelphia was full and sick patients
were being turned away. Meanwhile, Cruisin kept up the refrain
that everything was under control and the worst was over.
As the daily deaths in Philadelphia climbed to two hundred
(28:47):
and then three hundred, and then peaked at more than
seven hundred. Teams were dispatched to collect bodies from homes
and literally could not keep up with the deaths. Cruising
banned public meetings, and close churches, schools, and theaters only
after Philadelphia was experiencing hundreds of deaths today. And it
wasn't just government officials who were down playing the pandemic.
(29:11):
A lot of newspapers carried daily or weekly updates of
how many new cases and deaths had occurred, along with
news about how there were shortages of doctors and nurses,
and shortages of coffins and other obviously serious problems. But
at the same time, they also repeated this refrain that
this pandemic was just the flu, or, to use a
(29:33):
term of the day, it was just the grip, that
people didn't need to be alarmed. That Surgeon General's advice
to avoid influenza that included like the world's most rudimentary
Basic Sanitation information UH that ran next to newspaper reports
about outbreaks and deaths. Lists of precautions often framed things
(29:55):
as preventing the spread of colds, tuberculosis, pneumonia, and the flu,
sort of lumping the pandemic in with these other illnesses
as though it was nothing unusual. Even Philadelphia's news coverage
framed Cruisin's ban on public gatherings as not being for
public health reasons or any cause for alarm that one
(30:15):
is particularly weird like then then why by then if
it wasn't for public health reasons. So this effort to
avoid panic by downplaying the severity of the pandemic was
not effective. People's friends and family members were dying. Morgues
were past capacity, there were not enough coffins. People were
(30:35):
being buried in mass graves. And in the face of
all this, people naturally were not calm, and they also
stopped trusting what they were hearing from official sources because
those sources were clearly not being honest with them. Historian
John M. Berry, author of The Great Influenza, The Epic
story of the deadliest plague in history, has written on
(30:57):
this phenomenon a lot, and was a subject matter expert
in two thousand five and two thousand six when the
CDC was putting together an influenza pandemic plan. In article
in The Washington Post, he's described as telling a reporter
that he felt like his job was to bang on
the tell the truth, Tell the Truth drum because lying
(31:18):
to the public for the sake of keeping calm and
maintaining order in nineteen eighteen not only did not work,
but it actually had the opposite effect. Minimizing the pandemic
also meant that there was a big range and how
serious people thought it was, especially if they were lucky
enough that they didn't personally know anyone who had died.
(31:39):
And you can see some of this in some of
the popular media of the day. One example is the
popular syndicated newspaper comic The Outbursts of Everett True. This
is a two panel comic, with the first panel being
the setup and the second panel being the punch line,
often literally, because usually Everett would hit somebody. In one
(32:01):
strip from the nine Pandemic, amasked, Everett says, quote, I
think it's everybody's duty to help combat the spread of
the contagion. And then another man says, quote, well, I
don't think these muzzles do any good. If a person
is going to get it, he's going to get it,
and I'm going to take my chances. And in the
second frame, Everett, having punched the other man's face in,
(32:23):
says well, then take a tip from me, where one
and improve the looks of that face, you owe that
much to the community. In another strip, someone sneezes on
Everett in the first panel, and in the second Everett
has him trapped under a giant box and has sent
someone to fetch the fumigating squad from the Board of Health.
Somebody shared these comics and a group chat that I'm
(32:45):
in and our response was all like, are you sure
these are not from today? He's in the newspaper this morning.
So apart from what people were hearing from the media
and government sources and all of that, the actual measures
being taken also really varied from place to place. We
(33:06):
mentioned in that earlier episode we did on the pandemic
that some cities shut down their public transportation systems and
movie theaters, or they closed schools and churches, but we
didn't mention that these closures often went on for weeks,
or that because of the it's just the flu messaging.
There were a lot of people who thought that this
was an unnecessary and ridiculous overreaction. However, there were also
(33:31):
business owners who supported these shutdowns. For example, in San Francisco,
movie theater owners had already seen a huge drop in
attendance before the city closed the theaters, and they were
really hoping that this temporary total closure would get things
under control faster. One paper that looked at this was
non Pharmaceutical Interventions implemented by US cities during the nineteen
(33:54):
eighteen and nineteen nineteen influenza pandemic. The paper was published
in two thousand seven, and it looked at the steps
taken by forty three cities between September eighteenth, nine eighteen
and February twenty second, nineteen nineteen, that period that covered
the pandemic's largest peak in the United States. All of
these cities had populations of more than one hundred thousand
(34:16):
people and were among the sixty six most populous cities
in the United States at the time. The cities among
those sixty six that weren't included in this study just
didn't have accurate enough data to use. They looked specifically
and information about school closures, the canceling of public gatherings,
and the isolation and quarantine of sick people in their
(34:38):
close contacts, and all the cities that they looked at
did at least one of these. Most of them did
more than one. The most common combination was closing schools
and also canceling public gatherings within that September to February window.
The median length for these closures was four weeks, but
in some cases they went on much longer. So of
(35:00):
the cities had at least some kind of non pharmaceutical
intervention in place for twenty weeks or more. And this
paper also concluded that these steps were generally effective at
slowing the spread of disease, especially when cities took a
layered strategy of taking multiple steps at once. The effect
was greatest when restrictions went into effect earlier, before infections
(35:23):
and deaths really started to climb, rather than afterward in
response to those increases. For example, St. Louis, Missouri, put
multiple steps in place early in the pandemic and fared
much better than most of the other cities. Overall, cities
that took multiple steps took longer to reach peak mortality,
and they had lower peak mortality and lower total mortality
(35:46):
rates than cities that did not. Various cities took other
steps as well, beyond the cancelations, closures, and quarantines that
were part of that study. We talked about San Francisco's
multipart response earlier. For example, some other examples. In Portland, Oregon,
the public library was closed, but then it reopened for
(36:07):
book circulation only, with the chairs taken out of the
circulation room and patrons being required to wait five feet
apart from each other. Many cities shut down their bars
and their pubs. At this point. The eighteenth Amendment to
the Constitution, which prohibited the manufacturer, sale, and transportation of
intoxicating liquors, had been passed, but it had not been
(36:29):
ratified by the states. That didn't happen until January of
n So in general, the nine eighteen bar and pub
closures made prohibitionists really happy, but in some places, steps
that were taken really didn't make any sense. In St. Paul, Minnesota,
for example, buildings under six floors were prohibited from using
(36:50):
their elevators because of the lack of fresh air. There
was a lot of resistance to this, and some of
it was definitely justified. Like shutting down the elevators made
the buildings inaccessible for disabled people and discouraged people from
going outside into the fresh air, which was believed to
be necessary for health. Ultimately, the elevators were put back
(37:12):
into operation and they had a limit of one person
per five square feet of space to quote a two
thousand seven article in Public Health Reports that discussed the
nineteen eighteen response in Minneapolis and St. Paul. Quote, because
clear orders were not being given to public health officials,
the public in turn was not receiving transparent and consistent
(37:35):
advice and information. Should the public wear masks? Why was
it allowable to be next to someone in a street
car and not in an elevator? Why were church services
closed while Red Cross workers gathered in crowded conditions in
those very same churches? Was influenza a life threatening condition?
Or was the panic the most dangerous element of the
(37:56):
influenza pandemic? And Minneapolis and St. Paul, there was no
single message on any of these issues. In many cases,
the public had to decide for itself, in which case
the effect of the messages that were communicated only serves
to contradict each other. I read that and was like,
is this about today? So we have talked mainly about
(38:19):
cities here, but in nineteen eighteen, almost half of the U.
S population was living in more rural areas, and the
pandemic was devastating in those areas as well. Smaller communities
were taking many of the same non pharmaceutical steps that
big cities were, but in rural areas, people in general
had even less access to medical care and fewer resources.
(38:41):
It was particularly bad in places that were outside of
cities but also densely populated, like in coal mines. So
we have spent this episode mostly talking about masks and
the generally scattered, chaotic response to the nineteen eighteen pandemic
in the United States. Now next time we were going
to dive into some more focused topics, which is honestly
(39:04):
what I thought this episode was going to be like
when I started on it, Like, for example, was anything
happening with vaccines in nineteen eighteen, were there the kinds
of food and supply shortages that we have seen through
some of this pandemic, and were there any places that
managed to actually get things under control? Uh? While we
ruminate on all of this, Tracy D of listener Mail,
(39:26):
how do I have listener mail that has a connection
in that it discusses some of the medical stuff that
we have talked about lately, but it's not about the pandemic.
This is from Megan. Uh. Megan says, Hi, Holly and Tracy,
I hope that this email finds you well. First of all,
I want to thank you for all the great work
you do. You definitely make my car drives, housework, and
(39:47):
projects that I've been doing during the pandemic more interesting.
I'm writing to you as I've just finished your most
recent podcasts on the Mississippi Freedom Summer and w Montague Cobb.
When listening to your episode on Freedom Summer, you mentioned
the Mississippi Burning case. I immediately thought to myself, why
do I feel like I know much more about this
case than I would have learned in school. When you
(40:08):
mentioned the other bodies found, it clicked for me. Another
podcast that I've discovered during the pandemic is called Someone
Knows Something That takes a hard look at unsolved crimes.
The third season of that show was on the murder
of two of the bodies that were discovered when trying
to find Cheney, Goodman and Schwerner. What struck me most
(40:28):
about this podcast was that it made me realize that
for some people, this is not history. One of the victims, brother,
who the show followed, was still very frightened to look
into this case and even returned to that part of
Mississippi as he felt it was still unsafe for racial minorities.
It was definitely a check your privilege moment for myself.
I would recommend it to any of your listeners who
(40:48):
enjoy true crime. The second reason I am writing to
you is that I am a nursing student, so I
highly enjoy any of your podcasts about medical history. This
latest podcast about Dr Cobb was not any differ rent.
As you mentioned in your podcast, he focused a lot
on the disparities and healthcare for non whites. I've come
across a book and my attempt to better serve my
patients that I think any of your listeners and health
(41:10):
care might be interested in, called Mind the Gap, a
handbook of clinical signs in black and brown skin. It
was written by a black medical student in London that
realized that he was only learning the white symptoms in
school and wanted to better educate his spellow students as
well as better serve his community. I hope that your
listeners will look into this and we can continue to
(41:31):
correct the disparities and our healthcare system. Again, thank you
for all that you do bringing the more obscure and
less talked about parts of history to light. Megan uh
Megan also sent dog pictures. Thank you so much for
the dog pictures and for this email. I spent a
moment looking at this UM at the Mind the Gap handbook. UM.
(41:52):
There's a whole website for it online and some of
it has uh like photographs of things like skin conditions
that look very different depending on the coloring of a
person's skin. UM. One of the ways that I know
this has come up with the COVID nineteen pandemic is
the oxygen monitors that go on your fingers, reading people's
oxygen saturation very differently if they are black or brown. UM.
(42:16):
So it's a there's a whole, huge and immediate relevance
to this, So thank you again for this email. If
you would like to write to us about this or
anither podcast, we're at history Podcasts that I heart radio
dot com. And we're also all over social media at
miss in History. So you'll find our Facebook, Twitter, Pinterest,
and Instagram, and you can subscribe to our show on
(42:37):
the I heart radio app and Apple podcasts and anywhere
else to get your podcasts. Stuff you missed in History
Class is a production of I heart Radio. For more
podcasts from I heart Radio, visit the iHeart Radio app,
Apple podcasts, or wherever you listen to your favorite shows.
Stuff You Missed in History Class News
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Tracy V. Wilson
Holly Frey
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