From Fugitive Leaves: “I Love the Flu”

~Guest post courtesy of Emily T.H. Redman, an Assistant Professor of History at the University of Massachusetts, Amherst where she teaches history of science.

I love the flu.

Don’t get me wrong. I don’t love the fever and chills, the runny nose, the sore throat, or the all-encompassing ache that seems to span from deep in the bones all the way to one’s hair follicles. I don’t love the complications—the respiratory infections, the myocarditis. In particular, I really don’t love the potential for death. What I love the flu for is divorced from these horrors, and lies in the pedagogical value afforded by teaching students about the history of influenza epidemics. Influenza epidemics are fascinating on a micro level, an evolving and mutating virus hitting the body with a slightly different impact every year. But flu season hits us on another level; as we collectively respond to epidemics it shapes our cultures, ideas, and traditions.

It was for additional information about the flu, among other examples from medical history, that I came to the collections of the College of Physicians of Philadelphia in January 2014. I was planning a new seminar on the history of medicine, and sought primary source materials for both lectures and for supplemental independent student research projects. I also used my visit to look for materials useful to my other courses, which span various topics in the history of science, technology, and medicine from my home department as an assistant professor of history at the University of Massachusetts, Amherst.

Nearly every fall semester, I (shamelessly) use my position at the front of the classroom to proselytize getting a flu shot. As a historian of science, I use examples from history to make the argument that it is imperative that most healthy individuals should protect themselves from the flu, for their own health as well as the health of the collective public. With the opportunity afforded by a new seminar in the history of medicine, I came to the archives to strengthen these arguments.

One of the aspects of the 1918-1919 influenza outbreak that makes for such compelling classroom fodder is the fact that this particular strain disproportionately impacted healthy young adults. This flu was fast acting, with a shockingly high rate of mortality. It was a flu that would have ravaged, say, a community of college-aged students living in close proximity in dorms and small apartments. This morbid drama offers the perfect opportunity for teaching about epidemiology and the cultural impact of disease on populations.

The materials I collected during my time researching at the College of Physicians of Philadelphia provided me with a rich assortment of primary source materials to explicate the devastation wrought by the flu. These primary sources

are crucial, as I have found a major obstacle to teaching about the influenza outbreak (and indeed, convincing students of the need for a yearly flu shot) is debunking the myth that the common flu is at worst a mere annoyance. Many students come to the classroom assuming the flu is nothing more than a more severe cold. One student—not alone in her query—asked why people no longer die from the flu. There are many misconceptions about the disease, and a historical approach can help us address them.

 

Using materials collected during my research, I developed a lesson beginning with the origins of the influenza outbreak. This history offers a complex view of epidemiology, as the flu spread with rapidity not just by sneezes and coughs, but also by the opportunity afforded by the waning years of WWI, when soldiers congregated in close quarters and civilians joined in large celebrations to mark the end of combat. These gatherings provided the perfect storm of disease propagation.

Unfortunately, this perfect storm was met with a flu unlike most others. This was a flu with an extremely high mortality rate. The chart below dramatically depicts the devastation wrought, with the high peak at the right side of the graph signifying the sharp uptick of deaths related to the flu as compared to earlier years’ epidemics.

A similar chart underscores the relative devastation among communities, particular in cities, by the flu. The figure below charts the total deaths in Philadelphia. Though the reproduction is of poor quality, the chart shows a spike in deaths in the mid fall of 1918. Two lines draw this spike: the outermost indicates the total deaths from all causes in the city, while the inner, nesting spike indicates the total number of deaths from influenza alone. This chart is chilling. The dramatic increase of deaths in Fall 1918 is clearly due almost exclusively to the outbreak of the flu.

Such images certainly lay the groundwork for teaching about the impact of the epidemic, yet numbers and line graphs only go so far in driving home historical reality. To make the winter of 1918-1919 come alive for students, I employ a seemingly benign table of figures to create a hands-on activity that packs a punch.

The table below lists the number of cases of influenza (and related pneumonia) among U.S. troops in camps and barracks. I use this example to mimic, somewhat, the close proximity with which our students live (though presumably they do so in a bit more luxury than that afforded by military barracks). In class, I annotate the image, replacing the numbers with figures reflecting the size of the class. I then ask students to take index cards corresponding to the first week, then the second, and so on. Over the course of our simulated autumnal flu season, we see how many students survive into January. This never fails to hit home.

Undoubtedly morbid, this exercise is nevertheless highly effective if implemented with care. Students gripping slips of paper can look around the classroom and begin to internalize what it might have been like, in those days before flu shots, to experience such a dramatic loss of life in their community, to live in fear of succumbing to this pervasive death themselves.

This exercise brings the historical reality of the epidemic from mere charts and tables, and underscores its human aspect.

This is why I love history. Collecting source material from the past—even the seemingly dull charts and graphs full of raw data—helps us understand the social, cultural, and political impact of events of the past. As students more fully comprehend the historical import of this moment in time, I allow them to explore a rich variety of sources related to the flu. One of the most valuable resources I obtained from my visit to the archives came in the form of a thick portfolio of clippings from local Philadelphia newspapers, magazines, posters, and other ephemera produced during and after the peak of the epidemic in 1918 and 1919. The bound collection is full of examples ranging from gruesome images of mass graves within city limits, to published reminders to citizens of hygiene recommendations like handwashing, drinking water, and, improbably, rinsing fruit.

These documents enrich students understanding of the history of medicine in ways my lecturing along cannot convey. They

allow students to read and experience it as if among the historical actors they are studying. The documents provide important opportunity for critical thinking and historical analysis, placing each within a multifaceted context. The documents, the materials I collected while conducting research at the College of the Physicians of Philadelphia, are crucial tools in my attempts to teach the history of medicine.

Of course, the collections I examined contain far more than only materials on the flu epidemic of nearly a hundred years ago. I feverishly photographed text and images from myriad sources in the collection, helping develop lectures on Progressive Era mental health policies and how these were related to themes of nationalism, tied to the emergence of psychology as a scientific profession. I transcribed documents related to the Northampton Lunatic Hospital, which was once situated just miles from the classroom where I teach. I collected countless ephemera – advertisements, promotional materials, product labels, and essays by medical professionals – on various (and often appallingly humorous in their dated sexism) aspects of women’s health.

My time in the reading room was not just professionally productive, but highly enjoyable, punctuated by laughter over old texts that did not quite stand the test of time, by jaw dropping moments, and by sober reflections on the impact of disease. I left the archives armed with hundreds of photographs and dozens of pages of notes, as well as new friendships forged with staff at the Historical Medical Library and Mütter Museum. I have since directed students to the collections, with one spending time in the archives and others using digital collections for various research projects.

Perhaps you should take it with a grain of salt, as I’m a self-proclaimed fan of the flu, but I cannot recommend more highly the collections or the experience of working at the archives of the College of Physicians of Philadelphia.