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"There Wasn't a Lot of Comforts in Those Days:" African Americans, Public Health, and the 1918 Influenza Epidemic

Author(s): Vanessa Northington Gamble

Source: Public Health Reports (1974-) , APRIL 2010, Vol. 125, Supplement 3: The 1918- 1919 Influenza Pandemic in the United States (APRIL 2010), pp. 114-122

Published by: Sage Publications, Inc.

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Community Response

"There Wasn't a Lot of Comforts in Those

Days:" African Americans, Public Health, and the 1918 Influenza Epidemic

Vanessa Northington Gamble, MD, PhD*

synopsis

When the 1918 influenza epidemic began, African American communities were already beset by many public health, medical, and social problems, including racist theories of black biological inferiority, racial barriers in medicine and pub- lic health, and poor health status. To address these problems, African Ameri- cans mounted efforts such as establishing separate hospitals and professional organizations and repudiating racist scientific theories. Contradicting prevailing theories about African Americans' increased susceptibility to disease, it appears that during the 1918 epidemic the incidence of influenza was lower in African Americans. Although the epidemic had a less devastating impact on African American communities, it still overwhelmed their medical and public health resources. Observations about the lower rates of influenza in African Americans

did not derail racist theories about the biological inferiority of black people or overturn conceptualizations of black people as disease threats to white people. When the epidemic ended, the major problems that African Americans faced still remained.

department of History, The George Washington University, Washington, DC

Address correspondence to: Vanessa Northington Gamble, MD, PhD, The George Washington University, Gelman Library, Ste. 709G, 2130 H St. NW, Washington, DC 20052; tel. 202-994-0978; fax 202-9944571; e-mail <[email protected]>. ©2010 Association of Schools of Public Health

114 О Public Health Reports / 2010 Supplement 3 / Volume 125

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African Americans and the Epidemic О 115

"This pesky flu's all over town! And white and black and rich and poor are all included in its tour."1

When the 1918 influenza epidemic began its deadly tour across the United States, African Americans were already beset by a host of irayor public health, medi- cal, and social problems that shaped how they expe- rienced the epidemic and how the epidemic affected them. By 1918, medical and public health reports had documented that African Americans suffered higher morbidity and mortality rates than white people for several diseases. The Atlanta Board of Health, for example, reported in 1900 that the black death rate exceeded that of the white death rate by 69%. 2 In an analysis of the 1900 census, W.E.B. Du Bois, the influential sociologist and civil rights activist, found that African American death rates were two to three

times higher than for white people for several diseases including tuberculosis, pneumonia, and diarrheal disease. Although African Americans had lower rates for scarlet fever, cancer, and liver disease, Du Bois con-

cluded, "The Negro death rate is, however, undoubtedly considerably higher than the white."3

The medical and public health problems that Afri- can Americans faced during the 1918 influenza epi- demic must be understood within a broader context.

At the turn of the 20th century, black people found themselves in the midst of the "nadir in American race

relations," an historical period marked by disfranchise- ment, anti-black violence, legalized segregation, black peonage, and white supremacist ideology.4 Racism and legalized segregation restricted access by black patients and health professionals to health-care facilities. Racist scientific theories advanced notions of African Ameri-

can's biological, physiological, and moral inferiority. In addition, African Americans lacked political and economic power and lived in the least desirable and most disease-ridden neighborhoods. But despite their plight, African Americans created separate hospitals, facilities, and organizations to take care of themselves. During the 1918 influenza epidemic, these institutions proved essential because of rigid racial barriers in medicine and public health.

AFRICAN AMERICANS AND HEALTH IN THE EARLY 20TH CENTURY

Between 1900 and 1920, black physicians and social scientists sought to understand the factors contribut- ing to the poor health of African Americans. They aggressively repudiated theories that attributed the race's health status to biological or racial inferiority and ardently supported those that emphasized social factors. In 1906, Du Bois published The Health and

Physique of the Negro American to document the poor health status of African Americans and to analyze the underlying causes. A major objective of the mono- graph was to refute theories of black racial inferiority postulated by Frederick L. Hoffman, a statistician at Prudential Life Insurance Company. In his influential 1896 treatise, Race Traits and Tendencies of the American Negro , Hoffman argued that the excessive mortality rates in African Americans were due "not in the conditions

of life, but in race traits and tendencies."5 He viewed

immorality, general intemperance, and congenital poverty as race traits. Hoffman also contended that during slavery, African Americans were healthy and disease free, but that since emancipation "the colored race is shown to be on the downward grade, tending toward a condition in which matters will be worse than

they are now . . . and gradual extinction of the race take [sic] place."5 Public health historian Megan J. Wolff has called Race Traits "a compilation of statistics, eugenic theory, observation, and speculation" written to provide Prudential with scientific ammunition to demonstrate the uninsurability of African Americans and to halt the passage of state laws banning insurance discrimination.6

Du Bois agreed that black people had higher rates than white people for some diseases, including tuber- culosis, pneumonia, and infant mortality. However, he contended these disparities reflected social conditions, not racial susceptibilities. "The high infant mortality of Philadelphia today," Du Bois wrote, "is not a Negro affair, but an index of social condition."3 He argued that with "improved sanitary conditions, improved educa- tion, and better economic opportunities," the health conditions of African Americans would improve.3 Dr. C.V. Roman, editor-in-chief of the Journal of the National Medical Association , the organ of the black physicians organization, also harshly criticized Hoffman's "deduc- tions and prophesies" as giving solace to racism.7

Hoffman was not alone in his theory that African Americans were biologically inferior, inherently dis- eased, and doomed. In 1915, Dr. J. Madison Taylor, a white physician on the faculty of Temple University Medical School, contended that black and white people were totally unlike in racial characteristics and that black people were susceptible to tuberculosis because they were structurally maladapted to live in northern cities.8 Black physicians vehemently contested such theories and stressed that African American health

disparities reflected socioeconomic inequalities, not physiological and biological difference and inferiority. Roman maintained, "All history shows that ignorance, poverty and oppression are enemies of health and longevity."7 Despite the efforts of black physicians

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116 О Community Response

and social scientists, by the beginning of the influ- enza epidemic, many white physicians and scientists continued to believe in the biological inferiority of African Americans.9

Between 1900 and 1920, black physicians and nurses, frequently in concert with other black profession- als, used several strategies to improve the health of African Americans. In contrast to the fatalistic views of

Hoffman and his supporters, they firmly believed that disease rates in African Americans could be reduced. At

times their actions were political. They pushed for the enforcement of sanitation laws to clean up tenements and for housing reforms to improve black neighbor- hoods that had greatly deteriorated with the influx of African Americans to northern cities during the Great Migration. Between 1916 and 1919, approximately one- half million African Americans had moved from the

South.10 Historian Samuel Kelton Roberts notes that in

Baltimore, black public health activists viewed actions against housing segregation as inextricably linked to efforts to fight tuberculosis.9 Black health professionals also created programs to teach personal hygiene and sanitation, especially to poor African Americans and to recent migrants from the South. They also sought to increase the number of medical facilities open to black patients. Nationwide, hospitals either denied African Americans admission or accommodated them, almost universally, in segregated wards, often placed in undesirable locations such as unheated attics and

damp basements. The intransigence of the color line in medicine

and public health forced African Americans to create separate, and not always equal, medical institutions and organizations to provide training and employment opportunities for black health professionals. In 1891, the rejection of a young black woman by all Chicago nurse training schools solely because of her race prompted the prominent black surgeon Daniel Hale Williams to establish the nation's first black-controlled

hospital. By 1920, African Americans had established several hospitals, including Tuskegee Institute Hospital and Nurse Training School in Tuskegee, Alabama, in 1892; Frederick Douglass Memorial Hospital and Train- ing School in Philadelphia in 1895; and Home Infirmary in Clarksville, Tennessee, in 1906.11 The racially exclu- sionist policies of professional organizations also led African Americans to establish their own associations.

Black physicians created the Lone Star State Medical, Dental, and Pharmaceutical Association of Texas in

1886; the Old North State Medical Society of North Carolina in 1887; and the National Medical Association in 1895.12 In 1908, black nurses established the National Association of Colored Graduate Nurses.

At the turn of the 20th century, the African Ameri- can lay community also established self-help activities to improve the race's health status. The largest and most significant effort was National Negro Health Week, whose origins can be traced to 1913 when the National Organization Society of Virginia, under the leadership of Robert Russa Moton, established a local health week.13 The Virginia program attracted the atten- tion of Booker T. Washington, the influential head of Tuskegee Institute, who viewed good health as critical for racial advancement. He called for a national health week

whose goals would be to teach African Americans about the principles of public health and hygiene to help them become stronger and more economically produc- tive. The first health week in 1915 proved successful - 16 states held activities.14 Unfortunately, Washington died shortly after it. Robert Moton, his successor at Tuskegee, broadened the scope of health week activities, which included lectures, films, newspaper articles, health clin- ics, vaccinations, insect and rodent extermination, and street cleaning. The black community enthusiastically embraced health week. By 1925, at least 139 communi- ties held health week activities.15

During the first decades of the 20th century, Afri- can American women played essential roles in health activities. In 1908, black women established Atlanta's

Neighborhood Union, a settlement house that emerged as the focal point for several health efforts, including National Negro Health Week. The Neighborhood Union operated a health center; offered classes in nursing, hygiene, and prenatal care; provided health education; sponsored clean-up campaigns; investi- gated local health conditions; and lobbied for urban reforms.16 In Indiana, as early as 1903, public health officials recognized that more African Americans died annually from tuberculosis than white people. However, public funding to fight the disease in African Americans did not occur until 1919. The Woman's Improvement Club, a black woman's organization, stepped in and took the lead in black anti-tuberculosis efforts in India-

napolis. In 1905, the organization started an outdoor camp for black children with tuberculosis, and between 1916 and 1918 sponsored lectures on hygiene and the prevention of tuberculosis.17

The medical establishment did not totally neglect the public health problems of African Americans - self- interest prompted some action. At the 1914 American Public Health Association annual meeting, Georgia physician Dr. L.C. Allen called the health problems of African Americans the "white man's burden" because

"disease among the negroes [sic] is a danger to the entire community." He further observed, "Disease germs are the most democratic creatures in the world;

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African Americans and the Epidemic О 117

they know no distinction of 'race, color, or previous condition of servitude."'18 The public health threats posed by African Americans with "death-dealing micro-organisms at their hands" and concerns that their neighborhoods represented sources of conta- gion forced white people to provide some medical and public health services to black people.19 However, such views reinforced stereotypes about the cleanliness of African Americans, particularly women who had intimate access to white homes as maids, cooks, and

laundresses.20 In addition, such sentiments conceptual- ized African Americans as disease carriers rather than

as disease victims.

INFLUENZA'S TOUR THROUGH AFRICAN AMERICAN COMMUNITIES

On November 7, 1918, as part of a class assignment, 10 school girls from Public School 17, a black junior high school in Indianapolis, wrote letters to Sergeant Irven Armstrong, a former teacher who was then stationed with the Army in France. The letters, all written in perfect hand, contained news about home. The girls informed Armstrong that "a contagious disease . . . known as the Spanish influenza"' had struck the city and that several people had died. None of the letters mentioned that any of their family members had died. One correspondent did note that she had been "a victim of the influenza" but had recovered. The girls reported that their school and other public facilities had been closed for about a month because of the

epidemic. By November 7, their "vacation" had ended. Their school had been reopened for about a week, but they "were working with might and main to make up those four weeks." But, said one of the letter writ- ers, "I was very sorry school closed, but I would much rather stay at home than to come to school while the Epidemic [sic] was raging."21

The girls' letters make plain that the 1918 influenza epidemic included African American communities on its tour. However, as this article demonstrates, in stark contrast to the higher disease rates of African Americans for tuberculosis and pneumonia, it appears that during the influenza epidemic, African Ameri- cans were less susceptible than white Americans to influenza. Although the epidemic probably had a less devastating impact on African American communities, it still overwhelmed their medical and public health resources. Consistent with contemporary medical and racial practices, African Americans assumed primary responsible for providing care to race members struck by influenza, and black influenza victims received care primarily in segregated facilities. Furthermore, the

lower incidence of influenza in African Americans

did not derail racist theories about the biological inferiority of African Americans or overturn concep- tualizations of black people and their neighborhoods as disease threats to white people.

In 1918, mainstream newspapers rarely covered black life and when they did, they frequently reinforced racist stereotypes about black people. It was left for black newspapers to provide African Americans with "visibility and a voice."22 These newspapers dispensed news about events in black communities, chronicled the achievements of African Americans, articulated black

concerns, and attacked racial inequities.23 By 1918, the Chicago Defender was the largest and most influential black newspaper and the Philadelphia Tribune was one of the oldest. The Defender had a circulation of between 125,000 and 180,000, two-thirds of which was outside of Chicago.10 The newspaper operated as a national news weekly, rather than a local newspaper. It covered national and regional events and its extensive network of agents provided the editorial offices in Chicago with news about black communities nationwide. With

a circulation of approximately 20,000 and a focus on the Philadelphia area, the reach of the Philadelphia Tribune was vastly smaller than that of the Defender. 24 However, it covered events in a city that was especially hard hit by the 1918 influenza epidemic.

Throughout October and November 1918, the two newspapers carried news about how the epidemic affected African American communities nationwide.

Most of their coverage consisted of brief items mixed in with social news about church gatherings, gradu- ations, births, and social teas. It gave the impression that the epidemic did not substantially disrupt life in black communities, all the while underscoring the view that influenza took a greater toll on white lives. Although the papers provide a useful lens to examine the impact of influenza on African Americans, it is an incomplete one. The newspapers frequently based their reports on information submitted to or observed by their corresponding and distributing agents.

The newspapers told the stories of African Ameri- cans who had been sickened or killed by influenza, illustrating as the Baltimore Afro-American put it, "while the death rate from the epidemic ... is not as high as the white death rate, colored people are far from being immune of the disease."25 On October 12, the Defender revealed that attorney N.S. Taylor, vice president of the Equal Rights League, a black political organization, had contracted influenza while attending a league meeting in Chicago.26 It also reported that league president Wil- liam Monroe Trotter found his wife Geraldine gravely ill with the disease upon returning home to Boston.27

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118 О Community Response

She died a few days later.28 The October 19 edition of the Defender contained several items chronicling vic- tims of the pandemic. In Jamaica, New York, Mrs. May Robinson "had a bad attack of Spanish influenza" but was doing much better under the care of Dr. Carter, "the Race physician of this section."29 In Guthrie, Kentucky, influenza had killed Miss lone Barbara and Richard Fox. Twenty-five miles away in Hopkinsville, Kentucky, Charles Massie was recovering from the "dread disease" and the mother of Alex Brent, Jr. had received a telegram immediately summoning her to Newport News, Virginia, to see her critically ill son.30 In Chicago, Mrs. Nettie George Speedy, a Defender writer, had recovered and had resumed her responsibilities.31 But Elmwood Turnbo, age 23, and Joe Johnson, age 50, had both died from the disease.32'33 Throughout November 1918, the Defender continued to report on illnesses and deaths of African Americans from influ-

enza, including the November 1 death of renowned heavyweight boxer, "Battling" Jim Johnson.34

Historian Alfred W. Crosby describes Philadelphia as "reeling" from the influenza epidemic by mid-October. Deaths from the disease were mounting, medical per- sonnel and facilities were in short supply, and the city's infrastructure was crumbling.35 Yet, the magnitude of the crisis was not reflected in the pages of the Phila- delphia Tribune. The paper's first reporting appeared on October 12 and consisted most frequently, as did reports throughout October and November, of brief news items dotted throughout the paper detailing the closing of churches, announcing illnesses and deaths, and heralding the valiant efforts of black people against the epidemic. On October 12, the Philadelphia Tribune reported that not many people on North Ringold Street in North Philadelphia had escaped the "severe sickness," but only one person had died.36 It also noted that Chester resident, Private William Smith, was recu-

perating from influenza at Camp Sherman, Ohio.37 On October 19, the Tribune ran four front-page

articles about the epidemic. The first two announced the deaths of two prominent black Philadelphians, William H. Jackson and Joseph Williams. Jackson, age 44, had been an administrator at the Keystone Aid Society, a black insurance company, and had contracted influenza while nursing his wife and three sons who were too ill to even attend his funeral.38 The 27-year- old Williams worked as a chauffer and had been active

in several civic organizations, including the Citizens Republican Club.39 The third article reported that John T. Gibson, a successful entrepreneur, had closed his majestic Standard Theatre to comply with the orders from the department of health.40 The final article posted from Atlantic City read, "All Churches Were

Tightly Closed Last Sunday."41 It described how black physicians in the resort town were busy taking care of influenza victims, so much so that Dr. E.H. Terry had to take a few days rest and revealed that influenza had most likely killed Charles Deaver, the son of the rector at St. Augustine's Protestant Episcopal Church. The article also mentioned that Shiloh Baptist Church's pastor had intended to defy the "nonsensical" church closing order until the health department discovered his plans and placed a closing notice on church doors. Yet, in the midst of this influenza-related news, the article also announced that Dr. Sampson Brooks, the pastor of Baltimore's Bethel Church, had been visit- ing Atlantic City for a few days and that Mrs. Gardiner Pinkett had returned home after enrolling her son at Howard University.

The Tribune's muted coverage of the influenza epi- demic is significant. Historian V.P. Franklin contends that during the period 1912 to 1920, the Tribune "did not merely involve itself in educating black Philadel- phians about social problems, but played an active role in trying to improve the conditions within the community."24 The Tribune , for example, extensively covered the city's July 1918 race riot. The Tribune's limited coverage of the epidemic perhaps reflected the widespread belief that influenza affected primarily white people and that it was not a pressing problem for African Americans.

The closing of public-gathering places to prevent the spread of influenza affected the institutions that anchored and sustained African American neighbor- hoods. A public health order prematurely ended the season for the Chicago American Giants, one of the best black baseball teams.42 The epidemic forced Vir- ginia's Hampton Institute to postpone its 50th anni- versary celebration.43 Black churches throughout the country closed, forcing alternative forms of worship. In Philadelphia, the First African Baptist Church held a 30-minute open-air service in front of its building and the minister of Zoar Methodist Episcopal Church urged church members to hold home services and "to keep the fires of the spirit burning upon the home altars."44 The Chicago Defender supported the closing of public places because the epidemic was rapidly spreading and "too strict a caution cannot be observed in our efforts to stamp out this disease." It urged the health commissioner to order police to discontinue placing 25 to 30 prisoners in small, unsanitary cells. Underscoring ongoing tensions between the police and the black community, the Defender said that the police stations were "doing more to breed disease than any other agency supposed to be working for good in the city of Chicago."45

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African Americans and the Epidemic О 119

The epidemic mobilized African Americans, but shortages of resources, health-care facilities, and prac- titioners hampered their efforts. A white Red Cross nurse providing care in a small North Carolina town observed, "In the colored section of the town, there developed very few cases, but the colored Red Cross chapter was active and rendered great aid to its race."46 Black women volunteers in Maysville, Kentucky, led relief activities and went to the homes of influenza

victims to provide care and clean homes. However, the Cleveland Advocate , a black newspaper, criticized some of the town's leading black citizens for not doing enough during the epidemic.47 In Philadelphia, black home economics teachers volunteered to cook at

food centers, schools, hospitals, and nurseries.48 Local affiliates of the National Urban League, an organiza- tion established in 1910 to promote the social and economic welfare of African Americans in cities, also

implemented programs. In Columbus, Ohio, it hired a trained nurse to provide free care to influenza victims.49 At the Chicago branch, Mrs. MaryJ. Gordon organized volunteers to care for influenza victims in their homes.

In one case, the volunteers visited a home where a mother and her five children were stricken. Upon their arrival, they discovered that two of the children had died. The volunteers cleaned the house and also

summoned a nurse.50 Mrs. Gordon also supervised a health department clinic at the league's headquarters.51 The city's Red Cross also used the Urban League's offices to distribute food to African Americans during the epidemic.52

The crisis precipitated by the 1918 epidemic did not ease racial barriers in medical care. Black influ-

enza patients continued to receive care in segregated facilities and African Americans assumed the primary responsibility for providing care to race members. In Philadelphia, flu victims rapidly filled the 75 beds at the Frederick Douglass Memorial Hospital, one of the city's two black hospitals, forcing its medical director, Dr. Nathan Francis Mosseli, to establish an "emergency annex" three blocks away on the first floor of St. Peter Claver School, a black parochial school. Mosseli planned to take care of 40 "pay patients and those without means" in the temporary facility for "as long as our ability to maintain them holds out."53,54 Mosseli operated this clinic without financial support from the city's board of health, which had opened several emergency clinics under its direct supervision.55 Black patients in Richmond originally received care in a hos- pital basement until the city opened a separate hospital staffed by African Americans under white supervision at Baker Street Elementary School.56,57 When Virginia Governor Westmoreland Davis visited the hospital, he

hailed the segregated hospital and its staff: "It is an excellent thing to have our colored people so well able to work out their own problems . . . without any mixing of activities."58 In Baltimore, the epidemic overwhelmed the capacity of the 40-bed Provident Hospital, the only facility for black patients, and the hospital had to turn patients away. The Baltimore Afro-American criticized the situation as "the pitiable result of the jim crow [sic] policy practiced in white hospitals in the city, and the woeful lack of larger quarters in Provident."59

Black nurses also provided much needed care. In Chicago, Miss M. Diggs, a graduate nurse at Cook County Hospital, gave "generously of her strength" in caring for influenza patients, and Miss Mildred Jones contracted influenza while taking care of patients.60 At the start of World War I, black nurses had attempted to serve in the Army Nurse Corps, but racial discrimi- nation blocked their entry.61 However, the influenza epidemic did what the war could not - it forced the Army to drop its ban on black nurses. On December 1, 1918, three weeks after the war ended, 18 black nurses arrived in Ohio at Camps Sherman and Grant, where large numbers of black soldiers were stationed. Although the nurses lived in segregated quarters, they took care of black and white soldiers.62,63 But the epidemic did not end all racial obstacles. The dean of Ohio's Hiram College refused to allow a black nurse to care for influenza victims at the college after he discovered that she was black.64

THE RACIAL INCIDENCE OF INFLUENZA

Tommie Burns, Sr. was 12 years of age when influ- enza struck his hometown of Lumberton, Mississippl. Recalling his experiences he remarked, "It killed more whites than it did blacks."65 Several items from black

newspapers echoed Burns' view. On October 12, the Defender published a piece from its Atlantic City corre- spondent, who reported that the town had been dealt a "staggering blow" by influenza but that "among our own population we have had but few cases . . . , and we have had no deaths." The writer continued, "While

in the usual parlance, the town 4s dead' we are not, so cheer up, we have that much more to be thankful for."66 On the same day, the Philadelphia Tribune wrote that in West Philadelphia, "hundreds are lying now at the point of death, colored and white" but added, "There seems to be more influenza and deaths among white people than the colored people."67 The Defender published three items on October 26 that also con- tended that the influenza epidemic affected African Americans less frequently. One dispatched from Com- merce, Texas, noted, "The Spanish influenza is still

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120 О Community Response

spreading here. So far no deaths have been reported among our people." Another from El Paso proclaimed, "The Spanish 'flu' is still raging in the city among the Mexicans and whites. No fatalities nor serious cases

among our people as yet."68 The third under the head- line, "Influenza Spares Race," maintained that not one African American in Cape Girardeau, Missouri, had contracted the disease.69 On November 1, in a letter in

the Baltimore Afro-American, у Franklin Johnson opined, "As far as the 'Flu' is concerned the whites have the

whole big show to themselves." "Otherwise," he con- tinued, "if the "Flu" . . . had been prevalent among the colored we would have never heard the last of it, and health talks to colored people would have been printed by the wholesale in seventy-two point type in the daily papers."70

Medical and public health professionals confirmed these lay observations about the racial incidence of influenza. A November 2 headline in the Cleveland

Gazette read, "'Flu' Shuns Us, Says Health Doctor."71 In the article, Dr. G.M. Converse of the United States Pub- lic Health Service contended that African Americans

had suffered fewer deaths than white people during the epidemic. It went on to say that these "facts are so apparent" and had also been noted by black physicians and undertakers. The Chicago Department of Health in its analysis of the influenza epidemic concluded, "The colored race was more immune than the white."72 Dr.

W.H. Frost of the U.S. Public Health Service reported that in seven localities with substantial black popula- tions, their incidence rates were lower than white

people's even after adjusting for sex and age. Frost concluded that this incidence rate was "quite contrary to what would have been expected" given the docu- mented increased black death rates from pneumonia and influenza and "that the colored population live generally under conditions presumably more favor- able to the spread of contact infections."73 A study of influenza deaths in industrial policyholders covered by Metropolitan Life Insurance Company found that for the period 1911-1917, the influenza death rates for black females, aged 20-45, and black males, aged 20-55, exceeded those of white people, but during the pandemic dropped below them.74 The observation that African Americans had lower morbidity and mortality rates from the influenza epidemic was not universal. Other theories suggested that African Americans may have been less susceptible to influenza, but, if they contracted it, they died more frequently because of their social conditions and their susceptibility to pneumonia.75,76

Black physicians contended that it was a "matter of common observation" by physicians and the lay public

that the "susceptibility and fatality" during the epidemic had been greatest among whites."77 A January 1919 editorial in the Journal of the National Medical Associa- tion pointed to data from the Philadelphia Board of Health that showed that between September 20 and November 8, 11,875 white people died from influenza and pneumonia and 812 black people died. The edito- rial called the racial differences "interesting" because the death rates of African Americans in the city were "normally much higher than that of the white."78

These observations about influenza contradicted

prevailing theories about the susceptibility of African Americans to pulmonary diseases, especially as many of the influenza victims died from complications of pneumonia. Physicians, including black ones, offered few explanations for the lower influenza rates. One hypothesis suggested that African Americans were less susceptible specifically to the type of influenza that struck in 1918.75 Another theory reinforced claims that African Americans were biologically different. It held that African Americans were less susceptible to infections that entered the body through the upper respiratory tract, such as influenza and polio, because the lining of their noses were more resistant to microor- ganisms.79 An additional study analyzing the influenza rates between black and white soldiers concluded that

African Americans were not as susceptible to the disease when they lived under good hygienic conditions.80

The lack of accurate data collection during the public health crisis and the possibility that African American influenza cases may have been underre- ported because of inadequate access to medical care make it difficult to conclude definitively whether the incidence of influenza was lower in African Americans

during the epidemic. However, in 1918 the belief that influenza took a lesser toll on African Americans was

widespread and strongly held. The black lay public, black physicians, and white public health officials all shared this conviction. Thus, it appears likely that the incidence of influenza was lower in African Americans.

Several factors might explain this racial differential. Alfred W. Crosby argues that African Americans were more susceptible to Spanish influenza and that many contracted it during the milder spring epidemic and thus were immune during the more severe fall epi- demic.35 But it can also be argued that black people were less susceptible to influenza during both waves of the epidemic. Segregation cannot be discounted as a factor. It may have functioned as a de facto quaran- tine that limited the exposure of African Americans to influenza. The reasons for the apparent racial disparity are not clear.

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African Americans and the Epidemic О 121

INFLUENZA ENDS ITS "PESKY" TOUR

In October 1918, black Philadelphia physician, John P. Turner, hailed the "noble work" and "unselfish devotion

to duty" of black physicians "in treating and relieving victims of every race" during the influenza epidemic.81 He optimistically predicted that the epidemic had brought a "new brand of professional democracy." "No one stopped to inquire into the racial identity of the doctor," he wrote. Turner's optimism proved prema- ture. The influenza epidemic led to no major changes in opportunities for black health professionals - they remained segregated in the black medical world. The epidemic also did not prompt white people to develop any major public health or medical initiatives to improve the continued poor health status of African Americans. It also did not overturn racist scientific

theories about the inferiority of African Americans or conceptualizations of black people and their neighbor- hoods as disease threats to white people.

In 1918, even after the "War to Make the World Safe

for Democracy," African Americans continued to live under the specter of poor health, legalized discrimina- tion, socioeconomic inequities, disenfranchisement, and growing white supremacy. Discussing his experi- ences during the epidemic, black Philadelphian Clif- ford Adams recalled, "There wasn't a lot of comforts in those days." Adams's assessment held for African American life during the 1918 influenza epidemic and for many years after the "pesky flu" had finished its American tour.82

The author thanks Paul R. Goldstein for research assistance in

the preparation of this article, Kathleen Danielson and Marian Moser Jones for providing references, and Alexandra M. Stern and Howard Markel of the University of Michigan Center for the History of Medicine for providing digital copies of historical materials.

This work was supported in part by an RWJF Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation®, Princeton, New Jersey. The views expressed imply no endorsement by the Robert Wood Johnson Foundation.

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