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Welcome to Stuff You Missed in History Class A production of I Heart Radio. Hello and welcome to the podcast. I'm Tracy B. Wilson. And I'm Holly Fry. We're coming up on the one year anniversary of the World Health Organization's announcement that covid-19 could be characterized as a pandemic that happened on March 11th of 2020.


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 aired our previous episode on the 1918 flu pandemic as a Saturday classic because it 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 and in Boston was one of the early, hard hit places, and she talked about getting a briefing at work saying that we were probably looking at 18 months to two years of pandemic.


But there's a big difference between intellectually having that possibility in your minds and actually living through it.


So I researched and wrote our episode on the 1918 flu pandemic that we aired as a Saturday classic after the covid-19 pandemic started. I wrote that back in 2014 and over the last year I have wandered over and over. Is this what it was like in 1918 and how would I have approached that episode differently if I were working on it today instead of seven years ago? 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. So we are going to take another look at the 1918 flu pandemic. I do want to note here that the 1918 flu pandemic was global and so is the covid-19 pandemic. But a big part of today's episode is how my own lived experience has shifted my my understanding of that earlier event and drawn my attention to totally different parts of the 1918 pandemic than were on my mind back in 2014.


So by definition, this gives things the more U.S. centric focus. I cannot tell you how how a person's lived experience in another place would have changed their understanding.


I also didn't start out thinking this was going to be a two part episode, but it is turned out there was a lot to talk about that we did not touch on back in 2014, much or at all.


OK, so we're going to do a quick review here as we lead in the 1918 flu pandemic stretched from early 1918 into the spring of 1920, although the largest peak was between October of 1918 and January of 1919, with a smaller but still significant peak between February and April of 1919. 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 vary considerably.


At the time, the global death toll was estimated at 20 million people. But today's estimates are more like 30 million to 50 million people, and sometimes even more so.


Illnesses like the flu are often particularly lethal for the very old and the very young. And that was true of the 1918 flu. But then in addition to that, it also disproportionately killed young, otherwise healthy adults, people who are in their 20s and 30s. 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 1918, more than 200000 of the two 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 1918 the world had the germ theory of disease, but not antibiotics. We knew which specific microorganisms caused some diseases, including tuberculosis, malaria 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 pandemic was a bacterium known as fifers bacillus that was named after its discoverer, Richard Friedrich Phifer.


During the 1918 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 in their cultures. Today, this bacillus is actually called Haemophilus influenzae, and while it does not cause influenza, it's not the flu virus. It does cause things like pneumonia, cellulitis and meningitis.


We also talked about 1918 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 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 hand washing because I used to work in it like food safety, education.


And when things started trending toward 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 keep up this habit for the rest of our lives. There were, though, some notable differences in the public health recommendations in 1918, though, at least in terms of U.S. culture, the idea that spitting on the ground is rude and unsanitary was really fairly new in 1918.


The first anti spitting campaigns had gotten underway just a couple of decades before that to try to prevent the spread of tuberculosis. Common drinking cups and shared towels were also frequently found in public places. So back in 1918, 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 1918, which brings us to the biggest, most obvious thing. We'd approach way differently now versus back in 2014. 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 of efficacy coming from virus particles being too small to be blocked by simple fabric, which is true, and which actually came from a U.S. Department of Health and Human Services website that was written about the 1918 pandemic.


But as has been discussed at length in the last year, well, fitting masks made of tightly woven cloth can stop respiratory droplets that are carrying those virus particles. That is not necessarily true. Of the masks that were being worn in 1918, though, those were typically made of gauze, which is a very thin fabric with an open weave. Some of them were made from cheesecloth, which also has a similar open weave, even with multiple layers. These fabrics might leave you with a relatively porous mask.


If you look at photos from the 1918 pandemic, sometimes you'll see people's facial features through their masks pretty clearly. Sometimes you can see the gozi holes in the material. Sometimes people also cut holes in their masks to smoke, or if they didn't have gauze or cheesecloth, they made masks out of materials that were way too thin to do any good at all. They almost look like wearing a translucent veil instead of a mask. Like I saw one photo of Red Cross nurses and it was literally only attached up over the bridge of their nose and had this filmy diaphanous quality.


And I was just like, that's not helping.


No. Well, it'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.


A publication called an Experimental Study of the efficacy of Gauze Masks, which was published in the American Journal of Public Health in 1920, 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 the sides of the mask instead. So if you're hearing us talk about this and you're thinking, wait a minute, didn't you talk about gauze masks being effective in that episode on Woolie and 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 than viruses. And those masks efficacy was really clearest among health care professionals who would have been wearing the masks in addition to other precautions and probably also with better masks, discipline and more thorough hygiene steps than the general public would have had.


Back to that 1920 paper, the author cited five reasons why Mask mandates did not seem to slow the spread of the disease in the 1918 pandemic. Quote, First, the large number of improperly made masks that were used. Second, 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, etc.. Third, wearing masks at improper times when applied compulsorily masks were universally worn in public, on the streets, in automobiles, et cetera, 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 of all kinds. This type of gathering with the attendant social intercourse between friends and office associates seems. To afford a particular facility for the transfer of the virus, another study in nineteen twenty one concluded that, quote, The face mask as used was a failure. The important bit there is the AV 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 1918 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 ducts 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. Hey, it's Holly. Listen, everybody is spending lots of time on video conference calls these days, but during those long calls, there's someone else you'd probably rather be connecting with.


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The most famous group of mass resisters during the 1918 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 22nd of 1918, and it ended on November 21st of that year. A full page ad ran in the San Francisco Chronicle that read, quote, Wear a mask and save your life. This ad was signed by the mayor as well as civic and business leaders and health officials.


The Red Cross distributed about 100000 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 ten dollars or imprisoned for up to 10 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 27th, 1918, health officer Henry D. Miller escorted James Wesser to a pharmacy to purchase a mask.


The details here are a little bit fuzzy, but Wesser refused to either buy or wear one. It's not clear which thing happened first, but these two things happened. Wesser struck Miller with a sack of silver dollars, and Miller fired his gun in the air. Miller kept firing as Wesser beat him up in the street. Miller's shots hit Wesser and two bystanders, and Wesser and Miller both faced charges after this altercation.


Yes, some of the mentions of this that have floated around in in the last year have sort of made it sound like Miller just unprompted shot somebody 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. Not that any of that is OK, 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 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 11th of 1918, that stopped most of the active fighting and mass compliance in San Francisco started to drop.


Then when the mask order expired at noon on the 21st, 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 mask situation. Some people set their masks on fire. The mask law in San Francisco was just one part of the city's strategy to control the flu. Other steps included closing dance halls and ordering streetcars 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 have reduced the rate of infection in San Francisco during the pandemic's worst spike in the fall of 1918.


But when flu cases started spiking again in San Francisco at the end of 1918 and early 1919, the city tried to reinstate this mask mandate and that is when the Anti Mask League formed. In response, they 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.


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 of the U.S. cities that mandated mask wearing during the 1918 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 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 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 social distancing and staying away from crowds. But there are lots of pictures from 1918 of huge groups of masked people standing shoulder to shoulder. Another recurring question that Tracy has had over the last year was the U.S. response to the 1918 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 to most of us, that's what this has seemed to be sure feels like a big old mess to me.


Yes. The short answer to all of Tracy's questions and probably years, I think most of us have had a similar resilience before.


The answer is yes. Yes.


So the US response to the 1918 pandemic was almost completely decentralized. The Centers for Disease Control had not been established yet. That happened in 1946 and the World Health Organization was established two years after that. So it did not exist either. U.S. 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 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. Blue's efforts to organize a federal response were essentially nonexistent until September, when the illness had been circulating for months and cases and deaths were increasing rapidly. Cities and states repeatedly asked 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 useful.


Presidential press briefings were not nearly as common in 1918 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 to get sick. Donald Friary, who was an aide with the U.S. 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 U.S. during the covid-19 pandemic also did not exist. Yet at this time, the Supplemental Nutrition Assistance Program, or SNAP, is a monthly benefit to help low income U.S. citizens buy nutritious foods. And this grew out of the government's first food stamp program. But that was not established until 1939.


There were union workers who had some kind of unemployment compensation as part of their union contracts in 1918.


But in general, unemployment insurance did not exist. Yet the first of many state unemployment bills was introduced in Massachusetts in 1916. But all of these bills failed until Wisconsin finally passed one in 1932. Unemployment insurance didn't really become widespread in the U.S. until after that point. During and after the Great Depression, Medicare and Medicaid also did not come into existence until 1965.


Congress did approve a one million dollar budget for the Public Health Service in 1918 to try to address a serious shortage of doctors and nurses. Many had been called up or had volunteered 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 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 700 nurses. The. Public Health Service worked on 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 U.S., the vast majority of aid during the 1918 pandemic was coming from charities and religious organizations and private citizens, not from 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 50 representatives actually there. The two parties worked out a unanimous consent agreement to push this legislation through. The final bill was approved by both the House and Senate on October 27th. 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 and 15000 to the Treasury because it simply did not recruit enough people to use all of the allocated money.


So we mentioned a moment ago that some of the communication around the pandemic was also not particularly effective in the U.S. and we will get to that after response to break. Hey, it's Tracy. Everybody is spending a lot of time on video conference calls these days, but during those long calls, there's someone else you'd probably rather be connecting with. You want to be online with your fiends?


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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 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 got sick is somehow connected to this supposedly foreign invader. And obviously, this type of othering nickname is not unique to the 1918 pandemic. The 1968 flu pandemic was known as Hong Kong flu. The worldwide HIV epidemic started out as gay related immune deficiency, and the racist nickname China Virus has stuck around long after the current pandemic disease was officially named covid-19.


Since there was no centralized agency formalizing public health advice in 1918, people were also hearing a lot of contradictory information about what to do and how to protect themselves. And in 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.


For example, Surgeon General Blue's first public communication about the pandemic was published on September 22nd of 1918. 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 food well, avoiding tight clothes and, quote, don't let the waste products of digestion accumulate.


They basically don't leave crap lying around. Right. Basic sanitation and extremely basic sanitation and health steps. Then on October 17th, as cases and deaths were really climbing dramatically, 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, the symptoms disappear after three or 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 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, 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. Then it was urgent.


As another example, Philadelphia Public Health Director William Kruzan repeatedly suggested to residents of Philadelphia that everything was under control and that the number of infections had peaked. In September of 1918, he decided not to cancel a Liberty Loan parade that was to promote war bonds. That parade had been scheduled for the 28th and he carried on with it, even though an outbreak had started at the Philadelphia Navy Yard just nine days before that.


Within 72 hours after the parade, every hospital bed in Philadelphia was full and sick patients were being turned away. Meanwhile, Kruzan kept up the refrain that everything was under control and the worst was over as the daily deaths in Philadelphia climbed to two hundred and then three hundred and then peaked at more than 700 teams were dispatched to collect bodies from homes and literally could not keep up with the deaths. Kruzan BAMN. Public meetings and closed churches, schools and theaters only after Philadelphia was experiencing hundreds of deaths a day, and it wasn't just government officials who were downplaying the pandemic.


A lot of newspapers carry daily or weekly updates of how many new cases and deaths that 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 term of the day, it was just the grip that people didn't need to be alarmed, that surgeon generals advice to avoid influenza that included like the world's most rudimentary basic sanitation information that ran next to newspaper reports about outbreaks and deaths.


Lists of precautions often framed things 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 Kruzan ban on public gatherings as not being for public health reasons or any cause for alarm. You one of the 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 passed capacity. There were not enough coffins. People were 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 Embury, author of The Great Influenza The Epic Story of the Deadliest Plague in History, has written on this phenomenon a lot and was a subject matter expert in 2005 and 2006 when the CDC was putting together an influenza pandemic plan in a twenty twenty 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 to the public for the sake of keeping calm and maintaining order in 1918 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.


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 punchline. Often, literally, because usually Everett would hit somebody in one strip from the 1918 pandemic. A masked Everet 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 muscles do any good. If a person's 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, 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 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 mentioned in that earlier episode we did on the 1918 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 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 U.S. cities during the 1918 to 1919 influenza pandemic. A paper was published. In 2007, and it looked at the steps taken by 43 cities between September 18th, 1918 and February 22nd, 1919, a period that covered the pandemic's largest peak in the United States. All of these cities had populations of more than 100000 people and were among the 66 most populous cities in the United States at the time.


The cities among those 66 that weren't included in this study just didn't have accurate enough data to use. They looked specifically at information about school closures, the canceling of public gatherings and the isolation and quarantine of sick people in their close contacts and all the cities that they looked at that 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.


Some of the cities had at least some kind of non pharmaceutical intervention in place for 20 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 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 rates than cities that did not.


Various cities took other steps as well. Beyond the cancellations, 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 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 18th Amendment to the Constitution, which prohibited the manufacture, sale and transportation of intoxicating liquors, had been passed.


But it had not been ratified by the states that didn't happen until January of 1919. So in general, the 1918 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 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 into operation and they had a limit of one person per five square feet of space, to quote a 2007 article and public health reports that discussed the 1918 response in Minneapolis and St. Paul, quote, Because clear orders were not being given to the public health officials, the public in turn was not receiving transparent and consistent advice that information should the public wear masks, why was it allowable to be next to someone in a streetcar and not in an elevator?


Why were church services closed while Red Cross workers gathered in crowded conditions in those very same churches with influenza a life threatening condition? Or was the panic the most dangerous element of the 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 cities here. But in 1918, 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. 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 1918 pandemic in the. It states next time we are going to dive into some more focused topics, which is honestly what I thought this episode was going to be like when I started on it. Like, for example, was anything happening with vaccines in 1918? 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 while we ruminate on all of this trace of listener mail?


I 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. 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 house work and projects that I've been doing during the pandemic.


More interesting. I'm writing to you as I have just finished your most recent podcasts on the Mississippi Freedom Summer and Debbie 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 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 Chaney, Goodman and Schwerner. What struck me most about this podcast was that it made me realize that for some people, this is not history. One of the victim's brother here, the show followed, was still very frightened to look into this case and even return 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 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 different. As you mentioned in your podcast, you focused a lot on the disparities in health care for nonwhites. I've come across a book in my attempt to better serve my patients that I think any of your listeners in health 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 fellow students as well as better serve his community. I hope that your listeners will look into this and we can continue to correct the disparities in our health care system. Again, thank you for all that you do. Bringing the more obscure and less talked about parts of history to light. Megan, Megan, also scent dog pictures.


Thank you so much for the dog pictures and for this email. I spent a moment looking at this at the Mind the Gap handbook. There's a whole website for it online. And some of it has like photographs of things like skin conditions that look very different, depending on the coloring of a person's skin. One of the ways that I know this is come up with the covid-19 pandemic is the oxygen monitors that go on your fingers reading people's oxygen saturation very differently if they are black or brown.


So it's a there's a whole huge and immediate relevance to this. So thank you again for this email.


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