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Listen to NPR's award winning pop culture Happy Hour on the I Heart radio app or wherever you get your podcasts. Welcome to stuff you missed in History Class, A production of I Heart Radio. Hello and welcome to the podcast. I'm Tracy Wilson. And I'm Holly Fry. OK, if you have missed our previous episode, we are revisiting the 1918 flu pandemic, which we previously covered on the show in 2014, that 2014 episode. Looking back on it, it's mostly just an overview of the disease itself and its international spread, its most of its focus.
If that's not at all how I would have approached that topic today after having lived through the covid-19 pandemic for the last year or so. In part one of this episode, we talked a lot about masks and how they were used in the 1918 flu pandemic and the general lack of an organized national response in the United States. When I started on this, I did not think those two things are going to fill up an entire episode, but they did.
So he made it a two parter. I made it a two parter.
Today, we are taking a shorter look at a wider range of things that have caught my attention over the last year and raised my curiosity about how they compared to what happened in 1918 and really 1919 and a little in 1920 also.
So something that's become increasingly clear over the course of the covid-19 pandemic is that the virus spreads easily in poorly ventilated areas. We have seen outdoor vaccine clinics and outdoor dining and schools having class outside or even just keeping windows open, plus discussions about what to do in places where the windows cannot be opened and at what point the enclosure around an outdoor dining location isn't any different from being indoors.
Yeah, that's been a whole process. Yeah, I feel like unless you have been asleep for the last 12 months, you have heard some or all of these conversations in the public square, by which I mean everywhere. Everywhere.
Yes. So there was also a big focus on ventilation in the U.S. in 1918, really even a bigger focus. The Anti Tuberculosis League distributed signs that read, quote, keep your bedroom windows open, prevent influenza. Demona tuberculosis. As we noted in part one, San Francisco ordered the streetcars to keep their windows open unless it was raining. And the Board of Health recommended that anything that could not be moved outside in San Francisco be canceled. One of the very most common public health recommendations nationwide during the 1918 pandemic was to get plenty of fresh air and to avoid crowded, stuffy indoor spaces.
Some of this was a response to the pandemic, but it was also connected to an ongoing overall trend of seeing fresh air as necessary to good health all the time. Even when there was not a disease outbreak. The Fresh Air Movement, established in the mid 19th century was focused not just on the health benefits of fresh air in general, but also on taking children from urban areas, many of whom were living in poverty for outdoor experiences in the country where they could breathe fresh, wholesome air.
So at first, this movement was rooted in the idea that miasmas or bad air were what caused disease. But around the 1880 medical science built on the work of people like Louis Pasteur and Robert Koch to conclude that microscopic pathogens rather than bad air were what caused disease. But some of these pathogens seem to be airborne. We now know that some of them are airborne, even as the miasma theory fell out of favor.
This focus on fresh air really did not.
Fresh air also was not just a preventative. It was also used as a treatment for respiratory diseases, in particular tuberculosis. Feel like you see this in all kinds of of older movies and books where it's like they took ill. So they were sent to the shore for fresh air. Yes, we have had it come up in many episodes of the show. When we talk about people's biographies, the first really effective treatment for tuberculosis was the antibiotic streptomycin developed in 1944.
Four decades before that point, tuberculosis treatment typically involved being sent to a sanatorium where people got plenty of rest and a nutritious food and got lots of fresh air, including sleeping outside.
The idea that ventilation was generally necessary for healthy bedrooms and other parts of your home, that was also well established by the late eighteen hundreds. For example, an eighteen eighty nine article in Ladies Home Journal, which was written by Kate Upson. Clark read quote, Windows in sleeping rooms should be kept wide open as much of the time as possible when the apartments are unoccupied. And while other chamber work should be done as soon as it can be managed after breakfast beds should be left to air several hours if they can be conveniently allowed.
The air in bedrooms is often obscurely foul because the bed does not get proper airing. People also slept on sleeping porches or in tents. Wealthy people who had enough room for it had just entire open their bedrooms built on to their houses who were living Rivendell style.
I also just really love the phrase obscurely foul and I'm going to claim that for my autobiography. One article that has gone viral during the covid-19 pandemic contends that Steam Radiator's, which are prevalent in a lot of older buildings in the US. Trace back to the pandemic, the basic idea was that the radiator would intentionally make apartments and other homes too hot to be comfortable. The solution open the window, which would both cool things off and bring in fresh air from outside.
That part of this whole argument is that the reason that radiators are often under the windows is because you were supposed to open the windows. But really also like that was the coldest part of most rooms. So it made sense to put the radiator there and also, like the space under a window, didn't have a lot of other use a lot of the time, like definitely more complicated than you're just supposed to leave the window open. However, in addition to all that, the steam radiator was invented in the mid 19th century and over the next couple of decades, they were refined to a design that still exists in many homes.
Today they are in my home here in the home I lived in before this one. They were already an increasingly popular method of home heating well before the 1918 pandemic started. It is definitely true that a lot of these earlier radiator systems really overheated and in some cases still overheat people's living spaces. But another big reason for that is that the first thermostat used for home heating was not introduced until 1986. Before that, and then until people retrofitted their older systems with new thermostats, people had to adjust their furnaces and boilers manually.
And in a lot of multiunit buildings, there was just no way for people in individual units to adjust their boilers and their radiators at all.
So while it's possible that the 1918 pandemic accelerated some of these trends that were already underway, radiator's and fresh air as a health necessity like those were already really well established.
Also, just in case you go looking around for it, Snopes Dotcom has rated this claim about Steam Radiator's in the 1918 pandemic as true. But most of the articles claiming that the 1918 flu pandemic led to two hot radiator systems, all traced back to the same person. And we haven't been able to confirm this idea through any other sources.
Yeah, there's like one person who's making that argument, from what I can tell, and a lot of other places picking that same argument up. Moving on. During covid-19, we have seen a huge trend and people working from home, if their jobs are conducive to doing that, there really were not nearly as many jobs that met that criteria in 1918. So a bigger trend in 1918 was people just not going to work, even though they were not being paid because they were afraid of getting sick and dying.
In a lot of industries. Concrete numbers on this are hard to track, but anecdotally, absenteeism was really high in businesses that weren't shut down because of the pandemic. One industry that did keep good records was shipyards. Shipyard workers were essential, especially in the context of the war, and many shipyards had medical staff on site even as the pandemic led to such an enormous shortage of medical workers. But in New England shipyards, the rate of absenteeism was often around 50 percent.
Yeah, some of those surely would have been folks who were sick, but others were folks who were like not I'm not not doing it. In other news, remember when the covid-19 pandemic started, nobody could find toilet paper flour. Yes. And there are still things I would want from the grocery store that did still have that day there out of a. There were also shortages in 1918 as I started to wonder, but it was really not necessarily because of the flu pandemic since the 1918 pandemic started near the end of World War One.
A lot of basic necessities were already being rationed. So in general, things like food and fuel were already in short supply because of the war. So it's likely that existing shortages made the pandemic more difficult rather than the pandemic causing a lot of shortages. Similarly, it's kind of hard to pinpoint the impact of the pandemic on the U.S. economy or the global economy because it is largely overshadowed by the economic impact of the war and then demobilization when the war ended.
Yeah, that's kind of like a saying where the onion has two layers, but the layers have fused and kind of crossed over into one another. You can't really feel them apart.
The general conclusion is like the 1918 pandemic impact on the economy, which is a nebulous thing, was more shorter term and and more confined to specific industries than like the total wartime and then demobilization impact. One actual shortage that was connected to the pandemic was coal. Coal production in the US dropped by as much as a sixth due to illnesses and absenteeism. And this in turn created problems for the steel industry, railroads, shipping and for heating and electricity, leading to a series of government inquiries into the matter.
In some cities, health authorities took steps to make sure that quarantined families had enough coal to heat their homes.
So aside from this, there was huge demand for every over-the-counter cold and flu remedy in existence, along with disinfectants. None of that seems really surprising to me. People bought up all the stock at their local pharmacies and drugstores of all of these products. There was also a massive run on atomizers, which people would use to mist themselves and the people around them and the environment where they were. Sometimes these were just filled with water to keep the nasal passages moist.
But there were also antiseptics and supposedly anti flu preparations that people would miss out with their atomizers.
So we are going to take a quick sponsor break and then we are going to talk about some vaccines. This episode is brought to you by audible plus from audible dotcom audible plus gives you full access to the popular plus catalog. That means you can listen to thousands and thousands of audiobooks, original entertainment and podcasts, including ad free versions of your favorite shows and exclusive series. And if you need guided fitness, meditation or sleep help, they have tracks for those so you can get better rest.
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We mentioned in part one of this episode that there was no vaccine for influenza in 1918 and that before the 1918 pandemic, researchers thought the culprit for the flu was a bacterium called fifers bacillus that was also known as bacillus influenzae. However, that lack of knowledge did not stop health authorities from trying to create vaccines and vaccinate people against the disease in 1918 and in some cases, these vaccines were meant to try to prevent bacterial pneumonia. This was a secondary infection that did cause a lot of the pandemic's deaths and other situations, though doctors really believed that they were targeting the actual flu with their vaccines or they were just desperate enough to save people's lives, that they were willing to pretty much try anything.
Hundreds of thousands of doses of these vaccines, possibly more than a million doses, were administered during the pandemic. The federal government and the U.S. Public Health Service weren't really involved with this and didn't create any kind of national development testing or distribution plan for these vaccines. Instead, multiple different researchers and institutes were working on this as quickly as they could, including the Rockefeller Institute, the Pasture Institute and the Army Medical School. State and local health departments were on the case as well.
William Park at the New York City Health Department developed a vaccine that used heat killed Fifers bacillus in early October 1918. The Army Medical School created one as well. In Philadelphia, Dr. SeeWhy White created a vaccine that combined killed bacillus influenzae and two different strains of pneumococci. The list goes on and on. Overall, the methods for creating and testing these vaccines were not scientifically very rigorous. Even in established research centers, timelines were rushed and abbreviated. The very basic steps of killing a bacterium and making it into an injectable form.
We're not all that difficult. So all kinds of people with varying levels of skill and experience. We're all working on this and in some cases we're making vaccines that we're then actually administered to people.
These vaccines could not prevent the flu, though, since they had nothing to do with the influenza virus, but they could potentially prevent bacterial pneumonia studies into whether they actually did were also all over the place. A 2010 article in the Journal of Infectious Diseases looked at 13 different vaccine studies that took place during the 1918 pandemic. None of them were double-blind or randomized, and their methods were inconsistent. But overall, this report estimated that the vaccines used among civilian populations were 34 percent effective at preventing secondary pneumonia and showed a 42 percent reduction in case fatality rate in military populations.
Those numbers were 57 percent and 70 percent.
Those 13 studies do not represent all the different vaccines that were in use, though, and some of the papers that were published at the time paint a far less rosy picture than that one. That suggests that some of the vaccines did have some efficacy, at least in treating secondary infections. For example, in 1919, the Journal of the American Medical Association published the results of a vaccination effort using a vaccine that was supplied by Dr. Ottone, who was the chief of the laboratory of the Chicago Health Department.
The recipients were all impatient residents at a mental hospital. So that had some medical ethics questions as well. This vaccine contained bacillus influenzae for different types of pneumococci and two types of streptococcus. That's a lot in this case, more vaccinated people developed influenza and secondary pneumonia and more vaccinated people died than unvaccinated people. The American Medical Association was generally pretty pessimistic about the efficacy and the promise of these vaccines during the pandemic.
And just to be 100 percent clear, the preponderance of different vaccines in 1918, which were put into use just a few months after the disease started to spread, was largely because the process of developing and testing a vaccine wasn't yet standardized, and the development and testing procedures that did exist were often skipped over because the situation was so dire. But that is not why vaccines for covid-19 have been developed surprisingly quickly. The covid-19 vaccines have built on years or in some cases decades of existing research into viruses, vaccines and manufacturing methods.
This includes research into two other coronaviruses which cause SARS and merged RNA vaccine. Technology has also been in the news a lot, but it's been going on way before this for more than a decade. Yeah, a big reason things have gone so quickly with covid vaccines is money. Governments and philanthropists have funded vaccine research. Governments have also preordered vaccines in bulk so that pharmaceutical companies are not running the financial risk of making a vaccine that it turns out nobody actually wants to buy.
The influx of funding has meant that pharmaceutical companies are willing and financially able to work a lot faster and to run multiple trials in parallel. That is something that would go a lot more slowly without all that money.
OK, so moving on, something that didn't come up at all zero times in our original episode on the 1918 flu was the fact that there was a midterm election in 1918.
And it seems like a little bit of a weird omission. Having lived through November of twenty twenty. But if you're looking at it, not having had the hindsight of an election year during a pandemic, it just may not be the thing that bubbles up. Now, in 1918, voting in general was most accessible to white men in theory under the 15th Amendment to the Constitution, quote, The rights of citizens of the United States to vote shall not be denied or abridged by the United States or by any state on account of race, color or previous condition of servitude.
But in practice, discriminatory voting laws made it much harder or even impossible for most people of color to vote. Indigenous people in many Asian people were not considered citizens, and the 19th Amendment had not been passed yet. So women had the right to vote in some places, but not in others.
In November of 1918, the pandemic had largely peaked in the eastern part of the U.S., and many eastern cities and states had returned or were returning to business as usual. So effects on the election there were pretty minimal. But in the Midwest, in the West Coast, the pandemic flu is still spreading rapidly, especially in these areas. Candidates did a lot more of their campaigning by mail and gave interviews in newspapers. This was especially true in places where large gatherings and door-To-Door canvassing were banned for the sake of public health.
And sometimes these bans led to accusations of partisan interference. For example, Democratic Party leaders in New York were outraged when an all Republican board of health ordered the Democratic candidate, Alfred E. Smith, could only give a planned speech if it were moved to an open air location.
Asked for Election Day itself, people in high risk areas tried to time their trip to the polls to avoid crowds. Some of the votes in Salt Lake City were cast in tents in some places, faced a shortage of poll workers because they were sick. And since this was happening in Western states, where mask requirements were already a lot more common, a lot of jurisdictions specifically required voters to wear masks to the polls. For example, the Rocky Mountain News of Denver, Colorado, published an article titled, quote, Precautions at the Polls ordered to prevent the spread of plague, which advised people to wear the standard Red Cross mask, not crowd polling places, and refrain from assembling in groups for political discussions.
I kind of love. In Toledo, Ohio, police reinforce the need to close the saloons, restaurants and other public places on Election Day and night, and probably some people just didn't vote or in some other way didn't participate in the election. In Oakland, California, a quarter of the election board resigned because of fear of the pandemic. Nationwide, voter turnout was about 10. Percent lower than the previous two midterm elections, although some of the drop is probably because so many men were away at war and in some places flu cases increased sharply after Election Day, something that happened again in the wake of celebrations following the November 11th, 1918, armistice.
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Across the board around the world, the 1918 flu pandemic was hardest on the poorest people, although the virus could and did strike people of all social and economic classes, poor people were the most likely to get sick and the most likely to die. Data on how different racial and ethnic groups were affected is spottier even in places where overall record keeping was generally good. The sheer magnitude of illnesses and deaths often overwhelmed the system entirely. In most of the U.S., demographic data was less granular than it often is today, with populations grouped as white and non-white.
But even with those caveats, it's clear that some of the same disparities we've seen during the covid-19 pandemic were also there in 1918. This really isn't something that we talked about much when we discussed the pandemic back in 2014. One exception was a brief mention of the fact that the pandemic was incredibly devastating to the Inupiat population of Alaska, killing as many as 90 percent of the residents in some of those communities. The pandemic was particularly deadly among other Alaska native peoples as well.
This was not confined to Alaska. Globally, indigenous people were some of the most profoundly affected by the 1918 pandemic. Death rates were also particularly high among Internet peoples in northern Canada and Greenland. The same was true for Aboriginal peoples in northern Australia, Maori in New Zealand and indigenous peoples from several Pacific islands, including Western Samoa, Nauru, Tahiti and Tonga.
Looking at death rates by continent is tricky because within one continent there could be a huge variation from country to country or region to region. And taking a continent wide view of the pandemic also excludes the Pacific islands that we just mentioned where the death toll was truly catastrophic.
However, some sources do look at this data by continent, and when you look at death tolls that way, the place with the highest average mortality rate in the world was sub-Saharan Africa.
In addition to factors stemming from things like economics, resources, racism and colonialism. A possible reason for this was that the pandemics first wave in the first half of 1918 mostly seems to have stopped in northern Africa and a small area in southeastern Africa without nearly as much spread elsewhere on the continent. Then the virus mutated before it's particularly lethal second wave around October of that year. So when the more lethal strain of the virus made its way to sub-Saharan Africa, mostly introduced through European ships involved in World War One, most people had no immunity to it.
And it spread particularly easily in the United States. Specifically, the mortality rate for indigenous people was four times higher than that of the general population. Although those numbers did vary widely among different indigenous tribes and nations, black people in the United States had a lower mortality rate overall than white people during the pandemic, according to a 2019 article in the International Journal of Environmental Research and Public Health. 1918 was the only year in the 20th century when that was the case.
However, black Americans had a higher case fatality rate than white Americans did in the 1918 pandemic. And this suggests that black Americans were somewhat less likely to contract the disease but more likely to become seriously ill and die when they did. The exact cause of this combination is not entirely clear, but it was surely affected by racism within the health care system, including doctors and hospitals that did not treat black patients even in the middle of a pandemic.
There were a few places in the U.S. and around the world that managed to protect themselves from the 1918 pandemic, or at least severely limit its impact. A 2006 report by the University of Michigan Medical School looked at seven communities in the U.S. that didn't have many flu cases during the pandemics deadly second wave and also had no more than one death. They were the San Francisco Naval Training Station at Yerba Buena Island. That's in California, of course, Gunnison, Colorado, Princeton University in New Jersey, the western Pennsylvania Institution for the Blind in Pittsburgh, Trudeau Tuberculosis Sanatorium in Saranac Lake, New York.
Bryn Mawr College in Pennsylvania and Fletcher, Vermont.
It is not entirely clear why these communities were relatively spared, though most of them implemented the same types of non pharmaceutical interventions that we talked about in part one, things like masks and social distancing and hand hygiene and closing schools and banning large gatherings. In other words, they were doing a lot of the same basic things that a lot of other places were also doing, but with apparently better results.
But some of these communities also showed some relatively risky behaviors. Fletcher, Vermont, for example, held a Red Cross dance in September and some of its residents traveled to Essex, Vermont, for a fare. A soldier from Camp Devens, Massachusetts, also traveled to Fletcher for his wedding while Camp Devons was in the middle of an outbreak that infected almost one third of the camp.
But somehow the flu nearly skipped past Fletcher entirely because that wedding part especially feels almost like, you know, a 20 20 super spreader headline in the making. Uh huh. So among the report's conclusions, quote, The escape of a community from the brunt of the pandemic was likely the result of multiple factors in the cases we studied, not least of which included good fortune, viral normalization patterns and geographical separation. We should not be seduced into thinking we can easily translate these historical examples into contemporary situations beyond the scope of this study.
There were some island communities that were able to delay the pandemic at least somewhat. American Samoa required all ships to quarantine for five days and actually kept that requirement in place until 1920. By the time the flu was introduced there, it had mutated into a milder form and American Samoa reported no deaths. American Samoa and Western Samoa, now the independent state of Samoa, are part of the same island chain. And as we noted earlier, Western Samoa was particularly hard hit.
More than a fifth of its population died of the disease after it was introduced by people aboard the steamship typhoon. The harbormaster in Apia, Western Samoa, had not realised that there was an outbreak at the ship's departure point of Auckland, New Zealand, and had allowed people to disembark, Australia also quarantined strictly every ship that arrived through most of the pandemic. But in January of 1919, disease spread from ship to shore, possibly through medical workers who were treating six sailors.
The strain of the virus that spread around Australia in January and February of 1919 was less lethal than the one that had peaked around the world the prior October.
Consequently, Australia had one of the lowest death rates in the world two point seven per 1000 people. But that's still meant that at least 15000 people died. The island of Tasmania was even more isolated and did not start seeing cases at all until August of 1919.
Other places that saw relatively low mortality rates included Denmark and China, although it's not entirely clear why there's a lot of not quite sure, like some of the first cases that are usually noted as like these were the first 1918 pandemic flu cases were seen in the United States at Fort Riley, Kansas.
But there's some some suggestion that possibly this basic same virus was circulating in a lot of places earlier and that it just mutated into a form that became more noteworthy at that point. And so one idea is that maybe some of these other places that had relatively low numbers of cases had been some of the places that this earlier, much more mild version of the of the flu was circulating. So people already had some immunity. One last thing before we close out these episodes, I know during the covid-19 pandemic, a lot of us have been trying to find ways to stay active while also not really being able to get out much.
This is also true, obviously, in 1919, and not just because people were trying to reduce their exposure to other people, it was also because this was during World War One and a lot of people were being held as prisoners of war or otherwise being interned around the world.
Joseph Hubertus Politesse was a German national who was living in Britain during World War One. After the war started, he was interned as an enemy alien anacleto camp on the Isle of Man. Politesse was an athlete, a gymnast and a boxer, and he worked out ways to try to keep himself and his fellow internees fit while they were incarcerated for the rest of his life. Palletize would claim that when the pandemic struck, no one at Nikolo Camp who was doing his exercises got sick.
Of course, there's a lot in this story that's a little hard to pin down today. There were definitely flu outbreaks at Anacleto and this so-called enemy aliens at the camp were blamed for introducing the virus to the rest of the Isle of Man. That's probably as much about xenophobia as it was about people actually being brought to this camp, but knuckler was also divided up into multiple compounds that were pretty isolated from each other. And it's not entirely clear if there was an outbreak in the compound where Paladin's was actually housed.
This did become part of the origin story of the politesse exercise method, though I'm sure many people are doing it at home because it is easy to do on your own in your house.
You don't need a reformer. I'm riding an exercise bike and playing ring fit adventure.
Nice. Just lifting my cats 50 times a day. No, I'm kidding.
Yeah. For a while I was doing nothing except walking outside when the weather permitted and then as as it got a lot snowier and colder here in Massachusetts, the weather was not permitting nearly as often. And I was like, I feel bad never moving.
I need to address that. Yes, I am very thankful that we have a treadmill in our house for a long time because it's been real handy. You know what else is handy? Yeah. Listener mail. You got some.
I do. I do. I have listened to me. OK, this is this is a reference to an episode from quite some time ago, but it's honestly one of my favorite episodes. And I love it every time we get an email like this. This is from Jennifer. Jennifer has the subject line of this email. Thanks to you. I found out my mom was a smuggler. Nice. And so the email begins. No, seriously, dear Holly and Tracey, long time listener, never a writer of fan mail, but this has been long overdue.
I wanted to thank you for your episode back in 2016. Butter versus margarine. I grew up in Wisconsin but had never learned about the banning of margarine. Perhaps some folks were still nursing grudges with a smiley emoji. But what was truly the delight of the episode was the conversation it led to with my mom, now 84, I asked her if she remembered the margarine ban. Oh, yes. And what she thought of it. She was quiet for a moment and then mentioned that she used to drive ladies from church down to Illinois in her car and they used to fill up the trunk with their olio purchases and then drive back north.
My mother was a smuggler and I'd never have known it if it weren't for you. So thank you. I've attached a picture of her. You'd never guess this high school princess was going to turn rebel, would you? Also, I've been working on my family genealogy and my great grandfather, mom's grandpa was a dairy farmer, which I knew. What I didn't know is that he helped lead what I am personally calling the great Swiss cheese rebellion of nineteen thirty six.
It turns out the feds were demanding Swiss cheese be made with a certain percentage of butterfat and the farmers were saying that percentage was terrible and they demanded it be changed to the percent they thought made it more delicious. Swiss cheese. They withheld their milk until demands were met. I'm pleased to report they won and that their specific Swiss cheese butter fat percentage is now codified in U.S. law. Title twenty one, Section one three three point one nine five of the FDA's regulations on food for human consumption.
Apparently I come from a line of daring dairy ne'er do wells and I'm so happy to know this. Thank you again and again for these shows. They are fun to listen to you and they've sparked some great family conversations.
Cheers, ladies. Keep up the great work.
Thank you so much, Jennifer. This for this email. I love both of these stories so much. I love the whole weirdness about the fight between butter and margarine. And I love the oleo smuggling and I love the rebellion over how much butter fat is in the Swiss cheese. Listen, always more. Always more.
Last night, my spouse was cooking our dinner. And I saw him put an entire third of a stick of butter in the carrots. I think that sounds about right.
It was amazing. The carrots were fantastic. So I just felt like everyone needed to know about our butter.
Anyway, if you'd like to write to us about this or any other podcast or history podcast that I heart, radio, dotcom, and we're also all over social media edmiston history, which is where you'll find our Facebook, Twitter, Pinterest and Instagram. And you can subscribe to our show on the I Heart radio app and Apple podcasts and anywhere else you get your favorite podcasts.
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