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The Influenza Epidemic of 1918–1920 among the Navajos: Marginality, Mortality, and the Implications of Some Neglected Eyewitness Accounts

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Abstract

The article examines the history of the 1918-1920 influenza pandemic as experienced by the Navajo people. Details on risk factors for the pandemic among the Navajo and other indigenous peoples and on influenza-related mortality on the Navajo reservation are presented. According to the author, the Navajo experienced unusually high mortality due to low socioeconomic and health status and limited community infrastructure. It is suggested that U.S. federal government neglect contributed heavily to these losses.

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... Many observers at the time described the 1918 pandemic as "socially neutral" [21]. However, race and income were critical to how the pandemic was experienced by the public [22,23]. ...
... [11,12] Native Americans suffered worst from influenza. The infection rate was 24% and total mortality among Navajos has been estimated to be as high as 12%, with 60% of deaths occurring in children under 15 years old [21]. Between October 1, 1918, and March 31, 1919, over 2% (6,270/304,854) of the general population died [26]. ...
... Access to care also predicted mortality [21]. Most cities lacked healthcare workers, who themselves were susceptible to infection. ...
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... Many died while in custody at Indian Schools, isolated from their homelands. The great influenza pandemic of 1918-1919 hit the Native American population "hard" (Brady & Bahr, 2014;Child, 2000). "Thousands of children died in these schools" due to poor health conditions, abuse, nutrition, and medical neglect, including suicide (Smith, 2009, p. 7). ...
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... The "health preconditions" of Native Americans living on reservations (about a quarter of Native Americans) are worse than those of any other group in America. This situation, combined with overcrowding, lack of sanitation, and extreme poverty, will likely lead to a repeat of the 1918 influenza pandemic, when nations such as the Navajo experienced a 12 percent mortality rate (Brady and Bahr 2014). 7 A Google search on the media follow-up to Adams's comment revealed that neither critics such as CNN's Bakari Sellers, Essence, and Congresswoman Maxine Waters nor supporters such as the Wall Street Journal, the New York Post, and John McWhorter stressed Adams's comment on the "burden of social ills." ...
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In 1863 the Dine began receiving medical care from the federal government during their confinement at Bosque Redondo. Over the next ninety years, a familiar litany of problems surfaced in periodic reports on Navajo health care: inadequate funding, understaffing, and the unrelenting spread of such communicable diseases as tuberculosis. In 1955 Congress transferred medical care from the Indian Bureau to the Public Health Service. The Dine accepted some aspects of western medicine, but during the nineteenth century most government physicians actively worked to destroy age-old healing practices. Only in the 1930s did doctors begin to work with - rather than oppose - traditional healers. Medicine men associated illness with the supernatural and the disruption of nature's harmony. Indian service doctors familiar with Navajo culture eventually came to accept the value of traditional medicine as an important companion to the scientific-based methods of the western world.
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Howard Philips and David Killingray Introduction Part I: Virological and Pathological Perspectives 1. Edwin D. Kilbourne A Virologist's Perspective on the 1918-1919 Pandemic 2. Jeffery K. Taubenberger Genetic Characterisation of the 1918 'Spanish' Influenza Virus Part II: Contemporary Medical and Nursing Perspectives 3. Wilfried Witte The Plague That was Not Allowed to Happen: German Medicine and the Influenza Epidemic of 1918-1919 in Baden 4. Nancy K. Bristow 'You Can't Do Anything for Influenza': Doctors, Nurses and the Power of Gender During the Influenza Epidemic in the United States Part III: Official Responses to the Pandemic 5. Geoffrey W. Rice Japan and New Zealand in the 1918 Influenza Pandemic: Comparative Perspectives on Offical Responses and Crisis Management 6. Mridula Ramanna Coping with the Pandemic: The Bombay Experience Part IV: The Demographic Impact 7. Wataru Iijima Spanish Influenza in China, 1918-1920 8. Kevin McCracken and Peter Curson Flu Downunder: A Demographic and Geographic Analysis of the 1919 Pandemic in Sydney, Australia 9. N. P. A. S. Johnson The Overshadowed Killer: Influenza in Britain in 1918-1919 10. D. Ann Herring and Lisa Sattenspiel Death in Winter: Spanish Flu in the Canadian Subarctic 11. Beatriz Echeverri Spanish Influenza seen from Spain 12. Patrick Zylberman A Holocaust in a Holocaust: The Great War and the 1918 'Spanish' Influenza Epidemic in France 13. Andrew Noymer and Michel Garenne Long-Term Effects of the 1918 'Spanish' Influenza Epidemic on Sex Differentials of Mortality in the USA: Exploratory Findings from Historical Data Part V: Long-Term Consequences and Memories 14. James G. Ellison 'A Fierce Hunger': Tracing Impacts of the 1918-1919 Influenza Pandemic in Southwest Tanzania 15. Myron Echenberg 'The Dog that Did Not Bark': Memory and the 1918 Influenza Epidemic in Senegal Part VI: Epidemiological Lessons of the Pandemic 16. Stephen C. Schoenbaum Tranmission of and Protections against Influenza: Epidemiological Observations Beginning with the 1918 Pandemic and the Implications
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The influenza pandemic swept through the Caribbean during the period October 1918 to March 1919 and resulted in c. 100 000 deaths. This article focuses on the British possessions and is based principally on official reports and the local press. It looks at how the virus entered and spread through the region, the possible reasons for variations in levels of morbidity and mortality between islands, popular responses to the infection, and the mainly fruitless official attempts to arrest and deal with the disease. Jamaica was the first island to be affected, and along with Belize and Guyana, suffered most severely. A number of islands, particularly those in the eastern Caribbean, appear to have escaped relatively lightly. Although all sections of the population were vulnerable, the heaviest mortality rates were among the very poor, East Indian immigrant labourers, and native Americans. There was also a high toll among males aged 15–40. Altogether the death rate from influenza in the British Caribbean was c. 30 000. In London influenza was added to the official list of British ‘imperial diseases’, and although it was recognized that poverty provided the conditions for the spread of disease, the resources in the Caribbean were barely used to improve standards of living and nutrition.
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Approximately 5,640 references oriented to the Navajo people, their land, and environment compose this revised bibliography. The references--published between 1638 and 1971--include historical, enthnographic, biographic, technical, popular, and fictional works as well as archival and congressional materials, newspaper accounts, articles from journals and magazines, books, pamphlets, manuscripts, and technical papers from governmental and Navajo tribal files. A subject index is included. (MB)
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New York City approached the 1918 influenza epidemic by making use of its existing robust public health infrastructure. Health officials worked to prevent the spread of contagion by distancing healthy New Yorkers from those infected, increasing disease surveillance capacities, and mounting a large-scale health education campaign while regulating public spaces such as schools and theaters. Control measures, such as those used for spitting, were implemented through a spectrum of mandatory and voluntary measures. Most of New York City's public health responses to influenza were adapted from its previous campaigns against tuberculosis, suggesting that a city's existing public health infrastructure plays an important role in shaping its practices and policies during an epidemic.
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The Spanish influenza arrived in the United States at a time when new forms of mass transportation, mass media, mass consumption, and mass warfare had vastly expanded the public places in which communicable diseases could spread. Faced with a deadly "crowd" disease, public health authorities tried to implement social-distancing measures at an unprecedented level of intensity. Recent historical work suggests that the early and sustained imposition of gathering bans, school closures, and other social-distancing measures significantly reduced mortality rates during the 1918-1919 epidemics. This finding makes it all the more important to understand the sources of resistance to such measures, especially since social-distancing measures remain a vital tool in managing the current H1N1 influenza pandemic. To that end, this historical analysis revisits the public health lessons learned during the 1918-1919 pandemic and reflects on their relevance for the present.
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To describe and analyse the nurses' role in responding to the influenza epidemic in New York City in 1918. Today the world is facing the threat of pandemic avian influenza and there is renewed interest in lessons learned from the influenza pandemic of 1918, one of the deadliest disease outbreaks recorded in history. Much of the published history has been written from a medical or military perspective. No comprehensive account of nursing's role has been written. A social history framework was used. Traditional historical methods were used for data collection, data immersion, the development of a chronology and themes. Critical analysis of social, political and economic context was also done. Primary sources included the Lillian D. Wald papers at the New York Public Library, newspapers, journal articles and other archival data. In 1918, New York City nurses provided care to thousands of patients. They did so with minimal federal support, relying on local community agencies to establish makeshift hospitals and provide soup kitchens. The Henry Street Visiting Nurses, assisted by numerous social agencies and Red Cross volunteers, visited patients in their homes and provided them with the only treatment there was: nursing care. In 1918, immediate cooperation among a previously established network of nursing and other social organisations and prompt cooperation with the American Red Cross and the United States Public Health Service was essential to New York City's response to the crisis. Should an influenza pandemic occur today, as many as a billion people could fall ill. Shortages of antiviral drugs, the speed with which the pandemic could occur and its widespread effects are such that nursing, public health and medical professionals will need to rely on local personnel and supplies. Immediate cooperation and collaboration among federal, state and local organizations will be essential to the response.
Article
The influenza pandemic swept through the Caribbean during the period October 1918 to March 1919 and resulted in c.100,000 deaths. This article focuses on the British possessions and is based principally on official reports and the local press. It looks at how the virus entered and spread through the region, the possible reasons for variations in levels of morbidity and mortality between islands, popular responses to the infection, and the mainly fruitless official attempts to arrest and deal with the disease. Jamaica was the first island to be affected, and along with Belize and Guyana, suffered most severely. A number of islands, particularly those in the eastern Caribbean, appear to have escaped relatively lightly. Although all sections of the population were vulnerable, the heaviest mortality rates were among the very poor, East Indian immigrant labourers, and native Americans. There was also a high toll among males aged 15-40. Altogether the death rate from influenza in the British Caribbean was c.30,000. In London influenza was added to the official list of British 'imperial diseases', and although it was recognized that poverty provided the conditions for the spread of disease, the resources in the Caribbean were barely used to improve standards of living and nutrition.
America's Forgotten Pandemic: Th e Infl uenza ofGeography May Explain Adult Mortality from the 1918-20 Infl uenza PandemicGeography May Explain
  • J N Hays Alfred
  • W Crosby
J. N. Hays, Epidemics and Pandemics: Th eir Impacts on Human History (Santa Barbara ca: abc-clio Inc., 2005), 385; Alfred W. Crosby, America's Forgotten Pandemic: Th e Infl uenza of 1918 (New York: Cambridge University Press, 1989), 311. 3. Svenn-Erik Mamelund, "Geography May Explain Adult Mortality from the 1918-20 Infl uenza Pandemic, " http://www.ed.In.se/papers/mamelund .pdfEpidemics 3, no. 1 (2011): 46-60; Barry, Great Infl uenza, 363; Crosby, America's Forgotten Pandemic, 228. 4. Mamelund, "Geography May Explain. "
Diné Bibliography to the 1990s: A Companion to the Navajo Bibliography of
  • M Howard
  • Bahr
Howard M. Bahr, Diné Bibliography to the 1990s: A Companion to the Navajo Bibliography of 1969 (Lanham md: Scarecrow Press, 1999);
Infl uenza defi nes an epidemic as "a local or national outbreak, a pandemic a worldwide one Discussing the 1918 pandemic in specifi c localities, he sometimes uses the term "epidemic, " and so have we
  • Barry 's Th E Great
Barry's Th e Great Infl uenza defi nes an epidemic as "a local or national outbreak, a pandemic a worldwide one. " Discussing the 1918 pandemic in specifi c localities, he sometimes uses the term "epidemic, " and so have we. Barry, Th e Great Infl uenza, 101, 215, 319, 328.
159; Svenn-Erik MamelundA Socially Neutral Disease? Individual Social Class, Household Wealth and Mortality from Spanish Infl uenza in Two Socially Contrasting Parishes in KristianiaSpanish Infl uenza Seen from Spain
  • Edgar Sydenstricker
Edgar Sydenstricker, "Th e Incidence of Infl uenza among Persons of Different Economic Status during the Epidemic of 1918, " Public Health Reports 46, no. 4 (1931): 159; Svenn-Erik Mamelund, "A Socially Neutral Disease? Individual Social Class, Household Wealth and Mortality from Spanish Infl uenza in Two Socially Contrasting Parishes in Kristiania 1918-19, " Social Science & Medicine 62, no. 4 (2006): 924; Beatriz Echeverri, "Spanish Infl uenza Seen from Spain, " in Th e Spanish Infl uenza Pandemic of 1918-1919: New Perspectives, ed. Howard Phillips and David Killingray (London: Routledge, 2003), 187; Crosby, America's Forgotten Pandemic, 227-28.
Living with Enza: Th e Forgotten Story of Britain and the Great Flu Pandemic of
  • Mark Honigsbaum
Mark Honigsbaum, Living with Enza: Th e Forgotten Story of Britain and the Great Flu Pandemic of 1918 (New York: Macmillan, 2009), 5; Jeff ery K.
Infl uenza Pandemic in Western Polynesia Howard Phillips and David Killingray, introduction to Phillips and Killingray, Th e Spanish Infl uenza Pandemic, 10; TomkinsInfl uenza Epidemic, " 181; D. I. Pool
  • Phyllis Herda Geoff
  • Rey W Rice
Phyllis Herda, "Disease and the Colonial Narrative: Th e 1918 Infl uenza Pandemic in Western Polynesia, " New Zealand Journal of History 34, no. 1 (2000): 133-44; Howard Phillips and David Killingray, introduction to Phillips and Killingray, Th e Spanish Infl uenza Pandemic, 10; Tomkins, "Infl uenza Epidemic, " 181; D. I. Pool, "Th e Eff ects of the 1918 Pandemic of Infl uenza on the Maori Population of New Zealand, " Bulletin of the History of Medicine 47, no. 3 (1973): 273-81; Geoff rey W. Rice, "Japan and New Zealand in the 1918 Infl uenza Pandemic: Comparative Perspectives on Offi cial Responses and Crisis Management, " in Phillips and Killingray, Th e Spanish Infl uenza Pandemic, 73-85.
106-7; Idaho Department of Health and WelfareHistory of Pandemic Infl uenza
  • Lynette Iezzoni
  • Infl Uenza
Lynette Iezzoni, Infl uenza 1918: Th e Worst Epidemic in American History (New York: tv Books, 1999), 106-7; Idaho Department of Health and Welfare, "History of Pandemic Infl uenza, " 2007, http:/healthandwelfare.idaho.gov/ Health/PanFluHome/History/tabid/872/Default.aspx. 12. Quinn, Flu; Craig T. Palmer, Lisa Sattenspiel, and Chris Cassidy, "Boats, Trains, and Immunity: Th e Spread of the Spanish Flu on the Island of Newfoundland, " Newfoundland and Labrador Studies 22, no. 2 (2007): 473-504;
Alaska's Greatest Disaster: Th eTh ere Were Young People and Old People and Babies Dying Every Week': Th e 1918-1919 Infl uenza Pandemic at Norway House
  • Ronald L Lautaret
Ronald L. Lautaret, "Alaska's Greatest Disaster: Th e 1918 Spanish Infl uenza Epidemic, " Alaska Journal 16, no. 2 (1986): 238; Ann D. Herring, "'Th ere Were Young People and Old People and Babies Dying Every Week': Th e 1918-1919 Infl uenza Pandemic at Norway House, " Ethnohistory 41, no. 1 (1993): 73-105.
Cytokine Storms: Systemic Disasters of Infectious DiseasesPreparing for the Next Pandemic
  • Rosenthal Michael
  • T Osterholm
Rosenthal, "Cytokine Storms: Systemic Disasters of Infectious Diseases, " Infectious Diseases in Clinical Practice 18, no. 3 (May 2010): 188-92; and Michael T. Osterholm, "Preparing for the Next Pandemic, " New England Journal of Medicine 352, no. 18 (May 5, 2005): 1839-42. 16. Barry, Th e Great Infl uenza, 239.
Th e Infl uenza and the Navajo
  • Albert B Reagan
Albert B. Reagan, "Th e Infl uenza and the Navajo, " Proceedings of the Indiana Academy of Science 29 (1919): 243-49;
Traders to the Navajos: Th e Story of the Wetherills of Kayenta
  • Frances Gillmor
  • Louisa Wade Wetherill
Frances Gillmor and Louisa Wade Wetherill, Traders to the Navajos: Th e Story of the Wetherills of Kayenta (Albuquerque: University of New Mexico Press, 1953); Franc Johnson Newcomb, Hosteen Klah: Navaho Medicine Man and Sand Painter (Norman: University of Oklahoma Press,
A History of the Navajos: Th e Reservation Years (Santa Fe nm: School of American Research Press, 1986), 119. 23. Wade Davies, Healing Ways: Navajo Health Care in the Twentieth Century (Albuquerque: University of New Mexico Press, 2001); Trennert, White Man's Medicine. 24
  • Garrick Bailey
  • Roberta Glenn Bailey
Garrick Bailey and Roberta Glenn Bailey, A History of the Navajos: Th e Reservation Years (Santa Fe nm: School of American Research Press, 1986), 119. 23. Wade Davies, Healing Ways: Navajo Health Care in the Twentieth Century (Albuquerque: University of New Mexico Press, 2001); Trennert, White Man's Medicine. 24. Newcomb, Hosteen Clah, 145; Kennedy, Tales, 36; Faunce, Desert Wife,
Th e 'Flu' among the Navajos
  • Tall Mitchell
  • Woman
Mitchell, Tall Woman, 128; Reagan, "Th e 'Flu' among the Navajos, " 134 (emphasis added).
Tall Woman, 128. 27. ReaganTh e 'Flu' among the Navajos 136-38; Alva C. Shinn, enclosure to "Hon. Commissioner of Indian Aff airs
  • Wetherill Gilmor
Gilmor and Wetherill, Traders to the Navajos, 228. 26. Newcomb, Hosteen Klah, 145-46; Mitchell, Tall Woman, 128. 27. Reagan, "Th e 'Flu' among the Navajos, " 136-38; Alva C. Shinn, enclosure to "Hon. Commissioner of Indian Aff airs, " in Alva C. Shinn to Carl Hayden, October 20, 1919, rg 75, ccf 1907-39 Navajo, box. no. 216, 97437-1920-731 to 223-1937-732, folder 93110-Navajo 1919-731, National Archives, Washington dc;
382. 28 Th e Problem of Indian Administration
  • Russell Lewis
Russell, "Navajo and the 1918 Infl uenza, " 382. 28. Lewis Meriam et al., Th e Problem of Indian Administration (Baltimore: Johns Hopkins Press, 1928), 437, 445, 452. 29. Trennert, White Man's Medicine, 109, 110, 117, 119, 121.
Infl uenza Epidemic of 199. 34. Trennert, White Man's Medicine
  • Haile
  • Lukachukai
Haile, "Lukachukai, " 447; McPherson, "Infl uenza Epidemic of 1918, " 199. 34. Trennert, White Man's Medicine, 109, 111, 117. 35. Weber, "Fort Defi ance, " 442-43.
Infl uenza Epidemic of White Man's Medicine, 123, 125-26. 40. Trennert, White Man's Medicine, 123. 41. Trennert, White Man's Medicine, 126; McPherson
  • Pete Davies
Pete Davies, Th e Devil's Flu (New York: Henry Holt, 2000), 83; Barry, Th e Great Infl uenza, 359. 37. Reagan, "Th e 'Flu' among the Navajos, " 131. 38. Gilmor and Wetherill, Traders to the Navajos, 222-24; McPherson, "Infl uenza Epidemic of 1918, " 191-92. 39. Trennert, White Man's Medicine, 123, 125-26. 40. Trennert, White Man's Medicine, 123. 41. Trennert, White Man's Medicine, 126; McPherson, "Infl uenza Epidemic of 1918, " 194-95. 42. Faunce, Desert Wife, 301-3. 43. Mitchell, Tall Woman, xxi, 130-33, 135. 44. Newcomb, Hosteen Klah, xv, 144-45, 147.
Th e 'Flu' among the
  • White Man Trennert
  • Bailey Bailey
Trennert, White Man's Medicine, 126; Bailey and Bailey, History of the Navajos, 119-20; Reagan, "Th e 'Flu' among the Navajos"; Reagan, "Infl uenza and the Navajo, " 247. 46. Trennert, White Man's Medicine, 248.