– Dr. Victor Vaughan, President of the American Medical Association
This quote from John Barry's The Great Influenza: The Epic Story of the Deadliest Plague in History (page 403) got me thinking about how intellectual histories – those of knowledge, the transference of ideas and methods – can be interwoven with medical histories – chronologies of disease and environment, and the social and political institutions that scramble to command them. How does our knowledge progress through time, and how does that knowledge (and its limitations) impact disease outbreaks? How do we avoid engaging linear, "progressive" narratives of scientific/medical histories?
Barry cites a single day when 759 people perished from the flu in Philadelphia – compared to an average 485 deaths from all other illnesses, accidents, suicides, and murders per week (329). His juxtaposition of different statistics certainly serves to contextualize the circumstances of the epidemic. However, I question the relative feasibility/accuracy of picking and choosing numbers to encapsulate such dark histories. Where is the pathos? When/how can statistics get overblown for the sake of melodrama and the objectification of tragedy? If an exhibit were to feature a "wall of numbers" to convey the variety of experiences and issues at play, would we not bore our audience?
Thomas Wirth opens his article "Urban Neglect: The Environment, Public Health, and Influenza in Philadelphia, 1915-1919" on that same day (October 10th). He vividly describes the context – a sick mother and her five children, sharing beds – and infuses his narrative with empathy. Yet he still manages to incorporate statistics without detracting from the humanity of the story: "13,000 dead" (316), rental prices (317), "1,077 complaints related to nuisance, maintenance, sanitation, and building code violations on a total of 639 properties" (326), mortality rates (327), case numbers (332), funding (333), demographics (336). If anything, he treats these numbers as evidence for an overarching theme of negligence and suffering. One cannot incorporate statistics for statistics' sake.
Barry describes the effects of age on mortality rates: "influenza outbreaks ... start with a peak representing infant deaths, then fall into a valley, then rise again, with a second peak representing people somewhere past sixty-five or so" (239). He describes this as a "U-shape," then notes the exception of 1918-19, when this correlation was shaped like a "W." People in their late twenties, early thirties, and early twenties were the most likely to die, respectively. A reviewer of Barry's book (Andrew Noymer) commended him for not using any graphs or tables to describe this phenomenon, claiming that it was good for a "general nonfiction audience." Since when are graphs and tables unsuitable for the layperson? I found that quite alarming. I would think that, in the context of an exhibit, these visuals would help us engage visitors and their various learning styles. Personally, I would have found charts preferable to Barry's multi-paragraph explanation.
As such, I've included a Google Ngram chart as my "image" for this post. I'm interested in exploring how suitable digital history tools are for a physical (interactive?) exhibit – the accuracy of the data they produce and its accessibility for our audiences. In this chart, please note the uptick in mentions of "influenza," "Spanish influenza," and "influenza epidemic" between 1900 and 1930 (peaking in the 1918-19 period). While these results seem obvious, there are other phrases we might explore, and the digitized literature (e.g., old medical journals) that these charts yield may be of use.
Questions for an advisory group of public health professionals (by theme):
Those that emphasize "expert knowledge":
- When educating the public, what are some of the most common statistics that you use to convey the impact of the flu and the importance of vaccinations?
- What do you think are some of the most common misconceptions surrounding the flu and vaccinations?
- Demographically, who is most at risk for getting the flu and other infectious diseases?
Those that emphasize testimony and individual perspectives:
- Have you experienced or do you know of differences in how public health is treated in a large urban setting like Philadelphia compared to suburban or small rural environments?
- Have you witnessed, participated in, or know of any watershed moments in the state of public health as a field/practice in the past twenty years? In the past fifty? In the past century?
- Have you experienced or witnessed any controversies or backlash in your work, especially as it pertains to the flu and vaccinations?
- Have older colleagues or colleagues with whom you used to work when you first started out ever "pass down" anecdotes or stories about the DDC or DPH?
- What kind of campaigns and PSAs has the Division of Disease Control produced, and how do they relate to the common misconceptions and demographic risk factors that you shared earlier?
Those that emphasize our service as public historians, community wants/needs:
- What would you like to learn more about the history of public health in Philadelphia?
- What would you like other people to learn about the history of public health in Philadelphia as it relates to the issues of today?