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a born-digital, open-review volume edited by Jack Dougherty and Kristen Nawrotzki

Case Study of the American Influenza Epidemic of 1918: A Digital Encyclopedia (Fall 2011 version)

1 Leave a comment on paragraph 1 0 The digital revolution offers historians the opportunity to interpret and write about history as never before. Now historical narratives can be viewed alongside the primary documents that informed them and interactive features can aid in historical discovery. The Center for the History of Medicine (CHM), the historical research unit of the University of Michigan Medical School (UMMS), along with the University of Michigan’s digital publishing arm, MPublishing, is currently constructing a project that takes advantage of this new format.

2 Leave a comment on paragraph 2 0 Upon its release in 2012, The American Influenza Epidemic of 1918: A Digital Encyclopedia (AIE), funded by CHM, the U.S. Centers for Disease Control and Prevention (CDC), and the National Endowment for the Humanities (NEH), will use the emerging format of the digital encyclopedia to present the history of the 1918 American influenza epidemic like never before. The NEH awarded a prestigious We the People designation to the project for its ambition to strengthen the teaching, study, and understanding of American history and culture. The AIE will be powered by the University of Michigan’s Digital Library eXtension Service (DLXS).

3 Leave a comment on paragraph 3 0 The Center for the History of Medicine
Founded in 1990, CHM holds as its mission the intent to: “conduct scholarly research on the history, culture and philosophy of medicine; to instruct and collaborate with students, colleagues, and the broader community on these topics; and to place contemporary medical dilemmas in context with past events and, thus, help inform public health and medical policies.”1 CHM is currently headed by Director Dr. Howard Markel, and Associate Director Dr. Alexandra Minna Stern. Other staff members are historians, researchers, writers, and information professionals. At the present time, the main focus of CHM’s research is epidemic preparedness, specifically as it relates to the infamous influenza epidemic of 1918 – 1919 and the recent outbreak of H1N1 in 2009.

4 Leave a comment on paragraph 4 0 Project History
The materials that comprise the AIE collection originated as research for two commissioned reports. In 2005, the Defense Threat Reduction Agency (DTRA) contacted CHM and asked the staff to conduct a study of “escape communities,” or places that experienced few influenza cases and no deaths during the 1918 pandemic. A formal report, focused on a historical evaluation of the non-pharmaceutical interventions (NPI) employed by seven communities2 was delivered to DTRA in early 2006.3 Following the DTRA study, in 2007, the CDC tasked CHM with conducting a quantitative historical study of American cities during the pandemic. Expanding their original project a great deal, CHM researchers studied fifty diverse cities across the United States. At the project’s end, they concluded that cities that acted early, implemented a layered response, and kept health measures in place for longer fared better, experiencing lower influenza and pneumonia mortality rates.4 Their final report, published in JAMA, became the basis for the United States government’s pandemic preparedness policy.

5 Leave a comment on paragraph 5 0 Recognizing the importance of the materials they had collected during the DTRA and CDC projects, CHM staff members originally intended to pursue publication of a print-based encyclopedia, based on their research. However, when it became clear that the comprehensive volume they envisioned would be cost-prohibitive, they decided to adapt the project for a digital format. With the guidance of colleagues in the University of Michigan’s Scholarly Publishing Office (now part of MPublishing), the CHM staff began to prepare a digital encyclopedia, known as The American Influenza Epidemic of 1918: A Digital Encyclopedia.

6 Leave a comment on paragraph 6 2 Features of the AIE
The AIE will be a collection of over 50,000 pages of materials that document the experience of diverse communities in the United States in fall 1918 and winter 1919 when flu took the lives of hundreds of thousands of Americans from coast to coast. It will highlight the human and social experiences of disease, death, and dislocation associated with the pandemic. The AIE will provide access to an extensive set of interpretative documents, such as city essays, timelines, information boxes, and sidebars that will help guide the reader and serve as templates for self-guided research projects. It is intended for a wide-ranging audience that encompasses high school and college students, historians and social scientists, epidemiologists and public health practitioners, journalists and writers, as well as casual internet users interested in the period. The bulk of the collection will consist of original archival materials, namely:

  • 7 Leave a comment on paragraph 7 0
  • Relevant newspaper articles from all cities studied for the CDC report (September 1918 – March 1919)
  • Relevant excerpts from minority newspapers, categorized by circulation, readership, and political affiliation, including immigrant (Italian, Polish, Mexican) and African American newspapers (September 1918 – March 1919)
  • All available municipal annual health and other reports from 50 of the most populous cities in the United States (1917-1922)
  • Every available U.S. state and federal report on influenza (1917-1922)
  • U.S. Census mortality data and local and state case incidence data (September 1918-March 1919)
  • The corpus of published medical, public health, and popular literature on the 1918 influenza pandemic in the United States (1918-1928)
  • U.S. military records, primarily from the Army and Navy (1918-1921)
  • Letters and correspondence
  • Minutes of organizations and groups
  • Official proclamations and orders
  • Reports of agencies and charities
  • Diaries and recollections
  • Photographs

8 Leave a comment on paragraph 8 0 These materials were collected at over 142 archival repositories across the United States. The majority of these materials were scanned from high-quality photocopies made from the original repository collections.

9 Leave a comment on paragraph 9 0 The AIE will be the first to document exhaustively the impact of the 1918-1919 influenza pandemic on one nation. It will be valuable to scholars and generate a great deal of human interest. The AIE project is unique in three ways:

  1. 10 Leave a comment on paragraph 10 0
  2. It is the first digital collection to document the social, cultural, public health, and human dimensions of the most devastating infectious health crisis to occur in the world during the post-germ theory era
  3. It is the first digital collection to highlight the responses of over 50 differing American communities to the 1918-1919 pandemic, with attention to multiple social forces, organizations, communities and to the human experiences of death and disease
  4. It provides access to an extensive set of interpretative documents, such as city essays, timelines, information boxes, and sidebars that will help guide the reader and serve as templates for self-guided research projects

11 Leave a comment on paragraph 11 0 The AIE will make available, for the first time, a wealth of materials that have great appeal to scholars in the fields of American history, American studies, the history of medicine, women’s and gender studies, ethnic studies, African American studies, science and technology studies, and cultural and literary history. Scholars will be able to explore how the 1918 influenza epidemic impacted many communities and sub-communities in the early twentieth-century United States and to understand on a fine-grained level how individuals and society responded to a health crisis of extraordinary magnitude. In addition, this digital encyclopedia will be of great value for social scientists and public health practitioners who wish to determine if any lessons from 1918 might be applied in the advent of newly emerging infectious diseases, such as swine or avian influenza.

12 Leave a comment on paragraph 12 1 The AIE will explore every aspect of the pandemic, ranging from detailed personal struggles and triumphs to the big picture of health and disease at the time. One of the great strengths of the digital encyclopedia will be the interpretive documents that CHM historians wrote about America’s experience during the epidemic. These interpretive documents will situate this global health crisis in a national context vis-à-vis public health, medical research, race and ethnic relations, urbanization, World War I militarism, gender dynamics, political governance, volunteerism, and other salient factors. The interpretive documents will showcase hundreds of previously untold stories of Americans from myriad backgrounds, including industrialists, reformers, politicians, orphans, and teachers. The AIE will also provide sections that explain the basic science of viruses, and specifically the antigenic shift, re-assortment, and transmission of the influenza virus, all highlighted with visuals and graphs.

13 Leave a comment on paragraph 13 8 The largest set of interpretative documents will be the fifty “city biographies” written by our research team. These essays explore the responses taken by fifty of the most populous cities during fall 1918 and winter 1919 as influenza ravaged their communities. They present the social and cultural context of each city and explore the issues that became significant as the epidemic unfolded over the fall and winter. Taken as a whole, these cities, which accounted for over 22% of the total American population at the time, represented a wide cross-section of society in terms of class, race, gender, ethnicity, region, and pre-existing health and disease indicators. Each essay is approximately 2,000 words and provides not only a portrait of the city during the epidemic—steps taken to prevent infection, spread of disease, death totals, introduction to major officials—but also the current state of the city at the time. Since the essays are brief, considering the breath of material available, we plan to feature “sidebars” on related pages (for example, next to the relevant city essay) that include material cut from the original essays, such as the roles of important civilian figures. These interpretive essays will include hyperlinked footnotes that will take readers directly to sources in the digital collection.

14 Leave a comment on paragraph 14 0 We envision the AIE being used as both an introduction to the topic of the influenza epidemic in the United States, as well as a resource for further study. The city essays are a good example of this intention, since they collocate the primary sources gathered, as well as highlight sources of particular interest. The hyperlinked footnotes will lead the user directly to the primary sources used by staff historians. Yet, although we believe the essays will be a good entry point, especially for non-historians, a user will also be able to browse the database independently of the essays. The timelines will also function as a way for users to navigate the website even if they have little previous knowledge about the epidemic. The timelines will be hyperlinked so that a user can jump directly to a specific date or event. Historians or epidemiologists might use the AIE to see how successful different methods of containment proved to be and the resulting mortality rates of each city, as well as browse the primary sources for their own use. It is also possible that users might use our website for secondary and off-topic uses. For example, many of our newspaper clippings feature ads that might prove useful for someone studying advertising in the early twentieth century.

15 Leave a comment on paragraph 15 4 Concerns & Proposed Solutions
Of course a project as complex as the AIE is not without its challenges. Our primary concern is accurately presenting the broad range of Americans’ experiences, despite the many diverse geographical and cultural factors endemic to a large nation. The broad focus of the two genesis studies, resulting in materials from fifty-seven locations throughout the United States, went a long way toward helping us achieve this goal. But, beyond this, in designing the AIE, we were careful to devise methods to showcase each city’s unique experience, specifically the narrative city essays and their respective, hyperlinked metadata, that will lead researchers to notable primary documents.

16 Leave a comment on paragraph 16 0 Apart from our interpretive documents, like the city biographies, we want to make sure that the wealth of materials collected by our researchers are easily retrieved by even the most casual user of the database. To achieve this, we have associated robust metadata to each item in our collection, knowing that quality cataloging will aid with discovery. All scanned text (for example, newspaper images) will be tagged with keywords and key-phrases from a controlled vocabulary list resulting in a modified TEI header at the item level. Images (photographs, drawings, maps) will be tagged using the Dublin Core metadata set. We created a general keyword list, comprised of organizations and people of national importance (the Red Cross, Surgeon General Rupert Blue), as well as individual keyword lists for each city. All keywords went through a peer-editing process to ensure accuracy and value.

17 Leave a comment on paragraph 17 0 All digitized materials will have the full range of search capabilities offered by the OpenText search engine. These include simple word and phrase searching of all text (as well as a variety of advanced search possibilities) with search restrictions as made possible by the data. Each format will have available to it a variety of display and navigation tools appropriate to that format, such as panning and zooming tools for continuous tone images and multiple views (KWIC, outline and full text) for document search results. Each format will be searchable through a format-specific interface that will take full advantage of the possibilities offered by the data. In addition, all materials will be searchable through an integrated interface that allows searching any combination of formats.

18 Leave a comment on paragraph 18 0 Finally, the staff worked closely with a web designer, placing emphasis on a functional design that will allow users to navigate the website as easily as possible. As currently envisioned5 (see Image 1), the homepage will describe the project and provide an overview of its scope and content. From the homepage, users will be able to access materials by: type (city essay, archival), subject (people, places, topics), location, or by text search.

19 Leave a comment on paragraph 19 0 Image 1: AIE homepage prototype, designed by Dennis Smith

20 Leave a comment on paragraph 20 0 Before the AIE launches, we plan to complete user testing to gather feedback to further strengthen the design. The project was presented at the 2010 Society of American Archivists meeting and our archival colleagues provided valuable feedback about the project’s direction, which we have taken into consideration. We are currently seeking more presentation opportunities in order to gather further advice from library and archival colleagues.

21 Leave a comment on paragraph 21 0 Significance
The recent swine flu (A/H1N1) outbreak in April 2009 revived the threat of a global influenza pandemic and prompted governments and citizens to consider in real time how best their communities might respond to the appearance of a new and potentially deadly virus. During the swine flu outbreak, the most constant historical reference point was the 1918-1919 influenza pandemic, which killed approximately 50 million people worldwide. Indeed, the 1918 pandemic remains the most calamitous infectious event in the post-germ theory modern era.

22 Leave a comment on paragraph 22 1 In creating the AIE, we aim to provide the first comprehensive virtual collection of archival, primary, and interpretive materials related to this important episode in United States medical history, with hope that it will prove useful to the historians of today, as well as the future. On a broader note, we hope that the AIE will be a pioneering digital database that will inspire other scholars to share their research in a similar manner, making it accessible to a larger audience. We hope the project will grow with CHM’s research. Plans to expand the AIE’s content to include more recent outbreaks of influenza, in particular materials from the “swine flu” incidents of 1976 and 2009, are currently under way.

23 Leave a comment on paragraph 23 0 About the author: Julie Judkins is the digital librarian at the Center for the History of Medicine. She previously held positions at the Gerald R. Ford Presidential Library and the Dolph Briscoe Center for American History.

  1. 24 Leave a comment on paragraph 24 0
  2. “Home,” Center for the History of Medicine, University of Michigan Medical School, accessed August 8, 2011, http://med.umich.edu/medschool/chm/index.htm.
  3. The communities studied include: the San Francisco Naval Training Station (Yerba Buena Island, California), Gunnison, Colorado, Princeton University (Princeton, New Jersey), the Western Pennsylvania Institution for the Blind (Pittsburgh, Pennsylvania); Trudeau Tuberculosis Sanatorium (Saranac Lake, New York), Bryn Mawr College (Bryn Mawr, Pennsylvania), and Fletcher, Vermont
  4. Howard Markel, et al., “A Historical Assessment of Nonpharmaceutical Disease Containment Strategies Employed by Selected U. S. Communities During The Second Wave of the 1918 – 1920 Influenza Pandemic,” (2006).
  5. Howard Markel, et al., “Nonpharmaceutical interventions implemented by US cities during the 1918-1919 influenza pandemic,” JAMA 298 (2007): 644-54.
  6. The prototype website can be accessed at: http://www.lib.umich.edu/spo/influenzaarchive/welcome.html

Source: http://writinghistory.trincoll.edu/new-ways/the-american-influenza-epidemic-of-1918-judkins/