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The Influenza Epidemic and Jim Crow Public Health Policies and Practices in Chicago, 1917–1921

2019; University of Chicago Press; Volume: 104; Issue: 1 Linguagem: Inglês

10.1086/701105

2153-5086

Elizabeth Schroeder Schlabach,

Race, History, and American Society

Previous articleNext article FreeThe Influenza Epidemic and Jim Crow Public Health Policies and Practices in Chicago, 1917–1921Elizabeth SchlabachElizabeth SchlabachPDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreWeeks after the deadliest day of the influenza outbreak in Chicago, the Chicago Defender ran a story on the Chicago Telephone Company's employment crisis—the company's white women workers were falling ill to influenza at conspicuous rates. The Defender wanted to know, would the company replace these workers with women of color? Its inquiry began: "In a recent issue of the daily papers we are informed that more than 300 telephone girls have been stricken with influenza and the Chicago Telephone Company is advertising for young women to take their places. What we would like to know is whether or not this company is willing to accept applications from our girls, and if not, why not? The company is employing young women of every nationality on earth, French, German, Polish, Lithuanian, Irish and Swedish, the only test being that they must be white, apparently."1 The article identifies a curious phenomenon that was sweeping over Chicago's home front in 1918, namely, that influenza was spreading more among white and foreign-born immigrant populations than among African Americans. According to Dr. John Dill Robertson, Chicago's Commissioner of Public Health, "the white population of the city showed an increase of 2610 percent deaths from influenza and pneumonia during the month of October as compared with an increase of only 1400 percent for the colored residents."2 He concluded that "the colored race was more immune than the white" to these illnesses.3 Moreover, among whites, "the native born were less affected than the foreign born."4 But according to Jim Crow's labor tactics, African Americans were ineligible for employment at the Chicago Telephone Company. The Defender's editorialist made a final diagnosis: "The whole situation is ridiculous and could obtain in no other country except America. The disease is strictly Dementia Americana."5Like other papers in the black press, the Defender closely followed the influenza epidemic of 1918, public health ordinances, and the resurgence of the disease in 1920 after a bloody race riot clutched the city in July 1919. The epidemic, the world war, and race riots gripping the nation were events conditioned by Progressive Era health rhetoric of scientific racism, eugenic theories, and "right living" grandiloquence. Segregationist strategies for controlling infectious disease and southern African American migrants informed this rhetoric. Robertson's Public Health Ordinances of Chicago and the city's 1919 race riot, which began at a beach under Robertson's jurisdiction, highlight an increasing precocupation with policing public spaces where whites and blacks might meet. Building on the work of previous commissioners, Robertson invoked medical and patriotic rhetoric to control Chicago's public health crisis, while employing segregationist strategies to keep black and white bodies separate. African Americans got sick at lower levels within the context of these segregationist strategies. Black Chicago kept itself healthy and thriving despite such Jim Crow public health tactics, bombing campaigns, and state-sanctioned violence of race riots through shear tenacity and an uncompromising demand for equality. Employing health columns from the Chicago Defender, the Broad Ax, and the Half-Century Magazine and archival records from Provident Hospital and the Visiting Nurses Association, this article works to situate black Chicago's fight against racist public health campaigns prominently within the history of the influenza pandemic of 1918.A Historiography of Race, Public Health, and the "Spanish Flu"The historiography of the African American experience during the influenza epidemic is shockingly sparse. General overviews of the outbreak have little to say about responses to the epidemic along racial lines, nor do those studies engage in an examination of the racist elements of the public health response to the epidemic in Chicago specifically. For example, while John M. Barry, in The Great Influenza: The Story of the Deadliest Pandemic in History, cites the outbreak among African Americans in Philadelphia, referencing squalid housing conditions that made Philadelphia fertile ground for an outbreak, he does not mention responses to the epidemic in Chicago that were informed by similar segregationist housing practices.6 Alfred W. Crosby's America's Forgotten Pandemic also suffers from no clear engagement with African Americans' battle with white supremacy for both access to medical care and entrance into the medical fields as professionals. Crosby cites plenty of Dr. John Dill Robertson's responses to the epidemic in Chicago, but he offers no examination of the effects of Robertson's strategies on the city's African American population.7For scholarly engagement of the epidemic along racial lines, one should look to the work of Nancy K. Bristow, Samuel K. Roberts, and Vanessa Northington Gamble. Bristow devotes a section of American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic to the examination of race and the epidemic. In these pages, she offers a helpful overview of the ways in which "people of color frequently experienced the epidemic from positions of economic disadvantage, complicated further by racial prejudice."8 She also stresses that white public health and aid workers routinely framed minorities as being culpable for conditions that made the outbreak worse.9 She highlights that the African American experience during the epidemic was framed by racial prejudice and segregated medical care. She follows her section on race and epidemic with chapters detailing Robertson's stand against school closures, his focus on school inspections, and home visits by school nurses to control influenza among children.10 Keeping children in school created a way for nurses and medical professionals to maintain a surveillance of African American communities.Historian Samuel K. Roberts's study of tuberculosis and race goes one step further to say that such surveillance was informed by whites' fear of infection, grounded in the troubling politics of black urban health. While his book Infectious Fear: Politics, Disease, and the Health Effects of Segregation focuses on African Americans and tuberculosis, it offers much for my examination of African Americans and the flu epidemic in Chicago. Most importantly, Roberts offers both a theoretical and political apparatus for studying the outbreak in racialized terms to emphasize what he calls "the politics of black urban health." He argues that the national urbanization of blacks shaped a racialized scientific response to diseases such as tuberculosis. He puts place, specifically Baltimore, at the forefront of public health history, stating that such an analysis "produces a radical rethinking of tuberculosis history in the African American context."11 Citing the protest of African American intellectual and medical leaders, he finds that white physicians mainly expressed negative views of the relationship between racial heritage, urbanization, and tuberculosis. Such views informed the public health response to how and when municipal authorities located and treated disease. His framing of Baltimore, tuberculosis, and the racist response of white medical and health professionals is particularly instructive when examining African Americans' experience with the influenza epidemic in Chicago. Although he mentions influenza only once, Roberts's study of the politics of tuberculosis and black urbanization is nevertheless invaluable to my examination of Chicago.12The most focused study of African Americans, northern cities, and the influenza epidemic is Vanessa Northington Gamble's article published by Public Health Reports titled, "'There Wasn't a Lot of Comforts in Those Days:' African Americans, Public Health, and the 1918 Influenza Epidemic."13 Gamble argues that "when the epidemic began African American communities were already beset by many public health, medical, and social problems, including racist theories of black biological inferiority, racial barriers in medicine, and public health, and poor health status."14 She details African American health professionals' crusade against racist casting during the years preceding the outbreak of influenza. She also describes influenza's "tour through African American communities," using newspapers to catalog the closing of public gathering spaces to prevent spread of influenza in both Philadelphia and Chicago.15 Her article clearly builds on her previous work in that she is careful to show how "the crisis precipitated by the 1918 epidemic did not ease racial barriers to medical care."16 The health problems of African Americans could be improved and prevented by better access to medical care, but because African Americans "were depicted more as public health pests than as the hapless victims of disease," racism in hospitals and in admissions policies for nursing and medical schools persisted.17 Black influenza patients continued to receive care in segregated facilities, further evidencing why Provident Hospital was so valuable to the black community in Chicago. This was particularly devastating to Chicago's African American community as the population of the South Side and racial tensions increased with each wave of the Great Migration.Flu along Chicago's Color LineChicago's African American population grew exponentially in the years after World War I. Before World War I, African Americans constituted only 2 percent of Chicago's population, but by 1970, triggered by World War II, they made 33 percent of the population.18 Such density made Chicago's South Side a stifling place. According to historian William Tuttle, the disquieting aspects of the housing situation likewise multiplied: "Between 1910 and 1920 the black community almost tripled, rising from 34,335 to 92,501, which was close to 90 percent of Chicago's black population. None of Chicago's blacks in 1910 had lived in a census tract that was more than 75% black; in 1920, 35.7% of the black population did. Only 30.8% in 1910 had lived in one that was more than 50 percent Negro; in 1920, 50.5% did."19 Rents were on average 15–25 percent higher for African Americans than they were for whites,20 since the demand for housing in what became known as the Black Belt of Chicago far exceeded availability. It was overcrowded, and landlords neglected repairs and overcharged tenants for rent. Restrictive housing covenants were another way African Americans had to submit to the city's demand for control over migration. These were agreements among homeowners associations, real estate agents, and institutions such as the University of Chicago to refuse rental or sale of homes to people of color. Restrictive housing covenants kept upwardly mobile middle-class African Americans from moving out of the Black Belt into neighboring suburbs. Where covenants failed, bombing campaigns stepped in. From July 1917 to March 1921, precisely during the influenza epidemic and the race riot of 1919, fifty-eight bombs were hurled at black homes and those of white and black real-estate men who sold homes or rented property to newcomers who attempted to leave the Black Belt.21 As of January 1919, six months before the race riot, no arrests were made in the bombings.22 The result was a triad of social inequality—overpopulation, price gouging, and rigid segregation—that increased racial unrest.Articles running in the Chicago Daily Tribune, a white newspaper, confirmed these opinions when restrictive housing covenants and violence served as strategies to submit African Americans to the city's demand for control. A series of articles beginning in March 1917 conflated hysteria about migration of African Americans to the north with fears of contagious diseases. Initial headlines sounded the alarm: "2,000 Southern Negroes Arrive in Last Two Days" and23 "Rush of Negroes to City Starts Health Inquiry"24 (whose subheading read: "Philadelphia Warns of Peril—Health, Police Heads to Act").25 A July headline blared: "Half a Million Darkies from Dixie Swarm to the North to Better Themselves."26 This article began a series of racist rants by reporter Henry M. Hyde, who observed that migrants "are compelled to live crowded in dark and insanitary rooms; they are surrounded by constant temptations in the way of wide open saloons and other worse resorts."27 He closed his article with a warning: "the outrage at East St. Louis still sounding its terrible warning."28 Two days later, Hyde commented in an article titled "Negroes Partly Responsible for Woes in North: Many 'Invaders'[s] Lazy and Ignorant and an Easy Prey to Rascals"29 that the African Americans who migrate north are not the "respectable southern Negroes," noting that the "better class like the south are intelligent enough to know that they are more independent and better off in their old home than they can hope to be in any northern city."30 Thus, he placed the blame for racial antagonism "to some extent" on African Americans themselves.31 In a subsequent article, Hyde solicited information on how to send recent African American migrants south to cotton fields ready for harvest. He suggested that "many of the recent immigrants who would have had their eyes opened to the difficult [sic] of getting along in Chicago would be glad enough to get safely back to their old homes in the south."32 If such conditions exist, he implored, the Tribune would like to be informed.33Black migration to Chicago influenced notions of racialized disease causality;34 the newspapers exacerbated tensions with incendiary reports like Hyde's from public health professionals. The Tribune ran columns by health editor Dr. William A. Evans, former commissioner of health and a member of Robertson's Influenza Commission.35 On September 28, 1918, the Council of National Defense assembled the Illinois Influenza Commission. The Influenza Commission held conferences daily to deploy physicians and nurses to areas it deemed in need; furnished vaccines; collaborated with the State Department of Health to prohibit public dances and funerals; served as arbiter of medical inspections; and was an information hub responsible for the forwarding of daily telegraphic reports of influenza to keep the city and entire state well.36Evans's experience on the Influenza Commission spilled over into his Tribune column, titled "How to Keep Well," in which he gave advice on clean living, sanitation, and keeping rooms ventilated during the outbreak. Here he also theorized about the extinction of the African Americans in his September 19, 1917, article: "the conclusion is that the stock that has been in this country more than two generations shows a strong tendency to dry rot. The death rates of this group are low, but the birth rates are also so low that there is but little natural increase."37 Less than a month after the July 1919 race riot, he devoted an article to the "Negroes' Physical Condition," responding to some industry owners' desire to have medical professionals inspect every migrant physically before setting him to work.38 A medical professional known to Evans found that although African American applicants to industries were under age 40, 8 percent of them had a considerable degree of heart disease, and many had "bad teeth, flat feet, and venereal disease" and were more physically aged than a white man at 40. For Evans, this proved that "all of us, blacks and well as whites, are in need of a better health service than has been the custom."39Despite this call for commonality, Evans theorized on the "bad effect of crossing racial stocks that are widely different" in a September 5, 1921, article titled "Hybridization and Humanity."40 Here, the former commissioner and current member of the Influenza Commission, introduced a scale of "best to worst" racial mixing, best being white with white, with worst being "the sambo or cross between the Indian and the Negro."41 In his closing statement for the article, he stated that "there is no proof that mixed races become infertile or acquire susceptibility to certain diseases or lose their immunity to others."42 As a former commissioner of health and then as a member of the Influenza Commission, Evans advocated for the separation of black and white bodies; he stated this unequivocally when he stressed that for the white race to continue its existence "it must remain itself, and it must breed its best. … It must not mate with any other race and it must keep up its birth rate and keep down its death rate."43 This was a deadly science and performance of Jim Crow public health policy in the hands of men with tremendous influence and in possession of the press, a vehicle used to create panic. As a consequence, public opinion mirrored the press.Surveys taken in 1921 indicated that white Chicago considered blacks minimally educable, emotional, "unmoral," sexual, prone to sex crimes, larcenous, and malodorous.44 According to the Chicago Crime Commission, an interracial commission charged with investigating the 1919 race riot, "half of all articles on 'racial matters' printed by these newspapers during 1916–1917 either ridiculed blacks or focused on violence, black criminals, or vice."45 Historian John Grossman commented on the effect of these words: "Most of the reports from Chicago newspapers dramatically overstated the volume of migration; many evoked images of hordes of blacks inundating the city, bringing their disease and vice, and low standards of living."46Chicago was already in a state of panic during the spring prior to the influenza outbreak due to the alarming rates of incoming migrants, with no one, it appeared, present to take care of them. In April 1918, a Tribune article suggested that in the previous eighteen months, between 75,000 and 100,000 migrants landed in Chicago, but there were only church accommodations for 18,000.47 The news stoked fears that there would be no ward for the incoming travelers. The newspaper informed its readership that "thirty percent of the new arrivals were illiterate and all had the ballot." Rev. Dr. Edgar Black of Chicago wrote: "We are facing an explosion unless we do something for these Negroes—unless we provide for them better."48 African Americans had the ballot—they had political power and potentially unpredictable access to the levers of the city.49 The language used—words like swarm, explosion, rush, and invasion—worked well to convey the seriousness of the matter to white Tribune readers.50 This was language with which readers would be familiar, as it was the language of both disease and war.51 Historian Nancy Bristow argues that the language Americans employed to narrate their experiences in the pandemic reveals how completely World War I and the epidemic were joined in American minds and memories.52 Such pieces conveyed the feeling that contact would expose whites to communicable disease and contamination by African Americans' supposed dirtiness, laziness, and illiteracy.53 The articles also positioned African Americans as a political threat. It left the door open for aggressive public health campaigns to upend all urban spaces at precisely the moment when blacks were asserting their right to public and political spaces of all kinds.54 Leisure spaces such as beaches, as historian Victoria W. Wolcott shows in her book Race, Riots, and Rollercoasters, and working spaces such factories or telephone companies, as evidenced by the Chicago Defender piece quoted at length at the beginning of this article, became hotly contested spaces.55Chicago's Influenza: Surveillance or CareOver one-quarter of Americans, roughly 25 million people, were infected by influenza. Epidemiological studies indicate that the pandemic began in the United States in March 1918 at a crowded army camp in Fort Riley, Kansas.56 From there, troops moved all over the globe, as "Spanish influenza" infected millions. Allied troops dubbed it so because Spain's uncensored press was the first to report freely on its widespread distribution.57 Influenza attacked in four waves, hitting first in the spring of 1918. Then, in late August, the pandemic exploded in its second wave with morbidity rates in most American communities ranging between 25 and 40 percent. A third wave followed close behind, attacking in the winter as most were only beginning to recover from August's death toll. The fourth wave made its final assault in early 1920. Historically, influenza resulted in high death rates among infants and the elderly. But the 1918 infection rates defied previous patterns as 99 percent of excess influenza deaths occurred among Americans younger than 65, with higher death rates for adults between ages 20 and 40.58 As American deaths from the disease were mounting, medical personnel and facilities became in short supply, and city infrastructures started to crumble.59News of Chicago's outbreak started when hundreds of sailors contracted influenza at the Great Lakes Naval Training Center thirty-two miles north of the city.60 With public opinion solidly in his corner, Robertson moved freely to control public space and the dissemination of information during the outbreak of influenza. The story ran in the Tribune on September 23, 1918. The health department soon recommended wearing medicated masks as a preventative measure against catching the virus.61 By the end of the month, all flu cases were quarantined by a city order,62 with Robertson reassuring Chicagoans in a Tribune article in which he predicted a "small influenza toll."63 By the next week, officials began to enforce an anti-spitting order (an ordinance in existence since 1901).64 Movie houses and dance halls hung placards banning the sick. Dr. St. Claire Drake, head of the state public health department, organized a series of bulletins describing preventative measures that flashed on screens before films. Theater managers gave essential information about influenza before their shows.65 Churches remained open but called off meetings.66 Funerals were made private.67 The health department placed a tighter and tighter grip on public spaces where bodies might meet; this echoes historian and author of Infectious Fear Samuel K. Roberts's assertion that "integral to the project of modern urban public health were theoretical and practical compromises that moved the politics of black health from absolute neglect to qualified inclusion based on specific notions of care, expertise, public utility, citizenship, social control, and responsibility."68 African Americans were a welcome presence only in their support of and abidance by these measures, not in moves to protest the segregation of medical training facilities or medical care facilities to treat victims of influenza or other diseases.Curiously, African Americans across the nation simply weren't dying from influenza despite desires to classify them as irreparably "diseased." Befuddled, Dr. W. H. Frost of the US Public Health Service reported that "in seven localities with substantial black populations, their incidence rates were lower than white people's even after adjusting for sex and age."69 Frost determined that this incidence rate was "quite contrary to what would have been expected" given the documented increased black death rates from pneumonia and influenza and "that the colored population live generally under conditions presumably more favorable to the spread of contact infections."70 Philadelphia reported that "the disease was especially prevalent among Caucasians, and the mortality among them was unusually high, while among the Negro population, the death rate was comparatively low."71 The Journal of the National Medical Association reported that between September and November 1918, there were 11,875 white deaths and only 812 deaths among African Americans: "these figures are interesting" the Journal reported, "when we consider the death rate of Philadelphia's colored population is normally much higher than that of the white."72 These medical findings exacerbated racial tensions at a time when people of color were already marginalized by segregation of medical care and lack of facilities and when violence against them was state-sanctioned. Regardless of the number of African Americans falling ill to influenza, segregation became the solution to the disease because segregation was a metaphorical and physical solution to the spread of germs from one body to another. Even though African Americans were not carrying the deadly influenza virus, their bodies became the metaphorical vessels of transmission, and, therefore, in the eyes of whites African Americans were worthy of punishment and physical acts of violence and unworthy of adequate medical treatment. For Chicago, lack of medical care and compassion was motivated by and relied on the purposeful racist casting of thousands of black migrants as dirty, crude, and likely to be infected by communicable disease.Robertson's department had been laying down the infrastructure for a tighter clasp on the city since 1910 (fig. 1). Between 1910 and 1918, the health department passed nearly seventy-five health ordinances regulating such things as the sale of bread, the use of drinking cups, children's playtime on public streets, and the establishment of "zones of quiet."73 Several examples are worth noting: an ordinance mandated that all "free lunch" be wholesome, while another outlawed the dumping of refuse in Lake Michigan.74 The department made influenza a "placardable disease," a designation that gave health officials access to people's homes, thus depriving families of their privacy.75 Health department officials placarded a home when a family refused to comply with requirements for quarantine and would post a "red placard on front and rear doors of premises occupied by the family."76 Field health officers canvassed districts, visiting each house in search of unreported or unrecognized cases of influenza and illness. A total of 49,078 visits were made by this survey work.77Figure 1. Red Cross women sitting at tables making influenza masks, Chicago, 1918 (DN-0070539; Chicago Daily News negatives collection, Chicago History Museum).View Large ImageDownload PowerPointSurvey work was a form of surveillance that public health officials learned from their experiences with tuberculosis. During the antituberculosis movement of the late nineteenth century, American cities adopted strategies of universal notification inspired by Philadelphia physician Lawrence Flick's theory of "house infection," the idea that the bacillus is most virulent and easily transmitted within closed spaces.78 Public health officials embraced the theory, mandating that all tuberculosis cases and their habitations be registered with the state, a situation that received serious opposition from private physicians and those individuals who could afford private physicians. Most cities adopted universal notification, and the specific terms, according to Roberts, were often class- and race-inflected in that middle-class white patients were not subject to household inspections and other intrusions. These developments paved the way for significant gains in epidemiology but also provided rationale for stigmatization and surveillance.79The department extended its grasp to include regulation of the common drinking cup in public places, schools, office buildings, lodge halls, factories, and stores.80 It also regulated play. The department issued a play street ordinance on August 22, 1918, which mandated that "no children afflicted with a communicable disease shall be allowed to join in games on streets designated as 'play streets,' except with the permission of the commissioner of health."81 Robertson had the police department at his disposal to "carry out the various measures resorted to by the Health Department to restrict the spread of disease."82 The measures are synchronous with the advent of germ theory and had toxic racialized effects. In combining racialization with bans on public congregation and "other measures to stop the epidemic,"83 Chicago in effect had created its own elaborate but unnamed system of Jim Crow laws. Ordinances such as these had the same effects as Jim Crow laws governing racial dynamics south of the Mason-Dixon line. Robertson championed the efforts in a preliminary report on influenza in the American Journal of Public Health writing, "on October 18th, all public gatherings not essential to the war, such as banquets, conventions, lectures, social affairs, athletic contests, of a public nature stopped. Music cabarets and other entertainment stopped in restaurants and cafes. Crowding prohibited in poolrooms, saloons, etc."84 Patriotism was the defense; the department draped an elaborate web of control over the city and neighborhoods of Chicago in the name of self-defense. Upon reflection, in his Annual Report in 1919 Robertson tried to back away from this aggressive stance when he argued that "the only special measures to prevent crowding were the closing of places of public amusement. Churches, schools, business of all kinds were conducted as usual."85 Robertson saw the effects of prohibiting assemblage in Chicago's large commercial centers and vice districts as beneficial but his anxiety was evident. He wrote in 1919, the same year as Chicago's race riot, "it is true that [the bans on assemblage] impress upon the people the urgency of the situation, but this in turn may give rise to undue fear which is provocative of ill effects."86 He knew there would be consequences.The Black Press RespondsThree black Chicago papers—t