{"id":44251,"date":"2024-11-08T11:00:31","date_gmt":"2024-11-08T16:00:31","guid":{"rendered":"https:\/\/circulatingnow.nlm.nih.gov\/?p=44251"},"modified":"2024-12-03T11:09:28","modified_gmt":"2024-12-03T16:09:28","slug":"revealing-data-american-soldiers-and-the-1918-influenza-epidemic","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2024\/11\/08\/revealing-data-american-soldiers-and-the-1918-influenza-epidemic\/","title":{"rendered":"Revealing Data: American Soldiers and the 1918 Influenza Epidemic"},"content":{"rendered":"

Circulating Now welcomes guest blogger Dr. E. Thomas Ewing, who discusses the efforts of his students at Virginia Tech to analyze published epidemiological data from the U.S. Army during the First World War held at the National Library of Medicine (NLM). Students also engaged with the personal stories of soldiers from Virginia. This post is part of our<\/em>\u00a0ongoing Revealing Data<\/a> series.\u00a0<\/em><\/p>\n

The Medical Department of the United States Army in the World War<\/a> is a multi-volume collection of medical reports that provides remarkable insights into the experiences of the four million U.S. service members who participated in the First World War. The amount of information, however, can be overwhelming. Volume 15, part 2 alone has more than a thousand pages of charts and tables about the medical department during the war. The impact of the 1918 flu is recorded in more than fifty tables and more than eight hundred pages. While the digital version of this publication greatly increases accessibility, the resources themselves require considerable effort to investigate, categorize, and interpret.<\/p>\n

As part of a course on the 1918 flu, students at Virginia Tech took up the challenge of using this data to better understand American military service during the epidemic. Students worked collaboratively to reveal themes contained within this data, including the timeline of the epidemic, statistics on race, the number of cases and deaths in Europe and in the United States, and comparisons between Virginia and the rest of the country. These themes were suggested by the content of the statistical tables as well as connections with other class assignments, including the examination of individual stories of Virginia soldiers using newspapers, service records, census documents, memorials and gravestones.<\/p>\n

Developing a Methodology<\/strong><\/p>\n

The students worked collaboratively to explore two sections of the Medical Department report: the section on influenza in the volume on infectious diseases (Volume 9<\/a>) and statistics on disease and battle casualties (Volume 15, part 2<\/a>). Students began by accessing the statistical tables in both digital and print form. The digital volume, held in the National Library of Medicine online collection, had several advantages, including the flexibility of a digital product, accessibility from any location, visibility on any kind of screen, full text searchability, and the capacity to zoom to any size of magnification. The class also had access to a print copy of the volume as part of Virginia Tech\u2019s Library collection, which provided a more tangible and, at least for some students, more manageable way to access these statistical resources.<\/p>\n

\"A<\/a>
Virginia Tech students (from left to right) Ethan Black, Mitch Bolt, Grace Kostrzebski, Azat Hedgepeth (standing), Darence Cooks, Jamie Raczynski, and Avery Dodson <\/span>analyze illness and mortality rates among U.S. soldiers during the final year of the First World War.
Photograph by Dr. E. Thomas Ewing<\/em><\/figcaption><\/figure>\n

Students pursued three parallel tracks in the research process. First, they reviewed the statistical tables and developed research questions to address the five broad themes set by the instructor. Second, they developed more focused questions within the broad themes, located and entered data from the tables into spreadsheets, and developed visualizations in a presentation addressing these research questions. Third, each presentation also included stories of Virginia soldiers who died of disease, which illustrated the data presented in the slides. This combination addressed two key themes of the course: ensuring that statistical analysis acknowledged the human dimensions of the impact of the 1918 flu and contextualizing individual soldiers\u2019 stories in relation to both the war and the flu. A class presentation of data visualizations and analysis enabled students to have the experience of engaging a public audience with the results of their collaborative research.<\/p>\n

A chart comparing the rate of soldiers admitted for treatment and deaths, created by Grace Kostrzebski, indicates the value of understanding the experience of soldiers in statistical terms.<\/p>\n

\"A<\/a>
Comparison of White vs. African American Deaths and Admissions per 100 Enlisted
Chart by Grace Kostrzebski<\/em><\/figcaption><\/figure>\n

During the peak of the epidemic, in October 1918, White enlisted soldiers were admitted for treatment at a higher rate, but African American soldiers died at a higher rate. By contrast, the rates were broadly similar in the month preceding and the month following this peak. These contrasts suggests that as the epidemic surged through training camps in October 1918, White soldiers were slightly more likely to receive treatment and slightly less likely to die of disease. This chart uses a graphic display, contrasting colors, and clear labels to convey an important dimension of the epidemic\u2019s impact on American soldiers.<\/p>\n

Tabulating Disease Mortality<\/strong><\/p>\n

Several charts showing deaths from respiratory diseases published in Volume 9 of the report illustrate the value of revealing data as an analytical and instructional process. Chart IX and Chart X document epidemic-related cases and deaths among soldiers by month, race, and location. These charts allow for comparisons of deaths over time, the location of soldiers at the time of their deaths in Europe and the United States, and the differential impact of the epidemic on White and African American (\u201cColored\u201d) soldiers. Yet these charts are complicated, requiring not only considerable time and effort to interpret, but also knowledge of the context to make sense of why these data categories matter to understanding both the trajectory of the war and the history of American soldiers.<\/p>\n

\"Two<\/a>
The Medical Department of the United States Army in the World War, Volume 9<\/em>, Chart IX and X.
National Library of Medicine #14120390R<\/em><\/a><\/figcaption><\/figure>\n

To address this difficulty, it is possible to create a simpler chart that allows for similar comparisons by time, race, and number of deaths. The illustration shows both the total number of deaths and the death rate per 1000 cases from all diseases in the United States throughout 1918. The chart vividly indicates the remarkable change in October, when the total number of deaths from disease (12,847) accounted for more deaths than the entire rest of the year. The chart clearly indicates how quickly the death totals increased from the lowest total in June (367), to slightly higher numbers in July (428) and August (557), and then a jump to more than ten times those levels in September (7,240). The chart also shows how quickly the epidemic receded with death totals decreasing by 90% from the October peak in the final two months of 1918.<\/p>\n

\"A<\/a>
Graph of mortality rates and number of deaths among Black and White soldiers in the U.S. Army from January to December 1918, with data from Medical Department of the United States Army in the World War, Vol15, Pt 2, Tables 58,59, 70, 71<\/a><\/em>
Chart by Dr. Tom Ewing
<\/em><\/figcaption><\/figure>\n

Race and Disease in the U.S. Army<\/strong><\/p>\n

A comparison of deaths by rate, however, provides insights into the relative situation of White and African American soldiers in the United States during this crucial year of the war. While the rate of death for White soldiers follows closely with the total number of deaths, the rate of deaths by disease for African American soldiers was always higher. In the spring and summer of 1918, before the epidemic affected death totals, the rate of death for African American soldiers was consistently four or five times higher than the White rate. The only times when the White rate of death approached that of African Americans was as the epidemic began to peak in September 1918 (when the White rate was only slightly higher) and in November 1918 (when the rate for African Americans was slightly higher). Even in October 1918, the most devastating month of the epidemic, the rate of death for African Americans was about 10% higher than the white rate.<\/p>\n

This chart thus tells a story about the experience of American soldiers in the United States in the final stage of the war. As these soldiers received training and prepared for transportation across the Atlantic in spring and summer 1918, the death rates from disease were low. The rates rose very quickly in September, peaked in October, and then declined almost as quickly in November and December. The quantitative evidence that the rate of deaths from disease were consistently higher for African American soldiers, as illustrated in this chart, demonstrates that the service of soldiers was always connected to broader contextual factors, including the relative health of soldiers at the time of enlistment as well as their treatment and health while in U.S. army camps. The fact that death rates for White and African American soldiers only approached comparable levels at the peak of the epidemic, from September to November 1918, provides further confirmation of the extraordinary effects of this epidemic, which affected all soldiers.<\/p>\n

Making History Personal<\/strong><\/p>\n

As part of the course projects on American soldiers in the war, students also performed research on the lives of Virginia soldiers who died of disease during the peak of the epidemic. These stories were presented as part of a poster exhibit<\/a> in Virginia Tech\u2019s Newman Library.<\/p>\n

\n
\"A<\/a>
Private Wilbur R. Payne, ca 1918
Soldiers of the Great War, Volume 3<\/em><\/a>, 1920
Courtesy Virginia Tech Special Collections<\/em><\/figcaption><\/figure>\n

Some of the Virginia soldiers who died of disease at the peak of the epidemic include:<\/p>\n