Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-23T20:27:59.298Z Has data issue: false hasContentIssue false

Influenza-Associated Mortality during the 1918–1919 Influenza Pandemic in Alaska and Labrador

A Comparison

Published online by Cambridge University Press:  04 January 2016

Abstract

Some of the most severely affected communities in the world during the 1918–19 influenza pandemic were in Labrador and Alaska. Although these two regions are on the opposite ends of North America, a cultural continuum in the Inuit populations extends throughout the North American Arctic. Both regions contain other population groups, however, and because of these similarities and differences, a comparison of their experiences during the pandemic provides new insights into how culture and environment may influence patterns of spread of infectious disease. We describe here analyses of the patterns of influenza mortality in 97 Alaska communities and 37 Labrador communities. The Alaska communities are divided into five geographic regions corresponding to recognized cultural groups in the region; the Labrador communities are separated into three regions that vary in the degree of admixture between European and indigenous (primarily Inuit) groups. In both Alaska and Labrador mortality was substantially higher than the worldwide average of 2.5–5 percent. Average mortality ranged from less than 1 percent to 38 percent at the regional level in Alaska and from 1 percent to 75 percent at the regional level in Labrador with up to 90 percent mortality in some local communities in both Alaska and Labrador. A number of factors influencing this heterogeneous experience are discussed, including the impact of weather and geography; attempts to protect communities by implementing quarantine policies; accessibility of health care; nutritional deficiencies; cultural factors, such as settlement patterns, seasonal activities, and ethnicity; and exposure to earlier outbreaks of influenza or other diseases that may have increased or lessened the impact of influenza in 1918–19.

Type
Articles
Copyright
Copyright © Social Science History Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aaby, PeterMartins, Cesário L.Garly, May-LillBalé, CarlitoAndersen, AndreasRodrigues, AmabeliaRavn, HenrikLisse, Ida M.Benn, Christine S.Whittle, Hilton C. (2010) “Non-specific effects of standard measles vaccine at 4.5 months and 9 months of age on childhood mortality: Randomized controlled trial.” British Medical Journal 341 (7785): c6495, doi:10.1136/bmj.c6495.Google Scholar
Alaska Legislature, House of Representatives, Special Committee to Investigate Influenza Epidemic and Territorial Fish Commission (1921) Report of Special Committee to Investigate Influenza Epidemic and Territorial Fish Commission. Juneau: Special Committee to Investigate Influenza Epidemic and Territorial Fish Commission.Google Scholar
Alaska Packers Association (1919) Report on 1919 Influenza Epidemic: Naknek Station; Nushagak Station; Kvichak Station; Bristol Bay, Alaska. San Francisco: Alaska Packers Association.Google Scholar
Andreasen, ViggoViboud, CécileSimonsen, Lone (2008) “Epidemiologic characterization of the 1918 influenza pandemic summer wave in Copenhagen: Implications for pandemic control strategies.” Journal of Infectious Diseases 197 (2): 270-78.Google Scholar
Bacon, GlennDixon, E. James Jr. (1974) “Reply to Hippler’s ‘The Athabascan of interior Alaska: A culture and personality perspective.’” American Anthropologist 76 (3): 569-71.Google Scholar
Barry, John M. (2004) The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Viking.Google Scholar
Barry, John M.Viboud, CécileSimonsen, Lone (2008) “Cross-protection between successive waves of the 1918-1919 influenza pandemic: Epidemiological evidence from US Army camps and from Britain.” Journal of Infectious Diseases 198 (10): 1427-34.Google Scholar
Bell, R. RainesHeller, Christine A. (1978) “Nutrition studies: An appraisal of the modern North Alaskan Eskimo diet,” in Jamison, Paul L.Zegura, Stephen L.Milan, Frederick A. (eds.) Eskimos of Northwestern Alaska: A Biological Perspective. Stroudsburg, PA: Dowden, Hutchinson, and Ross: 145-56.Google Scholar
Beynon, William (1941) “The Tsimshians of Metlakatla, Alaska.” American Anthropologist 43 (1): 83-88.Google Scholar
Birket-Smith, Kajde Laguna, Frederica (1938) The Eyak Indians of the Copper River Delta, Alaska. Copenhagen: Levin and Munksgaard.Google Scholar
Bodenhorn, Barbara (2000) “The Iñupiat of Alaska,” in Freeman, Milton M. R. (ed.) Endangered Peoples of the Arctic: Struggles to Survive and Thrive. Westport, CT: Greenwood: 131-49.Google Scholar
Brundage, John F.Shanks, G. Dennis (2008) “Deaths from bacterial pneumonia during 1918-19 influenza pandemic.” Emerging Infectious Diseases 14 (8): 1193-99.Google Scholar
Budgell, Anne (1994) “The Spanish influenza of 1918 in Okak and Hebron, Labrador.” Paper written in November 1994 for History 4671, taught by Lewis Fischer. Copy on file at the Center for Newfoundland Studies, Memorial University of Newfoundland. E99 E7 B785 1994.Google Scholar
Budgell, Anne (1996) “The Spanish influenza of 1918 in Okak and Hebron, Labrador.” Paper presented at the Inuit Studies Conference, Saint John’s, NL, August. Copy on file at the Center for Newfoundland Studies, Memorial University of Newfoundland. E99 E7 B7852 1996.Google Scholar
Burnet, F. MacfarlaneClark, Ellen (1942) Influenza: A Survey of the Last Fifty Years in the Light of Modern Work on the Virus of Epidemic Influenza. London: Macmillan.Google Scholar
Cadigan, Sean T. (2009) Newfoundland and Labrador: A History. Toronto: University of Toronto Press.Google Scholar
Cliff, Andrew D.Haggett, PeterOrd, J. Keith (1986) Spatial Aspects of Influenza Epidemics. London: Pion.Google Scholar
Corbett, Helen D.Swibold, Susanne M. (2000) “The Aleuts of the Pribilof Islands, Alaska,” in Freeman, Milton M. R. (ed.) Endangered Peoples of the Arctic: Struggles to Survive and Thrive. Westport, CT: Greenwood: 1-16.Google Scholar
Crosby, Alfred W. (1989) America’s Forgotten Pandemic: The Influenza of 1918. Cambridge: Cambridge University Press.Google Scholar
Cuff, Robert H. (1994) “Settlers,” in Poole, Cyril F. (ed.) Encyclopedia of Newfoundland and Labrador. Vol. 5. Saint John’s, NL: Cuff: 142-43.Google Scholar
Doane, Ernest (1918) “Nocturnal.” Grenfell Historical Society, Saint Anthony, NL.Google Scholar
Dorais, Louis-Jacques (2002) “Inuit,” in Magocsi, Paul R. (ed.) Aboriginal Peoples of Canada: A Short Introduction. Toronto: University of Toronto Press: 129-52.Google Scholar
Draper, Harold H. (1977) “The aboriginal Eskimo diet in modern perspective.” American Anthropologist 79 (2): 309-16.Google Scholar
Dutt, Asim K. (2006) “Epidemiology and host factors,” in Schlossberg, David (ed.) Tuberculosis and Nontuberculous Mycobacterial Infections. New York: McGraw-Hill: 1-14.Google Scholar
Evening Telegram (1919) “The influenza epidemic in Labrador: A story of horror and death,” June 21.Google Scholar
Fellows, F. S. (1934) “Mortality in the native races of the territory of Alaska, with special reference to tuberculosis.” Public Health Reports 49 (9): 289-320.Google Scholar
Fienup-Riordan, Ann (2000) “The Yup’it of western Alaska,” in Freeman, Milton M. R. (ed.) Endangered Peoples of the Arctic: Struggles to Survive and Thrive. Westport, CT: Greenwood: 247-66.Google Scholar
Fortuine, Robert (1989) Chills and Fever: Health and Disease in the Early History of Alaska. Fairbanks: University of Alaska Press.Google Scholar
Ganley, Matt L. (1998) “The dispersal of the 1918 influenza virus on the Seward Peninsula, Alaska: An ethnohistoric reconstruction.” International Journal of Circumpolar Health 57 (supp. 1): 247-51.Google Scholar
Gordon, Henry (1919a) “Letter to the colonial secretary of Newfoundland, January 6.” Provincial Archives of Newfoundland and Labrador (PANL). GN 2/5. Special file 352-A, Colonial Secretary’s Department.Google Scholar
Gordon, Henry (1919b) A Winter in Labrador, 1918-1919. New York: Gordon.Google Scholar
Grenfell, Wilfred T. (1895) Vikings of Today; or, Life and Medical Work among the Fishermen of Labrador. London: Marshall.Google Scholar
Halpin, Marjorie (1984) “The structure of Tsimshian totemism,” in Miller, JayEastman, Carol M. (eds.) The Tsimshian and Their Neighbors of the North Pacific Coast. Seattle: University of Washington Press: 16-35.Google Scholar
Hanrahan, Maura (2008) “Tracing social change among the Labrador Inuit and Inuit-Métis: What does the nutrition literature tell us?Food, Culture, and Society 11 (3): 315-33.Google Scholar
Henriksen, Georg (1973) Hunters in the Barrens: The Naskapi on the Edge of the White Man’s World. Saint John’s: Institute of Social and Economic Research, Memorial University of Newfoundland.Google Scholar
Herring, D. Ann (1994) “‘There were young people and old people and babies dying every week’: The 1918-1919 influenza pandemic at Norway House.” Ethnohistory 41 (1): 73-105.Google Scholar
Herring, D. AnnSattenspiel, Lisa (2003) “Death in winter: The Spanish flu in the Canadian subarctic,” in Phillips, HowardKillingray, David (eds.) The Spanish Influenza Pandemic of 1918-1919: New Perspectives. London: Routledge: 156-72.Google Scholar
Hopkins, Scarlett E.Kwachka, PatLardon, CécileMohatt, Gerald V. (2007) “Keeping busy: A Yup’ik/Cup’ik perspective on health and aging.” International Journal of Circumpolar Health 66 (1): 42-50.Google Scholar
Hunt, William Chamberlin, and US Bureau of the Census (1921) Fourteenth Census of the United States, 1920: Bulletin; Population of Alaska; Number of Inhabitants, by Judicial Districts and Minor Civil Divisions. Washington, DC: US Government Printing Office.Google Scholar
Johnson, Frank C. (1919) “Spotted Islands station, 1919.” Among the Deep Sea Fishers 17 (3): 83-85.Google Scholar
Johnson, Niall (2006) Britain and the 1918-19 Influenza Pandemic: A Dark Epilogue. New York: Routledge.Google Scholar
Johnson, NiallMueller, Juergen (2002) “Updating the accounts: Global mortality of the 1918-1920 ‘Spanish’ influenza pandemic.” Bulletin of the History of Medicine 76 (1): 105-15.Google Scholar
Kennedy, John C. (1982) Holding the Line: Ethnic Boundaries in a Northern Labrador Community. Saint John’s: Institute of Social and Economic Research, Memorial University of Newfoundland.Google Scholar
Kennedy, John C. (1991) “Inuit,” in Poole, Cyril F. (ed.) Encyclopedia of Newfoundland and Labrador. Vol. 3. Saint John’s, NL: Cuff: 57-65.Google Scholar
Kennedy, John C. (1995) People of the Bays and Headlands: Anthropological History and the Fate of Communities in Unknown Labrador. Toronto: University of Toronto Press.Google Scholar
Kennedy, John C. (1996) Labrador Village. Prospect Heights, IL: Waveland.Google Scholar
Kleivan, Helge (1966) The Eskimos of Northeast Labrador: A History of the Eskimo-White Relations, 1771-1955. Skrifter 139. Oslo: Norsk Polarinstitutt.Google Scholar
Lautaret, Ronald L. (1986) “Alaska’s greatest disaster: The 1918 Spanish influenza epidemic.” Alaska Journal 16: 238-43.Google Scholar
Leacock, Eleanor B. (1955) “Matrilocality in a simple hunting economy (Montagnais-Naskapi).” Southwestern Journal of Anthropology 11 (1): 31-47.Google Scholar
Leacock, Eleanor B.Rothschild, Nan A., eds. (1994) Labrador Winter: The Ethnographic Journals of William Duncan Strong, 1927-1928. Washington, DC: Smithsonian Institution Press.Google Scholar
Lovisek, Joan A. (2002) “Algonquians/subarctic,” in Magocsi, Paul R. (ed.) Aboriginal Peoples of Canada: A Short Introduction. Toronto: University of Toronto Press: 98-128.Google Scholar
Mamelund, Svenn-Erik. (2006) “A socially neutral disease? Individual social class, house-hold wealth, and mortality from Spanish influenza in two socially contrasting parishes in Kristiania, 1918-19.” Social Science and Medicine 62 (4): 923-40.Google Scholar
Mamelund, Svenn-Erik. (2011) “Geography may explain adult mortality from the 1918-20 influenza pandemic.” Epidemics 3 (1): 46-60.Google Scholar
Markham, Nigel (1986) “The north coast of Labrador and the Spanish influenza of 1918.” Them Days 11 (3): 3-4.Google Scholar
Mathews, John D.McBryde, Emma S.McVernon, JodiePallaghy, Paul K.McCaw, James M. (2010) “Prior immunity helps to explain wave-like behaviour of pandemic influenza in 1918-19.” BMC Infectious Disease 10 (1), doi:10.1186/1471-2334-10-128.Google Scholar
Mayhall, John T. (1970) “The effect of culture change upon the Eskimo dentition.” Arctic Anthropology 7 (1): 117-21.Google Scholar
McCracken, KevinCurson, Peter (2003) “Flu downunder: A demographic and geographic analysis of the 1919 epidemic in Sydney, Australia,” in Phillips, HowardKillingray, David (eds.) The Spanish Influenza Pandemic of 1918-1919: New Perspectives. London: Routledge: 110-31.Google Scholar
Miller, JayEastman, Carol M., eds. (1984) The Tsimshian and Their Neighbors of the North Pacific Coast. Seattle: University of Washington Press.Google Scholar
Morens, David M.Taubenberger, Jeffery K.Fauci, Anthony S. (2008) “Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: Implications for pandemic influenza preparedness.” Journal of Infectious Diseases 198 (7): 962-70.Google Scholar
Moss, Madonna L. (1993) “Shellfish, gender, and status on the Northwest Coast: Reconciling archeological, ethnographic, and ethnohistorical records of the Tlingit.” American Anthropologist 95 (3): 631-52.Google Scholar
Murray, Christopher J. L.Lopez, Alan D.Chin, BrianFeehan, DennisHill, Kenneth H. (2006) “Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918-20 pandemic: A quantitative analysis.” Lancet 368 (9554): 2211-18.Google Scholar
Newfoundland and Labrador Statistics Agency (2012) “Population estimates, July 1, 1996, to 2011, census divisions and St. John’s Census Metropolitan Area (CMA), Newfoundland and Labrador,” www.stats.gov.nl.ca/Statistics/Population/PDF/Population_Estimates_CDCMA.pdf (accessed June 17, 2012).Google Scholar
Newfoundland Colonial Secretary’s Department (1914) Census of Newfoundland and Labrador, 1911. Saint John’s, NL: Withers.Google Scholar
Newfoundland Colonial Secretary’s Department (1923) Census of Newfoundland and Labrador, 1921. Saint John’s, NL: Colonial Secretary’s Office.Google Scholar
Newfoundland House of Assembly (1919) “Annual report of the registrar general of births, marriages, and deaths, for the year ended December 31st, 1918.” Journal of the House of Assembly of Newfoundland, 1919, 759-71.Google Scholar
Newfoundland House of Assembly (1920) “Annual report of the registrar general of births, marriages, and deaths, for the year ended Dec. 31st, 1919.” Journal of the House of Assembly of Newfoundland, 1920, 677-95.Google Scholar
Noymer, Andrew (2009) “Testing the influenza-tuberculosis selective mortality hypothesis with Union army data.” Social Science and Medicine 68 (9): 1599-1608.Google Scholar
Noymer, Andrew (2011) “The 1918 influenza pandemic hastened the decline of tuberculosis in the United States: An age, period, cohort analysis.” Vaccine 29 (supp. 2): B38-B41.Google Scholar
Okak Church Book (1919) Digital copy secured in 2008 from Hans Rollmann, Memorial University of Newfoundland, Saint John’s.Google Scholar
Paddon, Harry L. (1919) “Emily Beaver Chamberlin Hospital: Winter, 1918-19.” Among the Deep Sea Fishers 17 (3): 80-83.Google Scholar
Paddon, Harry L. (2003) The Labrador Memoir of Dr. Harry Paddon, 1912-1938, ed. Rompkey, Ronald. Montreal: McGill-Queen’s University Press.Google Scholar
Palmer, Craig T.Sattenspiel, LisaCassidy, Chris (2007) “Boats, trains, and immunity: The spread of the Spanish flu on the island of Newfoundland.” Newfoundland and Labrador Studies 22 (2): 473-504.Google Scholar
Patterson, K. DavidPyle, Gerald F. (1983) “The diffusion of influenza in sub-Saharan Africa during the 1918-1919 pandemic.” Social Science and Medicine 17 (17): 1299-1307.Google Scholar
Pearl, Raymond (1919) “Influenza studies, I: On certain general statistical aspects of the 1918 epidemic in American cities.” Public Health Reports 34 (32): 1743-83.Google Scholar
Pearl, Raymond (1921) “Influenza studies, II: Further data on the correlation of explosiveness of outbreak of the 1918 epidemic.” Public Health Reports 36 (7): 273-89.Google Scholar
Perrett, Walter W. (1986) “The superintendent’s report to the S. F. G.” Them Days 11 (3): 38-42.Google Scholar
Petrivelli, Patricia J. (2004) “Unangam Aleut social system.” Arctic Anthropology 41 (2): 126-39.Google Scholar
Pettigrew, Eileen (1983) The Silent Enemy: Canada and the Deadly Flu of 1918. Saskatoon, SK: Western Producer Prairie Books.Google Scholar
Philip, R. N.Lackman, D. B. (1962) “Observations on the present distributions of influenza A/swine antibodies among Alaskan Natives relative to the occurrence of influenza in 1918-1919.” American Journal of Hygiene 75 (3): 322-34.Google Scholar
Phillips, HowardKillingray, David, eds. (2003) The Spanish Influenza Pandemic of 1918-1919: New Perspectives. London: Routledge.Google Scholar
Pritzker, Barry (2000) A Native American Encyclopedia: History, Culture, and Peoples. New York: Oxford University Press.Google Scholar
Provincial Archives of Newfoundland and Labrador (PANL) (1918-19) Death records, reels 32-33. Saint John’s, NL.Google Scholar
Pullar, Gordon L. (1996) “Aleut,” in Hoxie, Frederick E. (ed.) Encyclopedia of North American Indians. Boston: Houghton Mifflin: 19-21.Google Scholar
Samson, Colin (2003) A Way of Life That Does Not Exist: Canada and the Extinguishment of the Innu. London: Verso.Google Scholar
Sattenspiel, Lisa (2011) “Regional patterns of mortality during the 1918 influenza pandemic in Newfoundland.” Vaccine 29 (supp. 2): B33-B37.Google Scholar
Sattenspiel, LisaHerring, D. Ann (1998) “Structured epidemic models and the spread of influenza in the Norway House District of Manitoba, Canada.” Human Biology 70 (1): 91-115.Google Scholar
Schaaf, JeanneSmith, Thetus, eds. (1996) Ublasaun, First Light: Inupiaq Hunters and Herders in the Early Twentieth Century, Northern Seward Peninsula, Alaska. Anchorage: Interior Department, National Park Service, Alaska Support Office, Alaska Region, Shared Beringian Heritage Program.Google Scholar
Smallman-Raynor, MatthewCliff, Andrew D. (2004) “Impact of infectious diseases on war.” Infectious Disease Clinics of North America 18 (2): 341-68.Google Scholar
Smallman-Raynor, MatthewJohnson, NiallCliff, Andrew D. (2002) “The spatial anatomy of an epidemic: Influenza in London and the county boroughs of England and Wales, 1918-1919.” Transactions of the Institute of British Geographers, n.s., 27 (4): 452-70.Google Scholar
Smythe, Charles W. (1996) “Eskimo (Yupik/Inupiat/Inuit),” in Hoxie, Frederick E. (ed.) Encyclopedia of North American Indians. Boston: Houghton Mifflin: 182-87.Google Scholar
Society of the Furtherance of the Gospel (SFG) (1986) “Profits and loss: From the minutes of the July 9, 1919, meeting.” Them Days 11 (3): 37-38.Google Scholar
Sørup, SigneVillumsen, MarieRavn, HenrikBenn, Christine StabellSørensen, Thorkild I. A.Aaby, PeterJess, TineRoth, Adam (2011) “Smallpox vaccination and all-cause infectious disease hospitalization: A Danish register-based cohort study.” International Journal of Epidemiology 40 (4): 955-63.Google Scholar
Speck, Frank G. (1931) “Montagnais-Naskapi bands and early Eskimo distribution in the Labrador Peninsula.” American Anthropologist 33 (4): 557-600.Google Scholar
Strong, William Duncan (1929) “Cross-cousin marriage and the culture of the northeastern Algonkian.” American Anthropologist, n.s., 31 (2): 277-88.Google Scholar
Tanner, Adrian (1991) “Innu,” in Poole, Cyril F. (ed.) Encyclopedia of Newfoundland and Labrador. Vol. 3. Saint John’s, NL: Cuff: 47-50.Google Scholar
Tanner, Adrian (1998) “The aboriginal peoples of Newfoundland and Labrador and confederation.” Newfoundland Studies 14 (2): 238-52.Google Scholar
Tanner, Vaino (1944) Outlines of the Geography, Life, and Customs of Newfoundland-Labrador. Helsinki: Acta Geographica.Google Scholar
Thomas, Gordon W. (1955) “New era.” Among the Deep Sea Fishers 53 (3): 76-78.Google Scholar
Tuckel, PeterSharon Sassler, Richard MaiselLeykam, Andrew (2006) “The diffusion of the influenza pandemic of 1918 in Hartford, Connecticut.” Social Science History 30 (2): 167-96.Google Scholar
Turner, Edith (1989) “From shamans to healers: The survival of an Inupiaq Eskimo skill.” Anthropologica 31 (1): 3-24.Google Scholar
US Senate, Committee on Appropriations (1919) Influenza in Alaska. Sixty-Fifth Cong., 3rd sess., on S.J. Resolution 199: A Joint Resolution for Relief in Alaska. Washington, DC: US Government Printing Office.Google Scholar
van den Brink, Jacob H. (1974) The Haida Indians: Cultural Change, Mainly between 1876-1970, trans. I. Seeger. Leiden: Brill.Google Scholar
Vanstone, James W. (1974) Athapaskan Adaptations: Hunters and Fishermen of the Sub-arctic Forests. Chicago: Aldine.Google Scholar
Vaughan, Warren T. (1921) Influenza: An Epidemiologic Study. American Journal of Hygiene Monographic Series 1. Baltimore, MD: American Journal of Hygiene.Google Scholar
Veltre, Douglas W.Smith, Melvin A. (2010) “Historical overview of archaeological research in the Aleut region of Alaska.” Human Biology 82 (5-6): 487-506.Google Scholar
Waldmann, Siegmund (1919) “A deserted Eskimo village: Being extracts from the annual report of the Okak Mission Station, Labrador, for the year 1918-19.” Moravian Missions, November, 56.Google Scholar
Waldram, James B.Herring, D. AnnYoung, T. Kue (2006) Aboriginal Health in Canada: Historical, Cultural, and Epidemiological Perspectives, 2nd ed. Toronto: University of Toronto Press.Google Scholar
Williamson, H. Anthony (1964) “The Moravian mission and its impact on the Labrador Eskimo.” Arctic Anthropology 2 (2): 32-36.Google Scholar
Wolfe, Robert J. (1982) “Alaska’s great sickness, 1900: An epidemic of measles and influenza in a virgin soil population.” Proceedings of the American Philosophical Society 126 (2): 91-121.Google Scholar
Worl, Rosita (1996) “Tlingit,” in Hoxie, Frederick E. (ed.) Encyclopedia of North American Indians. Boston: Houghton Mifflin: 630-32.Google Scholar
Zane Jolles, Carol (1997) “Changing roles of St. Lawrence Island women: Clanswomen in the public sphere.” Arctic Anthropology 34 (1): 86-101.Google Scholar
Zylberman, Patrick (2003) “A holocaust in a holocaust: The Great War and the 1918 ‘Spanish’ influenza epidemic in France,” in Phillips, HowardKillingray, David (eds.) The Spanish Influenza Pandemic of 1918-1919: New Perspectives. London: Routledge: 191-201.Google Scholar