Description
Increased interest in the relationship between tuberculosis and influenza mortality and morbidity during the 1918-19 Influenza (H1N1) pandemic has encouraged numerous studies in the last decade. However, the limited number of patient records surviving from the period restricts the extent to which generalised conclusions can be made on the influence of comorbidity in tuberculosis-influenza interactions, impacting both historical understanding and future pandemic preparedness efforts.This paper utilizes an analysis of Southern Californian influenza and tuberculosis comorbidity during the 1918-19 influenza pandemic to propose an expansion to the way we conceptualize comorbidity within the study of historical epidemics. First, this paper introduces a novel patient dataset with an analysis of H1N1 Influenza-TB comorbidity at the Barlow Sanatorium, Los Angeles. In doing so this paper challenges the selective mortality hypothesis pioneered by Noymer (2011) as it applies to Southern California and align more closely with the findings of Mamelund and Dimka (2019), especially concerning age, sex, and duration of illness. The broader links between tuberculosis and influenza in pandemic-era southern California will then be discussed, and in doing so this paper proposes the concept of ‘cultural comorbidity’ as a solution to patient data scarcity within historical epidemic research. By considering medical and popular reactions to influenza in 1918 as the products of pre-existing cultural ‘infection’ with TB based understandings of disease and contagion, this paper will demonstrate the value of considering comorbidity beyond the biological, as a cultural construct formed by the everyday experiences of disease and its prevention measures in areas of concurrent endemic and epidemic disease.
Despite Southern California representing an ideal setting for a case study on influenza and tuberculosis comorbidity, existing histories of both tuberculosis and influenza in the region fail to recognise how the uniquely tuberculous nature of California’s southern counties impacted experiences of influenza in 1918. A 1914 study calculated the average mortality from tuberculosis in the state as 1/500 people per year, with 20,000 estimated active cases. Southern California, which housed the majority of these cases, was intimately linked to tuberculosis and its networks of care, having benefited from largescale development as a result of 19th century invalid migration to its so-called ‘healthful’ climate. When influenza arrived then, it did so not just into the institutions built for California’s invalid population, but also into a region in which tuberculosis was foundational and culturally ever-present.
The Barlow Sanatorium represents one such Southern Californian institution. The patient data consulted for the paper’s comorbidity analysis derives from patient records published in the Sanatorium’s annual reports in the pandemic and post-pandemic period (1918-1921). As with Mamelund and Dimka’s (2019) dataset, the Barlow Sanatorium records contain detailed patient information, including age, sex, condition on admission and discharge, duration of illness, length of stay at the sanatorium and complications (comorbidities). My paper thus contributes to existing literature in its analysis of this data, while also expanding the definition of comorbidity through its inclusion of cultural responses drawn from medical journals, meeting minutes, newspaper articles and personal ephemera.
| Period | 9 Feb 2024 |
|---|---|
| Event title | Epidemics and their Determinants: Past and Present Workshop |
| Event type | Workshop |
| Location | Barcelona, SpainShow on map |
| Degree of Recognition | International |