Defense Threat Reduction Agency
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A Historical Assessment of Nonpharmaceutical Disease Containment
Strategies Employed by Selected U.S. Communities During the Second
Wave of the 1918-1920 Influenza Pandemic
January 31, 2006
Howard Markel, M.D., Ph.D.
Alexandra M. Stern, Ph.D.
J. Alexander Navarro, Ph.D.
Joseph R. Michalsen, B.S.
The University of Michigan
Center for the History of Medicine
100 Simpson Memorial Institute
Ann Arbor, MI 48109-0725
Approved for public release; distribution is unlimited.
DISCLAIMER: The views expressed herein are solely those of the
authors and do not necessarily reflect the official policy or position of
the Defense Threat Reduction Agency, the Department of Defense, or
the United States Government.
Advanced Systems and Concepts Office FINAL REPORT DTRA01-03-D-0017
TABLE OF CONTENTS
I. Executive Summary
II. Purpose and Methods
A. Specific Aims and Methods of Study
B. Caveats of Applying Historical Research to Present-Day
Public Health Concerns
C. Historiography of Epidemics
III. Definitions of Terms
IV. The 1918-1920 Influenza Pandemic in the Continental United States
A. Historical Overview
B. State of Virology
C. Influenza Mythologies
V. Provisional Influenza Escape Community Case Studies
B. Yerba Buena Island, California
C. Gunnison, Colorado
D. Princeton University, Princeton, New Jersey
E. Western Pennsylvania Institution for the Blind, Pittsburgh,
F. Trudeau Tuberculosis Sanatorium, Saranac Lake, New York
G. Bryn Mawr College, Bryn Mawr, Pennsylvania
H. Fletcher, Vermont
VI. Additional Factors Related to the Attempted Containment of the