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The Eighteen of 1918–1919: Black Nurses and the Great Flu Pandemic in the United States

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The Eighteen of 1918–1919: Black Nurses and the Great Flu Pandemic in the United States AJPH HISTORY The Eighteen of 1918–1919: Black Nurses and the Great Flu Pandemic in the United States Marian Moser Jones, PhD, MPH, and Matilda Saines, BSc This article examines the role of Black American nurses during the 1918–1919 influenza pan- study of nursing and racism in a demic and the aftermath of World War I. The pandemic caused at least 50 million deaths world- public health emergency, while wide and 675 000 in the United States. It occurred during a period of pervasive segregation and raising transhistorical questions: Do public health emergencies racial violence, in which Black Americans were routinely denied access to health, educational, spur advancements in health and political institutions. We discuss how an unsuccessful campaign by Black leaders for admis- equity? Or do they merely allow sion of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during exploitation of already-margin- World War I eventually created opportunities for 18 Black nurses to serve in the army during alized persons? Although a single the pandemic and the war’s aftermath. Analyzing archival sources, news reports, and published case study cannot off er defi nitive materials, we examine these events in the context of nursing and early civil rights history. This answers, it can provide valuable analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse insights. Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity. (Am J Public Health. 2019;109: 877–884. doi: 10.2105/ BLACK WOMEN AND AJPH.2019.305003) NURSING Throughout US history, Black women have nursed the sick. Enslaved women cared 5 See also D’Antonio, p. 832. n 1918, Aileen Cole and in the United States. It also cre- for members of slaveholding IClara Rollins ached to be- ated opportunities for previously families while nursing their come Red Cross war nurses.1 excluded Black nurses, including own communities. Antislavery Cole, aged 24 years, had the fi rst 18 to serve in the Army crusaders Sojourner Truth and recently passed her registration Nurse Corps (ANC) between Harriet Tubman nursed soldiers exams, and Rollins, 34, had December 1918 and August and civilians during the Civil years of nursing experience.2 1919.6 War. 8 After this war revealed The two boarded with other Although Black nurses’ roles shortcomings in hospital nursing nurses in a Washington, DC, in World War I and the pandem- care, nurse training programs brick row house near Freed- ic have been noted by numerous began and admitted a few Black men’s Hospital, where they had historians, this article represents women. Many programs were all graduated from the rigorous the fi rst eff ort to move these based on Florence Nightingale’s nurse training school. The Red nurses from periphery to center, model of a hospital-based school, Cross had enrolled Cole and and to critically analyze their which provided instruction in Rollins on paper, but had done struggle to serve as a seminal scientifi c methods of sanita- nothing else: the US Army and episode in the long and ongo- tion and patient care.9 Students Navy, for which the Red Cross ing movement for civil rights worked in hospitals for 24 to 36 served as the offi cial recruiter, and racial health equity.7 Using months, while receiving room did not accept Black nurses.3 archival materials, news reports, and board.10 In October, the infl uenza census records, and published lit- Even before the US Supreme pandemic brought change. The erature, we highlight how Black Court’s 1896 Plessy v Ferguson Red Cross called up Cole, nurses fulfi lled a critical need for decision permitting racially “sep- Rollins, and several other Black skilled care during the pandemic arate but equal” public facilities, nurses for civilian duty, and and the war’s aftermath, but exclusion of Black Americans sent them to West Virginia to received little recognition. We from schools and hospitals had battle pandemic infl uenza.4 also show how nurses and Black become widespread.11 South- This 1918–1919 pandemic was community leaders viewed this ern nursing schools barred responsible for at least 50 million service as a political act. We pres- Black students, and Northern deaths worldwide and 675 000 ent this story as a historical case ones admitted very few.12 In June 2019, Vol 109, No. 6 AJPH Jones and Saines Peer Reviewed Public Health Then and Now 877 AJPH HISTORY the 1900 US Census, approxi- prove they were loyal Americans White nurses, for assignment mately 10 000 men and women who deserved the full benefi ts of to a training camp for Black identifi ed themselves as profes- citizenship.18 “Racially, this war soldiers.27 But these assignments sional or trained nurses, but this spells for us the most glorious failed to materialize. number included only 201 Black word in the vocabulary of free- In 1918, prominent Black Americans.13 dom—opportunity,” C.V. Ro- leaders vociferously challenged As historian Darlene Clark man, MD, a professor at Meharry this inaction. National Ur- Hine has shown, Black com- Medical School, stated.19 Over ban League Secretary Eugene munities responded to such 100 Black physicians served as Kinckle Jones wrote Scott, and exclusion by pooling resources US Army Medical Corps offi - Tuskegee Institute President to establish Black hospitals and cers, along with 12 Black dental Robert Moton wrote the Red hospital-based nurse training offi cers, 639 Black infantry of- Cross leadership, to call for the programs. Between 1891 and fi cers, and 400 000 Black enlisted immediate enrollment of Black 1907, 12 such nurse training men.20 Fourteen Black women nurses. Their exclusion “reacts programs opened for Black served as navy clerks.21 The War in a certain sort of indiff erence women, including ones at Department appointed Emmet on the part of colored people New York’s Lincoln Hospital, J. Scott, former Secretary of which ought not to be when the Chicago’s Provident Hospital, Tuskegee Institute, as its special country needs every ounce of and Freedmen’s Hospital in assistant for Negro aff airs.22 Scott eff ort along every available line,” Washington, DC.14 In 1908, worked as an intermediary be- Moton stated.28 In its annual Black women nurses formed the tween Black Americans and the meeting, the NAACP also voted National Association of Colored military on issues from discrimi- to allow its secretary to act to Graduate Nurses (NACGN). By nation to Black troop morale.23 “forward acceptance by the War the 1910 Census, 3010 Black However, Black nurses Department of Colored nurses women and about 200 Black were barred from serving. The overseas.”29 men self-identifi ed as profes- American Red Cross, a quasi- These actions elicited a re- sional or trained nurses.15 governmental humanitarian sponse from Delano. She wrote In the 1910s, trained Black organization, recruited about Jones that she had “deferred” en- female nurses nevertheless faced 23 000 nurses for the ANC and rollment of Black nurses, “on the steep obstacles. Most Whites and the Navy Nurse Corps.24 The advice of colored people with some Black men, according to organization restricted enroll- whom I have consulted, feeling Hine, viewed them through a ment to graduates of reputable that if their assignment to duty “triple index of inferiority”: as hospital-based nursing schools was delayed for any great length nurses (not doctors), women who had passed a physical of time it would make the nurses (not men), and Black (not examination and obtained a restless and discontented.”30 White).16 In 1916, the Ameri- positive character reference from But now Delano promised to can Nurses Association began a supervisor.25 By 1917, most begin their enrollment imme- requiring membership in a state trained Black nurses could meet diately—with one condition. nursing association. Associations these qualifi cations.26 But in Although each enrolled Black in 16 states and the District 1911, the Red Cross had voted nurse, like any other Red Cross of Columbia excluded Black to exclude Black nurses from nurse, would receive a num- nurses, eff ectively barring them enrollment, citing a surgeon bered badge, Black nurses’ badge from membership in the Ameri- general’s statement that the army numbers would be preceded by can Nurses Association.17 would be unable to provide suit- an “A” to prevent them from able (i.e., segregated) quarters for being assigned to duty “without these nurses. In 1917, the Red reference to their color.”31 RACE AND CITIZENSHIP Cross reversed this policy. Then, By the November 11 armi- IN WORLD WAR I after NACGN President Adah stice, the Red Cross had enrolled When the United States Bell Thoms protested that no 77 Black nurses but still had not entered World War I in 1917, nurses were actually being en- assigned any to military duty.32 many Black Americans, includ- rolled, Red Cross nursing leader This slow response stemmed ing those in health professions, Jane Delano informed Thoms from “delays in the provision volunteered for military service that she was ready to enroll 150 of separate quarters and mess or joined voluntary patriotic qualifi ed Black nurses, with the for these women,” according organizations. Some did so to same “pay and allowances” as to Julia Stimson, later ANC 878 Public Health Then and Now Peer Reviewed Jones and Saines AJPH June 2019, Vol 109, No. 6 AJPH HISTORY superintendent.33 This rationale Henry Street Settlement, and our soldiers, didn’t you?” Cole however, holds little weight con- during the war worked for the recalled.
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