Americas Forgotten Pandemic: The Influenza of 1918 by Alfred W. Crosby

Americas Forgotten Pandemic: The Influenza of 1918 Reviews

• 
  Mark

  The pandemic originated outside the United States, but was brought to the country by people traveling abroad. A respiratory disease, it was concentrated first in urban areas but soon left few places untouched. Though the ebbing of the initial wave fueled hopes that the worst of the pandemic would soon end, a second and even deadlier wave soon swept through the country. As medical officers urged people to wear masks in public, health care services were strained to their limits by the number of the infected, forcing in some places a rationing of care and a resort to emergency measures to cope with the number of patients in need of treatment.
  
  Such a scenario is one everyone today has witnessed as the United States and the rest of the world deal with the COVID-19 virus. Yet this also describes the nation’s experience with the Spanish flu pandemic that plagued the country from its initial appearance in 1918 to the final wave of infections in 1920. In that time millions were sickened and as many as 675,000 Americans died from the complications from a virus that the nation’s best medical experts struggled to understand. Their efforts to cope with the pandemic are at the heart of Alfred Crosby’s book, which describes the course of the pandemic and identifies the ways in which it left its mark upon other events, some of which were subsequently forgotten afterwards.
  
  America’s experience with the Spanish flu was intertwined inextricably with that of the First World War. Many of the early cases were those of soldiers and sailors returning home from abroad. The crowded conditions in the army camps where millions of draftees were being trained provided an ideal environment for the virus to be spread, while public rallies in support of the war effort further facilitated the flu’s transmission among the population. As the number of cases mounted, some Americans even speculated that the Spanish flu was being disseminated as part of a German plot to disrupt war mobilization, which was testament to the impact it was having on the nation.
  
  Crosby describes the spread of the flu in general terms, which to a degree reflects the limitations of his sources. As he notes periodically throughout the text, reporting requirements were few, and diagnoses were often inaccurate, making the data less than comprehensive. When caseloads at their peak, medical personnel were so busy coping with the overwhelming number of patients that they had little time to maintain detailed records. This was despite the fact that, for all of the advancements in Western medicine over the past couple of generations, the only treatment available was “[w]arm food, warm blankets, fresh air, and . . . TLC—Tender Loving Care”, in the hope that by maintaining a patient’s health their body could fight off the flu before pneumonia set in.
  
  While the limitations of the medical knowledge of the era hindered the fight against the Spanish flu, Crosby notes how the behavior of Americans was usually the greatest obstacle to fighting the spread of the virus. Crowded cities aided the spread of the disease, while many resisted the imposition of even the most basic of mask requirements, offering a range of arguments that would be unknowingly echoed by their counterparts a century later. Though the ebbing of the pandemic’s first wave in the spring and summer of 1918 fueled hopes that the initial precautions had succeeded in minimizing its impact, two more devastating ways that autumn and again in the spring of 1919 dashed such hopes. It was only with the fourth wave in early 1920 that the signs indicated that the nation had suffered through the worst of the flu, and could begin the process of recovering from its impact.
  
  As a pioneer in the integration of biology into the study of human history, Crosby is ideally suited to write a history of the pandemic. Yet while his book is a readable overview of its subject, it suffers from three flaws. The first is its age: originally written in the mid-1970s, the decades of subsequent research on the origins and impact of the Spanish flu (some of it inspired by Crosby’s work) is missing from its pages. This has the effect of highlighting the second flaw, which is Crosby’s at times superficial analysis. His book is better at raising questions than it is at supplying answers, and while this may be a consequence of the relatively limited amount of data available to him the lack of an effort is regrettable nonetheless. The third is the book’s scope, as Crosby’s American-centric focus downplays the dynamics of what was ultimately a worldwide phenomenon. While he occasionally cites the impact of Spanish flu elsewhere, particularly in his chapters on the Paris Peace Conference, this is done primarily in service to his examination of the flu’s impact on the United States. Though a broader examination would have required considerably more research, it would also have resulted in a work better able to capture the global scale of the pandemic. All of this limits the value of Crosby’s book for readers today, which for all of its continuing value as an introduction to the Spanish flu pandemic has been surpassed in other respects by more recent studies.
• 
  Jeff

  I read this book with two rubrics in mind: it’s quality as a history of the 1918 pandemic, and the lessons we can draw from it for the COVID-19 pandemic we face today. On the first, the prose is readable, the archival work and its limitations explained, the statistical data presented is useful but not overwhelming, and the narrative is straightforward. On the second, it has mixed results.
  
  The context of the “patriotic” surge around the American entrance into the first world war is crucial for understanding the inability and failure of government and society to respond to the pandemic, as well as its spread. The mass mobilization of society as part of the war effort spread the influenza, with soldiers alternating between travel to and from bases and the warfront and sitting tight in overcrowded barracks and transportation. Of course, mass mobilization also meant mass record keeping, and Army and Navy medical records were early indicators that a pandemic was occurring. Additionally, Crosby highlights the War Bonds rallies as vectors of the rapid spread in cities throughout the country; rallies which frequently were not called off in spite of concerns, because to do so would be unpatriotic or even a treasonous attempt to undermine the war effort.
  
  Paranoia about disease warfare also finds its echo in the 1918 pandemic: Crosby cites a military health leader suspecting Germans of releasing the influenza in America after being dropped ashore by u-boats. “Most newspapers printed the story” (47). Additionally, Bayer Aspirin was fingered as a cause because it was a German patent, and the USPHS tested it in the middle of the pandemic to ensure it was not poisoning customers (216).
  
  One major flaw of the book is a middle chapter spent on the flu’s impact on the Paris Peace Conference after the end of the first World War. Crosby fails to make any useful conclusion about the impact of the pandemic on world history, and the whole thing reads like an effort by someone who is beholden to the Great Man theories of history to find something useful to say about it.
  
  The familiar theme of under-funded and under-resourced public health agencies also play a role. “The organ of government primarily responsible for maintaining the levees against infectious disease was the United States Public Health Service, but it wasn’t ready for danger of this magnitude.” (49). In this case, it was an issue of government institutions not having been built, rather than our own CDC being gutted.
  
  Still, the USPHS centralized the intake and dissemination of information throughout the country, attempted to unify public health departments and bureaus in the 48 states, and took part in ensuring that market forces did not disrupt the provisioning of medical supplies and services. “...no division would be permitted to recruit nurses from any other division without approval from National Headquarters, and a standard schedule of nursing fees was prepared and approved by the Red cross and army and USPHS Surgeon Generals” as “various areas affected by the pandemic were beginning to bid against one another for nurses” (51). Congressional support for the USPHS was rapid after the mostly unnoticed first wave hit and the second began in the Fall, with the Service gaining a 33% increase in its annual budget by unanimous bicameral agreement (52).
  
  Crosby notes variations in the impact of the disease, but refuses to draw conclusions or find explanations, even when they are sitting under his nose. In fact, Crosby is blase about whether anything could have been done at all to stop the spread of the influenza or blunt it’s impact. This conclusion is because he doesn’t attempt any statistical analysis from the data he has available.
  Instead of looking for trends or isolating variables, Crosby just writes that sometimes people tried things and they worked, and sometimes people tried the same thing elsewhere and it didn’t work. “For instance, the density of population on the ships seems to have had no effect on the course of the epidemics of those ships. Some transports which sailed in September with 100 to 122 percent of the authorized number of soldiers aboard had an incidence of flu of about 6.9 percent. Others sailing at the same time with 90 to 93 percent of authorized capacity had an incidence rate of 20 percent” (139).
  
  Throughout the book, he examines four different tactics: public closing orders, masks, vaccines, and organizational efforts to ameliorate the impact on communities. The same attitude towards finding conclusions occurs each time: Crosby refuses to draw conclusions from a mass of messy data simply because he doesn’t attempt to analyze it as anything other than anecdotes.
  
  Frustratingly, even when there are cases where clear conclusions can be drawn, such as the successful masking campaign in San Francisco immediately limiting the pandemic’s impact until social pressure and a mailbombing attempt end the campaign and a second wave occurs, Crosby ignores them and retreats back to an epistemic fatalism about our ability to understand how to combat the pandemic. It isn’t until nearly the end of the book until Crosby admits he’s no “biostatician” but just a historian who can’t draw conclusions from the data he has available (257).
  
  The book was a groundbreaking work of history shining a light on an overlooked and forgotten pandemic, so I’m not angry with Crosby for these failures, but they do dramatically limit the value. What we can take from it is examples and anecdotes around xenophobic paranoia, varied government responses, the efforts and failures of scientific institutions to combat the pandemic, and - despite Crosby’s chauvinistic failure to do the very, very obvious analysis - the racist, classist, and imperialist vectors on which the pandemic spread.
  
  I have not yet read other histories of the 1918-19 pandemic, so I can’t compare “America’s Forgotten Pandemic” to more recent historical works, but I would not be surprised if Crosby’s book is valuable for students of the historiography of the pandemic, rather than as the most useful or intelligent history available today.
• 
  Patrice

  I think this book is complimentary to Gina Kolata's work on the same topic. There is obviously some overlap. They both discuss the epidemic in 1918 and 1919 and they both discuss research since up to points of their respective dates of publication. Kolata's book spends less time on the epidemic and more time on the progression of research since leading up to isolating the 1918 strain of flu. The bulk of Crosby's book focuses on the epidemic and its impact on American and European civilians and military personel, relating it to world events at that time. There is some discussion of flu research since, although much less progress had been made at the time Crosby's book was published, so he probably had less to say about it. He did spend more time than Kolata discussing the research and theories about flu that did not pan out. Put together both books provide and extremely comprehensive review of the 1918 flu and twentieth century flu research since. All the set needs now is a book discussing the progress made in the 21st century, possibly detailing the connection betweent he 1918 flu pandemic and the 2009 flu pandemic. I would be interested in reading more on that.
• 
  Scott Holstad

  A reviewer of this book years ago started his review with this: "I think this book is complimentary to Gina Kolata's work on the same topic." And it's interesting because I was going to say basically the same thing, which would have looked stupid, so I'm glad I read through some reviews. That said, I do think Kolata's book is the better one, possibly more interesting to me personally, although I agree with the reviewer in thinking they compliment each other well. As I write this, it's March 2020 and the world is experiencing its first major pandemic since that one, and to this point, the similarities are eery. However, I think it would help people have some context as well as a glimpse of the probable future, no matter how grim, so I definitely recommend anyone looking at this at the time of my writing this invest in researching and reading this book, Gina's "Flu" or others like them, because I think it's important to educate ourselves in light of the present situation. Hence, recommended.
• 
  Fred Klein

  The reason why I was interested in reading this is obvious. I've never been through a pandemic until now, and I wanted to learn about the one from 1918 that kept being cited in the media.
  
  I must have heard of this pandemic before, but it was probably passing mentions in other books. I mean, I've read books on WWI and Woodrow Wilson, so it's incredible that I knew so little about it.
  
  While the information in this book was extensive, I was often lulled into inattention by long passages of statistics, which I found to be the least interesting parts.
  
  The most interesting parts were the human stories, how the pandemic affected real people and what came after. There was a fascinating chapter about its effect on the Paris peace talks, and there is a suggestion, because Wilson was so weak at that time, and because it led to certain people being elected to the Senate, that the pandemic had an impact that led to WWII.
• 
  Adam

  A reasonably sized history of the 1918-1919 pandemic, written in 1990. Some uncanny parallels with the Covid-19 pandemic.
• 
  Elizabeth

  The most striking thing to me is that human behavior and government response/policy (or lack thereof) remains unchanged since the 1918 pandemic. One would have hoped we could have learned our lesson the first time.
  
  This was a good read, and I feel well-versed in the 1918 pandemic. The writing got thick at times. I wonder what a 'popular' or 'journalistic' author could do with this strong content which got buried occasionally by academic author Dr. Crosby. HIGHLY RECOMMENDED for those interested in WWI, pandemics/health policy, Alaska, science research, cultural or military history
  
  SPOILERS below...
  
  Highlights of what I learned, with some quotes applicable to the SARS-CoV-2 Pandemic (remember, this book was written in 2003)
  
  - The pandemic behaved differently depending on where it was... the front line, boot camps, urban cities, isolated islands, ships. Regarding WWI - the flu illness did more "damage to the war effort" than battle deaths. Those ill with flu pulled critical human & physical resources away from the battles.
  
  -Most of the histories of this pandemic are pulled from cities (newspapers documented numbers and events) and naval ship records
  
  - The "line dividing the body from its environment is at its thinnest in the lungs". Typically, death curves with Flu are the very young and the elderly - creating a "U" curve. This particular pandemic had a W curve - many young adults were taken. Super-spreader events - war bond celebrations, victory parades - contributed to a faster spread.
  
  - Conspiracy theories were plentiful about the origins of the Spanish Flu - most of which targeted enemies of the times. Minorities and immigrants were also targets of dominant culture's suspicion.
  Asymptomatic spread was confirmed, and strong antibodies appeared in tests decades later.
  
  - Social support structures must be considered in building a response. In the case of the 1918 pandemic, adults with young children fell ill and were unable to care for their children. In some cases, especially in Alaska, children froze or starved to death because adults were incapacitated.
  
  - Flu does not leave a 'lasting mark' on its victims like pox or polio did. The lack of disfigurement lessens the fear people have of it, and as such, lowers the response to a flu pandemic. Flu low mortality rate contributes to a 'lack of fear' and thus flu is often ignored as a serious medical condition. In the case of the 1918 pandemic, it moved so fast through communities that responses were often too late to make a difference in prevention.
  
  -"China, which tops the list the world in its numbers of humans, aquatic birds, and pigs, has bene the source of many new flu strains since 1918 and will be again." pg.xiii [Note: SARS-CoV-2 is not flu, but I found it interesting this 2003 book identified China as 'the hotspot' for pandemic origins.]
  
  -"There is a bitter little pill of a joke currently circulating among infectious disease experts. It is short: The nineteenth century was followed by the twentieth century, which was followed by the... nineteenth century" (pg.xiii)
  
  -"The factors at work in the pandemic were so numerous and the ways in which they canceled or gained power from one another are so obscure that very few generalities can be drawn." pg. 64
  
  "Spanish influenza had a withering hand on all of the essential services." pg.75 (specifically phone operators, manufacturing, embalming/burial services, 1st responders). Volunteer services saved thousands through medical care, transportation, food prep, child care.
  
  -"Very few health officers and no communities as a whole really appreciated the devastation the pandemic could wreak until experiencing it." pg.92
  
  -Masking (see page 101-9) [interesting quote from 1918 that could have been written in 2020: "mask regulations subversive of personal liberty and constitutional rights"], and school/business/entertainment closures, and fear or authority and those of difference (minorities, immigrants, race), travel quarantines/bans will always be controversial during pandemics.
  
  
• 
  Erika

  This was an excellent book. I have read one other book on the Spanish Influenza Pandemic of 1918-1919, but it’s aims were different. This is a scholarly book, complete with footnotes. (The history major I me was very pleased to see this.)
  
  What struck me, first, was the similarities to the COVID-19 issues in 2020, and second how apt the title is. The world has forgotten the Spanish Flu, and doesn’t take the flu seriously enough under normal conditions, much less under such dire circumstances as we face this year.
  
  Having two degrees in history, I can tell you that not all books on history are this easy to read. I’m in the minority amongst historians in thinking that this is an important quality. Who cares how ground-breaking your research is if no one can get through your book to get the point? This one I did and I enjoyed learning something new.
• 
  Diana Petty-stone

  This is probably the best book written about the 1918 pandemic. I've read several others but this one had the most impact.
• 
  Caitlin

  This is by far the scariest book I have ever read and the worst part about it is the fact that it's true! I read this book shortly before the H1N1 virus started making headlines earlier this year. The current strain is closely related to the strain from 1918. "Official" estimates at that time were that close to 30 million people died, but modern day historians and scientists think that many people died in India alone! Some estimates go as high as 100 million!
  
  Crosby does a fantastic job of informing while keeping things interesting in a genre that is often written in a dry text-book style. Crosby uses dozens of anecdotal accounts from those who witnessed the pandemic; doctors, nurses, children, immigrants, soldiers, and everyone in between. Crosby also makes some interesting connections between the devastating impacts of influenza and world events. An example of this is the way WWI was fought. Crosby believes that fighting was heavily influenced by the fact that young healthy males were hit the hardest by the Spanish Influenza. This demographic also happened to be the same one that the free world was depending on to remain free. Crosby asserts that the outcome of the war, which culminated with the Treaty of Versailles, was also influenced by the pandemic. Pres. Woodrow Wilson and other leaders were struck down with the virus. Crosby questions these key negotiators abilities' given their mental and physical states. He argues that the "resolution" agreed upon was perhaps hastily written so that the sick parties could end their misery and go home. History shows us that only a few years later, an oppressed and disgruntled Germany (who were not consulted while the terms of the treaty were being written) started a second World War.
  
  I am not a history major, or even a college grad (yet), but I found this book easy to read and easy to understand all while being informative.
• 
  Rick

  “America’s Forgotten Pandemic” by Alfred W. Crosby (first published in 1976 with a second edition in 2003) is an in-depth look at the Spanish Influenza of 1918-1919 that gripped the world and caused more deaths than the total of military and civilian mortalities in World War I … and the influenza was much speedier. Between August 1918 and March 1919, 25 million people became victims of this influenza. The premise of the book is that while today we still remember and study World War I, we have pretty much forgotten the Spanish Influenza pandemic.
  
  Alfred Crosby (1931-2018) was a distinguished professor of History primarily at the University of Texas at Austin. Two of his major works – "The Columbian Exchange: Biological and Cultural Consequences of 1492" (1972), and "Ecological Imperialism: The Biological Expansion of Europe, 900–1900" (1986) – were ground-breaking works that used biology to explain much of the success of European exploration of the New World. Being an academic, his books took on an academic aura and never reached mass popularity; it would take Jerod Diamond with "Guns, Germs, and Steel" (1997) to write the popular version of Crosby’s ideas. With "America’s Forgotten Pandemic" Crosby takes an in-depth view of another major event and brings in biology and science to help explain its parts and pieces … and once again his work reads like an academic tome in places, but that should not dissuade one from trying it on for size.
  
  Takeaways: One of the fascinating takeaways from this book is the age disparity in the influenza’s mortality. Generally speaking, epidemics usually are hardest on the youngest and the oldest in the population … but the Spanish Influenza was hardest on the mid-age group, those in their twenties and thirties, whom one would have expected to survive the easiest. Another fact is that Black Americans who usually suffer higher death rates than whites from respiratory diseases suffered less in the Influenza Pandemic. Also Immigrants had a higher death rate than those born in the United States.
  
  This tale is replete with facts and figures that describe the pandemic in ways one might never have considered, and for this alone it is a good read. Consider for example that American servicemen often brought the Spanish Influenza with them to Europe and back again when returning. Crosby also touches on the effects of Swine Influenza and its import on the human Spanish Influenza. This narrative ends up a tale of virology versus bacteriology. All-in-all, this is a good book filled with detail. Recommended.
• 
  Kevin Mitchell Mercer

  Reading this in 2021 for, well, obvious reasons.
  I don't subscribe to the "history repeats itself" school of thought and was not really looking for any eternal pandemic truths by picking up Crosby's book. More some perspective and a general understanding of the pandemic that came before this one. I also was reading for some additional context to use as I craft some new lectures and lessons on this pandemic since students have requested more materials on this event.
  While a bit dated and certainly not predictive of the 2020-? COVID pandemic, this book is a solid account of the early 20th-century flu pandemic. This book is more of a military history than I expected, but that did allow me to understand better the connections between this flu pandemic and World War I.
  Some elements went far beyond my needs, and I'll confess to skimming some of the more medical-heavy portions. Their inclusion does suggest a thorough effort on Crosby's part to present a full history of the event.
  If there are take-a-ways for the current pandemic, while there were still challenges to get the public to wear masks, there was also a lot less undermining of authority and a general emphasis on lending a hand and all doing your part.
  
• 
  Beth

  A book I’ve been meaning to get to for a very long time and it felt like the right time to finally read it.
  
  My only complaint is that I wish that the many numbers were grounded with more individuals stories. It’s hard to imagine thousands of people dying in a week in a particular city. I also wish that there had been a little more on nonwestern countries—in particular, India. So I liked the chapter on Samoa and Alaska, which were at least outside mainstream US and outside the scope of the first world war.
  
  A bit disheartening for the moment, especially since many of the public and government reactions are so similar to what we’re experiencing now. But that’s history for ya!
• 
  Courtney Stoker

  Really dull and plodding, even though I was quite interested in the subject and am a former academic. I could have slogged through it if it was an assignment, but for fun? No, thanks.
• 
  Douglas

  I had seen books and information about the Flu pandemic of 1918 and it is shocking how devasting this was. It was a form (I think) of avian flu which is scary because of recent incidents with asian bird flu issues. The 1918 strain was estimated to have killed between 50 to 100 million people based in some data I have seen. That is so scary.
  I loved reading "Hot Zone" by Preston years ago and took some medical geography courses in college. I just find it fascinating how these medical detectives track down the virus and work to solve the puzzle of getting it - hopefully protecting us in the process. It also brings to light how America has the resources to create and store possible vaccines yet poorer countries are left to suffer. Always have the hope that one day we can actually help one another especially in the face of future pandemics. I found it very startling too that pharmaceutical companies are so driven by money that vaccines are not considered to be profitable and are in small production worldwide - daily meds that people take make much more money.
• 
  Chris Hart

  This is the second book I've read this year on the influenza of 1918; it also happens to be the 100 year anniversary of the pandemic. The first book was "Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused It" by Gina Kolata. While that book's subtitle was the main thrust of the book--the search for the virus--"America's Forgotten Pandemic" is more a history of the time and how the epidemic affected the era and people at the time. This is not surprising, as the late Dr Crosby was a professor of history and geography. It also makes for a more interesting book on the subject. The topic is covered in a well-rounded manner, and only occasionally falls into textbook-speak.
• 
  Richard

  A good chronicle of events that transpired in the 6 months prior to September 1918 and the six months after. The descriptions of what happened at Ft Devens and the naval prison on Deer Island in Massachusetts were of particular interest to me. I found it interesting that the government was issuing vaccines during and after the epidemic as a placebo. They actually had no idea what was going on. The idea of bacteria and virus was only about 50 years old at the time.
• 
  B

  More of a history book than anything else. It is saved by a few chapters full of memorable anecdotes, but the statistics in this book drag on and on until you're glazed over and numb. The afterward discusses why Americans seem to have forgotten about the 1918 influenza pandemic. If living through the pandemic is anything like reading this book about it, I think I understand why it has been largely forgotten.
• 
  Julia

  Though it's considered to be one of the best sources on the flu pandemic of 1918, I found this book to be incredibly dry. Maybe it's my video-game, Hollywood blockbuster, TV violence up-bringing, but it felt as if it read like a roster of how many soldiers got sick and how many died in every single army company across the globe.
• 
  Joy

  Bought it, set it aside. Started it, set it aside. It is well-written and interesting from an historical perspective, and full of stuff people just don't think about. (i.e., what was going on overseas during the War as people died at home in America from influenza.)
  I have yet to get past page 50! But I WILL finish this book!
• 
  Kelsey

  Probably would have gotten more out of it if I wasn't using it for my lit review.
  
  It was full of useful information and graphs. An updated edition would be nice, especially on some of the correlations between H1N1.
• 
  CMT-Michigan

  It was okay. It's scary to see how in about one year, a disease that could not be stopped spread around the world and killed so many,. However, the book is not written in a very interesting way.
• 
  Kurt Johnson

  Interesting & scary