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{{Infobox book
| name           = America’s Forgotten Pandemic: The Influenza of 1918
| image          = [[File:crosby_cover.jpg|200px|alt=Cover]]
| image_caption  = 
| author         = Alfred W. Crosby
| publisher      = Cambridge University Press
| pages          = 356
| isbn           = 978-0521541756
}}

At the time of this posting, the United States is in the mists of another flu epidemic, which has claimed many lives, including the children and elderly. However, while the country has dealt with flus on an annual level, none have had as much of an impact as the “Spanish Influenza” of 1918. According to Author Alfred W. Crosby, the Influenza strain of 1918 “killed as many servicemen as died in battle” and killed ten times as many U.S. citizens (Chapter 1). By reading this study, one can better understand how the Spanish Influenza spread, and the impact it had on American life. 

Part One “introduces” the reader to the Spanish Influenza, and how it came to be. At the time of the Influenza’s origins, several countries, including the United States, were involved in the Great War, and doctors were being called upon to examine the health of U.S. troops headed to Europe. One notable Doctor, William Henry Welch, worked to “troubleshoot” sanitary conditions of military camps. During this time, it was noted that the health of the army was “as good as any reasonable doctor could expect” (Chapter One). However, this was short-lived, as the first word of Spanish Influenza started to hit the camps, starting at Camp Devens, just west of Boston. Soon, one soldier complaining of flu-like symptoms became dozens being sent to the hospital with Influenza. Although it’s common for the flu to spread, the Influenza strain of 1918 was explosive; by September 23rd, more than 12,000 cases of Spanish Influenza had been reported in Camp Devens (Chapter one). This was also a deadly strain; within a month, 66 men had died as a result. As the hospital on base was short-staffed, both the medical staff and the morgue were overwhelmed with all the cases. 

The Second part of the book discusses the Spanish Influenza and the “first wave”. Not many Americans were initially concerned with the Spanish Influenza; much of the American consciousness was focused on war efforts, and it was looking uncertain as to who would “win” the war (Chapter 2). Also, there were unclear ways that the flu could be diagnosed; for example, the Denver Post informed readers on how to “tell the difference” between the cold and the flu, so that doctors could avoid “unneeded house calls” (Chapter 2). It would be later discussed in the book that bacteriological tests were also unable to determine which strain caused the flu. The third reason why the United States was so unprepared for the pandemic was because unlike today, there was not much communication regarding public health between the various government levels and agencies. What made this flu and the pneumonia more difficult to manage was that unlike other strains that kill those at the extremes of life (the very young and old), these strains were killing soldiers in their prime (Chapter two). These factors, including the fact that over one million Americans were headed to Europe helped to spread Influenza, overwhelming doctors when ships from Europe were headed into Boston with hundreds of cases on board (Chapter 2). 

While the second part of the book focuses on the first wave, Part 3 of the book focuses on the second and third waves. Despite the ongoing war efforts, as well as the rise of tensions with those of German heritage, Boston and Massachusetts slowly began to take measures against the pandemic. However, by that time the disease spread as far south as Louisiana and as far west as San Francisco. In August, 2,800 Americans died of flu and pneumonia, and the number spiked to over 12,000 in September (Chapter 4). As the author notes, there were several reasons why the flu had spread. Firstly, although more than 1500 nurses volunteered in the effort, it still wasn’t enough to manage the outbreak. Secondly, there was a lack of funds from both the Red Cross and the government, as most of the resources were being used in the war effort. Because of the government running out of money to fund their war effort, a fourth bond drive was offered, with massive rallies held to raise money. Not only did this raise funds, but it helped to spread Influenza even faster. 

As Crosby notes, although this was a pandemic that affected every part of the country, it was hardest felt in its cities. In chapter 5, the author examines the different factors for the spread of the flu, including language barriers between immigrant groups and medical staff. For Philadelphia, the Spanish Influenza overwhelmed every sector of city life, from the police force (in which almost 500 officers didn’t show up for work) to the only morgue in the city, which was filled beyond normal capacity. Schools were shut down, and teachers volunteered to help in the effort, as did every other social and religious organization in the city (Chapter 6). Meanwhile in San Francisco, they were slightly better prepared, for they saw ahead of time the damage the Spanish Influenza was doing in eastern cities. Schools, churches, theaters, and other public spaces were shut down, while the city was being divided up into “districts” to manage the flow of doctors and nurses into local hospital spaces (Chapter 7). Although many social services were being shut down, overall death rates were much lower than in Philadelphia. Although there was a vaccine introduced, the author credits the distribution of masks as more effective in stopping the spread of the flu (Chapter 7). 

Chapter 8 focuses on the impact of Influenza on ships headed to Europe; it is indicated that as much as 40% of the US Navy had influenza in 1918 (Chapter 8). As a result, more navy personnel were killed by the flu than were killed by German Warships. Crosby describes one fateful tale of the Leviathan, a ship that left New Jersey for France in September 1918; over 2,000 individuals, including Assistant Secretary to the Navy Franklin Delano Roosevelt and Prince Axel of Denmark. Within days, the ship was overwhelmed by the increasing number of cases and lack of space to segregate between the healthy and sick. By the time the ship reached France, over 70 individuals had died, but many more fell ill and died shortly after landing. In total, more than 4,000 doughboys died from the flu while on transit to Europe (Chapter 8). While President Wilson was in France for the Paris Peace Conference, the Spanish Influenza was still raging. Crosby notes that in the midterm election resulted in a Republican victory, but this may have less to do with the Spanish flu than the growing unpopularity of President Wilson, especially after he attacked a Republican senate candidate from New Mexico (who was grieving over the deaths of two of his children from the flu). The attack backfired, as many was sympathetic to Fall, and after his win, he became one of the “Irreconcilables” who would oppose Wilson no matter what (Chapter 10). Wilson would later get the flu, and seemed to not fully recover; some who were around him during this time thought this weakness led to his eventual stroke. 

The fourth part of the book discusses the “measurements, research, conclusions, and confusions” of the book. He notes that it’s not necessarily easy to determine exactly how many total cases (and deaths) there were from the strain that caused the 1918 outbreak, because there were many flu cases that were misdiagnosed as other diseases. However, the best estimate is that 479,000 Americans, both civilian and military, died of the flu in 1918. About 80% of Americans who died in the war died of Influenza (Chapter 11). There is also an examination of common ideas surrounding the flu at the time; many had blamed it on the Germans, and others thought that the use of gases in the war poisoned the world. There have been several scientific hypotheses about what caused the 1918 strain to be so deadly, including the fact that it may have mutated so that not many humans could’ve been immune to the spread. Chapter 12 focuses on why certain groups, such as immigrants and African-Americans, had different death rates; this is largely attributed to living and working conditions that these groups faced.  The group that was hardest hit were Samoans, who lost up to 20% of the total population of one of their islands (Chapter 12). Chapter 13 focuses on the early research on the flu, but notes how this early research couldn’t answer all the questions about its severity or its numerous waves. Finally, chapter 14 discusses what became of the Flu of 1918; however, despite using animal blood and frozen victims of the flu, research could not “find and revive” the Spanish Flu. 

Finally, the afterword discusses human memory and the impact the Spanish Influenza had on American life. Because of the more than 400,000 deaths, citizens began calling for more public health research as well as stronger organizations that could more effectively help in the crisis. However, Crosby notes that shortly after, the influenza slipped from human memory, being replaced with local and political news of the day (Chapter 15). However, it has been the subject of some literature, such as the story “Pale Horse, Pale Rider” by Katherine Anne Porter, who not only got sick from the flu, but lost a sweetheart to it as well. 

This book effectively examines one of history’s most infamous outbreaks. Throughout the book, several graphs detailing deaths from Influenza in the U.S. and Europe also help to show just how devastating the outbreak is. There is also context and comparison to more contemporary outbreaks; the Preface to the new edition talks about the “newest fright” (at the time, it was SARS) which was showing more of the same symptoms as Influenza, but the difference now being that there are more tools to fight SARS, such as antibiotics and strong international organizations, such as the CDC and WHO (Preface).

[[Categories: Twentieth Century United States]]