Book Review: America's Forgotten Pandemic by Alfred Crosby

Introduction

Alfred Crosby's America's Forgotten Pandemic: The Influenza of 1918 is considered the definitive work on the Spanish influenza that spread worldwide between August 1918 and March 1919. Although this deadly pandemic claimed the lives of over 25 million people — more than the entire death toll of World War I — it has now largely been forgotten in the collective memory. Crosby vividly narrates the spread of the pandemic during the panic-stricken months it held the United States in its grip. His book has become extremely popular and is considered one of the classics of pandemic literature. The following review fully assesses Crosby's work and its lasting legacy.

Relevance to Modern Pandemics

Crosby's narrative has become extremely popular since the 1980s due to the emergence of other infectious diseases. While influenza scares have largely subsided with the advent of modern medicine, the spread of the AIDS virus, the Asian flu, and the SARS epidemic have thrust pandemics back into mainstream consciousness. Crosby's analysis is not only a narrative that describes the event and brings it to life, but also, just as importantly, it chronicles and explores the curious loss of national memory surrounding this cataclysmic event. His primary argument is that "the problem of infectious disease seemed more of an academic than immediate interest." Yet in the 1980s, the influence of other pandemics recast the Spanish flu in a new light.

Crosby suggests that the most apt analogue for the Spanish flu — and for influenza in general — is the AIDS virus. Just as with AIDS, the medical community has not found an effective method to prevent or fully control it. The influenza virus can mutate and render vaccines developed for one outbreak useless against another. Even vaccines themselves have posed severe risks: the 1976 "swine flu" episode threatened members of the public with Guillain-Barré syndrome, a paralytic condition blamed on the very vaccine intended to protect them. Through this comparison, Crosby maintains that much can be learned from the 1918 pandemic, because it sheds light on how humanity deals with viral crises. His argument is extremely persuasive; he highlights many of the important themes in the history of medicine and disease. Crosby reveals that during the pandemic, the role of nurses was critical — the major therapy prescribed was essentially "tender loving care" — thereby bringing to life the roles and attitudes toward healthcare professionals during that era. The thoroughness of his analysis demonstrates that Crosby gives a full and rigorous treatment of the disease.

The Pandemic as Wartime Hysteria and Public Health Legacy

Another of Crosby's major arguments is that the spread of the disease and the ensuing national panic can be attributed to how the pandemic was conceptualized within the framework of wartime hysteria — including fears of Germans dropping flu germs on the population. Crosby insists that during this period the pandemic became a part of daily life, with citizens attending parades in gauze masks. He reveals that it was partly because of the flu pandemic that government at the local, state, and federal levels was able to develop strong health agencies. The Public Health Service infrastructure also arose, in significant part, from the pandemic of 1918.

Crosby's primary point in this argument is that the spread of the disease became embedded in everyday life and was driven, to a large degree, by external factors such as wartime anxieties. The long-term result may ultimately have been positive, as it enabled the government to craft more effective responses to critical epidemics and viral infections. His analysis suggests that the flu pandemic occupied the national consciousness for a significant period before subsiding, as government reassurances persuaded citizens that the disease was under control. As a consequence, the pandemic fostered a greater respect for medical professionals among the public and enlarged the role of government in preventing and anticipating the spread of infectious diseases.

Conclusion

America's Forgotten Pandemic has become extremely popular over the course of the last twenty years, mainly because it provides a vivid account of a modern pandemic that threatens to mirror the myriad of epidemics the world continues to confront. The similarities between the avian flu scare and the ongoing fight against AIDS have made this book all the more resonant for both the public and scholars. The book has been in print for over twenty-five years and has been released in a new edition. It is primarily worth reading not only as an account of the pandemic itself, but more so as a thorough psychological inquiry into why the pandemic exerted such a powerful influence on the national consciousness of 1918, yet is barely referenced in contemporary narratives. The blending of psychology, medical history, and the craft of narrative writing makes this book a highly worthy read.