Peace­time killer


Canada's History - - CONTENTS - By John Lor­inc

The 1918 Span­ish flu pan­demic felled nearly as many Cana­di­ans as the pre­ced­ing war.

On Oc­to­ber 5, 1918, mil­i­tary of­fi­cials hastily moved fif­teen ill Cana­dian sol­diers trav­el­ling through Cal­gary on a Cana­dian Pa­cific trans­port train into an iso­la­tion unit at a nearby army base. A thor­oughly nine­teen­th­cen­tury ap­proach to dis­ease con­tain­ment, the quar­an­tine didn’t work, and Cal­gary was soon in­un­dated with in­fected civil­ians.

Only a few days after the train in­ci­dent, Toronto Western Hos­pi­tal found its wards rapidly fill­ing with ill pa­tients. Across the city at the Toronto Grace Hos­pi­tal, run by the Sal­va­tion Army, fully half the nurs­ing staff was ail­ing by the mid­dle of Oc­to­ber. The town of Syd­ney, Nova Sco­tia, had been vir­tu­ally shut­tered, its theatres, dance halls, and schools or­dered closed in the days after the sud­den deaths of three Amer­i­can ser­vice­men sta­tioned there.

Pub­lic and of­fi­cial sen­ti­ment had changed swiftly over the course of just a few weeks.

While many Cana­di­ans were well aware of the Span­ish in­fluenza epi­demic sweep­ing through the wartime trenches and post-con­flict de­mo­bi­liza­tion camps in Europe and the United States, some Cana­dian au­thor­i­ties ini­tially in­sisted that this wave of grippe, as the dis­ease was also known, didn’t dif­fer markedly from the an­nual fall flu out­break.

Yes, a young girl had died in Toronto in late Septem­ber — the first recorded civil­ian death in Canada — and many peo­ple had come down with colds. But as the Globe noted on Septem­ber 30, 1918, “no alarm is felt by the Toronto health of­fi­cials.” The rea­son? “The mea­sures which peo­ple them­selves took” to avoid get­ting sick.

As the fall wore on, how­ever, that san­guine out­look crum­pled in the face of far darker re­ports that ric­o­cheted across the coun­try. The dis­ease, which would kill fifty-five thou­sand Cana­di­ans and up to one hun­dred mil­lion peo­ple world­wide, spread along east-west rail cor­ri­dors, trav­el­ling with sol­diers re­turn­ing from the war or head­ing to fight in Siberia. As it leapt into civil­ian pop­u­la­tions, the Span­ish flu ripped through fam­i­lies and com­mu­ni­ties, es­pe­cially poorer ones. Like a hur­ri­cane, the pan­demic left a trail of seem­ingly ran­dom and abrupt tragedy, as well as the long so­cial and eco­nomic af­ter­math caused by the deaths of so many young, healthy peo­ple. The young turned out to be es­pe­cially vul­ner­a­ble to this par­tic­u­lar virus.

In Mon­treal, trol­ley cars were hastily con­verted into rolling hearses to ac­com­mo­date the tide of flu vic­tims headed for

burial, ac­cord­ing to a 2003 ac­count of the pan­demic by fed­eral Min­is­ter of Sci­ence and Sport Kirsty Dun­can, then an ad­junct pro­fes­sor of an­thro­pol­ogy and geog­ra­phy at the Univer­sity of Toronto. In Hamil­ton, cab­i­net­mak­ers worked around the clock to keep up with the de­mand for coffins. Cel­e­brated au­thor Lucy Maud Mont­gomery con­tracted the flu in Oc­to­ber. She re­turned to Prince Ed­ward Is­land in a mo­rose and phys­i­cally weak­ened state, only to watch her beloved friend and cousin Frede Camp­bell suc­cumb to the virus. In her book Hunt­ing the 1918 Flu, Dun­can re­lates a story of two young On­tario women — room­mates who had at­tended a lec­ture when the epi­demic was at its height. “In the morn­ing, Claire Hunter called to her friend in the same room, ‘Vera, I’m go­ing down­stairs for break­fast.’ There was no re­sponse. After break­fast, Claire re­turned to her room to get her purse and again called to her room­mate. No an­swer. This time, Claire pulled back Vera’s sheets. Vera was dead. The doc­tor said that she had died at about two in the morn­ing.”

At a sprawl­ing mil­i­tary base for the Pol­ish army in Ni­a­garaon- the- Lake, On­tario, the dis­ease jumped eas­ily from sol­diers to the lo­cal civil­ian pop­u­la­tion be­cause peo­ple were con­stantly com­ing and go­ing, ac­cord­ing to Wil­frid Lau­rier Univer­sity’s Kan­dace Boe­gart, an an­thro­pol­o­gist- his­to­rian and the Kleghorn Fel­low on War and So­ci­ety. After the pan­demic erupted, she said, “the camp tried to close” its gates, but the at­tempt to re­strict ac­cess came too late.

Im­prob­a­bly, the flu worked its way into the most re­mote lo­ca­tions, from Innu set­tle­ments in Labrador to tiny out­posts on the West Coast. James Al­lan Evans, a re­tired Univer­sity of Bri­tish Columbia clas­si­cist, re­counted in a 2000 es­say the story of a fam­ily of six liv­ing in “com­plete iso­la­tion” on an is­land be­tween Van­cou­ver Is­land and the main­land. “With no con­tact with the out­side world, they should have been safe from the virus.” When both par­ents fell ill, they piled their four chil­dren into a boat and headed out across choppy ocean wa­ters to­ward Alert Bay on Cor­morant Is­land. The fa­ther died en route; the mother died a few hours after they landed.

Mean­while, in Man­i­toba, the flu was spread­ing north, likely as the re­sult of “an elab­o­rate net­work of train lines, roads, and wa­ter routes” that fanned out from Win­nipeg, as so­cial sci­en­tists Lisa Sat­ten­spiel and Ann Her­ring noted in a 1998 study. The epi­demic,

they found, “over­whelmed” some Cree and Métis set­tle­ments in the vicin­ity of a hand­ful of Hud­son’s Bay Com­pany out­posts, in­clud­ing Nor­way House, where the mor­tal­ity rate ex­ceeded one in ten by De­cem­ber. “The dis­ease is rag­ing in Pel­i­can Nar­rows,” a news­pa­per in The Pas, Man­i­toba, re­ported re­gard­ing an HBC out­post just over the Saskatchewan bor­der. “In one house, there were 20 [peo­ple] ly­ing on the floor help­lessly sick, with four dead bod­ies ly­ing among them.”

“The dis­ease,” Sat­ten­spiel and Her­ring wrote, “hop-scotched across the land­scape, leav­ing most fam­ily groups in­tact while rav­aging and even ex­tin­guish­ing a rel­a­tively small num­ber of oth­ers.” But for the fact that many mem­bers of those Indige­nous com­mu­ni­ties were out on traplines in late fall and early win­ter, the dev­as­ta­tion would have been far greater, the au­thors con­cluded. Other com­mu­ni­ties weren’t so for­tu­nate. A 1967 study es­ti­mated that the pan­demic killed al­most four per cent of Canada’s Indige­nous pop­u­la­tion — a mor­tal­ity rate five times greater than among the gen­eral pop­u­la­tion. Some es­pe­cially re­mote com­mu­ni­ties that had no health-care re­sources were wiped out en­tirely.

With sick­ness and death in­fil­trat­ing ev­ery cor­ner of Cana­dian so­ci­ety, or­di­nary peo­ple reached for any­thing that promised some kind of pro­tec­tion, even as health of­fi­cials rec­om­mended the use of cot­ton masks and the avoid­ance of crowded places. Dun­can de­scribes mea­sures such as sacks worn around the neck con­tain­ing moth­balls or cot­ton balls soaked in cam­phor. The sick, many of whom had de­vel­oped fierce and of­ten lethal pneu­mo­nia, were treated with “poul­tices of goose grease, bran, lard and tur­pen­tine and com­presses of fir tree spills, mut­ton tal­low and mus­tard,” ac­cord­ing to Dun­can.

Mean­while, in the Quinte re­gion of east­ern On­tario, read­ers of Weekly On­tario learned that an ap­par­ently fail-safe rem­edy for the “thin” blood and “weak­ened” nerves as­so­ci­ated with the flu was essen­tially snake oil — a con­coc­tion pro­duced in Belleville and known as Dr. Wil­liams’ Pink Pills for Pale Peo­ple. As the news­pa­per re­ported, the treat­ment con­tained “just the el­e­ments needed to build up the blood, and re­store the lost colour and vi­tal­ity.” The cost: fifty cents a box, or six for $2.50.

By the early spring of 1919, it seemed as if noth­ing had been left un­touched by the pan­demic, in­clud­ing the Stan­ley Cup play­offs, which were tak­ing place that year in Seat­tle in late March. In the mid­dle of the fi­nals be­tween the Mon­treal Cana­di­ens and the Seat­tle Metropoli­tans, sev­eral play­ers on each team con­tracted the flu, and one died on the eve of the fourth game. The se­ries was abruptly can­celled.

Very soon after, the pan­demic — by then in its third wave — pe­tered out, re­ced­ing al­most as quickly as it had ar­rived. Now, a cen­tury later, it is both fas­ci­nat­ing and in­struc­tive to pon­der the elu­sive lessons of an out­break that killed more peo­ple than any other sim­i­lar event in his­tory, in­clud­ing wars and plagues, and yet rapidly re­ceded from col­lec­tive mem­ory.

We live in a fear­ful age, un­der the loom­ing shadow of some dev­as­tat­ing fu­ture pan­demic. After the out­break of SARS in 2003, and H1N1 in 2009, health of­fi­cials in many coun­tries started plan­ning for the sort of ma­jor global pan­demic that has oc­curred ev­ery thirty years or so over the past cen­tury. In some ways, the 1918 Span­ish flu rep­re­sents the night­mare sce­nario, fre­quently in­voked if not well un­der­stood.

But when flu his­to­rian Mark Humphries, di­rec­tor of the Cen­tre for Mil­i­tary Strate­gic and Dis­ar­ma­ment Stud­ies at Wil­frid Lau­rier Univer­sity in Wa­ter­loo, On­tario, talks about the legacy of the Span­ish flu pan­demic, he is quick to of­fer a cau­tion: Be­ware of com­par­isons, be­cause 1918 and 2018 are pro­foundly dif­fer­ent when it comes to in­fec­tious dis­ease con­trol and health. An adult who lived through the Span­ish flu, he said, would have grown up at a time when out­breaks of tu­ber­cu­lo­sis, yel­low fever, po­lio, small­pox, cholera, and ty­phoid were hardly un­com­mon. In­door plumbing, wa­ter treat­ment, san­i­ta­tion, hy­giene, milk pas­teur­iza­tion — these were all rel­a­tively new tech­nolo­gies, es­pe­cially in a coun­try that tended to lag be­hind the United States and Europe in pub­lic-health pol­icy.

While rudi­men­tary vac­cines ex­isted in 1918, Alexan­der Flem­ing’s dis­cov­ery of peni­cillin — which, in var­i­ous syn­thetic forms, is now rou­tinely used to treat most in­fec­tious dis­eases as well as pneu­mo­nia, one of the lead­ing causes of death in the 1918 pan­demic — was still ten years off. The flu virus it­self wouldn’t be iso­lated un­til the early 1930s, and an­tivi­ral drugs, now rou­tinely stock­piled and used in wealth­ier na­tions, didn’t ap­pear un­til the 1950s.

That same adult, more­over, likely had a far lower base­line of health and a shorter life ex­pectancy than she would have to­day, Humphries added. Coal was the pri­mary fuel source, caus­ing pol­luted air and the re­sult­ing lung ir­ri­ta­tion. For many peo­ple, their di­ets lacked suf­fi­cient fresh fruit and veg­eta­bles and other im­por­tant sources of nu­tri­tion. “I would ar­gue that what the flu did, at a time when the ma­jor nine­teenth-cen­tury epi­demic dis­eases were com­ing to an end, was re­mind peo­ple how sus­cep­ti­ble they were.”

While no one was im­mune, some peo­ple were more sus­cep­ti­ble than oth­ers. Univer­sity of Man­i­toba his­to­rian Esyllt Jones has writ­ten ex­ten­sively on the Span­ish flu. She points out that

Some es­pe­cially re­mote com­mu­ni­ties that had no health-care re­sources were wiped out en­tirely.

the poor, re­cent im­mi­grants and the mem­bers of iso­lated Indige­nous com­mu­ni­ties tended to be more vul­ner­a­ble, even though the flu virus — un­like in­fec­tious dis­eases linked to poverty — didn’t pay at­ten­tion to class lines.

Dur­ing pre­vi­ous epi­demics, pub­lic health of­fi­cials of­ten used co­er­cive mea­sures, such as quar­an­tines and plac­ard­ing homes with of­fi­cial signs in­di­cat­ing the pres­ence of sick peo­ple, to iso­late those who were in­fected — mea­sures that were of­ten in­flicted on poor com­mu­ni­ties that were more likely to ex­pe­ri­ence the over­crowd­ing, con­tam­i­nated wa­ter, and other con­di­tions that ac­cel­er­ate in­fec­tion. By 1918, how­ever, a grow­ing num­ber of mu­nic­i­pal health de­part­ments had aban­doned these tac­tics, in­stead de­ploy­ing small armies of nurses and vol­un­teers to visit and to treat suf­fer­ers in their homes. Toronto’s pub­lic-health nurses paid more than seven­teen thou­sand home vis­its dur­ing the out­break. Some of the two thou­sand nurs­ing aides in the Canada and New­found­land Vol­un­tary Aid De­tach­ment (VAD) also joined this ef­fort upon re­turn­ing from Europe to Canada, hav­ing treated flu-stricken sol­diers in France and, in some cases, hav­ing come down with the dis­ease them­selves.

Nurses kept pa­tients “calm, hy­drated, nour­ished and rested,” ob­served Linda Quiney of the Univer­sity of Bri­tish Columbia’s school of nurs­ing. De­spite this out­reach, Jones added, “in­fluenza threat­ened the frag­ile frame­work of sur­vival for many work­ing fam­i­lies, but it also cre­ated among im­mi­grants and work­ing-class com­mu­ni­ties a height­ened aware­ness of their mu­tual reliance and their abil­ity to sus­tain them­selves in times of cri­sis.”

For ex­am­ple, in Win­nipeg’s North End, home to the city’s Jewish com­mu­nity, the Yid­dish-lan­guage press pro­moted fundrais­ing cam­paigns to sup­port af­flicted fam­i­lies. “There was a sense that it wasn’t ap­pro­pri­ate for them to be seen to not be able to take care of their own,” said Jones, who sees such ef­forts as in­dica­tive of a new­comer com­mu­nity’s aware­ness of its own vul­ner­a­bil­ity.

Such ex­am­ples of grass­roots lo­cal sup­port cropped up in many com­mu­ni­ties across the coun­try, ac­cord­ing to Boe­gart. “With pan­demics, you get the best and the worst. There was a lot of vol­un­teerism, and peo­ple tak­ing care of their neigh­bours.”

Hun­dreds of kilo­me­tres north of Win­nipeg, as the flu swept through re­mote Indige­nous set­tle­ments, dif­fer­ent com­mu­ni­ties had starkly dif­fer­ent ex­pe­ri­ences. Univer­sity of Toronto med­i­cal an­thro­pol­o­gist Karen Slonim ob­served that at Nor­way House, a pre­dom­i­nantly Cree HBC out­post north of Lake Win­nipeg, fed­eral of­fi­cials dis­patched a physi­cian and two as­sis­tants for two months to treat flu suf­fer­ers. But at Fisher River — a set­tle­ment on the west side of the lake and ac­tu­ally much closer to the city — the res­i­dents re­ceived lit­tle fed­eral aid, re­ly­ing in­stead on lo­cal med­i­cal at­ten­dants and a hos­pi­tal. It’s not clear from the records why the re­sponse var­ied so widely.

As Slonim found when study­ing med­i­cal records, the epi­demic proved to be far more dev­as­tat­ing in Nor­way House, which was also ex­pe­ri­enc­ing food short­ages and plung­ing tem­per­a­tures when the dis­ease struck. Fisher River, sit­u­ated much far­ther south, had a more agri­cul­tur­ally based econ­omy. Yet in both com­mu­ni­ties, she ob­served, “the tra­di­tional way of life had been ir­refutably al­tered, and the sys­tems that once en­abled peo­ple to deal with hard­ship or catas­tro­phe had been dec­i­mated.”

Jones points out that the epi­demic cast a sim­i­larly long shadow over some ur­ban neigh­bour­hoods, par­tic­u­larly in work­ing-class fam­i­lies where the pri­mary male bread­win­ner died, leav­ing his spouse to pick up the pieces. Un­like the part­ners of sol­diers killed in bat­tle dur­ing the First World War, flu wid­ows re­ceived no pen­sion, al­though some re­ceived a mod­est mother’s al­lowance. Many ended up rais­ing chil­dren on mea­gre wel­fare pay­ments, forced to jus­tify their house­hold bud­gets to vis­it­ing so­cial work­ers, whose case files formed the ba­sis of Jones’ re­search. Re­mar­riage was very rare. Rather, the chil­dren raised in these house­holds faced enor­mous pres­sure to leave school and to start work­ing as soon as they could. “In­fluenza was a source of down­ward so­cial mo­bil­ity,” Jones ex­plained. “It had a long-term so­cio-eco­nomic im­pact, like the war it­self, but flu sur­vivors had no ben­e­fits.”

Gaug­ing the wider im­pact of the 1918–19 Span­ish flu has been a pre­oc­cu­pa­tion of his­to­ri­ans, pub­lic health ex­perts, and an­thro­pol­o­gists for years. It is a sur­pris­ingly elu­sive prob­lem, in part be­cause the his­tor­i­cal nar­ra­tive of the pan­demic was ei­ther sub­sumed by the na­tion-build­ing mythol­ogy of the war or for­got­ten. His­to­rian Al­fred Crosby, au­thor of Amer­ica’s

For­got­ten Pan­demic, said the ma­jor writ­ers of the pe­riod — Ernest Hem­ing­way, John Dos Pas­sos, F. Scott Fitzger­ald — barely men­tioned the flu, even though they’d per­son­ally en­coun­tered its dev­as­ta­tion. (One of the best-known ac­counts is a pow­er­ful 1939 novella by Kather­ine Anne Porter, Pale Horse, Pale Rider.)

The pan­demic’s speed “en­cour­aged for­get­ful­ness,” he added. “Many peo­ple thought of the flu as sim­ply a sub­di­vi­sion of the war.”

Un­like the war ef­fort, how­ever, there was scant post­war pub­lic com­mem­o­ra­tion of the he­roes of the pan­demic, and specif­i­cally the hun­dreds of nurses who at­tended to vic­tims and of­ten caught the dis­ease, some­times dy­ing from it. In the emo­tion of the im­me­di­ate af­ter­math, plans were drawn up to erect memo­ri­als to the doc­tors and nurses who fought on the front lines of this scourge. But, in the end, ac­cord­ing to Quiney, only two VAD nurses who died of the dis­ease, Dorothy Twist and Ethel Dick­in­son, were rec­og­nized. “There was a brief mo­ment when women were sup­posed to get medals and were spo­ken of as he­roes,” Jones ob­served, “but it didn’t last.”

There’s no ques­tion that they were he­roes. Twist, who had served in a Bri­tish mil­i­tary hos­pi­tal but died of the flu while work­ing in Sur­rey, B.C., is rec­og­nized on two ceno­taphs on Van­cou­ver Is­land, in­clud­ing one in her fam­ily’s home­town. Dick­in­son, a New­found­lan­der, did a two-year VAD stint in Lon­don, Eng­land, be­fore re­turn­ing to St. John’s in poor health in the sum­mer of 1918. Like Twist, she con­tracted the virus while at­tend­ing to ail­ing sol­diers in a lo­cal hos­pi­tal, and she died within two days. A memo­rial cross in her hon­our was erected in 1920 in St. John’s and ac­knowl­edges the con­tri­bu­tion New­found­land nurses made dur­ing both the war and the epi­demic. By con­trast, First World War memo­ri­als, ceno­taphs, plaques, and other mark­ers can be found in al­most ev­ery city, town, and school in Canada.

Humphries of­fered a dif­fer­ent view of the is­sue of mem­ory of the pan­demic. “It got lost not be­cause peo­ple for­got about it but be­cause of the many [dis­eases] around then that could kill you.” While he was do­ing re­search on the flu early in his ca­reer, he re­calls ex­cit­edly ar­rang­ing to in­ter­view his el­derly great-grand­mother, who’d been nine­teen in 1918. While he was eager to hear about her ex­pe­ri­ences with the flu out­break, she was far more in­ter­ested in talk­ing about the small­pox out­break of 1921. “She had for­got­ten about it be­cause it had been over­shad­owed by other things.”

Yet Jones ob­served that when she gives pub­lic lec­tures about the flu there’s in­vari­ably plenty of ev­i­dence that pri­vate mem­o­ries of the flu per­sist through the gen­er­a­tions. Au­di­ence mem­bers of­fer handed-down anec­dotes about grand­par­ents or other an­ces­tors. “The no­tion that we for­got [the pan­demic] just isn’t true.”

How did those pri­vate ex­pe­ri­ences trans­late into pub­lic ac­tion? The an­swers vary widely. There’s no spe­cific ev­i­dence es­tab­lish­ing a link be­tween the pan­demic and the Win­nipeg Gen­eral Strike in the spring of 1919, but Jones ar­gues that the hard­ships en­dured by flu-rav­aged work­ing-class or im­mi­grant fam­i­lies helped to stoke the sense of un­rest.

In other do­mains, both in Canada and abroad, the con­nec­tions be­tween the pan­demic and sub­se­quent events are far clearer. In the decade fol­low­ing the pan­demic, sci­en­tists in the United States and the United King­dom set to work try­ing to iden­tify the cause of the dis­ease, con­duct­ing re­search that even­tu­ally led to the iso­la­tion of the virus. In South Africa, mean­while, the pan­demic pro­vided lo­cal and na­tional white politi­cians with an ex­cuse to ce­ment land-use-plan­ning laws that in­sti­tu­tion­al­ized racial seg­re­ga­tion in the name of pub­lic health, rea­son­ing that such out­breaks flour­ished in poor com­mu­ni­ties with many black res­i­dents and poor san­i­ta­tion.

Here in Canada, the most spe­cific pol­icy re­sponse to the flu was the de­ci­sion by Prime Min­is­ter Robert Bor­den’s Con­ser­va­tive gov­ern­ment to es­tab­lish a fed­eral depart­ment of health re­gard­ing a pol­icy field that had been man­aged by most mu­nic­i­pal and some provin­cial gov­ern­ments as far back as the cholera out­breaks of the 1830s. Pres­sure to make this ju­ris­dic­tional in­cur­sion had come from pub­lic health prac­ti­tion­ers and or­ga­ni­za­tions like the On­tario Med­i­cal As­so­ci­a­tion. In fact, at a May 1919 sym­po­sium at the Univer­sity of Toronto, con­vened by the Cana­dian Pub­lic Health As­so­ci­a­tion and other groups, speak­ers called on the fed­eral gov­ern­ment not only to es­tab­lish a na­tional depart­ment of health but also to in­vest in in­fluenza re­search and to es­tab­lish a pub­lic-health in­sur­ance sys­tem, a re­form that didn’t hap­pen un­til the early 1960s.

Humphries said the new depart­ment’s ini­tial man­date was broad and in­cluded labour stan­dards, hous­ing, im­mi­gra­tion, in­fec­tious-dis­ease re­port­ing, and quar­an­tines. “It very quickly lost steam,” he added. In a mat­ter of a few years, and ab­sent an­other pan­demic, the depart­ment de­volved into an in­for­ma­tion clear­ing house and a fo­rum that al­lowed the fed­eral gov­ern­ment to work with provin­cial pub­lic-health of­fi­cials.

The cre­ation of the fed­eral health depart­ment also came on the heels of years of ac­tivism by so­cial re­form­ers and pro­gres­sives whose broad mod­ern­iz­ing agenda in­cluded ev­ery­thing from im­proved san­i­ta­tion to pro­hi­bi­tion. Canada, what’s more, had lagged the United States and Europe when it came to so­cial­wel­fare and pub­lic-health pol­icy. The calls for a fed­eral agency, in fact, re­flected a thor­oughly twen­ti­eth-cen­tury be­lief that this re­spon­si­bil­ity re­quired the heft of a cen­tral­ized bu­reau­cracy and na­tional stan­dards. The pan­demic, Humphries ex­plained, am­pli­fied the ur­gency of such de­mands and gal­va­nized fig­ures such as Dr. Charles Hast­ings, Toronto’s cru­sad­ing med­i­cal of­fi­cer of health and one of the coun­try’s lead­ing pro­po­nents of pub­lic-health ad­vo­cacy.

In­deed, per­haps the most im­por­tant legacy of the 1918 pan­demic is that it marked the wan­ing of the think­ing that had dom­i­nated Cana­dian pub­lic-health prac­tice for gen­er­a­tions: that the vec­tor of in­fec­tious dis­eases could be halted us­ing iso­la­tion, ex­clu­sion, and san­i­tary re­form. (The ap­proach didn’t dis­ap­pear en­tirely: In the United States, Mary Mal­lon, known as Ty­phoid Mary, was quar­an­tined for the last twen­tythree years of her life be­cause she had been iden­ti­fied as an asymp­to­matic car­rier.)

As Jones points out, be­cause the flu was just as likely to strike af­flu­ent com­mu­ni­ties as to strike poor or im­mi­grant ones, and be­cause it spread ex­tremely rapidly across large dis­tances, tra­di­tional con­tain­ment meth­ods sim­ply didn’t work. (Lo­cal of­fi­cials none­the­less con­tin­ued to post no­tices on the doors of ill fam­i­lies.) In­stead, dur­ing and after the pan­demic, med­i­cal of­fi­cers of health turned to preven­tion-minded pub­lic-ed­u­ca­tion cam­paigns, treat­ment, and, even­tu­ally, vaccination cam­paigns.

“The fed­eral depart­ment of health,” con­cluded Humphries, “laid the ba­sis for a new ide­ol­ogy of pub­lic health gov­er­nance, one that saw dis­ease as a prob­lem, not only an in­di­vid­ual hard­ship or a plague brought on by out­siders.”

Al­berta Tele­phone Ser­vice work­ers masked against the deadly Span­ish flu virus, 1918.

Cana­dian nurs­ing sis­ters like these three — listed only as Mowat, McNi­chol, and Guil­bride — worked tire­lessly to help those suf­fer­ing dur­ing the pan­demic. Many nurses them­selves suc­cumbed to the dis­ease.

In­fluenza no­tices like this one were posted on all pub­lic build­ings in St. John's, New­found­land and Labrador, dur­ing the pan­demic.

The flu virus thrived in wartime con­di­tions. Amer­i­can sol­diers stricken dur­ing the pan­demic are treated in a hos­pi­tal ward at Fort Ri­ley, Kansas.

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