WE HAVE HAD IT WORSE THAN COVID.

As part of my pandemic reading I've just finished The Plague. Not Albert Camus' 1947 novel about a fictional epidemic in the Algerian town of Oran but the late Michael Bliss's gripping 1993 account of a real smallpox outbreak in Montreal in 1885. Montreal proper's population in 1885 was 167,501 and the outbreak killed 3,157 people, according to Bliss's best estimate, which means 1.9 per cent of Montrealers died — almost one in 50. Unlike in our own pandemic, however, almost two-thirds of the dead were children less than five years old, and fully 93 per cent were people under 20.

In the late winter of 1885, Montreal had been bracing itself for a cholera outbreak. Many citizens and the city's health committee understood sanitation was a problem that needed addressing. At the time, there was no garbage collection in winter. People simply left their refuse, often including human waste, in back alleys where it sat frozen until spring, whereupon hired “scavengers” removed it and burned or buried it, though not before most of the city suffered terribly from the stench. In several suburbs, sewage was still diverted into open trenches. In 1885, Montreal's scavenging contract had to be re-let as the initial contractor failed to get the job done in good time.

In the event, cholera was not a problem. But in late February smallpox arrived from Europe via Chicago by train, carried by a conductor on the Grand Trunk Railway, who himself ultimately survived. He was seen by a doctor and in a major strategic error caused by a misunderstanding about his condition, admitted to hospital, where, shades of 2020, he infected at least one hospital worker, a young woman, who passed the infection along to others before becoming the epidemic's first fatality on April 1.

A number of what we would call “superspreader events” then reinforced the contagion, including the funeral of Ignace Bourget, the ultraconservative former Bishop of Montreal, and, later in the year, street protests, both against what were deemed overly restrictive anti-smallpox regulations, as well as against the conviction and eventual hanging of Louis Riel — that era's version of BLM. And all the while, despite contentious debate, churches remained open to anyone not showing sores.

The moral significance of plague loomed larger in those days. Many priests argued it was a sign of divine displeasure at events such as the Montreal winter carnival, where men and women shamefully tobogganed together, a first step, no doubt, to committing other even more indecent acts.

The great tragedy of 19th-century smallpox outbreaks was that they were almost completely unnecessary. English physician Edward Jenner had demonstrated the effectiveness of vaccination with cowpox at the turn of the century. Napoleon had all his troops vaccinated and in appreciation released two English prisoners of war when Jenner requested it. Moreover, unlike many modern vaccines, including the two leading candidates for coronavirus, cowpox vaccine could be stored at room temperature. From early on in Montreal's outbreak, free public vaccination was widely available, eventually being offered door-to-door.

But in 1885 vaccination was controversial, as in fact it may still be today. Its reputation was not helped when, early in the Montreal outbreak, a bad batch of vaccine caused serious side effects. And prominent anti-vaxxers, including two wellknown doctors, openly campaigned against it. As the plague continued through summer and the death rate climbed into the fall, vaccination was made compulsory: no one was vaccinated against their will but people who refused it were fined. Schools and employers required certificates of vaccination, as many may next year. One doctor sold them for $1 apiece, with or without vaccination.

Apart from vaccination, the main health measure was isolation. A 25-bed smallpox hospital on the slopes of Mont Royal that had been closed for four years was opened up and when demand exceeded its capacity, others were quickly built. Conditions in hospital initially were horrid and death rates high. But overcrowding was slowly reduced and conditions gradually improved, though treatment was mainly palliative.

Beyond that, health officers posted black-and-yellow quarantine placards on homes where people were infected. Residents regularly tore them down as soon as the officers left. And in several instances there were near riots when officers, some of whom were shot at, tried to take children off to hospital. Our own anti-mask rallies seem tame by comparison, though in fairness today's quarantines have been largely voluntary. We don't actually know what would happen if governments tried to enforce them by sending quarantine officers around to haul children off to hospitals with high death rates.

Montreal the city was itself effectively quarantined. As the epidemic proceeded, other jurisdictions refused to accept either Montrealers or Montreal-produced goods. To take the train to Ontario you had to show either a fresh vaccination scar or a certificate of vaccination. In what became a notorious scandal, the most prominent anti-vaxxer apparently showed a recent scar, though he swore that reports to that effect were a lie.

For whatever reason, by the spring of 1886 the outbreak had died down. “Montreal's ordeal,” Bliss reports, “did not create an instant revolution in attitudes towards vaccination or public health in Canada.” We will learn, over the next year or two, whether we are as superior to our forbears as we usually assume we are.

THE OUTBREAK KILLED 3,157 PEOPLE ... WHICH MEANS 1.9 PER CENT OF MONTREALERS DIED.