The Last Plague: Spanish Influenza and the Politics of Public Health in Canada 9781442686625

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THE LAST PLAGUE Spanish Influenza and the Politics of Public Health in Canada

The ‘Spanish’ influenza of 1918–19 was the deadliest pandemic in history, killing as many as fifty million people worldwide. Canadian federal public health officials tried to prevent the disease from entering the country by implementing a maritime quarantine, as had been their standard practice since the cholera epidemics of 1832. But this was a different type of disease. In spite of the best efforts of both federal and local officials, nearly fifty thousand Canadians died. In The Last Plague, Mark Osborne Humphries examines how federal epidemic disease management strategies developed before the First World War, arguing that the deadliest epidemic in Canadian history ultimately challenged traditional ideas about disease and public health governance. Using federal, provincial, and municipal archival sources, newspapers, and newly discovered military records, as well as original epidemiological studies, Humphries’ sweeping national study situates the flu within a larger social, political, and military context for the first time. His provocative conclusion is that the 1918–19 flu crisis had important long-term consequences at the national level, ushering in the ‘modern’ era of public health in Canada. mark osborne humphries is an assistant professor in the Department of History at Memorial University of Newfoundland.

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The Last Plague Spanish Influenza and the Politics of Public Health in Canada

MARK OSBORNE HUMPHRIES

UNIVERSITY OF TORONTO PRESS Toronto Buffalo London

© University of Toronto Press 2013 Toronto Buffalo London www.utppublishing.com Printed in Canada isbn 978-1-4426-4111-2 (cloth) isbn 978-1-4426-1044-6 (paper)

Printed on acid-free, 100% post-consumer recycled paper with vegetablebased inks

Library and Archives Canada Cataloguing in Publication Humphries, Mark Osborne, 1981– The last plague : Spanish influenza and the politics of public health in Canada / Mark Osborne Humphries. Includes bibliographical references and index. isbn 978-1-4426-4111-2 (bound) isbn 978-1-4426-1044-6 (pbk.) 1. Influenza Epidemic, 1918–1919 – Canada – History. 2. Influenza Epidemic, 1918–1919 – Social aspects – Canada. 3. World War, 1914–1918 – Health aspects – Canada. 4. Public health – Political aspects – Canada – History – 20th century. 5. Disease management – Canada – History – 20th century. – 6. Medical policy – Canada – History – 20th century. I. Title. rc150.55.c3h84 2012

614.5⬘18097109041

c2012-902022-2

University of Toronto Press acknowledges the financial assistance to its publishing program of the Canada Council for the Arts and the Ontario Arts Council.

University of Toronto Press acknowledges the financial support of the Government of Canada through the Canada Book Fund for its publishing activities. This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Awards to Scholarly Publication Program, using funds provided by the Social Sciences and Humanities Research Council of Canada.

Contents

List of Figures and Tables Acknowledgments

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1 Introduction

3

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2 Establishing the Grand Watch: Epidemics and Public Health, 1832–83 11 3 ‘Everybody’s Business Is Nobody’s Business’: Sanitary Science, Social Reform, and Ideologies of Public Health, 1867–1914 33 4 A Pandemic Prelude: The 1889–91 Influenza Pandemic in Canada 58 5 Happily Rare of Complications: The Flu’s First Wave in Canada and the Official Response 68 6 A Dark and Invisible Fog Descends: The Second Wave of Flu and the Federal Response 91 7 ‘A Terrible Fall for Preventative Medicine’: Provincial and Municipal Responses to the Second Wave of Flu 109 8 The Trail of Infected Armies: War, the Flu, and the Popular Response 130 9 ‘The Nation’s Duty’: Creating a Federal Department of Health 149

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10 ‘Success Is Somewhere around the Corner’: The Changing Federal Role in Public Health 171 11 Conclusion Notes

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197

Bibliography

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Index 307 Illustrations follow page 148

Figures and Tables

Figures 5.1 British Columbia cases of infectious respiratory disease, January– June 1918 73 5.2 Admissions and deaths from influenza-like illnesses, St-Jean Military Hospital, St-Jean Barracks, Quebec, December 1917–January 1919 75 5.3 Admissions for influenza-like illnesses, Quebec Military Hospital, Quebec City, April 1917–March 1918 76 5.4 Admissions and deaths from influenza-like illnesses, Saint John Military Hospital, Saint John, New Brunswick, 1 January 1918–31 March 1918 76 5.5 Admissions and deaths from influenza-like illness, Kapuskasing Station Hospital, Kapuskasing, Ontario, January 1918–April 1919 86 5.6 Admissions and deaths from influenza-like illness, Toronto Base Hospital, 1 April 1918–9 December 1918 87 7.1 Deaths and public health interventions in Montreal, October– November 1918 117 Tables 6.1 Comparison of mortality (all causes) for Canadian provinces with available data, 1918 106 7.1 Influenza cases and deaths in Montreal as reported by the Municipal Board of Health, October and November 1918 114 7.2 Mortality during the 1918 influenza pandemic and infant mortality in Montreal by ward 127

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List of Figures and Tables

7.3 Comparison of deaths and mortality rates for Aboriginal peoples by province 128 10.1 Comparison of mortality (all causes) for Canadian provinces with available data, 1919 173

Acknowledgments

This project began in the winter of 2004 as an essay I wrote for a thirdyear history class at Wilfrid Laurier University. John Maker, my tutorial adviser at the time and now a close friend and collaborator, marked the essay, thought it was all right, and suggested that I see what else I could find. At the time, I remember feeling that I had said all there was to say in those twenty-five pages. I hope he agrees that I was wrong! Wilfrid Laurier University was an exceptional place to study as an undergraduate and then master’s student. The faculty, staff, and students of the Department of History left a deep impression on me during my five years there. Hilary Earl (now at Nipissing University), Leonard Friesen, John Laband, Doug and Joyce Lorimer, Michael Sibalis, and Cynthia Comacchio all taught me the importance of finding the best evidence and testing your assumptions as a historian. Roger Sarty, who co-supervised my MA thesis, read an early draft of several of these chapters. At the Laurier Centre for Military Strategic and Disarmament Studies (LCMSDS), I had the chance to work with scholars, administrators, and students, all of whom supported this project in one way or another: Mike Bechthold, Sarah Cozzi, Geoff Hayes, Andrew Iarocci, Geoff Keelan, Marc Kilgour, Kellen Kurschinski, David Livingstone, Vanessa McMackin, Katie Rose, Matt Symes, Jane Whalen, and Jim Wood. While Tim Cook of the Canadian War Museum is not a Laurier alumnus, I first met him there through the annual Canadian Military History Conference in 2004, and over the years he has provided me with guidance, insight, and friendship. Tim read two early draft chapters from this book and, as usual, his comments have improved the project immensely. Terry Copp, who was my BA thesis supervisor and co-MA supervisor, and my mentor in so many ways, has now read this book in several forms.

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In 2004, he suggested that the project was too big for an MA thesis – even when it focused on the Canadian military and the flu alone – and suggested that I should begin my research but leave the project for my PhD. That advice was probably the best I have ever received. Without the opportunities and funding that Terry provided me through LCMSDS and the Department of National Defence’s Security and Defence Forum (SDF) program, this book would have never been written. I owe him more than I can ever repay. I took a break from flu during my master’s degree in 2005, then returned to it for my PhD dissertation at the University of Western Ontario, which I defended in 2008. At Western, I am indebted to Adrian Ciani, Dorotea Gucciardo, Shelly McKellar, Rod Millard, Thomas F. Sea, and Robert Wardhaugh. My dissertation committee was assembled around some very tight timelines, and despite the compelling pressures of a Christmas defence, provided probing and meaningful feedback. A warm thank you is due to Luz Maria Hernández-Sáenz and Francine McKenzie (both of whom also completed fields with me in medical history and the British Empire), Mark Speechley, and Pat Brennan of the University of Calgary. Jonathan Vance, who supervised my thesis, was an excellent mentor and supervisor. He was always willing to read chapters and provide feedback in an amazingly short time, despite his many other important commitments. Thank you for having faith in the project and in me. I must thank Joe Anderson and Thomas E. Brown of Mount Royal University (MRU) in Calgary, Alberta, for reading drafts of several chapters; also at MRU, Peter Morton, Scott Murray, Jennifer Pettit, and Jeffrey R. Wigelsworth provided friendship and support in other ways. Joe was also crazy enough to join me on an overseas field school in the spring of 2011 – thankfully, we are still friends. I have subjected my students to countless readings and long discussions on influenza; your insights are reflected in this book in one way or another. Here I wish to specifically thank Alexander Large, Paula Larsson, Heather Randall, and Fay Wilson who, as my BA thesis students and research assistants, were all forced to endure more flu talk than the rest. Teaching is always a two-way street. This book was completed in the Department of History at Memorial University of Newfoundland, where I want to thank all my colleagues and especially Sean Cadigan and Jeff Webb. Regarding my research at Library and Archives Canada, I am indebted to Andrew Horrall, Sophie Tellier, and the circulation and reference staffs. The personnel of the National Archives Records Administration

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in Washington, the National Archives, Kew, and the archives of the provinces of New Brunswick, Prince Edward Island, Manitoba, British Columbia, Saskatchewan, and Ontario all helped enormously. The staff at the corporate archives of the Canadian Pacific Railway provided photocopies of some railway timetables from 1918 at no charge. The archivists at the City of Toronto Archives helped me track down some rather obscure reports, while the people at the City of Vancouver Archives, the Glenbow Museum, the McCord Museum in Montreal, the University of Alberta, and the Lois Hole Digital Library at the University of Calgary helped me choose photographs and secure permissions. My research between 2004 and 2008 was supported by generous funding from the Department of National Defence’s Security and Defence Forum (SDF), the Laurier Centre for Military Strategic and Disarmament Studies, the Ontario provincial government in the form of a John A. Macdonald Fellowship in Canadian History, the Department of History and Faculty of Graduate Studies at the University of Western Ontario, and a Social Science and Humanities Research Council (SSHRC) Canada Graduate Scholarship (CGS). I would also like to thank the Humanities and Social Sciences Federation of Canada, which provided a grant for this book through funds provided by SSHRC. At the University of Toronto Press, many people have assisted in this project in one way or another. Len Husband has been a superb editor and has overseen this project over the past couple of years from a rather ragged dissertation to what I hope is a much better book. His sage editorial advice has been much appreciated. In the marketing and production departments, I would like to thank Shoshana Wasser and Frances Mundy; Matthew Kudelka improved my writing and made this a far better book. While any errors or shortcomings certainly remain my own, I am indebted to those scholars who have worked on flu in one capacity or another over the years and who have all been more than willing to share their wisdom. Some have read draft chapters of this book; others have shared their insights on conference panels, by e-mail, or over coffee. While I am sure to miss someone, thank you to Lucinda Beier, Janice Dickin, Elisabeth Engberg, Magda Fahrni, Patricia Fanning, Anne Herring, Esyllt Jones, Mary Ellen Kelm, Anne Lundberg, Heather MacDougall, Linda Quiney, and Karen Slonim. This book has also been made infinitely better by the positive and wholly constructive comments of two anonymous reviewers who read drafts of the manuscript in their entirety. My parents Hal and Judy Humphries have always been most supportive. The newspaper clippings that they and my sister Gillian have sent

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me over the years have always been appreciated and stored for future use. It was my parents who first exposed me to the ‘historical world’ in our yearly camping trips, introducing me and Jill to many a historic site from Cape Spear to Victoria. My Laurier friends, Ryan Dore, David Duong, Mike Hurren, Jennifer Major, Adam McMullin, Kelly O’Mara, Alisa Pigeon, Matt Shea, and Leslie Sykes, have listened patiently to too many stories about influenza and provided much needed moral support. Our pets, Farley, Audrey, and Levon, have always criss-crossed the country in good humour – from southern Ontario to Alberta and now from Calgary to Newfoundland. Farley chewed my computer cords, and Audrey slept beside (or on) me as I typed, while Levon terrorized us all and plotted to take over the world. Most important, I must thank Lianne Leddy, a fellow Canadian historian, Laurier alumnus, and my partner in everything personal and professional. She has read this manuscript more times and in more variations than anyone else. She has been generous with her time and exacting in her comments. I could not imagine what this book would look like if she had not been willing to discuss ideas, evidence, and theory over the dinner table each night. But pandemic flu is not always good table talk. While I like to say that ‘flu pandemics are inherently interesting,’ the details cannot be as fascinating as she allows me to believe – at least not when she’s been listening to them for the past eight years. But that is just another reason that she is the best partner I could ever hope to have. Conception Bay South, Newfoundland November 2012

THE LAST PLAGUE Spanish Influenza and the Politics of Public Health in Canada

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1 Introduction

On 27 September 1918, two weeks after his eighteenth birthday, Gunner George William F. fell ill. At first his symptoms were mild: chills, headache, pains all over; a slight cough, a moderate temperature. George William was an underage soldier and had been waiting more than two years to go overseas. All through September, men had been shipping out – some to France, others to Canada’s new mission in Siberia. Colds were common in the Halifax barracks where he was stationed, especially in the autumn months.1 He fought his symptoms for two days as he drilled, marched, and played sports in the chilly autumn rain.2 By the 29th, he had grown considerably worse and he was forced into hospital. There his condition quickly deteriorated. Within a couple of days, his breathing grew shallow and more infrequent as his pulse quickened to 112 beats per minute. His temperature climbed above 103 degrees. Blood dripped from his nose. On 4 October, doctors noted that his lips, fingertips, and earlobes were beginning to turn blue from lack of oxygen. His once slight cough became ‘considerable,’ and he began to complain of chest pain. A mild flu was rapidly progressing into a severe case of pneumonia. Although his doctors still hoped for recovery, his temperature remained high. On the night of 16 October, almost three weeks after entering hospital, his breathing quickened still more, rising above fifty shallow breaths per minute. The young soldier was gasping for air but his lungs were incapable of absorbing oxygen. At five the following morning, Gunner George William F. died from complications of Spanish flu. There was little doctors could do but watch him perish.3 F. was one of nearly 50,000 Canadians to die in the 1918 influenza pandemic. The last of the great plagues swept the world in three waves:

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the first in the spring, the second in the fall, and the third in the winter of 1918–19.4 The first wave caused much sickness but few deaths.5 During the summer the virus mutated and became deadlier. In August, new cases began to appear in quick succession in western Europe, Africa, and the eastern United States. This second wave of flu, which spread across the globe between August and December, caused the most deaths – perhaps as many as 100 million worldwide.6 Strangely, it tended to kill young, otherwise healthy adults, resulting in an unusual W-shaped mortality curve. A third wave in the winter and spring of 1919 was less virulent and less deadly. By the summer, the Spanish flu had run its course. Despite its shocking mortality, the 1918 influenza pandemic was largely ignored by historians until the late 1970s.7 In his seminal book Plagues and Peoples, William McNeil explained that while epidemics ‘could not be left out [of the narrative], their unpredictability made most historians uncomfortable.’8 He argued that because historians strive to make sense of human experience, they necessarily emphasize the elements in the past that are calculable, definable, and controllable while suppressing those which tend to challenge the supremacy of human agency. ‘Epidemic disease,’ he wrote, ‘when it did become decisive in peace or in war, ran counter to the effort to make the past intelligible [and] historians consequently played such episodes down.’9 McNeil’s 1976 book was part of a movement that began in the mid-1960s to write epidemic disease ‘into’ social, military, economic, and political history.10 Regarding flu, it was Alfred Crosby in Epidemic and Peace, 1918: America’s Deadliest Influenza Epidemic who first plotted the disease’s pattern of diffusion. He maintained that historical neglect had hid its political effects on the war and the Paris Peace conference, that the flu affected peoples around the globe differently, and that influenza offered a concerted challenge to modern bacteriology and the march of medicine.11 Crosby’s work focused attention on the pandemic, in part because its publication coincided with a major swine flu scare. The ‘first wave’ of flu scholarship that followed focused on elaborating the epidemiology of the disease and establishing its demographic impact, investigating the themes that Crosby had identified.12 Inspired in part by the AIDS pandemic – which reminded researchers that many viruses, including flu, had yet to be ‘conquered’ – historians such as Howard Phillips, K. David Patterson, and W.I.B. Beveridge traced the path of the illness, documenting its mortality and examining the ways in which government, society, and public health officials dealt with the last of the great plagues.13

Introduction

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When a revised version of his book appeared in 1989 under the title America’s Forgotten Pandemic, Crosby noted that influenza had begun to attract a growing number of scholars. He attributed this new-found interest to the flu’s tendency to inspire ‘anxiety and confusion in us – anxiety because it was so awful and we do not know why, and confusion because we cannot understand how we could have so nearly forgotten it.’14 This uncertainty motivated researchers to uncover the virology of the deadly strain. Historians traced the disease’s path into remote corners of the world, examining how colonialism, race, and geography affected mortality and conceptions of the disease;15 meanwhile, virologists increasingly came to view the 1918 pandemic as a lesson from history.16 In the late 1990s, fears about h5n1 ‘bird flu’ and SARS led researchers like John Oxford to warn the public that another deadly pandemic was just around the corner.17 Perceptions that the 1918 crisis was a medical and a historical mystery provided an impetus for scholarship, motivating governments to provide grants and incentives to researchers in social and ‘hard’ science disciplines to study the past with an eye to preparing for the future. The second wave of historical flu researchers have been less interested in the epidemiology and terror of the disease, focusing instead on its social and cultural history. One school has regarded flu as a social cleaver, examining how it revealed underlying class tensions and exacerbated ethnic and political conflicts or, rather, united communities and allowed contact across diseased boundaries;18 another has been more interested in the official response, studying the ways in which the state temporarily (or permanently) extended its power in an attempt to prevent disaster.19 Yet a third school has focused on the specific causes of mortality, examining how sex, ethnosocial factors, and geography defined the flu experience and mortality rates.20 Second-wave scholarship has extended our understanding of the pandemic experience; but it has also fractured the study of the disease, for most historians have taken a community case study approach, which localizes flu’s impact. Howard Phillips identifies the strengths of this approach as the employment of ‘thematic analysis, the use of new sources, and a determination to relate the epidemic experience to larger processes’; but he also laments that second-wave scholars ‘leave behind narratives of the epidemic’s lethal course … without which the reader, ninety years later, cannot entirely grasp just how frightening an event it was or how it could have been a historical actor itself.’21 Second-wave scholarship has exposed how the flu intersected with labour movements,

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exacerbated ethnic and racial divisions, and reinforced or challenged gender roles; but historians are still as reluctant to regard flu as an agent of broader change as they are to generalize from local case studies to reexamine the larger themes and tropes of national history. Canadian scholarship has followed a similar historiographical pattern. In the late 1970s and early 1980s, first-wave researchers followed Crosby’s lead, establishing the flu’s epidemiological course in Canada and outlining the official response.22 In her 1977 article ‘The Impact of Epidemic Influenza: Canada, 1918–1919,’ Janice Dickin McGinnis described the pandemic’s epidemiology, arguing that flu arrived in the Dominion with soldiers returning from the First World War, and detailed the federal, provincial, and municipal measures taken to control the disease. Eileen Pettigrew’s Silent Enemy: Canada and the Deadly Flu of 1918 (1983) took an anecdotal approach, exploring tragic experiences at individual and community levels.23 Like much of the first-wave research, her book emphasized the pandemic’s horror – unburied bodies, mass funerals, and the grotesque symptoms of the disease – using oral history to describe flu’s personal and emotional impact. Other early surveys in Canada likewise emphasized the unusually high mortality, detailing demographic effects and the public health measures that governments employed to combat the illness.24 Second-wave Canadian historians have also taken a case study approach, locating the flu’s most profound impacts in its capacity to fracture or unite communities.25 Magda Fahrni, Esyllt Jones, and Linda Quiney have explored influenza’s interaction with gender roles, citing it as a subversive force but debating the longevity of its impact on the ways in which women engaged with the public sphere in Montreal, Winnipeg, and Halifax.26 In Influenza, 1918: Disease, Death, and Struggle in Winnipeg, Jones suggests that the flu was a catalyst for class formation and that it exacerbated the disaffection that ultimately led to the Winnipeg General Strike in the spring of 1919.27 Other historians such as Mary-Ellen Kelm and Ann Herring have argued that ‘la grippe’ disproportionately affected minority groups and isolated populations, demonstrating that the effect on these communities was far greater than on urban populations.28 This has indirectly reinforced a historiographical trend that emphasizes the pandemic’s local effects. In part, this stems from the prominent position of disease in First Nations’ oral traditions in comparison to the limited emphasis on epidemics in the written histories of European-Canadian culture. For example, in ‘British Columbia First Nations and the Influenza Pandemic

Introduction

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of 1918–19,’ Kelm argues that for Aboriginal peoples on the West Coast, epidemic diseases have always been regarded as a result of native–newcomer interactions and as symptoms of the larger problem of Aboriginal marginalization.29 When influenza struck Aboriginal peoples an especially hard blow, the epidemic gained a prominent place in the oral traditions of BC’s Aboriginal peoples, because it fit into accepted patterns of historical explanation.30 Canadian historians have been reluctant to present the flu as an important actor in the national narrative. As Esyllt Jones writes in Influenza 1918, this has meant that Canadian ‘historians have been unduly cautious in their interpretation of [the pandemic’s] implications for society and public health policy.’31 A key question that surprisingly remains unanswered is this: Did influenza change how the state and average Canadians responded to epidemic disease? Perhaps this is because disease is a force that, as Charles Rosenberg has argued, can only be fully understood if it is framed within a broad historical context – one that looks beyond traditional analytical boundaries.32 Because epidemics cut across the divisions that historians normally employ as they confine their studies to manageable groups, regions, and categories of analysis, it is difficult to impose these limitations without skewing our perspective and obscuring important patterns. Only when we step back to view the pandemic as a national crisis can we hope to determine whether it had significant and lasting implications for society and public health policy. My intention is to frame the history of the pandemic in such a way that it becomes possible to answer this important question. In my investigation I have traced the development of official and popular responses to the problem of disease management from the first epidemic of cholera in 1832 to the influenza pandemic of 1918. I have also drawn upon the methods and literature of medical, social, military, and political history. I have found that the 1918 flu was a transformative event that had far-reaching consequences for both society and public health policy in Canada, marking a significant shift in the dominant ideologies and strategies of public health governance.33 Here, by ‘ideologies,’ I mean the ideas, beliefs, and assumptions that informed and defined the objectives and interests of the state, public health officials, and the public as well as understandings – social, medical, and political – of the practical nature of disease threats; and by ‘strategies,’ I mean the official efforts that were employed to protect communities from epidemics and other threats to collective health.34 I argue that since the cholera epidemic of 1832, epidemic disease had

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been understood as a foreign threat; and that public health governance strategies developed in response to an externally oriented ideology that blamed ‘the other’ for importing disease.35 Thereafter, the central government’s public health governance strategies were aimed at managing an effective maritime quarantine so as to exclude so-called undesirables from the social body – an approach that in the early twentieth century increasingly separated Canada from the United States and Great Britain.36 The 1918 pandemic challenged the external focus, causing federal officials to abandon exclusionary strategies in favour of positive interventions aimed at preventing disease within the social body. This shift was embodied by the creation of the federal Department of Health in 1919, which was itself shaped by the ideas of the social reform movement and wartime idealism. While the department’s effectiveness was ultimately hampered by budget cuts in the 1920s and 1930s, it nevertheless ushered in a new era in Canadian public health as policy shifted towards emphasizing a provincial and municipal focus on addressing the root causes of disease rather than protecting Canadians through a federal maritime quarantine. Chapter 2 examines how the epidemics of the mid-nineteenth century shaped both ideologies of disease and the strategies used by all three levels of government to protect Canadians from external threats. Chapter 3 studies the rise and fall of the sanitary movement, which sought to realign the federal role in public health so that it focused less on external sources of disease and more on the internal conditions that were thought to sustain sickness. In the end, the apparent success of maritime quarantine in preventing cholera and plague and the popular and official ‘othering’ of disease led to a renewed emphasis on immigrant screening and medical inspection as the primary strategies of defence. Chapter 4 examines the virology of influenza, which presented a different type of disease threat than cholera, one that that followed unfamiliar patterns. It looks to the 1889–91 pandemic to understand how public health officials in Canada dealt with earlier flu crises that might have challenged but instead reinforced dominant ideologies and governance strategies. The 1918 influenza pandemic was different. That virus was far more lethal, and it did not move in the way that public health officials expected; nor were maritime quarantine and immigrant screening effective in protecting Canadians from the disease. At the same time, Canada’s involvement in the Great War created new potential paths of diffusion while precipitating important social and political changes at home.

Introduction

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Chapter 5 details the pandemic’s first wave, which evaded quarantine by following new paths of diffusion in the winter and spring of 1918. Chapter 6 evaluates how the war effort shaped the federal response to the second and most deadly of the pandemic’s waves in the fall of 1918 when American soldiers brought the flu to Canada and the Canadian Siberian Expeditionary Force spread it across the country. Chapter 7 examines how provincial and municipal officials reacted to a wartime disease with few resources and little intergovernmental cooperation. Because officials could do little to combat the flu, volunteer nurses and caregivers took on a primary role as communities came together to cope with a crisis that reinforced the sanitarian’s old argument that the poor and marginalized suffered disproportionally from sickness – and that unhealthy segments of society threatened the whole. As traditional governance strategies failed, public health was politicized as never before. As Chapter 8 reveals, wartime centralization and political disaffection with Borden’s administration placed the federal government’s role in public health under increased scrutiny. As disaffection grew across the country with the Union government’s handling of conscription, labour relations, and reconstruction, disparate political agendas were united in the critique of Ottawa’s handling of the flu crisis and the seemingly pointless sacrifice of Canadian lives – symbolic of the government’s failure to reflect popular myths of noble sacrifice in its wartime and reconstruction policies. Chapter 9 demonstrates that the government created a federal department of health in order to address these critiques. That department, which was intended to symbolize the formation of a new covenant between citizen and state, was shaped by the ideas and demands of women’s voluntary associations and the Social Gospel movement as part of a larger program of social reconstruction. Chapter 10 shows that although the new department failed to live up to the expectations of its advocates in the 1920s and 1930s, it nevertheless marked a significant shift in the ideologies and strategies of public health governance and the role of the federal government in the emerging public health system. The flu pandemic had a lasting impact on public health governance and the nature of the state in Canada, for it forced federal officials to abandon the exclusionary strategies that had dominated since 1832 in favour of more positive interventions in the lives of Canadians. While flu narratives differ from community to community, at a national level the pandemic united Canadians in sickness and fear at exactly the time when wartime idealism, the influence of the social reformers, and politi-

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cal support for expanding the role of the central government were at their height and the war in Europe was ending. The ‘last plague’ challenged and then caused dominant public health ideologies and strategies to shift. This was an important change that led to closer working relations among all three levels of government, laying a foundation for a more interventionist Canadian state.

2 Establishing the Grand Watch: Epidemics and Public Health, 1832–83

Fly this plague-stricken spot! The hot, foul air Is rank with pestilence – the crowded marts And public ways, once populous with life, Are still and noisome as a churchyard vault; Aghast and shuddering, Nature holds her breath In abject fear, and feels at her strong heart The deadly fangs of death Susanna Moodie, ‘Our Journey up the Country’1

In 1832, Susanna Moodie arrived in British North America with her husband J.W. Dunbar Moodie to start a new life near Belleville in Upper Canada.2 Like most British immigrants, they believed that Canada was a healthy country with a vigorous, salubrious climate; instead, they found a land in the grip of a terrifying new disease. 3 ‘The cholera was at its height and the fear of infection, which increased the nearer we approached its shores, cast a gloom over the scene, and prevented us from exploring its infected streets,’ she wrote in her memoir Roughing it in the Bush. ‘The city itself was, at that period, dirty and ill-paved; and the opening of all the sewers, in order to purify the place and stop the ravages of the pestilence, rendered the public thoroughfares almost impassable, and loaded the air with intolerable effluvia, more likely to produce than stay the course of the plague, the violence of which had, in all probability, been increased by these long-neglected receptacles of uncleanliness.’4 Susanna Moodie had come to a country unfamiliar with the crowd diseases of Europe and unaccustomed to dealing with major epidemic crises among the settler population.

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The six colonies clustered along the St Lawrence waterway were sparsely populated; it was not a country where urban diseases spread easily. As a result, the inhabitants of Britain’s North American colonies believed that they lived in inherently healthy places characterized by clean air and cool waters – a climate contrasted by the much warmer British colonies in the Caribbean and on the Indian Subcontinent, which the Imperial imagination contrasted as places of sickness.5 Supporting this view, when epidemic diseases did strike the Canadian provinces, they appeared to spread inland on the waterways, along the main routes of communication.6 This made it seem that illnesses arrived from overseas with immigrants, traders, and supply ships – that they were the result of foreign pollution.7 As the colonies grew, so too did the need for a formal system of organized protection against epidemics. Public health governance attempts to encompass all practices, social activities, and economic exchanges that threaten to spread disease or undermine collective health. It entails negotiations among doctors, the state, and the public, as result of which normal individual freedoms, rights, and privacies are sacrificed to secure the community from illness.8 At the same time, the official public health response – that is, the methods employed by the state to control disease – is constrained by dominant political ideologies and popular attitudes towards disease, the state, and medical science. The specific strategies of governance adopted by the state to protect community health thus reflect dominant social and political values as well as medical systems of knowledge.9 Until the late nineteenth century, medical knowledge changed very slowly over long periods of time, with various theories coexisting because they each proved useful in explaining diseases in different contexts. From ancient times, some illnesses were understood to be constitutional, or the result of individual choices in diet, exercise, and vice that unbalanced the body’s four ‘humours.’ According to Roy Porter, this explained why ‘some people fell sick, and others did not’ in an everyday context.10 It also placed responsibility for many chronic health problems on the individual. But humoral theory could not easily account for epidemics, which seemed to strike indiscriminately like a wildfire, burning some sections of the populace and not others. During a plague, collective action was required to combat sickness in the crowd. Here miasmatic theory suggested that some sicknesses were caused by unseen clouds of effluvia – identified only by their bad smell – which rose from garbage piles, sewage, and various sources of environmental pollution. As early as the 1400s, public health boards, especially in Italy, correlated fevers

Establishing the Grand Watch

13

with social conditions and local environmental sources of infection.11 In this analysis, the link between sickness and filth mandated the clean-up of public spaces in order to prevent diseases of the crowd from spreading. Despite a formal and popular association between filth and bad smells, and illness, the ancient practice of quarantine usually constituted a first line of defence against plagues of various types. That practice was based on the contagion theory, which held that sickness moved with people and was transmitted by contact through breath, touch, or physical objects.12 Quarantine was used as early as the mid-1300s to protect cities in southern Europe from the Black Death, which – people had noticed – moved along trade routes.13 Those who interacted with the sick often contracted the disease themselves; thus a correlation between contact and illness became evident. The appearance of syphilis or ‘the pox’ two centuries later supported the premise that a living seed of illness – what Italian physician Girolama Francastoro called a contagion vivum – might actually be transmitted by contact.14 Physicians and civic officials hoped that by erecting a physical barrier between outsiders and the community, the worst effects of an epidemic might be prevented. All three theories coexisted because each served to explain illness in a separate context.15 In this way, diseases were roughly divided into those that were common (either to an area or to a type of person) or unusual and foreign. Uncommon diseases – plagues and pestilence – were constructed as outside invaders, aided by local environmental factors as well as individual predispositions. Combating these threats required collective community action. In New France, some of the earliest sanitary laws were passed in 1707. Although these aimed to clean up the streets and houses of the inhabitants of Quebec, in this way removing sources of noxious gases, most early regulations targeted foreign sources of infection. In British North America, laws were enacted in 1775 in Nova Scotia that allowed local officials to detain any persons ‘visited with the plague, smallpox, pestilential or malignant fever, or other contagious sickness, the infection whereof may be communicated to others,’ placing them in quarantine.16 Indeed, quarantine regulations usually formed the primary line of defence. As early as 1720, a plague epidemic at Marseilles led French officials in New France to mandate that any vessel arriving from Europe was to anchor offshore and wait for an inspection by trained physicians. The crew was forbidden on pain of corporal punishment from offloading cargo or sending small boats ashore. A similar regulation was passed in Halifax in 1761 requiring any vessel from a port infected by ‘plague, smallpox,

14

The Last Plague

malignant fever, or other contagious distemper’ to remain at least two miles from port and signal the need for inspection by hoisting special signal flags. A captain who concealed plague or another deadly disease might even be put to death.17 As trade networks grew, new diseases that were common (or endemic) to non-European places were transported across oceans and continents. Finding previously unexposed populations, these became the great epidemic diseases of the nineteenth century. The most feared of these plagues was cholera, a disease that would shape public health in Canada for nearly a century. Asiatic cholera was first documented by European medicine in British India in 1817. From there, it crossed the Middle East and moved northwards, reaching Russia in 1829–30 and London and Paris by 1832.18 Cholera was a horrifying disease that killed as many as half its victims as bowels emptied, faces shrivelled, and bodies collapsed from dehydration. Today we know that cholera is caused by a rod-shaped gram-negative bacterium, Vibrio cholerae, which is spread through drinking water contaminated by the fecal matter of infected persons.19 Cholera bacteria attack the body by releasing a toxin into the small intestine, resulting in the ‘rice water’ diarrhoea characteristic of the disease.20 In the early 1830s, medical experts had difficulty explaining how the disease moved through populations as it did not behave like plague or smallpox. Some doctors believed that it spread through clouds of miasma, influenced by the climate and winds but arising from a confluence of local factors. In this analysis, the bad smells given off by decaying organic matter and the filth accumulating in rapidly growing urban centres were understood to generate disease spontaneously. Others argued that cholera was contagious and spread from person to person. Neither theory, however, could adequately explain the disease’s pattern of diffusion. Some people who had direct and intimate contact with cholera victims did not contract the disease, while families who isolated themselves were wiped out. It was a terrifying illness precisely because it seemed to strike at random, confounding physicians and frightening the public.21 Russia was the first European power affected by cholera, and it set the pattern. In 1829, although Russian doctors were divided on whether it was contagious or miasmatic, the government imposed quarantine.22 Medical professionals and civic officials in Britain watched and learned as the disease crossed the empire of the tsars. The Russian quarantine failed to stop the epidemic, but the British chalked this up to administrative inefficiencies rather than mechanistic failure.23 From the way the dis-

Establishing the Grand Watch

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ease was steadily progressing westwards, cholera appeared to spread by contact. Also, it seemed to be affecting the poor most severely, which led some to argue that it could best be prevented by addressing the underlying filth and dirt associated with poverty and overcrowding.24 British medicine was thus divided between those who saw the threat as external and those who saw it as internal. According to R.J. Morris, in formulating strategies to combat the disease, the state had two options: ‘contagion meant quarantine with loss of trade and disruption of family life – miasma meant cleansing and poor relief on a massive scale, expensive for rates and charitable subscriptions.’ The British government chose a middle course and embraced both strategies.25 Like the plague, smallpox, and yellow fever in the eighteenth century, cholera crossed the Atlantic along the trade routes, first arriving in British North America in the spring of 1832. Canadian physicians had followed its grim march across Europe the previous year as it killed 7,000 in London and many more in Paris.26 Newspaper dispatches, medical journals (a relatively new medium), and Colonial Office reports told a terrifying tale of death and destruction on a scale not seen since the Black Death.27 The cholera outbreaks in Europe generated unprecedented levels of fear in British North America; this in turn provoked a crisis that led to extraordinary public health interventions.28 The defensive methods employed in British North America were patterned on the British response. Indeed, as Jay Cassel notes, the early history of Canadian public health must be viewed in light of metropolitan attitudes and directives. The view that dominated public health in the British Empire at the time regarded the social body as analogous to the physical body – that is, as a series of individual parts. When one part broke down, it required repair. This mentality tended to result in an episodic approach. Cassel argues that while ‘there were problems that obviously affected the community as a whole … these usually drew attention to themselves when a disease spread, often rapidly, to many people … such crises prompted a recognition that collective action was needed and that the activity of individuals and groups might have to be constrained for the collective good.’ Public health governance in British North America, as in Great Britain, was driven by a crisis mentality.29 Quarantine was the first line of defence, even though Canadian doctors were as divided as their British counterparts with regard to its utility. It was clear that the disease was moving steadily westwards, and those who believed it was contagious anticipated that it would arrive in the ports of the St Lawrence estuary and the east coast, where ships were disembarking tens of thousands of immigrants each year.30 British North America,

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The Last Plague

isolated as it was from Europe and to a certain degree from the United States, seemed to stand the best chance of blocking the disease before it appeared. In the spring of 1832, Lord Aylmer, the Governor General of Lower Canada, established Canada’s first permanent quarantine station at Grosse Île, thirty miles below Quebec City, in order to guard the interior of British North America against the cholera.31 As cholera was seen as an imported disease, the station was paid for with a new tax on immigration. 32 Grosse Île was a tiny station, consisting of a few sheds providing temporary accommodation for those under detention as well as quarters for a small contingent of doctors and military men, who would enforce the regulations.33 Similar stations were subsequently established at Halifax and Saint John and off the coast of Prince Edward Island.34 As the immigrant ships arrived at Grosse Île, the quarantine staff were instructed to inspect them for cholera. Ships sailing from an infected port but without any evidence of disease on board were detained for three days; those carrying cholera victims were quarantined for thirty.35 All ships had to be cleaned and disinfected before docking at Quebec City. Susanna Moodie, who arrived on Grosse Île in August 1832, described the scene on the island: ‘A crowd of many hundreds of Irish emigrants had been landed during the present and former day; and all this motley crew – men, women, and children, who were not confined by sickness to the sheds (which greatly resembled cattle-pens) – were employed in washing clothes, or spreading them out on the rocks and bushes to dry.’36 Cabin passengers like Moodie were not subject to the same strict regulations and were generally allowed to proceed to the mainland unchecked.37 As a result, the quarantine was ineffective and easily breached. Only a few days after the first immigrant ship appeared in the St Lawrence, the illness spread to the mainland.38 Catharine Parr Traill, Susanna Moodie’s older sister, also arrived in Canada during the spring of 1832, and she described the epidemic in Montreal in a letter to her mother back in England: The cholera had made awful ravages, and its devastating effects were to be seen in the darkened dwellings and the mourning habiliments of all classes. An expression of dejection and anxiety appeared in the faces of the few persons we encountered in our walk to the hotel, which plainly indicated the state of their minds. In some situations whole streets had been nearly depopulated; those that were able fled panic-stricken to the country villages, while others remained to die in the bosom of their families.39

Establishing the Grand Watch

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Undoubtedly the hardest hit were the poorer recent arrivals who clustered along the water in the immigrant sheds and shacks of the city below the hill. There hunger, hardship, and poverty reinforced the link between class and the disease.40 A similar association took hold in the United States. Cholera had appeared in Canada several weeks before it arrived south of the border. There the association between disease and outsiders was also reinforced by the fact that impoverished immigrants tended to congregate in the city’s filthy slums, where cholera spread easily through an unprotected water supply.41 In his study of immigration and perceptions of disease in the United States, Alan M. Kraut notes that ‘in East Coast cities, large numbers of foreign-born were struck down, especially in the poorest quarters, where immigrants from Ireland were concentrated. Many Americans perceived a link between these two unwelcome guests, cholera and the Irish.’42 According to Barbara Rosenkrantz, Americans like Canadians have ‘tended to respond to disease and disorder as though they were corruptions imported to [an] uncontaminated continent from foreign sources.’43 Foreigners from Europe – especially the Irish – became victims of angry mobs. There were murders in Chester, Pennsylvania, as armed crowds fired on ships as well as on those who were trying to flee New York City.44 In British North America, fear also gave rise to popular expressions of anger and resentment towards immigrants.45 In Upper Canada, politicians and prominent citizens accused the Lower Canadian government of failing to properly enforce the quarantine against sick immigrants, wilfully allowing the disease to spread up the river to the English colony.46 Such fears were widespread, transcending divisions of language and culture. In the newspapers of Lower Canada, immigrants infected with cholera were described as an army that would ravage the countryside and depopulate the former French colony on behalf of the English.47 At Lake Champlain, farmers and villagers even turned back immigrant ships with rocks, gunfire, and angry shouts.48 But even as public fears centred on the immigrant threat, some Canadian physicians noted that ‘there appear[ed] to be a local concentration of influences capable of producing the disease, sometimes confined to one house, and sometimes embracing a considerable neighbourhood.’49 As quarantine failed, some argued for a second tier of strategies to combat the illness in the event that it reached Canada’s cities. In Upper and Lower Canada and in the Maritime colonies, boards of health were created along the British model in the cities and towns. These were tasked

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The Last Plague

with removing the conditions that were thought to enable cholera to spread – essentially, this meant launching a program of urban clean-up in accordance with the principles of the miasmatic theory. These boards of health, which were filled with prominent local officials, citizens, and medical men, moved quickly to eradicate the various ‘evils’ that were thought to weaken constitutions with miasmatic clouds of effluvia, such as piles of filth, stagnant water, darkness, overcrowding, and stale air.50 In Halifax, Saint John, Toronto, and Quebec, hospitals were erected at public expense to segregate and care for immigrants, the indigent, and travellers.51 Vats of tar were kept burning in public places to eliminate miasma, and in Quebec City the local garrison fired off a nightly artillery barrage to clear the air of disease-causing stink.52 British North American doctors were more successful than their American counterparts in establishing a combined program of civil restrictions and civic cleansing. American physicians were generally unable to convince townspeople or elected officials that miasmatic clouds of effluvia given off by their own garbage heaps, cesspools, and urban filth might be contributing to the spread of the disease.53 During the early stages of the epidemic in New York, physicians could not persuade civic officials that a sustained clean-up program aimed at removing dirt and rubbish from the city’s streets would have any impact on the severity of the epidemic.54 Medical professionals in Canada had more success in realizing their reforms because decision making was concentrated in the governor’s office.55 This centralized power in the hands of a few elites, who drew on expert advice from the small colonial bureaucracy and from London rather than from the public.56 In Canada, public sentiment influenced policy, but it was guidance from London and from prominent local physicians that carried the most weight.57 The implementation of these miasmatic strategies further reified a link between ethnicity, class, and disease as officials focused their efforts primarily on the working-class and immigrant districts. In urban areas around Montreal’s docks, for example, poor immigrants lived in slum conditions, which forced them into intimate contact with the wastes that we now know spread the cholera bacterium. In 1832 it was the smells and ‘unpleasantness’ of the slums and their occupants that these by-laws were intended to alleviate – not the specific practices that enabled Vibrio cholerae to spread. But those by-laws did not reflect a recognition that the economic forces of industrialization and the ebb and flow of the waged economy might be to blame for both poverty and the living conditions of the poor and immigrants. Instead, those people were viewed

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as dirty bodies that polluted dwellings and, in turn, cities; and as sources of miasma that threatened the public health. Increases to charitable funds and state-sponsored poor relief were actually designed to protect elites in times of crisis; they were not intended to address underlying economic disparities or the problems created by emergent capitalism. They were residual measures employed to preserve the status quo. This type of crisis-oriented public health appealed directly to utilitarian political proclivities.58 The measures enacted in 1832 did little to stop cholera. By the time the first epidemic finally subsided in November of that year, it had killed as many as 6,000 people in British North America.59 Between 1800 and 1840, the mortality rate hovered around 30 per 1,000, but with the appearance of cholera in 1832 it reached 45 per 1,000. 60 Although such statistics are incomplete, they indicate the disease’s impact. In Montreal, more than 1,100 people died in June alone, and in the countryside, the case fatality rate ranged between 5 and 15 per cent in places like St-Eustache, Vaudreuil, and Chambly.61 Only Nova Scotia escaped the disease entirely through a successful quarantine – that is, until it reappeared in 1834, when it took a similar toll in that province, killing more than 400 in Halifax alone.62 Nevertheless, in Canada as in the United States and Europe, the official response pioneered in 1832 set a precedent for public health governance strategies during future epidemics. Quarantine and urban sanitary reforms would thereafter form first and second lines of defence within a framework in which public health interventions and restrictions on individual freedom remained the exception rather than the norm.63 Cholera set the pattern for disease management in the Canadian provinces, with contagionist and miasmatic strategies forming first and second lines of defence. Thereafter, central governments – the six colonial governments of British North America – were responsible for monitoring for disease and for protecting the colony from the external threat posed by immigrants and contagion. The means employed for this were an effective quarantine and the implementation of precautionary reforms suggested by officials in London. For their part, local governments – that is, city councils and municipal boards of health – were tasked with cleaning up city streets and removing the conditions that were thought to support disease once the central government had determined that a threat was looming on the periphery. These boards of health would only be constituted in times of epidemic, whereas the quarantine stations would permanently guard the approaches. This division of powers, which gave

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The Last Plague

local governments a degree of autonomy, represented an unusual compromise.64 The 1830s were a period of political strife in the two Canadas, culminating in the dual rebellions at the end of the decade. As Login Atkinson argues, cholera exacerbated tensions between the centralizing Tories and the devolutionist Reformers as medical professionals and politicians from both sides struggled to decide whether cholera was more of a central or a local concern.65 But the urgency of the cholera crisis mandated compromise between the two sides of the sort that was impossible on other, more political matters. The result was a two-pronged strategy that in effect divided the official response into primary and secondary tiers – central and local. The central government was given the first task of guarding the approaches, while local governments managed the internal factors that were thought to enable the disease to spread if it breached quarantine.66 Subsequent epidemics tended to reinforce this division of powers. An epidemic of typhus in 1847 that left more than 30,000 dead in the united province and a new epidemic of cholera in 1848–9 led to the passage of the first Canadian Public Health Act, which further refined the specific responsibilities of the various levels of government.67 This act gave the Governor in Council of the United Province of Canada the power to ‘issue orders and adopt measures at any time’ for ‘the protection of the Public Health in cases when the Province shall be visited by epidemic, endemic or contagious disease.’68 It extended him the power to appoint a Central Board of Health for Canada East and West that would coordinate local governmental responses to epidemic disease. The act established the supremacy of the Central Board of Health and reinforced the idea that quarantine should be the primary – indeed, only – permanent public health strategy. When cholera arrived at the Grosse Île quarantine station in the summer of 1849 and again in 1854, the Central Board was called into existence. Its directives continued to identify immigrants and the working class as the primary sources of infection and called on local boards to remould their behaviours and practices so as to eliminate any local influences that would support the disease.69 Dung heaps and filth were to be removed from backyards and privies were to be cleaned. Water and dampness in cellars and smaller dwellings was to be dried up. Windows were to be kept open to promote ‘free circulation of the atmosphere, both day and night,’ and walls were to be whitewashed twice a month. Bedding was to be aired every day. The Central Board issued these directives, but it was the local boards that were tasked with enforcing compli-

Establishing the Grand Watch

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ance. Municipal boards of health in all cities and towns were to adopt ‘the system of daily medical domiciliary visits’ and to open small temporary hospitals to treat the poor and indigent. Temporary dwellings to house families whose houses were being fumigated would be established, while overcrowding in immigrants’ and sailor’s quarters was banned. The local boards were required to make reports to the central authority and to enforce a total of twenty-two different regulations pertaining to everything from dietary habits to sanitary precautions in tanneries.70 Such measures shifted the gaze of state medicine from nuisances in public spaces to the homes of the working class. The private sphere encompassed the domestic/intimate and also the rights of private property, both of which were traditionally off limits to the state for regulation.71 But when the private activities and practices of working-class citizens came to be regarded as threatening the interests of the ‘public’ – that is, elites, bourgeois, and bourgeois-aspirant citizens – public health strategies were put in place that were intended to remould their behaviours.72 As Pamela Gilbert notes in her case study of the conflict between the public and the private in housing reform, physical health became ‘connected to notions of appropriate domesticity, both of which were believed to contribute to the formation of the nascent citizen. Public medicine … initially meant state-supported health intervention, practiced on behalf of a public formed of individual private citizens in whose service the state laboured and to whom it was accountable.’73 The measures taken by the Central Board of Health constituted a similarly significant intervention by the state into the private lives and habits of Canadians,74 but they were only temporary and ended with the passing of the crisis. These public health governance strategies responded to the public’s demands for protection, but they were based on a variety of medical theories that did little to explain why some people got sick and others did not. This began to change in the mid-1850s. During the 1854 epidemic of cholera, the British physician John Snow traced cholera cases in London back to drinking water tainted by a cholera victim’s feces. In one of the first epidemiological experiments, he mapped out cases of cholera in the Broad Street area of London, proving thereby that patterns of use for a common public water pump explained why some people in the area got sick and others did not. Those families that used the Broad Street pump at one end of the neighbourhood were sickened by the feces-tainted water; those who used another pump that was farther away remained healthy. This established the first definitive link between filth and disease, which in turn suggested that some type of carrier mecha-

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The Last Plague

nism caused illness, not just smells or effluvia.75 Early epidemiological studies supported some of the tenets of the miasmatic theory but challenged others.76 Around the same time, William Jenner differentiated typhoid from typhus fever; a few years later, Bristol physician William Budd argued that typhoid too was transmitted through water, thus clearly establishing a link between filth and disease.77 Although the two had always been linked, before it was the odour or smell that was thought to give rise to illness.78 Snow and others had thus confirmed William Farr’s earlier observation that it was some unseen thing in the water that transmitted disease, not smells or people.79 These discoveries gave impetus to the efforts of reformers in Great Britain and across Europe who were already advocating that sewers be constructed, water supplies protected, and nuisances removed – albeit for miasmatic reasons. Reformers like Edwin Chadwick promised that ‘improved sewage disposal, greater ventilation, and a reduction in overcrowding, among other reforms, would lesson epidemic disease, lower the death rate and increase life expectancy.’80 In England in 1855, John Simon became the first Chief Medical Administrator in the Privy Council’s newly established Medical Department.81 Under his guidance, Britain passed the Sanitary Act of 1866, which compelled the local authorities to enforce a slew of earlier, piecemeal reforms requiring the removal of nuisances from city alleys and streets, oversight for slaughterhouses, control of food-borne illness, the regulation of overcrowding in workingclass neighbourhoods, and the reformation of industrial working conditions.82 These pieces of legislation were strengthened with funding from the central government in 1872 and eventually consolidated in 1875 in the Public Health Act, which mandated that all districts appoint a local medical officer and begin to implement the reforms. Public health reform took a somewhat different course in the United States. In Massachusetts in the 1850s, public health reformers like Lemuel Shattuck were able to convince state legislature to conduct comprehensive surveys of sanitary conditions as well as mandate the registration of births and deaths. As in England, this allowed reformers to correlate sanitary problems in urban areas to increased mortality from specific diseases. Unlike Great Britain, however, the United States had to deal with massive numbers of new immigrants, who were thought to spread disease. This made tracing more difficult than in England, where populations tended to be more stagnant. This also stifled public health developments, for Americans – including sanitary reformers – continued to want to blame immigrants for spreading disease. As Barbara Rosenk-

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rantz notes, the Americans ignored ‘endemic diseases which, a decade before, would have caused community alarm and received concerted attention.’83 Shattuck’s statistical studies implicated the urban environment as a cause of disease and death, yet it was not until the mid-1860s that boards of health were formed to implement his reforms. Even then, health boards had little real power to enforce laws to protect the community, for such laws required that a consensus be reached regarding the ‘public good.’ In other words, it was up for debate what constituted a public nuisance as opposed to a necessary consequence of progress. This meant that the power to prevent disease continued to rest with the individual rather than with legislatively empowered state bodies, and that the boards could do little more than provide guidance and instruction. Only during an epidemic crises did their real power increase.84 In contrast to the British and American models, British North Americans found little need to challenge the long-standing and accepted methods of managing epidemic disease. As a consequence, public health governance strategies at the metropole and periphery diverged, being implanted at a later time and in a uniquely Canadian context.85 Population densities and industrial expansion in Great Britain had created crisis conditions in British and American cities and towns. By contrast, the Canadian population was more dispersed and the problems of overcrowding and poor sanitation were less immediate; furthermore, such problems retained their old association mainly with immigration and the immigrant slums.86 At the same time, absent any meaningful vital statistics to test the link between sanitation and public health – beyond the causes of death collected during the 1851 census – a correlation between immigration and disease seemed to be more evident than the one between poverty and ill health alone.87 Disease prevention relied on the relative isolation promised by quarantine and thus on central rather than local (i.e., provincial or municipal) governments. This is consistent with Heather MacDougall’s observation that there were three requirements that any municipal sanitary movement in Canada required for success. First, accurate statistical information had to be gathered on mortality and morbidity so that problems could be identified and solutions theorized. Second, activists had then to use this information to mobilize public opinion and gain the support of state actors to implement reforms. Third, this latter criterion required a highly developed municipal infrastructure to police sanitary laws and to ensure compliance with regulations. None of these conditions existed in Canada when Chadwick’s reforms were implemented in Great Britain or Shattuck’s in

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The Last Plague

Massachusetts. As a result, public health innovations at the municipal level came much later in the century.88 The importance of the central government’s role in public health governance was solidified in the last great cholera scare of the nineteenth century. When a new epidemic of cholera was reported in Europe in 1865, Dr von Iffland, the physician in charge of Grosse Île, readied the island’s defences, increasing surveillance and strengthening the regulations against immigration.89 That winter, the Central Board of Health was constituted by Thomas D’Arcy McGee, the Minister of Agriculture; its head, the Deputy Minister of Agriculture, Joseph-Charles Taché, convened a conference in Ottawa to examine the measures that could prevent the illness from making headway in Canada.90 Doctors who attended the conference remained as divided as their predecessors regarding cholera’s precise aetiology. Despite the work of Snow and others, the 1860s were a period of transition in medical thinking: zymotic (or infectious), miasmatic, contagion, and even humoral theories of disease continued to coexist within a profession comprised of individuals from a number of generations and traditions.91 While most now agreed that unsanitary conditions should be cleaned up, all accepted that cholera would arrive in North America with immigration from overseas.92 In 1866, the Central Board of Health was made up exclusively of members of the medical profession.93 Its members produced a Memorandum on Cholera, authored by Taché and overseen by McGee, that outlined the government’s official response, strengthened quarantine regulations, and required that information be disseminated to the more than fifty local boards of health that were being convened in Canada East and West.94 According to the memorandum, cholera would again be fought primarily by quarantine, with municipal measures such as bans on public gatherings, isolation of victims, and forced disinfections of private dwellings becoming a secondary line of defence. ‘There is a community of interest to be subserved in averting the common danger; there must also be a community of action in preparation and defence for such an object,’ explained the Memorandum. And on the [central] government devolves the duty of the general organization, of the gathering of the forces, of the promulgation of general information, of the external surveillance. It is its duty to keep the grand watch, and to defend the approaches, if they can be defended … [M]ore special duties devolve upon municipal bodies; but they are restricted within narrower limits as to space. Each corporation is to see that every possible thing for the

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salubrity of their locality is done, that the poor are furnished with the necessities of life, and, in case of sickness, with the necessaries called for by their painful situation; they have to invite to their assistance the councils of men who, by their position and their avocations, can advise them in devising local measures and calling for general action from the higher authorities, if wanted.95

According to Taché, the central government would take the primary role in preventing the disease from entering the country while the regional and municipal levels of government would be charged with administering treatment schemes for the poor and establishing local specialist boards to ensure that the naturally ‘salubrious’ climate was maintained during the crisis. While this memorandum spoke of specific interventions and a ‘community of interest,’ it reminded citizens that they should not make the ‘error of expecting more from government than the government can possibly perform.’96 Here, the ‘community of interest’ was a temporary construct necessitated by a specific, extraordinary ‘common danger.’ Increased poor relief and state assistance for the disadvantaged were temporary measures necessary to combat the epidemic threat to the community if the disease breached quarantine. Given that cholera spread easily through major European cities even though they had begun to build sewage systems and implement the lessons of the 1854 outbreaks, Canada’s cities would have been a breeding ground for the disease. In the United States, too, cholera killed as many as 50,000 Americans in 1866.97 In both Great Britain and the United States, the 1866 cholera epidemics reinforced and supported the efforts of municipal health reformers to clean up cities and devolve public health responsibilities to local government boards; in their wake, laws were passed that gave local governments more sweeping powers to address problems that might otherwise have been left unattended.98 In British North America, the experience and outcome were quite different. Cholera never actually made headway in the six colonies except for a few sporadic cases in Canada West and Nova Scotia.99 In both places, the individuals who spread the disease were quickly identified by officials as immigrants who had evaded quarantine, and they were successfully isolated before they could spread the disease to the larger population.100 In Canada, the seemingly miraculous escape in 1866 reinforced rather than challenged the role of the central government and the importance of quarantine as the primary line of defence.

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The Last Plague

For Dr von Iffland, who had witnessed every cholera scare over the previous thirty-five years in both private and public practice, the experience of 1866 marked a major step in disease prevention.101 In his final report to the central government a few months before Confederation, he wrote: ‘On being carefully reviewed by members of the medical profession in general, it will be admitted that [the measures taken by the Central Board], which concern all classes of the community, if strictly carried into effect, can scarcely fail to control, or, at least, afford a high degree of protection and security from so dreadful a disease as cholera, or other contagious or infectious maladies.’102 According to him, quarantine had spared the United Province of Canada from another visitation of the dreaded cholera. Despite their own efforts to control the disease, municipal officials in the largest city in Canada West agreed. ‘The extraordinary attention paid to the condition of emigrant ships, the enforcement of quarantine, the isolation and placing under sanitary control of the persons and premises of all cholera patients, the adoption of processes of disinfection and cleanliness, along with attention to the cities and towns of North America,’ read the report of Toronto’s Medical Officer of Health, ‘were instrumental in mitigating the devastations of cholera, where they did not altogether prevent its occurrence.’103 According to Geoffrey Bilson, this sentiment was widely shared by medical professionals and civic officials.104 Eighteen months after the crisis passed, the local boards of health were once again dissolved.105 Whatever the real epidemiological reason, the apparent efficacy of quarantine had seemingly been proven. After 1866 it remained Canada’s only permanent protection against epidemic disease, even while British and American officials were beginning to move towards more interventionist policies aimed at removing local souces of infection. At Confederation in 1867, the delineation of responsibilities that had seemingly proven so successful the previous year in the United Province of Canada was written into the British North America (BNA) Act. Under Sections 91 and 92, the provinces became responsible for ‘the Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province,’106 while the central government retained control over ‘Quarantine and the Establishment and Maintenance of Marine Hospitals.’107 While it is tempting to look back at this division of powers and see in it the threads of future developments when provincial responsibilities would become most

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important, this was not how it was understood at time. In 1867, it was the recently proven public health responsibilities that were retained by the central government, while the provinces took on tasks that had traditionally been less important. It was the central government that would guard the approaches against disease while the provinces and municipalities managed local problems. In England, at about the same time, local boards of health were being given new powers and significant resources in order to begin to address many of the health problems that had been associated with urbanization and industrialization.108 The very fact that they were urban problems necessitated a local rather than a national response; as Anthony Wohl notes, ‘however much direction the central government might give from above, ultimately the health of the nation depended on sanitary measures at the local level.’109 Across England, sewers were built, meat inspectors were hired, and urban slums were inspected and cleaned up. In the United States, too, reformers at the state level succeeded in winning the support of the medical profession and legislatures in creating activist boards of health. The first permanent State Board of Health in Massachusetts, for example, was created in 1869 and was tasked with collecting vital statistics and coordinating the efforts of city and town governments, which, like their British counterparts, were already responsible for controlling local nuisances, polluted water, contaminated food, and sewage disposal.110 Here too it was local governments at both the state and city levels that took the lead in implementing public health reforms. Again they tended to develop in response to a need to coordinate local efforts and thus arose from the bottom up.111 In contrast, in Canada the central government’s role grew. In 1867, Ottawa assumed responsibility for the quarantine stations at Halifax, under J.J. Gossip, and at Partridge Island off Saint John, under G.D. Harding. The busiest and most important quarantine station, however, remained Grosse Île. For the thirty years following the final outbreak of cholera in 1866, Grosse Île was overseen by Dr Frederick Montizambert. A broad-shouldered, barrel-chested giant with a drooping moustache and wild, dark, bushy eyebrows, Montizambert looked more the part of a frontiersman than a public health official. Born into an influential anglicized French Canadian family in Quebec City in 1843, Montizambert was educated at Upper Canada College in Toronto and at seventeen decided to pursue a career as a physician.112 Like many young men on a similar path, he began his studies in Canada (at Laval)

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The Last Plague

but completed his MD in Edinburgh in 1864.113 On returning to Canada in 1865, he married Mary Jane Walker, the daughter of a longserving member of the legislature.114 Despite the advantages afforded him by his wealthy and well-connected family, Montizambert was never interested in private practice.115 Instead he sought to make his way in the emerging field of public health. As a medical student in Scotland during the early 1860s, he had learned first-hand about many recent innovations in medical thinking and in the field of state medicine. When he returned to Canada, he sought to build his career with the federal government as there were simply no permanent provincial or municipal positions.116 After serving in the Fenian Raids in 1866, Montizambert secured a position at Grosse Île as inspector of incoming steamers during the cholera scare. He worked under Dr von Iffland until the latter retired in 1868, at which time Montizambert was promoted to superintendent of the island station. A careerist who bickered often and loudly with his bosses over his salary, rank, title, and holidays, he moved up in the federal civil service, eventually serving as Director-General of Public Health for more than two decades. He would spend fifty-four years in the public service before being forced to retire in 1920.117 During his remarkable career – which was bookended by the splendid ‘success’ of 1866 and by tragic failure during the 1918–19 influenza pandemic – Montizambert came to embody the federal public health system As a young quarantine officer, each day at Grosse Île, Montizambert climbed aboard the Hygiea or the Challenger (the two steam yachts employed by the quarantine service) to inspect incoming ships. It was his duty to protect the Dominion from disease by examining the immigrants who were arriving through Grosse Île. There he began to collect statistics to track both the efficiency of the quarantine stations and the health of the immigrants he examined.118 He rose quickly, becoming known as an enterprising and innovative doctor. Von Iffland said of his service during the 1866 cholera scare that ‘he performed [his duties] with so much zeal and diligence, displaying no ordinary powers in the detection of disease, among emigrant passengers and ship’s crews, that, I hold, he had fully established his claim to be considered a highly efficient public officer.’119 Over the next two decades, Ottawa’s role in protecting the Dominion from ‘foreign’ diseases continued to expand to include the management of all ‘exotic’ diseases that breached the country’s outer defences. Here the assumption was that as the federal government was responsible for

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guarding the approaches from ‘foreign’ diseases, so too was it responsible for dealing with those cases that evaded detection. To this end, in 1879, Isaac Burpee, a businessman and politician from Sheffield, New Brunswick, demanded in the House of Commons that Ottawa take responsibility for cases of leprosy in New Brunswick: The disease is peculiar in its character, and while it is true that under Confederation the Governments of the several Provinces were obliged to provide for local charities of all kinds, it is also true that this is a peculiar and special disease such as exists in no other part of the Dominion … It seemed, therefore, to be unfair that New Brunswick should be burdened with the charge of the victims of that disease, and that it is the duty of the Government of the Dominion to assist at least in dealing with that disease.120

In this analysis, leprosy was a ‘peculiar’ and ‘exotic’ disease that Burpee felt should rightly fall under federal jurisdiction because it was not believed to be local in origin. Other members of the house agreed, noting that as cases of the disease had clearly escaped quarantine – as it could not be an endemic Canadian aliment – it fell to the federal government to assume responsibility for its management.121 In 1881, the Macdonald government agreed and took control of all cases of leprosy within Canada’s borders – both prevention and treatment – at a government-owned lazarette in Tracadie, New Brunswick. The prime minister explained that he was ‘quite willing to take charge of [leprosy in the Dominion] because it is a disease which spreads most insidiously … [T]he Government thought it better that [as] this was certainly a matter connected with the public health, that it should be maintained by the Dominion Government.’122 In British Columbia, the ‘othering’ of leprosy as a foreign disease rested on its association with Chinese immigrants and what ethnocentric Canadians believed to be ‘unsanitary’ Chinatowns.123 In that province, between 1891 and 1905, cases of leprosy among Chinese immigrants were dealt with at a lazarette established and run by the municipal government of Victoria on D’Arcy Island. In BC, the identification of leprosy as ‘a foreign disease’ contributed to the segregation of the Chinese community from the island’s settler society.124 Leprosy reified racist fears. Once it was linked to Chinese immigrants, who were already seen as polluting the social and economic body, the disease became a tangible physical manifestation of a perceived socio-economic threat.125 The official methods used to deal with leprosy continued to target

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The Last Plague

immigrant bodies for segregation and isolation. Of the forty-nine men sent to the lazarette between 1891 and 1905, forty-three were Chinese and the rest were immigrants from Japan or eastern Russia.126 While the lazarette had been created by the Victoria municipal government to manage a local public health problem, from the start the city tried to convince the federal government to take control of D’Arcy Island just as it had done in Tracadie. Here again the ‘foreign’ nature of the disease and its specific link in the public and medical imaginations to immigration and ‘foreigners’ were seen to make the illness a federal responsibility. Protecting British Columbians also provided a tangible, medical rationale for restricting Chinese immigration. In 1901, the federal government pledged half the revenues from the head tax on Chinese immigration to run the institution; in 1906, it assumed full control over it. As Renisa Mawani notes, D’Arcy Island under federal jurisdiction became more than just a space in which ‘diseased’ persons could be detained; it became a temporary detention centre where the federal government could use its powers over immigration to deport most of the lepers, thereby physically removing from the Dominion both a public health threat and social ‘undesirables.’127 Canadian disease management policies were as much about protecting the social body from unwanted groups as they were intended to protect Canadians from real diseases. This is why the long American border was not seen as a serious source of contagion in comparison to the main Canadian immigration ports. Americans were regarded as ‘racial’ cousins – wayward as they may have been politically and ideologically, they were nonetheless British or northern European in ‘racial’ ancestry. ‘White’ Americans were not othered in the same way as the Chinese and (later) eastern Europeans. In her study of political borders and disease, Amy Fairchild suggests that fear of ‘the other’ rather than fear of disease directed the medical and social gazes towards racial and ethnic outsiders. Regarding the American experience, she writes that immigrants who were unacculturated to American values represented a threat to order and efficiency in the new industrial economy. Those immigrants who appeared to fit dominant cultural norms were viewed as less dangerous. Thus, ‘only when groups of immigrants failed to conform to societal expectations about the fit industrial worker’ were they excluded at the nation’s borders.128 Alan Kraut makes a similar argument. He posits that social, economic, and cultural difference was identified by native-born Americans as a serious threat to the coherence of the social body: ‘Unhealthy, then, became a convenient metaphor for

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excludable, legislation the remedy, and public health bureaucrats – first state, later federal – the instruments of cure.’129 In this analysis, borders were points of contact where the familiar and the other might cause friction.130 The Canadian quarantine system thus provided the main defence against the ‘evils’ of immigration, with disease acting as both a symptom of a larger socio-economic problem as well a convenient excuse to deny undesirables entry to the country.131 As a public health governance strategy, quarantine arose from an ideology that accepted this link as fact. In part, this was based on observation and tradition. During the colonization and early settlement periods, settler populations remained small and crowd diseases tended to appear with immigrant and trade ships, diffusing into the interior along lines of trade and communication. The acceptance of this pattern was then reinforced by the cholera epidemics of the mid-nineteenth century. As the Canadian state and apparatus of governance solidified during the 1830s and 1840s, episodes of crisis drove developments in public health governance. In the wake of these epidemics, quarantine became the Dominion’s main line of defence, with local governments taking on responsibility for removing environmental conditions that might support the disease. Both levels of government in British North America initially modelled their responses on the British system. But whereas quarantine failures and developments in disease knowledge helped promote the devolution of public health responsibilities to lower levels of government in Britain during successive epidemics, Canadians continued to rely on quarantine as the main line of defence. Here the experience of 1866 was of central importance. Cholera ravaged British and American cities that year, thus challenging the usefulness of quarantine while also emphasizing the importance of local sanitary reforms and new public health ideas; Canada, however, largely escaped that epidemic and thereby evaded any impetus for significant reform. The apparent success of the Dominion’s anti-cholera measures that year was significant and buttressed the validity of existing governance structures – clearly, it was thought, no reforms were needed. When the BNA Act was passed the following year, it imported an existing set of responsibilities and structures from Canada East and West and, in the context of the time, assigned the most important tasks to the federal government. After 1867, the federal role was to prevent and later manage diseases that were understood as originating outside the Dominion. This task reflected the clear linkage that had been drawn in the popular and offi-

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cial imaginations between immigrants and deadly ‘exotic’ diseases. Just as immigrants were understood to pose an economic and social threat in the popular imagination, so too did their bodies seem to be a tangible, physical danger. In the dominant view, then, Canada was a wilderness land of clean water and fresh air; it had a salubrious climate that would promote health rather than make people sick. Thus outsiders became sources of pollution against which quarantine seemed to offer the best defence.

3 ‘Everybody’s Business Is Nobody’s Business’: Sanitary Science, Social Reform, and Ideologies of Public Health, 1867–1914

[Public hygiene] takes cognizance of the places and houses in which [people] live, of their occupations and modes of life, of the food they eat, the water they drink, and the air they breathe. It has to do with the physician and his patient, the statesman, the scholar and the divine, the farmer at this plough, the artisan in his workshop, the miner in his pit, the student at his desk, the mariner on the ocean, the condemned in his cell. It is not only a study, but it is a large and comprehensive science. It unmasks the hidden poison that desolates our cities. It offers protection from destructive epidemics. It teaches a remedy that stays the shaft of death, and secures to the thoughtful and attentive citizen a healthy, a happy and a prosperous home.1 Dr William Brouse, 1881

In 1894, the Quebec physician Emmanuel-Persillier Lachapelle was asked to address the American Public Health Association at its annual meeting on the future of preventative medicine in Canada. It was the first time that the meeting had been held in Montreal. Like Frederick Montizambert, Lachapelle came from a prominent Quebec family whose roots in Canada stretched back to the late 1600s. But unlike the anglicized, Edinburgh-educated doctor, he had completed his schooling in Montreal. There he began his career at the Hôtel-Dieu; in 1891, he helped found the Société Médicale de Montréal. Later he taught pathology at the Montreal School of Medicine and Surgery and was called to evaluate the mental state of Louis Riel, an old school friend, at his 1885 trial. In his public life, Lachapelle used his political and professional ties in Montreal to advocate for improvements to the health of working-class French Canadians in the city, becoming the head of the province’s Board of

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Health in 1887. When he addressed the American Public Health Association in 1894, he was regarded as an international authority on preventative medicine, which he famously described as ‘prophylaxis in action.’2 While public health was a growing concern in the mid-1890s, the medical community remained as divided as before on how best to achieve this prophylaxis: Was it by addressing the environmental and socio-economic conditions that allowed diseases to flourish, or by maintaining an effective quarantine? Since Koch’s discovery of the tuberculosis bacillus in 1882 two camps had formed, each attributing disease to a main underlying cause or mechanism of transmission and each demanding a different set of state interventions. ‘According to the one,’ Lachapelle told the audience, ‘epidemics are due to, or are maintained by, the unhealthiness of the soil; to insure its permanent salubrity is therefore the best means of preventing and suppressing epidemics.’3 In the first camp were those who argued that epidemic disease could only spread if it found fertile soil in a chronically unhealthy population. For these so-called ‘sanitarians,’ disease was a secondary consequence of poor sanitation, ignorance, poverty, overcrowding, poor nutrition, and improper personal hygiene. It was a problem of urbanization and industrialization. ‘According to the other,’ he continued, ‘the real danger lies in the importation of the morbid germs; therefore, protection is sought in the efforts to prevent their introduction along sea-board and frontiers, or, in other words, in the establishing of an effective quarantine service.’4 Here disease was the product of contamination from an external source, constituting the pollution of an otherwise healthy social body. It was, contaminationists argued, imported by immigrants, livestock, and infected goods. In this construction, Canada was pure and the outside world unclean. The outcome of the debate would determine whether the state changed its approach to public health governance, with both sides mounting a fierce campaign to win politicians and the public to their side. As in Britain and the United States, public health became an important political issue only after fallout from urbanization and industrialization threatened the health of the middle and upper classes. During the last three decades of the nineteenth century, the Dominion’s cities grew at an astonishing pace. Between 1861 and 1891, Montreal’s population soared from 90,323 to 182,695.5 In 1850 a visitor commented on the strange, backward mixture of old and new, seeing Montreal as an oldstyle mercantilist city rather than an industrial centre on par with those emerging in Europe and the eastern United States. As Bettina Bradbury

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observes, three decades later that same visitor would have described the city as a truly industrialized and urban environment, the ‘workshop of Canada.’6 The rapid transition to a new waged economy required men (and often women and children) to sell their labour to pay for food, clothing, and shelter.7 Steady immigration and an economy that routinely swung from boom to bust ensured that wages remained depressed as living costs rose steadily.8 In 1888, when a Royal Commission was appointed to investigate the relations between labour and capital, rent was said to have risen 25 per cent in fifteen years while wages remained largely stagnant.9 By one estimation, in 1888 rent and fuel alone ate up one-third of most working-class families’ incomes.10 As a result of the transition to industrial capitalism, the living conditions of the working class deteriorated steadily through the later half of the 1800s.11 Low wages meant that families were forced to share accommodations, and sanitary facilities were often inadequate.12 As Desmond Morton and Terry Copp observed, survival depended on good times when working people might be able to afford to live in a two- or three-room house with ‘a pit privy outside but usually without running water.’13 Diet was restricted by income and consisted mainly of bread, root vegetables, cheese, and liquor.14 Life was precarious, and illness or injury of a breadwinner could spell disaster for the family. All of these factors increased adult and infant mortality, worsened the general health of the urban classes, and helped foster the spread of diseases that did not respect class boundaries. The sanitary movement was the elite’s response to a public health crisis that began in Canada much later than it did in Great Britain or the United States.15 In the sanitarian’s world view, disease was the product of ignorance, immorality, poverty, and uncontrolled filth. Their movement married scientific conceptions of disease with the moralizing reformist spirit of the late nineteenth century, one that targeted the working class as the main threat to the collective health. Public health policy was thus a tool – like education and the law – employed by the ruling classes to ‘improve’ the behaviours of workers and stabilize the transition to industrial capitalism.16 In this case, the ‘public’ to be protected, at least as defined by reformers were those middle-class and elite city dwellers who felt threatened by the rapid changes taking place around them and by their new proximity to the working class in urban environments.17 The sanitary movement thus drew on the same impulses and values as the larger social reform movement, which was comprised of a fluid mixture of voluntary associations and professional organizations, women and men. They were united by their desire to identify and correct an array of

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social ills where cleanliness was equated with purity and morality.18 Both religious organizations and lay voluntary ones viewed sanitary reform as part of a larger program that aimed to reshape Canadian society according to the moral code of Canadian Protestantism.19 Here science was deployed to put a modern twist on age-old moral arguments. ‘Of the necessity for some general laws on the subject [of public sanitation] there can be no doubt,’ read a Dominion Medical Association report in 1867. ‘Moses, the Law-giver, inculcated the care with which disease, occurring by infection and otherwise, are to be prevented. Those laws were imposed upon the people, and were enforced with vigour … [A] necessity exists for the introduction by the General Government – or simultaneously by the Local Governments – of a comprehensive system of sanitary laws, not so complete, perhaps, as those of the Mosaic code.’20 In this context, sanitary reform became a moral duty as well as a civic necessity.21 Social reformers, including women’s groups, labour activists, temperance unions, and religious organizations, used ‘sanitary science’ to translate abstract sociological critiques of urbanization into proposals for extending state power in the interests of creating a healthier society.22 Medical knowledge was thus used to demonstrate that the city’s moral problems were letting germs find fertile soil in unclean bodies and minds.23 Wrote one reformer: Let the people be brought to understand that in the present state of society, with its constant, close, and universal intercourse … [that] germs exist everywhere, and … that each individual must fortify his or her own body by healthy living in order that soil for the growth of the germs shall not be available.24

While reformers believed that boards of health could do much to cleanse dirty bodies, individuals had also to take responsibility for their own actions: Simplicity in diet must be loudly preached or enforced – as well prohibit certain tempting-to-over-eat food concoctions as alcoholic beverages. And, perhaps most important of all, better ventilation in dwellings, shops, schools, etc., must be enforced, and the people taught to breath only pure air, and in abundance with well-developed respiratory organs. Thousands die actually and practically from ‘want of breath.’ Some laws respecting the marriage of diseased persons should be enacted and enforced; and it will be

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a great benefit to the race if some way could be devised for having the delicate subject of sexual relationship better and more generally understood, and the relationship improved, and temperance therein promoted.’25

Sanitarians’ demands, like those of other social reformers, were couched in idealistic terms but ultimately sought to change people’s private behaviours by educating them in a new ‘sanitary code.’ In this way, so they believed, they would regenerate or improve society as a whole, for healthy people would make for effective workers and an improved citizenry.26 From a public policy point of view, sanitarians were most concerned with eradicating stench and filth, thus improving the condition of common spaces. In the movement’s early years, before Confederation, this meant building sewers and draining cities so as to remove the sources of noxious smells and odours that, according to miasmatic theories of disease, were responsible for high urban death rates. Toronto’s first drainage sewers had been built in 1843, but no systematic plan was made until the city’s engineer, Thomas H. Harrison, recommended dividing the city into eight drainage areas in 1856.27 The system was only completed by the mid-1880s, by which time 136.65 miles of combined sewer – storm water, ground water, and household waste – were draining Toronto’s problems into the bay.28 This sort of solution was characteristic of a ‘sanitary idea’ that emphasized cleanliness as an end in itself: out of sight, out of mind.29 The new ‘social’ sciences also aided sanitarians in identifying, evaluating, and comparing problems. By studying the patterns of illness, street by street, alleyway by alleyway, house to house, workplace to workplace, and family to family, reformers hoped to use statistical knowledge and the emerging methodologies of epidemiology and sociology to define the combinations of behaviours and environmental hazards that caused ill health.30 The overcrowded, unsanitary, poorly ventilated working-class homes were already reviled as dark spaces that the ‘scientific light’ of hygiene never reached.31 Statistical surveillance – gathered first through the compilation of vital records and later through compulsory domicile visits – would finally provide the light necessary to correlate slum conditions, working-class behaviours and specific ‘types’ of individual with disease.32 But as reformers had already discovered in Great Britain, accumulating such knowledge would require a significant level of state intervention and cooperation.33 In England, births, deaths, and marriages had been registered since 1837.34 Edwin Chadwick used these returns,

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published by the Registrar-General, to compile his famous 1842 Report on the Sanitary Conditions of the Labouring Population of Great Britain, which made a clear connection between inadequate sewage disposal, impure water supplies, drainage, and overcrowding, on the one hand, and mortality from epidemic diseases, on the other.35 Chadwick’s report proved to be a remarkable public health success, selling 100,000 copies and shaming politicians into passing the Nuisance Removal Acts of 1846 and 1855, as well as the first Public Health Act in 1848.36 These early British successes inspired one of the more prominent Canadian sanitarians, Edward Playter, to use a similar tactic.37 Born into an old Upper Canadian loyalist family in 1834, Playter was trained as a physician at the University of Toronto and used his family connections to obtain a job as the coroner for York County. He was typical of the reformers of the age. Financially independent, he was imbued with a social conscience. As a doctor, philanthropist, author, and civil servant he applied science to the evils of urbanization and industrialization in a paternalistic attempt to right social ills.38 ‘Knowledge is power,’ Playter told readers of the 1874 inaugural issue of his Sanitary Journal, ‘and as we come to know more of the conditions which favour the spread of diseases, as we do daily, it is our own fault if we neglect to use the power which that knowledge gives us.’39 For Playter, addressing issues of social welfare would improve collective health because poverty equalled sickness. Yet accumulating the knowledge base necessary to tackle illness and its underlying causes was a significant problem in Canada, for neither local governments nor the central authority collected detailed information on mortality or morbidity from disease. By 1872, Ontario, Quebec, Nova Scotia, and British Columbia had begun to assemble rudimentary records of births, deaths, and marriages, but reformers desired comprehensive numbers for the Dominion as a whole; they also wanted those numbers broken down into categories of disease, which would allow a comparison of causes of death across places and times.40 Collecting statistics required more than building the political will to incur new expenses, because it was unclear which level of government held jurisdiction: provincial or federal.41 The British North America Act had left matters of property and civil rights – on which the records of births, deaths, and marriages were based – to the provinces; yet the federal government was tasked with ‘census and statistics.’42 Given the central government’s primary role in public health, advocates tended to emphasize the need to secure federal legislation. After a lengthy discussion of provincial and federal rights, in 1876, the Cana-

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39

dian Medical Association passed a motion declaring that ‘the sanitary laws at present in existence in the Dominion are insufficient to meet the requirements of public health, that a system of public hygiene must embrace an acquaintance with vital statistics, that the importance of that knowledge is recognized elsewhere, and that in countries no more favourably situated than Canada, systems more or less complete of vital statistics obtain, and sanitary laws have been enacted and enforced.’43 This motion was taken up in Parliament by Dr William Henry Brouse, a Liberal senator from Dundas County.44 In a special session, he told the house that although some provinces had already moved to collect vital statistics, these presented an incomplete, anecdotal picture; thus a central means of statistical collection or compilation was required. He then outlined the national systems of medical registration that had already been established in Great Britain, France, and Germany, noting that a similar movement was already under way in Washington.45 Although Prime Minister Alexander Mackenzie refused to acknowledge that federal jurisdiction was necessarily supreme in this instance, Brouse came armed with the support of Sir Charles Tupper. Tupper had been a prominent member of the Macdonald government, a Nova Scotia physician, and the first president of the Canadian Medical Association.46 He was also a ‘founding father’ whose opinion in constitutional matters held sway in Ottawa. In Tupper’s view, ‘the question of statistics, whether vital or otherwise, under the Union Act, had been placed exclusively within the control of the Dominion Parliament, and the attention which had been given to the subject by [provincial governments] was entirely unconstitutional.’47 Mackenzie’s solution was to appoint a Select Committee of House and Senate members, headed by Brouse, to give the matter further attention. It was not a popular proposal with a government caught between dwindling tariff revenues and an economic depression while struggling to pay for the promised transcontinental railway.48 It was also doubtful that the issue would raise the broad public support necessary to make it a priority. But as one sanitarian said, it was the duty of Canadian physicians to educate public opinion on the necessity of public health reforms so as to secure the means of ‘achieving a proper position for State medicine,’ even though it was a ‘somewhat thankless task.’49 While lay organizations like the Citizens’ Public Health Association of Montreal might support the physical clean-up of streets and the protection of drinking water, many Canadians doubted that state intervention was necessary in the private sphere and the marketplace.50 As William Canniff, the head of Toronto’s municipal public health department, dis-

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The Last Plague

covered, many were unwilling to accept the imposition or cost of public health measures that required the outlay of private and public capital to, for example, install hygienic waste disposal systems in the home. 51 Also, local and provincial politicians – many of whom were businessmen – had a vested interest in maintaining a deregulated marketplace, especially in the sale of food and drink, and thus blocked reforms to appease their constituents and protect their right to do business as they saw fit.52 For others, the extension of state authority over the body was intolerable.53 In any case, public health initiatives were viewed with scepticism and concern by both the public and the government. Playter and other prominent public health activists were confident that if a statistical bureau were allowed to ‘tabulate all sanitary statistics [it] would show the connection between the death rate and the sanitary or unsanitary conditions of various parts of the country, the prevalence of any particular disease in certain areas, and so on.’54 Sanitarians assumed that once the necessary statistics were generated to measure the prevalence of disease and to identify its causes, the need for regulation and other reforms would become self-evident.55 Statistics, they argued, were a matter for the federal government, because few provinces and municipalities collected records on public health and federal funding and legislation might provide an incentive to do so. This is what made the collection of accurate vital statistics so essential to their cause. In February 1881, Mackenzie’s committee recommended that the government compile the statistics collected by the provinces and municipalities and publish them on a yearly basis. With prompting from Tupper, John A. Macdonald – who had returned to power in 1879 – agreed. The following year, $10,000 was voted to fund the new undertaking, a sum that was doubled in the following budget.56 Thus, $20,000 would be provided by the Department of Agriculture to Canadian cities that had populations over 25,000 and that had lawfully sanctioned boards of health headed by a licensed medical practitioner. That money would go to collect information about births, infectious disease, and causes of mortality.57 The fiscal impetus for the development of permanent public health infrastructures at the provincial and municipal levels came from the federal government. Until federal legislation was passed, there had been little movement by local governments towards acquiring more public health responsibilities. The central government then provided funding to cities like Toronto that had been reluctant to create permanent boards of health.58 The Province of Ontario during an epidemic in 1873 had passed an act allowing an emergency board of health to be called

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into existence, but that board was not permanent.59 Only in 1882, after the federal legislation was passed, did Ontario under Premier Oliver Mowat pass its own Public Health Act, which not only created the first permanent provincial board of health but also enabled the creation of municipal boards that could act under its aegis.60 This provincial act was inspired in large part by the British legislation of 1875, which required all districts to appoint a local medical officer to begin a coordinated clean-up of Britain’s cities.61 Toronto created its first permanent board of health in 1882. At that time, the city was one of the dirtiest and unhealthiest places in North America and the British Empire.62 In 1884, of 5,181 residences inspected, 23 per cent lacked any form of drainage while 65 per cent had pit privies.63 In terms of water supply, 145 had no access to water, 655 drew water from unsanitary wells, and 843 used cisterns.64 The situation was similar in Montreal. In the later part of the nineteenth century, Canada’s largest city was a notoriously dangerous place to live. One commentator noted in 1875 that strangers who visited the city, either for business or for pleasure, seldom escaped without suffering a severe gastrointestinal attack of some kind.65 As late as 1899 there were still 3,000 horse stables and 300 cowsheds within Montreal’s city limits and in excess of 5,000 outdoor pit privies despite ordinances and bans against such ‘nuisances.’66 In addition, only 27 of the 178 miles of Montreal’s road network were paved, which ensured that when rain, people, horses, and cows mixed, the streets turned to filthy mire.67 The water supply was unreliable, untreated, and potentially dangerous in spring and fall. In 1895, Montreal had a notoriously high death rate, 24.81 per 1,000 – higher than London, Paris, Rome, Boston, or New York.68 The general death rate was inflated by an infant mortality rate, which was the highest in the Western world.69 Again, sanitarians looked to the federal government for a solution. In 1884, Playter and a number of other prominent physicians from across Canada met in the Railway Committee Room of the House of Commons to formulate strategy to lobby for a federal Department of Sanitation. The committee included physician-members of the Senate and the House as well as fifteen doctors. Playter acted as secretary, with Dr Darby Bergin, the MP for Cornwall and Stormont, sitting as chair. The committee aimed to establish an arm of government dedicated to public health education and governance, to be administered almost wholly by medical professionals. They envisioned a sanitary bureau created under the aegis of the Department of Agriculture, with the Minister of Agriculture taking on the joint title of Minister of Public Health. The new Sanitary Bureau

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would be headed by a physician with the rank and title of Deputy Minister, who would be in charge of a system of physician-sanitary officers spread out across the Dominion. These officers would report monthly on disease activity; and in the event of an epidemic, they were to ‘make investigation into the source, origin, or cause of such an outbreak.’ The Chief Sanitary Officer and the minister would be advised by a Sanitary Committee made up of physicians from each province, who would meet several times a year to advise the government on policy and on ‘matters relating to the public health of the Dominion as they shall think most desirable.’ This proposed Sanitary Bureau would provide the infrastructure necessary to tackle the problems of illness across the Dominion by bridging the gap between the local and the national. The sanitary officers spread out across the country would be the eyes and ears of the state.70 Although the Macdonald government initially expressed support for the idea, legislative jurisdiction was unclear.71 A literal reading of the British North America Act suggested that sanitation (as opposed to public health) fell under the jurisdiction of the provinces, which were responsible for ‘property and civil rights’ and matters of a purely local nature.72 Members like Dr George Landerkin, a physician and Liberal MP for Grey South, thought that ‘if we have not authority to deal with this question then [we] should seek that authority [as] any measure tending to lengthen human life and prevent human suffering is one which will command itself to right-thinking men in the House [even] though it appeared at the time of Confederation that these questions were relegated to the Local Legislature.’73 According to Landerkin, how one interpreted the law depended on how one defined public health.74 In the face of jurisdictional uncertainty, the committee’s demands made little headway. Recent and unpleasant memories of the debate over provincial rights and prohibition likely gave the government pause.75 In response to the lobbying of temperance advocates and physicians, between 1869 and 1873 Ontario passed legislation that allowed municipalities to limit the number of tavern licences issued within their boundaries, a law that would be enforced by provincial inspectors.76 But in 1879, Alexander Mackenzie’s Liberal government passed the Canada Temperance Act, which allowed counties across the Dominion to ‘go dry’ following a referendum. When John A. Macdonald returned to power later that year, however, he tried to extend the Dominion’s powers by enacting legislation that required tavern owners to secure a Dominion liquor licence. The issue eventually went before the Judicial Committee of the Privy Council, which decided in favour of the provinces.77

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While sanitarians lobbied for a government agency to pursue their reforms, in 1886 the first comprehensive mortality statistics were published by the Department of Agriculture. These suggested that the neglect of public health in Canada carried a significant cost. According to Playter, contagious or epidemic diseases accounted for 35 per cent of deaths, constitutional diseases 13 per cent, ‘local’ diseases 30 per cent, and ‘developmental’ diseases 22 per cent. A Canadian had a three times greater chance of dying from an epidemic disease in any one of the Dominion’s twenty-three largest cities than in the twenty-eight largest cities in Great Britain. To drive the matter home, there were three times more deaths from contagious diseases in Montreal as compared to London, England. Even the healthiest Canadian city had double the death rate of the British capital. Mortality rates also varied widely among Canada’s urban centres. In Montreal, the mortality rate was reported as 50 per 1,000, whereas in Toronto it was only 25 per 1,000. The lowest mortality rate for Canada’s largest twenty-three cities was reported by Guelph, Ontario (11 per 1,000), but size did not seem to offer specific protection from disease: towns like St-Hyacinthe, Quebec, with a population of 6,000, reported death rates as high as Montreal; whereas Fredericton (also with a population of 6,000) reported a number identical to Toronto.78 For Playter, one of the movement’s leading voices, the most shocking and important conclusion from these statistics was that most of these deaths were preventable, but only if the federal government and public agreed to act: The first and greatest want in relation to preventing sickness and premature death is, I contend, a head, ONE centre, a Federal Government organization to look after the health interests of the whole Dominion, similar to such organizations in other countries. The old saying that what is everybody’s business is nobody’s business will apply here. The chief object of Government is to protect life and property. It is surely as much the province of the Federal Government to protect the people from disease and death as from robbery and murder, to protect them from the inroads of an epidemic as from the invasion of an army of men from a foreign foe.79

Armed with hard statistics, Playter’s committee thus reconvened on 26 March 1886 for a discussion with Tupper and the prime minister. Their proposals remained largely unchanged, but they hoped that the political climate would be more hospitable. ‘Now that the Canadian Pacific

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Railway is completed,’ wondered Playter, ‘what better can engage some attention on the part of the Government than the health of the people?’80 Their bureau of sanitation would cost but $18,000 to $20,000 per year, he promised, and would prolong the life of all Canadians. Macdonald again graciously accepted the proposals and assured the committee – which had now grown to thirty members – that the government would consider the question at the earliest opportunity.81 Again the government refused to form a national sanitary bureau. In large part, this was because ideas about the nature of disease were beginning to change, shifting the emphasis away from sanitation towards the control of diseased bodies. Buried in Playter’s statistics was the excessive mortality caused by a disease that had little to do with sanitation. In 1885, a smallpox epidemic devastated Montreal. Smallpox, which could be prevented by vaccination, came in two forms. Endemic cases were caused by the virus Variola minor, which killed relatively few people and accounted for most instances of smallpox in Canada. On rare occasions, however, an outbreak of Variola major, which was far more severe and often proved fatal, could find virgin soil in unvaccinated populations. This is what happened in 1885 when the more severe form of smallpox was introduced to the city from a Chicago passenger train.82 Out of a total population of 167,501, almost 3,250 people died – about 2 per cent of the population.83 This was a remarkable death toll for a disease for which there was an effective vaccine. But in Montreal and across the Western world, people were reluctant to be poked with an ivory lancet and dosed with a murky serum that medical professionals claimed would usually (but not always) prevent the disease. Their fears were not unfounded. If the lancet were unclean, the physician’s hands dirty, or the vaccine contaminated – what vaccination advocates acknowledged were ‘the accidents that too often occur’ – secondary infections ranging from minor rashes to incurable syphilis could result.84 At the same time, doctors in Montreal were often English elites – a circumstance that led a majority of the working class, and especially French Canadians, to refuse vaccination for themselves and their children, because of a language barrier or a lack of trust.85 Even fifteen years after the epidemic, a study conducted in the Montreal Civic Hospital showed that of the 503 patients admitted there during 1901–2, 446 (89 per cent) had never been vaccinated.86 The failure of public vaccination programs indicated not only the limited penetration of scientific conceptions of preventative medicine, but also a lack of confidence in the medical profession as a whole.87 In the eyes of the committee appointed to look into the

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outbreak, human errors – specifically those of Dr William Hingston, a prominent local public health advocate, in assigning the case to a public hospital – were to blame: ‘the greatest mistake was to allow an outside case of smallpox to enter our city and one of our largest charitable institutions … [If this had not happened,] a great public misfortune would probably have been avoided.’88 Although the link between immigrants and disease was old, tracing the epidemic to a specific individual carrier was new. This epidemiological exercise drew on the relatively new idea that it was bodies and people, who spread disease through living germs, rather than environmental and miasmatic influences, that produced sickness. The advent of the germ theory of disease began to reshape public health ideologies. Beginning in the late 1860s, experiments by Louis Pasteur, John Tyndall, and Robert Koch cast doubt on the premise that smells caused disease.89 Their collective work on the emerging germ theory recognized the connection between filth and illness but also emphasized that sickness was caused by microscopic, living organisms – unseen and odourless – rather than by processes of decay and fermentation.90 Germ theory taught that microbes could be acquired directly from the environment and transmitted between people – which explained why Toronto’s citizens continued to get sick each year from their drinking water even though it looked clean.91 The same theory connected the old theories of miasma and contagion by proving the existence of a missing link.92 In the 1880s, sanitary science began to shift its emphasis from environmental hazards to people and, as Michael Worboys argues, in the process was redefined by the notion that ‘every infection had its origins in a prior human case.’93 A consequence of the germ theory was that shaking hands, kissing, shared drinking cups, using public toilets, and spitting in the street all came to be regarded as problematic, hazardous activities that transmitted germs.94 Behaviours that were previously private became the subject of public scrutiny and regulation. Prohibitionist groups used such thinking to argue that excessive alcohol consumption not only led to poverty but also fertilized the ‘soil’ in which contagious diseases thrived.95 Taking in boarders – which led to overcrowding – was construed as a source of sexual deviance and venereal disease and as encouraging the spread of tuberculosis.96 Because the new ‘gospel of germs’ made poor housekeeping and cooking potential sources of illness, it fell to women to maintain the family’s health and to protect society from disease.97 Cultural Victorian attitudes towards cleanliness and morality were in this way translated into a hygienic code that

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linked transgressions – real and imagined – to physical sickness. This constructed the body and its by-products as the sources of disease, rather than the environment.98 In this case, the influence of American physicians and public health advocates was decisive. There, doctors like Charles Chapin and Walter Reed increasingly began to emphasize the role of physical contact in spreading disease, localizing illness in specific people and groups rather than in unclean places and social interactions.99 As investigative methods and technology grew more sophisticated, it also became clear that benign dirt and dust did not harbour germs and, in fact, that microbes were easily killed with the proper use of temperature or chemicals. As the organisms that caused typhoid, cholera, anthrax, rabies, diphtheria, smallpox, and syphilis were identified, as bacteriological tests were perfected, and as vaccines or drug therapies were developed, it became possible to diagnose, prevent, and treat many illnesses. If germs spread disease, then the most effective preventions must be those that broke the cycle of transmission through case finding and isolation.100 Yet epidemiology could not escape prevailing prejudices. The case of ‘Typhoid Mary’ Mallon provides a good example of the new public health in action. A healthy carrier of typhoid, Mallon worked as a cook in New York City, where public health inspectors used a combination of epidemiological analysis and bacteriology to trace twenty-six cases of typhoid to the unknowing cook in 1907.101 Mallon, dubbed ‘Typhoid Mary’ by the newspapers, was thereafter labelled a threat to the public’s safety, her body a source of disease to be quarantined and isolated. While she was undoubtedly a typhoid carrier, it was the fact that Mallon was an Irish-born, working-class woman who failed to live up to gender and class expectations that made her a target of such unusual measures.102 The identification of germs with foreign bodies had the effect of legitimizing traditional fears of immigrants and the ‘other’ by providing a scientific rationale for racist and nativist views. The fact that permanent public health governance structures were developing in Canada just as germ theory was being accepted by medical professionals had a profound effect on the specific strategies and responsibilities acquired by the state. Unlike the sanitarian impulse, which tended to cast blame for disease on endemic sources of infection, the new public health supported a contaminationist view that outsiders were the primary sources of contagion. Since 1832, it had been common to assume that the Dominion was an inherently healthy place and that serious sources of contagion came from beyond its borders. The federal

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quarantine system had always been predicated on the notion that immigrants were the main vectors for cholera, typhoid, smallpox, and plague; it was they who introduced contagion into an otherwise healthy population. Race, ethnicity, and class, which socially and culturally marked immigrants as the ‘other,’ doubled as indicators of disease, and vice versa. In British Columbia, for example, Chinese immigrants were viewed with fear and disdain by the local population, which regarded them as morally and physically subversive. As Kay J. Anderson notes, the identification of the Chinese as the ‘other’ in British Columbia ‘assimilated an ancient and medieval baggage of distinctions between “West” and “East,” civilized and barbarian, master and slave, Christian and heathen, white and non-white into a doctrine of discrete and immutable types.’103 This binary typology was reinforced by a public health discourse that labelled racial groups as clean or unclean, healthy or sick, disease-free or disease carriers. ‘The fact is, there is a class of immigrants coming to British Columbia, such as Chinamen, a class who are likely to disseminate diseases,’ Dr J.W. Milne, the Medical Officer of Health for the City of Vancouver, told the 1892 meeting of the Canadian Medical Association. ‘They will eat rice and you cannot keep them clean … I think that, as far as we are concerned in the far West, we could well do without the Chinese immigrants.’104 Race thus provided a means of identifying the unseen microbes that caused illness; it also provided both a target for public fear and an outlet for the persecution of foreigners.105 In British Columbia, this fear of the ‘other’ was translated into public health legislation that singled out Chinese immigrants as sources of infection 106 – a medico-racial discourse that also lent legitimacy to federal anti-Chinese immigration laws.107 This reflected the deep-seated racial tensions in British Columbia; it also carried weight with medical professionals across the Dominion.108 When smallpox broke out in northwestern Ontario in 1893, for example, Ontario’s Medical Officer of Health reported that, without a shadow of a doubt, the disease could be traced to immigrants destined for the Canadian West. ‘The immigrants had been infected in Europe,’ he told the province’s Board of Health, and the disease had been allowed to spread because ‘the ship surgeons neglect[ed] to vaccinate steerage passengers.’109 The board voted that any expenses incurred by municipalities in treating cases of smallpox linked to immigrants should be billed to the federal government.110 In Montreal, a 1905 epidemic of favus was linked to ‘a large influx of Russian Jews, some ten thousand or more’; and the Montreal Medical Journal warned that ‘unless some measures are taken by the [Dominion]

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Government to prevent its admission, we shall soon have an alarming increase in what is rightly looked upon as a loathsome disease.’111 In a similar vein, the Secretary of the British Columbia Board of Health, Dr Duncan, argued that whether Chinese immigrants appeared healthy or not, they should be vaccinated ‘before leaving the ports of [their] country,’ and that any ‘diseased celestials’ should be barred through a joint quarantine enstated by Canada and the United States.112 Here languages of class, ethnicity, and race intersect with those of medicine to provide a scientific critique of immigration policy. ‘Loathsome’ diseases are associated with ‘loathsome’ categories of people. Dr John McCrae summed up the view of physicians at the Royal Victoria Hospital in Montreal when he said that the ‘immigrant is at the very least thrice as liable as the native’ to the effects of disease.113 This discourse was as much environmental as social. Politicians and civic boosters spoke of the Canadian climate as ‘healthful’ and ‘invigorating’ and of the Canadian people as an ‘athletic’ and ‘robust’ race. ‘The climate [that Canadians] live in is, for the most part, cold and rugged in winter and not too extremely hot in summer,’ wrote F. Clement Brown in The Canadian Magazine. ‘It is eminently favourable to the building up and maintenance of robust physical constitutions. The Canadians, as a race, are large men and women, with good health and athletic forms. Their powers of endurance are certainly not excelled by any other civilized race.’114 Others saw the physical environment as restorative and spoke of the Dominion as a place where the consumptive and the neurasthenic could regain their health through clean air, pure water, and sunshine. ‘The climate, if rigorous in winter, is most healthful and enjoyable,’ wrote Peter H. Bryce, the first head of Ontario’s Board of Health and the Chief Inspector of Immigrants for the federal government, in an 1897 book titled Health Resorts and Climates of Canada: Many are those who, delicate and consumptive, have sought health and not in vain in the rough life of the lumber woods, with plain shanty fare where bacon, bread, and beans have been the staples. The snow under foot is dry, and the air crisp and ozonized in the highest degree … The snow gone, summer is almost immediately present in these regions; and such summers! The ice cold streams from hundreds of lakes buried in the forest recesses form highways in every direction for the tourist, sight-seer, or sportsman, who, traversing river and lake and portage, lies down at night by the camp fire marvelling that he is only tired, never exhausted. Muscles, appetite, eye, ear, indeed his whole physical nature, are aroused, and in an atmosphere never sultry and always bracing he inhales an air as intoxicating as wine.115

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The association between immigration and disease was strengthened by fears that a rapid influx of immigrants was weakening an inherently healthy Canadian nation. In the late nineteenth century, concerns about declining birth rates, ever-increasing infant mortality, and the effects of poverty on the lives of the working class were leading to profound anxiety about the long-term health of the nation.116 At the same time, the eugenicist ideas of Francis Galton cast such ‘evils’ as evidence of a broader pattern of social degeneration – the supposed tendency of uncontrolled populations to weaken physically and mentally over time.117 Here fears of immigration mixed with anxieties about the effect of urban environments on the morals of the working class to suggest that overcrowding and lack of familial oversight were allowing the ‘unfit’ to breed at an alarming rate.118 Soon, reformers feared, the nation would be awash in degenerate immigrants who would spread disease across the country.119 The contaminationist argument provided a guilt-free means of expressing latent fears and anxieties about a rapidly changing world. When cholera threatened in 1888, the Toronto Mail, the Quebec Canadien, and the Quebec Chronicle, among other papers, feared that railways and steamships would allow the disease to spread with unprecedented rapidity.120 Moreover, they wondered aloud whether technological improvements had outpaced developments in preventative medicine and quarantine. An editorial in the Toronto Mail read: In these days of ‘ocean greyhounds’ and short passages, it may very easily happen that a person exposed in some Liverpool lodging house or on shipboard to smallpox, will have reached Manitoba or the Western States before the disease, with its incubative period of two weeks, will have appeared. We trust that, in the interests of national safety [if defects exist in the quarantine system], they will be remedied, and every possible precaution taken to protect the cities and towns inland, along the lines of immigrant travel, as well as the Atlantic and St. Lawrence ports, from the introduction of epidemic disease, destructive of life and business alike.121

In Parliament, Macdonald extolled the virtues of the nation’s quarantine service, arguing that it had always preserved the nation’s health and would continue to do so. Canada’s ‘immunity from disease has resulted from the watchful manner in which [quarantine] has been carried out,’ he told the house, ‘and [this] shows that the system has worked well.’122 In 1892, Asiatic cholera forced a showdown between sanitarians and contaminationists. Cholera erupted first in Russia and then spread to the rest of Europe, reaching the immigrant port of Hamburg before appear-

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ing in American and British harbours later that summer.123 On 1 August, the Toronto Globe predicted that cholera would arrive in North America the following spring; for the rest of the year, similar stories ran in papers throughout the Dominion, causing widespread panic.124 As in 1866, a conference of senior politicians and public health officials was called, held on 21 September 1892, to advise the Minister of Agriculture, John Carling, who was in charge of quarantine and matters of public health, regarding the best course of preventative action. Peter Bryce, Ontario’s Chief Medical Officer, spoke first: The question … arises, what can we as medical men, viewing the situation broadly, recommend to all the health authorities with regard to next year? Our opinion is that of many gentlemen in the United States, that excepting, probably, immigration from Norway and Sweden and the British Isles, we shall urge that for this year at any rate, that is, next year – there shall be a complete embargo put upon that kind of immigration which comes to this country, especially through the port of Hamburg. You all know what it is, I need not describe it … The only fight we can make of a really effective character is the external fight.

Bryce envisioned a modern quarantine aimed at destroying germs through new technologies such as steam disinfectors, chemical baths, and laboratory testing. Most important, the sick would have to be systematically isolated along with their belongings and the ships that had carried them. In contrast, Dr Edward Playter argued that quarantine would inevitably fail to contain the disease and that domestic and civil sanitary measures would have to be taken in Canadian cities to prevent the disease from spreading inland: We know that there are yet other factors in the causation of all diseases of an infectious nature … There [are] necessarily two factors in the causation of [disease], one the bacillus and the other the soil on which it grows. It is most desirable that everything should be done through quarantine to prevent the infection reaching this continent, but I think attention should be directed to the other essential more than it has been. Not that we should neglect the first, but the infection will escape the best quarantine and the best disinfection … I think practitioners might do a good deal in the way of suggesting means to prevent the development of the disease from infection and if the infection should reach Canada, as it probably

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will next year, that by keeping the digestive organs in an acid condition and the system in a clean state, there will be no epidemic of cholera even if we do have a number of outbreaks if there is no soil in which the disease can spread.125

In Playter’s view, it was impossible to stop germs from entering the country, so measures had to be taken to deal with the underlying social factors that would allow the disease to thrive. He thus argued that it was up to the government to ensure that Canadians were well fed and their bodies cleansed. It was, in his analysis, poverty, overcrowding, poor hygiene, and immoral behaviours – the ills of urbanization and industrialization – that would enable cholera to flourish. Prevention entailed removing those evils.126 Playter, who had been the leader of the public health movement a decade earlier, now found himself out of step with the other doctors at the conference. ‘I don’t think that, with all the good-will that the Honourable Mr. Carling has, he will undertake to keep the digestive organs of the people of Canada in good order,’ F.W. Campbell mockingly retorted, referring to Playter’s insistence that prevention efforts be focused at the level of individual Canadians. ‘That is a matter which comes under the cognizance of the Provincial authorities.’ Most of those attending expressed their support for Bryce’s modern quarantine methods, which would target the germs themselves and the people who were thought to carry them. In the end, Carling too agreed with the contaminationist view and promised to furnish the most advanced disinfecting technologies, which had already been requested by the Dominion’s chief quarantine officer, Dr Frederick Montizambert. He was confident that with these technologies and the application of scientific knowledge, cholera could be stopped with a minimum of economic or social disruption or federal intervention. ‘I believe the largest vessel that comes up the St. Lawrence can be disinfected inside of 12 to 14 hours with these [modern] appliances,’ he said, pausing while the room erupted in spontaneous applause. ‘No stone will be left unturned to make every quarantine station in Canada as complete as it is in any other country in the world, not excepting the United States.’127 Under the regulations passed in 1892, every vessel arriving in Canada from a port declared to be infected with cholera was to be inspected by a quarantine officer before it made landfall. It was up to the officer to declare a ship free of illness, and each of its passengers was required either to provide proof of vaccination for smallpox or to be inoculated

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before entering the country. If leprosy was discovered – especially on the west coast – the passenger was to be returned at his or her own expense to the port of origin. Lunatics, idiots, the deaf, the mute, the blind, and the ‘infirm’ were not allowed entry unless accompanied by a relative or guardian.128 If contagious illnesses were found, all cargo and luggage was to be disinfected using one of the new disinfecting machines that had been installed at Grosse Île in preparation for the possible arrival of cholera. The disinfecting machine was a twelve-foot tube, four feet in diameter. Baggage was inserted into one end; then, under immense pressure, the tube was pumped full of steam heated to 212 degrees Fahrenheit for thirty minutes. Articles that would be destroyed by steam were instead wiped down with a solution of mercuric chloride. The holds of infected ships were cleansed with the same solution or, again, blasted with steam. Steerage passengers – unlike their counterparts in cabin accommodations – were forced to strip naked and their clothes put into the disinfector while their bodies were subjected to needle baths with an ‘antiseptic solution of chloride of mercury.’ The new public health targeted the microbes that caused disease.129 As in 1866, an effective quarantine seemed to work: between 1892 and 1894, no cases of cholera breached Canada’s prophylactic defences. A triumphant Montizambert felt that the old word was insufficient to describe the modern methods he had used to block cholera’s advance. ‘[Quarantine] was founded on an idea which science has outgrown, and its retention causes modern methods to inherit undeservedly the objections rightly urged against the old,’ he told the Montreal meeting of the American Public Health Association in 1894. ‘The keynote of the old system was prolonged detention; that of the modern system is prompt disinfection.’130 This vision of public health maximized the importance of applying the new science of bacteriology so as to eliminate germs before they breached the nation’s walls. With the apparent success of quarantine, there was little need to change the central government’s approach. Quarantine, coupled with limited sanitary interventions directed at specific cases rather than general reforms, offered a uniquely Canadian solution to the problem of disease prevention, as Montizambert explained at the public medicine session of the 1897 conference of the British Medical Association. There, he contrasted the English and Canadian systems and pointed out that in England, owing to the number of ports, the comparative smallness of the area, the most perfect system of sanitation in the homes, the compulso-

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ry vaccination, and the vast amount of shipping which touched upon the shores of Great Britain, the Canadian system would be found undesirable and impracticable. England was so thoroughly organized inland that she could afford to relax a little at the port of entry, while in Canada it was necessary to carry out strict quarantine regulations for if a case were allowed to proceed inland, the person might travel a week, spreading contagion before detection. The best triumphs of sanitation were negative. The chief thing in a country like Canada, a country of distances, was prevention.131

To summarize, quarantine was the most effective means of protecting a country such as Canada from outside diseases. In the autumn of 1899, the government of Wilfrid Laurier moved to formally reject the comprehensive sanitary arguments that Playter had been making since the mid-1880s and to endorse Montizambert’s ‘scientific’ quarantine. It did so by naming him the first Director-General of Public Health and Sanitary Advisor to the Dominion Government.132 This move, which expanded the government’s targeting of immigrants as sources of disease, reflected popular and official fears about Canada’s changing demographics. Between 1896 and 1914, around one million immigrants, many from non-English-speaking countries, were enticed to the Dominion by the Immigration Branch under Clifford Sifton and Frank Oliver.133 Immigration officials hoped these newcomers would become farmers in the West; many, instead, moved to growing Canadian cities like Winnipeg.134 In the popular imagination, immigrants were willing to work for less money than native-born Canadians; as a consequence, they were greeted with suspicion and resentment by the working class.135 At the same time, differences in language, dress, and customs intertwined with middle-class fears about morality and race degeneration to engender widespread and cross-class resentment towards people whom Canadians feared were ‘nothing more than “professional vagrants” whose habits and attitudes were “repugnant” to Canadian ideals.’136 As Donald Avery writes, because a vocal and politicized segment of the Canadian public believed that immigrants were ‘people who tended to lower the Canadian standard of living,’ the Immigration Branch was eventually forced to meet the demands of those who advocated a more selective immigration policy.137 In 1902, formal medical inspection of immigrants was adopted in Canada at the insistence of the new head of the Medical Branch of the Canadian immigration office, Dr Peter H. Bryce. Bryce had been

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a long-time advocate of public health in Ontario and had served as the province’s first Medical Officer of Health. His move to the federal immigration service (where he also headed the Department of Indian Affairs Medical Branch) reflected a shift in emphasis within the public health movement from local to national preventative strategies. Medical inspection consisted of a visual and sometimes laboratory examination of immigrants as they arrived at Canada’s maritime ports in order to screen for quarantinable and constitutional diseases. According to Allan Sears, ‘Medical inspection used a broad conception of health, derived from the theory and practice of public health, as the criterion to assess the overall desirability of immigrants. Health was defined as overall physical, mental and moral well-being in the interest of usefulness to the nation.’138 Bryce acknowledged the ambiguity of the process and the power it gave physicians. When asked how doctors decided to admit or reject ambiguous cases, he said: ‘It just depends on the opinion of the medical officer. The idea is, is that man going to be of use to Canada?’139 Medical inspection was thus a racialized process that targeted ‘non-European diseases’ as well as groups who could be quickly, easily, and visually identified as the ‘other.’140 Immigrant inspection medicalized racial and nativist biases by deploying scientific language and definitions of health to support a process aimed at excluding unwanted groups. Germ theory became the rationale for this; in Barbara Roberts’s words, immigrant inspectors ‘considered [themselves] responsible for the protection of the public purse, the public health, and the public morals.’141 The scientific language of preventative medicine thus played an important role in legitimizing nativist sentiments. Racial, ethnic, and gendered assumptions were used to identify ‘threats’ at the border and to create a medical language of exclusion. The introduction of medical inspection promised to protect the nation’s health by excluding sources of human ‘pollution.’ The resultant strengthening of the Dominion’s quarantine practices142 was applauded by public health advocates of all types. But in the popular imagination, immigrant inspection was designed to do more than exclude dangerous germs and bodies; it was also meant as a panacea that would solve a host of moral and social ills, as well as public health nuisances. As Allan Sears writes, ‘Canadian public health officials often blamed the immigrants themselves for the dismal conditions in which they were forced to live. Slums, pauperism, physical and mental disorders – these were all lumped together as “old” world problems brought to Canada by immigrants.’143 Slums were thus imported, as were diseases, and such perceptions linked the moral problems of the city to

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immigration. Regulation was the logical solution. To provide a further screening mechanism, Ottawa introduced new standards of admission in 1908 and 1910 that required most immigrants to pass a means test. From now on they would be required to have between $25 and $200 on arrival, depending on their place of origin.144 Despite the triumph of the contaminationist view, the medical profession continued to press for a federal Department of Health. Montizambert was Director-General of Public Health, but he only had direct control of quarantine, which left authority for the other areas of federal governance – including immigration – divided among several departments. This sometimes made it difficult for the Director-General to carry out his task of ‘guarding the approaches.’ When the Secretary of the British Columbia Provincial Board of Health wrote to Montizambert in 1900, asking him to intervene because the post office was refusing to fumigate Chinese mail from San Francisco during an epidemic of plague, he found that he lacked the authority necessary to compel officials of the other federal department to follow his quarantine procedures.145 In the House of Commons, concerns were often raised about whether immigrant inspection was actually serving its assigned purpose. However, responsibility for immigrants who were not suffering from one of the graver quarantinable diseases, such as smallpox, typhoid, cholera, or plague, fell to the Department of the Interior, not to Montizambert.146 Members of the house were startled to learn that sick immigrants were often allowed to enter Canada because quarantine officers lacked the authority to detain them unless they had one of the more serious conditions.147 In 1902, a committee of the Canadian Medical Association met with Laurier to press him to form a federal Department of Health. The committee explained: The main idea [of the meeting was] to show that the present system of having the various subjects scattered through several departments with consequent multiple divisions of authority was not calculated to impress the public with the great importance of the administration of this branch of the public service. It was pointed out that the skeleton of this plan is already well laid and a Director-General of Public Health holds an appointment to-day, an earnest hardworking able official at present issuing his orders in regards to quarantine from the Department of Agriculture, which is an anomaly per se and lessens the authority in a measure, and yet he has nothing to say as regards sick seamen, sick Indians, adulteration of food, vital statistics, and has no laboratory under his control.148

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After repeated meetings, the Laurier government’s only concession was to create a Commission of Conservation in 1909. That commission, headed by Clifford Sifton, who had served as Laurier’s Minister of the Interior until 1905, was tasked with studying and proposing means of protecting and managing Canada’s natural resources.149 It was essentially a government-run think tank, operating at arm’s length from Parliament and comprised mainly of academics from across the country. The commission’s mandate was to establish a means of safeguarding Canada’s natural resources, which included air, water, minerals, timber, and the public’s health. The commission’s main contribution was to public discourse through the publication of dozens of studies on subjects ranging from altitudes in Canada to Great Lakes water pollution.150 Although the commission suggested forming a Department of Public Health in 1910, its recommendation that the powers of the Dominion government be consolidated under one minister were not followed up on after Laurier’s government was defeated in 1911.151 In 1916, Prime Minister Sir Robert Borden’s acting Minister of Agriculture, J.D. Hazen, most clearly explained the government’s objections to reimagining the federal role in public health: I think it may be fairly said, speaking from a constitutional standpoint, that while there are certain matters in public health, such as quarantines, sick mariners, etc. that come exclusively within the jurisdiction of the Federal Parliament, there are many other matters connected with public health over which the Federal Parliament and the provincial parliaments exercise a joint control … There is no constitutional objection to the establishment of a department of public health, but the question will arise, if such a department should be established, with what subjects connected with public health that department should deal, so that it will not intrench [sic] upon what, by practice, has fallen under the jurisdiction of the different provinces, and before any such health department is established, it would be most desirable to consult the different provincial governments so that no action may be taken that would be regarded as trespassing upon the jurisdiction of the provinces, and upon the work which they feel it is their duty to undertake.152

According to Hazen, the Borden government was as disinclined as its predecessors to tread on provincial jurisdiction and was content to restrict its role to screening immigrants at the border and guarding the approaches.

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The triumph of the contaminationist view had led to the consolidation of existing ideologies and strategies of governance under the federal umbrella. By the outbreak of the Great War in August 1914, the Dominion government was responsible for thirty-two different areas of public health governance administered under fifteen different departments.153 Ottawa was in charge of the sanitary inspection of ships, leprosy in the Dominion, detention hospitals, health in prisons, the health of Aboriginal people, supervision of public health in the Yukon, infectious diseases spread by money or mail, public health in regard to ‘public works, railways, canals, etc,’154 and ‘investigation into general questions of Public Health.’155 It was also charged with overseeing the health of Canadian soldiers, sanitation in military camps, and military hospitals. Yet its greatest role remained manning an effective maritime quarantine and protecting public health by screening immigrants for disease. The apparent success of this quarantine between 1866 and 1914 emphasized the need for continuity rather than change – even minimizing the importance of consolidating the Dominion’s existing responsibilities into a single department.

4 A Pandemic Prelude: The 1889–91 Influenza Pandemic in Canada

In January 1890, a deadly pandemic of influenza raged around the world. It puzzled medical professionals and frightened governments from St Petersburg to London. It was an almost mystical disease that defied scientific explanation. Wrote the editors of Canada Health Journal: Epidemic influenza is the most contagious disease known. There are authentic cases where crews of ships have caught it from merely sailing past an infected coast, even at a distance of miles … [It is] a disease which causes medical men as well as laymen to exclaim: ‘Ye Gods, it doth amaze me’ … Medical science must bestir itself. The welfare of humanity, and our professional pride demands every possible activity, in searching for its cause, prevention, and cure.1

For medical professionals, influenza proved especially sinister because it called the emerging germ theory into question. Why did a normally mild disease suddenly become so severe? How did it travel so rapidly? Why did some die and others only suffer mild illness? Newspapers alleged that ‘physicians and scientific experts are alike at fault and powerless in the face of the varying symptoms and terrifying progress made by the epidemic. While the doctors are debating and charlatans are making fortunes by trading on the timidity and ignorance of the panic-stricken masses, the disease continues its course practically unchecked and with increasing virulence.’2 The Canada Health Journal cautioned its audience that ‘medical men cannot pass lightly by the taunts that have been flung at us by the lay press so frequently of late.’3 History, they warned, would repeat itself.4 Today we know there are three distinct influenza viruses in the family

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Orthomyxoviridae, designated A, B, and C. The majority of human infections are the result of the influenzavirus A, although B and C can also cause sickness. The virus is tiny, only about 100 nanometres in diameter, and roughly spherical. Its core contains a single strand of viral RNA protected by an envelope made up of two large glycoproteins, hemagglutinin (H) and neuraminidase (N), as well as several smaller proteins. These proteins allow the virus to attack healthy cells in the lungs, nose, or throat. When the virus targets a cell, the hemagglutinin protein binds to the cell’s outer wall, allowing the viral RNA to penetrate the cellular membrane and make its way into the nucleus. Once inside, the infected cell is forced to make copies of the virus. The process eventually kills the cell, but not before the neuraminidase glycoprotein allows new viruses to escape so as to go in search of more victims.5 The host, however, is not helpless. The mammalian immune system usually uses the specific, spiky characteristics of the hemagglutinin and neuraminidase proteins to identify the virus and to dispatch antibodies to defend against its attack. The hemagglutinin and neuraminidase glycoproteins are thus antigens, meaning that they can be used by the immune system to identify the virus and to render it harmless with the right antibodies. The relationship between an antigen and an antibody can be thought of as similar to that between a lock and key: only the right antibody key will fit a specific antigenic lock. Once the lock is turned, the virus is neutralized. As long as the immune system recognizes the type of lock and dispatches the proper key, the invading virus will be thwarted before it does significant damage to the host.6 In healthy individuals, the immune system is usually able to quickly recognize the invader and dispatch the right antibodies before the individual is put at serious risk. This is why influenza is commonly a mild disease. But flu viruses are constantly changing and evolving through a process called antigenetic drift. When an infected cell is forced to produce copies of the attacking virus, mistakes are sometimes made in the RNA of the new viruses so as to change the antigenetic characteristics of the hemagglutinin and neuraminidase glycoproteins. As these mutated viruses infect new cells and replicate themselves, the mutations are passed on. If a specific mutation makes it more difficult for the immune system to identify the virus, it will have more success at reproducing than other influenza viruses. This evolution by natural selection means that more efficient viruses will out-compete their less well-adapted competitors. As new, more virulent strains of influenza emerge, they quickly

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become the dominant pathogens in circulation, that is, until they too are surpassed by more efficient viruses.7 These antigenic variations can be used to identify the many different strains of influenza that circulate in animal and human populations. Specific strains of influenzavirus A, for example, are grouped by how antibodies respond to the virus’s hemagglutinin and neuraminidase proteins – in other words, by the type of lock, or antigenic subtype. Sixteen hemaggluttin and nine neuraminidase subtypes have been identified, and each has been assigned a number. The numbered antigenic subtypes are used to label each strain of flu. Thus, an influenzavirus A exhibiting hemagglutinin (H) subtype 1 and neuraminidase (N) subtype 1 is referred to as H1N1 influenza.8 Seasonal outbreaks and local epidemics of influenza result from the ebb and flow of the viral evolutionary process as old strains are out-competed and disappear and new strains emerge. As people get sick with the seasonal flu, the body learns to recognize the specific antigenic characteristics of the new strain. This is why a healthy person who catches the flu retains immunity to future infections from the same strain of virus. The same principle underlies seasonal flu vaccinations. Each spring, doctors examine the most common strains of influenza then in circulation and formulate a vaccine that will confer immunity to the most common strains of influenza in the autumn. Because the virus is constantly evolving, a new shot is needed each year, which is formulated to provide immunity to the most current flu strains.9 The immune system is usually able to quickly fend off the flu virus because most are not innately adapted to be human pathogens. The natural reservoir or home for the influenzvirus A, for example, is wild birds. To infect humans, the virus must first cross the species barrier. Here the interactions of wild birds, domesticated livestock, and humans are critical. Because flu viruses are well adapted to attack the intestinal cells of birds, they have a more difficult time binding to the cells in the nose, throat, and lungs in mammals. But birds shed the flu virus in their feces, sometimes into ponds or rice paddies that humans or livestock also use as sources of drinking water. Where wild birds, domesticated animals, and people share sources of drinking water or come into sustained and intimate contact with one another, the likelihood increases that one variation of the virus will eventually succeed in crossing the species barrier to infect human beings with influenza.10 The emergence of a novel virus – whether it crosses the species barrier directly or evolves from the human form of influenza – is known as an

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antigenetic shift because the antigenic characteristics of the hemagglutinin and neuraminidase proteins change to such a degree that they are unrecognizable to the immune system. Scientists hypothesize that these shifts can occur through one of two processes: a viral shift or reassortment. The first, viral shift, takes place when the seasonal drift described above results in a random change to the viral RNA that alters the virus’s proteins in a significant way. The second, reassortment, can occur when a single host cell is simultaneously infected by two different strains of influenza virus, which then recombine to create an offspring virus sharing some of the characteristics of both parents. In either case, when a novel influenza virus emerges, there is always the chance that it will cause a pandemic. Because the immune system is unable to recognize the antigenic characteristics of the new virus – essentially, it lacks a key to the virus’s lock – the novel virus is able to replicate itself more easily than common, endemic strains. It can thus spread freely within a population lacking any natural immunity.11 By definition, then, pandemic viruses are new viruses that are both virulent in humans and usually far more lethal than seasonal influenza because they are not as easily recognized and neutralized by the immune system. They are said to be pandemic rather than epidemic because they spread quickly around the globe instead of being confined to a specific geographic area. According to the Centers for Disease Control, pandemics are most likely to occur when a novel virus crosses the species barrier.12 This can happen when a human is infected with an animal (usually avian) influenza virus, which then begins to spread from one person to another; or it can happen through reassortment, when a human being is infected with both a human and an animal virus. Both events are relatively rare because animal viruses are usually not very well adapted to thrive in humans. As in the case of the h5n1 influenza virus – the Hong Kong bird flu that sparked global panic in 1997 – when avian flu is contracted directly by a human being it is usually because of sustained contact between people and birds.13 Although such cases are more often lethal than the seasonal flu, the virus is usually not as well adapted to humanto-human transmission. As a case in point, the h5n1 avian influenza virus killed nearly 60 per cent of those diagnosed with it, but it infected only about 500 people worldwide between 2003 and 2010.14 For a virus like h5n1 to pose a serious risk of causing a pandemic, it would have to become more efficient at transmitting itself from one person to another. But if a person infected with an ordinary seasonal strain of influenza were also to catch a novel avian strain like h5n1, those two viruses might

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recombine to create a new virus that shares the characteristics of both parents. It could thus be lethal and easily transmissible. In its surveillance of global influenza patterns, to gauge the likelihood of a pandemic, the World Health Organization looks for signs that a novel, animal influenza virus has carried out sustained human-to-human transmission.15 Since the late nineteenth century there have been five influenza pandemics: 1889–90, 1918, 1957, 1968, and 2009.16 Each pandemic has resulted in a higher mortality rate from flu than would normally be expected.17 Also, those who die from pandemic influenza are not the flu’s normal victims. Because pandemic influenza is typically more virulent than the seasonal flu, young people and those who are otherwise healthy are more likely to die than they would be in a ‘normal’ year.18 The severity of the pandemic, in terms of both morbidity and mortality, is determined by antigenic characteristics of the new virus. As the virus sweeps around the world, it often attacks in waves, sometimes circling the globe several times over a period of years before it out-competes other flu strains to become the dominant virus. Pandemics end when the human population gains immunity to the new strain.19 Pandemic influenza was certainly not unknown in 1889, but it was not well understood. Although influenza was regarded as a common disease in the late nineteenth century, medical professionals knew that every so often it had a tendency to turn deadly. Doctors associated pandemic influenza with other, more deadly diseases. ‘[Influenza] broke out in Paris in 1847 (where 5,000 people died of la grippe) and spread to Madrid, England, and Scotland,’ warned Dr J.L. Irwin in the Montreal Medical Journal in 1890, ‘and in six weeks 11,339 people died in [London] alone from influenza. It preceded “the black death” in the fourteenth century and the great plague in 1665; also the epidemic of cholera and typhoid fever … No part of the world was exempt from it.’20 In part this was because it was a mysterious disease that seemed to defy logical explanation. The editors of Maritime Medical News noted that in 1847 the flu had ‘in one month, skipped from Spain to Newfoundland, and from New Zealand to Valparaiso, Syria, Africa, and even to Hong Kong.’21 It did not move like cholera, smallpox, or the plague. In the winter and spring of 1889, influenza was reported to be epidemic in Asia – what epidemiologist Gerald Pyle calls a seeding or herald wave.22 There was then a lull during the summer before flu began to spread westwards through Russia.23 By November it had reached Ber-

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lin and by December, New York.24 It was the first modern pandemic to occur in the age of rapid rail travel, enabling the disease to move with an almost mystical speed.25 In Canada, it first broke out in Nova Scotia and New Brunswick in late October 1889, reaching Quebec by the third week of November and Ontario in early December, when it also appeared on Prince Edward Island.26 Influenza was reported in Winnipeg and on Vancouver Island just before Christmas, so it had taken about six weeks for the germs to cross the country.27 Flu was understood to have spread inland from the Atlantic ports, diffusing along the rivers and railways into the interior. By February, it had disappeared from most parts of the country.28 The symptoms of the 1889–90 flu were familiar. It began very rapidly, signalled by ‘chills, rigors, fever, marked depression, severe frontal headache, followed by the evidences of acute catarrh.’29 Notwithstanding its reputation as a ‘three-day fever,’ the Russian influenza – as it was known – lasted about a week, with a high fever of 104 degrees peaking on the fourth or fifth day.30 The tendency of the flu to travel great distances in short periods of time made it a peculiarly modern disease, one that attacked all classes and ‘occasioned widespread dread.’31 In the 1889–90 wave alone, 4 million Britons were sickened and 27,000 died.32 The numbers for Canada are unknown because accurate mortality and morbidity statistics were not kept for influenza. Those who did die in the pandemic tended to perish from complications, usually secondary infections like pneumonia.33 As Maritime Medical News concluded: ‘the old and debilitated run considerable risk, the young and healthy very little. Uncomplicated cases rarely result in death in the young and strong. Relapses are not infrequent [sic]. Pregnant women are apt to abort.’34 For most victims, the illness was severe but not deadly.35 In Calgary, for example, where the North-West Mounted Police ran a hospital for civilians and police officers, out of a total of 200 patients there were 59 admissions in 1890 for influenza-like symptoms, but no deaths.36 While as many as one-third of Canadians probably suffered from a mild form of influenza, Canada’s Aboriginal peoples were disproportionally affected. The Walpole Island First Nation was hit particularly hard. ‘Owing to the prevalence of influenza the Chippewas have not held their own during the year,’ reported the local Indian Agent. ‘Many of the old people and weakly ones, after having had the influenza, were taken with other diseases and died in a very short time.’37 In northern Ontario, ‘few escaped attacks of influenza or “la grippe” which caused

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several deaths, particularly amongst the old people and children.’38 The disease slowly worked its way west and later in the spring was reported in Muscowpetung Agency, where it killed those already suffering from other lung conditions such as tuberculosis and chronic bronchitis.39 The death rate on some reserves reached 115 per 1,000.40 As the 1889 flu killed mainly the old and infirm, it carried off many elders in communities that had already been devastated by starvation, disease, and conflicts with the government.41 There was little that physicians could offer in the way of treatment. The most common prescription was bed rest and a careful diet.42 Meals were ideally to be limited to milk and foods heavy in flour and starch.43 These were meant to afford the body every opportunity to repair itself. Undue stress was understood to be the most dangerous thing during the illness. ‘The seemingly mild attacks have often been the most obstinate,’ wrote one Canadian physician, ‘simply because they have been so generally neglected, and the citizens continued to go about their accustomed duties, thoughtlessly taking the risks of exposure to cold and damp. In such cases the trouble runs on for days.’44 Others, however, took a more heroic approach, prescribing a variety of medicines, including quinine and morphine, to fortify the body and relieve pain. Ipecac wine and laudanum were considered useful to induce vomiting and treat coughs, while bromides might relieve headaches.45 Physicians also recommended mustard plasters to the chest and hot water vaporizers for nasal congestion.46 Such remedies might comfort the patient or relieve some symptoms, but they did nothing to cure the underlying infection. In fact, physicians admitted that they had few tools with which to fight any disease once it had struck. ‘To accept a great group of maladies, against which we have never had and can scarcely ever hope to have curative measures, makes some men as sensitive as though we were ourselves responsible for their existence,’ William Osler told the Ontario Medical Association. ‘[But] we work by wit and not by witchcraft, and while these patients have our tenderest care – and we must do what is best for the relief of their sufferings – we should not bring the art of medicine into disrepute by quack-like promises to heal, or by wire-drawn attempts at cure.’47 According to Osler, the conscientious physician had to admit that there were few diseases that could be cured.48 Despite advances made over the previous decade towards proving the germ theory, medical authorities were divided regarding flu’s aetiology. This is evident in a January 1890 editorial in Maritime Medical News that aimed to unravel the ‘facts’ behind the mysterious illness. The editors

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noted that ‘influenza is held by many to be caused by “unascertained atmospheric conditions”’ and that experts thought it ‘a miasmatic disease, caused by a living miasm.’49 They acknowledged that bacteriology would probably prove that the ‘specific poison or irritant’ was a living organism, but this did not dissuade them from quoting American experts who emphasized ‘that influenza is not infectious or contagious.’50 As Dr Frederick Montizambert noted in 1890, this uncertainty had implications for the preventative measures taken at Grosse Île: Epidemic influenza seems to spread by the atmosphere, either by some peculiar condition of the air itself or possibly by micro-organisms carried in it and breathed into the lungs. It is thus that it can sweep over a country with such marvellous rapidity, and strike in one city 100,000 persons within twenty-four hours as it is stated to have done in Paris this autumn … Against influenza spreading through the atmosphere, quarantines are useless.51

In this analysis, flu was a poison, a literal infection of the climate and air. Quarantines could do little to check the spread of an ‘atmospheric’ disease. Continued Montizambert: Cholera, on the contrary, spreads mainly by infected water, infected persons, and infected things. It follows always along the lines of human travel … Cholera has never been brought to the American continent except on, and by, a ship. It therefore should be, and is, one of the diseases from which a country can be protected with certainty by efficient maritime sanitation.52

Researchers thus began an earnest search for the organism that caused the disease. In 1892, Dr Richard Pfeiffer, a bacteriologist at the Académie de Médecine de Paris, reported that he had definitively traced the cause of influenza to a bacterium, which he named Bacillus influenzae (popularly known as ‘Pfeiffer’s Bacillus’).53 In 1882, Robert Koch, who discovered the tuberculosis bacterium, had listed four requirements (Koch’s postulates) for establishing a causal relationship between a disease and a specific organism.54 First, the organism had to be evident in all cases of the disease examined in the laboratory; second, the organism had to be obtained from diseased tissue and cultured; third, it should cause infection when introduced into healthy animals; and fourth, the organism should be recoverable from new cases and prove identical to the original specimen.55 While Pfeiffer was able to find samples of the bacterium in most cases of the flu, his experiments began after the pan-

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demic ended and thus were retroactive rather than contemporaneous. At the same time, the bacterium did not always cause illness when animals were inoculated with it. Nevertheless, it was recovered often and frequently resulted in illness, which led Pfeiffer to carelessly label the causal organism.56 This flawed view would stand for several decades. It would be shaken in 1918 but would remain unrefuted until, in the mid-1930s, two groups of researchers proved that influenza is actually caused by a virus.57 Bacillus influenzae, since relabelled Haemophilus influenzae, is a relatively common and opportunistic bacterium, one that preys on already diseased bodies.58 But in 1892, despite the now obvious shortcomings in his research methodology, Pfeiffer appeared for all intents and purposes to have demystified the disease by providing a clear bacteriological explanation. He was hailed as a conqueror. Wrote Professor Fraser Harris of the Dalhousie Medical School in October 1917: The usual expressions were in vogue, [influenza] was a corruption in the air, a miasma, an exhalation and so on; until in 1892 the bacteriologist Pfeiffer isolated the organism of influenza and named it the Bacillus Influenze [sic]. Not the air, then, but the microscopic fungi it may hold for evil influence, is the true cause of influenza. The influence is now materialized, nay indeed is isolated and sealed down under glass for the inspection of trained eyes. Thus by the microscope are these deadly powers of the air one by one distinguished from each other and identified each by its particular malignancy.59

Once identified as another ‘bacteriological’ disease, it thus became theoretically possible to prevent influenza by applying the same measures used against cholera.60 As Montizambert wrote during the 1889–90 pandemic, scientific quarantine relied on the control of germs and diseased bodies to effectively isolate cases and contacts.61 As Maritime Medical News concluded, Canadian public health experts believed that the ‘diffusion of influenza in fresh localities from infected immigrants ha[d] been traced’ definitively as the root cause of the 1889–90 pandemic.62 The Russian flu struck during a period of transition in medical thinking, one in which contagious, miasmatic, and bacteriological theories of disease vied for professional and public acceptance. The 1889 flu challenged bacteriologists, who sought desperately to unravel its cause in the laboratory. It was a chance to demystify a disease that many still associated with ‘atmospheric changes,’ weather, and clouds of unseen

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poison. It tested Canada’s quarantine system and preventative strategies, which attributed disease to foreign sources of infection. And when no major plagues followed the 1889 flu, influenza also began to lose its capacity to spark fear among medical professionals. Once it was thought that the causal organism had been identified and pinned down under a microscope, it no longer seemed so frightening, and old explanations that linked epidemics to immigration resurfaced.

5 Happily Rare of Complications: The Flu’s First Wave in Canada and the Official Response

Diseases and war have long been linked. In the nineteenth century, sickness often caused more casualties than enemy action.1 At the beginning of the Great War, doctors worried that a truly global conflict might thrust new diseases upon unprepared populations. Colonel Guy Carleton Jones, a Nova Scotian doctor and a veteran of the Boer War, warned his colleagues early in 1914 to heed the lessons of history2: The trail of infected armies leaves a sad tale of sickness amongst the women and children and non-combatants. Laws and regulations may govern the conduct of war, but disease and infections recognise no such laws and refuse to signal out the combatant only. Thus we see that war forces itself on the civilian, on the innocent child, on the non-combatant who stays at home … for who can tell, or count up, or even recognise the victims of war when it once places its hand on a country?3

Four years later, Jones was Surgeon General of Canada’s military forces and would find himself at the centre of the greatest epidemic in a century. In 1918, civilian public health officials remained confident that maritime quarantine would be sufficient to protect from any overseas threat. But that year, a particularly virulent H1N1 strain of influenza emerged, causing the most devastating influenza pandemic in history.4 According to Alfred Crosby, the 1918 pandemic crossed the globe in three distinct waves. It began in the spring of 1918 before dissipating in the summer. A second wave in the fall was followed by a third in the winter of 1918–19; in some places this final wave lasted until 1920.5 Crosby holds that the first wave caused few deaths and would likely have gone unnoticed but for the second and deadly wave in autumn. While the name ‘Spanish

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flu’ suggests that the 1918 virus first appeared on the Iberian Peninsula, researchers agree that this was not the case. Because Spain was not a combatant during the Great War, the uncensored Spanish newspapers were the first to publish accounts of the disease in May 1918; the international press subsequently began to refer to it as ‘influenza of the Spanish type,’ or Spanish flu.6 When and where the virus or viruses responsible for the pandemic first emerged is still a matter of unresolved debate.7 The search for the origins of the 1918 flu started soon after the pandemic ended in 1919. As the epidemiologist Edwin Oakes Jordan noted in his comprehensive 1927 study ‘the 1918 pandemic of influenza resembles all previous [ones] in that its origin is largely shrouded in obscurity.’8 He argued that the pandemic must have radiated outwards from a single ‘endemic focus’ or combined from ‘several foci,’ but the available data made it almost impossible to establish a definite origin point for the disease.9 When Jordan was writing in the 1920s, researchers had yet to discover that a virus was responsible for influenza, and most still believed it was caused by Pfeiffer’s bacillus.10 Jordan’s observations were therefore derived solely from his epidemiological investigations. Then as now, research was hampered by the fact that before 1918, the flu was not a reportable disease in most Western localities; thus the detailed cause-specific data that researchers usually rely on is largely absent for the period before the autumn of 1918. Nevertheless, in evaluating disease reports in medical journals and published mortality statistics from around the world, Jordan identified three possible sites where strange respiratory diseases similar to influenza were said to be circulating in the months and years before the pandemic’s recognized first wave in April and May 1918: British military camps in Great Britain and France (1916–17), Haskell, Kansas (March 1918), and China (winter 1917–18). In all three cases, while Jordon believed that there was evidence to support the theory that an unusually virulent and deadly respiratory disease was circulating well before the first wave, he concluded that the available evidence prevented him from drawing firm conclusions as to the actual origin of the pandemic. In a series of articles published in the late 1990s and early 2000s, virologist John Oxford re-examined the military camps theory.11 His work identified two specific outbreaks of a respiratory disease that British doctors called ‘purulent bronchitis’ at two bases in France and England.12 The first began at Étaples in northern France in late December 1916 and peaked in January and February 1917; the second occurred at the Aldershot barracks southwest of London in March and April of that same year. Both epidemics were described in The Lancet well before

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the pandemic. The articles detailed how soldiers died with symptoms that together would become the hallmark of pandemic flu during the autumn of 1918: bloody sputum production, tachycardia, a high temperature, and a dusky heliotrope cyanosis that often preceded death.13 In Oxford’s view, the Great War allowed these local outbreaks to develop into a pandemic virus through a lethal combination of gas, filth, overcrowding, and livestock/human cohabitation.14 Modern virological research also seems to explain the difference in morality between these early outbreaks and the pandemic’s first wave. Virologists, including Oxford, hypothesize that pandemic viruses may only emerge in fits and starts as a novel avian strain gradually begins to infect new human hosts. In this case, a pure avian virus would begin by causing deadly disease in humans in primarily localized outbreaks.15 As it became better adapted to attacking the throats and lungs of people, it would become less deadly but also more easily transmissible. Oxford applied this theory to the 1916–17 outbreaks at Étaples and Aldershot, positing that they constituted pandemic ‘herald waves,’ or early examples of a novel virus in the process of crossing the species barrier and learning to adapt to humans.16 In his view, these early outbreaks planted seeds from which the pandemic exploded in the autumn of 1918 as soldiers demobilized at the end of the Great War.17 But the lack of any definitive epidemiological evidence to connect the 1916–17 European outbreaks with the 1918 pandemic led Edwin Oakes Jordan to discard this theory in 1927. In examining the pattern of diffusion and symptomologies in the spring, autumn, and winter waves, he instead argued that one had to look elsewhere for the origins of the virus – to a point closer in time to the spring wave and to a place that would fit the available evidence that supported an east-to-west pattern of diffusion during the earlier wave and a worldwide eruption from the North Atlantic in the late summer. Jordan’s exhaustive investigation next led him to a strange report from Haskell, Kansas, dated March 1918, that linked an outbreak of influenza to deaths from pneumonia. From his study of the evidence, he concluded that it was the first published instance of unusual influenza activity with marked mortality prior to the pandemic that could also be connected to subsequent outbreaks. Because the flu was well documented to have been rampant in American military camps in April and May 1918, it seemed possible the disease first appeared in Haskell and was then transmitted to army camps as civilian recruits were called to the colours. Once in the army, it would have spread quickly from west to east across the United States and then across the Atlantic

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to Europe, where it simmered during the summer of 1918 only to erupt outwards from the west coast of the continent in the early fall.18 John Barry is now the most vocal advocate of an American origins theory. In his book The Great Influenza, as well as several articles, he contends that the report noted by Jordan identifies the origin site. He says that a severe epidemic of flu overwhelmed the local doctor, Loring Miner, forcing him to sleep in his buggy between house calls; eventually he became so ‘perplexed by the unusual severity of the disease that he filed a report with the U.S. Public Health Service late that March.19 Barry’s main evidence is a one-line report in the 5 April 1918 issue of the American journal Public Health Reports, which reads: ‘On March 30, 1918, the occurrence of 18 cases of influenza of severe type, from which 3 deaths resulted, was reported at Haskell, Kansas.’20 From his research into the social columns of the Santa Fe Monitor, Barry holds that Loring’s epidemic actually occurred in February but was only reported at the end of the following month.21 He argues that from a local outbreak of a novel influenza virus in Haskell, the flu spread to nearby Camp Funston, Kansas, at the beginning of March, then to other army camps across the United States, and later around the world.22 Jordan thought it likely that the first wave began in the United States, but he was intrigued by reports of an earlier and much deadlier outbreak of influenza-like illness in China. In Jordan’s view, China had to be considered as a possibility because southeastern Asia had been linked clearly with the origins of previous pandemics.23 Indeed, the pandemics of 1957 and 1968 have both been traced conclusively to viruses that emerged in China. It is also suspected that the 1889 virus originated in the same region. In examining China as a possible site of origin of the 1918 flu, Jordan observed that several English-speaking writers had previously assumed this was the case, suggesting that the flu had been brought to Europe by the Chinese Labour Corps, which had been raised by the French and British in northern China for service on the Western Front. One such author described ‘a curious, mild, febrile disease reported among Chinese labor troops on the coast of France early in the spring of 1918, about which [he had] never been able to obtain definite clinical or epidemiological information.’24 But given the limitations of the available sources and the lack of detailed epidemiological records from the Chinese interior, Jordan was forced to conclude that the hypothesis could not be fully tested.25 In recent years, this third hypothesis has been supported by Chistopher Langford, Dorothy A. Pettit, and Janice Bailie, who have uncovered

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evidence of a severe form of respiratory illness, which they argue was misdiagnosed as pneumonic plague, that circulated in the interior of China during the winter of 1917–18.26 According to their studies, the victims of the outbreak died from a severe form of pneumonia. It spread sporadically, though, and the case fatality rate was far too low for it to actually be pneumonic plague, the airborne version of the disease that is thought to have caused the Black Death. They contend that the outbreak was actually the earliest instance of pandemic influenza. They argue that from China, the disease diffused around the world with the mobilization of the Chinese Labour Corps.27 Canadian historians have accepted the European origin theory, claiming that the Spanish flu arrived in Canada with soldiers returning from the Great War during the summer of 1918.28 According to Janice Dickin McGinnis, the Spanish flu first appeared in Canada in July 1918 on-board two troopships, the Araguyan and the Somali, both of which she assumed carried soldiers returning from the Great War. Eileen Pettigrew’s The Silent Enemy reiterates Dickin McGinnis’s assertion, suggesting that the first case of flu appeared in Canada as early as 26 June 1918.29 Reconstructing the early epidemiology of flu is difficult because civlian public health statistics for the period are generally unreliable: most municipalities and provinces did not make influenza a reportable cause of death until the autumn of 1918 and many jurisdictions did not even publish mortality statistics identifying cause of death. Nevertheless, a thorough examination of the extant records suggests that influenza was circulating in Canada much earlier than previously thought, during the late winter and early spring of 1918. In British Columbia, for example, pneumonia was the most common form of disease during the first half of 1918, accounting for 61 per cent of all cases of reportable illness in the province. This is significant because pneumonia was the most common side effect of influenza infections during the 1918 pandemic and the leading cause of death during the more fatal autumn wave. When influenza and bronchitis are included with those numbers, respiratory infections accounted for almost 73 per cent of all infectious disease activity on Canada’s west coast between January and June 1918 (see Figure 5.1).30 According to the reports of the BC Board of Health, during the winter and spring of 1918 there were 278 deaths from all different types of respiratory infection – excluding tuberculosis and cancer – such as influenza, pneumonia, broncho-pneumonia, and bronchitis – for a total estimated

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Figure 5.1NBritish Columbia cases of infectious respiratory disease, January–June 1918 Bronchitis, 23

Bronchopneumonia, 48 Other diseases, 79

Influenza, 9

Pneumonia, 131

Source: H.E. Young, Report of the Provincial Board of Health (Victoria: Government of British Columbia, 1919), A47.

population of 474,000. This represented an annual mortality rate of 117 per 100,000 from respiratory conditions, or an average of about 46.3 deaths per month. Based on similar data collected for 1913 to 1917, the expected number of deaths from respiratory illness – if the winter of 1918 had been a normal year – would have been 34.6 deaths per month or a mortality rate of 88 per 100,000. This means that in the first half of 1918, mortality from respiratory infections was more than 25 per cent higher than expected.31 At the same time as the number of deaths from pneumonia and other respiratory conditions was rising in BC, these same conditions began to account for a much larger proportion of overall mortality in the province. Between January and June 1918, these illnesses were reported as being responsible for 13.5 per cent of all deaths. During the previous five years, they had accounted for only 10.24 per cent. Again, this represented an increase of about one-third from what would normally be expected. In other words, not only were more people dying of respira-

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tory disease in the first few months of 1918, but it was also becoming a more prevalent cause of death. The first written report that actually mentions influenza in Canada was made by the Medical Officer of Health for Toronto, who wrote in April 1918 that ‘because of an exceptional prevalence of grippe with the usual accompaniment of excessive pneumonia mortality, the general death rate for the month of April is considerably higher than in the same month of last year.’32 That month there were 15.9 deaths per 1,000 from pneumonia versus 13.6 the previous year.33 While the mortality rate spiked, so too did the number of families requiring assistance. In April 1918, public health nurses made 11,276 home visits versus only 7,655 the previous year.34 In Ottawa, where the total population was around 107,000, the highest rates of respiratory illness also occurred between January and April. This is not unusual, given the seasonal nature of pneumonia and other similar diseases; what is remarkable is that the highest number of respiratory deaths occurred in April, when the normal flu season was ending. Both of these cities experienced an unusual spike in respiratory illness in the winter and early spring of 1918. Because Canada was a nation at war in 1918, military hospital records provide the most consistent source of statistical information on disease activity in the Dominion. Every hospital, military or public, that treated Canadian soldiers was required to keep a daily record of patients admitted to and discharged from care. Unlike private citizens, who would normally be cared for at home during a mild illness, in the spring of 1918 soldiers had no choice but to report to hospital if they were sick.35 According to military law, an ill soldier had to fall into sick parade or remain on duty. Given this choice, sick soldiers with an incapacitating disease such as influenza would have reported to hospital and thus been recorded in the admission and discharge books. A systematic examination of the available records at Library and Archives Canada supports the theory that an usually severe respiratory illness was circulating in Canada in the winter and spring of 1918. At St Luke’s Base Hospital in Ottawa, for example, there were fifty admissions for influenza-like illnesses – including one death – in January and February 1918, representing about 21 per cent of all admissions during the same period.36 In March there was a lull with only ten, but in April admissions spiked to a total of forty-nine. During the second spike there were also two deaths from pneumonia. Given the experience of the previous winter, when there had been only twenty-eight admissions for influenza-like illnesses between January and April 1917 and no deaths,

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Figure 5.2NAdmissions and deaths from influenza-like illnesses, St-Jean Military Hospital, St-Jean Barracks, Quebec, December 1917–January 1919 30 25

Cases

20

Deaths

15 10 5

29-Jan-19

08-Jan-19

18-Dec-18

27-Nov-18

16-Oct-18

06-Nov-18

04-Aug-18

25-Sep-18

24-Jul-18

14-Aug-18

03-Jul-18

12-Jun-18

22-May-18

10-Apr-18

01-May-18

27-Feb-18

20-Mar-18

06-Feb-18

16-Jan-18

26-Dec-17

05-Dec-17

0

Source: ‘Admission/Discharge Books: St-Jean Military Hospital, St John, Quebec,’ vol. 9, series II-L-1, RG 9, LAC.

this was unusual activity.37 The records of St-Jean Military Hospital at StJean Barracks in Quebec show a similar pattern for admissions between December 1917 and January 1918, with a spike larger than any other before the fatal autumn wave of the pandemic appearing in midwinter (see Figure 5.2). In total during the first three weeks of January, there were twenty-three admissions for influenza, bronchitis, or pneumonia. As in Ottawa, a second spike appeared in April 1918 that did not result in as many admissions but that was sustained over a longer period of time. The same was true at the Quebec Military Hospital farther down the St Lawrence in Quebec City, where admissions for influenza-like illnesses began to increase in January, peaked in February, and then declined in March (see Figure 5.3). Unfortunately, the records do not allow us to compile statistics for April. At Saint John Military Hospital farther east in Saint John, New Brunswick, two spikes again appear in the number of admissions. The first begins in mid-February, while the second begins to spike at the end of March, when the records end (see Figure 5.4).38 Collectively these records show that respiratory illnesses among Canadian soldiers peaked in the winter of 1918 in January–February and again in March–April. It should be remembered that while respiratory

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Figure 5.3 Admissions for influenza-like illnesses, Quebec Military Hospital, Quebec City, April 1917–March 1918 80 70 60

Cases

50 40 30 20 10 Mar-18

Feb-18

Jan-18

Dec-17

Nov-17

Oct-17

Sep-17

Aug-17

Jul-17

Jun-17

Apr-17

May-17

0

Source: ‘Admission/Discharge Books: Quebec Military Hospital, Quebec City,’ vol. 11, series II-L-1, RG 9, LAC.

Figure 5.4NAdmissions and deaths from influenza-like illnesses, Saint John Military Hospital, Saint John, New Brunswick, 1 January 1918–31 March 1918 9 8 Cases Deaths

7 6 5 4 3 2

26-Mar-18

19-Mar-18

12-Mar-18

05-Mar-18

26-Feb-18

19-Feb-18

12-Feb-18

05-Feb-18

29-Jan-18

22-Jan-18

15-Jan-18

08-Jan-18

0

01-Jan-18

1

Source: ‘Admission/Discharge Books: Saint John Military Hospital, Saint John, New Brunswick,’ vol. 15, series II-L-1, RG 9, LAC.

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disease activity is seasonal, usually climaxing in late winter, the patients affected here were all soldiers, meaning that they were between eighteen and forty-five years of age – not the usual victims of pneumonia or influenza. This is consistent with the American evidence. As in Canada, army records provide the most complete picture of respiratory illness activity in the United States for the immediate pre-pandemic period in 1917 and 1918. Using the statistics compiled by the U.S. Army after the war from daily hospital logs across the country, it is possible to establish a baseline for normal disease activity within the population that was most susceptible to the 1918 virus: young, otherwise healthy individuals. In the spring of 1917 – a year before the 1918 flu’s first wave and the outbreak at Haskell – about 120 of every 1,000 soldiers in uniform could expect to be admitted to a military hospital for some form of influenza-like condition or lobular and broncho-pneumonia.39 In April 1917, about four of those soldiers would have died from their infections – a case fatality rate of 3.3 per cent. As in Canada, morbidity and mortality due to respiratory disease increased dramatically during the winter of 1917–18. In a statistical analysis of the prevalence of respiratory infections during this period, George Soper concluded that ‘reports rendered by camp surgeons, camp epidemiologists, and inspectors from the Surgeon-General’s repeatedly mentioned an unusual prevalence of influenza, bronchitis, bad colds, grippe, rhinitis, etc. during the winter and spring periods [of 1917–18]. As further evidence of the presence of influenza, the pneumonia rates were unusually high during March and April.’40 In 1928, an examination of the American military hospital returns for the war period led doctors to conclude that there had been a definite epidemic of influenza in the United States in late December, peaking in mid-January 1918.41 These early cases of flu, often complicated by pneumonia, resulted in an abnormally high level of mortality: 1,093 of every 100,000 American soldiers died of respiratory infections in January 1918.42 This epidemic began to subside in February but returned with increased virulence in March.43 The official historians of the American Medical Services in the Great War concluded that these outbreaks were due to an influenza-like illness – a conclusion also reached by the American Public Health Service.44 According to Carol Byerly, these outbreaks received little media or public health attention because of fears that such reports would give aid and comfort to the enemy.45 The Public Health Service did not report on the disease until it appeared in Spain in May, long after it had peaked

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in America.46 By then, American soldiers had already carried the illness to Europe.47 The Canadian and American experiences in 1918 best fit a Chinese or early North American origin for the flu. During 1917 and 1918, 94,000 Chinese workers were shipped across Canada by the British from China. In the spring of 1917, the Foreign Office requested that Ottawa allow the Chinese labourers to pass through the Dominion and that the Borden government arrange for their transportation from Vancouver Island to Halifax. At the same time, the flu could have begun in the United States, although evidence from both countries suggests that it appeared much earlier than the outbreak at Haskell, Kansas. In either case, the early appearance of flu in Canada discounts a European origin for the virus. But why then did this first early wave of flu escape the notice of quarantine officials in the winter and spring of 1917–18? Quarantine officers relied on a list of reportable diseases, and influenza was not on it. At the same time, quarantine was a racialized process that targeted immigrant bodies rather than germs to protect socio-economic interests as much as public health. But during the war, immigration to Canada all but ceased and the majority of traffic across the Canada–U.S. border was military in nature – especially in 1918 as American forces began to mobilize and cross the Atlantic on Canadian as well as American ships. As a result, germs were free to cross with American and Canadian soldiers, most of whom were of British or European ancestry. The end result was that the first wave of flu in Canada went unnoticed at Canada’s quarantine stations because the virus did not follow previous patterns of diffusion, nor was it carried by immigrants, whom the quarantine system was designed to intercept and screen. The flu’s diffusion from North America to Europe in the spring of 1918 also broke long-established patterns. In the spring of 1918, the Canadian Expeditionary Force spread the disease back across the ocean to Canadian troops in England, France, and Belgium. According to a report by J.A. Amyot, the ‘Consultant in Sanitation’ to the Canadian Director-General of Medical Services – the army’s head medical officer serving overseas – influenza was first identified in April among Canadian troops in England.48 Reports from the front, however, suggest that it had been circulating among soldiers even earlier.49 According to a memorandum from the Deputy Director of Medical Services for the Canadian Corps, during March and April 1918 ‘the prevailing illness [was] influ-

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enza. An epidemic originated from billeting too many troops at one time in a cave. The three battalions crowded there have suffered from many cases of influenza. Fortunately the illness is of short duration and few have been evacuated on account of it.’50 Similar reports were soon being received from worried medical officers in the 1st and 2nd Canadian Divisions, which suggested that some units were even being incapacitated by the epidemic.51 ‘This influenza runs a very rapid course,’ wrote the 1st Division’s Assistant Director of Medical Services: a man being prostrated for 36 to 72 hours, sudden onset with a temperature from 102–104 degrees, general malaise and severe headache; small percentage of cases showing marked gastro-intestinal symptoms. Three or four day men [sic] are able to return to their respective duties. It is apparently extremely contagious – often several cases occurring in a billet within 24 hours time. Reports from the Medical Officers of other units show that there are practically no complications or sequaele.52

Influenza posed a significant danger. It did not necessarily need to kill, only sicken, to have a potentially severe impact on a unit’s fighting strength.53 Because of wartime censorship, Canadians learned little about the flu in the Canadian Expeditionary Force overseas or among civilians at home. Canadian papers were prohibited from printing stories that might give aid or comfort to the enemy or damage morale at home.54 As Jeff Keshen argues in his study of wartime censorship in Canada, ‘despite some grumbling, most newsmen, in exemplifying pervasive jingoism, a resignation to new realities, and unencumbered by professional standards promoting dispassionate reporting, responded by promising greater efforts to help with the war.’55 This included hiding domestic troubles from Canadians as well as sickness in the army. As in the United States, the first mention of the disease in the Canadian papers described an outbreak of influenza – or grippe – in Spain in May 1918. They reported that there people were falling sick from a strange new disease.56 ‘Business life in Madrid is almost paralyzed by the outbreak of a species of grip,’ read a Canadian Press dispatch of 28 May. ‘Reports from the provinces show that thirty percent of the population is affected by the strange disease.’57 At first it seemed that the epidemic would not be serious. Much sickness was reported, but few deaths.58 Then on 3 June, rumours began to circulate in London that hundreds

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were dying in Spain’s capital city and that King Alfonso XIII was gravely ill. ‘As the disease spreads it tends to lose its benign reputation,’ read a report in The Times (London). ‘Yesterday’s deaths were 111 and the total for the last ten days is over 700.’59 As public health officials in Britain began to identify the spring wave of influenza as a genuine threat, Canadian officials too began to take note of the disease for the first time. In the minds of Canadian public health officials, ships from Europe had always carried disease to Canada; and as the disease spread throughout Britain, military officials on Canada’s east coast waited for it to appear in their harbours with wounded soldiers returning home. When the hospital ship Araguayan sailed into Halifax harbour during the second week of July from England, 23 per cent of its passengers and crew were sick with influenza.60 The military authorities in Halifax had not faced any major epidemics of contagious disease aboard troopships, and jurisdiction was unclear. They first asked the local quarantine officer if he would take responsibility for the sick soldiers and sailors, but N.E. MacKay informed them that they fell under military or naval jurisdiction.61 The army had neither the quarantine facilities nor the personnel to carry out the necessary inspections and to house the sick. At a loss, officials wired Ottawa for instructions. Major-General Guy Carleton Jones, the military’s Surgeon General, immediately cabled Frederick Montizambert to inform him that his men were holding all the soldiers on-board the Araguayan pending further instructions.62 Despite the murky jurisdictional issues, Jones suspected that Montizambert would be willing to assist. Because Ottawa had jurisdiction over any sickness on-board incoming ships, Jones assumed that this could include soldiers, and he suspected that although MacKay may have been acting according to the letter of the law, he was not carrying out its spirit. ‘Quarantine authorities Halifax disclaim any responsibility respecting troop ships,’ he urgently told Montizambert. ‘This is not according to my understanding of your regulations [stop] desired to meet you in every way [and] consider that coordinated action should be taken.’63 As Jones suspected, the Director-General agreed with his assessment. ‘Am wiring MacKay … consider ship comes under him [under] section 9 regulations.’64 Flu was also reported at Grosse Île that summer. In 1918, quarantine at the island was in the charge of George E. Martineau.65 Around the 7th or 8th, two ships chartered for military transport – the Nagoya and the Somali – appeared for inspection. Although the ships were empty on their journey up the St Lawrence, they nevertheless stopped at Grosse

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Île as there were several cases of influenza among their crews. But flu was not a quarantinable disease, which meant the federal officials lacked the authority necessary to quarantine the sick sailors. So Martineau sent them on their way up the St Lawrence.66 At Montreal, the military again intervened. There the Embarkation Medical Officers – the military doctors in charge of inspecting departing troops and certifying that it was medically safe for them to cross the Atlantic – refused to grant permission for either ship to begin loading passengers owing to the sickness among the crew. They wired the Secretary of the Department of the Naval Service in Ottawa informing him of the situation: The ‘Nagoya’ was scheduled to sail shortly, but was not passed by the American Embarkation Medical Officer, owing to sickness among the crew. A meeting was held this morning in reference to the matter, and it was found that out of a crew of 160 there were 100 cases of influenza. When this vessel passed the Quarantine Station she reported 6 cases, but was allowed to proceed. It is now hoped that this vessel will be disinfected and ready to embark her troops at a later date. The master of the ‘Somali’ reported at the meeting that 7 of his crew were down with influenza. The Canadian Medical Officer stated that troops could not be placed on board until this ship has been disinfected. It is now very doubtful if she can get the next convoy. The Medical Officers have taken the case up with the Principal Medical Officer in Ottawa.67

The Embarkation Medical Officers were astonished that the ships had been allowed to pass quarantine at Grosse Île when there were a large number of infectious cases on-board. They tried to contact Montizambert but were unable to reach him, so instead wired the Deputy Minister of Immigration and Colonization.68 The office of the Director-General of Public Health had been transferred from the Department of Agriculture to the Department of Immigration and Colonization early in 1918 in an attempt to consolidate the federal government’s most important public health activities under one minister.69 But this only confused matters more. W.W. Cory, the Department’s Acting Deputy Minister and serving Deputy Minister of the Interior, wired Martineau directly to inform him that the two ships were being returned. ‘I would respectfully suggest that all … crew be landed and kept under observation and then fumigate vessel entirely.’70 Cory got a

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response that he was not expecting: ‘I will act in accordance with your wishes but would kindly ask you to communicate with our department so that they give me special authority to that effect.’71 Martineau did not yet know that his office had been transferred to a new department. The 1918 flu was the first pandemic disease to seriously test Canada’s quarantine system since the cholera outbreak of 1866. It was met by a chaotic system that quickly broke down along the cracks created by confused lines of authority. In the summer of 1918, Martineau was receiving contradictory directions from the Deputy Minister of the Interior, the Superintendent of Immigration, the Navy, the Department of Militia and Defence, the Department of Immigration and Colonization, and his own superior, Frederick Montizambert. To complicate matters even more, Cory was still using Department of the Interior stationery to send directives under the authority of the Minister of Immigration and Colonization. This disorganization stemmed from the loose amalgam of federal public health responsibilities that Ottawa’s departments had accumulated since Confederation. In the absence of any serious test, and with the emphasis clearly on screening immigrants for contagious disease through quarantine, the structures of governance and authority remained largely undefined. The official strategy employed to combat flu in 1918 was strikingly similar to that used in 1866 against cholera. The system’s immutability was embodied in the fact that Frederick Montizambert, who had inspected immigrant ships for cholera at Grosse Île more than five decades before, remained in charge. But throughout the crisis, Montizambert was unavailable. At seventy-six he preferred to spend the warm months at his summer retreat on the St Lawrence River, known as Woodside Cottage, near Cacouna, Quebec. After corresponding with Jones about the arrival of the Araguayan in Halifax and after a quick jaunt from Ottawa to Halifax to investigate the situation, he stopped on the way back to begin his summer vacation. In Montizambert’s absence, Cory was forced to continue issuing directives on his behalf without really understanding the situation or the duties of the quarantine officers serving under him.72 It was also unclear who would be asked to pay for the expense of disinfecting and treating the crew of the Nagoya and the Somali, for influenza was not actually a quarantinable disease.73 Cory believed that the ship’s owners – or the Department of Militia and Defence, which had contracted its services – would be liable. He instructed Martineau accordingly but received even more questions in return: Could civilians be quarantined or only sol-

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diers?74 If the company was unwilling to pay, was Martineau to release the boat from quarantine?75 Cory was growing impatient, and he worried about how his haphazard response would be construed by his superiors. On the 10th, he wrote a memorandum to Montizambert, placing a copy in his departmental file and sending another to the Superintendent of Immigration, W.D. Scott, that recorded Montizambert’s absence during the epidemic, that Cory had been forced to issue instructions to Martineau, and that the DirectorGeneral’s staff was misinformed about the department they were actually working under. ‘Under these circumstances,’ he concluded, ‘I would feel greatly obliged if you would arrange to notify the various members of your staff that the Public Health Branch is now part of the Department of Immigration and Colonization.’76 Montizambert had now been out of contact for a week.77 On 13 July, one of his deputies sent a desperate wire to Cacouna. ‘Martineau wires epidemic of influenza in old country. Many steamers arriving here have cases on board. As this is not quarantinable disease kindly wire me how to act … please wire reply.’78 On the 13th, the Director-General made his first communication from Woodside Cottage, belatedly writing the Minister of Immigration and Colonization. It was clear that he now understood that this flu was different from the pandemic he had witnessed thirty years before: A new form of disease of the influenza type has been present in Europe under the title of ‘Spanish Influenza.’ It is severe in most cases, fatal in some. I beg to recommend that it be included amongst the graver forms of quarantinable disease, and that I be authorised to direct the quarantine officer to make every effort to keep it out of this country. I have, as an emergency so instructed the officers at Halifax and Grosse Isle, subject to your ruling.79

Two days later he received the minister’s confirmation. Yet Cory was forced to again remind him to notify all of the quarantine officers of the change.80 By the 21st, Montizambert had still not done so, prompting further prodding from Cory. This finally produced a curt directive that Montizambert sent to his quarantine officers by wire: ‘I am instructed to inform you that by Ministerial order the new form of epidemic influenza, known as Spanish Influenza, is to be included in the list of the graver forms of quarantinable disease, under section 4 of the Quarantine regulations, and dealt with accordingly.’81 Canada’s quarantine service had lumbered into action.

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An analysis of six military hospitals across Canada demonstrates that despite a clumsy official response, influenza did not spread into the interior during the summer of 1918. Camp Hill Hospital in Halifax, for example, serviced local naval and military personnel as well as those returning from overseas. As Halifax was one of the country’s busiest ports for both departing and returning soldiers, one would expect it to have been a hotbed of disease activity during the summer of 1918, especially with the arrival of dozens of soldiers in July from the Araguayan. Even with sick soldiers from that ship inflating the number of flu victims in July, only 285 cases resembling influenza were admitted to hospital between 1 July and 29 September.82 This represented about 13 per cent of all admissions for the same period. In contrast, during the first two weeks of October alone, the same hospital admitted 249 cases. This means that during the summer there were on average 3.13 cases admitted each day to hospital for influenza, pneumonia, or bronchitis, while in October the numbers jumped to 17.78 per day. A similar story emerges from the records of St-Jean Military Hospital in Quebec City. During the Great War, that hospital serviced the soldiers of the Canadian Engineers Depot at St-John Barracks, St-Jean, Quebec, as well as others passing through on the journey between home and the front. In the winter of 1918 (5 December 1917 to 4 March 1918), ‘influenza-like’ disease activity was relatively insignificant, spiking slightly in January. During this time, sixty-three patients were admitted to the hospital with influenza-like symptoms, an average of 0.7 patients per day (a tiny number compared to overall admissions). During the spring months (5 March to 4 June 1918), ninety-two people were admitted to hospital with influenza or influenza-like symptoms, an average of 1.02 per day, with larger spikes appearing in April. Throughout the summer (5 June 1918 to 4 September 1918), when the disease is supposed to have arrived at the Port of Quebec, the hospital had only thirty-six admissions for influenza-like diseases, an average of only 0.4 patients per day. When these numbers are compared to the fall of 1918 (5 September 1918 to 4 December 1918), the contrast becomes apparent (see Figure 5.2). During this period 245 patients were admitted with influenzalike symptoms, an average of 2.7 patients per day, with thirty-two people on one day alone – almost the same number as for the entire summer. The number of deaths is even more revealing: during the winter, spring, and summer of 1917–18, not one death was recorded for patients with influenza-like symptoms. In contrast, during the fall of 1918, twenty-one

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85

patients, or 9 per cent of those admitted, died of their illness or related complications.83 The station hospital at Kapuskasing, Ontario, a small town in the vast expanse of northern Ontario, looked after soldiers who either were passing through by rail on their way across Canada or were from units guarding and servicing the local prisoner-of-war camp. A study of this hospital is revealing because it provided a stop on a soldier’s route west or east. As well, the POW camp, which housed hundreds of interned enemy aliens, accepted prisoners from across the country.84 These factors combined to make the hospital a unique location where people from across the Dominion were placed in close proximity in an otherwise isolated environment. It appears that during the winter there had been a low rate of admission for respiratory illness. For the winter months, data are unfortunately available only for the period 5 February 1918 to 4 March 1918, during which time one soldier was admitted with influenza-like symptoms. During the spring, activity did increase: eight soldiers were admitted with similar complaints between 5 March 1918 and 4 June 1918. During the summer, when a number of prisoners were transferred from Halifax to Kapuskasing, admissions for influenza or similar conditions dropped off again to only one soldier during the period 5 June 1918 to 4 September 1918. When these numbers (a total of ten soldiers in seven months) are compared to the ninety-two soldiers who were admitted between 5 September 1918 and 4 December 1918, the contrast is evident (see Figure 5.5). The rate of daily admissions essentially increased from nearly zero to more than one per day. As well, it is significant that none of the ten soldiers admitted in the winter, spring, and summer died of their illness while four of the ninety-two succumbed to the disease in the autumn, a case fatality rate of more than 4.3 per cent.85 Unlike the Kapuskasing Station Hospital, the Toronto Base Hospital was a hive of activity on a daily basis. Created in the spring of 1916 to deal with a lack of space in existing military hospitals, the Toronto Base Hospital took over the facilities of the old Toronto General Hospital to provide accommodation for up to 1,000 Canadian soldiers. The autumn epidemic was long remembered by those who served there. ‘In September 1918, there occurred the great epidemic of influenza, and within one week the bed state of the hospital jumped from about 200 to 800,’ wrote one of the hospital’s doctors. ‘The marquee tents were again brought into use, beds were erected in the corridors, clinic rooms, and

12

10

0 31-Jan-18 14-Feb-18 28-Feb-18 14-Mar-18 28-Mar-18 11-Apr-18 25-Apr-18 09-May-18 23-May-18 06-Jun-18 20-Jun-18 04-Jul-18 18-Jul-18 01-Aug-18 15-Aug-18 29-Aug-18 12-Sep-18 26-Sep-18 10-Oct-18 24-Oct-18 07-Nov-18 21-Nov-18 05-Dec-18 19-Dec-18 02-Jan-19 16-Jan-19 30-Jan-19 13-Feb-19 27-Feb-19 13-Mar-19 27-Mar-19 10-Apr-19

Figure 5.5 Admissions and deaths from influenza-like illnesses, Kapuskasing Station Hospital, Kapuskasing, Ontario, January 1918–April 1919 16

14

Cases

Deaths

8

6

4

2

Source: ‘Admission/Discharge Books: Kapuskasing Station Hospital,’ vol. 6, series II-L-1, RG 9, LAC.

0

Source: ‘Admission/Discharge Books: Toronto Base Hospital,’ vol. 3, series II-L-1, RG 9, LAC. 09/12/1918

02/12/1918

25/11/1918

18/11/1918

11/11/1918

04/11/1918

28/10/1918

21/10/1918

14/10/1918

07/10/1918

30/09/1918

23/09/1918

16/09/1918

09/09/1918

02/09/1918

26/08/1918

19/08/1918

12/08/1918

05/08/1918

29/07/1918

22/07/1918

15/07/1918

08/07/1918

01/07/1918

24/06/1918

17/06/1918

10/06/1918

03/06/1918

27/05/1918

20/05/1918

13/05/1918

06/05/1918

29/04/1918

150

22/04/1918

15/04/1918

08/04/1919

01/04/1918

Figure 5.6 Admissions and deaths from influenza-like illnesses, Toronto Base Hospital, 1 April 1918–9 December 1918 250

200 Cases

Deaths

100

50

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The Last Plague

every possible place in the hospital, and the beds were no sooner up than they were filled. The staff worked day and night with un-remitting zeal.’86 While the autumn wave stuck in people’s memories, there is no evidence in the records of a summer wave of influenza. Between 1 July and 24 September, 198 patients were admitted with influenza-like symptoms, a rate of about 2.15 per day. In comparison, between 25 September and 25 October there were 1,577 admissions, or 52.56 per day.87 As the epidemic curve in Figure 5.6 shows, there was no spike in the summer although there were minor spikes in April and May. At Tuxedo Park Hospital in Winnipeg, Manitoba, a hub for soldiers in Military District Ten (Manitoba) as well as the east–west rail link, the statistics are slightly more complicated, but again fit a general pattern. The hospital received an influx of patients from other facilities in the final week of June (about 215), some of whom were suffering from respiratory complaints, which created a spike in the numbers. In the week beginning 30 June 1918 there were thirty-six admissions for influenzalike complaints, followed by thirteen the following week and nineteen the week after. In contrast, on average there were only four admissions for respiratory illnesses between 21 July and 28 September. As a percentage of total admissions, however, it is clear that there was no real spike in the disease rate. For the week of 30 June, respiratory admissions accounted for about 17 per cent of all admissions. For the following two weeks, respiratory disease accounted for 22 and 28 per cent respectively. In any given week between the beginning of June 1918 and the end of August 1919, respiratory admissions accounted for an average of about 27 per cent of admissions. In the autumn, the admission rate was far greater. During the week of 20 October, for example, 92 per cent of all admissions (106 in total) were for respiratory complaints. The following two weeks saw 89 and 83 per cent of all admissions for influenza-like illnesses. On average, between 29 September, when rates began to climb, and the end of the fall wave around 29 December, the hospital averaged thirty-four admissions per day for flu.88 On the west coast, the course of disease activity was similar. Victoria Military Hospital at Esquimalt, BC, had been set up to service both recruits and Home Service Canadian soldiers. As with the other hospitals, little evidence can be found to support a summer epidemic of influenza. Between 5 April 1918 and 4 June 1918 (no data are available for the winter months), only fifteen people were admitted to the hospital with influenza-like symptoms (less than 0.3 patients per day). During the summer months (5 June 1918 to 4 September 1918), only eight

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soldiers were admitted with influenza or a similar diagnosis (or around 0.09 patients per day). In comparison, between 5 September 1918 and 4 December 1918, 235 soldiers were admitted to hospital with influenzalike illnesses, of whom eleven died (an admission rate of more than 2.6 per day and a mortality rate of 4.6 per cent).89 Flu clearly did not spread inland during the summer of 1918 from Canada’s Atlantic ports. The most likely explanation is that Canadian soldiers and the public had acquired immunity earlier in the year during the spikes identified in the winter of 1917–18. Someone who becomes sick with a flu virus and survives acquires immunity from infection with the same strain of virus.90 This is known today, but in 1918 influenza was thought to be caused by bacteria, not a virus. Crediting a successful quarantine was plausible because it fit a long-established pattern. In the winter of 1917–18, federal quarantine officials did not notice the upturn in respiratory disease that is now evident in military and civilian records. Indeed, federal officials only became aware of the flu when it threatened to cross back over the Atlantic from Europe to Canada and began to fit into previous epidemic patterns. When the Nagoya and the Somali arrived on Canadian shores, they appeared at Canada’s oldest quarantine station, where immigrants had once been checked for cholera and outsiders were routinely scrutinized for ‘foreign’ diseases. In his 1927 history of medicine, J.J. Heagerty (who himself was a federal quarantine officer in 1918) recalled that in the minds of Canadian officials, it was the racial background of the Somali’s crew that identified them as a potential source of disease: Most of those who were admitted into the Grosse Isle quarantine hospital [from the Somali] were East Indians. They were not suitably dressed for the climate; in fact, the ship owners engaged them with the understanding that they were not to enter northern latitudes; their resistance was low, and as a result pneumonia seemed to follow faster upon the heels of the initial influenza than is usual with Europeans.91

For Heagerty, this explained the high death rate among the sailors.92 Neither the Nagoya nor the Somali was a regular Canadian troopship – both had been chartered by the Imperial government during the spring of 1918 to meet the demands of the escalating war in Europe.93 The need for more men overseas had pushed ships crewed by non-Europeans into service. When the two ships arrived at Grosse Île they were met by a medical gaze that linked race and disease. In his view, the flu then sim-

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mered below the surface during August, exploding in the autumn of 1918 from the seeds sown by the Indian crews. But during the summer of 1918, quarantine officials felt confident that they had successfully blocked influenza from spreading inland.94 In August, Montizambert considered the situation secure enough that he journeyed across Canada to William Head in order to inspect the quarantine station on Vancouver Island. While visiting British Columbia, he went so far as to assure the Vancouver World that his office and other federal authorities had taken every precaution against a disease that had begun to devastate Europe. He was confident that another catastrophe had been prevented by maritime quarantine.95

6 A Dark and Invisible Fog Descends: The Second Wave of Flu and the Federal Response

The Captain looked suddenly tired. ‘Sometimes I think, Mr. Benson, that the very air is poisoned with the damned influenza. For four years now millions of rotting corpses have covered a good part of Europe from the Channel to Arabia. We can’t escape it even when we’re 2,000 miles out to sea. It seems to come as it did on our last trip, like a dark and invisible fog.’ From HMS Cephalonia: A Story of the North Atlantic in 1918

The first wave of influenza in the spring was unusually severe as far as seasonal flu was concerned, but it caused few deaths. In fact, that wave had much in common with the previous pandemic in 1889–91, and, as happened three decades before, by midsummer the crisis appeared to have passed. ‘The influenza pandemic has been on the wane for the past two or three weeks,’ reported the British Medical Journal on 27 July 1918, ‘both in this country and among our troops and allies on the Continent … It has already given rise to a great quantity of ephemeral medical literature, and no doubt in the future will form the subject of more deeply studied and even laboured official reports.’1 Quarantine officials in Canada remained confident that it had been turned back from the Dominion’s Atlantic ports. But unbeknownst to physicians, across the ocean the virus was mutating to acquire a far more deadly form. When this new flu virus spread outwards from southern England in August, it caused the greatest spike in mortality. In the fall of 1918, for the first time in half a century, Canada would face a severe epidemic of contagious and deadly disease. The fall virus was capable of eliciting symptoms that doctors had never seen before in otherwise healthy young adults. According to the editors

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of the Canadian Medical Association Journal, the second wave produced two types of infection during the autumn of 1918: ‘first, the simple nonpneumonic infection, secondly; the severe and frequently fatal, pneumonic type.’2 The first type of case differed little from seasonal influenza. Recalled John Hunter, a Toronto doctor: The onset and course of the disease were remarkably uniform. Quite suddenly there appeared a more or less marked hyperaemia3 of the respiratory tract – nose, throat, and bronchial tubes. A temperature range of 101–104 and a rather pronounced feeling of exhaustion. Patients seemed very willing to go to bed. Nasal haemorrhage, an irritable cough, gastric disturbances, pain in the nerves, joints, and muscles were the more frequent complications … It took a heavy toll on the pregnant and on those in labour, or who had been recently confined.4

Hunter’s clinical description was almost identical to those recorded during the outbreak in 1889–91. It was the second type of influenza that set the 1918 pandemic apart. Continued the editors of the Canadian Medical Association Journal: This latter [type of flu] is a very dangerous, rapidly progressing, septicaemia with high fever, a curiously slow pulse, often running an erratic course, which may kill in a surprisingly short time. Between the two is no absolute separation; type 1 may either quickly or sometimes after days develop into type 2, and then rapidly lead to death.5

The most ominous hallmark of the second wave was that an atypically large proportion of otherwise healthy young adults developed the more severe symptoms and ultimately died from complications like bronchopneumonia.6 Mortality among those in their late twenties was two to twoand-a-half times greater than during the previous four years.7 Recent research suggests that these victims may have died from cytokine storms – that is, from an overreaction of the immune system as it rapidly cascaded out of control.8 This explains why otherwise healthy young people died in disproportionate numbers: it was the strength of their body’s immune response that ultimately may have killed them. These severe cases could progress rapidly. Dr E.A. Robertson recalled a typically severe case that he treated in the Jeffrey Hale Hospital in Quebec City:

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A.B. was admitted to the Jeffrey Hale Hospital with nausea and vomiting of blood, severe abdominal pain and diarrhoea. His temperature was 103° and pulse 96, respiration 28; he was restless and excited, but not delirious. He rapidly became profoundly toxic and died within twenty-four hours after getting out of bed and having a profuse bowel movement on the floor. Signs of broncho-pneumonia were found in the lungs.9

Others took much longer to die, progressing slowly from initial infection to pneumonia over several days or even weeks. Robertson continued: When first seen the patient was drowsy and stupid, hard to rouse, irritable and with a depressed expression. The face was flushed, the nostrils were blocked, and breathing was oral. The tongue was heavily coated with thick whitish fur at the edges, with a brown centre. The lips were dry and often covered with secretion or with herpes, and they were slightly blue. The throat was dark red and the … pharynx swollen. The breath was of a peculiar feverish throaty odour. The voice was husky. The skin was hot but moist. No rash was visible but the capillary circulation was increased, as shown by a decided flush. The temperature was 103° or 104°, the pulse below 100 and the respirations 24. Physical examination of the lungs showed bronchial breathing general over both lungs … The sputum was greenish yellow or stained with dark blood, thick and tenacious … The subjective symptoms were extreme weakness, severe headache and backache, aching of the limbs and pain in the abdominal muscles from coughing. As time went on coughing became more productive, quantities of blood stained expectoration or nearly pure dark blood were expelled, the respiration became rapid and laboured, the face and fingers cyanosed, active delirium came on[,] the patient was with difficulty kept covered and often tried to get out of bed. Prostration became more marked, the tongue dry and brown, the whole surface of the body blue, the temperature rapidly fell and the patient died from failure of the respiration. The signs of a spreading broncho-pneumonia were usually evident early in the disease.10

These victims slowly drowned as their lungs filled with fluid. It is impossible to say where and when the crucial mutation necessary to produce such horrific symptoms took place; what is clear is that the second wave of flu, unlike the first, did spread outwards from western Europe, most likely from Great Britain.11 Ships plying the sinews of war and Empire spread a mutated version of the virus that had started to kill

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soldiers in Plymouth, England, during the first week of August to Sierra Leone, Brest, and eventually the United States.12 One of those ships arrived in Boston, in the last week of August.13 On the 27th, the first truly severe cases were reported among American soldiers stationed at the Receiving Ship, Commonwealth Pier.14 The Receiving Ship was not a naval vessel but an administrative ‘ship on land’ that processed outgoing and returning soldiers.15 It was, in fact, a crowded barracks, providing a perfect incubator for the virulent new form of influenza. Within two weeks, 2,000 sailors and soldiers were sick. Many developed severe pneumonia, and of these, upwards of 60 to 70 per cent died.16 By 3 September it had spread to Boston’s civilian population and into the army camps on the outskirts of the city. By the second week in September, flu had reached Massachusetts and upper New York State.17 All across the Northeast, local newspapers reported the disease to be widespread. By the 14th, it was in Newport News and Philadelphia.18 By then, hundreds of cases had appeared among the thousands of soldiers at Camp Devens who were waiting to be transported overseas.19 Although Canadians often assume that flu arrived in the Dominion with soldiers returning home from the war, this is not the case.20 Canadian soldiers did not begin to arrive home in Canada until months after the Armistice was signed on 11 November, well after the epidemic had peaked on this side of the Atlantic.21 Indeed, the intensity of the war effort actually increased during the pandemic; it did not wane. Throughout the autumn, the British, American, and French armies were chasing the retreating Germans back from the gates of Paris, across the Somme, and towards the Rhine.22 In the final three months of the war, the Canadian Expeditionary Force suffered its highest casualties: 11,257 killed and 33,478 wounded, more than during the gas attacks of the Second Battle of Ypres, Vimy Ridge, and Passchendaele combined.23 To replace those who were killed or wounded, tens of thousands of soldiers were actually being funnelled overseas; almost none were returning home. Between July and December 1918, 59,310 soldiers were inducted into the Canadian Expeditionary Force, almost as many as the 61,000 who joined during all of 1917!24 In the summer and autumn of 1918, the United States also was trying to transport its million-man army to France as quickly as possible. German successes in the spring had forced the American commander, John J. Pershing, to ship men aboard anything that would float.25 In March, 60,000 American soldiers embarked for France; 93,000 followed in April, 240,000 in May, and 280,000 in June.26 The American Expedi-

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tionary Force grew from 650,000 men in June to 1.25 million in September – an increase of 600,000 in only twelve weeks.27 Many of them were shipped overseas via Canadian ports when space was available on British transports. This was partly in order to avoid the U-boat menace off the coast of the United States.28 Thus, soldiers were moving across the Atlantic, but from west to east rather than from east to west. Furthermore, few wounded were actually being returned home.29 After the Llandovery Castle hospital ship was sunk on 27 June 1918 by a German U-boat, killing all but twenty-four of the 258 passengers and crew, the Canadian authorities indefinitely suspended all transportation of injured soldiers back to Canada.30 At the time, it required every destroyer in service to escort Canadian and American ships conveying soldiers to Europe, and these destroyers could not be spared to protect soldiers returning home.31 As a result, ‘the last transport conveying other ranks to Canada sailed on 22 June 1918 [and] there has been no sailing of a Hospital ship since the sailing of the HS Araguayan on June 26th,’ read a report dated 18 September from the Adjutant General for Canada’s overseas forces, ‘and consequently the number of [injured soldiers ready to return] to Canada in the various hospitals has accumulated.’32 This meant that Canada’s maritime ports were an unlikely source of infection. In fact, the first place in the Dominion struck by the second wave was an army camp at Niagara-on-the-Lake, Ontario.33 But this camp was not like any of the dozens of other camps that dotted the Canadian countryside with white bell tents. In September 1917, the Canadian government had agreed to train Polish soldiers, who were to form a new national Polish Army.34 Between September 1917 and the end of the war, more than 22,000 Poles were trained on the grounds of Fort George at Niagara-onthe-Lake and sent to France.35 According to the camp’s commandant, 99 per cent came from the United States.36 Influenza first appeared in the camp with recruits from the eastern seaboard of the United States on 13 September 1918, and over the next several months, hundreds of soldiers fell ill. Out of a total strength of 2,500 men, 24 died.37 Around the same time, flu also leapt the border in Quebec when American soldiers carried it into army barracks in the provincial capital and Montreal.38 Wrote Captain Robertson of the Jeffrey Hale Hospital: Spanish influenza was brought to Quebec in September by a party of American sailors from many different parts of the United States. Although this party which numbered six hundred, was promptly quarantined, sufficient

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contact was made with soldiers in the same building to introduce the disease into the garrison, and with marvellous rapidity it developed among the soldiers and the civilian population.’39

As Robertson observed, soldiers provided a perfect conduit for influenza. They lived in cramped quarters with a transient population. This prevented epidemics from quickly burning out by providing a constant source of new fuel and by making quarantine impossible. In Montreal, the Assistant Director of Medical Services, LieutenantColonel F.S. Patch, noted with dismay that flu had arrived in his district at the end of the third week in September.40 He also traced its origins to the United States, specifically to Boston. It was not long before local Canadian soldiers began reporting sick at the barracks hospital.41 By the 26th, there were more than 400 cases and two deaths had been recorded.42 In public, the military tried to minimize the epidemic’s severity. ‘The only ripple on the otherwise perfect calm in local military affairs is the epidemic among the troops in barracks at St. Johns,’ Major-General E.W. Wilson told the Montreal Star on 25 September. ‘The entire garrison at St. Johns is of course under the strictest quarantine, and it is confidently expected that the plague will be speedily eradicated.’43 But by the 30th, the number of cases in hospital had grown to 660.44 Sick American soldiers also brought flu to the Maritimes, where it arrived by sea. Early on the morning of 17 September, the SS Nestor sailed from Hoboken, New Jersey, filled with American doughboys destined for the trenches of France.45 When the steamer left the pier, there were no cases on board, but the military authorities had crammed more soldiers aboard the Nestor than the ship could comfortably (or safely) hold.46 Edward A. Spitzka, the ship’s Chief Surgeon, explained what happened next in a memorandum to the American Surgeon General: In the emergency [to get men overseas] I acceded to the Boat Commander’s request to allow the sergeants to find temporary shelter in the hospital. On the third day of the trip, however, it was necessary to evacuate the hospital to make room for the sick who began to come in. It was soon recognised that the largest number of influenza cases came from those decks of the ship which were least ventilated. The situation grew more trying from day to day.47

On some decks of the ship there was less than ninety-six cubic feet of air space per man. With flu rampant, three days after sailing the Nestor was forced to put into Sydney, Nova Scotia.48 ‘I went ashore with Gen-

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eral Allen and made representations of the situation on board on the shore authorities,’ reported Spitzka. ‘As a result 660 men, including the transportable sick and those who had been in contact with the sick in the infected decks, were taken ashore and placed in the Moxham-Ross Military Hospital.’49 Rough seas delayed disembarkation until the 22nd, by which time the number of ill had grown.50 Those admitted to hospital in Sydney overwhelmed the small facility, forcing authorities in Halifax to begin shipping supplies and supporting personnel to the island.51 The situation of those aboard the Nestor may have improved, but as the supply convoys returned to Halifax and Saint John, they carried disease from Cape Breton to the mainland. Again, lines of authority were unclear when it came to quarantining military vessels. On 29 September, the Director-General received a request from the mayor of Halifax, Dr A.C. Hawkins, for assistance in quarantining Spanish flu. It was almost an identical telegram to the one sent by General Guy Carleton Jones back in July: Eight sailors admitted Military Hospital here suffering from Spanish Influenza. Protest strongly against quarantine officials action in allowing these patients ashore should be sent to Lawlor’s Island also request Quarantine Department Arrange to take these and other cases arriving to Lawlor’s Island otherwise disease will spread amongst troops and Civilian population with disastrous results.52

Already confusing jurisdictional issues were not clarified by a personal conflict between the mayor and the local federal quarantine officer. In 1908, Hawkins had been appointed to a prominent surgical position at the Victoria Hospital in Halifax. Norman E. MacKay – who headed up quarantine operations in 1918 – had a bitter dislike for the surgeon and called his appointment a ‘disgrace’ in a newspaper editorial that described Hawkins as ‘an able and skilful surgeon, but a man who is inflicted with an infirmity that leads him to look with contempt on any other surgeon who can perform operations probably as well as he can.’53 Hawkins did not shy away from the fight. In an editorial of his own in the Halifax Mail he wrote: I see Dr. MacKay is out again at his old work of disparagement and detraction … In private and in public, in season and out of season, in places of low repute and high repute, he pursues his libelling way … One would imagine that a man of Dr. MacKay’s position, with a large practice, and fat salary from the Dominion Government for doing next to nothing, could afford

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to let others live unmolested and work without being slandered … It is well known that he is a hindrance in many ways. His place could be filled very easily by an equally good man, who would work in harmony with the staff and be a source of assistance and strength to it.54

These were unusually strong words for one doctor to use to describe another. The Montreal Medical Journal responded to the feud by chastising Hawkins. ‘The whole affair is discreditable to the profession, none of it more so than the letter to another newspaper from Dr. Hawkins,’ scolded the editors. ‘The charge, and the method of making it, against Dr. MacKay, is shocking and contrary to all the amenities of the profession which have existed for 2,500 years.’55 Hawkins nevertheless understood the quarantine regulations. Sixteen years before, he too had served as Halifax’s quarantine officer when Guy Carleton Jones was overseas in South Africa.56 In 1918, it was up to Dr Frederick Monizambert to mediate a dispute between two old rivals, both of whom had claims to specific expertise in dealing with maritime quarantine. A day after Hawkins’s telegram, the Director-General wired a cautious response: ‘Diseases infectious or otherwise on coastwise vessels and vessels in port come under municipal or provincial jurisdiction not federal.’57 Coastwise vessels were ships on a ‘continuous voyage’ – that is, they might be forced to stop in Canada, but they were ultimately destined for another foreign port. But the provisions of Canada’s Quarantine Act only applied to ships arriving in port to offload passengers and cargo from a foreign point of origin – that is, passengers who were intending to remain in Canada.58 While such a distinction appears nonsensical as regards the prevention of disease, it must be remembered that these regulations were specifically intended to target immigrant bodies.59 In the autumn of 1918, Montizambert may also have believed that Hawkins was using the flu cases to chip away at his old enemy; he may also have resented Hawkins’s intrusion on federal jurisdiction. In the words of Janice Dickin McGinnis, the Director-General definitely ‘evidenced a lack of ability to act in co-operation with other people.’60 Whatever the reason, he soon realized that his telegram had been a mistake. At 4 a.m. on 7 October – ten days after flu first appeared in the province – MacKay sent an urgent wire to Montizambert: Vessels from the United States and from Montreal arrived with clean bills of health when at the time of sailing some of the crew are ill with influenza and have a temperature of one hundred and five. A Montreal steamer

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arrived today with twenty sick should quarantine deal with them when New York and ports north of it have not been declared infected by the minister? Are vessels from them subject to quarantine detention? Nearly every vessel arriving from the United States and Montreal have cases of influenza … Is quarantine to take hold of them?61

The next day the Director-General reversed course: Minister has not quarantined against United States but desires to help restrain influenza. You are authorised to accept for quarantine hospital influenza cases from United States or Montreal boats when requested.62

But it was too late. Influenza had already entered the civilian population at several points. The subsequent civilian paths of infection are the most difficult to trace. As the Montreal Star noted in September 1918: ‘It is only when the epidemic strikes a school, or college, or any place where a large number of people are in constant close association with each other that the public becomes aware of the disease among them.’63 The earliest account of influenza within Canada’s civilian population comes from southeastern Quebec, where the epidemic began on 15 September in a Victoriaville college.64 This time the source was not American soldiers, but American Catholics attending a regional Eucharistic Congress.65 Between 12 and 16 September the Congress attracted more than 25,000 people to the small Quebec town.66 Only hours after the celebrations ended, priests and students at le Collège Sacré-Coeur grew sick.67 Later, outbreaks were reported at the seminary and convent in nearby Nicolet and among priests in the surrounding towns.68 The Montreal papers reported that during the celebrations, a large number of foreigners had attended the conference.69 Given that transatlantic voyages between Europe and North America were impossible for civilians in the autumn of 1918, these visitors must have come from the United States. Ties between the Catholic Church in Quebec and the U.S. Northeast were strong.70 During a similar Eucharistic Congress in 1910, several dozen American priests and bishops – not to mention hundreds of parishioners – had attended celebrations in Montreal.71 Once across the artificial border, flu spread quickly. It was the army that then spread flu across the country. As influenza appeared in the barracks and towns of Quebec, Ontario, New Brunswick, and Nova Scotia, the Department of Militia and Defence was preparing

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to mobilize a completely new military force for service in Russia. Russia had been an ally of Great Britain and France during the war, but it had also been racked by political instability. After several failed military campaigns, and with people starving and desperate on the home front, the empire of Tsar Nicholas II collapsed in the spring of 1917.72 Alexander Kerensky’s provisional, democratic government promised to keep Russia in the war, thus preventing Germany and Austria-Hungary from transporting millions of men from east to west.73 But in October 1917, a second socialist revolution led by Vladimir Ilyich Lenin’s Bolsheviks succeeded in toppling the government. The Bolsheviks, who had campaigned on the slogan ‘Peace! Bread! Land!’, quickly entered into armistice negotiations with the German High Command.74 In early March 1918, Leon Trotsky signed the Treaty of Brest-Litovsk on behalf of the new government, taking Russia out of the war. The collapse of the Eastern Front freed up dozens of German divisions, which were soon diverted to the West to support the Kaiser’s spring offensive.75 The remaining Entente war leaders believed that the Eastern Front had to be re-established, even if it came at great cost. During the war, the Entente’s strategy had been two-pronged. While the armies of France, Britain, and Italy fought Germany and AustriaHungary on the battlefield, the Royal Navy maintained a blockade of the Central Powers, the purpose of which was to deprive the enemy of war supplies and resources.76 Russia’s collapse now opened the possibility that the enemy would gain access to vital oil resources in the Caucasus as well as the ports of Murmansk in northern Russia and Vladivostok on the Pacific.77 To complicate matters, civil war in Russia followed the peace treaty with Germany as socialist forces vied for control of that vast territory with ‘White’ Russian forces, who were loyal to the tsar.78 The Supreme War Council, which directed the combined war effort of the Entente powers, decided in the spring of 1918 to dispatch expeditionary forces to the Caucasus, northern Russia, and Siberia to protect oilfields and ports and to encourage White Russian forces to re-establish a front against Germany in the East.79 Canada agreed to send troops to all three theatres as part of a multinational force that included British, American, French, Italian, Serbian, Czech, and Russian soldiers. Canada’s largest contribution was to the Siberian Expeditionary Force (SEF). In July, the Dominion was asked to send a brigade headquarters, two battalions of infantry, a battery of field artillery, a machine-gun company, and supporting troops – 4,000 men all told.80 Despite Canada’s pre-existing manpower difficulties, Prime Min-

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ister Robert Borden signalled his agreement to the British proposals on 12 August 1918. Benjamin Isitt argues that Canada’s aims for the mission were complicated and even contradictory. ‘Military strategy, international diplomacy, economic opportunity, and ideology,’ he writes, ‘influenced the decision of Canada and its allies to intervene in the Russian Civil War.’81 Re-establishing an Eastern Front against Germany was an obvious strategic priority, but the mission offered more tangible and long-lasting opportunities for Canada specifically. Leading the mission in Siberia, as the Dominion was being called to do, would allow Borden’s government to seek ‘greater power and independence within the British Empire’ and would be the first step towards forming an independent foreign policy.82 It could also be economically advantageous, for it promised to secure new markets for Canadian goods in the East while protecting Canadian investments from Bolshevik seizures of private property.83 But as Isitt reminds us, the most important motive was ideological. The Bolshevik Revolution was viewed as a direct challenge to the rights of private property in the west, industrial capitalism, and democracy. It had sprung from socialist ideals that were the antithesis of the liberal tradition on which Canada had been founded. The inversion of class and economic relations in Russia threatened elite and bourgeois interests in an industrial capitalist economy that relied for its survival on a docile working class that accepted the dominant power structures. In this sense, it was a means of preventing domestic conflict by fighting a pre-emptive war overseas. The Great War had, after all, put an enormous strain on relations between labour and capital.84 While the conflict brought full employment during its first years, wages had failed to keep pace with inflation as the fighting dragged on.85 While workers watched real wages shrink, owners seemed to be enjoying record profits.86 Moreover, the demand for war materiel was outstripping the usual supply of labour, and this was making it possible for eastern European immigrants to find factory work. Many immigrant labourers had been shut out of the labour market before the war; by 1917, press reports were fuelling resentment that these same workers were now receiving higher wages than native-born Canadians.87 Working-class discontent began to boil over in 1917–18, fuelled by employers’ unwillingness to bargain collectively and the government’s clear support for the interests of capital rather than labour.88 In the summer of 1918, strikes broke out across the country, disrupting war production from Cape Breton to Ontario to British Columbia.89 In the autumn, a general strike vote was taken in Calgary and the West as a whole threatened to erupt in a general labour revolt.90

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Greg Kealey contends that the ‘Canadian state initiated a whole new set of repressive measures and agencies during this war and in its immediate aftermath in response to the significant challenge mounted by Canadian workers.’91 In the late summer of 1918, the federal government banned all collective action for the duration of the war; at the same time, it rounded up and interned labour leaders and suspected revolutionaries – especially ‘dangerous foreigners’ with eastern European accents.92 As Donald Avery notes, enemy aliens, who had already been disenfranchised by the 1917 Wartime Elections Act, now found themselves imprisoned by the same country that had pledged to embrace ‘men in sheepskin coats.’ In dispatching an expeditionary force to Siberia, the Canadian government was able to support a domestic policy of repression by quelling the ideological source of labour radicalism.93 As the Canadian army had been funnelling as many soldiers to Europe as possible, the bulk of Canadian manpower was in eastern Canada. Given the shortage of trained fighting men, small groups would be drawn from almost every camp in the Maritimes, Quebec, and Ontario. The plan was for them to move across the country to converge at Victoria. From there they would be shipped over the Pacific, first to Japan and then on to Russia; secrecy was imperative.94 The mobilization and transportation of this new Siberian Expeditionary Force spread flu across Canada. The barracks and camps from which these soldiers came were already infected when orders went out in late September for the movement of troops to begin. When flu broke out in Sydney on the 22nd, the Canadian Army Medical Corps (CAMC) training depot at Halifax sent several officers and men to the city to assist temporarily with the epidemic.95 As men and supplies were being ferried back and forth between the training depot and Cape Breton, the first Nova Scotian draft for the SEF was being readied for transport to Vancouver. At 7:30 a.m. on the morning of the 27th, medical troops from the Halifax depot boarded the Ocean Limited service to Montreal.96 The following day, the first cases of Spanish flu broke out among the men.97 Meanwhile, at Sussex Military Camp, New Brunswick, the signallers of the 260th Battalion were preparing for their own cross-Canada journey. At 1:15 a.m. on 27 September 1918, 156 recruits crowded onto a railway platform. Three hours later, at 4:04 a.m., they boarded the train to Moncton, where they then boarded the Ocean Limited on its way from Halifax.98 By the time that train pulled into the station, some of the men who had boarded in Halifax were already suffering from influenza.99 As the Ocean Limited pulled out of Moncton, bound for Montreal,

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flu spread with it. By the time the train reached Montreal, several of its passengers were severely ill. Privates R.E. Hickie and F.E. Vincent were removed from the train in Montreal and put into hospital.100 As Hickie and Vincent were carried off the train on stretchers, forty-two soldiers from SEF medical units formed in the city climbed into the crowded cars. By this time, almost all of the barracks in Montreal were infested.101 This troop train, and two others like it, spread the disease across Canada. In Winnipeg on 28 September 1918, sick soldiers from Camp Sussex were admitted to a local military hospital.102 The next night, ‘C’ Company of the 260th Battalion boarded the train at Regina. When the engine pulled the cramped cars out of the station at 11:45 p.m., both the District Quartermaster and the commander of the Saskatchewan soldiers recorded that the new group were free of illness.103 However, at 4:00 the next morning, when the train reached Calgary, twelve soldiers had to be taken off and admitted to the Calgary Isolation Hospital, dangerously ill.104 Authorities in Alberta wired ahead to warn of the impending arrival of influenza in BC.105 When ‘C’ Company arrived in Vancouver on 2 October 1918, it brought the first cases of influenza to the west coast.106 While the disease would have inevitably spread west, the mobilization of the SEF worsened its effects, for the disease erupted in Vancouver before it hit many of the major population centres in eastern Canada.107 Public health officials had little time to react. The sudden appearance of pandemic influenza in all parts of the country, almost simultaneously, provoked an administrative crisis.108 Although lines of authority were unclear, during previous crises, provincial and federal officials had met to discuss a two-pronged strategy in which quarantine would form only the first of two lines of defence; in 1918, by contrast, the flu moved too quickly to allow for this type of advance planning. As a result, local officials were left unprepared. A 2007 study of forty-three American cities by Howard Markel and colleagues found that when municipalities implemented quarantines, placarding, and bans on public gatherings early during the second wave of the 1918 flu – in other words, before the disease entered the community – mortality was less severe than in those cities that were unable (or unwilling) to implement similar measures. The authors concluded that there was ‘a strong association between early, sustained, and layered application of non-pharmaceutical interventions and mitigating the consequences of the 1918–1919 influenza pandemic in the United States.’109 But success depended on implementing these interventions as early as possible. In Philadelphia, which put controls in place after

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the disease had begun to kill people in the city, such measures had no noticeable effect on mortality. New York, on the other hand, took steps before the flu reached the city. There, individuals sick with flu were sent to isolation hospitals while contacts were quarantined in their homes with a public placard affixed to the door.110 As a consequence of ‘an early and sustained response, … New York experienced the lowest death rate on the eastern seaboard’ despite being one of the most overcrowded cities on the continent.111 The secretive nature of the SEF’s movements allowed the disease to move across the Dominion unnoticed, negating the effects of any precautions. Because military operations were carried out independent of contact with civilian public health officials, the flu often entered communities long before it was identified by the local authorities. At the same time, without a mechanism for cooperation between federal and provincial officials – similar to that which existed in the United States – there was no means of sharing knowledge or information about the flu’s epidemiology. In other words, while American municipal boards of health were able to respond to influenza before it appeared in major metropolitan areas like New York, soldiers seeded the disease in Halifax, Saint John, Quebec City, Montreal, Hamilton, Toronto, Winnipeg, Regina, Calgary, and Vancouver almost simultaneously. This pattern of diffusion precluded any major urban centre in the Dominion from establishing non-pharmaceutical interventions during the critical early period. Only Prince Edward Island was able to implement an effective quarantine.112 As an island, the province was uniquely situated to attempt a prophylactic defence. In mid-October, influenza raged in New Brunswick’s eastern counties of Westmorland and Kent and threatened to jump across the Northumberland Strait to PEI.113 Under the articles of Confederation, the province was able to ask for federal protection from epidemics; and in mid-October, Premier Aubin E. Arsenault asked Montizambert to quarantine the island from the mainland.114 The previous spring a similar request had been made after an outbreak of smallpox in New Brunswick. At that time, quarantine had been effectively carried out by Dr George Cook of Sackville. The Director-General now asked to be allowed to appoint him ‘inspector for epidemic influenza between Sackville and Cape Tourmentine … for persons destined to Prince Edward Island.’115 The minister agreed, and PEI was placed under federal protection from the mainland. An examination of mortality in PEI suggests that this may have

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reduced the pandemic’s impact on the island. The standardized mortality ratio (SMR) compares expected deaths with observed deaths in a given population. Excess mortality is defined as the number of deaths above what would be normal or expected – usually established by averaging mortality rates over a period of years. Ideally in examining influenza deaths, one would analyse age-stratified, case-specific data for pneumonia or influenza deaths – or even mortality from respiratory diseases in general. Unfortunately, given the slipshod nature of the Canadian public health infrastructure in 1918, no detailed or uniform statistics exist that would provide the basis for an interprovincial comparison. More complete are crude mortality statistics – or deaths from all causes. Despite their shortcomings, the figures for PEI suggest that the pandemic had only a marginal impact on mortality in the province. Between 1913 and 1917 the normal annualized mortality rate for PEI was 10.89 deaths per thousand. If 1918 were a typical year – one absent from pandemic influenza or another source of usual and high mortality – we would expect the crude mortality rate to be close to this average, within a standard deviation of about 0.68 deaths per thousand. If the pandemic had a significant impact on mortality, then the overall death rate should climb to well above the expected average, with the difference between the mean and observed mortality ratios representing excess deaths (the standardized mortality ratio), or the approximate number of deaths attributable to an unusual disease event – in this case, most likely the 1918 influenza pandemic. The greater the distance from the mean, the more likely it is that these deaths were caused by unusual events and were not the result of natural variance. But in 1918, PEI’s crude mortality rate was 11.3 per 1,000, representing only about 39 more deaths that year than during any average year between 1913 and 1917, well within a single standard deviation and thus within the realm of what might be considered ‘normal.’ In fact, the crude mortality rate was higher in PEI in 1911, 1915, and 1916 than in 1918. It would also appear that PEI escaped the ravages of flu in 1919 as well, when the annual crude mortality rate dipped to 7.9 per 1,000 – a statistically significant number because it is far lower than that which would be normally expected.116 An examination of mortality rates for Nova Scotia and Quebec puts the figures from PEI into perspective (see Table 6.1). In Nova Scotia, for example, the average crude mortality rate between 1913 and 1917 was 15.08 per 1,000. In 1918, that number rose significantly to 17.71 per 1,000, representing about 1,351 more deaths than would normally have been expected to occur. In Quebec the impact was even greater.

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Table 6.1 Comparison of mortality (all causes) for Canadian provinces with available data, 1918

Prince Edward Island Ontario Quebec Saskatchewan Nova Scotia Manitoba Alberta British Columbia

Expected mortality rate per 1,000

Observed mortality rate per 1,000

SMR

Actual number of excess deaths

10.89 12.57 16.85 6.80 15.08 10.56 7.93 7.58

11.30 15.37 21.42 13.30 17.71 11.66 14.30 15.21

1.04 1.22 1.27 1.27 1.17 1.10 1.80 2.00

111 39 17,837 10,234 14,352 11,351 1 612 13,293 13,669

Source: Dominion Bureau of Statistics. Canada Yearbook 1920 (Ottawa: F.A. Acland/ King’s Printer, 1921), 109–10.

Between 1911 and 1917 there were an average of 16.9 deaths per 1,000, while in 1918 the crude mortality rate skyrocketed to 21.42 per 1,000, representing excess mortality of about 10,118. In every other province where statistics were kept, the SMR was significantly greater than in PEI (see Table 6.1).117 Clearly, it was impossible for any other province to achieve a similar degree of success through isolation. Quarantine of entire population centres was difficult and rarely contemplated on the mainland. Prince Edward Island was in a unique situation in that it could isolate itself with comparative ease from the mainland. It was also the only province that was not transversed by either American recruits or the SEF. Its experience is thus closer to that of the American cities studied by Merkel and tends to suggest that non-pharmaceutical interventions in Canada might have been as efficacious as they proved south of the border, had provincial and municipal public health officials been given the chance to implement them before flu’s arrival. The second wave of the 1918 flu demonstrated the inherent ineffectiveness of federal strategies for protecting Canadians from epidemic disease. Originating in England, the second wave spread to Africa and France and across the Atlantic to North America at the end of August. The first ports and cities infected with the disease were in the northeastern United States. From there, flu spread north across the border to Niagara-on-the-Lake, Victoriaville, Montreal, Quebec City, Quebec, and

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Sydney. Influenza thus exposed an underlying weakness of the quarantine approach: the regulations identified and targeted immigrant bodies rather than disease for scrutiny. But in the autumn of 1918, those who carried influenza were young Canadian and American soldiers, most of whom were European in ancestry. They crossed a relatively unwatched and imaginary border, made all the more permeable by the exigencies of wartime. This reflected a strategy that identified otherness as the threat and disease as only one aspect of a larger socio-economic problem related to immigration. It was the status of immigrants as cultural or visual outsiders that identified them as a threat and thus made them the objects of medical scrutiny.118 Writes Alan Kraut: Natives have [always] gazed upon newcomers with a mind to determine whether or not they looked well or ill, strong or weak, alert or full, sane or insane, attractive or homely, in short whether or not they were desirable as neighbours … Those deemed fit, which often as not has meant similar in appearance and origins to those already here, were allowed to remain. Those judged unfit, either physically or mentally, were excluded, lest they enfeeble those already here. Unhealthy, then, became a convenient metaphor for excludable, legislation the remedy, and public health bureaucrats – first state, later federal – the instruments of cure.119

Quarantine and medical inspection were thus meant to guard against a socio-economic threat, by protecting insiders from outsiders.120 But Americans were hardly considered outsiders in Canada. In fact, Americans had been the most sought-after immigrants precisely because they were considered to be so much like Canadians. ‘The American settlers [do] not need sifting,’ wrote former Minister of the Interior Clifford Sifton in a 1922 issue of Maclean’s. ‘They were of the finest quality and the most desirable settlers.’121 Between 1900 and 1920 more than 1,179,245 Americans crossed the border to settle in the Dominion.122 Quarantine and immigrant inspection were not necessary to protect Canadians from their southern neighbours. The medical gaze instead settled on those whose race, ethnicity, or class marked them as outsiders. For decades, public health experts had expected that major epidemic diseases would arrive in Canada at the Dominion’s chief Atlantic ports with these foreigners from Europe and Asia. The success of quarantine in 1866 and 1892 minimized the need for cooperation between all levels

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of government and maximized confidence in the maritime approach. Yet in 1918, the soldiers who carried the disease to Canada were predominantly young males of European descent who had joined up for war in either Canada or the United States, and it was these men who spread flu across the country on their way to Siberia. In this way, flu crossed the Dominion quickly and before local public health officials could take action. It was a spectacular failure for a system that had stood largely unchanged for more than fifty years.

7 ‘A Terrible Fall for Preventative Medicine’: Provincial and Municipal Responses to the Second Wave of Flu

Our soldiers have shown Canadians how to die. It is up to the health authorities to show the people how to live. City of Ottawa Annual Report on Public Health, 1918

In the autumn of 1918, just before the pandemic struck, W.H. Hattie, the Medical Officer of Health for Nova Scotia, reflected on his province’s lack of preparedness for a major epidemic crisis. It was an ominous warning. On 30 September 1918, he wrote: It must be confessed that the incompleteness of the organization which had been effected in our province makes me most apprehensive at this juncture. Our system of public health administration has not infrequently been made the subject of criticism, much of which has been by no means unreasonable. The various local boards of health are composed, in most instances of laymen, who cannot be expected to take an active or well ordered part in activities which are so foreign to their other interests. While these boards may show evidence of an awakening when a dangerous infectious disease invades their districts, they do not always take efficient action, nor do they commonly realize that the most important function of a health organization is to prevent disease – that control of infection once it has obtained a footing is of less consequence to the community than the elimination of those conditions which invite the incidence of the communicable diseases [emphasis in original].1

Hattie felt that because of almost sole reliance on maritime quarantine, insufficient attention had been paid to the underlying conditions that caused or might support disease.

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Most Canadian provinces had a health department or central board of health,2 but the scope of those departments varied, as did their funding. Nova Scotia had the smallest public health service, spending about $0.0125 per capita in 1916. It consisted of a small clerical staff headed by a Chief Medical Officer, and its functions were limited to conducting local quarantines and maintaining a small laboratory service. Quebec, by contrast, had the oldest and most sophisticated public health infrastructure and spent about $0.0252 per capita. Its Central Board of Health was headed by a president and executive; it employed a statistician, bacteriologist, chemist, and sanitary engineer as well as ten district inspectors and a large clerical staff. Besides overseeing local quarantines and operating a bacteriological laboratory service, Quebec conducted sanitary inspections, monitored school hygiene, examined working conditions in factories, collected vital statistics, and distributed public health information. But it was Saskatchewan that spent the most money on public health both in real dollars and per capita. In 1916, the provincial budget for this was $187,000, or $0.25 per capita. The service was headed by a Commissioner of Public Health and employed a medical inspector, three sanitary inspectors, a statistician, a bacteriologist, clerical staff, and laboratory assistants. Besides overseeing quarantines and operating provincial laboratories, Saskatchewan maintained public hospitals for the ‘feeble-minded and incurables,’ administered a maternity benefit plan ($25 per child), gathered statistics, inspected provincial dairies, and distributed public health information.3 In New Brunswick, the provincial Department of Health was only a few days old when the flu epidemic struck in late September.4 Before the pandemic, efforts to encourage local municipalities to inspect schools, treat drinking water, and dispose of sewage had been unsuccessful.5 Legislation had been passed at the turn of the century requiring municipalities to support boards of health, but this was unenforceable without corresponding funding from the province. A lack of money and political will necessitated what one historian has called an ‘episodic approach’ to public health.6 In response, physicians began a campaign for centralization. By 1917, economic arguments that linked public health to economic productivity succeeded in convincing the legislature to create a Ministry of Health. Even so, when flu struck, the staff of the new Ministry of Health consisted of only two doctors.7 In New Brunswick, as elsewhere, public health officials tended to react to crises rather than take proactive measures. As Jane E. Jenkins notes, only after the pandemic passed did a ‘weak, disorganized public health system … [grow] into a centralized

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system focused on prevention rather than curative reactions to disease outbreaks in the province.’8 Prince Edward Island did not have a health department of any kind during the pandemic, and it too took an episodic approach to disease management. Douglas Baldwin notes that ‘during the 19th century, PEI governments provided public health services on a piecemeal, ad hoc basis. When confronted with epidemics, the authorities initiated emergency measures that were later transformed into legislation. After the perils subsided, these enactments lapsed until the next contagious disease visited the island.’9 This meant that there too, disease management took precedence over disease prevention.10 Prevention, by definition, was understood to include paying particular attention to the underlying causes of sickness in the community: poor nutrition, lack of hygienic education, overcrowding, and poor sanitation – essentially the factors that sanitary reformers once said created ‘fertile soil’ for epidemics to take root. In contrast, the focus on episodic management stemmed from acceptance of the old contaminationist view.11 For both provincial and municipal governments, imposing non-pharmaceutical interventions such as quarantine and bans on public gatherings had long been the first response when disease appeared in the community. In that respect, despite the newness of the ministry, the measures imposed by the Government of New Brunswick were typical of those employed throughout the Dominion at the provincial level. On 7 October the province’s Minister of Health, William Roberts, ordered the local board to ‘procure a suitable building or buildings, such as public halls, vacant houses, etc. for use as emergency hospitals’ and that ‘all cases of the disease, diagnosed as such by the attending physician, be notified to your Board, and that your Board, immediately upon receipt of such notification, placard the house affected, and place the patient in strict isolation, if remaining at home; and close contacts in quarantine.’12 The province also distributed information bulletins advising citizens to ‘live as much as possible in the open air, and have houses well ventilated.’ People were to avoid travel and crowds, isolate sick family members, and cover their mouths with handkerchiefs when coughing, and were further advised to refrain from excessive worry and anxiety.13 The minister ordered that all ‘schools, theatres, churches in New Brunswick be closed on and after Friday October 11th, until further notice, and that all public meetings be prohibited, in view of the danger of an epidemic of severe (so-called Spanish) influenza.’14 Despite such forceful pronouncements, we must be careful not to assume that the orders

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of a small group of civil servants were actually carried out. Closure orders were not always enforced, and church leaders in particular circumvented the department. A lack of local staffing also led to lax enforcement.15 Centralized control in New Brunswick was possible because of the absence of permanent and well-defined structures at the municipal level. In most jurisdictions, however, where permanent or semi-permanent municipal boards did exist, provincial officials had to vie with lower levels of government to claim authority and win public support. This process of negotiation and cooperation could break down when medical opinions were divided. Vancouver’s Medical Officer of Health, Frederick T. Underhill, believed that school closures, bans on public gatherings, and church cancellations would be ineffective; yet more than a dozen surrounding municipalities applied to the provincial Board of Health for legislative ‘town closures.’16 Underhill also found himself in direct conflict with his own mayor, who insisted that no cases of influenza were local and that all were a result of contact with outsiders.17 He promised only to shut schools and close the town if influenza began to spread among native Vancouverites.18 Although there was provision for town closure in the event of epidemics, it was up to the province to impose the order. Fears in surrounding municipalities that Vancouver would become a reservoir for influenza if it refused to close down led several neighbouring city councils to appeal directly to the province to enforce a closure order on that city; Victoria even asked to be quarantined from the mainland.19 Here the disagreement spoke to the underlying divisions within the professional public health community. On the one hand, provincial officials believed that prophylactic measures would be most effective at checking the epidemic, by preventing microbes from moving between towns; on the other, Underhill emphasized the need for education and sanitation – what Margaret Andrews sees as ‘reminiscent of the sanitarian approach popular in mid-nineteenth century Britain’ and in Canada.20 Ultimately the province won out when popular support for Underhill’s position waned.21 Public acceptance of medical authority was a determining factor.22 Citizens’ willingness to comply with the orders of physicians and civil officials hinged on individual judgments about the relative necessity or ineffectiveness of disease management efforts. In Alberta, the provincial legislature passed a law requiring all citizens to wear masks over their mouths and noses when they left home and ‘provided instructions on how citizens could manufacture their own from readily available supplies.23 But Calgarians routinely complained to the newspapers that the

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masks were grotesque, depressing, and even dangerous if used improperly.24 Besides being unpopular, the measures were clearly ineffective because they were unenforceable.25 When the provincial health minister visited the city, he complained to the Medical Officer of Health, Cecil Mahood, that only 20 per cent of the population seemed to be wearing their masks as required.26 But when ‘offenders’ were arrested and brought before the local court, it was often pointed out that those present to hear the cases – including judges – were not actually wearing the masks themselves as proscribed.27 Most escaped with a warning.28 In Saskatchewan, local public health officials attempted to quarantine a number of towns from contact with the outside world. Following the assumption that influenza was spread by outsiders, towns like Markinch, Dafoe, and Sheho – forty-five in all – notified the Canadian Pacific Railway that trains would not be allowed to stop or deposit passengers at their stations. At points all along the CPR and CN lines, mobs of angry and frightened townspeople congregated on station platforms to enforce a self-imposed isolation regime. At Lloydminster and North Battleford, armed guards patrolled the roads in and out of the towns. One town council even required ‘country-folk’ who lived outside the municipality to conduct their business as quickly as possible and then leave. Maureen Lux shows that the province responded to these vigilante municipal efforts as infringements on provincial authority. The Saskatchewan Medical Officer of Health told the towns of his province that such efforts not only were illegal but also contradicted established methods for preventing disease.29 The orthodox view was that councils of respected medical professionals were best equipped to manage and implement a variety of preventative measures. Here the efforts of officials in Montreal provide a typical case in large urban environment. According to military records and newspapers, flu first appeared in Montreal’s military barracks around 20 September and within the week had been identified in city schools, which was when the public became aware of the disease.30 As shown in Table 7.1, the number of cases then began to increase slowly over almost three weeks before peaking around 15 October. Mortality from the pandemic followed a similar pattern, although delayed by about a week. The number of deaths per day from influenza peaked at 201 on 21 October 1918.31 At its height, flu killed a Montrealer every seven minutes. Dr Boucher, the Director of Montreal’s Department of Health, was initially reluctant to declare an emergency. ‘The Spanish influenza seems at the present time to be nothing else than the disease which has been

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Table 7.1 Influenza cases and deaths in Montreal as reported by the Municipal Board of Health, October and November 1918

Date

Cases reported

Deaths

Date

Cases reported

1 October 2 October 3 October 4 October 5 October 6 October 7 October 8 October 9 October 10 October 11 October 12 October 13 October 14 October 15 October 16 October 17 October 18 October 19 October

17 3 7 22 111 21 111 119 132 398 202 357 367 378 1,868 1,748 1,300 750 617

11 13 10 12 26 18 27 27 23 59 51 68 43 165 153 162 166 163 195

20 October 40 21 October 1,633 22 October 1,063 23 October 907 24 October 865 25 October 989 26 October 487 27 October 19 28 October 1,148 29 October 336 30 October 151 31 October 139 1 November 161 2 November 116 3 November 16 4 November 154 5 November 103 6 November 224 7 November 73 Total 17,152

Deaths 113 201 155 133 139 125 94 73 142 69 77 55 43 58 35 46 23 24 31 3,028

Source: S. Boucher, ‘The Epidemic of Influenza,’ Canadian Medical Association Journal 8, no. 12 (December 1918): 1087–8.

known for several years as grippe or influenza, although it is nevertheless more contagious,’ he told the Montreal Star on 27 September. ‘Persons in good health should avoid any intellectual or physical strain, keep out of draughts, and not stay in damp surroundings, and especially should avoid contact with those who are affected with the disease.’32 Although officials implored the public to remain calm, as the death toll mounted so too did demands for a more interventionist official response. Read an editorial in the Montreal Star of 4 October: So far the Public Health authorities of the city have done little more than issue a series of stereotyped maxims that if followed should aid the individual in fighting the disease or modify its virulence. It is time that some more specific measures were taken to combat the menace … We must realize that the epidemic of Spanish Influenza is gaining ground and that it will be too late to lock the stable door when the fair steed ‘Good Health’ has been

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stolen. If the Health Department is unable to cope with the epidemic they should immediately call a conference of the medical men of the city and representative business men in order to take whatever steps may be prudent to ward off the danger.33

In response, a meeting of was held on 7 October at the Montreal Administrative Commission. There, medical men conferred with civic officials and businessmen on the measures that could reasonably be taken to combat the disease. The Gazette described the decisions that were reached: With hardly a dissenting voice, prominent medical men of the city advised the Administrative Commission yesterday afternoon to order schools, theatres, and other public institutions closed in the City of Montreal as a precautionary measure to prevent the further spread of influenza. The virulence of the army type of the disease and the danger of letting it spread to the civilian population was emphasised by two medical men present.34

The next day, Boucher adopted the meeting’s resolutions, issuing the following proclamation: Public notice is hereby given that until further orders all places of public gathering such as schools, theatres, dances, moving pictures, and concert halls and all other meeting halls, as well as places where the public may gather socially or otherwise shall be closed under the penalty provided by law.35

Despite the support of the clergy, Boucher had been unable to secure the closing of the city’s churches or its businesses. Rev. Curé Gauthier of St James Parish recommended that all services, save one on Sundays, be cancelled, but he could not support an outright ban.36 Businessmen attending the public meeting also adamantly opposed mandatory closings.37 As a result, the board was unable to agree on a definitive course of action.38 For the board’s physicians (some were lay members), it was clear that to prevent transmission, the chain of infection would have to be severed. But instituting such measures required control of the board. Over the next two days, the physician members lobbied through the newspapers to win public support for a reorganization of the Board of Health, and on 10 October, a new board composed entirely of medical professionals replaced the old. Its first action was to close all churches –

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even on Sundays – and to mandate that all stores, ‘with the exceptions of those selling necessities of life,’ close at 4 p.m. In addition, new rules were brought in that closed all places of amusement and that regulated boarding schools, public offices, hospitals, banks, courts of justice, tramcars, and the transportation and burial of influenza deaths.39 At the same time, emergency hospitals were established to deal with the influenza patients who were ‘too poor or friendless to be treated at home or unable to get a place at the general hospitals.’40 Together these provided 596 beds in addition to those of the conventional city hospitals while patient care was coordinated by a ‘Hospitals Commission’ created at City Hall, which directed patients to the institution nearest their residence and arranged for emergency staffing. The official response in Montreal relied on an initial and accurate identification of cases, then on the isolation of victims and, eventually, on broad-ranging efforts to limit crowds and contact in public spaces. Esyllt Jones identifies a similar response in her study of the pandemic in Winnipeg. She explains how mandatory reporting and tracking of disease formed the backbone of official actions in Manitoba’s capital.41 Victims were encouraged to isolate themselves; compulsory isolation through quarantines, placarding, and public closures came much later in the pandemic period.42 In both cities, the intervention of health authorities in public sphere activities was contingent on popular acceptance of the need for them. Officials in Winnipeg acknowledged that public cooperation was essential in combating flu. ‘If the public wants to crowd, it is up to the public,’ wrote Alexander Douglas, the city’s Medical Officer of Health. ‘The people were told what to do to avoid the disease and if they don’t do it it is up to them. Nothing more than we are doing can be done.’43 Municipal health officials everywhere in Canada had to wrestle with a similarly varied array of private and public interests to support the non-pharmaceutical interventions that they hoped would help control the disease.44 Most provincial authorities supported a disciplined regime of public closures and interdictions. However, officials in Ontario thought these ineffective, which, as in the case of BC, led to clashes between the two levels of government. ‘With respect to the closing of schools, churches, theatres, and other public assemblages, each Medical Officer of Health or Local Board of Health has power to close such places if it seems desirable,’ explained John W.S. McCullough, the Chief Officer of the Ontario Provincial Board of Health. ‘[But the] utility of this measure of prevention is obviously limited when department stores, business places, street

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Figure 7.1 Deaths and public health interventions in Montreal, October– November 1918 ...----- ---~--

-----~~---,

Source: Cite de Montréal, Rapport du Bureau Municipal d’Hygiène et de Statistique de Montréal, 1918 (Montreal: A.A. Pigeon, 1919).

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and railway cars are allowed to carry on business as usual.’45 Instead of recommending far-reaching non-pharmaceutical interventions, the province chose to rely on education, distributing information leaflets to physicians and the public. Indeed, one such pamphlet, titled ‘Influenza: Precautions,’ warned local officials against closing public places and businesses. Read the section of the document titled ‘Warning to Health Officers’: There is no great danger of spreading the disease in churches, theatres, and other assemblages if these places are well ventilated. Health officers should do nothing consistent with the welfare of the public likely to dislocate business or the ordinary affairs of life. They should not be moved from their duty by public clamour, to adopt fussy and ill-advised measures which only serve to irritate the public and accomplish no useful purpose. If, however, the health officer of any municipality deems it his duty to utilize the section of the Act referred to the Provincial Board will not interfere with him but the Board does not … propose its enforcement.46

In Ontario, the province had the authority only to recommend municipal courses of action; it could not make them mandatory. In the end, public health officials in cities like London and Windsor chose to close schools, churches, and businesses despite McCullough’s warning.47 This lack of coordination between the two levels of government resulted in an uneven response, with some municipalities implementing strict non-pharmaceutical interventions, others not. According to Heather MacDougall, ‘age-old methods such as case identification, contact tracing, quarantine, and isolation are the first stage of containment and hopefully eradication’ during an epidemic.48 Success, however, is always contingent on consistency, coordination, communication, and capacity.49 These were usually absent during the pandemic.50 As non-pharmaceutical interventions failed, public health officials turned to the laboratory. If a vaccine could be developed, physicians would not have to rely on uncertain public compliance with non-pharmaceutical interventions or engage in jurisdictional disputes among various levels of government. Vaccines were prepared across North America in the autumn of 1918, each containing a pot-pourri of dead bacteria. Vaccination represented the ‘modern’ response of the new scientific preventative medicine, offering a sharp contrast with what many physicians painted as older, ineffective non-pharmaceutical interventions.

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The Canadian military was the first to test the prophylactic value of vaccination.51 Wrote Major T.C. Cadham, the army’s district medical officer for Manitoba: With the knowledge that the disease was to reach us, methods were considered of combating it. The information, which could be derived at the time, was meagre. Quarantine and isolation methods appeared uncertain in their effect, and the value of prophylactic methods was not established. It seemed, however, to be an outstanding feature that infections of the respiratory tract were coincident with the disease and accounted largely for the mortality. With the knowledge of this, it was considered advisable to use a vaccine as prepared from micro-organisms infecting the respiratory tract of those suffering from the disease. The vaccine was to be used as a prophylactic to raise the immunity of those inoculated against respiratory infection.52

The vaccine created by uniformed doctors in western Canada consisted of three strains of streptococcal bacteria, several strains of pneumococci, and Pfeiffer’s Bacillus.53 Patients were administered a dose of about one-half of a cc containing ‘approximately 300 million streptococci, 200 million influenza bacilli and 150 million pneumococci.’54 Of the 7,600 soldiers stationed in Military District 10 during the pandemic period, 4,842 were vaccinated.55 The effect of the vaccine was ambiguous. According to Cadham’s own statistics, 528 soldiers from Manitoba were admitted to hospital for influenza and pneumonia.56 Most of those – 282 – had been inoculated. Yet Cadham claimed that the vaccine did seem to lessen the risk of severe complications: 7.1 per cent of those who had not been inoculated and who were admitted to hospital died as a result of influenza or pneumonia, compared to 1.7 per cent of those who had received the injections.57 Under the direction of Dr Gordon Bell, the province’s Chief Medical Officer, 700,000 doses of vaccine were prepared and distributed to civilian practitioners across the province.58 But vaccination was not made compulsory.59 Although inoculation was free, only 28,815 civilians opted to receive injections. Of those, 61 (or about 0.21 per cent) died, compared to a recorded case-specific mortality rate of 0.66 per cent among those who had not been inoculated.60 Doctors were cautious, but of thirty-seven Manitoba physicians who were polled, thirty-two believed that the vaccine had had a favourable effect on mortality.61 Ontario also experimented with public vaccination programs. Reported McCullough, head of the province’s Board of Health:

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Strains of bacteria were procured from Boston and New York and a prophylactic vaccine prepared both by the Connaught Laboratories of the University of Toronto, and the Laboratories of the Provincial Board of Health. This vaccine has been supplied very freely to the public all over Ontario and to some extent throughout Canada. The Board in issuing this vaccine took occasion to point out that while its use rested upon a rational and scientific basis, no results could be promised with certainty. The limited reports received, however, indicate that it has been of some value in prevention of this disease.62

For McCullough, vaccination offered the opportunity to deploy the rising power of the laboratory to aid in the crisis. Such measures also represented an advance to a new generation of physicians who found the older prophylactic methods to be out of date and reflective of a different understanding of disease processes.63 Medical opinion on the efficacy of vaccination was divided and reveals a conflict between those medical professionals who believed that laboratory interventions must form the first course of action and those who believed that ‘heroic’ remedies should be taken as a last resort. For some, like J.J. Heagerty, vaccination, at least in the case of influenza, was an unproven science that posed a very real danger to patients. As a young quarantine officer stationed at Grosse Île, the future historian wrote: Leaders of preventive medicine tell us that the only way we can hope to prevent a recurrence of influenza is by means of vaccination. Unfortunately for the health officer and the practitioner, there were a number of vaccines on the market during the recent epidemic. All of them had their advocates; all of them their detractors. Some of these vaccines claimed preventive properties, only; others claimed curative properties as well. Between them all the practitioner was lost in a sea of confusion, was doubtful of all of them, used them, if at all, with trepidation, and then only as a last resort in hopeless cases, never as a preventive.64

As Heagerty pointed out, in the autumn of 1918 there was no credible scientific research to support claims that the influenza vaccine was effective or even safe. Some studies had been improvised, but their findings were highly anecdotal. In the face of uncertainty, to some it seemed better to rely on older methods that, if also ineffective, would do no harm. This was the view taken by the Quebec Superior Board of Health, which sent investigators to Boston during the epidemic to study the use of a vac-

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cine. That board ultimately decided not to distribute a similar concoction, deeming it to be still at the experimental stage.65 Professional fears reflected public scepticism. In Manitoba, only 4 per cent of the doses procured by the province were administered. In Calgary, 15,000 doses were provided to an uninterested and distrustful public.66 Vaccination campaigns do not seem to have been attempted in either neighbouring Saskatchewan or BC.67 As Eileen Pettigrew notes, boards that chose not to use a vaccine tended to recommend that the advice of physicians was the most effective treatment for flu, not dubious prophylactic measures.68 The epidemic divided the medical community into two camps: those advocating aggressive, interventionist policies designed to stop flu in its tracks; and those who felt it was best to organize an effective program of treatment to alleviate symptoms and comfort the sick. Those in the latter camp felt there was little that physicians could do for the sick but try to help the body fight off the infection while treating the symptoms.69 Wrote Dr F.H. Wetmore of Hampton, New Brunswick: The things that count in the general management of a case [of influenza] are absolute rest in bed from the first, fresh air, and good nursing. When called to a case, isolate the patient, arrange masks and hand washing for the attendants, and see that the sputum is properly taken care of. This last can be done by having bits of rags or paper and a paper bag as a receptacle pinned to the bedside and later burned. See that a bed-pan is available … Give liquids entirely at first. A mixture of milk and lime water is good … or milk and raw eggs may be taken, an egg to a pint of milk … If the case is serious, see that the patient has nourishment at night as well as during the day.70

Only when conventional bed rest failed did Wetmore advocate that more heroic measures be taken. If a patient refused to recover, the digestive tract was to be cleared out as early as possible with a saline solution. For coughs and insomnia, he recommended heroin ‘or a stronger opiate.’ Alcohol, too, was of use for alleviating a ‘dangerous toxaemic condition.’ Wetmore suggested that doctors try withdrawing small amounts of serous fluid from the body to ‘start the patient on the road to recovery.’ Once the patient was convalescent, a mixture of quinine hydrochloride, dilute hydrochloric acid, tincture of nux vomica, and pepsin might be used to speed him or her along the road to recovery.71 Wetmore’s recommended therapies included ideas drawn from the modern arsenal of pharmacology, traditional heroic remedies, and even

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humoral medicine. Educated at McGill and Edinburgh in the mid-1880s, he was a highly respected physician and public health advocate in New Brunswick.72 At various times he had served as the Chief Medical Officer of Health, Medical Inspector of Schools, and Coroner for King’s County as well as president of the Saint John Medical Society.73 Wetmore’s suggestions, which were printed in the Canadian Medical Association Journal, pointed to the desperation that well-known and experienced physicians felt when faced by a novel flu. Confronted with divisions in the medical community and the lack of a clear ‘magic bullet,’ ordinary Canadians shared their own ideas about how to treat influenza, drawing upon an even more diverse array of remedies derived from germ theory, old sanitary science, traditional knowledge, and ‘common sense.’ ‘Place a piece of warm flannel on a very hot plate, with a piece of muslin covering the flannel,’ advised a reader of the Edmonton Journal named T. Garner, ‘then mix four teaspoonfuls of Keen’s or Colman’s mustard in four cupfuls of linseed meal, boiling hot. Spread over muslin, pour on some warm glycerine, cover with muslin and apply nearly scalding hot back and front of the lung. Have another poultice ready to apply when the other comes off.’74 Garner’s poultice promised a quick cure for pneumonia. R.C. Ghostley, also of Edmonton, swore by a ‘copious enema’ of two quarts of warm water with a tablespoon of salt. ‘After the bowels move from the injection of water,’ he wrote, ‘the bath should be taken, and continued until all pain and discomfort are gone.’75 The editors of the Montreal Star advocated a less gut-wrenching cure that involved saturating a cotton ball in alcohol and adding three drops of chloroform. The ball was then to be placed between the patient’s teeth and the fumes inhaled for fifteen minutes. J.W. Wragg believed in the usefulness of an ‘exotic’ cure that he had learned from an ‘African physician’ that involved a mixture of phenol and glycerine, to be taken every hour in a desert spoon.76 While the patient might certainly have felt better, it was not because his pneumonia was clearing up. Alcoholic beverages were by far the most common colloquial curative for flu, and given the prohibition legislation that had been passed the previous winter, many Canadians used the epidemic to demand access to banned spirits.77 Even where the cure might seem worse than the disease, patients gravitated towards those treatments that provided them with a sense of power over an unseen, misunderstood, and potentially dangerous enemy. Formal and informal interventions – whether they worked or not – provided physicians and patients with a sense of agency rather than victimhood.

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In homes and hospitals, nurses and volunteer caregivers took on primary responsibility for managing individual sickness, administering formal and informal treatment as well as simply comforting the dying.78 Across Canada, thousands of untrained Volunteer Aid Detachment (VAD) nurses were recruited in Montreal, Toronto, Winnipeg, Vancouver, and most other cities.79 As Linda Quiney points out, VAD service provided a ‘unique opportunity for an active part in the war effort, not available to women through any other form of voluntary patriotic work.’80 Nurses became volunteer soldiers on the home front, fighting germs just as their husbands, fathers, brothers, or sons were fighting Germans overseas. Read an appeal by Mary Ellen Smith, British Columbia’s first female member of the Legislative Assembly: The call has gone forth for volunteers, girls and women, trained or others, to help out while this condition lasts. There are a number of girls who have not a great deal of responsibility and have wanted for some time to render national service who have their opportunity now to perform a duty second only to that of our girls who have gone overseas … To respond to the call now, they will rank amongst the best self-sacrificing patriots. We look for numbers joining the ‘volunteer army’ to help stamp out this disease so that we can get back to normal once more.81

Volunteer nurses were described using patriotic and militaristic language; even so, this was a role that built on traditional gender norms, which cast women as nurturers and natural caregivers. But it must be added that this was a public and sometimes dangerous form of service, and one that provided opportunities to cross traditional gender boundaries.82 Those women who answered the call during the pandemic were knowingly exposing themselves to a deadly disease on a daily basis in public spaces and in private homes occupied by the less fortunate. In Vancouver, each nurse was expected to work a twelve-hour shift in the domicile of a person unable to care for himself or his family. Supplied with food and bedding by a group headed by a local woman – identified only as Mrs Brooks – the nurses understood that they were placing themselves directly in the path of a deadly disease, nursing the sick, feeding families incapacitated by disease, and comforting the dying. In Edmonton, Christina Frederickson was one of the first nurses among many to die. As the Edmonton Bulletin reported, Ms Frederickson had ‘volunteered when the soldiers of the Siberian forces were taken from a troop train some days since suffering from the influenza and placed in

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the isolation hospital to assist in nursing them, and she had been steadily at work with little respite up to the time that she herself became infected with the disease.’83 That the work was dangerous did not discourage volunteers. As one nurse said, ‘It is dangerous – undoubtedly. So is overseas service; yet that did not hinder enlisting to any large extent. It would be better to have the ’flu than to carry through life the uneasy feeling that by your indifference you allowed some other woman to die.’84 Quiney acknowledges that few of these caregivers were professionally trained. This served to highlight the value of nursing as well as the need to register, legislate, and regulate paid nursing work in postwar Canada.85 Magda Fahrni’s case study of women’s voluntary efforts in Montreal suggests that the experience gave them a role that was not only public but publicly recognized.86 The pandemic crisis broke down notions of public and private space as men and women struggled to deal with a true community disease. Fahrni maintains that as volunteer aid workers entered private homes during the epidemic to assist the sick, these visits increased awareness of working-class homes and neighbourhoods, creating new knowledge and temporarily reducing social barriers between classes.87 The permanent result, though, was a heightened awareness of the conditions that many poor Canadian families endured in their daily struggle for survival. When the health authorities in Edmonton sent citizens door to door, looking for families suffering in isolation and silence, middle-class volunteers found squalid living conditions in many parts of the city. One family of six was discovered in a ten- by twelve-foot shack with one tiny window and a door.88 Even though all were sick, the family continued to sleep in the single bed on which the mother and her infant child had died.89 In Montreal, volunteers found families living below street level in houses without any windows or sources of ventilation.90 One family of seven inhabited the basement of an inside court without any heat, food, or water. The father had a broken leg and was unable to assist his sick wife and five children.91 In another Montreal home, a young mother with five children was uncovered by relief workers in a severely weakened condition.92 Although her husband had initially tried to stay home to nurse her, he was told by his employer that he would lose his job if he did not return to work, and he was forced to leave her at death’s door while he went off to work.93 Another volunteer worker entered a tenament in the city to find a sick young mother whose baby was dying of starvation because she was too malnourished to nurse the child.94 Efforts to find the single woman better accommodations initially failed, but public appeals for assistance were eventually answered: an anonymous family agreed to take the both into their home.95

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Nursing and home caregiving familiarized middle- and upper-class women with the daily hardships faced by the working class – hardships that were the result of the inequities of the economic system, but exacerbated by sickness. In the wake of the pandemic and the contact it necessitated across social boundaries, reformers identified poor nutrition, lack of sanitation, and crowded living conditions as the chief causes of flu mortality. While social reformers had long identified poverty as the ‘evil’ that bred sickness, the flu underscored this connection. ‘Housing conditions, lamentable beyond ordinary comprehension, have been brought to light in this city by the Emergency Bureau of the Board of Health,’ reported the editors of the Montreal Star: Human beings suffering from the grippe epidemic were found huddled together in hovels whose unsanitary state was a crying disgrace to any civilised community … The inhumanity of tolerating slums must appeal to all. They are more deadly than war as their destruction of life never ceases … It has been proven in other cities that the enactment of laws pertaining to what kinds of houses shall be rented has struck directly at slums; the owners of these places promptly discovered, they were against the laws and had to be demolished and replaced by much different structures … Similar action ought to be taken by our Administrative Commission. It has far reaching powers and can exercise them in no better way than protecting the public health.96

But it is important to make clear that social reformers did not see the economic system itself as the cause of illness; rather, they correlated the economic ‘choices’ that arose from poverty (shared accommodations, poor diet, and lack of hygiene) with illnesses that posed a potential threat to their own class interests and personal health. The severity of the epidemic among the working class was understood to be a symptom of a much larger problem one that was rooted in basic immorality and social evils. ‘An investigation of the outbreak of the ’flu will reveal that many of the places that were first afflicted were houses, shacks, and hovels not having proper ventilation, sanitation and air space,’ wrote A.W. Coone, the chairman of the Edmonton Relief Committee. ‘The deaths which came under my own personal observation were much larger where these conditions existed than anywhere else. It is quite evident that these unsanitary houses became the breeding ground of the influenza germs.’97 In this cogent analysis, it was the working classes themselves who were to blame for their plight – they were to be pitied and helped, but nevertheless they were responsible. Flu exposed middle- and

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upper-class women to the inequities of industrial capitalism; but it also confirmed the suspicions of moral reformers, who felt that ignorance and a lack of education were primarily to blame. ‘A great many cases came from rooming houses, and places where people live in numbers,’ wrote Mary Ellen Smith in her weekly newspaper column. ‘There are numbers of places in the city where God’s good sunlight and fresh air never enter, where the only air these people get is from dark wells. Surely the people will wake up!’98 For Smith and other reformers, flu revealed the failures and limitations of the moral reform movement and pointed to the need for increased attention to the underlying causes of disease. The available evidence suggests that the working class did indeed suffer a disproportionately high level of mortality during the pandemic.99 The report of Winnipeg’s Department of Health for 1918 divided the city into four districts. Districts A and B – the northwest end of the city – suffered the lowest mortality rates, at 402.2 and 466.5 per 100,000.100 Those districts were less crowded than C and D, which were predominantly populated by the city’s working class and which saw rises in mortality to 836.3 and 672.6 per 100,000 respectively.101 This suggests that mortality was highest in working-class neighbourhoods with high population densities and less where densities were lower. A similar pattern is apparent in Montreal. After the pandemic, the Bureau municipal d’hygiène et de statistique compiled a study of influenza deaths by wards of the city. As Table 7.2 illustrates, the wards with the highest mortality levels were in the eastern part of the city, clustered along the river. These were predominantly working-class neighbourhoods that also had some of the city’s highest rates of infant mortality.102 A comparison of the two columns reveals a correlation of 0.7 between infant mortality and mortality from flu, indicating that the two were related. In other words, wards with high infant mortality were also likely to suffer more heavily from influenza, indicating a link between poverty and flu mortality. The two exceptions were La Fontaine and StJacques, both of which had high infant mortality rates but comparatively few deaths from flu. Both La Fontaine and St-Jacques were long, narrow wards adjacent to St-Laurent and St-Jean-Baptiste, which housed the Royal Victoria and Hôtel-Dieu hospitals. During the pandemic, both institutions opened emergency flu wards, which admitted 517 and 196 patients respectively. As the hospitals primarily took-in working-class patients who had nowhere else to go and who had no one to look after them, it is likely that flu deaths among the residents of both St-Laurent and StJean-Baptiste were much higher than reported – their deaths were trans-

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Table 7.2 Mortality during the 1918 influenza pandemic and infant mortality in Montreal by ward

Ward

Mortality per 1,000 from influenza (1918)

Infant mortality per 1,000 live births (1922)

St-Gabriel St-Henri Ste-Marie De Lorimier Ste Anne St-Denis St-Joseph Laurier Hochelaga Papineau Mercier-Maisonneuve St-Louis La Fontaine St-Georges St-Jacques St-Jean-Baptiste St-Laurent St-André Average

8.35 7.55 7.14 6.70 6.52 6.41 6.28 6.23 6.10 5.22 4.54 4.18 4.12 4.00 3.84 3.57 2.66 2.59 5.30

175.6 212.9 213.8 102.4 182.4 111.0 180.5 98.4 114.8 195.7 123.1 68.9 155.5 43.9 140.7 78.5 49.1 48.6 127.5

Source: Cite de Montréal, Rapport du Bureau Municipal d’Hygiène et de Statistique de Montréal, 1918 (Montreal: A.A. Pigeon, 1919); Terry Copp, The Anatomy of Poverty: The Condition of the Working Class in Montreal, 1897–1929 (Toronto: McClelland and Stewart, 1974), 92–6 at 94.

posed to the districts where they died in hospital. When these two wards are excluded from calculations, the general correlation becomes even stronger: 0.77. If infant mortality is used as a baseline measurement of community health, then the data from Montreal and Winnipeg support a conclusion that mortality from flu was directly related to social class.103 The links among poverty, overcrowding, pre-existing health conditions, and flu mortality were also apparent in rural Canada, where Aboriginal people suffered disproportionally high mortality in 1918 just as they had in 1889–91.104 A Department of Indian Affairs report compiled in 1919 put the flu death toll among Aboriginal people living on reserves at 3,694 people out of a total population of about 106,000, a mortality rate of 34.85 per 1,000 – more than five times the national average.105 In other words, influenza killed nearly 4 per cent of the Aboriginal population of Canada. Communities in the West were again hardest hit; there, 6

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Table 7.3 Comparison of deaths and mortality rates for Aboriginal peoples by province

Province Nova Scotia New Brunswick Prince Edward Island Quebec Ontario Manitoba Saskatchewan Alberta British Columbia NWT Yukon Inuit Canada (non-Aboriginal)

Aboriginal Population

Deaths

2,031 1,846 292 13,366 26,411 11,583 10,646 8,837 25,694 3,764 1,528 3,296

35 74 3 87 622 696 499 539 1,139 – – –

8,100,000

Mortality Rate per 1,000 17.2 40.1 10.3 6.5 23.6 60.1 46.9 61.0 44.3 – – –

50,000 (approx.) 6.2

Source: ‘Influenza Epidemic,’ 28 May 1919, file 851-4-D96 Part 1, vol. 2970, RG 29, LAC and Dominion of Canada, Annual Report of the Department of Indian Affairs for the Year Ended March 31, 1919 (Ottawa: Department of Indian Affairs, 1919), 7.

per cent of Aboriginal people in Alberta and Manitoba and 4.7 per cent in Saskatchewan died in the pandemic.106 At the time, government officials claimed that ‘it was impossible to secure adequate medical attention for the Indians living in the more outlying parts [of the Western Provinces].’107 Even so, Aboriginal mortality in Alberta and Manitoba was nearly ten times greater than the average for Canada as a whole – assuming that the highest estimates of 50,000 total flu deaths for Canada are accurate. As Table 7.3 illustrates, mortality for Aboriginal people in each province was significantly higher than for the non-Aboriginal population.108 Residential and industrial schools were most severely affected by the pandemic because they brought children together in crowded conditions, creating the perfect environment for the virus to spread.109 One school principal called the conditions at his school ‘criminal’ after five children died in two days.110 The experience of the children at the Spanish River school in Ontario illustrates the horror that befell Aboriginal children in the autumn of 1918. The Spanish River Industrial School (later known as Garnier College) was located between the Serpent River and the Sagamok First Nation on the north shore of Lake Huron, about 120 kilometres west of Sudbury.111 In 1915 the Roman Catholic school opened to replace separate male and female industrial schools at Wikwemikong.112 On its opening, the principal, a Jesuit priest

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named L.N. Dugas, reported that the school was ‘equipped with all modern comforts’ and that about 200 acres of land had been cleared by the pupils. ‘The main industry taught the boys is farming,’ he wrote in 1915, ‘but instructions are also given in wood-work and shoemaking. The girls are taught domestic science. Owing to the complete ventilation system installed, the sanitary conditions are excellent.’113 He was wrong. Three years later, the Spanish River school suffered the worst fatalities of any departmental school. Of 208 students who were officially enrolled there, 16 died in the epidemic – a mortality rate of 76.9 per 1,000.114 Yet the department’s annual report for 1919 indicates that only 178 students actually attended the school on a regular basis, which suggests a real mortality rate of around 89.9 per 1,000. Poor sanitation, overcrowding, overwork, lack of nutrition, and physical abuse combined to make industrial schools unhealthy places.115 Although flu affected working-class and marginalized groups most severely, as Alan Kraut concludes, the pandemic failed to trigger ‘a wave of medicalized prejudice’ as had previous epidemics; while classist and nativist sentiments did not disappear, they were not fuelled by the crisis.116 It appears that instead, the flu strengthened communities and united people across class and ethnic divides during a crisis characterized by widespread fear and death.117 It became clear during the pandemic that disease did not cloister itself in one part of the community; instead, it spread across physical and social barriers. Regardless, the severity of the crisis and the mortality rate were both increased by poverty, overcrowding, and other underlying conditions. In the end, the failure to address these issues before the pandemic – and to thus prevent the crisis from unfolding in the first place – was identified as responsible for the unprecedented loss of life rather than immigrants or the working class themselves. In part this was because the epidemic led to contact across diseased boundaries, and Canadians were thereby familiarized with the plight of those who were often seen as the ‘other’ rather than as legitimate neighbours.118 This contact united communities in the fight against the disease and at least temporarily weakened boundaries defined by class, ethnicity, and gender.119 Flu encapsulated a moment ‘when the citizenry could no longer exist as if in separate worlds,’ Esyllt Jones writes. ‘Influenza affected the entire community.’120 In turn, this recognition necessitated a reform of prevailing public health strategies that had clearly been inadequate to the tasks of prevention.

8 The Trail of Infected Armies: War, the Flu, and the Popular Response

In October 1918, Private Victor G. lay struggling to breathe, feverish and alone in Halifax’s Station Hospital. That spring he had been conscripted into the army, and had reported for duty in his hometown of Peterborough, Ontario. After being inducted at Kingston that summer, he shipped east to Halifax. At the end of September, Victor caught a cold that grew rapidly worse. Although he tried to carry on, with a fever of 102.5° and a deep, hacking cough he was taken to hospital on 6 October.1 Like many other Canadians, G. never wanted to serve in the army. He was eligible to join up after the summer of 1915, but his income was needed at home. After his father died, he began working as a labourer in Peterborough, supporting the family as best he could. But the Canadian war effort required soldiers. In the autumn of 1917, Victor was forced to register for service under the new Military Service Act. At first he was granted an exemption because he was his mother’s sole source of support. But in April 1918, Ottawa cancelled all exemptions for men between the ages of twenty and twenty-two, and on 6 May he was called up for service. When he departed Peterborough for Barriefield Camp, his mother was left alone. At 5'7", Victor was of average height but strong, well built, and healthy.2 Certified as front line material by army medical men, the twenty-year-old soldier was destined for the trenches of France. He was just about to go overseas when he took sick in Halifax.3 His illness started with a simple cough. ‘The patient has had a cold for some time,’ recorded his doctor on the 6th. ‘Yesterday he was seized with a severe headache and pains all over his body; his eyes were sore; he was slightly dizzy at times. His present temperature is 102.5°. Patient is

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sweaty and slightly drowsy.’ Until the 9th, his condition remained stable, although he was constantly febrile. By the 10th there were signs of pneumonia in the lungs. Victor’s breathing also became more rapid, rising from about twenty-two breaths per minute to thirty. His pulse quickened as his temperature climbed over 103°. Doctors could do little for him except ask the nursing staff to keep him comfortable and well fed and to monitor the disease’s progress. There were no drugs, no injections, and no magic bullets. Nurses tried to lower his temperature by applying cold cloths and sponges, but there were not enough to go around and his condition worsened.4 On the 11th, pneumonia was confirmed when his temperature climbed to 104°. As his breathing grew more laboured, exceeding forty breaths per minute, Victor lost control of his bowel and bladder functions. The next day his temperature was still above 104° and his breathing was steady at around thirty-five breaths per minute. That night he began to cough up bloody, frothy pus. Filled with fluid, his lungs were no longer absorbing enough oxygen, and he became cyanotic. Doctors noted that his condition was ‘grave.’ But then came signs of improvement. During the night of the 12th, Victor’s temperature dipped below 102° for the first time in nearly a week. For a brief moment it looked like he might recover. The next day, his temperature rose again and his breathing grew more laboured and rapid, climbing to above fifty shallow breaths per minute. Victor was now struggling to breathe. Each rapid, wheezing inhalation drew air into the congested, soggy mass of pus and blood that used to be a pair of healthy lungs. On the morning of 14 October, at about 7:30, his breathing grew shallower still. A nurse recorded that he was taking in excess of sixty breaths a minute. Gurgling with fluid, his lungs could not absorb enough oxygen to keep him alive. At 8:00, Victor G., a conscript, died of the Spanish influenza far from his home and family less than a month before the war ended.5 His body was shipped home to his mother in Peterborough, who buried him beside her husband. It was difficult for her and thousands of other families to find meaning in the deaths of unwilling soldiers whose lives seemingly ended in vain. The pandemic challenged conceptions of public health, divided the medical community, and united Canadians across traditional social boundaries. But it also struck at a decisive moment when Canadians were more divided than they ever had been. In 1914, English Canadians had greeted the war with a certain degree of excitement. While Quebeckers were slower to enlist, the prevailing mood among fran-

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cophones reflected Sir Wilfrid Laurier’s 1910 pledge that ‘when Britain is at war, Canada is at war.’6 Yet Prime Minister Sir Robert Borden was determined to use the conflict to strengthen Canada’s role within the British Empire and internationally.7 He believed that the Dominion could secure a voice in formulating imperial policy – a role that would be won by hard work at home and sacrifices on foreign battlefields. With this goal in mind, between 1914 and 1916, English Canada began to drift away from Laurier’s vision of a limited and voluntary war towards a total war in which the entire state and society would be mobilized.8 By the end of 1916, Borden had pledged an army of 500,000 for overseas service from a country with a total male population of around four million.9 Borden’s overseas commitments made compulsory military service inevitable.10 They also constructed the conflict in moral terms, as a purifying experience that would unify and strengthen the nation by providing Canadians with a collective purpose.11 Yet this also made the war unpalatable for those who regarded it as an imperial, classist, and primarily British struggle – as an opportunity for elites to entrench already dominant English values. As the weight of sacrifice made the war a moral struggle, political opposition to Borden’s vision was conflated with disloyalty and sedition.12 Public support for the government’s war policies thus began to fracture along lines defined more by ethnicity, language, and class than by traditional cleavages between Liberals and Conservatives.13 In this context, old issues like schooling, railway policy, immigration, and minority rights became fresh battlegrounds in the evolving conflict between French and English, East and West, labour and capital, farmer and city dweller.14 The conscription debate during the spring and summer of 1917 broke the Liberal Party in two as English-speaking Grits crossed the floor to form a new Union government with Borden’s Conservatives.15 In the election that followed, the Unionists trumpeted their party as a harbinger of the ‘new politics’ – the war had brought together a politically diverse group of individuals, united by a common desire to transform the Canadian state and society. The Unionists promised to usher in a new, idealistic era in which the power of the state would be harnessed not only to make war but also to bring harmony to industrial relations, reform the morality of the citizenry, and provide for the welfare of the population as a whole.16 They claimed that centralization and collaboration would solve the problems long ignored in a regionalized country divided by language and party politics. Union government would cor-

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rect the ills of urbanization and industrialization and address the underlying social problems that reformers had long identified as responsible for the degeneration of Canadian society.17 On those pledges (and much electioneering), Unionists won a resounding victory in December, cutting a perpendicular line through the traditional Canadian party machinery. By using the language of progressive social reform and the Social Gospel to unite disparate groups across the country, they sparked expectations that Canada had reached a new ‘idealistic moment’ – expectations that no government brought together to support traditional English-Canadian, middle-class, urban interests could ever hope to live up to. In the aftermath of the election rhetoric, though, the Laurier Liberals were left with eighty-two seats, sixty-two of which were in Quebec. In the winter of 1918, Canada was a country divided, governed by an uneasy coalition united by its commitment to the war and by a promise that the trials of conflict would produce a new social contract and a fresh bipartisan political era. Notwithstanding idealistic election promises – and a handful of true believers – the Union government was formed for a single purpose: to sustain the Canadian war effort in a now almost totally militarized society. By 1918, almost 8 per cent of Canadians – 16 per cent of the male population – had enlisted or been drafted into the Canadian Expeditionary Force (CEF).18 There were more soldiers in uniform between July and November 1918 than at any time during the previous four years.19 By the time the pandemic struck, tens of thousands of Canadian parents were already grieving for their dead sons. Over 100,000 more Canadians had been wounded. Families had scraped together donations for the Canadian Patriotic Fund; society women were organizing rallies to encourage the public to buy Victory Bonds. Women were nursing the injured and dying, both in uniform and at home. Gender roles were blurring as men and women increasingly worked side by side in factories and on farms producing goods essential for the war effort. The front page of every local paper, big or small, was plastered with news from the front, while lists of casualties, medal winners, and pictures of new recruits covered the inside pages. When influenza struck in the autumn of 1918, the military was Canada’s largest employer; it controlled the most manufacturing contracts; it administered the largest network of hospitals. Every sphere of Canadian life, both public and private, was tinged with khaki.20 The war effort resulted in an unprecedented centralization of government and the extension of state power into areas of Canadian life

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that had previously been considered private, off limits.21 In a series of speeches in August 1918 that were intended to boost public support for the Union government, Newton W. Rowell, the President of the Privy Council and one of the true believers in Union government, outlined the extent of the measures that had been taken to make war on Canada’s enemies. Between January and August 1918, more than 66,542 soldiers had been sent overseas – double the number dispatched at the war’s outbreak in 1914. At the same time, more than 79,000 had been inducted into the army under the Military Service Act. Soldiers’ pensions and separation allowances for their dependants had been established and were being administered by the government, and the new Department of Soldiers Civil Re-establishment had been created to shepherd returned men from the army to productivity in civilian life. The Imperial Munitions Board had overseen the production of sixty million shells, tendered contracts worth in excess of $1 billion, and managed more than 300,000 munitions workers; the Industrial Disputes Act forbade most of those workers from striking, thus neutering collective bargaining. The War Trade Board was regulating production of raw materials and finished goods in Canada, while the War Purchasing Commission managed the acquisition of supplies for all departments of government – those connected to the war and otherwise. The Canada Food Board and the Food Production Board were managing agricultural production and had increased the wheat crop by more than one million acres between 1917 and 1918 alone. The government was also sponsoring shipbuilding in the Maritimes, and more than 445,000 tons of new shipping had been launched in 1918. Business taxes, income taxes, and luxury taxes were all ‘conscripting wealth’ to finance the war effort. The government had taken control of power generation at Niagara Falls under the Power Controller, Sir Henry Drayton, while a Fuel Controller rationed supplies of coal and petrol for industry and families. The Canadian Northern Railway was in the process of being nationalized, and Ottawa was in talks to acquire the Grand Trunk Railway as well. The civil service, that bastion of patronage, had been reformed, and a Civil Service Commission had been created to reorganize government employees and to manage the exponential increase in the federal bureaucracy. In one way or another, by the summer of 1918 the state controlled most aspects of public and private life.22 Early in the war, Canadians had accepted that such measures were necessary to organize the nation for victory over German militarism. But in the autumn of 1918, as the German army began a massive retreat for

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the first time in four long years of war, the nation began to contemplate the shape of the new postwar world and the central question of the day became this: Should the state relinquish the powers it had acquired in wartime or utilize them to improve peacetime society? As John Herd Thompson notes: ‘The expansion of government power necessary to meet the wartime emergency gave government intervention a sanction which it had not had before 1914. The state became “more than a mere tax-collector or polling clerk,” it became an organization capable of vigorous, positive activities.’23 Wartime centralization and the bipartisanism of Union government thus presented an opportunity to turn the state into a positive force that would advance social change and help build a new and better society. Rowell, for one, believed that the Union government was only ‘at the beginning of its work’ in the autumn of 1918.24 Postwar reconstruction was not simply a matter of returning the country to a peacetime footing; it encompassed a broader debate about the nature of the state, the purpose of government in Canada, and the meaning of wartime sacrifices.25 The realities of a total war were such that by 1918, most families had been touched by grief in some way.26 Almost 2 per cent of the male population died overseas between 1914 and 1918. As Jonathan Vance argues, most Canadians thus needed to believe that the war had a higher purpose. In response to the psychological need to explain trauma and tragedy, the dominant public memory painted the conflict as a moral crusade, using the Christian metaphor of sacrifice and resurrection as an allegory to give meaning to tragedy.27 Soldiers may have died far from home in the mud and blood of Flanders and northern France, grieving Canadians told themselves, but their noble sacrifice would redeem Canada and usher it into a new era.28 Nellie McClung summarized this view for her readers in In Times Like These: We have made our investment of blood. The investment thus made has paid a dividend already, in an altered thought, a chastened spirit, a recast of our table of values. ‘Without the shedding of blood, there is no remission of sin’ always seemed a harsh and terrible utterance, but we know now its truth … When we are face to face with the elemental things of life, death and sorrow and loss, the air grows very still and clear, and we see things in bold outlines.29

As early as 1915, when McClung wrote those words, the war had already become a cleansing force that would have to reshape Canadian society if the sacrifices of Canada’s young men were to be honoured.

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This view reflected the popular discourses of both secular and religious social reformers, who identified collective welfare rather than individualism as the key to the new state.30 The war provided the opportunity for them to realize their goals. ‘The herald of the new age comes in the form of a new social ethics,’ wrote William Irvine in The Farmers in Politics. ‘Everywhere there is evidence of a spirit entirely different from that which was the expression of the individualistic past.’31 The same sentiment was echoed in Mackenzie King’s Industry and Humanity, in the pages of Protestant periodicals, and by politicians from diverse backgrounds.32 ‘Canada should set up a new ideal,’ wrote Clifford Sifton in 1917. ‘It is not successful nation-building to create a cultivated and comfortable class, while the masses struggle for the barest necessaries of life, under conditions which prohibit moral and physical development.’33 As one labour activist wrote: ‘Reconstruction means, in short, that all the activities that go towards the making and distributing of the necessities and pleasures of life shall be taken out of the Individualistic and places on a Social Basis.’34 Reformers and activists believed that the war had to redeem society – that it was a cleansing fire that would spur new growth when it ended. Jonathan Vance argues that the myth of redemptive war extended far beyond the rhetoric of politicians, labour activists, and social elites to encompass a widespread popular view that assuaged grief and at the same time gave meaning to sacrifice: The Great War was a purifying force that could transform anyone, even the most hard-bitten wastrel, into a soldier for righteousness. It was a refining force that ‘revealed the pure gold’ of Canadians by burning off sham and insincerity and laying bare the true nature of the individual … By allowing Canadian men and women to offer their lives for humanity, the war had afforded them the rare opportunity to emulate Christ.35

Average Canadians comforted themselves with the notion that soldiers were dying for a moral and just cause – a higher purpose. Argues Vance: Each death was an atonement, each wound a demonstration of God’s love, and each soldier a fellow sufferer with Christ … The war’s end only served to strengthen this view, and the seed that had been planted took root in the public consciousness as a simple way to comprehend the war … By drawing a parallel between the sacrifice of Christ and the sacrifices of 1914–1918,

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the war took on a sense of purpose. The soldier gave his leg, the woman her husband, and the parents their son’s mind, all to save the world.36

The idealistic rhetoric of Union government and of politicians from every background was thus meant to appeal to a wider public need to explain unimaginable sacrifices and to allow the grieving to go on. It was a myth that served Unionist politicians well in the 1917 election, but it was also one that was difficult to translate into public policy or the pragmatic art of governance. Nevertheless, for many Canadians, talk of wartime sacrifice, reconstruction, and regeneration was not just rhetoric; it reflected ideals they expected the government to honour.37 But by the autumn of 1918, the political consensus that had brought the Unionists to power was beginning to fall apart. Far from addressing the concerns of workers and bridging the interests of industry and labour, Borden’s government cracked down on working-class political organizers, who they feared would be influenced by the Bolshevik revolution in Russia.38 At the same time, the old chasm between English and French had, since the imposition of conscription in late 1917, been growing deeper and wider by the day. Earlier in the war, English papers had accused French Canadians of not ‘doing their bit,’ and there had been persistent rumours of mutiny among French-speaking soldiers. In 1916, there were ‘recruiting disturbances’ in Montreal; in 1917, there had been riots in Shawinigan.39 Now, in 1918, real violence erupted in Quebec.40 In the early morning hours of April Fool’s Day, English troops from Ontario opened fire with machine guns on a crowd of several hundred protesters in Quebec City. Four civilians were killed and many more were injured.41 Returning soldiers, too, were showing signs of discontent. Veterans’ organizations had formed soon after the first wounded began arriving back on Canadian shores in 1915.42 By 1918, groups like the Great War Veteran’s Association had become strong advocates for those who had given life and limb for their country; these groups now began demanding jobs for veterans, land to settle on, pensions, and medical care.43 They argued that soldiers had entered into a covenant with the state when they joined the army – a covenant that included reciprocal obligations to them and their families.44 ‘Let it never be forgotten that, as a matter, of undeniable fact, these men have been the saviours of human freedom,’ intoned the Vancouver Sun in the first week of November 1918.45 It was argued that veterans deserved a prominent place in the postwar economy and society. Many felt forgotten.

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The arrival of flu brought to the fore a growing belief that a gulf was emerging between Unionist rhetoric and practice – between myth and reality – and that the military authorities were sacrificing civilians’ and soldiers’ health to meet the demands of the expanding Canadian war effort. Callous disregard for the lives of Canadians did not go unnoticed or unchallenged, even by Conservative politicians like Tommy Church, the outspoken mayor of Toronto. In the autumn of 1918, the mayor tried to stop the military authorities from loading soldiers onto trains when flu was already rampant in the ranks. Church wrote to the Chief Medical Officer of Military District 2 (Toronto): ‘Certain soldiers [have] been murdered by the military authorities and … as Chief Magistrate [I will] not stand by and see any more of them murdered.’46 He claimed that Toronto’s Base Hospital had become overcrowded with flu cases and was unsanitary.47 In support, he offered letters from a number of Torontonians who felt that their sons had been ill-treated. ‘The place is unsanitary and unventilated,’ cried one anonymous soldier in a letter to the mayor. ‘The men’s bunk houses are a disgrace and smell like a dago sleeping car … One person was notified their boy was dead. Wrong man. Another parent left a sick wife in Quebec to see his dying son at the Base Hospital. He found his son quite well at his unit.’48 Others feared that healthy soldiers were being needlessly sickened at the hospital. Asked one concerned parent: Is it right that boys should be put into such a position when the ‘flu’ is so catching? Think of all the mothers so far away and their boys dying without even a nurse with them in their last moments, and the other boys who are well for the moment sent into this net of infection, with bad coughs and colds, to clean up wards, wash dead bodies, etc. I think it simply awful. These boys also tell me that the Base Hospital is left so dirty.

Sacrifice with purpose was noble; meaningless deaths undermined faith in the cause. In his complaints, Church cited the fact that Toronto men stationed at Camp Niagara – many of whom were destined to head to BC for deployment to Siberia – had been provided with inadequate protection from the cold, wet autumn weather.49 He further alleged that this was cruel and unusual punishment as most other soldiers in the district had already been moved into winter quarters and out of their summer bell tents. He thus requested that the army move them indoors, offering up quarters in the City of Toronto. ‘Could you not,’ he asked, ‘bring

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back the Siberian draft at Niagara? We have good house accommodations at Exhibition for them. Two men of this draft died yesterday from outbreak. Niagara draft really all TO men. Fear further casualties here owing to heavy outbreak of this epidemic at fort Niagara and in Polish Camp. See no reason why Siberian Draft should be singled out and kept there in tents.’50 Church, who was sometimes prone to political posturing, was ignored by military officials, who dismissed his concerns out of hand.51 Instead, the army decided to move the draft from Niagara to BC sooner than planned.52 The newspapers tended to take the mayor’s side. Read an editorial in the Globe: The shocking situation, with its tragic toll of soldier lives, brought about by official carelessness, mismanagement, and neglect in connection with the Base Hospital, has thoroughly aroused the indignant and determined Canadianism of the people in all parts of the country … There is – as there should be – an insistent demand for the dismissal of the [military medical officials], and for the complete renovation and reorganization of that essential branch of the military service which they have shown themselves indisposed or unable properly to administer.53

Reflecting Church’s view, it was not the war effort that the Globe opposed, but how the military set its priorities. This sentiment was shared by other papers all across the country. In Montreal, the Englishlanguage Star reported on the controversy in Toronto almost every day, risking the ire of the Chief Press Censor to describe the inadequate conditions there, as well as the dispute between the military and the mayor; it even applauded a coroner’s verdict against the military after an inquest into one of the deaths.54 In Edmonton, letters from parents to the Morning Bulletin echoed the protests printed in the Globe: ‘We have at least the right to claim something more than sheer neglect of our boys … We certainly had this promptly and full as to those overseas [sic]. This much we should have therefore from medical authorities within this Dominion.’55 A later editorial in the Globe captured the public indignation. The editor of that Toronto paper summed up the crisis, claiming that the military was an ‘arrogant and insolent system, which regards the continued interest and concern of civilians in their sons and brothers after they have become part of the military forces as presumptuous and calling for reprimand and punishment. This is the attitude of Prussianism – and there is no home for Potsdam at Otta-

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wa.’56 The ceaseless pursuit of military aims at the expense of civilian health and welfare was exactly what Canadians had mobilized to combat in 1914.57 The Toronto Base Hospital scandal was symptomatic of a growing sense of disillusionment with the Union government – a disillusionment that the flu brought to the surface. In a series of scathing editorials against the government – even for a Liberal paper – Frank Oliver’s Edmonton Bulletin accused the Union government and the army of undermining public health and the health of Canadian civilians in the absence of any real military emergency. After all, why had it been necessary to mobilize the Siberian Expeditionary Force in October when Germany was already suing for an armistice? Not only did they do nothing to prevent ’flu entering [the country] but since it has entered the military authorities have shipped hundreds of soldiers for the Siberian Expedition across Canada, starting them from the barracks in the east where ’flu was prevalent and transporting them under the conditions that made the spread of the disease certain and with increased virulence. Within the week two train loads of soldiers for Siberia have passed through Edmonton for Vancouver and Siberia … A number of ’flu cases were taken off both trains and cared for by the military authorities. But what must have been the condition of the men in both trains on arrival at Vancouver? Every condition for taking the disease had been provided during the long train journey. Either the disease does not need to be taken seriously – which supposition is directly contrary to the universally accepted facts – or these soldiers of Canada were subjected to disease through the criminal negligence of the military authorities. Every sort of outrage has been justified on the grounds of military urgency. There is no such urgency in the case of the Siberian Expedition now that winter has already set in Siberia. And whatever the urgency, there is nothing gained by shipping men across the continent under conditions that condemn a large proportion to the hospital and some to the grave.58

Canadians had fought a long and hard war, and they clearly expected that the ideals of sacrifice would be honoured. Now many appeared to be dying needlessly and in vain. Wrote Oliver in another editorial: Canada is in the grasp of the worst epidemic of the past fifty years of her history. Her soldiers who enlisted or were drafted to risk their lives in fighting the Huns are being stricken with this terrible disease … Hundreds from

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the ’flu infected camps are packed into a troop train and practically locked up for five days and nights. There can be only one result. Every facility for the spread of the infection is present, and as well every cause by which its virulence can be increased. No wonder the military authorities refuse to allow information to be given out as to the number of deaths which have taken place.’59

Although the Edmonton Bulletin was certainly a partisan paper – as Oliver’s personal mouthpiece, it vociferously opposed Borden and the Union government from 1917 onwards – its criticisms spoke to larger concerns about the power of the state and how wartime centralization should be used to improve or protect the lives of Canadians, not to undermine public health. Oliver was not alone. The Alberta Non-Partisan, for example, a progressive Calgary paper run by William Irvine and dedicated to the principles of the Social Gospel, gave voice to the disillusionment of many western farmers and labour activists, supporting strike actions in Calgary and the West and identifying the central government as an enemy of the working class.60 To say that Oliver and Irvine had different constituencies would be an understatement, but Irvine, too, took the Dominion government to task for its handling of the flu. For him it proved that while Canadians were expected to make sacrifices for the state during wartime, the state had little interest in or sympathy for them. In an editorial, he wrote: The Spanish ‘Flu’ is a plague which has now spread so far as to be beyond control. We must put upon the shoulders of our governmental authorities at Ottawa the blame for many of the deaths which this scourge has caused, and once again it has been demonstrated that business is more important in the mind of the Government than human life. Even from this viewpoint it is a case of being ‘penny wise’ and ‘pound foolish.’ There was no prompt action or real effort made to prevent the influenza plague getting further West than Toronto. Where was the Order-in-Council prohibiting all travel until such time as the plague subsided, and making provision for the proper disinfecting of all mails, express, and freight? This would have interfered with profits and dividends so was not done, but the disease itself has interfered to the extent that traffic has been seriously interfered with … If the Dominion Government had acted … promptly and effectively … there would have been much less ‘flu’ west of Toronto and hundreds of lives have been saved.’61

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Irvine’s criticisms centred on the government’s inability to coordinate a uniform response across the country. He contended that it had been too laissez-faire and that it had failed to intervene in time to prevent the pandemic from spreading westwards. Wartime centralization meant that Canadians had seen the ability of the government to intervene not only in the affairs of the provinces and municipalities, but also in the lives of average citizens.62 If the state could mobilize to move hundreds of thousands of men overseas, retool industry to make war materiel, and rewrite relations between labour and capital, surely it could manage to organize an effective response to the epidemic of influenza. Nowhere did the idealistic rhetoric of the Union government ring more hollow than in Quebec.63 French Canadians had greeted war in 1914 with less enthusiasm than their English counterparts to be sure, but few outside of radical circles thought that Canada should stay out of the conflict altogether.64 But as the war intensified, Quebeckers increasingly came to argue that Canada’s greatest contribution should be economic and voluntary; certainly, it should not be enforced through conscription.65 In the event, Wilfrid Laurier’s Liberals argued against compulsion and were left with only eighty-two seats in Parliament, sixtytwo of which were in Quebec.66 Nevertheless, the Military Service Act was imposed to solve the military’s problem of dwindling voluntary enlistments and to ensure that a sufficient number of replacements could be found for casualties overseas.67 In the autumn of 1917, every man between eighteen and sixty was ordered to register for possible military service. Of the 332,000 who had registered by 10 November 1917, 93 per cent had asked for an exemption from the draft for medical, religious, personal, or economic reasons. Most such exemptions had been granted to secure the vote of the farmers, but in April 1918 those same exemptions were cancelled and most of those who had registered the previous fall were legally required to report for duty.68 Draftees who had failed to comply with the provisions of the Military Service Act were granted an amnesty until 24 August 1918, when they had to appear at a barracks or a recruiting centre to be registered and inducted into the service. At the end of August, the government began efforts to apprehend those people who had defaulted on their obligation to the state. While the military believed that the draft was necessary to sustain the war effort, in Quebec the imposition of conscription during the epidemic crisis only confirmed that English-speaking Canadians had little concern about wasting French lives.69 Defaulters were pursued across Canada, but the military authorities

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focused their efforts on Quebec. Soldiers in groups varying in size from a couple of dozen to several hundred men – ‘special service detachments’ – were assigned to apprehend French Canadian draft dodgers.70 These roving bands were tasked with ‘raiding theatres, pool-rooms and visiting, by night, that part of the [cities] occupied by the labouring class.’71 They roved the countryside, searching lumber camps and farmers’ fields for defaulters.72 If any were discovered, the treatment meted out was brutal: [A]ll deserters and absentees without leave should be punished no matter what their medical category … even if they cannot be made use of for strictly military service and even if they … have never been on duty … field punishment number two (to twenty eight days when imposed by a Commanding officer, or to three months when imposed by a court martial) will be found a convenient punishment to impose.73

Field punishment ‘number two’ consisted of forcing a prisoner to perform hard labour while restrained in iron shackles. All across Quebec this search for deserters, absentees, and defaulters intensified during the pandemic period. Special Service Detachment Number 1, administered out of Quebec City, set out to apprehend defaulters throughout October and early November. Between 1 October and 13 November, this small detachment of soldiers dealt with more than 300 men under the provisions of the Military Service Act. Groups of soldiers travelled across the Quebec countryside searching the woods, lumber camps, and villages.74 On 3 October, soldiers stalked the streets of Laterriere and Hebertville; on the 8th, those of St-Gédéon. On the 15th – by which time influenza had broken out within the unit itself – two parties went to Lake Edward and St-Fulgence; on the 25th, Bagotville was searched. On the 28th, the same detachment returned to Laterriere, where two prisoners were taken. On 1 November, it was in Chicoutimi; on the 2nd, in Chambord. On the very day the armistice was declared, a party of Special Service soldiers searched the village of Jonquières and subjected two defaulters to field punishment number two.75 The French-language press was quick to challenge the need for such harsh tactics, especially during an epidemic. La Patrie questioned whether it was prudent to search the streets and houses of the city for defaulters while public health authorities were attempting to restrict public gatherings and the movements of people through public spaces:

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Il semble qu’il n’est guère sage d’arrêter chaque jour sur la rue des centaines de jeunes gens et de les conduire sur la rue Peel ou la rue Guy. Les autorités militaires prétendent que la police ne recherche pas les nouveaux conscrits se contentant de mettre le grappin sur les déserteurs. D’aucuns croiront que dans les circonstances il serait plus sage et plus prudent d’attendre que l’épidémie ait disparu avant de pourchasser les déserteurs. Si l’on veut enrayer les ravages de l’épidémie le plus vite possible il ne faut rien négliger. Les autorités militaires doivent seconder les efforts des autorités municipales et du bureau d’hygiène.76

La Patrie further alleged that these nocturnal raids would needlessly sicken innocent men as they were detained in police stations and military barracks. When the innocent were released, they might return to their families carrying influenza. ‘Dans ces arrestations nocturnes d’hommes qui paraissaient être d’âge militaire, certains agents amenaient des conscrits,’ read an 11 October editorial, ‘dont les papiers étaient complètement en règle. On les relâchait vers les 10 heur du soir. Plusieurs passaient la nuit et s’éveillaient le matin complètement « grippés »; par le contact de leurs compagnons déjà malades.’77 Henri Bourassa’s Le Devoir expressed a similar view. On 5 November that paper reported that ‘plusieurs personnes … ont protesté contre cette mesures qui exposait les jeunes gens à contacter la grippe aux casernes ou la maladie n’est pas encoure complètement disparue.’78 While such attacks were clearly part of a larger and terribly partisan debate about the need for conscription, flu provided a vehicle by which the Union government might be subjected to direct and less divisive criticism. Whatever the press’s political motives, these were not baseless accusations: innocent civilians who were sent to infected barracks and who then returned home to their families could well be expected to spread disease. The newspapers were banking on the fact that even those who supported conscription might find fault with a careless application of the Military Service Act during a major epidemic, especially when civilian officials were attempting to limit mortality through far-reaching non-pharmaceutical interventions. A key question sat at the heart of the debate: Was the war effort (as embodied by conscription) more important than protecting the lives of those at home? Civilian public health officials answered in the negative, arguing that regardless of military necessity, the health of the community was of primary importance. As others had suggested in the Englishlanguage press, a war effort that claimed to be protecting Canadians from ‘Prussianism’ overseas could not simultaneously endanger the lives

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of those at home without real necessity. With Germany’s allies capitulating and the kaiser’s army mounting a headlong retreat for the Rhine, it was questionable whether that necessity actually existed. On 10 October a delegation from Montreal’s Board of Health met with General Wilson, the Commander of Military District Four, to demand that he stop contravening their ban on public gatherings. ‘Il est tout simplement insensé,’ the physicians told Le Devoir, ‘pour la police militaire de parquer au poste de police No. 4 dans une salle grande comme la main, une centaine de jeunes gens an moment précis ou le bureau d’hygiène défend tout attroupement. Il va falloir que cela cesse immédiatement.’79 The military was unmoved. Provincial politicians also weighed in on the debate. In the third week of October, Arthur Sauvé, the leader of the provincial opposition, echoed the board of health’s demands when he wrote to the military authorities to ask that recruiting under the Military Service Act be suspended. Sauvé claimed that ‘the military police continued their work, in the town and throughout the countryside, taking men without mercy to the barracks, where the epidemic was prevalent’; and he asked that all recruiting be stopped for the duration of the crisis.80 Although he did not support conscription, Sauvé was not as radical as Bourassa and had actually publicly opposed the Francoeur Motion earlier that the year.81 But like the editors of the French-language papers and officials on Montreal’s Board of Health, Sauvé believed that the enforcement of conscription posed a very real but unnecessary risk to the health of the civilian population of Quebec. In an attempt to force the military to respect the demands of civilian officials, on 31 October 1918, Quebec’s Central Board of Health passed a resolution that read: ‘Whereas the transport of conscripts is the cause of the dissemination of influenza and is also dangerous to the conscripts themselves as well as to the localities to which why are taken, the Central Board of Health demands that no transport of conscripts shall be made during the prevalent epidemic. This is to include absentees without leave.’82 But the provincial board lacked the authority (or the power) to impose its will on the military. Senior army officials in Quebec decided to ignore the province’s orders after confirming their right to do so with the Minister of Militia and Defence in Ottawa.83 It was more difficult for military officials to ignore the rising public anger. In response, they issued denials, promising to protect civilian public health. ‘Since the epidemic of influenza reached such grave proportions the pursuit of draftees by the military police had been called

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off,’ General Wilson told the Montreal Gazette in mid-October. ‘No more men were being called out by the registrar, nor would be until the epidemic was ended … The only work being done by the military police since the outbreak of the epidemic had been the securing of deserters and this had been done under great precautions.’84 Officially, the call for new draftees had been temporarily suspended on 4 October.85 In reality, the search for existing defaulters continued unabated. On 8 October the military police turned over seventeen men ‘of various nationalities’ to the 2nd Quebec Regiment for induction.86 The next day, the 4th Battalion of the Canadian Garrison Regiment sent out a party of more than one hundred men ‘for the purpose of assisting the Assistant Provost Marshal in enforcing the provisions of the Military Service Act.’87 An order dated 11 October 1918 from the Assistant Provost Marshal of Military District 4 ensured that nothing changed: Adverting to our conversation of yesterday regarding men apprehended by Military Police on the streets, and taken to the Depot Battalions, the procedure is as follows: Those whose papers do not satisfy the Officer Commanding of the Detachments operations on the streets are sent to the offices of the Civil Section CMPC No. 4 Detachment, 144 Drummond Street, and I might say in passing that this building has been thoroughly fumigated. There papers are then examined by the Deputy Inspector without delay and those whose papers are satisfactory are released and allowed to go at once. With regard to those whose papers are not satisfactory, or who have not registered at all, our Deputies immediately get in touch with the Registrar’s officer … [and] the Registrar’s Dept. then gives a ruling on the case and if the man’s registration papers and category are such as to allow his release, he is immediately liberated, otherwise he is sent to the Depot Battalion, as ordered by the Registrar.88

The provisions of the Military Service Act and the pursuit of violators continued beyond Montreal’s city limits in towns such as St-Agathe, Valleyfield, and St-Hyacinthe.89 The military authorities maintained that a strict enforcement of conscription needed to be sustained and that officials in Ottawa never intended subordinates to suspend the call for draftees or operations to apprehend deserters. On 21 October 1918, the Adjutant General in Ottawa clarified headquarters’ position on the administration of the Military Service Act during the influenza epidemic: ‘Registrars not to be

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requested to discontinue ordering men to report, but you may, at your discretion, after consulting with the Assistant Director of Medical Services [in each district], take steps to prevent temporary assembly of men in Barracks.’90 Instead, officials decided to extend harvest leaves for those who had already reported, thus protecting healthy soldiers from becoming infected. Defaulters who were captured or men who reported voluntarily for duty were also granted temporary leave for the duration of the epidemic, but only if it could ‘be done without danger of losing the men.’91 Then, on 25 October, the military quietly began to resume calling up all draftees for service. In a memorandum titled ‘Influenza Epidemic,’ an officer at the headquarters of Military District 4 asked the registrar in Montreal to ‘please start ordering men to report for duty, at the same rate you were doing immediately before the Epidemic, we can then gradually speed up as you think fit.’92 The epidemic was just reaching its peak. The Borden government had been elected on its promise to usher in a new, bipartisan political era that would use the war effort to regenerate Canadian society. While many in Quebec had initially been sceptical of such promises, English-speaking Canadians lost faith much later.93 For those Canadians who lost a loved one in the war, the idealistic rhetoric that characterized the public face of Unionism spoke to a public and private myth that gave their sacrifices meaning. In equating death in battle with Christian notions of redemptive suffering, Canadians required that military authorities honour the sanctity of the covenant that had been struck between citizen-soldiers and the state: deaths should not occur in vain and must serve a higher, redemptive purpose. The military’s handling of the pandemic in military and civilian contexts was interpreted in both French and English Canada as a rejection of this sacred covenant. Actions that seemed callous or careless undermined individual notions of redemptive sacrifice and the ideal that the war was a collective action fought to secure a better future for the nation as a whole. It also seemed to fly in the face of propaganda which claimed that the war effort would protect civilians from German aggression and unbridled militarism. It was difficult to maintain the façade when the military ignored and actively disregarded warnings and directives from public health officials, provincial politicians, and newspapers. Public indignation reached a high point when it appeared that the health of individual soldiers and the civilian population was being sacrificed without any apparent military necessity. Whether it was the SEF bringing flu to the West, soldiers dying at the Base Hospital in Toronto, or

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conscription in Quebec, critiques focused on the lack of adequate public health protections and the callous actions of government officials. Wrote one newspaper editor: ‘The military authorities seem to take the view that the way to deal with a virulent epidemic is to ignore its existence, and if they can keep the facts from getting into the papers, all is well. The deaths of a few common soldiers – draftees – is neither here nor there.’94 The military’s handling of the flu crisis caused latent disaffection to crystallize.

Dr. Frederick Montizambert when he was Quarantine Officer at Grosse Isle, 1880. McCord Museum, Montreal, II-55687.1.

Dr. John A. Amyot became the first Director-General of the Federal Department of Health in 1919. Courtesy of the Canadian Veterinary Medical Association.

KONTREAL'S lo"IGJlT.>U.YOR ON WS GHASTLY ROUNDS. lplUICAUD 1'0 T• l UOA~ Ot U CI.L'JU.)

An 1875 lithograph illustrating the linkage between industrialization and miasmatic conceptions of disease. McCord Museum, Montreal, M992X.5.82.

.

·.

.

Cartoon satirizing Charles Hastings efforts at sanitary reform in Toronto, c. 1910–1914. The caption reads ‘MHO Hastings: I had no idea you needed cleaning up so badly.’ Archives of Ontario, I0006074. Used with permission.

Grosse Isle Quarantine Station’s disinfecting building and detention quarters, c. 1900–1905. Library and Archives Canada, PA-148826.

THE K IND OF "ASSISTED EMIGRANT" W E CAN NOT AFFORD TO ADMIT.

A July 1883 illustration from Puck magazine illustrating the popular link between cholera and immigration in the United States, a sentiment shared by many Canadians. From the Bert Hansen Collection, New York. Used by permission.

Immigrants awaiting medical inspection upon entry into Canada, place unknown, c. 1890–1910. Library and Archives Canada, PA-122657.

Members of the SEF being inspected in their camp at Vancouver before embarking for Russia. 9 October 1918. City of Vancouver Archives, Mil P13.3, PN 6591.

The steamship Monteagle leaving Vancouver carrying members of the Siberian Expeditionary Force to Russia, 17 November 1918. City of Vancouver Archives, 99-679.

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Clf:i~o- ()F ltl.t SrA/Un lt¥'N1'1r)',

Cartoon from the 26 October 1918 issue of the Calgary Herald satirizing the Department of Health’s order forcing all citizens to wear masks when outside their homes.

WE. SHOULD

WORRY

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Cartoon from the Alberta Non-Partisan, 6 November 1918, 9.

Alberta was one of the few jurisdictions to require that masks be worn in public as these telephone operators demonstrate for the photographer. Glenbow Archives, NA-3452-2.

The employees of the Calgary branch of the Canadian Bank of Commerce demonstrate their compliance with the Department of Health’s mask order. Glenbow Archives, NA-964-22.

Victory parade in Calgary, November 1918. Note the masks being worn by the crowd. Glenbow Archives, NA-3965-7.

Surgeon-General Guy Carleton Jones (left) and General Sir Sam Hughes (right). Library and Archives Canada, PA-007240.

9 ‘The Nation’s Duty’: Creating a Federal Department of Health

The widespread critique of the government’s handling of the epidemic was accompanied by demands for significant reforms to Canadian public health policy. Wrote William Irvine in the Alberta Non-Partisan in November 1918: The epidemic known as the ‘Spanish flu,’ which has ridden rough shod over so many Canadian homes has like the Great War, compelled us to see our weakness through tears and sorrow…. The Great War put many of our boasted institutions to a test so severe as to overthrow them and render imperatively necessary the building of new institutions to more adequately meet human demands. In a similar manner the common danger from a plague pointed out to us that the old way of dealing with the matter of public health can no longer be tolerated … The way has therefore been opened for a complete change of aim and organization with respect to the forces available for the protection of human health and life … The state must assume responsibility for the health of the people, and must take control of the institutions necessary.1

For Social Gospellers like Irvine, the dual tragedies of war and epidemic signalled the need for collective repentance while proving the necessity of national regeneration. Both revealed underlying failures of governance and the need for significant change. But achieving reform in the realm of public health would require abandoning contaminationist strategies to refocus on positive interventions aimed at promoting collective health. It would necessitate a shift away from exclusion towards active prevention, a step that Canadian politicians – unlike their European and American counterparts – had been reluctant to take.2

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This shift in emphasis had begun decades earlier across the Atlantic and south of the border, signalling a fundamental and larger change in the nature of the state. ‘From the end of the nineteenth century, change in the economic and social structures of industrial and industrializing societies were shadowed by ideological shifts,’ writes Dorothy Porter. ‘These changes resulted in a renegotiation of the relationship between the state and civil society which had significant implications for the meaning of citizenship in modern societies.’3 Germany, between 1883 and 1889, was the first European country to establish a national health insurance system as well as to make provisions for worker’s compensation, old age security, and disability insurance.4 These programs operated on a co-payee basis, with employers paying one-third and employees two-thirds of premiums.5 Sweden and France established similar national insurance programs in the early 1890s, and Great Britain passed health insurance in 1911 under David Lloyd George’s direction.6 In the British system, employees paid 4d per week, employers 3d, and the state 2d.7 In return for their contributions, workers gained access to medical care from a ‘panel’ doctor as well as weekly payments in case of injury. These classical welfare programs were predicated on the assumption that the state had an interest in securing the health of its collective citizenry.8 The move from an individualist to a collectivist philosophy of national health in Europe can be explained in part as an elite-sponsored official response to the traumas of industrialization and urbanization. As traditional familial and community networks of social assistance were fragmented and even eliminated by the move towards comparatively anonymous urban environments, the state gradually stepped in to fill the gaps.9 Early welfare and insurance programs were designed as much to limit the influence of socialism and to reduce the economic inefficiencies caused by workers’ sickness as they were to improve the wellbeing of the working class. But as Porter argues, a late Victorian shift in ideology ‘away from individual freedom and towards collective responsibility of the state for its citizens’ is equally important in explaining the rise of the classical welfare state.10 By the turn of the last century, the ideas of Herbert Spencer, John Stuart Mill, John Ruskin, and Francis Galton had begun to influence how elites perceived the social body.11 No longer was it seen as ‘a collection of freely competing atoms’; rather, it was an organic whole. Social Darwinist ideas about race and the competition for scarce resources were making their influence felt; by the early decades of the twentieth century, promoting a healthy social body had become an important aspect of domestic security.12 Healthy bodies fos-

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tered a more productive nation, stronger armies, and a more competitive state. Unhealthy bodies threatened to undermine collective security and national potential.13 In Britain, at least part of the impetus for this shift was the Boer War, during which it was revealed the extent to which industrialization and unhealthy urban environments had made British bodies unhealthy.14 As men joined the army to fight in South Africa, three in five were rejected as medically unfit because of conditions that could be related to malnutrition, overcrowding, and poor hygiene.15 This provoked a wave of elite and popular criticism in Britain, stoking fears of social degeneration and ‘race suicide.’16 At the same time, eugenicists identified the ‘feeble-minded’ as posing a similar threat to national health, arguing that alcoholics, the promiscuous, and the disabled were contributing to the decline of British society and weakening the social body.17 Maternal feminist organizations added their voices to the chorus by identifying motherhood and childhood as especially dangerous times of life: if properly managed, they would create healthy citizens; if mismanaged, the nation might be weakened.18 These disparate perspectives were united by a focus on urbanization and poor health and the impact of both on the quality and quantity of population.19 A similar ideological shift was evident in the United States. The new public health of the laboratory that emerged in the last two decades of the nineteenth century emphasized the social practices that enabled bacteria and viruses to spread and called on the state to take a more interventionist approach with regard to eliminating the sources of disease in the nation’s cities.20 In this cause, public health reformers found allies in the Progressive movement, which identified industrialization and urbanization as the sources of social and bodily evils.21 By the end of the nineteenth century, public health reformers and Progressives were arguing that public health policy should be removed from the influence of local, interest-based politics and placed on a scientific footing at the national level; this would unite fragmented and unevenly developed bureaucracies under one central planning agency.22 Concurrent successes in combating yellow fever during military expeditions to Cuba and Panama in the late nineteenth and early twentieth centuries led American public health officials in the national Marine Hospital Service to apply their findings to similar epidemics in the United States.23 Their methods included ‘compulsory notification of infectious diseases, isolation of sufferers and their families, tracing contacts, laboratory diagnostic testing of “carriers,” and voluntary immunization’ –

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all fundamental to the new bacteriological and social public health.24 In 1912, Congress created the U.S. Public Health Service, which was tasked with studying the conditions behind ill health in the United States and educating the public to produce healthier citizens. By the time the Great War began, the U.S. Public Health Service and the Rockefeller Foundation had ‘bec[o]me the major agencies involved in public health activities, supplemented on a local level by a network of state and city health departments.’25 The movement towards a collectivist mentality of public health in Britain and the United States was precipitated by fears about the health of the social body. Once the nation came to be viewed as an organic whole rather than an assortment of unrelated individuals, disease, poverty, and ignorance became threats to everyone rather than only to isolated segments of society. It was now held that chronic problems – non-contagious nutritional conditions such as rickets and pellagra, for example – posed a threat to economic stability and the capitalist system, for such diseases weakened bodies and thereby lowered productivity and potential. The ‘new public health’ enabled reformers to identify the sources of these various health problems, and to propose solutions. Across Europe and North America, national public health strategies were formulated and given substance in bureaucratic structures that took a more interventionist approach to governing the health practices of the social body. These ranged from the classical welfare strategies of Lloyd George’s 1911 health insurance program to the creation of national activist agencies like the U.S. Public Health Service, whose tasks were to gather information about disease, educate the public, and coordinate the activities of local public health agencies.26 These external developments had not gone unnoticed in Canada. The creation of the Canadian Public Health Association in 1910 signified a growing demand for change within the medical profession and among public health advocates. In one of the first issues of that organization’s Public Health Journal, Peter H. Bryce explained exactly what reformers meant by national health and why attention to the problem was of immediate importance. He argued that while the term ‘National Health,’ for the general public, implied a measure of the number of deaths within a given population, ‘from a national standpoint, it may further be understood as indicating the maintenance of the largest possible number of effective citizens, viewed from the standpoint of their economic value to the state.’27 Bryce and his contemporaries feared that inattention to

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national health would endanger the nation itself. Healthy bodies, they reasoned, were necessary in order to exploit natural wealth.28 Promoting national efficiency, reformers suggested, required a national agency to manage public health. Argued an editorial in the Canadian Public Health Journal: It is becoming increasingly more evident that real co-ordination of public health matters in Canada can be accomplished only through a Federal Department with real power to co-operate with the various Provincial Boards of Health and to organize extra-provincial as well as intra-provincial work. Canada is big enough to establish and maintain a Federal Department of Health which will command respect and consideration … one which would make certain that every Canadian present and future, enjoys a maximum of good health, reasonable hours of labour, health insurance, and other benefits which as citizens of a country of great natural wealth, we are entitled to.29

As in the United States, Canadian physicians were joined by a chorus of social reformers who saw scientific management – through the aegis of the bureaucratic state – and public health education as the solutions to a whole host of social problems. Both before and during the war, the National Council of Women was one of the most vocal advocates for a federal bureau.30 Early in Borden’s first term, a 1912 resolution drafted by Florence G. Huestis, Mrs Campbell Myers, and Hattie Austin of the organization’s Toronto chapter demanded that Ottawa create a specialized department. Their resolution specifically called for an arm of government that would ‘deal with the sanitary supervision of interprovincial and international railways and steamers; the examination of all immigrants; the care of quarantine stations … and with the general furthering by means of Bacteriological, Physical, and Sociological Research of all questions of health as applied to the inhabitants of the Dominion of Canada.’31 Led by Jennie Smillie of Ottawa, the National Council of Women gradually expanded its vision for a new department to include the investigation and restriction of venereal disease, prostitution, and tuberculosis, as well as child welfare and food safety.32 Reformers feared that as a result of increased urbanization and a corresponding weakening of traditional familial oversight, prostitution, venereal disease, and rooming houses were creating a moral and public health crisis in the nation’s cities.33 If the families of the future were to be saved, people

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would have to be educated about the dangers and ultimately protected from themselves. Dr Margaret Patterson, the future magistrate of the controversial Toronto Women’s Court, before the war had been convener of the Toronto Committee for the Prevention of Traffic in Women and Equal Moral Standard. In March 1918 she wrote: It seems to me that the need at present is to have Venereal Diseases added to the list of contagious diseases in every province in the Dominion … to have proper custodial care of the feeble minded, so that the great supply of prostitutes (80% of whom are mentally sub-normal), may be stopped, and that each city should cause all the boarding or rooming houses to be licensed and under proper supervision and to keep a registry of all inmates of the house … We must take courage to attempt great things.34

Regulating venereal disease, collecting vital statistics, and coordinating public health activities across the Dominion would require an expansion of the apparatus of government and a redefinition of its powers. But Borden understood that meddling in the affairs of the provinces remained politically difficult and that administrative reforms carried little political currency and some risk.35 ‘If people would only realize [that] the accomplishments of governments really rest in the people’s hands,’ complained the editors of Canadian Public Health Journal. ‘Public Opinion is the strongest factor in producing reforms, and it is not the opinion of a few men in a cabinet but of the people at large. The people can have exactly what they want if they take the trouble to ask for it [emphasis in original].’36 As the Great War began, the federal approach to public health in Canada continued to be based on the assumption that the Dominion was an inherently healthy place. The federal role was limited to keeping the grand watch at the approaches and excluding immigrants who might pollute or contaminate the social body. This mentality was forged during previous epidemic threats, and while these contaminationist strategies had been challenged by social reformers at various times, quarantine’s apparent success remained unimpeached. Advocates of the status quo could point to the fact that not since the 1850s had a major epidemic disease breached Canada’s outer defences. In the absence of any meaningful, new threat, there had been little incentive for change. As a result, while successive governments from Macdonald to Borden were willing to consider consolidating the existing federal role in inspecting immigrants, managing ‘foreign’ diseases, and maritime quarantine, they

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refused to expand the central government’s mandate into areas that were seen as provincial or municipal responsibilities.37 The Great War and the 1918 influenza pandemic proved to be the dual crises that together created the momentum necessary to precipitate change. Just as the Boer War had revealed serious deficiencies in the health of British recruits, the Great War proved that Canadians were not a strapping group of rustic, burly lumberjacks and frontiersmen. As the Colonist (Victoria) noted, the enumeration of manpower mandated by the Military Service Act had been a form of self-examination.38 As recruiters shone light into every dark corner of the Dominion, they found a population that was malnourished, underdeveloped, and prone to sickness.39 Tuberculosis, venereal disease, and ‘feeblemindedness’ seemed to exist on a scale that even sanitarians, Social Gospellers, and public health reformers had not imagined. ‘There has been a rude awakening from the complacent fallacy that the proportion of the unfit to the general population is negligible,’ wrote Lieutenant-Colonel J.L. Biggar of the Board of Pension Commissioners. ‘The most authoritative information goes to show that one man in every four of those of military age was found to be incapable of active service because of physical unfitness, and that this, in the majority of instances, was the result of preventable disease.’40 Of the 261,695 soldiers who had been examined under the Military Service Act in 1917–18, 181,225 – almost 70 per cent – were declared physically unfit to serve in the army.41 If the war gave the lie to the notion that Canadians were inherently healthy, it had also made them an unhealthier people. By the autumn of 1918, 172,000 Canadians had been injured or wounded overseas.42 Many would require some form of medical care when they returned home; some would require state assistance for life. Venereal disease was one of the army’s greatest scourges. During the war, 66,083 cases had been reported among Canadian soldiers – as many as 16 per cent of the Canadian Expeditionary Force, 4.5 per cent infected with syphilis alone.43 Canadian military officials, moral activists, and physicians feared that when the war ended, these soldiers would spread the disease to innocent Canadian women at home. Early in 1918, Ontario passed legislation that, in Jay Cassel’s words, was ‘severe and thoroughgoing. The regulations specified the forms to be used in reporting and recording cases, outlined approved courses of treatment, listed recognized drugs, stipulated what a person infected with VD had to do, and set penalties for non-compliance with these additional laws.’44 Most other provinces quickly followed Ontario’s lead, although Quebec

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did not pass its act until 1920, and Prince Edward Island waited until 1929.45 Pressure mounted in the autumn of 1918 and into the winter of 1919 for the creation of a federal branch of government to oversee VD management across the Dominion and to coordinate the provinces’ efforts before the soldiers returned home. In October 1918, Mr Justice Hodgins tabled his Report on Venereal Disease, which argued that a federal department of health was necessary to control the disease across the country.46 If Canada was to become a ‘home fit for heroes,’ then venereal disease would have to be eradicated across the nation as a whole.47 Although public health reform found new supporters during the war, it was women’s voluntary organizations – groups that had long sought to harness the power of the state to achieve moral and sanitary reforms – that continued to form the vanguard of the movement. Diverse groups shared the view that women should be mothers to the nation, applying ‘natural female’ instincts to nurture and care for the family to the larger social and political concerns of the nation.48 The vote, suffragettes argued, would best be used to secure legislation against a variety of moral evils and to protect the country’s future. During the contentious 1917 conscription election, the wives, sisters, and daughters of serving soldiers had been given the vote by the Union government in the expectation that they would cast their ballots in favour of conscription and Borden’s government.49 This also served to give new political impetus to the causes of English, middle-class social reformers – exactly those also most likely to have a male relative serving overseas. Together they sought an opportunity to remove the various ‘evils’ of urbanization and industrialization through a series of federal initiatives. Prohibition had been one of the main concerns for groups such as the Women’s Christian Temperance Union.50 Booze, reformers argued, was a genuine social ‘evil’ that led to unemployment, poverty, and illness, thus affecting the well-being of the family and hastening the process of moral and physical degeneration that they thought plagued urban society.51 Although not all women’s voluntary organizations agreed that temperance was necessary, the politicization of the female vote in 1917 helped prohibitionists win their crusade: they achieved a national ban on the import and sale of alcohol in Canada except for medicinal purposes.52 The imposition of national prohibition illustrated for reformers the power and sweeping effectiveness of the centralized approach to what had formerly been considered a purely local problem. It opened the possibility of furthering other long-standing goals in a similar way, of

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harnessing the central government’s power to tackle all the ‘evils’ that threatened national health and efficiency. Following the election, middle-class women quickly became a new and effective voice in federal politics, for the Borden government recognized the necessity of courting the support of the voters who had helped keep the Union government in power. To this end, on 28 February 1918, the government called a conference in Ottawa of leading women’s groups from across the country to engage women in political processes and to formulate ‘with the War Committee [of the Cabinet] plans for their wider participation in war work.’53 The Unionist representatives included Sir George Foster, C.J. Doherty, J.A. Calder, Thomas Crerar, S.C. Mewburn, and Newton Rowell – the Borden cabinet’s leading lights. The female delegates, numbering more than seventy-five from all nine provinces and the territories, included the heads of the National Council of Women (NCW), Féderation Nationale St-Jean-Baptiste, the IODE, the Canadian Suffrage Association, the National Equal Franchise League, and the Women’s Christian Temperance Union.54 Rowell, who presided over the conference as vice-chair of the committee and President of the Privy Council, asked the delegates to consider how the women of Canada could contribute to such matters as ‘increased agricultural production, commercial and industrial occupations, the compilation of the national register, conservation of food and the further development of a spirit of service amongst the Canadian people.’ But the women who attended the meeting were more interested in furthering their own reformist agendas. After listening to several hours of speeches from cabinet members, Mrs H.P. Plumptre took the chair and the delegates promptly agreed that the first item of business would be a discussion of national health and child welfare.55 The delegates formed committees to look into press propaganda and cooperation between women’s organizations, as well as several of the issues identified by Rowell, but they were anxious to air a specific grievance with the government. Since the turn of the century, the National Council of Women and other voluntary organizations had been advocating for the creation of a federal department of health and welfare to address tuberculosis, venereal disease, child poverty, urban housing, health and hygiene education, and drug use, among other pressing social issues.56 The Women’s War Conference presented an opportunity to again press the government on the issue – this time from a position of greater political power.

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The committee convened to examine the question in detail was chaired by Helen Reid of Montreal. Reid was director of social work for the Montreal branch of the St John’s Ambulance, as well as a poet and valedictorian of her 1889 graduating class at McGill.57 She was an experienced reformer and social activist; under her guidance, the committee outlined the need for a federal department to oversee the registration of births, protect milk supplies, safeguard the nation against the feebleminded, establish prenatal care, create pensions for mothers, and educate children about sex.58 The committee formulated a resolution that was later passed by the conference. It stipulated that ‘the first and most essential thing needed by the country at the present time is the establishment of a Federal Department of Health.’59 For Reid and the other delegates, Canada’s future depended on the application of maternal feminist principles to national problems – specifically, on preventing disease and educating Canadians in healthy practices from childhood onwards. ‘If we are to be a great nation,’ she told the conference, ‘we must begin at the basis, the health of the nation, and see that we have healthy boys and girls born to be our future citizens.’60 Her fears centred not on foreign sources of pollution, but rather on the need to encourage and promote health from within the social body – to secure the health of the organic whole, in the functionalist rhetoric of the day. Rowell was sympathetic to her views, but he pointed out that the field of public health was already occupied by the provinces and that the Dominion government operated a quarantine service to protect the nation from disease. ‘We realize now more than at any other time that we are a nation,’ replied Reid, ‘and it would be for a federal health department to co-ordinate and suggest exactly the functions of the provinces, but such a question as infantile mortality or venereal disease should be treated in a national way, through the provinces, but headed up by the federal government.’61 J.A. Calder echoed Rowell, suggesting that federal intervention into the realm of public health would violate the BNA Act and infringe on provincial rights. But the delegates were unwilling to back down from a demand that they believed was essential to winning the war and achieving a successful postwar reconstruction. ‘The Women of Canada feel that the question of public health is a national question and that it must be dealt with nationally,’ concluded Dr Octavia Ritchie England of Montreal. ‘We have conditions of public health which necessitate some means of prevention of trouble between the provinces. For instance, at present, there are no interprovincial restrictions in regards to contagious disease … That is a national question, and cannot be dealt with provincially.’62 While Rowell acknowledged the delegates’ concerns,

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he repeated that the government was doing all it could (under the circumstances) and that existing policies were adequate to protect Canadian health.63 Despite Rowell’s patronizing assurances, he knew the conference delegates were expressing a widely held view: wartime sacrifices must produce meaningful social and political change or they would be in vain. By the spring of 1918, the popular press was beginning to consider how wartime centralization might be used to improve the lives of Canadians after the guns fell silent. In the context of national sacrifice, wartime centralization, and a desire for postwar regeneration, some editors proposed that any future government would have to treat public health as a national priority. Read an editorial in the Manitoba Free Press: A Dominion Bureau should ‘think’ for the nation in the matter of health. Canada has been waking up to the need of knowing more about health, about sanitation and housing and their relation to health; and a score or more things that might be roughly classified under ‘public welfare’ but so far this work has mainly been done in the provinces … But Canada should have a Dominion bureau of health; it has asked for it, and perhaps nothing would bring the need of it home so forcefully as a little plain ‘thinking.’64

In this functionalist analysis, the nation was understood as an organic whole in which the central government formed the brain – evidence of the degree to which medical and reformers’ ideas had penetrated the non-specialist imagination. Health could no more be left to the provinces than could any other aspect of national life. In war the state had proven that it was capable of efficient intervention in the lives of Canadians in the pursuit of centralized goals; the application of these same powers would be necessary to restore the nation to health in the postwar period and to address the human costs of conflict. Read an editorial in the Hamilton Herald: In these terrible days, when the destruction of life is the main object of millions of men, the conservation of life within the national boundaries should be one of the prime cares of statesmen. And one of the most effective ways of conserving life is to combat the conditions which cause preventable deaths. In every government national and provincial there should be a minister of health, who would be responsible for the public health; and more public money should be spent upon this department of public welfare.65

With the backing of the press, reformers adopted the popular rhetoric

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of patriotism and national efficiency to make their case for reform. In mid-April of 1918, a delegation from the NCW led by Jennie Smillie, Professor Carrie M. Derick, Mrs H.P. Plumptre, and Dr Octavia Ritchie England met with Rowell and Calder to restate their demands for a dedicated Department of Public Health. ‘They urged very strongly the formation of a Federal Department of Health,’ Rowell told the prime minister, ‘and made a most impressive statement in connection with the urgency of the work at the present time, having regard to the conditions which we must face immediately following the war.’66 In a memorandum titled ‘Six Things Necessary for the Formation of a Federal Department of Health,’ the NCW laid out its proposal for the new department. While it cited the war as the motivating factor, its demands were clearly geared towards establishing a social minimum in the postwar period and realizing longstanding social reform goals. First, the work of the different branches of government in Ottawa would need to be centralized and their activities coordinated with the provinces. Four branches were to be established to deal with tuberculosis, infant mortality, venereal diseases, and mental deficiency. The work of these branches was to be informed by statistical returns gathered by the department as well as by research carried out in a Dominion laboratory. In part, the NCW modelled its proposal after the U.S. Public Health Service, in that it called for the creation of a weekly bulletin to track and document disease activity and for special conferences to ‘study and discuss methods to overcome the special diseases that are menacing our national efficiency.’67 With the newspapers growing ever more interested in postwar reconstruction, and fearful of the number of wounded, diseased, and maimed men who would have to be reintegrated into society, Rowell was now willing to support the NCW’s demands. ‘Personally I think the time has come where there should be a Federal Department of Public Health,’ he told Borden.68 Rowell was the social reformers’ chief ally in the cabinet. He had served as the leader of the Liberal opposition in Ontario and had agreed to join the Union government because he believed that bipartisanship was necessary to sustain the war effort in the face of mounting popular criticism.69 As President of the Privy Council, Rowell was one of the government’s key members and, along with Arthur Meighen, the architect of most of the pieces of legislation that had bestowed unprecedented powers on the central bureaucracy.70 But while Meighen saw assumptions of power and interventionism as temporary wartime exigencies, Rowell believed that the Union government should use the powers it had gained to achieve a higher moral purpose.71 As a devout and activ-

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ist Methodist, he believed that it was the duty of Christians to work to achieve the Kingdom of Heaven on earth. He was a pragmatic politician, but his philosophy of government was rooted in the Social Gospel.72 Borden, on the other hand, appeared reluctant to adopt the NCW’s recommendations, perhaps because war work was simply too pressing during the spring and summer of 1918. While the NCW’s demands for reform had been heard, they were soon rejected and replaced with halfmeasures. Instead of creating a new federal department, the Cabinet transferred the Department of Agriculture’s public health responsibilities to the Department of Immigration and Colonization, thereby uniting most of the central government’s responsibilities under one minister – something that Canadian doctors had been calling for since 1902.73 Yet this administrative change did little to satisfy the underlying demands of social reformers as it only reinforced Ottawa’s traditional emphasis on quarantine and immigrant screening. Meanwhile, Rowell asked Vincent Massey, the Associate Secretary of the War Committee of the Cabinet, to look into how a new Department of Health might be justified to the Cabinet and how it might be organized to meet the demands of the NCW and the Women’s War Conference.74 He then left on a publicity tour to promote the domestic achievements of the Union government and to counteract a growing revolt that the Cabinet believed was brewing among both the press and the general public. That fall, activists’ demands for reform received new impetus as the popular press blamed the federal government for failing to organize a successful defence against the 1918 pandemic. During late September and early October – before deaths peaked during the second wave – press criticism tended to focus on the ineffectiveness of the federal quarantine. ‘It is argued that it has been known for some months that this epidemic was raging in Europe,’ read an editorial in the Manitoba Free Press, ‘and that in the course of time and much sea-faring it was absolutely certain to reach these shores. Yet no adequate effort was made to prepare for it from the point of view of treatment or to watch the ports of entry for its appearance and to adopt measures to check it there.’75 The Edmonton Bulletin placed blame for the damage done by the disease squarely on the shoulders of Canada’s quarantine officials. ‘Flu is a communicable and therefore quarantinable disease,’ argued its editors. ‘The Dominion government have sole authority to enforce quarantine. They did not establish quarantine. They took no notice of the fact that there was an epidemic spreading over the world.’76 Such criticisms rested on the assumption that a more intervention-

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ist approach would have lessened the severity of the disease. ‘When the menace appeared,’ wrote Frank Oliver, had the Dominion authorities through the war railway board, taken charge of all arrivals at ocean ports and entry ports along the boundary, and subjected them to the inconvenience of two or three days in quarantine, there is every reason to suppose that the disease could not have got past the borders; certainly it could not have attained the proportions of a nation-wide epidemic … Certainly there is no excuse for the Government having made no attempt whatever to keep it out. Is human life of no account in Canada?77

In Quebec, Henri Bourassa’s Le Devoir mocked the government’s inability to control the flu. Read an October editorial: Dans le couloirs de Parlement, ce matin, quelqu’un déclarait que la cabinet est sur le point de faire quelque chose au sujet de l’épidèmie. – Mais quoi? demanda un autre comment le gouvernement peut-il intervenir? À quoi un loustic – il s’en trouve mème aux moments les plus sérieux – répondit dans sa langue maternelle, l’anglais: Oh! on dit qu’ils vont adopter un arrêté ministériel supprimant carrèment le microbe et le menaçant d’un an de prison s’il récidive. Un an de session serait encore une plus due punition. Mais il ne faut pas évoquer de malheurs nouveaux il en court assez de par le monde.78

Such criticisms were typical of the editorials printed in Canadian newspapers across the Dominion during the pandemic.79 While these were certainly partisan critiques, wartime censorship regulations – which had been strengthened to their repressive peak during the pandemic’s second wave – meant that any criticism of government policy would be regarded by the Chief Press Censor as sedition.80 John W. Dafoe’s Free Press, Frank Oliver’s Bulletin, and Henri Bourassa’s Le Devoir were all but immune from prosecution given the stature and political clout of their owners; smaller papers were less willing to criticize the government for fear of fines and closure.81 But it is telling that no editorial can be found that was supportive of the government’s handling of the crisis.82 In letters to the editor, the public addressed the failures of the official response, the lack of centralized leadership during the crisis, and the inability of the government to apply the methods it was using to prosecute the war overseas to domestic problems at home. Read a communiqué from G.P. England of Dunham, Quebec, to the editor of the Montreal Star:

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In all this influenza business what stands out ‘like Mars at Perihelion’ is Canada’s utter inability to deal efficiently with such serious epidemics, or rather lack of means to prevent occurrences of epidemics such as are afflicting us at present … what we really need is a National Health Officer, as these problems are national, and such diseases should not be left to local boards of health nor even the provinces. There should be one supervising the health of the whole nation, with power to act as to the quarantine of a certain city or of certain cases immediately, and not allow such a scourge to get a hold upon the whole people.83

It was as difficult for some newspaper readers as for their editors to understand how the power of the state could be harnessed to make war, but not to protect the well-being of Canadians at home. Ottawa’s official response fuelled doubts about whether the Union government had any intention of actually following through on its promise to use wartime centralization to achieve postwar social regeneration. ‘The Federal power at Ottawa is idle,’ wrote J. Arthur Macbride, the President of the Baby Welfare Committee of Montreal, ‘the concentrated strength (in this case its weakness) of all the people – is dormant. To protect the citizens of Canada against such calamities a Department of Health at Ottawa should be established immediately by the Federal Government.’84 G.J. Hope of Edmonton agreed, arguing that the federal government’s lack of preparations and its inability to manage the crisis were symptomatic of its general neglect of the public’s welfare: Now if it is at all possible to learn, the best way is by experience, possibly even governments may be taught that way. If so why does the Dominion government not immediately establish a live department of health instead of a forgotten corner in the department of agriculture as I believe it exists at present, to deal with this problem and other such problems, which already exist and will continue to exist after the Spanish influenza is entirely forgotten by the large majority of the people of Canada.85

The pandemic was politicizing public health and focusing popular discourse on the need for reform as never before. Though these critiques were bound to specific elite and middle-class interests in social and moral reform, they were shared by the labour press as well. Wrote Will Workman in the Alberta Non-Partisan: The health of the community must no longer be left in the chaotic state

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it is in today. If the teachings of Christianity cannot compel us to alter it, then the fact that it is poor business to leave the health of the present to the vagaries of charity and a profit-seeking profession … that the life and usefulness of the whole community should be curtailed because the State has not realized it has a duty to its citizens in this regard is a very serious reflection on the efficacy of the Christian church to instil the teachings of Christ, and on our National pride to have a race of weaklings. The health of all must be the business of all. If the military find it necessary to provide medical care for the soldier, surely it is the business of the State to provide for those who by their every-day activities produce the essential[s] of life.86

For columnists like Workman, the flu pandemic was a reminder of both the fragile existence of many working-class families and the lack of a mandatory minimum. After all, it was working-class families that had suffered most, in large part because flu threatened breadwinners’ economic security.87 Read the proceedings of the Alberta Convention of Labour: The demand for a better and more rigid enforcement of the laws governing sanitation, housing, and general health matters proved the knowledge and consciousness that if life is to be something more than existence, these things must be attended to and that it is the business of the state to attend to them. The prevention of sickness and disease rather than its cure was generally conceded should be the aim of the state.88

Flu illustrated why labour leaders believed that the state should step in to ensure a social minimum and thereby minimize social and economic friction for individuals and families.89 As writer and public intellectual Stephen Leacock observed, Canadians had been led to believe that the war would cast a new covenant between citizen and government in which ‘the obligation to die must carry with it the right to live.’90 This reconception of the role of the state and the meaning of citizenship was also described by William Lyon Mackenzie King in Industry and Humanity: A Study in the Principles Underlying Industrial Reconstruction. In this dense, verbose volume, Mackenzie King argued that the postwar role of the state was to act as a buffer between the interests of industry and those of workers. To smooth industrial relations and to promote harmony between capitalists and workers, the state, in King’s view, was to take on a host of social responsibilities; these would provide a social minimum, thus alleviating fears of ill health, pov-

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erty, and destitution that undercut relations between classes. This was a utopian – indeed, almost corporatist – vision of the state, one that placed new emphasis on the role of government in protecting public health and thus national efficiency.91 ‘Health denotes physical, mental, and moral wellbeing,’ wrote Mackenzie King. ‘As such, it is the basis of efficiency, and lies at the very foundations of industry and society.’92 King wrote Industry and Humanity before the pandemic struck and found himself editing his chapter ‘Principles Underlying Health’ while the City of Ottawa was struggling to deal with the pandemic around him. On 13 October, while walking home from dropping off the proofs for the chapter, he saw all around him reminders of the frictions caused by ill health. He recorded in his diary that evening: The Spanish influenza which is prevalent everywhere is a very terrible disease. It is like a plague and prevalent everywhere. The city hall is surrounded by Red Cross care and young girl VAD workers are doing splendid service in all parts of the city. The number of families without anyone to help them, persons dying and others ill and unfed beside them – is frightful. Right and left men and women are being carried off suddenly to their graves. It is a frightful plague rampant all over the world. These are strange and awful times to be living in.93

The government became vulnerable to criticism of its handling of the crisis because flu had the effect of uniting disaffected voices that would normally have been separated by class or ideological differences. To passify its critics, the cabinet was forced to reconsider the option of creating a federal Department of Health. When the flu’s second wave struck, Sir Robert Borden was on a much needed vacation.94 He had left Ottawa for the hot springs in New York State, arriving there on 22 September and he only learned of the extent of the crisis when he returned on 18 October.95 When he met with his Cabinet during the week of 21 October, Borden was presented with Vincent Massey’s report for the War Committee examining the feasibility of a federal Department of Public Health, which he had completed at the height of the crisis. The initial question before the cabinet was whether the constitution would even allow such a portfolio. Rowell and Calder had argued earlier that it was a matter of purely local interest and thus left to the provinces by the BNA Act; Massey, however, presented a new interpretation.96 ‘Constitutionally such matters as are not specified in the BNA Act fall within the jurisdiction of the Dominion,’ read his report, which continued:

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Technically, therefore, public health, which in the modern sense is a new subject, falls within the cognizance of the Federal Government. This principle is confirmed by the Clause in the Act of Parliament which constituted the Department of Agriculture in 1868 (31st Vic.Cap.51) which assigns to this department ‘Public Health and Quarantine.’ The fact, however, that provincial boards of health were created by Ontario in 1882, and in New Brunswick, Nova Scotia and Quebec a few years after, has been taken as evidence that the Federal Government was relieved of this function of government. Legally, however, the obligation resting on the Federal Government to assume the duties of public health administration has remained.97

While the committee acknowledged that by convention, authority had been vested concurrently in all three levels of government, there was nothing legally to prevent the central government from assuming a leadership role in the field. The war had witnessed the federal government acquire an array of new responsibilities that had formerly been left to the provinces. The flu situation was a crisis that justified the reorganization of public health governance in the Dominion.98 The only question was whether the provinces would object. Massey continued: A federal department of public health is justified now that it is clear that Provincial Governments are no longer competent to deal with Public Health in its new and wider application, and that their efforts require correlation and amplification. The establishment of a federal department of public health should, of course, be undertaken only after careful consultation with Provincial authorities. There would seem, however, to be few constitutional difficulties in the way, and provided that harmonious relations are maintained between the Federal and Provincial authorities the determining factor in such negotiations would be only the efficient administration of Public Health.99

Politically, the creation of a federal department had become an important issue because women had been granted the vote and had been demanding action since the previous spring. The pandemic was merely proving their point and making decisive action all the more politically urgent. Wrote Massey: The demand for a Department of Public Health, which has been more or less active for a generation, is now greatly accelerated by the enfranchisement of the women of the country. Women are naturally interested

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in questions of social welfare, and it had been very clearly shown in woman’s journals, and in the periodical meetings of their organizations that the women of the country regard the establishment of a Department of Public Health as essential to the national well-being. As the women’s electorate begins to make itself more and more felt this demand is likely to be expressed with increasing insistence.100

At the same time, four years of war had clearly proven the need for federal intervention in health: The war has shown how inadequate the methods of all civilized countries have been to promote the physical welfare of its population [sic]. The rejections from the Army on grounds of military unfitness, which in Canada run from 30 to 50% and over are sufficient evidence of this fact, when it is remembered that the cause of such rejections were … in the majority of cases preventable.101

Here Massey was adopting the language of the social reformers, constructing health as both a national interest and a natural extension of modern state governance. Reconstruction, Massey wrote, provided a logical opportunity for the government to step into a new central role in managing the health of the Dominion’s citizens. The War Committee of the Cabinet suggested that the ‘loss in man-power’ required ‘efficient conservation of human life’ and identified a range of issues that would have to be dealt in order to prevent disease and improve the welfare of Canadians. Argued Massey: The period of reconstruction will present many problems which are closely related to public health and hygiene.’ The housing problem, industrial unemployment, the transfer of labour to special public works construction and to permanent employment and the attendant problems of industrial hygiene – such questions would seem in themselves to justify the organization of public health on a national scale.102

Massey was proposing a significant shift in federal strategies of public health governance, one that would move towards the prevention of disease within the social body and away from the exclusion of diseased individuals: The advocates of a Federal Department of Public Health in Canada base

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their arguments on the assumption that an effective public health administration has a direct bearing on the economic, social, moral, and general well being of the community. This fact can now be regarded as almost selfevident.103

As he acknowledged in his report, the Spanish influenza was the immediate catalyst, the crisis having made the creation of such a department an urgent priority: The recent epidemic of Spanish Influenza points to the need of a Federal Health authority. Throughout this crisis there was no organization competent to handle the problem on a national scale. The control of the disease was necessarily left to local boards, many of them ill-informed and all of them inevitably lacking in co-ordinated effort.104

Massey acknowledged the validity of public criticisms, arguing that a cohesive federal department could have managed the epidemic crisis more effectively. After citing newspaper editorials and public criticisms of the government’s handling of the pandemic, his report delineated five areas in which a dedicated department would have been more competent in dealing with the pandemic.105 First, it could have issued warnings and advice to the various provincial officers. Second, it could have given specific directions and ensured that a uniform, coordinated plan was followed. Third, it could have guaranteed that proper information was circulated and that ‘quack’ doctors and bad science were not allowed to exert undue influence on either the public or the official responses of local governments. Fourth, it could have led the fight to ‘isolate the influenza bacillus and discover preventative sera.’106 Fifth and last, it could have monitored the disease, compiled statistics, and tracked its spread across the country. The absence of a federal department had been conspicuous during the pandemic; officials now moved forward in reaction to the failure of the old contaminationist ideal.107 On 2 November, at the height of the public outcry over the government’s handling of the crisis, Borden met with James Calder, Arthur Sifton, Arthur Meighen, and John Reid to approve the creation of the new department.108 During the next legislative session, he told the meeting, the Union government would introduce a bill to create a federal Department of Public Health.109 The first test of the government’s resolve came at the Dominion–Provincial Conference on 18 November 1918. Sir Thomas White and the other members of the Cabinet – Meighen, Calder, Rowell, Mewburn, and James Lougheed – walked up the steps

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of the imposing Victoria Memorial Museum (the temporary home of Parliament since the 1915 fire), prepared to introduce their rationale for creating the new department. Inside the temporary Senate Chamber – it was the usual home of the museum’s ‘gallery of invertebrate fossils’ – the representatives of the federal government sat across the aisle from thirty-one delegates from every Canadian province.110 Natural resources, land rights, soldiers’ settlement, and civil re-establishment were high on the agenda. Public health had been squeezed into the program at the last minute. After a forty-five-minute speech outlining the government’s plan for returning soldiers to civilian life, Sir Thomas White read aloud a representative motion from the NCW, which had been penned by the organization’s Corresponding Secretary, Ida A. Fairbairn. That motion called for the creation of a federal Department of Health with widespread powers. It also demanded a department that would better coordinate the fight against epidemic disease, monitor the health of Canadians, and ensure uniformity of public health measures across the Dominion. The motion was read into the minutes of the conference without objection or discussion. In the wake of the pandemic, the provinces agreed on the need for increased coordination.111 Thus, in the autumn of 1918, a number of forces converged to bring the new federal department into existence. The idea of the healthy nation, which had gripped Britain and the United States before the war, gained political capital in Canada between 1914 and 1918 as it became apparent that Canadians were not nearly as healthy as many had assumed. This realization intersected with pre-existing fears of physical and social degeneration and served to construct the protection of health as essential to national survival. At the same time, the imminent return of soldiers from overseas raised the spectre that venereal disease would spread to innocent young women across the Dominion even while the wounded and maimed became permanent wards of the state. The debate about the federal government’s role in public health was taken up in the context of wartime centralization and increased state intervention as well as the looming process of postwar reconstruction. But it was women’s voluntary associations, which had long supported the idea, who made the final proposals for a new Department of Public Health. In achieving the vote, women had gained new political weight, which now lent support to the NCW’s demands for a federal health department that would support activists in their role as mothers to the nation. It was their vision – rather than that espoused by the medical profession – that shaped the new department. But none of these factors alone succeeded in mobilizing the government to take action.

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Despite demands for change, the Borden government resisted calls to create a new department that would necessitate a more interventionist approach to preventative medicine and challenge the existing division of federal–provincial responsibilities. Instead, it retrenched Canada’s governance strategies along old lines, amalgamating the duties of the quarantine and immigration branches in the spring of 1918 – the old goal of the Canadian Medical Association. The traditional approach to public health therefore remained largely unchanged in the summer of 1918. Since 1832, Canada’s quarantine system had been designed to protect the Dominion from external threats; the federal inspection of immigrants had later been added to eliminate what many professionals and lay people believed were the main sources of infection. But the 1918 influenza pandemic revealed not only the ineffectiveness of the negative or exclusionary approach, but also the degree to which public health governance strategies were out of step with the expectations of the Canadian press and public. The flu crisis demonstrated that borders were imaginary, porous constructs; that Canadians and Americans, not immigrants, could spread catastrophic and horrible new diseases; that not all Canadians were healthy enough to fight off disease; that provincial and municipal public health programs were unevenly developed throughout the country and inadequate to the task of dealing with a major crisis; and that without a central authority to direct the official response, chaos ensued. Worse still, the actions of some federal officials in the quarantine service and the military had actually contributed to the spread of the disease. The federal Department of Health was thus created in response to the failures of the official pandemic response. It was a reactionary decision designed to alleviate a political crisis and to appease a critical press and public. The new department was patterned along the lines imagined at the Women’s War Conference and proposed by the NCW, and it would aim to address a number of pressing social problems in addition to guarding against epidemic disease. In essence, it would combine strategies stemming from sanitarian and contagionist views within one office, thus eliminating the ‘two lines of defence’ concept that had stood since 1866 and replacing it with a more comprehensive and permanent approach to disease prevention. It was a department that was given form by wartime idealism; social reformers hoped it would symbolize a new and lasting covenant between citizen and state.

10 ‘Success Is Somewhere around the Corner’: The Changing Federal Role in Public Health

On Sunday, 24 November 1918, less than two weeks after the Armistice in Europe, Newton Rowell attended celebrations in Toronto to mark one hundred years of Methodism in Canada. It was an occasion to reflect on the triumphs and tragedies of the past year and to look forward to the future. Canada basked in the glow of the recent and hard-fought victory in Europe and the waning tragedy of the flu crisis. A new era seemed to be dawning that Rowell believed would see the Social Gospellers’ greatest ambitions realized. His speech reflected on the lessons of the past few months, the greatest of which was that the war and the pandemic had together revealed the artificiality of national borders and the false division between the familiar and the ‘other’: This war has made clear to us certain very important facts of human life and human experience. [It] has revealed to us the fact that our humanity is essentially one … Our humanity is bound together now as one great community, and corruption of mis-government or crime in any section of the world affects more or less all the other parts of the world. And this war has emphasized that truth perhaps, as it has never been emphasized before. Let me give you [an] illustration. The Spanish Influenza … not at first virulent, visited England at the early part of the present year with comparatively few deaths. It then passed through our army; there were many cases of illness but very few deaths. It then visited Central Europe and found a home among the impoverished people there and developed under these conditions into a much more virulent type. Then it proceeded across this country and left death and misery in its wake. We may think in lines of nationality; we may try to build up walls between one nation or people and another; but

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this war has forced upon us the lesson that humanity is essentially one and that that which affects any for weal or woe, affects all.1

Since the cholera epidemics of 1832, disease had been treated as a foreign or external threat posed by the ‘other’. In this view, just as nasty germs caused disease in healthy individuals, so too did unwelcome groups weaken and sicken the social body. Canada’s maritime quarantine had always been the most important preventative measure against this outside threat. But as Rowell noted, the pandemic had demonstrated the limitations of maritime quarantine by highlighting underlying deficiencies in the social body. It was not a disease bound to particular immigrant groups, nor did it respect artificial borders. Flu was a community disease; though one segment of society might suffer more than another, no class or group could escape its ravages.2 During the winter of 1919, the pandemic’s third wave swept across the country. This final iteration is more difficult to track.3 In some places, it appeared in December and reappeared in February. In other parts of the country, it did not strike until April or May. Flu diffused across the Dominion, infecting those who had not acquired immunity to the virus during the previous two waves in an erratic pattern that mimicked a dying brush fire, moving underground unseen only to burst into flames again in a distant location.4 The overall death toll from the third wave was much lower. In most provinces, mortality declined significantly in 1919, not just from the highs of the previous autumn but to well below the average. Figure 6.1 showed that every province except Prince Edward Island reported a considerable number of excess deaths in 1918 (for clarity, excess mortality is defined as the number of deaths above what would be expected given previous patterns of mortality and is established by averaging mortality rates over a period of several years) – 33,560 in 1918 from all causes. Table 10.1 provides a comparative set of figures for 1919; that year, there was a deficit of about 2,664 deaths, meaning that fewer people died than would have been expected had 1919 been similar to the average mortality of the period 1913–17. This shadow effect can be explained as the result of mortality displacement: deaths are ‘borrowed’ from future years owing to an unusual event, essentially killing those who would have been expected to die in the short term from other causes.5 The third wave’s best remembered impact was probably the cancellation of the 1919 Stanley Cup finals between the Seattle Metropolitans

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Table 10.1 Comparison of mortality (all causes) for Canadian provinces with available data, 1919

Alberta British Columbia Manitoba New Brunswick North West Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Total

Expected crude mortality rate per 1,000

Observed crude mortality rate per 1,000 SMR

Estimated number of excess deaths

Total Population*

7.9 7.6 10.6 10.– 10.–

9.4 9.2 10.6 10.– 10.–

1.19 1.21 1.00 10.– 10.–

784.6 819.0 44.1 10 10. – 10 10. –

545,622 498,162 580,373 380,679 7,812

15.1** 12.6 10.9

17.7 12.1 7.9

1.17 0.96 0.72

1,372.5 –1,449.0 –268.2

517,537 2,852,388 89,638

16.9 6.8 7.7

15.1

0.89 10.– 0.81

–3,970.1 10 10. – –7.0 –2,664.1

2,289,563 704,494 5,028 8,471,300

6.3

* Estimates are based on the census populations from 1911 and 1921, prorated for 1918 ** Not including deaths from the Halifax Explosion in 1917 Source: Dominion Bureau of Statistics. The Canada Year Book, 1920 (Ottawa: F.A. Acland, 1921); Statistics Canada. Historical Statistics of Canada: A2-14. Population of Canada, by Province, census dates, 1851 to 1976 (Ottawa: Statistics Canada), accessed at www.statscan.ca on 20 August 2008.

and the Montreal Canadiens.6 The Canadiens, who travelled to the west coast for the games, gradually succumbed to the virus; on 1 April, after five matches, the series was ruled a draw and the cup went unclaimed. A few days later, Joe Hall, one of the Canadiens’ star players, died of complications from pneumonia.7 Meanwhile, in Ottawa, Bill 27, An Act Respecting the Department of Health, was introduced into the House of Commons.8 The new department would pursue more interventionist, proactive preventative strategies. Vincent Massey’s October 1918 report to the War Committee of the Cabinet had read: Most governmental agencies, dealing with public health in Canada are primarily concerned with the prevention and quarantine of contagious diseases. These however are evils which in these days are more or less under

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the control of Public Health authorities, and the attention of experts is now very generally turned towards the four problems of tuberculosis, venereal diseases, feeblemindedness, and infant mortality, which we can only cope with by well organized effort.9

These four areas were all ‘internal’ problems that, in the minds of reformers, stemmed from local housing conditions, sexual immorality, degeneration, or poor nutrition. The new department was intended to refocus the public health gaze inwards, on internal Canadian problems, rather than on the country’s maritime approaches. The activities allotted to the new department by the proposed legislation revealed the significance of this shift, in that it extended the reach of the department while changing the federal role in public health. ‘The duties and powers of the Minister,’ reads Bill 27, ‘shall extend to include all matters and questions relating to the promotion or preservation of the health and social welfare of the people of Canada.’10 The legislation proposed that the department would be responsible for nine specific areas. It was to ensure cooperation between the provincial, territorial, and other health authorities and was to safeguard child life and welfare. Public health and disease on ‘railways, boats, ships, and all methods of transportation’ would also fall under its jurisdiction. It was further tasked with coordinating public health measures with American authorities along the US–Canada border and was to distribute information to ‘promote good health and improved sanitation’ across the Dominion. These new duties would complement those already performed by the various government departments, including quarantine, the inspection of immigrants, and the administration of marine hospitals, all of which would be transferred to the new department. Finally, the bill created a Dominion Council of Health, which was to be made up of the Dominion’s Minister of Health and the medical officers of health from each province as well as social experts from across the country. This council was intended to be both a forum for discussion and a centralized administrative apparatus that could coordinate an official response to national epidemic crises.11 Rowell recognized that the department’s new mandate constituted a rejection of the exclusionary strategies employed before the war. On introducing the bill for its second reading on 4 April, he told the house: It is a new departure in the emphasis which it places upon the conservation of the health of the people and upon their social welfare. It means that in the new day in which we are living, when the welfare of the masses of the

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people must become more and more the concern of the whole people, the Government of the country must devote its best thought and attention to the[se] questions … so that here in Canada, with all our natural advantages, with our great opportunities of developing a truly great nation, we shall have a strong, vigorous, robust, healthy people of whom Canada may be proud, and who will retain for her the magnificent place which her soldiers won for her in the field.12

This mandate was meant to embrace social reformers’ calls for a more interventionist approach – one that would focus on addressing the problems that they had linked to urbanization and industrialization.13 The new department would provide an opportunity to achieve the aims of social regeneration. Wrote Peter Bryce in 1920: Social government is possible only through a series of sanctions, by which the individual expects and has a right to get back advantages as a member of the community in lieu of certain natural rights which he, as an individual, has surrendered … so there is at the present moment a claimant demand that in matters of health, as in those of economic and political opportunity, the individual be freed from all physical hindrances to the realization of the highest possibilities for himself, his family, his community and nation, and for mankind.14

This was an important shift in emphasis and ideology. Flu was the chief catalyst behind this change of direction. Charles Sheard, a physician, professor, and the Unionist MP for Toronto South, suggested that the influenza pandemic had proved Canada’s vulnerability and provided ample evidence that a more interventionist federal role in preventing disease was essential to guaranteeing the nation’s security: I can conceive at this juncture of no department of the public service which any Government could institute more replete with opportunities beneficial to all classes of the community than a public health service rightly and justly administered. We have had an illustration of one [epidemic] in the ravages of the ‘flu.’ ‘Flu’ has been very severe in some localities … Investigations were being made by the French and British governments when the epidemic broke out. While I admit that no department under present conditions, is in the slightest degree to blame for the ravages throughout Europe and this continent of such an epidemic, I merely cite that illustration to strengthen the point I have to make regarding this matter. [The

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European governments] knew how these epidemics spread and developed and they were able in a large measure to take preventative measures which, I am quite convinced, restricted the further ravages of this disease. Would it not be a profitable thing for the Federal Government to have a scientific bureau of investigation where trained men would be able and competent to investigate all these sporadic and serious infectious maladies so that we would be able to deal with the situation before the advent of the infection and thus prevent the wholesale and general infection which is apt to follow if these diseases are not thoroughly and scientifically understood?15

Richard Frederick Thompson, a Unionist MP from Weyburn, Saskatchewan, agreed with Sheard, pointing to potential dangers down the road that had to be addressed by the state at the national level. With the imminent return of Canada’s soldiers, the threat of a new epidemic – be it of influenza or some other disease – could not be ignored: A Department of Health at Ottawa can do a great deal towards reducing that danger to a minimum. Take the great influenza epidemic which is sweeping over the world at the present time and which caused the deaths of thousands of Canadian people within the few months that it scourged and ravaged this country. We do not know yet what the cause of it is. The greatest bacteriologists in the world have devoted their best efforts to the solution of that problem, but the medical profession is not united as to what the cause of this disease is. There is a field for a Department of Health; there is an opportunity for scientists to investigate and inquire into the cause of that fatal scourge and try to secure a remedy. So it is with cholera, that seaborne disease; so it with bubonic plague. Because of the situation of our country in relation to the ocean highways of the world, these diseases may invade us at any time. They have invaded us in the past … I think, therefore, we should have a Department of Health, and I should welcome it now.16

While the legislation was embraced by reformers as well as by members of the Union government, who were anxious to deflect criticism for their handling of the crisis the previous fall, others anticipated that there would be significant obstacles placed in the new department’s path. Asked William C. Kennedy, a Laurier Liberal from Essex North: Do you not think, Mr. Speaker, that such a department would conflict with the boards of health in the respective provinces, and with those established by the municipalities in the cities and in the rural districts? I fear so, and

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this measure suggests difficulties that invite criticism and which ought to be avoided. I believe the only way out is to leave the matter of Public Health in the hands of the provincial and municipal authorities.17

As Kennedy argued, the creation of the department would legitimize the powers and activities gained by the central government in wartime and extend centralizing and interventionist tendencies into the postwar period. The Liberals could do little else but reject the new department, for it embodied the principle of strong central government that they had fought since the 1917 election.18 Nevertheless, the interim leader of the Official Opposition, Daniel Duncan McKenzie, was willing to concede that a federal Department of Health might be necessary, given the experience of the previous months, but he expressed the hope that the new department would carve out a new role for itself rather than duplicating the tasks already performed by the lower levels of government. But in this course, he again anticipated serious challenges: All I have to say about that is that I am not in favour of duplications; I am not in favour of conflicting authority between provincial and Dominion institutions. Strangely enough, the provisions of the BNA Act would seem to permit duplication on this point, but up to now the Federal Government has not dealt very much with public health … Let this Government, if it is going to deal with the matter of public health take complete control of it. Let public health be under one control; do not have two bodies representing the same people doing the same thing and spending the money twice when spending it once under proper control would bring about better results.19

Predictably, the vote that followed the debate split down party lines: 82 to 153. On 6 June 1919, Bill 27 was given Royal Assent. One of the first tasks of the new department and the Dominion Council of Health, which included W.H. Hattie, H.E. Young, Gordon Bell, John W. McCullough, and the other provincial health officers who had battled flu, was to prepare for a new pandemic by planning and standardizing an official response across the country. At their first meeting, in October 1919, it was decided that in the event of another flu outbreak, the federal department’s initial task would be to disseminate information about the nature of the disease so as to counteract any false theories or ideas. First, the public would be told that ‘this is a germ disease

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transmitted by droplets … through drinking or eating out of utensils improperly cleansed, [and] by direct contact.’ Second, it would be made known that there was no vaccine against influenza but that there was a vaccine that seemed (to doctors at the time) to guard against complications from pneumonia. The council also established specific recommendations for treatment that would alleviate any confusion in future: ‘The patient should if possible go to bed, send for a physician, and remain in bed until all acute symptoms are over,’ read their recommendations. The first order of business during a recurrence of the pandemic would thus be public education.20 The department and council would also coordinate provincial responses to the disease. During another pandemic, each province would be expected to expand its hospital facilities rapidly to house up to 1 per cent of the population. Nurses – who had been in such short supply during the recent outbreak – were to be registered and categorized in advance so that in an emergency, trained staff could be called out of retirement, reducing the need to rely on the volunteer sector. Lastly, masks would not be mandated, except for use by primary care workers.21 These discussions produced a coherent official strategy to control future outbreaks of influenza by all three levels of government. This was an attempt to organize the official response and to standardize it across the Dominion in advance of catastrophe. The courses of action agreed upon in October 1919 emphasized the primacy of provincial and municipal responses and the distribution of information. Federal responsibility for quarantine was not even mentioned. Instead, the new plan emphasized the central government’s role in surveillance and in organizing community interventions, ensuring national coordination, and promoting information sharing.22 The federal department’s most important role in future epidemics and the control of contagious disease would thus be to act as a coordinating body. To this end, the Dominion Council of Health would meet twice a year to provide a forum for provincial and federal officials as well as leaders of various voluntary associations to discuss and agree upon policies and courses of action to tackle specific problems. This was a welcome opportunity for public health officials, who in the past had relatively little official contact with one another. ‘The Dominion Council of Health has again justified its existence in that the highest medical authority in each province had been able to lay his views and recommendations before those of the other provinces,’ reported the council in 1920. ‘Understanding has been reached on many points in connec-

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tion with the administration of Public Health in the various provinces, such as could hardly have been done by any other means.’23 In 1921 the provinces standardized quarantine and isolation periods for a variety of contagious diseases and agreed upon the methods that would be adopted to control outbreaks relating to more than two dozen infectious microbes.24 The following year, the ministers of the various provincial departments agreed to standardize a list of notifiable diseases across the Dominion and, for the first time since the early 1890s, to report statistics to the central government; they also passed a series of regulations to define procedures for the surveillance and the isolation of contacts.25 The Dominion Council of Health gradually abandoned the old regime of maritime quarantine and immigrant inspections in favour of multilevel preventative measures and social interventions. Cooperation between provinces and municipalities, combined with programs to increase general health and prevent disease, now replaced the earlier conception of primary and secondary lines of defence. Maritime quarantine had become all but obsolete.26 In 1921 the Dominion Council of Health recommended that ‘since the Federal foreign quarantine as carried out by the Health authorities in Great Britain and the United States is directed only against the major communicable diseases; and since it has been found that this affords adequate protection,’ Canada should adopt the same practice.27 Afterwards, cases of measles, scarlet fever, diphtheria, and chicken pox were allowed to proceed up the St Lawrence unchallenged at Grosse Île. Vaccination and education would now be relied on to protect against them.28 In 1926 the department adopted the International Sanitary Convention of Paris, which limited quarantinable diseases to plague, cholera, yellow fever, typhus, and smallpox.29 In 1920, the first full year of operations, quarantine and related services had constituted more than 35 per cent of the department’s budget: $241,000 of $683,500.30 A decade later, the budget for quarantine had been reduced to $182,610 from an entire budget of $1,393,616: just over 13 per cent.31 At the same time, transfer payments to volunteer organizations such as the St John Ambulance Association, the Victorian Order of Nurses, the Canadian Council of Child Welfare, and the Canadian National Committee for Mental Hygiene increased from $0 in 1920 to $100,000 in 1930.32 Completing the shift from exclusion to positive intervention, the inspection of immigrants was farmed out to doctors in Europe at points of embarkation, instead of being conducted at Canadian ports.33 Immigrants were still perceived as social, political, and economic ‘threats’ to be strictly managed; however, the localization of inspection at the point

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of embarkation rather than the point of arrival reflected a new emphasis on proactively selecting ‘desirable’ immigrants.34 In the American context, Nayan Shah and Amy Fairchild argue that in the interwar period, immigrants were increasingly seen as deserving citizens rather than as threats to public and economic health; this attitudinal change shifted the purpose of medical inspection from exclusion to facilitating inclusion.35 Esyllt Jones makes a similar argument for Canada. She writes that the 1918 flu also marked a departure from past experiences: immigrants were now accepted as part of the larger ‘social body’ and were no longer scapegoated as the sole vectors of disease.36 ‘Although still far from rejecting the belief that the immigrant community was prone to disease and incapable of rational response without guidance,’ she writes, ‘health officials developed a philosophy of disease containment that no longer accepted the necessity or wisdom of coercion.’37 As the medical gaze turned inwards to examine the practices and behaviours that spread disease, immigrants remained problematic. But they were no longer seen as the sole vector. Exclusion continued to have social and economic functions, but it became less important to disease prevention strategies.38 In part this shift was a response to larger postwar changes in immigration patterns . Immigration reached postwar highs of 166,783 in 1928. New exclusionary regulations designed to restrict immigration during the worst of the Depression years slowed it to 27,530 in 1931 and to 11,277 in 1935.39 As immigration decreased, so too did expenditures on medical inspection. In 1930–1, the Immigration Branch of the Department of Pensions and National Health spent $254,160.10 on inspections conducted in Canada and overseas.40 By 1933 that amount had been reduced to $141,500 and most of Canada’s overseas offices had closed.41 In March of that year, the budget was slashed by a further 30 per cent. By 1936, with immigration slowed to 11,643 and inspection localized at embarkation points, mass maritime quarantine had become obsolete.42 ‘After twenty-five years of experience in connection with maritime quarantine in Canada,’ J.J. Heagerty told the Dominion Council, ‘I am firmly convinced that the boarding of all vessels by a Quarantine Officer in ports is quite unnecessary and should be discontinued or modified.’43 He recommended that ‘the large, expensive, unwieldy and unnecessary quarantine stations be abandoned.’44 In the summer of 1937, Canada’s oldest public health institution, the quarantine station at Grosse Île, was closed. It had become obsolete, the relic of a bygone era. While the importance of maritime quarantine and immigrant inspec-

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tion declined, the significance of programs designed to encourage healthy practices and to improve the living conditions of Canadians grew. The Division of Child Welfare was one of the most active and interventionist branches of the new department. Headed by Dr Helen MacMurchy, a prominent Toronto physician and social reformer, the department aimed to reduce infant mortality and to secure the health of the nation by educating Canadian mothers in the new ‘science’ of motherhood.45 Dianne Dodd writes that the creation of the Child Welfare Division was the culmination of ‘a reform movement led by women’s groups, public health professionals, the medical profession, and eugenicists.’46 Under MacMurchy’s watch, the department published a series of ‘Blue Books’ that dealt with pre- and post-natal care, childbirth, childrearing, cooking, housecleaning, nutrition, household accounting, and domestic waste disposal.47 The Blue Books were important insofar as they were the first attempts to establish, among other things, national nutritional guidelines for parents.48 The division also responded to changing socioeconomic conditions, publishing books on childhood diseases in the late 1920s and a pamphlet titled ‘Good Food for Little Money’ at the apex of the Depression in 1932.49 Although the Child Welfare Branch was disbanded in 1934 when MacMurchy retired (its functions were outsourced to the Canadian Council on Child and Family Welfare), it had played an important role throughout the 1920s and the worst years of the Depression in educating Canadians on a variety of hygienic and health issues. And, according to Dodd, the Blue Books had a significant impact on family health in Canada. MacMurchy attempted ‘to represent her female constituency, with demands for improved health care, working conditions, and status of women – propaganda which may have given women some leverage to renegotiate relationships within a changing family structure … The Blue Books also helped to fuel and channel political demands for improved access to medical services [by forcing] the federal government … to consider the problem of restricted access to “essential” medical services.’50 The Food and Drug division also played a significant role in guarding the health of Canadians and meeting the nutritional needs of Canadian families during the 1920s and 1930s.51 This branch originated in a federal laboratory that had been established in 1884 to test for adulteration in imported goods.52 At the central lab in Ottawa and three sub-laboratories in Halifax, Winnipeg, and Vancouver, health inspectors performed two types of work: policing and investigation.53 Policing work was ‘concerned with supplying the evidence necessary for convictions in violations of the

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various Acts administered by this department,’ while investigative work consisted of accumulating information on the nature of ‘specific classes of foods, drugs, fertilizers, etc., as may enable standards to be defined, and limits of variation to be fixed.’54 The department’s most important task was to ensure that the quality and ingredients in various foods met certain minimum standards as defined by Section 26 of the Adulteration Act.55 Explained J.A. Amyot in his first report as Deputy Minister: When an article is offered as milk, butter, pepper, flour, vinegar, etc., the purchaser should know that such an article possesses a certain food value, is, in other words, a standard article of its kind. It may not be the very best of its kind, but it must not fall below a certain fixed minimum value designated as the legally established standard. It is unnecessary to describe it as pure or genuine, because the mere fact that it meets standard requirements makes it pure and genuine, in a legal sense.56

Standardization would ensure that foods were safe for consumption and that they would provide the nutrition consumers expected. Identifying adulterated foods and false nutritional claims became most important during the 1930s.57 In the Depression, increased competition and empty consumer pockets forced manufacturers to make false claims for the efficacy of their foods, suggesting to young mothers, for example, that certain breakfast cereals were ‘vitamin enriched.’58 This put pressure on the Department of Health to improve laboratory services and on the Food and Drug Division to screen advertisers’ claims as well as the labels on a variety of products.59 By the middle of the decade the department was, according to Aleck Ostry, ‘overseeing an increasingly sophisticated and comprehensive food surveillance system.’60 The programs of the Child Welfare and Food and Drug Divisions demonstrated an active federal interest in preventing disease and encouraging health through state intervention in childrearing practices as well as through food supply monitoring. These strategies reflected a mentality that identified health with wellness, thus giving preference to prevention rather than management of disease. Although they were not aimed at alleviating poverty, inequality, or the root ‘social’ causes of illness, they were emblematic of the shift in federal public health strategies that occurred after the 1918 pandemic. The department’s most interventionist program was related to housing. In 1919 it made a $25 million fund available to local governments to promote housing construction on the basis of 25 per cent co-partici-

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pation. Dennis Guest writes that ‘as with all other social welfare matters … the weakness of municipal government was a paramount barrier to innovation.’61 Yet by the end of 1924, 179 municipalities had tapped into the program to build more than 6,240 single-family homes across the Dominion. In Winnipeg alone, 712 homes were built between 1920 and 1923.62 The General Project for Housing provided monies for housing societies, companies, or individual owners of lots to build homes. But it was aimed at those who could pay more than $25 per month in rent, and as such was intended to provide adequate housing for the middle classes and returned soldiers, not those living in overcrowded slums.63 Nevertheless, the program linked the concept of ‘healthy homes’ to healthy citizens and provided federal support for local programs designed to address housing shortages. In requiring the provinces to comply with a number of regulations related to planning, sewage, and building standards in order to participate in the program, the money encouraged standardization of similar principles across the Dominion.64 Cost-sharing programs directed at provinces and municipalities provided a new solution to the financial and organizational problems that had hindered public health development in the early twentieth century. Programs aimed at controlling venereal disease patterned a system that would be used later, in the 1940s, when officials implemented state health insurance.65 In 1919, $200,000 was appropriated to be divided among the provinces by population, provided that the lower level of government made a matching contribution. These grants were intended to establish free clinics, free hospital beds, diagnostic laboratories, and an education campaign. As with housing, they also served to standardize measures across the Dominion by forcing the provinces to comply with specific federal regulations in order to access funds. By 1926, these transfer payments had been reduced to $125,000, but the money funded fifty-six VD clinics that operated across the Dominion. That same year, the department distributed more than 95,000 pieces of literature to various municipal organizations, schools, and social welfare groups. The VD branch also supplied drugs to various hospitals and institutions across the country to provide for the free treatment of venereal disease. The aim of the branch was to reduce the VD threat by making treatment available to those who were most susceptible to the disease but who could not afford new drugs like Salvarsan. The program was not entirely altruistic, and it aimed to protect ‘the innocent’ rather than cure ‘the immoral’; nevertheless, it recognized that community health interventions were necessary to eliminate or reduce the spread of contagious diseases.66

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On 18 May 1931, H.E. Spencer, the Member of Parliament for Battle River, tabled a motion in the House of Commons calling on the Department of Health to provide one-third of the funding to establish and maintain district health units across the country, modelled on those already in existence south of the border: Today, both in provincial and federal legislation, we are giving consideration to many things that were at one time left to the individual. We are … more and more coming to the opinion, generally speaking, that health should be put on exactly the same basis as education, that the health of the nation is a national asset, and that its care cannot be left entirely, as has been too much the case in the past, to the individual. In world competition today, an unhealthy nation can no more compete against a healthy nation than can an ignorant nation stand up against a well-educated one.67

Spencer explained that while the house had approved a similar motion the previous year, the change in government forced him to again poll the members’ support. Health, he argued, was increasingly governed by the ‘length of a man’s purse,’ which was unacceptable. To wait for a person to grow sick and then to expect him or her to seek and pay for treatment was too dangerous to Canada’s future. In support he cited the case of ‘a family in 1918 during the flu epidemic.’ This family, he told the house, was attended by a medical practitioner, but as soon as he found out that they had no money and that he was not likely to get paid, he left instructions with them how to take care of themselves and said that he was too busy to come again. But just as soon as the municipality decided to guarantee all the medical bills of those who were suffering from influenza, this same practitioner came back and continued to visit the family regularly … Under present conditions, too many people, fearing the cost of medical or hospital care, put off calling in the necessary medical assistance until it is too late. It is to get around this difficulty that I am proposing this resolution to the house. Through preventative medicine a lot of people can be guarded against sickness. That is much better than allowing themselves to become ill, and then attempting a cure.68

These health units were intended to address four community problems across the Dominion: child welfare, the control of contagious diseases, public health education, and ‘life extension work.’ Health officers

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would standardize the medical inspection of schools across the country and identify eye, ear, dental, heart, lung, and nutritional issues in children when they entered school. Parents would then be visited and counselled on how best to care for the children. Contagious diseases such as diphtheria, smallpox, and scarlet fever were to be eradicated through immunization, while venereal disease, tuberculosis, and infantile paralysis were to be ‘taken control of’ by the health unit. Education work would include sanitary inspection, testing of water supply and food, vital statistics, disposal of sewage, and hygienic teaching. The final task of the units would be to extend the lives of Canadians by addressing emerging problems such as diabetes, heart disease, and kidney disease. The cost of the health units was justified on the grounds that ill health was more expensive than preventative medicine. On this point the prime minister, R.B. Bennett, agreed. ‘Measures to improve public health are based in the first place upon a selfish desire on the part of the state,’ he told the house. ‘It realizes that ultimately disease means loss, loss of earning power, loss from inability to create new wealth, loss through maintenance during periods of illness, loss to families sometimes resulting in poverty itself. To no inconsiderable extent the state has been governed by selfish consideration.’69 In the end the motion was agreed to. While such debates illuminate the assumptions that politicians were making about the nature of public health and the duty of the state, they do not capture the budgetary constraints under which governments operated during the 1930s. In 1934, Spencer reported to the house that while his previous motions in 1930 and 1931 had been supported, the financial crisis had prevented the government from providing more than $100,000 in support of his initiative. The prime minister again sided with Spencer, agreeing that the situation was urgent, but he asked: ‘Does he not realize that under present financial considerations nothing can come of referring a resolution of this sort to a committee?’70 Spencer replied that he understood that ‘with financial considerations as they are, nothing can be done, but we do hope that we are on the upward trend and that success is somewhere around the corner. If that is so – and we most sincerely hope it is – we might fairly give consideration to this matter now, even if we cannot do anything for twelve or eighteen months.’71 Financial constraints in the postwar years and later during the Depression did much to thwart innovation in the federal Department of Health.72 Programs that were intended to address the underlying causes of illness dwindled – and many others were discontinued. Throughout, the department limped

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along until it was again split off from the pensions department to become the Department of National Health and Welfare in 1944.73 Nevertheless, the conditional granting programs that survived had the effect of standardizing public health measures and programs throughout Canada; grants-in-aid, as they were called, required provincial ministries to earmark funding for specific purposes, and a number of conditions determined by federal officials were usually attached to them.74 As Jay Cassel argues, ‘no provincial government was likely to turn down a sizeable amount of money, so the federal conditions helped shape local programmes. Health grants also helped establish the Canadian tradition of linking the amount contributed by the federal government to the amount spent by the province on particular programs.’75 In this way, the federal government was able to shape programs at the provincial and municipal levels by targeting funding towards specific initiatives and goals, although its role in their actual administration was indirect.76 While many of the programs implemented by the Department of Health in the early 1920s were innovative, no serious attempt was made to move towards state health insurance.77 State health insurance was first proposed in Canada in 1912, in response to the national insurance schemes pioneered by David Lloyd George in Britain the previous year.78 While Mackenzie King endorsed the idea of a state-sponsored program at the Liberal Party’s first national policy convention in 1919, the promise was soon after dropped from his agenda. Robert Bothwell and John English contend that ‘medical insurance, like so many wartime social schemes, was all but forgotten during the 1920s.’79 Yet state insurance never disappeared from the agenda, and it was ultimately a lack of political will and financial resources that led the Mackenzie King and Bennett governments to resist state insurance schemes. During the Depression, when physicians watched their revenues drop as families cut back on expenses, support from the Canadian Medical Association grew for such a program. A 1934 report by the association titled ‘Plan for Health Insurance in Canada’ called on Ottawa to establish a central health insurance board, collect insurance premiums from those who wanted to participate with an income over $1,200 ($2,400 for families), and pay the premiums for those who made less.80 The money would then be transferred to provincial boards, which would administer the program. Doctors claimed that this would ensure the ‘systematic practice of preventative medicine.’81 No action towards considering such a scheme was taken at the federal level until 1939.82

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The failure of the federal Department of Health to implement health insurance has been seen as its greatest failure. Bothwell and English charge that the Department of ‘Pensions and National Health had failed to win, show, or place in the health insurance sweepstakes. It was regarded in Ottawa as a mediocre department filled with second raters. Its functions were confined to house-keeping on the health side, and it had never developed a comprehensive approach to health insurance, which it believed was a provincial responsibility.’83 Janice Dickin McGinnis is also sceptical of the department’s impact, arguing that an obsolescent approach to public health forced its marriage with the pensions department in the late 1920s, with ‘both concerns having lost their urgency with the passing from memory of the reform euphoria.’84 She suggests that the department failed to live up to its mandate because it was unable to adopt institutional welfare models of governance; instead, it sidestepped the question of national health insurance and other programs that might have succeeded better at linking poverty to ill health.85 But such criticisms evaluate the significance and success of the department solely on the basis of its failure to propose or adopt national state-funded health insurance – an outcome that Canadians now see as important but that was only one of several possibilities in the 1920s and 1930s. More important, this argument also ignores the fact that the development of national or even provincial insurance schemes was impossible so long as disease was viewed as an external threat and sickness as the responsibility of the individual rather than the community. The nineteenth-century legacy of Canada’s exclusionary policies would have to be replaced before such innovations could become politically or ideologically possible. The 1918 influenza pandemic caused dominant ideologies to shift away from a reactionary policy focused on disease management through exclusion towards a more proactive policy based in a community concept of preventative medicine. The Dominion Council of Health, founded in 1919, enabled provincial and federal officials to interact and devise protocols to coordinate crisis management efforts in the event of another national epidemic. Pre-planning and standardization became key policy goals in the interwar period as federal funding and direction was provided to the provinces and municipalities through transfer payments. At the same time, the new federal Department of Health launched ambitious programs to address child welfare, housing, food and drug safety, and community health. These programs led to unprecedented

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interventions in the lives of Canadians. As the department focused more on preventing disease through education and programs designed to address underlying social problems, maritime quarantine and the medical inspection of immigrants declined in importance. The new federal Department of Health embodied a fundamental shift in Canadian public health governance, laying the foundation for future developments in public medicine.

11 Conclusion

When the federal Department of Health was formed in the spring of 1919, Frederick Montizambert was seventy-six years old. After fifty-four years managing maritime quarantine in Canada, his department had experienced its greatest failure. Since the cholera epidemics of 1832, quarantine had formed the primary line of defence in Canada against epidemic disease. The focus on external disease threats had taken shape in the early nineteenth century, a time when settlement patterns, population densities, and trade patterns made Canada’s Eastern immigrant ports the primary points of entry for sickness and constructed immigrants as the main vectors of disease. Immigrants were easy targets of popular and official anger; the link between ‘otherness’ and disease built on and reinforced existing prejudices that had their origins in economic and social fears. Canadians liked to think of their country as an inherently healthy place; immigrants thus became sources of pollution and maritime quarantine the main defence against disease. Under Montizambert’s watch, the federal role became the primary one, while the two levels of local government were given the secondary task of eliminating conditions that might facilitate disease if it spread inland. This was a reactionary system of disease management designed to deal with perceived threats when they appeared on the periphery. In the latter part of the nineteenth century, developments in bacteriology, epidemiology, and preventative medicine challenged this external mentality but did not succeed in provoking change. In Great Britain and the United States, epidemics of cholera in the 1850s, 1860s, and 1890s led to the recognition that disease was a community threat stemming from what reformers identified as internal problems of sanitation, education, and morality – not just external sources of infection. There,

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successive epidemics combined with statistical studies of the population’s general health forced the state to begin to regulate the practices and behaviours that caused disease or that enabled it to spread quickly through growing cities. In Canada, too, reformers like Edward Playter had advocated for change in the distribution of powers that had been agreed upon at Confederation and that essentially codified the old, twotiered approach. While municipal and provincial governments gradually took on new responsibilities for managing sanitation and public health, the emphasis on external sources of disease minimized the need for significant change to existing strategies. In the debate that developed between sanitarians and contaminationists, Montizambert was the chief advocate of the exclusionary approach. He was a rising star in the public health movement, supported by apparent successes against cholera, plague, and other ‘foreign’ diseases – successes that seemed to set his organization apart from those in the United States or Great Britain. The external mentality held on for much longer in Canada because few crises arose to challenge the supremacy or efficacy of quarantine. While smallpox in 1885 and an influenza pandemic in 1889–91 could have been used to challenge those strategies, potential criticisms were parried when, in both cases, outsiders were identified as the main sources of infection and mortality proved limited to specific locations and socio-economic or ethnic groups. In the wake of these events and a final cholera scare in 1892, quarantine regulations were tightened while the medical inspection of immigrants was expanded and reinforced. Despite repeated calls for reform, there was little impetus for change. By 1918, Montizambert was Director-General of Public Health and could look back over a long and successful career. But the disease that appeared in his final year in office was unlike cholera, plague, or the other epidemic diseases that he had designed quarantine to protect against. Flu did not travel with immigrants, and it moved faster and more insidiously than water-borne or zoonotic diseases. In the winter and spring of 1918, flu appeared in Canada, perhaps from China or from the United States. It was an intense epidemic but had low mortality, spreading across the country unnoticed by federal officials but leaving its mark on communities throughout the Dominion. Only when it crossed the Atlantic to Europe, sickening soldiers fighting in the Great War and civilians in neutral countries, did the epidemic reach the public consciousness. Montizambert first became aware of the disease during the summer as British officials sent warnings to the Dominion government through

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the colonial office. As ships carrying sick soldiers began to appear at Canada’s Atlantic ports, flu fit accepted patterns of disease diffusion. Montizambert assisted military officials in quarantining vessels and their passengers in Halifax and at Grosse Île, as he had done for more than five decades. When flu failed to spread inland from the coast during the summer of 1918, because many Canadians had acquired prior immunity during the spring wave, the Director-General assumed that maritime quarantine had again proven effective. That autumn, however, influenza reappeared with increased virulence and a new deadliness. The pandemic’s second wave spread outwards from Great Britain but arrived in Canada by a circuitous route. Naval and commercial passenger traffic between Europe and Canada had been suspended in the autumn of 1918; it was American soldiers and civilians who were travelling to Europe via Canada that spread the disease to the Dominion. Flu thus evaded quarantine by crossing continental borders that had been ignored as sources of infection. Disease had been ‘othered,’ identified with those who were visibly ‘foreign,’ so the American border was not regarded as a significant source of infection. Bureaucratic inefficiencies and mistakes on the part of public health officials in Montizambert’s office led to a confused and ineffective official response. Once in Canada, the Canadian military spread the flu across the country with the mobilization of the Siberian Expeditionary Force. As sick soldiers from eastern Canada were taken off trains in Winnipeg, Regina, Calgary, and Vancouver, flu spread across the country in a matter of hours. Provincial and municipal governments formed the second line of defence, as had always been the case since 1832. While researchers debate the efficacy of non-pharmaceutical interventions, it would appear that early and far-reaching interventions had some impact on flu morbidity and mortality in American cities and on Prince Edward Island – the only province through which sick soldiers did not travel. But the early dispersal of flu victims across Canada minimized the possibility of any effective intervention at the provincial or municipal levels in the rest of the country. As non-pharmaceutical interventions and experiments with vaccination failed, it fell to professional nurses and lay volunteers to care for the pandemic’s victims. The flu was not an egalitarian disease, and its effects were felt most acutely among the working class and marginalized groups, who were already struggling for economic and physical survival. As women (and some men) visited the homes of the sick, they

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crossed class and gendered boundaries, and their observations about the living conditions faced by those whom they assisted reinforced the link between poverty and disease. In this context, flu came to be seen as a disease that required a unified community response. As flu brought communities together and temporarily broke down social barriers, it became a focal point for latent disaffections that had long simmered under the surface of patriotic fervour during the war. The 1918 pandemic coincided with larger political and social upheavals associated with the intensification of the war effort during the latter half of 1918. Popular anger over conscription, labour politics, and mounting death tolls was fuelled by the pandemic as Canadians came to associate the official response with larger breaches of the public trust. Young draftees perished in overcrowded quarters and military hospitals in Toronto while defaulters were rounded up and sent to flu-infested barracks in Quebec. For a nation that had embraced ideals of noble sacrifice and that had been told the war was necessary to secure social regeneration, the military’s lack of attention to its soldiers seemed to run counter to the idealistic rhetoric that had brought the Union government to power in December 1917. Successive governments from Macdonald to Borden had resisted calls for reform, largely because quarantine continued to provide a cheap and seemingly effective barrier against disease. But as popular anger with the Union government and its handling of the pandemic rose in the autumn of 1918, demands for reform could no longer be ignored. That fall, victory overseas and the need to define a program of social postwar reconstruction at home led to discussions about the shape that postwar society and its institutions would take. At the height of the Social Gospel movement, when it appeared that war might indeed succeed in regenerating society by redefining the covenant between citizen and state, the Borden government proposed a federal Department of Health. The department was a response to those who felt that the government had mishandled the epidemic crisis, but its aims and scope were based largely on proposals that had been made by various women’s voluntary associations at the Women’s War Conference in the spring of 1918. When the new Department of Health was announced, Montizambert was certain he would be asked to serve as its first Deputy Minister. But on Saturday, 29 March, he opened his morning copy of the Ottawa Citizen to find that Dr Peter Bryce, a long-time rival, was rumoured to be in line for that post. First thing Monday morning, he sent off a hastily written letter to James Calder, his supervisor. He told Calder that he hoped the report

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was untrue. Perhaps, he asked, it originated with Bryce himself? Angrily he wrote: ‘I have not approached you on this subject because I have felt my claims for that office so far transcend those of anyone else that it is inconceivable that the Government should pass me over … According to the Civil Service List, Dr. Bryce has had ten years permanent service as Medical Inspector of Immigrants, while I have had over fifty years of permanent service.’ All he required, he told the minister, was a brief tenure in the office to cap a lifetime spent in the service of his country and profession. He promised that he would then retire, though he might perhaps be called upon from time to time as a consultant to advise his successor if he proved ‘superficial and impractical.’ Calder had no plans to reward the aging Director-General. Instead, he offered Montizambert a chance to continue his service, but only if he accepted a demotion from Director-General of Public Health to head of the new Quarantine Branch.1 Frederick Montizambert had indeed spent more than fifty years in the federal public health service, but that was precisely the problem. He had been educated long before the advent of germ theory or laboratory medicine. The era of modern public health in Canada had begun with his appointment to the civil service by the United Province of Canada during the cholera epidemics of 1866. He was a veteran of the Fenian Raids who had overseen the Dominion’s quarantine responsibilities from Confederation to the end of the Great War. During that time he had risen from an inspector of immigrants on Grosse Île to a position that he had created for himself. But in 1919, the Union government was interested in signifying change rather than continuity. Unbeknownst to Montizambert, the cabinet felt that Bryce, too, represented the past. New blood was needed.2 The position of Deputy Minister of a health department dedicated to protecting social welfare broadly defined was instead offered to Dr John Amyot, a professor of hygiene at the University of Toronto, director of Ontario’s public health laboratory, and commander of the sanitary section of the 1st Canadian Division during the Great War. Amyot was a scientist as well as a disciple of the new field of preventative social medicine, not an inspector of immigrants or an advocate of quarantine. He was a veteran of the most recent war, and he represented a new, scientific direction for the department, one focused on improving the health of Canadians and managing epidemic disease through national and international cooperation.3 Amyot desired a clean slate, and the following winter he and Rowell

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forced Montizambert into retirement. The aging doctor was sent on his way without the customary one year of leave before retirement – a move that led him to appeal to Sir Robert Borden for assistance. Montizambert had once been able to secure audiences with Sir John A. Macdonald and Sir Wilfrid Laurier when requested. Now the prime minister refused to take his calls. As was customary, Calder noted the former Director-General’s fifty years of service in the House of Commons upon the official announcement of his retirement. When a member of the opposition picked up on Ottawa rumours to ask if the old doctor had left voluntarily, Calder responded ‘No, I can hardly say that. I think he was quite prepared to carry on.’ The elderly doctor would probably have stayed indefinitely if he had been allowed.4 Montizambert had been the embodiment of the federal quarantine and public health service for more than fifty years in Canada. But the network of quarantine stations was now an anachronism, having changed very little in eighty-five years. Scientific disinfecting apparatuses had been added and fine-tuned over the decades, but basic procedures remained remarkably stagnant – the hospital and detention centre were still physically separated at Grosse Île because they had been erected when physicians feared that disease would spread between them through miasmatic clouds.5 Although the new federal Department of Health failed to live up to the idealism on which it had been founded, its new mandate marked a fundamental shift in Canadian public health. The old exclusionary policies based on the contaminationist view were quickly replaced by programs intended to address underlying social problems and to reform behaviours that were understood to facilitate disease. During the interwar years, many of those early programs aimed at protecting child welfare, eliminating venereal disease, and improving housing disappeared as funding was cut. Yet the department’s most important legacy was that it enabled a shift from disease management to disease prevention. The federal government’s role in coordinating and facilitating the management of public health in Canada outlived most of the program in the department, as did the use of funding transfers and cost-sharing programs to standardize services across the Dominion and to allow the federal government a degree of control over the scope and boundaries of provincial programs. The federal Department of Health laid the basis for a new ideology of public health governance, one that saw disease as a community problem, not only an individual hardship or a plague brought on by outsiders.

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The development of public health in Canada had always been crisis driven. Initial strategies had been designed in response to crises in the 1830s and 1840s; they then solidified as disaster was averted in the 1860s. But in the absence of a major crisis between Confederation and the end of the Great War, the basic assumptions of those entrusted with protecting the public’s health remained unchallenged. The 1918 flu provided the impetus for change, overthrowing the supremacy of the exclusionary approach in a few short weeks. The shift from exclusionary to preventative strategies and the acceptance that public health was indeed a community and state concern worthy of federal funding were its most significant legacies. It marked the beginning of the modern era in Canadian public health.

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Notes

1. Introduction 1 Case History Sheet, George F. no. 203, Accession 1992–93/166, Box 3281– 10, RG 150, Library and Archives Canada (hereafter LAC). The patient’s last name has been withheld to protect his identity. His medical records are publically available through LAC. 2 Ibid. 3 Ibid. 4 Johnathan S. Nguyen-Van-Tam et al., ‘The Epidemiology and Clinical Impact of Pandemic Influenza,’ Vaccine 21 (2003): 1762–8 at 1763–4. 5 Ibid. 6 Niall Johnson and Juergen Mueller, ‘Updating Accounts: Global Mortality of the 1918–1920 “Spanish” Influenza Pandemic,’ Bulletin of the History of Medicine 76 (2002): 105–15. 7 Alfred Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (New York: Cambridge University Press, 1989), xiv. 8 William McNeil, Plagues and Peoples (Garden City: Anchor Press, 1976), 4. 9 Ibid. 10 For example, see Alfred Crosby, The Columbian Exchange: Biological and Cultural Consequences of 1492 (Westport: Greenwood Press, 1972); Roderick E. McGrew, Russia and the Cholera, 1823–1832 (Madison: University of Wisconsin Press, 1965), 6–8; R.J. Morris, Cholera 1832: The Social Response to an Epidemic (New York: Holmes and Meier, 1976), 17. Charles E. Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, [1962]1987), 6–7. 11 Alfred Crosby, Epidemic and Peace, 1918: America’s Deadliest Influenza Epidemic (Westport: Greenwood, 1976).

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12 Historiographical overviews are provided by Guy Beiner, ‘Out in the Cold and Back: New-Found Interest in the Great Flu,’ Cultural and Social History 3, no. 4 (2006): 496–505; and Howard Phillips, ‘The Re-Appearing Shadow of 1918: Trends in the Historiography of the 1918–19 Influenza Pandemic,’ Canadian Bulletin of Medical History 21, no. 1 (2004): 121–34. 13 For example, see W.I.B. Beveridge, Influenza: the Last Great Plague, rev. ed. (New York: Prodist, 1978), 24–38; K. David. Patterson, ‘The Geography and Mortality of the 1918 Influenza Pandemic,’ Bulletin of the History of Medicine 65, no. 1 (1991): 4–21; and Howard Phillips, ‘Black October’: the Impact of the Spanish Influenza Epidemic of 1918 on South Africa (Pretoria: Government Printer, 1990). 14 Crosby, America’s Forgotten Pandemic, xiv. 15 Terence Ranger, ‘The Influenza Pandemic in Southern Rhodesia: A Crisis of Comprehension,’ in Imperial Medicine and Indigenous Societies, ed. David Arnold (Delhi: Oxford University Press, 1989); Geoffrey Rice, Black November: The 1918 Influenza Epidemic in New Zealand (Wellington: Allen and Unwin, 1988); M. Tomkins, ‘Colonial Administration in British Africa during the Influenza Epidemic of 1918–19,’ Canadian Journal of African Studies 28, no. 1 (1994): 68–70. The best collection of international studies is Howard Phillips and David Killingray, The Spanish Influenza Pandemic of 1918–1919: New Perspectives (London: Routledge, 2003). 16 Overviews of the scientific investigation into flu include Pete Davis, The Devil’s Flu: The World’s Deadliest Influenza Epidemic and the Scientific Hunt for the Virus That Caused It (New York: Henry Holt, 2000); Kirsty Duncan, Hunting the 1918 Flu: One Scientist’s Search for a Killer Virus (Toronto: University of Toronto Press, 2003); and Gina Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused it (New York: Farrar, Straus and Giroux, 1999). See also Ann H. Reid et al., ‘The 1918 Spanish Influenza: Integrating History and Biology,’ Microbes and Infection 3 (2001): 81–7; and Jeffery K. Taubenberger et al., ‘Characterization of the 1918 influenza Virus Hemagglutinin and Neuraminidase Genes,’ International Congress Series 1219 (2001): 545–9. 17 J.S. Oxford et al., ‘Early Herald Wave Outbreaks of Influenza in 1916 Prior to the Pandemic of 1918,’ International Congress Series 1219 (2001): 151–61 at 161. 18 Margaret Humphreys, ‘No Safe Place: Disease and Panic in American History,’ American Literary History 14, no. 4 (2002): 845–57; Julia F. Irwin, ‘An Epidemic without Enmity: Explaining the Missing Ethnic Tensions in New Haven’s 1918 Influenza Epidemic,’ Urban History Review 36, no. 2 (2008): 5–17; Robert S. McPherson, ‘The Influenza Epidemic of 1918: A Cultural

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Response,’ Utah Historical Quarterly 58, no. 2 (1990): 183–200; Thomas Wirth, ‘Urban Neglect: The Environment, Public Health, and Influenza in Philadelphia, 1915–1919,’ Pennsylvania History 73, no. 3 (2006): 316–42. Carol R. Byerly, Fever of War: The Influenza Epidemic in the US Army during World War I (New York: NYU Press, 2005); David L. Cockrell, ‘“A Blessing in Disguise”: The Influenza Pandemic of 1918 and North Carolina’s Medical and Public Health Communities,’ North Carolina Historical Review 73, no. 3 (1996): 309–327; Niall Johnson, Britain and the 1918–19 Influenza Pandemic: A Dark Epilogue (London: Praeger, 2005); Pierce C. Mullen, ‘Montanans and “the Most Peculiar Disease”: The Influenza Epidemic and Public Health, 1918–1919,’ Montana: The Magazine of Western History 37, no. 2 (1987): 50–61. Andrew Noymer and Michel Garenne, ‘The 1918 Influenza Epidemic’s Effects on Sex Differentials in Mortality in the United States,’ Population and Development Review 26, no. 3 (2000): 565–81; Christopher Langford, ‘The Age Pattern of Mortality in the 1918–19 Influenza Pandemic: An Attempted Explanation Based on Data for England and Wales,’ Medical History 46, no. 1 (2002): 1–20. Howard Phillips, ‘Review of Influenza 1918: Disease, Death, and Struggle in Winnipeg,’ Bulletin of the History of Medicine 83, no. 1 (Spring 2009): 227–8. Janice P. Dickin McGinnis, ‘The Impact of Epidemic Influenza: Canada, 1918–1919,’ in Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queen’s University Press, 1981), 471–83. It originally appeared as Dickin McGinnis, ‘The Impact of Epidemic Influenza, 1918–19,’ CHA Historical Papers (1977): 120–41. Eileen Pettigrew, Silent Enemy: Canada and the Deadly Flu of 1918 (Regina: Western Producer Prairie Books, 1983). Margaret W. Andrews, ‘Epidemic and Public Health: Influenza in Vancouver, 1918–1919,’ BC Studies 34, (Summer 1977): 43; Robert C. Belyk and Diane M. Belyk, ‘No Armistice with Death: The Spanish Influenza, 1918–19’ The Beaver, October-November 1988): 43–9; Heather MacDougall, ‘The Fatal Flu,’ Horizon Canada 8, no. 8 (1985): 2089–95; Ian Miller, ‘No Cause For Alarm,’ The Beaver 80, no. 6 (2000–1): 33–7; Peter Wiliton, ‘Spanish Flu Outdid WWI in Number of Lives Claimed,’ Canadian Medical Association Journal 148, no. 11 (1993): 2036–40. For example, see Jadranka Bacic, ‘The Plague of the Spanish Flu: The Influenza Epidemic of 1918 in Ottawa,’ Bytown Pamphlet Series (Ottawa: Ottawa Historical Society, 200); Janice P. Dickin McGinnis, ‘A City Faces an Epidemic,’ Alberta History 24, no. 4 (1976): 1–11; Antonio Drolet, ‘L’épidémie de grippe espagnole a Québec en 1918,’ in Trois siècles de médicine québécoise

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27

28

29 30

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(Québec: Société historique de Québec, 1970), 98–106; Pierre Frenette, ‘Le cauchemar de la grippe espagnole,’ Revue d’histoire de la Côte-Nord 3 (1985); Ann Herring, ed., Anatomy of a Pandemic: The 1918 Influenza in Hamilton (Hamilton: Allegra Press, 2006); Niall Johnson, ‘Pandemic Influenza: An Analysis of the Spread of Influenza in Kitchener, October 1918’ (MA thesis, Wilfrid Laurier University, 1993); Maureen K. Lux, ‘“The Bitter Flats”: The 1918 Influenza Epidemic in Saskatchewan,’ Saskatchewan History (Spring 1997): 3–13; Lux, ‘The Impact of the Spanish Influenza Pandemic in Saskatchewan, 1918–1919’ (MA thesis, University of Saskatchewan, 1989); Denise Rioux, La grippe espagnole à Sherbrooke et dans les Cantons de l’Est (Sherbrooke: Études supérieures en histoire, Université de Sherbrooke, 1993); see also Rioux’s dissertation, ‘Le grippe espagnole à Sherbrooke en 1918’ (PhD diss., Université de Sherbrooke, 1985); Raymond Ouimer, ‘La grippe espagnole de 1918 à Hull,’ Asticou 43 (1990): 2–14; and Yvette Paquin, ‘Les sœurs grises en tenue de service – l’influenza de 1918,’ Cahiers Nicoletians 8, no. 2 (1986) :101–21. Magda Fahrni, ‘“Elles sont partout …”: le femmes et la ville en temps d’épidémie Montréal, 1918–1920,’ Revue d’histoire de L’Amerique francaise 58, no. 1 (2004): 67–85; Esyllt Jones, ‘“Co-operation in All Human Endeavour”: Quarantine and Immigrant Disease Vectors in the 1918– 1919 Influenza Pandemic in Winnipeg,’ Canadian Bulletin of Medical History 22, no. 1 (2005): 77–8; Linda J. Quiney, ‘“Filling the Gaps”: Canadian Voluntary Nurses, the 1917 Halifax Explosion, and the Influenza Epidemic of 1918,’ Canadian Bulletin of Medical History 19, no. 2 (2002): 351– 73. Esyllt Jones, Influenza, 1918: Disease, Death, and Struggle in Winnipeg (Toronto: University of Toronto Press, 2007). See also Jones, ‘Politicizing the Labouring Body: Working Families, Death, and Burial in Winnipeg’s Influenza Epidemic, 1918–19,’ Labour: Studies in Working Class History of the Americas 3, no. 3 (2006): 57–75. D. Ann Herring, ‘“There Were Young People and Old People and Babies Dying Every Week”: The 1918–1919 Influenza Pandemic at Norway House,’ Ethnohistory 41, no. 1 (1994): 73–105; Herring, ‘The 1918 Influenza Epidemic in the Central Canadian Subarctic,’ in Strength in Diversity: A Reader in Physical Anthropology, ed. Ann Herring and Leslie Chan (Toronto: Canadian Scholars’ Press, 1994), 365–84. Mary-Ellen Kelm, ‘British Columbia First Nations and the Influenza Pandemic of 1918–19,’ BC Studies 122 (1999): 23–47. See also Mary-Ellen Kelm, Colonizing Bodies: Aboriginal Health and Healing in British Columbia, 1900–1950 (Vancouver: UBC Press, 1999).

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31 Jones, ‘Co-operation in All Human Endeavour,’ 78. A recent addition to this literature is Jane E. Jenkins, ‘Baptism of Fire: New Brunswick’s Public Health Movement and the 1918 Influenza Epidemic,’ Canadian Bulletin of Medical History 24, no. 2 (2007): 317–42. 32 Charles Rosenberg and Janet Golden, eds., Framing Disease: Studies in Cultural History (New Brunswick: Rutgers University Press, 1992), xvi–xvii. 33 On the development of public health in Canada, a succinct narrative overview is provided in Jay Cassel, ‘Public Health in Canada,’ in The History of Public Health and the Modern State, ed. Dorothy A. Porter (Amsterdam: Rodopi, 1994). See also Robert D. Defries, The Development of Public Health in Canada (Ottawa: Canadian Public Health Association, 1940); J.J. Heagerty, Four Centuries of Medical History (Toronto: Macmillan, 1928), I:337–93 and II:1–71; and Christopher Rutty and Sue C. Sullivan, This Is Public Health: A Canadian History (Toronto: Canadian Public Health Association, 2010). On developments at the federal level, see Janice Dickin McGinnis, ‘From Health to Welfare: Federal Government Policies regarding Standards of Public Health for Canadians, 1919–1945,’ PhD diss., University of Alberta, 1980; Tom Nesmith, ‘The Early Years of Public Health: The Department of Agriculture, 1867–1918,’ Archivist 12, no. 5 (1985): 1–3; and Aleck Ostry, ‘Differences in the History of Public Health in 19th Century Canada and Britain,’ Canadian Journal of Public Health 86 (January–February 1995): 5–6. See also Jay Cassel, The Secret Plague: Venereal Disease in Canada, 1838–1939 (Toronto: University of Toronto Press, 1987); Alvin Finkel, Social Policy and Practice in Canada: A History (Waterloo: Wilfrid Laurier University Press, 2005); and Katherine McCuaig, The Weariness, the Fever, and the Fret: The Campaign against Tuberculosis in Canada, 1900–1950 (Montreal and Kingston: McGill–Queen’s University Press, 1999). 34 Here the work of Michel Foucault, or rather the modification of his ideas by subsequent scholars, is useful for conceptualizing the relationship between policy aims and dominant ideologies. For an introduction, see Graham Burchell, Colin Gordon, and Peter Miller, eds., The Foucault Effect: Studies in Governmentality (Chicago: University of Chicago Press, 1991), esp. 87–104; see also Mitchell Dean, Governmentality: Power and Rule in Modern Society (London: Sage, 1999), esp. 9–39. There are numerous studies of public health at the municipal and provincial levels in Canada. The field was defined by Heather MacDougall, Activists and Advocates: Toronto’s Health Department, 1883–1983 (Toronto: Dundurn Press, 1990). See also Denyse Baillargeon, Babies for the Nation: The Medicalization of Motherhood in Quebec, 1910–1970 (Waterloo: Wilfrid Laurier University Press, 2009); Cynthia Comacchio, ‘Nations Are Built of Babies’: Saving Ontario’s Mothers and Children,

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1900–1940 (Montreal and Kingston: McGill–Queen’s University Press, 1993); Terry Copp, ‘Public Health in Montreal, 1870–1930,’ in Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queen’s University Press, 1981), 395–416; Heather MacDougall, ‘Public Health and the “Sanitary Idea” in Toronto, 1866–1890,’ in Essays in the History of Canadian Medicine, ed. Wendy Mitchinson and Janice Dickin McGinnis (Toronto: McClelland and Stewart, 1988), 62–87; and Michael J. Piva, The Condition of the Working Class in Toronto, 1900–1921 (Ottawa: University of Ottawa Press, 1979), 113–142 35 The international literature on immigrants, ‘the other,’ and disease is well developed. See Amy Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labour Force (Baltimore: Johns Hopkins University Press, 2003); Mark Harrison, Climates and Constitutions: Health, Race, Environment, and British Imperialism in India, 1600–1850 (Oxford: Oxford University Press, 2002); Alan M. Kraut, Silent Travelers: Germs, Genes, and the ‘Immigrant Menace’ (Baltimore: Johns Hopkins University Press, 1994); Erika Lee, At America’s Gates: Chinese Immigration during the Exclusion Era, 1882–1943 (Chapel Hill: University of North Carolina Press, 2003); Howard Markel, Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (Baltimore: Johns Hopkins University Press, 1997); Natalia Molina, Fit to Be Citizens? Public Health and Race in Los Angeles, 1879–1939 (Berkeley: University of California Press, 2006); David Rosner, ed., Hives of Sickness: Public Health and Epidemics in New York City (New Brunswick: Rutgers University Press, 1995); and Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: University of California Press, 2001). 36 See Kay Anderson, ‘Engendering Race Research: Unsettling the Self-Other Dichotomy,’ in Body Space, ed. Nancy Duncan (New York: Routledge, 1996), 197–211. Canadian responses to immigration in this era are most fully examined in Anderson, Vancouver’s Chinatown: Racial Discourse in Canada, 1875–1980 (Montreal: McGill–Queen’s University Press, 1991); Donald Avery, ‘Dangerous Foreigners’: European Immigrant Workers and Labour Radicalism in Canada, 1896–1932 (Toronto: McClelland and Stewart, 1979); Avery, Reluctant Host: Canada’s Response to Immigrant Workers, 1896–1994 (Toronto: McClelland and Stewart, 1995); Valerie Knowles, Stranger at Our Gates: Canadian Immigration and Immigration Policy, 1540–1990 (Toronto: Dundurn Press, 1992); Ninette Kelley and Michael Trebilock, The Making of the Mosaic: A History of Canadian Immigration Policy (Toronto: University of Toronto Press, 1998); and David Goutor, Guarding the Gates: The Canadian Labour Movement and Immigration, 1872–1934 (Vancouver: UBC Press, 2007). Good international studies of public health development include Dorothy

Notes to pages 11–12

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Porter, Health, Civilization, and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999); Porter, ed., The History of Public Health and the Modern State (Amsterdam: Rodopi, 1994); and George Rosen, A History of Public Health (Baltimore: Johns Hopkins University Press, expanded ed. 1993). Studies on Britain and the United States include Jeanne L. Brand, Doctors and the State: The British Medical Profession and Government Action in Public Health, 1870–1912 (Baltimore: Johns Hopkins University Press, 1965); John Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins University Press, 1979); Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventative Medicine, 1856–1900 (Oxford: Oxford University Press, 1993); R. Lambert, Sir John Simon, 1816–1904 and English Social Administration (London: MacGibbon and Kee, 1963); Barbara Rosenkrantz, Public Health and the State: Changing Views in Massachusetts, 1842–1936 (Cambridge, MA: Harvard University Press, 1972); F.B. Smith, The People’s Health, 1830–1910 (London: Croom Helm, 1979); Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns, eds., History and Health Policy in the United States: Putting the Past Back In (New Brunswick: Rutgers University Press, 2006); John W. Ward and Christian Warren, Silent Victories: The History and Practice of Public Health in Twentieth-Century America (Oxford and New York: Oxford University Press, 2007); and Anthony Wohl, Endangered Lives: Public Health in Victorian Britain (Cambridge, MA: Cambridge University Press, 1983). 2. Establishing the Grand Watch 1 Susanna Moodie, Roughing it in the Bush or Life in Canada, Second Edition (London: Richard Bentley, 1852), 34. 2 On Susanna Moodie, see Charlotte Gray, Sisters in the Wilderness: The Lives of Susanna Moodie and Catharine Parr Trail (Toronto: Penguin, 1999). Moodie’s journals are available in an edited form in Margaret Atwood, ed., The Journals of Susanna Moodie (Toronto: Oxford University Press, 1971). 3 Susanna Moodie, Roughing it in the Bush or Life in Canada, New Edition (London: Richard Bentley, 1857), vii. 4 Ibid., 23. 5 See Mark Harrison, Climates and Constitutions: Health, Race, Environment and British Imperialism in India, 1600–1850 (Oxford: Oxford University Press, 2002). The idea that the Canadian environment provided an inherently healthy climate persisted well into the twentieth century. See E. Desjardins, ‘Deux Medecins Montréalais du XIX Siecle Adeptes da la Pensee Ecologique,’ L’Union Médicale du Canada 99 (1970): 487–92; William

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8 9 10 11 12 13 14 15 16

Notes to pages 12–13

Hingston, The Climate of Canada and Its Relations to Life and Health (Montreal: Dawson Brothers, 1884); and A.J. Horsey, ‘Healthfulness of the North-West Campaign – Value of Pure Air,’ Man 1, no. 3 (January 1886): 108–9. Arthur J. Ray, ‘Diffusion of Diseases in the Western Interior of Canada, 1830–1850,’ Geographical Review 66, no. 2 (1976): 141–2. J.J. Heagerty, The Romance of Medicine in Canada (Toronto: Ryerson Press, 1940), 37–8. The literature on immigration and disease is growing. See, among other works, Kay J. Anderson, Vancouver’s Chinatown: Racial Discourse in Canada, 1875–1990 (Montreal and Kingston: McGill–Queen’s University Press, 1991); Erika Lee, At America’s Gates: Chinese Immigration during the Exclusion Era, 1882–1943 (Chapel Hill: University of North Carolina Press, 2003); Amy L. Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labor Force (Baltimore: Johns Hopkins University Press, 2003); Alan Kraut, Silent Travelers: Germs, Genes, and the ‘Immigrant Menace’ (Baltimore: Johns Hopkins University Press, 1994); Howard Markel, Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892 (Baltimore: Johns Hopkins University Press, 1997); Natalia Molina, Fit to be Citizens? Public Health and Race in Los Angeles, 1879– 1939 (Berkeley: University of California Press, 2006); David Rosner, ed., Hives of Sickness: Public Health and Epidemics in New York City (New Brunswick: Rutgers University Press, 1995); and Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: University of California Press, 2001). Peter Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge University Press, 1999), 528. Dorothy Porter, Health, Civilization, and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999), 97–112. Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton, 1997), 259. Carlo M. Cipolla, Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age (New Haven: Yale University Press, 1992), xx. Ibid. Porter, Health, Civilization, and the State, 34–7. Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction, 2nd ed. (Toronto: University of Toronto Press, 2010), 170. Porter, The Greatest Benefit to Mankind, 259–60. See J.J. Heagerty, Four Centuries of Medical History in Canada, vol. 2 (Toronto: Macmillan, 1928), 50–2. The standard work on the history of medicine in Quebec is Jacques Bernier, La médecine au Québec: Naissance et évolution d’une profession (Québec: Presses de l’Université Laval, 1989). Other works

Notes to page 14

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18 19 20

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that cover general medicine in New France include Michael-Joseph Ahern, Useful Notes on the History of Medicine in Lower Canada: From the Founding of Quebec to the Beginning of the 19th Century (Toronto: Hannah Institute for the History of Medicine, 1983); Georges Desrosiers, ‘Histoire de la santé publique au Québec,’ Canadian Journal of Public Health 75, no. 5 (1984): 359–65; François Guérard, Histoire de la santé au Québec (Montréal: Boréal, 1996); K. Hardill, ‘From the Grey Nuns to the Streets: A Critical History of Outreach Nursing in Canada,’ Public Health Nursing 24 (2007): 91–7; Vincent Lemieuz et al., Le system de santé au Québec: organisation, acteurs et enjeux (Québec: Les Presses de l’Université Laval, 1994); and Rénald Lessard, ‘Pratique et praticiens en contexte colonial: le corps médical canadien aux 17e et 18e siècles,’ PhD diss., Université Laval, 1994. On Upper Canada and the Atlantic provinces, see Jacques Bernier, Disease, Medicine, and Society in Canada: A Historical Overview (Ottawa: Canadian Historical Association, 2003); William W. Canniff and Charles G. Roland eds., The Medical Profession in Upper Canada 1783–1850 (Toronto: Hannah Institute for the History of Medicine, 1980); Allan Everett Marble, Surgeons, Smallpox, and the Poor: A History of Medicine and Social Conditions in Nova Scotia, 1749–1799 (Montreal and Kingston: McGill–Queen’s University Press, 1993); Relief MacKay, ‘Poor Relief and Medicine in Nova Scotia, 1749–1783,’ in Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queen’s University Press, 1981), 75–92; and Charles G. Roland, ‘Sunk under the Taxation of Nature: Malaria in Upper Canada,’ in Health, Disease, and Medicine: Essays on Canadian History, ed. Charles G. Roland (Toronto: Hannah Institute for the History of Medicine 1984), 154–70. On Newfoundland see Melvin Baker, ‘Disease and Public Health Measures in St John’s, Newfoundland, 1832–1855,’ Newfoundland Quarterly 78, no. 4 (1983): 26–9. Heagerty, The Romance of Medicine in Canada, 25–7. On quarantine in Canada before 1832, see Geoffrey Bilson, ‘Science, Technology, and 100 Years of Canadian Quarantine,’ in Critical Issues in the History of Canadian Science, Technology, and Medicine, ed. Richard A. Jarrell and A.E. Roos (Thornhill: HSTC Publications, 1983), 89–100; and André Sévigny, Synthèse sur l’histoire de l’immigration au Canada via Québec entre 1815 et 1945 (Québec: Parks Canada, 1995). Porter, The Greatest Benefit to Mankind, 402–3. Duffin, History of Medicine, 148–9. The standard works on cholera in Europe and North America include François Delaporte, Disease and Civilization: The Cholera in Paris, 1832 (Boston: MIT Press, 1986); Richard J. Evans, Death in Hamburg: Society and Politics

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29 30

Notes to pages 14–15

in the Cholera Years (London: Oxford University Press, 1987); Catherine Jean Kudlick, Cholera in Post-Revolutionary Paris: A Cultural History (Berkeley: University of California Press, 1996); Roderick McGrew, Russia and the Cholera, 1823–1832 (Madison: University of Wisconsin Press, 1965); R.J. Morris, Cholera, 1832: the Social Response to an Epidemic (London: Croom Helm, 1976); and Charles Rosenberg, The Cholera Years: The United States in 1832, 1849, and 1866 (Chicago: University of Chicago Press, [1962] 1987). Morris, Cholera, 1832, 176–84. McGrew, Russia and the Cholera, 78–80. Morris, Cholera, 1832, 30–5. Ibid. Ibid. The quote is from page 35. Porter, The Greatest Benefit to Mankind, 403. Geoffrey Bilson, ‘Canadian Doctors and the Cholera,’ in Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queens University Press, 1981), 123. G.M. Craig, ‘The 1830s,’ in Colonists and Canadiens: 1760–1867, ed. J.M.S. Careless (Toronto: MacMillan, 1971), 179. The standard work on cholera in British North America is Geoffrey Bilson, A Darkened House: Cholera in Nineteenth-Century Canada (Toronto: University of Toronto Press, 1980). In addition to those works cited in this chapter, see the following: Bilson, ‘The First Epidemic of Cholera in Lower Canada, 1832,’ Medical History 21, no. 4 (October 1977): 411–33; Bilson, ‘Canadian Doctors and the Cholera’; Bilson, ‘The Cholera Epidemic in Saint John, N.B., 1854,’ Acadiensis 4, no. 1 (Fall 1974): 85–99; Bilson, ‘Two Cholera Ships in Halifax,’ Dalhousie Review 53, no. 3 (Fall 1973): 449–59; Bernard Dufebvre, ‘L’épidémic de cholera de 1832 à Québec,’ Laval medical, 19, no. 5 (1854): 696–712; S.E.D. Shortt, ‘Cholera: Doctors’ Dilemma, Historian’s Delight,’ Queen’s Quarterly 88, no. 1 (Spring 1981): 130–4; and Chris Raible, ‘In Sable Garments of Mourning … Cholera Devastates Upper Canada, 1832,’ The Beaver 72, no. 2 (1992): 43–50. A good primary-source description is Elam Stimson, The Cholera Beacon: Being a Treatise on the Epidemic Cholera as it Appeared in Upper Canada in 1832–4 (Dundas: Hackstaff, 1835). Jay Cassel, ‘Public Health in Canada,’ in The History of Public Health and the Modern State, ed. Dorothy A. Porter (Amsterdam: Rodopi, 1994), 277–8 at 278. On the othering of the immigrant, see Kay Anderson, ‘Engendering Race Research: Unsettling the Self–Other Dichotomy,’ in Body Space, ed. Nancy Duncan (New York: Routledge, 1996), 197–211; and Daiva Stasiulius and Radha Jhappan, ‘The Fractious Politics of a Settler Society: Canada,’ in

Notes to pages 16–17

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32 33 34 35 36 37 38 39 40

41 42 43 44

45 46 47

48

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Unsettling Settler Societies: Articulation or Gender, Race, Ethnicity, and Class, ed. Daiva Stasiulis and Nira Yuval-Davis (Thousand Oaks: Sage, 1995), 95–131. Lower Canada, Journal of the House of Assembly of Lower Canada (16 February 1832), 455–8; and Bilson, A Darkened House, 6. On the history of the Grosse Île station, see Christine Chartré, La Désinfection dans la système quarantenaire maritime de Grosse-Île: 1832–1937 (Quebec: Parcs Canada, 1995); Jason King, ‘Famine Diaries: Narratives about Emigration from Ireland to Lower Canada and Quebec, 1832–1853,’ MA thesis, Simon Fraser University, 1996; Frederick Montizambert, ‘The Story of Fifty-four Years Quarantine Service from 1866 to 1920,’ Canadian Medical Association Journal 16 (1926): 314–19; and J. Page, ‘Grosse Isle Quarantine Station,’ Canadian Public Health Journal (September 1931): 454–8. Bilson, A Darkened House, 6, 66–7. Ibid. Ibid., 92–110. Ibid., 9. Moodie, Roughing it in the Bush, Second Edition, 10. Bilson, A Darkened House, 10–11. Ibid., 11–12. Catharine Parr Traill, The Backwoods of Canada (London: Charles Knight, 1836), 37. Ninette Kelley and Michael Trebilock, The Making of the Mosaic: A History of Canadian Immigration Policy (Toronto: University of Toronto Press, 1998), 49–51. Rosenberg, The Cholera Years, 62. Kraut, Silent Travelers, 32. Barbara Rosenkrantz, Public Health and the State: Changing Views in Massachusetts, 1842–1936 (Cambridge, MA: Harvard University Press, 1972), 1. Rosenberg, The Cholera Years, 37; for a contemporary perspective, see James Ellsworth De Kay et al., Report of the Commissioners Employed to Investigate the Origin and Nature of the Epidemic of Cholera in Canada (New York: Peter van Pelt, 1832). For the British context, see Morris, Cholera 1832, 108–17; for Russia, see McGrew, Russia and the Cholera, 154–6. Heagerty, The Romance of Medicine in Canada, 81. Mason Wade, The French Canadians, 1760–1967, vol. 1, 1760–1911 (Toronto: Macmillan, 1968), 142. See also Heagerty, The Romance of Medicine in Canada, 80–1; and Ferdinand Ouellet, Lower Canada 1791–1840: Social Change and Nationalism (Toronto: McClelland and Stewart, 1980), 138–9. Craig, ‘The 1830s,’ 179. See also Valerie Knowles, Strangers at Our Gates:

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51 52 53 54 55 56

57 58

59 60 61 62 63 64

65 66

Notes to pages 17–20

Canadian Immigration and Immigration Policy, 1540–2006, rev. ed. (Toronto: Dundurn Press, 1998), 60–2. Anon., ‘Cholera,’ The Halifax Monthly Magazine 3, no. 27 (October 1832), 218. For example, see Lower Canada, Bill to make more effectual provision for the preservation of the Public Health, and to establish an effectual system of Quarantine (1833), 7. Bilson, A Darkened House, 92–3. Ibid., 34–5 Rosenberg, The Cholera Years, 37. Ibid., 23. Bilson, A Darkened House, 6–7. Michael J. Piva, ‘Government Finance and the Development of the Canadian State,’ in Colonial Leviathan: State Formation in Mid-Nineteenth Century Canada, ed. Allan Greer and Ian Radforth (Toronto: University of Toronto Press, 1992), 257. Bilson, A Darkened House, 6–15. Cassel, ‘Public Health in Canada,’ 278. See also Ian Radforth, ‘Sydenham and Utilitarian Reform,’ in Colonial Leviathan: State Formation in Mid-Nineteenth Century Canada, ed. Allan Greer and Ian Radforth (Toronto: University of Toronto Press, 1992), 64–102. Heagerty, The Romance of Medicine, 81. Ouellet, Lower Canada 1791–1840, 138. Ibid. Bilson, A Darkened House, 99. Ibid., 118. See also Cassel, ‘Public Health in Canada,’ 277–8. Logan Atkinson, ‘The Impact of Cholera on the Design and Implementation of Toronto’s First Municipal By-Laws, 1834,’ Urban History Review 30, no. 2 (2002): 3–15 at 13. Ibid. For the political background, see G.M. Craig, Upper Canada: the Formative Years. 1784–1841 (Toronto: McClelland and Stewart, 1963); Aileen Dunham, Political Unrest in Upper Canada, 1815–1836 (Toronto: McClelland and Stewart, 1963); Allan Greer, The Patriots and the People: The Rebellion of 1837 in Rural Lower Canada (Toronto: University of Toronto Press, 1993); Ouellet, Lower Canada, 1791–1840; Colin Read and Ron Stagg, eds, The Rebellion of 1837 in Upper Canada (Toronto: Champlain Society, 1985); and Joseph Scull, Rebellion: The Rising in French Canada, 1837 (Toronto: Macmillan, 1971). A recent reinterpretation is Bryan Palmer, ‘Popular Radicalism and the Theatrics of Rebellion: The Hybrid Discourse of Dissent in Upper

Notes to pages 20–2

67 68 69 70

71

72

73 74 75

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Canada in the 1830s,’ in Transatlantic Subjects: Ideas, Institutions, and Social Experience in Post-Revolutionary British North America, ed. Nancy Christie (Montreal and Kingston: McGill–Queen’s University Press, 2008), 403–38. For a historiographical overview, see Allan Greer, ‘1837–38: Rebellion Reconsidered,’ Canadian Historical Review 76 (1995): 1–18. Knowles, Strangers at Our Gates, 42–3. United Province of Canada. An act to Make Provision for the Preservation of the Public Health in Certain Emergencies (1849). See various documents in the letter books found in volumes 2432–3, RG 17, Library and Archives Canada (hereafter cited as LAC). Central Board of Health, ‘Regulations of the Central Board for the Preservation of the Public Health,’ (Montreal: S. Derbishire and G. Desbarats, 1849); Central Board of Health, Regulations etc. adopted by the Central Board of Health (Quebec: Canada Gazette Office, 1854). Pamela K. Gilbert, ‘Producing the Public: Public Medicine in Private Spaces,’ in Medicine, Health, and the Public Sphere in Britain, 1600–2000, ed. Steve Sturdy (London: Routledge, 2002), 43–4. See also the same author’s book Mapping the Victorian Social Body (Albany: SUNY Press, 2004); On statesanctioned medical intrusions into the private sphere in this era in Canada, see, among other sources, Angus McLaren and Arlene Tigar McLaren, The Bedroom and the State: The Changing Practices and Politics of Contraception and Abortion in Canada, 1880–1980 (Toronto: McClelland and Stewart, 1986), esp. 15–53; and Wendy Mitchinson, The Nature of Their Bodies: Women and Their Doctors in Victorian Canada (Toronto: University of Toronto Press, 1991), 14–48. Ibid. On the idea of private and public spaces in Canada during the nineteenth century, see Cecilia Morgan, Public Men and Virtuous Women: The Gendered Languages of Religion and Politics in Upper Canada, 1791–1850 (Toronto: University of Toronto Press, 1996); and Peter Ward, A History of Domestic Space: Privacy and the Canadian Home (Vancouver: UBC Press, 1999). Gilbert, ‘Producing the Public,’ 43–4. Cassel, ‘Public Health in Canada,’ 277–8. See John Snow, On the Mode of Communication of Cholera (London: John Churchill, 1855). For an overview of his impact on theories of disease, see Porter, Health, Civilization, and the State, 412–3; and for more detail, Peter Vinten-Johansen et al., Cholera, Chloroform, and the Science of Medicine: A Life of John Snow (Oxford and New York: Oxford University Press, 2003). On the subsequent rise of preventative medicine in Britain, see Anne Hardy, The Epidemic Streets: Infectious Disease and the Rise of Preventative Medicine, 1856–1900 (Oxford: Oxford University Press, 1993); and Margaret Pelling,

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79

80

81 82

83 84 85

86

87

88

Notes to pages 22–4

Cholera, Fever, and English Medicine, 1825–1865 (Oxford: Oxford University Press, 1978). Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 30–1. Porter, Health, Civilization, and the State, 413–14. On the power of smell in medical thinking at the time, see Alain Corbin, The Foul and the Fragrant: Odor and the French Social Imagination (Cambridge, MA: Harvard University Press, 1986). See John Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins University Press, 1979) and Eyler, ‘The Conceptual Origins of William Farr’s Epidemiology: Numerical Methods and Social Thought in the 1830s,’ in Times, Places, and Persons, ed. A.M. Lilienfeld (Baltimore: Johns Hopkins University Press, 1980), 1–21. F.B. Smith, The People’s Health, 1830–1910 (London: Croom Helm, 1979), 195. On Chadwick, see Christopher Hamlin, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge University Press, 1998). Porter, Health, Civilization, and the State, 414. Ibid. A succinct overview of the British legislation is provided in Smith, The People’s Health, 198–203. See also James G. Hanley, ‘Public Health, London’s Levels, and the Politics of Taxation, 1840–1860,’ Social History of Medicine 20 (2007): 21–38. Rosenkrantz, Public Health and the State, 26–31. Ibid., 26–71. Aleck Ostry, ‘Differences in the History of Public Health in 19th Century Canada and Britain,’ Canadian Journal of Public Health 86 (January–February 1995): 5–6. Ibid. See also Desmond Morton with Terry Copp, Working People: An Illustrated History of Canadian Labour (Toronto: Deneau and Greenberg, 1980), 3–6. For a case study, see Michael J. Doucet, ‘Working Class Housing in a Small Nineteenth-Century Canadian City: Hamilton, Ontario, 1852–1881,’ in Essays in Canadian Working Class History, ed. Gregory S. Kealey and Peter Warrian (Toronto: McClelland and Stewart, 1976), 83–105. On the making of vital statistics in Canada see Bruce Curtis, The Politics of Population: State Formation, Statistics, and the Census of Canada, 1840–1875 (Toronto: University of Toronto Press, 2001), esp. 113–15. Heather MacDougall, ‘Public Health and the “Sanitary Idea” in Toronto, 1866–1890,’ in Essays in the History of Canadian Medicine, ed. Wendy Mitchinson and Janice Dickin McGinnis (Toronto: McClelland and Stewart, 1988), 62–87.

Notes to pages 24–7

211

89 Bruce Curtis, ‘Social Investment in Medical Forms: The 1866 Cholera Scare and Beyond,’ Canadian Historical Review 81, no. 3 (2000): 347–79 at 356. 90 Ibid., 359. 91 Michael Worboys, Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000). On the Canadian context, see Jacalyn Duffin’s study of James Miles Langstaff: Langstaff: A Nineteenth-Century Medical Life (Toronto: University of Toronto Press, 1993). 92 Ibid., 360. For more on the debate about the nature of cholera in 1866, see Bruce Curtis, ‘La morale miasmatique: le “memoire sur le cholera” de Joseph-Charles Taché,’ Canadian Bulletin of Medical History 16, no. 2 (1999): 317–40. 93 See Bilson, A Darkened House, 136–40. 94 ‘Public Health Act in Force,’ The Daily Globe (Toronto), 16 April 1866, 2. 95 House of Commons, ‘Report of the Medical Conference on Cholera: Memorandum on Cholera, March 1866,’ SP, 3 (1867), 83. 96 Ibid.; Bilson, A Darkened House, 136–7. 97 See Rosenberg, The Cholera Years, 175–225. 98 Ibid., 213–14. 99 Bilson, A Darkened House, 138–9. 100 Ibid. 101 A. Von Iffland, ‘Report of the Quarantine Hospital at Grosse Isle,’ Sessional Papers of the Dominion of Canada, 8 December 1866,’ vol. 8, no. 40 (1867– 8), 53. Hereafter cited as SP. 102 Ibid., 55. 103 W. Tempest and J. Rowell, ‘Report of the Medical Health Officers of the City of Toronto,’ The Globe (Toronto), 4 February 1868, 1. 104 Bilson, A Darkened House, 137–8. 105 Ibid., 139. 106 House of Commons, British North America Act (1867), para. 92(7). 107 Ibid., para. 91(11). 108 For a good, succinct overview of the historiography and the debate between the importance of central or local reforms, see Deborah Brunton, ed., Medicine Transformed: Health, Disease, and Society in Europe, 1800–1930 (Manchester: Manchester University Press, 2004), 195–8. On the specific steps taken by local governments in Great Britain, see Anthony Wohl, Endangered Lives: Public Health in Victorian Britain (London: J.M. Dent, 1983), 166–204. 109 Ibid., 166.

212

Notes to pages 27–30

110 Rosenkrantz, Public Health and the State, 52. 111 Ibid., 51–3. On the development of public health in the United States, see John Duffy, The Sanitarians: A History of American Public Health (Champaign: University of Illinois Press, 1992); Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns, eds., History and Health Policy in the United States: Putting the Past Back In (New Brunswick: Rutgers University Press, 2006); and George Rosen, A History of Public Health, Expanded Edition (Baltimore: Johns Hopkins University Press, 1993). 112 Geoffrey Bilson, ‘Dr Frederick Montizambert (1843–1929): Canada’s First Director General of Public Health,’ Medical History 29, no. 4 (October 1985): 386–7; André Sévigny, ‘Frederick Montizambert,’ in Dictionary of Canadian Biography, vol. 15, 1921–1930, ed. Ramsay Cook and Réal Bélanger (Toronto: University of Toronto Press, 2005), http://www.biographi.ca, accessed 30 August 2010. 113 Bilson, ‘Dr Frederick Montizambert,’ 387. 114 Sévigny, ‘Frederick Montizambert.’ 115 Bilson, ‘Dr Frederick Montizambert,’ 386–7; Sévigny, ‘Frederick Montizambert.’ 116 Ibid. 117 ‘Newspaper Clippings and Obituaries,’ Montizambert Family Fonds, vol. 1, Manuscript Group (hereafter MG) 29-C-101, LAC. On Montizambert’s personality see Bilson, ‘Dr Frederick Montizambert,’ 386–400. 118 On immigrants and disease in Canada, see Tom Nesmith, ‘The Early Years of Public Health: The Department of Agriculture, 1867–1918,’ Archivist 12, no. 5 (1985): 1–3; and Ryan Eyford, ‘Quarantined within a New Colonial Order: The 1876–1877 Lake Winnipeg Smallpox Epidemic,’ Journal of the Canadian Historical Association 17 (2006): 55–78. See also the various reports of the Department of Agriculture, SP (1867–85). 119 F. Montizambert, ‘The Story of Fifty-Four Years,’ 315; Iffland, ‘Report of the Quarantine Hospital at Grosse Isle,’ 54. 120 HC Debates (21 April 1879), 1402. 121 Ibid., 1404. 122 HC Debates (20 March 1884), 1010. 123 See Anderson, Vancouver’s Chinatown, 82–92. 124 Ibid. 125 David Goutor, ‘Drawing Different Lines of Color: The Mainstream English Canadian Labour Movement’s Approach to Blacks and the Chinese, 1880–1914,’ Labor 2, no. 1 (2005): 55–76. 126 Renisa Mawani, ‘“The Island of the Unclean”: Race, Colonialism, and “Chinese Leprosy” in British Columbia, 1891–1924,’ Law, Social Justice, and

Notes to pages 30–4

127 128 129 130 131

213

Global Development 1 (2003), http://www2.warwick.ac.uk/fac/soc/law/elj/ lgd/2003_1/mawani, accessed 15 August 2011. Ibid. Fairchild, Science at the Borders, 7–8. Kraut, Silent Travelers, 6. Ibid., 5–7. On Canadian attitudes to immigrant workers, see among others Donald Avery, ‘Dangerous Foreigners’: European Immigrant Workers and Labour Radicalism in Canada, 1896–1932 (Toronto: McClelland and Stewart, 1979); David Goutor, Guarding the Gates: the Canadian Labour Movement and Immigration, 1872–1934 (Vancouver: UBC Press, 2007); and Gregory Kealey, Toronto Workers Respond to Industrialization, 1867–1892 (Toronto: University of Toronto Press, 1980), esp. chs 12 and 14. On Canadian attitudes towards Americans, see Allan C.L. Smith, Canada – an American Nation? Essays on Continentalism, Identity, and the Canadian Frame of Mind (Montreal and Kingston: McGill–Queen’s University Press, 1994), esp. chs 2 and 3. For a contemporary argument for the cultural, social, and economic similarities between the two nations, see Goldwin Smith, Canada and the Canadian Question (Toronto: University of Toronto Press, 1971); as well as Carl Berger’s introduction to this 1971 edition, vi–xvii.

3. ‘Everybody’s Business Is Nobody’s Business’ 1 Canada, Debates of the Senate of the Dominion of Canada (25 January 1881), 92–3. Hereafter Senate Debates. 2 George Desrosier, Benôit Gaumer, and Othmar Keel, ‘Emmanuel-Persillier Lachapelle,’ in Canadian Dictionary of Biography, vol. 14, 1911–1920, ed. Ramsay Cook and Réal Bélanger (Toronto: University of Toronto Press, 2000), http://www.biographi.ca/009004–119.01-e.php?BioId=41621, accessed 30 August 2010. For more on Lachapelle and his influence on public health in Quebec, see Gabrielle Cloutier, ‘Un disciple de Pasteur: Emmanuel Persillier-Lachapelle, médecin, humaniste et homme de science,’ Science et francophonie 43 (septembre 1993): 7–12; and Claudine Pierre-Deschênes, ‘Santé publique et organisation de la profession médicale au Québec, 1870–1918,’ in Santé et société au Québec: XIXe–XXe siècles, ed. Peter Keating and Othmar Keel (Montréal: Boréal, 1995), 115–32. 3 E. Persillier Lachapelle, ‘Address of the President of the American Public Health Association,’ Montreal Medical Journal 23, no. 4 (October 1894): 246–7. 4 Ibid.

214

Notes to pages 34–5

5 Bettina Bradbury, Working Families: Age, Genders, and Daily Survival in Industrializing Montreal (Toronto: University of Toronto Press, 1993), 19. 6 Ibid., 23. 7 Bettina Bradbury, ‘The Fragmented Family: Family Strategies in the Face of Death, Illness, and Poverty, Montreal, 1860–1885,’ in Childhood and Family in Canadian History, ed. Joy Parr (Toronto: McClelland and Stewart, 1982), 109–28. 8 Gregory Kealey, ed., Canada Investigates Industrialism: The Royal Commission on the Relations of Labor and Capital, 1889 (Toronto: University of Toronto Press, 1973), features several discussions of wages. The most comprehensive is found at 87–90. 9 Ibid., 56. 10 Bradbury, Working Families, 89–101. 11 Michael Cross, The Workingman in the Nineteenth Century (Toronto: Oxford University Press, 1974), 4–7. 12 Bradbury, Working Families. 13 Desmond Morton with Terry Copp, Working People: An Illustrated History of the Canadian Labour Movement (Ottawa: Deneau and Greenberg, 1980), 4. 14 Ibid. 15 See Heather MacDougall, Activists and Advocates: Toronto’s Health Department, 1883–1983 (Toronto: Dundurn Press, 1990), 10–11. The literature on industrialization and urbanization is especially large. On the latenineteenth-century transition to industrial capitalism and its impact on the working class, see Bradbury, Working Families; Douglas Belshaw, Colonization and Community: The Vancouver Island Coalfield and the Making of the British Columbia Working Class (Montreal and Kingston: McGill–Queen’s University Press, 2002); Gordon Hak, Turning Trees into Dollars: The British Columbia Coastal Lumber Industry, 1888–1913 (Toronto: University of Toronto Press, 2000); Jean Hamelin, ed., Les Travailleurs Québécois, 1851–1896 (Montreal: Presses de l’Université de Québec, 1973); Craig Heron, Working in Steel: The Early Years in Canada, 1883–1935 (Toronto: McClelland and Stewart, 1980); Gregory S. Kealey, Toronto Workers Respond to Industrialization, 1867–1892 (Toronto: University of Toronto Press, 1980); Ian McKay, The Craft Transformed: An Essay on the Carpenters in Halifax, 1885–1985 (Halifax: Holdfast Press, 1985); Bryan D. Palmer, A Culture in Conflict: Skilled Workers and Industrial Capitalism in Hamilton, Ontario (Montreal and Kingston: McGill– Queen’s University Press, 1979); and Joy Parr, The Gender of Breadwinners: Women, Men, and Change in Two Industrial Towns, 1880–1950 (Toronto: University of Toronto Press, 1990). 16 Cross, The Workingman, 3–4.

Notes to pages 35–6

215

17 Ibid. 18 See Mariana Valverde, The Age of Light, Soap, and Water: Moral Reform in English Canada, 1885–1925 (Toronto: McClelland and Stewart, 1991), 40. On the ideological background to the movement, see Ramsay Cook, The Regenerators: Social Criticism in Late Victorian English Canada (Toronto: University of Toronto Press, 1985), esp. 4–6. See also Nancy Christie and Michael Gauvreau, A Full Orbed Christianity: The Protestant Churches and Social Welfare in Canada, 1900–1940 (Montreal and Kingston: McGill–Queen’s University Press, 1996). 19 Richard Allen, The Social Passion: Religion and Social Reform in Canada, 1914–28 (Toronto: University of Toronto Press, 1971), 3–4. In addition to the works cited in the notes above, see George Emery, The Methodist Church on the Prairies, 1896–1914 (Montreal and Kingston: McGill–Queen’s University Press, 2002); Linda Kealey, ed., A Not Unreasonable Claim: Women and Reform in Canada, 1880s–1920s (Toronto: Women’s Press, 1979); Joseph Levitt, Henri Bourassa and the Golden Calf: The Social Program of the Nationalists in Quebec, 1900–1914 (Ottawa: University of Ottawa Press, 1969); and Paul Rutherford, ed., Saving the Canadian City: The First Phase, 1880–1920 (Toronto: University of Toronto Press, 1974). 20 W.H. Hingston, ‘Statistics and Hygiene,’ Montreal Herald, 4 September 1868, 2. 21 Valverde, The Age of Light, Soap, and Water, 46–8. On moral regulation and the state, see, among other works, Cynthia Comacchio, ‘Nations Are Built of Babies’: Saving Ontario’s Mothers and Children, 1900–1940 (Montreal and Kingston: McGill–Queen’s University Press, 1993); Margaret Little, ‘No Car, No Radio, No Liquor Permit’: The Moral Regulation of Single Mothers in Ontario, 1920–1997 (Toronto: Oxford University Press, 1998); J. Snell, In the Shadow of the Law: Divorce in Canada, 1900–1939 (Toronto: University of Toronto Press, 1987); and Jane Ursel, Private Lives, Public Policy: 100 Years of State Intervention in the Family (Toronto: Women’s Press, 1992). 22 On the intellectual origins of the movement, see Cook, The Regenerators, 4–5. A good overview of how doctors envisioned the broader meaning of sanitary reform is provided in Alfred J.H. Crespl, ‘Sanitary Science from a Religious Point of View,’ Public Health Magazine and Literary Review 2, no. 6 (December 1876): 180–1. 23 See S.P. Kutcher, ‘Toronto’s Metaphysicians: The Social Gospel and Medical Professionalization in Victorian Toronto,’ Journal of the History of Canadian Science, Technology, and Medicine 5, no. 1 (1981): 41–51. 24 Edward Playter, ‘Notes on the Soil Factor in the Development and Prevention of Infectious Diseases,’ Public Health Papers and Reports 21 (1895): 59–60.

216

Notes to pages 37–9

25 Ibid. 26 See Cook, The Regenerators. 27 Alan MacDougall, ‘Toronto Sewers,’ Public Health Papers and Reports 12 (1887): 42–3. 28 C.H. Rust, ‘Construction of Toronto Sewers,’ Transactions of the Canadian Society of Civil Engineers 2 (1888): 302. 29 Michael J. Piva, The Condition of the Working Class in Toronto, 1900–1921 (Ottawa: University of Ottawa Press, 1979), 118. 30 Valverde, The Age of Light, Soap, and Water, 134–9. See also Alvin Finkel, Social Policy and Practice in Canada: A History (Waterloo: Wilfrid Laurier University Press, 2005). 31 See Valverde, The Age of Light Soap and Water. 32 Anthony Wohl, Endangered Lives: Public Health in Victorian Britain (Cambridge: Cambridge University Press, 1983), 145–7. 33 Bruce Curtis, The Politics of Population: State Formation, Statistics, and the Census of Canada, 1840–1875 (Toronto: University of Toronto Press, 2002), 307–8. See also William Stokes, ‘A Discourse on State Medicine,’ British Medical Journal (13 April 1872): 385. 34 Wohl, Endangered Lives, 145. 35 Ibid., 147–8. 36 Smith, 199. 37 Paul Adolphus Bator, ‘Edward Playter,’ in Dictionary of Canadian Biography, vol. 13, 1901–1910, ed. Ramsay Cook et al. (Toronto: University of Toronto Press / Les Presses de l’université Laval, 1994), http://www.biographi.ca. See also Christopher Rutty and Sue C. Sullivan, This Is Public Health: A Canadian History (Toronto: Canadian Public Health Association, 2010), 1.5–1.6. 38 Ibid. 39 ‘Sanitary Science,’ Sanitary Journal 1, no. 1 (July 1874): 2. 40 J.J. Heagerty, Four Centuries of Medical History in Canada (Toronto: Macmillan, 1928), 40–1. 41 Anon., ‘Canadian Medical Association Annual Meeting Minutes: Vital Statistics and Public Hygiene,’ Canada Medical and Surgical Journal 5, no. 3 (September 1876): 104. 42 Heagerty, Four Centuries of Medical History in Canada, vol. 2, 42. 43 Anon., ‘Canadian Medical Association Annual Meeting Minutes: Vital Statistics and Public Hygiene,’ Canada Medical and Surgical Journal 5, no. 3 (September 1876): 104–6. 44 Rutty and Sullivan, This Is Public Health, 1.9–1.12.

Notes to pages 39–41

217

45 HC Debates (21 February 1877): 199–200. 46 On Tupper, see Jock Murray and Janet Murray, Sir Charles Tupper: Fighting Doctor to Father of Confederation (Toronto: Allied Medical Services, 1999). 47 HC Debates (21 February 1877): 200–1. 48 See Peter B. Waite, Canada, 1874–1896: Arduous Destiny (Toronto: McClelland and Stewart, 1971). 49 Anon., ‘Annotations: Canadian Medical Association,’ Sanitary Journal 3, no. 5 (October 1877): 222. 50 Heagerty, Four Centuries of Medical History in Canada, vol. 2: 1–2. For the public reaction to interventionist proposals see ‘Public Health Meeting,’ Montreal Herald, 5 May 1886, 8. 51 MacDougall, Activists and Advocates, 19–20. 52 Ibid. 53 Katherine Arnup, ‘“Victims of Vaccination?” Opposition to Compulsory Immunization in Ontario, 1900–90,’ Canadian Bulletin of Medical History 9 (1992): 162. See also Jennifer Keelan, ‘The Canadian Anti-Vaccination Leagues, 1872–1892,’ PhD diss., University of Toronto, 2005. 54 W. Marsden, E. Playter, and G.A. Baynes, ‘Submission to Special Committee of the House of Commons,’ 6 April 1876, Journals of the House of Commons 3rd Session, 3rd Parliament (1876), A5–5. 55 Ibid. 56 HC Debates (1882), 847. 57 Heagerty, Four Centuries of Medicine in Canada, 45–6. 58 MacDougall, Activists and Advocates, 18. 59 Ibid.; Province of Ontario, Second Annual Report of the Provincial Board of Health (Toronto: Office of the Provincial Board of Health, 1884), vi. 60 Ibid. 61 Ibid, iv. On the British legislation see F.B. Smith, The People’s Health, 1830– 1910 (London: Croom Helm, 1979), 198–203. 62 MacDougall, Activists and Advocates, 70–1. 63 Ibid., 71. 64 Ibid. 65 Anon., ‘Citizen’s Public Health Association,’ Canada Medical and Surgical Journal 4, no. 1 (July 1875): 37. 66 Terry Copp, The Anatomy of Poverty: The Condition of the Working Class in Montreal, 1897–1929 (Toronto: McClelland and Stewart, 1974), 17. For a similar study of Toronto, see Piva, The Condition of the Working Class in Toronto. 67 Copp, 18. 68 Ibid., 25.

218

Notes to pages 41–4

69 Ibid., 25–6, 93–6. 70 Anon., ‘Proposed Sanitary Bureau,’ Canada Medical and Surgical Journal 12, no. 8 (March 1884): 506–8. 71 Anon., ‘Vital Statistics,’ Canada Medical and Surgical Journal 11, no. 5 (December 1882): 309. 72 Garth Stevenson, Ex Un Plures: Federal-Provincial Relation in Canada, 1867– 1896 (Montreal and Kingston: McGill–Queen’s University Press, 1993), 18–22. 73 HC Debates (1884), 1015. 74 Ibid. See also the record of a meeting of doctors from the Canadian Medical Association with Tupper, in Anon., ‘Vital Statistics for the Dominion,’ Canadian Practitioner 8, no. 1 (January 1883): 22–3. 75 On doctors’ role in advocating for prohibition, see Craig Heron, Booze: A Distilled History (Toronto: Between the Lines, 2003), 139–45. On the jurisdictional dispute see Stevenson, Ex Un Plures, 69–70. 76 Ibid., 70. 77 For a case study, see Jacques Paul Couturier, ‘Prohibition or Regulation: The Enforcement of Canada’s Temperance Act in Moncton, 1881–1896,’ in Drink in Canada: Historical Essays. ed. Cheryl Warsh (Montreal and Kingston: McGill–Queen’s University Press, 1993), 144–165. 78 Anon., ‘The Public Health in Canadian Cities,’ Canada Health Journal 8, no. 9 (September 1886): 288–90. 79 Edward Playter, ‘An Address to the Members of Parliament of Canada,’ Man: A Public Health Magazine 1, no. 6 (April 1886): 189. 80 Ibid., 191. 81 Rutty and Sullivan, This Is Public Health, 1.10–1.12. 82 J.A.U.B., ‘The Montreal Smallpox Epidemic – Report of the Investigating Sub-Committee – How the Disease Spread,’ Man 1, no. 3 (January 1886): 103. On smallpox in Canada, see Arnup, ‘“Victims Of Vaccination?”’ 159– 76; Douglas O. Baldwin, ‘Smallpox Management on Prince Edward Island, 1820–1940: From Neglect to Fulfillment,’ Canadian Bulletin of Medical History 2, no. 1 (1985): 147–81; Paul Adolphus Bator, ‘The Health Reformers versus the Common Canadian: The Controversy over Compulsory Vaccination against Smallpox in Toronto and Ontario, 1900–1920,’ Ontario History 75, no. 4 (1983): 348–73; Barbara Lazenby Craig, ‘State Medicine in Transition: Battling Smallpox in Ontario, 1882–1885,’ Ontario History 75, no. 4 (1983): 319–47; Ryan Eyford, ‘Quarantined within a New Colonial Order: The 1876–1877 Lake Winnipeg Smallpox Epidemic,’ Journal of the Canadian Historical Association 17 (2006): 55–78; Paul Hackett, ‘Averting Disaster: The Hudson’s Bay Company and Smallpox in Western Canada during the Late

Notes to pages 44–6

83 84

85 86 87 88 89

90 91 92

93 94 95

96

97 98

219

Eighteenth and Early Nineteenth Centuries,’ Bulletin of the History of Medicine 78, no. 3 (2004): 575–609; Arthur J. Ray, ‘Smallpox: The Epidemic of 1837–1838,’ The Beaver 306, no. 2 (1975): 8–13; and Barbara Tunis, ‘Public Vaccination in Lower Canada, 1815–1823: Controversy and a Dilemma,’ Historical Reflections 9, nos. 1–2 (1982): 264–78. Michael Bliss, Plague: How Smallpox Devastated Montreal (Toronto: Harper Perennial, 1991), 10–12, 259. J.E. Laberge, ‘Smallpox and Vaccination,’ Montreal Medical Journal, 32, no. 2 (February 1903): 90. See also Bator, ‘The Health Reformers Versus the Common Canadian’; and Tunis, ‘Public Vaccination in Lower Canada.’ Bliss, Plague, 210–11. Laberge, ‘Smallpox and Vaccination,’ 92. Bliss, Plague, 263. ‘Report of the Board of Health,’ quoted in ibid., 260. See Michael Worboys, Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865–1900 (Cambridge: Cambridge University Press, 2000), esp. ch. 4. Ibid., 234–77; Dorothy Porter, Health, Civilization, and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999), 165. Piva, The Condition of the Working Class in Toronto, 117–19. Theories of disease did not change overnight, and it took more than a generation for doctors to universally accept the idea that microbes caused infection. See Worboys, Spreading Germs, 234–6. Ibid., 234. Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 49–62. Heron, Booze, 139–45. On prohibition in Canada, see Warsh, ed., Drink in Canada; and Mariana Valverde, Diseases of the Will: Alcohol and the Dilemmas of Freedom (Cambridge: Cambridge University Press, 1999). On the efforts of social reformers, see, among other works, Wendy Mitchinson, ‘The WCTU: “For God, Home, and Native Land”: A Study in NineteenthCentury Feminism,’ in A Not Unreasonable Claim: Women and Reform in Canada, 1880s–1920s, ed. Linda Kealey (Toronto: Women’s Press, 1979), 151–68. Katherine McCuaig, The Weariness, the Fever, and the Fret: The Campaign against Tuberculosis in Canada, 1900–1950 (Montreal and Kingston: McGill–Queen’s University Press, 1999), 3–31. Tomes, The Gospel of Germs, 135–54. See Worboys, Spreading Germs, 234–77; and Porter, Health, Civilization, and the State, 165.

220

Notes to pages 46–9

99 Ibid., 147–62. 100 Tomes, The Gospel of Germs, 237–9. 101 Judith Walzer Leavitt, Typhoid Mary: Captive to the Public’s Health (Boston: Beacon Press, 1996), 14–19. 102 Ibid., 98–101. 103 Kay J. Anderson, Vancouver’s Chinatown: Racial Discourse in Canada, 1875– 1980 (Montreal and Kingston: McGill–Queen’s University Press, 1991), 71. 104 Quoted in Anon., ‘The Cholera,’ Montreal Medical Journal 21, no. 4 (1892): 307. 105 See Donald Avery, ‘Dangerous Foreigners’: European Immigrant Workers and Labour Radicalism in Canada, 1896–1932 (Toronto: McClelland and Stewart, 1979). 106 Anderson, Vancouver’s Chinatown, 53. 107 Canada, An Act to Impose Certain Restrictions on Immigration (1899). Chinese immigration had already been restricted by the 1885 Chinese Immigration Act. Its provisions were strengthened in 1898 when the head tax was increased from 50 to 500 dollars. See Canada, An Act Further to Amend the Chinese Immigration Act (1898). 108 See Anderson, Vancouver’s Chinatown, 53; see also Anon., ‘Canadian Hospital’s Association: Keep Out Disease,’ Canadian Practitioner and Review 33, no. 8 (1908): 528–9; and Anon., ‘Editorial: The Canada Association for the Prevention of Tuberculosis,’ Canadian Practitioner and Review 26, no. 3 (1901): 165–9. 109 Anon., ‘Report of the Second Quarterly Meeting of the Provincial Board of Health,’ Ontario Medical Journal 1, no. 10 (May 1893): 432. 110 Ibid. 111 Editorial, ‘Immigration and Disease,’ Montreal Medical Journal 34, no. 5 (May 1905): 358. 112 Report, ‘Hygiene and Public Health,’ Canadian Practitioner 22, no. 11 (November 1897): 822. 113 John McCrae, J.C. Fyshe, and W.E. Ainley, ‘Acute Lobar Pneumonia: An Analysis of 486 Cases and 100 Autopsies,’ Montreal Medical Journal 33, no. 1 (1904): 21. 114 F. Clement Brown, ‘Canadians Abroad,’ Canadian Magazine 8, no. 3 (January 1897): 254. 115 P.H. Bryce, The Climates and Health Resorts of Canada (Montreal: Canadian Pacific Railway, 1897), 8. 116 Comacchio, ‘Nations Are Built of Babies,’ 18. 117 Ian R. Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940 (Ithaca: Cornell University Press, 1997), 70–96.

Notes to pages 49–54

221

118 Valverde, The Age of Light, Soap, and Water, 129–54. 119 See Angus McLaren, Our Own Master Race: Eugenics in Canada, 1885–1945 (Toronto: McClelland and Stewart, 1990). 120 See articles read into HC Debates, 13 April 1888, 658–9. 121 ‘St. Lawrence Quarantine,’ The Mail (Toronto), 2 April 1888, 122 HC Debates, 1888, 661. 123 On the 1892 epidemic, see Richard J. Evans, Death in Hamburg: Society and Politics in the Cholera Years (London: Oxford University Press, 1987). 124 ‘Cholera in Canada,’ The Globe (Toronto), 1 August 1892, 1. 125 Anon., ‘Canadian Medical Association: Discussion on Cholera,’ Ontario Medical Journal 1, no. 3 (October 1892): 116. 126 Ibid., 116. 127 Anon., ‘Canadian Medical Association: Discussion on Cholera (continued),’ Canadian Practitioner 17, no. 22 (16 November 1892): 523. 128 F. Montizambert, ‘The Canadian Quarantine System,’ Public Health Papers and Reports 19 (1893): 92–103; G.E. Martineau, ‘Annual Report on St. Lawrence Quarantine,’ SP 8 (1900): 81–2. 129 Montizambert, ‘The Canadian Quarantine System’; Martineau, ‘Annual Report on St. Lawrence Quarantine.’ 130 Montizambert, ‘Quarantine Appliances Illustrated,’ Public Health Papers and Reports 20 (1894): 346. 131 Anon., ‘Progress of Medicine,’ Canadian Practitioner 22, no. 11 (November 1897): 821–2. 132 Montizambert, ‘The Story of Fifty-Four Years Quarantine Service from 1866 to 1920,’ Canadian Medical Association Journal 16 (1926): 314–19 at 316. 133 Avery, ‘Dangerous Foreigners,’ 18–19. 134 See Alan Artibise, Winnipeg: A Social History of Urban Growth, 1874–1914 (Montreal and Kingston: McGill–Queen’s University Press, 1975). 135 Donald Avery, Reluctant Host: Canada’s Response to Immigrant Workers, 1896–1994 (Toronto: McClelland and Stewart, 1995), 220–42. 136 Avery, Dangerous Foreigners, 28. 137 Ibid. 138 Alan Sears, ‘Immigration Controls as Social Policy: The Case of Canadian Medical Inspection, 1900–1920,’ Studies in Political Economy 33 (Autumn 1990): 97. 139 As quoted in ibid., 97. 140 Ibid., 96. See also Geoffrey Bilson, ‘“Muscles and Health”: Health and the Canadian Immigrants, 1897–1906,’ in Health, Disease, and Medicine: Essays in Canadian History, ed. C.G. Roland (Hamilton: Hannah Institute for the History of Medicine, 1984), 398–411.

222

Notes to pages 54–8

141 Barbara Roberts, Whence They Came: Deportations from Canada, 1900–1935 (Ottawa: University of Ottawa Press, 1998), 70–1. See also Roberts, ‘Doctors and Deports: The Role of the Medical Profession in Canadian Deportation, 1900–1920,’ Canadian Ethnic Studies 18, no. 3 (1986): 17–36; Dickin McGinnis, ‘From Health to Welfare,’ 45–7. 142 Anon., ‘Undesirable Alien Immigration,’ Maritime Medical News 14, no. 10 (October 1902): 388. 143 Sears, ‘Immigration Controls as Social Policy,’ 95. 144 Avery, ‘Dangerous Foreigners,’ 28. 145 Correspondence between F. Montizambert and Secretary of the Board of Health, British Columbia, November 1900, file 937017, pt 7, vol. 8, RG 29, LAC Dickin McGinnis, ‘From Health to Welfare,’ 21. 146 HC Debates (25 February 1902), 386. 147 HC Debates (25 June 1903), 5493–4; Dickin McGinnis, ‘From Health to Welfare,’ 13–14. 148 ‘Memorandum to the President and Members of the Canadian Medical Association,’ 24 August 1903, File 10-3-1 vol. 1, volume 19, RG29, LAC. 149 On Sifton in this period, see D.J. Hall, Clifford Sifton: The Lonely Eminence, 1901–1929 (Vancouver: University of British Columbia Press, 1985). 150 Ibid., 238–40. 151 Commission of Conservation, Second Annual Report including a Report of the Proceedings of the Second Annual Meeting Held At Quebec, January 17–20, 1910 and of the Dominion Public Health Conference held at Ottawa, October 12–13, 1910 (Montreal: John Lovell and Son, 1911), 120–1. 152 HC Debates (28 February 1916), 1229. 153 Vincent Massey, ‘Report to the Vice Chairman of the War Committee of the Cabinet on the Establishment of a Federal Department of Health,’ 25 October 1918, file 10–3-1 vol. 2, vol. 19, RG 29, LAC, 21–22. Hereafter Report to the Vice Chairman of the War Committee. 154 This fell under the administration of the Public Works Health Act of 1902. See Dr Frederick Montizambert, ‘Memorandum: Public Health and Quarantine: Practice of the Department of Agriculture, and under what authority,’ 12 February 1909, file 10–3-1, vol. 1, vol. 19, RG 29, LAC, p. 4. 155 Report to the Vice Chairman of the War Committee, 22. See also Dickin McGinnis, ‘From Health to Welfare,’ 20–2. 4. A Pandemic Prelude 1 Anon., ‘Ye gods, it doth Amaze Me,’ Canada Health Journal 12, no. 2 (February 1890): 25. 2 Ibid.

Notes to pages 58–62

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3 Ibid. 4 Ibid, 25–6. 5 See World Health Organization (WHO), ‘Fact Sheet: Influenza,’ http:// www.who.int/mediacentre/factsheets/2003/fs211/en, accessed 23 August 2010; and Centers for Disease Control (CDC), ‘Types of Influenza Viruses,’ http://www.cdc.gov/flu/about/viruses/types.htm, accessed 23 August 2010. 6 Dorothy A. Pettit and Janice Bailie, A Cruel Wind: Pandemic Flu in America, 1918–1920 (Murfreesboro: Timberlane Books, 2008), 4–7. 7 Ibid., 5–6, 13; CDC, ‘How the Flu Virus Can Change: “Drift” and “Shift,”’ http://www.cdc.gov/flu/about/viruses/change.htm, accessed 23 August 2010; W. Graeme Laver, Norbert Bischofberger, and Robert G. Webster, ‘The Origin and Control of Pandemic Influenza,’ Perspectives in Biology and Medicine 43, no. 2 (2000): 175–6. 8 CDC, ‘Influenza Viruses,’ http://www.cdc.gov/flu/avian/gen-info/flu-viruses.htm, accessed 23 August 2010. 9 Ibid.; See also W.I.B. Beveridge, Influenza: The Last Great Plague, rev. ed. (New York: Prodist, 1978), 11–17. 10 CDC, ‘Influenza Viruses.’ See also WHO, Regional Office for Western Pacific, ‘Advice for People Living in Areas Affected by Bird Flu or Avian Influenza,’ 8 November 2004, http://www.who.int/csr/disease/avian_influenza/guidelines/advice_people_area/en/index.html, accessed 23 August 2010. 11 Ibid.; Pettit and Bailie, A Cruel Wind, 15–18. 12 CDC, ‘Influenza Viruses.’ 13 René Snacken et al., ‘The Next Influenza Pandemic: Lessons from Hong Kong, 1997,’ Emerging Infectious Diseases 5, no. 2 (March–April 1999): 197. 14 See the WHO’s tracking of worldwide cases of avian influenza since 2003 at http://www.who.int/csr/disease/avian_influenza/country/cases_ table_2010_07_29/en/index.html. 15 WHO, ‘Pandemic Preparedness,’ http://www.who.int/csr/disease/influenza/pandemic/en, accessed 23 August 2010. 16 For a good overview of the history and medical aspects of the three twentieth-century influenza pandemics, see Laver et al., ‘The Origin and Control of Pandemic Influenza,’ 173–91. 17 Ibid. 18 Pettit and Bailie, A Cruel Wind, 10–18. 19 See Beveridge, Influenza, 21–3. 20 J.L. Irwin, ‘The Local Aspects of the Present Pneumonia Epidemic,’ Montreal Medical Journal 18, no. 9 (March 1890): 651. 21 Anon., ‘Influenza,’ Maritime Medical News (January 1890): 5. There is no

224

22 23 24 25 26 27 28

29 30 31 32 33

34 35

36

37 38

Notes to pages 62–4

comprehensive international history of the 1889–94 pandemic, but readers are directed to F.B. Smith, ‘The Russian Influenza in the United Kingdom, 1889–1894,’ Social History of Medicine 8, no. 1 (1995): 55–73; and Mark Honigsbaum, ‘The Great Dread: Cultural and Psychological Impacts and Responses to the “Russian” Influenza in the United Kingdom, 1889–1893,’ Social History of Medicine 23, no. 2 (2010): 299–319. No one has studied the 1889 flu in Canada. A two-paragraph overview can be found in J.J. Heagerty, Four Centuries of Medical History in Canada (Toronto: Macmillan, 1928), II:214–15. Gerald F. Pyle, The Diffusion of Influenza: Patterns and Paradigms (Totowa: Rowman and Littlefield, 1986), 31. Ibid. Anon., ‘Influenza,’ Maritime Medical News 2, no. 1 (January 1890): 6; ‘Spread of the Influenza,’ The Globe (Toronto), 9 December 1890, 1. Pyle, The Diffusion of Influenza, 31. Ibid., 39–41. Ibid. The statistics available suggest that mortality did not spike significantly in the period 1889–91. There is some evidence that a first wave of flu swept across Canada in 1887–8, when mortality was actually higher. See A. McPhedran, ‘Epidemic Influenza: An Abstract of Clinical Remarks Delivered at the Toronto General Hospital,’ Canadian Practitioner 15, no. 4 (17 February 1890): 79. Anon., ‘Influenza.’ Ibid. Honigsbaum, ‘The Great Dread,’ 300. Ibid. Anon., ‘The Pneumonic Complications of Influenza,’ Montreal Medical Journal 18, no. 9 (1890): 714; Anon., ‘The Nature and Treatment of Influenzal Pneumonia,’ Montreal Medical Journal 20, no. 8 (February 1892): 636. Anon., ‘Influenza.’ Anon., ‘Hospital Reports – Montreal General Hospital: Condensed Reports of Cases in Dr. MacDonnell’s Wards,’ Montreal Medical Journal 18, no. 10 (April 1890): 756. House of Commons, ‘Diseases treated in the Calgary Hospital during the Year ended 30th November 1890,’ Sessional Papers, House of Commons (SP) 19 (1891), 19–150. House of Commons, ‘Alex McKelvey to the Superintendent General of Indian Affairs, 30 August 1899,’ SP 18 (1891), 18–1. House of Commons. ‘J.C. Phipps to Superintendent General of Indian Affairs, 30 August 1890,’ SP 18 (1891), 18–4.

Notes to pages 64–6

225

39 House of Commons, ‘J.B. Lash to Superintendent General of Indian Affairs, 18 August 1890,’ SP 18 (1891), 18–41. 40 Maureen Lux, Medicine That Walks: Disease, Medicine, and Canadian Plains Native People, 1880–1940 (Toronto: University of Toronto Press, 2001), 87–8. 41 Ibid. 42 Anon., ‘The Influenza Epidemic – What to do Before and After It,’ Canada Health Journal 12, no. 2 (February 1890): 23–4. 43 Anon., ‘Influenza.’ 44 Anon., ‘The Influenza Epidemic: What to do Before and After it.’ 45 Anon., ‘Influenza.’ 46 Ibid. 47 William Osler, The Treatment of Disease: The Address in Medicine Before the Ontario Medical Association, Toronto, June 3, 1909 (London: Oxford University Press, 1909), 7. 48 Ibid., 5. 49 Anon., ‘Influenza,’ 5–6. See also Local Government Board, Further Report and Papers on Epidemic Influenza, 1889–92 (London: HMSO, 1893), 40–3. 50 Ibid., 6. 51 Frederick Montizambert, ‘Quarantine: No. 1 Annual Report on the St. Lawrence Quarantine Station, Grosse Isle,’ SP 6 (1890): 5. 52 Ibid. 53 The best historical overview of Pfeiffer’s work on influenza remains Alfred Crosby, Epidemic and Peace, 1918: America’s Deadliest Influenza Epidemic (London: Greenwood, 1976), 264–72. The reaction of Canadian physicians is described in Anon., ‘Le bacilli de la grippe,’ L’union médicale du Canada 21, no. 3 (mars 1892): 158–9. 54 On Koch, see Thomas D. Brock, Robert Koch: A Life in Medicine and Bacteriology (Madison: Science Tech Publishers, 1988). 55 Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity (New York: W.W. Norton, 1997), 436–45. 56 Crosby, Epidemic and Peace, 264–72; S. Hanford McKee, ‘A Retrospect of some Ophthalmic Bacteriology,’ Montreal Medical Journal 39, no. 1 (January 1910): 24–9. 57 See Crosby, Epidemic and Peace, ch. 13. 58 Ibid., 271–2. 59 Fraser Harris, ‘From the Vague to the Concrete in Science and Medicine,’ Canadian Medical Association Journal 7, no. 10 (October 1917): 877. 60 Anon., ‘La bacilli de la grippe,’ L’Union Médicale du Canada 21, no. 3 (mars 1892): 158–9.

226

Notes to pages 66–9

61 On the development of laboratory medicine and testing in Canada during the late nineteenth century, see Christopher Rutty, ‘Personality, Politics, and Canadian Public Health: The Origins of the Connaught Medical Research Laboratories, University of Toronto, 1888–1917,’ in Essays in Honour of Michael Bliss: Figuring the Social, ed. E.A. Heaman, Alison Li, and Shelley McKellar (Toronto: University of Toronto Press, 2008), 278–9. 62 Anon., ‘Influenza.’ 5. Happily Rare of Complications 1 Desmond Morton, ‘Military Medicine and State Medicine: Historical Notes on the Canadian Army Medical Corps in the First World War, 1914–1919,’ in Canadian Health Care and the State: A Century of Evolution, ed. David Naylor (Montreal and Kingston: McGill–Queen’s University Press, 1992), 39. 2 J. George Adami, War Story of the Canadian Army Medical Corps (Ottawa: Canadian War Records Office, 1918). 3 Colonel Guy Carleton Jones, ‘The Importance of the Balkan Wars to the Medical Profession of Canada,’ Canadian Medical Association Journal 4, no. 9 (1914): 801–2. 4 See the following three articles: Jeffery K. Taubenberger et al., ‘Characterization of the 1918 Influenza Virus Hemagglutinin and Neuraminidase Genes,’ International Congress Series 1219 (2001): 545–9; Ann H. Reid et al., ‘Origins and Evolution of the 1918 “Spanish” Influenza Virus Hemagglutinin Gene,’ Proceedings of the National Academy of Science of the United States of America 96 (1999): 1651–6; and Reid et al., ‘1918 Influenza Pandemic Caused by Highly Conserved Viruses with Two Receptor-Binding Variants,’ Emerging Infectious Diseases 9, no. 10 (2003): 1249–53. 5 Virological and epidemiological studies confirm Crosby’s hypothesis. See Jonathan Nguyen-Van-Tam et al., ‘The Epidemiology and Clinical Impact of Pandemic Influenza,’ Vaccine 21 (2003): 1763–4. 6 Ibid., 26. 7 Most works on the flu begin with a summary of the debate about the flu’s origins. For an overview of the main points of debate, see Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (New York: Cambridge University Press, 1989), 21–31; Dorothy A. Pettit and Janice Bailie, A Cruel Wind: Pandemic Flu in America, 1918–1920 (Murfreesboro: Timberlane Books, 2008), 60–7; John Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Penguin, 2004), 91–7; and Gina Kolata, Flu: The Story of the Great Influenza Pandemic of 1918 and the Search of the Virus That Caused It (New York: Farrar, Straus and Giroux, 1999), 189–306. All of the

Notes to pages 69–71

8 9 10 11

12 13

14 15

16 17 18 19

20

227

various theories are summarized and discussed in Anton Eroreka, ‘Origins of the Spanish Influenza Pandemic (1918–1920) and Its Relation to the First World War,’ Journal of Molecular and Genetic Medicine 3, no. 2 (December 2009): 190–4. Edwin Oakes Jordan, Epidemic Influenza: A Survey (New York: American Medical Association, 1927), 60. Ibid. See W.I.B. Beveridge, Last Great Plague, rev. ed. (New York: Prodist, 1978), 1–7; Crosby, America’s Forgotten Pandemic, 264–94. J.S. Oxford et al., ‘Early Herald Wave Outbreaks of Influenza in 1916 Prior to the Pandemic of 1918,’ International Congress Series 1219 (October 2001): 155–61; Oxford et al., ‘The So-Called Great Spanish Influenza Pandemic of 1918 May Have Originated in France in 1916,’ Philosophical Transactions of the Royal Society, 356 (29 December 2001): 1857–9; Oxford et al., ‘World War I May Have Allowed the Emergence of “Spanish” Influenza,’ The Lancet: Infectious Diseases 2, no. 2 (February 2002): 111–14; Oxford et al., ‘A Hypothesis: The Conjunction of Soldiers, Gas, Pigs, Ducks, Geese, and Horses in Northern France during the Great War Provided the Conditions for the Emergence of the “Spanish” Influenza Pandemic of 1918–19.’ Vaccine 23 (2005): 940–5. For a summary of Oxford’s earlier work, see Kolata, Flu, 289–97. Oxford et al., ‘Early Herald Wave Outbreaks of Influenza,’ 156–7. Ibid., 156. For the original articles, see J.A.R. Hammond et al., ‘Purulent Bronchitis: A Study of Cases Occurring amongst the British Troops at a Base in France,” The Lancet 2 (1917): 41–5; and A. Abrahams et al., ‘Purulent Bronchitis: Its Influenza and Pneumococcal Bacteriology,’ The Lancet 2 (1917): 377–80. Oxford et al., ‘A Hypothesis.’ R.B. Belshe, ‘The Origins of Pandemic Influenza: Lessons from the 1918 Virus,’ New England Journal of Medicine 353, no. 21 (24 November 2005): 2209. Oxford et al., ‘Early Herald Wave Outbreaks.’ Ibid., 160. Jordan, Epidemic Influenza, 62–76. Barry, The Great Influenza, 92–6. See also Barry, ‘The Site of Origin of the 1918 Influenza Pandemic and Its Public Health Implications,’ Journal of Translational Medicine 2, no. 3 (2004), http://www.translational-medicine. com/content/2/1/3. Anon., ‘Influenza – Haskell, Kansas,’ Public Health Reports 33, no. 14 (1918): 502.

228

Notes to pages 71–4

21 Barry, ‘The Site of Origin.’ 22 Ibid. 23 See for example, Robert G. Webster, ‘Wet Markets: A Continuing Source of Severe Acute Respiratory Syndrome and Influenza,’ The Lancet 363 (17 January 2004): 234–6. 24 Jordan, Epidemic Influenza, 75. 25 Barry, ‘The Site of Origin.’ 26 See Christopher Langford, “Did the 1918–19 Influenza Pandemic Originate in China?” Population and Demographic Review 31, no. 3 (September 2005): 473–505; and Pettit and Bailie, A Cruel Wind, 27–8, 62–7, 231–2. 27 Ibid. 28 The first discussion of the flu’s arrival in Canada is found in Sir Andrew Macphail, Official History of the Canadian Forces in the Great War, 1914–1919: Medical Services (Ottawa: Queen’s Printer, 1925). 29 Eileen Pettigrew, The Silent Enemy: Canada and the Deadly Flu of 1918 (Saskatoon: Western Producer Prairie Books, 1983), 8. Other historians have repeated this account of the flu’s origins. See Maureen K. Lux, ‘“The Bitter Flats”: The 1918 influenza Epidemic in Saskatchewan,’ Saskatchewan History (Spring 1997): 3–13; Robert C. Belyk and Diane M. Belyk, ‘No Armistice with Death: The Spanish Influenza, 1918-19,’ The Beaver, October–November 1988: 43–49 at 44; Jadranka Bacic, “The Plague of Spanish Flu: The Influenza Epidemic of 1918 in Ottawa,” Bytown Pamphlet Series (Ottawa: Ottawa Historical Society, 1999), 1; and Gladys Morton, ‘The Pandemic influenza of 1918,’ Canadian Nurse 69 (1973): 26. 30 H.E. Young, Report of the Provincial Board of Health (Victoria: Government of British Columbia, 1919), A47. 31 Ibid. The mortality rate calculations are based on the following formula: number of deaths multiplied by 100,000, divided by the population. The population figures are taken from Government of British Columbia, Population of British Columbia, 1800-2006, http://www.for.gov.bc.ca/hfp/sof/2006/ figures/fig06.pdf, accessed 21 November 2011. 32 City of Toronto, Monthly Report of the Department of Public Health of the City of Toronto, April 1918, City of Toronto Archives. 33 Ibid. 34 Ibid. 35 On military law in Canada, see Chris Madsen, Another Kind of Justice: Canadian Military Law from Confederation to Somalia (Vancouver: UBC Press, 1999). 36 The term ‘influenza-like’ is used to refer to admissions with diagnoses recorded as influenza, grippe, cold, flu, bronchitis, catarrh, and sore throat, all conditions that are either euphemisms for influenza or have similar

Notes to pages 75–9

37 38

39

40 41 42

43 44

45 46 47 48 49 50 51 52 53 54

229

symptoms. Cases of pneumonia, broncho-pneumonia, and lobular pneumonia were also included as these were the leading causes of death during the pandemic, and patients were often admitted with these secondary infections alone. Non-contagious conditions such as gas inhalation, and other respiratory diseases such as tuberculosis, are not included. See ‘Admission/Discharge Books: St. Luke’s General Hospital, Ottawa, Ontario,’ vol. 8, series II-L-1, RG 9, LAC. ‘Admission/Discharge Books: St. Jean Military Hospital, St. John, Quebec,’ vol. 9, series II-L-1, RG 9, LAC; ‘Admission/Discharge Books: Quebec Military Hospital, Quebec City,’ vol. 11, series II-L-1, RG 9, LAC; ‘Admission/ Discharge Books: St. John Military Hospital, St. John, New Brunswick,’ vol. 15, series II-L-1, RG 9, LAC. Maj. Gen. M.W. Ireland, The Medical Department of the United States Army in the World War, vol. 9, Communicable and Other Diseases (Washington: U.S. Government Printing Office, 1928), 78. George A. Soper, ‘Health of the Troops in the United States during 1918,’ Military Surgeon (October 1919): 11. Ireland, The Medical Department, 83–4. Ibid., 79–80. This mortality rate is derived from combining deaths among white and ‘colored’ troops for influenza, bronchitis, broncho-pneumonia, and lobar-pneumonia. Ibid., 83. Public Health Service, ‘Influenza a Probable Cause of Fever of Undetermined Nature in Southern States,’ Public Health Reports 33, no. 25 (21 June 1918): 1003. Ibid., 72–3. Ibid. Ibid. J.A. Amyot, ‘Influenza Amongst Canadian Troops in England,’ 14 October 1918, file 25-3-7, vol. 3613, series III-B-2, RG 9, LAC, 1. War Diary, Assistant Director of Medical Services, Witley Camp, England, 3 April 1918, file 821, part 4, series III-D-3, vol. 5026, RG 9, LAC. Deputy Director of Medical Services, Canadian Corps, ‘Bulletin of Information No. 2,’ 10 May 1918, file 813, part 2, vol. 5024, series III-D-3, RG 9, LAC. War Diary, Assistant Director of Medical Services, 1st Canadian Division, 26 April 1918, file 815, series III-D-3, vol. 5025, RG 9, LAC. Ibid., 5 May 1918. Amyot, file 25-3-7, vol. 3613, series III-B-2, RG 9, LAC, 1. Jeff Keshen, Propaganda and Censorship during Canada’s Great War (Edmonton: University of Alberta Press, 1996), see esp. chs. 3 to 6.

230

Notes to pages 79–83

55 Ibid., 69. 56 ‘Grippe Epidemic Prevails in Spain,’ Morning Bulletin (Edmonton), 29 May 1918, 1. 57 ‘Spain Suffers from Epidemic,’ The Globe (Toronto), 29 May 1918, 4. 58 ‘600 Doctors Ill,’ The Globe, 31 May 1918, 5. 59 ‘The Spanish Epidemic,’ The Times (London), 3 June 1918, 5; See also ‘700 Die of the Plague,’ Toronto Star, 3 June 1918, 2. 60 Janice P. Dickin McGinnis claimed that several ships carried the disease into Canada in July 1918. For a full rebuttal of this argument, see Mark Osborne Humphries, ‘The Horror at Home: The Canadian Military and the Great Influenza Pandemic of 1918,’ Journal of the Canadian Historical Association 16 (2005): 235–60. 61 Cable (Med 1099): Major General Jones to Dr Montizambert, 8 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 62 Ibid. 63 Ibid. 64 F. Montizambert to Surgeon-General Jones, 8 July 1918, and F. Montizambert to Dr. N.E. MacKay, 8 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 65 See ‘Obituary: George E. Martineau,’ Canadian Medical Association Journal 21, no. 6 (1929): 749. 66 See various documents in file 416-2-12, vol. 300, RG 29, LAC. 67 W.G. Holloway to Secretary, Department of the Naval Service, 9 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 68 W.W. Cory to Martineau, 11 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 69 Rowell to Borden, 24 April 1918, Newton W. Rowell Papers (hereafter Rowell Papers), MG 27-II-D-13, reel C-932, 2588, LAC. 70 W.W. Cory to Martineau, 11 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 71 Martineau to Corry, 11 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 72 See various correspondence in July 1918 between Montizambert and Cory, file 416-2-12, vol. 300, RG 29, LAC. 73 Martineau to Corry, 12 July 1918, and Corry to Martineau, 12 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 74 E.B. Robertson, Assistant Superintendent of Immigration, to W.W. Cory, 12 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 75 Martineau to Cory, 12 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 76 Memorandum from W.W. Corry to F. Montizambert (copied to the Superintendent of Immigration), 10 July 1918, file 416-2-12, vol. 300, RG 29, LAC.

Notes to pages 83–90

231

77 Cory never attempted to send a wire to Montizambert in Cacouna until after Montizambert made contact with him. The fact that Cory resorted to mailing a memorandum – copied to another official – would also indicate that perhaps Montizambert did not make his whereabouts known. 78 A.L. Brown to F. Montizambert, 13 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 79 Montizambert to Acting Minister of Immigration and Colonization, 13 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 80 Cory to Montizambert, 15 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 81 See, for example, Director-General of Public Health to H. Rundle Nelson, William Head, Victoria, 22 July 1918, file 416-2-12, vol. 300, RG 29, LAC. 82 ‘Admission/Discharge Books: Camp Hill Hospital,’ 1 July–25 October 1918, vols. 11, 12 and 13, series II L 1, RG 9, LAC. 83 ‘Admission/Discharge Books: St. Jean Barracks Hospital, Quebec,’ vol. 9, series II-L-1, RG 9, LAC. 84 See Bohdan Kordan, Enemy Aliens, Prisoners of War: Internment in Canada during the Great War (Montreal and Kingston: McGill–Queen’s University Press, 2002). 85 These statistics for ‘Admission/Discharge Books: Kapuskasing Station Hospital,’ vol. 6, series II-L-1, RG 9, LAC. 86 C.J. Currie, ‘War Story of the CAMC Military District 2,’ file MD2 15-2-94, vol. 1, vol. 4271, RG 24, LAC. 87 ‘Admission/Discharge Books: Toronto Base Hospital,’ vol. 3, series II-L-1, RG 9, LAC. 88 ‘Admission/Discharge Books: Manitoba Military Hospital Winnipeg, Manitoba,’ vol. 17, series II-L-1, RG 9, LAC. 89 ‘Admission/Discharge Books: Victoria Military Hospital, British Columbia,’ vol. 18, series II-L-1, RG 9, LAC. 90 CDC, “Influenza Viruses.” See also Beveridge, Influenza, 11–17. 91 J.J. Heagerty, Four Centuries of Medical History in Canada (Toronto: Macmillan, 1928), vol. 2, 215. 92 Ibid. 93 See ‘Steamships chartered by Imperial Government to carry War Office supplies – Canadian ports to France and the United Kingdom – Somali,’ 1918, vol. 3702, file 1048-12-267, RG 24, LAC. 94 Any mention of flu in the Canadian documents ends in July and does not begin again until the end of September. See file 416-2-12, vol. 300, RG 29, LAC. 95 ‘Awake to Dangers of Spanish Grippe,’ Vancouver World, 9 August 1918.

232

Notes to pages 91–4

6. A Dark and Invisible Fog Descends 1 Anon., ‘The Pandemic of Influenza,’ British Medical Journal 2004, no. 2 (1918): 91. 2 Anon., ‘The Present Epidemic,’ 1028. 3 An inflammation due to increased blood. 4 John Hunter, ‘The Recent Influenza Epidemic,’ Canadian Practitioner and Review, 43, no. 12 (December 1918): 355. 5 Anon., ‘The Present Epidemic,’ 1028. 6 Ibid., 1029. 7 Christopher Langford, ‘The Age Pattern of Mortality in the 1918–19 Influenza Pandemic: An Attempted Explanation Based on Data for England and Wales,’ Medical History 46, no. 1 (2002): 1–20 at 10–12. 8 Kerri Smith, ‘Concern as Revived 1918 Flu Virus Kills Monkeys,’ Nature 445, no. 237 (2007), http://www.nature.com/nature/journal/v445/n7125/ full/445237a.html, accessed 5 August 2010. See also Darwyn Kobasa, ‘Aberrant Innate Immune Response in Lethal Infection of Macaques with the 1918 Influenza Virus,’ Nature 445 (18 January 2007): 319–323, http://www. nature.com/nature/journal/v445/n7125/abs/nature05495.html, accessed 10 August 2010. 9 Robertson, 157. 10 Ibid., 156–7. 11 Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (New York: Cambridge University Press, 1989), 37–9. See also the log of Plymouth Harbour for July and August 1918, ADM 53/48308, TNA 12 See Mark Osborne Humphries, The Duty of the Nation: Public Health and Spanish Influenza in Canada, 1918–19 (PhD diss., University of Western Ontario, 2008), 172–5. 13 Barry, The Great Influenza, 192–3. 14 Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918 (New York: Cambridge University Press, 1989), 39. 15 Ibid. 16 Ibid., 40. 17 Barry, 197–9. On flu in Massachusetts, see Dennis J. Carr, ‘The Spanish Influenza Epidemic of 1918 and Berkshire County,’ Historical Journal of Massachusetts 19, no. 1 (April 1991): 43–62; and Patricia J. Fanning, ‘Disease and the Politics of Community: Norwood and the Great Flu Epidemic of 1918,’ PhD diss., Boston College, 1995. For New York, see Debra E. Blakely, ‘Social Construction of Three Influenza Pandemics in the “New

Notes to pages 94–5

18 19 20

21 22

23

24 25

26 27

233

York Times,”’ Journalism and Mass Communication Quarterly 80, no. 4 (2003): 884–902. Other important regional studies for the United States include Julia F. Irwin, ‘An Epidemic without Enmity: Explaining the Missing Ethnic Tensions in New Haven’s 1918 Influenza Epidemic,’ Urban History Review 36, no. 2 (2008): 5–17; Robert C. Schmitt and Eleanor C. Nordyke, ‘Influenza Deaths in Hawai‘i, 1918–20,’ Journal of History 33 (1999): 101–17; and Peter Tuckel et al., ‘The Diffusion of the Influenza Pandemic of 1918 in Hartford, Connecticut,’ Social Science History 30, no. 2 (2006) 167–96. ‘Influenza is Now Spreading,’ Marion Daily Star (Ohio), 14 September 1918, 9. ‘2000 Cases of Influenza Found Among Soldiers,’ Syracuse Herald (Syracuse, NY), 15 September 1918, 11. See Eileen Pettigrew, Silent Enemy: Canada and the Deadly Flu of 1918 (Regina: Western Producer Prairie Books, 1983), 8–9; and Dickin McGinnis, ‘The Impact of Epidemic Influenza: Canada, 1918–19,” CHA Historical Papers (1977): 120–41 at 121. The assertions of Pettigrew and Dickin McGinnis have shaped subsequent discussions of the second wave’s origins in Canada. See, for example, Maureen K. Lux, ‘“The Bitter Flats”: The 1918 Influenza Epidemic in Saskatchewan,’ Saskatchewan History (Spring 1997): 3–13. See chapter 5; see also G.W.L. Nicholson, Canadian Expeditionary Force, 1914–1919 (Ottawa: Queen’s Printer, 1964), 524–36. Ibid., 389–483. See also Tim Cook, Shock Troops: Canadians Fighting the Great War, 1917–1918 (Toronto: Viking, 2009), 409–581. For the larger British context, see James Edmonds, Military Operations: France and Belgium, 1918, vols. 1–3 (London: Macmillan, 1935). These figures are taken from detailed statistics compiled by Major J.P.S. Cathcart in his investigation of pensions in the 1930s. See file GAQ 11-11E, vol. 1844, RG 24, LAC. See Nicholson, Canadian Expeditionary Force, Appendix C, Table 1: Appointments and Enlistments by Months, 1914–1920. On the German spring offensives, see Reichsarchiv, Der Weltkreig, 1914 bis 1918 Band 13 und Band 14 (Berlin: E.S. Mittler und Sohn, 1942–4). The most recent English-language source is David T. Zabecki, The German 1918 Offensives: A Case Study in the Operational Level of War (New York: Routledge, 2006); Nicholson, Canadian Expeditionary Force, 323–4. Edward G. Lengel, To Conquer Hell: The Meuse-Argonne, 1918 (New York: Henry Holt and Co., 2008), 41–5. Ibid., 45. See also John Terrain, To Win a War: 1918, the Year of Victory (New York: Doubleday, 1981), 51.

234

Notes to pages 95–6

28 Conversation with Dr Roger Sarty. See also Mark Osborne Humphries, ‘The Horror at Home: The Canadian Military and the Great Influenza Pandemic of 1918,’ Journal of the Canadian Historical Association 16 (2005): 235–60, esp. 252. 29 See ibid., 243–4. 30 Sir Andrew Macphail, Official History of the Canadian Forces in the Great War, 1914–1919: Medical Services (Ottawa: Queen’s Printer, 1925), 241. 31 Humphries, ‘The Horror at Home,’ 243–4. 32 Adj Gen OMFC to Deputy Minister OMFC, 18 September 1918, file 10-11-1, series III-A-1, vol. 84, RG 9, LAC. 33 See Pettigrew, Silent Enemy, 9. 34 ‘Department of Militia and Defence to General Officer Commanding Camp Borden Ontario (Military District 8),’ 22 September 1917, file 34-7-215, vol. 4401, RG 24, LAC. On the Polish Army in Canada, see M.B. Biskupski, ‘Canada and the Creation of a Polish Army, 1914–1918,’ Polish Review 44, no. 3 (1999): 339–80. 35 ‘Report of Lt. Col. A.T. LePan, Commandant, Polish Army Camp, Niagaraon-the-Lake to the Chief of the General Staff, Department of Militia and Defence,’ 22 March 1919, file ‘Polish Army Camp,’ vol. 1883A, RG 24, LAC. 36 Ibid. 37 Ibid. 38 See Pettigrew, Silent Enemy, 9. 39 E.A. Robertson, ‘Clinical Notes on the Influenza Epidemic Occurring in the Quebec Garrison,’ Canadian Medical Association Journal 9, no. 2 (1919): 155. 40 On the flu in Montreal, see Magda Fahrni, ‘“Elles sont partout...”: les femmes et la ville en temps d’épidémie, Montréal, 1918–1920,’ Revue d’histoire de l’Amérique française 58, no. 1 (2004): 67–85. 41 War Diary, Assistant Director of Medical Services, Military District 4 (Montreal), 20–1 September 1918, file 976, part 1, vol. 5061, RG 9, LAC. 42 ‘Epidemic at St. Johns,’ Montreal Star, 26 September 1918, 1. 43 Ibid. 44 ‘L’épidémie aux casernes,’ Le Devoir, 30 Septembre 1918, 1. 45 Port of E. Hoboken, New Jersey to Chief of E.S., 23 September 1918, entry 2023, RG 92, National Archives and Records Administration (hereafter cited as NARA), Washington, DC. 46 Memorandum by Lt. Col. Edward A. Spitzka, Chief Surgeon, 2 October 1918, Entry 2023, RG 92, NARA. 47 Ibid. 48 Cale C. Craig, Boat Sanitary Inspector to Chief Surgeon, 29 September 1918, ibid.

Notes to pages 97–9

235

49 Memorandum by Lt. Col. Edward A. Spitzka, Chief Surgeon, 2 October 1918, Entry 2023, RG 92, NARA. 50 War Diary, Assistant Director of Medical Services Military District 6 (Halifax), 22 September 1918, file 978, part 3, vol. 5062, RG 9, LAC. 51 Ibid. 52 A.C. Hawkins to Montizambert, 29 September 1918, file 416-2-12, vol. 300, RG 29, LAC. 53 ‘The Feud in Halifax,’ Montreal Medical Journal 37, no. 6 (1908): 441. 54 Ibid, 444–5. 55 Ibid, 441. 56 ‘Matters Personal and Impersonal,’ Maritime Medical News 14, no. 1 (1902): 31. 57 Montizambert to Hawkins, 30 September 1918, file 416-2-12, vol. 300, RG 29, LAC. 58 Ibid. 59 See chapter 3. 60 Janice P. Dickin McGinnis, ‘From Health to Welfare: Federal Government Policies regarding Standards of Public Health for Canadians, 1919–1945,’ PhD diss., University of Alberta, 1981, 34. 61 MacKay to Montizambert, 7 October 1918, file 416-2-12, vol. 300, RG 29, LAC. 62 Montizambert to MacKay [sic], 8 October 1918, file 416-2-12, vol. 300, RG 29, LAC. 63 ‘Dreaded Influenza Has Made Its Appearance in Some City Schools,’ Montreal Star, 26 September 1918, 1. 64 Rioux, La grippe espagnole à Sherbrooke et dans les Cantons de l’Est (Sherbrooke: Etudes supérieures en histoire / Université de Sherbrooke, 1993), 29–30. See also Pettigrew, Silent Enemy, 9–10; and Janice P. Dickin–McGinnis, ‘The Impact of Epidemic Influenza: Canada, 1918–1919,’ in Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queen’s University Press, 1981), 122. On the flu in rural Quebec, see Roger Delaunais, Le Camp de la Grippe Espagnole: La Grippe Espagnole dans la Matapédia (Amqui: n.p., 1991). 65 Anon., ‘Au Congres de Victoriaville,’ Le Devoir, 13 Septembre 1918, 1. 66 ‘Les Fetes de Victoriaville,’ Le Devoir, 16 Septembre 1918, 1. 67 L’Action Catholique, 24 Septembre 1918, 1. 68 ‘La Grippe Espagnole,’ L’Acadien, 1 Octobre 1918, 1; ‘Les fetes de Victoriaville,’ Le Devoir, 16 Septembre 1918, 1. 69 ‘Au congres de Victoriaville,’ Le Devoir, 13 Septembre 1918, 1. 70 Cardinal Bégin, the archbishop of Quebec, attended both the Eucharistic

236

71 72 73 74 75 76 77 78 79 80 81 82 83 84

85

86 87 88 89

Notes to pages 99–101

Congress at Victoriaville and, a few days later, the funeral of Cardinal Farley of New York State. ‘Final Honours Today to Cardinal Farely,’ New York Times, 24 September 1918, 13; see also Letter from Eujèbe Duthort to Charles Fitzpatrick, 23 October 1918, Fonds of Charles Fitzpatrick, vol. 18, MG 27IIC1, LAC, 8353–6. J. Castell Hopkins, Canadian Annual Review of Public Affairs, 1910 (Toronto: Annual Review Publishing Company, 1911), 351–8. See Norman Stone, The Eastern Front: 1914–1917 (New York: Penguin Books, 1998), 281–301. See Holger Herwig, The First World War: Germany and Austria-Hungary, 1914–1918 (New York: Arnold, 1997), 334. Ibid., 381–4. Ibid., 386–7 A recent history of the blockade is Eric W. Osborne, Britain’s Economic Blockade of Germany, 1914–1919 (New York: Frank Cass, 2004). Nicholson, Canadian Expeditionary Force, 510–23. Ibid. Ibid., 510–23. Ibid., 519. Benjamin Isitt, From Victoria to Vladivostok: Canada’s Siberian Expedition, 1917–19 (Vancouver: UBC Press, 2010), 5. Ibid., 6–7. Ibid., 7–8. Key works on labour radicalism during the war include Donald Avery, ‘Dangerous Foreigners’: European Immigrant Workers and Labour Radicalism in Canada, 1896–1932 (Toronto: McClelland and Stewart, 1979); Avery, ‘The Radical Alien and the Winnipeg General Strike of 1919,’ in The West and the Nation, ed. Carl Berger and Ramsay Cook (Toronto: McClelland and Stewart, 1976), 209–31; Gregory Kealey, ‘State Repression of Labour and the Left in Canada, 1914–20: The Impact of the First World War,’ Canadian Historical Review 73, no. 3 (1992): 281–314; and A. Ross MacCormack, Reformers, Rebels, and Revolutionaries: The Western Canadian Radical Movement, 1899–1919 (Toronto: University of Toronto Press, 1977). Craig Heron and Myer Siemiatycki, ‘The Great War, the State, and Working Class Canada,’ in The Workers’ Revolt in Canada, 1917–1925, ed. Craig Heron (Toronto: University of Toronto Press, 1998), 21. Ibid. Ibid., 23. Ibid., 24. Ian McKay and Suzanne Morton, ‘The Maritimes: Expanding the Circle of

Notes to pages 101–3

90 91 92

93 94

95 96 97 98

99 100

237

Resistance,’ in The Workers’ Revolt in Canada, 1917–1925, ed. Craig Heron (Toronto: University of Toronto Press, 1998), 43–86; James Naylor, ‘Southern Ontario: Striking at the Ballot Box,’ in ibid., 144–75; Tom Mitchell and James Naylor, ‘The Prairies: In the Eye of the Storm,’ in ibid., 176– 231; Allen Seager and David Roth, ‘British Columbia and the Mining West: A Ghost of a Chance,’ in ibid., 231–67. Mitchell and Naylor, ‘The Prairies,’ 176–230. Kealey, ‘State Repression of Labour,’ 314. On ethnic tensions and internment, see D.J. Carter, Behind Canadian Barbed Wire: Alien, Refugee, and Prisoner of War Camps in Canada, 1914–1946 (Calgary: Tumbleweed Press, 1980); Bohdan S. Kordan, Enemy Aliens Prisoners of War: Internment in Canada during the Great War (Montreal and Kingston: McGill– Queen’s University Press, 2002); Bohdan S. Kordan and Craig Mahovsky, A Bare and Impolitic Right: Internment and Ukrainian-Canadian Redress (Montreal and Kingston: McGill-Queen’s University Press, 2004); Lubomyr Luciuk, A Time for Atonement: Canada’s First National Internment Operations and the Ukrainian Canadians, 1914–1920 (Kingston: Limestone Press, 1988); Orest Martynowych, Ukrainians in Canada: The Formative Period, 1891–1924 (Edmonton: University of Alberta Press, 1991); and Francis Swyripa and John Herd Thompson, Loyalties in Conflict: Ukrainians in Canada during the Great War (Edmonton: Canadian Institute of Ukrainian Studies, 1983). Isitt, From Victoria to Vladivostok, 8–9. See ‘Office of the Chief Press Censor: Arrangements for Passage of Chinese Coolies through Canada,’ various dates 1917–1918, file 331, vol. 620, RG 6, LAC. See also Humphries, ‘The Horror at Home,’ 235–60; and Isitt, From Victoria to Vladivostok, 83–5. War Diary, Army Medical Corps Depot MD 6, 21–27 September 1918, file 978, vol. 5062, series III-D-3, RG 9, LAC. Ibid., 27 September 1918. War Diary, Assistant Director of Medical Services, MD 7, 28–9 September 1918, file 984, vol. 5063, series III-D-3, RG 9, LAC. General Officer Commanding MD 7 to Quartermaster General, Ottawa, 26 September 1918, file 3-9-47 vol. 2, vol. 4574, RG 24, LAC; ‘Canadian Pacific Railway Schedule,’ August and September 1918, Canadian Pacific Archives; War Diary, Assistant Director of Supply and Transport, MD 7, 27 September 1918, file 981, vol. 5062, series III-D-3, RG 9, LAC. War Diary, Assistant Director of Medical Services, MD 7, 28 September 1918, file 981, vol. 5062, series III-D-3, RG 9, LAC. Memo: District Records Officer Military District 4 to District Records Officer Military District 7, 7 November 1918, file 3-9-47 vol. 1, vol 4574,

238

101 102

103

104

105

106

107

108 109

Notes to page 103 RG 24, LAC; Note to Assistant Director of Medical Services Military District 7 from (District Records Officer), 27 November 1918, file 3-9-47 vol. 1, vol. 4574, RG 24, LAC. War Diary, Assistant Director of Medical Services Military District 4, 29 September 1918, file 976, part 1, vol. 5061, RG 9, LAC. Acting Provost Marshall Military District 10 (Winnipeg) to the District Casualty Officer Military District 10, undated file MD10-20-102 vol. 1, vol. 4607, RG 24, LAC. War Diary, Assistant Adjutant General and Quartermaster General Military District 12 (Regina), 29 September 1918, file 988, series III-D-3, vol. 5065, RG 9, LAC; War Diary, 1st Depot Battalion Saskatchewan Regiment, 29 September 1918, file 988, series III-D-3, vol. 5065, RG 9, LAC. The Assistant Director of Medical Services, Military District 12, makes no mention of illness among the troops in his war diary either. Assistant Director of Medical Services Military District 12 (Calgary) to Director General Medical Services, Ottawa, 2 October 1918, file HW 76211-15, vol. 1992, RG 24, LAC. War Diary, Assistant Adjutant General in charge of administration Military District 11 (Victoria), 1 October 1918, file 990 part 1, series III-D-3, vol. 5065, RG 9, LAC. The Assistant Director of Medical Services for Military District 11 explicitly states: ‘First case of Spanish influenza appeared in district in advance company of Siberian Expeditionary Force. Hospital opened this date at Coquitlum for this type of case.’ War Diary, Assistant Director of Medical Services Military District 11 (Victoria), 3 October 1918, file 990 part 1, vol. 5065, RG 9, LAC. For example, influenza did not strike Halifax until later in the first week of October 1918, or London, Ontario, until the day after it arrived in Vancouver. Even as the disease reached Vancouver, Toronto was still relatively free from infection. Lux, ‘The Bitter Flats,’ 4. Howard Markel et al., ‘Non-Pharmaceutical Interventions Implemented by US Cities during the 1918–1919 Influenza Pandemic,’ Journal of the American Medical Association 298 (2007): 644–54, http://jama.ama-assn.org/ cgi/content/full/298/6/644, accessed 10 September 2010. A Canadian study reaches similar conclusions about the efficacy of early intervention. See S. Zhang, P. Yan, B. Winchester, and J. Wang, ‘Transmissibility of the 1918 Pandemic Influenza in Montreal and Winnipeg of Canada,’ Influenza and Other Respiratory Viruses 4, no. 1 (January 2010): 27–31. Another view is presented in Lisa Sattenspiel and D. Ann Herring, ‘Simulating the Effect

Notes to pages 104–7

110 111 112

113

114 115 116 117 118

119 120

121

239

of Quarantine on the Spread of the 1918–19 Flu in Central Canada,’ Bulletin of Mathematical Biology 65, no. 1 (2006): 1. Markel, ‘Non-Pharmaceutical Interventions,’ 651. Ibid. See Douglas O. Baldwin, ‘Volunteers in Action: The Establishment of Government Health Care on Prince Edward Island, 1900–1931,’ Acadiensis 19, no. 2 (Spring 1990): 121–47. See various descriptions of the disease in Northumberland County in L5d1, file 6 or 13, APNB. As early as 1 October the disease had been reported in Shediac. See ‘On craint une épidémie au N.B.,’ L’Acadien, 1 Octobre 1918, 3. Newfoundland was not a province of Canada in 1918, but see Craig T. Palmer, Lisa Sattenspiel, and Chris Cassidy, ‘Boats, Trains, and Immunity: The Spread of the Spanish Flu on the Island of Newfoundland,’ Newfoundland and Labrador Studies 22, no. 2 (January 2007): 473– 504. F. Montizambert to Minister of Immigration and Colonization, 21 October 1918, file 416-2-12, vol. 300, RG 29, LAC. Ibid. Dominion Bureau of Statistics, Canada Yearbook 1920 (Ottawa: F.A. Acland /King’s Printer, 1921), 109–10. Ibid. Alan M. Kraut, Silent Travelers: Germs, Genes, and the ‘Immigrant Menace’ (Baltimore: Johns Hopkins University Press, 1994), 3. The idea of the immigrant menace in public health discourse has yet to be fully explored in the Canadian context. See Geoffrey Bilson, ‘“Muscles and Health”: Health and the Canadian Immigrants, 1897–1906,’ in Health, Disease, and Medicine: Essays in Canadian History, ed. C.G. Roland (Hamilton: Hannah Institute for the History of Medicine, 1984), 398–411; Alan Sears, ‘Immigrations Controls as Social Policy: The Case of Canadian Medical Inspection, 1900–1920,’ Studies in Political Economy 33 (Autumn 1990): 91–112; and Barbara Roberts, ‘Doctors and Deports: The Role of the Medical Profession in Canadian Deportation, 1900–1920,’ Canadian Ethnic Studies 18, no. 3 (1986): 17–36. Kraut, Silent Travelers, 6. Amy Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labour Force (Baltimore: Johns Hopkins University Press, 2003). Clifford Sifton, ‘The Immigrants Canada Wants,’ Maclean’s Magazine (1 April 1922): 16, 32–4. On Sifton see D.J. Hall, Clifford Sifton: The Lonely Eminence, 1901–1929 (Vancouver: University British Columbia Press,

240

Notes to pages 107–11

1985). See also Susan W. Hardwick, ‘Borders and Boundaries: Geographies and Identity in Canada and the U.S.,’ Canadian Issues / Thèmes Canadiens (Spring 2009): 19–25. 122 Alan B. Anderson and James S. Frideres, Ethnicity in Canada: Theoretical Perspectives (Toronto: Butterworths, 1981), 140–55. 7. ‘A Terrible Fall for Preventative Medicine’ 1 W.H. Hattie, Department of Public Health Twenty-Sixth Annual Report (Halifax: Province of Nova Scotia, 30 September 1918), 7. 2 New Brunswick’s Department of Health was formed days before the outbreak of influenza, which is why that province is sometimes described as being without a department during the pandemic. See Jane E. Jenkins, ‘Baptism of Fire: New Brunswick’s Public Health Movement and the 1918 Influenza Epidemic,’ Canadian Bulletin of Medical History 24, no. 2 (2007): 317–42. The most detailed case study of public health developments at the municipal level is Heather MacDougall, Activists and Advocates: Toronto’s Health Department, 1883–1983 (Toronto: Dundurn Press, 1990). MacDougall argues, for example, that while there were important developments before the Great War, real gains against many diseases such as diphtheria and typhoid only came as the public health department became more activist in the 1920s. See ibid., 141–3. 3 Vincent Massey, ‘Report to the Vice Chairman of the War Committee of the Cabinet on the Establishment of a Federal Department of Health,’ 25 October 1918, file 10-3-1, vol. 2, vol. 19, RG 29, LAC, 25. Hereafter Report to the Vice Chairman of the War Committee. See also Robert Davies Defries, ed., The Development of Public Health in Canada (Ottawa: Canadian Public Health Association, 1940); and Jay Cassel, ‘Public Health in Canada,’ in The History of Public Health and the Modern State, ed. Dorothy Porter (Atlanta: Editions Rodopi, 1994), 289–90. New Brunswick created a Ministry of Health just a few weeks before the pandemic struck. 4 ‘The Epidemic in New Brunswick,’ undated, L5d3, Archives of the Province of New Brunswick (hereafter APNB). 5 Jenkins, ‘Baptism of Fire,’ 322–6. 6 Ibid., 318, 322–3. 7 Ibid., 320–5. 8 Ibid., 318. 9 Douglas O. Baldwin, ‘Volunteers in Action: The Establishment of Government Health Care on Prince Edward Island, 1900–1931,’ Acadiensis 19, no. 2 (Spring 1990): 121–47 at 121.

Notes to pages 111–13

241

10 Ibid., 122. 11 For more on the pandemic’s effects on public health policy in Saskatchewan, see Maureen Lux, ‘“The Bitter Flats”: The 1918 Influenza Epidemic in Saskatchewan,’ Saskatchewan History 49, no. 1 (Spring 1997): 4; and Lux, ‘The Impact of the Spanish Influenza Pandemic in Saskatchewan, 1918–1919,’ MA thesis, University of Saskatchewan, 1989. A municipal perspective is found in Heather MacDougall, ‘Toronto’s Health Department in Action: Influenza in 1918 and SARS in 2003,’ Journal of the History of Medicine and Allied Sciences 62, no. 1 (2007): 56–89 at 69. 12 William Roberts to Secretary, Board of Health, St John, 7 October 1918, L5d3, APNB. 13 ‘Rules: For the Avoidance of “Spanish Influenza” and for the Preventative Care of Those Sick With It,’ October 1918, L5d3, APNB. 14 ‘Proclamation,’ undated, L5d3, APNB. See also ‘La Grippe Espagnole,’ L’Acadien, 11 October 1918, 1. 15 Jenkins, ‘Baptism of Fire,’ 336. 16 Margaret W. Andrews, ‘Epidemic and Public Health: Influenza in Vancouver, 1918–1919,’ BC Studies 34 (Summer 1977): 21–44 at 30. 17 Ibid. 18 Ibid. 19 Ibid. 20 Ibid., 28–31. 21 Ibid., 34. 22 See ibid.; and Janice P. Dickin McGinnis, ‘A City Faces an Epidemic,’ Alberta History 24, no. 4 (1976): 1–11. 23 ‘Gauze Masks Must Be Worn Constantly, Except at Home, Is New Order,’ Edmonton Journal, 25 October 1918, 1. Vancouver instituted a similar but voluntary program; ‘All Citizens Asked to Don Flu Masks,’ Vancouver Sun, 28 October 1918, 14. On flu in Alberta, see Dickin McGinnis, ‘A City Faces an Epidemic.’ 24 Ibid., 4. 25 Edmonton Journal, 25 October 1918, 1. 26 Ibid., 6. 27 Ibid., 5–6. 28 Ibid. 29 See Lux, ‘The Bitter Flats,’ 9. 30 ‘Dreaded Influenza Has Made Its Appearance in Some City Schools,’ Montreal Star, 26 September 1918, 1. 31 S. Boucher, ‘The Epidemic of Influenza,’ Canadian Medical Association Journal 8, no. 12 (December 1918): 1087–8.

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Notes to pages 114–19

32 ‘Instructions on Influenza Sent Out by the City,’ Montreal Star, 27 September 1918, 1; see also ‘Precautions à prendre,’ Le Devoir, 27 Septembre 1918, A. 33 ‘Take Precautions,’ Montreal Star, 4 October 1918, 10. 34 ‘Urged Closing Action: Heard Doctor’s and Citizen’s Views,’ Montreal Gazette, 8 October 1918, 1, 10. 35 ‘Public Places Closed by City Health Board,’ Montreal Gazette, 8 October 1918, 1. 36 ‘The Decisive Meeting,’ Montreal Gazette, 8 October 1918, 1. 37 Ibid. 38 Boucher, ‘The Epidemic of Influenza,’ 1089. 39 Ibid.; see also Magda Fahrni, ‘ “Elles sont partout” : le femmes et la ville en temps d’épidémie Montréal, 1918–1920,’ Revue d’histoire de L’Amerique francaise 58, no. 1 (2004): 67–85 at 71. 40 Ibid. 41 Esyllt Jones, Influenza 1918: Disease, Death, and Struggle in Winnipeg (Toronto: University of Toronto Press, 2007), 46–8. 42 Ibid., 48–55. 43 Alexander Douglas is quoted in ibid., 53. 44 Jones, Influenza, 1918, 40–63. 45 John W.S. McCullough, ‘The Control of Influenza in Ontario,’ Canadian Medical Association Journal 8, no. 12 (1918): 1084. 46 Provincial Secretary’s Department, Ontario Provincial Board of Health, ‘Influenza: Precautions,’ 12 October 1918, RG 62-4-9-450a.1, Archives of the Province of Ontario. 47 See Province of Ontario, The Report of the Provincial Board of Health, 1918 (Toronto: Government of Ontario, 1919). See also Mark Humphries, ‘The Duty of the Nation: Public Health and the Spanish Influenza in Canada, 1918–19,’ PhD diss., University of Western Ontario, 2009, 214. 48 MacDougall, ‘Toronto’s Health Department in Action,’ 89. 49 Ibid., 56. 50 For different municipal responses to flu in Ontario, see Niall Johnson, ‘Pandemic Influenza: An Analysis of the Spread of Influenza in Kitchener, October 1918,’ MA thesis, Wilfrid Laurier University, 1993; and E.B. Oliver, ‘The Influenza Epidemic of 1918–19,’ Thunder Bay Historical Society Annual 10 (1919): 9–10. 51 A similar program was pioneered in the United States Army. See Carol R. Byerly, Fever of War: The Influenza Epidemic in the US Army during World War I (New York: NYU Press, 2005), 163–4. 52 F.T. Cadham, ‘The Use of a Vaccine in the Recent Epidemic of Influenza,’ Canadian Medical Association Journal 9, no. 6 (1919): 519.

Notes to pages 119–23 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78

79

80

243

Ibid., 521–2. Ibid., 522. Ibid., 522–3. Ibid. Ibid., 523. See also Eileen Pettigrew, Silent Enemy: Canada and the Deadly Flu of 1918 (Regina: Western Producer Prairie Books, 1983), 20–1. Ibid. E. Jones, Influenza 1918, 43. Cadman, ‘The Use of a Vaccine,’ 523. Ibid., 522–3. See also Pettigrew, Silent Enemy, 19–20. McCullough, ‘The Control of Influenza,’ 1085. Pettigrew, Silent Enemy, 19–20. J.J. Heagerty, ‘Influenza and Vaccination,’ Canadian Medical Association Journal 9, no. 3 (1919): 226–7. Pettigrew, Silent Enemy, 19–21. Dickin McGinnis, ‘A City Faces and Epidemic,’ 4–5. See Lux, ‘The Bitter Flats’; and Andrews, ‘Epidemic and Public Health.’ Pettigrew, Silent Enemy, 2. See A.D. Blackader, ‘The Therapeutics of To-Day,’ Canadian Medical Association Journal 2, no. 10 (1912): 865–6. F.H. Wetmore, ‘Treatment of Influenza,’ Canadian Medical Association Journal 9, no. 12 (1919): 1079. Ibid., 1079-80. ‘Obituary: Dr. Frederick Henry Wetmore,’ Canadian Medical Association Journal 39, no. 5 (November 1938): 510. Ibid. T. Garner, ‘Re Treatment of Ordinary Pneumonia,’ Edmonton Journal, 2 November 1918, 4. R.C. Ghostley, ‘About Influenza,’ Edmonton Journal, 24 October 1918, 4. ‘A Cure for Grippe,’ Montreal Star, 16 October 1918, 10. ‘Influenza and Spirits,’ Edmonton Journal, 14 November 1918, 4. Linda J. Quiney, ‘“Filling the Gaps”: Canadian Voluntary Nurse, the 1917 Halifax Explosion, and the Influenza Epidemic of 1918,’ Canadian Bulletin of Medical History 19, no. 2 (2002): 351–74. See, for example, ‘Hundred Volunteer Nurses Wanted in Vancouver to Battle with Influenza,’ Vancouver Sun, 17 October 1918, 3; and ‘Flu Patients Dying Through Lack of Care,’ Edmonton Journal, 15 October 1918, 6. Quiney, ‘Filling the Gaps,’ 367. On women and war in Canada, see Linda Kealey, ‘Women and Labour during World War I: Women Workers and the Minimum Wage in Manitoba,’ in First Days, Fighting Days: Women in Mani-

244

81 82

83 84 85

86 87 88 89 90 91 92

Notes to pages 123–4

toba History, ed. Mary Kinnear (Regina: Canadian Plains Research Centre, 1987), 76–99; Susan Mann, ed., The War Diary of Clare Gass (Montreal and Kingston: McGill–Queen’s University Press, 2000); Desmond Morton, Fight or Pay: Soldier’s Families in the Great War (Vancouver: UBC Press, 2005); M. Leslie Newell, ‘“Led by the Spirit of Humanity”: Canadian Military Nursing, 1914–1929, MScN thesis, University of Ottawa, 1996; G.W.L. Nicholson, Canada’s Nursing Sisters (Toronto: A.M. Hakkert, 1975); Alison Prentice et al., Canadian Women: A History (Toronto: Harcourt Brace, 1996), 230–4; Linda J. Quiney, ‘“Sharing the Halo”: Social and Professional Tensions in the Work of World War I Canadian Volunteer Nurses,’ Journal of the Canadian Historical Association, new series, 9 (1998): 105–24; Ceta Ramkhalawansigh, ‘Women during the Great War,’ in Women at Work: Ontario, 1850–1930, ed. J. Action et al. (Toronto: Canadian Women’s Educational Press, 1974), 261–307; Robert Rutherdale, Hometown Horizons: Local Responses to Canada’s Great War (Vancouver: UBC Press, 2004), 192–223; Joan Sangster, ‘Mobilizing Women for War,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David MacKenzie (Toronto: University of Toronto Press, 2005), 157–93; and Kori Street, ‘Bankers and Bomb Makers: Gender and Women’s Work in the First World War in Canada,’ PhD diss., University of Victoria, 2001. Mrs Ralph Smith, ‘Spanish Flu,’ Vancouver Sun, 19 October 1918, 6. Ibid.; see also Esyllt Jones, ‘“Contact across a Diseased Boundary”: Urban Space and Social Interaction during Winnipeg’s Influenza Epidemic, 1918–1919,’ Journal of the Canadian Historical Association 13 (2002): 119–39 at 137–9. ‘Brave Nursing Sister Dies at her Post from Influenza After Caring for Soldiers,’ Edmonton Bulletin, 29 October 1019, 1. Anon., Volunteer Nurse, ‘What the ’Flu is Doing to Us,’ Edmonton Bulletin, 2 November 1918, 4. Quiney, ‘Filling the Gaps,’ 367–8. On the development of nursing in Canada, see Kathryn McPherson, Bedside Matters: The Transformation of Canadian Nursing, 1900–1990 (Toronto: Oxford University Press, 1996). Fahrni, ‘“Elles sont partout,”’ 68. Ibid. A.W. Coone, ‘Living Conditions in Parts of This City,’ Edmonton Bulletin, 26 November 1918, 7. Ibid. ‘Bad Housing is Portion of Poor,’ Montreal Star, 2 November 1918, 2; ‘Five Victims in One Bed Hovel,’ Montreal Gazette, 26 October 1918, 5. Ibid. Ibid.

Notes to pages 124–8

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93 Ibid. 94 ‘Epidemic Adds to Social Problems,’ Montreal Gazette, 9 October 1918, 3. 95 Ibid.; see also J. Scanlon, H. Casey, and T. McMahon, ‘Almost Only Women: Canadian Volunteer Response to the 1918–1920 Pandemic,’ American Journal of Disaster Medicine 4, no. 6 (November–December 2009): 331–43; and C. Gidney, ‘Institutional Responses to Communicable Diseases at Victoria College, University of Toronto, 1900–1940,’ Canadian Bulletin of Medical History 24, no. 2 (2007): 265–90. 96 ‘Why Tolerate the Slums?’ Montreal Star, 3 November 1918, 10. 97 Coone, ‘Living Conditions in Parts of This City.’ 98 Mrs Ralph Smith, ‘Some Lessons from the ’Flu,’ Vancouver Sun, 26 October 1918, 6. 99 Jones, 139. 100 Ibid., 58–63. See also City of Winnipeg, Report of the Department of Health for the Year Ending 31st December 1918 (Winnipeg: City of Winnipeg, 1919), 10–11. 101 Ibid.; See also Jones, Influenza 1918, 61. 102 See Terry Copp, The Anatomy of Poverty: The Condition of the Working Class in Montreal, 1897–1929 (Toronto: McClelland and Stewart, 1974), 92–6. 103 Ibid.; Cite de Montréal, Rapport du Bureau Municipal d’Hygiène et de Statistique de Montréal, 1918 (Montreal: A.A. Pigeon, 1919), 23–5. 104 See chapter 3. 105 ‘Influenza Epidemic,’ 28 May 1919, file 851-4-D96, Part 1, vol. 2970, RG 29, LAC. Accuracy is always an issue when dealing with statistics compiled by Indian Affairs, but the numbers are confirmed by independent research. Ann Herring calculated that 188 people died at Norway House during the pandemic. The Indian Affairs statistics list 190 deaths, including two that were recorded after the period examined by Herring. See Ann Herring, ‘“There Were Young People and Old People and Babies Dying Every Week”: The 1918–1919 Influenza Pandemic at Norway House,’ Ethnohistory 41, no. 1 (1994): 73–105. 106 Ibid. 107 Dominion of Canada, Annual Report of the Department of Indian Affairs for the Year Ended March 31 1919 (Ottawa: Department of Indian Affairs, 1919), 41. 108 I would like to thank Dr. Lianne Leddy of Memorial University of Newfoundland for her assistance in interpreting the Aboriginal experience in 1918 and specifically that of the Serpent River First Nation. 109 Maureen Lux, Medicine That Walks: Disease, Medicine, and Canadian Plains Native People, 1880–1940 (Toronto: University of Toronto Press, 2001), 186–7.

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Notes to pages 128–30

110 Ibid., 186. 111 On the Spanish River School, albeit in a much later period, see Basil H. Johnston, Indian School Days (Toronto: Key Porter Books, 1988). 112 Jennifer Pettit, ‘“To Christianize and Civilize”: Native Industrial Schools in Canada,’ PhD diss., University of Calgary, 1997, 351. 113 Dominion of Canada, Annual Report of the Department of Indian Affairs for the Year Ended March 31 1915 (Ottawa: Department of Indian Affairs, 1915), 158. 114 Dominion of Canada, Annual Report of the Department of Indian Affairs for the Year Ended March 31 1919 (Ottawa: Department of Indian Affairs, 1919), 90. 115 Pettit, ‘To Christianize and Civilize,’ 254. On Aboriginal people and the flu, see Mary-Ellen Kelm, “British Columbia First Nations and the Influenza Pandemic of 1918–19,” BC Studies 122 (1999): 23–47; and Kelm, Colonizing Bodies: Aboriginal Health and Healing in British Columbia, 1900–1950 (Vancouver: UBC Press, 1999). 116 Alan M. Kraut, ‘Immigration, Ethnicity, and the Pandemic,’ Public Health Reports 125, supp. 3 (2010): 132. 117 See Amy Fairchild, Science at the Borders: Immigrant Medical Inspection and the Shaping of the Modern Industrial Labour Force (Baltimore: Johns Hopkins University Press, 2003), esp. 77ff. See also Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: University of California Press, 2001). 118 Jones, ‘Contact across a Diseased Boundary,’ 119–39. See also Jones, ‘Searching for the Springs of Health: Women and Working Families in Winnipeg’s 1918–1919 Influenza Epidemic,’ PhD diss., University of Manitoba, 2003. 119 See Jones, ‘Contact across a Diseased Boundary’; and Fahrni, ‘Elles sont partout.’ 120 Jones, ‘Contact across a Diseased Boundary,’ 139. 8. The Trail of Infected Armies: War, the Flu, and the Popular Response 1 Personnel File, J. Victor G., box 3693, Accession 92-93/166, RG 150, LAC. The soldier’s last name has been removed to protect his identity. The medical records used here are publicly available at Library and Archives Canada. 2 On masculinity and militarism, see Mark Moss, Manliness and Militarism: Educating Young Boys for War in Ontario (Toronto: Oxford University Press, 2001). 3 Attestation Papers, Personnel File of J. Victor G.

Notes to pages 131–2

247

4 Case History Sheet, Station Hospital, Halifax, 6–10 October 1918; Clinical Chart, Station Hospital Halifax, 6–9 October 1918, ibid. 5 Case History Sheet, Station Hospital, Halifax, 12–14 October 1918; Clinical Chart, Station Hospital Halifax, 12–14 October 1918. 6 C.A. Sharpe, ‘Enlistment in the Canadian Expeditionary Force, 1914–1918: A Regional Analysis,’ Journal of Canadian Studies 18, no. 3 (1983): 15–29. 7 See Robert Craig Brown, ‘Sir Robert Borden and Canada’s War Aims,’ in War Aims and Strategic Policy in the Great War, 1914–1918, ed. Barry Hunt and Adrian Preston (London: Croom Helm, 1977), 55–6. See also Robert Bothwell and Robert Craig Brown, ‘The “Canadian Resolution,”’ in Policy by Other Means: Essays in Honour of C.P. Stacey (Toronto: Clarke Irwin, 1972), 163–78; Robert Craig Brown, Robert Laird Borden: A Biography, 1914–37 (Toronto: Macmillan, 1980), II:24–82; Stephen Harris, ‘From Subordinate to Ally: The Canadian Corps and National Autonomy, 1914–1918,’ Revue International d’Historie Militarie 54 (1982): 109–30; and Desmond Morton, ‘“Junior but Sovereign Allies”: The Transformation of the Canadian Expeditionary Force, 1914–1918,’ Journal of Imperial and Commonwealth History 8, no. 1 (October 1979): 56–67. 8 See as in note 7, esp. Brown and Morton. 9 On the background to Canada’s imperial ambitions see Carl Berger, Sense of Power: Studies in the Ideas of Canadian Imperialism, 1867–1914 (Toronto: University of Toronto Press, 1976). The best survey of the period remains Ramsay Cook and Robert Craig Brown, Canada, 1896–1945: A Nation Transformed (Toronto: McClelland and Stewart, 1974). 10 Robert Craig Brown, Robert Laird Borden: A Biography, vol. 2 (Toronto: Macmillan, 1980), 83–98; See also J.L. Granatstein, ‘Conscription in the Great War,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David MacKenzie (Toronto: University of Toronto Press, 2005), 62–75; A.M.J. Hyatt, ‘Sir Arthur Currie and Conscription: A Soldier’s View,’ Canadian Historical Review 50, no. 3 (September 1969): 285–96; Desmond Morton, ‘Conscription Crisis,’ in A Military History of Canada (Edmonton: Hurtig Publishers, 1985), 151–8; and A.M. Williams, ‘Conscription, 1917: A Brief for the Defence,’ Canadian Historical Review 37, no. 4 (December 1956): 338–51. 11 John Herd Thompson, The Harvests of War: The Prairie West, 1914–1918 (Toronto: McClelland and Stewart, 1978), 97–8. See also R. Matthew Bray, ‘Fighting as an Ally: The English-Canadian Patriotic Response to the Great War,’ Canadian Historical Review 61 (June 1980): 151–68; and Jonathan F. Vance, Death So Noble: Memory, Meaning, and the First World War (Vancouver: UBC Press, 1997), esp. chs. 1 and 2.

248

Notes to pages 132–3

12 See Martin Robin, ‘Registration, Conscription, and Independent Labour Politics, 1916–1917,’ Canadian Historical Review 47, no. 2 (June 1966): 101– 18; and Robert Rutherdale, Hometown Horizons: Local Responses to Canada’s Great War (Vancouver: UBC Press, 2004), 119–53. 13 Donald Avery, ‘Ethnic and Class Relations in Western Canada during the First World War,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David MacKenzie (Toronto: University of Toronto Press, 2005), 272–99; Bohdan Kordan, ‘Between Ambition and Threat’ and ‘Enemy Alien Internment,’ both in Enemy Aliens, Prisoners of War: Internment in Canada during the Great War (Montreal and Kingston: McGill-Queen’s University Press, 2002), esp. 16–51; Desmond Morton, ‘Sir William Otter and Internment Operations in Canada during the First World War,’ Canadian Historical Review 55 (1974): 32–58. 14 On conscription, see Elizabeth Armstrong, Le Québec et la crise de la conscription 1917–1918 (Montréal: VLB, 1998); and J.L. Granatstein and J.M. Hitsman, Broken Promises: The History of Conscription in Canada (Toronto: Copp Clark Pitman, 1985). See also Amy Shaw, Crisis of Conscience: Conscientious Objection in Canada during the First World War (Vancouver: UBC Press, 2008). A good local case study is Tarah Brookfield, ‘Divided by the Ballot Box: The Montreal Council of Women and the 1917 Election,’ Canadian Historical Review 89, no. 4 (2008): 473–501. 15 See John English, The Decline of Politics: The Conservatives and the Party System, 1901–1920 (Toronto: University of Toronto Press, 1977); and Thomas P. Socknat, ‘Canada’s Liberal Pacifists and the Great War,’ Journal of Canadian Studies 18, no. 3 (Fall 1983): 30–44. A succinct discussion of the political aspects of the war is John English, ‘Political Leadership in the First World War,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David MacKenzie (Toronto: University of Toronto Press, 2005), 76–96. 16 On the idealism of the union government, see Margaret Prang, N.W. Rowell: Ontario Nationalist (Toronto: University of Toronto Press, 1975). See also Richard Allen, The Social Passion: Religion and Social Reform in Canada, 1914–28 (Toronto: University of Toronto Press, 1971), esp. chs. 3 and 4. 17 On the role of the Protestant churches, see Michael Bliss, ‘The Methodist Church and World War I,’ Canadian Historical Review 49, no. 3 (1968): 213– 33; and David B. Marshall’s response in ‘Methodism Embattled: A Reconsideration of the Methodist Church and World War I,’ Canadian Historical Review 66, no. 1 (1985): 48–64. Also useful is Michelle Fowler, ‘“Death Is

Notes to pages 133–6

18

19 20

21 22 23

24 25

26 27

28 29 30

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Not the Worst Thing”: The Presbyterian Press in Canada, 1913–1919,’ War and Society 25 (October 2006): 23–38. G.W.L. Nicholson, Canadian Expeditionary Force, 1914–1919 (Ottawa: Queen’s Printer, 1964), 519–524. The historiography of the war is most fully developed in Tim Cook, Clio’s Warriors: Canadian Historians and the Writing of the World Wars (Vancouver: UBC Press, 2006), esp. chs. 2 and 6. On the social history of the Great War, see Desmond Morton, When Your Number’s Up: The Canadian Soldier in the First World War (Toronto: University of Toronto Press, 1993); Rutherdale, Hometown Horizons; Vance, Death So Noble. The best macro-level political overview remains Cook and Brown, Canada 1896–1921. Nicholson, Canadian Expeditionary Force, 521–2. See Mark Osborne Humphries, ‘The Limits of Necessity: Public Health, Dissent, and the War Effort during the 1918 Infleunza Pandemic,’ in Epidemic Encounters, ed. Magda Fahrni and Esyllt Jones (Vancouver: UBC Press, 2012). For an overview, see Cook and Brown, Canada 1896–1921, 212–93. Thompson, The Harvests of War, 97–8. ‘Ten Months under Union Government,’ 24 August 1918, Rowell Papers, reel C-939, 10143-10152, LAC. Thompson, Harvests of War, 97. See also John H. Thompson, ‘“The Beginning of our Regeneration”: The Great War and Western Canadian Reform Movements,’ Canadian Historical Association Historical Papers (1972): 227–45. Thompson, Harvests of War, 101–5. For a comparative approach, see Jeff Keshen, ‘The Great War Soldier as Nation Builder in Canada and Australia,’ in Canada and the Great War: Western Front Association Papers (Montreal and Kingston: McGill-Queen’s University Press, 2003), 3–26. See Desmond Morton, Fight or Pay: Soldiers’ Families in the Great War (Vancouver: UBC Press, 2004). Vance, Death So Noble, esp. ch. 2. See also Vance, ‘Remembering Armageddon,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David Mackenzie (Toronto: University of Toronto Press, 2005), 409–34; and A.R. Young, ‘“We Throw the Torch”: Canadian Memorials of the Great War and the Mythology of Heroic Sacrifice,’ Journal of Canadian Studies 26, no. 4 (Winter 1989–90): 5–28. Vance, Death So Noble, 37–42. Nellie McClung, In Times Like These (New York: D. Appleton and Co., 1915), 161–2. For example, see the introduction to J.O. Miller, ed., The New Era in Canada:

250

31 32

33

34 35 36 37

38

39

40

Notes to pages 136–7

Essays Dealing with the Upbuilding of the Canadian Commonwealth (Toronto: J.M. Dent and Sons, 1917), 5–6. William Irvine, The Farmers in Politics (Toronto: McClelland and Stewart, 1920), 22. See Mackenzie King, Industry and Humanity: A Study in the Principles Underlying Industrial Reconstruction (Toronto: Thomas Allen, 1918); and Michael Bliss, ‘The Methodist Church and World War I,’ Canadian Historical Review 49, no. 3 (1968): 232–3. See also Thompson, Harvests of War, 97. Clifford Sifton, ‘The Foundations of the New Era,’ in The New Era in Canada: Essays Dealing with the Upbuilding of the Canadian Commonwealth, ed. J.O. Miller (Toronto: J.M. Dent and Sons, 1917), 56. Will Workman, ‘What Reconstruction Means,’ Alberta Non-Partisan, 4 December 1918, 3. Vance, Death So Noble, 55–6. Ibid., 36. See also Bliss, ‘The Methodist Church and World War I’; and Marshall’s response, ‘Methodism Embattled.’ A recent examination of the honourable sacrifice motif in the Canadian religious periodical literature is Fowler, ‘“Death Is Not the Worst Thing.”’ See Donald Avery, ‘Dangerous Foreigners’: European Immigrant Workers and Labour Radicalism in Canada, 1896–1932 (Toronto: McClelland and Stewart, 1979); Avery, ‘The Radical Alien and the Winnipeg General Strike of 1919,’ in The West and the Nation, ed. Carl Berger and Ramsey Cook (Toronto: McClelland and Stewart, 1976), 209–31; Gregory Kealey, ‘State Repression of Labour and the Left in Canada, 1914–20: The Impact of the First World War,’ Canadian Historical Review 73, no. 3 (1992): 281–314; A. Ross MacCormack, Reformers, Rebels, and Revolutionaries: The Western Canadian Radical Movement, 1899–1919 (Toronto: University of Toronto Press, 1977); and Rutherdale, Hometown Horizons, 119–53. District Intelligence Officer (Military District 4, Montreal) to the Assistant Adjutant General (Military District 4), ‘Anti-recruiting Disturbances,’ 24 August 1916, file 25-1-13, vol. 4479, RG 24, LAC; General Officer Commanding Military District 5 (Quebec) to the Secretary of the Militia Council, ‘Anti Conscription Activities Shawinigan Falls, P.Q.,’ 12 September 1917, file C159a 1, vol. 4517, RG 24, LAC. Chief Press Censor, ‘Memorandum for the Office File,’ 22 February 1918, file 142, vol. 6, RG 6, LAC. On recruiting and voluntarism in Canada, see Craig Brown and Donald Loveridge, ‘Unrequited Faith: Recruiting the CEF 1914–1918,’ Revue internationale d’histoire militaire, 54 (1982): 53–79; Paul

Notes to pages 137–9

41

42

43 44 45 46 47

48 49 50 51

52

251

Maroney, ‘“The Great Adventure”: The Context and Ideology of Recruiting in Ontario, 1914–1917,’ Canadian Historical Review 77, no. 1 (1996): 62–98; James Walker, ‘Race and Recruitment in World War I: Enlistment of Visible Minorities in the CEF,’ Canadian Historical Review 70, no. 1 (March 1989): 1–26; Rutherdale, Hometown Horizons (Vancouver: UBC Press, 2004), 46–87; and C.A. Sharpe, ‘Enlistment in the Canadian Expeditionary Force, 1914–1918: A Regional Analysis,’ Journal of Canadian Studies 18, no. 3 (1983): 15–29. Martin F. Auger, ‘On the Brink of Civil War: The Canadian Government and the Suppression of the 1918 Quebec Easter Riots,’ Canadian Historical Review 89, no. 4 (2008): 503–40 at 519. Desmond Morton and Glenn Wright, Winning the Second Battle: Canadian Veterans and the Return to Civilian Life, 1915–1930 (Toronto: University of Toronto Press, 1987), 62–78. Ibid., 74–5. Ibid., 224–5. Editorial, Vancouver Sun, 5 November 1918, 6. Report from Deputy ADMS Sanitation to ADMS MD 2, 9 October 1918, file 34-7-136, vol, 5, vol, 4386, RG 24, LAC. Colonel, CAMC for ADMS, MD 2 to DGMS, Ottawa, 14 October 1918, file 34-7-136, vol. 5, vol. 4386, RG 24, LAC; see also T.L. Church to Captain Seymour, RAF 15 October 1918, file 34-7-136, vol. 5, vol. 4386, RG 24, LAC. ‘A RAF’ to Thomas Church, 15 October 1918, Borden Papers, MG 26H, reel C4416, 136666. T.L. Church to Major-General Logie, Military Headquarters, Toronto, 16 October 1918, Borden Papers, MG 26H, reel C4416, 136666. T.L. Church to Minister of Militia, 8 October 1918, file HQ 762-11-15, vol. 1992, RG 24, LAC. Brigadier General Gwynne for Adjutant General to Private Secretary of the Minister of Militia and Defence, 10 October 1918, file HQ 762-11-15, vol. 1992, RG 24, LAC. Major General, Canadian General Staff to Adjutant General, Ottawa, 9 October 1918, file HQ file HQ 762-11-15, vol. 1992, RG 24, LAC. This discussion of the controversy at the Toronto Base Hospital draws on Mark Osborne Humphries, ‘The Limits of Necessity: Public Health, Dissent, and the War Effort during the 1918 Influenza Pandemic,’ in Epidemic Encounters, Madga Fahrni and Esyllt Jones, eds. (Vancouver: UBC Press, 2012). Readers should consult that essay for a more detailed examination, specifically the military’s response to Church’s accusations.

252

Notes to pages 139–43

53 ‘Hospitals for Our Soldiers,’ The Globe, 1 November 1915, 6. 54 See various articles on the Ontario page of the Montreal Star in late October and early November 1918. See esp. 6, 7, and 8 November 1918, 2. 55 Anonymous letter to the editor, Edmonton Bulletin, 2 November 1918, 7. 56 ‘Ottawa – and the Base Hospital,’ The Globe, 30 October 1918, 6. 57 Vance, Death So Noble, 12–34. 58 ‘Union Government and the Flu,’ Edmonton Bulletin, 25 October 1918, 7. 59 ‘Fight Flu With the Censorship,’ Edmonton Bulletin, 31 October 1918, 7. 60 Alex Ross, ‘The Sympathetic Strike,’ Alberta Non-Partisan, 6 November 1918, 4. See Tom Mitchell and James Naylor, ‘The Prairies: In the Eye of the Storm,’ in The Workers’ Revolt in Canada, 1917–1925, ed. Craig Heron (Toronto: University of Toronto Press, 1998), 176–231. 61 William Irvine, ‘The Flu,’ Alberta Non-Partisan, 6 November 1918, 5. 62 Thompson, Harvests of War, 97. 63 Elements of this discussion on the pursuit of defaulters in Quebec are adapted from Humphries, ‘The Limits of Necessity.’ Readers should consult that work for a more detailed examination of the problem, including the horrors that befell soldiers packed onto crowded troopships that left Quebec and Montreal that autumn. 64 See Brown and Cook, Canada, 1896–1921, 212–13. 65 See English, The Decline of Politics, 186–221. 66 Socknat, ‘Canada’s Liberal Pacifists.’ 67 On the debate about whether conscription was necessary, see Williams, ‘Conscription, 1917’; Granatstein and Hitsman, Broken Promises, 1–99; Brown, Robert Laird Borden (Toronto: Macmillan, 1980), II:83–98; and Morton, ‘Conscription Crisis,’ in A Military History of Canada, 151–8; Granatstein has recently changed his position on the issue; see Granatstein, ‘Conscription in the Great War.’ 68 See Robin, ‘Registration, Conscription, and Independent Labour Politics’; and W.R. Young, ‘Conscription, Rural De-Population, and the Farmers of Ontario, 1917–19,’ Canadian Historical Review 53, no. 3 (September 1972): 289–320. 69 Nicholson, Canadian Expeditionary Force, 321–2. 70 See, for example, Brigadier-General J.F. Landry, ‘Confidential Operations Orders,’ 13 and 14 September 1918, file 4170, vol. 4518, RG 24, LAC. 71 Canadian Military Police, Civil Section, MD 5, 31 September 1918, file C170, vol. 4518, RG 24, LAC. 72 See various reports in file C170, vol. 4518, RG 24, LAC. 73 Telegram 110 from General Service Officer (unspecified) to Colonel J.A. Beaubien, n.d., file 4170, vol. 4518, RG 24, LAC.

Notes to pages 143–8

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74 See ‘Reports on activities of Troops of Quebec Special Service Detachment Number 1,’ 15, 17–18, 24, and 26 October 1918, file 4170-2, vol. 4518, RG 24, LAC. 75 See various ‘Reports on activities of Troops of Quebec Special Service Detachment Number 1,’ 1 October–13 November 1918, file 4170-2, vol. 4518, RG 24, LAC. 76 ‘Prudence militaire,’ La Patrie, 10 Octobre 1918, 4. On the earlier closure of public spaces see ‘Public Places Closed by City Health Board,’ Montreal Gazette, 8 October 1918, 1. 77 ‘Les policiers militaires vont chômer,’ La Patrie, 11 Octobre 1918, 3. 78 ‘Les appels suspendus,’ Le Devoir, 5 Novembre 1918, 1. 79 ‘En guerre ouverte contre l’épidémie,’ Le Devoir, 11 Octobre 1918, 2. 80 ‘Wants Recruiting Stopped Pro Tem,’ Montreal Gazette, 17 October 1918, 3. 81 Richard Ouellet, ed., Les débats de l’Assemblée législative (reconstituée), 14e législature, 2e session (Québec: Assemblée national du Québec), 154–63. 82 Deputy Minister of Militia and Defence to Deputy Minister of Department of Justice, 31 October 1918, file 2362-1918, vol. 1939, RG 13, LAC. 83 Deputy Minister of Justice to Deputy Minister of Militia and Defence, 5 November 1918, file 2362-1918, vol. 1939, RG 13, LAC. 84 ‘Wants Recruiting Stopped Pro Tem,’ Montreal Gazette, 17 October 1918, 3. See also, for example, ‘Les appels suspendus,’ Le Devoir, 5 Novembre 1918, 1. 85 Captain, MSA, DO, MD No. 4, to Registrar D, MSA, Montreal, 4 October 1918, file MD4-60-1-1, vol. 4498, RG 24, LAC. 86 Lieut. Colonel Commanding 2nd/2nd Que. Regt. To A.A.G., MD 4, 8 October 1918, file MD4-60-1-1, vol. 4498, RG 24, LAC. 87 War Diary, 4th Battalion, Canadian Garrison Regiment, October 1918, file 976 part 1, vol. 5061, RG 9, LAC. 88 Memorandum by Assistant Provost Marshal, MD 4, 11 October 1918, file MD4-60-1-1, vol 4498, RG 24, LAC. 89 War Diary, 4th Battalion, Canadian Garrison Regiment, 20 October 1918, file 976 part 1, vol. 5061, RG 9, LAC. 90 ‘Telegram 15307, Reference Influenza Epidemic from Adjutant General,’ 21 October 1918, file MD4-60-1-1, vol. 4498, RG 24, LAC. 91 Ibid. 92 Captain, MSA, DO, MD 4 (Headquarters) to Registrar ‘D,’ Military Service Act, Montreal, 25 October 1918, file MD4-60-1-1, vol. 4498, RG 24, LAC. 93 On the attitudes of English-speaking Canadians to the war, see Bray, ‘Fighting as an Ally.’ A good community comparison of small towns in Ontario, Quebec, and Alberta is found in Rutherdale, Hometown Horizons, 154–91. 94 ‘Fighting Flu With The Censorship,’ Edmonton Bulletin, 31 October 1918, 7.

254

Notes to pages 149–50

9. ‘The Nation’s Duty’ 1 ‘Nationalizing the Medical Profession,’ Alberta Non-Partisan, 20 November 1918, 5–6. 2 For another interpretation of the formation of the federal Department of Health, see Dickin McGinnis, ‘From Health to Welfare,’ 8–30. 3 Dorothy Porter, Health, Civilization, and the State: A History of Public Health from Ancient to Modern Times (London: Routledge, 1999), 196. 4 Ibid., 198; E.P. Hennock, The Origin of the Welfare State in England and Germany, 1850–1914 (Cambridge: Cambridge University Press, 2007), 151–65. See also Manfred Berg and Geoffrey Cocks, eds., Medicine and Modernity: Public Health and Medical Care in Nineteenth- and Twentieth-Century Germany (New York: Cambridge University Press, 1997); Larry Frohman, Poor Relief and Welfare in Germany from the Reformation to World War I (Stony Brook: State University of New York, 2008); Arleen Marcia Tuchman, Science, Medicine, and the State in Germany: The Case of Baden, 1815–1871 (New York and Oxford: Oxford University Press, 1993); and Paul Weindling, Health, Race, and German Politics between National Unification and Nazism, 1870–1945 (Cambridge: Cambridge University Press, 1993). A good brief overview of developments in Germany is Paul Weindling, ‘Public Health in Germany,’ in Dorothy Porter, The History og Public Health and the Modern State (Amsterdam: Rodopi, 1994), 119–31. 5 Porter, Health, Civilization, and the State, 198. 6 Ibid., 201–4. See also Martha L. Hildreth, Doctors, Bureaucrats, and the Public Health Service in France, 1888–1902 (New York: Garland, 1987). An earlier study is Anne Elizabeth La Berge, Mission and Method: The Early NineteenthCentury French Public Health Movement (Cambridge: Cambridge University Press, 1992). Good overviews are provided by Matthew Ramsey, ‘Public Health in France,’ in The History of Public Health and the Modern State, ed. Dorothy Porter (Atlanta: Editions Rodopi B.V., 1994), 45–118; and by Karin Johannisson, ‘The People’s Health: Public Health Policies in Sweden,’ in the same, 165–82. 7 Porter, Health, Civilization, and the State, 206–8; Jeanne L. Brand, Doctors and the State: The British Medical Profession and Government Action in Public Health, 1870–1912 (Baltimore: Johns Hopkins University Press, 1965); Derek Fraser, The Evolution of the British Welfare State: The History of Social Policy Since the Industrial Revolution (London: Macmillan, 1973); W.M. Frazer, A History of English Public Health, 1834–1939 (London: Baillière, Tindall, and Cox, 1950); Helen Jones, Health and Society in Twentieth-Century Britain (New York: Longman, 1994); R. Lambert, Sir John Simon, 1816–1904 and English Social

Notes to pages 150–1

8

9 10 11

12

13 14 15 16 17 18 19 20

21

22 23

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Administration (London: MacGibbon and Kee, 1963); F.B. Smith, The People’s Health, 1830–1910 (London: Croom Helm, 1979); Anthony S. Wohl, Endangered Lives: Public Health in Victorian Britain (London: J.M. Dent, 1983); Simon Szreter, ‘The GRO and the Public Health Movement in Britain, 1837–1914,’ Social History of Medicine 4 (1991): 435–63. A comparative study is J. Rodgers Hollingsworth, Jerald Hage, and Robert Hanneman, State Intervention in Medical Care: Consequences for Britain, France, Sweden, and the United States, 1890–1970 (Ithaca: Cornell University Press, 1990). See Dennis Guest, The Emergence of Social Security in Canada (Vancouver: UBC Press, 1980), 9–17. Porter, Health, Civilization, and the State, 205. See also Guest, 41. Ibid. See also Richard A. Soloway, Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth-Century Britain (Chapel Hill: University of North Carolina Press, 1990), 1–37. See also Ian R. Dowbiggin, Keeping America Sane: Psychiatry and Eugenics in the United States and Canada, 1880–1940 (Ithaca: Cornell University Press, 1997), esp. ch. 3. For the larger context, see Angus McLaren, Our Own Master Race: Eugenics in Canada, 1885–1945 (Toronto: McClelland and Stewart, 1990). Soloway, Demography and Degeneration, 41–3. Porter, Health, Civilization, and the State, 176. Soloway, 41. Ibid, 38–59. Ibid. See also Porter, Health, Civilization, and the State, 168–82. Porter, Health, Civilization, and the State, 182–6. Ibid.; and Soloway, Demography and Degeneration, 38–59. Porter, Health, Civilization, and the State, 159–62. See also Nancy Tomes, The Gospel of Germs: Men, Women, and the Microbe in American Life (Cambridge, MA: Harvard University Press, 1998), 91–112. On the Progressive movement in the United States, see the following overviews: Steven J. Diner, A Very Different Age: Americans of the Progressive Era (New York: Hill and Wang, 1998); and John Whiteclay Chambers II, The Tyranny of Change: Americans in the Progressive Era, 1890–1920, 2nd ed. (New York: St Martin’s Press, 1992). See also Porter, Health, Civilization, and the State, 156. Ibid., 159–62. Margaret Humphreys, Yellow Fever and the South (Baltimore: Johns Hopkins University Press, 1992). An earlier study is John Duffy, The Sword of Pestilence: The New Orleans Yellow Fever Epidemic of 1853 (Baton Rouge: Louisiana State University Press, 1966).

256

Notes to pages 152–3

24 Porter, Health, Civilization, and the State, 165. See also John Duffy, The Sanitarians: A History of American Public Health (Champaign: University of Illinois Press, 1990). 25 Porter, Health, Civilization, and the State, 159. Of course the United States did not adopt public health insurance. See Ronald Numbers, Almost Persuaded: American Physicians and Compulsory Health Insurance, 1912–1920 (Baltimore: Johns Hopkins University Press, 1978). On the development of public health in the United States, see also David Cutler and Grant Miller, ‘The Role of Public Health Improvements in Health Advances: The TwentiethCentury United States,’ Demography 42 (2005): 1–22; Rosemary A. Stevens, Charles E. Rosenberg, and Lawton R. Burns, eds., History and Health Policy in the United States: Putting the Past Back In (New Brunswick: Rutgers University Press, 2006); and John W. Ward and Christian Warren. Silent Victories: The History and Practice of Public Health in Twentieth-Century America (Oxford and New York: Oxford University Press, 2007). 26 For a comparison between developments in Great Britain and the United States, see Jeffrey L. Berlant, Profession and Monopoly: A Study of Medicine in the United States and Great Britain (Berkeley: University of California Press, 1975); Daniel M. Fox, Health Policies, Health Politics: British and American Experience, 1911–1965 (Princeton: Princeton University Press, 1986); and J. Rodgers Hollingsworth, A Political Economy of Medicine: Great Britain and the United States (Baltimore: Johns Hopkins University Press, 1986). 27 P.H. Bryce, ‘Maintenance of Public Health and Its Improvement,’ Canadian Journal of Public Health 1, no. 10 (October 1910): 475. 28 Ibid., 475–7. 29 Editorial, “A Federal Department,” Canadian Public Health Journal 9, no. 2 (February 1918): 92. 30 See Veronica Strong-Boag, The Parliament of Women: The National Council of Women of Canada, 1893–1920 (Ottawa: National Museums of Canada, 1976); N.E.S. Griffiths, The Splendid Vision: Centennial History of the National Council of Women of Canada, 1893–1993 (Ottawa: Carleton University Press, 1993); and Rosa L. Shaw, Proud Heritage: A History of the National Council of Women of Canada (Toronto: Ryerson Press, 1957). See also Nancy Christie and Michael Gavreau, A Full-Orbed Christianity: The Protestant Churches and Social Welfare in Canada (Montreal and Kingston: McGill–Queen’s University Press, 1996), 116–17. 31 National Council of Women to Robert Laird Borden, undated 1912, BP, reel C-4423, p. 144595. On the original drafting of the motion, see Local Council of Women of Toronto, Twentieth Annual Report, 1913 (Toronto: Bryant Press, 1913), 26.

Notes to pages 153–5

257

32 See various documents in ‘Health and Welfare Correspondence, 1895– 1916,’ Fonds of the National Council of Women, file 1, vol. 67, MG 28I25, LAC. On her fears of VD, see Dickin McGinnis, ‘From Health to Welfare,’ 9. 33 Ibid. See also various documents in ‘Public Health, National Council of Women’s Committee: Correspondence, 1917–18,’ file 9, vol. 67, MG 28I25, LAC. 34 Margaret Patterson to the Montreal Local, Canadian Council of Women, 1 March 1918, file 31, vol. 151, MG28I25, LAC. On Margaret Patterson, see Dorothy E. Chunn, “Maternal Feminism, Legal Professionalism, and Political Pragmatism: The Rise and Fall of Magistrate Margaret Patterson, 1922–1934,” in Canadian Perspectives on Law and Society: Essays in Legal History, ed. W. Wesley Pue and J.B. Wright (Ottawa: Carleton University Press, 1988); and Lorraine Gordon, ‘Doctor Margaret Norris Patterson: First Woman Police Magistrate in Eastern Canada, Toronto, January 1922– November 1934,’ Atlantis 10, no. 1 (Fall 1984): 95–109. On reformers and the VD problem, see Dickin McGinnis, ‘From Health to Welfare,’ 9–11. 35 In 1907, Borden had campaigned on a platform that promised to minimize federal–provincial jurisdictional and administrative conflicts. Robert Craig Brown, Robert Laird Borden: A Biography, vol. I (Toronto: Macmillan, 1975), xx. 36 Editorial, ‘On Leaving It to the Government,’ Canadian Public Health Journal 9, no. 6 (June 1918): 293. 37 Ibid. See also Jay Cassel, ‘Public Health in Canada,’ in The History of Public Health and the Modern State, ed. Dorothy Porter (Atlanta: Editions Rodopi, 1994), 276–312; and Christopher Rutty and Sue C. Sullivan, This Is Public Health: A Canadian History (Ottawa: Canadian Public Health Association, 2010). 38 Editorial, The Colonist (Victoria), 21 June 1918. 39 Dickin McGinnis, ‘From Health to Welfare,’ 1–12. 40 J.L. Biggar, ‘State Medicine and Rehabilitation,’ Canadian Medical Association Journal 9, no. 11 (November 1919): 1013. 41 Dickin McGinnis, ‘From Health to Welfare,’ 8. 42 G.W.L. Nicholson, Canadian Expeditionary Force, 1914–1919 (Ottawa: Queen’s Printer, 1964), Appendix C, table 4. 43 Jay Cassel, ‘Making Canada Safe for Sex: Government Measures to Control Sexually Transmitted Diseases in the Twentieth Century,’ in Canadian Medicine and the State: A Century of Evolution, ed. David C. Naylor (Kingston and Montreal: McGill–Queen’s University Press, 1992), 141–92 at 147. See also Cassel, The Secret Plague: Venereal Disease in Canada, 1838–1939 (Toronto: University of Toronto Press, 1987), 122–44; and MacPhail, Medical Services, 293.

258

Notes to pages 155–6

44 Cassel, The Secret Plague, 162–3. 45 Ibid., 163. 46 Suzann Buckley and Janice P. Dickin McGinnis, ‘Venereal Disease and Public Health Reform in Canada,’ Canadian Historical Review 63, no. 3 (1982): 344. 47 Heather MacDougall, ‘Sexually Transmitted Diseases in Canada, 1800– 1992,’ Genitourinary Medicine 70 (1994): 58. On VD and sexual health in Canada before the Great War, see also Mary Louise Adams, ‘In Sickness and in Health: State Information, Moral Regulation, and Early VD Initiatives in Ontario,’ Journal of Canadian Studies 28, no. 4 (Winter 1993): 117–31; Jay Cassel, ‘Private Acts and Public Actions: The Canadian Response to the Problem of Sexually Transmitted Disease in the Twentieth Century,’ Transactions of the Royal Society of Canada 4 (1989): 305–28; J. Fingard, The Dark Side of Life in Victorian Halifax (Porter’s Lake: Pottersfield Press, 1991); Angus McLaren and Arlene T. McLaren, The Bedroom and the State: The Changing Practices and Politics of Contraception and Birth Control in Canada, 1880–1980 (Toronto: McClelland and Stewart, 1986); and Wendy Mitchinson, The Nature of Their Bodies: Women and Their Doctors in Victorian Canada (Toronto: University of Toronto Press, 1991). See also Joan Sangster, Regulating Girls and Women: Sexuality, Family, and the Law in Ontario, 1920–1960 (Toronto: Oxford University Press, 2001). 48 See Sharon Anne Cook, ‘Through Sunshine and Shadow’: The Woman’s Christian Temperance Union, Evangelicalism, and Reform in Ontario, 1874–1930 (Montreal and Kingston: McGill–Queen’s University Press, 1995); and several other articles by the same author, including ‘“Sowing Seed for the Master”: The Ontario WCTU and Evangelical Feminism, 1874–1930,’ Journal of Canadian Studies 30, no. 3 (Fall 1995): 175–95. See also Dianne Dodd, ‘Advice to Parents: The Blue Books, Helen MacMurchy, MD, and the Federal Department of Health, 1920–34,’ Canadian Bulletin of Medical History 8, no. 2 (1991): 203–30; Linda Kealey, ed., A Not Unreasonable Claim: Women and Reform in Canada, 1880s–1920s (Toronto: Women’s Press, 1979); Wendy Mitchinson, ‘The Women’s Christian Temperance Union: A Study in Organization,’ International Journal of Women’s Studies 4, no. 2 (1981): 143–56; Christabelle Sethna, ‘Men, Sex, and Education: The Ontario Women’s Temperance Union and Children’s Sex Education, 1900–20,’ Ontario History 88, no. 3 (September 1986): 185–206; Nancy M. Sheehan, ‘The WCTU on the Prairies, 1886–1930: An Alberta–Saskatchewan Comparison,’ Prairie Forum 6, no. 1 (April 1981): 17–33; Veronica StrongBoag, ‘Ever a Crusader: Nellie McClung, First-Wave Feminist,’ in Rethinking Canada: The Promise of Women’s History, ed. Veronica Strong-Boag and Anita Clair Fellman (Toronto: Copp Clark Pitman, 1986); Shauna Wilton,

Notes to pages 156–8

49

50

51 52 53

54 55 56

57

58 59 60 61

259

‘Manitoba Women Nurturing the Nation: The Manitoba IODE and Maternal Nationalism, 1913–1920,’ Journal of Canadian Studies 35, no. 2 (Summer 2000): 149–66; Joanne Elizabeth Veer, ‘Feminist Forebears: The Woman’s Christian Temperance Union in Canada’s Maritime Provinces, 1875–1900,’ PhD diss., University of New Brunswick, 1996; and Jill Vickers, ‘Feminisms and Nationalism in English Canada,’ Journal of Canadian Studies 35, no. 2 (Summer 2000): 128–49. On suffrage, the 1917 election, and the Borden government, see Carol Lee Bacchi, Liberation Deferred? The Ideas of the English-Canadian Suffragists, 1877–1918 (Toronto: University of Toronto Press, 1983); Tarah Brookfield, ‘Divided by the Ballot Box: The Montreal Council of Women and the 1917 Election,’ Canadian Historical Review 89, no. 4 (December 2008): 473–501; Larry A. Glassford, ‘“The Presence of So Many Ladies”: A Study of the Conservative Party’s Response to Female Suffrage in Canada, 1918–1939,’ Atlantis 22, no. 1 (1997): 19–30; Gloria Geller, ‘The War-Time Elections Act of 1917 and the Canadian Women’s Movement,’ Atlantis 2, no. 1 (1976): 88–106; and Linda Kealey, ‘Canadian Socialism and the Woman Question, 1900–1914,’ Labour 13 (Spring 1984): 77–100. See M. Valverde, The Age of Light, Soap, and Water: Moral Reform in English Canada, 1885–1925 (Toronto: McClelland and Stewart, 1991), 17–18; See also Craig Heron, Booze!: A Distilled History (Toronto: Between the Lines, 2003), 204–5. See Cook, ‘“Through Sunshine and Shadow,”’ 74–113. Heron, Booze!, 204. Report of the Women’s War Conference held at the Invitation of the War Committee of the Cabinet, February 28–March 2, 1918 (Ottawa: King’s Printer, 1918), 3 (hereafter Women’s War Conference Report). Ibid. See the sources in notes 47 and 48. Women’s War Conference Report, 12. For example, see National Council of Women to Robert Laird Borden, undated 1912, BP, reel C-4423, p. 144595. On the origins of the motion, see Local Council of Women of Toronto, Twentieth Annual Report, 1913 (Toronto: Bryant Press, 1913), 26. Desmond Morton, ‘Supporting Soldiers’ Families,’ in Canada and the First World War: Essays in Honour of Robert Craig Brown, ed. David MacKenzie (Toronto: University of Toronto Press, 2005), 205–6. Women’s War Conference Report, 19. Ibid. Ibid., 32. Ibid., 33.

260 62 63 64 65

66 67 68 69 70 71 72 73 74 75 76 77 78 79

80 81 82

83 84 85

Notes to pages 158–63

Ibid. Ibid., 34. Editorial, Manitoba Free Press, 27 May 1918. Editorial, The Herald [Hamilton], 8 June 1918 quoted in ‘The Report to the Vice-Chairman of the War Committee,’ file 10-3-1, vol. 2, vol. 19, RG 29, LAC, 4. Rowell to Borden, 24 April 1918, Rowell Papers, reel C-932, 2588. ‘Six Things Necessary for the Formation of a Federal Department of Health,’ in ibid., 2585. Rowell to Borden, 24 April 1918, Rowell Papers, reel C-932, 2588; Dickin McGinnis, ‘From Health to Welfare,’ 14–15. On Newton Rowell see Margaret Prang, N.W. Rowell: Ontario Nationalist (Toronto: University of Toronto Press, 1975). Ibid., 208. On Arthur Meighen, see Roger Graham, Arthur Meighen: A Biography, 3 vols. (Toronto: Clarke, Irwin, 1960–65). Prang, N.W. Rowell, 270–5. For example, see ‘Liberalism and Social Reform’ and ‘Obligations of Citizenship,’ Rowell Papers, reel C-939, 9373-9387 and 9468. See chapter 3. Vincent Massey to Rowell, 26 June 1918, 2743, and Rowell to Borden, 2 September 1918, 2873–4, Rowell Papers, C-932. ‘Responsibility for the Pandemic,’ Manitoba Free Press, 30 October 1918, 11. ‘Union Government and the Flu,’ Edmonton Bulletin, 25 October 1918, 7. ‘Why the Epidemic?’ Edmonton Bulletin, 17 October 1918, 7. ‘En temps d’epidémie,’ Le Devoir, 17 Octobre 1918, 2. The unanimity of newspaper sentiment was acknowledged in a Cabinet report. See ‘The Report to the Vice-Chairman of the War Committee,’ file 10-3-1, vol. 2, vol. 19, RG 29, LAC, 3–5. See Jeffrey Keshen, Propaganda and Censorship during Canada’s Great War (Edmonton: University of Alberta Press, 1996), 73–95. Ibid., 77. A survey of more than two dozen Canadian newspapers – many of which were Conservative organs – from across the country did not turn up any editorials in favour of the government’s handling of the flu. While some may undoubtedly exist, it is safe to say that these would represent the minority view. G.P. England to Editor, Montreal Star, 22 October 1918, 10. J. Arthur McBride, President of the Baby Welfare Committee, to Editor, Montreal Star, 22 October 1918, 10. ‘Spanish Influenza,’ Edmonton Bulletin, 23 October 1918.

Notes to pages 164–9

261

86 ‘What Reconstruction Means,’ Alberta Non-Partisan, 4 December 1918, 3. 87 Esyllt Jones, Influenza 1918: Disease, Death, and Struggle in Winnipeg (Toronto: University of Toronto Press, 2007), 109–16. 88 ‘Alberta Convention of Labour,’ Alberta Non-Partisan, 15 January 1919, 4. 89 Dennis Guest, The Emergence of Social Security in Canada (Vancouver: UBC Press, 1985), 1–4. 90 Stephen Leacock, ‘The Unsolved Riddle of Social Justice,’ in The Social Criticism of Stephen Leacock, ed. Alan Bowker (Toronto: University of Toronto Press, 1973), 135. 91 Historians disagree on the meaning of King’s ideas. See Reginald Whitaker, ‘The Liberal Corporatist Ideas of Mackenzie King,’ Labour / Le Travail 2 (1977): 137–69. 92 King, Industry and Humanity, 304. 93 Diary of William Lyon Mackenzie King, 13 October 1918, MG26-J13, 286–7. 94 ‘M. Borden en vacances,’ Le Devoir, 20 Septembre 1918, 1. See Diaries of Robert Laird Borden, 22 September 1918, MG 26 H, reel C-1864, LAC (hereafter Borden Diaries). 95 ‘La Cabinet se Réunira,’ Le Devoir, 19 Octobre 1918, 1. See also Sir Robert Borden to Sir George Perley, 18 October 1918, Perley Papers, file 4, vol. 2, MG 27IID12, LAC. 96 Women’s War Conference Report, 32–3; Dickin McGinnis, ‘From Health to Welfare,’ 18. 97 ‘The Report to the Vice-Chairman of the War Committee,’ File 10-3-1, vol. 2, vol. 19, RG 29, LAC. 98 Ibid., 12–14. 99 Ibid., 29; Dickin McGinnis, ‘From Health to Welfare,’ 19. 100 Ibid., 1. 101 Ibid., 11. 102 Ibid., 12. 103 Ibid., 12. 104 Ibid., 14. 105 Ibid. See also Dickin McGinnis, From Health to Welfare, 21–2. 106 Ibid. 107 Dickin McGinnis, ‘From Health to Welfare,’ 21–2. 108 Borden Diaries, 2 November 1918, reel C-1864. 109 ‘To Organize Dept. of Public Health,’ The Globe, 25 October 1918, 2; ‘Un bureau d’hygiène fédéral,’ La Patrie, 25 Octobre 1918, 4. 110 The Canadian Parliament buildings had burned down in 1916.

262

Notes to pages 169–75

111 Government of Canada, ‘Proceedings of the Conference between the Government of Canada and the Provincial Governments at Ottawa, November 1918,’ Third Session, 18 November 1918, Papers of Sir Edward Kemp, vol. 136, MG 27IID9, LAC, 5. 10. ‘Success Is Somewhere around the Corner’ 1 ‘Mr. Rowell’s Address at the Centenary Service in Metropolitan Methodist Church, Toronto, to Commemorate 100 Years of Methodism in Toronto,’ 24 November 1918, Rowell Papers, C-939, 10236–7. 2 Ibid. 3 The most detailed examination of the third wave in Canada is a case study of Hamilton, Ontario. See D. Ann Herring and Sally Carraher, eds., Recurrence and Resilience: The Third Wave of the 1918-19 Influenza Pandemic in Hamilton (Hamilton: McMaster University, Department of Anthropology, 2010), http://digitalcommons.mcmaster.ca/anthro_coll/3, accessed 23 November 2011. 4 See, for example, ‘Keep Disease from Spreading,’ The Globe, 1 January 1919, 2. As flu deaths declined, so too did media interest in the disease. 5 For example, heat waves often cause mortality displacement. See S. Haja et al., ‘Mortality Displacement of Heat-Related Deaths: A Comparison of Delhi, São Paulo, and London,’ Epidemiology 16, no. 5 (September 2005): 613–20. 6 ‘Stanley Cup Series is Off,’ The Globe, 2 April 1919, 11. 7 ‘Joe Hall Dies in Seattle,’ The Globe 7 April 1919, 12. 8 HC Debates (26 March 1919), 843. 9 ‘The Report to the Vice-Chairman of the War Committee,’ 15. 10 Bill 27, ‘An Act Respecting the Department of Health,’ 2nd Session, 13th Parliament, 9–10 George V, 1919. 11 Ibid. See also ‘Unites Rouge with Orange,’ The Globe, 27 March 1919, 1, 5; and Dickin McGinnis, ‘From Health to Welfare,’ 23–4. 12 HC Debates (4 April 1919); for a different interpretation of the debate, see Dickin McGinnis, ‘From Health to Welfare,’ 31–3. 13 See Jonathan F. Vance, Death So Noble: Memory, Meaning, and the First World War (Vancouver: UBC Press, 1997), 37–42. See also the sources cited throughout chapter 9. 14 P.H. Bryce, ‘The Scope of a Federal Department of Health,’ Canadian Medical Association Journal 10, no. 1 (January 1920): 1–2. This paper was presented at a medical conference while the debate on the creation of the Federal Department of Health was still under way.

Notes to pages 176–80

263

15 HC Debates (27 February 1919), 82–3. 16 Ibid. (7 March 1919), 301. 17 HC Debates (28 February 1919), 136; see also ‘Kennedy, William Costello,’ in Dictionary of Canadian Biography, 1921–1930, ed. George W. Brown (Toronto: University of Toronto Press, 2005). 18 HC Debates (14 March 1919), 508–9. 19 Ibid. (15 February 1919), 25–6. 20 Minutes of the First Meeting of the Dominion Council of Health, Ottawa, 7 October 1919, reel C-9814, Dominion Council of Health Fonds, MG 28-I63, LAC. 21 Ibid. 22 Ibid. 23 Minutes of the Fourth Meeting of the Dominion Council of Health, 19–20 May 1920, 2, reel C-9814, ‘Dominion Council of Health Fonds,’ MG 28-I63, LAC. 24 ‘Communicable Diseases,’ in Minutes of the Fifth Meeting of the Dominion Council of Health, 19–21 October 1921. 25 ‘Control of Communicable Diseases,’ in Minutes of the Sixth Meeting of the Dominion Council of Health, 13–15 June 1922. 26 Janice P. Dickin McGinnis, ‘From Health to Welfare: Federal Government Policies regarding Standards of Public Health for Canadians, 1919–1945,’ PhD diss., University of Alberta, 1981, 40. 27 ‘Resolutions Passed,’ Minutes of the Fifth Meeting of the Dominion Council of Health, 19–21 October 1921, reel C-9814, Dominion Council of Health Fonds, MG 28-I63, LAC. 28 Ibid. 29 Dickin McGinnis, ‘From Health to Welfare,’ 41. 30 ‘Annual Report of the Department of Health,’ SP 12 (1920): 19. 31 ‘Annual Report of the Department of Health,’ SP 11 (1930): 128. 32 Ibid. 33 Dickin McGinnis, ‘From Health to Welfare,’ 52–4. 34 Ibid., 53–4 35 Ibid., 77. See also Nayan Shah, Contagious Divides: Epidemics and Race in San Francisco’s Chinatown (Berkeley: University of California Press, 2001). 36 Esyllt Jones, ‘“Co-operation in All Human Endeavour”: Quarantine and Immigrant Disease Vectors in the 1918–1919 Influenza Pandemic in Winnipeg,’ Canadian Bulletin of the History of Medicine 21, no. 1 (2005): 77–8. 37 Ibid., 77. 38 Dickin McGinnis, ‘From Health to Welfare,’ 54–6. 39 Citizenship and Immigration Canada, Facts and Figures: Immigration Overview (Ottawa: Government of Canada, 2002), 3.

264 40 41 42 43 44 45

46

47

48 49

50 51 52 53 54 55 56 57 58

Notes to pages 180–2

HC Debates (17 March 1933), 3121. Ibid. Dickin McGinnis, ‘From Health to Welfare,’ 40. Minutes of the 32nd Meeting of the Dominion Council of Health, 15 June 1936, reel C-9814, Dominion Council of Health Fonds, MG 28-I63, LAC. Ibid. For a good international overview of the topic of scientific motherhood, see Rima D. Apple, ‘Constructing Mothers: Scientific Motherhood in the Nineteenth and Twentieth Centuries,’ Social History of Medicine 8, no. 2 (1995): 161–78; and Apple, Perfect Motherhood: Science and Childrearing in America (New Brunswick: Rutgers University Press, 2006), 11–55. The Canadian literature is relatively large. See especially Katherine Arnup, Education for Motherhood: Advice for Mothers in Twentieth-Century Canada (Toronto: University of Toronto Press, 1994); Cynthia Commachio, ‘Nations Are Built of Babies’: Saving Ontario’s Mothers and Children, 1900–1940 (Montreal and Kingston: McGill–Queen’s University Press, 1993); Norah L. Lewis, ‘Creating the Little Machine: Child Rearing in British Columbia, 1919–1939,’ BC Studies 56 (winter 1982–3): 44–60; and Andrée Lévesque, Making and Breaking the Rules: Women in Quebec, 1919–1939 (Toronto: McClelland and Stewart, 1994). Dianne Dodd, ‘Advice to Parents: The Blue Books, Helen MacMurchy, MD, and the Federal Department of Health, 1920–34,’ Canadian Bulletin of Medical History 8, no. 2 (1991): 205–6. Ibid., 206. For the American context see R.D. Apple, Mothers and Medicine: A Social History of Infant Feeding, 1890–1950 (Madison: University of Wisconsin Press, 1987), esp. 11–55. Aleck Samuel Ostry, Nutrition Policy in Canada, 1870–1939 (Vancouver: UBC Press, 2006), 56. Dodd, ‘Advice to Parents,’ 206. For an overview of the Depression in Canada, see John Herd Thompson and Allen Seager, Canada, 1922–1939: Decades of Discord (Toronto: McClelland and Stewart, 1985), 193–221. Dodd, ‘Advice to Parents,’ 225. See also Dickin McGinnis, ‘From Health to Welfare,’ 122–5. Dickin McGinnis, ‘From Health to Welfare,’ 56–60. See also chapter 3 for a thorough overview ‘Annual Report of the Department of Health,’ SP 12, (1920): 10. Dickin McGinnis, ‘From Health to Welfare,’ 58. ‘Annual Report of the Department of Health,’ SP 12, (1920): 10. Ibid., 10–14; Dickin McGinnis, ‘From Health to Welfare,’ 59–60. ‘Annual Report of the Department of Health,’ SP 12, (1920): 14. Ostry, Nutrition Policy in Canada, 61–2. Ibid.

Notes to pages 182–86

265

59 Ibid. 60 Ibid., 62. 61 Dennis Guest, The Emergence of Social Security in Canada (Vancouver: University of British Columbia Press, 1985), 82. 62 ‘Annual Report of the Department of Health, 1924.’ Sessional Papers, 29. 63 Ibid. 64 ‘Annual Report of the Department of Health, 1920,’ SP 12 (1920): 22–4. 65 Jay Cassel, The Secret Plague: Venereal Disease in Canada, 1938–1939 (Toronto: University of Toronto Press, 1987), 169–70. 66 ‘Annual Report of the Department of Health, 1926,’ SP 12 (1920): 64–5; Dickin McGinnis, ‘From Health to Welfare,’ 87–104, for a detailed overview. 67 HC Debates, 18 May 1931, 1688. 68 Ibid., 1689. 69 Ibid., 1697. 70 HC Debates (12 February 1934), 501. 71 Ibid. 72 On the politics of the 1930s, see H. Blair Neatby, The Politics of Chaos: Canada in the Thirties (Toronto: Macmillan, 1972); and for federal finances see Robert B. Bryce, Maturing in Hard Times: Canada’s Department of Finance through the Great Depression (Toronto: Institute of Public Administration of Canada, 1986). For an overview, see Dickin McGinnis, ‘From Health to Welfare,’ chapters 5 and 6. 73 Dickin McGinnis, ‘From Health to Welfare,’ 310–11. 74 Jay Cassel, ‘Public Health in Canada,’ in The History of Public Health and the Modern State, ed. Dorothy Porter (Atlanta: Editions Rodopi, 1994), 290. 75 Ibid., 290. 76 Ibid. 77 On the development of public health insurance in Canada, see C. David Naylor, Private Practice, Public Payment: Canadian Medicine and the Politics of Health Insurance, 1911–1966 (Montreal and Kingston: McGill–Queen’s University Press, 1986). A good overview is Eugene Vayda and Raisa Deber, ‘The Canadian Health Care System: A Developmental Overview,’ in Canadian Healthcare and the State, ed. David Naylor (Montreal and Kingston: McGill– Queen’s University Press, 1992), 125–41. 78 Robert Bothwell and John English, ‘Pragmatic Physicians: Canadian Medicine and Health Care Insurance, 1910–1945,’ In Medicine in Canadian Society: Historical Perspectives, ed. S.E.D. Shortt (Montreal and Kingston: McGill–Queen’s University Press, 1981), 479. 79 Ibid., 481. 80 Ibid., 483–4. 81 Ibid., 483–4.

266 82 83 84 85

Notes to pages 186–95

See Dickin McGinnis, ‘From Health to Welfare,’ chapters 5 and 6. Bothwell and English, ‘Pragmatic Physicians,’ 486. Dickin McGinnis, From Health to Welfare, 310. Ibid., 312–14.

11. Conclusion 1 Montizambert to Calder, 31 March 1918, file 10-3-1, vol, 2, vol. 19, RG 29, LAC. See also Janice P. Dickin McGinnis, ‘From Health to Welfare: Federal Government Policies regarding Standards of Public Health for Canadians, 1919–1945,’ PhD diss., University of Alberta, 1981, 35; Geoffrey Bilson, ‘Dr Frederick Montizambert (1843–1929): Canada’s First Director General of Public Health,’ Medical History 29, no. 4 (October 1985): 399–400; and André Sévigny, ‘Frederick Montizambert,’ in Ramsay Cook and Réal Bélanger, Dictionary of Canadian Biography, vol. 15, 1921–1930 (Toronto: University of Toronto Press, 2005), http://www.biographi.ca, accessed 30 August 2010. 2 ‘Dr. Peter Henderson Bryce,’ Canadian Medical Association Journal 26, no. 3 (1932): 378–9; Dickin McGinnis, ‘From Health to Welfare,’ 35. 3 Bilson, ‘Dr Frederick Montizambert,’ 398–400; Dickin McGinnis, ‘From Health to Welfare,’ 35–6. 4 Bilson, 399; HC Debates (1921), 3134; Dickin McGinnis, ‘From Health to Welfare,’ 35. 5 Dickin McGinnis, ‘From Health to Welfare,’ 40.

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Index

2nd Quebec Regiment, 146 absentees, 143–5 An Act Respecting the Department of Health (Bill 27, 1919), 173ff Adulteration Act, 182 AIDS, 4 Alberta, 63, 101, 103–4, 121–8, 139–41, 161, 191; Aboriginal Peoples and flu (mortality), 127–8; influenza (1889–91), 63–4; influenza (fall 1918), 103, 106, 112, 121–8, 139–41; influenza (winter 1919), 173; labour press, 141, 149, 163; Northwest Mounted Police in, 63–4; Siberian Expeditionary Force and, 103; strikes, 101, 164; wearing of masks, 112 Alberta Convention of Labour, 164 Alberta Non-Partisan, 141, 149, 163 alcohol, 35–6, 45, 121–2, 151, 156. See also prohibition; temperance Aldershot barracks, 69–70 Amyot, J.A., 78, 182, 193 Anderson, Kay J., 47 Andrews, Margaret, 112 anti-vaccination movement, 44–5

Araguayan (ship), 72, 80–2, 84, 90, 95 Armistice, 94, 100, 140, 143, 171 Atkinson, Login, 20 Austin, Hattie, 153 Avery, Donald, 53, 102 Baby Welfare Committee of Montreal, 163 Bagotville, 143 Bailie, Janice, 71–2 Barry, John, 71 Bell, Dr Gordon, 119–20, 177 Belleville, 11 Bennett, R.B., 185–6 Bergin, Dr Darby, 41–2 Beveridge, W.I.B., 4 Biggar, Lieutenant-Colonel J.L., 155 Bilson, Geoffrey, 26 Black Death, 13, 15, 62, 72 Board of Pension Commissioners, 155–6 Bolsheviks, 101, 137 Borden, Sir Robert, 9, 56, 78, 101, 132, 137, 141, 147, 153–4, 157, 160–1, 165, 168, 170, 192, 194; 1917 Election, 132–3, 147, 156;

308

Index

Chinese Labour Corps and, 78; conscription and, 132; creation of federal department of health, 168–70, 192; direction of war, 9; farmers and, 136–7, 141–3; female voters, 157–61; imperial aspirations of, 78, 100–2, 132; influenza (fall 1918), 165–8; labour, 137; Military Service Act, 132; Montizambert, Frederick, 194; Oliver, Frank and, 141–2; pledge of 500,000 men, 132; public health reformers and, 56–7, 153–61, 165–70, 192; Quebec and, 137; reconstruction and, 147; recruiting and, 132; Social Gospel and, 147; vacation habits of, 165–6. See also First World War, Canada; Union Government Bothwell, Robert, 186–7 Bourassa, Henri, 144–5, 162 Bradbury, Bettina, 34 Brest-Litovsk, Treaty of, 100 British Columbia, 6, 29–30, 38, 47–8, 55, 72–3, 90, 101, 106, 123, 128, 173; Aboriginal Peoples and flu (mortality), 6–7, 128–9; Chinese immigration, 29–31, 47–8; D’Arcy Island, 29–30; influenza (1889– 91), 63; influenza (fall 1918), 103, 106, 112–13, 123–4; influenza (spring 1918), 72–3, 78, 88–90; influenza (winter 1919), 173; laboratory, 181; leprosy in, 29–30; Military Service Act and, 155; nurses, 123–4; public health jurisdiction, 112–13; racism, 29–30, 47–8, 55; San Francisco Plague (1900), 55; Siberian Expeditionary Force, 102–4, 138–40, 191; strikes, 101;

vaccination, 121; Victoria Military Hospital (Victoria), 88; Victoria, request for quarantine, 112; vital statistics, 38; volunteerism, 123–4 British North America Act (1867), 26, 31, 38–9, 42, 158, 165, 177 Broad Street pump experiment, 21–2 Brouse, Dr William Henry, 33, 39–40 Brown, Clement E., 48 Bryce, Peter H., 48, 50–4, 152, 156, 169, 174–5, 192–3 Budd, William, 22 Burpee, Isaac, 29 Byerly, Carol, 77 Cadham, T.C., 119 Calder, J.A., 157–8, 160, 165, 168, 192–3, 194 Calgary, 63, 101, 103–4, 121, 141, 191 Calgary Isolation Hospital, 103 Camp Niagara, 138 Campbell, F.W., 51 Canada East. See Quebec Canada Food Board, 134 Canada Health Journal, 57–8 Canada Temperance Act (1879), 42–3 Canada West. See Ontario Canadian Army Medical Corps (CAMC), 102 Canadian Council of Child and Family Welfare, 179, 181 Canadian Expeditionary Force (CEF), 78–9, 94, 133, 155 Canadian Garrison Regiment, 146 Canadian Medical Association, 38–9, 47, 55, 92, 170, 186 Canadian Medical Association Journal, 92, 114, 122

Index Canadian National Committee for Mental Hygiene, 179 Canadian Northern Railway, 134 Canadian Pacific Railway, 43, 113 Canadian Public Health Act, 20 Canadian Public Health Association, 152–3 Canadian Women’s Suffrage Association, 157 Canniff, William, 39–40 Carling, John, 50 Cassel, Jay, 15, 155, 186 censorship, 69, 79, 139, 162 Central Board of Health (United Province of Canada), 38, 142–6, 155–6, 166 Chadwick, Edwin, 22–3, 37–8 Challenger (ship), 28 Chambord, 143 Chapin, Charles, 46 Chicoutimi, 143 Chief Press Censor, 139, 162 childhood, 151, 158, 181 Chinatowns, 29. See also immigration: Chinese, restrictions against Chinese Labour Corps, 71–2, 78 cholera, 7–8, 11, 14–21, 24–8, 31, 46–7, 49–52, 55, 57, 62–3, 65–7, 82, 89, 172, 176, 179, 189–90, 193; bacteriology, 14; Broad Street pump experiment, 21–2; descriptions of, 11; Great Britain and, 14, 21; London (England), 14–15, 21–2; medical views of, 14–15, 21–6; official response in Europe (1832), 14–15; origins of, 14–15; Paris, 14–15; quarantine, 13–16; Russia, 14, 49, 58, 62–3; Snow, John, 21–2, 24 cholera, Canada (1832–1892):

309

1837–8 Rebellions and, 19–20; epidemic (1832–4), 11, 14–20, 63, 172, 189; epidemic (1848–54), 20–4, 189; epidemic (1866), 24–8, 82, 189, 193; epidemic (1892), 49–52, 190; first appearance of, 17; immigrants and, 15–18, 24; Lake Champlain, riot at, 17; legislation, 18–20; Lower Canada, 15–16; medical views of, 14–15, 21–6; Memorandum on Cholera (1866), 24–7; mortality, 19, 25; Nova Scotia, 19; Parr Traill, Catharine, 16; politics, 20; public health officials, 19–21; public health strategies, 19–20; quarantine, 14–19; reformers and, 20, 25–7; sanitation and, 18–20; Susanna Moodie and, 11, 16; Tories, 20; United States, 17–18; Upper Canada, 11, 17, 27. See also public health, Canada Church, Tommy, 138–9, 164 Citizen’s Public Health Association (Montreal), 39–40 Civil Service Commission, 134 climate and disease, 14, 25, 32 climate and health in Canada, 11–12, 25, 32, 48–9, 65, 89 Collège Sacré-Coeur, 99 Commission of Conservation, 56–7 Committee for the Prevention of the Traffic in Women and Equal Moral Standard, 154 Confederation (1867), 26–9, 37, 42, 57, 82, 104, 190, 193, 195 Connaught Laboratory, 120, 193 Cook, George, 104 Coone, A.W., 125 Copp, Terry, 35

310

Index

Cory, W.W., 81–3 Crerar, Thomas, 157 Crosby, Alfred, 4–6, 68 Cuba, 151 D’Arcy Island, 29–30 degeneration, 49, 53, 133, 151, 156, 169, 174–5 Department of Agriculture, 24, 40–3, 50, 55–6, 81, 161–3, 166 Department of Health (Canada), 8–9, 149, 153, 156–8, 160–1, 163, 165, 169–70, 173, 176–7, 182, 184–9, 192, 194; activities of, 178ff, 186–7; Canadian Medical Association and, 56; Conditional Granting Programs, 185–7; co-operation with United States, 179–80; creation of, 8–9, 156–69, 173–89, 192; district health boards, proposal for, 184–5; Division of Child Welfare, 181; Dominion Council of Health, 174, 177–80, 187; early proposals for, 41–4; failure of, 187–8; Food and Drug Division, 181; General Project for Housing, 183; grants in aid, 186–7; Great Depression, 185–7; historians and, 187–8; housing, 182–3; immigrants and, 153–4, 170–2, 180–1, 188; Immigration Branch, 172; infant mortality, 181; influenza and, 163–76; laboratory, 181–2; medical profession and creation of, 55–6, 153, 173; municipal relations, 168, 176–8, 183, 190; pandemic planning, 177–9; politicians and, 53–5, 56, 176–7, 184–5; poverty and, 182, 185–7, 192; pub-

lic perceptions of, 152–4, 159–64, 170; quarantine branch, 179–80, 193; scientific motherhood, 181–2; social conditions and, 174–82, 192; social reformers and, 41–4, 156–63, 169–73; venereal disease and creation of, 155–7; Venereal Disease Branch, 183; women’s voluntary associations and creation of, 156–63, 169–73 Department of Indian Affairs, 54, 127–8 Department of the Interior, 55–6, 81–2, 107 Department of Soldiers Civil Reestablishment, 134 Derick, Carrie M., 160 deserters, 143, 146 Devoir, Le (Montreal), 144–5, 162 Dickin McGinnis, Janice, 5, 72, 77, 98, 187 disability insurance, 150 disease, war and, 68–9 disease, theories of: contagion, 13–5, 19, 24, 30, 45–7, 53, 170; germ theory, 34–6, 39, 45–6, 50–8, 63–6, 78, 122–5, 172, 177, 189, 193; humoral, 12, 24, 122; miasmatic, 12–15, 18–19, 22–4, 37, 45, 65–7, 194; zymotic, 24 diseases: anthrax, 46; diphtheria, 46, 179, 185; favus, 47; heart disease, 185; kidney disease, 185; leprosy, 29–30, 52, 57; plague, 8, 11–15, 47, 55, 62, 72, 96, 176, 179, 190; rabies, 46; scarlet fever, 179, 185; smallpox, 13, 14, 15, 44–7, 49, 51, 55, 57, 104, 179, 185, 190; typhus, 20, 22, 179; yellow fever, 15, 151, 179. See also cholera; influenza

Index disinfecting machines, 51–3 Dodd, Dianne, 181 Doherty, C.J., 157 Dominion Council of Health, 174, 177–80, 187 Dominion-Provincial Conference (1918), 168–9 Drayton, Henry, 134 Dugas, L.N., 128–9 Edmonton, 122–5, 139–41, 161, 163 Edmonton Bulletin, 123, 139–41, 161–2 Edmonton Relief Committee, 125 English, John, 186–7 epidemiology, 4–6, 21–2, 37, 57, 72, 104, 189 Étaples, 69 eugenics, 49, 53, 133, 151, 181 Fahrni, Magda, 6, 124 Fairbairn, Ida A., 169 Fairchild, Amy, 30, 180 Féderation Nationale St-Jean-Baptiste, 157 Fee, Elizabeth, 252 feeblemindedness, 110, 151, 154–5, 158, 174 field punishment ‘number two,’ 143 First World War, Canada: 1917 Election, 132–3, 147, 156; anticonscription movement, 137–8; Armistice, 94, 100, 140, 143, 171; censorship, 69, 79, 139, 162; Chief Press Censor, 139, 162; conscription and, 130–4; demobilization, 70–1, 95–6, 156; expansion of state, 133–6, 141–2, 145–6; immigration and, 78; labour and, 5, 9, 101–2, 132–43, 153, 163–7, 192;

311

Laurier, Sir Wilfrid and, 132–3, 142, 146; manpower and, 132–3; militarization of society, 133–5; military pensions, 134, 137, 155; Passchendaele, 94; poison gas, 70, 94; Polish Army and, 95–6, 139; reconstruction, 9, 135–7, 158–67, 192; repression, by state, 102, 137–8; sacrifice, motif of, 9, 12, 132–41, 147, 159, 192; social reform and, 132–3; Somme, Battle of, 94; veterans of, 137; Vimy Ridge, 94; war aims, 132–3; war effort, 94ff, 131–5; Ypres, Second Battle of, 94 First World War, influenza and, 69–70 Food Production Board, 134 Foster, Sir George, 157 Francoeur Motion, 145–6 Frederickson, Christina, 123 Fredericton, 43 Fuel Controller, 134 Galton, Francis, 49, 150 Gauthier, Curé, 115 General Project for Housing, 183 German Spring Offensive (1918), 100 Gilbert, Pamela, 21 Globe (Toronto), 50, 139 Gossip, J.J., 27 Grand Trunk Railway, 134 Grosse Îsle, 16, 20, 24, 27–8, 52, 65, 80–3, 89, 120, 179–80, 191–4 Guelph, 43 Guest, Dennis, 183 Halifax, 3–6, 13, 16, 18, 19, 27, 78, 80, 82–5, 97–8, 102–4, 130–1, 173, 181, 191

312

Index

Hall, Joe, 173 Harding, G.D., 27 Harrison, Thomas W., 37 Hattie, W.H., 109, 177 Hawkins, A.C., 97–8 Hazen, J.D., 56 Heagerty, J.J., 89–90, 120, 180 health insurance, 150–3, 183, 186–8 Hebertville, 143 Hickie, R.E., 103 Hingston, Dr William, 45–6 Hodgins, Mr Justice, 156 Hôtel-Dieu (Quebec), 33, 126 Huestis, Florence C. 153 Hygiea (ship), 28 Iffland, Dr von, 24, 26, 28 immigration/immigrants, 8, 11–12, 15–35, 45–50, 53–5, 57, 66–7, 78, 81–4, 89, 98, 101, 107, 129, 131–2, 153–4, 161, 170, 172, 174, 179–80, 188–90, 193 immigration/immigrants, Canada: attitudes towards, 8, 30–1, 35, 47–50, 101, 107, 172, 180, 189; bodies, 30–1, 47–50, 66–7, 78–82, 98–101, 107, 172; Chinese, restrictions against, 29–31, 47–9, 55; cholera and, 16–18, 23, 30–1, 82; Department of Immigration and Colonization, 81–3, 161; Department of Interior, 53; governance of, 24, 30, 53–5, 81–3, 132, 161, 170, 180; Great Depression, 180; Irish, 16–7, 46; Jewish, 47; labour and, 34–5, 47–9; living conditions, 23; othering, 8, 30–1, 47–53; patterns, 24, 50, 78, 180; public health and, 8, 16–18, 23–4, 30–1, 35, 47–55, 57, 78–82, 101, 107,

161, 172, 180, 189; screening, 8, 30–1, 52–5, 78–82, 101, 107, 161, 172, 179. See also public health, Canada; federal Department of Health; influenza Imperial Munitions Board, 134 Imperial Order of the Daughters of the Empire (IODE), 157 In Times Like These (book), 125–6 income tax, introduction of, 134 India, 12, 14, 90 Industrial Disputes Act, 134 industrial schools, 128–9 industrialization, 18, 27, 34, 38, 49, 51, 133, 150–1, 156, 175 Industry and Humanity (book), 136, 164–5 influenza: 2009 pandemic, 62; antigenetic drift, 59; antigenetic shift, 61; avian (bird flu), 61–2, 70; Canadian historians and, 6–7; epidemic (defined), 61–2; H1N1, 60, 68; international historians and, 3–6; natural reservoir of, 61; pandemic (defined), 61–2; Pfeiffer’s Bacillus and, 65–9, 119; re-assortment, 61; viral shift, 61; virology, 5, 8, 58–62, 69–70. See also under influenza entries below; and public health, Canada influenza (1889–91 pandemic), Canada: Aboriginal Peoples and, 63–4; bacteriologists and, 65–7; Chinese origins of, 71; comparisons to 1918, 91–2; germ theory and, 65; medical views on, 57, 65–6; miasmatic theory and, 65; morbidity and mortality of, 63–4; Muscowpetung Agency and, 64; Northwest Mounted Police and,

Index 63; Pfeiffer’s Bacillus, discovery of, 65–9, 119; prior health problems, 64; quarantine and, 65–6; symptoms of, 63–4, 91–2; treatment of, 64; Walpole First Nation and, 63. See also public health, Canada influenza (1889–91 pandemic), international, 57–71, 91–2, 119; Africa, 62; Chinese origins, 71; comparisons to 1918, 91–2; Hong Kong, 62; London (England), 58, 62; New Zealand, 62; Paris, 62; St Petersburg, 57; Syria, 62 influenza (1918 pandemic): Africa, 4, 106; Aldershot barracks, 69–70; Armistice, 94, 100, 140, 143, 171; Brest, 94; China and, 71–2, 78; Commonwealth Pier, 94; cytokine storms, 92–3; Étaples, 69; Europe, 70–1; Great Britain, 80; Haskell, Kansas, 70–1; herald waves, 69–72; Hoboken, 96; London (England), 80; New York, 94; Newport News, 94; origins of, 68–72, 78; Paris Peace Conference and, 4; Philadelphia, 94, 103; Plymouth, 94; precursors to, 69–72; Sierra Leone, 94; Spain, 69, 79–80; United States, 71–2, 77–8. See also influenza; public health influenza (1918 pandemic), Canada, first wave: aetiology of, 69; American army, 77–8; appearance in Canada, 4–8, 68–78, 89–91; Araguayan (ship), 72, 80–2, 84, 90, 95; British Columbia, 72–4; Canadian Expeditionary Force and, 79–81; censorship and, 79–80; China and, 71–2, 78; civil-military co-operation, 79–81;

313

Esquimalt, 88–9; federal response, 68, 78–84, 89–91; Kapuskasing, 85; Kapuskasing Station Hospital, 85–6; Manitoba, 88–9; military and, 74, 78–84; Montizambert, Frederick and, 78–84, 90 (see also main entry); morbidity and mortality of, 72–8, 81–9; Nagoya (ship), 80–2; nativism, 89–90; newspapers and, 79–80; origins of, 68–72, 78; Ottawa, 74; quarantine and, 78–84; Quebec, 75–6, 82, 84; Quebec Military Hospital, 75–6; racism, 89–90; Saint John Military Hospital, 75–6; severity, 4, 68–9, 78–80, 89, 91–2; Somali (ship), 72, 80–2, 89; spread in Canada, 78; St Luke’s Base Hospital (Ottawa), 74–5; St-Jean Military Hospital (Quebec), 75–6; Toronto, 74; Toronto Base Hospital, 85–7; Tuxedo Park Hospital (Winnipeg), 88; Victoria Military Hospital (Esquimalt), 88–9; Winnipeg, 88. See also public health, Canada influenza (1918 pandemic), Canada, second wave: Aboriginal Peoples and, 6–7, 127–8; Alberta, 112–13, 121; appearance in Canada, 95; Armistice, 94, 100, 140, 143, 171; bans on public gatherings, 111–12, 115–19; Base Hospital, 85–7, 138– 40, 147, 192; British Columbia, 111–12, 116–17; Calgary, 112–13; Canadian Army Medical Corps (CAMC), 102; Catholic Church and, 99, 111–12; civil-military relations, 103ff; clergy, 111–12, 115–16; Collège Sacré-Coeur, 99; diffusion, 93–103; disaffection

314

Index

and, 134–47, 161–5; ethnicity and, 127–9; Eucharistic Congress, 99–100; federal response, 4, 68, 91, 93–108, 130–48; gender roles and, 123–5; immigrants and, 106–8, 129; industrial schools, 128–9; Jeffrey Hale Hospital, 92–3, 95–6; labour unrest and, 101–2; lay treatment, 121–3; living conditions and, 124–7; Lloydminster, 113; London (Ontario), 118; Manitoba, 119–21; masks, 112–13, 121; McCullough, John W., 116, 119–20; military and, 99–103, 119–21, 142ff; Military District 2 (Toronto), 138; Military District 4 (Montreal), 145–7; Military District 10 (Manitoba), 88, 119; Military Service Act and, 142–6, 162; Montizambert, Frederick, 98–104 (see also main entry); Montreal, 113–16; mortality, 92–3, 105–6, 114, 126–7, 129; Moxham-Ross Military Hospital, 97; municipal quarantines, 103–4, 112; municipal response, 111–29; New Brunswick, 11–12; newspapers’ coverage, 109, 161–5; Niagara-onthe-Lake, 95; non-pharmaceutical interventions, 103–4, 106, 116–18, 144, 191; North Battleford, 113; nurses, 123–4; Ocean Limited, 102–4; Ontario, 118–21, 138–9; origins, 93–4, 106, 191; plague, as, 149, 165, 176; pneumonia and, 92–4; Polish Army and, 95–6, 139; popular response, 120–3, 161–5; provincial responses, 111–29; public health literature, 118; Quebec, 95–9, 102, 105–10, 120, 128,

142ff, 192; religious services and, 11–12, 115–16, 118; residential schools, 128–9; Saskatchewan, 113; Serpent River First Nation, 128–9; Siberian Expeditionary Force and, 99–103; social reformers and, 125–6; Spanish River Industrial School, 128–9; Station Hospital (Halifax), 130–1; Sydney (Nova Scotia), 96–7, 102, 107; symptoms of, 3–5, 91–3, 95–6; Toronto, 138–40; treatments, 121–3; vaccination, 118–22; Victoriaville, 99, 106; Volunteer Aid Detachment (VAD) nurses, 123–4; volunteerism, 123–5; Wikwemikong, 128; Wilson, Major-General E.W. and, 96, 145–6; Windsor, 118; Winnipeg, 6, 88, 103–4, 116, 123, 126–7; working-class and, 124–7; w-shaped mortality, 4, 92. See also influenza; public health, Canada influenza (1918 pandemic), Canada, third wave: creation of federal department of health, 173ff; diffusion, 172; Hall, Joe, death of, 173; hockey, 172; Paris Peace Conference and, 4; Quebec, 173; severity, 4; Stanley Cup and, 172; Winnipeg General Strike and, 6. See also influenza; public health, Canada influenza (1976 ‘Swine Flu’), 4 institutional welfare, 187 International Sanitary Convention of Paris, 179 Irvine, William, 136, 141–2, 149 Irwin, Dr J.L., 62 Isitt, Benjamin, 101 Japan, 30, 102

Index Jeffrey Hale Hospital (Quebec City), 92–3, 95–6 Jenner, William, 22 Jones, Esyllt, 6–7, 116, 129, 180 Jones, Guy Carleton, 68, 80–2, 97–8 Kealey, Gregory, 102 Kelm, Mary-Ellen, 6 Kennedy, William C., 176 Keshen, Jeff, 79 Koch, Robert, 34, 45, 65–6 Koch’s Postulates, 65–6 Kraut, Alan M., 17, 30, 107, 129 Lachapelle, Emmanuel-Persillier, 33–4 Lake Champlain, 17 Lake Edward, 143 Landerkin, Dr George, 42 Langford, Christopher, 71–2 Laterriere, 143 Laurier, Sir Wilfrid, 53, 55–6, 132–3, 142, 176, 194 Leacock, Stephen, 164 Lenin, Vladimir Ilyich, 100 liquor. See alcohol liquor licenses, 42–3 Llandovery Castle, 95 Lloyd George, David, 150, 152, 186 Lloydminster, 113 London, England (mortality rates), 41, 43 Lower Canada. See Quebec Lux, Maureen, 113 Macdonald, Sir John A., 29, 39–42, 44, 49, 154, 192, 194 MacDougall, Heather, 23, 118 MacKay, N.E., 80, 89, 97–8 Mackenzie, Alexander, 39–40, 42

315

Mackenzie King, William Lyon, 136, 164–5, 186 Mahood, Cecil, 113 Mallon, Mary, 46–7 Manitoba, 6, 49, 53, 63, 88, 106, 116, 119–21, 127–8, 159, 181, 183, 191; Aboriginal Peoples and flu (mortality), 127–8; cholera, 49; housing program, 183; influenza (1889–91), 63; influenza (fall 1918), 103–4, 116, 191; influenza (spring 1918), 88, 106, 119–21, 127; influenza (winter 1919), 173; laboratories, 181; mortality, 126; newspapers, 159, 161; nurses, 123; poverty and flu in, 126; vaccine, influenza, 119–21 Maritime Medical News, 62, 63, 64–5, 66 Markel, Howard, 103 Martineau, George E., 80–3 Massey, Vincent, 161, 165–8, 173 maternal feminists, 153–62, 169–70, 181–3 Mawani, Renisa, 30 McClung, Nellie, 135–6 McCrae, Dr John, 48 McCullough, John W., 116, 119–20, 177 McGee, Thomas D’Arcy, 24 McKenzie, Daniel Duncan, 177 McNeil, William, 4 Meighen, Arthur, 160, 168 Memorandum on Cholera (1866), 24–7 Methodist Convention (1918), 171–2 Mewburn, S.G., 157, 168 Military District 2 (Toronto), 138 Military District 4 (Montreal), 145–7 Military District 10 (Manitoba), 88, 119

316

Index

military medical records, reliability of, 74 military pensions, 134, 137, 155 Military Service Act, 130–4, 142–8, 155–8; anti-conscription movement, 137–8; defaulters, 142–7; Easter riots (1918), 137–8; election of 1917 and, 132, 147, 156; enforcement of, 142–7; enlistments under, 134, 155; exemptions, 130, 142; influenza and, 143–8; labour and, 137–47; medically unfit, 155–6; need for, 132; opposition to (Quebec), 142–3; public health, 155–6; pursuit of defaulters, 142–8; Quebec politicians and, 145–8; special service detachments, 142–8 milk supply, 64, 121, 158, 182 Mill, John Stewart, 150 Milne, Dr J.W., 47 Montizambert, Dr Frederick, 27–8, 33, 51–3, 55, 65–6, 80–3, 90, 98, 104, 189–94; British Medical Association, 52; Director General of Public Health, as, 55, 78–84, 90, 98–104, 189; early career and education, 27–8; evaluation of, 28; failure in 1918, 189–91; family, 27–8, 33; federal Department of Health, formation of, 192–3; hired at Grosse Îsle, 28; influenza (1889–91) and, 65–6; influenza (fall 1918), 98–104; influenza (spring 1918), 80–4, 90; interpersonal skills, 81–3, 98–104; Laurier, Sir Wilfrid, and, 53, 194; Macdonald, Sir John A., and, 194; marriage to Walker, Mary Jane, 28; personality, 27–8, 80–3; provinces,

work with, 55; retirement of, 192–3; service in Fenian Raids, 28; technology, 51; vacation habits, 81–2; views on disease, 65, 82, 192–4; views on quarantine, 51–3, 65, 80–2, 90, 189–5 Montreal Canadiens (hockey team), 172–3 Montreal Medical Journal, 47, 62, 98 Montreal School of Medicine and Surgery, 33 Montreal smallpox epidemic (1885), 44–5 Montreal Star, 96, 99, 114, 122, 125, 162 Moodie, Susanna, 11, 16 Morris, R.J., 15 Morton, Desmond, 35 mothers’ allowances, 158 Mowat, Sir Oliver, 41 Moxham-Ross Military Hospital (Sydney, Nova Scotia), 97 Muscowpetung Agency, 64 Myers, Mrs Campbell, 153 Nagoya (ship), 80–2 National Equal Franchise League, 157 Nester (ship), 96–8 New Brunswick, 16, 18, 27, 29, 63, 75–6, 97–104, 121–2; Aboriginal Peoples and flu (mortality), 128; cholera, 16, 18; Department of Health, creation of, 110; First World War and, 75–6, 97–9; influenza (1889–91), 63; influenza (fall 1918), 97–104, 110–12; influenza (spring 1918), 75–6; influenza (winter 1919), 173; influenza, mortality, 75–6; military and, 75,

Index 97–9; public health legislation, 16, 18, 166; quarantine, 27; Saint John, 16, 18; Saint John Medical Society, 122; Siberian Expeditionary Force and, 97–104; Sussex Military Camp, 102 Newfoundland, 62 Niagara-on-the-Lake, 95 Nicholas II (Tsar of Russia), 100 non-pharmaceutical interventions, 103–4, 106, 116–18, 144, 191 North Battleford, 113 Nova Scotia, 3–6, 13, 18–19, 25, 27, 38, 63, 78, 80–5, 96–102, 104–6, 109–10, 128, 130–1, 166, 173, 181; Aboriginal Peoples and flu (mortality), 128; board of health, 109–10, 166; Chinese Labour Corps and, 78; cholera, 19, 25; First World War and, 78, 96, 99–102; influenza (1889–91), 63; influenza (fall 1918), 3–6, 96–9, 104–6, 109–10, 128, 130–1, 191; influenza (spring 1918), 80–5; influenza (winter 1919), 173; laboratories, 181; public health legislation, 13, 16, 18–19, 25, 27, 38, 166; Siberian Expeditionary Force and, 99–102; vital statistics, 38 Nuisance Removal Acts (England, 1846 and 1855), 36 nutrition, 34, 111, 125, 129, 151–2, 174, 181–2, 185 Ocean Limited (ship), 102–4 Oliver, Frank, 53, 140–1, 162 Ontario, 11, 17, 27, 38, 40–3, 47–8, 50, 54, 63–4, 85–6, 95, 99, 101–2, 106, 116, 118–20, 128, 130, 137, 155, 160, 166, 173, 193; Aborigi-

317

nal Peoples and flu (mortality), 128–9; Board of Health, 40–2, 48, 50; cholera, 11–7, 26, 27, 49–52; Easter Riots (1918) and, 137–8; First World War and, 85–6, 95–6, 99–102; influenza (1889–91), 63–4; influenza (fall 1918), 95–6, 99–102, 106, 116–19; influenza (spring 1918), 85–6; influenza (winter 1919), 173; laboratories in, 193; mortality, 43, 106; public health, development of, 40–2, 155–6, 160, 166; public health legislation, 40–2, 166; Siberian Expeditionary Force and, 102; smallpox, 47; Spanish River School, 128–9; strikes, 101 Osler, Sir William, 64 Ostry, Aleck, 182 overcrowding, 15, 18, 21–3, 34, 38, 45, 49, 51, 70, 111, 127, 129, 151 Oxford, John, 5, 69–71 Panama, 151 Paris (mortality rates), 41 Paris Peace Conference, 4 Parr Traill, Catharine, 16 Partridge Island, 27 Pasteur, Louis, 45 Patch, F.S., 96 Patterson, David, 4 Patterson, Dr Margaret, 154 Pershing, John J., 94–5 Pettigrew, Eileen, 6, 72, 77, 90, 121 Pettit, Dorothy A., 71–2 Pfeiffer, Dr Richard, 65–7, 69, 119 Pfeiffer’s Bacillus, 65–9, 119 Phillips, Howard K., 4–5 Playter, Edward, 38, 40–1, 43–4, 50–3, 57, 190

318

Index

Plumptre, H.P., 157, 160 Polish Army, 95–6 pollution, 12, 56–7 Porter, Dorothy, 150, 152 Porter, Roy, 12 Power Controller, 134 Prince Edward Island, 16, 63, 104–5, 111, 128, 173; Aboriginal Peoples and flu (mortality), 128; cholera, 16; influenza (1889–91), 63; influenza (fall 1918), 104–5; influenza (winter 1919), 173; mortality in, 104–5; public health, 111; public health legislation, 16, 111; quarantined from mainland (1918), 104–5 progressive movement, 133, 151 prohibition (Canada), 45, 122, 156–7 public health: boards, 12, 27–9, 104; France, 39, 150; Germany, 39, 150–1; governance (definition of), 7, 12; Great Britain, 15, 22–3, 25, 27, 37–8, 151–2; ideologies (definition of), 7; Nuisance Removal Act (England, 1846), 36; origins of, 12–14; Public Health Act (England, 1848), 38; statistics, development of, 22–3, 27–8, 37–40, 43–4, 55, 57; Sweden, 150; United States, 22–3, 25, 71, 77–8, 151–2; women and, 45–6 public health, Canada: 1918 flu and development of, 155, 164–70, 172, 190–3; American influence, 46, 151–3, 160; boards, 17–21, 23–6, 36; borders, 30–1, 78, 95–6, 106–8; British Columbia, 47–8, 55, 72–4; British influence, 15, 21–3, 34–8, 80, 150–2; British North

America Act (1867) and, 26, 31, 38–9, 42, 158, 165, 177; Canadian Public Health Act (1848), 20; Central Board of Health, 20–1, 24; conditional granting programs, 185–7; Confederation (1867) and, 26–9, 37, 42, 57, 82, 104, 190, 193, 195; conflicting views, 36–8, 48ff, 151ff, 173ff; contaminationist view, 19–24, 30, 34, 45–9, 51–5, 57, 80, 111, 149, 154, 168, 170, 190–4; crisis mentality, 15, 23–4, 35, 44–5, 109, 124, 129, 142, 148, 162–73, 195; disease, war, and, 68–9; division of powers, 26–7; elites and, 21, 36–9, 52–3; environment and, 48–9; federal/central role, 15–7, 19–27, 39–41, 47–8, 55–7, 66–7, 81ff, 103–5, 141ff, 149ff, 158ff, 165–70, 171ff, 190–3; First World War and, 141ff, 154ff, 166–8; geography and, 23, 52–3; germ theory and, 45–6, 50–2, 66; governance, 7–10, 12–15, 19–21, 23–4, 31–4, 41, 46, 50–7, 82, 137, 149, 166–70, 187–8, 193–4; grants in aid, 186–7; Great Depression, 185–7; health insurance, 186–8; ideologies of, 8, 15, 31, 34, 101, 150–4, 175, 182, 189, 190–4; immigrants and, 8, 15ff, 47–50, 54–5, 65, 89–90, 107, 153–4, 170–2, 180–1, 188; immigration and, 28–31, 45ff, 52–5, 107–8, 172; journals, 152–4; legislation, 19–20, 22–3, 26–8, 38–41, 46–8, 50–6, 81, 83, 173–5; leprosy, 29–30, 52, 57; maritime threats, 34, 48–50; maternal feminists, 153–62, 169–70, 181–3; middle-

Index class views of, 35, 53, 163; military and, 145ff; municipal role, 20–7, 36–8, 41, 55–7, 106–7, 109, 112– 16, 145–6, 168, 176–8, 183, 190; National Council of Women and, 159–62, 169–70; New Brunswick, 110–12; nurses, 74, 123–4; origins in Canada, 12–14; poverty and, 9, 15–18, 21–5, 34–8, 45–9, 51, 116, 124–9, 152–7, 182, 185–7, 192; Prince Edward Island, 111–2; provincial role, 20–7, 33, 40–1, 47–8, 51, 55–7, 109–12, 116–24, 166, 168, 176–82, 186, 190; public perceptions of, 21–2, 35, 39–40, 52–4, 112ff, 122–4, 140–3, 149, 152–4, 159–63, 170; quarantine (see quarantine, Canada); racism and, 28–31, 47–9, 54–5, 78, 107, 190; reconstruction and, 167; reformers and, 23–4, 32–56, 112ff, 122–7, 149ff; responsibility for, 19–20, 23–8, 37ff, 46–7, 50–6, 81–2, 109ff, 154ff, 166–9, 176–8, 189ff; Sanitarians, 9, 34–46, 49, 112, 155, 170, 190; Saskatchewan, 113; social conditions and, 9, 15, 18–19, 25, 34–7, 41–4, 51–5, 124–8, 148–57, 174–82, 192; social control, as, 35; Social Gospel and, 35ff, 154–6; South African War and, 151–2; Toronto, 41; United States and, 24, 30–1, 34–5; vital statistics, 39–41, 43, 72, 105, 154; war, disease, and, 68–9; women’s advocacy groups and, 35–6, 153–61, 167–70. See also influenza (1918 pandemic), Canada; Department of Health; Montizambert, Frederick

319

Public Health Act (England, 1848), 38 Public Health Act (Great Britain, 1875), 22 Public Health Act (Ontario, 1875), 40–2 Public Health Journal, 152–4 punishment (military), 143–4 Pyle, Gerald, 62 quarantine, 8, 13–32, 34, 46, 48–57, 65–7, 78, 80–3, 89–91, 95–99, 103–20, 153–8, 161–3, 166, 170, 172–4, 178–80, 188–94 quarantine, Canada: cholera and, 15–20, 23, 24–6; critiques of, 49–52, 55–6, 65, 118, 153–4, 158–63, 178–9; D’Arcy Island, 29–30; development of, 13–16, 19–20, 23–7, 31, 46–55, 57, 65–7, 103, 153–4, 158–63, 170–4, 178–9, 189–95; early use, 13, 15; economy and, 107; effectiveness, 16, 49–52, 65–7, 103–7, 118, 153–4, 158–3, 178–80, 189–95; effectiveness, perceptions of, 16, 19, 26, 29, 34, 49–52, 54, 57, 65–7, 78, 82, 89–91, 103–4, 107–8, 109, 153–4, 170–4, 178–80, 191–5; exclusionary strategy, 107–8, 189–95; failure (1918), 78–83, 89, 97–99, 103–6, 190–1; germ theory and, 46–7, 50–2, 65–6; Grosse Îsle, 16, 20, 24, 27–8, 52, 65, 80–3, 89, 120, 179–80, 191–4; ideologies of, 8, 15, 31, 34, 101, 150–4, 175, 182, 189, 190–4; immigrants and, 8, 15ff, 47–50, 54–5, 65, 89–90, 107, 153–4, 170–2, 180–1, 188; influenza (1889–91), 65–6; influenza (spring 1918),

320

Index

78–83, 89, 97–9, 103–6, 190–1; legislation, 13, 19–20, 24–7, 51–3, 55–7, 65–7, 78–9, 83, 97–9, 118, 158, 166–74, 178–80, 188–91, 193; Lower Canada, 15–16; military and, 78–83, 95–7, 107–8, 119, 170; municipal, 46, 103–4, 110–13, 116–18; Ontario, 118; Partridge Island, 27; politics and, 16, 26–8, 52, 55–7, 67, 82–3, 97–8, 158, 166–74, 188; practices, 16, 28, 49–55, 65–7, 78–83, 89–91, 96–8, 103–6, 179–81; Prince Edward Island, 104–5; provinces and, 109–13, 116, 166–70, 178–80; public health strategy, as, 8, 15, 19–20, 23–7, 31–2, 46–55, 57, 65–7, 78–82, 103, 153–4, 158–63, 170–4, 178–9, 188–95; racism and, 47–9, 54–5, 65–6, 78, 89–90, 107, 153–4; reformers and, 49–52, 159–61; sanitarians and, 49–52; Saskatchewan, 113; smallpox, 104–6; St Lawrence River and, 15, 49, 51; technology and, 51–2, 65–7; Toronto, 118; Tracadie (New Brunswick), 29–30; Upper Canada, 16; Vancouver Island, 112; venereal disease and, 153–8, 160, 169, 174, 183–5, 194; Victoria, 112. See also public health, Canada; Montizambert, Frederick; Department of Health Quebec, 13, 16, 18, 27, 33, 38, 43, 49, 63, 75–6, 82, 84, 92, 95, 99, 102, 104–7, 110, 120, 128, 131, 133, 137–8, 142–3, 145–8, 155, 162, 166, 173, 192; Aboriginal Peoples and flu (mortality), 128; Central Board of Health, 38, 142– 6, 155–6, 166; cholera, 13–18;

Easter Riots (1918), 137; First World War and, 131–3, 137, 142– 7; Grosse Îsle, 16, 20, 24, 27–8, 52, 65, 80–3, 89, 120, 179–80, 191–4; influenza (1889–91), 63; influenza (fall 1918), 95–9, 102, 105–10, 120, 128, 192; influenza (spring 1918), 75–6, 82, 84; influenza (winter 1919), 173; Military Service Act and, 131–3, 137, 142–6, 162; mortality, 43; public health legislation, 13, 16, 166; Siberian Expeditionary Force and, 102–4, 192; smallpox epidemic (1885), 44–5; vital statistics, 38 Quebec City, 16, 18, 27, 75–6, 84, 92, 95, 104, 106, 137, 143 Quiney, Linda, 6, 123–4 railways, disease and, 49–50 reconstruction, 9, 135–7, 158–67, 192 Reed, Walter, 46 Regina, 103–4, 191 Reid, Helen, 158 Reid, John, 168 residential schools, 128–9 Riel, Louis, 33 Ritchie England, Dr Octavia, 158–60 Roberts, Barbara, 54 Roberts, William, 111 Robertson, Dr E.A., 92–3, 95–6 Rockefeller Foundation, 152 Rosenberg, Charles, 7 Rosenkrantz, Barbara, 17 Rowell, Newton W., 134–6, 157–61, 165, 168, 171–2, 174, 193; Department of Health, creation of, 174ff; Dominion-Provincial Conference (1918), 168–9; Methodism and,

Index 171–2; Montizambert and, 193; National Council of Women and, 160–1; President of Privy Council, as, 134, 160–1; public health, British North America Act and, 165–6; public health, views on, 157–61, 165–6, 171–2; Social Gospel and, 135, 160–1, 171–2; women’s voluntary associations and, 158–61; Women’s War Conference and, 157–9 Royal Commission on Relations of Labour and Capital (1888–9), 35–6 Ruskin, John, 150 Russia, 14, 49, 58, 62–3 sacrifice, motif of, 9, 12, 132–41, 147, 159, 192 Saint John Medical Society, 122 Saint John Military Hospital, 75–6 San Francisco Plague (1900), 55 sanitary science, 36, 45, 122 Saskatchewan, 103–4, 106, 110–11, 113, 121, 127–8, 173, 176, 191; Aboriginal Peoples and flu (mortality), 127–8; influenza (fall 1918), 103–4, 106, 113, 121; influenza (winter 1919), 173; laboratories, 110; military and, 103; public health legislation, 110–11; Siberian Expeditionary Force and, 103–4, 191 Sauvé, Arthur, 145 scientific motherhood, 181–2 Scott, W.D., 83 Sears, Allan, 54 Seattle Metropolitans (hockey team), 172 Serpent River First Nation, 128–9

321

sewers, 11, 22, 27, 37 sex education, 37, 158 sexual deviance, 45, 174 Shah, Nayan, 180 Shattuck, Lemuel, 22–3 Sheard, Charles, 175 Siberia, origins of Canadian involvement in, 3, 100–2, 108 Siberian Expeditionary Force, 9, 100–3, 106, 140, 147, 191 Sifton, Arthur, 168 Sifton, Sir Clifford, 53, 56, 107, 136, Simon, John, 22 slum conditions, 17–18, 23, 27, 54, 125, 183 Smillie, Jennie, 153, 160 Smith, Mary Ellen, 123, 126 Snow, John, 21–2, 24 Social Darwinism, 150 Social Gospel, 9, 133, 141, 149, 155, 161, 171, 192 social reformers, 8–9, 35–8, 125, 133–6, 153–6, 160–2, 167, 170, 175, 181 social sciences, 37 Société Médicale de Montréal, 33 Somali (ship), 72, 80–2, 89 South African War, 68, 98, 151 Spanish River Industrial School, 128–9 special service detachments, 143–7 Spencer, H.E., 184 Spencer, Herbert, 150 Spitzka, Edward A., 96 St-Agathe (Quebec), 146 Stanley Cup, 172–3 Station Hospital (Halifax), 130–1 steamships, disease and, 49–50 St-Fulgence (Quebec), 143 St-Gédéon (Quebec), 143

322

Index

St-Hyacinthe (Quebec), 43, 146 St-Jean Military Hospital (Quebec), 75–6 St John’s Ambulance, 158, 179 St Lawrence River, 15, 49, 51 St Luke’s Base Hospital (Ottawa), 74–5 Sussex Military Camp, 102 Sydney (Nova Scotia), 96–7, 102, 107 Taché, Joseph-Charles, 24–7 tavern licenses, 42 technology, and disease, 49–53 temperance movement (Canada), 36–7, 42, 45, 122, 156–7 The Farmers in Politics (book), 136 Thompson, John Herd, 135 Thompson, Richard Frederick, 176 Toronto, 18, 26, 27, 37, 43–5, 49–50, 74, 85–7, 92; Base Hospital, 85–7, 138–40, 147, 192; cholera, 49–50; Church, Tommy, and, 138; Committee for the Prevention of the Traffic in Women and Equal Moral Standard, 154; Connaught Laboratory, 120; General Hospital, 85; influenza, doctors and, 92; influenza first reported in Canada, 74; influenza, military and, 104; influenza (spring 1918), 74; Methodism in, 171; military and, 138–40, 147, 192; mortality rates, 43; National Council of Women, 153; nurses, 123; reformers and, 38–41; sanitation, 37, 44–5; sewage system, 37; Toronto South (riding), 175 Toronto Women’s Court, 154 Tracadie, 29–30 Trotsky, Leon, 100

Tupper, Sir Charles, 39–40, 43 Tyndall, John, 45 U-boats, 95 Underhill, Frederick T., 112 Union Government, 9, 132–5, 137, 140–2, 144, 156–7, 160–1, 163, 168, 176, 192–3; conscription and, 132–3; disaffection with, 9, 133–47; election of, 133, 156; expansion of state, 132–6; farmers and, 136, 141–3; formation of, 132; idealism of, 132–3; influenza and, 133; labour and, 133–8; promises made by, 132–3; public health and, 153–61, 165–70, 192; Quebec and, 142–3; reconstruction and, 135–6; Social Gospel and, 133–4, 141–2; social reformers and, 133–6; war aims of, 132–3; war effort of, 133–4; women and, 136 University of Toronto, 193 Upper Canada. See Ontario urbanization, 27, 34, 36, 38, 51, 133, 150–1, 153, 156, 175 vaccination, 44, 51, 53, 60, 118–21, 179, 191 Valleyfield (Quebec), 146 Vance, Jonathan, 135 Vancouver, 47, 90, 102–4, 112, 123, 137, 140, 181, 191 Vancouver Island, 63, 78, 90 venereal disease, 44–6; army and, 155–8, 169; public health legislation and, 153–8, 160, 169, 174, 183–5, 194 Victoria, 29–30, 88, 102, 112, 155 Victoria Hospital (Halifax), 97

Index Victoria Memorial Museum (Ottawa), 169 Victoria Military Hospital (Victoria), 88 Victorian Order of Nurses, 179 Victoriaville (Quebec), 99, 106 Vincent, F.E., 103 voluntary associations, 9, 35–6, 156–8, 169, 178–9, 191–2 volunteerism, 9, 123–4, 132, 142, 156–7, 178–9, 191–2 Walker, Mary Jane, 28 Walpole First Nation, 63 war, disease and, 68–9 War Committee of the Cabinent, 157ff War Purchasing Commission, 134 War Trade Board, 134 Wetmore, F.H., 121

323

Weyburn, 176 White, Sir Thomas, 168–9 White Russians, 100 Wikwemikong, 128 Wilson, Major-General E.W., 96, 145–6 Windsor, 118 Winnipeg, 6, 53, 63, 88, 103–4, 116, 123, 126, 181, 183, 191 Winnipeg General Strike, 6 Women’s Christian Temperance Union, 156–7 Women’s War Conference, 157–61, 170, 192 Worboys, Michael, 45 worker’s compensation, 150 Young, H.E., 73, 177 Yukon, 57, 128, 173