Peacetime Killer

How the 1918 Spanish flu pandemic felled nearly as many Canadians as the war

John Lorinc – Senior Editor, Defining Moments Canada

On October 5, 1918, military officials hastily moved 15 ill Canadian soldiers travelling through Calgary on a Canadian Pacific transport train into an isolation unit at a nearby army base. A thoroughly 19th-century approach to disease containment, the quarantine didn’t work, and Calgary was soon inundated with infected civilians.

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

Public and official sentiment had changed swiftly over the course of just a few weeks. While many Canadians were well aware of the Spanish influenza epidemic sweeping through the wartime trenches and post-conflict demobilization camps in Europe and the United States, some Canadian authorities initially insisted this wave of grippe, as the disease was also known, didn’t differ markedly from the annual fall flu outbreak.

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

As the fall wore on, however, that sanguine outlook crumpled in the face of far darker reports that ricocheted across the country. The disease, which would kill 55,000 Canadians and up to 100 million people worldwide, spread along east–west rail corridors, travelling with soldiers returning from the war or heading to fight in Siberia. As it leapt into civilian populations, the Spanish flu ripped through families and communities, especially poorer ones. Like a hurricane, the pandemic left a trail of seemingly random and abrupt tragedy, as well as the long social and economic aftermath caused by the deaths of so many young, healthy people, who turned out to be especially vulnerable to this particular virus.

In Montreal, trolley cars were hastily converted into rolling hearses to accommodate the tide of flu victims headed for burial, according to a 2003 account of the pandemic by (former) federal minister of science Kirsty Duncan, then an adjunct professor of anthropology and geography at the University of Toronto. In Hamilton, cabinetmakers worked around the clock to keep up with demand for coffins. Celebrated author Lucy Maud Montgomery contracted the flu in October.  She returned to Prince Edward Island in a morose and physically weakened state, only to watch her beloved friend and cousin, Frede Campbell, succumb to the virus.

In her book Hunting the 1918 Flu, Duncan relates a story of two young Ontario women – roommates who had attended a lecture when the epidemic was at its height. “In the morning, Claire Hunter called to her friend in the same room, ‘Vera, I’m going downstairs for breakfast.’ There was no response. After breakfast, Claire returned to her room to get her purse and again called to her roommate. No answer. This time, Claire pulled back Vera’s sheets. Vera was dead. The doctor said that she had died at about two in the morning.”

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

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

Meanwhile, in Manitoba, the flu was spreading north, likely as the result of “an elaborate network of train lines, roads and water routes” that fanned out from Winnipeg, as social scientists Lisa Sattenspiel and Ann Herring noted in a 1998 study. The epidemic, they found, “overwhelmed” some Cree and Métis settlements in the vicinity of a handful of Hudson’s Bay Company outposts, including Norway House, where the mortality rate exceeded one in 10 by December. “The disease is raging in Pelican Narrows,” a newspaper in The Pas reported of an HBC outpost just over the Saskatchewan border. “In one house, there were 20 [people] lying on the floor helplessly sick, with four dead bodies lying among them.”

“The disease,” Sattenspiel and Herring write, “hop-scotched across the landscape, leaving most family groups intact while ravaging and even extinguishing a relatively small number of others.” But for the fact that many members of those Indigenous communities were out on trap lines in late fall and early winter, the devastation would have been far greater, the authors concluded. Other communities weren’t so fortunate: a 1967 study estimated that the pandemic killed almost 4% of Canada’s Indigenous population – a mortality rate five times greater than the general population. Some especially remote communities that had no health-care resources were wiped out entirely.

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

Meanwhile, in the Quinte region of eastern Ontario, readers of The Weekly Ontario learned that an apparently fail-safe remedy for the “thin” blood and “weakened” nerves associated with the flu was essentially snake oil – a concoction produced in Belleville and known as Dr. Williams’ Pink Pills for Pale People. As the newspaper reported, the treatment contained “just the elements needed to build up the blood, and restore the lost colour and vitality.” The cost: 50 cents a box, or six for $2.50.

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

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

We spent the early years of this century living in looming shadow of some devastating future pandemic. After the outbreak of SARS in 2003 and H1N1 in 2009, health officials in many countries started planning for the sort of major global pandemic that has occurred every 30 years or so over the past century. Those emergency management exercises in some places have proven to be vitally important. In others countries, but especially in the US under President Donald Trump, critically national security planning efforts to prepare for major pandemics were scrapped for political reasons.

In many ways, the 1918 Spanish flu represents the nightmare scenario, frequently invoked, if not well understood, and certainly well beyond the reach of living memory. However, the rapid and devastating spread of COVID-19, moving within a few months in early 2020 from a food market in China’s Wuhan region to virtually every corner of the globe, has provided a harsh refresher on what it’s like to live through a viral hurricane.

But when flu historian Mark Humphries, director of the Centre for Military Strategic and Disarmament Studies at Wilfrid Laurier University in Waterloo, Ontario, talks about the legacy of the Spanish flu pandemic in particular, he is quick to offer a caution: beware of comparisons, because 1918 and 2020 are profoundly different when it comes to infectious disease control and health. An adult who lived through the Spanish flu, he said, would have grown up at a time when outbreaks of tuberculosis, yellow fever, polio, small pox, cholera, and typhoid were hardly uncommon. Indoor plumbing, water treatment, sanitation, hygiene, milk pasteurization – these were all relatively new technologies, especially in a country that tended to lag behind the US and Europe in public health policy.

While rudimentary vaccines existed in 1918, Sir Alexander Fleming’s discovery of penicillin – which, in various synthetic forms is now routinely used to treat most infectious diseases as well as pneumonia, one of the leading causes of death in the 1918 pandemic – was still 10 years off. The flu virus itself wouldn’t be isolated until the early 1930s, and antiviral drugs, now routinely stockpiled and used in wealthier nations, didn’t appear until the 1950s. Life-saving devices like ventilators, though in critically short supply during the COVID-19 crisis, obviously didn’t exist, which meant more people didn’t survive the pneumonia that is perhaps the most lethal byproduct of infectious viral diseases like H1N1. (A 2008 paper by the National Institute of Allergies and Infectious Diseases, in Washington, DC, found that bacterial pneumonia was not only responsible for most of the deaths in 1918/1919, but would likely be a major factor in future flu pandemics.)

That same adult, moreover, likely had a far lower baseline of health and shorter life expectancy than she would have today, Humphries added. Coal was the primary fuel source, meaning polluted air and resulting lung irritation. For many people, their diets lacked sufficient fresh fruit and vegetables and other important sources of nutrition. “I would argue that what the flu did, at a time when the major 19th-century epidemic diseases were coming to an end, was remind people how susceptible they were.”

While no one was immune, some people were more susceptible than others. University of Manitoba historian Esyllt Jones has written extensively on the Spanish flu. She points out that the poor, recent immigrants, and the members of isolated Indigenous communities tended to be more vulnerable, even though the flu virus – unlike infectious diseases linked to poverty – didn’t pay attention to class lines.

During previous epidemics, public health officials often used coercive measures, such as quarantines and placarding homes with official signs indicating the presence of sick people, to isolate infected people – measures that were often inflicted on poor communities that were more likely to experience the conditions that accelerate infection (over-crowding, contaminated water, etc.). By 1918, however, a growing number of municipal health departments had abandoned these tactics, instead deploying small armies of nurses and volunteers to visit and treat sufferers in their homes. Toronto’s public health nurses paid more than 17,000 home visits during the outbreak. Some of the 2,000 nursing aides in the Canada and Newfoundland Voluntary Aid Detachment (VAD) also joined this effort upon returning from Europe to Canada, having treated flu-stricken soldiers in France and, in some cases, come down with the disease themselves.

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

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

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

Hundreds of kilometres north of Winnipeg, the flu swept through remote Indigenous settlements when the virus was carried along train and shipping routes radiating out of the Manitoba capital. But different communities had starkly different experiences. University of Toronto medical anthropologist Karen Slonim observed that at Norway House, a predominantly Cree HBC outpost north of Lake Winnipeg, federal officials dispatched a physician and two assistants for two months to treat flu sufferers. But at Fisher River – a settlement on the west side of the lake, and actually much closer to the city – the residents received little federal aid, relying instead on local medical attendants and a hospital.

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

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

Gauging the wider impact of the 1918/1919 Spanish flu has been a preoccupation of historians, public health experts, and anthropologists for years. It is a surprisingly elusive problem, in part because the historical narrative of the pandemic was either subsumed by the nation-building mythology of the war or forgotten. Historian Alfred Crosby, author of America’s Forgotten Pandemic, said that the major writers of the period – Ernest Hemingway, John Dos Passos, F. Scott Fitzgerald – barely mentioned the flu, even though they’d personally encountered its devastation. (One of the best-known accounts is a powerful 1939 novella by Katherine Anne Porter, Pale Horse, Pale Rider.) The pandemic’s speed “encouraged forgetfulness,” he added. “Many people thought of the flu as simply a subdivision of the war.”

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

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

Mark Humphries offered a different view of the issue of memory and the pandemic. “It got lost not because people forgot about it but because of the many [diseases] around then that could kill you.” While he was doing research on the flu early in his career, he recalls excitedly arranging to interview his elderly great-grandmother, who’d been 19 in 1918. While he was eager to hear about her experiences with the flu outbreak, she was far more interested in talking about the smallpox outbreak of 1921. “She had forgotten about it because it had been overshadowed by other things.”

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

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

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

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

Humphries said the new department’s initial mandate was broad, including labour standards, housing, immigration, infectious disease reporting, and quarantines. “It very quickly lost steam,” he added. In a matter of a few years, and absent another pandemic, the department devolved into an information clearinghouse and a forum that allowed the federal government to work with provincial public health officials. (Prime Minister Paul Martin’s government resurrected the notion of a federal public health agency in the aftermath of SARS. That decision proved to be highly proactive during the COVID-19 crisis, with Dr. Theresa Tam, the chief public health officer of Canada, playing a highly visible leadership role in determining the national response.)

The creation of the federal health department also came on the heels of years of activism by social reformers and progressives whose broad modernizing agenda included everything from improved sanitation to Prohibition. Canada, what’s more, had lagged American and European social welfare and public health policy. The calls for a federal agency, in fact, reflected a thoroughly 20th-century belief that this responsibility required the heft of a centralized bureaucracy and national standards. The pandemic, Humphries explained, amplified the urgency of such demands and galvanized figures such as Dr. Charles Hastings, Toronto’s crusading medical officer of health, and one of the country’s leading proponents of public-health advocacy.

Indeed, perhaps the most important legacy of the 1918 pandemic is that it marked the waning of the thinking that had dominated Canadian public health practice for generations: that the vector of infectious diseases could be halted using isolation, exclusion, and sanitary reform. (The approach didn’t disappear entirely: in the US, Mary Mallon, known as Typhoid Mary, was quarantined for the last 23 years of her life because she had been identified as an asymptomatic carrier.)

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

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

This article was originally published in Canada’s History magazine on September 10, 2018, and has been updated March 28, 2020.