Medical Responses and Public Health

Doctor calls, hospital admissions and military posts were all experiencing heightened numbers as the onset of the influenza was quite quick. The government response to the Spanish Flu was dull to say the least; they controlled communication and stressed that there was no need for alarm or fear when it came to the illness. Doctors across the country did indeed realize the potential of this sickness, but with little medical technology it was hard to give out exact instructions on how to keep everyone safe and healthy. As shown in a clip from The Varsity Periodicals from the University of Toronto doctors recommended the following: stay away from the infected, eat healthy, wear comfortable clothes, disinfect mouth and nose, drink half an ounce of whiskey daily, etc. There was no set vaccine for the Spanish Flu, though doctors in Toronto, Ontario made many samples showing some advances in our medical field. Quarantine was not an absolute must in 1918, other than for anyone who was coming to the country in the Maritimes on ships. As the influenza continued, and not many laws or helpful claims were made, people were starting to fear like the government was hoping they wouldn’t.  

Image: A clip from The Varsity Periodicals; University of Toronto, explaining origin, treatment and offering advice about the Spanish Flu. 

Courtesy of University of Toronto Archives

A Look Inside Kingston Ontario Hospital, 1918

In Ontario, one of the cities that were hit the hardest was Kingston. In the year of 1918 when the epidemic hit was approximately 22,000 people with 644 deaths per 100,000 which was very high compared to other surrounding cities. Many people came to Kingston due to their free medical care offered at Queen’s University as well as their large medical centre. Kingston had three hospitals already that were offering services to WW1 soldiers and influenza patients. When the Spanish Flu epidemic started, they opened five more hospitals to be able to treat even more patients from not only their own city but surrounding places as well.  

Kingston General Hospital had 902 admissions between October 1918 and February 1920 which is when the influenza cases started to slow down. Most of the people who came for medical help were averaged to be 22.3 years old. The reasoning behind Kingston’s high death rate is said to be because of their medical response to the pandemic as whole. It was one of the best in Ontario for its time.  

Limited Medicine 

By today’s standards, the medicine available to the general public in the early 20th century was limited, therefore local health departments were left to rely on their own to prevent and control the spread of the Spanish influenza.  The first official reaction was to allay the fears of the public and after that, local health officials tried their best to combat the swift-moving disease. Minneapolis’ health department enacted quarantine measures in their hospitals by preventing visitors and establishing an isolation ward for infected patients.    

The cities’ private hospitals took the non-influenza patients and the main hospital became the influenza epicenter.  As well, they advised the physicians of the city to report any suspected cases.  Minneapolis also relied more on public compliance to prevent the spread of the disease and public health authorities “called for voluntary efforts to avoid crowds [or] public gatherings.”  Modern health care systems are blessed with enhanced medicine which physicians or health officials could only dream of this long ago.  Thus, the aforesaid measures were their best line of defense.   

Ignorance of Public Health 

Cognitive inertia, “the tendency of existing beliefs or habits of thought to blind people to changed realities,” was unfortunately quite prevalent among the inhabitants of the United States during the epidemic despite the obvious danger.  In this case, the flawed thinking of the public stemmed from the understanding of the flu as a seasonal visitor that rarely killed those who were otherwise strong and healthy.  Even doctors were more concerned about an “after dinner presentation on diabetes” than the incoming epidemic.  However, even a cursory reading of the American newspapers reveals “that it was widely reported that this strain was significantly more contagious than a normal flu”.   

Due to this mass ignorance of the public, health officials lost weeks of preparation time.  Both prevention and treatment would have benefited from a chance to prepare in lieu of the influenza’s arrival.  In fact, one month after the virus reached the United States, the physicians of the Green County Medical Society had failed to prepare for an epidemic that would kill two hundred and fifty people and incapacitate one-third of the city of Missouri.  

Anti-Maskers 

As the Spanish flu wreaked havoc from 1918- 1919, many refused to wear masks, claiming that this enforcement violated their civil liberties.  Americans responded to mask regulations with behaviors ranging from eager compliance, to indifferent neglect, to open defiance. A major challenge created by anti-maskers is that they view themselves as less vulnerable than others, underestimate health risks, or display a “limited awareness of actions that pose a health risk.”  To make matters worse, an ‘Anti-Mask League’ was formed in San Francisco to protest against the mandated masks, ignoring the fact that masks were vital to slow the spread of disease.  The arrest of the citizens in the city for defying the mask regulations highlights the confrontation between individual actions and policy mandates.   

Adherence to regulations like face masks has a psychological component to it.  Specifically, it depends on three concepts; individualism versus collectivism; trust versus fear; and obeying social distance rules.  Furthermore, a related issue to compliance with regulations like these is understanding whether face masks are used for “individual protection against contracting the virus versus wearing one to protect others”.    

Age Demographics, Mortality Rates, spread of virus

The 1918 Spanish Flu had an abnormal number of deaths within the young adult age range. According to research, the age of 28 was the most common to die from the Spanish Flu. It is unknown to this day as to why that was. Though it was troublesome to pinpoint death rates, recorded deaths are some of the most important facts from this time. The deadliest rates within Ontario, Canada during October 1918 were in both Toronto and Montreal. Toronto also had the highest rate of cases in soldiers who contracted the flu; 45% of all cases. Due to the virus being airborne, most soldiers contracted the virus because of how close in contact they were. World War 1 soldiers were frequently coming in and out of the country, as well as staying at internment camps throughout Canada which meant that the struggle to keep the virus contained was difficult. A newspaper clip from The Winnipeg Evening Tribune from September 24, 1918 states more deaths from the Spanish Flu in a Niagara Internment Camp

Life of a Doctor During the Spanish Flu: Thomas Millman (1918/1919)  

Thomas Millman was a Canadian doctor who lived through the Spanish Flu Epidemic while in practice. His diary describes the daily life of one who was not only on the front lines but also one who described normal day-to-day life during these years. On Friday October 11, 1918 Dr. Thomas Millman described feeling ill and “owed it to the Spanish Flu”. The next day he returned to his normal routine at his practice. Thomas had decided after having had the influenza, he would be avoiding street cars in hopes to not catch it again. He speaks often about the prevalence of the flu, and as days pass, he gets more and more applications for death certificates as many people pass away from the influenza. On Friday December 20 1918, Millman said, “There is still considerable influenza throughout the country. Deaths have been worse than war..”

  On January 24th, 1919, he states how significant the death claims are, with the total reaching 500 in the province.  It is clear how much he is physically and emotionally distressed from this statistic because he states that he is sick to his stomach from reading the notes.    

The physical toll of this disease on citizens may be discussed to a certain extent, but its effect on doctors or nurses is often neglected.  The truth is that they are human as well and they were just as vulnerable to the grief of losing a friend or family member as much as anybody.  As well, he also mentions visiting the sanatorium on August 7th, which had all their institutions filled with infected soldiers.  The Spanish flu ravaged the soldiers in the trenches just as much it is destroyed the civilians back home, adding to the overall death rate.   

Winnipeg and Montreal   

The virus was carried over into Canada by American soldiers in Quebec City first appearing in Montreal in late September of 1918.  It then traveled west with the soldiers to reach the prairies and eventually hit Winnipeg.    

The Board of Health in Winnipeg did not take any initiative to slow or stop the spread of the virus until 2 weeks after the primary outbreak.  The declaration for ‘‘the immediate closing of all places of public meeting, such as schools, theatres, dance halls, moving picture houses, [and] concert halls” was not implemented until the 8th of October.  However, steps had been taken at the beginning of the epidemic to “provide an emergency hospital for influenza patients too poor to be treated at home or unable to get a place in the general hospitals” like the ward in figure 1.9.  Fortunately Montreal was far better prepared at dealing with the first stages of the epidemic.   

As the first cases appeared in Montreal, authorities quickly established a general series of measures to promote social distancing and quarantine was placed on army bases following the ban on public gatherings in the city.  Furthermore, “a vaccine prepared from micro-organisms infecting the respiratory tract of those suffering from the disease was to be used as a prophylactic to raise the immunity of those inoculated against respiratory infection.”