by Robert Smythe
By now we are all too conscious of terms like “flattening the curve”, “social distancing”, and “self-quarantine”. A pandemic’s behaviour has become frighteningly familiar.
In the final days of World War I the City of Ottawa was forced to react to a monstrous public health crisis without the benefit of advanced medical science or mass communication.
Yet the city’s–ultimately successful–response showed some similarity to actions being taken today.
The history of a local public health system in Ontario predates Confederation.
In 1833, the Legislature of Upper Canada approved an Act allowing local municipalities “to enact Boards of Health to guard against the introduction of malignant, contagious and infectious diseases in the Province.”
The City of Ottawa established its Board of Health in 1865 with the mayor as the chair. Part-time medical officers of health were appointed from the city’s pool of doctors. The Province of Ontario’s first Public Health Act was passed in 1873.
Ottawa had experienced acute health emergencies in the years that preceded the outbreak of the “Spanish Influenza” in 1918.
Communicable diseases like typhoid, tuberculosis, and smallpox had already taken their toll and tested the city’s administration, which was forced to hire public health nurses and build isolation hospitals.
Without the tardy but dogged leadership of Ottawa’s Mayor Harold Fisher and public health officials, the impact of modern history’s most devastating global epidemic could have been much worse.
When the Spanish Influenza arrived in September 1918, Ottawa’s newspapers were seized with the details surrounding the last battles of WWI. There was little mention of the growing epidemic in the press until the end of that month. As deaths mounted, the Board of Health issued a statement defining the symptoms of the disease and warning the public of its highly infectious nature.
“Undoubtedly the several cases of influenza which have appeared recently in this community are of the type popularly known as the Spanish grippe.
“This disease of influenza is a virulent form. It is characterized by a sudden onset, with a high fever, but not necessarily chills. It presents at its most pronounced diffuse pains throughout the body which are most severe at the base of the skull and in the small of the back.” (Ottawa Journal, September 26, 1918)
Some days later, the Journal revealed the severity of the outbreak: on Monday, September 30, it reported that eight people had died over the weekend.
Twenty-one more had died in the previous twenty days.
“Mayor Fisher said he thought every precaution should be taken to guard against the spread of the disease. He urged people to keep out of crowds when they felt an attack coming on, and that they should keep to themselves as much as possible in their homes,” the article went on.
By the end of the week the situation had become grave.
Medical staff in the city’s hospitals were down with influenza. Physicians were pushed to their limits, unable to attend many of the afflicted. Those who were not ill were taking precautionary measures to avoid the disease.
Section 56 of the Public Health Act of Ontario gave the municipality wide powers “where any communicable disease is found to exist to use all possible care to prevent the spread of disease or contagion by any means in their judgment most effective for the public safety.”
On October 4, the Board of Health convened an emergency session.
They ordered the immediate closure of every school, theatre and place of public gathering.
Churches were asked to not hold services that Sunday, and the owners of the Ottawa Electric Street Railway were directed to ventilate their cars as much as possible until further notice.
Said The Ottawa Journal on October 5:
“Such is the drastic action taken by the local Board of Health…to check the spread of the influenza epidemic which is reported to be increasing by the hour.”
Flu of 1918
Should the City of Ottawa have taken action weeks earlier? In hindsight it is easy to say yes. But many believed that this was the regular flu and not the Spanish type which was beginning to spread in large American cities. Once the city recognized the scale of the emergency, Mayor Fisher established a command centre at City Hall to track the spread and coordinate the public and private resources needed to fight the epidemic. He sent a memorandum to all heads of city departments:
“The only important business we have in the City Hall at present is the work in connection with the epidemic. People do not cease to be sick at five o’clock. There are therefore no office hours.”
His first battle was to cancel major planned public gatherings like the Ontario Plowmen’s Association International Plowing Match at the Experimental Farm set for October 16-18, an event which carries considerable political clout to this day.
Fisher’s chief opponent was Ontario’s Chief Health Officer, Dr. J.W.S. McCullough, who wrote, “I have no hesitation in approving of the meeting of farmers and implement manufacturers on this occasion, as the danger from the so-called Spanish Influenza is reduced to a minimum by meeting in the open air.” (Ottawa Citizen, October 12, 1918)
Alarmed that the match would attract hundreds of competitors and thousands of spectators from across the province, Fisher appealed directly to the Prime Minister and the Minister of Agriculture to withdraw permission to use the Farm.
Unsurprisingly unable to find a farmer willing to risk hosting the event, the organizers cancelled it “for the safety of human life which must receive first consideration” (Ottawa Citizen, October 15, 1918). Several business conventions expected to arrive in the city were also postponed indefinitely.
To respond directly to the outbreak, temporary emergency hospitals were opened in the Aberdeen Pavilion at Lansdowne Park and in several of the vacated public schools.
A platoon of Red Cross ambulances was organized to deliver patients to them. Ottawa’s Boy Scout troops were recruited to deliver 27,000 notices to city households on how to protect themselves against the Spanish Flu. An appeal to retired and married nurses, who were older and less likely to catch the disease, for assistance to the homes of the affected, was somewhat successful.
The nurses were provided with hand-made protective caps and aprons sewn by other volunteers.
Masks and gowns called ‘pneumonia jackets’ were fabricated in a sewing room at City Hall to fill the large orders placed by the hospitals.
Looking back, the chief failure was not closing nonessential businesses and the city’s places of work.
With a pre-work-from-home civil service supporting the Government of Canada still in the teeth of a world war, this was a challenge.
As a result each department was stripped of hundreds of staff members.
Business establishments like the Eaton’s Shoe Store on Sparks Street improvised.
They advertised, “For the Prevention of Spanish Influenza we will have a man in attendance continually disinfecting our establishment to prevent the spread of this epidemic.”
The mortality rate continued to jump until the fourth week of October when a drop in new cases began to appear. Home nursing assistants were still caring for over 2,500 flu victims, doctors had at least 1,000 patients, and the hospitals were beyond capacity.
Finally, on Monday, October 21, Mrs. A.J. Freiman, who had been coordinating the effort at Lansdowne Park reported that there had been no new deaths the previous day. By the end of the month, the official death toll from Spanish Influenza stood at 540 people, which was a relatively small percentage of the nation’s total of 55,000.
However, on some days almost twice as many deaths were said to have been caused by “pneumonia” or “la grippe”—so the total number may have been much higher.
The epidemic began to depart the city as quickly as it had come, with much smaller rebound outbreaks in 1919 and 1920.
There were lessons learned.
In 1919, Harold Fisher launched a relentless campaign to build the new Ottawa Civic Hospital—an institution that was once called “Fisher’s Folly”.
And the federal government created a new branch — the Department of Health.