The Spanish Flu Epidemic of 1918 in Ottawa, Ontario, Canada
and Other Historical Health History in the area



December 11, 2002:

OTTAWA'S DANCE WITH THE SPANISH LADY by Marc St. Pierre (marcstpierre59@hotmail.com)
The ‘flu began, often, like a cold, with a cough and a stuffy nose, progressing to a dreadful ache that pervaded every joint and muscle, a fever that shot as high as 104 degrees, and a marked inclination to stay in bed. If it stopped there the patient was usually back to normal in a week, but when it developed into pneumonia the outlook was grave indeed...(Pettigrew-16) OBJECTIVES This paper will introduce influenza and explain the historical context of the 1918 pandemic. It will also present an historical overview of past research into the cause of the virus, and then look at the 1918 pandemic through the eyes of an epidemiologist by applying the ecological framework to the virus. Specific attention will be given to the case in Ottawa. INTRODUCTION Epidemiologists have for decades searched for the cause of the 1918 influenza pandemic. Having killed an estimated 60 million people worldwide, there was scarcely a place on earth not touched by the virus. The Spanish Flu, as it was mistakenly called, struck in three waves; first during the height of World War I in the spring of 1918, then during de-Armament in the fall, and finally in early 1919. The first wave, known as the ‘three-day fever'(Kolata-10) swept across the globe disabling whole armies and putting economies on a standstill, but this was nothing in comparison to the second and third waves. Killing more people than the first and second world wars combined, the source of the deadly second and third waves confused even the best doctors of the day, and continues still today to occupy the minds of some of the world's best epidemiologists. WHAT IS INFLUENZA? Influenza is a virus which is transmitted by breathing in infected air. There are currently three known types of influenza (flu) virus, of which by far the "most important virus epidemiologically...(with) the widest range of hosts"(Stuart-Harris-8) is the A-virus. While the flu circles the globe every year, causing fevers, aching muscles, headaches and tiredness, every decade or so, a specifically deadly strain causes worldwide suffering and death. The virus which caused the 1918 pandemic was one of these mutant virus', and in mild cases caused regular flu symptoms such as the above ones. In severe cases, people would develop respiratory tract infections leading to pneumonia and pleurisy, as well as a condition called cyanosis, which "was characterized by a bluish discolouration of the skin and mucous membranes due to an excessive concentration of reduced hemoglobin in the blood."(Bacic-4). As Stuart-Harris and others point out, "the striking feature... was the large number of cases with pneumonia particularly among adults aged 20-40. In this age-group the case-fatality was around 50 per cent..." (Stuart-Harris-119). HISTORICAL CONTEXT In the spring of 1918, the Great War was still raging in Europe as soldiers from nearly every continent fought for either the English, French and Russians, or the German and Hungarians. Around the world many countries were enforcing strict rationing, and things were especially bad in the war-torn countries of continental Europe where citizens were starving. Medical diagnosis was quite basic in comparison with today. While the scientists knew of viruses, they still could not see them, and the genetic work so important to the discovery of the influenza virus was still 30 or so years away. That spring, a flu spread round the world infecting about 25% of people, and causing them to become bed ridden with ‘regular' flu symptoms. The flu was first reported in Spain, and therefore became known world-wide as the Spanish Flu, there are also references to people calling the flu ‘The Spanish Lady', thus to dance with The Spanish Lady was to get the flu. While this flu held no extraordinary symptoms, it did attack young adults more than any other age group, a situation which was most concerning to medics and politicians who saw most of their soldiers and workers fall sick for three days. Although the spring flu inconvenienced many, it was soon forgotten, that is, until the fall. In late August another flu virus struck, but this time it killed. Encircling the globe, the still highly contagious flu caused mild symptoms in about 20% of its victims, and one or two horrible diseases in the rest of the people. Influenza and the secondary infections of pneumonia and pleurisy would kill about 60 million people worldwide within 5 months. (Kolata-12) The 1918 influenza was initially thought to have begun in Europe, as nearly every returning soldier exhibited symptoms of the disease and became a carrier, bringing the disease home with them. However, this turns out to be only partially true.

THE SEARCH FOR THE CAUSE During the 1930's scientists were scrambling for clues as to the cause of the Spanish Flu when one man named Richard Shope noticed that pigs had come down with a flu-like virus in 1918 as well. Further investigation proved that it was a swine-flu virus, an A-virus just like the one causing the mass pandemics in humans. Thus, there arose the possibility that the 1918 flu was caused by a swine zoonosis, but evidence to link the two flus proved inconclusive. One thing was for sure though, and that was that flu could be passed from pigs to humans and vice versa, in other words, it was an anthropo-zoonosis. Scientists thus began to wonder what other animals might carry or be susceptible to influenza. Some 60 years later in the 1990's, a renowned flu scientist named Robert Webster of St. Jude's Children's Research Hospital in Memphis, came up with a new hypothesis for the spread of the 1918 flu. He suggested that a bird flu virus would be passed on to a pig, who at the same time would contract a human flu virus. Inside the pig, Webster said, the bird flu strand would ‘humanize', "that is, to change in a way that would allow it to keep the birdlike features that make it so infectious and yet acquire the human flu-like properties that would allow it to grow in the lung cells of a human being."(Kolata-223). He went on to explain that the reason all influenza pandemics seem to originate in South China is because of the presence of chicken farming (the disease reservoir), pigs (the vector), and humans (the hosts) in such close contact. However, the death in 1997, of a 3 year old Hong Kong boy brought another possibility to the table. This boy was found to carry a previously never before seen, in humans, bird flu virus; one which did not contain any trace of the swine flu virus in it. With Hong Kong's chicken markets experiencing a huge bird influenza epidemic, experts came to the conclusion that this was a case of direct zoonosis between bird and human, without the pig vector. The saving grace seemed to be that the bird flu could not be transmitted from human to human, people could only catch it through direct contact with chicken. With the true cause of the 1918 flu still unknown, the answer seems to lie somewhere between the two above hypothesis'. While it was definitely a variant of a bird flu, it either mutated to transmit directly to humans (similar to the 1997 Hong Kong case, except this time it was transmissible between humans), or it ‘humanized' in swine and then spread to humans, as stated by Webster. THE ECOLOGICAL FRAMEWORK The 1918 influenza pandemic can be looked at from an epidemiological standpoint, that is, by applying the ecological framework concept to it. The ecological framework outlines the relationship between the three most influential factors in the spread of an infectious disease; population, cultural behavior, and habitat. In 1918, the suspected origin of the pandemic, South China, had a very dense population. Of this dense population there were many young adults who had no previous experience with the last suspected bird flu virus of 1898 (Kolata-128), and therefore, lacked the antibodies to fight a similar virus. In addition to this the South Chinese culture is one which likes to eat fresh poultry and pork, often bought live from the market and butchered right in front of them. Lastly, the area of South China is one in which birds (ducks, chickens, etc.), pigs and humans are all in close contact. If one looks at this ecological framework as a whole, they will see a perfect starting point for influenza. Whether the 1918 virus was a direct bird zoonosis or whether it was a mixture of swine and bird flu, South China, according to the ecological framework, had all the ingredients necessary for it. Aside from where and how the virus first came about, the spread and distribution of the disease is not very hard to follow. The flu is thought to have been brought to Western Europe in 1918 by a group of Chinese laborers hired to dig trenches for the Allies (Kolata-297). With the average age of soldiers being about 25; the age most susceptible to the illness, it is quite easy to see how the virus would have spread. Sick troops were constantly being shipped back home, and supply ships were always going back and forth between Europe and the Colonies. Ships, in a rough sense, became the vectors for the disease, with the first outbreaks of influenza in North America occurring in port cities such as Boston and Quebec City. It has been suggested that, "this traffic could well have altered the progress of the pandemic from its usual pattern of spread in times of peace" (Stuart-Harris-119). Indeed, the first reported case of the deadly second wave in North America came from the port city of Boston. Once on land in North America, the flu typically traveled westward along the railways and highways. Which is how it came to Ottawa. SPANISH FLU IN OTTAWA The 1918 flu virus claimed its first victim of the Ottawa area on the 26th of September, after which the virus spread quickly throughout the city, leaving no community untouched. Although the virus was indiscriminate in terms of its victims' race, ethnicity, religion or class, certain groups of people were nonetheless affected more than others. In Ottawa, the "French and Irish Catholic population appeared to be the principal victims of the epidemic"(Bacic-2). One could also say that the lower class was hit harder than the upper class in Ottawa because the French and Irish Catholics made up a large majority of the lower class population. The reason these people were more affected by the virus, however, has nothing to do with their race or religion, and everything to do with where they lived in the city, and their lack of wealth. In 1918, railroad was the main form of transportation in North America. Ottawa was ‘unfortunate' enough to have three of its main stations within close proximity of high-density housing; the Lebreton Flats railway yard/station (CNR), in the Victoria Ward by the present day E.B. Eddy paper mill, the Grand Trunk station (CNR), in between the Capital and Central Wards, north of Isabella and south of Catherine, and the McTaggart Street station (CPR), in the By Ward on McTaggart (see Map of Ottawa). Typically, working class citizens clustered around the railways, which provided for most of their employment. In Lebreton Flats yard/station the huge and sprawling timber, paper and hydro industry was surrounded by, what Bacic terms, "an industrial working-class district with a large French and Irish Catholic population"(9). The McTaggart Street station was also surrounded by a high-density neighbourhood of mainly French and Irish, and lastly, the Grand Trunk station had a large working-class population very nearby it. The result of this is that these three Wards were the first to become infected by the virus in Ottawa. Not only were they the first to fall victim to The Spanish Lady, but they suffered the highest casualties. This is most likely because of the density of their communities and the general lack of plumbing, which together would have increased the rate of influenza contraction. Of a total of 440 people who died in the Ottawa area in October of 1918, 16% of the deaths came from the By Ward. According to Bacic, this proportion of deaths is higher than the population the By Ward should warrant, and this due to the prevailing social and economic situation of the area, which made individuals, "highly susceptible to infection"(Bacic-9). The situation was the same in the Victoria Ward, where, "the mortality rate... was significantly high at 11% considering the size of the area in terms of its population and geographic boundaries"(Bacic-9). The Grand Trunk station and surrounding area were no different, in that 9% of the total fatalities were suffered here, while the area had only 7% of Ottawa's population. So, with the arrival of influenza to North America, infected people (most likely soldiers) brought the flu, by railway, to Ottawa. From the railway stations, the virus ‘jumped' into the surrounding dense, impoverished host populations, and spread outwards, slowly dying off the further it got from the initial point of contact. While it is quite obvious that the Catholic populations in the immediate vicinity of the stations suffered the brunt of the casualties, non-Catholic communities located away from the railways did not get away unscathed. By populations, the middle to upper-class Wards of Central, Wellington and St.George, suffered lower mortality rates than the three working-class Wards. While the Wellington Ward did record the most casualties at 15% (double that of both the Central and St. George Wards), this can be accounted for by its close proximity to two of the most affected areas, Lebreton Flats and the Grand Trunk, as well as its very high population density. On a whole, "the virus had a much more moderate impact on wealthier districts than in working-class districts...", wealthier districts had, "premium housing in a cleaner environment, access to local amenities, and the purchasing power to obtain proper health services when necessary"(Bacic-10). Thus, the Spanish flu infected every corner of Ottawa regardless of class, religion, race or ethnicity. Some groups, however, were affected at a higher rate than other groups, and this was due to the proximity of their communities to major transportation hubs, and the density of their housing. CONCLUSION In conclusion, the flu of 1918 could not have possibly struck at a worse time. Around much of the world people were living in lower than usual living conditions due to the war. Likewise, travel during de-Armament was rife and widespread, with infected soldiers unwittingly bringing the disease home with them to their loved ones. While the world's best scientists are still stumped as to the exact ‘life cycle' of the virus, they have narrowed it down to a bird flu transmitted, either directly to humans, or through a pig vector. By studying the ecological framework of the virus, scientists have concluded that South China is the most obvious source of the 1918 pandemic, with its chicken, pigs and humans all living in close contact. Lastly, the path of the flu has been traced from the port cities of North America, along the railways into the communities of Ottawa, where the poorer, and denser districts surrounding the railway stations have suffered the most.

BIBLIOGRAPHY
1. Bacic, Jadranka. The Plague of the Spanish Flu (1998) in the Bytown Pamphlet Series (No.63), Historical Society of Ottawa, Ottawa. 2. Stuart-Harris et al. Influenza: The Virus and the Disease (1985) Edward Arnold Publishers Ltd., London. 3. Kolata, Gina. Flu (1999) Farrar, Straus and Giroux, New York. 4. Pettigrew, Eileen. The Silent Enemy (1983) Western Producer Prairie Book, Saskatoon, Saskatchewan. 5. Map of the City of Ottawa and Vicinity (1937) from the Ottawa Municipal Archives. *could find no author or publisher.
March 1, 2004: See also the Samuel Kipp page.
January 11, 2010:
Porter's Island Smallpox Tents, Ottawa, Ontario, Canada Photograph by William J. Topley Source: Our Times: A Pictorial Memoir of Ottawa's Past, page 57 Porter's Island Quarantine Station, Ottawa, Ontario, Canada

May 8, 2012: Jennie Barry from Barryvale on Calabogie Lake in Renfrew County, died during the 1918 Flu Pandemic. She was the wife of M. J. O'Brien, entrepreneur, railway contractor, silver mine owner and Canadian Senator.
New May 30, 2014: Book: The Plague of the Spanish Flu: The Influenza Epidemic of 1918 in Ottawa, by Jadranka Bacic, 1999, The Historical Society of Ottawa, Bytown Pamphlet Series No. 63, ISBN 0-920960-76-6.
E-mail Marc St. Pierre and Al Lewis
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