Monday, August 13, 2012

The Last Plague

The Last Plague: Spanish Influenza and the Politics of Health and War by Mark Osborne Humphries
University of Toronto Press, Fall 2012
Trade Paperback,  380 pages
ISBN-13: 9781442610446

The ‘Spanish’ influenza of 1918 was the deadliest pandemic in history, killing as many as 50 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 the 1918 flu was a different type of disease. In spite of the best efforts of both federal and local officials, up to 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 flu crisis had important long-term consequences at the national level, ushering in the ‘modern’ era of public health in Canada.

My Thoughts:
The Last Plague: Spanish Influenza and the Politics of Health and War by Mark Osborne Humphries documents the history of how Canadian federal health officials tried to control epidemics. Starting with the early history, especially how officials handled the cholera epidemics, Humphries carefully documents the official response and reactions to the epidemics. While the method of containing cholera was based on isolation and decontaminating immigrants, this proved ineffectual in handling the flu pandemic of 1918. It also clearly indicated a need for standardized policies in place and lead to the creation of a federal Public Health Department in Canada. This also signified the beginning of modern health care in Canada.  It's really only a matter of time until another flu pandemic hits and better preparation can, perhaps, save more lives.
Long time readers of She Treads Softly know that I have a particular fondness for books on plagues and peoples. Humphries' excellent, scholarly volume is a great edition to my collection. He actually had some information that I have never read before.  I do have one wee complaint. The tables and charts didn't translate so well in my Kindle edition. Plus I find it awkward to look up notes and sources on a Kindle. What this means is that I will be purchasing a paper edition of this book for my collection. I need to be able to easily turn to the notes, etc., while I read.
The Table of Contents include:
I. Introduction
II. Establishing the Grand Watch: Epidemics and Public Health, 1832-1883
III. 'Everybody's Business is Nobody's Business': Sanitary Science, Social Reform, and Mentalities of Public Health, 1867-1914
IV. A Pandemic Prelude: The 1889-90 Influenza Pandemic in Canada
V. Happily Rare of Complications: The Flu's First Wave in Canada and the Official Response
VI. A Dark and Invisible Fog Descends: The Second Wave of Flu and the Federal Response
VII. 'A Terrible Fall for Preventative Medicine': Provincial and Municipal Responses to the Second Wave of Flu
VIII. The Trail of Infected Armies: War, the Flu, and the Popular Response
IX. 'The Nation's Duty': Creating a Federal Department of Health
X. 'Success is somewhere Around the Corner': The Changing Federal Role in Public Health
XI. Conclusion
XII. Bibliography of Sources Consulted

Yes, there are extensive notes, a bibliography, index, illustrations, figures and tables, acknowledgements  - all things that make me happy in a nonfiction book.
Mark Osborne Humphries is an assistant professor in the Department of History at Memorial University of Newfoundland.

Very Highly Recommended - especially if you also have a consuming interest in books on plagues and pandemics and how they were handled.
Disclosure: My Kindle edition was courtesy of Netgalley for review purposes.


A key question that surprisingly remains unanswered is this: Did influenza change how average Canadians responded to epidemic disease?  Location 165-166

In my investigation of this important question 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. My answer will be that the 1918 flu was a transformative event that had far-reaching consequences for both society and public health policy Canada, marking a significant shift in the dominant ideologies and strategies of public health governance.32  Location 171-175 
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.  Location 270-273
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  Location 289-293

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  Location 333-336
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.  Location 582-585

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.  Location 593-596
The association between immigration and disease was strengthened by fears that a rapid influx of immigrants was weakening an inherently healthy Canadian nation.  Location 915-916

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  Location 1153-1155
In 1918, 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 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  Location 1264-1271

Canadian historians have long argued for a European origin, 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 But new research into the epidemiology of the pandemic suggests that the first wave occurred in Canada much earlier, in the winter and spring of 1918.  Location 1332-1337

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 of the infection was not American soldiers, but American Catholics attending a regional Eucharistic Congress.65  Location 1755-1757 

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