The Year Of The KILLER FLU
A MACLEAN’S FLASHBACK
As many Canadians died at home in the fall of 1918 as were killed overseas in the six years of World War II. And, if the world-wide flu struck again, medical authorities still aren’t certain they could stop it
HE FALL of 1918 was one of the toughest Canadians have ever known. Germany had its back to the wall in the Hindenberg Line but wouldn’t quit. Each day’s casualty list showed more than a hundred Canadians killed in action with many more wounded, missing and sick. At home there wasn’t enough coal for the nation’s fires or sugar for its tea. There seemed no end to death and suffering and hardships.
But Canada and the rest of the world hadn’t seen anything yet. A killer far more deadly than German guns or gas or bombs was stalking across the earth in the sheep’s clothing of the common cold. This was the influenza pandemic (an epidemic of worldwide scope) of 1918, the worst of its kind ever recorded and, next to the plague of 542 AD and the Black Death of 1348, the most deadly scourge mankind has ever seen. It hit the country full force in October and during that one dreadful month killed an average of almost a thousand persons a day.
Everybody called it Spanish flu possibly because first news of it came through Spain -but to this day nobody knows exactly where it began or why or, for that matter, what caused it. But we do know that it killed more than twenty million people, most of them in the prime of life twelve millions of them in India alone, more than two millions in Europe.
In North America more than a half a million U. S. citizens died, and almost as many Mexicans. It is impossible to discover exactly how many Canadians died, but estimates range !>etween
thirty thousand and forty-five thousand. The Department of Health and Welfare in Ottawa states, “one sixth of the population was affected.”
Flu broke out everywhere; in crowded cities, on farms, in lonely trading posts. Many people believed the germs were carried on the winds, and nobody has come up with a more satisfactory explanation for their almost simultaneous appearance in so many widely scattered areas.
It would be almost impossible to find a Canadian over forty who doesn’t remember the flu, either because he had it himself or someone in his family did. It struck with devastating suddenness. In Nokomis, Sask., in my own family, my father G. A. W. Braithwaite, my mother, and the seven of us children were all in bed at the same time. A visiting uncle was also sick. Mother barely managed to prepare meals. Neighbors were no help because they had it, too. Finally the town policeman came to the house to milk the cow and kill a chicken. Both of the town’s doctors were so busy that the father of one of them came out of retirement to assist. I remember the old doctor promising me a bag of chocolates for taking a dose of castor oil—I was eight at the time. I never received the candy because the elderly physician, like so many other medical men, worked himself into a state of exhaustion, caught flu and died.
Similar stories are told about nearly every Canadian community. In Calgary a young mother whose husband had been killed at the front caught the flu and died suddenly, leaving two small
children. In Montreal a sick mother was found in bed with her two-year-old daughter dead beside her. A Brandon, Man., wife remembers desperately giving her critically ill husband cold baths at night in their apartment above a hardware store while from the street below she could hear the eerie rattling of the carts collecting the bodies of the day’s victims.
Prairie homesteaders, living great distances apart without telephones, had no means of calling for assistance. A woman near Hanley, Sask., remembers how she and her family lost several of their best cows because no one was strong enough to milk and feed them. Their greatest problem, she remembers, was keeping the wood-burning stove supplied with fuel in below-zero weather. By Liking turns they barely managed enough trips to the woodpile.
The Rev. T. D. Jones, a retired United Church minister now living in Streetsville, Ont., has vivid memories of the fight against the flu in Lamont, Alta. The four schools in the area were converted into hospitals and every able-bodied person recruited to help take care of the sick. “The thing I remember most vividly,” he says, “is how the big, strong, deep-chested chaps seemed to take it the worst. One young man came to the school where I was in charge and said that although the doctor had ordered him to bed he really wasn’t sick. His temperature was 1043^. We put him to bed but soon he was delirious and we had to tie him down. Poor fellow died within two days.”
A Halifax doctor tells how on some ships, especially those with Asiatic crews, more than half the ship’s company would be down with the disease. Many ships were held in quarantine and their crews taken ashore for treatment.
Montreal was one of the hardest hit cities. Three thousand and twentyeight citizens died in one month, two hundred and one of them on the worst day, Oct. 21. In his book, Four Centuries of Medical History in Canada, John J. Heagerty estimates that one hundred thousand Montrealers had the flu. Persons living along streets leading to the cemeteries, he states, kept their blinds drawn to hide the “almost continuous procession of hearses and other vehicles conveying the dead to their last resting places.” Coffins were piled up at t he cemeteries, grocery wagons were pressed into service to supplement the hearses.
An undertaker in Toronto recalls, “At the peak we were holding funerals every hour, day and night. I once went for three days and two nights without sleep. Several times we buried whole families, mother, father and two or three children, within one week. Another undertaker downtown had twenty-three bodies stacked in a garage for a day because there was no room in his establishment. Double and triple funerals were common.
“It was almost impossible to get help. As soon as an assistant learned that a person had died of Spanish flu he was out of there like a shot. At the cemetery they were storing bodies in vaults while the grave diggers got caught up.”
Doctors who worked through the pandemic remember it as their hardest and most hopeless job. A Brampton, Ont., physician remembers finding whole families in bed and not a nurse to be had. “It wasn’t like anything we’d ever seen,” he said recently. “It struck so fast that people were seriously sick before they realized it.”
The first signs were usually severe pains in the back and loins. A businessman who walked to work in the morning was stricken at ten and carried home on a stretcher. A carpenter couldn’t complete the sawing of a board. One woman took ill in the middle of a game of whist and couldn’t finish the hand. In some cities hotel managers hired nurses to take care of guests suddenly hit by the flu.
The attacks were characterized by exceptionally high fever, severe pains in the limbs, neck, eyes and head, prostration and often delirium. Sometimes there were violent nosebleeds or stomach disorders. Often the lips and other parts of the body turned blue. The disease ran its course in two to three days, after which the patient either recovered rapidly or developed secondary infection — pneumonia or empyema—in which case there was little hope. Often the attacks were attended by a feeling of deep depression; suicides were common.
Doctors prescribed complete rest along with quinine or castor oil or brandy. Sometimes these remedies worked and sometimes they didn’t. “If everybody could have stayed in bed and got all the rest they needed, my guess is that the death rate would have been cut in half,” one doctor says.
Investigation has shown that there were three waves of flu during 1918 and
1919. The first often called “three-day fever,” broke out in June 1918. It was common in Western Europe and soldiers on both sides came down with it. Many Canadians at home had it, too. It didn’t amount to much, was like measles without the rash and caused few deaths. The second wave hit in the early fall of 1918, reached its peak in October and, in many localities, hung on until December. This was the bad one that accounted for nearly all the deaths. The third wave came in February and March of the next year and was much like the first one.
As far as can be ascertained the killer flu of the second wave first appeared in Canada among troops stationed in the Hamilton-Toronto area on the last day of September. Although the pandemic had already been raging for a full month in the United States, Canadian health officials displayed a peculiar nonchalance toward it.
Two hundred RAF cadets at Toronto had come down with the disease, but air force authorities said the situation was well in hand. Dr. C. J. O. Hastings, the city’s medical officer of health, said
it w’as “just plain grippe.” Col. J. W. McCullough, provincial health officer, reported sending out a circular letter of instructions to all doctors in the province, but remarked that “the public has been unduly alarmed already.” Mayor Tommy Church criticized the military for failure to move troops to warmer winter quarters in the exhibition grounds provided by the city, and demanded action from medical health officials. A number of cadets at Hamilton Air School also had the disease and the authorities were giving them “plenty of outdoor exercise, route marches and athletic games.”
The first reported death in Toronto vas that of a twelve-year-old girl from in outlying suburb. Before leaving home on a Wednesday she complained of a slight cold, but nobody thought anything of it because the rest of the family had it, too. On the journey into the city she complained to her mother of chills and a severe headache. Before she reached Toronto she was delirious. Her mother put her in hospital on Thursday. Saturday morning she died.
There were three cases in the Toronto hospitals and they had been placed in the detention ward for communicable diseases.
On Oct. 1 Hastings issued orders for children with colds to be sent, home from school and achvised the public to walk more and keep out of streetcars. At the same time he stated that there was “absolutely no need for anxiety.”
By Oct. 4, five hundred and forty members of the armed forces in Toronto were down with flu. Reports of the epidemic were coming in from outside points. Cadet Jeoffry H. Scot t , stationed at St. Johns, Que., died within six days of the first symptoms. Georgetown, Ont.., reported fifty cases, Renfrew between five hundred and six hundred with nine deaths. All hospitals in Renfrew were full, doctors were working night and day, and it was impossible to get enough nurses. Schools had been closed.
Sherbrooke, Que., reported eight deaths; London, Ont., had sixty-five cases; Brantford reported twenty-five hundred cases and the closing of all public buildings.
By the middle of October the disease was raging all over Canada. Ten thousand of the sixty-six thousand Toronto school children were out with it along with one hundred and twenty-four teachers. Sixty-eight Toronto citizens died in the twenty-four hours of Oct.. 15. Police forces and fire departments were working at half strength. At one point it was almost impossible to place a long-distance call because so many operators were home sick. An Ottawa-McGill football game was called off and racing was suspended at most tracks.
Schools, theatres, pool halls and sometimes churches were closed in most cities and towns. House; parties and social gatherings were discouraged. In Winnipeg all public assemblies were discontinued. In Toronto conventions were banned, including that of the American Public Health Association. Some judges stopped kissing the Bible in their courts. But. nothing had any apparent effect on the spread of the disease.
According to the Toronto Star, pathologists at the University of Toronto asked the Riverdale Zoo for three monkeys on which to experiment. They promised to pay thirty-five dollars each for the animals if any harm came to them. Zoo officials said nothing doing. They didn’t, want any monkeys that had been inoculated with flu germs and insisted on cash on delivery. Toward the end of the pandemic the Connaught Laboratories, with or without monkeys, did produce a serum consisting of dead flu germs for the prevention of the disease, but there was no evidence that it saved any lives.
In their desperation and helplessness people tried anything and everything. Streetcar conductors, store clerks and others forced to face the public tried wearing gauze masks that covered the nose and mouth, but they proved too much nuisance and were soon abandoned. Others carried wads of cotton soaked in eucalyptus oil and
sniffed at them constantly. Sulphur was burned in houses. Many people hung camphor bags on strings around their necks. Others advocated eating garlic and onions. Some believed that plenty of alcohol taken internally was the best treatment and pubs and bars advertised, “Come in. Don’t take a chance on the Flu.” Dr. J. B. Cullen scoffed at the drinking cure but advocated baîhing in alcohol instead. Still another doctor claimed to be curing the disease with a combination of iodine and creosote.
The sellers of patent medicines and cure-alls had a field day. An advertisement for a remedy called Pep described it as a germ killer that was handy, convenient, pleasant to take and causing no disorder to the stomach. Another proclaimed: “One yeast cake a day will keep the flu away.” In a Brampton, Ont., weekly paper, the Conservator, the only account of the widespread effect of the disease was an advertisement for a tonic called Tanlac.
It is probably the only time in history that druggists wished for less business. Customers filled their stores during the day and banged on their doors at night. They couldn’t stock enough cough syrup and cold remedies. One wholesale firm that normally sold six thousand bottles of cough syrup a week sold more than three thousand a day during the worst days of the flu. Customers lined up for the limited supply of quinine and Aspirin.
Since the disease lasted for only three or four days, unless the deadly pneumonia followed, and recovery was remarkably rapid, survivors swore by the particular remedy they had used.
Hundreds of trappers, prospectors, and other frontiersmen caught the disease from heaven knows where, fought their way through it, or died unattended. In Labrador whole villages were wiped out and nobody knew anything about it until the spring thaw restored communications months later. In some areas there was no one strong enough to bury the dead. Missionaries brought out shocking stories of sled dogs—starving when their owners died —eating corpses. At Okak, two hundred and seven died in a population of two hundred and sixty-six.
In other communities there were no hospitals and few doctors. Here the Red Cross, the Victorian Order of Nurses, the Salvation Army and other welfare organizations visited the sick, and helped staff the emergency hospitals. Citizens’ committees visited homes to discover where assistance was needed. Police and firemen delivered fuel and groceries to stricken families. Women’s organizations delivered broth and jellies from central kitchens.
The disease died down as quickly as it had flared up. By the end of October it was on the wane in most communities and by Armistice Day, most people were able to be out dancing around the bonfires where spiked helmeted effigies of Kaiser Bill burned to a crisp. By Christmas the virulent wave of the influenza pandemic had passed leaving thousands of orphans and wrecked families behind.
Today, more than thirty-four years later, there are still many unanswered questions about the disease. Why, for instance, was it so deadly to the young-adult group and comparatively
harmless to the very young anc very old? A graph of mortality rate age groups covering the period of pandemic shows the greatest increase in the thirty to thirty-nine-year-old group. The twenty-to-twenty-nines suffered just a little less, the fifteen-tonineteens less again, while those under ten and over forty showed a comparatively small increase.
Although an immense amount of research has been done in several countries since 1918 there has been no great advance in sure knowledge about influenza. Pathologists are pretty well agreed that the pandemic was caused by a filtrable virus, but the Rockefeller Institute of Medical Research warned recently:
If and when another pandemic of influenza should occur, it is to be hoped that it may be possible to establish directly the etiology (cause) of the disease. Until such time, however, it is of great importance to recognize that the cause or causes of previous pandemics, including that of 1918-19, are not yet known.
Researchers have isolated strains of influenza viruses which they call A and B. But there appear to be many others. Of thirty-two strains of influenza virus isolated from fifty-eight throat washings taken from different parts of Canada in 1949 only two could be identified with certainty. All of Canada’s postwar cases have been mild except, for some unknown reason, those on Victoria Island in the Arctic where seventeen of sixty-seven Eskimos who caught the flu died.
What are the chances of another influenza pandemic and what can science do to prevent it?
The disease has descended upon men since earliest times. Hippocrates describes an outbreak—undoubtedly the same disease—in Greece in 412 B.C. Canada has had epidemics in 1700, 1830 and 1889-90. None of them, however, was as severe as the 1918 attack.
There has been talk of magic vaccines that would prevent a future outbreak but so far few doctors care to guarantee that any of the vaccines yet developed would be of any practical help. Vaccines have been developed for A and B strains of the virus. The culture is grown in eggs, removed and refined by an involved and costly process. According to Dr. Arthur F. Peart, chief epidemiologist of the Department of Health and Welfare, Ottawa, “the immunity is specific for each strain of virus and is relatively short and uncertain. The results so far have not justified the widespread use of influenza vaccine in influenza pandemics.”
Other epidemiologists state flatly that no vaccine yet discovered could give any practical protection. In the first place a vaccine must be given before the disease is contracted so that the body can build up its own defenses. This would mean vaccinating everybody every two months (the effective length of the vaccine), an impossible task. In the second place, if another pandemic were to break out it would first he necessary to isolate the virus that is causing it, then develop a vaccine for that virus. By that time, since flu strikes fast and hard, it would be too late to do much good.
What, then, are our defenses? Medical men believe that secondary infections which were found in the lungs of many fatal cases in 1918 were the main causes of death. These can be combated, they point out, by sulfa drugs and antibiotics. Some doctors even speculate that some of the flu scares of recent years might have developed to pandemic proportions if it hadn’t been for these drugs.
But nobody knows for sure. ★