Education + Advocacy = Change

Click a topic below for an index of articles:

New Material

Home

Help us Win the Fight!

Alternative Treatments

Depression

Financial or Socio-Economic Issues

Health Insurance

Help us Win the Fight

Hepatitis

HIV/AIDS

Institutional Issues

International Reports

Legal Concerns

Math Models or Methods to Predict Trends

Medical Issues

Our Sponsors

Occupational Concerns

Our Board

Religion and infectious diseases

State Governments

Stigma or Discrimination Issues

If you would like to submit an article to this website, email us your paper to info@heart-intl.net


 

~

any words all words
Results per page:

“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

We offer a monthly newsletter dealing with the various issues surrounding infectious diseases.  To find out more click HERE.

The Spanish Flu Epidemic of 1918 in Ottawa

http://www.bytown.net/flu1918.htm

 

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.