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The Last Plague: Spanish Influenza and the Politics of Public Health in Canada
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.
- GenresNonfictionCanada
348 pages, Hardcover
First published May 30, 2012
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December 3, 2022
Good for essay
August 6, 2022
The 1918 influenza pandemic was the second deadliest pandemic in human history, surpassed in mortality only by the 14th-century “Black Death”. In The Last Plague, Mark Osborne Humphries offers a comprehensive national perspective on the pandemic experience in Canada. His book places special emphasis on the federal policy changes which stemmed from the government’s confrontation with this unique and devastating form of the H1N1 virus.
Like the Great War that ran concurrent with it, the 1918 influenza pandemic – more commonly known by its misnomer, the “Spanish flu” – was a major catalyst for world-historical change. The Last Plague does an excellent job showing how the young Dominion was implicated in these tectonic shifts in global health politics and disease management.
From 1832 until 1918, the federal government’s approach to communicable disease was essentially outward-facing and reactive. In the popular imagination, the nation was conceived as a “social body”, which was something akin to the individual human body writ large. This manner of thinking was quite common in the 19th-and-20th-centuries especially, and we can see the organismic analogy of nation-states recurring throughout European and North American thought. In Humphries’ interpretation, Canada was imagined as such a living organism – an “organic whole” that was naturally healthy, robust, and pure. Those qualities were dictated largely by Canada’s rugged northern geography and its racial makeup.
Under this organismic view of national health, if the nation became ill, it could only be due to external influences getting inside the “social body”. No other explanation became possible in this outward-facing framework. Thus, the main objective of the medical community was to keep pollutants and diseases out of Canada. Quarantine and immigrant screenings amounted to little more than the characterization of foreigners as pathogenic, diseased, and sick. Indeed, when immigrants were viewed as disease carriers, they also became the very embodiment of disease themselves. For all intents and purposes, foreigners were pathogens in the popular imagination and in their treatment at the ports.
Federal health policy was therefore built upon artificial divisions reified as laws of nature. Humphries brilliantly shows how Canadian physicians followed the implicit logic of this organismic concept of nationhood to rely on Maritime quarantines and immigrant screenings as the primary strategies for keeping Canada healthy. Of course, both practices were highly xenophobic and racialized. Yet for Canadian physicians and federal politicians, this disease model legitimized itself, as it appeared to be successful in managing other epidemic diseases, such as bacterial illnesses like cholera.
Safeguarding the borders seemed to work – that is, until 1918, when Maritime quarantine proved useless against the spread of influenza. When it struck, the Canadian “social body” became gravely ill. Quarantine failed because flu is an opportunistic disease; it therefore crossed borders through whatever host it could, not only through racialized and foreign bodies, but through racially familiar ones as well. As Humphries notes: “Disease had been ‘othered’, identified with those who were visibly ‘foreign’, so the American border was not regarded as a significant source of infection.” Canadian authorities put all of their eggs in one basket, trusting the supposed infallibility of xenophobic quarantine methods. Canadian citizens paid for that naivety and lack of understanding with their own lives.
The severity of the pandemic alongside the war effort necessitated a new way of thinking about disease, statehood, and federal health policy. Canadian citizens believed that they had paid the ultimate sacrifice to the state twice over – once through the Great War, and again through the “Spanish flu”. In the hearts and minds of Canadians, the ruptures and devastation caused by those two world-historical events opened up a space for the renegotiation of their statehood. As peace drew the war to a close, the aura of tragedy and disillusionment called the role of the state into question. Humphries described this change quite aptly, suggesting that Canadians felt their “covenant” with the state entitled them to certain guarantees of liberty, health, and wellness that were simply not being met.
The post-war reconstruction period thus became an opportunity to retool systems of government, with an eye toward better serving the public that dutifully served the nation. A reciprocal relationship between the state and its citizen-subjects was emerging, and “[t]he 1918 flu provided the impetus for change […]”. The result was the creation of the federal Department of Health in 1919, which refocused the medical gaze inward at the provinces and municipalities, rather than exclusively on the national borders. The new department signified a break away from the age of strict quarantine and xenophobic screenings, toward an emphasis on public health education, disease prevention, standardized practices, and greater centralized control. In other words, it marked the transition from reactive to proactive biopolitics at the federal level of government. The Department of Health was, according to Humphries, one of the biggest steps toward realizing the modern welfare state in general, and achieving socialized medicine in particular. If the assassination of Franz Ferdinand was the spark that lit the Balkan powder keg and began the Great War, then in the context of federal health reform in Canada, one could describe the Maritime quarantine system as the powder keg, flu as the spark, and the Department of Health as the result.
All of these points are convincingly argued by Humphries, yet there are elements of his conclusion that make me uncomfortable. At times, his argument implies a teleology of progress in Canadian health. On the one hand, it’s hard to deny that things are better now than they were back then. Vaccines, education, and a consensus on the validity of germ theory have unquestionably increased life expectancy and dramatically improved the quality of life for Canadians. The primary sources on display in The Last Plague are especially heartbreaking, and they really drive the point home that we’ve certainly come a long way since 1918.
However, the reality is not quite as neat and tidy as Humphries believes. If the medical gaze was redirected inward, as Humphries suggests, then it clearly did so at the cost of lugging all the externalized baggage along with it. Humphries concedes this point, but he doesn’t go far enough in his acknowledgment. He notes: “As the medical gaze turned inwards to examine the practices and behaviours that spread disease, immigrants remained problematic. But they were no longer seen as the sole vector. Exclusion continued to have social and economic functions, but it became less important to disease prevention strategies.” Other historians may disagree, and some have even suggested that the role of excluding the Other actually became more important once this gaze was turned inward. For instance, Elise Chenier’s study of sexual deviance and paraphilia in post-war Ontario, Strangers in Our Midst, is one example of this line of counter-reasoning. In her analysis, Canadian mental health professionals fused male homosexuality with the epidemiological model of infectious disease and the criminogenic model of paedophilia. Once again, the scientific community placed public fear of racialized and gendered Others at the centre of their domestic health concerns. We can hardly say with any degree of certainty that the move from outside to inside somehow lessened the role of discrimination in the treatment of illness.
In my experience, the macro approach of national histories tend to be a mixed bag. They have the benefit of providing a bird’s eye view of historical changes, whilst connecting them to broader themes of collective social relevance. The virtues of this approach are clear enough, and Humphries’ book is definitely one of the better national histories I’ve read.
And yet, within the hermeneutic of any national or global history, there seems to be a temptation to interpret time as the flow of human progress, and the nation-state as the cradle of that onward march. In Canadian national histories especially, I think there is a very real need to refract the past through the lens of Canadian identity, values, and nationalisms. I think we can see glimpses of that tendency in Humphries’ thesis, which could be a symptom of writing national history itself.
Putting that aside, The Last Plague is still a fantastic book. It’s timely, well researched, and critically astute. Highly recommended for any audience.
Like the Great War that ran concurrent with it, the 1918 influenza pandemic – more commonly known by its misnomer, the “Spanish flu” – was a major catalyst for world-historical change. The Last Plague does an excellent job showing how the young Dominion was implicated in these tectonic shifts in global health politics and disease management.
From 1832 until 1918, the federal government’s approach to communicable disease was essentially outward-facing and reactive. In the popular imagination, the nation was conceived as a “social body”, which was something akin to the individual human body writ large. This manner of thinking was quite common in the 19th-and-20th-centuries especially, and we can see the organismic analogy of nation-states recurring throughout European and North American thought. In Humphries’ interpretation, Canada was imagined as such a living organism – an “organic whole” that was naturally healthy, robust, and pure. Those qualities were dictated largely by Canada’s rugged northern geography and its racial makeup.
Under this organismic view of national health, if the nation became ill, it could only be due to external influences getting inside the “social body”. No other explanation became possible in this outward-facing framework. Thus, the main objective of the medical community was to keep pollutants and diseases out of Canada. Quarantine and immigrant screenings amounted to little more than the characterization of foreigners as pathogenic, diseased, and sick. Indeed, when immigrants were viewed as disease carriers, they also became the very embodiment of disease themselves. For all intents and purposes, foreigners were pathogens in the popular imagination and in their treatment at the ports.
Federal health policy was therefore built upon artificial divisions reified as laws of nature. Humphries brilliantly shows how Canadian physicians followed the implicit logic of this organismic concept of nationhood to rely on Maritime quarantines and immigrant screenings as the primary strategies for keeping Canada healthy. Of course, both practices were highly xenophobic and racialized. Yet for Canadian physicians and federal politicians, this disease model legitimized itself, as it appeared to be successful in managing other epidemic diseases, such as bacterial illnesses like cholera.
Safeguarding the borders seemed to work – that is, until 1918, when Maritime quarantine proved useless against the spread of influenza. When it struck, the Canadian “social body” became gravely ill. Quarantine failed because flu is an opportunistic disease; it therefore crossed borders through whatever host it could, not only through racialized and foreign bodies, but through racially familiar ones as well. As Humphries notes: “Disease had been ‘othered’, identified with those who were visibly ‘foreign’, so the American border was not regarded as a significant source of infection.” Canadian authorities put all of their eggs in one basket, trusting the supposed infallibility of xenophobic quarantine methods. Canadian citizens paid for that naivety and lack of understanding with their own lives.
The severity of the pandemic alongside the war effort necessitated a new way of thinking about disease, statehood, and federal health policy. Canadian citizens believed that they had paid the ultimate sacrifice to the state twice over – once through the Great War, and again through the “Spanish flu”. In the hearts and minds of Canadians, the ruptures and devastation caused by those two world-historical events opened up a space for the renegotiation of their statehood. As peace drew the war to a close, the aura of tragedy and disillusionment called the role of the state into question. Humphries described this change quite aptly, suggesting that Canadians felt their “covenant” with the state entitled them to certain guarantees of liberty, health, and wellness that were simply not being met.
The post-war reconstruction period thus became an opportunity to retool systems of government, with an eye toward better serving the public that dutifully served the nation. A reciprocal relationship between the state and its citizen-subjects was emerging, and “[t]he 1918 flu provided the impetus for change […]”. The result was the creation of the federal Department of Health in 1919, which refocused the medical gaze inward at the provinces and municipalities, rather than exclusively on the national borders. The new department signified a break away from the age of strict quarantine and xenophobic screenings, toward an emphasis on public health education, disease prevention, standardized practices, and greater centralized control. In other words, it marked the transition from reactive to proactive biopolitics at the federal level of government. The Department of Health was, according to Humphries, one of the biggest steps toward realizing the modern welfare state in general, and achieving socialized medicine in particular. If the assassination of Franz Ferdinand was the spark that lit the Balkan powder keg and began the Great War, then in the context of federal health reform in Canada, one could describe the Maritime quarantine system as the powder keg, flu as the spark, and the Department of Health as the result.
All of these points are convincingly argued by Humphries, yet there are elements of his conclusion that make me uncomfortable. At times, his argument implies a teleology of progress in Canadian health. On the one hand, it’s hard to deny that things are better now than they were back then. Vaccines, education, and a consensus on the validity of germ theory have unquestionably increased life expectancy and dramatically improved the quality of life for Canadians. The primary sources on display in The Last Plague are especially heartbreaking, and they really drive the point home that we’ve certainly come a long way since 1918.
However, the reality is not quite as neat and tidy as Humphries believes. If the medical gaze was redirected inward, as Humphries suggests, then it clearly did so at the cost of lugging all the externalized baggage along with it. Humphries concedes this point, but he doesn’t go far enough in his acknowledgment. He notes: “As the medical gaze turned inwards to examine the practices and behaviours that spread disease, immigrants remained problematic. But they were no longer seen as the sole vector. Exclusion continued to have social and economic functions, but it became less important to disease prevention strategies.” Other historians may disagree, and some have even suggested that the role of excluding the Other actually became more important once this gaze was turned inward. For instance, Elise Chenier’s study of sexual deviance and paraphilia in post-war Ontario, Strangers in Our Midst, is one example of this line of counter-reasoning. In her analysis, Canadian mental health professionals fused male homosexuality with the epidemiological model of infectious disease and the criminogenic model of paedophilia. Once again, the scientific community placed public fear of racialized and gendered Others at the centre of their domestic health concerns. We can hardly say with any degree of certainty that the move from outside to inside somehow lessened the role of discrimination in the treatment of illness.
In my experience, the macro approach of national histories tend to be a mixed bag. They have the benefit of providing a bird’s eye view of historical changes, whilst connecting them to broader themes of collective social relevance. The virtues of this approach are clear enough, and Humphries’ book is definitely one of the better national histories I’ve read.
And yet, within the hermeneutic of any national or global history, there seems to be a temptation to interpret time as the flow of human progress, and the nation-state as the cradle of that onward march. In Canadian national histories especially, I think there is a very real need to refract the past through the lens of Canadian identity, values, and nationalisms. I think we can see glimpses of that tendency in Humphries’ thesis, which could be a symptom of writing national history itself.
Putting that aside, The Last Plague is still a fantastic book. It’s timely, well researched, and critically astute. Highly recommended for any audience.
June 18, 2012
n the Last Plague, author Mark Humphries argues that the Spanish flu pandemic of 1918 provided the impetus to create a federal Public Health Department in Canada. Previous to this, it had been assumed by the government and the medical profession that Canada was a particularly healthy country and that any problems like the 19th c. cholera epidemics were the result of immigration. Thus, federal policy was to quarantine immigrants as they disembarked. Otherwise, health policies were left up to the provinces and municipalities resulting in a very uneven treatment across the country.
Spanish flu changed all that. It proved that borders were porous and that diseases like the Spanish flu didn't honour them. It also showed the need for a consistent, rigorous, and proactive health policy which could be extended across all provinces and territories.
In 1919, as a direct result of the flu and the devastating impact it had had on the population, the Federal department of Health was founded. Because of the flu, Canada's attitude towards health changed from exclusionary to inclusive, and from policies which tried to deal with diseases once they occurred to being more proactive about preventing them, and most importantly, cooperating with the other levels of government to ensure that all Canadians would have equal access to health care. As Humphries points out, this was the beginning of the modern era in Canadian health care.
The Last Plague is a well-documented and a fascinating read for anyone who has an interest in the history of the Spanish flu or the evolution of Canada's health programs. Spanish flu may have been the last plague but now, at least, we are better prepared for the next.
Spanish flu changed all that. It proved that borders were porous and that diseases like the Spanish flu didn't honour them. It also showed the need for a consistent, rigorous, and proactive health policy which could be extended across all provinces and territories.
In 1919, as a direct result of the flu and the devastating impact it had had on the population, the Federal department of Health was founded. Because of the flu, Canada's attitude towards health changed from exclusionary to inclusive, and from policies which tried to deal with diseases once they occurred to being more proactive about preventing them, and most importantly, cooperating with the other levels of government to ensure that all Canadians would have equal access to health care. As Humphries points out, this was the beginning of the modern era in Canadian health care.
The Last Plague is a well-documented and a fascinating read for anyone who has an interest in the history of the Spanish flu or the evolution of Canada's health programs. Spanish flu may have been the last plague but now, at least, we are better prepared for the next.
Currently reading
May 11, 2022Review incoming
Miasma
Salubrious Canada
Diseases came from immigrants
Koch - tuberculosis bacillus - led to two thoughts- dirty soil and importation of germs
The structure follows as
- 1850 cholera epidemic led to the belief that central government needed to overhaul the medical and public health system against immigration which most infections happen in. Local governments were in charge of enforcing sanitary rules while federal dealt more with quarantining. This is why Canadian didn't do much reform as compared to US and British, they were doing well. Led to immigrants screening and detention centres - miasmatic - was in fact certain bacteria
- after sanitary measure, Canadians needed to deal with influenza in the 1890s which and this reinforced dominant ideologies and governance strategies
Then the Spanish flu in the 1918s came in 3 waves, led to scrutinization of federal government, started department of health and introduced a shift in thinking from external invasion of diseases to dealing with internal climate of the country.
War effort shaped Canadian response to flu, American soldiers brought flu to Canada and Canadian Siberian Expeditionary Force
Because locL and minunicipal government had little control, nurses began to take over - reinforced paper and marginalised were more infected
New government health department led to a change in ideologies and change in governance stategies
Studies in bacteriology, epidemiology and preventative medicine challenged the external mentality
Disease travelled faster than water Bourne or zoonic diseases
Miasma
Salubrious Canada
Diseases came from immigrants
Koch - tuberculosis bacillus - led to two thoughts- dirty soil and importation of germs
The structure follows as
- 1850 cholera epidemic led to the belief that central government needed to overhaul the medical and public health system against immigration which most infections happen in. Local governments were in charge of enforcing sanitary rules while federal dealt more with quarantining. This is why Canadian didn't do much reform as compared to US and British, they were doing well. Led to immigrants screening and detention centres - miasmatic - was in fact certain bacteria
- after sanitary measure, Canadians needed to deal with influenza in the 1890s which and this reinforced dominant ideologies and governance strategies
Then the Spanish flu in the 1918s came in 3 waves, led to scrutinization of federal government, started department of health and introduced a shift in thinking from external invasion of diseases to dealing with internal climate of the country.
War effort shaped Canadian response to flu, American soldiers brought flu to Canada and Canadian Siberian Expeditionary Force
Because locL and minunicipal government had little control, nurses began to take over - reinforced paper and marginalised were more infected
New government health department led to a change in ideologies and change in governance stategies
Studies in bacteriology, epidemiology and preventative medicine challenged the external mentality
Disease travelled faster than water Bourne or zoonic diseases
October 2, 2021
This interesting and detailed academic study of the origins of the Canadian Health Care System in response to the "Spanish Flu" shows us why we need one strong federal policy about how to deal with pandemics. It was a good first step, but we still have differences between provinces that hamper our ability to safeguard public health during an international crisis.
April 25, 2023
Another book that is likely very good but I'm too stupid to enjoy. Lol
August 7, 2012
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.
http://shetreadssoftly.blogspot.com/
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.
http://shetreadssoftly.blogspot.com/
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