Book – “Influenza 1918: Disease, death, and struggle in Winnipeg” by Esyllt W. Jones (2007)

The COVID-19 Pandemic has turned our world upside-down. I wanted to do what I usually do in difficult times, which is to educate myself on what we were up against. Although the novel coronavirus is new, pandemics are not. The world has had other deadly and highly contagious microbes that it has dealt with, and it is documented in history. There are similarities to the Influenza of 1918-1919, also known as the “Spanish Flu.”

There are many books written on pandemics, and I wanted to start with something closer to home. I live in Winnipeg, Manitoba, Canada, and my late grandfather (Hilton Arthur Davis, see the photo of him and his family below) used to tell my mother, Virginia, stories about how, when he was 7-years-old, there was a flu outbreak, and he lost his father and a sister in the spring of 1919. My great grandfather (Arthur Hilton Davis see photo above) and his daughter (Muriel Davis) are now buried in the Brookside Cemetery here in Winnipeg (date of death April 4, 1919). My grandfather was laid to rest with them (and his mother) many years later.

“Influenza 1918” by the historian Esyllt W.  Jones is a scholarly volume, based on the research she did during her post-doctoral fellowship at the University of Winnipeg. It is well-edited and referenced, making it a credible read. My current lived experience during this pandemic has already been made more understandable by having a glimpse into what my ancestors dealt with. Some were survivors; some were victims. I feel closer to them now after having devoured what Jones has revealed to us through her investigative and thorough research.

We are a month into the COVID-19 Pandemic, which was proclaimed on March 11, 2020. Manitoba’s Premier Brian Pallister declared a State of Emergency on March 20, 2020. Prime Minister Justin Trudeau has been taking the lead on the pandemic, with most of his press conferences delivered from his home. His wife, Sophie Gregoire Trudeau, had tested positive for the novel coronavirus, and both she and the Prime Minister were self-isolating (March 12, 2020). There is no better way to get an official leader on board with effective pandemic planning than having a spouse diagnosed with it. We are very fortunate here in Canada to have a federal leader and provincial premiers who “get it” and are making important decisions to help “flatten the curve,” in the hopes of saving lives. The latest prediction by our Canadian government is that we will lose 11,000 – 22,000 lives to COVID-19. We can keep that number on the low end if we all do our part by staying home (unless necessary), practicing physical (social) distancing (2 metres/6 feet apart), washing our hands often, not touching our face, and wearing a cloth mask when out in public to help reduce the chances of spreading our germs.

Jones has uncovered many facts and stories to help us understand what Winnipeg went through during 1918-1919. World War 1 had been raging for the past four years when the influenza epidemic (the flu) hit Winnipeg. The first signs of the flu started in March of 1918 in the USA, and it took a few months to reach our city. A truce was declared on November 11 in 1918, as the flu raged on. Sandwiched between the First World War (1914-1918) and the Winnipeg General Strike (May – June 1919), it is estimated that in a city of 180,000, the flu took the lives of 1,216 Winnipeggers. Thousands were infected. Globally, it is estimated the flu claimed between 50 and 100 million lives. Why was this monumental event practically glazed over and forgotten in our human history? Historians, epidemiologists, and others ask the same question.

I will now share some of the highlights in “Influenza 1918” that I found helpful and insightful. When we are up against what many have called an “unprecedented” and “unchartered” time, many of us feel unsettled, afraid, and anxious. Stress can be at an all-time high. Not knowing what the future holds can cause us to have difficulty coping in these uncertain times. “Influenza 1918” sheds some light on what has been done in the past, illuminating what was done right and what could have been done differently.

The book has seven chapters, covering a range of topics. Some chapters were of more interest to me, so you will have to read the book to get the “whole story.” The introduction provides a lay of the land and says the flu arrived in Winnipeg on September 30, 1918. The flu had travelled along with soldiers and “troop trains” carrying war veterans all across Canada. Mail boats were also suspect. Sydney, Nova Scotia, had had five deaths by that date. The early strategies implemented in Winnipeg were similar to those used by our neighbours in the USA, which was to educate the public and to reduce crowds. In our modern-day pandemic, we are doing that. We have also put in additional strategies such as frequently washing our hands, physical (social) distancing, not touching our face, staying home if we are sick, self-isolating for 14 days when we return from travelling, staying home in general, and the ultimate extremes of closing our borders and non-essential services.

Chapter One, “Influenza Spans the Globe.” Although there is some debate about how and when the flu started (a variant of Influenza A), many historical accounts point towards the first wave starting in the spring of 1918 in a military camp in Kansas. I watched a PBS documentary, “American Experience: Influenza 1918,” and they think it was when the soldiers were burning a pile of manure. These soldiers came down with an illness on March 5, 1918. The documentary uses the date of March 11, 1918, as the start date (this is very ironic, as the WHO declared the COVID-19 outbreak a pandemic on this day, 102 years later). The second wave began in either France or the USA in August 2018. In Winnipeg, the peak of the epidemic arrived in early November 1918. Nearly 700 new cases were reported to the health authorities daily. Many who died had not received any medical care. The flu had arrived in Winnipeg on the second of its third global waves. A less severe wave followed in early 1919, which is when my great-grandfather and one of his daughters succumbed to the illness. My late grandfather, a young boy at the time, told my mother (his daughter) of the flu epidemic, and he recounted memories of seeing boxes and caskets outside of houses.

Symptoms of the Influenza A variant included some mild and some severe:

• General depression
• Chills
• Fever (sometimes 105 degrees)
• Headache
• Pain in the legs
• Weakness and dizziness
• Sore throat
• Congestion
• Frequent vomiting in severe cases
• Respiratory infections (bronchitis and pneumonia)

For those afflicted, there was no medical cure, so they were “urged to rest and get plenty of fresh air.” There were many alternative and home remedies such as hanging mothballs around the neck to prevent infection and violet-leaf tea. Some advice was harmless; other advice was quite the opposite. The recommendation to use enemas perhaps caused more harm than it helped, as it caused more dehydration in the already dehydrated flu sufferers. The only advice I have been given by my doctor (and I am immunosuppressed) is to take Vitamin C supplements to help strengthen my immune system.

This flu was often fatal, and the most considerable number of deaths occurred in people between the ages of 20-40 (my great-grandfather was 39, my great-aunt was 6). The flu rarely took the lives of the very young or very old. The wealthier population, those with better food and shelter, suffered less than those who were poor. It has been estimated that Canada, with a population of about 9 million in 1918, experienced a loss of 55,000 people to the flu. This is equivalent to about 6.1 people per 1,000 (similar to India, England, and the USA). The death rates were higher in Italy and Spain (10.7 and 12.3 respectively) and tremendous in Western Samoa (236.1) and Cameroon (445.0).

Various strategies used to combat the flu included:

• Quarantining entire communities
• Fumigating incoming trains, passengers, luggage, and public transportation
• Masks (in some communities it was optional, in others compulsory)
• The public was told to avoid congregating
• Closing schools, universities, medical school, boarding schools
• Closing cinemas, theatres, billiard rooms, and other places of entertainment
• Closing lodges,
• Banning exhibitions and all public meetings and gatherings
• Closing churches (less often)
• Health authorities urged rest and plenty of fresh air
• Prompt reporting of cases by physicians and the general public
• No involuntary hospitalization or strict quarantine of the infected

After all was said and done, public health authorities tended to agree that civil cooperation and education were preferable means of disease containment, and were more effective than compulsory measures such as placarding homes and the wearing of masks.

Chapter Two, “Winnipeg 1918: Social History and Public Health,” provides the context on what the social and economic situation was like. In 1916, Manitoba women were the first in Canada to be given the right to vote. Many people had come to Winnipeg not because they had money, but because they wanted to make money. There was no universal health care in Canada until 1961. Those with money were able to afford hospital care. Some immigrants were poor, and they lived mainly in the north end of Winnipeg. The southern end had more wealth. The Winnipeg General Hospital was the largest privately-run hospital in the city (now known as the Health Sciences Centre). In 1918-1919, community-based nursing care service provided a significant and essential component of the influenza response. The nurses treated many immigrant families of the Margaret Scott Mission.

Chapter Three, “Every Citizen a Health Officer: Influenza in Winnipeg,” describes how each citizen of Winnipeg was encouraged to feel as if they were a health officer. Fifteen sick soldiers were scheduled to arrive in Winnipeg on a military train on September 30, 1918. It was difficult to contain the flu during wartime, as the war took precedence over public health. The government was not able to contain the disease, so Winnipeg citizens were encouraged to help enforce health measures. The motto was, “Help the authorities to suppress the flu.” Military travelers were considered one of the main vectors in the spread of the flu – especially for the prairies, and for Canada as a whole. Nowadays, the leading carriers of the virus are travelers, especially those from China, the US, Italy, and Spain. Packed airplanes and congested airports are of concern as are any densely populated communities, including cities, cruise ships, hospitals, and long-term care facilities.

If you or anyone you know is on social media, such as Facebook, you will see many memes and posts by your friends and family telling people to “Stay home.” Many of us have become health officers and promoters of the “safer at home” and “stay home” guidelines to help reduce the spread of the COVID-19 virus, therefore “flattening the curve.” Some of us have even become enforcers of the physical (social) distancing rule of two metres. You may hear someone telling you to “wash your hands” or “just stay home.”

On Monday, October 7, 1918, two infected soldiers died in Winnipeg while two others lay near death.  The local paper, the Winnipeg Tribune, and the Free Press were publishing articles soon after, some more alarmist than others. In attempts to prevent hysteria, the news of the spreading illness was presented by using facts, reassurance, and even humour. The Liberal government, at the time, preferred to avoid the sensationalization of the outbreak. The first civilian death in Winnipeg was reported on Thursday, October 10, 1918. Eventually, the Free Press started to publish articles that were more alarmist in tone. Humour was used to help to make the crisis emotionally more manageable. But come mid-November, the appropriateness of comedic relief was long gone.

Winnipeg’s first public health response was to ask the ill (“victims”) to respect a period of quarantine in their own homes. Compulsory isolation in hospitals or placing a health department notice (“placards”) on the homes of those infected was not enforced. Reporting was instrumental in helping the authorities determine when the outbreak would peak, and they paid particular attention to poor and immigrant districts. It was soon realized that this was not a disease of the poor and that anyone was at risk. By October 12, 1918, there were 48 known cases of the flu in Winnipeg. On Friday, October 18, what has been called “Black Friday,” 20 patients were admitted to the King George Hospital. The next day, officials reported on October 19, there were 330 cases of influenza and eight deaths in total. Health authorities talked about the “crest of the wave,” whereas now we talk about the “peak of the curve.”

A vaccine was favoured instead of placarding homes, as it was thought that people would be less willing to report cases. A new aggressive vaccine campaign ensued, with no positive effect. At the end of October, the number of cases was doubling daily and then rose to over 300 cases and over ten deaths per day. City public health officials later announced they would commence the placarding of all infected houses on October 31. Strict quarantine measures were necessary, and differences in the spread of the flu in educated and uneducated districts became evident.

Unfortunately, it was difficult to enforce the placarding and quarantine measures, and on top of that, 25 members of the police force were down with the flu by the end of November. A balancing act was needed to generate enough concern by the public but avoiding too much concern that would evolve into fear and panic.

On November 7 and 8, the Free Press mistakenly announced that a World War 1 truce had been declared. Impromptu crowds of celebration sprung up all over the city, “dispelling the epidemic’s ‘sensation of gloom.’” On November 11, a “joy fest rage” swept the city, and Winnipeggers were celebrating the end of the long war. These celebrations were not broken up by the officials, as it was determined, “If the people were told what to do to avoid the disease and they don’t do it, it’s up to them.” (Douglas). Four hundred nine (409) deaths were reported by November 18.

The turning point occurred on November 21. The crest of the wave had been reached, as only 195 cases of the flu had been reported the previous day—the lowest number since October 26. Deaths stabilized at nearly 30 per day. The public meeting ban had lasted 46 days, ending on November 25. The ban had caused “considerable unrest among businessmen.” By November 30, there were 122 new cases and 12 deaths.

The third wave of the influenza epidemic arrived in Winnipeg in mid-March. This time there was no placarding, no quarantines, and no public meeting bans. Two thousand three hundred forty-two (2,342) cases and 301 deaths were reported. I can only imagine the horror and grief my grandfather, his siblings, and his mother endured that spring on Home Street. Comparing to the fall wave, which took 915 lives, the third wave was milder but deadly for many. Most people died at home as there wasn’t sufficient accommodation in hospitals. I often wonder if the public health authorities had taken more measures as they did in the fall if my ancestors would have survived this last wave.

Chapter Four, “Volunteers and Victims: Women’s Relief and Social Order,” describes the volunteerism of over 650 mostly Anglo-Canadian women who provided help to those affected by the flu. These women were the faces of compassion and heroism, as hospitals and community nursing were not able to keep up with the demand. Many of these women did not have nursing training, however. Female teachers were highly sought after as volunteers. These volunteers were caring for the diseased. Providing personal care, feeding, comfort, and “easing the deaths” of the infected flu victims was a female role at the time. Men rarely stepped up to do this type of work. Unfortunately, many of the nurses and volunteers who cared for the ill became ill themselves. These women were seen as being courageous and brave. Sadly, “seven nurses in Winnipeg, some trained and others who were volunteers, died of the flu.”

In today’s pandemic, the volunteer call has not been made yet here in Winnipeg. I have seen it being done in New York, however. Here, I see acts of volunteerism springing up as women are making cloth masks (for example, my husband’s aunt made me some, and my friend received four homemade masks the other day from her female coworkers). Men and women are doing shopping for others. There is a new program in Winnipeg called the “Student-Senior Isolation Prevention Partnership,” where health professional students are providing weekly phone calls to seniors to help alleviate isolation. It is also important to note here that those 60 and older and those with underlying medical conditions are more at risk of dying from COVID-19 complications.

Chapter Five, “‘Men Cannot Be Allowed to Starve’: Influenza and Organized Labour,” explores the conflict that was generated by the disease. The working people, the public health authorities, and the state all experienced conflict because of the flu. Of note, it is possible to read about the Winnipeg General Strike of 1919 without knowing Winnipeg was confronting and had just endured a devastating disease. The Influenza of 1918-1919 came and went without much acknowledgment by the historians who covered the strike.

The bans on public gatherings and closures of businesses such as theatres and billiard rooms provoked opposition from the working class because of the economic hardship it caused them and their families. The modern-day Liberal Canadian government has pledged to financially support those who lost their jobs in the current pandemic, as well as businesses. This will hopefully help encourage people to stay home and help reduce the spread.

Chapter Six, “Influenza and the Construction of Collective Identity,” includes a look at the challenges to disease prevention and cure. Public health authorities believed that the flu could be avoided if people took the proper precautions and avoided panic.

THEN – For those who were stricken with the Influenza of 1918-1919, they were instructed to:

• Go to bed at once and get rest and warmth
• Take warm drinks, broths
• Good nourishment
• Good hygiene
• Send for your physician as needed

NOW – Current guidelines on how to treat COVID-19 symptoms include:

• Stay home
• Rest
• Drink frequently, 1.5 litres of warm or cold liquid/day
• Protect your entourage by self-isolating in your room until you feel well
• Use a separate bedroom and bathroom if available (don’t share towels)
• Keep your environment clean, wash surfaces with disinfectant
• Monitor symptoms and call your doctor or public health line for guidance
• Seek help if needed
• Stay informed

Workplaces were sites of contagion. People went to work even when they were ill. Many disobeyed the bans and quarantines. Those in public service and professional occupations – doctors, nurses, social workers, and child welfare workers – were undoubtedly at high risk.

Women were not only experiencing the ‘pains of war,’ but also the pains of the influenza epidemic as well. Then came the working-class strains and then the General Strike of 1919.

Influenza preventatives in 1918:

• Camphor
• Sulphur
• Eucalyptus oil
• Raw garlic
• Poultices of hot bran
• Lard mixed with camphor and chloroform or turpentine
• Goose-grease

Sore throat remedies:

• A sip of oil of cinnamon
• A drink made of warm milk, ginger, sugar, pepper, and sugar

Alcohol was traditionally an essential prophylactic, and it was almost impossible to obtain unless a physician prescribed it. The officials stated that alcohol was not a treatment; however, pharmacists were accused of price gouging prescription medications that contained alcohol. Now the wine is pouring freely, and our liquor stores are deemed an essential service. Also, the current guidance is that any hand sanitizers we used should contain at least 60% alcohol!

The other interesting note here is that we have been encouraged to use household cleaners such as “Lysol wipes” or diluted bleach to help eliminate the COVID-19 virus. Back in 1918, they were “fumigating.” Not sure what they were using to fumigate with. Fumigating certain areas of hospitals, ships, planes, and trains sounds like a good idea if you ask me.

Chapter Seven, “Family Life after Influenza: Single Parents and Orphans.” Winnipeg lost many adults between the ages of 20 and 39. Like my grandfather, many were married and had children. Many single parents and orphans were left behind. Social supports, generosity, and community reciprocity helped these grief-stricken families get back up on their feet. The Winnipeg Children’s Aid Society and the Manitoba Mother’s Allowance provided resources and supports as needed. Men were more apt to remarry than women. Women were more prone to rely on friendships, family, and neighbours.

The “Conclusion” points out that the influenza pandemic of 1918 as the “best documented but least known pandemic in history.” Containment measures such as quarantine and placarding homes seemed to be ineffectual. The mask order, which lasted about a month, “had no apparent impact upon the increasing number of flu cases.”

Perhaps they could have considered adding the current guidelines:

• Physical (social) distancing (of at least two metres/six feet)
• Cover your cough and sneeze with a tissue or cough into your sleeve
• Keeping groups down to 10 or under
• Washing hands frequently with warm soap and water for at least 20 seconds and using alcohol-based sanitizer (at least 60% alcohol) if soap and water not available
• Wearing cloth masks when out in public to help prevent the spreading of droplets to others
• Staying home except when needing to get essentials such as groceries or medications
• Working from home when possible
• Self-isolating for 14 days after travelling or if feeling unwell

There was price gouging in the funeral industry, pharmaceuticals, and home remedies such as eucalyptus oil. Today, we see dwindling and high-demand supplies such as toilet paper and Tylenol. A positive side-effect we are experiencing for the average household is a decrease in the cost of gasoline – with prices currently at 66.9 cents per litre (CAD).

As the current pandemic days, weeks, and months ensue, we will be writing a new chapter in history. What will our “Pandemic 2020” book have to say about how our society handled this traumatic and life-changing event? How do we want it to go down in the books? Will it be discussed in the news and then disappear, much like the events of 1918-1919? What will happen to us? What will the world look like after the dust has settled?

If you are just as curious about your family tree as I am, check to see if you have any relatives who died in 1918 or 1919. They may have been a victim of the Influenza pandemic just like my great-grandfather and his daughter. Let me know if you find out anything, or you think I can help.

One can only hope our history will influence our future, and we can learn from it. Books like “Influenza 1918” by E. W. Jones helps shed light on our past and helps us cope in the present. Consider getting a copy of her book and see what you can glean from it. We will come together as a family, community, country, nation, and the world, supporting each other through this current pandemic.

You may also be interested in CBCNews (11 Apr 2020): How the Spanish flu compares to COVID-19: Lessons learned, answers still being pursued

Angela G. Gentile, MSW, RSW

http://www.AngelaGGentile.com