Dr. Fred and the Spanish Lady

Dr. Fred and the Spanish Lady

Fighting the Killer Flu

by Betty O’Keefe and Ian MacDonald

Heritage House; ISBN 1-894384-71-7; 2004

        The Guardian took a hard line, contending that the outbreak was a case of mind over matter. It argued that fear and not flu was the real enemy, declaring: "Remove fear and Spanish influenza will vanish as quickly as she came." (p. 62)

        As the shortage of hospital beds, doctors, and nurses became more acute, one caregiver decided to take an unusual step. Dr. Margaret Patterson knew something must be done to save the lives of the sick and dying, so she instituted a training program for volunteers that was described as a course in general preparation for nursing at home. Sponsored by the Ontario Emergency Volunteer Health Authority, the courses began October 16 and were held initially in the Parliament buildings.

She told her first students: "We must band together to fight this disease which seems to affect chiefly the respiratory organs and we are very much concerned with the heart's action." Graduates of the intensive two-day course were known as Sisters of Service (SOS), and each received a badge upon graduating. Patterson's programs proved effective in training hundreds of women in the best methods for reducing lung congestion and keeping fevers down, as well as for treating patients in the home. In fact, the program was so effective that it was soon taken up in other parts of the city and in other communities across Ontario. (p. 63)

        School cafeterias prepared food for families too sick to make their own meals; it was discovered that everyone in one family of nine was in bed, too sick to get up. Within days there was sharp criticism of the decision to provide food to the sick because of the effect it would have on the city's image. One newspaper said Winnipeg was "looking like London in the plague rather than a western city in the twentieth century." Winnipeg prided itself on being modern and progressive, and the sight of pestilence in the streets, even if conditions were the same everywhere else, did not appeal to the city fathers.  (p. 66)

        One day after his talk with Tubble, Underhill announced that there were no confirmed cases of Spanish flu in Vancouver. He did admit that several people were ill, but said it hadn't yet been confirmed whether it was the ordinary type of winter flu or the new strain that seemed to be so much more dangerous. Other city doctors, however, were quick to diagnose without laboratory confirmation some of their cases as Spanish flu. (p. 75)

        All three public health officers took immediate steps to meet the coming crisis. At the provincial level, Dr. Young acted to give municipal health officers around the province more authority. He recommended to the minister of health that municipalities be given the right to make whatever moves they deemed necessary to combat the flu in their own jurisdictions. A simple addition to the regulations gave municipal health officers the authority, at their discretion, to close schools, churches, and places of entertainment—movie halls, theatres, poolrooms, bowling alleys, ballrooms, and the like—for the health of the community.  (p. 76)

        He told reporters plans were in place to meet the attack but had to admit that, like medical authorities around the world, he was uncertain as to what the city was facing. From the outset, his objectives were to calm fears, recommend preventive measures, and find enough beds in isolation hospitals to accommodate the sick and keep them from infecting the rest of the population.

        In the much larger city of Vancouver, Underhill's primary concern was to prevent panic. He moved quickly, telling the press that Vancouverites had nothing to fear and would be kept fully informed of the situation. The Vancouver Daily Sun on October 5 stated that the disease hit town "quietly, almost stealthily," as Underhill cautiously confirmed the first case. (p. 77)

        Up to this point, Underhill had experienced difficulty trying to get the city fathers to prepare for the Spanish Lady's arrival. Gale was now anxious to be seen doing the right thing and suggested closing down the schools, as Price had done in Victoria. Underhill spoke strongly against this, but did agree diplomatically with Gale's proposal to ask places of entertainment to voluntarily keep children out.

        It was also agreed that Underhill would make daily reports to the press. In an era when the bureaucracy was even keener on holding information as close as possible to its chest than it is today, this was a slightly radical move. But despite being 60, the medical chief wasn't dyed-in-the-wool. He knew the value of public relations and how to get his message across, and he was respected and liked by people in the newspaper business. (p. 81)

        Several local doctors expressed pro-closure views when Winnipeg reported that it was shutting down, but they were taken to task by city physician H.B. Gourlay, who said private medical men should not be offering opinions because "there are many others better placed and informed to know what is developing."

Fred Underhill, always the diplomat, knew any precipitous moves on his part would meet with criticism and hostility, possibly increasing the general level of conflict, apprehension, and fear. His political colleagues, Mayor Gale and the city fathers, were concerned about the need to juggle their responsibilities for public health with the need to keep the city operating. Moreover, Underhill had studied the results of general closures in the U.S. and knew that such action had mixed results. He asked, "Should we seek permission from Victoria to save the people from themselves or leave them to exercise their own free will and common sense to go or stay away as they see fit?" He did strongly advise staying away from crowds when possible, adding somewhat testily that he couldn't understand why women "pottered" around stores when they didn't have to. He sniffed and noted they probably had wet feet, too. (p. 82)

        His reporting regulations and system of quarantine signs were accepted as standard procedure, and they became assets in controlling the disease. During October and November 1918, the quarantine signs proliferated everywhere in the city. In most cases, the large yellow posters simply kept visitors away, but they were also the source of some fear and concern. It was not a heartening sight when nearly every house on the block boasted a contagious-disease sign. (p. 83)

        In advocating prevention as the best defense, he issued a list of do's and don'ts for children. He wrote in simple language that they could readily understand.

                Use hankies.

                Don't borrow a hankie and don't lend yours to anyone else.

                Don't spit.

                Don't take a lick of anybody else's sucker.

                Don't take a bite of a friend's apple.

                Don't bite the end of your pencil.

                Don't lick your marbles.

                Keep your feet dry and out of dirty water.

                Keep windows open.

                Swat flies, because they carry disease.

                Save your pennies and keep away from crowded picture halls.

                Keep desks tidy.

                Don't leave hankies around, keep them in your pocket. (p. 84)

        Mayor Gale hurried to say that most of the Vancouver cases involved people from outside coming into the city, although what point he was trying to make was rather obscure; possibly it was just the jitters of a new mayor with a critical crisis on his hands. (p. 88)

        In order to accommodate hospital crowding, which occurred within a day or two of the outbreak, Vancouver city officials and leading medical men conferred and decided to take over the auditorium and adjacent classrooms at the University of British Columbia. The original UBC buildings, known as the King Edward campus, were close to VGH and were quickly converted into an isolation unit for the sole purpose of treating flu cases during the crisis. (p. 92)

As the caseload increased, nurses found their ranks depleted as they, too, contracted the Spanish flu in large numbers, despite their wearing gowns and masks that covered them from head to toe. One doctor said it was a rather eerie sight in dimly lit wards at night to see these white apparitions floating through a sea of tightly packed, white-quilted beds.

It was not long before the first of many calls went out for volunteers to help in hospitals. In this instance, as well as in many other later calls for help, there was a mixed response. Some women came forward readily to do what they could; others hesitated for fear of contracting the flu themselves; still others were so afraid, they all but shut themselves in their homes, seeing no one.

In addition to hospital duties, volunteers were often assigned to homes in which all of the adults were prostrate. It was not an easy job, particularly for some of the younger women, who quickly lost their eagerness to help when they found themselves in ramshackle, dirty houses where they were expected to wash and diaper ragged, runny-nosed children on top of cleaning up after adult patients who could do nothing for themselves. (p. 96)

Life-insurance companies in particular were doing a bustling trade, and while it would be difficult to categorize life insurance as an essential service, the need for insurance was obvious and offices were open and flourishing. (p. 98)

An unexpected opposing view came from a Vancouver Medical Association spokesman, who now said that all schools should be closed immediately. He even questioned the wisdom of bringing together the 100 people to whom he was speaking. A ministerial association representative favoured closing all public places.

With municipalities all around him closing, Underhill continued to stick to his position. His main opposition was to school closures; he still firmly believed that children were better off in school than roaming the streets or confined to homes with sick parents. His view did worry Victoria officials, and provincial secretary S.D. MacLean, who was responsible for health, said he was sending Dr. Young to check out the situation. (p. 103)

The ranks of police and fire departments were depleted as members fell ill and took to their beds. (p. 104)

Some of the strongest complaints about the Vancouver closures came from church ministers who were unhappy with the cancellation of services. They claimed their buildings were well ventilated and that congregations needed a place to pray together in these difficult times. Reverend W. Pascoe Goard made the point that people were only in church once a week, for a relatively short time. City hall, however, had made its decision and turned a deaf ear to Goard's and all other objections. (p. 109)

…sick and barely able to cope with preparing food and keeping furnaces stoked. Neighbourhood volunteers were being organized to check regularly on isolated farms and to step in to help keep families alive wherever they were needed. (p. 112)

What baffled them most was the Spanish Lady's focus on 20- to 40-year-olds. Nothing like it had ever been seen before anywhere. Surely the young men of the country were suffering enough in the war. More deaths were unthinkable ... yet the daily toll continued. (p. 113)

He paid particular tribute to some teenagers who had offered their services but had to be turned down because they were considered too young. Older men were still needed for the heavier lifting and carrying at hospitals. Ireland was not satisfied with the response he had so far received and sharply criticized the small number of volunteers coming forward to fill the gaps in the medical workforce. "We are wringing our hands and unable to help, in many cases because women of the city who are in a position to assist as a duty are not doing so," an irate Ireland told The Daily Province.

"All we can do is appeal to the consciences of these ladies who can give us assistance but have not done so." He zeroed in on recently idled schoolteachers who were not coming forward "in appropriate numbers" to help now that the schools were closed. At the same time he thanked those who had come forward and were serving in makeshift isolation wards.

Fear of catching the flu and dying was the stumbling block. Many people were not prepared to risk their own lives by getting too close to strangers who were seriously ill. The escalating shortage of helpers produced a radical suggestion for the times when civic officials recommended that men also be used as volunteer nurses. It didn't happen. (p. 114)

There was little to boost morale in reports emanating from across Canada or anywhere in the world. In some cities the pandemic seemed to be abating, but in other locations the number of cases continued to climb. Toronto had 76 deaths in one day; Bombay had 768 deaths over a week; Paris recorded almost 900 new cases in 24 hours. It seemed to make little difference whether cities had shut down most of their public places or left them in full operation; the Spanish Lady struck with the same ferocity. (p. 116)

Governor Thomas Riggs Jr.'s ban on travel into Alaska was a major factor in delaying the Spanish Lady's arrival in Dawson City, Yukon. The strict quarantines he imposed were of considerable help to Canadians living in this northern outpost. He banned all travel from Alaskan communities into Canada and even halted mail delivery for the winter season. As a result, it was April 1919 before the pandemic reached Dawson, and by then it was a much less severe strain than had ravaged Alaska in the fall.

As the pandemic raged on and the number of deaths continued to rise across North America, some medical authorities ordered that masks be worn in public, often imposing penalties if the regulation was not obeyed. In Calgary, where masks were mandatory, 100 residents were fined for failing to wear them. In B.C., debate arose once again, partly because Underhill and Price held differing views on the subject.

Victoria's Price was against the wearing masks under any circumstances. He contended that they only collected germs and did not help prevent the flu from spreading. Underhill wasn't prepared to suggest they be mandatory in Vancouver, but he did recommend that managers of banks, stores, and similar essential operations—those still dealing with the public—encourage their staff to wear them. Underhill very much believed in preserving the freedom of the individual to make his or her own decision. He felt that if he explained why he had made a recommendation, the people of Vancouver would do the right thing for themselves and the rest of the community. (p. 119)

Medical opinion was split on the question of masks throughout the pandemic. Some doctors complained that those made of cheesecloth quickly became dirty, wet, and clammy and that an all-wool mask like Tom's was a major improvement. Others insisted that masks did little to prevent catching the flu. Dr. Underhill chose not to comment on this particular issue.

As the situation become more critical, organizations throughout the city did what they could to help. The Rotary Club organized a volunteer taxi service among its members to ferry doctors, nurses, and clergy to the now full emergency hospital at King Edward High School. Hill Tire Company offered free repairs to all cars being used in the shuttle service. (p. 121)

Local hospitals were now coping more efficiently than they had a month earlier. Time had given supervisory staff the opportunity to reorganize shifts and duties so that no one was required to work the long hours that had been in effect through October. As the pandemic continued, greater cooperation developed among municipalities, and officials were able to eliminate duplication and waste of services. Various labour organizations stepped in and helped to set up a centralized temporary employment system for all of Greater Vancouver. (p. 133)

Public places remained closed, and the lack of services and everyday comforts was beginning to pall on everyone; as a result, people began to find ways of getting around any regulations they considered inappropriate. St. George's Anglican Church and the First Baptist Church in Vancouver held outdoor Sunday services, which were well attended. And, unlike the earlier episode with the Salvation Army, the authorities didn't find the downtown churches in violation of regulations.

Going a little further, Reverend F.E. Farris of St. John's Anglican Church in North Vancouver reopened his church and was totally unrepentant when he was fined $10 for conducting a Sunday service. He told the court that by permitting stores, offices, and factories to remain open, but not churches, the "law is serving Mammon instead of God." Two token members of his congregation were fined $2.50 each for attending the service. But maybe their prayers helped: A newspaper headline noted that with a continuing drop in the number of cases, the flu situation was "encouraging." (p. 134)

A Vancouver doctor, an obstetrician named John Barker, later recalled, "I was still in bed when the Armistice was signed. I remember the funerals passing along Sixth Avenue that same day. Nurses were almost unobtainable and doctors were so overworked that during the time I was ill, I had five different doctors. They worked themselves into a state of exhaustion, but returned as soon as possible when another one dropped. It was terrible. Many of my friends died." (p. 136)

The fight against the flu throughout B.C. had been hampered from the outset by a shortage of medical personnel. The end of the war did mean that doctors and nurses would eventually return home, but certainly not in time to have any effect on the battle against the Spanish Lady. That was why volunteers played such an important role in the fight. (p. 138)

In late November Dr. J.S.W. McCullough, the chief medico officer for Ontario, released some chilling figures of the terrible death] toll in the first six weeks of the epidemic in that province—figure that increased in a later final tally. Based on deaths per 100,00( McCullough's figures showed that Kingston paid the highest price, followed by Toronto, Ottawa, Windsor, and London. Dr. J.A. Beaudry, inspector general for the Quebec Board of Health, also released new figures showing that his province lost 9,925 people, 3,100 of then from Montreal alone.

In Toronto, statistics proved that the Spanish flu had targeted younger men. The tally for the first 167 deaths in the city showed age groups and the fatalities within them: under age 10, 8 deaths; 11 to 20, 18; 21 to 30, 63; 31 to 40, 54; 41 to 50, 20; over 50, 4. A greater number of 20- to 40-year-old men had gone off to war than from any other age bracket; even more men from this age group who stayed home were taken by the Spanish Lady. Later figures from New York confirmed that more than 60 percent of its dead were between 15 and 45 years of age, and that the age of the greatest number of victims was 28. (p. 151)

The early breakdown of deaths by region showed: Vancouver, 778; Victoria, 127; Nanaimo, 143; Alberni, 188; Ashcroft, 69; Fairview (covering the Prince George area), 175; and Beaton (the Kootenays), 340. Vancouver's total was much higher than the other regions because of the large population in the Lower Mainland and because of the large number of patients who had come there seeking treatment.

If the overall death toll in Canada was bad, it was staggering in other parts of the world. In the last 12 weeks of 1918 alone, more than six million people died worldwide, and many more than that had died earlier in the year. There were more than 32,000 fatalities in England and Wales. Undertakers in London were unable to take care of the huge number of bodies needing burial, and coffins were stacked waiting to be placed in the ground. London officials said that more than three million people had died in recent months in India, and this figure could be low by as much as several million because of poor statistical reporting in that country. At the peak of the pandemic, nearly 800 died daily in Delhi, a city that at the time had a population of 200,000 people. (p. 154)

Suddenly, the renewed closure discussed by the provincial committee was close to becoming a reality. As always, there were those who disagreed, and this time a delegation of churchmen rushed to the capital to urge exemption for places of worship.  (p. 156)

There was one interior B.C. city well prepared for the onslaught of the Spanish Lady. Early in the fall, Dr. J.T. Robinson, chairman of the Royal Inland Hospital Board in Kamloops, had personally experienced the devastation the Lady could cause when he travelled with his family to Toronto. The city was in turmoil, all its hospitals were overcrowded, and hundreds were dying when Robinson's wife and two daughters fell ill. Unable to find hospital beds for them, he nursed them back to health in their rooms at the King Edward Hotel.

Following their recovery, he hurried back to B.C. and called an urgent meeting of the hospital board. Robinson warned that the pandemic was on the move and would soon reach Kamloops. When it arrived he wanted the town to be well prepared, and it was.  The hospital ward was stocked and made ready to handle a large influx of patients. Extra cots were secured and set up wherever they could be fitted in. A vacant building on Nicola Street became a secondary facility.