The Last Plague: Spanish Influenza and the Politics of Public Health in Canada by Mark Osborne Humphries (review)

Although precise figures on how many suffered from the influenza epidemic of 1918–19 in Canada are unknown, since the late 1970s mortality has been estimated at around fifty thousand. The first book-length study on the subject—Eileen Pettigrew’s The Silent Enemy: Canada and the Deadly Flu of 1918 (1983)—mainly included anecdotal accounts and did not provide footnotes for its references. The past two decades have seen a growing number of more rigorous academic publications, with a particular focus on local studies. The quality of the present state of the art is evident in a recent volume of collected essays edited by Magdalena Fahrni and Esyllt Wynne Jones titled Epidemic Encounters: Influenza, Society, and Culture in Canada, 1918–20 (2012). Having already contributed articles to this new wave of critical scholarship, Mark Osborne Humphries has now made a substantial contribution to the field with The Last Plague, which focuses on the politics of public health.

Humphries shows how, within the space of a few months, influenza brought the collapse of the outdated quarantine system, which was presided over by the aging Dr. Frederick Montizambert, federal director general of public health since 1899. This policy had been shaped in response to earlier epidemic outbreaks, in particular the cholera epidemic of 1832, and at first it misleadingly seemed that it had successfully combatted the first wave of the influenza epidemic (which Humphries dates to the late winter or early spring of 1918, notably earlier than the previous assumption that it commenced in the summer of that year). However, the arrival in the fall of 1918 of the deadly second wave of influenza in consequence of American troops traveling via Canada to join the war in Europe exposed the misconception in the ideological belief that diseases are necessarily brought from overseas by foreigners, rather than across continental borders. Though the government moved to prevent the return of infected soldiers from the battlefields of Europe, its commitment to intensifying the war effort, and in particular the raising of the Canadian Siberian Expeditionary Force, increased the internal movement of Canadian troops, which contributed to the spread of influenza at home.

Using archival and newspaper sources, Humphries documents the failed responses to the epidemic at federal, provincial, and municipal levels, revealing the ultimate helplessness of the authorities. This aroused an angry popular response. On the one hand, the struggle with the hardships of the epidemic promoted solidarity, which temporarily transcended social divides, as communities rallied to assist the weaker working class and marginalized sections that suffered most. But at the same time, dissatisfaction mounted against Sir Robert Borden’s Unionist government, which in its unwavering commitment to the war effort was seen to neglect its duty to safeguard public health. Criticism was directed against the death of new conscripts from influenza. The rounding up of draft defaulters, who were sent to influenza-infected barracks, was particularly vexing in Quebec.

Following its mishandling of the epidemic, the postwar government was pressured into reforming public health. This was the outcome of a change of approach, from a passive policy of disease management toward an interventionist commitment to disease prevention, which came to fruition in the creation of a federal Department of Health (which unsurprisingly was not headed by Montizambert). Humphries concludes that this change “embodied a fundamental shift in Canadian public health governance, laying the foundation for future development in public medicine” (p. 188). According to this optimistic analysis, the catastrophe that affected hundreds of thousands of Canadians produced long-term positive change.