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

Despite its unprecedented mass mortality and recent popularity among historians, the 1918–19 Spanish influenza pandemic rarely figures into national histories. Similarly, national, social, and political histories rarely inform histories of this pandemic. Mark Osborne Humphries attempts to fill these gaps in The Last Plague: Spanish Influenza and the Politics of Public Health in Canada by examining the effect of the 1918–19 epidemic on the development of Canada’s public health system. The devastating influenza epidemic, Humphries argues, was the catalyst that helped change the relationship between state and citizen in the realm of public health beginning in late 1918. Prior to the epidemic, the federal government focused on protecting the Dominion from external, foreign threats. After the epidemic, however, the federal government would take responsibility for the health and social welfare of its people.

Humphries’s narrative traces public health ideology and strategy in Canada from the nineteenth century through the 1918–19 epidemic. For most of the book, this is a narrative about the continuities in public health practice. Following the cholera pandemics of the early and mid-nineteenth century, federal public health officials established maritime quarantine as their primary strategy for protecting Canadians’ health. Even though doctors and public health officials accepted a variety of understandings of disease throughout the century, federal quarantine continued to be basis of Canadian public health. Moreover, federal health officials continued to work separately from underfunded provincial and municipal public health boards responsible for maintaining local sanitary conditions. Quarantine persisted as the federal government’s main strategy not only because it addressed political anxieties over increasing immigration, but also because epidemics in the late nineteenth and early twentieth centuries were not devastating enough to call the effectiveness of quarantine into question. While the rather mild first wave of the 1918–19 influenza epidemic did not expose the limits of maritime quarantine, the second wave did.

By the end of 1918, it was clear that an emphasis on quarantine would not protect the population from deadly disease. Federal officials could not contain the spread of influenza in the fall, and mortality rates skyrocketed. As masses of soldiers mobilized to defend the eastern front in Siberia, young men recruited to fight in the Great War were being incapacitated by a disease the government was not prepared to control. This sparked widespread critique of the federal government and military institutions. Social reformers’ critiques of the government’s inability to protect its citizens with a decentralized, externally focused public health system gained significant traction during the epidemic. Since the disease spread across geographic and social boundaries, reformers cited mass influenza mortality as evidence of state neglect. Reformers then called for a centralized public health system based on preventative measures in Canadian communities to repair the broken covenant between the state and its citizens. In 1919, legislators, some of whom cited the epidemic as justification, passed a bill to create a new federal Department of Health that would focus on controlling domestic disease threats and providing social welfare to citizens. Therefore, Humphries concludes, the 1918–19 influenza epidemic played a considerable role in shaping disease prevention strategies, helping to usher in the “modern era in Canadian public health” (195).

While Humphries is not the first to incorporate this pandemic into a national, historical narrative, he makes a great contribution by inserting the epidemic into the history of Canadian public health. He clearly shows that the epidemic was an important agent of change that altered the way Canada’s government intervened in the welfare of its citizens via public health services. Humphries demonstrates the fruitfulness of looking at this epidemic through a political–historical lens to illuminate new connections that had heretofore not been recognized. Furthermore, Humphries sheds considerable light on the role of the Canadian military in this epidemic...