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

The scholarly world was awakened to the staggering and profound impact of the 1918–19 Spanish influenza seventy years after that pandemic had killed somewhere between 30 and 100 million people worldwide, when the renowned medical historian Alfred Crosby published his 1989 book, America’s Forgotten Pandemic. Since that publication, a spate of books has advanced our understanding of the virus itself; the social and economic impacts of local outbreaks; the origin, diffusion patterns, and processes of the disease’s relentless waves around the world; and the public and media constructions of the disease that fuelled collective memories and influenced public policy.

Mark Osborne Humphries’s book The Last Plague: Spanish Influenza and the Politics of Public Health in Canada takes a different scholarly approach, focusing on Canada and the federal government’s role, evolving from protection against “outside” disease invasions through quarantines at ports and frontier inspections along interior borders, to the establishment in 1919 of an internally focused modern public health apparatus. Approximately 50,000 Canadians died in 1918, and yet there was no cohesive pandemic plan before 1919. Social reformers, medical professionals, and their organizations were challenged by outdated miasmic theories of disease causation, military authorities who disagreed with civilians, and the prevailing notion that Canada’s salubrious environment was protective and healthy. Could Canada, such a geographically and culturally diverse country, ever achieve national standards in health and welfare?

The first two chapters of the book contextualize the Canadian situation, with comparisons to the United States and Britain. The following chapters focus on influenza waves and outbreaks, before Humphries moves into his final chapters on the politics that precipitated a change in public health in Canada. One of his last chapters is a sad account of Frederick Montizam-bert, Canada’s director general of public health, who had managed the quarantine system of protection for years but was miffed by modernity and replaced with a younger scientist, whose task was to guide Canada through a paradigm shift in public health policy and practice.

The pandemic coincided with demands on Canadians regarding the Great War, which precipitated social and policy changes at home. This is where Humphries steps back and frames the pandemic, not as a series of local outbreaks as other scholars have done, but as a national crisis. Surely the cost of the war could be offset through meaningful reform to health care. We memorialize the Great War in a variety of ways – lest we forget – but perhaps the legacy of the pandemic, Humphries argues, is our public health system, which we now largely take for granted.

What is refreshing and persuasive about Humphries’s narrative is the extensive use of evidence and the clarity in his arguments, especially around his descriptions of the science of the disease. The book is peppered with human accounts of this catastrophe and the newest theories about the pandemic, both of which add to the luring appeal of his narrative. It will attract a wide readership as it is an accessible read and poignant reminder that we are always on the defensive against micro-organisms and should be attentive to lessons from the past.