by Bruce Cherney
To date, four Manitobans have died after contracting H1N1 influenza A virus. The latest victim was an adult over 18 years, according to a provincial government bulletin.
Another government bulletin indicated there have been 458 laboratory-confirmed cases of H1N1 in Manitoba with most infected people recovering without specific medical care or hospitalization.
The virus has been a problem among Manitoba’s isolated northern First Nations communities. Aboriginal Manitobans, who make up just 10 per cent of Manitoba’s population, have two-thirds of the people requiring extensive treatment due to H1N1.
Aboriginal leaders in Manitoba have declared a state of emergency in their communities as a result of the presence of the virus.
Most of the 22 deaths reported across Canada have been the result of complications arising due to pre-existing medical problems after contracting the virus.
The spread of the virus across the globe has prompted the United nations’ World Health Organization to declare the H1N1 flu a phase six pandemic, meaning it is a world-wide outbreak to which no one has a previous immunity and the disease had been unknown to exist until it burst upon the scene.
Such was the case in 1918-19 when the world experienced what became the terror of a virulent strain of influenza which has not since been duplicated.
Alan McLeod was fortunate to have survived dogfights in the skies above France and Belgium during the First World War, but ironically couldn’t survive a trip back home. On March 17, 1918, McLeod, who was born in Stonewall, Manitoba, was wounded several times while piloting his bomber in a melee over No-Man’s Land. After his crash-landing, the young pilot received a Victoria Cross for his exploits, which was the British Empire’s highest award “For Valour.”
His six wounds earned McLeod a trip home to recuperate, but the 19-year-old contracted the Spanish Flu when he arrived in Winnipeg and died just five days prior to the signing of the armistice which ended the war on November 11, 1918.
The worldwide outbreak of 1918-19 was one of the worst occurrences of a disease in recorded history, accounting for up to an estimated 50-million deaths, including about 50,000 in Canada. Approximately one-fifth of the world’s population contracted the disease with two to three per cent of those afflicted dying. The flu actually killed more people than all the battles of the First World War. In the United States, an estimated 675,000 people died of the Spanish Flu, including 43,000 service men, which was equal to the number of Americans killed on the battlefield after the U.S. entered the First World war in April 1917. Nearly 80 per cent of the U.S. Army’s war casualties were caused by the flu.
Every flu season today in Canada, some 3,500 people die, mainly the very young and the elderly. What differentiated the Spanish Flu of 1918-19 was that it struck down those in the prime of their lives, typically people from 15 to 40 years of age.
The Spanish Flu got its name from the French, who blamed the Spanish for the outbreak. But its real origin is felt to have been in Asia. It is also believed to have been a rare example of an animal virus making a genetic shift into a human strain.
Some investigators have said the first cases occurred in 1918 in British camps in France behind the front lines where pigs were slaughtered to feed troops. The relationship between hogs and the flu virus was first officially noticed by J.S. Koen of Fort Dodge, Iowa. The inspector for the U.S. Bureau of Animal Industry observed that pigs had a disease similar to the flu then raging in 1918-19.
“It looked like ‘flu,’ and until it is proved it was not ‘flu,’ I shall stand by the diagnosis,” wrote Koen.
The Spanish Flu is known as influenza A (H1N1), a virus which is found in many animal species, including pigs, birds, whales, horses and seals. It should be noted that the flu strain now making its way across the globe is also an H1N1 virus.
Today’s flu outbreak is a similar genetic shift, which has earned the new strain the nickname “Swine Flu.”
The 1918-19 strain received its nickname primarily due to the press reporting its outbreak in Spain, which was one of the few nations to have an uncensored press during the First World War. By being the first nation to report the presence of the flu, Spain became forever saddled with the unflattering nickname for the influenza outbreak.
Flus arise from highly-adaptable virus strains — one strain that hits you early in the season can mutate into another strain to again make you sick. People are only immune to a strain of flu virus they have previously contracted or have been vaccinated against. New mutations of the flu virus are not recognized by the body’s immune system, which is why a new flu vaccine is required before the outbreak of flu season.
The Avian Flu, which struck Hong Kong in 1997, resulted in 18 people being diagnosed with a strain of influenza virus that had previously only been seen in birds. Six people died, all of whom had been healthy before contracting the disease.
Studies found that the virus could spread easily from poultry to people, but not as easily from person to person, which is not the case with today’s flu strain. The virus in 1997 caused chickens’ tissue to hemorrhage and turn into a bloody mush. Local officials ordered the slaughter of every chicken in Hong Kong. Today, the Swine Flu is not transmitted from pork products, but the fear of the disease has caused many people to shun pork with disastrous consequences to the hog industry.
“If the Hong Kong virus had developed the ability to spread efficiently among people, we could have faced a crisis along the lines of the 1918 pandemic,” said one of Canada’s leading leading experts on infectious diseases in 1997.
Influenza itself rarely kills. It is primarily when complications arise, such as pneumonia setting in, when the death toll mounts as was the case in 1918-19. It was the complication of pneumonia setting in after he contracted the flu virus that killed McLeod.
Pneumonia was a feared killer in an era which lacked antibiotics. While the flu is a virus which rules out using antibiotics, pneumonia bacteria — pneaumobacillus — can be fought with antibiotics.
Although the Spanish Flu is now believed to have started in Asia, the first cases in North America — the second of three worldwide waves of the disease — were reported among soldiers in the spring of 1918 in a Kansas military camp. Before this, it had already been infecting the men fighting in the trenches of Europe, but few noted the nasty strain of flu among the widespread carnage and death that marked First World War battlefields that killed 17-million people.
Whatever, the flu’s place of origin, it was particularly virulent. A person could appear to be healthy on Monday and dead by Friday.
A 22-year-old enlisted in the Royal Newfoundland Regiment on October 14, 1918, and two days later was on sick parade and admitted to hospital. He died of the Spanish Flu on October 20, just five days after enlisting.
In 1918, three of four American women playing bridge together contracted the flu and died overnight.
A physician said patients with seemingly ordinary flu symptoms would rapidly “develop the most vicious type of pneumonia that has ever been seen” and suffocate.
Will Byrd, a noted Canadian diarist of the war years, wrote that while in London, England, in 1919, he and his friend Tommy — they both had survived two years of brutal fighting in the trenches — experienced the flu first-hand.
“Tommy roused me at noon and said he was feeling feverish. At four in the the afternoon, I began trying to locate a doctor. There was no luck on the telephone, so out I went, and after an hour of searching, helped wonderfully be a huge Bobby (policeman), I contacted a doctor and told him of the circumstances. He looked a tired man but he went with me, and in half an hour Tommy was on his way to a hospital ... I had put on a mask before we went in the long ward. By now Tommy looked wretched, but he managed to grin at my appearance, and then urged me to get out before I caught the influenza too ...”
The next day Bird returned to the hospital, staying in the waiting room. A doctor came by and Bird begged him to see if he could visit his friend. “He was back quickly and his message stunned me, Tommy had died that morning.”
The Canadian Army camp at Bramshott, England, reported 2,247 flu cases with 163 soldiers eventually dying.
For soldiers, McLeod’s contracting the disease at home was the exception not the rule, as those fighting along the front usually contracted the disease overseas. Eric von Ludendorff, the German commander on the Western Front, blamed the flu outbreak for stalling his army’s spring offensive.
The first wave of the flu seemed like any run-of-the-mill influenza outbreak — highly-contagious, but most people soon recovered. The second and most virulent wave struck in the spring and summer of 1918. The first major outbreak among Canadian civilians was diagnosed at Quebec’s Victoriaville College where 400 students became ill.
Once the flu began to spread across the nation, hysteria bordering on panic broke out. Some western Canadian municipalities tried to cut themselves off from the rest of the world, while some cities passed bylaws making it mandatory to wear a gauze mask whenever anyone stepped outside.
In Winnipeg, churches, theatres, schools and universities, as well as all public meetings, were closed. Winnipeg Medical Health Officer Dr. A.J. Douglas told everyone to wear a gauze mask to protect themselves from the flu. A bylaw was passed and imposed a $50 fine for spitting on the street to prevent the spread of the disease.
During the SARS outbreak, people wore masks wherever crowds gathered, especially at airports. Severe Acute Respiratory Syndrome is a respiratory disease in humans which is caused by the coronavirus. Between November 2002 and July 2003, there were 8,096 known cases and 774 deaths, according to the World Health Organization. Within a matter of weeks in early 2003, SARS spread from the Guangdong province of China to rapidly infect individuals in some 37 countries around the world, including Toronto. At the time, the fear was that people aboard airplanes facilitated the spread of SARS. Ships and trains were the 1918-1919 transportation equivalent.
The Alberta government made gauze masks compulsory for all its citizens at all times, “except when necessary to partially remove the mask for the purpose of eating.”
“The Canadian Medical Association Journal of January 1919 turned a sneering eye on the latter practice,” wrote Pat Sullivan in his article, More Deadly Than War Itself (Legion Magazine January/February 2001). The association reported that the number of cases actually continued “to increase rapidly for some time after the (face mask) order was enforced, and public confidence in it as a prevention soon gave place to ridicule.”
Dr. Harvey Medovy in the Manitoba Historical Society article, The Early Jewish Physicians of Manitoba (1872), said he remembered standing in a line with his father to see Dr. Abram Bercovitz in 1918. He said the line of flu patients extended “all the way from his second floor office down the long stairway to the front door.”
For a $2 fee, his family received vaccine shots. “The vaccine was of doubtful value but at any rate none in our family got the flu. There were two deaths in the house next to us, and each evening edition of the paper carried a frightening list of names and addresses of victims of the epidemic.”
His father told him to stay at home and avoid all contact with the outside world. Another preventative measure urged by Medovy’s father — which we now know is useless — was to wear a necklace with camphor sewn in a tiny bag dangling against the chest.
Some felt ingesting commodious quantities of liquor would protect them against catching the flu. On December 18,1918, the Ottawa Citizen told the public that consuming liquor to avoid the flu was myth.
Other so-called cures were tried, such as daily glass of purgative water to clean out the digestive organs. Unfortunately for people trying this cure, the flu was a respiratory disease and often led to pneumonia that killed people who drowned in their own fluids.
“The apparent futility of practically all measures of prevention, and the failure of any particular line of treatment, make it incumbent on one attempting to discuss any phase of this subject to approach it with becoming modesty and diffidence,” said Dr. T.H. Whitelaw, Edmonton’s medical officer.
The virulent strain of flu arrived with three soldiers at the CPR station in Winnipeg on September 30, 1918. The soldiers were immediately quarantined, but it was too late. A railway worker contracted the disease from the soldiers. Three days after their arrival two of the soldiers and the railway worker were dead. By January, 824 Winnipeggers were dead.
In Toronto, 1,682 people died between October 9 and November 2.
Montreal was particularly hard hit by the flu, making it necessary to convert a trolley car to perform the same duties as the city’s overworked hearses.
At least 1,000 Canadians were dying every day by October 1918. A Toronto undertaker reported to McLean’s magazine that he sometimes had to bury whole families who had died from the flu.
In Labrador and isolated northern communities, whole villages would be wiped out. In fact, some northern communities saw half their population fall victim to the epidemic. Fully a third of all people and half the Inuit of Labrador died from complications arising due to the flu.
Three of four doctors treating flu patients in Carmen, Manitoba, came down with the disease, leaving Dr. A.E. McGavin as the sole heath care provider for people in a 100-kilometre radius. It is probable Dr. McGavin’s fastidious habits saved him from contracting the disease. He wore a gown and mask whenever he saw a patient and disinfected his clothing and instruments afterwards. Even his wife and children continued to be healthy while others around them fell ill.
Today, health-care professionals urge flu patients and those treating them to repeatedly wash their hands to prevent spreading the virus.
In 1918-1919, a victim at first felt sudden weakness, pain and chills. Dr. E.A. Robertson in a report on the Spanish Flu at the Quebec Garrison wrote in 1918 that these symptoms were followed by coughing which produced “quantities of blood stained expectoration or nearly pure dark blood ... the face and fingers cynosed, active delirium came on ... the tongue dry and brown, the whole surface of the body blue, the temperature rapidly fell and the patient died from failure of the respiratory system.”
Because of the Spanish Flu, the Stanley Cup was not awarded for the first time since its founding by Canadian Governor General Lord Stanley in 1893. The National Hockey League Montreal Canadiens were scheduled to face the Pacific Coast Hockey Association champions Seattle Metropolitans in 1919.
The series actually came down to the final game of the home-and-away best-of-five series in Seattle. The final game was slated for April 1, but the Canadiens couldn’t continue as all the team’s players, with the exception of one, had the flu, leading to the cancellation of the series.
“The great overtime games of the series have taxed the vitality of the players to such an extent that they are in poor shape indeed to fight off such a disease as influenza,” reported the Montreal Gazette.
Montreal player “Bad” Joe Hall, a defenceman from Manitoba, died four days after the series was cancelled.
A third and equally deadly wave hit Canada in February, March and April 1919, but by the spring, the pandemic was already waning.
In total, 1,216 Manitobans died of the Spanish flu, most of them in Winnipeg.
The only real positive aspect of the flu pandemic was that it forced governments to spend more on health care and the expansion of hospitals. In 1919, the federal government passed the Department of Health Act at the urging of the Canadian Medical Association.
It wasn’t until 1933 that the influenza virus was first isolated. The same virus that was isolated in 1933 reappeared in 1977 under the name Russian Flu.
This “raises the uneasy possibility that a return of the 1918-19 influenza epidemic with its devastation of human life is possible and perhaps likely,” wrote Michael B.A. Oldstone in his book Viruses, Plagues and History, “... of the plagues that visit humans, influenza is among those that require constant surveillance, because we can be certain that some form of influenza will continue to return.”
Today’s H1N1 flu pandemic partially bears out his 1998 prophesy, although to date it has not been as deadly as the 1918-1919 Spanish Flu. Actually, it is unlikely to claim millions of victims as was the case in 1918-19 due to the advances of modern medicine, including anti-viral treatments.