Mark Osborne Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada.
The Spanish Influenza was the last of the great plagues, killing more than 50,000 people in Canada and felling perhaps five percent of the global population. The pandemic, which crossed the globe in three waves between January of 1918 and December of 1920, was distinguished not just by its virulence, but also by its unusually high mortality among young, otherwise healthy adults, a generation already depleted in the Canada by World War I. Despite its devastating global reach, the flu largely faded from popular consciousness and, until the 1990s, it garnered little attention from historians. This historical amnesia, Mark Humphries argues, stems in part from the intrinsically problematic nature of epidemics, which tend to defy and disrupt other historical forces and leave little room for human agency. The solution, he argues, is to treat disease as an historical actor in its own right, and he contends that the flu ought to be understood as an historical change agent that helped to transform the Canadian state.
Humphries situates The Last Plague within a third wave of recent scholarship on the flu. He identifies in the first those waves, inspired by the AIDS epidemic, the attempt to document the disease's demographic impact and to assess responses in medical and epidemiological terms. The second wave localized the pandemic's impact through community-level case studies. These studies brought clarity to the ways in which social relations were disrupted or consolidated and communities fractured or united by the flu. But Humphries is critical of what he identifies to be the self-limiting nature of this body of work, arguing that in their attention to the local and particular, authors failed adequately to place the pandemic within a national or global narrative. This assessment is, perhaps, unduly harsh, but the author's claims to innovation are legitimate, and his book is at once a masterful synthesis of existing scholarship and one that and breaks new ground as a national history of the flu.
Humphries' predominant concern is to address the questions of how the state and individual Canadians understood epidemic disease and how the Spanish flu altered Canadians' relationship to, and expectations of, their government. Framing the pandemic as a national crisis, he argues that the flu, because it invalidated prevailing ideologies of public health governance, required a re-figuring of the role of the federal government in securing the health of citizens. More particularly, he argues that the nature of the epidemic, which could not be contained by traditional quarantine measures, compelled planners to understand disease not as a foreign threat that could be addressed by externally-oriented responses aimed at regulating immigrant bodies, but rather as an endemic threat that could only be met with positive measures to improve the health of the social body. The most concrete of these responses was the creation, in 1919, of a national Department of Health. This act affirmed a new covenant between Canada and its people at precisely the time when wartime idealism, progressivism, and the social gospel, as well as widespread popular support for an expanded central government, were at their zenith.
The book's temporal scope is much broader than its title would suggest. The author compiles a history of Canada's responses to epidemic disease that the spans a century, beginning with the cholera epidemics of 1930s and concluding with an assessment of the first two decades of the federal health department. He argues that over the long 19th century, the lesson that Canadian authorities had consistently taken from a succession of epidemics was that Canadians were an intrinsically healthy population living in a salubrious land. Disease was something that came from abroad, and the best hope of containing it was through negative measures like quarantine and immigrant inspection; positive public health measures were simply unwarranted. This anachronistic approach was entrenched in the British North America Act, which designated quarantine as a federal responsibility and charged the provinces with addressing endemic problems through the operation of asylums and poorhouses. This division stunted the development of uniform public health measures and, when the flu struck in 1918, Canada was caught unprepared. Whereas in Great Britain and the United States advances in sanitary science, bacteriology, and medicine had spurred the creation of robust public health bodies, the apparent success of Canada's quarantine measures, especially during the 1890 influenza outbreak, foreclosed such developments, and Canada remained a backwater.
The primitive state of Canada's public health apparatus left the government helpless in the face of the Spanish flu, and local measures to contain the epidemic were largely negated by the incompetence and impotence of the federal authorities. Extant regulations did not name influenza as a reportable disease and public health authorities asserted no jurisdiction over troop movements. Consequently, Canadian and American soldiers, predominantly white and Anglo-Saxon, crossed borders made more permeable by the exigencies of war and they were largely invisible to a system that was, by 1918, grounded more in rituals designed to discipline immigrant bodies than measures to identify and contain disease.
The manifest failure of government to address the crisis of the flu strongly influenced debates about postwar reconstruction as Canadians considered whether the government ought to relinquish the unprecedented powers it had gained in wartime, or whether it ought to turn these powers to the public good. While popular opinion favoured the latter, the Union government, formed to militarize Canadian society but elected on the basis of a fragile coalition with social reformers, opted to appease progressive voters rather than to seize the moment. The newly created Department of Health was far from being the far-reaching public health apparatus that many demanded. Nonetheless, Humphries chooses to count the department's successes, not its failures, and to emphasize change over continuity. He argues that the department oversaw a fundamental shift in public health policy from disease management to disease prevention, that new approaches to border screening reframed immigrants as potential citizens instead of potential threats, and that the development of innovative cost-shared programs marked the arrival of a new model whereby the federal government could work within the framework of the BNA Act to influence areas of provincial jurisdiction.
Well researched and argumentatively coherent, this is one of those rare books that will please readers of disparate interests. While Humphries is principally concerned with governance and public policy, readers interested in social or medical history will also find much for them in this book. One of the author's signal accomplishments is to integrate into his narrative clear and accessible explanations of the biology and pathology of the flu and a detailed account of contemporary understandings of the origins and spread of the epidemic. To his great credit, he does so without anachronism. He also breaks ground by bringing new sources to bear on old questions. By mining military records, he is able to offer a new and convincing assessment of how jurisdictional disputes between military and civilian authorities, combined with a singular focus on immigrants as the only plausible source of contagion, opened the doors to the rapid diffusion of the disease across Canada. And while his gaze remains substantially political, he does not neglect the social and the personal. Especially when concerned with reporting the flu's morbidity and mortality, he lends poignancy to his account by including carefully selected passages that give a sense of the psychic impact of this terrifying disease, and he reminds the reader that while the flu afflicted all social classes, its effects were not evenly distributed.
University of Winnipeg
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|Article Type:||Book review|
|Date:||Mar 22, 2014|
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