Medical Response to the Spanish Flu

Initial Medical Response to the Spanish Flu

    Initially, the government and medical officials’ responses to the Spanish flu were somewhat tepid; after all, the society of the early 1900s was no stranger to various epidemics and had previously had to cope with outbreaks of scarlet fever, typhus, and various different subtypes of influenza, and there was no way of foreseeing that the Spanish flu was going to be worse than any of these diseases. Also, Canada suffered from a lack of a government medical organization during the outbreak. As the Report to the Vice-Chairman of the War Committee stated after the outbreak, “Throughout this crisis there was no organization competent to handle the problem on a national scale. The control of disease was necessarily left to local boards, many of them ill-informed and all of them inevitably lacking in co-ordinated effort” (Belyea, 2018). One example of this initial lack of response was in Kingston, Ontario, where the local Medical Health Officer did nothing to try to prevent or control the spread of the disease beyond informally advising people to avoid public assemblies (Belyea, 2018).

Restrictions, Quarantines, and Hospitals

It was only on October 19th of 1918 that Ontario’s Provincial Medical Health Office, Dr. John McCullough, issued instructions to shut down public places like schools and businesses throughout the province. Around this time, various other parts of Canada started to introduce measures in an attempt to prevent the flu from spreading to them. Multiple communities, including Grosse Isle on the St. Lawrence river and Edmonton, Alberta opted to quarantine themselves to prevent the flu from spreading either from or to them. Emergency hospitals were set up around Canada, many of them, like the Great War Veterans’ Association Hospital in Kingston, Ontario, only treated victims of the flu (Belyea, 2018).

Figure 4. An emergency hospital for the Spanish flu in Fort Riley, Kansas; the hospitals in Canada would have looked similar to this. Adapted from “Lessons in Global Cooperation from the Spanish Flu, 100 Years Later,” by M. Callaghan, (2018, November 7), Ottawa Citizen, retrieved from https://ottawacitizen.com/opinion/columnists/callaghan-lessons-in-global-cooperation-from-the-spanish-flu-100-years-later. Copyright 2019 by Postmedia Network Inc. Reprinted without permission.

Vaccine Trials

Canadian medical professionals worked very hard to find a cure for the Spanish Flu. The general principles of vaccination were understood at this point in time; as previously mentioned, the Canadian medical community had just come to accept the effectiveness of the smallpox vaccine. So, many Canadian doctors tried to apply them and tested various vaccines by inoculating people with a preparation containing serum from patients who were recovering from the Spanish flu (Belyea, 2018). Many of these trials ultimately proved to be ineffective, but one of them, conducted by Dr. Guilford B. Reed, made significantly more progress than others.

    Dr. Reed was a physician born in Nova Scotia during 1887. At the time of the outbreak of the flu, he was the assistant to the first professor of Pathology and Bacteriology at Queen’s University in Kingston, Ontario, and a captain of the Canadian Army Medical Corps at Queen’s Military Convalescent Hospital, as hospital that was set up to treat injured soldiers returning from World War I. Dr. Reed gained knowledge of the flu working at this hospital, as many soldiers who returned from the war were infected with it. When the flu broke out, he immediately started to conduct research with its bacteria. On October 1st, 1918, he collected samples from the upper pharynxs of 70 people infected with the flu. Upon analyzing these samples, he identified four types of bacteria that were present in many of the patient’s throats: 94% of the swabs contained Bacillus influenzae (known today as Haemophilus influenzae type b), 56% contained Streptococci (now called Streptococcus pneumoniae), 50% contained pneumococci, and 31% had Moraxella catarrhalis. So, Dr. Reed and his assistants grew multiple strains of these bacteria in pure cultures on agar (a jelly-like substance extracted from algae) with rabbit’s blood, and then created a vaccine from these cultures. Dr. Reed conducted vaccine trials with 193 medical students at Queen’s; of these 193, 142 were given three doses of the vaccine, while 51 were not vaccinated. The results of these trials were promising. During the period from October 1st to November 1st, 45.3% of the students who were not vaccinated caught the flu, while only 12% of the ones who had been did. Dr. Reed also sent the vaccine to various military units in his area, including ones in Kingston, Ottawa, Cobourg, and Deseronto. Within these units, 16.2% of soldiers and officers decided to be vaccinated. Only 0.8% of these men came down with the flu, as opposed to 21.6% of the men who didn’t receive the vaccine. Encouraged, Dr. Reed then sent his vaccine to 30 other doctors in eastern Ontario and asked them to test it on their patients and send him the results. 28 doctors responded, and their results showed that, on the whole, the vaccine had a positive effect.

    However, despite these promising results, Dr. Reed’s vaccine ultimately didn’t prove to be of that much use during the pandemic. For one thing, his research required a lot of time and he was only able to publish his findings in his paper “Some Results of Protective Inoculation Against Epidemic Influenza” during June of 1921, a year after the Spanish flu had mostly faded. Also, even after Dr. Reed started to share his findings with the medical community, it was extremely difficult to produce a large number of vaccines within a short period of time, especially as his research, while promising, was not considered definite enough to be warranted conclusive and therefore deserving of priority in the manufacturing process (“Dr. Guilford B. Reed,” 2017). Moreover, the influenza disease is not caused by a bacterial infection as Dr. Reed thought; rather, it is a virus. Viruses are much smaller than bacteria, so much so that medical professionals were unaware of their existence until 1933, after the powerful electron microscope had been invented (Belyea, 2018). It is likely that the success of Dr. Reed’s vaccine during trials came about because of the fact that the bacteria samples that he took from infected patients, along with at least some of the ones that he cultivated, were carrying the Spanish influenza virus.

Figure 5. Some diseases that are bacteria and some that are viruses

However, although Dr. Reed’s idea about bacteria transmitting the flu was only partially correct, his understanding of the principles of vaccination (ie. taking samples from people who are infected, testing them for patterns, and developing a vaccine based on the results) was quite correct, and these principles would go on to be important for medical research.

Creation of the Federal Health Department

    

    As previously mentioned, many people were unhappy about the lack of organization and government input during the pandemic. Technically speaking, national health matters were under the control of the Department of Agriculture, but they, like everyone else, were ill-prepared for the outbreak. So, in 1919, the Federal Health Department was created to handle future health issues in Canada (Belyea, 2018). The Federal Health Department joined with the Department of Soldiers' Civil Re-establishment to create the Department of Pensions and National Health in 1928. It then became the Department of National Health and Welfare in 1944, and, more recently, Health Canada in 1993. Today, Health Canada continues to oversee national health and is especially active in preventing the spread of influenza (Cheung-Gertler, 2014). The creation of the Federal Health Department was one of the few good things that came about as a result of the Spanish flu.

Figure 6. The modern Health Canada logo