Epidemic

The application of the principles of hygiene in recent decades has virtually eliminated epidemic outbreaks of the most deadly of the contagious diseases. Canada, at least until the last century, had no overcrowded cities and all the benefits of alternating hot and cold seasons, but it did not manage to escape the devastation of epidemic outbreaks.

Two main reasons explain this fact. The overcrowded, unhealthy ships which linked America to Europe favoured the development of contagious diseases such as SMALLPOX, typhus, CHOLERA and INFLUENZA among their passengers. Ignorance of the causes of these diseases and how they were transmitted helped spread them into port cities. The outbreak of an epidemic almost always coincided with the arrival of a vessel full of sick passengers. The second factor had to do with the native population. Since they had had no contact with the germs of these diseases, they had no natural defences against them and so formed an ideal reservoir for the multiplication of the responsible bacteria or virus.

By the end of the 18th century inoculation against smallpox (the introduction beneath the skin of smallpox pus) had become a popular preventive method in Europe. Soon after, vaccination - more effective and less dangerous - appeared in North America. Epidemics of smallpox continued to affect the population, however, and Montréal was particularly hard hit. The epidemic of 1885 was especially dramatic; its scale persuaded municipal authorities to make vaccination obligatory, but medical opinion divided into pro- and antivaccination camps, with the latter accusing the former of spreading the disease. The population, terrified, refused to be vaccinated. On 18 September 1885 a riot broke out in the city. People tore down provaccination posters and ransacked the home of the official medical vaccinater, the city hall, pharmacies and the homes of municipal magistrates. The extent of the catastrophe (it took 3164 lives, 2117 of them children) finally sobered Montréalers into more reasonable behaviour and they obeyed the sanitary authorities and the clergy.

Typhus first reached Canada in 1659, but the episode of 1746 was notable for its severity. France had sent a large flotilla of warships to Canada to retake Port-Royal in Acadia. Of the 3150 soldiers aboard, 1270 died at sea and another 1130 in Bedford Basin, where they were supposed to rendezvous with an army coming from Québec. The disease hit the Micmacs of the region and more than one-third died. Eighteen forty-seven was "the year of the typhus," when 9293 British immigrants died during the Atlantic crossing. Another 10 037 died at GROSSE-ÎLE, the quarantine station in the St Lawrence River below Québec, or in the hospitals of Québec, Montréal, Kingston and Toronto. Monuments at CAP DES ROSIERS on the Gaspé coast commemorate those who died at sea.

The Canadian government feared the introduction of cholera by European immigrants, especially in 1831, when Asian cholera was devastating Europe. New regulations forbade the local population to visit ships in port. A sanitation committee was set up early in 1832, quarantine laws were strengthened and Grosse Île was placed under military command. One ship was permitted to leave the quarantine station, however, and was responsible for the cholera epidemic in 1832 which was responsible for the deaths of some 6000 people. Barely 2 years later the disease struck again, and sporadic outbreaks occurred throughout the century.

Influenza mortality was usually low, but some epidemics of it occurred during outbreaks of typhus or other diseases. Since the post-WWI outbreak of Spanish influenza, scientific discoveries have rendered infectious diseases less deadly. Recent influenza epidemics, for example, have caused much sickness but few deaths. In the 1997-98 year, approximately 4500 Canadians reported laboratory confirmed cases of influenza. Health Canada reports that immunizing high-risk persons, such as the elderly and very young, before each influenza season is the most effective measure for reducing influenza-related complications.

Epidemics of other diseases included yellow fever, leprosy and tuberculosis. In 1710, the germs of a disease as yet unknown in Canada, at the time called "the Siamese disease" and today known as yellow fever, arrived in the port of Québec from the West Indies. The vector insect is Stegomya fasciata. This mosquito found the heat and humidity on board ship ideal for its reproduction and infected the vulnerable passengers with the dangerous virus. The sick sailors were taken to HÔTEL-DIEU in Québec, where they died - as did 6 nurses and 12 priests. The epidemic must have claimed many victims, but the exact number is unknown. Once winter came, the insect and its disease both disappeared. There do not seem to have been any other such epidemics in Canada, even if a few sporadic cases occurred in the country's port cities. The Canadian government has on occasion declared quarantine against American ports where the disease has raged.

In 1773 a mysterious disease appeared in the Baie Saint-Paul area which spread through neighbouring parishes and finally reached the Montréal region. It was marked by buccal ulcers, pain in the limbs and finally the destruction of the bones of the nose, the palate, the gums and the appearance of swellings on the head, the clavicles and the bones of the limbs. Men, women and children were all afflicted. After some hesitation and discussion, medical opinion decided that this malady, known as the Baie Saint-Paul disease, was of syphilitic origins.

There were a few cases of leprosy in Canada in the 19th century, even if the cases cannot be called an epidemic. In 1815 the disease was brought to the Tracadie region of NB by 2 Norwegian sailors. Cases multiplied and the authorities built a leprosarium which was run by the sisters of Hôtel-Dieu in Montréal and, from 1815-1924, received 319 lepers. Some cases of leprosy were also observed in Cape Breton, Manitoba and PEI. In 1882, in New Westminster, BC, the compatriots of a Chinese leper hanged him in the hope of choking off the infection. After other lepers were discovered in the province, a leprosarium was opened at D'Arcy Island in 1907. There has been an increase in leprosy in Canada in recent years, almost all of its victims being recent immigrants, usually from the Orient or the West Indies.

Because of the insidious beginnings of a tubercular attack and the chronic nature of its evolution, tuberculosis cannot be defined as an epidemic. However tuberculosis, that universal social scourge, existed in endemic state in the Canadian population during the 19th century and early 20th century. Poor hygiene, urban overcrowding and malnutrition all encouraged the outbreak and spread of the illness. Thanks to better living conditions and the discovery of antibiotics, TB has been contained and is now quite rare. Unfortunately it persists in endemic form among certain disadvantaged populations such as Canada's native peoples.

Epidemics have had a great impact on society, preoccupying whole communities and making severe demands on the abilities of individuals and their societies to cope with the crisis. Epidemics also spur the development of control and prophylactic measures.

Author MARCEL CADOTTE

Links to Other Sites
Health Canada
The website for Health Canada. This section contains an overview of Health Canada and provides you points of entry to many Health Canada-specific related topics.

Toronto forged its identity amid cholera outbreak
An account of the devistating cholera outbreak in 19th century Toronto. Also includes a listing of landmark events in Canadian public health. From the healthzone.ca website.

Canadians for Health Research
The website for Canadians for Health Research provides the latest news and information about programs that promote science and health research initiatives in Canada.

fightflu.ca
The fightflu.ca website provides one-stop access to online information and resources about influenza (flu). From the Government of Canada in collaboration with provincial and territorial governments.

Community and Hospital Infection Control Association of Canada
An informative website about effective practices for the prevention and control of infectious diseases for health care professionals and the general public. Check out the contact information for local chapters in your region.

CBC Digital Archives: Health
Search this extensive multimedia CBC website for news stories about a wide range of public health issues in Canada.

Canadian Bioethics Society
The website for the Canadian Bioethics Society, an organization concerned with ethical issues relating to human life and health, biology, and the environment. Click on "Bioethics Community" to access their blog and other online resources.

Canadian Institute of Child Health
CICH is a national charitable organization dedicated to improving the health of children and youth in Canada. Check out the informative CICH Communiqués and other resources about children’s health.

Endemic Leprosy in 19th Century New Brunswick
An article about the outbreak of leprosy in the Acadian Population of New Brunswick during the 19th century. From the University of Western Ontario Medical Journal. A PDF file.

UNICEF Canada
UNICEF programs focus on the health, education and safety needs of children around the world. UNICEF also provides assistance to children involved in natural disasters and other emergency situations.

Canadian Bulletin of Medical History
Search for full text articles on a variety of medical topics at the website for the Canadian Bulletin of Medical History. Published by Wilfrid Laurier University Press.

Hand Hygiene
Learn why washing your hands is good for you. From the website for the Community And Hospital Infection Control Association.