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Delivering Flu to Toronto: an Anthropological Analysis of the 1918-19 Influenza Epidemic in Toronto, Ontario, Canada

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Delivering Flu to Toronto: an Anthropological Analysis of the 1918-19 Influenza Epidemic in Toronto, Ontario, Canada “SEND ONLY YOUR SERIOUS CASES.” DELIVERING FLU TO TORONTO: AN ANTHROPOLOGICAL ANALYSIS OF THE 1918-19 INFLUENZA EPIDEMIC IN TORONTO, ONTARIO, CANADA _______________________________________ A Dissertation presented to the Faculty of the Graduate School at the University of Missouri-Columbia _______________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctorate of Philosophy _____________________________________________________ by KAREN SLONIM Dr. Lisa Sattenspiel, Dissertation Supervisor DECEMBER 2010 © Copyright by Karen Slonim 2010 All Rights Reserved The undersigned, appointed by the Dean of the Graduate School, have examined the dissertation entitled “SEND ONLY YOUR SERIOUS CASES.” DELIVERING FLU TO TORONTO: AN ANTHROPOLOGICAL ANALYSIS OF THE 1918-19 INFLUENZA EPIDEMIC IN TORONTO, ONTARIO, CANADA Presented by Karen Slonim A candidate for the degree of Doctor of Philosophy And hereby certify that in their opinion it is worthy of acceptance. _____________________________________ Professor Lisa Sattenspiel _____________________________________ Professor Todd VanPool _____________________________________ Professor Mark Flinn _____________________________________ Professor Matthew Gompper _____________________________________ Professor D. Ann Herring This dissertation is dedicated to Ethan Slonim Reusch. Don’t ever let anyone else define your potential. If you invest your heart, your brain will follow. ACKNOWLEDGEMENTS I would like to thank my advisor Dr. Lisa Sattenspiel for the tremendous number of hours she put into correcting numerous drafts of this dissertation. I would also like to thank her for challenging me to be a better anthropologist. I am an improved scholar and more well rounded person for having met you. Thank-you for investing in me, I look forward to hearing about new models and fun flu facts from Newfoundland. I would also like to thank my committee members for all of their hard work. Dr. Ann Herring, there are no words. I can’t thank you enough for infecting me in Paris; my life has been forever changed. I hope that I am able to maintain your level of passion and innovation throughout my career. Dr. Todd VanPool, you have forever changed my vantage point on gender and statistics. You are a tremendous teacher and I thank you for providing me access to worlds I felt were beyond my reach. Dr. Mark Flinn, a fellow big-picture thinker, thank you for deepening my understanding of evolution and health. Dr. Matt Gompper for reminding me that all animals get sick, thank-you for challenging me to see the ‘host’s’ perspective, and last but not least, Dr. Reed Wadley you were an amazing anthropologist and it was a true honour to have been taught by you. Special thanks should also be given to the many archivists who assisted me with this project. I am in awe of the knowledge you hold and your willingness to share it. I would also like to thank the Life Science Program at the University of Missouri-Columbia, not only for your generous funding but also your commitment to student development. ii On a personal level I would like to thank my family. Dad, again your generous support and encouragement helped me make it to this milestone. Mom, Dave, John, Amanda and Emma you make an amazing support system, and I thank you for that. My wonderful husband, Ryan Reusch, you make me crazy but you make me better. Thank you so much for always challenging me to push beyond my limitations and when I can’t get there on my own, being patient enough to explain it to me. You are an amazing teacher! I love you and would not have made it here without your help; you make me whole. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................ ii LIST OF FIGURES .......................................................................................................... vii LIST OF TABLES ...............................................................................................................x ABSTRACT ...................................................................................................................... xii Chapter 1. INTRODUCTION ....................................................................................................1 2. FRAMEWORKS ......................................................................................................7 Evolutionary Medicine Political Economy Syndemics 3. HISTORICAL CONTEXT .....................................................................................19 Toronto the Good Influenza Epidemiology 1918-1919 Epidemic in Canada 4. METHODS AND MATERIALS ............................................................................43 A Day in the Life: Reconstructing the Spanish Flu in Toronto Death Registries Establishing Inclusion Parameters – Flu v. Pneumonia America’s Forgotten Pandemic – Finding Flu in the Archives Reporting Bias – Assessing Toronto Newspapers 5. AN EPIDEMIOLOGICAL LOOK AT FLU ..........................................................65 iv Timing of the Epidemic “Send Only the Very Serious Cases” – Delivering Flu to Toronto Age Distribution of Pandemic Mortality in Toronto Sex Distribution of Pandemic Mortality in Toronto Occupation and Ethnicity 6. FRAMING FLU ......................................................................................................98 Just the Facts: Using the Printed Word to Reconstruct the Pandemic Experience in Toronto Framing Influenza Act I: Prologue Act II: Managing Randomness Act III: Negotiating Public Response Act IV: Epilogue 7. WAR AND PLAGUES: SPANISH FLU AND THE FIRST WORLD WAR .....128 Conflict Participation Decreases the Ability of the State to Confront Epidemics War Weary!? – Psychological Strain and Physiological Discomfort Military Matters Care and its Consequences Conflict Participation Increases the Ability of the State to Confront Epidemics Women’s Work The Neighborhood Workers’ Association Sisters of Service Rotary Means Service 8. DISCUSSIONS, CONCLUSIONS AND FUTURE DIRECTIONS ....................176 v The Toronto Pandemic Experience in a Nutshell Findings Derived From a Political Economy Framework Adopting a Syndemics Analysis Incorporating Evolutionary Medicine Future Directions Public Health Response to H1N1; Summary of What Was and What Should Be APPENDIX 1. EXTENDED CAUSE OF DEATH TABLES.......................................................190 2. PORPORTIONATE MORTALITY SCATTER PLOTS ....................................194 BIBLIOGRAPHY ............................................................................................................199 VITA ................................................................................................................................227 vi LIST OF FIGURES Figure Page 1.1 Map of Toronto ............................................................................................................2 3.1 Rally of the Anti-Vaccination League of Canada ......................................................24 3.2 Influenza A Genetic Reassortment Schematic ...........................................................30 5.1 Introduction of the Virus From Niagara-on-the-Lake to Toronto via Troop Movements ................................................................................................................67 5.2 Deaths Attributable to Spanish Influenza, Toronto, 1 September to 31 December 1918 ...........................................................................................................................71 5.3 Disease Causing Death for Compiled Toronto Data, 1 September to 31 December 1918............................................................................................................................77 5.4 Immediate Cause of Death for Compiled Toronto Data, 1 September to 31 December 1918 ..........................................................................................................78 5.5 Comparison of Disease Causing Death and Immediate Cause of Death for Compiled Data, Toronto, 1 September to 31 December 1918 ...................................................79 5.6 Population Pyramid Displaying Mortality in Toronto from 1 September to 31 December 1918 ..........................................................................................................85 5.7 Influenza and Pneumonia Deaths for the City of Toronto, 1 September to 31 December 1918 by Sex .............................................................................................89 5.8 Proportionate Mortality by Age in Ten-year Intervals for the Crest of the Second Wave of the Spanish Flu Epidemic, Toronto, 9 October to 2 November 1918 ........90 5.9 Six Occupations With the Highest Mortality, by Age ..............................................95 6.1 Spanish Influenza Time-Line, Toronto, 1 September to 31 December 1918 ...........99 6.2 Davies Department Store Ad ..................................................................................104 6.3 Proportionate Mortality by Individuals Aged 1-19, 8 October to 18 November 1918 ...................................................................................................................................113 6.4 Northway Ad for Department Store Disinfection ....................................................117 vii 6.5 Toronto Influenza and Pneumonia Mortality for November 1918 ..........................125 6.6 Influenza and Pneumonia Mortality, Toronto, 1 September 1918 to 31 December
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