Spanish Influenza in the City of Vancouver, British Columbia, 1918-1919
by
Sarah Buchanan B.Sc., Queen‟s University, 2007
A Thesis Submitted in Partial Fulfillment of the Requirements for the Degree of
MASTER OF SCIENCE
in the Department of Geography
Sarah Buchanan, 2012 University of Victoria
All rights reserved. This thesis may not be reproduced in whole or in part, by photocopy or other means, without the permission of the author. ii
Supervisory Committee
Spanish Influenza in the City of Vancouver, British Columbia, 1918-1919
by
Sarah Buchanan B.Sc., Queen‟s University, 2007
Supervisory Committee
Dr. Aleck Ostry, (Department of Geography, University of Victoria) Supervisor
Dr. Denise Cloutier, (Department of Geography, University of Victoria) Departmental Member
Dr. Mary-Ellen Kelm, (Department of History, Simon Fraser University) Additional Member
iii
Abstract
Supervisory Committee
Supervisor Dr. Aleck Ostry, Department of Geography, University of Victoria Departmental Member Dr. Denise Cloutier, Department of Geography, University of Victoria Additional Member Dr. Mary-Ellen Kelm, Department of History, Simon Fraser University
During the last year of World War I (1918), a second deadly foe was causing mortality around the world. Spanish Influenza killed an estimated 50-100 million people worldwide, including 50,000 people in Canada during the 1918-1919 pandemic. This thesis examines the impact of Spanish Influenza on people living in Vancouver, British
Columbia, Canada between June of 1918 and June of 1919. Statistical analysis with SPSS was used to determine the association between influenza-caused deaths and socio- demographic characteristics such as age, gender, immigration status, and employment. In
Vancouver, those who were between the ages of 19 to 39, and those who were employed, showed higher odds of dying from influenza during the epidemic. iv
Table of Contents Supervisory Committee ...... ii Abstract...... iii Table of Contents ...... iv List of Tables ...... vi List of Figures ...... vii Acknowledgments ...... viii Dedication ...... ix Chapter 1: Introduction ...... 1 1.1 Purpose/Objectives ...... 1 Chapter 2: Literature Review ...... 4 2.1 Understanding Spanish Influenza through the Lens of Medical Geography ...... 4 2.2 Spanish Influenza around the World ...... 5 2.3 Public Health and the Response to Spanish Influenza ...... 7 2.4 Origins, Timing, and Mortality from the Epidemic ...... 10 2.5 Groups Most Vulnerable to the Epidemic ...... 20 2.6 Spanish Influenza in British Columbia and Vancouver ...... 21 2.7 Summary ...... 23 Chapter 3: Methods ...... 25 3.1 Data Collection and Determining Population Size ...... 25 3.2 Boundary of Analysis ...... 26 3.3 Calculating Mortality Rates ...... 27 3.4 Managing the Association between Pneumonia and Influenza ...... 28 3.5 Analysis using the Statistics Package for Social Sciences (SPSS) ...... 28 3.6 Visual Representation ...... 30 3.7 Limitations ...... 31 Chapter 4: Results ...... 34 4.1 Boundaries ...... 34 4.2 Case Definition of Influenza Deaths...... 35 4.3 Socio-demographic description of influenza versus non-influenza deaths in both time periods ...... 38 4.4 Temporality of Influenza Deaths within Vancouver ...... 46 4.5 Distribution of Influenza Deaths in Vancouver ...... 47 4.6 Mortality Rates in the City of Vancouver ...... 49 4.7 Statistical Analysis of Links between social and geographic characteristics of residents and influenza deaths in Vancouver ...... 51 4.7.1. Univariate analyses...... 51 4.7.2 Multivariate Analysis ...... 58 Chapter 5: Discussion ...... 61 5.1 Timing and Intensity ...... 62 5.2 Spatial Distribution of Influenza Deaths in Vancouver ...... 63 5.3 Socio-Demographic Characteristics of Influenza in Vancouver ...... 64 5.4 Mortality Rates for Spanish Influenza in Vancouver ...... 65 5.5 Contributions to Medical Geography ...... 66 5.6 Future Research Opportunities...... 67 v Chapter 6: Conclusion ...... 69 Bibliography ...... 71 Appendix A: Codebook ...... 78 A.1 Coding for Cause of Death and Secondary Cause of Death ...... 78 A.2 Coding for Occupation ...... 115 A.3 Coding for Birthplace ...... 131 A.4 Coding for Place of Death ...... 135 A.5 Coding for Residence ...... 135 A.6 Coding for Immigrant Status ...... 135 A.7 Coding for Race ...... 136 Appendix B: Immigrant Proportions ...... 137 Appendix C: Socio-Demographic Characteristics ...... 138
vi
List of Tables Table 1. Overview of Canadian provincial and city mortality rates from the literature. ... 15 Table 2. Primary cause of death in 1918-19 and 1921-22...... 36 Table 3. Secondary cause of death for 1918-19 and 1921-22...... 37 Table 4. Influenza versus non influenza deaths by time period...... 38 Table 5. Influenza versus non influenza deaths by residence and time period...... 38 Table 6. Influenza versus non influenza deaths by gender and time period...... 39 Table 7. Influenza versus non influenza deaths by age category and time period...... 40 Table 8. Influenza versus non influenza deaths by place of death and time period...... 41 Table 9. Influenza versus non influenza deaths by birthplace and time period...... 42 Table 10. Influenza versus non influenza deaths by employment status and time period. 42 Table 11. Influenza versus non influenza deaths by employed occupation and time period...... 43 Table 12. Influenza versus non influenza deaths by marital status and time period...... 44 Table 13. Influenza versus non influenza deaths by race and time period...... 44 Table 14. Influenza versus non influenza deaths by simple immigration status and time period...... 45 Table 15. Influenza versus non influenza deaths by length of residence in Canada and time period...... 45 Table 16. Mortality Rates for Gender, Age Group, Immigrants, and the Employed, 1918- 1919...... 50 Table 17. Chi-square test for gender and influenza deaths in 1918-1919...... 51 Table 18. Chi-square test for gender and influenza deaths in 1921-1922...... 51 Table 19. Chi-square test for age category and influenza for 1918-19 and 1921-22...... 52 Table 20. Chi-square test for place of death and influenza in 1918-19 and 1921-22...... 53 Table 21. Chi-square test for birthplace and influenza in 1918-19 and 1921-22...... 53 Table 22. Chi-square test for employment status and influenza in 1918-19...... 54 Table 23. Chi-square test for employment status and influenza 1921-22...... 54 Table 24. Chi-square test for occupation and influenza in 1918-19 and 1921-22...... 55 Table 25. Chi-square test for marital status and influenza in 1918-19 and 1921-22...... 55 Table 26. Chi-square test for immigration status and influenza in 1918-19...... 56 Table 27. Chi-square test for immigration status and influenza in 1921-22...... 56 Table 28. Chi-square test for race and influenza in 1918-19...... 57 Table 29. Chi-square test for race and influenza in 1921-22...... 57 Table 30. Chi-square test for length of residence in Canada and influenza in 1918-19 and 1921-22...... 58 Table 31. Correlation between age, gender, birthplace, immigration status, length of residence in Canada, and employment status for Vancouver residents in 1918-19...... 59 Table 32. Multivariate analysis showing odds ratio‟s for age category, marital status, gender, and employment status in 1918-19...... 60
vii
List of Figures
Figure 1. Crowd outside of Hotel Vancouver, November 1918...... 7 Figure 2. The SEF leaving the Port of Vancouver...... 14 Figure 3. Vancouver, 1915...... 22 Figure 4. City of Vancouver boundary in 1915...... 35 Figure 5. Influenza versus non influenza deaths by time period...... 47 Figure 6. Location of residence for Vancouver residents dying of influenza in 1918-19. 49
viii
Acknowledgments
First and foremost, I would like to extend my heartfelt thanks to my supervisor Aleck
Ostry for his guidance and encouragement throughout this project. To my committee members, Denise Cloutier and Mary-Ellen Kelm, thank you for your time, feedback, and support toward this work; I have truly appreciated your perspectives. Additionally, a big thank you to Ashley LeBourveau who so carefully transcribed the death certificates from microfiche into Excel for me. And finally, Patrick Lucey and Cori Barraclough, thank you for your total support and keen interest in all that I do and for teaching me to see the world with new eyes; I would not be where I am today without you both.
ix
Dedication
I dedicate this thesis to my family for their never-ending love, support, encouragement, and belief in me; and to Adriel and Bruiser for keeping a smile on my face.
Chapter 1: Introduction From the spring of 1918 until the spring of 1919 the world was under siege from a deadly influenza virus known as Spanish Influenza. As an H1N1 influenza A strain, the virus caused
“severe infection in the upper and lower respiratory tract, resulting in fatal respiratory complications and bacterial pneumonia” (Pica et al., 2010, p. 125). During this period, the pandemic killed an estimated 50 to 100 million people worldwide (Johnson and Mueller, 2002).
In Canada, approximately 50,000 people died from Spanish Influenza resulting in a mortality rate of 6.1 per 1,000 people (Fahrni, 2004; Jenkins, 2007; Johnson and Mueller, 2002; Jones,
2005; Pettigrew, 1983; Patterson and Pyle, 1991). The social consequences of the pandemic were severe and altered the way in which public health was understood.
While there is a plethora of historical research on the Spanish Influenza around the world, there is little research that takes a geographical and epidemiological approach, especially in
Canada. Furthermore, very little research has been conducted on the influenza‟s effect on cities in British Columbia. This research sought to fill this knowledge gap by taking a medical geography approach in conjunction with epidemiological methods to characterize the timing, extent, and socio-demographic determinants of influenza mortality in the City of Vancouver,
British Columbia, Canada.
1.1 Purpose/Objectives The purpose of this research was to conduct an in-depth geographical and epidemiological analysis of Spanish Influenza in Vancouver, British Columbia, during the pandemic of 1918-1919 and identify its demographic and geographical characteristics. One investigation of Spanish Influenza in Vancouver, British Columbia, estimated, using newspaper articles, that the disease had a mortality rate of 23.3 per 1,000 which was significantly higher
2 than the Canadian average of 6.1 per 1,000 (Andrews, 1977). This same rate is quoted by Kelm
(1999) and O‟Keefe and MacDonald (2004). However, in all these publications, it is unclear whether this is a maximum or an average rate and the methods are not detailed enough to determine how these rates were calculated. Additionally, there is no indication as to which populations were most affected or whether socio-economic status or location (separately or interactively) played a role in either contracting the disease or dying from this virulent strain of influenza. This research was based on detailed and comprehensive analysis of all Vancouver deaths from influenza during the epidemic and two years after the epidemic. The study sought to determine the timing of the epidemic, clearly define mortality rates and demographic/population risk factors for contracting Spanish Influenza. As well, adoption of a “case” and a “control” period permitted a comparison of the characteristics of the pandemic influenza with the more normal influenza season, which occurred in 1921-1922.
Based on the literature, six categories of questions were used to guide the analysis of Spanish
Influenza in Vancouver for 1918-1919. These questions are:
1. Did the first wave of Spanish Influenza in Vancouver occur in the Fall of 1918 and how many waves of the infection occurred? 2. Was the Fall 1918 wave of influenza more deadly than the other waves? 3. Were the effects of influenza consistent across all areas of Vancouver or did some locations experience a more severe mortality rate? 4. Were employed people more likely to die of Spanish Influenza? Were there specific occupations that experienced higher numbers of deaths? 5. Were young adults in Vancouver more likely to die of influenza than other age groups? 6. Did foreign born populations experience higher mortality rates than Canadian born citizens?
In order to answer these questions, the thesis is organized into five sections. Chapter two, the literature review, grounds this thesis in medical geography and highlights the story of the
Spanish Influenza pandemic on the world scale then focuses more specifically on the experience
3 of influenza in the United States and Canada. Chapter three explains the methods used to answer the research questions while chapter four reveals the results of the analysis. Finally, chapter five
(Discussion) and chapter six (Conclusions) link the results back to the specific research questions posed for this thesis and to other research conducted on Spanish Influenza.
4
Chapter 2: Literature Review
2.1 Understanding Spanish Influenza through the Lens of Medical Geography Medical geography is defined by the Encyclopedia of Geography as the “application of geographical methods and techniques to the study of health” (Jordan, 2012, p.1). While the term medical geography suggests a relationship to medicine, Mayer (2010) points out that this may be a misnomer due to the fact that the research has little to do with diagnoses and treatment but is more of an examination of the geography of disease and health service delivery with an epidemiological view point. Medical geography first arose in 1952 with the production of a report by the Commission on Medical Geography (Ecology) of Health and Disease to the
International Geographic Union (Meade and Earickson, 2000), with a focus on disease ecology, disease distribution, and health care service delivery and provision. However, as Meade and
Emch (2010) indicate, medical geography goes beyond just the simple presence of disease and also allows for the inclusion of social, political, and economic factors that influence the susceptibility of a population to disease and overall population health in general.
One of the key elements of medical geography is its biomedical perspective, a way of viewing issues of health using biological mechanisms of illness and disease (Moon, 2009). The idea of a biomedical gaze is attributed to the works of Michael Foucault, a philosopher of history
(or historical philosopher) who has written extensively on theoretical/methodological approaches related to the medical field (Bishop, 2009). The biomedical gaze involves examining/understanding a person based on their illness and the way that illness is biologically manifested within their body (Frank and Jones, 2003; Hick, 1999).
Consequently, the major critique of medical geography is not the research focus itself but the employment of the biomedical gaze which is dehumanizing and reductionist (Gatrell and
5 Elliot, 2009). What is interesting to note is that Meade and Earickson (2000) in the preface to their medical geography textbook specifically state that medical geography has become “less concerned with the optimization of health service delivery or a dichotomy between health service and disease ecology” in favour of becoming more “concerned with health geography as a behavioral and social construction and disease ecology as an interface between the natural
(physical world) and cultural dimensions of existence” (Meade and Earickson, 2000, p.v). This advancement in the field of medical geography has allowed, as part of this research, the inclusion of socio-demographic characteristics that help contextualize the quantitative results.
Furthermore, in their identification of questions of medical geography, Meade and Earickson
(2000) include a question regarding place which is typically associated with health geography as one of that discipline‟s central themes rather than a key element of medical geography. This suggests that medical geographers are distinctly aware of the prominent critique in their field of being dehumanizing and reductionist and that this is an evolving methodology moving toward a more broadly conceptualized health geography.
The framework of medical geography forms the basis of this research because it focuses on disease and illness (factors of ill-health) rather than health promotion and incorporates the use of quantitative analysis of disease. Due to the nature of the data being used to undertake this research, quantitative analysis is necessary as death certificates do not provide the opportunity for interviews nor qualitative analysis. Consequently, a medical geography approach was taken as opposed to a health geography approach.
2.2 Spanish Influenza around the World During the last year of World War One (1918), the world experienced a horrendous death toll as a direct result of this conflict and also due to a deadly strain of influenza commonly
6 referred to as the Spanish Flu. While the Spanish Influenza did not originate in Spain, it is believed by many authors that neutral Spain was the first to publicize its emergence because of less wartime censorship (Canadian Medical Association Journal, 1918; Rogers, 1968; Dickin
McGinnis, 1981; Kreiser, 2006).
Between the spring of 1918 and the following spring of 1919, Spanish Influenza spread around the world killing millions of people. First estimates of the worldwide death toll in the
1920s suggested that 20 million people died (Jordan, 1927). However, this mortality estimate has increased over time. For example, Patterson and Pyle (1991) estimated 24.7-39.3 million people died and, more recently, Johnson and Mueller (2002) estimated somewhere from 50 to 100 million may have died in the pandemic. Regardless of which estimate is deemed reliable, as
Tuckel et al. (2006) point out, this worldwide pandemic was unique as it killed millions of people in a very short time altering the way in which public health was viewed and understood.
For the purposes of this literature review, only material from the United States of
America and Canada were referenced in support of specific research to determine the effect of
Spanish Influenza on people living in Vancouver, British Columbia. The global mortality highlights the effect Spanish Influenza had during the period between the spring of 1918 and the spring of 1919. While the focus of this literature review was Canada, and to a lesser extent, the
United States, Spanish Influenza was not unique to North America, nor were mortality rates the highest in this part of the world (Canada 6.1 per 1,000; USA 6.5 per 1,000; Mexico 20.6 per
1,000) (Johnson and Mueller, 2002). In fact, the most deaths attributed to this disease occurred in
India with a recorded estimate of 18 million deaths (6.1 per 1,000) while the highest morality rates (between 10.7 and 445 per 1,000) were likely experienced in Africa (Johnson and Mueller,
2002).
7 2.3 Public Health and the Response to Spanish Influenza Beyond discussions of mortality rates and death tolls, specific themes relating to this epidemic appear and reappear throughout the Canadian and US literature, regardless of the location being examined. These themes include greater emphasis on waging war than on dealing with the public health problems created by the pandemic; the ineffectiveness of quarantine; a lack of hospital beds, equipment, and personnel; the use of influenza fears to market so-called curative or preventative treatments; and, finally, the mobilization of ordinary citizens into volunteer organizations to take care of the sick.
Andrews (1977), Byerly (2005), and Kreiser (2006) point out that despite warnings about public gatherings, people still congregated in city streets to welcome soldiers home from the war. These authors claim that these public gatherings resulted in a spike in influenza cases in the days following. Furthermore, Kreiser (2006) calls attention to the fact that the desire to Figure 1. Crowd outside of Hotel Vancouver, November 1918. Thomson, Stuart. (Photographer). Armistice Day provide people and supplies to the war crowd outside Hotel Vancouver, Georgia Street. [Online image]. Retrieved from City of Vancouver Archives, effort precluded precautions, such as http://searcharchives.vancouver.ca/armistice-day-crowd- outside-hotel-vancouver-georgia-street;rad. quarantine, from being implemented in the early days of the epidemic. Hence, activities specifically related to the war effort were not hampered by quarantine protocols leading to the conclusion that quarantine measures were not implemented effectively. The inability to effectively implement quarantine measures is also illustrated by the Toronto experience, whereby
8 the disease spread so quickly to so many people that quarantine and isolation became impractical almost immediately (MacDougall, 2007).
Additionally, hospitals were badly understaffed during the war and communities had to compensate by opening other buildings such as schools and hotels to care for the sick (Boucher,
1918; Dickin McGinnis, 1976; Andrews, 1977; Jones, 2005; MacDougall, 2007). As well, personnel were difficult to find with large numbers of citizens overseas, and provisioning was more difficult because the military had first access to materials. Finally, many medical professionals became ill with the flu further straining resources for caring for the sick (Dickin
McGinnis, 1981).
As a result of the widespread concern about contracting Spanish Influenza, many businesses and other organizations cashed in on the panic to promote and market products as essential flu prevention and protection techniques (Andrews, 1977; Jenkins, 2007). Pettigrew
(1983) spends a whole chapter describing these different products. Some of the more interesting remedies included: lard mixed with turpentine, gin pills, goose grease, camphor, sulphur, and oil of cinnamon (Pettigrew, 1983; Jones, 2007). However, none of these products proved to be consistently effective remedies.
One of the most impressive feats throughout the epidemic was the mobilization of volunteers and organizations to care for the sick. The lack of medical personnel resulting from the war effort was well recognized and entire communities responded to supply the labour and care necessary to help those who were ill in the community. Dickin McGinnis (1976, p. 7) undertook a study of Calgary, Alberta, and noted that volunteering to help with influenza was viewed as an opportunity for “women to do their bit for war and for civilization”. These women acted as personal nurses and provided food via soup kitchens. The use of the volunteer force is
9 also reflected by Jones‟ work on influenza in Winnipeg (Jones, 2002, 2005, 2006, 2007). For more information see Jones (2007) who examines in her book the role of women and volunteering in aiding in the care of those ill with influenza.
So what made Spanish Influenza so deadly and unique? Researchers such as Herring
(1993) and Kelm (1999) hypothesize that part of its virulence was because it was a virgin soil epidemic so no one had immunity to it. Others postulate that it was not necessarily the flu itself that was deadly but the secondary pneumonia infection that caused fatality (Canadian Medical
Association Journal, 1918; MacDougall, 2007; Robertson, 1919). Perhaps, as Dickin McGinnis
(1981) suggests, the conditions created by the war, the transportation of large numbers of people in a short amount of time, and the dismal conditions of the war trenches produced an environment ripe for the influenza virus to thrive. Additionally, it could have been that the medical world was not clear on what the cause of influenza was. The Spanish Influenza strain was not identified until 1933 by British scientists (MacDougall, 2007; Noymer and Garenne,
2000) and is still being analyzed genetically by researchers such as Taubenberger today. The genetic analysis of the influenza virus gathered from the frozen lung tissue of victims of influenza indicates that the 1918 virus was an H1N1-subtype influenza A virus (Taubenberger,
2003). Taubenberger (2003 and 2006) further classifies this Spanish Influenza virus as containing genes from avian-influenza strains and suggests that pigs may have acted as the intermediary host between birds and humans. Furthermore, the flu is an illness that consistently infects populations, often with high morbidity but low mortality so it may not have been taken seriously at the outset; i.e.an attitude of “after all, it‟s only the flu” may have set in (Kreiser,
2006, p.29).
10 2.4 Origins, Timing, and Mortality from the Epidemic There is much debate within the literature regarding where Spanish Influenza originated.
Some researchers suggest that the flu began in China in February 1918 and was brought to
Western Europe by Chinese labourers before being disseminated by troops fighting throughout
Europe and, from there, back to soldiers‟ countries of origin (Dickin McGinnis, 1981; Pettigrew,
1983). The virus requires an intermediate host, such as pigs, to be transmitted from the avian population to the human population. The close proximity between the natural influenza reservoir of birds, the intermediate hosts (pigs), and humans in Asia has resulted in that area being considered an influenza epicentre (Shortridge and Stuart-Harris, 1982; Webby and Webster,
2001). Consequently, China as the origin makes sense biologically.
Now consider how the virus could have been transmitted from China to the western front.
A recently published book by Guoqi (2011) documents the journey of upwards of 80,000
Chinese labourers across the Pacific Ocean to Vancouver. From Vancouver they boarded onto railway cars being transported across Canada to the eastern ports for passage to the Western front. This transportation of Chinese labourers occurred between March 1917 and March of 1918 and was considered to be of utmost secrecy with a complete blackout of the media. At the time, a
$500 head tax was required from any Chinese person entering Canada; however, because these labourers were enroute to Europe, the Government of Canada waived the tax on the condition the labourers did not get off the trains (Guoqi, 2011). Not all of the 140,000 – 200,000 Chinese labourers, sought to address manpower shortages in Western Europe, travelled through Canada on their way to France. King (1918) indicates that some of them were sent through the
Mediterranean although the majority are said to have passed through Canada and the United
States. Whatever the route, perhaps some of these labourers harboured a precursor to the deadly
Spanish Influenza.
11 Another hypothesis of the origin of Spanish Influenza comes from Oxford (2001) who suggests that an acute respiratory infection at Etaples, France, in the winter of 1916 was an influenza virus of a type similar to the 1918 flu. However, most authors suggest that this strain of influenza actually originated in the United States in Haskell County and spread to the Camp
Funston army base in north central Kansas where the illness was first reported on March 5, 1918
(Vaughan, 1921; Patterson and Pyle, 1991; Crosby 2003; Barry, 2004). From there it was carried by troops transported by ships to serve on the European battlefields and then to the rest of the world. However, Erkoreka (2009, p.192) cautions that it is “problematic to assign such a specific date to the beginnings of the pandemic, since its origins are likely to be much more complex and varied”. This statement leaves room for continued debate on where the Spanish Influenza strain first developed.
Whether Spanish Influenza originated in Kansas or not, the infection‟s presence there was a factor in the dissemination of the virus and kicked off the first of three influenza waves beginning in the spring of 1918, the fall of 1918, and the winter of 1918-1919 (Crosby, 2003).
By June of 1919, 675,000 people had perished in the United States as a result of Spanish
Influenza that, according to Kreiser (2006), is more than the total number of American military deaths incurred during World War One, World War Two, the Korean War, and the Vietnam War combined.
Part of the reason for this high death toll, and the speed with which the epidemic spread throughout the United States, is attributed to the efforts of supplying as many soldiers as possible to the battlefields in Europe, which ruled out a public health approach of complete quarantine.
Crosby (2003, p. 56) indicates that the American armed services (Army and Navy) were affected
“earlier and more severely than the civilian population and to a certain extent were the foci from
12 which the civilian population received the disease”. Furthermore, Byerly (2005) and Kreiser
(2006) propose that quarantine (the only public health measure that could be used to effectively combat the epidemic) would have counteracted efforts to rapidly deploy US forces in Europe.
The war was deemed a more important task and troops were dispersed despite illness among the ranks.
Overall, the US mortality rate directly attributable to Spanish Influenza between 1918 and 1919 is 6.5 deaths per 1,000 people (Johnson and Mueller, 2002). However, as we will see for Canada, this rate was not consistent across the country. Rogers (1968) identifies mortality rates for five cities: Philadelphia (158 per 1,000), Baltimore (109 per 1,000), Washington (109 per 1,000), Boston (100 per 1,000), and New York (60 per 1,000). These rates suggest that while the overall mortality rate for the United States may have been relatively low, certain centers were more severely impacted. This is also reflected in a study conducted by Noymer and Garenne
(2000) who reveal that in the United States the life expectancy at birth dropped by 11.8 years in
1918 showing the disproportionate impact of the epidemic on young people.
Influenza did not reach Canada until late summer/early fall of 1918; although Dickin
McGinnis suggests it could have arrived earlier in June or July 1918, her hypothesis is refuted by
Humphries (2005). Therefore, it appears that the first wave of the pandemic did not involve
Canada directly. Despite this, the second wave was still destructive to Canadian populations when it did arrive. The most commonly cited estimate for the Canadian death toll caused by
Spanish Influenza and the pneumonia that accompanied it is 50,000 people out of a total population of about eight million, a mortality rate of approximately 6.1 deaths per 1,000 people
(Fahrni, 2004; Jenkins, 2007; Johnson and Mueller, 2002; Jones, 2005; Pettigrew, 1983;
Patterson and Pyle, 1991).
13 While this mortality rate of 6.1 per 1,000 is consistently documented, it is unclear when
Spanish Influenza first arrived in Canada. This is because of an unresolved debate about how the epidemic arrived and spread throughout the country. Early researchers such as Dickin McGinnis
(1976, 1981), Pettigrew (1983), and early works of Jones (2002), support the belief that the epidemic originated with Canadian soldiers returning from Europe on troop ships. The broader implication of this origin is that American troops infected in the first wave went to Europe where they infected Canadian troops who then brought the illness to Canada.
However, Humphries (2005) makes a strong case, based on military archives and ship records, that ships thought to have brought ill soldiers back from Europe were actually sitting empty in quarantine waiting to be sent to Europe. Thus, these ships could not have brought
Spanish Influenza to Canada. Instead, he presents a new hypothesis that the “physical path taken by pandemic influenza in Canada was determined by the intensification of the war effort, not by its waning” (Humphries, 2005, p. 241). In short, he theorizes that Spanish Influenza entered
Canada in late August 1918 with newly trained American recruits who were to be sent overseas via Canada. The “greatest single factor in the diffusion of the disease” according to Humphries
(2005, p.252) was the creation of the Siberian Expedition Force, which was to travel to Russia from Vancouver and included both American and Canadian troops. This expeditionary force was recruited during late August and early September of 1918, around the same time that the first influenza cases appeared in Ontario, Quebec, and Nova Scotia. This force was assembled in
Eastern Canada and transported via rail to Vancouver on October 2, 1918 (Humphries, 2005).
However, according to Humphries (2005), and corroborated by Jones (2007), the train did not make a direct journey but was forced to stop in major Canadian cities along the way to
14 drop off military members sick with influenza to the local hospitals. Accordingly, this railway
expeditionary force seeded the epidemic across Western Canada in the early fall of 1918.
The theory of an August 1918 arrival of influenza in Canada is in conflict with research
conducted by Palmer et al. (2007) who show that influenza was present in Newfoundland as
early as May 1918. Thus, it is possible that influenza entered Atlantic and Eastern Canada a few
months prior to August 1918; however, the train
journey of September 1918 was the primary route that
seeded the influenza virus into the west.
As influenza made its way across Canada,
different localities had dissimilar experiences with the
illness. Some areas such as Newfoundland (Palmer et
al., 2007) experienced two long waves of the illness Figure 2. The SEF leaving the Port of Vancouver. Thomson, Stuart. (Photographer). (May – July 1918, September 1918 – June 1919) while “Monteagle” leaving Vancouver with Siberian Expeditionary Force. [Online image]. Retrieved other locations like Winnipeg experienced two shorter from City of Vancouver Archives, http://searcharchives.vancouver.ca/monteagle- waves (October – December 1918 and February – leaving-vancouver-with-siberian-expeditionary- forces;rad. April 1919) (Jones, 2005). This discrepancy implies a
geographical determination of the character and timing of the illness as it could have been
shaped by different regional attributes such as the make-up of the social organization in the
cities, towns, and communities‟ Spanish Influenza affected.
Such local or regional heterogeneity appears to also be reflected in mortality rates across
Canada. As shown in Table 1, rates varied from a low of 3.6 per 1,000 (in Ontario) to a high of
780 per 1,000 in one small town in Newfoundland). Why certain regions experienced higher
mortality is unclear as the methods of prevention were similar across Canada with quarantine,
15 reduction of business hours, closure of theatres, picture shows, and schools, sanitation agendas, and provision of vaccines being the common medical and public health practices (Andrews,
1977; Jenkins, 2007; Jones, 2006; McCullough, 1918; Dickin McGinnis, 1976).
Table 1. Overview of Canadian provincial and city mortality rates from the literature. City Mortality Rate (per 1,000) Source
Newfoundland (Nfld) 5.0 Palmer et al., 2007
New Brunswick 4.0 Jenkins, 2007
Ontario (ON) 3.6 Jenkins, 2007
Quebec 7.0 Jenkins, 2007
Winnipeg, Manitoba 6.0 to 6.5 Jones, 2006
South Winnipeg 4.0 Jones, 2005
North Winnipeg 6.7 Jones, 2005
Saskatchewan cities 6.0 Lux, 1997
Rural Saskatchewan > 10 Lux, 1997
Alberta 11.5 Jenkins, 2007
British Columbia: non-native 6.2 Kelm, 1999 population
Vancouver, British Columbia 23.3 Andrews, 1977
Aboriginal Communities
Hebron, Nfld 680 Palmer et al., 2007
Okak, Nfld 780 Palmer et al., 2007
Norway House, Manitoba 183 Herring and Sattenspiel, 2003
British Columbia: native 46.0 Kelm, 1999 population
16 One of the difficulties in understanding these marked differences in rates is that the methods used to obtain them are not clearly stated. Most of these rates appear to have been derived from the media (especially newspapers). It is therefore impossible to determine their and to assess the suitability of the methods used to obtain them.
For example, Jenkins (2007), while providing mortality rates for New Brunswick,
Ontario, Quebec, Saskatchewan and Alberta, is unclear which populations were used as the denominator in the rate calculation. Jenkins extracts the total number of deaths from influenza from various other authors, and then (it appears) calculates rates using the quoted numbers as numerators. For example, the total number of influenza deaths for Quebec was extracted from
Patterson and Pyle (1991). Jenkins then calculated a rate but does not say which denominator was utilized; therefore, this calculation cannot be repeated and its accuracy is unknown.
Lux (1997) provides an overview of the impact of Spanish Influenza on Saskatchewan cities and rural regions. Influenza rates were lower in urban than in rural Saskatchewan, however, as with many of these historical accounts of influenza, the methods used to calculate rates are not explicit. The only clue provided by Lux is that the mortality data were based on information from the Saskatchewan Board of Public Health.
A similar conundrum is presented with the work of Jones (2005 and 2006). Rates for
Winnipeg are extracted from City Health Department records. While these may be good secondary sources, it is not indicated whether the mortality data obtained was raw, with rates calculated by Jones, or whether the rates were obtained directly from the City Hall records.
Either way, it is unclear how the rates were determined.
While methods were not explicit for Jones and Lux, they were based on “official” health information. And, in both studies rates ranged from a low of four (Winnipeg) to a high of more
17 than 10 in rural Saskatchewan. These studies have the advantage of being based on official data rather, than in some of the other studies quoted in Table 1, on media reports and appear to put a range on rates in the prairies in 1918-19 of 4 to 10 deaths per 1,000 population, much lower than the extremely high rates of 780 per 1,000 observed in one Newfoundland study.
There are very few studies that undertake an examination of the impact of Spanish
Influenza in British Columbia. Two commonly cited papers discussing the influenza epidemic in
British Columbia were written by Andrews (1977) and Kelm (1999). Andrews (1977), specifically examines influenza in the City of Vancouver. While she specifically acknowledges
“precise morbidity and mortality figures are not available for Vancouver for the six-month epidemic period” she does provide a mortality rate of 23.3 per 1,000 (Andrews, 1977, p. 27).
This rate is based upon information provided by the Vancouver Daily Province newspaper and the 1918 annual report for the City of Vancouver. The period of the epidemic this rate represents is from the beginning of the epidemic to the end of January 1919. Unfortunately, it is not clear when the beginning of the epidemic is, as numerous cities are included within the same timeframe but not all cities were infected at the same time. Nor is it clear whether Andrews herself calculated the rate or if it was provided by the newspaper or annual report. While the mortality rate of 23.3 per 1,000 has been quoted in other historical discussions of Spanish
Influenza, its accuracy is unclear. My research will, by using death certificates and clear denominators, be able to calculate the mortality rate associated with Spanish Influenza for the
City of Vancouver with greater accuracy.
Kelm (1999) quotes an overall B.C. mortality rate of 6.21 per 1,000 (based on Vital
Statistics Sessional papers for May of 1919) and the same Vancouver mortality rate of 23.3 per
1,000 as presented by Andrews (1977). According to Kelm, the mortality rate for the Aboriginal
18 population was 46 per 1,000 implying that Aboriginals suffered much more severely than the non-Aboriginal population. The Aboriginal mortality rate is based on Department of Indian
Affairs and Vital Statistics population information at the band level and mortality from flu- related illness (Kelm, (1999); Kelm, 2011, pers. comm.). It is not clear from Kelm‟s article what year the population totals represent or what mortality figures were used (Vital Statistics versus
Department of Indian Affairs) as part of the rate calculation.
One of Kelm‟s key findings is that, among Aboriginals in BC, young children and older adults were most affected whereas mortality from Spanish flu appears to have been greater among young adults in the non-Aboriginal populations. One reason for these differences may be that at this time “one-third of the total population of British Columbia‟s First Nations were under the age of fifteen” (Kelm, 1999, p. 30). However, that does not explain the greater impact among older Aboriginal adults versus older non-Aboriginal adults she observed.
The studies that do clearly identify how the rates were calculated are Palmer et al. (2007) and Herring and Sattenspiel (2003). Palmer et al. (2007) used 1911 census population data to calculate death rates per 10,000 for districts across Newfoundland by wave of influenza infection. Sources of information to determine mortality rates included death records, interviews with island residents, census data, vital statistics, records of international shipping, newspapers, local museums, and government correspondence about the influenza epidemic. Accordingly, the overall mortality rate for Newfoundland came from a fairly rigorous methodological investigation. However, the rates provided for Hebron and Okak (small towns in Newfoundland) were not calculations conducted by the authors but sourced elsewhere. Consequently, the methods and accuracy of these rates are not verifiable.
19 Herring and Sattenspiel (2003) undertook a slightly different approach to determining mortality rates for the isolated, primarily Aboriginal community of Norway House in Manitoba.
The authors used parish records to estimate the mortality rate of Norway House (183 per 1,000) and performed a more detailed analysis using Treaty Annuity Pay Lists for population estimates to examine family distributions of mortality. The analysis of family distribution reveals that while there is a high community mortality rate, the impact of influenza was concentrated within seven nuclear families (25% of the deaths) and within “families related through the male line”
(56% of the deaths) (Herring and Sattenspiel, 2003, p. 169). Therefore, the high mortality rate is more of a result of the impact on these particular families than on the impact of influenza on the community as a whole.
They also conducted a travel-based analysis using Hudson‟s Bay Company journals to establish the travel patterns between Norway House and other trading posts where influenza was contracted. These journals indicate that travel occurred more frequently during the warmer months when waterways were open, to accommodate travel by water, while in winter months travel was less frequent, and took longer, which delayed the dissemination of influenza into the community. However, after running computer simulations on the movement of influenza between communities, in the vicinity of Norway House, the author‟s note that while travel (i.e. rate of travel and patterns of travel) influenced the timing of influenza infection it did not affect the number of cases experienced by the community. The study did not provide seasonal mortality rates so there is no discussion on how mortality rates were influenced by travel patterns.
My research follows a similar method, in determining mortality rates, to that of Palmer et al. (2007) by also utilizing census populations, census information, and death records. Death certificates were used as the primary source of information to identify the number of deaths
20 caused by Spanish Influenza in Vancouver. The key difference is that this study will utilize the census population from 1921, rather than from 1911, as it is closer in time to the period of the epidemic (1918-1919) so the population numbers should be more reflective of 1918 – 1919 than the 1911 census numbers.
2.5 Groups Most Vulnerable to the Epidemic Perhaps the most commonly cited unique feature of this strain of influenza is that it resulted in high mortality rates among young adults. Noymer and Garenne (2000) and Palmer et al. (2007) discuss the W-shaped age-specific mortality curve where high mortality rates are experienced in the youngest and oldest populations, as well as a peak between the ages of 15 to
45. Additionally, virtually all authors cited in this literature review indicate at some point within their research that young adults were most affected. The use of the term „young adult‟ in these studies is not consistent. For example, Jones (2006) identifies that 60% of all deaths in the city of
Winnipeg occurred in people between the ages of 20 to 39. On the other hand, Humphries (2005) suggests that the majority of deaths in Canada were healthy males and females between the ages of 15 and 35. Tuckel et al. (2006) in their analysis of Hartford, Connecticut indicate that there was a higher mortality rate among males and for young adults between the ages of 25 to 35 years.
In addition to the age-specific population effects, there is some discussion within the literature that socio-economic status may have played a role. This suggestion is primarily based on observed differences in mortality rates between immigrant populations and non-immigrant populations in American cities. The most detailed examination of this population difference is conducted by Tuckel et al. (2006) in their study of Hartford, Connecticut. They demonstrated that mortality from influenza was lower among those with Irish, English, and German maternal
21 nativity and higher among those with Canadian, Russian, Austrian, and Polish maternal nativity.
Those people with Italian maternal nativity experienced the highest mortality rates in Hartford.
Tuckel et al. (2006) concluded that a higher proportion of immigrants, renters, and the less educated tended to have higher mortality rates in Hartford. Accordingly, this suggests that socio- economic status may indeed have been a risk factor for death caused by influenza in 1918-19 with those of a lower socio-economic status more at risk. Moreover, a similar immigrant effect is proposed by Jones (2002, 2005, 2006, and 2007) in her analysis of Winnipeg, where the mortality rate for northern Winnipeg, with a population primarily composed of immigrants and the poor, was higher than southern Winnipeg where the wealthier, Canadian-born citizens lived
(see Table 1). However, it is important to keep in mind that the way that Jones calculated the mortality rates is unclear so the accuracy of these rates is undeterminable.
2.6 Spanish Influenza in British Columbia and Vancouver Very little can be found in the literature specifically related to British Columbia; the most widely quoted papers are written by Andrews (1977) and Kelm (1999) and a book written by
O‟Keefe and MacDonald (2004). Andrews (1977), and O‟Keefe and MacDonald (2004), concentrate on the City of Vancouver, while Kelm (1999) conducts her analysis on the First
Nations populations of British Columbia.
Andrews (1977) investigated the influenza epidemic in the city of Vancouver using newspaper articles published in 1918 and 1919 as her primary references. From these, she quotes the mortality rate as 23.3 per 1,000 (a total of 795 deaths) and suggests miners and pregnant women suffered the highest mortality rates. The same mortality rate is also referenced in
O‟Keefe and MacDonald (2004) but does not explain where this figure originated. Additionally,
O‟Keefe and MacDonald suggest that Vancouver‟s mortality rate was one of the highest in North
22 America but, as suggested by Keiser (2006, p.
130) in her review of this book, these rates “beg
analysis”.
O‟Keefe and MacDonald (2004) in their
book exploring the actions of Vancouver‟s
medical health officer, Dr. Underhill, reveal that
Figure 3. Vancouver, 1915. Calder, Walter H. his assessments of mortality rates show that the (Photographer). View of north west area of downtown Vancouver, showing parts of Stanley white population of Vancouver was most Park, Burrard Inlet, and the North Shore. [Online image]. Retrieved from City of Vancouver affected in contrast to other ethnicities such as Archives, http://searcharchives.vancouver.ca/view-of- the Chinese, Japanese, and Hindu populations. If north-west-area-of-downtown-vancouver- showing-parts-of-stanley-park-burrard-inlet-and- this is correct, then Vancouver‟s ethnic north-shore;rad. mortalities are in opposition to other locations in Canada, and also the United States, where studies indicate that the highest mortality rates occurred among immigrant populations (Tuckel et al., 2006; Jones, 2002, 2005, 2006, and 2007). However, O‟Keefe and MacDonald were not clear whether the white population was composed of Canadians only or if it also includes white immigrants. Consequently, analysis of race (based on immigration status and Caucasian versus non-Caucasian) in order to clarify this point will be part of the forthcoming research.
Furthermore, Andrews indicates that there were three waves of Spanish Influenza in
Vancouver, the first in October of 1918, the second in January of 1919, and the third in March of
1919. This observation is consistent with Humphries‟ hypothesis of spread of influenza from the
American military to a location in Eastern Canada and subsequent early fall spread, via train, across to Vancouver (Humphries, 2005). However, without clear methods and a more precise investigation of mortality in Vancouver this cannot be ascertained with any reliability.
23 Kelm (1999), in her examination of the 1918-1919 influenza epidemic in the Aboriginal populations of British Columbia, highlights the varied mortality rates stated for these populations depending on who is doing the reporting; for example, the Department of Indian Affairs (600 deaths) versus the Vital Statistics Branch (700 deaths) versus agent reports (over 1,000 deaths), and suggests that under reporting is likely. Additionally, Kelm indicates that First Nations populations experienced higher relative mortality rates (46 per 1,000) as compared to non-Native populations (6.21 per 1,000). However, it is not clear on the exact method with which these rates were calculated other than that native mortality rate is based on Department of Indian Affairs and
Vital Statistics population information at the band level and mortality information from flu- related illness (Kelm, (1999); Kelm, 2011, pers. comm.).
Similar to the rest of the literature, transportation routes such as railways and shipping lines are highlighted as key influenza dissemination vectors in British Columbia with Kelm
(1999) also citing the closure of canneries and the exodus of ill workers back to the reserves as an example.
2.7 Summary In conclusion, the Spanish Influenza pandemic of 1918-1919 circumnavigated the globe in a very short time frame and killed millions of people worldwide. The Spanish flu targeted young adult populations, a fact uncommon to the more typical influenza virus strains, and highlighted the importance of transportation routes as dissemination corridors. What remains fascinating about this pandemic is the speed at which infectious disease can circle the globe, which is potentially much greater today with the speed and accessibility of world travel. By understanding the elements of historical epidemics and identifying susceptible populations, better risk management and improved public health measures can be accomplished.
24 As expressed previously, there is still little known about how Spanish Influenza affected the population of British Columbia and, according to Kelm (pers. comm., 2011), there is uncertainty about how socio-economic factors may have played a role in the experience of the disease during and after the epidemic. The purpose of this research was, therefore, to re-examine
Vancouver death certificates from 1918 and 1919 as a case study and determine what populations in Vancouver were affected the most and whether or not this can be tied to socio- economic differences at that time.
There are major limitations in the literature on Spanish Influenza. The biggest limitation is the difficulty in determining the exact number of deaths because of incomplete reporting, misdiagnosis, and the potential for confusing diagnoses between this particular influenza strain and pneumonia (Johnson and Mueller, 2001; Palmer et al., 2007; Patterson and Pyle, 1991).
Specifically, when official records indicate the cause of death as pneumonia during 1918-1919 it is difficult to know whether the individual had Spanish Influenza and then contracted pneumonia or whether they only had pneumonia. Overall, these limitations culminate in a commonly suggested underestimate in both the number of cases and number of deaths from Spanish
Influenza.
25
Chapter 3: Methods With the limitation of misdiagnosis in mind, the following methods, grounded in medical geography, were employed to create as accurate a representation as possible of the impact of
Spanish Influenza in Vancouver.
3.1 Data Collection and Determining Population Size Death certificates from the City of Vancouver in 1918-1919 and 1921-1922 were collected from the British Columbia Vital Statistics Agency. The hard copies of these records were obtained from the microfiche vaults at Simon Fraser University library and the information on them transcribed to create the excel database used for analysis. Transcription of the records was conducted by Ashlee LeBourveau at Simon Fraser University. The transcription was verified by reviewing a random sampling of the original death certificates and comparing it to the created database. The information provided by these death certificates included some or all of the following: name of deceased, registered number of the certificate, date of birth of deceased, date of death, place of death, how long deceased was at place of death, former or usual residence, cause of death, duration of cause of death, secondary cause of death, duration of secondary cause of death, sex, age, occupation, parent occupation, race, marital status, birthplace, length of residence in Canada, father, father‟s birthplace, mother, mother‟s birthplace, informant‟s name, and informant‟s address. In short, the data used for this thesis were Vancouver mortality data for the period of June 1918 to June 1919 and June 1921 to June 1922.
Mortality rates were calculated for influenza deaths for both of these time periods in order to determine if Spanish Influenza had a larger affect during the 1918-1919 flu season. The total population size used for the calculations was based on Government of Canada 1921 census records. This method worked well for the 1921-1922 mortality rate calculations as a census was
26 completed in 1921. However, the population size for 1918-1919 is also based upon the 1921 population size. Considering population size can change substantially over a short timeframe, it was necessary to examine what was happening in Vancouver in terms of demographics between
1918-1919 and 1921-1922. As an example Macdonald (1992) states that between the census years of 1911 and 1921, Vancouver‟s population increased by a third to 163,000 people.
One way to do this was to see how fast the city grew or shrank and whether migration patterns changed over this time period. According to Macdonald (1992), Vancouver experienced a large population drop between 1910 and 1920 especially around the years of 1913 and 1914 as a result of the depression and the beginning of World War I when military personnel went overseas. However, Barman (1986, p. 98) states that by World War I the “socio-demographic framework of Vancouver was in place and the growth was moderated”. During the 1920s growth in Vancouver occurred again and between the 1921 and 1931 censuses the population grew from
175,000 to 246,000 (Macdonald, 1992). Because 1921-1922 is still the early part of the 1920s decade in which the major growth began, the 1921 census should still be a good estimate in terms of population for 1918-1919. Military personnel would have begun returning home during this period as well increasing population levels to better match those assessed in 1921. During this same period, populations in Point Grey and South Vancouver more than doubled to 13,000 and 32,000 respectively (Macdonald, 1992) which becomes important when determining the boundary of analysis. Or in other words, how should Vancouver be physically defined for the purposes of this study?
3.2 Boundary of Analysis Identifying the boundary of Vancouver to use for the analysis of Spanish Influenza mortality rates could have been conducted in one of two ways. First, the historical boundary of
27 the City of Vancouver prior to the amalgamation of Point Grey and South Vancouver in 1929 could be used. This boundary, as represented by historical maps in Hayes (2005), would include
Alma Street to the west, Boundary Street to the east, 16th Avenue to the south, and Burrard Inlet to the north. In this case, only death certificates with place of residence within this geographical area would be included for analysis. The second option would be to include both South
Vancouver and Point Grey along with the City of Vancouver, which represents the boundary of present day Vancouver.
Due to the fact that death certificates were only collected for people who died in
Vancouver and excluded certificates that stated death occurred in Point Grey or South
Vancouver, the boundary of analysis is the City of Vancouver proper, prior to amalgamation (i.e. option one).
3.3 Calculating Mortality Rates Mortality rates have been selected as a method of analysis as they provide an “index of the severity of the disease from both clinical and public health standpoints” (Gordis, 2009, p.
67). This provides an indication of how negatively the population of the City of Vancouver was affected by Spanish Influenza. Three sets of mortality rates, most conservative, moderately conservative, and least conservative were used to analyze the affect of Spanish Influenza in
Vancouver, British Columbia. All mortality calculations followed the basic epidemiological calculation of number of resident deaths from Spanish Influenza divided by number of residents in the population multiplied by 1,000 as shown in Equation 1 (Gordis, 2009). The denominator used for this calculation will be 117, 217, the population of the City of Vancouver (excluding
South Vancouver and Point Grey) according to the 1921 Canadian census (Government of
Canada, 1925).
28 Equation 1. Mortality Rate Formula
The most conservative mortality rate was calculated using only those records that indicated influenza as the primary cause of death. The moderately conservative mortality rate used only those records with influenza listed as either the primary cause of death or secondary cause of death. Finally, the least conservative mortality rate included records having influenza as the primary or secondary cause of death as well as all pneumonia deaths. Pneumonia deaths were included in this mortality rate to acknowledge the close association between pneumonia and
Spanish Influenza.
3.4 Managing the Association between Pneumonia and Influenza In order to manage the close association with Spanish Influenza and pneumonia, the initial analysis was conducted with the two causes of death categories reviewed separately. By treating influenza and pneumonia separately and using the 1921-1922 data set as a comparison any discrepancy in pneumonia deaths can be observed. If pneumonia deaths for 1918-1919 far exceed the deaths for 1921-1922, it is likely that Spanish Influenza played a role in this difference. As this was observed, cases having the primary or secondary cause of death as influenza or primary cause of death as pneumonia are included in the analysis. The amalgamation of pneumonia and influenza deaths follows methods used by Tuckel et al. (2006) and Palmer et al. (2007).
3.5 Analysis using the Statistics Package for Social Sciences (SPSS) Prior to conducting the analysis, the data from the death certificates were coded to collect similar variables into larger categories (Appendix 1). Cross-tabulations, univariate and multivariate analysis of the data gathered from the death certificates was undertaken using SPSS
29 version 20. Once coded, cross-tabulations were run for each year to assess the number and percent of people in each category versus influenza or non-influenza deaths for the whole data set. Variables with high proportions of influenza deaths are carried over into univariate analysis focusing only on residents of Vancouver. Univariate statistical analysis uses chi-square tests to determine if there is any association between influenza deaths and the following social/geographical characteristics: gender, age, place of death, birthplace, employment status, type of employed occupation, marital status, race, simple immigration status, and length of residence in Canada. The Fisher‟s Exact test for statistical significance was used for two-by-two cross-tabulations and the Pearson Chi-square test for significance was used for cross-tabulations larger than two-by-two (Field, 2009). Chi-squares were selected as they test whether there is an association between two categorical variables, the type of variables present in this study. While one limitation to chi-square tests is that the “sampling distribution of the test statistic has an approximate chi-square distribution” because there was a large sample size and the expected frequencies for the analysis run here were above five in each cell, this limitation was overcome
(Field, 2009, p. 690).
Prior to running the multivariate model, a correlation test using the Cramer‟s V statistic determined whether any of the variables are correlated to each other or acting as confounders
(Field, 2009). Based on the output of the correlation matrix along with the information provided by the univariate analysis, age, gender, marital status, immigrant status, birthplace, length of residence in Canada, and employment status were entered into the multivariate model.
The multivariate analysis used logistic regression to determine if the significant relationships between influenza and the socio-demographic characteristics presented in the univariate analysis held true after controlling for age, gender, and marital status. The variables
30 for age, gender, and marital status were forced into the multivariate model followed by the introduction of immigrant status, birthplace, and length of residence in a forward stepwise fashion. This means that:
“[T]he current model is compared to the model when that predictor is removed. If the removal of that predictor makes a significant difference to how well the model fits the observed data, then the computer retains that predictor (because the model is better if the predictor is included). If, however, the removal of the predictor makes little difference to the model then the computer rejects the predictor.” (Field, 2009, p.272)
The SPSS model rejected all three of these variables indicating that neither immigrant status, length of residence or birthplace could be considered to influence death by influenza when age, gender, and marital status are controlled.
Employment status was then added to the model, again using the forward stepwise method, to determine if employment impacted influenza deaths when controlling for age, gender, and marital status. This variable was retained in the model implying that employment could be considered to influence death by influenza when age, gender, and marital status are controlled.
3.6 Visual Representation Finally, maps of Spanish Influenza were created for the City of Vancouver using ArcGIS
9.3. As detailed neighbourhood classification cannot be undertaken, maps pinpointed locations of residence rather than providing amalgamated mortality rates for communities. An Address
Locator created in ArcGIS used present day street configuration information from the open source database at the City of Vancouver. The addresses for only the residents of the City of
Vancouver in 1918-1919 were uploaded into the GIS program and the address locator geocoded them to the current street configuration. Any addresses that showed up outside of the boundaries of the city prior to amalgamation were removed from analysis. ArcGIS then produced a map
31 showing the density of deaths in the City of Vancouver during 1918-1919. The mapping was used as a visual aid due to the limited ability to match the historical addresses to present day configuration with a high percentage of accuracy.
3.7 Limitations While death certificates, census data, and mortality rates provide useful information regarding the affect of Spanish Influenza in Vancouver, it is important to recognize and acknowledge the limitations of using these sources and methods.
The death certificates collected for the analysis are from 1918-1922 and are hand-written.
While they represent a good primary source of data, in some cases the information provided was illegible or did not have all sections completed resulting in missing information. If the missing information excluded important elements such as age or location of death, or the cause of death was illegible then this record was removed from the analysis when those variables were used.
The higher the number of records that are removed from analysis the less accurately the results will represent what actually occurred during the 1918-1919 Spanish Influenza epidemic in
Vancouver. For this reason, missing information could be a severe limitation to this study.
Additionally, all death certificates that were from Vancouver were selected; however, it is not clear what area this actually constitutes, i.e. does it include Point Grey and South Vancouver? As such, residence information provided by the death certificate was relied upon for the majority of the study but this information was not consistently recorded. The address locator was also intended to reduce error in terms of the boundary of analysis. Lastly, at that time, death certificates were generally not recorded for the Aboriginal population meaning that there is no analysis of this population component included in this study (Belshaw, 2009). To conclude, the death certificates supply only limited information on experience, socio-economic and social
32 factors therefore restricting the understanding of these elements to indirect measures such as occupation.
The census provides population data for amalgamated areas, for example, British
Columbia, and Vancouver but does not provide information on smaller neighbourhood areas within Vancouver such as Shaughnessy, Kitsilano, or other smaller neighbourhood units.
Because the census data is limited in what it can provide on the small scale, a neighbourhood analysis is impossible to undertake. Neighbourhood analysis would have been useful in teasing out underlying socio-economic risk factors such as poor versus wealthy as some neighbourhoods are known for the financial attributes of their residents.
Other limitations to the census data, as pointed out by the census itself include error sources such as the uncertainty of exact age, intentional misstatements, missing information
(missing data/lost data/no response), or collection of information via third parties (i.e. not the individual themselves) (Census, 1921). Furthermore, within the census itself there is little, to no, analytical or interpretive discussion of what the data provided represents or what the margin of error may be. Lastly, the census did not occur during the period of 1918-1919 so analysis for both sets of death certificate data is conducted using population sizes from 1921. However, census data are useful as they follow a consistent method of data collection.
As mentioned previously, mortality rates are a good indication of the severity of a disease in a population; however, these rates do not give any indication of how many people were affected by the disease, as they only consider those who have died as a result of the disease.
Cases of influenza cannot be analyzed using this method and, as such, the total impact of Spanish
Influenza cannot be fully understood. Furthermore, death certificates do not include any information related to the experience of those individuals who contracted the infection leaving
33 out the ability to examine more social impacts or responses to the epidemic. Finally, mortality rates are restricted by a reliance on population data. As this is a historical analysis, specific elements such as a neighbourhood analysis had to be left out due to the lack of appropriate available population information.
Mapping the residence locations also proved to be a challenge and the resulting map does not capture all the deaths as not all the addresses could be matched to present day street configurations in Vancouver.
Lastly, the choice to solely use the quantitative data provided by the death certificates and census population information limited my ability to utilize all the facets of a medical geography approach which also supports understanding the spatial distributions and patterns of movement of people within the city, to and from the city, and other more social facets of life in Vancouver
(i.e., the movement of troops and the introduction of Chinese labourer populations as examples).
34
Chapter 4: Results The results are organized into six sections: boundaries, the case definition of influenza deaths, socio-demographic descriptions of influenza versus non-influenza deaths, the temporality of influenza deaths in the City of Vancouver, the distribution of influenza deaths in Vancouver, and statistical analysis of links between social and geographic characteristics of residents and influenza deaths in Vancouver.
The first section describes the boundary of the study area as all deaths included in the analysis occurred within the limits of the City of Vancouver. The second section identifies the primary and secondary causes of death for the time periods of 1918-19 and 1921-22.
Furthermore, it considers the issue of misclassification of deaths for influenza and consequently, describes the definition of an influenza death which accounts for any potential misclassification.
The third section describes the socio-demographic characteristics of the people who died from influenza compared to those who died of other causes (non-influenza deaths). The fourth and fifth sections explore the temporal and spatial elements of the Spanish Influenza epidemic revealing the months when the epidemic was at its peak and the locations in Vancouver that were most affected. Lastly, section six presents the statistical analysis identifying the links between influenza and the socio-demographic and geographic aspects of those who died of influenza.
4.1 Boundaries This study focused on events that happened within the City of Vancouver. As such, it is important to define that boundary based on the time period of interest, 1918-19 and 1921-22. At this time, the official boundary of the city was much smaller than today as it did not include the areas of Point Grey or South Vancouver which were amalgamated in 1929 (Hayes, 2005). For
35 the purposes of this study these historical boundary lines have been selected as the limits of the
City Vancouver which also defines the population used to determine mortality rates (Figure 4).
Figure 4. City of Vancouver boundary in 1915. South Vancouver and Point Grey were amalgamated into the City of Vancouver in 1926. Image Source: Natural Resources Canada. “The Atlas of Canada”. http://atlas.nrcan.gc.ca/site/english/maps/archives/2ndedition/peopleandsociety/culturalgeography/page79_80
4.2 Case Definition of Influenza Deaths In the two study time periods, June 1918 to June 1919 and June 1921 to June 1922, a total of 3,886 deaths occurred in Vancouver. Of these, 2,442 deaths (62.8%) occurred in 1918-1919 and 1,444 deaths (37.2%) occurred in the 1921-1922 period. Death records consist, in almost all cases, of a primary cause of death and in most cases, a secondary cause of death was also available. Table 2 shows primary causes of death for both time periods.
36 Table 2. Primary cause of death in 1918-19 and 1921-22.
Time Period Primary Cause of Death 1918-1919 1921-1922 Accident 48 (2.0) 99 (6.9) Child/Child Birth 137 (5.6) 169 (11.7) Coronary Heart/Stroke 464 (19.0) 279 (19.3) Influenza 189 (7.7) 43 (3.0) Non Influenza Pulmonary 1,046 (42.8) 280 (19.4)
Other Infectious 183 (7.5) 179 (12.4)
Other Non-Infectious 323 (13.2) 341 (23.6) Unknown 52 (2.1) 54 (3.7) Total 2,442 (100.0) 1,444 (100.0) *Numbers in brackets represent the percent (%) of total deaths i.e. the column percent.
Table 2 shows 189 primary death from influenza in 1918-1919 (7.7%) and 43 (3%) influenza deaths characterized as primary were noted in 1921-1922. As well there were 1,046
(42.8%) deaths from non influenza pulmonary infection or disease in 1918-1919 compared to
280 (19.4%) in 1921-1922. This means that the proportion of deaths from pulmonary illness in
1918-1919 was more than double that in 1921-1922.
This likely indicates that some of the primary non influenza pulmonary deaths in 1918-19 were due to influenza. The misclassification of influenza as non influenza pulmonary deaths if, left uncorrected, will lead to a major under-ascertainment of influenza deaths in 1918-19. By looking at the pattern of secondary causes of death (Table 3) it may be possible to correct this misclassification.
37 Table 3. Secondary cause of death for 1918-19 and 1921-22.
Secondary Cause of Time Period Death 1918-1919 1921-1922 Accident 105 (4.3) 68 (4.7) Child/Child Birth 84 (3.4) 37 (2.6) Coronary Heart/Stroke 257 (10.5) 207 (14.3) Influenza 851 (34.8) 26 (1.8) Non Influenza Pulmonary 200 (8.2) 130 (9.0) Other Infectious 177 (7.2) 102 (7.1) Other Non-Infectious 265 (10.9) 235 (16.3) Unknown 503 (20.6) 639 (44.3) Total 2,442 (100.0) 1,444 (100.0) *Numbers in brackets represent the percent (%) of total deaths.
During 1918-1919, 851 death certificates listed influenza as the secondary cause of death, accounting for 34.8% of the total for that year compared to 26 (1.8%) in 1921-1922 (Table 3). In
1918-1919, 7.7% of primary deaths were due to influenza (Table 2). The fact that so many more deaths and a much higher proportion of deaths from influenza are registered as secondary causes of death implies that only considering primary causes of deaths would result in an underestimate of deaths due to influenza. Furthermore, of the 1,046 non influenza pulmonary deaths, 754
(72.1%) had secondary cause of death listed as influenza. In other words, especially for those diagnosed with death from pulmonary disease as the primary cause of death, influenza appears to have been a factor.
Therefore, in order to get a more accurate representation of deaths caused by influenza, for analysis all deaths listing influenza as a primary or secondary cause of death and all primary causes of death listed as pneumonia or bronchopneumonia will be combined into one category as influenza deaths. This means of the 2,442 deaths which occurred in 1918-19 in Vancouver 1,167
38 (47.8%) were due to influenza (Table 4). Of the 1,444 deaths which occurred in 1921-22, 202
(14.0%) were due to influenza. The large difference in proportion again indicates the presence of a deadlier influenza virus for the 1918-1919 influenza season.
Table 4. Influenza versus non influenza deaths by time period. Cause of Death 1918-1919 1921-1922 Influenza 1,167 (47.8)* 202 (14.0) Non Influenza 1,275 (52.2) 1,242 (86.0) Total 2,442 (100.0) 1,444 (100.0) *Numbers in brackets represent the percent (%) of total deaths.
4.3 Socio-demographic description of influenza versus non-influenza deaths in both time periods This section compares influenza deaths to non influenza deaths by time period for residence, gender, age category, place of death, birthplace, employment status, employed occupation, marital status, race, simple immigration status, and length of residence in Canada.
As shown in Table 5, there is virtually no difference, in both time periods, in the pattern of influenza or non influenza deaths for residents compared to non-residents of Vancouver. In other words, the proportion of people dying of influenza or non influenza causes is similar.
Table 5. Influenza versus non influenza deaths by residence and time period. 1918-1919 1921-1922 Resident Non Non Status Influenza Influenza Total Influenza Influenza Total 934 1,046 1,980 175 1,055 1,230 Vancouver (47.2) (52.8) (100.0) (14.2) (85.8) (100.0) Outside 191 196 387 25 176 201 Vancouver (49.4) (50.6) (100.0) (12.4) (87.6) (100.0) 1,125 1,242 2,367 200 1,231 1,431 Total (47.5) (52.5) (100.0) (14.0) (86.0) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 75 missing cases; in 1921-1922 there were 13.
39 Table 6 shows that influenza deaths accounted for 47.8 % of deaths in 1918-19 and
14.0% of deaths in 1921-22. In both time periods more males than females died of both influenza and non influenza. However, the proportion of males dying from influenza is slightly higher than for females in both time periods (i.e. 62.5% of influenza deaths in 1918-19 were male versus
59.6% of non influenza deaths in 1918-19.
Table 6. Influenza versus non influenza deaths by gender and time period. 1918-1919 1921-1922 Non Non Gender Influenza Influenza Total Influenza Influenza Total 730 760 1,490 129 736 865 Male (62.5) (59.6) (61.0) (63.9) (59.3) (59.9) 437 515 952 73 506 579 Female (37.5) (40.4) (40.0) (36.1) (40.7) (40.1) 1,167 1,275 2,442 202 1,242 1,444 Total (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) *Numbers in brackets denote column percents. Note: For this category, there are no missing data.
Similar to other studies conducted on Spanish Influenza, the young adult age category
(19-39 years) had the highest proportion of influenza deaths in 1918-19 (64.3%) (Table 7).
Conversely, in 1921-22, the age group with the highest proportion of deaths due to influenza is the 40-59 years age group (25.7%) followed closely by the 60-79 years age group (24.3%).
40 Table 7. Influenza versus non influenza deaths by age category and time period. 1918-1919 1921-1922 Age Category Non Non (years) Influenza Influenza Total Influenza Influenza Total Stillborn 20 208 228 9 202 211 (0-7days) (1.7) (16.4) (9.4) (4.5) (16.3) (14.6) 8days- 190 168 358 42 143 185 18years (16.5) (13.2) (14.8) (20.8) (11.5) (12.8) 741 270 1,011 38 207 245 19-39 (64.3) (21.2) (41.7) (18.8) (16.7) (17.0) 157 321 478 52 350 402 40-59 (13.6) (25.2) (19.7) (25.7) (28.2) (27.9) 40 265 305 49 290 339 60-79 (3.5) (20.8) (12.6) (24.3) (23.4) (23.5) 80 and 5 40 45 12 48 60 above (0.4) (3.1) (1.9) (5.9) (3.9) (4.2) 1,153 1,272 2,425 202 1,240 1,442 Total (100.0) (100.0) (100.0) (100.0) (100.0) (100.0) *Numbers in brackets denote column percents. Note: For this category, in 1918-1919 there were 17 missing cases; in 1921-1922 there were 2.
As shown in Table 8, the proportion of influenza deaths that occurred in the home
(46.6%) and in the hospital (43.5%) is very similar during 1918-19. This is in contrast to a much higher proportion of influenza deaths occurring at home (65.3%) than in hospitals (12.6%) in
1921-22. Other deaths in this table include any deaths occurring for example, on the street, in a body of water, or at a place of work.
41 Table 8. Influenza versus non influenza deaths by place of death and time period. 1918-1919 1921-1922 Place of Non Non Death Influenza Influenza Total Influenza Influenza Total 506 658 1,164 109 757 866 Hospital (43.5) (56.5) (100.0) (12.6) (87.4) (100.0) 432 495 927 226 120 346 Home (46.6) (53.4) (100.0) (65.3) (34.7) (100.0) 226 120 346 3 11 14 Other (65.3) (34.7) (100.0) (21.4) (78.6) (100.0) 1,164 1,273 2,437 112 771 883 Total (47.8) (52.2) (100.0) (12.7) (87.3) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 5 missing cases; in 1921-1922 there were 561.
Table 9 shows the number and proportion of deaths by place of birth, study period, and cause of death. In 1918-19 the proportion of deaths due to influenza are lowest among the
Canadian (41.4%) and UK born (46.0%) and highest among those born in “Other” (i.e. Mexico, the Caribbean, Africa, and South America (70%)). The proportion of deaths among those born in
Asia, USA, and Europe were 55.8, 57.6, and 61.0 percent, respectively. There is less variation in the proportion of influenza deaths by place of birth during the 1921-22 time period.
42 Table 9. Influenza versus non influenza deaths by birthplace and time period. 1918-1919 1921-1922
Non Non Birthplace Influenza Influenza Total Influenza Influenza Total 439 622 1,061 96 605 701 Canada (41.4) (58.6) (100.0) (13.7) (86.3) (100.0) 95 70 165 10 71 81 USA (57.6) (42.4) (100.0) (12.3) (87.7) (100.0) 303 356 659 65 356 421 UK (46.0) (54.0) (100.0) (15.4) (84.6) (100.0) 133 85 218 7 67 74 Europe (61.0) (39.0) (100.0) (9.5) (90.5) (100.0) 153 121 274 18 114 132 Asia (55.8) (44.2) (100.0) (13.6) (86.4) (100.0) 21 9 30 2 8 10 Other (70.0) (30.0) (100.0) (20.0) (80.0) (100.0) 1,144 1,263 2,407 198 1,221 1,419 Total (47.5) (52.5) (100.0) (14.0) (86.0) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 35 missing cases; in 1921-1922 there were 25.
Table 10 shows that in 1918-19 the proportion of influenza deaths among the employed population as 57% compared to 39.8% among the non-employed. This is in contrast to 1921-22 where an equal proportion of employed and not employed succumbed to influenza (14.1%).
Table 10. Influenza versus non influenza deaths by employment status and time period. 1918-1919 1921-1922 Employment Non Non Status Influenza Influenza Total Influenza Influenza Total 670 506 1,176 82 498 580 Employed (57.0) (43.0) (100.0) (14.1) (85.9) (100.0) Not 435 658 1,093 114 694 808 Employed (39.8) (60.2) (100.0) (14.1) (85.9) (100.0) 1,105 1,164 2,269 196 1,192 1,388 Total (48.7) (51.3) (100.0) (14.1) (85.9) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 173 missing cases; in 1921-1922 there were 56.
43 The proportion of influenza deaths among different categories of the employed was similar in 1918/19 and in 1921/22 although these proportions were slightly elevated for unskilled clerical workers in both time periods (Table 11).
Table 11. Influenza versus non influenza deaths by employed occupation and time period. 1918-1919 1921-1922 Employed Non Non Occupation Influenza Influenza Total Influenza Influenza Total Professional/ 241 183 424 29 199 228 Skilled (56.8) (43.2) (100.0) (12.7) (87.3) (100.0) Unskilled- 318 252 570 35 222 257 Labour (55.8) (44.2) (100.0) (13.6) (86.4) (100.0) Unskilled- 111 71 182 18 77 95 Clerical (61.0) (39.0) (100.0) (18.9) (81.1) (100.0) 670 506 1,176 82 498 580 Total (57.0) (43.0) (100.0) (14.1) (85.9) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 1266 missing cases; in 1921-1922 there were 864. These numbers are high because this category excludes all “not employed” records which totaled 1,901 plus the unknown occupations totaling 229.
Table 12 shows that about half the married and half the single people who died in 1918-
19 in Vancouver died of influenza but 17.8% of widowed/divorced people died of influenza.
Therefore, the proportion of deaths due to influenza in 1918-19 was much lower among the widowed/divorced population. For 1921-22 the proportion of deaths due to influenza are similar for all 3 groups.
44 Table 12. Influenza versus non influenza deaths by marital status and time period. 1918-1919 1921-1922 Marital Non Non Status Influenza Influenza Total Influenza Influenza Total 577 549 1,126 94 495 589 Married (51.2) (48.8) (100.0) (16.0) (84.0) (100.0) 529 558 1,087 75 529 604 Single (48.7) (51.3) (100.0) (12.4) (87.6) (100.0) Widowed/ 30 139 169 27 176 203 Divorced (17.8) (82.2) (100.0) (13.3) (86.7) (100.0) 1,136 1,246 2,382 196 1,200 1,396 Total (47.7) (52.3) (100.0) (14.0) (86.0) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 60 missing cases; in 1921-1922 there were 48.
As shown in Table 13, there is almost no difference in the proportion of influenza deaths for Caucasian versus Non-Caucasians in either time period. However, many more non-
Caucasians died than did Caucasians in both 1918-19 and 1921-22. For a clear outline of how race was determined see Appendix A.7 Coding for Race.
Table 13. Influenza versus non influenza deaths by race and time period. 1918-1919 1921-1922
Non Non Race Influenza Influenza Total Influenza Influenza Total 188 195 383 27 185 212 Caucasian (49.1) (50.9) (100.0) (12.7) (87.3) (100.0) Non- 976 1,077 2,053 166 1,028 1,194 Caucasian (47.5) (52.5) (100.0) (13.9) (86.1) (100.0) 1,164 1,272 2,436 193 1,213 1,406 Total (47.8) (52.2) (100.0) (13.7) (86.3) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 6 missing cases; in 1921-1922 there were 38.
Table 14 shows that in 1918-19 a higher proportion of influenza deaths occurred among immigrants than non-immigrants. This holds true for the 1921-22 period as well although the proportions themselves are less than half of the 1918-19 period.
45
Table 14. Influenza versus non influenza deaths by simple immigration status and time period. 1918-1919 1921-1922 Simple Immigrant Non Non Status Influenza Influenza Total Influenza Influenza Total 705 641 1,346 102 616 718 Immigrant (52.4) (47.6) (100.0) (14.2) (85.8) (100.0) Non- 439 622 1,061 96 605 701 Immigrant (41.4) (58.6) (100.0) (13.7) (86.3) (100.0) 1,144 1,263 2,407 198 1,221 1,419 Total (47.5) (52.5) (100.0) (14.0) (86.0) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 35 missing cases; in 1921-1922 there were 25.
Table 15 reveals that the highest proportion of influenza deaths in 1918-19 (59.6%) occurred in the group that had been living in Canada for less than 15 years. The variation in the proportion of influenza deaths by length of residence in Canada was much less in 1921-22 with the highest proportion of deaths due to influenza (16.4%) having occurred in the population living in Canada for 15 years or more in 1921-22.
Table 15. Influenza versus non influenza deaths by length of residence in Canada and time period. 1918-1919 1921-1922 Length of Residence in Non Non Canada Influenza Influenza Total Influenza Influenza Total Less than 15 512 347 859 40 289 329 years (59.6) (40.4) (100.0) (12.2) (87.8) (100.0) 15 years or 124 237 361 55 280 more (34.3) (65.7) (100.0) (16.4) (83.6) 35 (100.0) 439 622 1,061 96 605 701 Life (41.4) (58.6) (100.0) (13.7) (86.3) (100.0) 1,075 1,206 2,281 191 1,174 1,365 Total (47.1) (52.9) (100.0) (14.0) (86.0) (100.0) *Numbers in brackets denote row percents. Note: For this category, in 1918-1919 there were 161 missing cases; in 1921-1922 there were 79.
46 4.4 Temporality of Influenza Deaths within Vancouver This section illustrates the temporality of the epidemic in the City of Vancouver in 1918-
1919. Figure 5 shows that the epidemic began in October 1918 and ended in March 1919 and was bi-modal peaking in October and again in January. In 1918-19, the highest number of influenza deaths occurred in October (366) and November (284) 1918. Deaths declined to 100 in
December but surged in January with 229 then declined again in February and March of 1919.
For the control period of 1921-1922, only 10 influenza deaths occurred in October 1921 and only
5 in November that year. The highest number of influenza deaths in 1921-22 occurred in March with 46 deaths which is similar to the March count in 1918-19 with 58 deaths. Figure 5 shows that there was a significant increase in influenza deaths in the epidemic period as compared to a more typical influenza season of 1921-22.
The first incidence of more than one influenza death occurring in a single day was on
October 10th, 1918 and escalated from there up to 42 deaths in a single day on October 27th,
1918. The first case of influenza in the City of Vancouver was undeterminable based on the data sources used in this study; however, O‟Keefe and MacDonald (2004) suggest that the first case of Spanish Influenza in Vancouver was confirmed on October 4th, 1918.
47
Figure 5. Influenza versus non influenza deaths by time period. The dark grey bars represent influenza deaths while the lighter grey bars represent non influenza deaths. The first set of June-June bars are for 1918-1919, while the second set represents 1921-1922.
4.5 Distribution of Influenza Deaths in Vancouver ArcGIS was used to create a map showing the locations of the residence of those people who died of influenza during 1918-19 represented by points (Figure 6). Due to data limitations including the inability to match all the historical addresses using present day information, this map is incomplete. However, it is still a useful indication of the distribution of deaths in the City of Vancouver.
As mentioned previously, 934 residents of Vancouver died of influenza in the 1918-19 epidemic. Of the 934, 879 specific addresses were listed as their place of residence while the
48 remaining 55 did not include a specific address. These 879 specific addresses were uploaded into
ArcGIS to create the residence map. Of the 879 addresses, 736 (84%) were matched using an address locator of present day Vancouver addresses to within one to two blocks of the original address. Of the 143 (16%) unmatched addresses, 116 (81%) were found to be located in four areas of Vancouver: downtown, the downtown east side, the Westside, and East Vancouver.
Thirty-two percent were located in East Vancouver, 29.3% were in the downtown east side,
19.8% were on the Westside and 19% of these unmatched locations were in the downtown area.
This leaves a total of 27 (3%) unmatched addresses.
49
Figure 6. Location of residence for Vancouver residents dying of influenza in 1918-19. Red dots represent addresses where more than one resident died and blue dots represent addresses where only one resident died. The streets are from the open source database provided by the City of Vancouver and are based on present day configuration.
4.6 Mortality Rates in the City of Vancouver Based on this information and the 1921 Canada census population numbers for the City of Vancouver, three mortality rates were calculated for the overall population. The population of the City of Vancouver in 1921 was 117, 217 (Government of Canada, 1925).
The most conservative mortality rate, including only those residents whose primary cause of death was influenza (152 deaths), was 1.3 per 1,000 for 1918-19. In 1921-22, the most conservative mortality rate was 0.3 per 1,000. The moderately conservative mortality rate included those residents whose primary or secondary cause of death listed influenza. In 1918-19 the moderately conservative mortality rate was 7.0 per 1,000 and in 1921-22 it was 0.5 per 1,000.
Lastly, the least conservative estimate of mortality rates included influenza deaths as well as
50 pneumonia deaths as per the definition discussed in section 4.2 Case Definition of Influenza
Deaths. Recall that the total number of residents who died of influenza was 934 in 1918-19 and
175 in 1921-22. Using these numbers, the mortality rate from influenza for the total population of Vancouver was 8.3 per 1,000 for 1918-19. In comparison, a much smaller influenza mortality rate of 1.3 per 1,000 was calculated for 1921-22.
Mortality rates were also calculated using the combined influenza and pneumonia deaths for the following variables: gender, age, immigrants, and the employed (Table 16).
Table 16. Mortality Rates for Gender, Age Group, Immigrants, and the Employed, 1918-1919. Population in City of Number Vancouver, Mortality Influenza 1921 Rate per Variable Deaths Census 1,000 Gender Malea 552 62,230 8.9 Female 382 54,987 6.9 Age Group 0-18b 188 35,962 5.2 19-39 587 44,682 13.1 40-59 118 28,800 4.1 60-79 31 6,631 4.7 80 and above 4 400 10.0 Immigrant 584 59,932 9.7 Non- Immigrant 374 57,285 6.5 Employedc 509 53,090 9.6 a. All male residents who died of influenza, including male residents whose occupation was listed as soldier, were included in the calculation of this mortality rate. b. The 1921 census does not separate stillborn records as such the stillborn age category is included in the 0-18 group for this table. c. The employed category according to the 1921 census includes those gainfully employed from the ages of 10 and up in the City of Vancouver.
51 4.7 Statistical Analysis of Links between social and geographic characteristics of residents and influenza deaths in Vancouver This section is divided into two sub-sections. In the first one I discuss univariate results and in the second section, multivariate analysis.
4.7.1. Univariate analyses This section of the results examines whether there are any statistically significant linkages between social and geographic characteristics of Vancouver residents and influenza deaths during the 1918-19 epidemic in Vancouver and during the same months in 1921-22.
Table 17 and Table 18 show that there is no significant association between gender and influenza for the 1918-19 period or for 1921-22. Although not statistically significant, results from both years indicate greater likelihood of death for males (OR= 1.13 in 1919-19 and
OR=1.34 in 1921-22).
Table 17. Chi-square test for gender and influenza deaths in 1918-1919.
Influenza p- Odds 95% CI Gendera Deaths Total Deaths value Ratio Lower Upper Male 552 (59.1) 1,139 (57.5) Female 382 (40.9) 841 (42.5) 0.187 1.13 0.95 1.35 Total 934 (100.0) 1,980 (100.0) *Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a No missing data
Table 18. Chi-square test for gender and influenza deaths in 1921-1922. Influenza p- Odds 95% CI Gendera Deaths Total Deaths value Ratio Lower Upper Male 112 (64.0) 714 (58.0) Female 63 (36.0) 516 (42.0) 0.098 1.34 0.96 1.86 Total 175 (100.0) 1,230 (100.0) *Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact a No missing data
52 As shown in Table 19, the association between age category and influenza deaths is statistically significant (p<0.01) for both time periods. In 1918-19, young adults between 19 and
39 years were more likely to die of influenza while in 1921-1922 those in the 40-59 age group were more likely to die of influenza.
Table 19. Chi-square test for age category and influenza for 1918-19 and 1921-22. 1918-1919 1921-1922 Age Influenza Total p- Influenza Total p- Categorya Deaths Deaths value Deaths Deaths value Stillbornb 17 211 7 190 (0-7days) (1.8) (10.7) (4.0) (15.5) 8days-18 171 317 37 164 years (18.4) (16.1) (21.1) (13.4) 587 782 32 202 19-39 (63.3) (39.7) (18.3) (16.4) 118 360 47 324 40-59 (12.7) (18.3) <0.01 (26.9) (26.4) <0.01 31 257 41 293 60-79 (3.3) (13.0) (23.4) (23.9) 80 and 4 44 11 55 above (0.4) (2.2) (6.3) (4.5) 928 1,971 175 1,228 Total (100.0) (100.0) (100.0) (100.0) *Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a For 1918-19 there are 9 missing and for 1921-22 there are 2 missing cases. b. The term stillborn has been used here to describe a specific age category, not a cause of death. The determination of influenza deaths in this age category is based upon the same definition as described in Section 4.2.
Table 20 illustrates that the association between place of death and influenza in 1918-
1919 is statistically significant. Of all the deaths from influenza, a higher proportion occurred within the home (45.0%) than in hospitals or other locations such as streets, bodies of water, or places of employment. In 1921-22, there was no statistically significant association between place of death and influenza.
53 Table 20. Chi-square test for place of death and influenza in 1918-19 and 1921-22. 1918-19 1921-22 Place of Influenza p- Influenza p- Deatha Deaths Total value Deaths Total value 350 824 83 682 Hospital (37.5) (41.7) (96.5) (98.0) 420 914 0 2 Home (45.0) (46.2) (0.0) (0.3) <0.01 0.354 163 240 3 12 Other (17.5) (12.1) (3.5) (1.7) 933 1,978 86 696 Total (100.0) (100.0) (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a For 1918-19 there are 2 missing cases and for 1921-22 there are 534 missing cases.
Table 21 shows that for the 1918-1919 period there was a significant association between birthplace and influenza deaths (p<0.01) with a higher proportion of influenza deaths occurring in people born in Canada (40.6%). The “Other” category includes Mexico, the Caribbean, Africa, and South America.
Table 21. Chi-square test for birthplace and influenza in 1918-19 and 1921-22. 1918-19 1921-22 Influenza Influenza Birthplacea Deaths Total p-value Deaths Total p-value 374 920 84 612 Canada (40.6) (46.9) (48.8) (50.5) 76 127 7 57 USA (8.2) (6.5) (4.1) (4.7) United 250 550 57 371 Kingdom (27.1) (28.0) (33.1) (30.6) 100 167 7 60 <0.01 0.914 Europe (10.8) (8.5) (4.1) (4.9) 104 173 15 104 Asia (11.3) (8.8) (8.7) (8.6) 18 26 2 9 Other (2.0) (1.3) (1.2) (0.7) 922 1,963 172 1,213 Total (100.0) (100.0) (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a For 1918-19 and 1921-22 there are 17 missing cases.
54
Fisher‟s Exact chi-square test, as shown in Table 22, reveals statistically significant association between employment status and influenza in 1918-1919. A total of 57.1% of people who died of influenza were employed. This is further emphasized with the odds ratio showing employed people were 2.1 times more likely to die of influenza.
Table 22. Chi-square test for employment status and influenza in 1918-19. Influenza p- Odds 95% C.I. Employment Statusa Deaths Total value Ratio Lower Upper 509 878 Employed (57.1) (47.5) 383 970 <0.01 2.11 1.76 2.55 Unemployed (42.9) (52.5) 892 1,848 Total (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 132 missing cases.
In 1921-1922, there was no significant association between employment status and influenza as (Table 23).
Table 23. Chi-square test for employment status and influenza 1921-22. Influenza p- Odds 95% C.I. Employment Statusa Deaths Total value Ratio Lower Upper 69 466 Employed (40.4) (39.2) 102 722 0.403 1.06 0.76 1.47 Unemployed (59.6) (60.8) 171 1,188 Total (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 42 missing cases.
When the employed occupations are separated, there is no significant association between a particular occupation group and influenza in 1918-1919 nor in 1921-22 (Table 24).
55
Table 24. Chi-square test for occupation and influenza in 1918-19 and 1921-22. 1918-19 1921-22 Influenza p- Influenza p- Occupationa Deaths Total value Deaths Total value 205 356 24 Professional/Skilled (40.3) (40.5) (34.8) 190 (40.8) 208 363 29 Unskilled - Labour (40.9) (41.3) (42.0) 189 (40.6) 0.792 0.440 96 159 16 87 Unskilled - Clerical (18.9) (18.1) (23.2) (18.7) 509 69 466 Total (100.0) 878 (100.0) (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a There are 1,120 missing cases in 1918-19 and 764 missing cases in 1921-22.
As shown in Table 25, the association between marital status and death by influenza in
1918-19 is significant (p<0.01) with married people representing the highest proportion of influenza deaths (51.7%) and divorced/widowed the lowest (2.6%). In contrast, there is no significant association between marital status and influenza in 1921-1922.
Table 25. Chi-square test for marital status and influenza in 1918-19 and 1921-22. 1918-19 1921-22 Influenza p- Influenza p- Marital Statusa Deaths Total value Deaths Total value 472 911 82 495 Married (51.7) (46.8) (48.0) (41.4) 417 890 65 520 Single (45.7) (45.8) (38.0) (43.4) <0.01 0.162 Divorced/ 24 144 24 182 Widowed (2.6) (7.4) (14.0) (15.2) 913 1,945 171 1,197 Total (100.0) (100.0) (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a There are 35 missing cases in 1918-19 and 33 missing cases in 1921-22.
As shown in Table 26, Fisher‟s Exact test indicates that there is a significant association
(p<0.01) between immigrant status and influenza in 1918-19 with immigrants 1.62 times more
56 likely to die from influenza. Furthermore, 59.4% of influenza deaths were immigrants compared to non-immigrants who accounted for 40.6% of influenza deaths.
Table 26. Chi-square test for immigration status and influenza in 1918-19. Immigration Influenza Odds 95% C.I. Statusa Deaths Total p-value Ratio Lower Upper Immigrant 548 (59.4) 1,043 (53.1) Non-Immigrant 374 (40.6) 920 (46.9) <0.01 1.62 1.35 1.93 Total 922 (100.0) 1,963 (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 17 missing cases in 1918-19.
In contrast, for 1921-1922, Table 27 shows that there was no significant association between immigration status and influenza deaths.
Table 27. Chi-square test for immigration status and influenza in 1921-22.
Immigration Influenza Odds 95% C.I. Statusa Deaths Total p-value Ratio Lower Upper Immigrant 88 (51.2) 601 (49.5) Non-Immigrant 84 (48.8) 612 (50.5) 0.681 1.08 0.78 1.49 Total 172 (100.0) 1,213 (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 17 missing cases in 1921-22.
As indicated by Table 28 and Table 29, there is no significant association between race and influenza deaths in either 1918-1919 or 1921-1922. For a clear outline of how race was determined see Appendix A.7 Coding for Race.
57
Table 28. Chi-square test for race and influenza in 1918-19.
Influenza Odds 95% C.I. Racea Deaths Total p-value Ratio Lower Upper 133 270 Caucasian (14.3) (13.7) 799 1,706 0.471 1.10 0.85 1.43 Non-Caucasian (85.7) (86.3) 932 1,976 Total (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 4 missing cases in 1918-19.
Table 29. Chi-square test for race and influenza in 1921-22. Influenza Odds 95% C.I. Racea Deaths Total p-value Ratio Lower Upper Caucasian 23 (13.7) 177 (14.7) Non-Caucasian 145 (86.3) 1,026 (85.3) 0.814 0.91 0.57 1.46 Total 168 (100.0) 1,203 (100.0) Note: numbers in brackets denote column percents. P-value determined using Fisher‟s Exact Test. a There are 27 missing cases in 1921-22.
For the 1918-19 period, the Pearson‟s chi-square test indicates that there is a significant association (p<0.01) between the length of residence in Canada and influenza with those who lived in Canada for less than 15 years accounting for 45.8% of influenza deaths (Table 30). This is in contrast to the 1921-22 period where there was no significant association found between length of residence in Canada and dying from influenza.
58 Table 30. Chi-square test for length of residence in Canada and influenza in 1918-19 and 1921-22. 1918-19 1921-22 Length of Residence in Influenza p- Influenza p- Canadaa Deaths Total value Deaths Total value Less than 15 401 675 35 285 years (45.8) (35.8) (21.0) (24.2) 15 years or 101 291 48 282 more (11.5) (15.4) (28.7) (23.9) <0.01 0.244 374 920 84 612 Life (42.7) (48.8) (50.3) (51.9) 876 1,886 167 1,179 Total (100.0) (100.0) (100.0) (100.0) Note: numbers in brackets denote column percents. P-value determined using Pearson‟s Chi-Square Test. a There are 94 missing cases in 1918-19 and 51 missing cases in 1921-22.
4.7.2 Multivariate Analysis Univariate analyses for the 1921-22 period showed statistically significant associations only for age and influenza deaths. Therefore, no multivariate models were developed for this time period.
In contrast, in 1918-19 statistically significant associations between age, gender, birthplace, immigration status, length of residence in Canada, and employment status and influenza death were demonstrated. To help determine how best to utilize these variables in the multivariate analysis, Table 31 shows the correlation matrices for these variables in 1918-19.
The effect sizes for any correlations were determined using Cramer‟s V due to the presence of categorical variables. An effect size of 0.1 is a small effect, 0.3 is a medium effect, and anything
0.5 or more is a large effect (Field, 2009).
In Table 31, birthplace, immigration status, and length of residence in Canada have a
Cramer‟s V of 1 indicating that they are measuring the same thing (p<0.01). As such, these particular variables were entered into the multivariate model using a forward stepwise method so that the model selects the variable that best fits the observed data.
59 Additionally, the correlation matrix was used to determine if there was any association between employment and immigrant status, birthplace, or length of residence in Canada. The highest correlation value was between employment status and birthplace with a Cramer‟s V of
0.340 indicating a moderate correlation.
Table 31. Correlation between age, gender, birthplace, immigration status, length of residence in Canada, and employment status for Vancouver residents in 1918-19.
Age Length of Employ- Catego- Birth- Immigrant Residence ment Variable rized Gender place Status in Canada Status Cramer's V 0.094 0.254 0.534 0.442 0.495 Approx. Age Sig. 0.004 0.000 0.000 0.000 0.000 Categorized N 1,971 1,957 1,957 1,881 1,842 Cramer's V 0.094 0.220 0.097 0.077 0.600 Approx. Sig. 0.004 0.000 0.000 0.004 0.000 Gender N 1,971 1,963 1,963 1,886 1,848 Cramer's V 0.254 0.220 1.000 0.708 0.340 Approx. Sig. 0.000 0.000 0.000 0.000 0.000 Birthplace N 1,957 1,963 1,963 1,883 1,837 Cramer's V 0.534 0.097 1.000 1.000 0.286 Approx. Immigrant Sig. 0.000 0.000 0.000 0.000 0.000 Status N 1,957 1,963 1,963 1,883 1,837 Cramer's V 0.442 0.077 0.708 1.000 0.276 Length of Approx. Residence in Sig. 0.000 0.004 0.000 0.000 0.000 Canada N 1,881 1,886 1,883 1,883 1,767 Cramer's V 0.495 0.600 0.340 0.286 0.276 Approx. Employment Sig. 0.000 0.000 0.000 0.000 0.000 Status N 1,842 1,848 1,837 1,837 1,767
60
Table 32 shows that even after controlling for age, gender, and marital status, being employed versus not being employed was a major risk factor for dying from influenza
(OR=1.51; CI 1.06-2.15). Additionally, this table continues to show the impact of influenza on the young adult population (ages 19-39). This age category was 21 times more likely to die of influenza than the reference group (OR=21.13; C.I. 6.88-64.91).
Table 32. Multivariate analysis showing odds ratio‟s for age category, marital status, gender, and employment status in 1918-19. 95% C.l. Variable* Odds Ratio Lower Upper p-value Age (years)
80 and above (reference) 0.000 0-7days 0.86 0.24 3.01 0.808 8days-18 11.02 3.46 35.11 0.000 19-39 21.13 6.88 64.91 0.000 40-59 3.38 1.10 10.43 0.034 60-79 1.10 0.36 3.41 0.867 Marital Status Widowed/Divorced (reference) 0.729 Single 1.26 0.65 2.43 0.492 Married 1.28 0.70 2.33 0.427 Gender 0.99 0.73 1.35 0.978 Employment Status 1.51 1.06 2.15 0.021 n = 1, 745; 235 missing
61
Chapter 5: Discussion This discussion focuses on the epidemic period from 1918-19 as the 1921-22 data was used primarily to determine if an epidemic did occur during this time or if the pattern of influenza was more typical of a “normal” influenza season. As indicated by the variation in the number of influenza deaths between the two years, 1,167 in 1918-19 and 202 in 1921-22, the
1918-19 influenza was a unique epidemic. This is further emphasized by the difference in mortality rates from influenza for City of Vancouver residents. In 1918-19 the mortality rate was
8.3 per 1,000 as compared to 1.3 per 1,000 in 1921-22.
From the univariate analysis, it was determined that age, place of death, birthplace, employment status, marital status, immigration status, and length of residence in Canada were significantly associated with death caused by influenza. Those who were between the ages of 19-
39, the immigrant population, and those who were employed had the highest odds of dying from influenza. While gender was not found to be statistically significantly associated with influenza death, more males than females did die of the virus in 1918-19.
The multivariate modeling after controlling for age, gender, and marital status, revealed that immigration variables were no longer significantly associated with influenza deaths. In the multivariate model, the strongest predictors of death from influenza were age between 19 and 39
(OR=21.13; C.I. 6.88-64.91) and employment (OR = 1.51; C.I. 1.06-2.15).
The discussion is organized to address the six categories of questions posed at the beginning of the thesis which were:
1. Did the first wave of Spanish Influenza in Vancouver occur in the Fall of 1918 and how many waves of the infection occurred? 2. Was the Fall 1918 wave of influenza more deadly than the other waves? 3. Was the impact of influenza consistent across all areas of Vancouver or did some locations experience a more severe mortality rate?
62 4. Were employed people more likely to die of Spanish Influenza? Were there specific occupations that experienced higher numbers of deaths? 5. Were young adults in Vancouver more likely to die of influenza than other age groups? 6. Did foreign born populations experience higher mortality rates?
The first two items are addressed in section 5.1, the third question is addressed in section 5.2, questions four and five are addressed in section 5.3, and question six is addressed in sections 5.3 and 5.4.
5.1 Timing and Intensity The first question posed in the introduction was related to determining when the first wave of Spanish Influenza occurred in Vancouver while the second question asks which wave of infection was most deadly. The dates of death indicated by the death certificates suggest that the epidemic period of Spanish Influenza in Vancouver was from October 1918 to March of 1919.
The number of deaths peaked in October with 366 and then again in January with 229 deaths suggesting two waves of influenza enveloped Vancouver. Based solely on the number of deaths, the Fall of 1918 wave of influenza was more deadly in the City of Vancouver the Winter of 1919 wave. As presented in Figure 5, numbers of deaths start to increase about the second week of
October which corresponds with the arrival of the Siberian Expedition Force (SEF) as discussed by Humphries (2005).
Humphries (2005) hypothesis suggests that influenza was transmitted across Canada from the east to west via SEF soldiers who were travelling by train to the Port of Vancouver. This train is said to have arrived in Port Coquitlam on the 2nd of October, 1918. According to reports,
Spanish Influenza took anywhere from a few days to a few weeks to kill its host (Robertson,
1919) which could explain the large numbers of deaths first appearing the second week of
October.
63 Even though it is stated that soldiers were the carriers of influenza on board this train, the death certificates show records for very few soldiers in Vancouver (a total of 68 out of 2,442; thirty of whom died of influenza). In other words, although the timing of the epidemic fits with
Humphries thesis, we did not see elevated mortality among those indicating they were soldiers.
5.2 Spatial Distribution of Influenza Deaths in Vancouver The third question proposed at the beginning of this thesis was intended to determine the distribution of influenza deaths among Vancouver neighbourhoods; this outcome was unattainable due to the absence of neighbourhood population numbers in the 1921 census.
Consequently, a basic GIS map was produced using points to mark the address of residents who died of influenza for the entire City of Vancouver. Based on this map, there was a concentration of deaths in the Gastown/downtown eastside/Strathcona area. This area is just north of the rail- yards so one potential explanation for the concentration of deaths there is that they were close to a major transportation route which played a key role in disseminating the influenza virus around the country.
Jones (2002, 2005, 2006, and 2007) in her studies of influenza in Winnipeg notes that the rates in north Winnipeg, where the immigrant population is highest, are higher than in south
Winnipeg where the wealthier residents lived. North Winnipeg is also closer to the railway than
South Winnipeg so it could be suggested that some combination of proximity to the railway and impoverishment (lower socio-economic status) may have played a role in higher rates of influenza deaths there. Taking this same idea and transposing it to the City of Vancouver and the downtown eastside/Strathcona area which were also close to the railway could partially explain the concentration of influenza deaths in this neighbourhood. If there was a high concentration of influenza deaths all the way around the rail-yard perhaps a case could be made for close
64 proximity to transportation routes increasing the risk of dying from influenza. However, this is not the case as the streets to the east and south of the rail-yard do not have a high concentration of points.
Additionally, this area encompassed Vancouver‟s “Chinatown” and housed a large contingent of single, working men (McDonald, 1996). McDonald (1996, p. 213) indicates that immigrants to Vancouver came to work rather than become “established members of local society” and would take unskilled, lower-wage employment that the non-immigrant population avoided. Subsequently, this area was likely home to a higher proportion of immigrants from other nations and of poor people relative to most other Vancouver neighbourhoods. McDonald
(1996) also points out living conditions in this area were poor with people crowded into residences which may have made the dissemination of the influenza virus that much easier.
5.3 Socio-Demographic Characteristics of Influenza in Vancouver Tuckel et al. (2006, p. 176) in their study of Spanish Influenza in Hartford, Connecticut, identified that there was an “over-representation of males, young adults, and the foreign-born” as well as those from eastern and southern Europe who died of influenza. The results for Vancouver are consistent in that a higher proportion of males died of influenza than females and the young adult category, between 19 and 39 also showed the highest proportion of deaths by influenza.
However, differences between the Hartford and this study were noted in the immigrant status association. The univariate analysis shows a statistically significant relationship between immigrant status and influenza with immigrants having a higher proportion of death and a higher odds ratio. However, when this variable was presented to the multivariate logistic regression it was no longer a factor after age, gender, and marital status were controlled. Perhaps, this is because 53% of immigrants were in the 19-39 age bracket whereas only 24.3% of non-
65 immigrants were 19-39 (Appendix B). In other words, the significant relationship between immigrant status and influenza is already accounted for in the significant association between age and influenza.
Another key difference from the Hartford study is the inclusion of an employment status variable. The multivariate model revealed that employment status was still a factor in influenza deaths even after controlling for age, gender, and marital status. Even though the City of
Vancouver was „closed‟ for a period of time between October 18, 1918 and November 19, 1918, businesses and industry remained open (Andrews, 1977; O‟Keefe and McDonald, 2004).
Subsequently, this employed group would have been interacting on a more frequent basis with other individuals increasing their chance of contracting the virus. The employment category was broken down into sub-categories for univariate analysis but no specific occupation proved to have a significant relationship with influenza death. To put it briefly, an individual had an increased risk of dying of influenza if they were employed no matter what occupation they held.
The importance of employment in relation to dying of influenza may also explain the removal of the immigrant variables from the multivariate analysis as a higher proportion of immigrants were part of the working population (60.4% of immigrants were employed; 31.8% of non-immigrants were employed) (Appendix B).
In summary, in the City of Vancouver, young adults were more likely to die of influenza than other age groups and those who were employed were more likely to die of influenza than those who were not employed.
5.4 Mortality Rates for Spanish Influenza in Vancouver The mortality rate of 8.3 per 1,000 was based on the 1921 census population for the City of Vancouver of 117, 217 people. It is very difficult to say whether or not this rate differs from
66 others found in cities at this time because of methodological differences in ascertaining mortality rates and because of lack of information, in many studies, about exactly how these were calculated. In any case, 8.3 per 1,000 found in my study is higher than rates observed in the city of Winnipeg (6.5 per 1,000 (Jones, 2006)) and in Saskatchewan cities (6 per 1,000 (Lux, 1997)).
For the purposes of this study, mortality rates were also calculated for gender, age group, immigrant status, and the employed group to determine if specific socio-demographic groups had higher rates of influenza death. The highest mortality rate was seen in the 19-39 age group with a rate of 13.1 per 1,000. However, the key question was whether immigrants had higher rates of mortality than non-immigrants. This was shown to be true for the City of Vancouver with immigrants having a mortality rate of 9.7 per 1,000 as compared to non-immigrants with a rate of
6.5 per 1,000. This result reflects conclusions drawn by Jones (2002, 2005, 2006, and 2007) and
Tuckel et al. (2006) which also showed higher rates of mortality among immigrant populations.
While rates are based on a thorough review of death certificates in this study, it is impossible to determine whether the boundary for the denominator (population of Vancouver in
1921) exactly matches the boundary for the numerator. Vancouver‟s exact boundary for the 1921 census was never clearly defined, nor was there a map to identify the area.
5.5 Contributions to Medical Geography The association between employment and influenza is one not commonly discussed in the influenza literature. Andrews (1977) makes mention of gasworks employees and tin miners being less affected by influenza than miners and Jones (2006, p. 61) states that in Winnipeg nurses, doctors, health department employees, policemen, firemen, and those in the textiles trades were “heavily hit by the flu”. Additionally, Frankel and Dublin (1919) examined influenza mortality among wage earners based on insurance claims; but, none of these studies looked
67 specifically at the association between influenza and employment as has been done in this study.
Consequently, this study contributes new information about the importance of employment as a risk factor for dying of influenza, at least in the City of Vancouver during the 1918-19 epidemic.
Furthermore, this study identifies that immigrants made up a large proportion of the young adult age group who died from influenza and also represented a larger proportion of the employed group who died of influenza. With McDonald (1996, p. 212) suggesting that immigrants came to
Vancouver in order to “make money” and “leave when their stay was no longer profitable” it makes sense that they would be of working age. In short, immigrant mortality rates may be higher not because they were immigrants (i.e. biological differences) but because of their focus on working to make money and their subsequent social patterns and high level of person to person interaction. These results provide further insight into why mortality rates were higher in immigrant populations in other studies such as Tuckel et al. (2006), and in Jones (2002, 2005,
2006, and 2007) and presents a new avenue of study in medical geography which overlaps with health geography.
5.6 Future Research Opportunities With the present day knowledge that many influenza viruses emerge from China and the fact that tens of thousands of Chinese labourers were transported across Canada to serve in infrastructure maintenance in Europe during the First World War, conducting a similar analysis of influenza in the City of Vancouver during the period that the transport of the workers occurred may shed more light on the question of the origin of Spanish Influenza. Future work in this area could also include mapping out the movement of Spanish Influenza more specifically into and out of Vancouver, through British Columbia and across Canada similar to work undertaken by
Patterson and Pyle (1991) and also by Herring (1993) and Herring and Sattenspiel (2003).
68 Furthermore, this research did not include any qualitative sources of information, or, any qualitative analysis. These findings would be enhanced by the inclusion of qualitative information for example, considering historical novels, personal diaries, and other such documents, to shed light on why these patterns expressed in the quantitative data existed in the
City of Vancouver.
69
Chapter 6: Conclusion This study has identified some key conclusions about Spanish Influenza and the population characteristics of the people it killed in the city of Vancouver during the 1918-1919 epidemic. First of all, like other studies conducted on Spanish Influenza, the young adult population (ages 19-39) was most affected. This is a population that contributes heavily to the economy of a city, as this age group encompasses a majority of those eligible to work and manage city business. Furthermore, this is an age group that is creating new life and bringing up families that will take over control of the economy in the next generation. The devastation in this population‟s numbers leaves behind the young and the old who could be more vulnerable and for whom there are economic implications if an epidemic comes again.
Secondly, being employed increased the odds of dying from influenza in Vancouver.
Now that more people belong to the work force, including women, the speed at which an influenza virus moves through the population could be increased as a larger number of people are potential targets.
Understanding how influenza viruses move through a population and what socio- demographic characteristics increase the odds of dying from such an infection is relevant today, especially in light of a recent article published in Science. This paper by Herfst and colleagues
(2012) documents the mutation of an A/H5N1 avian influenza virus from a non-airborne transmission virus to one that is capable of aerosol or respiratory droplet transmission in ferrets.
As a result of this research, the authors have concluded that these highly pathogenic avian influenza A/H5N1 viruses “have the potential to evolve directly to transmit by aerosol or respiratory droplets between mammals, without reassortment in any intermediate host, and thus pose a risk of becoming pandemic in humans” (Herfst et al., 2012, p. 1541). Evidently, the threat
70 of pandemic influenza in the future is not unlikely and understanding the patterns associated with influenza pandemics of the past can provide insight into the management and/or prevention of future pandemics.
This research further exemplifies the usefulness of a medical geography approach at looking not only at patterns of disease but also in identifying social elements that influence these patterns. While this research was narrowly focussed on quantitative data, there is opportunity in the future within this field to include more qualitative methods to enhance the understanding of the characteristics, spatial patterns, individual and family experiences of Spanish Influenza in the
City of Vancouver.
71
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Appendix A: Codebook
A.1 Coding for Cause of Death and Secondary Cause of Death Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Accident Accident Accident Accident, Fall from Scaffold Accident Accident Accidental Burns Accident Accident Accidental Collision between Sled and Automobile Accident Accident Accidental Drowning Accident Accident Accidental Drowning Accident Accident Accidental Explosion of Blowtorch Accident Accident Accidental Explosion of Gasoline Can Accident Accident Accidental Fall Accident Accident Accidental Fall down Hatchway Accident Accident Accidental Fall down Stairs Accident Accident Accidental Fall down Stairs Accident Accident Accidental Fall Down Stairway Accident Accident Accidental Fall down Stairway Accident Accident Accidental Fall from Barn Roof, Fractured Pelvis Accident Accident Accidental Fall from Roof of Building Accident Accident Accidental Fall from Wharf Accident Accident Accidental Fall into Hold Accident Accident Accidental Fall into Hold of Vessel Accident Accident Accidental Fall on Street Accident Accident Accidental Fall over Stair Rail Accident Accident Accidental Fall Through Trap Door Accident Accident Accidental Poisoning Accident Accident Accidental Scalding Accident Accident After Operation for Thyroid Accident Accident Asthemia, Uraemic Poisoning Accident Accident Auto Accident Accident Accident Automobile Accident Accident Accident Beach Flood Accident; Fractured Ribs and Exposure Accident Accident Bicycle Accident Accident Accident Blood Poisoning Accident Accident Boating Accident Accident Accident Caesarian for Obstructed Labor Accident Accident
79 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Complications following Operation Accident Accident Complications from Removal of Cancerous Growth in Large Bowel Accident Accident Drowning Accident Accident Drowning - Accidental Accident Accident Fracture at Base of Skull, Fall out Window Accident Accident Fracture of Spine Accident Accident Freight Elevator Accident, Fractured Pelvis with Ruptured Bladder and Liver Accident Accident Implosion of Veins Accident Accident Injury of Back from Fall, Senile Decay Accident Accident Injury to Head during Delivery Accident Accident Lumber Mill Accident. Fractured Leg and Pelvis Accident Accident Mill Accident Accident Accident Morphine Poisoning Accident Accident Opium Poisoning Accident Accident Overdose of Morphine - Accidentally Self-Administered Accident Accident Pendonitis Accident Accident Pile Driving Accident, Fractured Pelvis, Ruptured Kidney Accident Accident Pile Driving Accident, Fractured Skull, Head Almost Severed Accident Accident Poisoning Accident Accident Post Operative Shock Accident Accident Post-Operative Peritonitis Accident Accident Post-Operative Shock Accident Accident Pulmonary Embolism following Operation for Uterine Fibroids Accident Accident Railway Accident Accident Accident Ruptured Uterus at Delivery Accident Accident Salvarsan Poisoning Accident Accident Saw Mill Accident Accident Accident Saw Mill Accident - Bruised Leg Accident Accident Scalding, Shock Accident Accident Strychuine Poison Accident Accident Toxic Poisoning Accident Accident Tug Boat Accident Accident Accident Homicide Homicide Accident Strangulation Strangulation Accident
80 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Strangulation by Cord Strangulation Accident Strangulation of Cord around Neck Strangulation Accident Aphyxia Pallida Suffocation Accident Suffocation Suffocation Accident Suffocation - Acute Oedema of Larynx Suffocation Accident Suffocation from Mucus Suffocation Accident Suicide Suicide Accident Suicide by Carbolic Acid Suicide Accident Suicide by Carbolic Acid Poisoning Suicide Accident Suicide by Cutting Suicide Accident Suicide by Cutting Throat Suicide Accident Suicide by Cyanide of Potash Poison Suicide Accident Suicide by Drowning Suicide Accident Suicide by Hanging Suicide Accident Suicide by Inhaling Illuminating Gas Suicide Accident Suicide by Jumping Suicide Accident Suicide by Jumping from Window Suicide Accident Suicide by Revolver Shot Wound Suicide Accident Suicide by Revolver, Shot Wound Puncturing Heart Suicide Accident Suicide by Shot Wound Suicide Accident Abortion Abortion Child/Child Birth (Blue Disease) Congenital Heart Disease Congenital Child/Child Birth Anencephalic Child Congenital Child/Child Birth Cleft Palate Congenital Child/Child Birth Congenital - Heart Congenital Child/Child Birth Congenital Atelctasis Congenital Child/Child Birth Congenital Debility Congenital Child/Child Birth Congenital Deformity Congenital Child/Child Birth Congenital Heart Defect Congenital Child/Child Birth Congenital Heart Disease Congenital Child/Child Birth Congenital Heart Trouble Congenital Child/Child Birth Congenital Malformation Congenital Child/Child Birth Congenital Pyloric Stenosis Congenital Child/Child Birth Congenital Syphilis Congenital Child/Child Birth Congenital Weakness Congenital Child/Child Birth Haemophilia Congenital Child/Child Birth Hemophilia Congenital Child/Child Birth Hydrocephalus Congenital Child/Child Birth Rickets Congenital Child/Child Birth
81 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Spina Bifida Congenital Child/Child Birth Spina Bifida, Stillborn Congenital Child/Child Birth A Doubled Breach, Large Baby, Small Pelvis in Mother Stillborn Child/Child Birth Aesthemia due to Prematurity Stillborn Child/Child Birth Aesthemia due to Prematurity Stillborn Child/Child Birth Asphyxiation due to Prolonged Pressure on Cord Stillborn Child/Child Birth Asthemia, Premature Stillborn Child/Child Birth Baby (one of twins) Hard Birth, Died of Convulsions Stillborn Child/Child Birth Baby had been Dead Before Birth Stillborn Child/Child Birth Baby Tired a Few Hours Stillborn Child/Child Birth Bad Health in Newborn Stillborn Child/Child Birth Birth Trauma Stillborn Child/Child Birth Breach Birth with Strangulated Cord Stillborn Child/Child Birth Breach Presentation, Difficult Delivery Stillborn Child/Child Birth Child Died in Second Stage of Labour, Cord Around Chest and Neck Stillborn Child/Child Birth Child Died in Uterus, Probably Three Days Prior. Separation of Placenta Stillborn Child/Child Birth Child Never Breathed Properly Stillborn Child/Child Birth Contracted Pelvis of Mother Stillborn Child/Child Birth Dead in Utero Stillborn Child/Child Birth Deadborn Stillborn Child/Child Birth Death in Uterus Stillborn Child/Child Birth Debilitis Stillborn Child/Child Birth Debility, Premature Birth Stillborn Child/Child Birth Died in Uterus Stillborn Child/Child Birth Difficult Birth, Stillborn Stillborn Child/Child Birth Difficult Breach Delivery, Parial Asphyxiation Stillborn Child/Child Birth Do Not Know - Was Dead in Uterus Stillborn Child/Child Birth Fetus Dead Several Days before Birth Stillborn Child/Child Birth Fetus Died in Uterus - Stillborn Stillborn Child/Child Birth Haemorrhage of Newborn Stillborn Child/Child Birth Haemorrhage of Newborn from Stomach and Intestines Stillborn Child/Child Birth Immaturity Stillborn Child/Child Birth Infantile Haemorrhage of Stomach in Premature Child Stillborn Child/Child Birth Long labor, Cord around Neck - Strangulation, Stillborn Stillborn Child/Child Birth
82 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Mother Fell - Premature Laber Stillborn Child/Child Birth Natural Causes Stillborn Child/Child Birth Natural Causes (Stillborn) Stillborn Child/Child Birth Nephritis in Mother Stillborn Child/Child Birth Nephritis of the Mother Stillborn Child/Child Birth Placenta Braevia Stillborn Child/Child Birth Premature Stillborn Child/Child Birth Premature - 7 Months Gestation Stillborn Child/Child Birth Premature - Practically Stillborn Stillborn Child/Child Birth Premature , Weakened Heart, Indigestion Stillborn Child/Child Birth Premature (Appears to be stillbirth) Stillborn Child/Child Birth Premature and Deficient Vitality Stillborn Child/Child Birth Premature and Malnutrition Stillborn Child/Child Birth Premature Asthemia Stillborn Child/Child Birth Premature Birth Stillborn Child/Child Birth Premature Birth - Asthemia and Heart Failure Stillborn Child/Child Birth Premature Birth - Pyelitis of Mother; Stillborn Stillborn Child/Child Birth Premature Birth - Stillborn Stillborn Child/Child Birth Premature Birth at Sixth Month Stillborn Child/Child Birth Premature Birth due to Accident to Mother Stillborn Child/Child Birth Premature Birth, Death Occuring Shortly after Birth Stillborn Child/Child Birth Premature Birth, Weakness Stillborn Child/Child Birth Premature child death due to rupture Stillborn Child/Child Birth Premature Delivery Stillborn Child/Child Birth Premature Infant Stillborn Child/Child Birth Premature Labor - Asthemia due to Inanition Stillborn Child/Child Birth Premature Labor, Exhaustion, Bronchopneumonia Stillborn Child/Child Birth Premature Separation of Placenta Stillborn Child/Child Birth Premature Separation of Placenta, Starving of Fetus Stillborn Child/Child Birth Premature Stillbirth Stillborn Child/Child Birth Premature Stillbirth due to Premature Separation of Placenta Stillborn Child/Child Birth Premature Twins Stillborn Child/Child Birth Premature Weak Child Stillborn Child/Child Birth Premature, Abnormal Development Stillborn Child/Child Birth Premature, Badly Nourished Stillborn Child/Child Birth
83 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Premature, Double Pneumonia Stillborn Child/Child Birth Premature, Mother with Myocarditis Stillborn Child/Child Birth Premature, Stillborn Stillborn Child/Child Birth Premature, Transverse Presentation Stillborn Child/Child Birth Prematurity Stillborn Child/Child Birth Prematurity, Lack of Development Stillborn Child/Child Birth Prematurity, Non-Development Stillborn Child/Child Birth Pressure on the Cord Stillborn Child/Child Birth Prolapsed Cord at Full Term Stillborn Child/Child Birth Six months premature Stillborn Child/Child Birth Stillborn Stillborn Child/Child Birth Stillborn - "I do not know any particular reason" Stillborn Child/Child Birth Stillborn - One of Twins had been Dead Several Days Before Birth Stillborn Child/Child Birth Stillborn - Premature Stillborn Child/Child Birth Stillborn - Trauma due to Fall Stillborn Child/Child Birth Stillborn (Short Cord?) Stillborn Child/Child Birth Stillborn from Abscess of Mother Stillborn Child/Child Birth Stillborn, Forceps Delivery and Cord About the Neck Stillborn Child/Child Birth Stillborn, Pregnancy Complications Stillborn Child/Child Birth Stillborn, Premature Stillborn Child/Child Birth Stillborn, Premature Birth Stillborn Child/Child Birth Stillborn, Premature Separation of Placenta Stillborn Child/Child Birth Stillborn, Prolapsed Cord Stillborn Child/Child Birth Stillborn, Unknown Cause Stillborn Child/Child Birth Strangulated by Umbillical Cord, Hernia Stillborn Child/Child Birth Strangulated Umbillical Cord Stillborn Child/Child Birth Umbilical Cord Stillborn Child/Child Birth Umbilical Phlebitis Stillborn Child/Child Birth Under Development Stillborn Child/Child Birth Unhealthy Newborn Stillborn Child/Child Birth Unruptured Membranes Stillborn Child/Child Birth Weak Child, Premature Stillborn Child/Child Birth Weak Vitality Stillborn Child/Child Birth ??, Arterio Sclerosis CHD Coronary Heart/Stroke Acute Cardiac Dilatation CHD Coronary Heart/Stroke Acute Dilatation of Heart CHD Coronary Heart/Stroke Acute Endocarditis CHD Coronary Heart/Stroke
84 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Acute Endocarditis and Dilatation of Heart CHD Coronary Heart/Stroke Acute Endocarditis and Myocarditis following Intestinal Influenza CHD Coronary Heart/Stroke Acute Heart Failure CHD Coronary Heart/Stroke Acute Myocardial Failure CHD Coronary Heart/Stroke Acute Myocarditis CHD Coronary Heart/Stroke Aesthmia due to Myocarditis; Bronchitis CHD Coronary Heart/Stroke Aneurism causing Asphyxiation CHD Coronary Heart/Stroke Aneurism of the Aorta CHD Coronary Heart/Stroke Angina CHD Coronary Heart/Stroke Aortic Incompetency CHD Coronary Heart/Stroke Aortic Regurgitation CHD Coronary Heart/Stroke Aortic Stenosis and Mitral Regurgitation CHD Coronary Heart/Stroke Arteriosclerosis CHD Coronary Heart/Stroke Ascites, Mitral Heart Disease CHD Coronary Heart/Stroke Asthema, Dilatation of Heart CHD Coronary Heart/Stroke Asthemia (Cardio renal failure) CHD Coronary Heart/Stroke Broken Compensation CHD Coronary Heart/Stroke Calcareous Pericarditis CHD Coronary Heart/Stroke Cardiac Aesthemia CHD Coronary Heart/Stroke Cardiac and Respiratory Failure CHD Coronary Heart/Stroke Cardiac Arithmia CHD Coronary Heart/Stroke Cardiac Asthemia CHD Coronary Heart/Stroke Cardiac Collapse CHD Coronary Heart/Stroke Cardiac Decompensation CHD Coronary Heart/Stroke Cardiac Dilatation CHD Coronary Heart/Stroke Cardiac Dropsy CHD Coronary Heart/Stroke Cardiac Failure CHD Coronary Heart/Stroke Cardiac Failure and Chronic Nephritis CHD Coronary Heart/Stroke Cardiac Failure due to Acute Myocarditis CHD Coronary Heart/Stroke Cardiac Failure due to Mitral Incompetancy CHD Coronary Heart/Stroke Cardiac Failure following Hemiplegia CHD Coronary Heart/Stroke Cardiac Failure resulting from Toxaemia CHD Coronary Heart/Stroke Cardiac Failure, Anaemia CHD Coronary Heart/Stroke Cardiac Failure, Asthemia CHD Coronary Heart/Stroke Cardiac Failure, Diabetic Coma CHD Coronary Heart/Stroke Cardiac Failure, Double Pneumonia CHD Coronary Heart/Stroke
85 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Cardiac Failure, Exhaustion CHD Coronary Heart/Stroke Cardiac Failure, Hypostatic Pneumonia CHD Coronary Heart/Stroke Cardiac Failure, Inanition CHD Coronary Heart/Stroke Cardiac Failure, Myocarditis CHD Coronary Heart/Stroke Cardiac Failure, T.B. CHD Coronary Heart/Stroke Cardiac Hypertrophy with Nephritis CHD Coronary Heart/Stroke Cardiac Hypertrophy, Mitral Disease CHD Coronary Heart/Stroke Cardiac Insufficiency CHD Coronary Heart/Stroke Cardiac Paralysis CHD Coronary Heart/Stroke Cardiac Synapse CHD Coronary Heart/Stroke Cardiac Syncope CHD Coronary Heart/Stroke Cardiac Weakness CHD Coronary Heart/Stroke Cardiace Defficiency, Myocarditis CHD Coronary Heart/Stroke Cardial Hemmorhage CHD Coronary Heart/Stroke Cardio Renal Dropsy CHD Coronary Heart/Stroke Cardiorenal Disease CHD Coronary Heart/Stroke Cardiorenal Uraemia CHD Coronary Heart/Stroke Cardiovascular type of Senility CHD Coronary Heart/Stroke Chronic Aortic and Mitral Endocarditis CHD Coronary Heart/Stroke Chronic Arteriosclerosis CHD Coronary Heart/Stroke Chronic Cardio-Renal Disease CHD Coronary Heart/Stroke Chronic Carditis CHD Coronary Heart/Stroke Chronic Endocarditis CHD Coronary Heart/Stroke Chronic Endocarditis and Myocarditis CHD Coronary Heart/Stroke Chronic Endocarditis and Myocarditis, with General Oedema CHD Coronary Heart/Stroke Chronic Endocarditis and Nephritis CHD Coronary Heart/Stroke Chronic Endocarditis, Chronic Nephritis, Cystitis CHD Coronary Heart/Stroke Chronic Endocarditis, Failing Compensation CHD Coronary Heart/Stroke Chronic Endocarditis, Mitral Stenosis CHD Coronary Heart/Stroke Chronic Mitral Endocarditis, Cirrhosis of Liver CHD Coronary Heart/Stroke Chronic Myocardial Degeneration CHD Coronary Heart/Stroke Chronic Myocarditis CHD Coronary Heart/Stroke Chronic Myocarditis with Attacks of Angina for Past Two Months CHD Coronary Heart/Stroke Chronic Myocarditis, Chronic Interstitial Nephritis CHD Coronary Heart/Stroke
86 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Chronic Myocarditis, Chronic Nephritis, Arteriosclerosis CHD Coronary Heart/Stroke Chronic Myocarditis, Hypertrophy following Chronic Diptheria CHD Coronary Heart/Stroke Chronic Myocarditis, Mitral Stenosis CHD Coronary Heart/Stroke Chronic Myocarditis, Septicaemia following Panhysterectomy CHD Coronary Heart/Stroke Chronic Valvular Disease CHD Coronary Heart/Stroke Chronic Valvular Disease of Heart (Mitral Regurgitation) CHD Coronary Heart/Stroke Chronic Valvular Disease of the Aorta CHD Coronary Heart/Stroke Chronic Valvular Heart Disease CHD Coronary Heart/Stroke Chronic Valvular Heart Disease, Shock, Toxaemia CHD Coronary Heart/Stroke Chronic Valvulitis CHD Coronary Heart/Stroke Chronic Valvulitis and Nephritis CHD Coronary Heart/Stroke Chronic Valvulitis with Renal Atrophy CHD Coronary Heart/Stroke Chronic Valvulitis, Chronic Nephritis CHD Coronary Heart/Stroke Circulatory Failure CHD Coronary Heart/Stroke Diffuse Arteriosclerosis CHD Coronary Heart/Stroke Dilatation of Heart CHD Coronary Heart/Stroke Dilatation of Heart, Myocarditis CHD Coronary Heart/Stroke Dilatation of Heart, Uraemia, Exhaustion CHD Coronary Heart/Stroke Dilatation of Right Ventricle CHD Coronary Heart/Stroke Dilatation with Loss of Compensation CHD Coronary Heart/Stroke Embolism CHD Coronary Heart/Stroke Embolism in Brain, Heart Failing CHD Coronary Heart/Stroke Embolism Pulmonary Artery CHD Coronary Heart/Stroke Endocarditis CHD Coronary Heart/Stroke Endocarditis and Myocarditis CHD Coronary Heart/Stroke Endocarditis with Dilatation CHD Coronary Heart/Stroke Endocarditis, Nephritis CHD Coronary Heart/Stroke Exhaustion of Heart CHD Coronary Heart/Stroke Failure Compensation, Myocarditis CHD Coronary Heart/Stroke Failure of Compensation CHD Coronary Heart/Stroke Failure of Heart CHD Coronary Heart/Stroke Fatty Myocarditis CHD Coronary Heart/Stroke Fatty Myocarditis, Chronic CHD Coronary Heart/Stroke Filling of Pericardium CHD Coronary Heart/Stroke General Failure of Circulation CHD Coronary Heart/Stroke Generalized Arteriosclerosis CHD Coronary Heart/Stroke
87 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Heart block CHD Coronary Heart/Stroke Heart Dilatation CHD Coronary Heart/Stroke Heart Disease CHD Coronary Heart/Stroke Heart Disease, Decompensation CHD Coronary Heart/Stroke Heart Exhaustion CHD Coronary Heart/Stroke Heart Failed under Strain CHD Coronary Heart/Stroke Heart Failure CHD Coronary Heart/Stroke Heart Failure - Fatty Degeneration of the Heart CHD Coronary Heart/Stroke Heart Failure - Myocarditis CHD Coronary Heart/Stroke Heart Failure due to Dilated Heart CHD Coronary Heart/Stroke Heart Failure due to Senile Decay CHD Coronary Heart/Stroke Heart Failure following Abdominal Obstruction CHD Coronary Heart/Stroke Heart Failure was Immediate Cause CHD Coronary Heart/Stroke Heart Failure, Acute CHD Coronary Heart/Stroke Heart Failure, Dropsy CHD Coronary Heart/Stroke Heart Failure, Oedema CHD Coronary Heart/Stroke Heart Failure; Endo and Myocarditis CHD Coronary Heart/Stroke Heart Trouble (?) CHD Coronary Heart/Stroke Heart-Block with Angina Pectoris CHD Coronary Heart/Stroke Heart, Kidney, and Liver Disease CHD Coronary Heart/Stroke Malformation of Heart CHD Coronary Heart/Stroke Mitral Disease with Dropsy CHD Coronary Heart/Stroke Mitral Disease, with Broken Compensation CHD Coronary Heart/Stroke Mitral Incompetence, Mitral Regurgitation CHD Coronary Heart/Stroke Mitral Incompetency, Chronic Interstitial Nephritis CHD Coronary Heart/Stroke Mitral Insufficiency CHD Coronary Heart/Stroke Mitral Insufficiency, Heart Failure CHD Coronary Heart/Stroke Mitral Regurgitation CHD Coronary Heart/Stroke Mitral Regurgitation (Probably Rheumatic) CHD Coronary Heart/Stroke Mitral Regurgitation with Failing Compensation CHD Coronary Heart/Stroke Mitral Regurgitation, Ascites CHD Coronary Heart/Stroke Mitral Regurgitation, Pericardium CHD Coronary Heart/Stroke Mitral Stenosis, Complicated by Pregnancy CHD Coronary Heart/Stroke Mitral Stenosis, Exhaustion CHD Coronary Heart/Stroke Mitral Valve Disease of Heart CHD Coronary Heart/Stroke Myocardiac Decompensation CHD Coronary Heart/Stroke
88 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Myocardial Degeneration CHD Coronary Heart/Stroke Myocardial Degeneration Amythmia CHD Coronary Heart/Stroke Myocardial Degeneration of Heart CHD Coronary Heart/Stroke Myocardial Degeneration, Valvular Disease CHD Coronary Heart/Stroke Myocardial Failure CHD Coronary Heart/Stroke Myocardial Failure, Pneumonia CHD Coronary Heart/Stroke Myocarditis CHD Coronary Heart/Stroke Myocarditis and Loss of Compensation CHD Coronary Heart/Stroke Myocarditis and Nephritis CHD Coronary Heart/Stroke Myocarditis and Syphilis CHD Coronary Heart/Stroke Myocarditis following Endocarditis and Arteriosclerosis CHD Coronary Heart/Stroke Myocarditis, Acute Cardiac Dilatation CHD Coronary Heart/Stroke Myocarditis, Acute Dilatation of Heart CHD Coronary Heart/Stroke Myocarditis, Anaemia CHD Coronary Heart/Stroke Myocarditis, Brights Disease CHD Coronary Heart/Stroke Myocarditis, Cardiac Failure, Uraemia CHD Coronary Heart/Stroke Myocarditis, Cardiac Insufficiency CHD Coronary Heart/Stroke Myocarditis, Chronic Interstitial Nephritis CHD Coronary Heart/Stroke Myocarditis, Dilatation of Heart CHD Coronary Heart/Stroke Myocarditis, Dropsy CHD Coronary Heart/Stroke Myocarditis, Exophthalmic Goitre CHD Coronary Heart/Stroke Myocarditis, Heart Failure CHD Coronary Heart/Stroke Organic Heart Dilatation CHD Coronary Heart/Stroke Organic Heart Disease CHD Coronary Heart/Stroke Organic Heart Disease (Mitral Regurgitation) CHD Coronary Heart/Stroke Paralysis of Diaphragm, Myocarditis CHD Coronary Heart/Stroke Paralysis of Heart CHD Coronary Heart/Stroke Paralysis of Heart following Spastic Paraplegia CHD Coronary Heart/Stroke Paralysis of the Heart (Vagus) CHD Coronary Heart/Stroke Patency of Foramen Orale (Cardiac) CHD Coronary Heart/Stroke Pericarditis CHD Coronary Heart/Stroke Pericarditis with Adhesions CHD Coronary Heart/Stroke Pericarditis with Effusion CHD Coronary Heart/Stroke Probably Pulmonary Embolism following Septicaemia CHD Coronary Heart/Stroke Progressive Sclerosis CHD Coronary Heart/Stroke Pulmonary Embolism CHD Coronary Heart/Stroke
89 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Pulmonary Thrombosis, Embolism after Simple Operation CHD Coronary Heart/Stroke Purulent Pericarditis CHD Coronary Heart/Stroke Rheumatic Endocarditis CHD Coronary Heart/Stroke Rupture Aortic Valve CHD Coronary Heart/Stroke Rupture of Aneurysm of Aorta CHD Coronary Heart/Stroke Ruptured Aneurism CHD Coronary Heart/Stroke Ruptured Aneurism of Ascending Aorta CHD Coronary Heart/Stroke Ruptured Aorta CHD Coronary Heart/Stroke Sclerosis of Coronary Artery CHD Coronary Heart/Stroke Septic Embolism of Lungs and Heart CHD Coronary Heart/Stroke Septic Endocarditis CHD Coronary Heart/Stroke Septic Pericarditis CHD Coronary Heart/Stroke Septicaemia, Toxaemia, Cardiac Failure CHD Coronary Heart/Stroke Sudden Cardiac Dilatation CHD Coronary Heart/Stroke Sudden Heart Failure CHD Coronary Heart/Stroke Toxaemia, Acute Cardiac Dilatation CHD Coronary Heart/Stroke Toxaemia, Cardiac Failure CHD Coronary Heart/Stroke Toxic Myocarditis CHD Coronary Heart/Stroke Valvular Disease of Heart CHD Coronary Heart/Stroke Valvular Disease of Heart (Aortic) CHD Coronary Heart/Stroke Valvular Disease of Heart (Arteriosclerosis) CHD Coronary Heart/Stroke Valvular Heart Disease CHD Coronary Heart/Stroke Valvular Heart Disease, Nephritis CHD Coronary Heart/Stroke Valvular Incompetency CHD Coronary Heart/Stroke Valvulitis CHD Coronary Heart/Stroke Apoplexy Stroke Coronary Heart/Stroke Cereberal Hemmhorage Stroke Coronary Heart/Stroke Cerebral Stroke Coronary Heart/Stroke Cerebral Apoplexy Stroke Coronary Heart/Stroke Cerebral Arterio-Sclerosis, Myocardial Degeneration Stroke Coronary Heart/Stroke Cerebral Coma Stroke Coronary Heart/Stroke Cerebral Congestion and Cardiac Failure Stroke Coronary Heart/Stroke Cerebral Embolism Stroke Coronary Heart/Stroke Cerebral Enderteritis and Softening of Brain Stroke Coronary Heart/Stroke Cerebral Haemmorhage Stroke Coronary Heart/Stroke Cerebral Haemorrhage - Paralysis Stroke Coronary Heart/Stroke
90 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Cerebral Haemorrhage - slight one 3 weeks prior Stroke Coronary Heart/Stroke Cerebral Haemorrhage (Apoplexy) Stroke Coronary Heart/Stroke Cerebral Haemorrhage and Paralysis Stroke Coronary Heart/Stroke Cerebral Haemorrhage, Arteriosclerosis Stroke Coronary Heart/Stroke Cerebral Haemorrhage, Cardiac Toxaemia Stroke Coronary Heart/Stroke Cerebral Haemorrhage, Paralysis Stroke Coronary Heart/Stroke Cerebral Haemorrhage, Shock Stroke Coronary Heart/Stroke Cerebral Softening Stroke Coronary Heart/Stroke Cerebral Thrombosis Stroke Coronary Heart/Stroke Coma from Hemmorhage of Brain Stroke Coronary Heart/Stroke Haemorrhage Cerebral, Cerebral Psoriasis Stroke Coronary Heart/Stroke Haemorrhage of Brain Stroke Coronary Heart/Stroke Hemiplegia due to Cerebral Haemorrhage Stroke Coronary Heart/Stroke Internal Cerebral Pressure Stroke Coronary Heart/Stroke IntraVentricular Hemorrhage of the Brain Stroke Coronary Heart/Stroke Oedema of Brain following Hemmorhage Stroke Coronary Heart/Stroke Ruptured Cerebral Blood Vessel Stroke Coronary Heart/Stroke Second Cerebral Haemorrhage, Cardiac Failures Stroke Coronary Heart/Stroke Several Cerebral Haemorrhages with Resulting Paralysis Stroke Coronary Heart/Stroke Slight Cerebral Haemorrhage, Exhaustion Stroke Coronary Heart/Stroke Softening of Brain Stroke Coronary Heart/Stroke Septic Thrombosis Thrombosis Coronary Heart/Stroke Thrombosis Thrombosis Coronary Heart/Stroke Thrombosis of Cord Thrombosis Coronary Heart/Stroke Thrombosis of Pelvic Veins Thrombosis Coronary Heart/Stroke Acute Influenza Influenza Influenza Acute Pneumonia, Influenza Influenza Influenza Bronchopneumonia (Influenzal?) Influenza Influenza Bronchopneumonia and Pleurisy, Sequel to Influenza Influenza Influenza Bronchopneumonia following Influenza Influenza Influenza Bronchopneumonia, Influenza Influenza Influenza Bronchopneumonia, Spanish Influenza Influenza Influenza Coma, Heart Failure, Influenza Influenza Influenza Double Influenza and Pneumonia Influenza Influenza
91 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Double Lobar Pneumonia, Influenza Influenza Influenza Double Pneumonia, Influenza Influenza Influenza Epidemic Influenza, Double Pneumonia, Toxaemia Influenza Influenza Epidemic Influenzal Pneumonia Influenza Influenza Fever, Probably influenza, pneumonia Influenza Influenza Flu and Bronchopneumonia Influenza Influenza Flu and Pneumonia, Heart Failure Influenza Influenza General Septicaemia following Influenza Influenza Influenza Influenza Influenza Influenza Influenza (Intestinal) Influenza Influenza Influenza (Recurrence) Influenza Influenza Influenza and Bronchopneumonia, Emphysema Influenza Influenza Influenza and Pneumonia Influenza Influenza Influenza Pneumonia Influenza Influenza Influenza with Double-Pneumonia Influenza Influenza Influenza with Pneumonia Influenza Influenza Influenza-Pneumonia Influenza Influenza Influenza, Abscess around Originating Around Face and Bladder Influenza Influenza Influenza, Acute Pneumonia Influenza Influenza Influenza, Bronchopneumonia Influenza Influenza Influenza, Bronchopneumonia, Abscess of Lung Influenza Influenza Influenza, Cardiac Failure Influenza Influenza Influenza, Cerebrospinal Meningitis Influenza Influenza Influenza, Double Pneumonia Influenza Influenza Influenza, Gangrene of the Lung Influenza Influenza Influenza, Haemorrhage Influenza Influenza Influenza, Haemorrhagic Bronchits Influenza Influenza Influenza, Heart Failure Influenza Influenza Influenza, Jaundice - Heart Influenza Influenza Influenza, Lobar Pneumonia Influenza Influenza Influenza, Meningitis, Bronchopneumonia Influenza Influenza Influenza, Myocarditis, Oedema Influenza Influenza Influenza, Pleuropneumonia Influenza Influenza Influenza, Pneumonia Influenza Influenza Influenza, Pneumonia following Operation for Appendicitis Influenza Influenza
92 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Influenza, Pneumonia, Empyema Influenza Influenza Influenza, Pneumonia, Septicaemia Influenza Influenza Influenzal Bronchitis, Heart Failure Influenza Influenza Influenzal Bronchopneumonia Influenza Influenza Influenzal Double Pneumonia Influenza Influenza Influenzal Pneumonia Influenza Influenza Influenzal Pneumonia, Toxaemia Influenza Influenza Intestinal Influenza Influenza Influenza La Grippe (Influenza) Influenza Influenza Leptomeningitis following Intestinal Influenza Influenza Influenza Lobar Pneumonia, Influenza Influenza Influenza Pneumonia following Influenza Influenza Influenza Pneumonia with Influenza Influenza Influenza Pneumonia, Empyema, Influenza Influenza Influenza Pneumonia, Influenza Influenza Influenza Spanish Influenza Influenza Influenza Spanish Influenza, Bronchopneumonia Influenza Influenza Spanish Influenza, Double Bronchopneumonia Influenza Influenza Spanish Influenza, Pneumonia Influenza Influenza Toxaemia from Influenza Influenza Influenza Toxaemia, Influenza Influenza Influenza Acute Bronchitis Bronchitis Non Influenza Pulmonary Aesthemia due to Inanition, Bronchitis Bronchitis Non Influenza Pulmonary Bronchial Asthma Bronchitis Non Influenza Pulmonary Bronchitis Bronchitis Non Influenza Pulmonary Bronchitis and Infection (Abscess of Back) Bronchitis Non Influenza Pulmonary Bronchitis, Whooping Cough Bronchitis Non Influenza Pulmonary Capillary Bronchitis Bronchitis Non Influenza Pulmonary Chronic Bronchitis Bronchitis Non Influenza Pulmonary Chronic Bronchitis, Myocarditis Bronchitis Non Influenza Pulmonary Chronic Bronchitis, Myocarditis, Senile Decay Bronchitis Non Influenza Pulmonary Exhaustion due to Asthma Attacks Bronchitis Non Influenza Pulmonary Heart Weakness, Diaphragmatic Pleurisy, Bronchitis Bronchitis Non Influenza Pulmonary Myocarditis and Chronic Bronchitis Bronchitis Non Influenza Pulmonary Septic Bronchitis Bronchitis Non Influenza Pulmonary Acute Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Bronchial Pneumonia Bronchopneumonia Non Influenza Pulmonary
93 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia after Operation Bronchopneumonia Non Influenza Pulmonary BronchoPneumonia with Acute Nephritis Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia with Empyema of Chest Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia, Convulsions Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia, Myocarditis Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia, Nephritis Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia, Purpura Bronchopneumonia Non Influenza Pulmonary Bronchopneumonia, Toxaemia Bronchopneumonia Non Influenza Pulmonary Chronic Myocarditis, Chronic Endocarditis, Bronchial Penumonia Bronchopneumonia Non Influenza Pulmonary Complication, Asthma, Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Double Brochopneumonia Bronchopneumonia Non Influenza Pulmonary Double Bronchopneumonia, Cardiac Failure Bronchopneumonia Non Influenza Pulmonary Double Bronchopneumonia, Streptococcic Septicaemia Bronchopneumonia Non Influenza Pulmonary Double-Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Hypertrophic Bronchopneumonia, Cardiac Failure Bronchopneumonia Non Influenza Pulmonary Pleurisy with Effusion, Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Pleurisy, Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Pneumonia (Broncho) with Aortic Mitral Valvular Disease Bronchopneumonia Non Influenza Pulmonary Pyonephritis, Anaemia, Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Septic Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Septicemia with Terminal Broncho- Pneumonia Bronchopneumonia Non Influenza Pulmonary Toxaemia, Bronchopneumonia Bronchopneumonia Non Influenza Pulmonary Weakness after Bronchopneumoia Bronchopneumonia Non Influenza Pulmonary Cancer of Right Lung Lung Cancer Non Influenza Pulmonary Carcinoma of Lung Lung Cancer Non Influenza Pulmonary Growth of Lungs Lung Cancer Non Influenza Pulmonary Hydrothorax with Infarct of Lung Lung Cancer Non Influenza Pulmonary Acute Congestion of Liver and Lungs Other Respiratory Non Influenza Pulmonary Asthma, Acute Dilatation of Heart Other Respiratory Non Influenza Pulmonary Atelectasis Other Respiratory Non Influenza Pulmonary Brights Disease, Hypostatic Congestion of the Lungs Other Respiratory Non Influenza Pulmonary Congestion of Lungs Other Respiratory Non Influenza Pulmonary
94 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Dilatation of Heart, Congestion of Lungs Other Respiratory Non Influenza Pulmonary Double Congestion of Lungs Other Respiratory Non Influenza Pulmonary Empyaema Other Respiratory Non Influenza Pulmonary Haemorrhage from Lungs Other Respiratory Non Influenza Pulmonary Haemorrhage from Rupture of Varicose Veins in Large Bronchi Other Respiratory Non Influenza Pulmonary Hypostatic Congestion of Lungs Other Respiratory Non Influenza Pulmonary Infarct Lung Other Respiratory Non Influenza Pulmonary Myocarditis, Acute Congestion of Lung Other Respiratory Non Influenza Pulmonary Nephritis, Respiratory Failure, Adema of Lungs Other Respiratory Non Influenza Pulmonary One Lung Airless Other Respiratory Non Influenza Pulmonary Patent Foramen Other Respiratory Non Influenza Pulmonary Pertussis Other Respiratory Non Influenza Pulmonary Pulminary (Hypostatic) Conjestion Other Respiratory Non Influenza Pulmonary Pulmonary Failure Other Respiratory Non Influenza Pulmonary Pulmonary Haemorrhage Other Respiratory Non Influenza Pulmonary Pulmonary Haemorrhages Other Respiratory Non Influenza Pulmonary Pulmonary Phthisis Other Respiratory Non Influenza Pulmonary Pysemia Other Respiratory Non Influenza Pulmonary Respiratory and Cardiac Failure Other Respiratory Non Influenza Pulmonary Respiratory Failure Other Respiratory Non Influenza Pulmonary Respiratory Failure, Cerebral Pressure Other Respiratory Non Influenza Pulmonary Respiratory Failure, Exhaustion Other Respiratory Non Influenza Pulmonary Toxaemia, Respiratory Failure Other Respiratory Non Influenza Pulmonary Toxaemia, Rundown Lungs and Heart Other Respiratory Non Influenza Pulmonary Whooping Cough and Lymphaticus Other Respiratory Non Influenza Pulmonary Acute Double Pneumonia Pneumonia Non Influenza Pulmonary Acute Inanition with Toxamia, Pneumonia Pneumonia Non Influenza Pulmonary Acute Infantile Pneumonia Pneumonia Non Influenza Pulmonary Acute Lobar Pneumonia Pneumonia Non Influenza Pulmonary Acute Pneumonia Pneumonia Non Influenza Pulmonary Acute Pneumonia, Oedema of Lungs Pneumonia Non Influenza Pulmonary Acute Septicaemia (Pneumonia) Pneumonia Non Influenza Pulmonary Aesthemia due to Double Pneumonia Pneumonia Non Influenza Pulmonary Aortic Aneurism, Pneumonia Pneumonia Non Influenza Pulmonary Asthemia, Acute Pneumonia Pneumonia Non Influenza Pulmonary Bilateral Lobular Pneumonia Pneumonia Non Influenza Pulmonary Cerebral Pneumonia Pneumonia Non Influenza Pulmonary
95 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Chronic Interstitial Pneumonia Pneumonia Non Influenza Pulmonary Chronic Plerurisy, Acute Lobar Pneumonia Pneumonia Non Influenza Pulmonary Double Lobar Pneumonia Pneumonia Non Influenza Pulmonary Double Lobar Pneumonia, Cardiac Failure Pneumonia Non Influenza Pulmonary Double Lobar Pneumonia, Chronic Endocarditis Pneumonia Non Influenza Pulmonary Double Pneumonia Pneumonia Non Influenza Pulmonary Double Pneumonia and Extreme Toxaemia Pneumonia Non Influenza Pulmonary Double Pneumonia, Toxaemia Pneumonia Non Influenza Pulmonary Double Pneumonia, Toxaemia, Cardiac Failure Pneumonia Non Influenza Pulmonary Double Septic Pneumonia Pneumonia Non Influenza Pulmonary Empyema following Pneumonia Pneumonia Non Influenza Pulmonary Endocarditis, Lobar Pneumonia Pneumonia Non Influenza Pulmonary Exhaustion following Pneumonia Pneumonia Non Influenza Pulmonary General Toxaemia of Pneumonia Pneumonia Non Influenza Pulmonary Haemorrhagic Pneumonia Pneumonia Non Influenza Pulmonary Heart Failure, Pneumonia Pneumonia Non Influenza Pulmonary Hypostatic Pneumonia Pneumonia Non Influenza Pulmonary Hypostatic Pneumonia, Chronic Myocarditis Pneumonia Non Influenza Pulmonary Hypostatic Pneumonia, Heart Disease Pneumonia Non Influenza Pulmonary Infantile Pneumonia Pneumonia Non Influenza Pulmonary Lobar Pneumonia Pneumonia Non Influenza Pulmonary Lobar Pneumonia (Double) Pneumonia Non Influenza Pulmonary Lobar Pneumonia and Cirrhosis of Liver Pneumonia Non Influenza Pulmonary Lobar Pneumonia and Pericarditis Pneumonia Non Influenza Pulmonary Lobar Pneumonia with Pleurisy Pneumonia Non Influenza Pulmonary Lobar Pneumonia, Cardio and Respiratory Failure Pneumonia Non Influenza Pulmonary Lobar Pneumonia, Pulmonary Haemorrhage Pneumonia Non Influenza Pulmonary NeuroPneumonia Pneumonia Non Influenza Pulmonary Paralysis, Traumatic Pneumonia Pneumonia Non Influenza Pulmonary Peritonitis and Pneumonia Pneumonia Non Influenza Pulmonary Peritonitis, Septic Pneumonia Pneumonia Non Influenza Pulmonary Pleurisy, Pneumonia, Emphysema Pneumonia Non Influenza Pulmonary Pleuropneumonia Pneumonia Non Influenza Pulmonary Pneumonia Pneumonia Non Influenza Pulmonary Pneumonia - Cardiac failure Pneumonia Non Influenza Pulmonary
96 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Pneumonia - Terminal Pneumonia Non Influenza Pulmonary Pneumonia (Double) Pneumonia Non Influenza Pulmonary Pneumonia (Hypostatic) Pneumonia Non Influenza Pulmonary Pneumonia following Operation Pneumonia Non Influenza Pulmonary Pneumonia following Operation for Ulcer of Stomach Pneumonia Non Influenza Pulmonary Pneumonia with Hyperpyrexia Pneumonia Non Influenza Pulmonary Pneumonia, Acute Dilatation Pneumonia Non Influenza Pulmonary Pneumonia, Acute Dilatation of Heart Pneumonia Non Influenza Pulmonary Pneumonia, Cardiac Failure Pneumonia Non Influenza Pulmonary Pneumonia, Cholecytosis Pneumonia Non Influenza Pulmonary Pneumonia, Coma Pneumonia Non Influenza Pulmonary Pneumonia, Double Broncopneumonia Pneumonia Non Influenza Pulmonary Pneumonia, Double Lobar Pneumonia Non Influenza Pulmonary Pneumonia, Empyema (left side) Pneumonia Non Influenza Pulmonary Pneumonia, Haemmorhage Pneumonia Non Influenza Pulmonary Pneumonia, Heart Failure Pneumonia Non Influenza Pulmonary Pneumonia, Myocarditis Pneumonia Non Influenza Pulmonary Pneumonia, Oedema of Lungs Pneumonia Non Influenza Pulmonary Pneumonia, Peritonitis Pneumonia Non Influenza Pulmonary Pneumonia, Pleurisy Pneumonia Non Influenza Pulmonary Pneumonia, Pulmonary Oedema Pneumonia Non Influenza Pulmonary Pneumonia, Toxaemia Pneumonia Non Influenza Pulmonary Pneumonia, Toxaemia, Heart Failure Pneumonia Non Influenza Pulmonary Pnuemonia, Extreme Toxaemia, Cardiac Failure Pneumonia Non Influenza Pulmonary Pregnancy, Pneumonia Pneumonia Non Influenza Pulmonary Pulmonary Haemorrhage, Pneumonia Pneumonia Non Influenza Pulmonary Repeated Haemorrhage, Pneumonia Pneumonia Non Influenza Pulmonary Septic Lobar Pneumonia, Toxaemia Pneumonia Non Influenza Pulmonary Septic Pneumonia Pneumonia Non Influenza Pulmonary Septic Pneumonia, Acute Dilatation of Heart Pneumonia Non Influenza Pulmonary Septic Pneumonia, Myocarditis Pneumonia Non Influenza Pulmonary Septicaemia with Static Pneumonia Pneumonia Non Influenza Pulmonary Septopneumonia Pneumonia Non Influenza Pulmonary Sudden Cardiac Dilatation Following Pneumonia Pneumonia Non Influenza Pulmonary Terminal Pneumonia following Fracture of Femur Pneumonia Non Influenza Pulmonary Toxaemia of Pneumonia Pneumonia Non Influenza Pulmonary Traumatic Pneumonia Pneumonia Non Influenza Pulmonary
97 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Unresolved Lobar Pneumonia Pneumonia Non Influenza Pulmonary Acute Pyelitis of Pregnancy Pregnancy Non Influenza Pulmonary Cerebral Oedema, Difficult birth Pregnancy Non Influenza Pulmonary Eclampsia Pregnancy Non Influenza Pulmonary Eclampsia, Acute Toxaemia, Acute Dilatation of Heart Pregnancy Non Influenza Pulmonary Ectopic Gestation Pregnancy Non Influenza Pulmonary Pregnancy Pregnancy Non Influenza Pulmonary Toxemia of Pregnancy Pregnancy Non Influenza Pulmonary Acute Aedema of Lungs Pulmonary Edema Non Influenza Pulmonary Acute Oedema of Both Lungs, Broken Compensation of Heart Pulmonary Edema Non Influenza Pulmonary Acute Oedema of Lung Pulmonary Edema Non Influenza Pulmonary Acute Pulmonary Oedema Pulmonary Edema Non Influenza Pulmonary Anemia, Pulmonary Oedema Pulmonary Edema Non Influenza Pulmonary Ascites, Pulmonary Oedema Pulmonary Edema Non Influenza Pulmonary Dilatation of Heart, Oedema of Lungs Pulmonary Edema Non Influenza Pulmonary Eclampsia of the Lungs Pulmonary Edema Non Influenza Pulmonary Edema of Lungs, Cardiac Failure Pulmonary Edema Non Influenza Pulmonary Edema of the Lungs Pulmonary Edema Non Influenza Pulmonary Emphysema, Infection Pulmonary Edema Non Influenza Pulmonary General Aenemia and Edema of the Lungs Pulmonary Edema Non Influenza Pulmonary Myocarditis Oedema of Lungs Pulmonary Edema Non Influenza Pulmonary Myocarditis, Aedema of Lungs Pulmonary Edema Non Influenza Pulmonary Myocarditis, Oedema Pulmonary Edema Non Influenza Pulmonary Myocarditis, Oldema of Lungs Pulmonary Edema Non Influenza Pulmonary Oedema Pulmonary Edema Non Influenza Pulmonary Oedema of Brain and Lungs Pulmonary Edema Non Influenza Pulmonary Oedema of Glottis Pulmonary Edema Non Influenza Pulmonary Oedema of Lungs Pulmonary Edema Non Influenza Pulmonary Oedema of Lungs, Acute Cardiac Dilatation Pulmonary Edema Non Influenza Pulmonary Oedema of Lungs, Acute Dilatation of Heart Pulmonary Edema Non Influenza Pulmonary Oedema, Myocarditis Pulmonary Edema Non Influenza Pulmonary Pleurisy Pulmonary Edema Non Influenza Pulmonary Pleurisy with Effusion Pulmonary Edema Non Influenza Pulmonary Pulmonary Oedema with Cardiac Failure Pulmonary Edema Non Influenza Pulmonary Pulmonary Oedema, Cardiac Dilatation Pulmonary Edema Non Influenza Pulmonary Pulmonary Ordema Pulmonary Edema Non Influenza Pulmonary
98 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Purulent Pleuresy, Abcess of Lung, Nephritis Pulmonary Edema Non Influenza Pulmonary Acute Miliary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Acute Pulmonary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Bronchopneumonia, Acute Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Chronic Pulmonary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Chronic Pulmonary Tuberculosis with Pleurisy Pulmonary Tuberculosis Non Influenza Pulmonary Consumption Pulmonary Tuberculosis Non Influenza Pulmonary Laryngial Pulmonary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Miliary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Phthisis Pulmonary Tuberculosis Non Influenza Pulmonary Pleurisy, Effusion, Acute Miliary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis and Diabetes Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis of Right Lung Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis with Lobar Pneumonia Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis, Chronic Nephritis Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis, Paralysis Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis, Peritonitis Pulmonary Tuberculosis Non Influenza Pulmonary Pulmonary Tuberculosis, Pyothoran Pulmonary Tuberculosis Non Influenza Pulmonary Tubercular Bronchopneumonia, Left Side Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis of Lungs Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis of Lungs and Brain Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis of Lungs and Larynx Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis of Lungs, Larynx and Intestine Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis of the Lungs Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis Pulmonary Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis, Bronchopneumonia Pulmonary Tuberculosis Non Influenza Pulmonary Tuberculosis, Pneumonia Pulmonary Tuberculosis Non Influenza Pulmonary Cholera Infantum Cholera Other Infectious Diphtheria, Cardiac Failure Diptheria Other Infectious Diptheria Diptheria Other Infectious Cholecystitis Gallbladder Disease Other Infectious Gangrenous Gall Bladder Gallbladder Disease Other Infectious Acute Infection in the Face Causing Blood Poisoning Infection Other Infectious Acute Tonsilitis with Acute Suppurative Otitis in Left Ear Infection Other Infectious
99 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Aesthemia due to Infection Infection Other Infectious Erysipelas Infection Other Infectious Infection Infection Other Infectious Mastoiditis Infection Other Infectious Scarlet Fever Infection Other Infectious Syphilis Infection Other Infectious Syphilis, Heart Failure Infection Other Infectious Typhoid Fever Infection Other Infectious Typhoid Fever and Haemorrhage Infection Other Infectious Acute Bright's Disease Kidney Disease Other Infectious Acute Nephritis Kidney Disease Other Infectious Acute Nephritis with Convulsions Kidney Disease Other Infectious Bright's Disease Kidney Disease Other Infectious Chemia Nephritis Kidney Disease Other Infectious Chronic Brights Disease Kidney Disease Other Infectious Chronic Cystitis, Uraemia Kidney Disease Other Infectious Chronic Interstitial Nephritis Kidney Disease Other Infectious Chronic Interstitial Nephritis; Arteriosclerosis; Myocarditis Kidney Disease Other Infectious Chronic Nephritis Kidney Disease Other Infectious Chronic Nephritis and Cystitis Kidney Disease Other Infectious Chronic Nephritis, Aortic Aneurism Kidney Disease Other Infectious Chronic Nephritis, Heart Congestion Kidney Disease Other Infectious Chronic Nephritis, Myocarditis Kidney Disease Other Infectious Chronic Nephritis, Myocarditis, Arterio Sclerosis - Old Age Kidney Disease Other Infectious Chronic Pareachymalious Nephritis, Dropsy Kidney Disease Other Infectious Chronic Pyelonephritis Kidney Disease Other Infectious Chronic Topic Nephritis Kidney Disease Other Infectious Exhaustion from Chronic Nephritis Kidney Disease Other Infectious General Dropsy (Bright's Disease) Kidney Disease Other Infectious Interstitial Nephritis Kidney Disease Other Infectious Kidney Injury Kidney Disease Other Infectious Nephritis Kidney Disease Other Infectious Nephritis - myocarditis Kidney Disease Other Infectious Nephritis Interstitial Kidney Disease Other Infectious Nephritis, Chronic Endocarditis Kidney Disease Other Infectious Nephritis, Endocarditis Kidney Disease Other Infectious Nephritis, Heart Failure Kidney Disease Other Infectious
100 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Pyelitis Kidney Disease Other Infectious Pyelitis Acute Kidney Disease Other Infectious Pyelitis and Septic Endocarditis Kidney Disease Other Infectious Pyelonephrosis Kidney Disease Other Infectious Pyemic Abscess of Kidneys, Septic Infection of Spleen Kidney Disease Other Infectious Pyonephosis, Damage to Both Kidneys Kidney Disease Other Infectious Pyonephrosis Kidney Disease Other Infectious Pyonephrosis, Pyonephritic Abscess, Empyema Kidney Disease Other Infectious Pyronephritis, Septicaemia Kidney Disease Other Infectious Stone in the Right Kidney Kidney Disease Other Infectious Suppression of Urine Kidney Disease Other Infectious Suppression of Urine, Oedema of Lungs Kidney Disease Other Infectious Toxic Uraemia Kidney Disease Other Infectious Uraemia Kidney Disease Other Infectious Uraemia following Nephritis Kidney Disease Other Infectious Uraemia following Operation for Hypertrophied Prostate Gland Kidney Disease Other Infectious Uraemia following Retention of Urine Kidney Disease Other Infectious Uraemia from Chronic Interstitial Nephritis Kidney Disease Other Infectious Uraemia of Pregnancy Kidney Disease Other Infectious Uraemia, Valvular Heart Disease, Nephritis, Cirrhosis Kidney Disease Other Infectious Uraemic Coma Kidney Disease Other Infectious Uraemic Convulsions Kidney Disease Other Infectious Uraemic Intoxication, Renal Failure Kidney Disease Other Infectious Uraemic Poisoning Kidney Disease Other Infectious Uraemic Poisoning, Chronic Interstitial Nephritis Kidney Disease Other Infectious Acute Yello Atrophy of Liver Liver Disease Other Infectious Biliary Cirrhosis Liver Disease Other Infectious Cirrhosis of Liver Liver Disease Other Infectious Cirrhosis of Liver, Chronic Myocarditis Liver Disease Other Infectious Extensive Abscess of Liver extending from Gallbladder Liver Disease Other Infectious Hypertrophic Biliary Cirrhosis (Hanoi's Disease) Liver Disease Other Infectious Icterus (Jaundice?) Liver Disease Other Infectious Jaundice Liver Disease Other Infectious Rheumatic Liver Liver Disease Other Infectious
101 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Septicaemia, Liver Ascites Liver Disease Other Infectious Acute Meningitis Meningitis Other Infectious Acute Syphilis, Meningitis Meningitis Other Infectious Asthemia, Meningitis Meningitis Other Infectious Cerebral Meningitis Meningitis Other Infectious Cerebrospinal Meningitis Meningitis Other Infectious Chronic Leptomeningitis Meningitis Other Infectious Epidemic Cerebrospinal Meningitis Meningitis Other Infectious Epilepsy and Meningitis Meningitis Other Infectious Hydronephrosis, Meningital Inflammation Meningitis Other Infectious Mastoiditis and Meningitis Meningitis Other Infectious Meningitis Meningitis Other Infectious Meningitis (Streptococci) Meningitis Other Infectious Meningitis (Tubercular) Meningitis Other Infectious Meningitis Cerebral Meningitis Other Infectious Meningitis, Cardio Respiratory Failure - Birth Injuries Meningitis Other Infectious Meningitis, Septic Condition Meningitis Other Infectious Septic Meningitis Meningitis Other Infectious Strepticoccal Meningitis Meningitis Other Infectious Suppurlative Menengitis Meningitis Other Infectious Toxaemia, Spinal Meningitis Meningitis Other Infectious Traumatic Meningitis Meningitis Other Infectious Acute Sepsis Sepsis Other Infectious Acute Toxaemia Sepsis Other Infectious Asthemic Toxaemia Sepsis Other Infectious Brain Abscess Sepsis Other Infectious Brain Cyst Sepsis Other Infectious Chronic Cerebral Abscess of Left Side Sepsis Other Infectious Chronic Fibrosis with Multiple Abscesses Sepsis Other Infectious Emphysema, Abcess of Brain Sepsis Other Infectious Erysipelas with Acute Septicaemia Sepsis Other Infectious Exhaustion, Toxaemia Sepsis Other Infectious Gangrene Sepsis Other Infectious Gangrene of Foot Sepsis Other Infectious Gangrene of foot, Myocarditis, Degeneration of Arteries Sepsis Other Infectious Gangrene of Small Intestine from Intestinal Obstruction Sepsis Other Infectious Gangrene, Toxaemia Sepsis Other Infectious
102 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Gas, Gangrene Sepsis Other Infectious General Septicaemia Sepsis Other Infectious General Septicaemia due to Infection Sepsis Other Infectious Intestinal paresis following Caesarean operation Sepsis Other Infectious Intracranial Abscess, Bad Condition Sepsis Other Infectious Multiple Abcesses of Lung Sepsis Other Infectious Pyaemia Sepsis Other Infectious Pyaemia from Acute Gangrenous Appendicitis with Abscess in Appendix Sepsis Other Infectious Ruptured Abscess of Left Ovary Causing Peritonitis Sepsis Other Infectious Sepsis Sepsis Other Infectious Sepsis Resulting from Punctured Wound Sepsis Other Infectious Septic Infection Sepsis Other Infectious Septic Pyaemia Sepsis Other Infectious Septicaemia Sepsis Other Infectious Septicaemia (Streptococci) Sepsis Other Infectious Septicaemia following Abortion Sepsis Other Infectious Septicaemia from Peritonsillar Infection and Abcess of Neck Sepsis Other Infectious Septicaemia General Sepsis Other Infectious Septicaemia, Extensive Bedsores Sepsis Other Infectious Septicemia following Childbirth Sepsis Other Infectious Streptococcus Sepsis Other Infectious Surgical Shock and Toxaemia Sepsis Other Infectious Toxaemia Sepsis Other Infectious Toxaemia (Scarlet Fever?) Sepsis Other Infectious Toxaemia Acute Sepsis Other Infectious Toxaemia due to Typhoid Sepsis Other Infectious Toxaemia from Beri-Beri (mother) Sepsis Other Infectious Toxaemia from Cellulitis of Leg Sepsis Other Infectious Toxaemia from Celulitis of Neck Sepsis Other Infectious Toxaemia of Eclampsia Sepsis Other Infectious Toxaemia, Asthemia Sepsis Other Infectious Toxaemia, Exhaustion Sepsis Other Infectious Toxaemia, following a Hernia Sepsis Other Infectious Toxaemia, Secondary Anemia Sepsis Other Infectious Toxaemia, Shock Sepsis Other Infectious Toxemia Sepsis Other Infectious
103 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Varicose Ulcer, Gangrene Sepsis Other Infectious Aesthemia due to Tuberculosis Tuberculosis Other Infectious Chronic Tubucular Peritonitis Tuberculosis Other Infectious Exhaustion due to Tubercular Peritonitis Tuberculosis Other Infectious General Miliary Tuberculosis Tuberculosis Other Infectious General Tuberculosis Tuberculosis Other Infectious Meningitis, diagnosed it as Tubercular Tuberculosis Other Infectious Perforating Ulcer of Bowel (Probably Tubercular) Tuberculosis Other Infectious Pyelonephritis, probably Tubercular Tuberculosis Other Infectious Toxemia from Tuberculosis of Femur Tuberculosis Other Infectious Tubercular Enteritis Tuberculosis Other Infectious Tubercular Kidney Tuberculosis Other Infectious Tubercular Laryngitis Tuberculosis Other Infectious Tubercular Meningitis Tuberculosis Other Infectious Tubercular Peritonitis Tuberculosis Other Infectious Tubercular Peritonitis, Intestinal Obstruction Tuberculosis Other Infectious Tubercular Peritonitis, Ulcuration of Bowels Tuberculosis Other Infectious Tuberculosis Tuberculosis Other Infectious Tuberculosis Cervical Vertebrae Tuberculosis Other Infectious Tuberculosis Meningitis Tuberculosis Other Infectious Tuberculosis of Intestines Tuberculosis Other Infectious Tuberculosis of Kidney Tuberculosis Other Infectious Tuberculosis of Larynx Tuberculosis Other Infectious Tuberculosis of Liver Tuberculosis Other Infectious Tuberculosis of Right Kidney Tuberculosis Other Infectious Tuberculosis of Spine Tuberculosis Other Infectious Tuberculosis, Acute Tuberculosis Other Infectious Tuberculosis, Regurgitation Tuberculosis Other Infectious Tuberculosis, Sarcoma Tuberculosis Other Infectious Tuburcular Meningitis Tuberculosis Other Infectious Abcess of Brain Abcess Other Non-Infectious Abcess of Cerebellum Abcess Other Non-Infectious Abscess of Brain Abcess Other Non-Infectious Abscess of Cervical Glands Abcess Other Non-Infectious Abscess of Face Abcess Other Non-Infectious Abscess of Kidney, Congestion of Lungs Abcess Other Non-Infectious Abscess of Lung Abcess Other Non-Infectious
104 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Abscesses due to Blood Poisoning Abcess Other Non-Infectious Acute Appendicities and Abscess Abdominal Disease Other Non-Infectious Acute Appendicitis Abdominal Disease Other Non-Infectious Acute Colitis, Dysentery Abdominal Disease Other Non-Infectious Acute Dilatation of Stomach Abdominal Disease Other Non-Infectious Acute Dysentry Abdominal Disease Other Non-Infectious Acute Gangrenous Appendicitis Abdominal Disease Other Non-Infectious Acute Gastro-Enteritis Abdominal Disease Other Non-Infectious Acute Haemorrhagic Pancreatitis Abdominal Disease Other Non-Infectious Acute Indigestion with Meningeal Irritation Abdominal Disease Other Non-Infectious Acute Indigestion, Malnutrition Abdominal Disease Other Non-Infectious Acute Instestinal Obtruction Abdominal Disease Other Non-Infectious Acute Obstruction of Bowel, Extreme Toxaemia - Cardiac Failure Abdominal Disease Other Non-Infectious Acute Pancreatitis Abdominal Disease Other Non-Infectious Acute Peritonitis; died when anesthesia was being given Abdominal Disease Other Non-Infectious Acute Suppurative Retrocecal Appendicitis, Multiple Abscesses Abdominal Disease Other Non-Infectious Appendicitis Abdominal Disease Other Non-Infectious Appendicitis, Peritonitis Abdominal Disease Other Non-Infectious Appendicitis, Septicaemia Abdominal Disease Other Non-Infectious Ascites Abdominal Disease Other Non-Infectious Bowel Obstruction Abdominal Disease Other Non-Infectious Chronic Colitis Abdominal Disease Other Non-Infectious Chronic Gastroenteritis, Convulsions Abdominal Disease Other Non-Infectious Chronic Intestinal Obstruction Abdominal Disease Other Non-Infectious Chronic Peritonitis Abdominal Disease Other Non-Infectious Chronic Plyoric Ulcer Abdominal Disease Other Non-Infectious Chronic Ulcerative Colitis Abdominal Disease Other Non-Infectious Colitis with Ulceration of Bowels Abdominal Disease Other Non-Infectious Duodenal Ulcer with Many Haemorrhages Abdominal Disease Other Non-Infectious Dysentery Abdominal Disease Other Non-Infectious Endoteritis Abdominal Disease Other Non-Infectious Enteritis Abdominal Disease Other Non-Infectious Enterocolitis Abdominal Disease Other Non-Infectious Exhaustion from Bowel Malformation Abdominal Disease Other Non-Infectious Exhaustion from Intestinal Failure Abdominal Disease Other Non-Infectious Gastral Ulcer Hemmorhage Abdominal Disease Other Non-Infectious
105 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Gastric Ulcer Abdominal Disease Other Non-Infectious Gastric Ulcer, Chronic Pancreatitis Abdominal Disease Other Non-Infectious Gastroenteritis Abdominal Disease Other Non-Infectious Gastrointestinal Hemorrhage Abdominal Disease Other Non-Infectious General Peritonitis Abdominal Disease Other Non-Infectious General Peritonitis, Abscess of Liver Abdominal Disease Other Non-Infectious General Peritonitis, Cardiac Failure Abdominal Disease Other Non-Infectious General Peritonitis, Cyst Abdominal Disease Other Non-Infectious Interstitial Gastroenteritis (?) Abdominal Disease Other Non-Infectious Interstitial Obstruction , Acute Gangrenous Appendicitis with Peritonitis Abdominal Disease Other Non-Infectious Interstitial Splenic Anaemia Abdominal Disease Other Non-Infectious Intersusception of the Bowel Abdominal Disease Other Non-Infectious Intestinal Indigestion Abdominal Disease Other Non-Infectious Intestinal Obstruction Abdominal Disease Other Non-Infectious Intestinal Obstruction to Adhesions (Operation) Abdominal Disease Other Non-Infectious Intestinal Paresis Abdominal Disease Other Non-Infectious Intestinal Toxaemia and Convulsions Abdominal Disease Other Non-Infectious Obstruction of Bowel Abdominal Disease Other Non-Infectious Paralysis of Bowel following Gangrene Abdominal Disease Other Non-Infectious Partial Intestinal Obstruction Abdominal Disease Other Non-Infectious Perforated Gastric Ulcer Abdominal Disease Other Non-Infectious Perforation of Stomach, General Peritonitis Abdominal Disease Other Non-Infectious Perforation of Ulcer, Typhoid, Pelvid Abcess Abdominal Disease Other Non-Infectious Perforative Ulcer of Bladder and Rectum Abdominal Disease Other Non-Infectious Peritonitis Abdominal Disease Other Non-Infectious Peritonitis following Acute Appendicitis Abdominal Disease Other Non-Infectious Peritonitis following Operation Abdominal Disease Other Non-Infectious Peritonitis Following Ruptured Appendix Abdominal Disease Other Non-Infectious Peritonitis from Pelvic Abscess (Ruptured) Abdominal Disease Other Non-Infectious Peritonitis, Perforated Ulcer of Stomac Abdominal Disease Other Non-Infectious Peritonitis, Perforated Ulcer of Stomac Abdominal Disease Other Non-Infectious Peritonitis, Ulcer Abdominal Disease Other Non-Infectious Plyloric Obstruction (Adhesions) Abdominal Disease Other Non-Infectious Pylonic Stenosis Abdominal Disease Other Non-Infectious
106 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Pyloric Stenosis and Resulting Malnutrtion Abdominal Disease Other Non-Infectious Pyloric Stenosis, Haemorrhage from Stomach Abdominal Disease Other Non-Infectious Recto-Urethral Fistula Abdominal Disease Other Non-Infectious Rupture of Bowel, Toxaemia Abdominal Disease Other Non-Infectious Rupture of Duodenal Ulcer Abdominal Disease Other Non-Infectious Ruptured Gangrenous Appendix with General Peritonitis Abdominal Disease Other Non-Infectious Septic Peritonitis Abdominal Disease Other Non-Infectious Septicemia following Removal of Perforated Appendix Abdominal Disease Other Non-Infectious Strangulation of Intestines Abdominal Disease Other Non-Infectious Toxaemia with Diarrhea, Chronic Nephritis Abdominal Disease Other Non-Infectious Ulcer of the Stomach Abdominal Disease Other Non-Infectious Ulcerative Entercolitis Abdominal Disease Other Non-Infectious Acute Alcholism Alcoholism Other Non-Infectious Alcohol Poisoning Alcoholism Other Non-Infectious Anaemia Anaemia Other Non-Infectious Pernicious Anaemia, Exhaustion Anaemia Other Non-Infectious Pernicious Anemia Anaemia Other Non-Infectious Secondary Anaemia Anaemia Other Non-Infectious Secondary Anaemia, Duodenal Ulcer, Hemmorhage Anaemia Other Non-Infectious Abdominal Cancer Starting Originally in Uterus Cancer Other Non-Infectious Acute Lymphatis Leukemia Cancer Other Non-Infectious Adbominal Sarcoma Cancer Other Non-Infectious Aesthemia and Malnutrition due to Recurring Carcinoma of Jaw Cancer Other Non-Infectious Asthemia, Metastasic Carcinomas Cancer Other Non-Infectious Brain Tumor Cancer Other Non-Infectious Cancer Cancer Other Non-Infectious Cancer and Carcinoma Cancer Other Non-Infectious Cancer en Cuirasse Cancer Other Non-Infectious Cancer of Bladder Cancer Other Non-Infectious Cancer of Bone Cancer Other Non-Infectious Cancer of Brain Cancer Other Non-Infectious Cancer of Breast Cancer Other Non-Infectious Cancer of Colon Cancer Other Non-Infectious Cancer of Esophagus Cancer Other Non-Infectious Cancer of Jaw Cancer Other Non-Infectious
107 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Cancer of Jaw and Tongue Cancer Other Non-Infectious Cancer of Kidney Cancer Other Non-Infectious Cancer of Liver Cancer Other Non-Infectious Cancer of Liver and Gallbladder Cancer Other Non-Infectious Cancer of Liver and Lungs Cancer Other Non-Infectious Cancer of Pancreas Cancer Other Non-Infectious Cancer of Pancreas and Stomach Cancer Other Non-Infectious Cancer of Stomach Cancer Other Non-Infectious Cancer of Stomach and Liver Cancer Other Non-Infectious Cancer of the Bladder Cancer Other Non-Infectious Cancer of the Bladder with Metastasis in Glands Cancer Other Non-Infectious Cancer of the Uterus Cancer Other Non-Infectious Cancer of Thyroid Cancer Other Non-Infectious Cancer of Uterus Cancer Other Non-Infectious Cancer of Wall of Duodenum and Head of Pancreas Cancer Other Non-Infectious Carcinoma Cancer Other Non-Infectious Carcinoma Metastases Cancer Other Non-Infectious Carcinoma of Abscess Cancer Other Non-Infectious Carcinoma of Ascending Colon Cancer Other Non-Infectious Carcinoma of Bladder Cancer Other Non-Infectious Carcinoma of Bowel Cancer Other Non-Infectious Carcinoma of Breast Cancer Other Non-Infectious Carcinoma of Broad Ligament Cancer Other Non-Infectious Carcinoma of Cardiac and of Esophagus Cancer Other Non-Infectious Carcinoma of Cecum Cancer Other Non-Infectious Carcinoma of Cervix Uteri Cancer Other Non-Infectious Carcinoma of Colon Cancer Other Non-Infectious Carcinoma of Descending Calve Cancer Other Non-Infectious Carcinoma of Duodenum Cancer Other Non-Infectious Carcinoma of Esophagus Cancer Other Non-Infectious Carcinoma of Face Cancer Other Non-Infectious Carcinoma of Gallbladder Cancer Other Non-Infectious Carcinoma of Head of Pancreas Cancer Other Non-Infectious Carcinoma of Heart Cancer Other Non-Infectious Carcinoma of Intestine, Lungs, and Spleen Cancer Other Non-Infectious Carcinoma of Liver Cancer Other Non-Infectious Carcinoma of Liver and Pancreas Cancer Other Non-Infectious Carcinoma of Liver extending into Cancer Other Non-Infectious
108 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Right Lung Carcinoma of Lymph Cancer Other Non-Infectious Carcinoma of Omentum Cancer Other Non-Infectious Carcinoma of Pancreas Cancer Other Non-Infectious Carcinoma of Penis and Metastatic Grown in Groin Cancer Other Non-Infectious Carcinoma of Prostate Cancer Other Non-Infectious Carcinoma of Pylorans Cancer Other Non-Infectious Carcinoma of Rectum Cancer Other Non-Infectious Carcinoma of Segmund, Rupture of Colon Cancer Other Non-Infectious Carcinoma of Side of Neck Cancer Other Non-Infectious Carcinoma of Sigmoid Cancer Other Non-Infectious Carcinoma of Stomach Cancer Other Non-Infectious Carcinoma of Stomach and Intestines Cancer Other Non-Infectious Carcinoma of Stomach and Liver Cancer Other Non-Infectious Carcinoma of Stomach with Metastasis in Liver Cancer Other Non-Infectious Carcinoma of Stomach, Liver, Lymph Glands Cancer Other Non-Infectious Carcinoma of the Breast Cancer Other Non-Infectious Carcinoma of the Cervix Cancer Other Non-Infectious Carcinoma of the Colon Cancer Other Non-Infectious Carcinoma of the Left Kidney Cancer Other Non-Infectious Carcinoma of the Liver Cancer Other Non-Infectious Carcinoma of the Liver Cancer Other Non-Infectious Carcinoma of the Pancrease Cancer Other Non-Infectious Carcinoma of the Sigmoid Cancer Other Non-Infectious Carcinoma of the Stomach Cancer Other Non-Infectious Carcinoma of the Stomach and Intestine Cancer Other Non-Infectious Carcinoma of the Stomach, Aneurism of Aorta, Arterio Sclerosis Cancer Other Non-Infectious Carcinoma of the Uterus Cancer Other Non-Infectious Carcinoma of the Uterus and Liver Cancer Other Non-Infectious Carcinoma of Thyroid Cancer Other Non-Infectious Carcinoma of Tongue and Floor of Mouth Cancer Other Non-Infectious Carcinoma of Transverse Colon Cancer Other Non-Infectious Carcinoma of Upper Right Abdomen, Duodenum, and Head of Pancreas Cancer Other Non-Infectious Carcinoma of Uterus Cancer Other Non-Infectious Carcinoma Parotid Cancer Other Non-Infectious
109 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Carcinoma Primary in Stomach, Secondary in Liver Cancer Other Non-Infectious Carcinoma Pylori Cancer Other Non-Infectious Carcinoma, Primary in Gallbladder Cancer Other Non-Infectious Carcinomatosis Abdominal Cancer Other Non-Infectious Cerebral Tumor Cancer Other Non-Infectious Chronic Lymphalic Leukemia Cancer Other Non-Infectious Epithelioma of Penis Cancer Other Non-Infectious Exhaustion due to Cancer Cancer Other Non-Infectious Exhaustion from Carcinoma Cancer Other Non-Infectious Exhaustion, Carcinoma of Stomach Cancer Other Non-Infectious Extreme Exhaustion, Starvation following Cancer of Stomach Cancer Other Non-Infectious Generalized Sarcoma Cancer Other Non-Infectious Hepatic Carcinoma Cancer Other Non-Infectious Hodgkin's Disease Cancer Other Non-Infectious Leukemia Cancer Other Non-Infectious Leukemia, Shock Cancer Other Non-Infectious Lymphatic Leukemia Cancer Other Non-Infectious Lymphoma Cancer Other Non-Infectious Lymphosarcoma of Neck and Throat Cancer Other Non-Infectious Malignant Disease of Liver Cancer Other Non-Infectious Malignant Disease of the Prostate Gland Cancer Other Non-Infectious Malignant Growth in Right Chest Cancer Other Non-Infectious Malignant Tumor of Abdoman (Probably Ovaries) Cancer Other Non-Infectious Malignant Tumor of Duodenum Cancer Other Non-Infectious Metastases Cancer Other Non-Infectious Metastasis in Lungs of Cancer of the Breast Cancer Other Non-Infectious Metastasis, Obstruction Cancer Other Non-Infectious Metastatic Cancer in Liver Cancer Other Non-Infectious Numerous Metastases Cancer Other Non-Infectious Pancreatic Malignancy involving Diabetes Cancer Other Non-Infectious Peritoneal Carcinoma Cancer Other Non-Infectious Reoccurance of Cancer in Spine Cancer Other Non-Infectious Sarcoma Cancer Other Non-Infectious Sarcoma Metastasis of Brain Cancer Other Non-Infectious Sarcoma of Brain Cancer Other Non-Infectious Sarcoma of Cervix Cancer Other Non-Infectious
110 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Sarcoma of Glands of Neck Cancer Other Non-Infectious Sarcoma of Left Scapula with Metastasis in Skull and Brain Cancer Other Non-Infectious Sarcoma of Thigh Cancer Other Non-Infectious Sarcomatosis Cancer Other Non-Infectious Secondary Cancer in Lungs and Liver Cancer Other Non-Infectious Secondary Carcinoma of Spinal Cord Cancer Other Non-Infectious Splenic Leukaemia Cancer Other Non-Infectious Tumor of Brain Cancer Other Non-Infectious Tumor of Uterus Cancer Other Non-Infectious Convulsion Toxaemia Convulsion Other Non-Infectious Convulsion, Propaby Nephritic Convulsion Other Non-Infectious Convulsions Convulsion Other Non-Infectious Convulsions Assosiated with Diarrhea and Teething Convulsion Other Non-Infectious Convulsions from Meningitis Convulsion Other Non-Infectious Convulsions, Asthemia Convulsion Other Non-Infectious Convulsions, Premature Convulsion Other Non-Infectious Convulsions, Tetany Convulsion Other Non-Infectious Epileptic Convulsions Convulsion Other Non-Infectious General Toxaemia, Convulsions Convulsion Other Non-Infectious Asthemia from Diabetes Mellitus Diabetes Other Non-Infectious Diabetes Diabetes Other Non-Infectious Diabetes and Nephritis Diabetes Other Non-Infectious Diabetes Mellitus Diabetes Other Non-Infectious Diabetes Mellitus with Coma Diabetes Other Non-Infectious Diabetes Mellitus; Chronic Intestinal Nephritis Diabetes Other Non-Infectious Diabetes Pyelitis Diabetes Other Non-Infectious Diabetic Coma Diabetes Other Non-Infectious Diabetic Coma, Cardiac Failure Diabetes Other Non-Infectious Diabetic Gangrene Diabetes Other Non-Infectious Diabetus-Mellitus Diabetes Other Non-Infectious Weakness due to Cellulitis Diabetes Other Non-Infectious Acute Oedema of Larynx, Acute Dilatation of Heart Edema Other Non-Infectious Encephalities Syphilitic Encephalitis Other Non-Infectious Encephalitis Lethargica Encephalitis Other Non-Infectious Asthemia Exhaustion Other Non-Infectious Asthenia Exhaustion Other Non-Infectious Collapse Exhaustion Other Non-Infectious
111 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Endemic Asthemia Exhaustion Other Non-Infectious Exhaustion Exhaustion Other Non-Infectious Exhaustion, Toxaemia, Cardiac Failure Exhaustion Other Non-Infectious Exhaustion, Weakness, Malnutrition Exhaustion Other Non-Infectious General Collapse Exhaustion Other Non-Infectious Acute Anaemia result of Haemorrhages from Nose Hemorrhage Other Non-Infectious Generalized Haemorrhage, Streptococcal Septicaemia Hemorrhage Other Non-Infectious Haemmorhage, Exhaustion Hemorrhage Other Non-Infectious Haemorrhage Hemorrhage Other Non-Infectious Haemorrhage caused by Rupture Hemorrhage Other Non-Infectious Haemorrhage from Ruptured Pregnancy Hemorrhage Other Non-Infectious Haemorrhage, Coma Hemorrhage Other Non-Infectious Haemorrhage, Pachymeningitis Hemorrhage Other Non-Infectious Haemorrhage, Ruptured Aneurism Hemorrhage Other Non-Infectious Haemorrhage, Shock Hemorrhage Other Non-Infectious Haemorrhagic Disease of Newborn Hemorrhage Other Non-Infectious Hemmorhage from Pleural Cavity Hemorrhage Other Non-Infectious Hemmorhage from Stomach Hemorrhage Other Non-Infectious Hemmorhage in the Brain, Paralysis Hemorrhage Other Non-Infectious Hemorrhage Purpura Hemorrhage Other Non-Infectious Intercranial Haemorrhage due to Injury Hemorrhage Other Non-Infectious Internal Haemorrhage Hemorrhage Other Non-Infectious Internal Haemorrhage, Shock Hemorrhage Other Non-Infectious Intestinal Haemorrhage, Shock Hemorrhage Other Non-Infectious Intestinal Hemmorhage Hemorrhage Other Non-Infectious Intestinal Hemmorhage (Cause Unknown) Hemorrhage Other Non-Infectious Secondary Haemorrhage Hemorrhage Other Non-Infectious Secondary Haemorrhage following Operation for Cyst of Liver Hemorrhage Other Non-Infectious Secondary Haemorrhage, Toxaemia Hemorrhage Other Non-Infectious Acute Inanition Inanition Other Non-Infectious Acute Inanition Inanition Other Non-Infectious Inanition Inanition Other Non-Infectious Inanition, Enterocolitis Inanition Other Non-Infectious Inanition, Exhaustion Inanition Other Non-Infectious Inanition, Refusal of Food Inanition Other Non-Infectious Inanition, Stillborn Inanition Other Non-Infectious Toxaemia, Inanition Inanition Other Non-Infectious
112 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Asthemia - Malnutrition Malnutrition Other Non-Infectious Cachexia Malnutrition Other Non-Infectious Emaciation Malnutrition Other Non-Infectious Exhaustion due to Pellacra Malnutrition Other Non-Infectious Exhaustion, Marasmus Malnutrition Other Non-Infectious General Paralysis Malnutrition Other Non-Infectious Improper Feeding Malnutrition Other Non-Infectious Malnutrition Malnutrition Other Non-Infectious Malnutrition from Prematurity Malnutrition Other Non-Infectious Malnutrition from Throat Paralysis Malnutrition Other Non-Infectious Malnutrition, Chronic Jaundice Malnutrition Other Non-Infectious Malnutrition, Weakness Malnutrition Other Non-Infectious Marasmus Malnutrition Other Non-Infectious Nursing on Bottle, Collapse after Long Period of Digestive Trouble Malnutrition Other Non-Infectious Starvation Malnutrition Other Non-Infectious Starvation (Obstruction of Opening) Malnutrition Other Non-Infectious Starvation, Abnormally Dilated Stomach Malnutrition Other Non-Infectious Weakness Malnutrition Other Non-Infectious Aesthemia; Senile Dementia Senility Other Non-Infectious Feebleness, Senility, Intestinal Haemorrhage Senility Other Non-Infectious General Senility, Arteriosclerosis of Gradual Onset Senility Other Non-Infectious Old Age with Gradual Decline Senility Other Non-Infectious Senile Decay Senility Other Non-Infectious Senile Decay, Chronic Myocarditis Senility Other Non-Infectious Senility Senility Other Non-Infectious Senility - Failing for Years Senility Other Non-Infectious Senility - Health was Worn Out Senility Other Non-Infectious Senility, Arteriosclerosis, Myocarditis Senility Other Non-Infectious Senility, Gradual Failure of Health Senility Other Non-Infectious Weakness, Senility Senility Other Non-Infectious Apparently Shock following Operation Shock Other Non-Infectious Asthemia, Shock following Operation Shock Other Non-Infectious Constitutional Shock following Fall down Stairs Shock Other Non-Infectious Shock Shock Other Non-Infectious Shock and General Peritonitis following Ruptured Appendix Shock Other Non-Infectious Shock and Post-Operative Shock Other Non-Infectious
113 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Shock During Delivery Shock Other Non-Infectious Shock following Operation Shock Other Non-Infectious Shock following Protracted Labor and Operation Shock Other Non-Infectious Shock from Amputation Shock Other Non-Infectious Shock, Fatty Myocarditis Shock Other Non-Infectious Shock, Infection, Peritonitis Shock Other Non-Infectious Sudden Syncope Syncope Other Non-Infectious Syncope Syncope Other Non-Infectious Syncope due to Senile Aesthemia Syncope Other Non-Infectious Syncope from Cardiac Dilatation Syncope Other Non-Infectious Syncope. Had Myocarditis and Asthma Syncope Other Non-Infectious ? Unknown Unknown [illegible] Unknown Unknown ** Unknown Unknown Acute Eutritis Unknown Unknown Acute Hyperthyroidism Unknown Unknown Acute Laryngitis Unknown Unknown Acute Mylitis following Cervical Spondylitis Unknown Unknown Acute Osteomyelitis of Ribs Unknown Unknown Acute Pancystitis Unknown Unknown Apoplectic Seguine, Paralysis, Haemoplagea Unknown Unknown Arthritis Deformans in Jaws Unknown Unknown Autointoxication with Convulsions Unknown Unknown BenBen Unknown Unknown British Columbia Unknown Unknown Cellulitis Unknown Unknown Cellulitis of Neck and Throat Unknown Unknown Cerebral Oedema Unknown Unknown Chronic Arthritis lef and hip, Purulent Meningitis Unknown Unknown Coma Unknown Unknown Dropsy Unknown Unknown Dyspnea Unknown Unknown Effusion Unknown Unknown Enlarged Thymus Gland Unknown Unknown Enlarged Thymus, Patent Foramen Ovulae Unknown Unknown Enlarged Thyroid Gland Unknown Unknown Exclamation Unknown Unknown
114 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced General Paresis Unknown Unknown Goitre Unknown Unknown Haemophageia Unknown Unknown Hemoptysis Unknown Unknown Hydrocephalus, Perforation of Skin Unknown Unknown Hyper Thyroidism Unknown Unknown Hypertrophy of Prostate Unknown Unknown Illegible (Faded) Unknown Unknown Impetigo Contagiosa Unknown Unknown Inflammation of Blood Vessels of Brain Unknown Unknown Insanity Unknown Unknown Locomotor Ataxia Unknown Unknown Lymphangitis Unknown Unknown Melena Neonatorum Unknown Unknown Melena Neonatorum, Internal Hemmorhage - Stomach, Bowels, Lungs Unknown Unknown Miscarriage, Shock Unknown Unknown Mycosis Fungoide Unknown Unknown Myelitis Unknown Unknown Myoma Thoracic Unknown Unknown Neuritis Unknown Unknown Neurofibromatosis of Central and Peripheral Nerves Unknown Unknown No Cause Determined Unknown Unknown Not Known Unknown Unknown Osteomylitis of Femur Unknown Unknown Paralysis Unknown Unknown Paralysis Agitans Unknown Unknown Paralysis Agitans Unknown Unknown Paralysis, Taber Dorsalis Unknown Unknown Partition Unknown Unknown Pemphigus Unknown Unknown Pemphigus Neonatorum Unknown Unknown Pleus Unknown Unknown Potency of Forament Orale Unknown Unknown Psychosis Unknown Unknown Pyarthrosis Unknown Unknown Rheumatism Unknown Unknown Rheumatism, Dilatation of Heart, Brights Disease Unknown Unknown
115 Cause of Death as Listed on Death Certificate COD ReCode COD Code Reduced Rheumatoid Arthritis Unknown Unknown Spinal Caries Unknown Unknown Spinal Cord Sclerosis Unknown Unknown Strangulated Hernia Unknown Unknown Strangulated Hernia (Ventral) Unknown Unknown Syvalidism of Mother Unknown Unknown Tetanus Unknown Unknown Tetany Unknown Unknown Thoraxis Unknown Unknown Toxemia from Pyrrohea Unknown Unknown Toxic Goitre Unknown Unknown Toxio Absorption Unknown Unknown Transverse Myelitis Unknown Unknown Traumatic Haemoptyses Unknown Unknown Undetermined Unknown Unknown Uterine Fibrosis Unknown Unknown
A.2 Coding for Occupation Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Accountant Accountant Professional/Manager/Skilled Employed Bookkeeper Accountant Professional/Manager/Skilled Employed District Accountant Accountant Professional/Manager/Skilled Employed Manager at Cannery Cannery Manager Professional/Manager/Skilled Employed Medical Doctor Doctor Professional/Manager/Skilled Employed Physician Doctor Professional/Manager/Skilled Employed Physician, Surgeon Doctor Professional/Manager/Skilled Employed Assistant Engineer Engineer Professional/Manager/Skilled Employed Canadian Engineer Engineer Professional/Manager/Skilled Employed Civil Engineer Engineer Professional/Manager/Skilled Employed Downey Engineer Engineer Professional/Manager/Skilled Employed Electrical Engineer Engineer Professional/Manager/Skilled Employed Engineer Engineer Professional/Manager/Skilled Employed Engineer in Hospital Engineer Professional/Manager/Skilled Employed Gasoline Engineer Engineer Professional/Manager/Skilled Employed Locomotive Engineer Engineer Professional/Manager/Skilled Employed Marine Engineer Engineer Professional/Manager/Skilled Employed Mining Engineer Engineer Professional/Manager/Skilled Employed Stationary Engineer Engineer Professional/Manager/Skilled Employed
116 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Steam Engineer Engineer Professional/Manager/Skilled Employed Bank Manager Manager Professional/Manager/Skilled Employed Bathhouse Proprietor Manager Professional/Manager/Skilled Employed Cannery Manager Manager Professional/Manager/Skilled Employed Club Proprietor Manager Professional/Manager/Skilled Employed Dept. Matson (?) Manager Professional/Manager/Skilled Employed Foreman Manager Professional/Manager/Skilled Employed Foreman at Imperial Oil Co Manager Professional/Manager/Skilled Employed Foreman in CPR Manager Professional/Manager/Skilled Employed Foreman Northern Construction Manager Professional/Manager/Skilled Employed Foreman, Pile Driver Manager Professional/Manager/Skilled Employed Forest Ranger Manager Professional/Manager/Skilled Employed Hotel Business Manager Manager Professional/Manager/Skilled Employed Hotel Keeper Manager Professional/Manager/Skilled Employed Hotel Manager Manager Professional/Manager/Skilled Employed Hotel Proprietor Manager Professional/Manager/Skilled Employed Hotelkeeper Manager Professional/Manager/Skilled Employed Hotelman Manager Professional/Manager/Skilled Employed Jewelry Business Manager Professional/Manager/Skilled Employed Laundry Proprietor Manager Professional/Manager/Skilled Employed Lighthouse Keeper Manager Professional/Manager/Skilled Employed Linen Storekeeper Manager Professional/Manager/Skilled Employed Lumber Manufacturer Manager Professional/Manager/Skilled Employed Manager Manager Professional/Manager/Skilled Employed Manager - Milky Way Dairy Manager Professional/Manager/Skilled Employed Manager and Accountant of Lewis + Sills Hardware Manager Professional/Manager/Skilled Employed Manager Dingwall Cotts Co Manager Professional/Manager/Skilled Employed Manager Motor Accessories Manager Professional/Manager/Skilled Employed Manager of Govt Laboratory Manager Professional/Manager/Skilled Employed Manager of Macdonald and Co Manager Professional/Manager/Skilled Employed Manager: International Harvester Co Manager Professional/Manager/Skilled Employed Manager: Pacific Grain Co Manager Professional/Manager/Skilled Employed Managing a Dairy Manager Professional/Manager/Skilled Employed Mine Owner Manager Professional/Manager/Skilled Employed President - B.C. Sugar Refinery Manager Professional/Manager/Skilled Employed Proprietor of Rooming House Manager Professional/Manager/Skilled Employed Restaurant Keeper Manager Professional/Manager/Skilled Employed
117 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Restaurant Proprietor Manager Professional/Manager/Skilled Employed Rooming House Keeper Manager Professional/Manager/Skilled Employed Roomkeeper Manager Professional/Manager/Skilled Employed Sawmill Foreman Manager Professional/Manager/Skilled Employed Shipping Foreman Manager Professional/Manager/Skilled Employed Stonekeeper Manager Professional/Manager/Skilled Employed Storekeeper Manager Professional/Manager/Skilled Employed Storekeeper and Clerk Manager Professional/Manager/Skilled Employed Superintendant at Shipyard Manager Professional/Manager/Skilled Employed Telephone Supervisor Manager Professional/Manager/Skilled Employed Timber Operator Manager Professional/Manager/Skilled Employed Timber Ranger Manager Professional/Manager/Skilled Employed Unit Storekeeper Manager Professional/Manager/Skilled Employed Vice President of Company Manager Professional/Manager/Skilled Employed Automobile Dealer Merchant Professional/Manager/Skilled Employed Business Agent Merchant Professional/Manager/Skilled Employed Buyer of Staples Merchant Professional/Manager/Skilled Employed Cattle Buyer Merchant Professional/Manager/Skilled Employed Chinese Merchant Merchant Professional/Manager/Skilled Employed City Salesman - BC Leather Merchant Professional/Manager/Skilled Employed Clothing Merchant Merchant Professional/Manager/Skilled Employed Coal Merchant Merchant Professional/Manager/Skilled Employed Commercial Traveler Merchant Professional/Manager/Skilled Employed Commission Agent Merchant Professional/Manager/Skilled Employed Dry Goods Salesman Merchant Professional/Manager/Skilled Employed Fish Dealer Merchant Professional/Manager/Skilled Employed Fish Merchant Merchant Professional/Manager/Skilled Employed Fur Buyer Merchant Professional/Manager/Skilled Employed Furniture Dealer Merchant Professional/Manager/Skilled Employed General Agent Merchant Professional/Manager/Skilled Employed General Merchant Merchant Professional/Manager/Skilled Employed Grocer Merchant Professional/Manager/Skilled Employed Grocery Merchant Merchant Professional/Manager/Skilled Employed Hay and Grain Broker Merchant Professional/Manager/Skilled Employed House Dealer Merchant Professional/Manager/Skilled Employed Junk Dealer Merchant Professional/Manager/Skilled Employed Machine-tender Merchant Professional/Manager/Skilled Employed Merchant Merchant Professional/Manager/Skilled Employed Mining Broker Merchant Professional/Manager/Skilled Employed Peddler Merchant Professional/Manager/Skilled Employed
118 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Poultry Merchant Merchant Professional/Manager/Skilled Employed Purchasing Agent Merchant Professional/Manager/Skilled Employed Saleslady Merchant Professional/Manager/Skilled Employed Salesman Merchant Professional/Manager/Skilled Employed Saleswoman Merchant Professional/Manager/Skilled Employed Secondhand Dealer Merchant Professional/Manager/Skilled Employed Shipper Merchant Professional/Manager/Skilled Employed Shipping Agent Merchant Professional/Manager/Skilled Employed Softdrink Dealer Merchant Professional/Manager/Skilled Employed Tea Merchant Merchant Professional/Manager/Skilled Employed Timber Broker Merchant Professional/Manager/Skilled Employed Tobacco Merchant Merchant Professional/Manager/Skilled Employed Traveling Passenger Agent Merchant Professional/Manager/Skilled Employed Traveling Salesman Merchant Professional/Manager/Skilled Employed Traveller Merchant Professional/Manager/Skilled Employed Travelling Salesman Merchant Professional/Manager/Skilled Employed Wholesale Fish Dealer Merchant Professional/Manager/Skilled Employed Wholesale Junk Dealer Merchant Professional/Manager/Skilled Employed Wholesale Liquor Dealer Merchant Professional/Manager/Skilled Employed Wholesaler Merchant Professional/Manager/Skilled Employed Hospital Nurse Nurse Professional/Manager/Skilled Employed Hospital Orderly Nurse Professional/Manager/Skilled Employed Nurse Nurse Professional/Manager/Skilled Employed Nurse in Training Nurse Professional/Manager/Skilled Employed Orderly at VGH Nurse Professional/Manager/Skilled Employed Police Constable, Lifeguard Policeman Professional/Manager/Skilled Employed Police Matron Policeman Professional/Manager/Skilled Employed Police Officer Policeman Professional/Manager/Skilled Employed Policeman Policeman Professional/Manager/Skilled Employed Actress Skilled Service Professional/Manager/Skilled Employed Advertising Agent Skilled Service Professional/Manager/Skilled Employed Agent Skilled Service Professional/Manager/Skilled Employed Agent at Dominican Express Co Skilled Service Professional/Manager/Skilled Employed Architect Skilled Service Professional/Manager/Skilled Employed Assistant Superintendent VGH Skilled Service Professional/Manager/Skilled Employed Auditor Skilled Service Professional/Manager/Skilled Employed Author and Poet Skilled Service Professional/Manager/Skilled Employed Bakery Inspector Skilled Service Professional/Manager/Skilled Employed Barber Skilled Service Professional/Manager/Skilled Employed
119 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Barrister (Law) Skilled Service Professional/Manager/Skilled Employed Bookbinder Skilled Service Professional/Manager/Skilled Employed Broker Skilled Service Professional/Manager/Skilled Employed Butcher Skilled Service Professional/Manager/Skilled Employed Butcher, Merchant Skilled Service Professional/Manager/Skilled Employed Car Inspector Skilled Service Professional/Manager/Skilled Employed Chemist at Drug Store Skilled Service Professional/Manager/Skilled Employed Chiropractor Skilled Service Professional/Manager/Skilled Employed City Freight Agent Skilled Service Professional/Manager/Skilled Employed Clergyman Skilled Service Professional/Manager/Skilled Employed Collector Skilled Service Professional/Manager/Skilled Employed Collector of Customs Skilled Service Professional/Manager/Skilled Employed Collector of Customs Skilled Service Professional/Manager/Skilled Employed Customs Inspector Skilled Service Professional/Manager/Skilled Employed Customs Officer Skilled Service Professional/Manager/Skilled Employed Deputy Registrar of Land Titles Skilled Service Professional/Manager/Skilled Employed Designer Skilled Service Professional/Manager/Skilled Employed Dressmaker Skilled Service Professional/Manager/Skilled Employed Druggist Skilled Service Professional/Manager/Skilled Employed Editor and Publisher Skilled Service Professional/Manager/Skilled Employed Fabric Maker Skilled Service Professional/Manager/Skilled Employed Glass Silverer Skilled Service Professional/Manager/Skilled Employed Health Inspector Skilled Service Professional/Manager/Skilled Employed Horse Trainer Skilled Service Professional/Manager/Skilled Employed Inspector of Bank Skilled Service Professional/Manager/Skilled Employed Inspector of Fisheries Skilled Service Professional/Manager/Skilled Employed Inspector, Standard Milk Co Skilled Service Professional/Manager/Skilled Employed Insurance Agent Skilled Service Professional/Manager/Skilled Employed Insurance Broker Skilled Service Professional/Manager/Skilled Employed Insurance Solicitor Skilled Service Professional/Manager/Skilled Employed Insurance Underwriter Skilled Service Professional/Manager/Skilled Employed Japanese-Canadian Association Secretary Skilled Service Professional/Manager/Skilled Employed Jeweller Skilled Service Professional/Manager/Skilled Employed Journalist Skilled Service Professional/Manager/Skilled Employed Justice Supreme Court Skilled Service Professional/Manager/Skilled Employed Lady Barber Skilled Service Professional/Manager/Skilled Employed Land Surveyor Skilled Service Professional/Manager/Skilled Employed Lawyer Skilled Service Professional/Manager/Skilled Employed Life Insurance Salesman Skilled Service Professional/Manager/Skilled Employed
120 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Linotype Operator Skilled Service Professional/Manager/Skilled Employed Lithographic Artist Skilled Service Professional/Manager/Skilled Employed Lumber Inspector Skilled Service Professional/Manager/Skilled Employed Magazine Publisher Skilled Service Professional/Manager/Skilled Employed Meat Cutter Skilled Service Professional/Manager/Skilled Employed Mechanical Supt. Skilled Service Professional/Manager/Skilled Employed Moving Picture Operator Skilled Service Professional/Manager/Skilled Employed Musician Skilled Service Professional/Manager/Skilled Employed Officer Empress of Russia Skilled Service Professional/Manager/Skilled Employed Optician Skilled Service Professional/Manager/Skilled Employed Pattern Maker Skilled Service Professional/Manager/Skilled Employed Photographer Skilled Service Professional/Manager/Skilled Employed President of University of British Columbia Skilled Service Professional/Manager/Skilled Employed Public Stenographer Skilled Service Professional/Manager/Skilled Employed Real Estate Skilled Service Professional/Manager/Skilled Employed Real Estate Agent Skilled Service Professional/Manager/Skilled Employed Real Estate and Insurance Skilled Service Professional/Manager/Skilled Employed Real Estate Broker Skilled Service Professional/Manager/Skilled Employed Represenative of Alberta- Pacific Skilled Service Professional/Manager/Skilled Employed Seamstress Skilled Service Professional/Manager/Skilled Employed Secondary School Schoolboard Skilled Service Professional/Manager/Skilled Employed Secretary of Rotary Club Skilled Service Professional/Manager/Skilled Employed Shoemaker Skilled Service Professional/Manager/Skilled Employed Sign Writer Skilled Service Professional/Manager/Skilled Employed Sportsman's Representative Skilled Service Professional/Manager/Skilled Employed Stenographer Skilled Service Professional/Manager/Skilled Employed Tailor Skilled Service Professional/Manager/Skilled Employed Telegraph Operator Skilled Service Professional/Manager/Skilled Employed Telephone Skilled Service Professional/Manager/Skilled Employed Telephone Operator Skilled Service Professional/Manager/Skilled Employed Topographer Skilled Service Professional/Manager/Skilled Employed Worked in Dr's Office Skilled Service Professional/Manager/Skilled Employed Instructor Teacher Professional/Manager/Skilled Employed Lady Principal Teacher Professional/Manager/Skilled Employed Music Teacher Teacher Professional/Manager/Skilled Employed School Principal Teacher Professional/Manager/Skilled Employed School Teacher Teacher Professional/Manager/Skilled Employed Schoolmaster Teacher Professional/Manager/Skilled Employed
121 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Schoolteacher Teacher Professional/Manager/Skilled Employed Teacher Teacher Professional/Manager/Skilled Employed Apprentice - Auto-Mechanic Tradesman Professional/Manager/Skilled Employed Apprentice at Printing and Litho Ltd Tradesman Professional/Manager/Skilled Employed Aritificial Limb Maker Tradesman Professional/Manager/Skilled Employed Auto Repairman Tradesman Professional/Manager/Skilled Employed Automobile Machanist Tradesman Professional/Manager/Skilled Employed Automobile Mechanic Tradesman Professional/Manager/Skilled Employed B.C. Electric Motorman Tradesman Professional/Manager/Skilled Employed B.C. Tradesman Tradesman Professional/Manager/Skilled Employed BC Electric Employee Tradesman Professional/Manager/Skilled Employed Blacksmith Tradesman Professional/Manager/Skilled Employed Blacksmith Helper Tradesman Professional/Manager/Skilled Employed Boilermaker Tradesman Professional/Manager/Skilled Employed Boilermaker Helper Tradesman Professional/Manager/Skilled Employed Boxmaker Tradesman Professional/Manager/Skilled Employed Brewery Worker Tradesman Professional/Manager/Skilled Employed Brick Layer Tradesman Professional/Manager/Skilled Employed Brick Mason Tradesman Professional/Manager/Skilled Employed Bridge Builder Tradesman Professional/Manager/Skilled Employed Bridge Contractor Tradesman Professional/Manager/Skilled Employed Bridgeman Tradesman Professional/Manager/Skilled Employed Builder Tradesman Professional/Manager/Skilled Employed Building Contractor Tradesman Professional/Manager/Skilled Employed Cabinet Maker Tradesman Professional/Manager/Skilled Employed Carpenter Tradesman Professional/Manager/Skilled Employed Carpenter and Contractor Tradesman Professional/Manager/Skilled Employed Carriage Maker Tradesman Professional/Manager/Skilled Employed Carriage Painter Tradesman Professional/Manager/Skilled Employed Construction Tradesman Professional/Manager/Skilled Employed Contractor Tradesman Professional/Manager/Skilled Employed Contractor of Woodyard Tradesman Professional/Manager/Skilled Employed Coppersmith Tradesman Professional/Manager/Skilled Employed Decorator Tradesman Professional/Manager/Skilled Employed Dental Mechanic Tradesman Professional/Manager/Skilled Employed Draughtman Tradesman Professional/Manager/Skilled Employed Dredge Master Tradesman Professional/Manager/Skilled Employed Electrician Tradesman Professional/Manager/Skilled Employed Express and Transfer Contracter Tradesman Professional/Manager/Skilled Employed
122 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Furnace Repairman Tradesman Professional/Manager/Skilled Employed General Contractor Tradesman Professional/Manager/Skilled Employed Grain Miller Tradesman Professional/Manager/Skilled Employed Housing Contractor Tradesman Professional/Manager/Skilled Employed Interior Decorator Tradesman Professional/Manager/Skilled Employed Iron Moulder Tradesman Professional/Manager/Skilled Employed Machine Man Tradesman Professional/Manager/Skilled Employed Machinist Tradesman Professional/Manager/Skilled Employed Machinist Helper Tradesman Professional/Manager/Skilled Employed Machinist Helper Tradesman Professional/Manager/Skilled Employed Mason Tradesman Professional/Manager/Skilled Employed Master Mechanic Tradesman Professional/Manager/Skilled Employed Mechanic Tradesman Professional/Manager/Skilled Employed Millwright Tradesman Professional/Manager/Skilled Employed Motor Electrician Tradesman Professional/Manager/Skilled Employed Motor Mechanic Tradesman Professional/Manager/Skilled Employed Motorman Tradesman Professional/Manager/Skilled Employed Moulder Tradesman Professional/Manager/Skilled Employed Moving Contractor Tradesman Professional/Manager/Skilled Employed Oar Maker Tradesman Professional/Manager/Skilled Employed Organ Maker Tradesman Professional/Manager/Skilled Employed Painter Tradesman Professional/Manager/Skilled Employed Painter and Decorator Tradesman Professional/Manager/Skilled Employed Painter, Builder Tradesman Professional/Manager/Skilled Employed Painter, Decorator Tradesman Professional/Manager/Skilled Employed Painter, Director Tradesman Professional/Manager/Skilled Employed Plumber Tradesman Professional/Manager/Skilled Employed Printer Tradesman Professional/Manager/Skilled Employed Road Foreman Tradesman Professional/Manager/Skilled Employed Roadworker Tradesman Professional/Manager/Skilled Employed Roofer Tradesman Professional/Manager/Skilled Employed Sheet Metal Worker Tradesman Professional/Manager/Skilled Employed Shingle Bolt Cutter Tradesman Professional/Manager/Skilled Employed Shingle Boltman Tradesman Professional/Manager/Skilled Employed Ship Carpenter Tradesman Professional/Manager/Skilled Employed Ship Wright Tradesman Professional/Manager/Skilled Employed Ship-Carpenter Tradesman Professional/Manager/Skilled Employed Shipbuilder Tradesman Professional/Manager/Skilled Employed Shipbuilding in Seattle Tradesman Professional/Manager/Skilled Employed Shipwright Tradesman Professional/Manager/Skilled Employed
123 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Smithsman Tradesman Professional/Manager/Skilled Employed Steam Fitter Tradesman Professional/Manager/Skilled Employed Steam Fitting Tradesman Professional/Manager/Skilled Employed Steeple Jack Tradesman Professional/Manager/Skilled Employed Stone Cutter Tradesman Professional/Manager/Skilled Employed Tinsmith Tradesman Professional/Manager/Skilled Employed Watchmaker Tradesman Professional/Manager/Skilled Employed Woodcutter Tradesman Professional/Manager/Skilled Employed Attendant at Hospital Clerk Unskilled - Clerical Employed Bailmaker Clerk Unskilled - Clerical Employed Bank Clerk Clerk Unskilled - Clerical Employed Bank Ledger Keeper Clerk Unskilled - Clerical Employed Billing Clerk Clerk Unskilled - Clerical Employed Chief Clerk CPR Clerk Unskilled - Clerical Employed Chief Clerk, Dominion Express Co Clerk Unskilled - Clerical Employed Clerk Clerk Unskilled - Clerical Employed Clerk at Hudson's Bay Company Clerk Unskilled - Clerical Employed Clerk at Secondhand Store Clerk Unskilled - Clerical Employed Clerk at Wholesale House Clerk Unskilled - Clerical Employed Clerk in Grocery Store Clerk Unskilled - Clerical Employed Clerk or Mail Department Clerk Unskilled - Clerical Employed Clerk, Bookkeeper Clerk Unskilled - Clerical Employed Druggist's Clerk Clerk Unskilled - Clerical Employed Dry Goods Clerk Clerk Unskilled - Clerical Employed Government Employee Clerk Unskilled - Clerical Employed Government Office Clerk Clerk Unskilled - Clerical Employed Grocery Clerk Clerk Unskilled - Clerical Employed Hardware Clerk Clerk Unskilled - Clerical Employed Hardware Man Clerk Unskilled - Clerical Employed Hotel Clerk Clerk Unskilled - Clerical Employed Music Store Employee Clerk Unskilled - Clerical Employed Office Clerk Clerk Unskilled - Clerical Employed Shoe Clerk Clerk Unskilled - Clerical Employed Store Attendant Clerk Unskilled - Clerical Employed Store Clerk Clerk Unskilled - Clerical Employed Timekeeper Clerk Unskilled - Clerical Employed Timekeeper, Construction Work Clerk Unskilled - Clerical Employed Baker Cook Unskilled - Clerical Employed
124 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Camp Cook Cook Unskilled - Clerical Employed Candy Maker Cook Unskilled - Clerical Employed Chef Cook Unskilled - Clerical Employed Confectioner Cook Unskilled - Clerical Employed Cook Cook Unskilled - Clerical Employed Cook - CPR Cook Unskilled - Clerical Employed Cook in Camp Cook Unskilled - Clerical Employed Cook on Boat Cook Unskilled - Clerical Employed Dining Car Cook Cook Unskilled - Clerical Employed Hotel Cook Cook Unskilled - Clerical Employed Kitchen Cook Unskilled - Clerical Employed Pastry Cook Cook Unskilled - Clerical Employed Sea Cook Cook Unskilled - Clerical Employed Domestic Domestic Help Unskilled - Clerical Employed Domestic Servant Domestic Help Unskilled - Clerical Employed Homegirl Domestic Help Unskilled - Clerical Employed Houseboy Domestic Help Unskilled - Clerical Employed Housekeeper Domestic Help Unskilled - Clerical Employed Housemaid Domestic Help Unskilled - Clerical Employed Housework Domestic Help Unskilled - Clerical Employed Linen Maid Domestic Help Unskilled - Clerical Employed Maid Domestic Help Unskilled - Clerical Employed Servant Domestic Help Unskilled - Clerical Employed Auto Driver Driver Unskilled - Clerical Employed Automobile Driver Driver Unskilled - Clerical Employed Chauffeur Driver Unskilled - Clerical Employed Driver Driver Unskilled - Clerical Employed Teamster Driver Unskilled - Clerical Employed Truck Driver Driver Unskilled - Clerical Employed Janitor Janitor Unskilled - Clerical Employed Bank Messenger Unskilled Service Unskilled - Clerical Employed Bartender Unskilled Service Unskilled - Clerical Employed Bellboy Unskilled Service Unskilled - Clerical Employed Checker in Laundry Unskilled Service Unskilled - Clerical Employed Companion Unskilled Service Unskilled - Clerical Employed Letter Carrier Unskilled Service Unskilled - Clerical Employed Messenger Unskilled Service Unskilled - Clerical Employed Messenger, Clerk Unskilled Service Unskilled - Clerical Employed Missionary Unskilled Service Unskilled - Clerical Employed News Vendor Unskilled Service Unskilled - Clerical Employed
125 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Newsdealer Unskilled Service Unskilled - Clerical Employed Newspaperman Unskilled Service Unskilled - Clerical Employed Paper Vendor Unskilled Service Unskilled - Clerical Employed Porter at Barber Shop Unskilled Service Unskilled - Clerical Employed Postman Unskilled Service Unskilled - Clerical Employed Restaurant Employee Unskilled Service Unskilled - Clerical Employed Restaurant Helper Unskilled Service Unskilled - Clerical Employed Steward Unskilled Service Unskilled - Clerical Employed Waiter Unskilled Service Unskilled - Clerical Employed Waitress Unskilled Service Unskilled - Clerical Employed American Can Co Cannery Worker Unskilled/Labour Employed Cannery Cannery Worker Unskilled/Labour Employed Cannery Hand Cannery Worker Unskilled/Labour Employed Cannery Laborer Cannery Worker Unskilled/Labour Employed Cannery Mall Cannery Worker Unskilled/Labour Employed Cannery Man Cannery Worker Unskilled/Labour Employed Cannery Operator Cannery Worker Unskilled/Labour Employed Canneryman Cannery Worker Unskilled/Labour Employed Fish Cannery Cannery Worker Unskilled/Labour Employed Laborer at Cannery Factory Cannery Worker Unskilled/Labour Employed Dairyman Farmer Unskilled/Labour Employed Farmer Farmer Unskilled/Labour Employed Fruit-Rancher Farmer Unskilled/Labour Employed Hog Rancher Farmer Unskilled/Labour Employed Orange Grower Farmer Unskilled/Labour Employed Poultryman Farmer Unskilled/Labour Employed Rancher Farmer Unskilled/Labour Employed Rancher and Logger Farmer Unskilled/Labour Employed City Fireman Fireman Unskilled/Labour Employed Fire Warden Fireman Unskilled/Labour Employed Fireman Fireman Unskilled/Labour Employed Fireman Director Fireman Unskilled/Labour Employed Fireman on Boat Fireman Unskilled/Labour Employed Fireman, Marine Fireman Unskilled/Labour Employed Locomotive Fireman Fireman Unskilled/Labour Employed Marine Fireman Fireman Unskilled/Labour Employed Deep Sea Fisherman Fisherman Unskilled/Labour Employed Fisherman Fisherman Unskilled/Labour Employed Fishing Fisherman Unskilled/Labour Employed Mohrman Labourer Unskilled/Labour Employed
126 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Slayer (?) Labourer Unskilled/Labour Employed Warehouseman Labourer Unskilled/Labour Employed Car Cleaner Labourer Unskilled/Labour Employed Car Washer Labourer Unskilled/Labour Employed Caretaker Labourer Unskilled/Labour Employed Cartage Labourer Unskilled/Labour Employed City Employee Street Work Labourer Unskilled/Labour Employed Cleaner at VGH Labourer Unskilled/Labour Employed Day worker Labourer Unskilled/Labour Employed Deckhand Labourer Unskilled/Labour Employed Deliveryman Labourer Unskilled/Labour Employed Diver Labourer Unskilled/Labour Employed Elevator Operator Labourer Unskilled/Labour Employed Employee at General Hospital Labourer Unskilled/Labour Employed Employee of Sugar Refinery Labourer Unskilled/Labour Employed Farm Helper Labourer Unskilled/Labour Employed Farm Laborer Labourer Unskilled/Labour Employed Farmhand Labourer Unskilled/Labour Employed Filler at Imperial Oil Labourer Unskilled/Labour Employed Fish Curer Labourer Unskilled/Labour Employed Fruit Warehouseman Labourer Unskilled/Labour Employed Gardener Labourer Unskilled/Labour Employed General Hospital Laboratory Labourer Unskilled/Labour Employed Government Weighman Labourer Unskilled/Labour Employed Guard Labourer Unskilled/Labour Employed Harvester's Helper Labourer Unskilled/Labour Employed Hoistman Labourer Unskilled/Labour Employed Laborer Labourer Unskilled/Labour Employed Laborer at Sawmill Labourer Unskilled/Labour Employed Laborer at Shipyard Labourer Unskilled/Labour Employed Laborer in Logging Camp Labourer Unskilled/Labour Employed Laborer in Shinglemill Labourer Unskilled/Labour Employed Laborer, Sewer Work Labourer Unskilled/Labour Employed Landscape Gardener Labourer Unskilled/Labour Employed Lineman Labourer Unskilled/Labour Employed Linen Marker Labourer Unskilled/Labour Employed Lumber Sorter Labourer Unskilled/Labour Employed Lumberman Labourer Unskilled/Labour Employed Mill Labourer Unskilled/Labour Employed Miller Labourer Unskilled/Labour Employed
127 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Millhand Labourer Unskilled/Labour Employed Millman Labourer Unskilled/Labour Employed Night Watchman Labourer Unskilled/Labour Employed Packer Labourer Unskilled/Labour Employed Patrolman Labourer Unskilled/Labour Employed Pipe Fitter Helper Labourer Unskilled/Labour Employed Prospector Labourer Unskilled/Labour Employed Riveter Shipyard Labourer Unskilled/Labour Employed Saw Filer Labourer Unskilled/Labour Employed Saw Mill Worker Labourer Unskilled/Labour Employed Saw-mill Hand Labourer Unskilled/Labour Employed Sawer Labourer Unskilled/Labour Employed Sawmill Labourer Unskilled/Labour Employed Sawmill Employee Labourer Unskilled/Labour Employed Sawmill Hand Labourer Unskilled/Labour Employed Sawmill Laborer Labourer Unskilled/Labour Employed Shingle Mill Labourer Unskilled/Labour Employed Shingle Mill Hand Labourer Unskilled/Labour Employed Shingle Sawyer Labourer Unskilled/Labour Employed Shinglemill Hand Labourer Unskilled/Labour Employed Ship Yard Laborer Labourer Unskilled/Labour Employed Shipyard Labourer Unskilled/Labour Employed Shipyard Worker Labourer Unskilled/Labour Employed Shoe Black Labourer Unskilled/Labour Employed Stableman Labourer Unskilled/Labour Employed Steel Labourer Unskilled/Labour Employed Steelworker Labourer Unskilled/Labour Employed Sugar Packer Labourer Unskilled/Labour Employed Tile Setter Labourer Unskilled/Labour Employed Tool-Sharpener Labourer Unskilled/Labour Employed Watchman Labourer Unskilled/Labour Employed Worked in Brass Foundry Labourer Unskilled/Labour Employed Working in Shipyards Labourer Unskilled/Labour Employed Working Man Labourer Unskilled/Labour Employed Yardman Labourer Unskilled/Labour Employed J.V.L. Laundry Laundry Unskilled/Labour Employed Laundress Laundry Unskilled/Labour Employed Laundry Laundry Unskilled/Labour Employed Laundry Driver Laundry Unskilled/Labour Employed Laundry Employee Laundry Unskilled/Labour Employed
128 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Laundry Hand Laundry Unskilled/Labour Employed Laundry Shipper Laundry Unskilled/Labour Employed Laundry Worker Laundry Unskilled/Labour Employed Laundryman Laundry Unskilled/Labour Employed Steam Laundry Laundry Unskilled/Labour Employed Hand Logger Logger Unskilled/Labour Employed Logger Logger Unskilled/Labour Employed Logger, Prospector Logger Unskilled/Labour Employed Loggery Contractor Logger Unskilled/Labour Employed Logging Logger Unskilled/Labour Employed Longshoreman Longshoreman Unskilled/Labour Employed Coal Miner Miner Unskilled/Labour Employed Coal Passer Miner Unskilled/Labour Employed Copper Miner Miner Unskilled/Labour Employed Gold Miner Miner Unskilled/Labour Employed Miner Miner Unskilled/Labour Employed Miner and Promoter Miner Unskilled/Labour Employed Miner and Prospector Miner Unskilled/Labour Employed C.P.R. Railway Unskilled/Labour Employed Carman, CPR Railway Unskilled/Labour Employed Conductor Railway Unskilled/Labour Employed Freight Checker Railway Unskilled/Labour Employed Freight Handler Railway Unskilled/Labour Employed Railroad Construction Railway Unskilled/Labour Employed Railway Conductor Railway Unskilled/Labour Employed Railway Foreman Railway Unskilled/Labour Employed Railway Freeman Railway Unskilled/Labour Employed Railway Porter Railway Unskilled/Labour Employed Railway Switchman Railway Unskilled/Labour Employed Roadmaster, CPR Railway Unskilled/Labour Employed Sectionman Railway Unskilled/Labour Employed Stationman Railway Unskilled/Labour Employed Street Railway Conductor Railway Unskilled/Labour Employed Switchman Railway Unskilled/Labour Employed Track Watchman Railway Unskilled/Labour Employed Train Dispatcher Railway Unskilled/Labour Employed Train Master Railway Unskilled/Labour Employed Trainman Railway Unskilled/Labour Employed First Mate on Steamboat Sailor Unskilled/Labour Employed Marine Man Sailor Unskilled/Labour Employed
129 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Marine Master Sailor Unskilled/Labour Employed Mariner Sailor Unskilled/Labour Employed Master Mariner Sailor Unskilled/Labour Employed Mate on Boat Sailor Unskilled/Labour Employed On Boat Sailor Unskilled/Labour Employed On Ship Sailor Unskilled/Labour Employed S.S. Officer Sailor Unskilled/Labour Employed Sailor Sailor Unskilled/Labour Employed Sea Captain Sailor Unskilled/Labour Employed Seaman Sailor Unskilled/Labour Employed Ship Steward Sailor Unskilled/Labour Employed Steamboat Captain Sailor Unskilled/Labour Employed Retired Soldier Soldier Unskilled/Labour Employed Returned Soldier Soldier Unskilled/Labour Employed Soldier Soldier Unskilled/Labour Employed Soldier in Active Service Soldier Unskilled/Labour Employed Soldier, Air Force Mechanic Soldier Unskilled/Labour Employed Specialist on Explosives Soldier Unskilled/Labour Employed At School Child Child Unemployed Child Child Child Unemployed Father: any occupation Child Child Unemployed Infant Child Child Unemployed Mother: any occupation Child Child Unemployed None Child Child Unemployed Orphan (Father: Soldier) Child Child Unemployed Parents: Not Known Child Child Unemployed School Child Child Unemployed Schoolboy Child Child Unemployed Stillborn Child Child Unemployed Student Child Child Unemployed At Home Homemaker Homemaker Unemployed Helping at Home Homemaker Homemaker Unemployed House Homemaker Homemaker Unemployed House Duties Homemaker Homemaker Unemployed Housewife Homemaker Homemaker Unemployed Houswife Homemaker Homemaker Unemployed Married Housewife Homemaker Homemaker Unemployed Mother's Help Homemaker Homemaker Unemployed Widow Homemaker Homemaker Unemployed Widow, Invalid Homemaker Homemaker Unemployed
130 Occupation ReCode Employed/ Occupation Occupation ReCode Reduced Unemployed Invalid Invalid Invalid Unemployed Invalid at Hospital Invalid Invalid Unemployed Old People's Home Retired Retired Unemployed Retired Retired Retired Unemployed Retired Housewife Retired Retired Unemployed At School Student Student Unemployed College Girl Student Student Unemployed Highschool Boy Student Student Unemployed Highschool Pupil Student Student Unemployed In School Student Student Unemployed Schoolboy Student Student Unemployed Student Student Student Unemployed Not Employed Unemployed Unemployed Unemployed Unemployed Unemployed Unemployed Unemployed Married Married Unknown Unknown ? Unknown Unknown Unknown [Illegible] Unknown Unknown Unknown ** Unknown Unknown Unknown Campbell Storage Co Unknown Unknown Unknown Compositor Unknown Unknown Unknown Illegible Unknown Unknown Unknown Manned Trainer Unknown Unknown Unknown Manufacturer Unknown Unknown Unknown Manufacturer's Agent Unknown Unknown Unknown Manufacturing Representative Unknown Unknown Unknown N/A Unknown Unknown Unknown Not Known Unknown Unknown Unknown Penitentiary Unknown Unknown Unknown Private Hospital Unknown Unknown Unknown Religious Unknown Unknown Unknown Shipfitter Unknown Unknown Unknown Spinster Unknown Unknown Unknown Spruce Camp Unknown Unknown Unknown Steam Ship Passenger Unknown Unknown Unknown Vancouver Lumber Co Unknown Unknown Unknown Vulcanizer Unknown Unknown Unknown Worked at Specialty (?) Unknown Unknown Unknown
131 A.3 Coding for Birthplace
Birthplace Recode Birthplace Birthplace ReCode Reduced China China Asia India India Asia Japan Japan Asia Agassiz, BC BC Canada B.C. BC Canada BC BC Canada Bella Coola, BC BC Canada Britannia Beach BC Canada Britannia Mine BC Canada British BC Canada British Columbia BC Canada Chilliwack, BC BC Canada Grand Forks, BC BC Canada Kamloops, BC BC Canada Kelowna, BC BC Canada Ladysmith, BC BC Canada Maple Ridge, BC BC Canada Massett, BC BC Canada Nanaimo, BC BC Canada New Westminster, BC BC Canada North Vancouver BC Canada Port Moody, BC BC Canada Port Simpson BC Canada Powell River, BC BC Canada Ruskin, BC BC Canada Squamish, BC BC Canada Steveston, BC BC Canada Victoria, BC BC Canada Alberta Canada Canada Calgary Canada Canada Canada Canada Canada Cape Briton Canada Canada Charlottetown, PEI Canada Canada Manitoba Canada Canada Montreal Canada Canada New Brunswick Canada Canada Newfoundland Canada Canada Nova Scotia Canada Canada
132
Birthplace Recode Birthplace Birthplace ReCode Reduced Ontario Canada Canada Oshawa Canada Canada Ottowa, Ontario Canada Canada PEI Canada Canada Prince Edward Island Canada Canada Quebec Canada Canada Saskatchewan Canada Canada Toronto, Ontario Canada Canada Vermillion, Alberta Canada Canada Winnipeg Canada Canada Yukon Territory Canada Canada Eburne South Vancouver Canada South Vancouver South Vancouver Canada Vancouver Vancouver Canada Alsace Loraine Europe Europe Austria Europe Europe Belgium Europe Europe Carvatia Europe Europe Croatia Europe Europe Dutch Europe Europe France Europe Europe Germany Europe Europe Greece Europe Europe Holland Europe Europe Hungary Europe Europe Italy Europe Europe Montenegro Europe Europe Poland Europe Europe Portugal Europe Europe Romania Europe Europe Russia Poland Europe Europe Serbia Europe Europe Spain Europe Europe Switzerland Europe Europe Turkey Europe Europe Turkey Europe Europe Russia Russia Europe Denmark Scandinavia Europe Finland Scandinavia Europe
133
Birthplace Recode Birthplace Birthplace ReCode Reduced Iceland Scandinavia Europe Norway Scandinavia Europe Sweden Scandinavia Europe South Africa Africa Other Australia Australia Other Melbourne, Australia Australia Other New Zealand Australia Other Phillippines Australia Other Tasmania Australia Other British West Sudies Caribbean Other Cuba Caribbean Other Jamaica Caribbean Other West Indies Caribbean Other Addington Other Other Armenia Other Other Born at Sea Other Other Boswaine Other Other Dawson Other Other Northumberland Other Other Syria Other Other Chili South America Other Alderny Channel Island England UK England England UK Isle of Man England UK Jersey Channel Isles England UK New Castle-on-Tyne England UK Ireland Ireland UK North Wales Ireland UK S. Wales Ireland UK South Wales Ireland UK Wales Ireland UK Glasgow Scotland UK Scotland Scotland UK Illegible Unknown Unknown Not Known Unknown Unknown Unknown Unknown Unknown Alabama, USA USA USA Alaska, USA USA USA Alaska, USA USA USA
134
Birthplace Recode Birthplace Birthplace ReCode Reduced Arkansas, USA USA USA Buffalo, NY USA USA California USA USA California, USA USA USA Chicago, IL, USA USA USA Cleveland, Ohio USA USA Colorado, USA USA USA Connecticut, USA USA USA Illinois, USA USA USA Indiana, USA USA USA Iowa, USA USA USA Kentucky, USA USA USA Louisiana, U.S.A USA USA Maine, USA USA USA Maryland, USA USA USA Massachussetts, USA USA USA Michigan, USA USA USA Minnesota, USA USA USA Missouri, U.S.A. USA USA Montana, USA USA USA New Denver USA USA New Hampshire, USA USA USA New Jersey, USA USA USA New York, USA USA USA North Dakota, USA USA USA Ohio, USA USA USA Oklahoma, USA USA USA Oregon, USA USA USA Pennsylvania, USA USA USA Probably USA USA USA South Carolina, USA USA USA South Dakota, U.S.A. USA USA Tennessee, USA USA USA U.S.A. USA USA United States USA USA USA USA USA Utah, USA USA USA Vermont, USA USA USA Washington, USA USA USA
135
Birthplace Recode Birthplace Birthplace ReCode Reduced Wisconsin, USA USA USA
A.4 Coding for Place of Death Code Includes Residence and place of death are the same, or living Home at place of death for more than 1 month (unless a hospital or hotel)
Roycroft Hospital, Vancouver General Hospital, St. Paul's Hospital, Chinese Hospital, Infants Hospital, Bute St Hospital, Fairmont Military Hospital, Hospital Granview Hospital, Salvation Army Hospital, St. Luke's Hospital, Cedar Cottage Hospital, Beckett's Private Hospital, Shaugnessy Hospital
Other-street corners, ships, water bodies, misc. sites, Other misc addresses where people had been for less than a month, schools
A.5 Coding for Residence RESIDENT
If person had been at place of death (address only) for 1 month or more considered that "home" and therefore their residence. If person had been at place of death less than a month used address or city in residence column as their residence recode
Any listed address; except those that showed up outside the city boundary as per the GIS map
A.6 Coding for Immigrant Status IMMIGRANT STATUS Anyone born in Canada = Non-Immigrant Anyone born outside of Canada = Immigrant
136 A.7 Coding for Race RACE* Used "Race" category and the birthplace of the parents from the death certificates to determine ethnicity. Assumed people born in Canada, USA, Australia, Europe were Caucasian unless otherwise specified in the “race” column. If one birthplace was non-Caucasian assume case was non-Caucasian even if “race” was “English”. If the race says, for example, “black” then assumed non-Caucasian even if both birthplaces suggest Caucasian (i.e. birthplace in Canada, USA, Australia, or Europe). If the race was "unknown" but both parents were from USA, Canada, or Europe assumed Caucasian.
If birthplace and race left blank or unknown, race left as unknown.
*Note: There were a lot of assumptions included in the coding of this variable as the definition of race was not consistent across the death certificates. As such no conclusions can clearly be drawn based on this variable. This variable was included initially to get an indirect measure of socio- economic status but other variables such as immigrant status provide a better indication as fewer assumptions were required for categorization.
137
Appendix B: Immigrant Proportions
Table B.1. Proportion of Vancouver immigrants 19-39 and employed in1918-1919 Non- Variable Immigrant Immigrant Total Age Categorya 19-39 551 (53.0) 223 (24.3) 774 (39.6) Total 1,040 (100.0) 917 (100.0) 1,957 (100.0)*
Employment Statusb Employed 606 (60.4) 265 (31.8) 871 (47.4) Not Employed 397 (39.6) 569 (68.2) 966 (52.6) Total 1,003 (100.0) 834 (100.0) 1,837 (100.0)* Note: numbers in brackets are column percents. a. There are 23 missing cases. b. There are 143 missing cases.
138
Appendix C: Socio-Demographic Characteristics
Figure C.1. Influenza deaths by socio-demographic characteristics 1918-1919
Legend
80 year and above 0-7days 60-79 years 15 years or more in Canada 40-59 years Non-Resident Non-Caucasian 8days- 18 years Not Employed
Female Demographic Characteristic Demographic
- Life in Canada Non-Immigrant Socio Less than 15 years in Canada Employed Immigrant Male 19-39 years 0 200 400 600 800 1000 Resident Caucasian Number of Influenza Deaths 1918-1919
139 Table C.1. Socio-demographic characteristics and number of influenza deaths in the City of Vancouver, 1918-1919. Number of Influenza Socio-Demographic Characteristic Deaths Caucasian 976 Resident 968 19-39 years 741 Male 730 Immigrant 705 Employed 673 Less than 15 years in Canada 512 Non-Immigrant 439 Life in Canada 439 Female 437 Not Employed 435 8days- 18 years 190 Non-Caucasian 188 Non-Resident 157 40-59 years 157 15 years or more in Canada 124 60-79 years 40 0-7days 20 80 year and above 5