Medical Ottawa: Ottawa’s Smallpox Outbreak of 1911 and the Origins of the Hopewell Isolation Hospital

In Disease, History of medicine, Hospitals, Montreal Medicine, Ottawa Medicine by Kate Walker0 Comments

Porter Island, located on the Rideau River, was the site of a now largely forgotten isolation hospital, Hopewell Hospital, which officially opened its doors in February, 1913 against a background of preventable epidemic disease and public health policy changes in Canada. In 1911, while battling typhoid fever, Ottawa experienced an outbreak of smallpox, which prompted Mayor Charles Hopewell (1864 – 1931) to appeal to the Provincial Board of Health for assistance. He wired the request: “Please send officer at once. Great number smallpox cases coming here. Situation serious.”[1]

Porter's Island

Smallpox is – or was, as the World Health Organization declared the virus eradicated in 1979 following a successful containment and vaccination campaign that began in 1967 – an infectious disease caused by two variants (major and minor) of the variola virus, of which the variola major was a stronger version with higher mortality rates. Signs of infection began with flu-like symptoms: fever, fatigue, headache, vomiting, and backache. A few days after these symptoms, patients developed a rash on the face and extremities, which then spread on the body. In a small number of (usually fatal) cases, patients bled into the skin.[2] There is no cure for smallpox.

T. F. Ricketts, “The Diagnosis of Smallpox,” (Casell and Company, 1908), plate XLII, early pustules on the leg and foot in a case of unmodified smallpox. Link to source.

T. F. Ricketts, “The Diagnosis of Smallpox,” (Casell and Company, 1908), plate XLII, early pustules on the leg and foot in a case of unmodified smallpox. Link to source.

The arrival of smallpox to North America, carried by Europeans, was devastating, as Indigenous peoples lacked natural immunity to the virus; Europeans also deliberately spread the infection through contaminated ‘smallpox blankets.’[3] The Canadian Museum of Textile History has a short video explaining the use of the Hudson’s Bay Blanket for biological warfare in Canada.

Early methods of controlling smallpox included attempts to acquire a mild case of the disease, by feeding scabs from smallpox sores from an infected individual to family members or by transferring pus from the sores underneath the skin (this technique is called variolisation).[4] Edward Jenner’s Inquiry into the Causes and Effects of the Variolae Vaccine (1796) introduced the notion of vaccination.

Edward Jenner. Pastel by John Raphael Smith. Image from the Wellcome Library, Ref no.: ICV 18291. Link to source.

Edward Jenner. Pastel by John Raphael Smith.
Image from the Wellcome Library, Ref no.: ICV 18291. Link to source.

Jenner, who was inspired by milkmaids who had acquired cowpox and seemed to be resistant to smallpox, conducted an experiment by injecting an eight-year-old boy, James Phipps, with cowpox (vaccinia). Six weeks later, he inoculated the boy through variolisation: fortunately, Phipps did not get sick.[5]

Edward Jenner’s leaflet giving instructions for the vaccine inoculation of smallpox (London: D. N. Shury, 1801), image from the Wellcome Library London, Reference no.: EPB 303097/C/2. Link to source.

Edward Jenner’s leaflet giving instructions for the vaccine inoculation of smallpox (London: D. N. Shury, 1801), image from the Wellcome Library London, Reference no.: EPB 303097/C/2.

Smallpox vaccination spread through Europe and North America, although vaccination efforts were uneven.[6] There continued to be periodic outbreaks of the disease in Canada, particularly among indigenous and immigrant groups. In 1885, a particularly vehement epidemic killed more than 3,000 people in Montreal. Vaccination was controversial: the outbreak in Montreal led to riots over measures of control, which were wrapped up in fears that vaccination would spread, rather than prevent, smallpox, and were exacerbated by class and language conflicts.[7] The Museum of Health Care at Kingston features an online exhibition on ‘Vaccines and Immunization: Epidemics, Prevention and Canadian Innovation,’ including a section on Smallpox, which is an overview of the disease’s history in Canada.

The title page of A brief history of the small pox epidemic in Montreal from 1871 to 1880 and the late outbreak of 1885. Link to source.

The title page of A brief history of the small pox epidemic in Montreal from 1871 to 1880 and the late outbreak of 1885. Link to source.

In Ontario, partially in reaction to the Montreal epidemic, the government passed the Vaccination Act in 1887, which required that children be vaccinated at the age of three months and then every seven years thereafter when necessary. In addition, the Vaccination Act gave municipalities in Ontario the right to order general vaccination when facing an outbreak of the smallpox, and enabled local school boards to require pupils provide certificates of vaccination.[8]

In 1911, the outbreak of smallpox in Ottawa became a public health crisis, prompting Mayor Hopewell’s appeal for assistance from the Provincial Board of Health, which had been established in 1882.[9] The Globe and Mail reported on 5 April 1911 that there were 26 individuals with smallpox and that “twelve special police have been sworn in for quarantine duty.”[10] The following day, a Provincial Board of Health official, Dr. H. W. Bell, arrived in Ottawa. The Globe and Mail reported that Dr. Bell was “not alarmed at the presence of twenty-eight mild cases” in the city. According to the paper, “Owing to the great prevalence of the disease in the shanties, he says, it is only to be expected that a city in the centre of a lumbering district should be afflicted, due to cases coming down from the woods.”

After investigating in Ottawa for a period of a few days, however, the newspaper coverage reported a change in Bell’s attitude towards Ottawa’s public health efforts, declaring the measures the city had taken inadequate.  These had largely consisted of erecting hospital tents to isolate the infected individuals.[11] On 6 April 1911, The Globe and Mail informed their readership that the Bedford Apartments in Ottawa, which roomed about 40 individuals, were under quarantine for the second time in a week, as there was a new case of smallpox in the building, bringing the total of infected individuals to 27. Despite assurances in the paper the previous day that Dr. Bell would remain in Ottawa “as long as is necessary to see that proper measures are taken to prevent the spread of the disease,” the paper reported that there was also an outbreak of the disease in nearby Carleton Place with approximately 20 cases, and that Dr. Bell “has been ordered to proceed” to the city.[12]

Before leaving for Carleton Place, Bell “handed out to the Ottawa Health Department one of the stiffest roasts ever received by a local civic body. Bell severely condemned the lack of precaution against the spread of smallpox here, witnessed in loose quarantine enforcement and in some cases the entire absence of quarantining for several days after it should have been put in force.” Bell also criticized the conditions at the quarantine station on Porter Island, and “wound up by stating that unless dramatic action were taken at once the Ontario Health Department would put Ottawa under quarantine at the city’s expense, permitting no intercourse with the rest of the Province.”[13] Ironically, the paper advertised the services of Grand Trunk, which operated a train with a sleeper car going through Ottawa on its way from Toronto to Montreal, directly below the article describing Bell’s condemnation of Ottawa’s public health measures.

On 11 April 1911, Dr. J. W. S. McCullough, Ontario’s Medical Health Officer, informed the press that the outbreak “is now believed to be well under control.” He blamed the rise in smallpox cases (up to 38) on “the fact that sufficient care was not taken with the first cases. Still, the Doctor says, the officials think they have now checked the outbreak.”[14] On 14 April, the Ottawa Board of Health held a special meeting, during which they decided to ask the Mayor to “sign a proclamation for compulsory vaccination of all citizens.” The Globe and Mail reported, however, that there was a “considerable opposition to this move in the face of the statement that the smallpox situation has improved and that there are no new cases reported to-day.”[15]

Ottawa was far from alone in setting up isolation hospitals as a public health measure in the early twentieth century. In a contribution to the Canada Lancet, Dr. Robert E. Wodehouse, a Medical Health Officer in Ontario, wrote that “Isolation hospitals are a most important part of the equipment of a city department of health. The facilities of such hospitals to effectively quarantine all people suffering from communicable diseases, and also isolate perfectly one from another, is their first requisite. This second feature of perfect isolation of its compound parts, one from another, thus avoiding cross-infection, is a most important one.”[16] The existing isolation hospital on Porter Island, which had been in operation since 1902,[17] had several failings. The island had long been the site of a smallpox isolation hospital and its shortcomings were frequently debated by the board of health, but these discussions resulted in little action.[18] In his report of the Provincial Board of Health, John W. S. McCullough, Chief Officer of Health, confirmed that the facilities at Porter Island were insufficient, writing:

“On Porter’s Island about 300 yds. long and 50 to 100 yards wide lying in the Rideau River just below the St. Patrick’s St. bridge, and used as a dumping ground for city refuse (dry) was situated the Smallpox Hospital, a miserable old clapboard shack 20 x 24 ft. and 1½ stories high, with stove pipe running up the stairway so that one had to go on hands and knees to get underneath it to go upstairs.”[19]

In these conditions, 17 patients stayed in the hospital, “sleeping 3 in a bed,” and “cooking, eating and sleeping were going on, all in one room.”[20] In a small storage room, two nurses had a bed, but the same space was used to bathe patients.[21] One isolation tent had been set up, and “in it there were 10 patients fairly comfortable.”[22] He described these conditions in the Porter Island hospital as “disgraceful,” and “urged prompt measures to remedy them.”[23]

The following day, he met with the Board of Health and “insisted on immediate action in connection with further tent hospital accommodation, and prompt measures for public protection with any further patients, as the situation under the circumstances was serious and alarming.”[24] McCullough found the excuses of Ottawa’s Board of Health lacking and his report was scathing: “Various excuses were made for dilatoriness in action, until I finally had to threaten that if proper precautions to protect the public from exposure to the disease were not promptly taken, it might become necessary for the Provincial Board of Health to quarantine the city.”[25] His threat resulted in a small measure of action, as, according to his report, the city set up extra tents within two days of his meeting.[26] He concluded with his regrets that “much of the neglect and lack of prompt action arose through want of harmony among the health authorities.”[27]

Given the conditions on Porter Island, it is perhaps not surprising to hear of resistance to isolation. When faced with resistance, Ottawa’s health officials showed themselves willing to use force to transport individuals to Porter Island, as in the case of Mrs. Couvilion, a woman living on Langevin Avenue in 1912. According to a despatch by the Canadian Press, Couvilion, infected with smallpox, resisted attempts to send her to isolation at Porter’s Island in January 1912. After refusing to allow two public health officers into her home, they returned with a policeman. According to the report, “At the sight of the uniformed officer the door was opened, and the medical men found the woman had been suffering from smallpox for some time. She protested vigorously against going to the island, but, after some persuasion, she consented to go.” The men returned some time later with an ambulance, and, faced with the resistance from Couvilion, including a barricaded door. The article concludes by telling the reader that Couvilion was “taken by force”[28] by the police.

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The Hopewell Smallpox Isolation Hospital, 1912. Link to source.

In 1912, the Legislature of the Province of Ontario revised the Public Health Act and the Vaccination Act. In revisions to the Vaccination Act were undertaken in order to allow the Council to order compulsory vaccination and the requirement of certificates of vaccination from school children with the approval of the Local Board. The Act also imposed a fine for parents who did not vaccinate their children at the age of three months (at least in the case of parents who could not prove their child was too ill to receive the vaccination or, conversely, insusceptible to smallpox). The Act also allowed municipalities to require vaccination of its residents. In order to achieve these aims, the Vaccination Act required that all municipalities in Ontario appoint a public vaccinator to vaccinate individuals (there was a charge for this compulsory service, although individuals without financial means were to be vaccinated at the public’s expense). Furthermore, unlike contemporary Ontario,[29] the 1912 Vaccination Act did “not provide special means of exemption to the ‘conscientious objector,’ or invite each individual to avoid taking his share in the action which the State desires for the common good’.”

It was within this larger context of procrastination on the part of city officials, a preventable outbreak of smallpox in 1911, combined with resistance to, and disorganization surrounding, vaccination efforts, as well as growing public health legislation by the Province that the Hopewell Isolation Hospital opened in 1913.[30] The building of the hospital at Porter Island was not without its detractors. Before the smallpox outbreak of 1911, The Ottawa Citizen Two hundred concerned citizens attending a city council meeting in March, 1911, and several spokespeople argued that Porter Island was unsuitable as a site for the isolation hospital, suggesting that the island would be better suited as a public park. Dr. R. H. Parent also argued that Porter Island was not a remote enough location for the isolation hospital and, moreover, that “Ottawa should try to prevent smallpox by having a general vaccination. There had not been a general vaccination for ten years and if such was made compulsory now there might not be any need for a hospital.”[31]

The initial report regarding the new Hopewell Hospital from the Medical Officer of Health in Ottawa, Dr. T. A. Lomer (who took over for Dr. Shierreff in July of 1913), was positive, as “The Hopewell Hospital has proved extremely useful and a very valuable means of checking the spread of the disease in the city.”[32]  As of 31 October, 1913, the hospital housed 82 patients suffering from smallpox, as well as a handful of patients suffering from other diseases.[33]

Alfred G. Pittaway, “Female Ward, Hopewell Hospital,” 1912, gelatin silver print, Bytown Museum, P893e. Link to source.

Alfred G. Pittaway, “Female Ward, Hopewell Hospital,” 1912, gelatin silver print, Bytown Museum, P893e.

The fight for the use of Porter Island persisted. In 1927, for instance, Hopewell Hospital was considered as a site for a hospital to house incurable cancer patients.[34] To some extent, the closure of Hopewell Hospital was, in fact, likely due to prevention efforts, as the need for an isolation hospital for smallpox sufferers declined.

As the Canadian news media engages in debates surrounding vaccination in the wake of the measles outbreak in the winter of 2015, it is perhaps worthwhile to remember that enforcement of public health in the past was no less complicated than it is today. The background to the opening of the Hopewell Hospital reminds us that there is a long history in Canada of tensions between public health legislation and the reality of enforcement.

 

[1] As reported by The Globe and Mail. “Ottawa Wants Help to Fight Smallpox,” The Globe and Mail, 5 April 1911, p. 4.

[2] http://www.health.gov.on.ca/english/providers/pub/disease/smallpox.html.

[3] Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction (Toronto: University of Toronto Press, 1999), 177.

[4] Duffin, History of Medicine, 179.

[5] Robert Taylor, On the Shoulders of Medicine’s Giants: What Today’s Clinicians Can Learn from Yesterday’s Wisdom (New York; Springer, 2015), 88; Duffin, History of Medicine, 179.

[6] Katherine Arnup, “ ‘Victims of Vaccination?’: Opposition to Compulsory Immunization in Ontario, 1900-90,” CBMH/BCHM 9 (1992), 160.

[7] Duffin, History of Medicine, 180.

[8] Arnup, Opposition to Compulsory Immunization,” 160.

[9] Christopher Rutty and Sue C. Sullivan, This is Public Health: A Canadian History (Ottawa: Canadian Public Health Association, 2010), 1.7.

[10] “Ottawa Wants Help to Fight Smallpox,” The Globe and Mail, 5 April 1911, p. 4.

[11] “Infected from the Lumber Camps: Dr. Bell Not Surprised at the Outbreak of Smallpox in Ottawa,” (Canadian Press Despatch), The Globe and Mail, 6 April 2011, p. 11.

[12] “Ottawa’s Smallpox Epidemic,” The Globe and Mail, 7 April 1911, p. 11.

[13] “Ottawa Threatened with Isolation,” The Globe and Mail, 8 April 2011, p. 5.

[14] “Smallpox is Checked: Provincial Medical Health Officer Says Ottawa Cases are Under Control,” The Globe and Mail, 12 April 1911, p. 9.

[15] “Compulsory Vaccination,” The Globe and Mail, 15 April 1911, p. 5.

[16] Robert E. Wodehouse, M.D., “An Isolation Hospital Built and Operated by a City Department of Health,” The Canada Lancet, 888.

[17] Sheila Lloyd, “The Ottawa Typhoid Epidemics of 1911 and 1912: A Case Study of Disease as a Catalyst for Urban Reform,” Urban History Review / Revue d’histoire urbaine 8.1 (1979), 73.

[18] Lloyd, “The Ottawa Typhoid Epidemics,” 74, footnote 34.

[19] John W. S. McCullough, Thirteenth Annual Report of the Provincial Board of Health (for the year 1911), Published in the Ontario Sessional Papers (1912), 23.

[20] McCullough, Thirteenth Annual Report, 27.

[21] McCullough, Thirteenth Annual Report, 27.

[22] McCullough, Thirteenth Annual Report, 27.

[23] McCullough, Thirteenth Annual Report, 27.

[24] McCullough, Thirteenth Annual Report, 28.

[25]  McCullough, Thirteenth Annual Report, 28.

[26] McCullough, Thirteenth Annual Report, 28.

[27] McCullough, Thirteenth Annual Report, 28.

[28] “Smallpox Patient Resents Removal: Ottawa Woman Gives Health Officials Trouble – Barricaded the Doors,” The Globe and Mail, 30 January 1912, p. 13.

[29] Ontario and New Brunswick both require that school children be vaccinated (in other Canadian provinces vaccination is voluntary). The Ontario Immunization of School Pupils Act requires proof of immunization for a range of illnesses, but allows for medical and philosophical exemptions to vaccination.

[30] For an interesting blog that details the architecture of Hopewell Hospital (designed by Francis C. Sullivan, who was associated with Frank Lloyd Wright, see the post, “The Smallpox Hospital: Porter’s Island – Frank’s First Foray,” on the blog Urbsiste, 7 July 2014, http://urbsite.blogspot.ca/.

[31] “Hospital Site Still Unsettled,” The Ottawa Citizen 21 March 1911, p. 7.

[32] Thirty-Second Annual Report of the Provincial Board of Health of Ontario, Canada for the Year 1913, Printed by Order of the Legislative Assembly of Ontario (Toronto: Printed and Published by L.K. Cameron, Printer to the King’s Most Excellent Majesty, 1914). In the Ontario Sessional Papers, p. 230-232.

[33] Thirty-Second Annual Report of the Provincial Board of Health of Ontario, Canada for the Year 1913, Printed by Order of the Legislative Assembly of Ontario (Toronto: Printed and Published by L.K. Cameron, Printer to the King’s Most Excellent Majesty, 1914). In the Ontario Sessional Papers, p. 230-232.

[34] “Two Proposals About Hospitals for Incurables,” The Ottawa Citizen, 22 July 1927, p. 9.

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