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Review

Dr. Fred and the Spanish Lady: Fighting the Killer Flu

By Betty O'Keefe, Ian Macdonald

November 4, 2013

Review By Mona Kaiser

As the title suggests, Dr. Fred and the Spanish Lady is an account of the 1918 influenza pandemic as it swept through Vancouver and ran into preparations made for it by the city’s first full-time public health officer, Dr. Fred Underhill. The premise of the book appears to have been the medical response of Underhill, a Scottish-born physician with a strong interest in public health. However, as with most accounts of the Spanish flu, the drama of the pandemic overwhelms the work’s original intent. As a result, the book expands in both length and breadth and becomes a recounting of the pandemic’s toll throughout British Columbia and elsewhere in Canada as well as an overview of current pandemic preparations in the face of present-day anxiety over avian flu. While neither an epidemiological study of the pandemic nor a comprehensive historical account of the flu in Vancouver or British Columbia, the work does illuminate an interesting, and little known, BC figure and his role in shaping public health policies in the early years of this province.

Authors Betty O’Keefe and Ian Macdonald come from careers in journalism and have collaborated on several historical works published by Heritage House. Dr. Fred and the Spanish Lady follows their format of celebrating the pioneer spirit and the colourful history of western Canada. While accounts of Dr. Fred veer uncomfortably close to adulation – “adversity has a way of breeding heroes … When the deadly Spanish flu swept into Vancouver, fate decreed that there would be such a person on hand” (39) – the presentation of Underhill’s work for the City of Vancouver through his roles as medical health officer, police surgeon, city bacteriologist, and general public health advocate is notable. Appointed during years of rapid growth for Vancouver (pop. 40,000-110,000), Underhill was instrumental in pushing for a variety of progressive policies: upgrades to Vancouver’s water supply, organized garbage collection, formal quarantine practices and infectious diseases reporting, food handling regulations, and public education campaigns regarding personal hygiene and preventative medicine that helped to reduce Vancouver’s infant mortality to one of the lowest in North America (54).

Whether the authors’ suggestion that Underhill’s leadership during the 1918 pandemic was more successful than was that shown by his colleagues in Victoria or elsewhere in Canada is debatable. More than Underhill’s implementation of specific strategies during the pandemic, delayed exposure to the virus meant that Vancouverites gained valuable preparation time as the flu returned from Europe and eventually moved westward across Canada with soldiers returning from the Great War. The decisions to designate emergency hospitals, to enlist additional ambulance and nursing staff, and to improve disease reporting and quarantine policies were all the result of lessons learned from communities that had previously experienced the pandemic. Even with the benefit of time, however, pandemic preparations in Vancouver would ultimately prove inadequate. As O’Keefe and Macdonald note, Vancouver’s mortality rate figured as one of the highest for a major North American city (178). It is a statistic that begs analysis, but it is not explored within this work.

The pandemic chapters are perhaps the least illuminating of the book. Morbidity and mortality figures from communities around the province are listed inconsistently and seldom with the required measure of pre-pandemic population figures. The death tolls are indeed alarming but are rarely helpful in assessing the degree to which different communities experienced the flu. While historically unreliable population figures for First Nations and other non-white communities preclude an accurate assessment of mortality figures for these groups, an analysis of pre- and postpandemic numbers for groups with documented populations is possible and would be constructive. Although O’Keefe and Macdonald note that mining and logging communities were apparently harder hit by the flu than were other communities, incomplete population comparisons make this impossible to determine. However, if these groups were indeed more susceptible, an investi gation as to why this was so (barracks conditions, poor access to medical care, compromised lung function among miners?) might offer some insight into the nature of pandemic influenza.

It is certainly no longer possible to claim that influenza, and the 1918 pandemic in particular, has been over looked by historians. While historical and epidemiological work is unravelling some of the mysteries of the 1918 pandemic, the majority of accounts still follow the pattern of providing dramatic descriptions of the flu within individual communities. Dr. Fred and the Spanish Lady belongs to this group. The work is filled with gripping descriptions of the pandemic and its repercussions, as gleaned from the pages of community newspapers and felt by British Columbians before the benefit of socialized medicine, antibiotics, or even a widely accepted belief in germ theory. Revealing Underhill’s modern views on these subjects is one of the stronger points of the book.

Although not an academic work, Dr. Fred and the Spanish Lady provides a readable retelling of the 1918 pandemic as it affected Vancouver, and it intro duces readers to one of British Columbia’s early medical pioneers. Drawn from historical accounts and aimed at a popular audience, the book also chronicles a number of flu remedies tried in 1918. For the reader hoping to acquire some historical advice as a hedge against the next influenza pandemic, a surprisingly consistent theme came through the many anecdotal accounts, lay and medical alike: stock your home with fluids, take to your bed the moment your temperature rises, and stay there until fully recovered (71). Sound advice for any reader.