The Hungerford Smallpox Epidemic of 1884

On October 22, 2009, the Ontario Heritage Trust and the Tweed & Area Historical Society unveiled a provincial plaque at Lions Hungerford Hall in Tweed, Ontario, to commemorate the Hungerford Smallpox Epidemic of 1884.

The bilingual plaque reads as follows:

THE HUNGERFORD SMALLPOX EPIDEMIC OF 1884

The viral disease of smallpox — widespread in 19th century Ontario — flared up in a severe epidemic in Hungerford Township in 1884. The outbreak claimed at least 45 lives in 202 reported cases and disrupted economic activity and family life for many more. Local efforts by municipal authorities and private physicians were initially unable to halt the disease, and its wider spread throughout the province seemed likely. The newly established Provincial Board of Health and its hired officers swiftly undertook fumigation, enforced isolation and mass vaccination. The disease was contained, proving the value of public health measures applied consistently under coordinated direction. The Hungerford experience demonstrated the importance of quality vaccine, reliable supplies and skilled vaccinators. The Board’s actions in 1884 transformed Ontario’s approach to disease control when over 400 local boards of health were formed to assist in the delivery of essential medical services. As a result, Ontario earned an international reputation as an aggressive and innovative public health advocate during the mid-1880s.

L’ÉPIDÉMIE DE VARIOLE DE 1884 À HUNGERFORD

Historical background

Introduction: Smallpox and epidemic control before 1884

Smallpox was a common affliction in late 19th-century Ontario — an endemic disease whose scarred victims survived as testaments to the pox's inevitability. Although Dr. Edward Jenner¹ discovered the scientific principles of vaccination and a smallpox vaccine in the late 18th century, these had never been systematically practiced in Ontario.² A Vaccination Act had been enacted in 1861, but compliance was voluntary and official vaccination requirements varied greatly between communities. This tolerance for a disease that could be controlled was rooted in a tradition of inevitability and supported by a comparatively low death rate. Inaction appeared to be preferable when compared to the public cost of community programs and facilities that might be underused or idle. Moreover, at that time vaccination was widely acknowledged to be a decidedly unpleasant procedure frequently causing malaise, fever, sore arms and other symptoms severe enough to require confinement. Sophisticated technologies required to create a pure vaccine that would protect people were not available, nor were the rigorous cond-itions for successful completion of vaccination adequately understood by health professionals and the public.

Imperfectly practised and indifferently supported, vaccination conferred erratic community protection, making isolation facilities imperative for the inevitable outbreaks of disease. Fear of contagion provided a natural isolation for smallpox victims, who were informally denied all normal community interaction. But this natural isolation was uncontrolled and unsatisfactory. It bred fear rather than controlling it and encouraged irrationality in attitudes toward disease. Public notices of quarantine victims at home or sequestering in separate buildings set aside solely for isolation purposes provided a degree of community peace of mind by identifying specific areas of contagion and, by implication, freed others from suspicion.

Given the uneven practices in vaccination and rudimentary isolation facilities, outbreaks of epidemic smallpox were inevitable as well as unpredictable. When an epidemic flared up it was tackled more or less vigorously at the local level with traditional tools: free public vaccination for the unprotected and confinement in a temporary "pest house" or isolation hospital for victims. But both public vaccination and local isolation services were episodic. More often than not, they were hastily established after an epidemic appeared and were usually imperfectly applied and poorly funded. Consequently, their success was not guaranteed and they were never widely supported by the public.

In the late 1880s, a series of smallpox epidemics had a profound effect on the development of public health measures and services in Ontario. Epidemics of smallpox in Windsor (1882), Ayr, Peterborough, Prince Arthur’s Landing (1883, 1884) and Hungerford Township (1884) challenged the credibility and competence of Ontario's new and yet untested Provincial Board of Health, a central advisory group of medical professionals appointed by Oliver Mowat's government in May 1882. Over the next three years, the Board's aggressive actions in response to smallpox transformed Ontario's public health structures and challenged traditional attitudes. In particular, the Hungerford epidemic in the autumn of 1884 was the catalyst for the provision of direct health services by the provincial government.

Prior to this, responsibility for dealing with threats to the health of Ontario’s population, especially in times of epidemics, was divided among various levels of government and community organizations. Apart from immigrant quarantine, which was a long-standing responsibility of the federal government, disease control and other measures for protecting public health were municipal responsibilities officially mandated by the Public Health Act of 1873, but met by each community according to its perception of need. There was virtually no inter-municipal cooperation except in times of an officially declared emergency when the provincial government could appoint a central coordinating health board.

During the late 1870s, a vocal public health lobby campaigned to make the province more directly involved with health and disease control. Public Heath Acts were passed in 1873 and 1882. The latter act created a permanent, albeit unpaid, central Board of Health. But the approved public health code embodied in the acts of 1873 and 1882 reflected a continuing preference for local action. As a result, permissive legislation produced a patchwork pattern of public health arrangements. There was growing official uneasiness about the value of local options when epidemics threatened two or more municipalities. A third Public Health Act, passed in the spring of 1884, effectively ordered all municipalities to establish a local board, while the Provincial Board of Health was assigned extraordinary discretionary powers for public health action in crisis situations, a power previously assigned to the provincial government alone.³

Following passage of the act in May 1884, over 400 local boards of health were organized. Chair of the Provincial Board of Health, Dr. William Covernton, and its dedicated Secretary, Dr. Peter Bryce, pointed out that by the summer of 1884 nearly 75 per cent of the province’s population had been placed under "sanitary surveillance."⁴ Less public attention was devoted to provisions that assigned unusual discretionary powers of epidemic surveillance to the Board to be held on a continuing basis and exercised without special proclamation. The much-touted establishment of municipal boards of health was less important in smallpox control than the discretionary powers of the Provincial Board, which were soon used to authorize direct central intervention into local health matters.

The Hungerford Smallpox Epidemic: October to December 1884

The Hungerford epidemic of 1884 was the first serious epidemic crisis Ontario faced under its new regime of locally enforced, consolidated health laws. Despite the strengthening effects of the 1884 act, local action was perceived to be inadequate to prevent the spread of contagion into other parts of the province.⁵ No longer required to secure a special proclamation of emergency, the Provincial Board of Health undertook direct action to ensure strict conformity with sanitary laws, seeking political endorsement ex post facto.⁶ Their interventionism, however much justified by the current crisis, was severely criticized by local residents and members of the legislature, both for its costly nature and its unbalancing effect on local institutions, which more and more appeared subordinate to the growing authority of the Central Board.

On November 17, 1884, Secretary Bryce received a telegram from one of the Board's sanitary correspondents, Dr. W.A. Dafoe of Madoc, reporting the existence of a serious epidemic of smallpox in Hungerford. Located 48 kilometres (30 miles) up the Moira River from Belleville on the edge of the Canadian Shield, Hungerford was a sparsely populated rural township with no formal public health organization. The isolation of the community had provided a natural protection for Hungerford, which had weathered epidemics in the past. In the summer of 1884, a case of smallpox was misdiagnosed in Belleville as the "black measles." The victim moved north into the Hungerford region and by October 1884 the disease had spread amongst a mobile harvesting population and moved into neighbouring townships. As reports of the outbreak reached surrounding areas there was acute concern about a general epidemic in the province, which was served by recently developed rail and road connections through Hungerford.

In the absence of strong municipal direction, local physicians were the first line of defence. They were reluctant, however, to assume public initiative in their communities. With no prospect of financial compensation, they were hesitant to jeopardize their own practices by attending the early victims who were confined to the poorer farms in the francophone part of the township.⁷ The Reeve of Hungerford, Patrick Murphy, inexperienced in epidemic matters and unable to organize local efforts, requested that the Provincial Board of Health send its secretary, Dr. Peter Bryce, to Hungerford to advise on control measures. Bryce made three visits to Tweed and surrounding communities in November and December of 1884. He oversaw the establishment of local health boards, and later directed the work of specially commissioned inspectors and sanitary police secured from senior classmen at the University of Toronto. Dr. T.E. Pomeroy was chosen as the newly appointed medical officer of health. Direct action by the Provincial Board of Health was perceived as necessary to calm the mounting panic that accompanied Dr. Pomeroy’s travels throughout the region, and to ensure the rigorous application of scientific principles in controlling "what has been the severest outbreak of smallpox, which in so short a space of time, has within the past years afflicted any single locality in Ontario."⁸ Before the epidemic was fully under control it claimed the lives of over 45 residents, and in excess of 200 people were infected in Hungerford.⁹

Working with Dr. Pomeroy, Bryce's men systematically vaccinated the population, ran the isolation hospitals at Stoco and Marlbank, and ensured the strictest embargo on rail and road transportation of goods and people from the infected area. Many tried to avoid the embargo by using little-known back roads out of the township, but these were patrolled by sanitary police who turned back suspected traffic. Anti-vaccination sentiment was stirred up by a certain Mr. Maxwell "practising medicine empirically in the district" and there was an undercurrent of dissatisfaction with compulsory vaccination and fumigation of premises, which created economic hardship only met by charitable relief efforts.¹⁰ Local communities and the province relied on charities, especially those operated by local churches, to cushion the economic impact of measures imposed by the provincial authority. Public meetings were forbidden, schools closed, and the local election, although not forbidden, was effectively stalled by a proclamation-like notice, implying an official interdict.

The success of epidemic control in Hungerford in the fall and winter of 1884-85 minimized the spread of smallpox to other centres of population. Techniques for control first employed by the Board in Hungerford were used on an even wider scale the following year to protect Ontario and areas further west from the spread of smallpox from Montreal, where the disease claimed over 3,000 lives in 1885.

By the spring of 1886, when the threat of an outbreak of smallpox carried from Montreal had faded, government medical services in Ontario had been materially transformed. No longer a permissive code applied locally by irregular health workers who were strongly influenced by community attitudes to disease, Ontario's new health regime boasted a uniform health code framed by the new Provincial Board to guide consistent local application by professional public health workers. Moreover, in addition to central supervision and record-keeping, government intervention in the medical market was first accepted as legitimate to provide uniform service provincewide to all communities regardless of their divergent municipal resources.

The cost borne by Hungerford Township seemed the most inequitable aspect of the 1884 epidemic crisis. Although Bryce went to some lengths to demonstrate that the per capita cost of controlling the epidemic was much less than those incurred in American jurisdictions, it appeared mean-spirited if not unjust for a small and relatively poor township to bear the total financial burden of over $11,000 for epidemic control that also benefited the rest of the province.¹¹ After its experience in Hungerford, the Ontario Government would bear most of the cost of smallpox work in future, particularly in remote municipalities that were least able to fund health services and were in many ways the most susceptible to disease.

New roads for public medicine in Ontario

Whatever the political tensions created in Ontario by a central Board of Health with the power to intervene, its swift action earned the province a high reputation in international circles and laid the basis for international cooperation on disease reporting, which was readily accepted because of the mutual trust created by Ontario's response in 1884-85. Far from remaining the solitary provincial exponent of public health, the Board laid the groundwork for appointments of local health officers through the Public Health Amendment Act of 1885. Informal ties that developed in the course of combating smallpox in 1884 and 1885 were institutionalized in 1886 as the Association of Executive Health Officers. This alliance of professional public health officials met annually thereafter to discuss common problems and to establish workable programs for provincewide application.

Ontario's health officers, in retrospect, looked upon the smallpox crises of 1884 and 1885 as critical events that shaped government handling of disease outbreaks for years to come. In particular, official control measures encouraged public awareness and acceptance of isolation and mass vaccination. A major source of uncertainty about vaccination and opposition to its compulsory performance was identified immediately: the unpredictable quality of vaccine.¹² Serious complaints about bad or useless vaccine were frequent enough to prompt an inquiry by the Public Accounts Committee of the Legislature in 1885. Unable to assign fault or responsibility, the Committee, prompted by Bryce, voted to appropriate funds to support the operations of a separate vaccine farm in Ontario. This farm would, in theory, provide bovine virus of assured quality and remove Ontario's dependence on foreign sources.

The uncompromising actions of the Board of Health to control the spread of smallpox in 1884 through compulsory vaccination, rigorous isolation of cases and contacts, and the fumigation of premises and goods, helped reduce public indifference to smallpox.¹³ In their haste to protect a wider public in the province, public physicians, such as the local medical officer of health or Bryce's hired sanitary inspectors, were perceived as too quick to diagnose questionable cases as smallpox in order to remove possible threats within an isolation facility.¹⁴ Unfortunately, there were occasions when the case truly was not smallpox. The victim, confined to an isolation hospital, was then inadvertently brought into contact with genuine cases of the disease.¹⁵ During the Hungerford epidemic, one such confinement resulted in death. Public confidence in physicians whose calling was state medicine, was tempered occasionally by a strong sense that what was best for the wider public was not always best for the individual.

More and more, the province would be drawn into the medical market. Fluctuating demands for mass vaccination services and public isolation facilities made it impossible to maintain consistent levels of service based on local supply and delivery. As a protagonist of public health medicine, the central Provincial Board frequently had to act to bridge municipal gaps in the interests of safety for a wider public. Experience gained in 1884 and 1885 encouraged the province to hire physicians to provide necessary medical services, particularly in isolated areas and unorganized territories.

Conclusion

For Ontario, the experience of the smallpox epidemic in Hungerford, followed quickly by the Montreal epidemic, marked the beginnings of provincial government activity into areas that had previously been locally regulated or handled privately. Experience gained in 1884 and 1885 encouraged the province to hire physicians to provide necessary medical services. After the outbreak in Hungerford, the Ontario government would bear the majority of costs associated with smallpox work, particularly in frontier municipalities that were least able to fund health services. The 1884 crisis also emphasized the importance of quality vaccine, reliable supplies and skilful vaccinators. A new understanding of contagion and the benefits of systematic and enforced isolation followed by fumigation and disinfection evolved, and an increase in public awareness of these responses occurred. The Ontario government was encouraged to strengthen the Vaccination and Public Health Acts to ensure better and consistent response to epidemic threats in all communities throughout the province. During this period, the Provincial Board of Health entered the medical market as a producer, supplier and provider of medical services. In 1886, the province voted to provide tax support for vaccine production in the province. Also in that same year, the Association of Executive Health Officers was created out of informal ties that had developed during the course of combating smallpox in 1884 and 1885. In addition, Ontario earned an international reputation as an aggressive and innovative public health exponent.

The Ontario Heritage Trust gratefully acknowledges the research of Robert J. Burns in preparing this paper.

© Ontario Heritage Trust, 2009

¹ English surgeon (1749-1823). Fellow of the Royal Society. Jenner made his initial discovery in 1796 and published his findings in 1798.

² An Act Respecting Vaccination and Inoculation R.S.O. Cap.191 expressly forbade the practice of inoculation. It clearly established medical and personal responsibilities for vaccination but left serious loopholes by giving municipal councils and not local boards of health powers under the act. Deficiencies in the act aside, community vaccination practices were erratic and re-vaccination was rarely practised. Archives of Ontario (hereafter cited as AO), R.G. 18, D-1-13, Select Committee on Public Health, Boxes 2 and 3. Fourth Annual Report of the Provincial Board of Health (Toronto, 1886), 2, (hereafter cited as Board Annual Report).

³ 47 Victoria Cap. 38 Pt. 1, Sec. 3 established the powers of the Provincial Board of Health to make regulations for the prevention or mitigation of disease “whenever this Province or any part thereof or place therein appears to be threatened with any formidable epidemic, endemic, or contagious disease …”.

⁴ Board Annual Report 1884, 18.

⁵ “Special Report on the Hungerford Outbreak”, Sessional Papers #25, 1885, (hereafter cited as Sessional Papers/25).

⁶ Meaning ‘having a retrospective effect’, derived from the Latin; ex from + post ‘afterwards’ + factus ‘done’, from facere ‘to do’. Sessional Papers/25, 5, Newspaper Hansard 4 February 1885, Journal of the Legislative Assembly of Ontario, Sessional Paper 49 “Public Accounts” 304.

⁷ Sessional Papers/25, 2; Weekly Intelligencer (Belleville) 20 November 1884; Newspaper Hansard 4 February 1885. Although the Provincial Board of Health initially endeavoured to use local physicians to control epidemics, reliable service was not always available and some doctors were not willing to undertake hazardous temporary work for the province that might effect their private practice and regular livelihood.

⁸ Sessional Papers. 1885, 2.

⁹ The number of government-recorded deaths in Hungerford, Sheffield, Elzevir and Kaladar Townships is 45. However, local churches, cemeteries and family records indicate a higher number of fatalities. As an example, the records of St. Carthagh’s Roman Catholic Church, Tweed, show 67 deaths.

¹⁰ Compulsory vaccination, isolation of people infected with smallpox and fumigation of premises had a negative effect on the livelihood of people. Many farmers and rural workers experienced economic hardship for which there was no compensation. Anti-vaccination sentiment was always latent when neither the quality of vaccine nor the skill of vaccinators was reliable. See Evening News (Toronto) 8 December 1885.

¹¹ Newspaper Hansard 4 February 1885, AO R.G. 8 I-1-D 1686/1885; and Sessional Papers 25/1885.

¹² Board Annual Report 1886, 36. AO R.G. 62 H Minutes, Volume 49, 275-277.

¹³ It should be noted, however, that public acceptance to immunization continued to be challenged by aggressive anti-vaccinationism views that flourished well into the 20th century and impacted latent opposition to other public health measures.

¹⁴ See reflections of Dr. Coventry, Medical Officer of Health for Windsor, in Health Officers Report 1901, 9 and Newspaper Hansard 4 February 1885 and Medical Officers Report 1901, 11.

¹⁵ Ibid.

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The Hungerford Smallpox Epidemic of 1884