2020 and Covid-19 ...
As we try to understand how to cope with the tragic consequences of this 21st century pandemic, we look to experts for guidance and their expertise to help us with strategies to minimize our personal exposure to infection, and ways to treat those of us who don't succeed. In Canada, we get advice from the federal governmant and Dr. Theresa Tam, while here in British Columbia, we are comforted by the words and advice of Dr. Henry, to "Be calm, be kind, and be safe." In the United States, informed citizens look to advice from Dr. Fauci, much to the dissatisfaction of President Donald Trump, who would rather see himself in the limelight. Although we have unparalleled access to 21st century science and research, nearing the end of the year 2020, an effective preventive vaccine still appears elusive, although a number of potentially promising vaccines are being developed "at warp speed", and may be available as soon as next year. In the meantime we are encouraged by all these experts to "Wear a mask! Wash our hands! Keep our social distance! And stay home unless absolutely necessary."
Hunkered down in our homes and basements, we may now have time to Google the past for some historical context about contagious diseases, about the bubonic plague, the Spanish flu, looking for words of wisdom from experts past. And Canadians need look no further than Dr. Montizambert, who may well have been the Canadian Dr. Fauci of the late 19th century.
The Grosse Isle quarantine station historical context ...
The spread of disease became an issue in Canadian history almost immediately after Confederation, when the Dominion government embarked on a deliberate strategy to encourage the immigrant settlement of the Canadian West. The port city of Quebec, had always been the main point of entry for immigrants coming to Canada well before then, and an abandoned island 30 miles downstream, Grosse Isle, was purchased by the British Government for a quarantine station yet in 1832 to deal with an expected cholera outbreak. The years 1832, 1834 and 1847 proved to be the most tragic in the history of the island station, the former two with outbreaks of cholera, then rampant in Ireland and England, the latter with typhus, when the woefully inadequate quarantine facilities on the island were tested by hundreds of Irish immigrants fleeing the consequences of the devastating potato famine in Ireland. Some 20,000 Canadians died that year, with more than 3000 Irish immigrant deaths at Grosse Isle, and another two thousand during their sea voyage. When Dr. Montizambert became an assistant quarantine officer at Grosse Isle some twenty years later in 1866, the grave markers of the last epidemic were there, as clear reminders of the challenges facing him and the quarantine station in years ahead.
Trained as a physician and surgeon in Canada and abroad, Dr. Frederick Montizambert became interested in epidemiology, trying to understand the importance of bacteriology as it relates to infectious disease, learning from scientists in Europe and the United states, where he briefly studied contagious diseases at the John Hopkins University. But rather then pursuing a potentially lucrative career as a young physician, he chose instead, to commit his life to Canadian public service and public health. Initially an assistant to the retiring director at Grosse Isle, he was promoted in 1868 at the age of 26, as his replacement, becoming the Medical Superintendent of the Quarantine Station.
Over the course of the next 44 years, Frederick Montizambert tirelessly continued to promote and modernize Canadian quarantine medical facilities, update quarantine regulations and procedures, and supervise their enforcement by medical assistants and steamship captains. All along, he felt it his duty to monitor latest medical advances and the current spread of contagious diseases around the globe, while advocating for progressive public health policies at home in support of the well-being of Canadians. His comprehensive medical knowledge, his attention to detail, and his seemingly persistent requests for a salary commensurate with his contribution and accomplishments, occasionally frustrated his superiors, including the Prime Minister, who supposedly devised an Act of parliament to curb the burdensome detail of his annual reports and budget requests from the Minister of Agriculture, who was then in charge of public health. (Link to his full Report of 1899)
Nonetheless, Dr. Montizambert was finally given recognition in Ottawa for his public service in 1899, being given status as Director General of Public Health and Sanitary-Adviser, and in this capacity, effectively being given responsibility for the supervison of other Canadian quarantine stations beyond the St. Lawrence. Though generally residing in Ottawa, he travelled the country, installing or replacing quarantine officers, and assisting them with the infrastructure of their stations, even personally helping those short-handed, with their off shore inspections and vaccinations. When bubonic plague was discovered in California, and later Seattle, he was immediately there at the Pacific coast to supervise procedures to contain it at the border. Frederick Montizambert also received an appointment with the Department of the Interior in 1905, retiring from public service, only after having finally witnessed the creation of a federal government Department of Health in 1919.
The 1918 influenza pandemic (Spanish flu) certainly comes to mind as we look back at Dr. Montizambert's contribution to maritime quarantine in this time period. The virulent flu was carried into Canada on troop and civilian ships from England after World War I, through Grosse Isle, Quebec and Montreal, then by rail into the rest of Canada. About one sixth of all Canadians were stricken, and 55,000 died, often from related complications. But little was known about the virus, and influenza was not a reportable disease, and thereby, in a sense not on the radar of quarantine stations. The virus itself was not isolated until 1933, and there was in reality little that could be done to curb its devastation. But it did get the attention of provincial and federal Medical Associations and ultimately the Federal Government. A bill was presented in the House of Commons in April 1919, by N.W. Rowell, and he was later named the first Minister of Health, in late May of that year.
Parks Canada Map of Grosse Isle today.
Dr. Montizambert and the Doukhobor quarantines of 1899 ...
Smallpox was still a disease of epidemic potential in the nineteenth century, and although effective vaccination was available in the 1870s and 1880s, the federal government was reluctant to impose compulsory vaccination at quarantine stations. This changed after a resurgence of smallpox occurred in Canada in 1885, and in the following year, all ship passengers and crew arriving in Canada were required to either provide proof of immunization, or submit to vaccinations on arrival. And this was precisely the case when the first Doukhobor immigrants arrived in Canada in January 1899.
The quarantine stations at Quebec and Halifax were both under Dr. Montizambert's supervision at that time and we can gather interesting insights into his encounter with the Doukhobors, at both of these stations, from his voluminous, perhaps even "burdensome", report of 1899 to the Minister of Agriculture. (Link) The full segment of this report regarding the disinfection of the SS Lake Huron, is reproduced in its entirety at the bottom of this web page.
A few short clips from the Report:
"On the first day of November, 1898, I proceeded, by your instructions, to Halifax. I there took over the quarantine station from the out-going officer, performed the duties of inspecting officer for some days, and then installed the new incumbent in the office. I left there on November 11."
The "incumbent" officer Montizambert was referring to would have been Dr. MacKay, although Dr. Jones also accompanied him, as did Dr. Montizambert, on their first inspection of the SS Huron in 1899. Read Dr. MacKay's Annual Report of 1899. (Link)
"On January 3, 1899, I returned to Halifax to meet and deal with, by your desire, the unusual immigration of Doukhobors then expected. I remained there until February 17. The last three weeks of this period were passed at Lawlor's Island in quarantine for small-pox."
The doctor was at Halifax awaiting the arrival of both the SS Huron and SS Lake Superior. Newspaper artist, R.G. Mathews was also there with a sketchbook, awaiting the arrival of the SS Lake Huron, where he observed the doctor (doctors) inspecting passengers for signs of smallpox, as they disembarked from the vessel at Lawlor Island. (Link) Montizambert would have then returned from Halifax to Ottawa from where he was once again summoned by the Minister.
"On April 22 you directed me to go down and reopen the Grosse Isle Quarantine Station, to hold it until my successor in office there should be sent to me, to then install him and instruct him in the duties, and finally to await the arrival at, and discharge from, quarantine of two further shiploads of Doukhobor immigrants. Here, as at Halifax last winter, the second vessel had to be quarantined for smallpox. I left the St. Lawrence, therefore, only on July 3."
The new quarantine officer at the Grosse Isle station, Dr. G.E. Martineau, was just then being installed as a replacement for Montizambert. Martineau's annual report of that same year, on the St. Lawrence quarantine services to the Minister, is equally relevant to this web page, and is posted here. (Link) A comparison of the two reports offers us a means to fact check their accuracy.
A note to readers unfamiliar with the Canadian climate ... the first shipload of Doukhobors landed at Halifax, rather than elsewhere in January, because it was the only available mainland Atlantic seaport to be functional in winter months. The St. Lawrence River winter ice is generally gone by the end of March or early April, and Quebec or Montreal then generally become the seaports of choice at that time. The third and fourth transatlantic Doukhobor voyages thereby ended at Quebec.
The Formaldehyde Disinfection of the SS Lake Huron ...
The following paragraphs summarize the content of Dr. Montizambert's Annual Report of 1899, dealing with the disinfection of the SS Lake Huron steamer, in quarantine at Grosse Isle. His own words are also reproduced below.
There were two available strategies to disinfect ocean vessels at quarantine stations, the boats either tied at the station docks where they could be reached by fixed pressure hoses and other instruments, or anchored some distance off shore, where they could be approached by floating "steam yachts", as they were called, to be sprayed and fumigated. The SS Lake Huron remained at anchor off shore, while the crew, the Doukhobor passengers and their luggage were all methodically moved by small boats, landed and segregated on shore, for accommodation, isolation or treatment at the island hospital, while, the vessel itself awaited disinfection.
There were four available procedures to perform this sort of large scale disinfection, determined by the characteristics of the spaces and fixtures within the vessel involved, using either steam, or pressurized sprays with formaldehyde, sulphur dioxide or mercuric chloride. The sulphur blast instrument was not operational at Grosse Isle at the time, and formaldehyde was chosen in this instance instead, for the large steerage compartment and holds of the Lake Huron, a procedure not as yet proven effective with formaldehyde, potentially leaving the boat inadequately disinfected. This was in essence a test Montizambert was prepared to undertake. Once the boat was ready for release to the Beaver Line shippers, it could be moved away and resume its service elsewhere, in other contracts, the Doukhobors having been delivered to Canada, and their contract with the steamer company fulfilled.
What followed next is rather unusual, and somewhat difficult to rationalize without access to shipping logs, manifests, and contract agreements. The release of the SS Lake Huron to the Beaver Line agents at Quebec City, involved three different steamship crews, one of which was by a strange coincidence, from the Huron's sister ship, the SS Lake Superior, which happened to be at the Quebec harbour precisely at that same time.
The segment of Dr. Frederic Montizambert's 1899 Annual Report describing these circumstances, and the encounter with the Doukhobors in quarantine, was presented in a talk by him personally, to the Canadian Medical Association in Toronto, in August of the same year. Undoubtedly, the presentation would have been more about formaldehyde, than it was about Doukhobors.
Their quarantine fulfilled, the Doukhobors were then ferried by smaller steamboats to the Louise Embankment Pier and the Immigrant Hall at the Quebec harbour, from where they resumed their emigration west to Winnipeg and the Canadian prairies by train.
From the 1899 Annual Report of Dr. Frederick Montizambert ...
QUARANTINE AND PUBLIC HEALTH.
REPORT OF THE DIRECTOR GENERAL OF PUBLIC HEALTH.
(F. MONTIZAMBERT, M.D., Edin., F.R.C.S., D.C.L.)
The use of this disinfectant has been generally favourably reported upon during the year. The circumstances connected with the disinfection by this means, of a steamship at the St. Lawrence quarantine in June last having been somewhat unusual, I reported them in a paper read before the August meeting of the Canadian Medical Association at Toronto as follows:-
On the evening of Tuesday, June 6, the SS. Lake Huron arrived at the quarantine station of Grosse Isle, in the River St. Lawrence, below Quebec. She was twenty-five days out from Batoum on the Black Sea, with 2,300 Doukhobor immigrants on board, and a crew of sixty-nine, including the pilot.
Smallpox being found on board, the vessel was ordered into quarantine. Seventeen cases of this disease, eleven of the Doukhobors and six of the crew, were removed to the hospital between the time of the arrival of the vessel and the completion of the landing of the persons and effects she had brought. All the 2,300 passengers were landed by the Friday evening, the 9th. The heavy luggage from the hold was landed on the Saturday and Sunday. The vessel was disinfected on the Monday and Tuesday, the 12th and 13th, and she was offered to her agents for release, with a new crew, on Wednesday, the 14th, at 4 a.m.
The usual methods employed in the Canadian Quarantine Service for the disinfection of vessels are as follows –
Steam for all hospital cabins and other small apartments where it can be used; formaldehyde for saloons, staterooms and small apartments where the permanent fittings would be destroyed by steam; sulphur dioxide gas, under pressure from the blast furnace, for holds and steerages; and mercuric chloride solution for all free surfaces, alleyways, latrines, bilges, &c.
On this occasion the sulphur dioxide blast appliance of the station was not available. Steam is not suitable for large apartments as the temperature cannot be kept up, and the steam is therefore precipitated as simple hot water. Accordingly, formaldehyde was used for the holds and steerages on this occasion.
The formaldehyde was liberated from formalin, the forty per cent aqueous solution of the gas. Twelve ounces of the solution were allowed for each 1,000 feet of space. The time of exposure was eight hours. Two instruments were employed in the work.
Although, as stated, the disinfection of the vessel was completed on the morning of Wednesday, June 14, owing to heavy weather it was not until Friday, the 16th, that the new crew could be sent down to receive and take away the vessel. During this interval an 'anchor watch' was kept on the vessel's deck, and in her engine room, the officers and crew continuing to live on shore. When the small steamboat bringing the new crew came in sight, the last of the old crew were brought ashore, and the Lake Huron was left riding at anchor in the offing without anyone on board.
The new crew that then boarded and took her away were from a sister ship, the Lake Superior, then at Quebec. After taking the Lake Huron up to that port they had to leave her within a day or two to rejoin their own vessel. They were at once replaced on the Lake Huron by another, a third crew.
Thus two new sets of men boarded, occupied, lived and slept in this vessel within from two to four days following her disinfection, after there had just been removed from her seventeen cases of smallpox, scattered among nearly 2,400 people packed on board, and having occurred both in the steerage and in the fo'castles.
This constituted, of course, a much more severe test of this method of disinfection than the re-embarking of the original crew would have done. I am happy to be able to state that there has not been reported any subsequent case of the disease in connection with any of these persons, or traceable in any way to this vessel, during the two months and a half that have now elapsed since these events occurred.
I am aware that this disinfectant, formaldehyde, has been employed for the purification of vessels; notably some of the United States transports after recent service at Cuba. But I have not seen any instance recorded of its use on so large a scale in the face of actual infection with smallpox. Nor do I know of its results being put to so crucial a test as upon this occasion.
In my opinion the use of sulphur dioxide driven in from the sulphur furnace under the strong pressure of the exhaust fan must remain our chief reliance for large apartments, such as holds and steerages. But this instance of the successful employment of formaldehyde as an alternative is not without its value. I do not forget how careful we have to be not to hastily draw conclusions from anyone case or occurrence, still it is only by the noting of single cases that cumulative evidence can be obtained, and I have, therefore, thought this test of formaldehyde disinfection on a somewhat extensive scale to be of sufficient interest for me to bring it before this Association.