By Mona Gleason
The recent outbreak of measles in North America has again raised questions about why small numbers of parents refuse to have their children vaccinated, despite clear and commanding evidence of its safety and efficacy in preventing disease. Despite these outliers, the vast majority of Canadian families take advantage of publically funded immunization programs to protect their children against highly contagious diseases such as diphtheria, tetanus, pertussis (also known as whooping cough), polio, measles, mumps, rubella, meningococcal disease and varicella (chickenpox). Routinely scheduled vaccinations, occurring over the first decade or so of a child’s life, are taken for granted by most Canadians today as part and parcel of growing up. This taken-for-grantedness, however, belies a painfully fought history. For children and their families, vaccination finally confronted staggering levels of infant and child mortality in the early decades of the twentieth century. Immunization, the result of widespread vaccination programs, represented a new hope against decades of suffering and death for many young Canadians and their families.
In my recent book, Small Matters: Canadian Children in Sickness and Health, 1900 to 1940 (McGill-Queen’s University Press, 2013), I highlight the perspective of children and their families on medical and educational health interventions. This history reveals that, like many other encounters between professionals and families, mixed results often occurred. Attitudes towards race, class, gender, sexuality, ability, and age played a significant role in determining who benefited from professional medical and educational attention and who benefitted less so, or not at all. Mandatory attendance at public schools, a major tenet of health and welfare reform, for example, could itself have deleterious effects on health: public schools were crowded, often unhealthy spaces for children in which contagions of all manner spread quickly through the attending population.
From the perspective of children themselves, and not surprisingly, vaccination was never a joyous event. In the early twentieth century, the process involved scraping the arm and depositing the toxin or virus into the wound. It was daunting and painful and occasionally resulted in infection.  The development of injectable vaccination made the procedure easier and much more sterile, although still never anticipated by children with anything but dread. In an era before routine vaccination, however, the result of not getting vaccinated could be far worse, not just for children but for their entire families. Florence Drake was born in Vancouver, British Columbia in 1908. In 1910, when Florence was two years old, she contracted poliomyelitis. Coping with the effects of polio and its treatment preoccupied much of Florence’s memories of growing up, but they were not the only health challenges she recalled. Around the age of five she was diagnosed with diphtheria. The family was unceremoniously quarantined after the infection was diagnosed. “All they did,” Florence recalled, “was come and put a card on the door – a big red card with ‘Diphtheria’ on it.” In an era before the development of health insurance, illness and familial quarantine represented more than the threat of inconvenience and discomfort. It could well mean the loss of wages and possibly employment for familial breadwinners.
Marc Trapier, born in 1913, was one of twelve children and grew up in Hochelaga-Maisonneuve, a working-class suburb on the east end of Montreal, bordering the St Lawrence River. As an adult, Marc remembered the deep sadness he experienced through the illness and death of his younger sister. “My sister who was four years younger than me got diphtheria when she was about six or seven years old,” Marc recounted. “Her head was just like a ball of fire … she was suffering, suffering, suffering like mad you know … and she could not even sleep.” The 1918 flu pandemic struck also the Trapier family as it did others in the country and around the world. Although his father and brother were spared and continued to provide for the family when many others lost their main breadwinner, all the other members of the family contracted the flu. Marc was only six years old at the time. During his illness, Marc recalled looking out his window to the street below and seeing grocery carts filled with corpses, victims of the flu, being pushed to the local church. The bodies, however, were not allowed inside. “The priest,” he said, “wouldn’t let the corpses go into the church because of the influenza … they used to come out and put some blessed water on them and then they would be put straight into the graves.” Memories of his family’s concerted efforts to survive the influenza epidemic have long lingered in Marc’s consciousness over the years. “It is not easily forgotten,” he said. Like the experience of impoverished and working-class families in Winnipeg, as Esyllt Jones has shown, the influenza epidemic struck those with limited means and resources the hardest and with the most devastating consequences.
Jack McCrea was born in Huntsville, Ontario in 1926. Growing up, Jack recalled that his mother was well known in the community for her skill tending to the sick and dealing effectively with a variety of ailments. She was often more effective, he affirmed, then the conventional doctor. Proud of his mother’s accomplishments despite her lack of formal education, Jack pointed out that she never learned to read and write, relying instead on her memory for various healing salves and tonics. “My mother was the doctor on Mary Street,” Jack remembered. “Anybody that was having trouble or anything – you’d see her going with her hot water bottle and bottle of castor oil and a teaspoon.” For all their usefulness, home remedies also had their limitations. When the measles or chicken pox struck, for example, Jack recalled that “you just laid in bed until you got over it … you could do nothing for it … Mother just kept us warm … then when you got over it, you were over it.”
In 1900, 30.4 per cent of all deaths in Canada occurred among children younger than five years of age and the majority of these deaths were due to infectious diseases. By the late 1990s, that percentage was reduced to 1.4 per cent. Between 1920 and 1950, the average annual rate of death of infants from communicable diseases went from 47 per 100,000 live births, to 5 per 100,000 live births. Efforts to reduce high rates of infant mortality and, by the 1920s, to control killer contagions, such as measles, whooping cough and diphtheria, were massively successful as the twentieth century marched on. The experience with childhood illness before the benefits of widespread vaccination, shared in the childhood memories of Florence, Marc, and Jack, provide a cautionary tale.
Mona Gleason is a Professor in the Department of Educational Studies at the University of British Columbia. She is the author of Small Matters: Canadian Children in Sickness and Health, 1900 to 1940 (Montreal-Kingston: McGill-Queen’s University Press, 2013).
Thanks to Ian Mosby and Jim Clifford for the opportunity to contribute to Active History.
 Recent measles outbreaks at Disneyland, California sparked massive media coverage of anti-vaccination groups in North America. In the context of Canada, see “Measles Outbreak: The loophole in Canada’s Vaccination Laws,” CBCNews February 2, 2015. Accessed on March 10, 2015. http://www.cbc.ca/news/health/measles-outbreak-the-loopholes-in-canada-s-vaccination-laws-1.2943583 ; “Measles cases haven’t swayed anti-vaxxers,” The Globe and Mail March 9, 2015. Access on March 10, 2015. http://www.theglobeandmail.com/life/health-and-fitness/health/measles-cases-havent-swayed-canadian-anti-vaxxers-survey-finds/article23354632/ ; “80 Measles Cases in Lanaudière Region of Quebec,” The Huffington Post Canada March 10, 2015. Accessed on March 10, 2015. http://www.huffingtonpost.ca/2015/03/10/measles-lanaudiere-quebec-canada_n_6838550.html
 School medical inspections revealed this contradictory aspect of schooling for health in unhealthy schools early in the twentieth century in British Columbia, for example. See Gleason, “Race, Class, and Health: School Medical Inspection and ‘Healthy’ Children in British Columbia, 1890 to 1930.” Canadian Bulletin of Medical History 19 (2002): 95–112.
 Katherine Arnup, “Victims of Vaccination?”: Opposition to Compulsory Immunization in Ontario, 1900–90,” Canadian Bulletin of Medical History 9 (1992) : 159–76.
 Mona Gleason, Small Matters: Canadian Children in Sickness and Health, 1900 to 1940 (McGill-Queen’s University Press, 2013), pp. 50-51.
 Ibid., Appendix One, “Causes of Infant Death in Canada, for five-year periods, 1921-1950.”
 Ibid., pp. 53-54.
 Esyllt Jones, Influenza 1918: Death, Disease, and Struggle in Winnipeg (Toronto: University of Toronto Press, 2007).
 Gleason, Small Matters, pp. 77-79.
 Antonia S. Stang and Arvind Joshi, “The Evolution of Freestanding Children’s Hospitals in Canada.” Paediatric Child Health 11, 8 (October 2006): 501–6. See also Sutherland, Ibid.
 See Stang and Joshi, Ibid.
 Mona Gleason, Small Matters, pp. 51-54.
 Neil Sutherland, Children in English-Canadian Society: Framing the Twentieth Century Consensus (Toronto: University of Toronto, 1976), pp. 56-70.
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