In Canada, provincial governments are responsible for health care: Canada’s Constitution Act (1867), Section 92, Article 7 made the provinces responsible for the “Establishment, Maintenance, and Management of Hospitals, Asylums, Charities, and Eleemosynary Institutions in and for the Province, other than Marine Hospitals.”
Health care services in British Columbia at the time of the Spanish Flu were modest and of access often limited to those who lived in or near population centres.
Most medical services were provided for a fee by private practitioners.
Hospital and nursing services were funded in large part by subscription, donation, and fund-raising drives.
The 1918 Henderson’s Victoria City Directory lists 44 physicians and surgeons. Using the B.C. Vital Statistics office’s estimated 1919 population of about 56,000 for Greater Victoria, the ratio of doctors to populace was roughly 1 for every 1,340 people, or .75 doctors per 1,000.
That was fewer doctors than the most poorly supplied parts of the province today. A recent study of different regions of B.C. calculated that physician-population ratios vary from a low of 0.76:1000 in the Peace-Liard region to a high of 1.65:1000 in Vancouver. Harvey V. Thommasen et al, “Physician : population ratios in British Columbia.” Canadian Journal of Rural Medicine, 4:3 (1999), pp. 139-45
It’s not clear how many more doctors were away on wartime duty.
One important element of the health care system of the time has almost completely vanished. Doctors made house calls. The Victoria medical health officer advised people who felt the flu coming on to “go to bed at once and remain there warm and at rest, and send for the doctor” [added emphasis]. In this context, a doctor’s primary functions were diagnosis and reporting.
Equally important to patient care, or more important, were nurses. Besides the R.N.s working in the hospitals and other care facilities, many nurses were privately employed by families that could afford them. A new kind of nurse came to the fore during the Great War: the public health nurse, who visited homes, especially of disadvantaged families, and especially in rural areas.
The Victorian Order of Nurses for Canada (V.O.N.) was a society of public health nurses. The organization was established in 1897 in Ottawa.
The V.O.N. was operating in Victoria in its first year with a fund-raising intiative. Mr. A. J. C. Galletly, manager of the Bank of Montreal and treasurer for the Victorian Order of Home Nurses, reported funds raised by Victoria schoolchildren totalling $472.30.*
* The Daily Colonist, October 31, 1897.
A description of the work of the public health nurse was embedded in the Royal Charter of 1898 that created the V.O.N.:
Public health nursing is a branch of nursing service which includes all phases of work concerned with family and community welfare, with bedside nursing as a fundamental principle and developing from it all forms of educational and advisory administrative work that tends to prevent disease and raise the standard of the health of the community.
“Victorian Order of Nurses for Canada” by J. Charlotte Hannington, in The Canadian Nurse and Hospital Review, XVII:9 (1921), p. 557.
A later description of the V.O.N.’s mission:
The activities of the Victorian Order are carried on by a body of graduate nurses with a post-graduate training in public health nursing. Their field lies in the homes of the people, in serving and teaching. The care for the mother during pregnancy, and assist the doctor at the birth, give post-natal care, and follow up the child till school age. They also do all other branches of nursing requiring the services of a visiting nurse.
In the small communities they inspect the school children, and, in addition, give talks on home nursing. They receive their post-graduate training in one of the six training centres of the order.
These nurses will also staff the small hospitals of the order, of which there are twenty-four.
“Public Health Nursing Department — Canada,” in The Canadian Nurse and Hospital Review, XVI:2 (1921), p. 100. On Archive.org.
The fledgling Victorian Order made national headlines when it sent four nurses into the heart of Yukon Territory during the Klondike Gold Rush. The V.O.N. was described thus:
They are an organized and endowed body receiving a salary of four hundred dollars a year, together with board and uniform; they are protected by personal interest and supervision in all dangerous and disagreeable undertakings, and they are ready to perform emergency or other work in isolated and outlying districts and among the poor of the cities, while at the same time fees are taken from all who can afford to pay them in proportionate scale.
“The Order of Nurses. Claims of Those Locally Trained to the Sympathy of the Public They Serve. Addresses on Behalf of the Yukon Party Produce Some Criticism.” Letter to the editor by Quo Vadis, Colonist, May 1, 1898, p. 6.
The Victorian Order of Nurses for Saanich, established in 1916-17 with a local board of directors, assigned two nurses to Saanich to provide home nursing services across a rural area of 65 square kilometres (25 square miles). At the October 1917 monthly general meeting,* with about forty present at Tolmie School, the nurses reported that each worked an eight-hour day on weekdays plus five hours on Sundays. In September they had made sixty-three visits and examined three hundred twenty-two school children at five schools. Generally, students’ teeth required attention, and eyesight was, overall, not “up to standard.” The nurses’ collected fees totalling $53 for the month.
* Reported in The Daily Colonist October 16, 1917, p 7.
The public health work of the Victorian Order of Nurses for Saanich was on the leading edge of that movement in Canada. On the V.O.N. in Saanich during and after the Spanish flu epidemic, see Attack and Counterattack. On the establishment of the Saanich public health centre nursing establishment, see Spanish Flu and the rise of public health nursing.
Today the V.O.N. survives in only two provinces. Its last office in B.C., in Vancouver, went independent in 2006, morphing into the Health and Home Care Society of British Columbia.
The durable Canadian Red Cross Society was “Canada’s leading wartime humanitarian aid organization”* with a mission to serve the needs of soldiers. At the local level there were Red Cross societies in many neighborhoods; another local group provided nursing support in military hospitals.
Medical officers — local, provincial, military
Each of the four municipalities that comprised Greater Victoria had a Medical Health Officer. Personnel at the onset of the epidemic (all M.D.) were:
• City of Victoria: Arthur G. Price
• District of Saanich: C. Denton Holmes (to September 1918); James P. Vye
• District of Oak Bay: William P. Walker
• Township of Esquimalt: Eric W. Boak
The Medical Health Officer reported to the elected council of the municipality. They also formed collegial committees when concerted action was needed.
The Provincial Board of Health and its ex-officio secretary the Provincial Health Officer reported to the Provincial Secretary, who was a cabinet minister and an elected Member of the Legislative Assembly. Through orders-in-council the Provincial Secretary could empower local authorities to protect public health by imposing restrictions on public mobility via such measures as quarantines and bans on public meetings. Short of that, the Provincial Board of Health provided advice and support to the many M.H.O.s in the province.
The Provincial Health Officer was Henry Esson Young, M.D. Dr. Young recognized the importance of public health nursing in rural areas. A year before the outbreak of Spanish influenza, Dr. Young began implementing an initiative to fund public health nurses province-wide.
The Canadian military forces had a completely separate health care system. Military medical staff served the Esquimalt Naval Base, Willows (Army) Camp and the (Army) artillery garrison at Work Point.
Hospitals in the Victoria area were few and tiny but well-equipped and staffed.
Provincial Royal Jubilee Hospital
The Provincial Royal Jubilee Hospital, near Victoria’s eastern border, was operated by the City with a grant from the Province.
St. Joseph’s Hospital
St Joseph’s Hospital, on Humboldt Street, opposite St. Ann’s Academy, near downtown Victoria, was operated by the Roman Catholic Sisters of St. Ann.
Royal Jubilee and St Joseph’s hospitals had schools of nursing that trained Registered Nurses (R.N.)
City Isolation Hospital
The Isolation Hospital was on Mount Tolmie (now Richmond) Road, north of Royal Jubilee Hospital, as indicated (location not shown) on the 1913 fire insurance map:
These hospitals also served surrounding areas of Saanich, Oak Bay, Esquimalt and the unincorporated districts near Victoria, where there were no civilian hospitals.
Irving House Military Hospital
Irving House Military Hospital was a convalescence facility for officers.
Esquimalt Naval Hospital
William Head Quarantine Station
A world apart in Metchosin was the William Head Quarantine Station, where inbound passenger ships stopped to have the resident medical officer examine passengers for communicable diseases.
Metchosin Museum Society article about the William Head Quarantine Station.