In March 2020, a global pandemic of the SARS-CoV-2 coronavirus was declared by the World Health Organization (WHO). As Canada scrambled to contain the spread, they adopted measures that caused unprecedented upheaval to peoples’ lives not seen since the Second World War.
Academics and the media quickly drew comparisons to pandemics of the past to try and inform the public about what was happening. For example, John M. Barry’s series of guest essays in the New York Times comparing to the Influenza Pandemic of 1918–19 to Covid-19 pandemic. For the most recent contribution, see John M. Barry, “What We Can Learn From How the 1918 Pandemic Ended,” New York Times, January 31, 2022.
The Influenza Pandemic of 1918–20, which killed at least fifty million people across the world, was most often evoked with masks and physical distancing measures adopted at the time to stem the spread of influenza. As a historian of infectious disease, I think a forgotten epidemic in Canada’s own past might be a more appropriate historical analog in understanding our present pandemic moment—the tuberculosis epidemic.
In 1882, German physician Robert Koch discovered the bacterium responsible for the disease, and tuberculosis was subsequently recognized as infectious. From this newfound knowledge of tuberculosis as infectious, Canada embarked on social reform and public health campaigns to reduce tuberculosis mortality and improve the general health of its population beginning at the turn of the twentieth century. Lacking drug treatment or vaccines—much like in the early months of the Covid-19 pandemic—it was believed social interventions would be the most effective in containing transmission.
In the first decade of the 1900s, these social interventions created what I call a “culture of tuberculosis.” Tuberculosis hospitals (or sanatoria) were built throughout Canada to house tuberculous patients. By 1920, there were more than forty of these institutions with over three thousand beds across the country. Public health officials traveled extensively, educating Canadians about tuberculosis as a contagion and how they could avoid transmission. Like today, early twentieth-century public health officials advised those who listened to ensure their homes were well-ventilated with a regular circulation of fresh air. At the same time, “Tuberculosis Sunday” became a weekly observed event. Each Sunday, pastors, and priests communicated the important messages of public health to their congregants from the pulpit.
By the outbreak of the First World War in 1914, this tuberculosis culture was engrained in Canadian society, and its roots were soon transplanted overseas onto the battlefields of Europe. A sanatorium was set up in Lenham, England to treat tuberculous soldiers, which eventually received the nickname “Lung Lenham.” (Letter from Lt. Colonel William M. Hart of Canadian Special Hospital Lenham to A.D.M.S., October 7, 1918, File 25-10-1, vol. 3, Vol. 3616, Series III-B-2, Record Group 9, Library and Archives Canada.) Tuberculous soldiers began to affectionately refer to themselves and other sufferers as “lungers.” For example, a soldier-patient's poem in the Nova Scotia Sanatorium’s magazine X-Ray, where he writes: “Soon you’ll be with other lungers playing ‘round the moon / And viewing my prospects I made me feel sick.” “Try This Over On the Nurses’ Piano,” X-Ray 1, no. 5 (March 1920): 12).
As an increasing number of "lungers” began to report sick to “Lung Lenham” in 1916, military authorities were confronted with a long-standing question in the history of public health—how to strike a balance between civil liberties on one hand and the welfare of the community on the other. After being diagnosed with tuberculosis, an afflicted soldier no longer held any use to the Canadian Corps from a manpower standpoint (also called “wastage”) and therefore required treatment. But if they wanted to return home before their treatment regimen was completed, the Canadian Corps was faced with the decision of whether to deny their request. This denial would protect the soldier’s health, and prevent the transmission of disease to their family, neighbors, and larger community back home, but it would come at the expense of the soldier’s bodily autonomy. Although the Canadian Corps never devised an official policy, it tended to side with the civil liberties argument since its priorities were in prosecuting the war effort. (Letter from G.C. Jones, Major-General D.G.M.S., to Director General of Medical Services, Canadian Contingents, November 25, 1918, File 25-10-1, vol. 3, Vol. 3616, Series III-B-2, Record Group 9, Library and Archives Canada.) As with the Covid-19 pandemic today, debates over public health policy are often settled by short-term priorities rather than robust deliberation.
Thousands of “lungers” died throughout the war, but many more would return home to Canada for further treatment. Even afterward, returned soldiers continued to fall ill with tuberculosis; however, during the war, tuberculous soldiers and veterans began to see themselves as unique amongst the larger community of returned soldiers. By 1917, an activist group called the Invalided Tubercular Soldiers’ Welfare League had emerged with chapters forming in many sanatoria across the country. Their goal was to lobby the federal government for better provisions for fellow tuberculous veterans and to spread public awareness about the disease. There are many parallels between the political work these tuberculous veterans did and that of the “long Covid” community today—particularly around the push for their long-term ailments to be recognized as a legitimate disability.
Ultimately, tuberculous veterans’ lobbying efforts through the Welfare League proved successful. They were recognized as unique by the government and received some of the largest disability pensions in the country. Their success, however, was due to their status as returned soldiers, not tuberculosis sufferers. Those suffering from long-term complications of Covid-19 who have come together—in Canada—as part of Covid Long-haulers Canada, do not have the same political power as a defined voting bloc like disabled veterans after the war. Their ability to lobby for legislative changes on behalf of themselves and future sufferers is and likely will be greatly limited.
What has been most interesting to me during my journey in researching the history of tuberculosis is the post-war experience of tuberculosis veterans. The community of tuberculous soldiers that developed after the war published several journals, including X-Ray from the Kentville Sanatorium in Nova Scotia and The Tranquillian from Tranquille Sanatorium in British Columbia. In these journals, one gets a sense of how these veterans conceptualized their own identities. Though they strongly identified as tuberculosis patients, they saw themselves as distinct from civilian tuberculosis patients and Canadian veterans too. Their unique status as both patients and veterans gave legitimacy to their claims for greater government intervention in the lives of all to quell the menace of tuberculosis. As the editor of the X-Ray wrote in 1919 about the eight hundred Nova Scotians who died of tuberculosis that year: “If there was one thing that we fought for it was to make the world a better place to live in. We feel—we know—that one of, if not the best thing, for the betterment of life in Nova Scotia is to reduce those 800 graves to a minimum. We have served and suffered and throughout that service and suffering we demand that action be taken.” (“Editorial: Those 800 Graves,” X-Ray 1, no. 2 (December 1919).)
As a historian of infectious disease, I am sometimes asked when the Covid-19 pandemic will end. The hard truth is that although the state of pandemicity will eventually reside, SARS-CoV-2 will continue to infect, disable and kill. Even though tuberculosis was no longer viewed as a threat to wealthy nations by the 1970s, it began to ravage the LGBTQ+ community the following decade, co-infecting HIV-positive individuals, and leading to a new epidemic of tuberculosis. For a brief overview of the “new” epidemic of tuberculosis in the 1980s and 1990s, see Helen Bynum, Spitting Blood: The History of Tuberculosis (Oxford: Oxford University Press, 2013), 230–68. Just six years ago, tuberculosis incidence rates in Inuit communities were reported to be forty times greater than in the rest of Canada. Though tuberculosis has receded from the view of the most affluent, it still devastates poor and vulnerable communities. Such will likely be the case with Covid-19.
Lifting public health measures without appropriate programs of support risks exacerbating harm to already vulnerable groups. As we approach the endgame of this Covid-19 pandemic, we must learn from past epidemics that localized outbreaks will continue to spread to the most vulnerable for the foreseeable future and decide how best to support and protect those most severely affected.
Eric Story is a First World War historian with a particular focus on memory, colonialism, and infectious disease in Canada. His writing has been featured in blogs, magazines, news media, and academic journals. Most recently, his article, “The Indigenous Casualties of War,” on the racist discrimination Indigenous veterans and their families faced in the aftermath of the First World War while fighting for compensation for their war-incurred injuries was awarded the Canadian Historical Review’s Best Article Prize for 2021 and the Tri-University History’s Ph.D. Prize
Since he arrived at Laurier in 2015, he has been committed to engaging the public with history and historical ideas. In 2017, he became the Outreach Manager of the Laurier Centre for Military Strategic and Disarmament Studies—now, the Laurier Centre for the Study of Canada—and in this role, founded, hosted, and produced the podcast, On War & Society, a monthly sit-down interview with the world’s leading historians of war and conflict. Currently, he hosts a public lecture series on Canada’s past, present, and future.
The Covid-19 pandemic has greatly shaped his current dissertation project, which explores the history of tuberculosis in the era of the First World War and the ways in which ideas of disability and the body shaped the Canadian state’s response to the disease in war and its aftermath.