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Patient Zero arrived by train from Chicago. The Pullman conductor was diagnosed and admitted to hospital. His car’s contents were incinerated at the railyard, but it made no difference: smallpox was loose in Montreal again.

It was 1885 – a different time. Louis Riel was fighting Canadian troops across the Prairies. Medicine in Quebec was largely the preserve of the Catholic Church. Cities stank with animal corpses and industrial runoff.

But despite its old-fashioned trappings, the last “uncontained” outbreak of smallpox in a Western city has a renewed relevance. As the late historian Michael Bliss chronicled in his classic study, Plague, Montrealers reacted in ways that we may find eerily familiar. Authorities made many of the same mistakes and used many of the same public-health tools. Ordinary people showed the same kinds of heroism and frailty.

Although the medical treatment of COVID-19 is more sophisticated, the public response is not so different, said Jonathan Berman, the author of Anti-vaxxers: How to Challenge a Misinformed Movement and a recent study of anti-vaccine sentiment in 1885.

“The science has advanced, and maybe the politics haven’t.”

Smallpox was an almost uniquely horrible disease that killed three out of 10 people who got it, on average, and left survivors badly scarred; it mainly attacked Montreal’s children, not its elderly. But the parallels with today are striking and extend even to the medical facilities in use then and now. The hospital that housed the infected conductor, for example, is still standing. The thick stone walls and green copper dome of Hôtel-Dieu now serve as a COVID-19 testing site.

They were also the location of a terrible error that still resonates. In an effort to avoid becoming a viral cesspool at the beginning of the smallpox outbreak, the hospital sent patients home. As Quebec’s ministry of health has acknowledged, provincial authorities made a similar decision in the early days of our pandemic, sending hospital patients to long-term care homes in an effort to protect the health care system. Opposition parties argue the move backfired by spreading the disease in even more vulnerable settings.

The tinderboxes of 19th-century Montreal were crowded tenements occupied by mainly francophone working-class families. Soon smallpox was rampant in these impoverished neighbourhoods, as it had been during the city’s previous outbreaks of the disease. In rickety homes of 10 or 12 people, isolating safely indoors was impossible – just as it was for many retail and health workers living in Montreal’s underprivileged neighbourhoods two years ago.

Anyone who watched the misguided sanitation regime of disinfecting groceries and power-washing city buses in spring 2020 will be unsurprised at the ineffectual cleaning practices of 1885. The city burned sulphur in affected households and sprinkled the streets with a chemical called thymo-cresol, Prof. Bliss wrote. Smallpox continued to spread.

Government data was hardly more useful. In the early days of the outbreak, municipal authorities were in denial about the scale of the contagion. It took a journalist from the Montreal Witness newspaper to bring the growing disaster into view by studying records at one of the city cemeteries, which showed how many burials were related to the disease. In our time, Montreal Gazette reporter Aaron Derfel played a similar role, writing stories about appalling conditions in the province’s long-term care homes, where thousands of people were dying.

Eventually, the city mounted a muscular response to the epidemic, especially after prominent citizens came down with the pox. (Then, it was prominent statesman Francis Hincks, as opposed to our own COVID-19 canary, Tom Hanks.) The Canadian state at all levels was almost unimaginably smaller in the 19th-century than it is now. Michael Bliss calculated that Montreal’s outlay on the epidemic was about $15-million in today’s money, when the city’s population was nearly 170,000 and growing fast. The provincial board of health had one full-time employee, a detective named Cinq Mars. The federal government had no real role at all.

Still, the pandemic toolkit of the era was not so different from our own: isolate, contact trace, vaccinate. In some ways the disease fighters of 1885 were just as active as our own. There was no society-wide lockdown, but the mayor called for mandatory vaccination and the city eventually built high-quality additions to the municipal smallpox hospital.

In the end, local authorities and private companies combined to implement many of the same measures we live with today, like wage subsidies for those who were forced to isolate, and vaccine passports for work and travel.

The biggest obstacle to ending the outbreak was the same as our own, resistance to vaccination. (The word itself comes out of the battle against smallpox, when people were inoculated with the much less deadly cowpox virus, hence “vaccinate,” which has the same root as vache, the French word for cow.)

This relatively new technology inspired intense fear amongst many working-class francophones, especially, who “thought anglophones wanted to poison them,” said Marie-Claude Duchesne, a Quebec archivist and journalist who has written about the period. Montreal’s push to vaccinate reluctant citizens eventually led to a bloody riot in the fall of 1885 that saw the city’s police chief stabbed and soldiers firing warning shots above the angry mob.

Although our own anti-vax movement hasn’t led to serious violence, it shares many traits with its Victorian ancestor. Opposition to the jab in 1885 was fuelled by right-wing media outlets such as the Ultramontane Catholic newspaper L’Étandard in tandem with progressive alternative medicine types such as A.M. Ross, an advocate of natural healing who opposed the use of all drugs.

The same baseless anxieties about side effects and medical experimentation that now spread on social media also spread through newspapers and word-of-mouth back then, said Mr. Berman, whose Anti-vaxxers book was published in 2020. One rumour even warned that the vaccine could cause “minotaurization,” or the development of cow-like features.

The epidemic burned out around the end of the year. Nearly 6,000 people had died across Quebec. 86 per cent of the province’s deaths were among children, a fact that was used to minimize the seriousness of the disease in some quarters, because childhood mortality was so common at the time. If that attitude seems perverse, it is not so far removed from the way Quebec neglected the human loss caused by this pandemic because many of its victims are elderly, as former health minister Réjean Hébert argued before a coroner’s inquest last year.

In many ways, the world’s reaction to COVID-19 has been faster and more sophisticated. Thousands of years lay between the likely emergence of smallpox in humans and the development of a vaccine for it.

We got our shots in less than a year. But seen from present-day Montreal, our response to the two diseases can bring to mind a phrase that most residents of the city will recognize: plus ça change.

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