"Nothing is to be seen apart from the smallpox camp but tin cans, ashes, dead rats, decaying vegetables and fish," said the Ottawa Evening Journal. Many exposed to smallpox hid in fear of being forced to Porter’s Island.

OttawaMatters.com, in partnership with the Historical Society of Ottawa, brings you this weekly feature by Director James Powell, highlighting a moment in the city's history.

November 2, 1893

Be thankful that you live today and not a hundred years ago. Then, communicable diseases were rampant. Diphtheria, measles, whooping cough, and scarlet fever routinely killed babies and infants.

In 1909, the infant death rate in Ottawa was a horrific 283 out of 1,000 life births. (In 2017, the rate of infant mortality in Canada was 4.5 out of 1,000.) Even if you managed to survive the so-called "childhood diseases," you ran the gauntlet of contracting other lethal illnesses such as cholera, tuberculosis, and typhoid.

Epidemics periodically swept through the fetid cities of North America killing thousands. But of all the diseases, the one that people feared the most was smallpox.

Smallpox has a long history. There is some evidence that the disease was present in ancient Egypt more than three thousand years ago. More reliably, descriptions of the disease can be found in Chinese medical texts of the 4th century AD. It was prevalent in south-west Asia by the 10th century. By the thirteenth century, people in the Middle East were practising variolation to ward off the disease by inoculating people with the live virus-liquid from a smallpox pustule was rubbed into a scratch in the skin. This was a dangerous procedure, but it conferred life-long immunity.

Smallpox is caused by the variola virus, and came in two forms: the virulent variola major strain, which had a death rate of about 30 percent, and the less severe but less common variola minor type that had a death rate of about 1 percent. The characteristic symptom of the disease was raised pustules that spread across the body, especially the extremities. Survivors of smallpox often experienced terrible disfigurement and blindness.

By the 15th century, the disease was well-established in Europe.

Subsequently, European explorers and traders introduced smallpox to the Americas. Lacking resistance to the disease, indigenous populations were virtually wiped out. The fall of the Aztec and Inca civilizations in South and Central America was due far more to smallpox than the weaponry of the Spanish conquistadors.

In what was to become Canada, European settlers brought the disease to eastern First Nations. Later, the Plains tribes were infected through their interaction with voyageurs and traders. The result was calamitous. Whole communities died. In just one epidemic on the Prairies in the 1830s, two-thirds of the Blackfoot First Nation perished.

A major step towards conquering the disease occurred in 1796. Noticing that dairymaids who had contracted cowpox, a mild disease, appeared to be immune from smallpox, the British scientist Edward Jenner undertook an ethically-challenged experiment. First, he inoculated a young boy with cowpox serum. As expected, the child only experienced a slight fever, a few aches, and a temporary loss of appetite. Two months later, Jennings infected him with smallpox. Fortunately, the boy had no reaction; he was immune as Jennings had hypothesised.

Although several countries enthusiastically embraced vaccination, Bavaria reportedly introduced mandatory vaccination as early as 1807, it was a hard sell elsewhere. Like today, anti-vaxxers peddled "alternative facts" and received wide press coverage.

To give the anti-vaxxers their due, unclean vaccination equipment and unsanitary conditions could cause serious infection in an era long before antibiotics. Vaccinations also didn’t confer lifelong immunity and had to be repeated. However, the risks of contracting smallpox far outweighed the possible side effects of vaccination. But out of ignorance and fear, people still hesitated to get vaccinated, and epidemics continued to claim thousands of lives and maim many more.

Smallpox arrived in Ottawa as early as 1828 with the Rideau Canal workmen. Colonel By apparently averted an epidemic by organizing a speedy vaccination campaign.

Fortunately, the disease did not appear to be a major health risk until later in the century. In 1860, the Ottawa Daily Citizen reported that "smallpox and throat disorders [most likely diphtheria] were very general." Fatalities were comparatively rare.

In 1871, an outbreak of smallpox was reported in Sandy Hill in the Stewart Street area. In a letter to the editor, "Pro Bono Publico" complained that "cow yards, hog pens, and dirty yards in such abundance as to originate, let alone the nurturing of, disease and pestilence." Another article reported the unwillingness of civil service men to reclaim their laundry when their washerwoman came down with smallpox, necessitating them to buy new clothes.

Initially, smallpox victims were treated in isolation wards in the Protestant General Hospital located on Rideau Street. Later, such patients were segregated in an annex.

In the mid-1870s, despite considerable neighbourhood opposition, the Sisters of Charity opened a second, Catholic, smallpox hospital at the rear of the Catholic cemetery in Sandy Hill. Both hospitals were extensively used in a major smallpox outbreak in 1879-1880.

Mortuary statistics show that 219 died of smallpox in Ottawa during 1879. A further 97 died before the epidemic ended by the middle of the following year, out of 230 additional cases of smallpox -- a mortality rate of 42 percent. (Ottawa’s population at the time was only 27,000.)

When the Protestant Hospital was deemed "dangerous and unsuitable" as an isolation facility, the city began searching for another location for a new smallpox hospital.

In 1893, City Council finally chose Porter’s Island, an eight-acre, low-lying property in the Rideau River. The major factors in favour of Porter’s Island was its relative isolation and price.

Under provincial law, a smallpox hospital needed to be at least 450 yards away from inhabited areas. While a number of locations were considered, they were all deemed too expensive or not sufficiently accessible. A committee of city doctors also supported Porter’s Island on the grounds that the flowing water around the island lent itself to cleanliness.

Others, however, worried that the damp, low-lying island was unhealthy, and that the island was prone to flooding. The Ottawa Clinical Society noted that there was a highwater mark nine feet above the mid-summer water level, indicating that up to a half of the island could be submerged during the spring freshet.

Despite these misgivings, the city awarded a contract for the construction of a cottage hospital on the island to John Bruce, the low bidder, for $16,400 on November 2, 1893. Construction commenced as soon as the city formally acquired the land, the price of which was settled through arbitration. (It was set later at $6,713, costs included.) Bruce promised to build three brick hospital buildings, which could accommodate some 100 patients, and a separate administration building. Another contract was awarded to Dominion Bridge Company to construct an iron bridge linking the island to St. Patrick Street for an additional $5,000.

Work on the isolation hospital was suspended three months later after the city had spent $34,000, and with the contractor demanding another $10,000 to complete the job.

A local firm of architects, which inspected the site, found shoddy workmanship -- the hospital’s foundation was built above the frost line, the brickwork was a third thinner than specified and was already cracking, and the floors were sagging. The next month, with the spring run-off underway, the basement of the administration building flooded just as critics had warned.

Then, the blame game began, with some city alderman saying "I told you so."

Others went into denial. One Island apologist said the situation was "not at all bad" other than a "few blemishes."

In April 1894, an official of the Ontario Board of Health visited Porter’s Island to assess the situation. His report dropped like a bombshell on City Council. He said the island was unfit for a hospital. He recommended against further expenditures on the island for hospital purposes, suggesting instead that the semi-constructed buildings be converted into an incinerator for garbage.

Over the next decade, City Council bickered over what to do with Porter’s Island, how they could re-coup the thousands of dollars spent, and whether the island could ever be used as the location for an isolation hospital. Nothing was resolved.

Besides lawsuits, the only action taken was to fire G. F. Stalker, the project’s architect. He died of apoplexy shortly afterwards. Meanwhile, the semi-built hospital deteriorated owing to weather and theft despite the presence of a resident caretaker.

It wasn’t until 1902 that the administration of the Mayor Cook took the bull by the horns and built a new contagious disease hospital located on Regan’s Hill at the old Rifle Range in Sandy Hill (now the location of the Sandringham Apartments). Opening in 1903, the new Strathcona Hospital was designed to treat such diseases as diphtheria and scarlet fever—not smallpox which fortunately was in abeyance.

Meanwhile, Porter’s Island was used as a refuse dump. Its derelict hospital buildings were demolished in 1904.

The need for a smallpox hospital returned with a vengeance when a serious smallpox epidemic swept the city in 1910-1912.

In response, the Ottawa Board of Health converted the caretaker’s frame house on Porter’s Island into a makeshift isolation hospital. When the numbers of smallpox victims rose beyond the capacity of the house, the city erected large tents on the island, notwithstanding it being the middle of an Ottawa winter. The tents were heated using "Quebec heaters," whose warmth extended only a short distance. There was no running water, no modern flush lavatories, and rats abounded, a situation made worse by the continued use of the island as a refuse dump.

"Nothing is to be seen apart from the smallpox camp but tin cans, ashes, dead rats, decaying vegetables and fish," said the Ottawa Evening Journal. Many exposed to smallpox hid in fear of being forced to Porter’s Island. Guards were stationed at the bridge to stop people escaping.

In May 1911, a naval architect and his five children were stricken with smallpox and ordered to Porter’s Island. The architect, an employee of the Public Works Department, reported to the Journal that vermin had eaten through eight military blankets on his bed located in one of the tents, which itself was sited just a few feet from a filthy outhouse. He managed to catch five rats using an improvised trap. Meanwhile his dying eight-year old daughter, who was conveyed to the Island in an ambulance that lacked basic amenities such as sheets and pillows, complained of abuse from one of the nurses.

After the story broke, hospital staff said the man had exaggerated, saying he had only caught one rat. As for the charge of abuse, a nurse denied it. However, she admitted to occasionally slapping a child, after all "we had over thirty children at this Island and how could we make them behave and mind them all if we did not do this occasionally." Remember that these children were in a frightening environment, many of whom were desperately sick, and had been separated from their parents.

In November 1911, on a close 11-10 vote, with Mayor Hopewell casting the deciding ballot, City Council agreed to build a proper smallpox hospital on Porter’s Island.

Architect Francis C. Sullivan was commissioned for the job. George A. Crain won the contract to build it at a cost of $30,323 which later rose to more than $45,000. To avoid being flooded in the spring, the 107’ x 37’ brick building was constructed on a raised fill platform. There was no basement. When the new Hopewell Hospital opened in late January 1913, the city burned the old smallpox shack and tents.

The last big epidemic to hit Ottawa occurred in 1920-1921 with more than 1,000 cases. Fortunately, the infecting strain was relatively mild. There were only two deaths. For a time, the Hopewell Hospital was completely full. At one point during the outbreak, more than eighty houses in Ottawa were also under quarantine.

To interdict the disease at the border, the province of Quebec quarantined Ontario. Nobody could enter Quebec, including Quebec residents, from Ontario without an up-to-date smallpox vaccination certificate. Free vaccinations were given in the CPR station in Hull. By mid-year, the epidemic had been halted by a massive vaccination campaign with 40,000 vaccinations given out in Ottawa alone.

By the early 1930s, smallpox had become very rare, and was eradicated in Canada by 1946. With the underused Hopewell Hospital now obsolete, it was converted to apartments in the mid-1940s and demolished in 1967.

Its site is currently occupied by the Chartwell Rockcliffe Retirement Residence. The old bridge constructed in 1894 is still standing, although it is now closed to the public.

After a concerted global vaccination campaign carried out by the World Health Organization, smallpox was eradicated with the last naturally occurring case recorded in Somalia in 1977. The following year, a medical photographer caught the disease in a laboratory accident in Britain. She died. Currently, the only known smallpox virus stocks are held in the United States and Russia.