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REPORT Of the Commissioners appointed to inquire into the late epidemic outbreak of Small-pox in the… British Columbia. Legislative Assembly 1893

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 56 Vict. Royal Commission—Small-pox Matters. 507
EEPOET
Of the Commissioners appointed to inquire into the late epidemic outbreak of Smallpox in the Province of British Columbia, under Order in Council, dated the 6th
October, 1892.
Victoria, 20th February, 1893.
Sir,—We beg to enclose, for the information of His Honour the Lieutenant-Governor in
Council, our report upon the matters into which we were by him commissioned to inquire.
The extreme bulk of the evidence adduced has taxed the efforts of the stenographer to
reproduce, and our own efforts to digest; nor can we much congratulate ourselves on having
done this with much success. Upon some points, however, which are mentioned in our
report, we have been able to arrive at definite conclusions.
We have the honour to be,
Sir,
Your obedient servants,
Matt. B. Begbie,
Hon. Col. James Baker, E. A. Praeger.
Provincial Secretary.
REPORT.
In the course of our inquiries into this matter, we have examined viva voce fifty-six
witnesses, some of whom have, in addition to their sworn testimony, submitted written
reports. And with respect to one witness, especially, whom we heard with great interest,
Mr. Greig, an anti-vaccinationist, we have felt it our duty to peruse, at all events to some
extent, several treatises that he produced and kindly lent to us for our further information.
A list of the witnesses and a copy of their evidence and reports above mentioned, and also a
list of the books produced by Mr. Greig, is appended. The books themselves we propose
to restore to Mr. Greig.
The first subject of inquiry mentioned in our commission is as to the channel and means
through which the said epidemic of small-pox was introduced into the Province, referring to
the outbreak which occurred in the beginning of July last, which led to the Order in Council
of llth July, 1892. This inquiry is most intimately connected, both in point of time and in
regard to cause and effect, with the second matter referred to us for inquiry, viz., " The
spread and dissemination of the said epidemic in the Province." For as to isolated cases,
though Dr. Milne, late Health Officer, stated that there had been no case here for four or five
years, and though there is no specific evidence of the existence of the disease in Victoria
previous to March, 1892 (Richardson, p. 2), yet Mr. Huntley, the very careful Sanitary
Inspector in the City of Vancouver, mentions sporadic cases in that district at uncertain
intervals of a few months ever since his first appointment to the office. And Dr. Macnaughton
Jones, the Dominion Quarantine Officer at Victoria, with an experience of thirty years here
and on the Mainland, is of opinion that small-pox is endemic on this coast; meaning, we
suppose, that detached cases are likely to arise, and do from time to time arise, without any
extraneous source of contagion. The two questions, therefore, " what was the channel and
means of the introduction of the epidemic 1" and "how and why did this visitation become
epidemic 1" when, in its previous visits it had stopped short at one, or at most two, attacks on
individuals, appear intimately connected.
Without attempting minutely to examine all the cases adduced in evidence, or to trace
positively the genealogical source of infection in any case, and without any opinion upon the
endemic theory of Dr. Jones, we are persuaded that the " outbreak " of July last was  lineally 508 Royal Commission—Small-pox Matters. 1893
derived at one or two removes from one or more cases of small-pox on board the " Empress "
line of steamers from China and Japan, and which must have escaped, probably unavoidably,
the attention and the precautions of the Dominion Quarantine Officer here. We do not wish
to impute to him the least neglect or want of skill. On the contrary, in the course of his
evidence, his zeal and ability were manifest. But it seems almost certain that the symptoms
of small-pox were first developed after the steamer had passed on. And no officer can go beyond
his instructions, and in the earlier months of the year his instructions were not so minute or
careful as they are now ; nor was he then furnished with the disinfectants which are now
supplied. The fact is, that although individual cases of small-pox had often occurred in the
Province before, yet there has never been anything in the nature of an epidemic, at least
among the white population. About thirty years ago, and again about twenty-five years ago,
there was a very great mortality among the Indians, but it did not much, or at all, affect the
whites, whereas on this occasion the whites were the chief sufferers.
All measures of quarantine, even the mildest, are so distasteful to individuals, and so
injurious commercially, that nothing beyond the most necessary precautions will be tolerated,
either bj travellers, or by ship owners, or ship's captains, or by the home consignees. In the
present condition of international trade and commerce, and the enormous development of
passenger traffic, any stringency which is not apparently justified by some obvious danger has
an immediate tendency to divert traffic altogether, and to interfere very prejudicially with
the commercial results of commerce. Except, therefore, in the presence of actual contagion,
the Government instructions have a natural tendency to laxity, nor is it intended that such
instructions should be pushed to extremes. After thirty years of immunity from any
epidemic, after finding that even when cases of small-pox have arisen here they have shewn
no disposition to spread, it would, in April or May last, have probably been deemed by the
whole public in British Columbia quite, unreasonable and fantastic if the same measures of
quarantine had been directed or insisted on by the Dominion Government which the same
public deemed barely adquate in July or August. This long immunity sufficiently explains
how the Government instructions and the means at the disposal of the quarantine officer-
remained till July last precisely the same as had been issued many years previously, although
the number of entries of steamers alone, to say nothing of sailing vessels, had risen from five
in a month at the former period to 75 in July, 1892 ; and but for the recent panic, the
additional instructions and material furnished in August last (e. g., the quarantine officer's
steam tender and dioxide blast) might still have remained unprovided.
The Health Officer in charge at Victoria at the commencement of the outbreak (Dr.
Milne) did not recollect that any case had occurred here for four or five years previous to
May last. There had, however, been at Albert Head at least one case, Mrs. Livingstone, a
first-class passenger in one of the Empress steamers from Japan, in December, 1891. (This is
the case referred to by Dr. Richardson.) She was found to be infected at Vancouver City,
after the other passengers had landed and proceeded to their destinations (Huntley I., 61),
and was returned to Albert Head, and kept there eight weeks until cured. Other passengers
from the same steamer had also been landed at Victoria. It was suggested that Miss Sweet,
taken in July, was connected with this case, through some bedding, occupied by Mrs.
Livingstone after her discharge. The propagation of small-pox is so obscure, that it is
impossible to deny the possibility of this infection; but we think it highly improbable ; nor
does any other case appear to be connected with that voyage of the Empress.
The first case in Victoria, which appears to be connected with the outbreak at the end of
June and beginning of July, was that of Harry Farrer, reported to the Health Officer on the
28th May. Farrer stated before us that he had scarcely left Victoria for several months—
had not handled any freight from any Japan steamers, but had chiefly worked on the wharves
here; latterly on the Yosemite, which he said had been moored here for some time, passing
coal. He had been once to Nanaimo and Salt Spring Island, but did not admit having been
in Vancouver City. We are unable to assign any definite source from whence he could have
caught the disease. He seems to have felt unwell on the 24th or 25th May. During the next
few days he seems to have been visited at his lodgings by two men, Sullivan and Fitzpatrick.
(In Dr. Milne's evidence his lodging is termed a " cabin "—it was, in fact, a room on the lower
floor of a tenement house, called Carpenter's buildings, comprising some 30 or 40 distinct
apartments, access to which is afforded by galleries on each side of the house, all under one
roof, with wooden partitions.) On the 28th May, Farrer was driven out to the Jubilee
Hospital; Dr. Richardson at once diagnosed small-pox in the papular stage, and sent him to 56 Vict. Royal Commission—Small-pox Matters. 509
Dr. Milne, at that time Health Officer, with instructions to call on Dr. Hanington on his way.
Farrar noticed red spots on his wrists for the first time on his way to see Dr. Richardson.
After seeing Dr. Milne, he returned to his lodgings. Fitzpatrick and others had been to see
him ; Fitzpatrick sleeping there up to the 28th, when the patient was quarantined. Then he
was in contact with the hackman who drove him out to Albert Head. The quarantine on
Farrar's lodging appears to have been not very strict; the reason alleged being that it was a
very mild case—and it seems to have been forgotten that the mildest case of small-pox may
communicate a most virulent attack to an unprotected person, just as a person partially
protected, either by constitution or prophylactics, may contract a very mild attack from a
confluent patient. None of the other rooms or occupants in Carpenter's building appear to
have been quarantined or fumigated, but only Farrar's apartment.
The arrangements for the accommodation of patients at Albert Head, to which Farrar
was forthwith removed, and for their isolation, do not appear to have been calculated to eliminate
the chances of conveying infection thence. (Foster, passim : Dr. Compton, p. 47; Dr.
Richardson, p. 25 ; Dr. Milne's contradiction of Foster seems rather addressed to the actual
attendance on the sick there.) There can be but little doubt but that many of the persons in
contact with Farrar for a week before his removal may have carried the contagion to develop
elsewhere; though none of the subsequent victims assign his illness as the origin of their
own,—and so, all the persons brought in contact with him have been lost sight of. There was
some conflict of testimony as to the date of Farrar's discharge. Indeed, the extreme confusion
and uncertainty of dates of the attacks in Victoria have been the chief difficulty in tracing
the sources of infection.
The next case in point of date is a child at St. Louis College, in Pandora Avenue, in the
first week in June ; also a "mild case." The origin of this case is not alleged. No cases
appear to have been derived from it, the house having been sufficiently isolated. The
quarantine was raised about the 1st July. A child of a Mr. Ball, who lived on Pandora
Street, not far from the College, died on the 6th July. It was not reported till the 5th July :
and there was no evidence as to when it was seized. Nor was there any suggestion connecting
this'fatal case with the "mild" case in St. Louis College, except that both were in the same
neighbourhood.
The next cases in point of time that occurred in Victoria were Burrows, living at 56
Pandora Street, taken on the 26th June; Mr. Niles, in Fort Street, next to the Clarence
Hotel, on the 29th June, in the same house as Eckert, taken about the same time, and Foster,
110 Johnson Street, taken on the 30th June. Burrows had been in Vancouver (city) on the
occasion of a Foresters' picnic, whence he returned on the 16th June, with two companions,
Marsh and Williams. It was alleged that Marsh, while in Vancouver, had been for some
hours in communication with a Mrs. Bibby, in Dupont street. From the date of Mrs. Bibby's
seizure, however—she was discovered in a very bad state on the 17th May (Huntley, I. 37)—
and the fact that she has since died, we have some doubts as to this. However, all three of
these men were taken with the disease : Burrows is dead. It was suggested that Burrows and
Williams both caught the disease from Marsh : and it is to be remarked that both Mr. F. G.
Vernon and Mr. Waitt were also passengers on that same boat on that 16th June, and that
they also took the disease, though it does not appear that either of these two gentlemen were
at all associated, or even acquainted, with either of the other three (Foster, Marsh and
Burrows). Both of them, however, were likewise taken a few days later, and Mr. Waitt died.
It is true, the normal period of incubation from the 16th June would expire about the 1st
July, and Mr. Vernon and Mr. Waitt were not taken until the 4th or 5th, so that their
attacks may have been due to some other source of infection; on the other hand, 18 or 19
days is by no means an impossible period. But, as will appear from a subsequent part of our
report, it does not seem necessary to connect either of these cases with Marsh at all.
Foster was taken on the 30th of June. For many days previous to his removal " quite a
lot of fellows " used to come and see him, up to the time of his removal to Albert Head, which
did not occur till the 6th July, though ordered by the Health Officer on the 4th July. It was
impossible to trace all the cases that might have been derived from this attack of Foster's,
But it may very obviously have been a very fertile source of subsequent infection.
Where or whence Mr. Niles or Mr. Eckert was infected seems quite uncertain. From Mr.
Niles, or from the source which infected him, it seems almost certain that many cases developed:
the Misses Bull, and the  patients   Monkhouse, Phillips, and others, in the Clarence;   the 510 Royal Commission—Small-pox Matters. 1893
windows of which opened close and nearly opposite to Niles's. Monkhouse, with the eruption
on him, was suffered to walk about Victoria, getting his hair cut and taking a hot bath.
Phillips, in the incipient stage, being locked out of the Clarence (where he was lodging) by
the quarantine guard, was thus driven out of the very place in which he ought to have been
confined, and went and slept at the Delmonico. The very hands whose duty it was to confine
and smother the contagion, in their zeal, actually compelled the propagation of it.
Every twenty-four hours after the 4th or 5th July, up to the 10th or llth July, brought
several new cases. It is useless to pursue any further the history of the outbreak in Victoria ;
the outbreak was already there. Fortunately for the community, other directing powers
intervened, with an extraordinary and immediate effect. With the change of system and
administration, the number of cases, which seemed to be advancing in a rapidly increasing
geometrical progression, was checked as it were by magic, and the history of the epidemic
from the 10th July merely records the issue of the attacks already developed, and about an
equal number of new cases, probably derived from these. Previously to Dr. Davie being put
in charge, every case seemed to engender many. As soon as he put his system in operation,
the disease seemed to be entirely shorn of its mischievous reproductive energy. By the 1st of
August it seemed completely stamped out.
Looking to the rapidity with which the disease spread, and the proportions it had assumed,
and the still greater proportions it threatened, the Government acted most wisely in promptly
appointing a Provincial Health Officer, and in issuing the regulations of llth July, 1892, for
the suppression of the disease. These regulations were, from the necessity of the case, drawn
up in great haste, and may be perhaps altered with advantage in some minor details. But,
hasty as they were, they effected their object. Wherever they were properly enforced, the
disease, if present, was stamped out; if threatened merely, was excluded. It is impossible to
estimate what might have been the loss to the Province, in life and in commerce, but for the
energetic action of the Executive Council. And the want of accord between the views of the
Provincial Health Officer and the Municipal Officer made the suspension of the latter, in
accordance with the provisions in the Health Rules, an absolute necessity, in order to secure
obedience to the Provincial regulations.
This, then, was the outbreak, as to which we have endeavoured to ascertain : 1st. Whence
it arose 1    2nd.  How it came so suddenly to acquire such serious proportions 1
As to the first question : Without giving any opinion upon the endemic theory, we are
fully satisfied that a part at least of the outbreak, so sudden and so fatal, at the commencement of July, can be traced to the date of the Foresters' Excursion to Vancouver City, which
returned on the 16th of June, and to infection contracted in that city; which again was
derived from the China steamer on its April trip. That steamer (Empress of Japan) arrived
at Victoria on the 17th April. A case had been discovered on board during the voyage, on
the 10th April, of a Chinaman in the steerage. He, and all the Chinamen in the steerage,
516 in all, were landed at Albert Head ; the patient put in hospital, the others under observation. The official rule then was, that such observation was to continue for nine days from
the outbreak. The quarantine officer, however, did not enlarge them till the tenth day of
observation on shore; and on the 27th April 238 of their number were forwarded to Vancouver
City on the Islander; the remainder, bound for Victoria, were also discharged from observation,
and allowed to proceed thither; the patient being detained at Albert Head until cured. We
have no evidence that any other case occurred among these 516 Chinamen. But Mrs. Bibby
(already named in connection with Marsh and Burrows' cases) was a passenger on that same
April trip. She had not been detained at Albert Head, but proceeded to Vancouver, and on
the 17th May was found in a house in Dupont Street, with the eruption well developed,
probably four or five days out. She has since died. Marsh was stated (Dr. Richardson, I. 13.)
to have remained for some hours in a house on Dupont Street. It is not known whether
Burrows or Williams visited the same house. Bibby and Burrows are both dead. Neither
Marsh or Williams were produced before us.
It was from the 238 Chinamen, held at Vancouver for Custom House purposes, that
Read and Hyde, who kept guard over them and their effects on the wharf at Vancouver from
and after the 27th April, are supposed to have caught the disease, and we think this probably
was the case. They were reported on the 14th and 16th May, respectively. (There is an
arithmetical error in the report of Dr. McGuigan's evidence, II. 106.) Stott, we think, caught
it from them, or perhaps on the wharf, from the same source of infection (reported on the 6th
June).    Leask, reported 21st June, caught it from Stott, having been with him in his cabin 56 Vict. Royal Commission—Small-pox Matters. 511
about the 6th June—an old cabin in which germs were likely to be lurking, and which was
very properly burnt down by the sanitary officers—Then a clerk named Barnett, employed by
the C. P. R. in taking and exchanging the Chinamen's passenger tickets, on the April trip
(passengers arriving 27th April), was taken about the 20th May ; and then Harrington and
Gillick were discovered on the 22nd and 25th May, both being 'longshoremen in constant
attendance on the same wharves, where the China steamer's baggage was sometimes left for
weeks before being transhipped. These constitute seven cases, besides that of Mrs. Bibby, all
directly pointing to the April trip of the Empress, when we know she had one case on board,
which was detained at Albert Head. It seems, therefore, highly probable that at this time,
i. e., in May and June, there were some secret germs or source of infection on or about the
wharves at Vancouver, emanating from the baggage and cargo deposited there, and possibly
also emanating from the several cases above enumerated, from which the five passengers to
Victoria on the 16th June, already named, viz., Burrows, Marsh and Williams, Mr. Vernon
and Mr. Waitt, were infected, and whence the contagion was conveyed to Victoria.
We think, therefore, that there is clear ground for tracing the origin of the outbreak in
July either to the trip of the Empress of Japan of the 18th April, to which we think
may be attributed the cases of Hyde, Read, Stott, Mrs Bibby and others, at Vancouver;
and that there is also ground for connecting some at least of the patients in the early part of July
with infection conveyed on the trip of the same steamer arriving here on the 17th June, when
there was undoubtedly small-pox on board, though it unavoidably escaped the attention both of
the quarantine officer here and of the medical officer of the steamer ; in fact, was not capable
of diagnosis until the 20th June, on the third day after the arrival of the steamer at Vancouver
City, and was then detected only by reason of the patient having been accidentally detained on
board for custom-house regulations. The great bulk of the passengers, several hundreds in
number, had long been landed ; several forwarded by railway. And some Japanese, who had
been passengers booked for Portland, having been refused admittance into the United States
and returned to this Province via Tacoma, one of them was discovered to be in a fully developed
state on his return. There must, therefore, have been the germs of the disease on board,
though not capable of diagnosis on arrival here. And yet the quarantine officer, Dr. McN. Jones,
appears to have even exceeded his legal powers in some respects, both in requiring answers
from the master and medical officer in charge, which ought properly to have been omitted, and
by extra detention of the Chinamen passengers for observation at Albert Head for several days
beyond the official interval (Dr. Jones, I. 367-8; 363). On the tenth day of observation, however,
upwards of 200 Chinamen, 278 in all, were permitted access to Victoria, 238 being sent to
Vancouver on the " Islander."
These things we have to report as the probable origin of the outbreak. The mischief
came from the April and June trips of the "Empress of Japan." And the answer to the
second object of our inquiry is, we venture to think, tolerably obvious from the preceding
narrative. Nothing, we are convinced, could exceed the zeal and activity of the Mayor, and
the officials of the corporation. But we think their efforts were misdirected. They had very
inadequate professional assistance and advice. The lay staff employed was quite inexperinced,
very imperfectly instructed, and not sufficiently supervised. The methods of quarantining and
disinfecting, intended to be pursued, were in several cases imperfectly carried out. But the main
fault was, that these methods were erroneous in their conception. They were devised on the
theory of establishing a separate quarantine in every separate case : and this quarantine was
often confined to the single room in which a patient happened to be laid up. Thus, only a single
room in a large hotel, or a tenement house, would be quarantined. Moreover, it seems to
have been conceived, that in a mild case less care was to be exercised in quarantining,
fumigating, &c, than in a more serious attack. And this error seemed to be held even on the
investigation before us, by some practitioners. In some cases no quarantine was established
until all the residents had left ; and it was generally established too late, through delay in
reporting cases, and the filtering of orders through different grades of officials. An inspector
would deem his duty performed when he gave an order without seeing that it was carried out,
that is—without inspecting. The consequence of all this was that every yellow flag indicated,
not so much a centre where infection was sealed up, but a nursery from whence it might
spread. The difficulties of the Mayor and Council were greatly aggravated, not only by
inadequate advice, but by the entire absence of all material preparation. There was not any
building capable of being utilized as an hospital for those attacked, or as a quarantine quarters
for suspects.    It was attempted  at  first  to  have recourse to the Albert Head quarantine 512 Royal Commission—Small-pox Matters. 1893
station. But its distance from the city, the total want of water, which had to be conveyed
thither in casks, the absence of proper hospital buildings, or hospital attendants for patients,
rendered it most difficult to give the due medical treatment there. And besides, it was
required for its own proper purposes by the Dominion Executive, who accordingly, when the
cases increased, insisted on their removal. Not only was the Board of Health thus embarassed
through its own inexperience and unpreparedness, but the population was equally unprepared.
Lulled into confidence by years of immunity, a large proportion of the inhabitants had
neglected the well-known prophylactic, vaccination. There was such a rush of old and
young to be vaccinated and re-vaccinated, as speedily exhausted the vaccine points : and many
operations are believed to have been performed with inert points : and when these failed to
take, the person (if it were re-vaccination) was encouraged to believe himself impervious.
These were the conditions under which the outbreak grew serious; and if we are asked
what steps should be taken to avoid or smother a second outbreak, the answer is, to invert all
these conditions; in fact, to do what was done by Dr. Davie and his staff under his appointment
of the 9th of July. He immediately organized two establishments, quite separate and
distinct; an hospital for the treatment of developed cases, with a resident physician and
nurses, to which all cases were removed; a suspect station, to which all persons were removed
who had been in contact with the sick, or other sources of contagion; also in charge of a
resident physician. From this station, any suspect who developed the disease was immediately
removed to the hospital, established in a portion of the Jubilee 12-acre lot. Both these
stations were strictly guarded against any egress, a matter evidently impossible to be effected
in the case of forty or fifty houses, scattered about a large portion of Victoria, every house
requiring, on the average, a couple of guards, with two or three reliefs in the twenty-four hours.
And then every suspect and every patient was vaccinated. Dr. Richardson was in charge of
the hospital on the 14th of July, three or four days being spent in making the necessary
preparations and accommodations. The new cases, which had been occurring clay by day, ceased
at once ; for fifty-two hours not a new case was reported, and after the 1st of August no case at
all for several days, so that on the 21st of August Dr. Davie resigned his appointment. Most of
the cases after the 14th of July arose in the suspect station, where Dr. Hasell had established
order out of chaos.
It is to the credit of the Mayor and Aldermen that, notwithstanding a little natural
friction on finding their power and discretion summarily superseded, and their functions reduced
merely to that of administrators and paymasters, they very soon loyally accepted and supported
the new order of things, the beneficent result of which was so striking and immediate as to
command their immediate recognition.
A great deal of what has just been said applies to the small-pox epidemic at Vancouver
City, as well as to Victoria. Vancouver is, in some respects, in a more dangerous position
than Victoria, though in a more favourable position for the detection of disease. The additional day or two before the passengers are fowarded giving scope for development, so that a case
which could not have been diagnosed at Victoria, or at all perceived there, may be perceptible
before landing on the Mainland, as, indeed, was shown both in the April and June trips of
the Empress of Japan. But especially, so far as the cargo or its environments can carry
contagion, Vancouver is clearly exposed to the greater risk, for the bulk, or the whole, of the
cargo and baggage is landed there (some of which, we are told, remains on the wharf like
cargo). The health officer at Vancouver, though not a medical man, seemed to understand
his duties well and to keep a more regular record, particularly in the matter of dates, than we
could find at Victoria previous to Dr. Davie's appointment. This enabled us to trace the
cases more clearly, and with less delay, than at Victoria. The system of separate house
quarantines, which threatened such extensive mischief at Victoria, was not practised in
Vancouver City, except where removal would probably have been immediately fatal; but for
some unexplained reason, the Board of Health had established three places at which patients
were treated, which we think less convenient and economical than a single hospital, and the
care of the suspects was not so efficient as that established here by Dr. Davie. It would also,
in our opinion, have been far preferable to have worked entirely under the Provincial Health
Rules, instead of partly under these and partly under their city by-laws.
It was alleged before us, and not contradicted, that a Japanese, a passenger on the June
trip of the Empress of Japan, one of a party engaged to go to Portland, Oregon, and who had
been refused admission into the United States,   and returned  to Victoria, via Tacoma, under 56 Vict. Royal Commission—Small-pox Matters. 513
the Alien Contract Law, was returned to Vancouver from Victoria on board the " Yosemite" on
the Sth of July, with the disease fully developed and in the pustular stage. We cannot help
expressing the opinion that, under a proper system of inspection, this case ought either to
have been refused landing at Victoria, or carefully isolated there, and that inspection should
be so ordered for the future as to prevent the possibility of such persons being permitted to
travel at all. The case appears to have occurred just a few hours before instructions were given
for the inspection of the steamers for Vancouver, Dr. Davie not having been appointed
Provincial Health Officer until the 9th of July.
At New Westminster there were very few cases—seven in all—and only one death,
an Indian woman. (Pearce, II. 126-149.) This woman seems to have been the only
person properly quarantined, viz., removed to an isolated spot, one mile from the city,
together with ten suspects. All the other patients were quarantined in their own houses.
New Westminster affords a very favourable locality for that practice, as almost all the cases
occurred in widely detached houses in the outskirts of the city. There were no developments,
no " outbreak," as in Victoria and (to a much less degree) in Vancouver. The other patients
v/ere five whites and one Chinaman. Nothing was known of the origin of the disease in any
case, except that one, a Mr. Kelly, had caught it when attending on his niece, Miss Kelly,
as to whose, and also most of the other cases, it was suggested that it had been conveyed
from Vancouver by a passenger on the Empress.
No cases whatever appear to have originated in the Health District of Nanaimo. This
is greatly to the credit of the health officers in charge of the district, and also tends to show that
the general Provincial regulations have a strong tendency to check the transport of infection.
All municipalities are naturally disinclined to incur expense upon erections which may
remain, and which it is ardently desired will remain, unoccupied and unutilized for years to come.
But as Mayor Townsend, of New Westminster, remarked in his evidence before us, " it is better to
be safe than sorry." And the real line of defence against the invasion of an epidemic consists not
in attempting or expecting wholly to exclude the enemy; it is almost inevitable that some
case of contagious disease may be brought in ; but to be prepared beforehand to stamp the
enemy out of existence as soon as it appears. To do this, we must be prepared beforehand,
both with a plan of action, and with the material means of putting that plan into practice.
The delay of a very few clays may enable such an enemy as cholera, for instance, to gain a
footing from whence it cannot be driven for months. The medical officer at Hull, England,
deserved great credit in such a case. A vessel had arrived from Hamburg during the recent
epidemic there, and was duly examined, and allowed pratique. Within an hour, one of the
sailors was seized with cholera. " But," said the doctor, " within another forty minutes he was
isolated in the hospital on shore." Now that sort of action would, at present, be simply
impossible here. And the erection of the necessary buildings should, in the bare exercise of
common prudence, be commenced forthwith. At Deadman's Island, and Poplar Island, Vancouver and New Westminster appear admirably furnished by nature with most appropriate
sites.    Victoria has still to seek one.
There has been upon the following points almost an absolute consensus of opinion among
the medical witnesses. Small-pox, scarlet fever, diphtheria, measles, cholera, should all be
removed and treated separately in special hospitals, or at least in special wards. It would be
theoretically preferable, but we are not prepared to recommend it as essential, that these should
be in five separate buildings, or even in five separate wards. It is to be hoped that we shall
not be visited by many of these disorders at the same time : and one properly constructed
ward, after having served its turn with one epidemic, may take another turn with a second.
Perhaps, two wards, connected by a hall or gallery, would suffice for present apprehensions.
But the immediate erection of some such building is most earnestly to be recommended, to which
all patients seized with either of the above diseases should be removed for treatment. The
natural desire of every citizen to remain in his own home, ought not to be indulged in, so as to
enable him to be a public clanger. The general health must be preferred before the sentiment
of the individual. This building should be at a safe distance from others. It is alleged, we
believe with perfect truth, that with proper air filters such an hospital may be established with
perfect safety in the most crowded city, but the general sentiment of danger would not be
satisfied with that, and a site at a convenient distance is preferable.
There should be also another building, to which all suspects can be removed and where
they may be securely isolated, pending the period of incubation of the respective disorders.
If every health district of the Province (hereinafter mentioned) be furnished with these, 514 Royal Commission—Small-pox Matters. 1893
and if the rules under which the late Provincial Health Officer acted be efficiently carried out,
we think that there should be no apprehension of any epidemic of any character in such health
district, although of course sporadic cases of contagious disorders may be introduced.
All of the above diseases should, at the very outset, be notified to the Health Officer. And
not only these but also all attacks of whooping-cough, measles, chicken-pox (for which the
small-pox seems here often to be mistaken), and typhoid. And the Provincial Health Officer
should have power to order the removal and isolation and separate treatment of all such
diseases, as well as of the five already named, in cases where he apprehends an epidemic. It
will be the duty of the medical man in charge, to carry out the directions of the Health Officer
as to removal, &c, of patients or suspects. Especially if there should be any general sickness,
though not epidemic—every case even of suspicion should be reported to the Health Officer.
Nothing can be more deserving of censure than the action of some practitioners in Victoria,
during the recent outbreak, in actually giving certificates to some patients that they were not
suffering from small-pox, in order to gain them admission into St. Joseph's Hospital, who were,
nevertheless, immediately recognized there as having unmistakeable symptoms of small-pox
evident on their persons. In general, no doubt, a medical attendant is warranted in concealing
from his patient an opinion of the gravity of an attack of which he is not quite certain : but
nothing can be more calculated to bring distrust on the whole profession than the furnishing
such a patient with a certificate contrary to the evident truth ; especially in a time of
epidemic, and more especially still when the consequence of the certificate is to infect a whole
hospital with contagion. We question whether the giving of such a certificate, in time of
epidemic, by a registered medical man, ought not to be liable to exposure before the police
magistrate.
Protection against Contagion from abroad—Small-pox and Vaccination.
The best protection against all invasions of contagion seems to reside, not in the first line
of defence, viz., quarantine: Through any quarantine isolated cases, it is shown by experience,
will find their way; but in the second line, isolation and sanitation. Any case which
penetrates through quarantine must be immediately taken up, isolated, and treated in such a
manner as to prevent its propagation. It seems to be universally admitted that all these contagions are propagated by means of germs : whether carried in the air, or by water, or in solid
filth of any description may be disputed. But this further is everywhere admitted, that
cleanliness, both of the person and of man's surroundings, diminishes the nidus in which
such germs flourish, and also diminishes the susceptibility of individuals to yield to their
attacks. And as a principal means of cleanliness a copious supply of pure water is essential.
With these precautions it is tolerably certain that no contagion will ever become epidemic.
As against all other contagions these are the only provisions which can be made, viz.,
isolation and sanitation. But as against the particular disease of small-pox there is the well
known and approved prophylactic, vaccination ; to the supereminent value of which all the
professional men examined before us testified quite unanimously. There were differences of
opinion as to the mode of operating, some preferring calf lymph provided from vaccine farms,
some preferring arm to arm vaccination ; but all agreeing as to the great value of the operation.
The experience of the Province in the recent epidemic shows, however, that vaccination, and
re-vaccination, by no means affords the perfect protection against contagion which has been
sometimes supposed. The experience here, however, may to some extent be due to the inert
points used. Yet there can be no doubt that vaccination very greatly lessons the chances of
infection, and still more frequently disarms small-pox of its virulence. In the recent epidemic,
out of one hundred cases treated by Dr. Richardson fifty-three had been vaccinated, but only six
showed four scars, i. e., fully vaccinated. And out of thirteen deaths only one vaccinated person
died, and he was suffering from a complication of disorders. That is, one vaccinated person
died out of fifty-three attacked, and twelve unvaccinated persons out of forty-seven attacks.
This is certain, that although doctors and professional nurses are obviously more exposed to
contagion than any other classes of the community, not a single doctor or professional nurse
was attacked during the whole course of the epidemic here. They all believed and trusted in
vaccination. There are no statistics to show the numbers of vaccinated and unvaccinated
persons here; but probably the vaccinated are far more numerous—far more than the ratio of
fifty-three to forty-seven ; in which case the percentage of attacks, as well as of deaths, is largely
in favour of vaccination.    In fact, only six out of one hundred attacks had been fully vaccinated. 56 Vict. Royal Commission—Small-pox Matters. 515
Against this universal consent of all who had made a professional study of the question,
we offered to take the evidence of all who professed the contrary opinion. Two champions
presented themselves. One, who appeared much the stronger in his views, had confessedly
not studied the question at all, and the mere vehemence of the expression of his opinions of
course entitled them to no weight, but rather detracted from their impressiveness. The other,
Mr. Greig, had devoted a great deal of time and study to the subject of vaccination ; and
adduced a vast quantity of figures in support of his propositions, which were chiefly that (1)
vaccinia is in no degree a protection against small-pox, but rather predisposes to the
disease ; (2) the Austrian statistics show that the mortality per cent, in vaccinated cases is
nearly double that of the unvaccinated ; (3) small-pox in the 18th century was not usually
fatal, nor an object of dread, except among infants ; it was in fact a merely infantile disorder ;
(4.) vaccinia in itself was a highly dangerous disease, though perhaps not so immediately
fatal as small-pox, but with a high probability of conveying into the vaccinated persons various
deadly poisons: erysipelas, syphilitic, and scorbutic disorders, consumption, &c, more
to be dreaded than small-pox itself.
These propositions are so utterly contrary to all the accepted ideas of educated persons,
and to all common knowledge, that we examined a little into the tables and figures adduced.
But we found that they were all (with one exception) merely one-sided, extracted, or
constructed, in order to support a foregone conclusion (though we are quite sure that Mr.
Greig did not think so, and, in fact, that it would be impossible to persuade him to that effect)
and utterly unworthy of any reliance. The exception to which we allude, the only one in
which the whole case was placed before us, was the Blue Book on the Parliamentary investigation in the Norwich case. Mr. Greig handed this Blue Book up to us in order that we
might see the ipsissima verba of one or two witnesses, contained in one or two lines. This, of
course, we declined to do, and looked at the whole report. And it was so extraordinary, and
so completely exploded the whole case of the anti-vaccinationists that we shall shortly state
the case as it appears by the report of the commissioners :—
The Norwich case arose in this wise : Shortly after certain vaccinations by the Norwich
public vaccinator in June, 1882, nine of the infants had contracted erysipelas, and four had
died—two sickening within a very few hours after the operation. Complaints having thus
arisen, a Royal Commission was appointed to inquire into the case. It was ascertained that
it was perfectly true that nine children who had been vaccinated at the public station by the
public vaccinator had been seized with erysipelas—one within two hours after the operation—
and that four had died of that disease. The vaccination had been by arm to arm, taken on
bone points which had been frequently used before, a practice which the Commissioners condemned. Erysipelas was very prevalent in Norwich at the time, though not epidemic.
None of the vaccinifers were affected, either then or later on, with erysipelas. The vaccinator
had occupied his situation for nine and a half years, vaccinating 1,000 or 1,200 annually, and
this was the first complaint concerning any cases vaccinated by him. The Commissioners
exonerated him from all blame. They profess to be unable to assign with any certainty
the origin of the fatal erysipelas in any case, but think that in two cases it was contracted
while attending at the public station in order to be vaccinated, and that a " strong case of
suspicion" is raised against the purity of the vaccine lymph employed in these two cases. As
to the third child, they believe the erysipelas was also contracted at the station, but that there
was no evidence as to the probable source of infection. As to the 4th child, they find that it
caught the infection at the station, but at the inspection of its arm on the eighth day after
vaccination, and not from the operation at all. The Norwich Commissioners therefore found
that these four are the only deaths which it had been attempted to connect with any one of
10 or 12,000 operations—that as to one child, it did not catch erysipelas till eight days after
vaccination, and therefore clearly not from the operation at all; that as to another child, there
was nothing to connect the erysipelas with the operation, though there was no conclusive
disproof.
As to the third and fourth cases, the Commissioners seem quite puzzled. If they attributed
it to the points : these were inserted four times in the vaccinifer, and only once in the patients,
yet the vaccinifer never caught erysipelas. On the other hand, since he never had erysipelas,
it seemed impossible that he could give it. However, the Commissioners strongly suspected the
lymph. Notwithstanding this, Mr. Greig actually says (Evid. II., p. 329): "The result of
the Norwich Commission was to prove that the whole of the four deaths resulted from
vaccination."—"According to the Report, Dr. Guy killed all the four children."—"They (the 516 Royal Commission—Small-pox Matters. 1893
Norwich Commissioners) reported that there was no doubt about the cause of death of the four
children." And it was impossible to convince Mr. Greig that he was under a complete
hallucination as to the express declaration of those Commissioners; or that they had in the
clearest terms declared the exact contrary of what he so vividly imagined. When a man
cannot, as to a particular subject, be brought to understand the meaning of what he himself
says, or of what others have written, he cannot expect his opinions on that subject to be
treated' with great^ deference,'' however respectable in other respects. Whereas, in fact,
the Commissioners' Report does not distinctly trace one single case of infection to the
lymph of the vaccinator out of 10,000 operations, and only dubiously traces two deaths
to the operation, and that at a time when erysipelas was in the air in the city—expressly
pointing out, that the erysipelas might have been caught from others at the station, or
from the doctor himself. Whether vaccination should at all be proceeded with in the
presence of such a plague, and whether it should not at such times be postponed until the
atmosphere becomes more healthy, may be questioned. The Norwich inquiry seems to us to
prove that careful public vaccination, at times when the general health of the city is in a
normal state, is almost wholly free from any the slightest appreciable risk, either substantively
in itself, or as the vehicle of more serious infection And this is all that the medical profession
generally allege. And against this minute percentage of risk is to be weighed its well-proved
efficacy as a prophylactic during a whole century in every civilized country in the world—
tested too, in the face of most virulent opposition on all sorts of grounds, physical, sentimental,
and religious.
The extreme and unjust vehemence of the anti-vaccinationist mind may be perceived by
the degrading prejudice exhibited against the entire medical profession by Mr. Greig, who we
are quite convinced would be most fair and temperate upon any other topic. As to all public
vaccinators in England, he over and over again referred to the necessary bias in their minds by
reason of the fee (3 shillings). And he greatly preferred private vaccinators, because, he
insinuated, any of them might, to please the parents, vaccinate the infant with milk instead of
vaccine lymph and then give a vaccination certificate. And although repeatedly pressed,
whether he really and seriously thought that the latter would be guilty of such a fraud, or
that the former would be willing to out-Herod Herod by poisoning innocent infants at six
bits a head, he still smilingly adhered to his views: that if these motives were not always put
in practice, they were always present: nor was it possible to make him perceive that he was
ascribing the basest conduct to the entire muster-roll of the profession : since doctors who are
public vaccinators, and doctors who are not, necessarily exhaust the whole category.
In our opinion, though vaccination is not infallible—probably there is no infallible remedy
or prophylactic against any disorder in the world—yet it is so potent that, if universally
adopted, small-pox might be eliminated from the nomenclature of existing diseases. The
evidence of Mr. Kito, the Japanese Consul at Vancouver City, is valuable as illustrating the
high degree of appreciative intelligence possessed by his fellow-countrymen.
We think that vaccination should be compulsory on all children before attaining the age
of three months, followed by re-vaccination at the age of puberty.
Though we have no doubt but that humanized lymph and arm to arm vaccination is the
most efficient and economical method, yet as there is considerable divergence of professional
opinion in the Province on the subject, and as there may be, and doubtless are, many nonprofessional people who entertain sentimental or real objections to its compulsory adoption, we
suggest that the subject, or the parents or guardians of the subject, should have the choice of
being operated on with humanized or bovine lymph.
To insure due performance of the operation, we recommend the appointment of public
vaccinators by Government, who alone should be authorized to issue certificates of successful
vaccination, of insusceptibility, and of unfitness for submitting to the operation. They should
keep a register of all cases and results, and be subject to the supervision of a superior officer.
When the disease is prevalent, or threatens to become so, extra provision should be made
for vaccination and re-vaccination, and the routes of travel should be properly guarded to
prevent the departure from an infected place of any person capable of carrying the infection
elsewhere.
But these and all other measures of a like nature are best left to the discretion of a
Provincial Health Officer, who should, we think, be appointed by the Government and
responsible to the Executive : and to whom all health officers should report on any matters
connected with disease or sanitation as he may from time to time specify. We strongly recommend that the various municipalities should, so soon as such officer is
appointed, be deprived of the right to legislate in any way upon matters relating to the public
health, but that to ensure uniformity these should be regulated either by Parliament, or by the
Provincial Health Officer, so far as Parliament may think fit: and that the several municipalities
should be confined to administrative powers only. And in this view we suggest that the entire
Province be mapped out into health districts as large as may be, with a health officer in each,
to whom all reports from medical men in such district are to be made in the first instance.
As TO QUARANTINE GENERALLY.
The old notion, perhaps founded on the number of days of Lent, had in view the detention of vessels, &c, for forty days, as the word itself clearly expresses. This interval was
probably fixed long before any notion had been formed of the period of incubation of various
infectious diseases. In view of our present knowledge, and of the necessities of commerce and
personal intercourse, no such detention could be sanctioned in any civilized communities. In
1891 there were 52,000 passengers landed at Victoria from steamers alone, exclusive of those who
proceeded further, and exclusive of sealing vessels. In 1892 the steamers arriving here were
seventy-five per month (Dr. M. Jones, I. 382, and see I. 376). Indeed, it may be said that there
is nothing to justify the detention here (except for the purposes of inspection) of any vessel
arriving from a port which has no epidemic, and where the vessel herself has been free from
contagious sickness on the voyage, these matters being certified by the commander and medical
officer (if any) of the vessel, and by the inspecting medical officers or health officers of the
ports of arrival and departure respectively.
But it is to be remembered that disease may be developed at any time, immediately
after as well as immediately before arrival, and inspection of a newly arrived ship should
be repeated from day to day. For example, having regard to the period of incubation of
small-pox, and the average length of a voyage from Japan, it would be well that all steamers
arriving from the East with passengers and cargo, both for Victoria and Vancouver (city),
should be inspected at both places. The same principle would apply to vessels calling at
Victoria en route for Nanaimo. The second inspection would not, perhaps, require to be
equally strict with the first; but as the inspection of passengers was shown before us to
occupy no more than an hour, even when there are several hundred Chinamen on board, this
would not be an unreasonable or very irksome regulation, as regards passengers simply.
The disinfection of cargoes extending to several hundreds or thousands of tons presents
great difficulty. Evidently, infection may bo conveyed in the wrappings of a bale of goods as
readily as in the clothes of a passenger. The newly provided dioxide blast would probably
furnish a method of dealing with cargo far superior to any heretofore in use. But it might
damage for instance a cargo of tea. The tea itself would not be likely to carry infection, and
it is the wrappers or cases which are the only considerable seat of danger. It would uot be a costly
matter to have all these disinfected or sterilized at the port of loading. If so certified by a
competent authority, the dioxide blast might be dispensed with. A vessel arriving from an
infected port should hoist a yellow flag, even although there be no case of actual sickness on
board, or developed and passed through all its stages on the voyage.
Where passenger steamers, such as the China and Japan lines, carry regular medical
officers, it might be well that these should in some degree be recognized by and made responsible
to the Department at Ottawa, just as much as the officers at the quarantine ports of the
Dominion.
The inspection of a newly arrived ship should take place in daylight, unless there are
portable electric lights on board.
The real protection of the community lies, however, on shore. Every case of contagious
disease should be at once carried to a contagious hospital and treated there—and all berths,
bedding, &c, disinfected, or destroyed, where that is possible.
Seaports being the outposts of the whole Dominion, and the health of the whole Dominion
to its centre, so far as imported contagious disease is concerned, being entirely dependent on
the vigilance in detecting and treating such cases at the seaports, and the commerce of the
whole Dominion being also concerned in seeing to it that such protection should offer as little
inconvenience as may be compatible with effectiveness, the expense of isolation and disinfection
of such cases at the port of entry, of separate hospitals, etc., should not be thrown entirely
on the respective municipalities at such seaports; but a proportion, at least, of such expense
should be borne by the Dominion.    Not the whole expense:   for such hospitals are also 518 Royal Commission—Small-pox Matters. 1893
extremely necessary in these municipalities for dealing with non-imported cases : scarlet fever,
diphtheria, etc. The Dominion, in return, should be invested with an authoritative voice in
their management.
In the case of persons dying of contagious disease, cholera, etc., in an isolation hospital,
there can be no doubt but that cremation is the only really correct and proper method of
disposing of the body. The objections to this method seem to be of the purest sentimentality:
for the process is in its ultimate results absolutely identical with that which goes on after
earth to earth burial: but without its disgusting features. Cremation is a certain preventive
against contagion from the body, especially against any contamination of water springs from
the corruption of the corpse. If it were once properly understood that the results of
combustion and of decay are, as to the products, precisely identical, and that only the
phenomena vary : that after the lapse of (say) 50 years a corpse is resolved into precisely the
same gases and minerals as in a few minutes of combustion, but that in the one process a
sensible heat is exhibited, not perceptible in decay—and that a decaying body exhibits odors
and appearances not perceptible in combustion,—perhaps the sentimental objections would be
overcome. At any rate, if it should be impossible to compel cremation, the bodies of deceased
patients should not be allowed to leave the grounds of the isolation hospital: they should be
buried there and means taken to destroy their injurious properties.
Mr. Moore's evidence is worthy of consideration, and shows a possible source of danger
hitherto unnoticed. It suggests the great desirability of legislation in Canada similar to that
which in England regulates the importation of rags from Russia.
The sanitation of all localities is secured and maintained by keeping in repair all public
ways and drains : by the early and complete removal of filth : by the rigid inspection and
regulation of all unhealthy trades and establishments, especially by the prevention of overcrowded tenement houses and lodging houses : by ensuring a constant and abundant supply of
pure water. With respect to this last, it is very important, especially when the source of
supply is a lake, that it should be removed from human habitations, so that none such be
permitted to drain into the area of its water-shed.
At the commencement of any epidemic general directions should be published by the
government, with information as to the measures to be adopted, until the Health Officer shall
intervene.
With respect to cholera, it may be useful to point out that the theories accepted by the
best authorities of the day seem to he as follows:—
1. Asiatic cholera is an infectious disease, resulting from the entrance into the alimentary
canal of a poison, probably a specific bacterium, whose history has not yet been clearly
determined, i.e., the poison must be swallowed, not inhaled, etc.
2. The disease is endemic in India only. Elsewhere it is imported. It may be imported
by any vehicle, liquid or solid, which has derived, mediately or immediately, any of the specific
poison from the alimentary canal of a patient. There is a divergence of opinion as to the
degree of dryness, and the length of time necessary to destroy the bacterium. That a certain
degree of desiccation and a certain lapse of time will destroy it, seems admitted ; but the only
admitted degree of desiccation seems to be. that attained in a furnace.
3. No amount of filth or moisture will generate the poison; but filth and moisture furnish
the very best conditions for maintaining, invigorating and propagating the bacterium, if once
introduced.
4. The disease is not contagious in the sense of being communicable by contact.
Matt. Baillie Begbie,
E. A. Praeger.
VICTORIA, B. C. :
Printedby Richarp WOIfkndm, Printer to the Queen's Most Excell#nt{ Majesty.

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