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REPORT Of Dr. C. J. Fagan, Secretary of the Provincial Board of Health, who attended the Sanitorium Convention… British Columbia. Legislative Assembly 1901

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 1 Ed, 7    Report of De, Fagan on Tuberculosis Conference.       605
EEPOET
Of Dr. C. J. Fagan, Secretary of the Provincial Board of Health, who attended the
Sanitorium Convention held at Ottawa on 14th February, 1901.
D. M. EBERTS,
Attorney-General.
A ttorney- General's Department,
23rd March, 1901.
The Honourable D. M. Eberts,
A Itorney-General.
Sir,—In accordance with instructions, I attended the conference on tuberculosis, held at
Ottawa on February 14th, 1901, and following days.
Over three hundred delegates were present, consisting of representatives from every
Province in the Dominion, eminent medical men as well as prominent business and public
men.    There were also delegates frem scientific societies and municipal corporations.
His Excellency the Governor-General presided, and explained the objects of the meeting,
which briefly were as follows:—
1st.  The formation of a society for the prevention of tuberculosis, on lines similar to
societies already formed in Great Britain and other countries.
2nd.  To point out and explain to the people of Canada the urgent necessity of combatting
the danger which besets them.
3rd.  To show that it is the duty  of every government, municipality and individual to
adopt organised methods for lessening the spread of a disease which is causing, directly
or indirectly, probably one-fifth of the total deaths in the Dominion.
In conformity with these suggestions a society has been formed. The Duke of Cornwall
will be asked to become Patron. The Governor-General is Honorary President; Sir James
Grant, President; and the Lieutenant-Governors of the different Provinces are Vice-Presidents.
The duties of this Society are—
(a.) The publication of literature—technical and popular—on tuberculosis.
(b.) The encouragement of the formation of anti-tuberculosis societies in town and rural
municipalities.
(c.) The pointing out of the need and advantages of sanitoria.
(d.) Assisting and obtaining the co-operation of local governments, municipalities, philanthropic and charitable organisations and individuals towards the construction and
maintenance of consumption sanitoria.
All of these were fully discussed, and resolutions dealing with them were adopted. A
copy of most of the resolutions passed is appended hereto.
Facts Elicited.
In considering the gross outcome of the meeting, it appears to me the greatest stress was
laid on the want of knowledge by the general public as to the danger of their surroundings.
It was pointed out that there are very few families who have not, or have not had, some
members, friend or relation affected with tuberculosis, and it was freely admitted that little or
no precautions were taken to prevent infection, and very little done towards effecting cures. 606       Report of Dr. Fagan on Tuberculosis Conference.      1901
That this is true is evident when we consider the yearly mortality returns. In Canada the
deaths from consumption have been for a number of years up to 9,000 a year. In Ontario, in
the year 1898, there were 3,291 victims, and in the Province of British Columbia, although
returns are very incomplete, we have a record of nearly 200 deaths. In the United States
the conditions are no better, for we find that every year tuberculosis claims as many as 100,000
victims.
In industrial occupations it is the cause of nearly one-half of the mortality, and more than
one-half of the invalidism; of those who die between the ages of 15 and 60, no less than 37 %
die of this disease, so that 37 persons out of every 100 die at an age when their lives are of
most value. These figures are startling, and are rendered more so when we consider the
popular error that consumption is hereditary and incurable.
Consumption not Hereditary.
In 1882 Koch isolated the bacillus tuberculosis. Since that discovery scientists have
been working on the right lines with so much effect that now it is accepted as a fact that
consumption is not hereditary; that it is caused only by the introduction into the system of
an organism known as the bacillus tuberculosis; that it is contagious and infectious.
This discovery places a new and vitally important phase on the question of the consideration and treatment of tuberculosis. The late Professor Pasteur has said that "it is in the
power of man to cause all parasitic diseases to disappear from the world." If this is true, and
there seems to be no doubt it is, we arrive at the fact that consumption is preventible.
To sum up, we find the accepted facts of the present day are:—
(a.) Consumption is not hereditary, and not incurable.
(b.) It is contagious.
(c.) It is preventible, and
(ti.) Is under certain conditions curable.
This, though certainly a bright outlook, throws weighty responsibility on some shoulders,
for knowing and understanding the danger the responsibility follows of taking preventive
action.
It is conceded that the cause of tuberculosis in man or beast is the bacillus tuberculosis.
Without the presence of this organism there is no consumption. The bacillus enters the human
system through either the respiratory or digestive tract, or, though rarely, through an abrasion
of the skin.
How Tuberculosis is Spread.
An individual suffering from advanced pulmonary tuberculosis is estimated to expectorate
as many as seven billions of bacilli in twenty-four hours. Either from ignorance or carelessness he spits on the ground, on the floor, or in a handkerchief. So long as this remains moist
not much harm can be done, but when it dries, and becoming pulverised, it floats in the air or
settles on dust, it may be breathed by some unfortunate in a condition suitable for the growth
of the bacillus. These bacilli if exposed to direct sunlight for even a few hours are rendered
harmless, but if allowed to remain in dark places will retain their virulence iot months. It is
therefore apparent that ill-ventilated and dark homes, stores, warehouses, work-shops, public
halls, places of amusement and other public resorts are often most fruitful places of infection.
Milk from tuberculous cows is the greatest source of infection of the digestive tract. There
are, of course, other sources of infection, but the two cited, namely, sputum and milk, are the
principal offenders, and if they could be eliminated then a very decided improvement would be
effected.
I have lightly touched on these subjects so that the suggestions I propose to advance in
regard to preventive and curative measures will be more readily understood and appreciated.
Other Places Visited.
After attending the Ottawa conference I visited the Consumption Sanitorium at Graven-
hurst, in the Musquoka Mountains, and Saranac Lake, in New York. I gained a great deal of
information at these places, especially at Saranac, where Dr. Trudeau presides. He is an
enthusiast, and surrounds himself with earnest workers. The sanitorium, the equipment of
which is up to date in every particular, is built on  the  cottage plan, and  accommodates one 1 Ed. 7   Report of Dr. Fagan on Tuberculosis Conference.       607
hundred patients, and is always full. Patients are not kept longer there than five months.
The results are very satisfactory, averaging 85 °/0 of arrested disease.
The Gravenhurst Sanitorium accommodates about fifty patients, and also shows excellent
results.
I intended visiting the St. Agathe Sanitorium, in Quebec, but was unable to get there on
account of snow slides. I, however, spent the greater part of a day with Dr. Richer, the
Medical Superintendent, and obtained from him some very valuable information.
Sanitoria Treatment op Tuberculosis.
The consensus of medical and public opinion in both Europe and America is that sanitorium treatment of consumption produces the bests results. At the Congress of Berlin, in
1899, a resolution endorsing the sanitoria treatment of consumption was adopted. In Germany, where compulsory life insurance is in force, where all receiving a wage lower than
a certain amount are obliged to be insured, the growth of sanitorium treatment has been
remarkable, owing largely to the action of life insurance companies expending much money in
the erection and maintenance of sanitoria, where they send those of their insured who are
suffering from consumption, finding that from a financial standpoint this is economy.
Ontario's Recognition.
The Honourable Mr. Ross, Premier of Ontario, when introducing a Bill to aid in the
building of sanitoria, said : "the most valuable asset any nation can have is its people—its
men and women, its sons and daughters." The Ontario Legislature voted some $280,000, to
be divided among the Municipalities in such a manner that any Municipality building a
sanitorium would get one-fifth of its cost from the Government,' not to exceed $4,000,
together with a grant of twenty cents per head per day.
Suggestions.
Following the example of the Province of Ontario, I would suggest the Government
consider the question of assisting in building a sanitorium for the treatment of incipient consumption, and a hospital for advanced cases. I think these two would be enough, at least for
the present. I advise this distinction, because it has been found that more can be done for
incipient cases; and it is very depressing and injurious to patients to see many failures, not to
say deaths, in an institution. Besides, advanced cases should not be sent to an inaccessible
place, or where it costs much to get to, because critical conditions are liable to arise at any
time and friends naturally wish to be present.
The best location for a sanitorium for incipient cases is where the air is pure, and free
from dust, where the temperature is not liable to great changes, and where there is no excess
of moisture, especially fogs; the ground should be dry and porous, and above all there should
be a complete freedom from north and north-west winds. The architectural aspect is also
most important. The question of cost is, of course, one for consideration by the Government
in connection with cities and municipalities.
I think that all patients should pay, so that each should be on an equal footing. A
charitable fund could contribute part or all the fees of poor patients ; a committee managing
this charitable fund could determine who should, or should not, recieve help from it.
It would be beneficial to enact laws against spitting in public places, in railway or street
cars, or on sidewalks, and rigidly enforce them, although the enactment of such measures
would doubtless be the duty, largely, of Municipalities.
It is a debated question whether notification of tuberculosis should be made compulsory.
I, myself, think it would be well to pass such a law and enforce it only under certain conditions.
I append a copy of the paper I read at the Ottawa Conference.
I have the honour to be,
Sir,
Your obedient servant,
C. J. FAGAN,
Secretary. 608      Report of Dr. Fagan on Tuberculosis Conference.      1901
Paper read before the Tuberculosis Conference, held at Ottawa, February 11th and following
days, by Dr. C. J. Fagan.
Your Excellency, Ladies and Gentlemen :—
I left home on a day's notice, and did not know I was expected to address a meeting of
this character till late last night; I, therefore, am not prepared to treat as I should like to, the
important subject under discussion ; but, I assure you that the aims and objects of the meeting have my full and entire sympathy, and as a delegate from the British Columbia Government, I think my presence is sufficient surety for their good intentions, and I have no doubt
they will be only too glad to join in with the other Provinces and assist in carrying out, fully,
the measures decided on at the meeting for the prevention and cure of tuberculosis.
As you all know, tuberculosis is responsible for the deaths of a greater number of people
than all the other contagious and infectious diseases combined. Such theatrical diseases as
small-pox, plague, etc., are so dreaded that the neglect to provide against their incursions
would mean, and rightly too, the downfall of any Government.
A meeting, such as this, will educate the people ; and when they understand that the
dreaded consumption is as preventible as small-pox, they will demand that action be taken—
not only to prevent, but also to erect sanitoria for the cure of those affected.
At this present day, I think we are all united as to the value of preventive measures in
limiting and controlling the spread of contagious disease. I am quite satisfied that, if the
proper preventive measures are adopted and carried out, within five years the deaths from the
contagious disease under discussion will be reduced fifty per cent.
I am very glad this movement has begun, and have no doubt it will meet, as it ought to
do, the hearty support of all classes, and all in authority will shoulder a weighty responsibility
if they refuse aid.
. I now come to the last part of the resolution under discussion, and will only touch on
one of the many duties of individuals towards their neighbours in respect to tuberculosis.
My appeal is to the ladies, and, although I fear their hearts are hardened where fashion blocks
the way, I will state for their benefit a few facts :—
As is now admitted, the greatest cause of the spread of tuberculosis is the stirring up of
infected dust. The bacillus tuberculosis follows the ordinary laws of gravity and settles
down to earth, satisfied to live his life, probably, clinging to a particle of dust—but. Miss
Fashion comes along and, with an energy worthy of a better cause, sweeps up with her trailing skirt the peaceful bacillus to be inspired by some unfortunate.
This is happening day after day and hour after hour, and is, I am satisfied, a most
fruitful source of infection. Miss Fashion does not think she is cruel, yet, by her actions, she
kills thousands. She would be horrified were she told she is dirty. I have gone to dress-
cleaners in Victoria (and I am sure the same is true in every city in Canada) and have been
told that leaders in society have sent in skirts for cleaning and repair which the proprietor
refused to send to his workshop so loaded were they with filth. I refuse to believe that
Fashion will win against Humanity, and have every confidence in the kindliness of the
gentler sex and have no doubt they will be ready to assist us when they realise how serious a
matter this is.
Copy of Resolutions Passed at Ottawa.
Resolution No. 1.
Resolved, that in the opinion of this Conference, which represents the Governments and
people of every part of Canada, it is the duty of every Government, Municipality, and
individual citizen, to adopt organised methods for lessening the spread of a disease which is
causing, directly or indirectly, probably one-fifth of the total deaths in the Dominion.
Resolution No. 2.
Resolved, that this Conference does especially urge upon those Governments, and all
Municipal Councils and Boards of Health, the enactment of such legislation as will,—
1. Encourage the notification of all cases of tuberculosis ; 1 Ed, 7    Report of Dr. Fagan on Tuberculosis Conference.       609
2. Tend to prevent the spread of infection through expectorating in public buildings,
conveyances and private dwellings ;
3. Extend the inspection of places where work-people assemble, with a view to improving their ventilation, lighting, and general sanitation;
4. Assist in preventing the spread of the disease through milk and meat of animals ;
5. Aid in providing some scheme, such as that placed on the Statutes of Ontario in 1900,
whereby organised effort of the people may be assisted by Governmental and Municipal aid in providing sanitoria or " homes," where the curable may be given an
opportunity to recover, and the advanced cases cared for with comfort to themselves
and with freedom of danger to those in the homes to which they belong.
Resolution No. 8.
Resolved, that it is the view of this Conference that in a disease whose influence extends
from questions of the inspection of immigrants to that of imported cattle, and affects the
output of our farms and our factories, the Federal Government may greatly assist in the fight
against tuberculosis by,—
1. Preventing the entrance into the country of tuberculized immigrants and tuberculized
cattle;
2. Arranging with the Registrars-General of the Provinces for a system of Federal
health statistics of deaths;
3. Establishing a Sanitorium in each of several typical Canadian climates, where, under
careful medical supervision, the therapeutic effects of dry or moist, high or low, forest
or prairie climates may be scientifically studied, and the results published for the
information of the general public;
4. Making an annual grant for the preparation and distribution of literature regarding
the means of prevention and cure of tuberculosis; and for adopting such other
measures as will bring the objects of this Conference before those individuals and
corporations whose privilege and interest it will be to encourage the work.
Resolution No. 4-
Resolved, that it is the voice of this Conference that a " Dominion Association for the
Prevention of Tuberculosis" should be established, and to that end this Conference does
approve of the action taken by the members of the Canadian Medical Association and others,
at a meeting held in Ottawa, in September, 1900, in forming an association with provisional
officers; and does hereby agree to lend its hearty support to that association and its objects,
as then formulated.
victoria, b. c. :
Printed by Richard Wolfkndrk, Printer to the King's Most Excellent Majesty.
1901 

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