BC Sessional Papers

REPORT OF THE PROVINCIAL BOARD OF HEALTH. British Columbia. Legislative Assembly 1902

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 2 Ed. 7 Provincial Board of Health. 773
REPORT
OF  THE
PROVINCIAL BOARD OF HEALTH.
Office of the Provincial Board of Health,
Victoria, B. C,  1st January,  1902.
To the Honourable D. M. Eberts, K. C,
A ttorney-General.
Sir,—I have the honour to submit the Fifth Annual Report of the Provincial Board of
Health, being for the year 1901.
Although not a time fraught with such danger as that of 1900, yet the year just closed
has been an exceedingly busy one, partially from a legacy left from the previous year, and
partially from the necessity for stricter vigilance in warding off several threatened outbreaks
of small-pox. It was necessary to be more than ordinarily watchful, from the fact that the
disease made its appearance at widely opposite places, it being at different times at Victoria,
Vancouver, Revelstoke, Chilliwack, Sumas, Naas, Skeena, Quesnel, Rossland, Nelson, Kitchener,
Moyie, Cranbrook, Kimberley, Marysville, Fort Steele, Michel, Fernie, Morrissey Creek,
Sparwood, Phoenix, Grand Forks, Cascade and Fairview.
Almost without exception, the source of infection was traced to the American side. The
epidemic in Nanaimo and Phoenix gained good headway before it was recognised, and it
required energetic and thorough measures to bring it under control; this, however, was soon
accomplished, and the danger of spreading prevented. In no other place was it allowed to
make any material progress.
I may say that we are ever open to the danger of having this disease upon us, due, I
regret to say, to the laxity prevailing in certain sections of the United States along the border
line. As pointed out in my Report for 1900, there are certain towns along the boundary line
where positively no attempt is made to prevent infection, and when the disease makes its
appearance it is allowed to run its course, spread and propagate. It is in this connection that
I would draw particular attention to the necessity for a more stringent guard at the places of
entry from the United States into this Province. As the work of guarding the line has been
taken in hand by the Dominion authorities, this matter, I respectfully submit, should be placed
before them in as strong a light as possible. I have many times complained of laxity on the
part of the Dominion Health authorities, and I regret that there is still cause for complaint.
There are some most important points left in charge of laymen, and others are insufficiently
guarded. It is only to be hoped that there will not, at any time, arise serious cause for blame
on account of neglect.
In this connection I would refer to one incident which will indicate the spirit with which
the Dominion authorities enter into this, to us, most important matter. The steamer
" Mainlander" runs between Vancouver and Seattle. On December 16th, 1901, a case of smallpox was discovered in Vancouver, and it was found that the patient arrived from Seattle on the
" Mainlander " eight days previously. Again on the 28th another case developed. This, too,
came from Seattle on the same boat five days previous to the appearance of the rash. Although
I understand that in the last case the patient was ill while on the boat, with the usual premonitory symptoms, yet I do not think any blame is to be attached to the local Health Officer,
for without minute examination, which is impracticable, he could not have recognised or
suspected the trouble. When I had these matters placed before me I notified the Dominion
authorities.      Both cases were beyond doubt incubating the disease on date of arrival.      The 774 Provincial Board of Health. 1902
question in my mind was, in what condition was the boat ? I concluded that it probably was
infected, because, although it is doubtful whether the patients at such a stage could infect, yet
the probability was their clothes were infected at the time they themselves contracted the
trouble. Under such conditions, I considered that the only safe course was to ask the Dominion
Government to disinfect the boat. I did so, and received from Dr. Montizambert, through Dr.
McKechnie, the following reply :—
" Case developed after landing. Question as to it and ' Mainlander' are therefore Municipal or Provincial, and not Dominion."
I again applied, reminding them that the two cases came off the boat, and got the same
answer. Although the Williams Head appliances were offered to us if we paid all expenses, I
did not and do not consider that this was Provincial work. Recognising the importance of
immediate action, I asked the agents of the steamship company to get the boat disinfected.
They willingly agreed. The " Mainlander " was sent to Port Townsend, and on her next trip
carried a certificate of disinfection from the United States quarantine station there. I think
it very unfortunate that the Dominion authorities should take such a stand at such a critical
time. They undertake to protect us from outside infection, and are provided with the means
for carrying out disinfection of boats; we have no provision for such work. While discussing
the point raised, the Province might seriously suffer, and I therefore took the action above
stated. I regret to see that the " Director-General of Public Health " still maintains the
position he then adopted.
The Board expended during the year the sum of $33,881, a large portion of which was
spent in precautionary measures. As an example of the necessity and utility of this expenditure under the circumstances, I might say that in 1892, during the small-pox epidemic in
Victoria, the Municipality spent $59,102 in handling 112 cases, while during the same period,
without any actual cases to look after, the Province spent $13,501 in purely precautionary
measures. I may also say that the expenses of the Board of Health for the Cities of Victoria
and Vancouver together, during the year 1901, largely exceeded what has been spent by the
Provincial Board. It will thus be seen that in proportion to the area covered and the circumstances prevailing, the expenditure for the Province has been exceedingly moderate; and
further, I may say that every dollar was necessarily and properly spent. Of course all this
expenditure was not due to small-pox alone. All the contagious and infectious diseases claim
attention; they require active and careful handling at all times, but as the Province advances
the measures necessary of course become more comprehensive, and consequently more expensive.
In many instances during the past year, whole families were supplied not only with medical
necessaries, but with food and clothing.
I note that the vote for hospitals and charities is considerable, and I beg to say that, in
my opinion, such money properly expended is money saved in the end. I would suggest,
however, that so far as the hospitals are concerned, all such institutions as are in receipt of
grants of public moneys should be subject to inspection by this Department, under instructions,
of course, of the Minister having charge of the grants in question.
Owing to the expense of quarantining suspects and contacts, besides the inconvenience
and loss of time caused to those so quarantined, the Board adopted a set of regulations providing
that any person recently successfully vaccinated should not be subject to quarantine, and that
upon giving certain assurances he be disinfected and given his liberty. I have written to
mine managers calling attention to this provision, and I am pleased to say that many of them
are falling in with the suggestion and are insisting upon all their employees protecting themselves by vaccination.
The offices of the Government Agents at various points have been made repositories for
disinfectants and disinfecting apparatus, generally for the handling of small-pox. They are
now pretty well equipped in that respect.
Wherever possible, the building of isolation hospitals has been carried on in conjunction
with the neighbouring municipalities.
Canneries.
Complaint having been made that the canneries were not carrying out the regulations as
to the disposal of offal and other refuse in connection with their business, I visited and inspected
several of the Fraser River canneries, 28 in all, during the month of August. They were in
a fairly clean state, and the managers of most of them seemed to be making an honest effort
to avoid polluting the river. During the coming season I propose to have the regulations
strictly carried out, and will at the proper time so notify cannery managers. 2 Ed. 7 Provincial Board of Health. 775
Provincial Gaol, Victoria.
In accordance with your instructions, I visited the Provincial Gaol at Victoria on August
21st, 1901, and subsequently made a report to you regarding the sanitary conditions there. In
pursuance of this report a septic tank has been constructed, under the superintendence of Mr.
Mohun. It is working well, and the nuisances complained of are now abated. There is at
present in this office a complete copy of the plans, and these, with the tank itself, can be used
as models and for reference in future.
TURERCULOSIS.
As already reported, I attended the Tuberculosis 'Conference held at Ottawa during
February, 1901. A society was then formed, with very desirable objects in view. Many of
the most prominent men in public life attended, and showed practical sympathy with the movement by giving large subscriptions. His Excellency the Governor-General was pleased to be
present, and he took an active interest in the promotion of the objects of the Conference. The
outlook seemed favourable for the success of a highly important undertaking, but, unfortunately,
changes were made which, in my opinion, were not justified, and do not appear to have
advanced the ends in view. A new Executive was created, and the great results hoped for
and expected have not matured. I have endeavoured to do my part, and have issued a
pamphlet of instructions to the public in this Province. The Provincial Board have also
adopted regulations, but I may say that this movement, to be successful, must be national in
its character and actions.
Sanitoria Treatment of Tuberculosis.
In my report to you of the Ottawa Conference, I remarked that the concensus of medical
and public opinion in both Europe and America is that sanitorium treatment of consumption
produces the best results. At the Congress of Berlin in 1899 a resolution indorsing 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.
The Hon. 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
20 cents per head per day.
Following the example of Ontario, I would suggest that 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, when 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, such charitable fund to be
managed by a committee whose duty it would be to inquire into and deal with deserving cases.
Laboratory.
The Bacteriological Laboratory, I am pleased to say, has been largely taken atl vantage of,
and your order to examine sputum free of charge seems to be popular. I trust it has been
found useful. 776 Provincial Board of Health. 1902
In connection with this department of the Board of Health I am pleased to say that it
has been of service to the Agricultural Department. Dr. Tolmie, suspecting the presence of
hog cholera in a herd, brought me a specimen for bacteriological examination. I was able to
clearly demonstrate the presence of the bacillus, and so, at an earlier date than would otherwise have been possible, he was enabled to take steps to eradicate the disease.
The following is a summary of the work done :—
Typhoid blood    2
Diphtheria 14
Sputum for tubercle bacillus     21
Plague    1
Blood in murder cases    2
Water    6
Hog cholera    1
I append copies of regulations adopted by this Board during the year and circulars issued
by this Board.
I have the honour to be,
Sir,
Your obedient servant,
C. J. FAGAN,
Secretary.
PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA.
Supplementary Regulations re Small-pox.
Approved   by His Honodr the Lieutenant-Governor in Council, dated
November  14th,   1901.
To Medical Health Officers and others in charge of the Management of Outbreaks of Small-pox :
Upon discovery of the existence of small-pox, or of persons who have been exposed to
small-pox, act quickly.    Investigate at once all rumours or reports of infection.
The powers given by the " Health Act" are ample in almost any contingency.
The duty of the Local Board is to act promptly. No time should be wasted in an
endeavour to obtain the consent or approval of the Municipal Officers, or of anyone else.
Your Municipality, or whoever may be responsible, will be obliged to pay all reasonable
charges, and the more promptly you act the smaller the bills will be.
If any person breaks quarantine, violates the provisions of the health laws, or interferes
with the work of the duly appointed officers, have him arrested at once. If infectious, he
should be held until he can be disinfected and brought before a magistrate.
Suspects, or Exposed Persons.
Trace out, as speedily as possible, every person who has been exposed to the infection of
small-pox. Make a note of the date of exposure. When located, vaccinate every such person
as soon as possible. Vaccinate, also, all the members of his family, and of the household in
which he lives. 2 Ed. 7 Provincial Board of Health. 777
As to the question of quarantining a person who has been exposed to small-pox :
If he is a transient, and has not a certificate of recent successful vaccination, keep him
under close quarantine.
If, on the other hand, he is a permanent resident and trustworthy, and has not had an
intimate association with an infected case, vaccinate him, disinfect his person and clothing
and keep him under observation.
If, again, any transient can prove to the medical man in charge that he has been successfully vaccinated within the past two years, and can show that such vaccination was successfully effected in not less than three points (three scars), such person, if considered trustworthy,
may be disinfected and allowed to proceed, on condition—
(1.) That he states where he is to reside during the next sixteen days;
(2.) That he undertakes to consult a doctor, and gives his full history of exposure to
small-pox, on the very first indication of illness.
Persons who have been exposed to small-pox should be considered under two classes:—
(1.) Those who have been exposed but once to the infection, and are immediately vaccinated.    These  should  be  kept  under  observation until   there  are  unmistakable
evidences of the success of the vaccination, when they can be discharged from
further surveillance :
(2.) Persons who  have  been exposed  to small-pox, and  several  days (over four) have
elapsed before vaccination.    These should be kept under observation for sixteen days
from their last  possible  exposure.     The wearing of  their  own  possibly-infected
clothing should be deemed a continuation of exposure.
Vaccination.
In the vaccination of persons who have been exposed to small-pox "time is money." The
failure to effect prompt vaccination sometimes costs individuals and municipalities much money.
Prompt vaccination is required for the exposed person, so that the vaccination may get
ahead of the small-pox and modify it or prevent it entirely, and for the persons housed or
associated with him the aim should be the speediest possible "takes," so that these persons
may be fully protected if the person already exposed develops small-pox.
If, after reasoning with them, suspects refuse to be vaccinated, apply an absolute quarantine just as long as may be necessary.
Quarantine.
The Quarantine.—The quarantine of every small-pox patient should be prompt and
absolute. A guard should be placed over every infected house day and night, and special
visits should be made at unexpected hours to see whether the guards are doing their duty.
Nurses.—When it is known that persons have been exposed to small-pox, officers should
promptly arrange for the worst. Facilities for quarantine and treatment should be considered
Nurses and medical attendants should be arranged for, and, if possible, conditionally engaged.
For nurses, have persons who have had small-pox, or who are thoroughly protected by recent
successful vaccination (three or four scars).
Hospitals and Camps.
When small-pox breaks out the question will often arise whether the sick shall be kept
and cared for in their own houses or removed to other quarters. When at all practicable to
do so their removal should be ordered, and the house from which they are taken should be
disinfected without delay.
When a house is not available as a hospital, a temporary camp or shed may quickly be
built.    During the summer months a tent, or a number of tents, will answer the purpose.
Persons who have been exposed to small-pox, and persons who show uncertain symptoms,
should not be confined with small-pox patients.
Disinfection.—The disinfection of infected houses or rooms should be left to experts, or
else done under the direct supervision of a doctor.
Formaldehyde is the surest and least objectionable disinfectant. Compared with sulphur
it is a more efficient germicide, it is not poisonous, it does not escape from rooms so rapidly, it does not injure articles of furniture, &c, and it has greater power of penetration. The more
tightly the rooms are made to prevent the escape of the gas, the more penetrating will be the
power of the formaldehyde.    (For further information on disinfection, see circular).
Brief Points for Non-medical Members of Local Boards.
The period of incubation of small-pox, namely, time from entry of disease into the system
to the first symptom, is twelve to fourteen days. It may be longer or shorter. In from about
48 to 60 hours more the eruption begins to show as small red specks and then as pimples or
papules, at first on the forehead and wrists, gradually extending over the body so that the
eruption becomes general in about 24 hours. From the second to the fifth days of disease
(counting from the first symptoms) the eruption is papular and the characteristic " shotty"
sensation is obtained by passing the fingers over the skin. During the next 24 hours the
papules become vesicles. Vesicles are watery blisters containing clear fluid on their summits.
The next change is that the vesicles become pustules by becoming yellow, they now contain
pus or " matter." The pustules often present a slight depression in the centre, that is, they
are " umbilicated." The fever having declined when this eruption first appeared, now rises
again.    Severe pain in the small of the back is somewhat characteristic of small-pox.
In modified small-pox, or in mild epidemics, the eruption aborts at various stages or passes
rapidly to the pustular stage and very mild constitutional symptoms are present.
Small-pox is intensely infectious at all periods of the disease, but less so at the early
stages than when the scabs are peeling.
The United States Marine Hospital Service have issued the following maxims which you
would do well to bear in mind:—
" Small-pox cannot be suppressed without the expenditure of money."
" The more promptly you act the less it will cost."
"When in doubt act on the safe side."
And, finally, isolate, vaccinate, disinfect.
CHARLES J. FAGAN,
Secretary.
PROVINCIAL BOARD OF HEALTH, BRITISH COLUMBIA.
Re   Tuberculosis.
Regulations of the Provincial Board of Health, Approved by His Honour the
Lieutenant-Governor in Council, dated November 14th, 1901.
Whereas tuberculosis is now proved to be infectious, and is at the present time existing
in many parts of the Province, the Provincial Board of Health enacts the following regulations :—
Notification.
1. Whenever any physician knows or suspects that any person whom he is called upon to
visit is infected with or has died of tuberculosis, he shall immediately notify the Medicial
Health Officer, and give an account of the condition of patient and state what precautions are
being taken to prevent infection. 2 Ed. 7 Provincial Board of Health. 779
2. Whenever any householder knows or suspects that any person within his family or
household has tuberculosis, he shall immediately give notice to the Medical Health Officer.
3. Whenever any teacher in any school has reason to suspect that any pupil is suffering
from tuberculosis, he shall notify the Medical Health Officer immediately, and may prevent
the attendance of such pupil until medical evidence is produced that such pupil is not suffering
from tuberculosis, or any form likely to be infectious.
4. Whenever any Superintendent, or person in charge of any hospital—public or private
—asylum, gaol, orphanage, " home," convent, or private school, knows or suspects that any
inmate of such hospital, asylum, gaol, orphanage, " home," convent, or private school, is
suffering from tuberculosis in any form, he shall immediately notify the Medical Health
Officer.
5. In Municipalities or Districts where no Medical Health Officer has been appointed,
notification should be sent to the Secretary of the Provincial Board of Health.
Medical Health Officer.
6. " Medical Health Officer" shall mean and include the Medical Health Officer appointed
under the provisions of the " Health Act," to act within the limits of the jurisdiction of any
Local Board of Health or Health District.
7. The Medical Health Officer shall within forty-eight hours, give notice in writing to
the Secretary of the Provincial Board of Health of every case of tuberculosis reported to him,
and shall state as nearly as possible the condition of patient, and what precautions are being
taken to prevent infection.
8. In case the Medical Health Officer is not satisfied with the report of the physician in
charge, he may demand a fuller report, and in the event of his still being dissatisfied he shall
visit the patient and satisfy himself that all necessary precautions are being carried out.
9. In case where the Medical Health Officer and attending physician disagree as to precautionary measures, the matter shall be referred to the Provincial Board of Health for final
settlement.
10. Whenever a case is reported as not being under the charge of a physician the Medical
Health Officer shall forthwith visit such case and instruct the patient as to necessary precautions against general and self infection.
11. Whenever the Medical Health Officer or the physician in charge considers that a
house, or any part of a house, is infected with tuberculosis, he shall order said house, or part
of a house, to be disinfected, in accordance with instructions issued by the Provincial Board
of Health.
12. In all cases of death from tuberculosis the rooms or house occupied by deceased shall
be disinfected to the satisfaction of the Medical Health Officer, or the Secretary of the Provincial Board of Health or his deputy.
13. Whenever a case of tuberculosis is reported from a hotel or boarding-house, the
Medical Health Officer shall visit the patient while residing in said hotel or boarding-house
once a week, or as often as the Secretary of the Provincial Board of Health may direct.
Spitting in Public.
14. Inasmuch as spitting is purely a matter of habit, and is offensive to many, and is
often very harmful and a fruitful means of carrying disease, it is hereby declared unlawful to
spit in tram-cars, railway cars, or other public conveyance, or on sidewalks, or on floors and
other parts of public buildings.
Tuberculous Milk.
15. Inasmuch as tuberculous milk is a most fruitful source of consumption, it is hereby
declared unlawful for any person to sell milk unless he has a certificate, of a date not later
than six months, from the Provincial Veterinary Surgeon that the cows from which such milk
comes are free from tuberculosis. Such certificate may be demanded by any customer, or
Medical Health Officer, Sanitary Inspector, Secretary of the Provincial Board of Health or
his deputy.
Disinfection.
16. Whenever it appears necessary or advisable to the Medical Health Officer to have
any house, hotel, boarding-house, hall, theatre, car, railway car or other public conveyances
disinfected, he may order same to be done and at the expense of the owners. 780 Provincial Board of Health. 1902
Penalties.
17. Any person who violates any provision of these regulations shall be liable, upon summary conviction before any Police or Stipendiary Magistrate, or before any two Justices of the
Peace, for every such offence, to a fine not exceeding one hundred dollars, with or without
costs, or to imprisonment, with or without hard labour, for a term not exceeding six months,
or to both fine and imprisonment in the discretion of the convicting Court.
CHARLES J. FAGAN,
Secretary.
PROVINCIAL BOARD OF HEALTH.
Regulations for dealing with the Outbreak of Small-pox at the Town of
Fernie, East Kootenay.
Approved by His Honour the Lieutenant-Governor in Council the 17th day of January, 1902.
Health Act.
On account of the outbreak of small-pox in the Town of Fernie, it is hereby proclaimed:—
1. That the Town is in a state of quarantine until further notice.
2. That no person shall be allowed to leave the Town under any circumstances whatsoever.
3. That all meetings in churches, lodges and schools and other public gatherings are
hereby prohibited.
4. That no person shall under any circumstances hold any conversation whatsoever with
any person quarantined, and no person under quarantine shall attempt to break same or communicate with any outsider.
5. Any hotel-keeper, lodging-house keeper or householder suspecting, knowing, or having
good reason to believe, that any person residing upon or frequenting his premises is ill or
suffering from a rash of any description, shall at once notify the Medical Health Officer, giving
the name and occupation of, and other particulars necessary to properly identify, such person.
6. Any person having a rash on his body shall notify the Medical Health Officer on the
first appearance of same.
7. Under authority of the " Health Act," it is hereby declared that all and every person
not having a certificate of recent successful vaccination dated within one year, and further not
being able to give proof of same to the satisfaction of the Medical Health Officer, shall be at
once vaccinated.
8. After a period of seven (7) days from this date any person refusing to present to any
public officer, who may demand it, proof of vaccination, shall be liable to the prescribed
penalties under the " Health Act."
Penalties under the "Health Act."
Any person who violates any of the provisions of this Proclamation is liable to a fine of
$100 and to six (6) months' imprisonment.
Dated at Victoria this 16th day of January, A. D. 1902.
CHARLES J. FAGAN,
Secretary of the Provincial Board of Health.
By Command.
J. D.  PRENTICE,
Acting Provincial Secretary.
victoria, b. o.:
Printed by Richard Wolfenden, Printer to the King's Most Excellent Majesty.
1902.

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