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ANNUAL REPORT OF THE PROVINCIAL BOARD OF HEALTH. 1907. British Columbia. Legislative Assembly 1908

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 ANNUAL   REPORT
-of the-
PROVINCIAL BOARD OF HEALTH.
1907.  8 Ed. 7 Provincial Board of Health. G 3
REPORT OF THE PROVINCIAL BOARD OF HEALTH.
Provincial Board op Health,
Victoria, B.C., February 24th, 1908.
The Honourable Henry Esson Young, M.D.,
Provincial Secretary, Victoria, B. G.
Sir,—I have the honour to submit the eleventh annual report of the Provincial Board of
Health, being for the year 1907.
It is pleasing to be able to state that the year just closed has been comparatively free
from the conditions which were so strikingly evident during some previous years. This, I
have no hesitation in saying, is contributed to mainly by that spirit of watchfulness which the
officers of the Federal Government have evinced on all occasions when we were threatened
with disease from outside the Province. It is hoped this spirit will continue uninfluenced by
extraneous considerations and may result in the adoption of precautionary measures for the
protection of the public health and safety.
I would suggest that the Federal authorities be invited to keep the Provincial Board of
Health posted as to the health conditions, not only throughout Canada and the neighbouring-
States, but throughout the world.
It would be a great advantage, it fact it is necessary, that the quarantine officials report
to the Provincial Board of Health all cases of disease arriving in port. This Board does not
look for or expect that all boats arriving with disease on board should be held in quarantine
for any longer time than the officer in charge properly deems necessary ; but it would assist
the Provincial Board if the exact conditions were reported, and a list of passengers and crew,
with their destinations, submitted. I would respectfully recommend that this important
matter be taken up at once with the Dominion authorities.
Small-pox.
Small-pox has been present during the year at nine centres, namely, Vancouver, Barnet,
Revelstoke, New Denver, Phcenix, Fernie, Cranbrook, Michel and Elcho. There were 38 cases
in all. In two instances only did the disease gain any headway, and in each a mistake in
early recognition of the malady was responsible, When it was established that small-pox was
present, strict measures were adopted and the disease stamped out. In this connection it is
gratifying to be able to say that the municipalities concerned co-operated actively and willingly.
In almost every instance the trouble was imported from the United States, where, I regret to
say, the disease continues unarrested. The utility of promptness in handling a case is, I
think, conclusively shown, when we find that during the past year the State of Washington
was afflicted with over 1,100 cases, while this Province, with its direct and constant interchange
of persons and materials, had only 38.
Dr. Arthur, in mailing his annual report on the health of Nelson for last year, says :—
"We were especially fortunate to escape small-pox, which during the year was on all
sides of us."
This immunity, it may be said, results largely from the careful and energetic actions of
our officers at the affected points.
While speaking of small-pox, 1 think it right to call your attention to the neglect of
vaccination that is painfully evident in the Province. In England all children are by law
compelled to be vaccinated before a certain age, and in Germany all classes must submit to
vaccination and re-vaccination till it no longer " takes." The law in the Province demands
that all children be vaccinated and re-vaccinated when the conditions demand it. G 4 Provincial Board of Health. 1908
I respectfully beg to recommend that the law be enforced, and I further recommend that
all school children be required to produce certificates of vaccination and re-vaccination, and
show evidence of same.
Bubonic Plague.
It is extremely gratifying to be able to report that bubonic plague has not yet obtained
a footing in the Province. Let us pray that our good luck may continue. Plague is present
at all seaport towns of any importance on the Pacific coast. The Government have wisely
insisted on the adoption of reasonable precautions, and have built and furnished a laboratory
for diagnostic purposes. Dr. Bapty, who has been appointed as Assistant Bacteriologist to
the Department, has proved to be a valuable and efficient officer.
The bacteriological laboratory is the most essential part of an equipment in the practical
handling of plague, and I am pleased to report that we are now ready to settle the too-often
very difficult question as to whether a suspected case is really plague or not.
The advent of plague in any port is always attended by alarm, and, as serious consequences
are looked for, the authorities adopt stringent precautions. If, afterwards, no evidence of high
mortality be forthcoming, popular alarm subsides, and the idea becomes prevalent that the
precautionary measures are no longer necessary. Later no mortalities occur, and, once more
re-assured, the populace abandons its vigilance. But in the meantime there is quiet evidence
that vermin, especially rats, are affected, and, in my opinion, here is the whole crux of the
question. The humans we can isolate and quarantine and so stamp out the disease, but with
the vermin it is quite another proposition. The disease slowly but surely spreads among
them, and to cope with the consequent danger to human life the only safe measure to adopt is
a systematic crusade towards exterminating every rat in the infected area. Thus it is that
the history of plague shows that the eradication of the disease, when once it has obtained a
foothold, may be a question of many years, and for many reasons is one of the most difficult
problems facing sanitarians to-day.
We have strong examples of this in San Francisco, Honolulu and Australia. The plague
appeared in San Francisco some seven years ago, and although it has been announced many
times that it was no longer present, yet we now know it was there all the time amongst the rats,
and periodically spread to the humans. Some of the latest reports show the human death-rate
to be high and the area of rat-infection to be extending; so that now, not only is the infection
present in San Francisco, but it has spread on to six or seven points in the State of California.
The financial loss to a country in which plague appears is very great. San Francisco has
already disbursed some $300,000 in its endeavours to extirpate the disease, but, so far, has
been entirely unable to do so. Honolulu has, I understand, expended the immense sum of
$2,000,000 for the same purpose, with a like result. There have been a few deaths from
plague in Seattle, and some rats have been found to be infected. The people in that city,
when last I was there, were expending the sum of over $8,000 per month in the effort to rid
themselves of the trouble.
The question, then, is one that must be looked at from a business as well as from a health
point of view, and I am satisfied a small expenditure in precautionary measures may obviate
huge payments ultimately in stamping out the disease.
The rat is very susceptible to the disease, and for all practical purposes is the great
carrier to human habitations. He generally contracts the trouble from the flea. Fleas live
and thrive on plague-infected rats, and are capable of carrying in their system up to 5,000
plague bacilli.   When the rat dies the fleas migrate to other rats, and so the infection spreads.
There are many species of fleas, but the varieties with which we have now to deal are
three, mamely, the human flea (pulex irritans), the dog and cat flea (judex felis), and the
rat flea.
The human and dog flea can carry plague, but they will not infest the rat unless driven
to him by extreme hunger, while, on the other hand, the rat flea is not so reluctant to feed off
the human when opportunity offers. This characteristic is peculiar to the East Indian rat
flea (pulex cheopis), and no doubt that is one reason why India is the home of plague. The
rat flea in England and Europe, except in a few seaport towns, is a different specimen. This
probably accounts for the early stamping out of plague in Glasgow.
With your concurrence, I instructed Dr. Bapty to investigate the flea condition among
our rats, and the results, so far, show that fleas are not strongly in evidence during the cold
weather, few rats being able to produce more than four or five.    Another point established is 8 Ed. 7 Peovinctal Boaed of Health. G 5
that the British Columbia rat flea is not the same as is found in England, but is the true
Indian rat flea. It is further found, and this is contrary to English views, that the pulex
cheopis infests both the brown and the black rat.
Although these are not pleasant views to express, yet, if they are facts, it is well we
should know them and govern ourselves accordingly.
It cannot be too strongly urged that cities and towns adopt some method for the destruction
of vermin. Business houses should be requested to protect their warehouses from the entry of
rats, and all wharf-owners should be compelled to adopt measures so that rats cannot easily
invade the surrounding premises,
Rats abound in uncleanly surroundings only, and it is hoped that authorities and hotel-
keepers will unite in general cleaning and removal of rubbish heaps and unnecessary outhouses, etc. The individual householder, too, should see that his place is clean and that rats
are not allowed to live with him.
Various experiments, conducted in the laboratory, tend to show that reliance cannot be
placed upon bacteriological poison in the extermination of rats. The only poison of this class
admitted and sold here is " Azoa," prepared by the Parke Davis Co. We have found this to
be extremely slow and uncertain in its results, many rats recovering completely. We are now
engaged in testing some viri prepared by Evans Sons, Lescher & Webb, Ltd., ana the Ratin
Bacteriological Laboratory, and will report results later. In the meantime I would advise
that the ordinary chemical poisons and traps be used in preference to any advertised remedy.
I understand that the Federal quarantine officers occasionally disinfect boats arriving in
British Columbia from plague-infected ports. Sulphur di-oxide is the disinfectant used, and
undoubtedly is very destructive to rats and vermin generally. Unfortunately, one of the
properties of sulphur is that it is destructive to certain materials and, therefore, it cannot be
used on cargoes. Further, its power to penetrate is not great, and the time it takes for
action is comparatively lengthy.
As will be seen, from what I have already stated, it is of the greatest importance that
rats from infected ports be prevented from entering our Province. I therefore beg to
recommend that the Federal authorities be requested to use the most effective measures to
protect us, and, further, keep us informed as to the action taken.
I am indebted to Dr. J. H. Todd, of McGill University, for a pamphlet, in which is
minutely described the method adopted by the authorities at Hamburg. Carbon mon-oxide,
carbon di-oxide, and nitrogen are the gases used, and in certain proportions are now
recognised by authorities as being the simplest, the quickest and the most effective of known
methods. This can be used in fully laden ships, being harmless to cargoes, and whereas ten
hours are needed for complete destruction of vermin by sulphur, two hours are ample by the
Hamburg method.
General Health Conditions.
The general health throughout the Province has been about the same as previous years.
All preventible diseases flourish as before. Typhoid fever, scarlet fever, diphtheria, measles,
etc., are constantly in evidence. Every one of these could be prevented did each citizen know
what to do and do it, and did local authorities not hesitate to meet expense.
I remember reading an article by a well-known medical authority, in which he made the
statement that for every death resulting from typhoid fever someone ought to be hanged. This
is a drastic suggestion and was probably only made to bring home to the minds of thinking
persons the criminality of carelessness.
That the prevention of typhoid fever could be reasonably easy, I beg to quote, in proof of
same, a statement by Professor Irving Fisher of Yale University:—
" Typhoid fever can be practically abolished by the prevention of the pollution of the
rivers and other sources of water supply and by improving our milk."
Again, Dr. McCormack, speaking to the American Medical Association, says:—
" Typhoid is not only a preventible disease, but the most typical of the filth diseases, for
no one can have it except by getting into his mouth and stomach some of the discharges from
the bowels or kidneys of some one who has typhoid fever. This is not a nice thing to think
about, but it is so much worse to do it that nice people ought to think and plan how to stop
doing it.    It usually gets into the mouth through infected water." G 6 Provincial Board of Health. • 1908
Disposal of Sewage.
The best method for the disposal of sewage is yet far from being solved. In my opinion,
all communities residing near large bodies of salt water should discharge their sewage into
same, at a point from which it will be carried out to sea. As to inland communities, there are
many difficulties to be met, but, so far, no satisfactory plan has been suggested.
There is a popular idea abroad that septic tanks solve the problem, and, as a result, many
persons have installed them, fully believing there was then no further need to worry over the
question. This view, I regret to say, is a great mistake, and I know of many instances where
considerable expense has been undertaken under false ideas as to effect. The septic tank
action is but a step in the process. It was never intended to pose as a complete method of
purification. No doubt there is a certain percentage of purification effected, but the main idea
is that it dissolves certain organic material, and so renders the liquid sewage (effluent) more
easily handled.
Diphtheria.
Diphtheria is responsible for 11 deaths out of 98 cases reported. This percentage is about
normal, but I have no hesitation in saying it could be further reduced if anti-toxin were used
more freely.
Since the introduction of anti-toxin the death-rate from diphtheria has been reduced from
55 % to about 14 %. Diphtheria anti-toxin is the one serum that stands out prominently as
being above criticism. It is an expensive benefactor and it is regrettable that it should have
a commercial aspect. By the time it reaches the consumer its cost almost makes it prohibitive,
and the result is that it is not used at all, or is used in such small quantities that its full
benefit is not obtained. The manufacture of this article should, in my opinion, be carried on
by the Government and supplied at cost to the public, on the direction of physicians.
I, therefore, beg to recommend that the Dominion Government be petitioned to establish
a laboratory for the supply of sera, especially diphtheria anti-toxin.
Dairies and Slaughter-houses.
I append copies of the regulations governing the sale of milk and the management of
dairies, cow-sheds and milk-shops, and the management and construction of slaughter-houses.
All new slaughter-houses are compelled to conform to these regulations, and I think the
time has arrived when those built prior to the adoption of the regulations should be compelled
to observe such regulations.
The dairies in the Province are not living up to the regulations, and as the importance of
a pure milk supply is receiving more attention than it formerly did, I beg to recommend that
more stringent measures be adopted to compel compliance with the law.
Health in our Public Schools.
No matter how we theorize as to the nature of man, we can at least distinguish two
essential parts—mind and body ; and however we speculate as to their essence and mode of
union, we know, at least, that all life long they are linked together for weal or woe—they
develop together, mature together, decay together, ever dependent upon each other, reacting
upon one another, sympathising, suffering with each other. When we strengthen the body
we invigorate the mind; when we starve and neglect the body we starve and enfeeble the
mind. It follows, therefore, that for the proper development of the individual the body must
be considered and cared for as well as the mind.
Recognising the elementary principle of social economic law that the continued existence
of a free country depends upon the general intelligence of its people, the State has assumed
the right to enforce the education of her future citizens. The State has also assumed the
right to prescribe the kind of instruction that shall be given in the public schools, and has
thus become responsible for the results of such education.
The trend of recent educational thought has been in the direction of encouraging the
proper development of the physical body as an aid to mental advancement. " A healthy mind
in a healthy body " should be the motto for all public school teachers who have not set up
a false standard of judging of education. It ought not to be considered that a boy or girl is
fitted to graduate into the world of business activity if he or she has attained to a certain
intellectual  standing which is measured by ability to produce answers to certain kinds of 8 Ed. 7 Peovincial Board of Health. G 7
questions. The State pays large sums of money for educational purposes, in order to qualify
her citizens to hold their position, not only in the race of man against man, but in the race of
nations for superiority.
It has been pointed out by Herbert Spencer that the first requisite of success in life is to
be a good animal, and that a nation of good animals is the first condition to national prosperity.
Now, what is the very laudable object of the State in establishing public schools 1 It is to
ensure the proper development of the individual so that each citizen may be in a position to
advance the interests of the State and thereby his own interests. According to Nature's plan,
body and mind develop simultaneously, not alternately. While bone, muscle and nerve are
growing, the child is busy observing, testing, comparing, gaining a knowledge of his environment, and learning to think and reason. So the process goes on, but soon the child is sent to
school. Is the same plan of development continued ? Do teachers realize that education
should look to the physical as well as the mental needs of their scholars, and that strong
bodies are as essential to success in life as well as stored minds ? When the school curriculum
is examined we find there no lack of prescribed studies—all are cared for; the highest
authorities are taken as guides, and the teacher sets himself out to obtain the best possible
results. But in how many schools is attention paid to the physical condition of the children 1
If they are bright and intelligent they are pressed forward and urged on to higher work. Is
there any consideration given to the question of their physical ability for such work 1 I fear
very little. Again, the backward children are reported as dull, stupid or lazy—that may be
true, but is not always so, and I believe the majority of dull children are dull because of some
physical obstacle.    Do the teachers always look for such 1    I fear not.
Now, I do not think it would be fair to throw the whole responsibility for this state of
affairs on the teacher, for we all know that the idea is abroad that schools are places where
certain subjects are taught and learned. Parents and trustees alike hold the teacher responsible
for the progress of his pupils in intellectual work alone ; no one ever thinks of holding him
responsible for any physical imperfections in the children under his care, nor do they even
expect that he report on such physical imperfections, or that he take them in any way into
his consideration. Yet he is paid to prepare the child, not only to be a good accountant or
distinguished classical scholar, but to be a good, useful and patriotic citizen capable of holding
his own, either in the office or in the field.
Judging by what can be observed almost everywhere, it is evident that the majority of
men and women know very little about hygienic conditions, and when it is considered that
the teacher alone has an opportunity of reaching all classes through the children, it becomes
of the greatest importance that children should not only work under hygienic conditions and
be under a teacher who not only understands and appreciates such conditions, but also that
they should be carefully instructed in the principles of hygiene, so that the men and women
of a few years hence may themselves know the meaning of proper conditions of living.
Opinion will doubtless differ as to the best method to be adopted for :—
(a.) Attending to the health of the children.
(6.) Imparting a reasonable and practical knowledge on health matters.
As to attending to the health of the children, I would strongly recommend the constant
and systematic supervision by a medical practitioner. If this cannot be obtained, because of
monetary or other reasons, I would then advise that a specially trained nurse be employed.
Provided the nurse is well trained, there are many matters she can attend to herself, and the
graver problems may be referred by her to the regular physician.
Regarding the teaching of health, I am satisfied that the public school teacher is the
person best suited to impart this knowledge. He understands the children and the children
understand him.
I, therefore, beg to recommend that means be adopted to qualify school teachers to impart
instruction in sanitary science.
I have the honour to be,
Sir,
Your obedient servant,
C. J. FAGAN, Secretary. G 8 Pbovincial Boabd of Health. 1908
APPENDICES.
REGULATIONS
Governing the Sale of Milk and the Management of Dairies, Cow-sheds and
Milk-shops.
Approved by Order of His Honour the Lieutenant-Governor in Council, dated the
21st day of July, 1904.
Interpretation. t
1. Throughout these regulations the expression " Milk-shop " shall mean any place from
which milk is sold or in which milk is kept before being sent out for sale; the expression
" Cow-keeper" shall mean any person keeping cows with the object of selling milk ; the
expression " Dairy " shall include any farm, farm-house, cow-shed, milk-store, milk-shop, or
other place from which milk is supplied, or in which milk is kept for purpose of sale; the
expression " Board " shall mean the Provincial Board of Health.
Inspection.
2. Every occupier of a dairy which a Medical Health Officer or Inspector of Dairies, or
any other officer of the Board specially authorised by them in that behalf may visit for the
purpose of inspection, and every person for the time having the care or control of any such
dairy, or of any cattle therein, shall afford such Medical Health Officer, Inspector of Dairies
or Officer, all reasonable assistance that may, for the purpose of inspection, be required by
him.
Cow-sheds.
Lighting.
3. Every cow-keeper shall provide that every cow-shed in his occupation shall be
sufficiently lighted with windows either in the sides or roof thereof.
Ventilation.
4. Every cow-keeper shall cause every cow-shed in his occupation to be sufficiently
ventilated, and for this purpose to be provided with a sufficient number of openings into the
external air to keep the air in the cow-shed in a wholesome condition, and a cowshed shall
not be occupied by a larger number of cows than will leave not less than eight hundred cubic
feet of air space for each cow.
Cleaning.
5. (1.) Every cow-keeper shall cause every part of the interior of every cow-shed in his
occupation to be thoroughly cleansed from time to time as often as may be necessary to secure
that such cow-shed shall be at all times reasonably clean and sweet.
(2.) Such person shall cause the ceiling or interior of the roof or walls of every cow-shed
in his occupation to be properly lime-washed twice at least in every year; that is to say, once
during the month of May and once during the month of October, and at such other times as
may be necessary. 8 Ed. 7 Pbovincial Boaed of Health. G 9
Provided that this requirement shall not apply to any part of such ceiling, roof or walls
that may be properly painted or varnished, or constructed of, or covered with, any material
such as to render the lime-washing unsuitable or inexpedient, and that may be otherwise
properly cleansed.
(3.) He shall cause the floor of every such cow-shed to be thoroughly swept, and all dung
and other offensive matter to be removed from such cow-sheds as often as may be necessary,
and not less than once in every day.
Drainage.
6. (1.) Every cow-keeper shall cause the drainage of every cow-shed in his occupation to
be so arranged that all liquid matter which may fall or be cast upon the floor may be conveyed
by a suitable channel to a drain inlet situate in the open air at a proper distance from any
door or window of such cow-shed, or to some other suitable place of disposal which is so
situate.
(2.) He shall not cause or suffer any inlet or drain of such cow-shed to be within such
cow-shed.
Water Supply.
7. (1.) Every cow-keeper shall keep in, or in connection with, every cow-shed in his occupation a supply of pure water, suitable and sufficient for all such purposes as may from time
to time be reasonably necessary.
(2.) He shall cause any receptacle which may be provided for such water to be emptied
and thoroughly cleansed from time to time, as often as may be necessary to prevent the pollution of any water that may be stored therein ; and where such receptacle is used for the
storage only of water, he shall cause it to be properly covered and ventilated and so placed as
to be at all times readily accessible.
Dairies.
8. Every cow-keeper shall provide that every dairy in his occupation shall be sufficiently
lighted with windows either in the sides or roof thereof, and that the floor and material used in
construction of dairy shall be of such kind as the Board may direct.
Ventilation.
9. Every cow-keeper shall cause every dairy in his occupation to be sufficiently ventilated,
and for this purpose to be provided with a sufficient number of openings into the external to
keep the air in the dairy in a wholesome condition.
Cleansing.
10. (1.) Every cow-keeper shall cause every part of the interior of every dairy in his
occupation to be thoroughly cleansed from time to time, as often as may be necessary to secure
that such dairy shall be at all times reasonably clean and sweet.
(2.) He shall cause the floor of every such dairy to be thoroughly cleansed with water at
least once in every day.
Drainage.
11. (1.) Every cow-keeper shall cause the drainage of every dairy in his occupation to be
so arranged that all liquid matter which may fall or be cast upon the floor may be conveyed
by a suitable open channel to the outside of such dairy, and may there be received in a suitable gully communicating with a proper and sufficient drain.
(2.) He shall not cause or suffer any inlet to any drain of such dairy to be within such
dairy.
Water Supply.
12. (1.) Every cow-keeper shall cause every dairy in his occupation to be provided with
an adequate supply of good and wholesome water for the cleansing of such dairy and of any
vessels that may be used therein for containing milk, and for all other reasonable and necessary
purposes in connection with the use thereof.
(2.) He shall cause every cistern or other receptacle in which any such water may be
stored to be properly covered and ventilated, and so placed as to be at all times readily
accessible. G 10 Provincial Boaed of Health. 1908
(3.) He shall cause every such cistern or receptacle to be emptied and thoroughly cleansed
from time to time, as often as may be necessary to prevent the pollution of any water that
may be stored therein.
Milk-Stores and Milk-Shops..
13. Every cow-keeper who is occupier of a milk-store or milk-shop shall cause every part
of the interior of such milk-store or milk-shop to be thoroughly cleansed from time to time, as
often as may be necessary to maintain such milk-store or milk-shop in a thorough state of
cleanliness.
Milk-Vessels.
14. Every cow-keeper shall from time to time, as often as may be necessary, cause every
milk-vessel that may be used by him for containing milk for sale to be thoroughly cleansed
with steam or clean boiling water, and shall otherwise take all proper precautions for the
maintenance of such milk-vessel in a constant state of cleanliness.
(2.) He shall, on every occasion when any such vessel shall have been used to contain
milk, or shall have been returned to him after having been out of his possession, cause such
vessel to be forthwith so cleansed.
General.
15. (1.) Every cow-keeper, dairyman, purveyor of milk, or person selling milk by retail,
sball take all reasonable and proper precautions in, and in connection with, the storage and
distribution of the milk, and otherwise to prevent the exposure of the milk to any infection or
contamination.
(2.) He shall not deposit or keep any milk intended for sale—
(a.) In any room or place where it would be liable to become infected or contaminated by
impure air or by any offensive, noxious or deleterious gas or substance, or by any
noxious or injurious emanation, exhalation or effluvium ; or
(b.) In any room used as a kitchen or living room ; or
(c.) In any room or building,  or part of a building,  communicating directly by  door,
window or otherwise, with any room used as a sleeping room, or in which there may
be any person suffering from any infectious or contagious disease, or which may have
been used by any person suffering from any such disease, and may not have been
properly disinfected ; or
(d.) In any room or building, or part of a building, in which there may be any direct inlet
to any drain.
(3.)  He shall cause every vessel, receptacle'or utensil used by him for containing milk for
sale to be thoroughly cleaned with steam or clean boiling water after it shall have been used,
and to be maintained in a constant state of cleanliness.
(4.) He shall not cause or suffer any cow belonging to him or under his care or control,
to be milked for the purpose of obtaining milk for sale—
(a.) Unless at the time of milking the udder and teats of such cow are thoroughly clean ;
(6.) Unless the hands of the person milking such cow also are thoroughly clean and dry
as possible, and free from all infection and contamination ;
(c.) Unless the cow from which milk is obtained is free from disease;
(d.) Unless the cow from which milk is obtained is free from any discharge and has
"cleaned ";
(e.) Unless the cow from which milk is obtained is a longer period than twenty days
before or five days after calving.
Milk.
16. All milk rooms shall be situate at least ten feet from any cow stable.
17. A cooling room with facilities acceptable to Board shall be provided for by cow-
keepers.
18. Milk that is bloody or stringy or unnatural in appearance shall not be offered for sale.
19. Milk intended for sale must not be allowed to "stand " in cow-shed, but shall, as soon
as possible, be removed to cooling room.
20. Milk intended for sale shall have the following minimum composition :—
(a.) Fat, 3 per cent.
(b.) Solids not fat, 9 per cent.
(c.) Total solids,  12 per cent. 8 Ed. 7 Peovincial Boaed of Health. G 11
21. Water existing in cows' milk in excess of 88 per cent, shall be an adulteration.
22. Drugs or colouring matter for any purpose whatever shall not be added to milk
offered for sale.
Cows.
23. " Calving " cows must be kept separate from milking herd till "cleaning " is complete.
24. Cows suffering from any infectious disease, such as "cow-pox," "mammitis," etc.,
must be kept separate from milking herd.
Tuberculosis.
25. Cow-keepers and dairymen must have a certificate from an Official Veterinary
Surgeon that cows from which milk is obtained for sale are free from tuberculosis. Such
certificate to hold good six months from date of issue, provided that disease is not in evidence
in the meantime.
Notification of Disease Amongst Attendants.
26. Every person in the production, storage, transportation, sale, delivery, or distribution
of milk, shall immediately, on the occurrence of any case or cases of infectious disease, such as
typhoid, scarlet fever, or diphtheria, either in himself or in his family, or amongst his
employees or within the building or premises where milk is stored, produced, sold or distributed, take care that the local Board of Health is notified of such case or cases, and at the
same time suspend the sale or distribution of milk until authorised to resume the same by the
local Board of Health.
It shall be unlawful for any person suffering from a contagious or infectious disease,
such as typhoid fever, scarlet fever, or diphtheria, to handle, transport, deliver, mix, taste,
work over, or distribute milk, or in about places where milk is stored, sold or distributed,
or to serve as a milker or milkman. No vessels which have been handled by persons
suffering from such disease shall be used to hold or convey milk.
Penal Clause.
27. Any person who violates any provision of these regulations shall be liable, upon
summary conviction before any Stipendiary or Police Magistrate or 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, M.D.,
Secretary Provincial Board of Health.
By Command.
Robert G. Tatlow,
Acting Provincial Secretary. G 12 Peovincial Boaed of Health. 1908
PLAGUE.
Provincial Board of Health,
Victoria, B. C, October 23rd, 1907.
The Hon. Dr. Young,
Provincial Secretary.
Sir,—I have the honour to submit a light resume of the history of bubonic plague.
As you are aware, we are now surrounded by the dread disease, in fact most of the ports
with which we have direct communication are infected, Seattle and San Francisco being the
latest. I do not wish to cause any scare, but I think I would be remiss in my duty did I not
call your attention to the fact that we are in danger, and therefore should prepare.
The experience of infected countries points to the Chinese and Japanese as our great
source of danger, and I therefore beg to suggest that these people be compelled to live more in
conformity with our manner of living.
My suggestions may be radical, and no doubt will cause loss to many, but if we wish to
protect ourselves and save the country from heavy loss we must take action.
We know that should the plague develop among them we would hear nothing of it till it
assumed such proportions as to be impossible to conceal.
The following Regulations, in addition to those already adopted, would, I think, fairly
well protect us :—
1. All Chinamen and Japanese to present themselves for medical examination every six
months (or every month in time of such danger as at present), if considered necessary by the
Provincial Board of Health. Certificates of health to be granted; such certificates to be produced, on demand, to the constituted authorities.
2. Private houses and lodging houses to be registered. Such registration stating full
particulars as to owner, tenant and other occupants, and complete plan of building and
sewerage connection.
3. All buildings occupied by Chinese and Japanese to be of proper size for number of
occupants, with adequate light.
4. In cities, all Chinese and Japanese houses to have cement floors in basement, and under
no condition will more than one cellar or room be allowed lower than the street level. Such
room to be cemented and used only as a cellar.
5. No pigs or fowl to be kept nearer than fifty feet from dwellings.
6. All dwellings already in existence to be brought to above stated requirements, otherwise may be destroyed by order of the Provincial Board of Health, after due notice to owner
or agent.
It is now established that rats and rat fleas are the greatest disseminators of plague. It
should, therefore, be urged that cities and towns should adopt some method for the destruction
of these vermin. The individual householder, too, should see that his place is clean and that no
rats are allowed to live with him.
I have the honour to be,
Sir,
Your obedient servant,
C. J. Fagan,
Secretary. 8 Ed. 7 Peovincial Boaed of Health. G 13
History of Plague.
The disease known almost from time immemorial as "plague" or "pestis bubonica," or
" black death," is now so near our own shores that it behooves us all to know something of
this terrible scourge.
Ancient history and the Bible tell of the ravages of the plague. Thucydides had the
disease and described it; Livy, who died 221 B.C., reports a great plague in Africa, when
over one million persons died.
It was not till the sixth century of the Christian era that we find mention of the plague.
In 542 it spread over Egypt, and during the same year carried off 10,000 persons in one day
in Constantinople.
In the fourteenth century plague was introduced from the East, and spread all over
Europe, with the result that over twenty-five millions of people died (Heckler). It is interesting
to note that it was after this epidemic the first preventive measures were adopted, namely, at
Venice, where a small island near the city was used as a quarantine station.
During the fifteenth, sixteenth and seventeenth centuries we find it appearing at various
times all over the East and at different points in Europe, always leaving a sad and terrible
memory.
In 1656 Naples lost 300,000 in five months, and during the same year London mourned
for 69,596 in an estimated population of 460,000, out of whom two-thirds are supposed to
have fled to escape contagion.
In the eighteenth century plague still had a hold on Europe, and continued to work
destruction wherever it spread. In 1720 Marseilles lost 40,000 out of a population of 60,000;
and in 1771, Moscow 50,000, which was about a quarter of its entire population. There are
many such records, but these will suffice to show the terrible havoc wrought.
The nineteenth century has been marked by a recession of the plague toward the East,
and from 1850 the western limit was the Canary Islands, and the most easterly point the
Island of Formosa, off the coast of China. Within these limits there were isolated outbreaks
from 1850 to 1893, when it appeared in epidemic form in Tonkin and Hong Kong, and shortly
after in Bombay, and so on increasing up to date. As will be seen by statistics, this dread
disease, when attacking where ignorance prevails, still shows the same virulence as it did in
the middle ages. We find that early in the present epidemic the Bombay Presidency had
220,907 cases, with the enormous mortality of 164,083, and Hong Kong had 1,600 cases, with
1,541 deaths.
These figures naturally aroused the authorities, and an effort was made to bring the recent
scientific discoveries of Pasteur and Koch to bear on the trouble.
The English, French, German, American and Japanese Governments sent their most
eminent bacteriologists to infected districts to study the disease and find the cause. The
honour of discovery fell to the Japanese physician Kitasate, and Yersin, of Paris ; each about
the same time isolated and demonstrated the plague bacillus. This, I need hardly add, is the
beginning of the end, for isolating and recognising this little pest means that its habits,
characteristics and methods of propagation are no longer unknown to us. How it flourishes
and spreads, and how it weakens and dies, are now matters of scientific certainty.
Preventive measures must be based on our knowledge of the disease, and the above
discovery has already led Haffkine to prepare a prophylactic from this bacillus, which is now
effecting great good. Yersin and Roux have also made a preparation—anti-pest serum—which
is a curative agent, and is yielding excellent results.
From close observation under different conditions it has been found that the plague
bacillus loses its virulence by drying, and retains it in the presence of moisture and low heat.
Organic matter, animal or vegetable, in a state of decomposition, furnishes the most favourable
nidus for its growth.    In direct sunlight the bacillus dies in from three to four hours.
There are many other characteristics, but the above will suffice for our use. Applied to
our own conditions, what do we find ? Clean, dry, well-lighted and aired homes are our best
protection, while over-crowding (which causes moist, low heat), darkness and filthy surroundings
are a constant menace. And where do we find such conditions! To a nicety you will get
them in the Chinese quarters in our cities and other places. I sincerely trust the disease
will not get a footing in our country, but if it does the present condition of Chinatown will
hold it.
Sanitary defence is a matter of so much concern that I think no expense or trouble should
be considered where there is any danger of harbouring this disease. G 14 Peovincial Boaed of Health. 1908
It is well known that microbial maladies may be divided into two great classes. In one
the microbe is parasitic, and is dependent for its life on the organism it infests; such diseases
are conveyed from person to person by actual contact. On the other the microbe is saprophytic,
or capable of living and multiplying in organic refuse, aptly called " matter in the wrong place,"
or dirt. Such diseases can be carried from the sick by water, air or clothing, etc. The
precaution necessary to be taken to prevent the diffusion of diseases depending on each class
is, of course, different. The plague bacillus is capable of leading both a parasitic and a
saprophytic existence, so that from a point of view of preventive measures, it is necessary not
only to isolate the patient, but to render the surrounding condition unfavourable to the growth
of the plague organism. So far we fortunately have not the germ to combat, but like the wise
virgins, our lamps should be trimmed, so that should he come, we have only to fight him as a
parasitic and not as a parasite and a saprophytic.
We now have skimmed over the general history of plague, and there is one point which
forced itself strongly in my mind while reading up the literature of this interesting subject,
and that is the fact that all great epidemics started with light cases (pestis minor or ambulans),
about which disputes arose as to the nature of the disease. Physicians had little experience
of the trouble, and the obscurity which often surrounds the earlier cases has again and again
led to terrible disaster by failure to grapple with the scourge in its initial and generally milder
stages. This, I think, is a most important point, and one on which too much stress cannot be
laid. I will therefore conclude by giving the following clinical symptoms of plague. They
are taken from a circular of instructions issued by the Department of Health of Berlin,
and translated by the United States Bureau of Health from the supplement to the
" Veroffentlichungen des Kaiserlichen Gesundheitsamtes " :
"Clinical Symptoms of Plague.
" In all epidemics it has been found that even skilled physicians fail to recognise the
disease, mistaking it for common carbuncle, infection of the lymph glands, typhus, intermittent fever, typhoid fever, pneumonia or anthrax.
"The disease attacks persons of all ages and social conditions, and both sexes. The
condition of declared illness is preceded by warning symptoms, sometimes of an hour's, and
sometimes of a day's, duration. These are pallor, depression, pains, headache, thirst, loss of
appetite. The onset of the disease is frequently sudden, with sharp, burning, or dull pains on
the spot on which later the glandular inflammation, or carbuncle, or the pneumonic manisfes-
tation, appears. This is followed by a sensation of cold, culminating in a severe, shaking
chill, succeeded by fever. The fever may last an hour or a day before the local symptoms
appear.
" The onset of the disease is almost invariably accompanied by a feeling of dizziness in
the head. This may increase to a painful roaring, accompanied by indications of great weakness and failing power to control the limbs. Nausea and vomiting frequently accompany this
condition, and not infrequently weakness of heart to the point of collapse.
" When the patient comes into the physician's hands, the disease is usually well developed.
The staring gaze, the bloated, languid and expressionless face, the injected cornea, the thick,
stammering speech, the uncertain gait, give the patient the aspect of a drunken man. This
appearance is heightened by the outbreak of bloody boils. The tongue is red and lumpy, or
else coated with white. The skin is generally hot and burning, especially about the face and
trunk, while the pulseless limbs are cold and covered with a slimy sweat.
" The breathing is painful and laboured, the heart action weak, the arteries are relaxed,
the pulse of the radials is dicrotic and approaches extinction, while the heart action is still
good.
" After taking to his bed the patient lies in a condition of great weakness and tendency
to sleep, murmuring softly and disconnectedly, or throws himself about restlessly, talking
deliriously, imagining that he must return to his home or his business, or quench his thirst,
and he will try to escape if his attendants do not hold him down in bed.
" With careful examination in the early stage of the disease the local focus of infection
may be found in the majority of cases and the diagnosis made with accuracy. A freshly-
developed glandular swelling or skin pustule, or the inception of an inflammation of the lungs,
belong to the complete picture of plague infection. The disease presents itself under one of
the three forms—glandular, skin or lung plague. Abdominal plague has been verified only in
the case of animals. 8 Ed. 7 Peovincial Boaed of Health. G 15
" In glandular or bubonic plague the most frequent form of the disease is characterised
by the appearance of a bubo, which, sooner or later and to a greater or less degree, develops
into an inflamed swelling and affects the surrounding tissues. Any external lymph gland may
be the first seat of the disease. In most cases the bubo appears in the region of the thigh or
groin, frequently under the arm, or especially in children, on the neck. In isolated cases the
buboes appear on. the back of the head, at the elbow joint, the knee caps, the outer or inner
ear glands, the hyoid bone, etc.
" The external lymph glands are often found to be in a minor state of inflammation or
appear to have escaped the influence of the germ, while the concealed glands have developed
buboes of the third or fourth order, so that, for example, the thigh glands may remain free
while a large iliac bubo or lumbar bubo may form that may be perceived as a perityphlitic
swelling of the abdominal covering; or the neck glands may be only slightly swollen while
there are evidences of the formation of a bubo in the upper chest cavity.
" The bubo may appear as a separate enlarged gland, or there may be an inflammation of
the connective tissue, which is hard-packed and is frequently accompanied by a doughy oedema
diffnsed about it. The bubo is generally' not painful in itself, but on pressure, and the patient
may lie in a position in which he suffers no pain. A small bubo is not often observed by the
patient or his attendants, so that it must be sought for by the physician by pressure of
suspected parts.
" Plague pustules or plague carbuncles are not frequent as compared with plague buboes.
They begin with a spot about the size of a flea-bite or a pea on some part of the skin. From
this very painful spot there develops a blister filled with cloudy matter. It then either retains
the character of a pustule, or the surrounding tissue becomes hard and thick, later developing
into a deep carbuncle and then into a burning swelling. Inflamed lymph vessels may convey
the infection to the nearest layer of glands, in which then a bubo may grow. A bubo may
also make its appearance in the neighbourhood of a carbuncle.
" Pneumonic plague, which is the prevailing form in some plague epidemics, generally
follows the course of an ordinary violent catarrhal or croupous pneumonia. When the general
symptoms are very severe there may be difficulty in differentiating it from either inflammations
of the lungs without bacteriological examination.
" Bubo, plague, pustule, or inflammation of the lungs appears at the beginning of the
disease, sometimes even before the fever, or de%*elops clearly a few hours or days after. Their
appearance is seldom deferred till the third day.
" In all forms of plague the early appearance of heart weakness is noted, together with
irritation of stomach and abdomen, extreme sensitiveness to pressure in the region of the
epigastrium and the csecum, violent nausea, later, also, the expulsion of black fsecal matter.
A slight degree of swelling of the abdomen is the rule ; soft swelling of the spleen and traces
of nucleo-albumen and serum albumen in the urine; bloody vomit or blood in urine are less
frequent. A diptheritic affection of the tonsils is often found in the early stages. Almost
universally there is observed a greater or less degree of irritation of the connective tissue, with
which is frequently associated an inflammation of the cornea, which comes on suddenly and
may lead to general suppuration of the eye. Hemorrhagic points or streaks in the skin or
mucous membrane are much more frequently observed. In the course of the disease buboes
develop in the vicinity of the lymph glands and in the different parts of the body.
"The course of the disease varies, many a case of skin and gland plague proving to be
fairly mild and benignant, while pneumonic plague may terminate rapidly in death. In the
bubonic form the neck buboes appear to be a condition of the gravest cases, frequently
causing death by suffocation. There are also cases in which death occurs before any appearance whatever of localisation, before the patient is even made aware, by pain, of his condition.
The third, or at most the fourth day, brings a reduction of the fever and very frequently death.
If the patient passes the third or fourth day, he may remain free from fever, and in the end
recover, or the fever may come on again and again run its course. On the sixth or ninth day
a marked lowering of the temperature and pulse curve almost invariably occurs, so that a
prolongation of the disease, even into the second week, may occur, apparently as the result of
supplemental infection due to the formation of secondary buboes. The temperature of the
body is usually 30° or 40° C, but may be much less. An increase to 41° C. may occur in the
beginning or at the exacerbation of the disease. Before death the fall in the temperature of
the body corresponds with the decline in strength, or it may fall suddenly. It may also rise
and even in the dead body be 42° C. and more. G 16 Peovincial Boaed of Health. 1908
" The progress of the disease as here traced may be diverted by other infections. More
frequently the accompanying infections are due to streptecocci, staphylococci, pneumococci, or
the bacilli of influenza.
" Death may occur at any point of the disease. In cases in which recovery occurs, the
decline of all the symptoms may take place suddenly or by degrees. When not due to suffocation caused by neck buboes or pneumonia, death is usually caused by a general failure of the
circulation.
" Recovery often occurs in 10 and often 40 per cent, of cases. It follows in bubonic
plague on the decline of the fever or the disposal of the bubo—in cases of carbuncle, on the
sloughing of the inflamed tissue.
" In severe cases recovery is slow. A sudden failure of the heart may attack a convalescent. Many patients die of septic fever; some of plague meningitis. Secondary infection of
the respiratory passages, favoured by want of proper care or unfavourable environment, causes
the death of numbers of convalescents. Even after weeks or months many languish and die
from prolonged suppuration, progressive degeneration of the organs, or impoverishment of the
blood.    Among the after effects, paralysis plays a large part.
" Prognosis of the disease is difficult. It may be stated that when the patient is free
from fever on the third or sixth day, he will probably recover should no complication occur.
" The early appearance of the buboes is relatively favourable. Unfavourable symptoms
are bloody vomit, bloody urine, petechise, the formation of boils or carbuncles, and diphtheria
of the tonsils. Hiccough is the immediate precursor of death. Recovery from pneumonic
plague is rare. Previous existing diseases of the lungs and other internal organs remove
almost all hope of recovery. Mortality is extraordinarily great among the consumptive, the
syphilitic, and infants.
"A second attack of plague is rare. The second attack is generally fatal. The diagnosis
of plague during an epidemic is generally rendered easy by the severe and febrile general
symptoms, by the formation of local foci in the lymphatic glands, on the skin or in the lungs,
by the unconscious condition of the patient, the unsteady gait, the extraordinarily weak pulse,
the injection of the eyes, and the white tongue. When no epidemic prevails the disease may
present, even in pronounced cases, an assemblage of symptoms resembling those of anthrax,
typhus or pneumonia. The light cases, with less severe local and general symptoms, and the
gravest cases, in which death occurs before the manifestation of any local product of disease,
escape diagnosis unless bacteriological examination is made, on the patient or in necropsy.
" Bacteriology of Plague.
" The evidence of the specific organism is especially important in preventing wrong
diagnosis.
" The specific organism of plague is a bacillus without voluntary motion which in form
and size shows considerable variations, according to the conditions of development, the nature
of the culture media, etc. It usually appears as a short rod, with rounded ends, and two or
three times as long as it is wide. Not infrequently the difference between length and breadth
is so slight as scarcely to preserve the rod shape.
" The plague bacillus takes analine colouration well in streaked preparations. The outer
portion of the bacillus, and notably the ends, take colouration four times more strongly than
the middle (polar staining), a peculiarity which is especially noticeable in careful methylen
blue colouration.
" The culture of the plague bacillus succeeds well at air temperature and in the usual
culture media and culture fluids (agar-agar, solidified blood serum, gelatin, bouillon, etc.).
When air is excluded the growth ceases. In culture media, containing sugar, the plague
bacillus does not produce fermentation with development of gas. Its growth is good at a
temperature of 25° to 37° C. Between 10° and 15° C. it is slow, but still strong, and even
at 5° C. it is not completely arrested. When the material for planting is taken from a plague
patient or a plague cadaver, the development, even at a favourable temperature, is slow. On
the surface of thick agar, for example, which has been kept at a temperature of 37° O, the
beginning of the formation of colonies can be seen with the naked eye only after the lapse of
twenty-four hours, and for full development a period twice or three times as long is required.
" Superficial cultures then appear on microscopic examination as transparent, small, drop-
shaped colonies which have little tendency to coalesce. Cultivated in bouillon, the plague
bacilli grow in chains like streptococci.    On very dry agar, to which from two to three per 8 Ed. 7 Peovincial Boaed of Health. G 17
cent, of cooking salt has been added, the plague bacilli grow abundantly in from one to two
days in involution forms, being large, ball-shaped, or irregularly formed masses, which are
deficient in their capacity to take colouration.
" Resistant forms of the plague bacillus are not known. In fluid media the bacilli die in
ten minutes at a temperature of 55° or 60° C. At the boiliug point they are killed immediately.    Dried on linen and the like, they remain alive in the climate of Europe many weeks.
" The plague bacilli are found in all the morbid products of the living patient and generally throughout a plague cadaver. The fluid and tissue of fresh buboes and carbuncles, the
exudation of inflamed lungs, contain bacilli in enormous quantities. In the contents of the
bubo, released either by spontaneous breaking down or by treatment, they are only exceptionally found, so that in cases of bubonic plague ending in recovery they must be obtained by
incision of the fresh bubo. Yet these cases occasion error in diagnoses. Blisters and
carbuncles readily yield, on puncture, material for bacteriological diagnosis.
"In the much more numerous cases of pneumonic plague the sputum, which always
contains numerous bacilli, furnishes the most reliable diagnostic material. In the absence of
sputum, section or puncture of the lung of a plague cadaver decides the diagnosis, if this
decision has not already been arrived at by bacteriological examination of the blood. Examination should not be neglected in any plague case, since it is always easily practised and is
often decisive. In the majority of plague cases which end fatally the bacilli are found, either
sparingly or in quantities, in drops of blood drawn by a needle prick in the skin, made either
during the last hours of life or several days previously. In the normal secretions they are not
often found and are more difficult to obtain. They always appear in numbers in terminal
lung cedema.
" If the bacteriological examination of a patient is for any reason unsatisfactory, it is
always easy and reliable in the case of material from plague cadavers. Besides the primary
localisations in the skin, lungs and glands, the blood, spleen, lung hypostasis, gall, cerebrospinal fluid, furnish especially good objects for the identification of the bacillus.
" Necropsy undoubtedly demonstrates the fact of plague cases which during life were
obscure. Anatomical findings are more uniform, and, therefore, more reliable than clinical
symptons. Besides the primary lesions, i. e., the fatty or warty swellings of the lymph glands,
juicy and often bloody permeation into the surrounding tissue, deep infiltration from carbun-
cular swelling, and lobular or lobar thickening of the lungs, almost every cadaver shows a soft,
swollen spleen, shellac-coloured blood, and almost always bloody effusions into various organs,
especially the stomach, small intestines, and caecum, the basin of the kidneys, etc.; also here
and there foci of necrosis and highly developed parenchymatous degeneration of the intestines,
especially the liver.
" Treatment.
"In the treatment of plague it is of the highest importance to secure a comfortable
location, fresh air, and cool lotions. The great thirst from which the patient suffers should
be unsparingly satisfied. Fresh water, acidulated drinks, and milk are the most acceptable.
The use of effervescent drinks is discouraged by many physicians when there is marked depression of the brain or other vital centres.
" Cleansing of the digestive organs by means of castor oil, or similar mild medicament, is
recommended by many physicians, and appears from necropsic findings to be efficacious. These
often show inflamed and packed bowels, with bloody effusions. Physicians are not agreed as
to heart stimulants.
" Cauterization of the pustules and the application of mercuric or carbolic washes or
salves to the buboes or inflamed glands appear advisable. The further treatment of the buboes
is surgical. In pneumonic plague the inhalation of a one per cent, carbolic and lime-water
spray is desirable.
"The best protection for physicians and attendants is absolute cleanliness. The great
danger of infection through the sputum of living plague patients and the cedematous exudation
from the lungs of the dying are to be especially guarded against.
" Disinfection must be applied to all excreta of the patients and to all articles that come
in contact with him. For chemical disinfection, solutions of sublimate (ToVo)> carbolic solution
(3 per cent.), cresol soap and chloride of lime solutions are especially to be recommended.
"As a prophylactic agent, for the protection of physicians and attendants, may be
mentioned  inoculation  with  dead  plague  culture,   which  constitutes the  so-called   active G 18 Peovincial Boaed of Health. 1908
immunizing process. This plague protective inoculation has been shown, by extensive use in
India, to be harmless and to confer protection against infection which, if not absolute, is yet
unmistakable. As far as animal experimentation shows, the inoculation loses it protective
power after seven days.
" Epidemiology.—It has been demonstrated that plague spreads slowly after its introduction. In many instances it has been found to be confined to the family in which the first case
occurred and to persons who have come in contact with the plague patient. It will then
make its appearance in neighbouring houses or in a distant quarter, to which it has been
conveyed by persons who have been in contact with the plague patient. In this manner the
disease fixes itself when it has found a favourable soil and remains unnoticed during weeks
and months, when it often develops quite rapidly and reaches its maximum at first by quick
and then by slow degrees. Its extinction is often only apparent. After a period of suspension, lasting weeks or months, a fresh epidemic not infrequently begins, and this may also
have still further developments.
" Epidemics of sudden development, such as Asiatic cholera and abdominal typhus, which
result from the long persistence of the germ in drinking water and water for domestic uses,
are not observed in plague.
" An important feature in the conditons affecting plague is the disposition of the disease to
confine itself to separate dwellings and to discriminate among the persons resident there. When
the persons affected are removed from the house further infection may, by care, be prevented.
"In the propagation of plague the transference of the germ from man to man is in the
first line of importance. This transference may occur directly or by means of contact with
articles of clothing and laundry, or, in general, any articles of use.
" The manner in which the cause of disease leaves the body has already been shown. The
danger of infection is generally slight in mild cases of the disease, where the plague germ is
confined to the swollen gland. The conditions are scarcely altered when the bubo becomes
soft or breaks down, since in that case the plague bacillus is, as a rule, already dead. The
facility of infection is much greater in severe types of septicaemic cases of bubonic plague, in
which the disease germ may be discharged, living, with the several secretions of the body, or
found in quantities, shortly before death, in pulmonary oedema. The most dangerous cases
are of pneumonic plague, on account of the quantities of bacilli which may be contained in the
sputum, which are thrown into the air by coughing, or even in the act of speaking.
" The plague germ is received into the lymphatic system of a healthy organism by small
unobserved injuries to the epidermis, slight scratches, flea-bites, and the like. In other cases
it may be taken in by way of the mucous of the mouth or throat, the conjunctival sack or the
nostrils, or may be taken into the bronchial tubes by way of the respiratory passages.
" That these various means of infection from man to man constitute an open door for
trans?nission when an unclean people live in close, dark and crowded houses is apparent.
Where light and air are freely admitted and cleanliness prevails, plague finds no soil for an
epidemic spread.
" Direct or indirect transmission of infection from man to man is not the only means of
the spread of plague. Many circumstances in the outbreak and spread of this disease are
explained by the fact that animals living in the vicinity of men are attacked by fatal
epidemics. Of these animals rats are the most important, they being in the highest degree
susceptible to infection by the abdominal canal. As they ha.ve the habit of gnawing their sick
or dead fellows, plague is easily spread among them, when it has once broken out.
"Plague-infected rats are dangerous not only to their own kind. Their excreta, which
contain great numbers of plague bacilli, may easily infect human dwellings, as plague-infected
rats generally lose their fear of man and not infrequently die in houses. Mice may play a
similar part, if not one as apparent or pronounced.
" Subterranean and entirely uncontrollable conditions explain to some extent the
apparently spontaneous outbreak of plague, together with its disposition to fix itself in crowded
quarters and to persist even after a period of cessation.
"If the foregoing considerations meet the demand for an understanding of the nature
and propagation of plague, their object will have been obtained. They may be especially
useful in demonstrating the first eases of a plague outbreak. It need not be added that the
final diagnosis of a plague case should be made only with corroborative statement of medical
authorities and on the ground of reliable bacteriological examination." 8 Ed. 7 Peovincial Boaed of Health. G 19
REGULATIONS
For the Detection and Treatment of a Disease known as Bubonic Plague.
Approved by Order of His Honour the Lieutenant-Governor in Council, dated the
24th day of October, 1907.
1. All sick Chinese, Japanese, Sikhs or other Orientals must send or give notice of their
illness to the Health Officer or Police Constable in the district where such Chinese, Japanese,
Sikhs or other Orientals reside.
2. Physicians in attendance on sick Chinese, Japanese, Sikhs or other Orientals shall
notify the Health Officer or Chairman of the Local Board of Health of Municipalities; or, if
an outlying district, the Government Agent must be notified. Such notification should state
the cause of illness and the condition of the glands throughout the body of the sick person,
and should be delivered to the Health Officer, Chairman of the Local Board of Health, or
Government Agent, as the case may be, at the earliest possible opportunity.
3. In City Municipalities, the Medical Health Officer shall be notified within six hours
of the death of any Chinese, Japanese, Sikhs, or other Oriental, by the person on whose
premises such death occurred, or by some relation or person having charge of the person so
dying.
4. In Rural Municipalities, the Medical Health Officer or the Chairman or Secretary of
the Local Board of Health must be notified within six hours of such death, and in outlying
districts the Government Agent or Provincial Constable shall be notified within twelve hours
after such death, or as soon after as possible. Certificates as to the cause of death must be
signed by the Health Officer in Municipalities, and in outlying districts by the Government
Agent or some person duly authorised by him.
5. No undertaker shall accept for burial the corpse of any Chinese, Japanese, Sikh or
other Oriental without having received, with respect to such corpse, a certificate of death
from a Medical Health Officer, or some other person duly authorised for the purpose by the
Government.
6. Any person violating any provision of these regulations shall be liable, upon summary
conviction 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.
By Command.
Henry Esson Young,
Provincial Secretary.
Charles J. Fagan, M.D.,
Secretary Provincial Board of Health. G 20 Peovincial Boaed of Health. 1908
REGULATIONS
Governing the Construction, Equipment and Management of Slaughterhouses, approved by Order of His Honour the Lieutenant-Governor in
Council, dated 22nd day of June, 19O0.
1. Every slaughter-house or abbattoir, together with the cattle yards and pens attached
thereto, shall be of a character and equipment as shall be approved by the Provincial Board of
Health and shall have :—
(a.) Yards and pens with shelter for cattle, and appliances and conveniences for feeding
and watering the same :
(b.) Killing floor:
(c.) Refrigerator or store-room with separate hanging room and ice-chamber, or  other
such arrangements as shall be acceptable to the Provincial Board of Health :
(d.) Proper and adequate appliances for killing, cleaning and hanging animals, for heating
water for removal of blood and offal, and for receiving the organs and fat:
(e.) An adequate supply of pure water for flushing and general cleansing purposes:
(f) Sufficient and proper appliances for heating and ventilation :
(g.) Properly constructed and adequate sewerage, and means for disposal of sewage :
(7i.) Adequate  arrangements  for  disposing  of  refuse and offal, so as not to create a
nuisance.
2. The ground on which the building is situated shall be selected for its dryness ; and
sub-soil water, where necessary, must be carried away by a three-inch field tile laid around the
outside of the foundation, and lower than the floor.
3. The floors must be laid in, either with vitrified brick laid in cement, or in concrete,
with roughened surface, on a foundation of concrete in both cases, or in such a manner that
they will be impervious to water, and generally to the satisfaction of the Provincial Board of
Health.
4. No building shall be erected or converted into, or used as a slaughter-house, until the
plans thereof have been duly submitted to the Provincial Board of Health and approved in
writing by said Board; and no building occupied as a slaughter-house or any part thereof, or
any building on the same lot, shall be occupied at any time as a dwelling or lodging place;
and every such building shall at all times be kept adequately and thoroughly ventilated.
5. No room or loft shall be constructed over a slaughter-house.
6. All floors where any meat, refuse, offal, fertiliser or any other materials derived,
directly or indirectly, from the slaughtering of animals, are treated or handled must be made
of water-tight, non-absorbent material and properly drained, and the walls of the killing, meat
dressing and cooling rooms must be covered to the height of six feet above the floor with some
non-absorbent material.
7. The yards, other than where cattle are kept, must be so constructed as not to absorb
liquid filth, and be so graded as to permit free drainage.
8. All woodwork, except counters, must be painted or whitewashed.
9. Blood from slaughtered animals must, while still fresh, be treated so as not to become
offensive. All offensive odours arising from the handling of meat and treating of and caring
for offal, blood or any other material stored or manufactured, must be cared for by destruction
or condensation, and not allowed to escape into the outside air.
10. No offal or butcher's refuse shall be conveyed through any street in an incorporated
town or city without permission in writing from the Local Board of Health, and when so
conveyed must be in tight boxes, barrels or receptacles, and tightly covered so that no odour
shall escape therefrom. 8 Ed. 7 Peovincial Boaed of Health. G 21
11. No blood-pit, dung-pit or privy well shall remain nor be constructed within any
slaughter-house, and no accumulation of any refuse whatever, when tainted or emitting a foul
odour, shall be permitted to remain in or around a slaughter-house,
12. The owners, agents or occupiers of all slaughter-houses shall, during the months of
June, July, August and September, distribute twice in each week not less than twenty-five
pounds of chloride of lime about their premises, and also remove the contents of any manure-
pit or manure pile on the premises twice in each week, except where only several head of
cattle are slaughtered weekly.
13. Officers of the Local Board of Health of every municipality in which a slaughterhouse is established, or from which meat is supplied to inhabitants of said municipality, or
officers of the Provincial Board of Health, may employ one or more competent persons to
inspect such slaughter-houses, cattle yards and pens, and all animals, carcases and meat intended
for human food.
14. Whenever any animal is found to be diseased or in a state unfit to be slaughtered for
the purpose of selling its meat for human food, said animal shall be condemned and shall not
be slaughtered for said purpose unless by permission of the Local Medical Health Officer or
Provincial Board of Health.
15. Free access to every slaughter-house, for the purpose of inspection, must be afforded
at all reasonable times to the Medical Health Officer, Inspector, Surveyor or Committees
appointed by the Local or Provincial Board of Health.
16. When meat or carcases are condemned as being unfit for human food they are liable
to be seized or destroyed, and shall not be offered for sale unless by permission of the Local
Medical Health Officer or Provincial Board of Health.
17. The meat of emaciated or wasted animals, or meat found to be diseased or unwholesome, or veal less than three weeks old when killed, or lamb less than eight weeks old when
killed, or pig less than five weeks old when killed, shall be considered unfit for human food.
18. Animals, other than those intended for slaughter, must not be kept in or around
slaughter-houses.
19. Pig pens must not be nearer than 200 yards to any slaughter-house.
20. Animals intended for slaughter must not be kept in or around a slaughter-house for
a longer period than 48 hours, and must be supplied with water.
For the Provincial Board of Health.
Charles J. Fagan, M D.,
Secretary.
By Command.
Frbd'k. J.  Fulton,
Provincial Secretary.
victoria, B. c.
Printed by Richard Wolfbxden, I.S.O., V.D., Printer to the King's Most Excellent Majesty.
1908.

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