That in the opinion of this House the time has arrived when parliament should take some active steps to lessen the widespread suffering and the great mortality among the people of Canada, caused by the various forms of tuberculosis ?
He said : Mr. Speaker, as a layman in both medicine and law, I feel very diffident about bringing this question before the House ; but the national importance of it and the great interest I take in it must be my excuse for so doing. The disease to Which the resolution refers needs no definition from me Consumption of the lungs, which is the most common and destructive form of tuberculosis, has been known ever since the dawn of medical science. It was discussed and studied by medical men even in the days of ancient Greece and Rome. I hold in my hand official returns from the secretaries of the boards of health of the provinces of Quebec and Ontario, according to which I find that in the year 1903, the last year of which we have official statistics, 60.540 people died in these two provinces. Of these, in the province of Quebec. 2,943 died from tuberculosis, while only 2,017 died from all other contagious diseases. In the same year, in the province of Ontario, 2,723 died from tuberculosis, and only 1,938 from ail other contagious diseases.
Now, on the basis of these two provinces, the total deaths in the Dominion from tuberculosis in 1903 were about 8,000.' That would be about 10 per cent of all deaths throughout the Dominion. And I find that practically all authorities agree that all the deaths caused by tuberculosis are not tabulated under that disease. In fact, some of the best writers claim that one-eighth of all deaths are caused by this disease, and others even say as many as one-fifth are caused by it. I have the official report for 1901 of the province of British Columbia, which states that in this form-that is in the form of consumption-tuberculosis causes about one-sixth of all the deaths occurring in the hums n race, and that omitting the deaths among children up to fifteen years and adults after sixty, it causes about a quarter of all deaths, so that its ravages are most deadly at a period when the life of the individual is most useful. Not only ore a great number of deaths caused by ibis disease, but it is estimated that between 30,000 and 40,000 persons are affected by it in the Dominion of Canada ; which means that a great percentage of these people are unfit to follow their ordinary occupations, and the families of those that are poor must be, more or less, a charge upon the public purse.
For many centuries, consumption was supposed to be an hereditary and incurable disease, and in consequence its Sir WILFRID LAURIER.
visitations were accepted by the people in a spirit of fatalism and hopelessness, and practically nothing was done to stop the terrible ravages it caused. During the last few years, however, this has all been changed, and we now know that this disease is not inherited. In fact, it has been shown that the children of consumptives, when removed from their parents at the time of birth and brought up in proper surroundings are very little more likely to take this disease than any other children are. We also know now that the cause, and the only cause, of this disease is a living germ known as the turbercle bacillus, which is taken into the human body chiefly by breathing air which is laden with the germs in a dry state. While this disease, therefore, is not directly contagious, it is communicable, and very readily so, when the patients suffering from it are careless or ignorant. But, though this disease can be easily communicated, its spread is very easily prevented, and patients can be kept from giving the disease to others by very simple means, chiefly by keeping the sputum of the patients wet and destroying it. In fact, it is now well known that the place where one is least likely to contract tuberculosis is in a well organized sanatorium, because if the rules are properly carried out there is absolutely no danger of contagion from the patients. I have known, and I have no doubt that every member of this House has known, cases of families where one member has had this disease, and, one after the other, the other members have contracted it from the patient entirely through ignorance of the proper rules to be observed In such cases. If our homes were guided by the same rules that prevail in sanatoria, there is no reason why this disease should not disappear from our midst. Now, to show that work through sanatoria and in other ways does effect a reduction in the mortality, 1 may say that, in the year 1891, in the city of London, England, 22 out of every 10.000 of the population died of tuberculosis. They have hospitals for this disease and fight it in other ways. In fact. His Majesty the King, who was given a million dollars to use for charitable purposes, decided that it was best to use it in erecting sanatoria for consumptives. The result of that work has been that, while the death rate in 1891 was 22 per 10,000 of the population, in 1896 it was reduced to 17-3 per 10,000. Not only that, but we find that in the different cities the percentage of deaths from tuberculosis is chiefly in proportion of the work done in attempting to prevent its spread. In 1894, the deaths from tuberculosis per 10,000 of the population were, in St. Petersburg, 44-3; Paris, 41-6; New York, 24-1 ; Berlin, 22-3 and London, 17-3.
This disease is not only preventable but the researches of medical men within the last few years have shown that it is curable-in fact that it readily yields to
treatment if taken in its early stages. Dr. Brehmer. of Germany, who has had a great deal to do with sanatoria, found, after investigating and reporting on 5,000 cases of tuberculosis, that 50 per cent of the incipient cases were cured, and, even of the moderately advanced cases, 21 per cent were cured. And these figures are borne out by reports of sanatoria in this country and Europe. X find that the reports run from 40 to 60 per cent of cures of cases taken in the *early stages. Some people think that climate has a great deal to do with the cure of this disease. Fortunately it is now known that a cure can be 'effected in any climate, provided the patient is able to be out of doors. The treatment is very simple ; it consists almost entirely of sun, fresh-air and good food. The wealthy are able to take care of themselves in this respect. When a member of such a family is taken with the dread disease, means are at hand to afford him proper treatment which will probably effect a cure, but the poorer people of this country are unable to provide for themselves. I am sure that every member of this House knows of cases among the poorer people, where members of a family have died one after another with practically nothing done to help them. I have mentioned these facts about the preventability and curability of tuberculosis simply to show that, if this parliament will take the matter in hand, a great deal of good, beyond all doubt, can be accomplished. As a matter of fact, very little is being done in our great country in this respect. The only sanatorium in this country owned by a province, I believe, is one in Kentville, N.S., with a capacity of eighteen patients. There are several private sani-toria, one in Nova Scotia with a capacity of eight patients, one in Quebec with a capacity of sixteen, and three in Ontario with a total capacity of 210 patients. And I believe that one has lately been started in the Northwest, although I do not know whether it has yet been opened.
It will thus be seen that in the sanatoria which are now open there is room for only 252 patients, while there are 40,000 afflicted with this disease in the Dominion of Canada. The municipalities throughout the Dominion, I am sorry to say, have not done a great deal in the direction of endeavouring to control this disease. Some cities have done something, but on the whole the disease has been allowed to flourish and spread in almost every part of the Dominion. There is no other place where a patient can go but to one of these sanatoria. As for the hospitals, nearly all of them strongly object to admitting consumptive patients. I may mention a very pitiable case that occurred a few years ago in Ottawa at the time of the great fire. The wife of a man who was burned badly was a consumptive, and he himself contracted the disease, as also did their two childern later, as they had no
place to go to, but had to remain at home and infect each other. Private charity has not yet been able to cope with this difficulty to any extent.
For the last five years we have had in existence in this country a society called the Canadian Association for the Prevention of Consumption and other forms of tuberculosis, with its headquarters in the city of Ottawa. This association was formed for the purpose of educating the people by disseminating literature and information, and urging on the municipalities and governments the necessity of doing something to stop the ravages of this dread disease. The late Governor General, Lord Minto, was the first honorary president, and took a great deal of interest in furthering its objects. I am happy to say that the present Governor General, Lord Grey, has taken up his work and has become honorary president. I have been a member of the executive since its organization, and am well acquainted with its operations, and believe we have accomplished something. We have a secretary and lecturer, who travels through the country /or the purpose of teaching the people the danger of the disease and the methods of preventing it, and we have sent out a great deal of information. Thanks to this government, a sum of $2,000 has been given the last few years annually for the purposes of this association, and I am glad to say on behalf of the association, that we are very grateful for that assistance. Now, the first thing we would like to get done is the establishment of sanatoria. Last spring, at our annual meeting, this question was brought up, and a deputation was appointed to interview the Dominion government and ask for assistance towards the establishment of sanatoria. We asked the federal government to assist the provincial governments in some way to build a sanatorium iu each province as an object lesson, which others might follow. Every patient suffering from this disease is now a source of contagion to all about him, and every patient who is taken to a sanatorium becomes thus an agent for the dissemination of information throughout the country, and, through his experience, the people learn what they ought to do in order to cure themselves of the disease and prevent their friends and relatives from taking it. In this way a sanatorium would do a double good, because, in saving the patient himself, it would help to save others.
Now, Sir, it has been said that this subject ought to be dealt with entirely by the provinces. To that argument I may answer that the provinces are unable properly and efficiently to deal wih this evil, it is so widely disseminated throughout the length and breadth of this Dominion. It is to be remembered that there are 30.000 or 40,000 people suffering from it in the Dominion of Canada, although many of them are able to work and move about. In fact, an ordin-
ary observer would not know that many of them had the disease at all. These people move about and spread the disease. It would be impracticable for a provincial government to take up the matter, because it could not draw a line at its own boundaries, and people suffering from this disease in other provinces would drift into the province which was providing for such sufferers. One province could not make rules and regulations to prevent people crossing into it from other provinces It is necessary for the patient to live much out of doors ; the weather is so much pleasanter in some sections than in others at this time of year, that the patients naturally move into that section where they can live outside most comfortably. It is manifestly impracticable for the provinces separately to deal with this question, and I believe that they cannot do so efficiently. Now, Sir, I consider that no greater obligation devolves upon this House than to provide some means of lessening this great evil. If we wait for the municipalities and private charities to come to the rescue of these unfortunate people, many of them will die in the meantime, and the_ disease will go on spreading. I do not say that the Dominion should take this matter up alone, but it should do so jointly with the provinces, and the municipalities must help as well The association asks this parliament to help build sanatoria, as I have already explained, but personally, I believe that the disease will never be properly dealt with until the Dominion government takes full charge of it, under the management of the Director of Public Health and an official staff here in Ottawa. Professor Knopf, who is a specialist in this disease, has said :
To combat consumption as a disease of the masses successfully, requires the combined action of a wise government, well-trained physicians and an Intelligent people.
If as many deaths-8,000 occurred from smallpox or scarlet fever, there would be such a tremendous outcry raised throughout the Dominion, that nothing would be left undone to stop its progress. Now, this disease causes more deaths than small-pox, diphtheria, scarlet fever, measles, typhoid and yellow fever combined [DOT] still tuberculosis is a preventable disease, and to a large extent it is a curable one. Now, Mr. Speaker, to come down to material arguments, I may mention that this disease, besides being so fatal to so many thousands, costs the people of this Dominion millions of dollars every year. We are now spending large sums of money on immigration.
In the estimates of this year, page 33, there is a vote of $767,200 for immigration ; and whatever difference of opinion there may exist regarding the quality of the immigrants we are bringing to this country,
I am sure we will all agree that they are not as good a class of people as our own Canadians living in the country, and if we Mr. PERLEY.
can lessen the mortality among our own people, caused by this dread disease of tuberculosis, we will be doing our country a far greater benefit than by any expenditure on immigration. It is generally admitted that every productive life is worth a thousand dollars to the country. Well, if you accept that estimate and apply it to the eight thousand people who are dying here of tuberculosis per annum, it means a loss of eight million dollars a year to the Dominion. And when, in addition to this mortality, there are from 30,000 to 40,000 people suffering from tuberculosis who are in a great measure unable to work, that loss is considerably increased. Some authorities estimate the loss arising from this cause much higher than I do, but it seems to me that at least eight million dollars per year must be lost to the country through the inability of these people to work. That makes a total loss of $16,000,000 per annum, caused by the ravages of this fell disease. Would it not then be well for this parliament to give some substantial help to assist in lessening this disease.. The saving of half these people would be an immense benefit to the Dominion from a humanitarian as well as from a financial point of view.
The argument has been made, I believe, that this parliament has no power to deal with this question, that the matter of public health is entirely within the jurisdiction of the provinces. True it is that at present the provinces have almost the entire charge of the public health, but I do not find anything in the British North America Act to give them the exclusive charge and prevent the federal authorities taking any action. The matter of public health is not mentioned in any of the exclusive clauses of the British North America Act at all. And in the year 1868, I find that in the first Act providing for the organization of the Department "of Agriculture. 31 Vic. chap. 53, it is enacted that public health and quarantine shall be under the control of that department. I find also in chapter 63 of the same year that in clauses 7. 8. 0, 10, and 11 of the Quarantine and Health Act, it is provided that the government may make regulations regarding health. Further my view of the case is confirmed by a memorandum which was written on .Tune 21. 1807. by Mr. John Low who was at that time the technical referee of the Department of Agriculture and who had been for years its deputy head. Mr. Low said
The administration of the subject of public health is joint between the Dominion and the provinces, in virtue of the Act of Confederation.
Until the year 1872, the Quarantine Act contained provisions charging the Department of Agriculture with the administration of public health, and which administration for many years before it had exercised as a bureau, there having been under it a public health
medical board, of which the late Dr. Tachfi, Deputy Minister of Agriculture, was the secretary.
In 1872, the Minister of Agriculture (the late Hon. J. H. Pope) advised the elimination of the public health clauses from the Quarantine Act, for the reason that he found heavy accounts for public health service were presented to him for payment by the provinces while he had no control in the direction of the service.
But in 1878, notwithstanding this decision, on the return of Sir John A. Macdonald to power, Mr. Pope, who became again Minister of Agriculture, took over, at the very urgent request and representation of Dr. Tache, the subject of leprosy and dealt with it as a part of the administration of his department, and ever since the treatment of leprosy throughout the Dominion and the hospital at Tracadie have been under the control of this government. 1 find besides a grant made to the Winnipeg and St. Boniface hospitals in our estimates of this year. It seems to me, therefore, that this question of the public health is joint between the Dominion and the provinces and that this parliament has every power to deal with it, particularly in virtue of section 91 of the British North America Act which provides that the federal parliament shall make laws in relation to all maters not assigned exclusively to the legislatures of the provinces.
Allow me, Sir, to briefly summarize the facts which I have brought before this House regarding this disease known throughout the world as the White Plague. It is a disease which carries off at least eight thousand of our people annually. It is a disease which costs this country at least $16,000,000 per annum and inflicts untold misery and woe throughout the land on the families of those whom it carries off. Today, medical science has discovered that to a iarge extent, if taken in its early stages, it may he cured; and it seems to me that we should not fail to take advantage of this knowledge and the means which medical science has placed at our disposal. There is nothing in the British North America Act to prevent our acting in the matter. Further there is not one of the provinces which is in the slightest degree adverse to our taking action, and in any case it would be criminal on our part to allow this great loss of life and wealth to continue simply because there should happen to be some few purely technical objections to our dealing with the subject. I appeal to this House to pass this motion. I appeal in the name of humanity, in the name of all the unfortunates who are suffering and dying from this disease, and I ask this parliament to take steps to save our people and keep this fair Dominion in the vanguard of' civilization.
Subtopic: PREVENTION OF TUBERCULOSIS.
I think it my duty, Mr. Speaker, to second this very important motion, but as it is of too great importance to be discussed within the short space of time at the disposal of the House this afternoon, I shall confine my remarks exclusively to expressing the great sympathy I have In the ideas which my hon. friend (Mr. Perley) has expressed and the views he has brought forward. In the hope he has expressed that some action will eventually be taken by this House and government tending towards the repression of this scourge I most cordially join. The loss of life and the loss of money to the state caused by tuberculosis is almost incalculable. The disease may be almost called a social one. There is perhaps not a municipal centre in the Dominion entirely free from it in some form or other, and it certainly is high time that governing bodies should take cognizance of the fact and adopt means for its removal or at least its mitigation. We know that the disease can he prevented if taken in time. We know that if the proper means be taken at the outset, the patient may be cured. But in order that an effective system be put in operation, you require the combined action of an intelligent public, the professional men, and the statesmen. For years our professional men have been attempting to educate the public and have succeeded to some extent. Within the last few years, thanks to the medical profession, there has been great improvement in the knowledge of the public in this matter, and many attempts have been made to grapple with the evil by private individuals impelled by philanthropic motives. With the governments, however, we have not had the same success. They as a rule have given the subject very little attention. In fact the only class ot individuals who still remain uneducated is our statesmen, but I am not without hope that in course of time they too will become educated and give to this subject the attention it deserves. I sincerely hope that those in charge of this movement will continue to press their representations upon governing bodies such as this until the governing bodies are thoroughly impressed with the sense of their duty and act accordingly.
Subtopic: PREVENTION OF TUBERCULOSIS.
Mr. Speaker, I think the hon. member for Ar-genteuil (Mr. Perley) who has introduced the subject to us this afternoon is deserving of the thanks of this House and of the people of this country. This is a subject which I think must receive the sympathetic consideration of this government, because I cannot conceive of any government having the interests of the people at heart which by any possibility can throw to one side a matter so important to them as that which has been brought before us this afternoon. The mover of this motion has gone so thoroughly into the matter that it leaves really very little for any one else to bring forward. This subject of tuberculosis has, within the
Subtopic: PREVENTION OF TUBERCULOSIS.
I shall not inflict upon the House a lecture on tuberculosis, its causes or its treatment ; neither shall I take more than a few moments of your time. I would like to say that I consider that the government and parliament even as a matter of national defence should take active steps for the prevention of tuberculosis. If it is considered good statesmanship-and I have no doubt it is-that large sums of money should be spent in bringing immigrants into this country and increasing our population, it must be better statesmanship to save the lives of our own citizens, for I maintain that one good Canadian whose life has been saved is better than a score of Doukhobors.
Subtopic: PREVENTION OF TUBERCULOSIS.
I say nothing against the Doukhobors ; I say that one good Canadian, whose life has been saved, is better than a score of Doukhobors. I believe, Mr. Speaker, that as a matter of self defence we should take steps to prevent the spread of tuberculosis. We have a department of agriculture; we give special attention to the prevention of this disease among cattle and why should we not protect the lives of our people ? We have every encouragement in making the attempt to defend ourselves against this disease because we have learned so much from the last few years that we can now prevent tuberculosis, we can save lives, [DOT]and judging from the short past of what may be done in the future we have every encouragement to hope that if proper steps are taken we shall accomplish a very great deal for the benefit of the state, for the benefit of this Dominion, in adopting some organized plans for the prevention of the disease. We all know that it is preventable ; we all know now that in its earlier stages, it is curable. We know that if knowledge were spread among the people many lives could be spared.
There are, I believe, somewhere about half a million people in this Dominion affected with tuberculosis. The percentage of deaths has been enormous, but with the knowledge we have gained in the last few years of its prevention and treatment the percentage of deaths is growing smaller every year, which is a great encouragement for us to go on to the prevention of this disease. We know now that nobody can have tuberculosis unless they catch it just as no one can have small-pox unless they catch it. The people do not know how to escape the contagion as they should and I think it is the duty of this country to have the people instructed. It seems to be the general idea that sanatoria are the only means for the proper cure of this disease and for its prevention, but how is the poor man going to get into the sanitorium ? I am very glad to say that my own province has taken a wise step and that a wise and a generous government there has built a provincial sanatorium. It is a good one and well equipped and I would say all credit to the government of Nova Scotia for having established it. But, Mr. Speaker, there are thousands of people, thousands of the poor, the workingmen, suffering and dying from this disease who have neither the opportunity nor the means of getting into the sanatoria, and the saddest part of all in these deaths from tuberculosis is that it is not the old, whose lives have been worn out for their families and for the State, but it is the lives of the young whose continued existence would be a benefit to the State and to their families-these are the classes that are going most rapidly from this disease. I was saying that the idea seems to prevail
that sanatoria scattered through the Dominion would be the only possible method of preventing the spread of this disease. But, Mr. Speaker, I think it is the duty of the government of this country to have the people instructed. The causes and treatment of tuberculosis are so easily explained -for we depend little on drugs, medicines and prescriptions for its cure- that plain language and plain teaching such as the common people can understand is all that is necessary to instruct the people how to avoid the contagion of the disease. I believe the first public pamphlet for the instruction of the people was issued by my late reverred friend Dr. Farrell, of Halifax, who was the delegate of the government of Canada to the first tuberculosis conference at Berlin. That pamphlet of that able gentleman was written in such simple language that even the ignorant might understand it. That is the class of literature which I think should be published all over the Dominion. Further, I think instruction on the subject should be given in the public schools and lecturers should he sent throughout the country. The knowledge of the disease is so easy to teach and understand that the people, even the most ignorant, may be instructed so effectually that they will be able to take such steps as are necessary to prevent their children catching it. For, as X said before, the disease is not inherited, it is not transmitted, but it is caught. Of course, there are many of us with broad shoulders and deep chests who will never be injured by it, but the child born of tubercular parents, with sloping shoulders and narrow chest, while he may not have the disease, has the ground in which it is easily cultivated. Such are the people whom it is our duty to teach how to avoid contracting the disease. I think, Mr. Speaker, that the time has come when we should have a bureau of public health, when steps should be taken, not only for the planting all over this Dominion of sanatoria, but of other modes of teaching the people how to escape this disease. The prospect of accomplishing good in this respect is excellent. We have done so much in a very short time since we became acquainted with the cause and cure or this disease, that I think the time is now ripe for taking steps to teach the people throughout the Dominion how it can be avoided and how it can be cured.
Subtopic: PREVENTION OF TUBERCULOSIS.
Mr. Speaker, I would have said nothing on this question but that my silence might have been misconstrued as a want of interest for suffering humanity or in the subject under discussion. In my judgment, the hon. member for Argenteuil (Mr. Perley) is entitled to the thanks not only of this House, but of the people of this country for the sympathetic way in which he has taken up this question, the philanthropic spirit which he has displayed and the able manner in which he has presented it to the House. We have too few people in the country to take Mr. BLACK.
an interest in this movement and give it that substantial .aid which it must havd if it is to be a success; and those individuals, one here and one there, who do take hold of it, as the hon. member has done, are entitled to the thanks of the people of this country. We have had this question before the House during my time, in the last quarter of a century, some four or five times. It has been discussed at great length, and the members of this House have shown a commendable desire to take it up in a practical way, but we have invariably been confronted with the contention that it is not within our jurisdiction to deal with the subject of public health-that the only matters relating to public health which the British North America Act places under the exclusive jurisdiction of the Parliament of Canada are defined in clause 11 to be : quarantine and the establishment and maintenance of marine hospitals, and, therefore, whatever we do in this respect must be be done along these lines. But it has always been a mystery to me why we should not take up this question jointly with the provinces and apply to the Imperial Parliament for an amendment to the British North America Act that would give the Dominion Parliament power to deal with it, if not exclusively, at least conjointly with the provinces. In that way some substantial good might be accomplished, a great deal more than is accomplished at the present time. We are also confronted with the next clause of the Act, which assigns to the provinces the establishment, maintenance and management of hospitals, asylums, charities and eleemosynary institutions in and for the provinces, other than marine hospitals. So that the provinces have assigned to them the subject of public health. But it has always been curious to me that this parliament seems to have a greater interest in the health of brute creation than that of the human being. In the exercise of our power over quarantine, we made a law a few years ago to prevent the importation of tuberculosis. Under that law we would not allow a farmer to bring into Canada an animal which the tubercular test indicated to be affected by tuberculosis-the animal must be slaughtered. In the human being the bacteriological test enables us to detect it in the early stages. Why do we not apply it to immigrants coming in who show signs of disease-and refuse them admission into our country ? But we allow all classes of immigrants to come in without being subjected to any tubercular test, and we know, from the statistics gathered in Toronto, Montreal, Calgary, Vancouver and elsewhere, that many of these immigrants have been in the incipient stages of tuberculosis, and have had to go to the hospital shortly after their arrival. We do not examine them as we do the animals. I never could understand why that is so, and why we do not to that extent exercise the power we have in regard to quarantine. The result is that we
are importing the disease as well as allow ing it to develop in the country ; we are not doing all that we could in the interest of humanity. One reason why even more interest should be taken in this question today than was done a few years ago is that whereas it was formerly believed that tuberculosis was practically incurable, to-daj the bacteriologist can tell from an examination of the sputa whether the tubercular bacillus is present or not in the early stages of the disease, which puts it within our power to cure a large percentage of the cases which could not a few years ago be cured.
No attempt was formerly made to affect a cure because the disease was not detected until too late, but at present it can be detected so readily that thousands of cases are cured in the incipient stages.
We are asked can we not do something. I think we can do a great deal. The hon. gentleman who preceded me said that we required greater education in the matter. Well, we can have that educational work done and there is nothing to prevent this government from undertaking to have it done. We can give the financial assistance required. We have the money and we have the power to spend it for that purpose. We can vote subsidies for the purpose of keeping up these sanatoria which are established and helping to establish others. One of the drawbacks which philanthropists have to contend with, in their efforts to do something for humanity, is the lack of the necessary financial assistance. We are not doing what we can. There can be no doubt that there is a large field in which we can act. There can be no doubt that there is an increasing need from year to year of means for the cure of these unfortunates who become afflicted with this disease. That need is increasing rapidly in many portions of the country despite the fact that if these unfortunates were only surrounded by favourable conditions the greater proportion of them would be cured. To prevent the spread of the disease is a work the importance of which is second to none. One individual will infect a whole family. X have seen six seven and eight members of a family one after another, dying in succession from the same disease. Why did they die ? Not because of some inherent constitutional defects, but because the infection was transmitted from one to another, because they were living under the same conditions, in the same houses, and had not been removed to healthy surroundings. They died simply because they did not get proper care and attention. Cases have come under my own observation in which three or four members of the one family have died, and the rest who were taken away entirely and put under favourable conditions were not attacked at all. That being the case, this disease being so well known for its contagious character, it is our bounden duty to make every effort to prevent its spreading. X think, therefore, this
parliament should take the matter up. There are certain lines in which we have the power to act. Why do we not have the turbercular tests applied to every immigrant that shows signs of weakness, so as to ascertain whether he is afflicted with tuberculosis or not; and if he is, he should not be allowed to land. Those who are in the country and are affected we should have put in an isolated hospital from which the contagion cannot spread. Why have we not quarantine regulations which would prevent people infected with this disease crossing into this country from the United States? Many of them are brought home here to die and no restraint is put upon their coming. We should go further. We should hold a conference between the federal parliament and the provincial legislature and apply to the Imperial parliament for an amendment to the British North America Act which will give us the right jointly or separately to deal with this most important subject. What is wanted is favourable conditions for those afflicted-plenty fresh air and good healthy diet. How is it that Indians, when they come under the conditions of civilization, perish in such a large number from the ravages of consumption, and yet in their nomadic condition are almost entirely free from it. It is because that when living in their wigwams they have plenty of fresh air. While their food is of the worst description, still the healthy conditions under which they lived kept them in perfect health. But let them come under the conditions of advanced civilization, let them live in warm sealed up houses, small rooms and general unsanitary conditions, and they very soon succumb to the ravages of consumption. This should be a lesson to us. It certainly appeals to medical men but it may not appeal with the same force to other members of the community. As a medical man I desire to emphasize the opinion that we are not doing all we can, that we are not working along the lines on which we have authority to work and are consequently not doing our duty to suffering humanity.
Subtopic: PREVENTION OF TUBERCULOSIS.
As a friend for many years of Professor Robertson, he requested me, when this question came up, to say a few words on it. While I am only a layman, and consequently not as well qualified to discuss it as are our medical friends and some others who are giving the question greater consideration and thought, yet its importance is such that I feel impelled to take some part in it. Those of us who have kept at all in touch with the current literature of the day on this subject, must be convinced that it is high time we should, as a united people, take some decided and decisive action in the way of attempting to check the spread of this disease. For many years there has been a considerable amount of educational work going on both in the provinces and the Dominion. A considerable amount of literature has been distri-
buted and with good effect, for in various parts of the province of Ontario we find our health boards, municipal councils and county councils, taking action in the matter, thus showing that this educational work is making an impression on their minds. Take the county council of the county of Oxford, a part of which county I have the honour to represent, I noticed a few days ago in one of the papers that the said council had granted $300 for the support of the sanatorium at Graven hurst.
In consideration of this grant, the county of Oxford will have the privilege of sending a certain number of persons to the sanatorium for treatment. I noticed a few days ago that an association had been formed in the city of Brantford to deal with this matter. And I notice that the subject has been taken up in Peterborough, and that it is proposed to establish there a sanatorium. Other instances might be given to show that the educational work that has been going on for the last three or four years has made an impression upon the minds and consciences of the people of this province.
Our attention has been called to the scientific aspect of this question. This, perhaps, is not the place to enter into a discussion of the question from a technical or scientific standpoint. But when we can consider the widespread effect and fearful ravages of this disease among our people it becomes our duty as far as possible to stem its tide. This Dominion is not peculiar as a place where tuberculosis has a foothold. We find that in European countries it is even more virulent. Russia, Austria, Germany and other countries have a larger percentage of deaths from this disease than we have. The loss through this disease is less in England than with us, being about 1,500 per million of the population, while in some of the other countries I have named it goes as high as 3,000 per million of the population. In the United States we find that the deaths resulting from this disease are in the neighbourhood of 100,000 per annum. I find in a newspaper published on February 4th a summary of the report of the New York State Board of Health, showing the mortality from various causes in that state. From tuberculosis, in its various forms, the deaths last year were 14,000. I do not doubt that these statistics were carefully prepared, and that they are to be relied upon. The number of deaths from this disease in the Dominion of Canada has already been stated- some 8,000, it is estimated, is our annual death rate from this cause. The number of our people who are supposed to be afflicted with this disease has also been added here as 40,000. I suppose these data are correct. Looking into this subject we find that where the establishment of sanatoria has been carried on with earnestness the reduction of deaths from this disease has been from 35 to 50 per cent. Where patients have been taken Mr. SCHELL.
into these sanatoria in the initial stages of the disease, the cures are as high as 75 per cent. And, even taking the patients promiscuously, of all ages and all classes, we find that from 30 to 40 per cent of cures have been effected. With these facts before us, I think it is incumbent upon us as a parliament, if it is within our province, to make our influence felt upon the subject. I do not know whether we can properly deal with this subject in a financial way. If we may, then we should show, in a practical way, our appreciation of the efforts that have been made to prevent the spread of this disease. If that is not within our province, perhaps we might assist by the dissemination of literature or otherwise, as the wisdom of this parliament may deem best. In any case, the question is one which may well engage the attention of the government and parliament of Canada. Whether the government deals with it or not, the discussion of this subject in this House from this high vantage ground overlooking, as it were, this whole Dominion from ocean to ocean, cannot fail to have a good effect upon the people at large. Through the medium of the press, which is so largely represented in this House, the discussion here will have wide educational results. I believe, further, that the consensus of opinion in this House is that something tangible ought to be done in this rnattei-. This is not a political question. Both sides of the House can take equal part in the discussion without being considered partisan and without reflecting upon or criticising one side or the other. I trust the question will be approached by the government as a non-partisan question, and one to be dealt with simply in the interest of the' people at large. If it is true that we can save the lives of at least 4,000 of our people annually-and we are led to believe that this is the case-what a triumph that will be. We know that economic authorities place the value of a human life to the state at from $1,000 to $1,500. It is easy to see the financial gain that will come to the Dominion if we can effect this saving of life. And so, even if we leave out of sight the higher considerations, the sympathetic and humanitarian considerations, and regard the subject from the lowest standpoint of mere economic gain, the country will be well repaid for taking action in this matter. But I appeal to this House from the standpoint of sympathy, from the humanitarian standpoint, to try, so far as lies within the province of this parliament, to alleviate present suffering and assist the authorities and the private individuals who are working to put down this disease. I thank you, Mr. Speaker, and the members of this House for the kind hearing you have given me.
Subtopic: PREVENTION OF TUBERCULOSIS.
The subject matter of the motion of the hon. member for Argenteuil (Mr. Perley) is one of very great importance to the members of
this House and to the people of Canada as a whole. The question of our public health Is one which should engage the interest and attention of every representative of the people. In the past, in this House, we have frequently indulged in what appeared to be somewhat useless discussions of questions of minor importance and, apparently, begrudged neither the time nor the space in ' Hansard ' necessary to lay our views before the country. The government of the day has evinced a desire in the past to spare neither time, energy nor expense in the enactment of certain legislation of much less importance than the protection of the health of the population of Canada. As has been stated here to-day, tuberculosis was at one time regarded as essentially an hereditary and incurable disease. But modern investigation has proved that, though contagious, it is a preventable disease, and the work of stamping it out is receiving the active sympathy and support of the government and people of almost every civilized country in the world.
This being the case, and since we have learned the nature of the disease, and especially when we have knowledge in our possession as to the means of grappling with it properly, it is the duty of any country to adopt every means and to devise every plan possible in order to prevent its ravages among the inhabitants of our common country. We are spending, as has been mentioned by an hon. member to-day, in round numbers this last year or two, $700,000 or $800,000 yearly for the purpose of bringing immigrants to our shores. Many [DOT]f them are from foreign countries where this disease abounds, and some of them were coming here who have actually died while on their journey. Many of them have succumbed during their first year of residence in our country. Owing to this large addition to our population annually it is apparent to any person-it is not necessary to be a professional man, for even a layman can understand that this danger will in crease in the future with this largely in creased addition to our population from year to year, particularly if we do not adopt proper measures to grapple with it and restrict it in its ravages. It has been mentioned here this afternoon that there are from 80,000 to 40,000 of our population annually who are infected with tuberculosis bacilli, who are practically invalided, and when so large a number as that are placed practically out of business and on the sick list, what will be the dire results if sufficient methods are not taken to protect our people from it, not only in this generation but in future generations?
The Department of Agriculture has been spending during the past year, as has been stated by the hon. member for Bast Grey (Mr. Sproule), from $25,000 to $30,000 per annum-for what purpose? For the purpose of restricting, and curtailing, and attempting to stamp out bovine tuberculosis, and I
believe that about two or two and a half per cent of our cattle have been afllieted with that disease, and the result therefrom has been practically nil. When this has been the result of our government action in looking after our cattle, is it not of vastly more consequence that our people should be protected against the ravages of this dire plague ? If nearly one-half of the annual increase to our population-practically this hast year about one-third of our annual immigration to this country-is required to replace those who are placed upon the sick list, those who are invalided through the tuberculosis bacilli in our country, it is evident that we have been making a very large waste of public money, especially when we have the means at our disposal, when by wise and judicious expenditure of money amongst our own people, we can effect so vast a saving in human life and thereby prevent the introduction of this disease. We have our experimental farms-for what purpose? For the purpose of carrying on experimentations, to give our agriculturists the benefit of those experiments and teach them the most modern methods of farming. We have our farmers' institutes where our agriculturists commingle and Interchange their views as to the best methods of farming. These institutes are addressed by lecturers sent out by the central government, who are experts in their particular line, and who teach our farmers and educate them as to the best means of looking after their stock, their lands, their crops, their grains, &c. Now when this is the case in regard to our stock and lands, is it not of much more consequence to look after our human beings? It is true that much has been done and much is being done by the medical men of our country in carrying on an educational campaign by means of their medical associations and public discussions, their medical journals for the dissemination of literature among the people, endeavouring by such means to secure the co-operation of tiie public, educating the public to co-operate with the profession for the adoption of the best methods to stamp out and eradicate this disease. Not only that, but we have our own provincial governments and boards of health who are also carrying on an educational campaign, and they cannot fail to prove very beneficial in the near future. The hon. member for Argenteuil (Mr. Per-ley) has referred to-day to the central association in the city of Ottawa that has been presided over by the ex-Governor General, Lord Minto, and that the hon. member is a member of the executive committee himself. This central association has been very useful in publishing its proceedings through the press of the country. And I may say here that the press of our country is a powerful lever in disseminating useful Information ; at the same time I think with all due deference to the press, that they have not been doing their full duty, and if they had given in the past as much of their
space to urging the public and teaching them the best methods of protecting themselves against the ravages of this disease as they have to advertisements of quack nostrums that have been deleterious to the public health, they would have been discharging more fully their duty. However, let justice be done where justice is due. It is necessary to say that they have evinced a desire lately, by the publication of the reports of the central association, to make amends in this regard. We have our provincial associations that are acting in concert with the central association. These associations are carrying on a very good work and cannot fail to be productive of great benefit. We have our sanatoria some of them under the direction of private individuals, some under provincial jurisdiction. These are doing a valuable work. But still very much remains to be done that cannot be done successfully, except by the central government, and in order to grapple sucessfully with this great piague we must have the assistance of the central government in our efforts to eradicate it.
It has been argued that the question of public health is one that belongs solely to provincial jurisdiction, but I think that argument should not have much weight when we are dealing with a question of such national magnitude. We have had this question of provincial rights raised on many questions in the past, but on a question of such great national importance affecting the public health in every portion of the Do-minon, there is no reason why there should not be concerted action, why there should not be united action between the Dominion, provincial and municipal authorities. We have had introduced in this session a Census Bill, some of whose provisions have not been drafted with that due regard, with that excessive regard for provincial rights that has characterized the arguments of those who appear to be so jealous of them. We have this government appointing officers to look after infectious diseases of our stock in one of the provinces, notably in Manitoba where there is a division of authority by means of which this Dominion is doing a share in looking after the health of the animals in that province. In many other matters there has been united action and mutual understanding by means of which duties are assigned some to the provincial and some to the Dominion jurisdiction. Now the time may not have arrived when we should have in this country a distinct and separate department of public health, or a minister in the cabinet holding a portfolio of public health. I know that in some of the older settled countries where the population is more dense, and where the urban population is much larger, extending into the millions, notably in France and some other European countries, they have a separate portfolio of the government called the portfolio of public health. Possibly in Mr. W. J. ROCHE.
this new country the population is yet too sparse for that, yet I think tl?e time has already arrived when we should have a central bureau of public health, working in connection with one of the existing departments; possibly the Agriculture Department, owing to the nature of its duties, would be better fitted to take up this work. If such a branch was established in connection with one of the existing departments under the charge of officers thoroughly competent and selected because of their ability and expert knowledge, not because of political service, we would have the nucleus of a very valuable source of information to the public that would prove of great benefit in stamping out contagious diseases. Another necessary adjunct to this department would be a public laboratory where experiments could be carried on, the results of which would be printed and published and circulated, not only amongst the profession, but also amongst the laity.
We should then, in my opinion, have a public laboratory where we could have experiments carried on and have the results printed and published not only for the benefit of the medical profession but also for that of the laymen. Not only that, but, in connection with this laboratory, we should manufacture our own serums, our tubercu-line serum, our prophylactic serum and our auti-toxines. I think it is humilating that a proud young country like Canada should be dependent on the United States and on European countries for these serums that we should make in our own country. There is the ability if it were only given a chance. There are young men in our country who are only awaiting an opportunity of developing that latent talent which opportunity they have not at the present time. We have all the elements that go to make up a strong Canadian nationality. Our climate is conducive to the protection of vigorous and stalwart men. Why should our young men not have an opportunity of discovering some of those drugs that have worked such great cures in recent years ? Why should we not give them an opportunity of making for themselves reputations not only national but world wide in their character and of reflecting credit upon themselves as well as upon the country that has given them birth ? We should also have a system of sanitary police working in connection with the provincial boards of health. We have a large number of people coming from other countries and bringing into this country their rather crude habits. A system of sanitary police, established under the jurisdiction of this parliament and working in harmony with the boards of health would be of incalculable benefit not only in connection with those at present here but also those who are coming to our shores. We should insist upon a rigid inspection of our immigrants before their embarkation for this country. I understand that within the last
year or two there has been a rather cursory examination of our immigrants before they leave, but in connection with this particular disease I do not think there has been so rigid an inspection as there should have been. Not only the government but the profession at large have been a little too apathetic on the question of this disease. We should not allow people to go to the trouble and expense of coming to Canada when they are likely to be deported again because they cannot comply with the immigration laws which I hope will be more rigid in the future. If we had a rigid inspection before they left their own country it would save them the expense of coming to this country. Immigrants' effects brought into this country should be put through a course of disinfection. All medical men know that a great deal of disease is introduced by this means, and if we had a rigid disinfection of settlers' effects we would put out of play one of the means through which that disease is often times introduced. In fact, there is a wide field of usefulness for this government in connection with the stamping out of this disease, and I trust it will rise equal to the occasion and adopt some means that will establish for Canada the reputation in this matter of keeping abreast of the progressive spirit of the age.
Subtopic: PREVENTION OF TUBERCULOSIS.
Mr. Speaker, I shall not attempt to speak very long on this question, but I feel that it is my duty to express my opinion upon it. I regret very much to-day that all of the ministers of the Crown are not present. I also regret that every hon. member of the House is not here to listen to this very interesting discussion on one of the most important questions that is before the people of Canada to-day. Now, I take exception to one of the remarks made by my hon. friend from Hants (Mr. Black). Speaking of the importance not only of bringing people into the country but of saving the people who are already in the country he said that one good Canadian was worth twenty Douk-hobors, and I think I must have misunderstood him when he said one hundred Englishmen. An hon. member beside me says that it must have been one hundred Indians. If that were so it would save me making a few more remarks, and it would save the feelings of some of my hon. friends behind me. I am only going to refer to two phases of this subject. Although this is a subject that may come more particularly within the province of the medical profession, I am glad that it has been introduced by my hon. friend from Argenteuil (Mr. Perley), a layman and I am glad that a layman on the other side of the House has seen fit to speak upon this question. The medical profession are entirely in accord in regard to the measures that should be taken in the treatment of consumption. I use the word consumption because that is the term which is more generally understood. I would like the galleries 1
and the pressmen to note what has been said on this question to-day as evidencing the great interest we take in it, and also because of the need there is of having the facts widely disseminated throughout the country. One of the phases of this subject to which I wish to refer is the educational value of the movement which has been carried on. The tendency at one time when a sanatorium was about to be established in any part of this country or in any other country was for people resident in the neighbourhood to dread that it should be placed in their midst. Experience has shown that this dread has been entirely overcome and that the people are now glad to have such an institution right in their midst because it has been proven beyond a doubt that the educational value of the institution is such that people become early educated in reference to taking care of the sputa and other things in connection with this disease, and the result is that those within the radius of the institution are safer than those outside of it. We have had that experience in Manitoba. Being a member of the provincial board of health, we have, during the last two years, taken up the question of providing a sanatorium for the province. The people are taking an interest in it. One means we took of tindiug out as to whether the people were interested or not was to ask them to subscribe. I think that is one of the best ways of ascertaining whether a man is interested or not. If he is willing to go down in his pocket he is certainly interested. Before going to the provincial government to ask them to give us a grant we thought we would interview the people, and the way to reach the people is through their municipal councils. We sent out a circular to every municipality in Manitoba and eighty per cent of those municipalities, without any very strong influence being brought to bear upon them, have returned subscriptions of all the way from $25 to $100, and have said in addition to that, something that pleased us more than all, that this was only the beginning of what they were willing to give. They indicated in that way their belief that the idea of a sanatorium was right and they said that they were willing to give their money in support of it. I hope the hon. Minister of Militia (Sir Frederick Borden) who is a medical man is paying some attention to me at least, as down in the province of Nova Scotia they have established the only provincial sanatorium there is in the Dominion of Canada. I do not want to take up the time of the House any longer, but I hope that the government and the people will appreciate the very great importance of this question of establishing sanatoria in this Dominion.
Subtopic: PREVENTION OF TUBERCULOSIS.
Mr. Speaker, I feel that the appeal of the hon. member for Argenteuil (Mr. Perley) is one that this House ought not
to refuse. He has put a case that appeals to the sympathies of everybody-sympathy for those in affliction, for those who are suffering, for those who cannot help themselves,- and it is an appeal which every hon. member of this House must naturally feel he would like to respond to. But. Canada, has adopted its constitution allotting certain work to the provinces and certain work to the Dominion parliament and government to perform. It happens that in connection with public health certain well defined work is allotted to the provinces and certain other well defined work is allotted to the Dominion powers. To the Dominion is given, by the British North America Act, the establishment and maintenance of quarantine and the establishment and maintenance of marine hospitals, while to the provincial authorities is given equally clearly and equally definitely the establishment, maintenance and management of hospitals, asylums, charities, eleemosynary institutions in and for the province, other than marine hospitals. At the time that these respective works were committed to the respective authorities there is no doubt that the general [DOT] question was considered, and while it was thoroughly understood that certain parts of hygienic work should be done by the Dominion and certain others by the provinces, we can only believe that the question was examined in order to find which definite piece of work could be done more properly, more beneficially and more effectively by the authority into whose hands it was given. We can quite understand and appreciate that quarantine work comes more properly within the purview of the government of the whole country.
Subtopic: PREVENTION OF TUBERCULOSIS.
Quarantine work as understood in the British North America Act,
1 think, applies to frontier quarantine. It will be necessary for the central Dominion authority to deal with work of that kind. As marine, and trade and commerce are also given into the power of the central government, it was quite natural that marine hospitals should also be given into the control of the Dominion government.
Subtopic: PREVENTION OF TUBERCULOSIS.
The hon. gentleman (Mr. Fisher) does not suggest that by reason of the words which he has quoted from the British North America Act this parliament might not have power to deal with the question of sanatoria throughout the Dominion ?
Subtopic: PREVENTION OF TUBERCULOSIS.
No, what I meant to imply is that there is certain work which is definitely and clearly allotted to the provinces, and I was going on to point out that I think where this is the case, it is undesirable and would not be politic for the Dominion parliament to undertake that Mr. FISHER.
work. I would not go so far as to say that perhaps we might not have power to do that work ; that is a legal point in connection with the interpretation of the British North America Act on which I would not undertake to give an opinion, but at the same time I say-and I think that in this I am in the judgment of a majority of the people-that where, under the British North America Act, any particular piece of administration is definitely and clearly assigned to one or other of the powers, that is to the Dominion or to the provinces, it is well that it should be left to the power to which it is thus assigned. I say that in general terms. Most of the gentlemen who have spoken have discussed this question in general terms. I have understood, however. from the hon. member who introduced the question and from various discussions that have been held, that at the present moment there is a decided desire on the part of many whose sympathies are aroused on the question of tuberculosis and who have been strongly appealed to to aid in the prevention of this disease, a desire that the Dominion government should vote a sum for some one or more sanatoria. I venture to say that I think that would be inadvisable, and I do not think that this House ought to adopt any motion or resolution which would pledge it to that, that is to say, would pledge it to something which is practically for the establishment and maintenance and management of a hospital or an asylum or a charity for the purpose of tuberculosis any more than for any other disease. If this resolution were to be supposed to indicate an instruction to the government to do that I would feel it to be my duty to vote against it and to ask the House to reject it. But I grant fully that there in a very large work which can be done from a hygienic point of view outside of and altogether apart from sanatoria or hospital treatment. This government had the honour a few years ago of asking parliament to grant a small sum in aid of the Canadian Association for the prevention of tuberculosis. That grant has been renewed, I think, now twice, and in the estimates which are before the House for the coming year,, we again ask for that grant. Several gentlemen have spoken about the spread of information and the gathering of information ; that grant has been devoted largely to that purpose. Without in any way wishing to take any credit, I think I may say that although the government has done so much for the purpose of spreading information and of drawing the attention of the people of Canada to the facts in regard to this dread disease, to the possibilities of preventing its spread, with a desire to rivet the attention of the people of the country everywhere on it and on what can be done to prevent its spread, till it may be that it will be wise, when we find a way to utilize the money, to increase that grant. That, I think, would
be quite within the purview of this parliament anti it would be quite right for the government to do it, but I would point out that up to the present time no scheme has been put forward by those who are interested and who form this association which they could lay before the government or before parliament to indicate in what way such work as that might be improved, extended or rendered more effective. Speaking personally, I would be very glad indeed if such information could be given. It is quite possible that the association for preventing the spread of tuberculosis may be able to provide that information. The government would have to examine and investigate any scheme that was put forward and would have to take the responsibility of saying whether they would aid it financially. It would be impossible, I think, for me or any other member of the government to decide or to say what we ought to do or what we could do until some detail of a scheme of the kind were laid before parliament and before the government, but we think that it would be in the interest of the people at large that those who are to-day giving their attention to this work should turn their attention most particularly to devising something which might be done under the authority and through the intervention of this parliament, which would not in any way invade or overlap the authority and the work which ought to be done by the provincial authorities. I think that we should find some scheme which we could carry out without doing that, and I believe that the attention and the thought of those who are in earnest in this work-as many of the leading men of the country are-should be directed in the direction I have indicated, and that the question of the establishment and maintenance of sanatoria should be left to the provincial authorities in whom apparently it is very clearly indicated by the British North America Act they ought to be vested. Now, it happens that the province of Nova iScotia has taken a step. If that province has done it, there is no reason that I can see why the other provinces should not do the same, and I think it is better that it "liould be left to them.
I will allude briefly to one or two of the reasons which have been given by hon. gentlemen why we should take this matter up. The leper lazaretto has been mentioned. It is true that has been administered by and on behalf of the Dominion government and parliament. That is being done under a definite and distinct arrangement entered into between the Dominion government and the government of the province of New Brunswick, which at the time was managing that institution. I have not under my hand at the moment the exact date of that arrangement, but I think it was in the year 1872.
Subtopic: PREVENTION OF TUBERCULOSIS.
I do not say that we could not, but as a matter of poliey I think it better to leave the provinces the establishment of sanitoria. The question of animal tuberculosis has been brought forward. 1 would point out to my hon. friends that there are no clear or definite instructions as to the health of animals. That is left entirely open. It may be attended to either by the provinces or by the Dominion. As a matter of fact, our experience is that part of it is attended to by the provinces and part by the Dominion. But there is no such clear, defined line with regard to that as there is with regard to the establishment of sanataria for human beings. My hon. friend from East Grey (Mr. Sproule) spoke of testing for tuberculosis animals. It is true, we can very easily test animals, but we would find great difficulty in testing human beings. As a matter of fact, while the tubercular test is as applicable to human beings as it is to animals, I think I am correct in saying that no country has yet applied that test to human beings.
Subtopic: PREVENTION OF TUBERCULOSIS.