D.C.) International Congress on Tuberculosis (6th : 1908.

Transactions of the sixth International congress on tuberculosis. Washington, September 28 to October 5, 1908 (Volume v.4:pt.1) online

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148 SIXTH INTERNATIONAL CONGRESS ON TUBERCULOSIS.

vide a number of beds for patients from elsewhere in Ontario. The hospital
of this association is situated in Weston, Ont., overlooking the Humber
Valley. It is the first institution in Canada to care for those advanced in
consumption. With a capital expenditure of S50,000, beds for over 60
patients have l3een provided. To September 30, 1907, 421 patients had
been cared for.

In connection with this hospital there has been opened this year the King
Edward Sanatorium (so named by special permission of His Majesty) for
paj'ing patients advanced in consumption. This hospital has 25 beds, and
admissions are not restricted to residents of Toronto.

Hayyiilton Health Association. — This association was formed for the pur-
pose of providing a local sanatorium for the early tuberculous cases of this
city of Hamilton and county of Wentworth. A splendid site of 100 acres on
the table-land overlooking the city was donated to the Association, and on
this property has been erected a group of buildings comprising a well-
equipped sanatorium of 35 beds. Initial cost of buildings and land, about
$32,000. Some of the buildings and much of the furnishing has been se-
cured through the earnest work of the Laches' Auxiliary Board.

A visiting nurse visits far- advanced cases in their homes, and necessaries
are provided.

The Ottawa Association for the Prevention of Tuberculosis, organized 1905,
undertakes personal house-to-house visitation of the sick, individual in-
struction, and provision of necessaries in way of food and clothing, as well
as tents and other appliances for outdoor living.

Literature has been distributed, anti-spitting signs placed on the streets
and elsewhere, and an active campaign carried on to secure for the city a
home for advanced cases. This has been successful; a site is chosen and
work will begin at once.

The Association has made a critical study of the deaths from tuberculo-
sis in the city during the past three years, and is moving along hues of im-
proved sanitation in houses.

The Lanark County Association for Prevention of Tuberculosis. — ^This
Association is endeavoring to secure a sanatorium for the county of Lanark
and adjacent counties. It is well organized, and pubhc meetings have been
held.

Quebec. — The Montreal League jor the Prevention of Tuberculosis. — This
was organized in the year 1903. It is carrying on an excellent campaign of
instruction and relief. Much literature has been distributed, not only to
patients and their famihes, but in schools, factories, and other institutions.
Lectures have been held on the subject in more than thirty Protestant
churches and nearly all the Roman Cathohc parishes in the city, as well
as in several schools, workingmen's clubs, etc. Through the efforts of the



PRESENT STATUS ANTITUBERCULOSIS WORK IN CANADA. — ELLIOTT. 149

Legislation Committee of the League a by-law has been passed prohibiting
spitting on the sidewalk.

All cases of tuberculosis reported to the League by physicians from hospi-
tals or otherwise are visited more or less frequently, as occasion requires,
by a quaUfied inspector, who distributes leaflets of advice, gives verbal in-
structions, supplies sanitary cuspidors, endeavors to provide better ventila-
tion, and disinfects habitations after death or removal.

In the autumn of 1904 the League opened a dispensary especially for
persons suffering from pulmonary tuberculosis, where physicians attend for
some hours daily for consultation, and patients may be examined and re-
ceive advice and medicines. Tliis branch of the work has grown steadily,
is much appreciated, and promises satisfactory results. When thought ad-
visable, patients are provided with nourishing food — eggs, milk, etc., also
warm clothing. For those who require nursing at home, the cooperation
of the Victorian Order of Nurses is enhsted. Cases in an advanced stage of
the disease who have no friends in the city are sent to an institution. The
great need in tliis branch of the work is a sanatorium in a healthy situation
for incipient cases. The work is supported by subscriptions from the pubhc,
aided by a municipal grant.

In the three years of its existence the League has dealt with about 1300
cases of tuberculosis, some of whom have received continuous care and
assistance for many months.

At the last session of the provincial legislature the League asked that
legislation similar to "the Ontario Act respecting Municipal Sanatoriums"
be enacted. This would doubtless have received sanction but for the act
passed at the same session providing for the appointment of a Royal Commis-
sion in Tuberculosis for the Province.

District of St. Francis League for the Prevention oj Tuberculosis. — This
was organized in 1903 and is carrying on a campaign of education. Local
societies or subcommittees are formed in each town or municipality of the
district about Sherbrooke. The League arranges for examinations of all
sputum submitted and looks after all indigent patients.

Quebec League for Prevention of Tuberculosis. — This League has received
a grant of land on Lake Edward. (See under head of "Proposed Sanatori-
ums.")

Nova Scotia. — The Colchester County Association for Prevention of Tw-
berculosis. — This is an association doing work in a comparatively small
community. Its work is principally educative. Much literature has been
distributed. A series of lectures are given to the pupil teachers of the prov-
incial normal school. The municipal council contributes to the fund of
the Association.

Prince Edward Island. — The Western Association of Prince Edivard



150 SIXTH INTERNATIONAL CONGRESS ON TUBERCULOSIS.

Island for the Prevention of Tuberculosis. — ^This Association has been active
in giving a series of lectures through the western part of the province, dis-
tribution of pamphlets and cards, timely articles in the provincial press,
addressing teachers' associations, endeavoring to secure preventive legisla-
tion, caring for patients by instruction, supplies, and food when necessary.
The Provincial Association, Charlottctown, P. E. I. — This Association has
been looking into the subject of school sanitation, caring for patients through
a district nurse, and endeavoring to secure notification of all cases in order
to insure that the patient is instructed in sanitary living and to secure proper
disinfection after death or removal.

List of Special Hospitals and Sanatoriums in Canada.

Ontario. — Muskoka Cottage Sanatorium, Gravenhurst. Eighty-five
beds; $12 to $18 weekly. For incipient cases.

Muskoka Free Hospital for Consumptives, Gravenhurst. Fifty to 70
beds. Free, or patient pays in part if able. Dr. W. B. Kendall, Physician-
in-charge; Dr. C. D. Parfitt, Resident Consultant to both institutions.

The Mountain Sanatorium., Hamilton. For incipient cases. Thirty-
five beds. For Hamilton and Wentworth County. Dr. J. H. Holbrook,
Physician-in-charge.

Toronto Free Hospital for Consumptives, Weston. For advanced and far-
advanced cases from city of Toronto. Free, or patient pays in part if able.

King Edward Sanatorium for Consumptives, Weston. A hospital for
advanced cases. Twenty-five beds; $15 weekly; semi-private wards, $8.00.
Dr. W. J. Dobbie, Physician-in-charge to both institutions.

Tents and other appliances for treatment of tuberculosis are in use in
Gait, Stratford, Peterboro', Ottawa, St. Catharines, Kingston, London.
Some are in connection with the local general hospital (Kingston); others
are provided by the municipality (Gait) ; others by local charitable associa-
tions (Ottawa, Stratford, St. Catharines) or by private philanthropy (Lon-
don).

Quebec. — UHopital des Incurables, Montreal, has 20 beds for consump-
tives.

The Grace Dart Home, Montreal, for advanced cases; 20 beds. Recently
organized by private subscription.

Brehmer Rest, Ste. Agathe des Monts. Patroness, Her Excellency, Count-
ess Grey; President, Mrs. F. H. Waycott; Secretary, Mrs. Geo. Chillas.
For patients not definitely tuberculous. Patients pay $4.00 weekly if able.
Dr. A. J. Richer, Physician-in-charge.

Nova Scotia. — Provincial Sanatorium, Kentville. Twenty-five beds for
residents of the province. Patients pay $5.00 weekly. Dr. W. S. Wood-
worth.



PRESEXT STATUS ANTITUBERCULOSIS WORK IN CANADA. — ELLIOTT. 151

Wolfville Highlands Sanatorium. Ten beds; private. Dr. G. E. DeWitt,
Wolfville.

Alberta. — Calgary Sanatorium, Calgary. Sixteen beds; private.

British Columbia. — Tranquille Sanatorium, Kamloops, for incipient
cases. Thirty beds. Free; patients pay in part, if able. Admissions at
present limited to residents of British Columbia, Dr. R. W. Irving, superin-
tendent.

Dispensaries.

1. Dispensary of the Montreal League for the Prevention of Tuberculosis,
691 Dorchester Street. Opened November, 1904. Open six days weekly.
When too ill to attend, patients are visited in their houses. Patients are
supplied with all the necessaries in the way of food and clotliing. The re-
port for 1907 (covering fifteen months) gives this resume of work: New cases
reported, 300; number receiving food or clothing, 80; eggs distributed,
3600; quarts of milk, 2640; clothing, blankets, etc., 500; patients on visit-
ing list, 132; new patients during year, 368; dispensary consultations, 2420;
disbursements, $3,628.93.

2. Tuberculosis Dispensary and Clinic, Toronto General Hospital. Opened
January, 1906. Visiting nurse visits all homes and reports surroundings
and conditions. Patient given sputum flask, etc., with instructions. Food
and clotliing supplied when needed. Special wards available if necessary to
bring patients into hospital. Houses reported to Board of Health for fumi-
gation. When possible, patients sent to sanatorium at Weston or Graven-
hurst. Dispensary open one day each week. The visiting nurse is paid for
by city health department. Visits by nurse, 1807; houses disinfected, 46;
quarts milk, 1558; eggs (dozen), 406; new patients, 140; dispensary con-
sultations, 404.

3. Tuberculosis Dispensary of Hamilton City Hospital. Opened 1906.
The physician of the Mountain Sanatorium attends weekly to examine
patients for admission to sanatorium. Those too advanced are visited in
their homes by the visiting nurse.

4. The May Court Club Tuberculosis Dispensary, Ottawa, Ont., opened
June, 1908. Food and clothing, medicine, and other necessaries are provided
for use by the visiting nurse of the Ottawa Association for Prevention of
Tuberculosis.

Protected Sanatoriums and Hospitals.
Quebec. — Lake Edward Sanatorium of Quebec League for Prevention of
Tuberculosis. The Province of Quebec granted in June, 1905, 137 acres
for sanatorium purposes, on Lake Edward, 1200 feet above sea-level. Work
has begun, and it is hoped that in another year it will be ready for occupation.
Jlev. Canon Scott reports $35,000 subscribed.



152 SIXTH INTERNATIONAL CONGRESS ON TUBERCULOSIS.

Camp of Montreal League for Prevention of Tuberculosis. There is an
earnest endeavor to secure this, but the committee are unable to secure a site.

Ontario. — Ottawa. A Relief Home for advanced cases will be built at
once by the Ottawa Association for Prevention of Tuberculosis. The site
is the gift of Mrs. Pugsley, and the plans are ready.

Hamilton. A prominent citizen has given sufficient funds to build a hos-
pital for advanced cases. This will be erected as soon as possible.

London and Middlesex County. A municipal sanatorium was projected,
but the movement is temporarily blocked.

Manitoba. — For the Manitoba Sanatorium over $75,000 has been sub-
scribed and building operations will begin when site is decided upon.

The Factors in Future Work.

The summary here presented of antituberculosis measures in Canada
would indicate that in the past twelve years much has been accomplished.
Yet we must deplore the difficulties which so far have prevented our Federal
and most of our provincial governments taking action in the matter. Our
municipalities are gradually awakening to the need of preventive measures,
and each year sees new measures enforced.

The work of prevention requires the cooperation of all the forces avail-
able. We must first deal with those suffering with the disease, for inasmuch
as the disease is spread only from those having an open tuberculosis, we
must concede (leaving out of discussion here the communicability to man of
bovine tuberculosis) that the disease would soon all but disappear could all
who have an open tuberculosis be placed under proper discipline, and all
sputa and other bacilli-bearing discharges be destroyed. Here the responsi-
bility to a great extent rests upon the physician. He must be careful and
proficient in diagnosis, and when open tuberculosis is present, inform the
patient, so that proper precaution may be observed. Personal instruction
must be given.

Special hospitals for detention are necessary, and should be provided for
such people as are wilfully unclean and whose habits are such that they are
spreading disease about wherever they may be.

Sanatoriums are a necessity for the care of those who cannot be kept
under close supervision at home, or whose surroundings are not conducive
to recovery, whether this be from unsanitary conditions, the presence of
meddlesome relatives and friends, or the thousand and one petty things
wliich prevent a patient following the necessary outdoor life and obsei'ving
the prescribed rest or exercise. Separate provision should be made for in-
cipient and far-advanced cases.

In cities and the larger towns where poverty is ever present, special dis-
pensaries can do much for those who must continue at work. The dispen-



PRESENT STATUS ANTITUBERCULOSIS WORK IN CANADA. — ELLIOTT. 153

saiy physician and visiting nurse in these cities can play an important part
in the warfare against the disease — watchful for unsanitary conditions, or-
dering disinfection, examining the families of patients, ever watchful for
new infections, instructing patient and family in hygienic living.

Notification of all cases of tuberculosis is necessarily a part of efficient
work in the crusade, and where there is a live, earnest board of health, which
will cooperate with the physicians, no time should be lost in enforcing com-
pulsory notification.

Local associations can do much in assisting the authorities. They can
carry on an educational campaign, disseminate knowledge concerning the
methods to be adopted for the prevention of tuberculosis, assist in movements
for the erection and maintenance of sanatoriums, special hospitals, dispen-
saries, etc.

Our citizens in general, and especially our school children, must be in-
structed in the laws of hygiene and health.

We must not forget that every measure that makes for a higher standard
of living is of value in the campaign against tuberculosis. In our houses
we should avoid dust-gathering and light-excluding hangings, provide proper
ventilation, and guard against catarrhal diseases. Our municipal authori-
ties should see that our cities and towns are rendered as sanitary as possible.
Keep our streets clean; do away with the smoke nuisance; inspect our
schools, workshops, and factories; institute careful medical inspection of
school children and of workmen in factories, especially those whose occupa-
tion predisposes to tuberculosis; guard our milk-supply, and, through noti-
fication, institute careful supemsion over all "open" cases, where this is
not already being done.

Our provincial governments are awakening to the necessity of doing
something to lessen the yearly mortality, and we trust with the aid of the
Federal government, we shall soon see an active interest taken in formulating
measures to overcome this preventable disease, which is responsible each
year for 13,500 deaths in the Dominion.



LA LUTTE CONTRE LA TUBERCULOSE EN HONGRIE.

Par M. le Dr. C. Chyzer,

Chef de I'llygifene et de I'Assistance Publique au Ministfere R. H. de I'lnt^rieur.



La Hongrie r^unit, sur un territoire relativement restreint, toutes les
particularitds qu'on ne rencontre ailleurs que dans des pays tres vastes et
qui sont alors separes par de grandes distances. Les sommets de la Haute-
Tatra et des Alpes de la Transylvanie sont presque toujours converts de
neiges, une maigre v^g^tation de gen^vriers s'attache k leurs flancs; des
forets s^culaires de hetres et de chines ombragent les croupes des montagnes
moyennes; le terreau humide de la petite plaine hongroise est sillonn6 par des
milliers de cours d'eau, tandis que dans la grande plaine, il arrive qu'on ne
rencontre pas une seule source pendant toute une journee de marche; dans
la " Hansdg", des lieues et des lieues sont couvertes de mar^cages remplis de
roseaux, tandis que le simoun de Serbie, le brulant "cossovo", forme de
veritables coUines en soulevant les sables mouvants du d6sert de Deliblat.

Dans ces contrees de configuration geographique si diff6rente, les popula-
tions sont 6galement tres h^terogenes. Or, soit que Ton envisage la Hongrie
au point de vue de la configuration geographique, soit h celui de I'ethnogra-
phie, on constate que la tuberculose est r^pandue partout, dans toutes les re-
gions, qu'elle atteint toutes les populations et, chose bizarre, chaque config-
uration geographique a une partie de sa region plus contaminee que les autres.
Trois regions de la Hongrie sont plus sp^cialeraent infestees et ravag6es
d'une mani^re permanente; la premiere est la partie montagneuse du Nord,
comprenant les comitats (d^partements) de Lipto, Zolyom et Turocz, et
habit6e par des Slovaques; la deuxi^me, les environs du lac "Ferto", sur-
tout dans les centres allemands du comitat de Moson; la troisieme enfin, les
rives de la Tisza et du Maros dans la grande plaine, parmi la population mag-
yare et serbe.

Sur ces trois territoires, la mortalite annuelle causee par la tuberculose
d^passe 40 pour 10,000 habitants.

Si nous examinons I'extension de la tuberculose uniquement au point de
vue de la race, nous constatons qu'il y a, dans chaque region, des territoires
plus atteints que d'autres qui sont relativement favoris6s.

Ainsi la tuberculose est fort r^pandue parmi les Slovaques de la Hongrie

154



LA LUTTE CONTRE LA TUBERCULOSE EN HONGRIE. — CHYZER. 155

occidentale, tandis que les cas sont pen nombreux k I'Est, chez les Slovaques
du comitat de Saros. Chez les premiers, la mortalite causae par la tubercu-
lose est de 42 a 45 pour 10,000 habitants, tandis que chez les derniers elle
est de 27 a 29. Un ph^nomene singulier reste encore k signaler: la phtisie
est beaucoup plus repandue parmi les Magyars vivant dissemines dans les
villages que parmi ceux qui resident dans les villes, Ainsi dans les comitats de
B^kes, Csongrad, Csanad, la mortality par la tuberculose est de 42 a 45 pour
10,000 habitants, tandis que dans les grandes villes entierement magyares
de Szeged et de Hodmezovasarhely, dans le comitat de Csongrad, bien que
la premiere compte plus de 100,000 ames, la mortalit6 reste constamment
au dessous de 30, ordinairement ^ 27 ou ^ 28. La proportion est aussi rela-
tivement favorable a Gyor, Komarom, Szekesfeh^rvar et dans d'autres
villes magyares. Les conditions les plus defavorables se rencontrent a
Fiume et a Szabadka, ou la proportion d^passe 60 pour 10,000: la mortalite
due k la tuberculose y atteint done le double de celle dans les villes mag-
yares sus-indiquees.

Cette circonstance prouve clairement que ce sont uniquement les condi-
tions locales qui, en favorisant la propagation des germes infectieux et la
disposition morbide, sont, en meme temps, les causes de I'extension de la
tuberculose. Ces facteurs sont extremement varies: selon les localites, c'est
tantot I'un, tantot I'autre qui devient la cause d^terminante de la propaga-
tion.

La lutte organis^e contre la tuberculose a commence en Hongrie en 1898;
11 avait bien ete pris auparavant quelques vagues mesures k ce sujet, mais
I'organisation proprement elite ne date que de cette ann^e-l^. Le point de
depart et le signal de la lutte fut le beau discours prononc^ k la Chambre des
Magnats en 1896, ann^e du mill^naire, par le D"" Fr^d^ric Koranyi, dans le-
quel I'illustre professeur de I'Universit^ de Budapest appelait I'attention sur
les ravages de la tuberculose en Hongrie et demandait qu'on engageat une
vigoureuse action sociale contre ce fl^au.

Ce discours eut pour premier effet d'eveiller I'attention de notre soci4t6,
mais son effet le plus durable fut rinitiative qu'il provoqua de la part du
Minist^re de I'lntdrieur.

Celui-ci appr^ciant ^sa juste valeur I'id^e 6mise d'entamer la lutte dans
toute r^tendue du pays, s'empressa de prendre sa part de I'organisation et
invita le Conseil d'hygi6ne k ^laborer un avant-projet sur cette question.
Ce travail fut achev6 en 1897 et servit de base au plan d'organisation officiel
de la lutte contre la tuberculose, r6dig6 par la section sanitaire du Ministers
de rint^rieur. Le Ministre ne se borna pas k en effectuer la realisation dans
le ressort de son D6partemcnt, mais il invita tous ses collogues du Gouverne-
ment k faire ex^cuter les mesures propos^es dans tous les offices, bureaux ou
institutions de leur ressort. En Hongrie, les municipes ont le droit de rendre



156 SIXTH INTERNATIONAL CONGRESS ON TUBERCULOSIS.

obligatoires dans toute I'^tendue de leur territoirre, par voie de statuts,
certaines mesures d'ordre administratif. En consequence, le Ministre de I'ln-
t^rieur, par la circulaire n° 49851 de 1897, dans laqiielle il faisait connaitre
les principes directeurs de la lutte centre la tuberculose, invita tous les muni-
cipes a 6tablir, en tenant compte des circonstances locales, un reglement re-
latif a cet objet. La circulaire recommandait d'une fagon generale I'appli-
cation des mesures suivantes:

Dissiper avant tout le prejuge que la phtisie est incurable, puis repandre
des notions justes sur la nature de la maladie.

Le Ministre de I'lnterieur appelait specialement I'attention des municipes
sur la necessite d'amcliorer les conditions de salubrite des logements et, en
particulier, de ceux des ouvriers agricoles, alors encore tres negliges.

Une amelioration sensible s'est produite dans ce domaine au cours de ces
dix dernieres annees: plusieurs municipes ont elabor6 non seulement un re-
glement relatif aux logements des ouvriers agricoles, mais ils Font fait execu-
ter dans la plus grande partie de leur territoire; ainsi a B6k6s, a Szabolcs des
maisons propres et salubres ont remplac6 les vieilles masures ou vivait en-
tassee toute une population d'ouvriers agricoles. La question des cites
ouvrieres a fait de grands progres, et beaucoup de fabriques ont construit
des habitations irreprochables.* Les exploitations et les domaines de I'Etat
ont tou jours donn6 le bon exemple a cet 6gard, et la prevoyance du Gou-
vernement s'est manifest^e surtout par I'article XLVL de la loi de 1907 qui
accorde des subventions, prets ou garanties, destines k f aciliter la construction
de maisons pour les ouvriers agricoles.

La circulaire susmentionn6e invitait ensuite les autorit^s h faire leur
possible pour am^liorer I'alimentation de la population, pour d^raciner les
habitudes nuisibles et pour parer aux dangers que causent tant les animaux
atteints de phtisie que leurs produits, en particulier le lait contenant des
germes de tuberculose.

En meme temps la circulaire minist^rielle recommandait ^nergiquement
aux autorit6s de veiller au d^veloppement de la propret^ en general.

En dehors de ces dispositions d'interet hygienique, les autorit^s recevai-
ent des instructions leur prescrivant de prendre des mesures pour que dans
les bureaux, dans les (§coles et dans tous les locaux ouverts au public, il soit
plac6 des 6criteaux interdisant de cracher sur le plancher, qu'on y installat
des crachoirs contenant de I'eau ou un liquide antiseptique, et que, le nottoy-
age des parquets se fasse avec des torchons humides.

En vue d'eviter la contamination directe, tous les hopitaux recurent I'or-
dre d'isoler les phtisiques et de desinfecter soigneusement leurs expectora-
tions.

* R^cemment, le Parlcment Hongrois a vot6 une loi d6cr6tant la construction de
10,000 maisons ouvrieres ^ Budapest.



LA LUTTE CONTRE LA TUBERCULOSE EN HONGRIE. — CHYZER. 157

Le Ministre de I'lnt^rieur, fit 6crire, en meme temps que la circulaire,
une brochure populaire qui fut traduite dans toutes les langues parlees en
Hongrie et distribuee a des centaines de milliers d'exemplaires.* La dis-
tribution fut renouvel^e pendant plusieurs ann6es de suite, la derniere eut



Online LibraryD.C.) International Congress on Tuberculosis (6th : 1908Transactions of the sixth International congress on tuberculosis. Washington, September 28 to October 5, 1908 (Volume v.4:pt.1) → online text (page 17 of 54)