Guarding the Nation’s Health
Ceaseless vigilance is the price of national fitness
NORMAN REILLY RAINE
HELLO! Good morning! How are you?”
The greeting, question and response to be heard numberless times a day, in every city, town and hamlet in Canada. Stereotyped, perfunctory as it is, yet the fact that it is the accepted form of salutation between Canadians—and, indeed, between English-speaking people, everywhere—argues that the question of health is one of the most vital importance to all of us.
And why not? For does not the incapacitation of one single member of the nation mean a sensible economic loss to the whole? Let us bring our rather hazy notions of the importance of a nation’s health to sharp focus by examining two simple statements, namely, that 180,000 individuals in the Dominion of Canada constantly are suffering from disabling disease, and that, among the adult population alone, there are lost each year 16,200,000 working days.
Sixteen million, two hundred thousand days or three hundred and eighty-eight million, eight hundred thousand hours of necessary work left unperformed because the nation’s health, excellent as it is compared to that of other countries, is not one hundred per cent, perfect!
There does, indeed, seem an urgent need for a government Department of Health and a colossal task for this department to perform.
The infinitely varied activities of the Department of Health roughly may be grouped under two broad subdivisions—the business of seeing to it that, by dissemination of information, the public health constantly is safeguarded, and the equally important business of guarding against the importation of disease from abroad.
Speaking generally, local health matters come within the jurisdiction of provincial and municipal boards of health. By the terms of the statute under which the federal department operates, it is forbidden the right to interfere with these provincial and local bodies. Disease knows no boundaries, however, and some sort of connecting power is needed to link the work being done by the provinces and the municipalities.
Hence the federal department.
Further than that, protection of the country as a whole against disease from abroad obviously calls for some sort of national action, and there are many other matters relating to health which demand similar treatment. It is easy to see, therefore, that there is more than enough for the federal department to do without danger of its treading on the toes of the provincial health authorities who are very jealous of their rights.
To be more explicit, the department co-operates with provincial, territorial and other health authorities, and co-ordinates the efforts made to preserve and improve public health, conserve child life and promote child welfare; it inspects and gives medical care to immigrants and seamen, and administers marine
hospitals, and supervises, so far as health matters are concerned, all railways, vessels and other means of transportation; it enforces the regulations of the International Joint Commission, which arose out of the treaty between Canada and the United States, regarding the pollution of boundary waters, and other questions relating to public health, of mutual interest; it administers all statutes relating to the health of the people of Canada over which parliament has jurisdiction, and collects, publishes and distributes information relating to public health, improved sanitation, and social and industrial conditions affecting the health and lives of our people.
All of which, couched as it is, necessarily, in the unimaginative language of officialdom, may not sound very exciting. It is only when any of the activities of the Department of Health are observed close up that one is able to realize what a close-knit net of protection against disease is maintained for us by the government.
This is What Saves Us From Typhus
TAKE, for example, the matter of quarantine service, the inspection of incoming foreigners to ensure that such scourges as plague, Asiatic cholera, yellow fever and smallpox are not visited upon us. This service means the
maintenance at every major port of a full quarantine staff with customs officers acting at minor ports where the full service of a quarantine station is not available.
There is a careful medical examination of every addition to our population—whether permanent or temporary—and this involves some very thorough and even drastic operations. A few vermin more or less mean nothing in the lives of some mid-European comers to our shores. But they mean something to our medical men,, for typhus is spread by body lice, and plague and cholera, by fleas and the parasites of rats. So suspects are energetically bathed and deloused. That is what the department calls it—delousing—with no concession to the tender ears of the over-sensitive.
None of the diseases named above have penetrated the barrier raised by the department during the past eight years—which is something of a record. The exchange of information between countries when an outbreak of contagious disease occurs helps considerably, for vessels, from the country affected are given particular attention when they come into a Canadian port.
Co-operation with the Department of Immigration in the inspection of prospective settlers is another important phase of the work. Feeble-minded, insane, psychopathic, nervous and epileptic types rigorously are excluded from Canada, as are those afflicted with venereal disease or other loathesome ailment, consumptives and those suffering from trachoma, a disease of the eyes. Physical disability need not mean rejection, however, provided the disability will not prevent the earning of a livelihood. A piano tuner may be blind, for instance, and not be an economic liability; a deaf man is capable of working at many things; yet a person suffering from psoriasis, a skin disease which is not transmissible, might be debarred, because his appearance—due to repulsivelooking scales—possibly would prevent his finding employment, and then he might become a public charge. It might be said, therefore, that any physical defect which handicaps or prevents an immigrant’s economic productiveness, is sufficient to debar him from entering Canada. This is not discrimination in any sense. It is merely self-protection.-
The Quarantine Service and the Immigration Inspection Service both deal with the prevention of disease from abroad, but each has its specific duties. The Quarantine Service deals with vessels as well as with individuals, and no ship may enter a port of Canada without passengers and crewbeing medically examined. Quarantine stations are maintained at Grosse Isle in the river St. Lawrence, with Father Point as the inspecting base, and Quebec and Montreal harbors, as sub-stations; at Halifax, with sub-stations at Sydney, North Sydney, and Point Edward; at St. John, New Brunswick and on the Pacific coast, at Victoria with Vancouver as a sub-station.
Each organized quarantine station
is”in charge of a medical quarantine officer who meets every vessel, and that vessel may not proceed until he has given her clearance. A quarantine sub-station is a port of final destination where vessels, after being emptied of their cargo may be fumigated or disinfected with greater facility.
Last year the Canadian Quarantine Service— including Atlantic and Pacific ports—inspected a total of 2,528 vessels and 471,813 persons, composing passengers, crews, cattlemen, stowaways and distressed seamen. Of this number, 240 were detained at quarantine stations, forty-one of whom were ill of quarantinable or minor infectious diseases. The balance either were detained for observation following contacts, or were members of families accompanying the sick, from whom they could not well be separated without inflicting hardship.
Asiatic ports are hot-beds of plague, and vessels coming from the Far East receive the particular attention of the Quarantine Service. An outbreak of virulent smallpox in Hongkong, for instance, immediately becomes known to the Canadian Government through consular services, trade commissioners and other sources. The information is passed along to the service and all vessels from that port undergo rigorous inspection and fumigation. Whether such dissemination of information is important or not may be gathered from the following anecdote.
An Ever Present Danger
A FEW years ago a Canadian Government Merchant Marine vessel was about to cast off her moorings in a Chinese port. One of the seamen had left his coat on the wharf, and shouted down to a group of natives to throw it up. A coolie complied, and the seaman died on the way home, of smallpox contracted in this casual fashion. Diseases common to the human race seem to attain particular virulence in the Far East, and if the malady had been allowed 1K> spread further on this vessel, and there had been no quarantine service in the Canadian home port the consequences might have been disastrous.
Pneumonic and bubonic plague occasionally attack the port of San Pedro, California, which is the tidewater outlet for Los Angeles. Immediately, regulations are erected in British Columbia ports, and all vessels hailing from San Pedro undergo the routine laid down for vessels from a plague-infested port.
There is a standing rule that every ship from San Pedro, New Orleans, San Francisco Bay, including Oakland, and the Straits Settlements must rat-guard on entering a British Columbia port. Rat-guarding is the placing of metal shields around all mooring lines to prevent the rodents, all of whom are potential plaguecarriers, from leaving the ship and spreading the disease on shore.
To illustrate how vessels are handled, whose personnel show signs of .„disease on arrival, the S.S. Lake Winthrop with a crew of thirtythree arrived in the St. Lawrence with an unclean bill of health from La Romana, West Indies, at which port smallpox was raging when she sailed. The captain claimed that his crew had been vaccinated before he sailed, but there being no evidence of the vaccine having taken; they were revaccinated at quarantine and kept under observation for three days, or until the period of incubation was complete.
A.few months later the steamer
Penrhydd arrived from West Africa, with one death and three cases of pneumonia among the crew. As this appeared to be a complication either of influenza or bubonic plague, the vessel was held pending a diagnosis through bacteriological examination, which revealed in throat swabs the presence of small baccilli. The steamer was fumigated and the crew disinfected and kept under observation for four days. They then were released, no new cases having developed. The hospital cases turned into relapsing fever and it was seven weeks before they could be discharged.
Passenger vessels are handled similarly. A liner from Liverpool arrived at Quebec with 221 cabin passengers,
492 steerage passengers, and 269 crew. There was one case of smallpox among the cabin passengers. The patient and two immediate contacts were admitted to hospital, while the other 218 cabin passengers and forty-seven members of the crew in that part of the ship were landed for quarantine and observation. The apartments occupied by the patient having been fumigated, the remaining 222 crew and steerage passengers were vaccinated, and after a detention of thirty-one hours the vessel was allowed to proceed.
The merchant ships of the Dominion travel all the waters of the globe, carrying with them a large number of Canadian seamen. Occasionally the latter fall ill, and have to be treated in foreign ports, just as foreign seaman fall ill in this country. A reciprocal arrangement, therefore, is carried out by the maritime nations of the world, whereby these strangers may be taken care of; and in pursuance of our Dominion’s share in that pact, the Department of Health maintains two marine hospitals, one at Sydney, Nova Scotia, and the other at Lunenburg, Nova Scotia. In addition, it makes arrangements at other points along our seaboard and inland waterways for the medical treatment of seamen of all nationalities.
Every ship entering a Canadian port in Quebec, New Brunswick, Nova Scotia, Prince Edward Island and British Columbia is assessed to maintain this service, and the balance is made up by the Federal Government. This service is without charge to the patient. The number of sick, injured and distressed mariners treated in 1925 was more than 3,600, these including a number of cases of incipient tuberculosis, who were given extended sanitorium treatment. The levy is two cents per ton, net or registered tonnage, on every ship from a foreign port or from another province, and dues are payable three times a year. Fishing vessels not registered in Canada are exempt, but do not participate in the benefits.
Our Leper Colonies
WHILE on the subject of the quarantine service and the safeguard it forms against the invasion of frightful diseases which emanate from the Far East, it might be well to say something about what the Department of Health is doing to relieve the lot of men and women afflicted with the most spectacularly horrible of all the ills the flesh of man is heir to—leprosy.
How many Canadians are aware that the Canadian Government maintains two leper colonies? One is at the village of Tracadie, New Brunswick, on the Gulf of St. Lawrence, and the other Bentinck Island, near the quarantine sub - station at William’s Head, British Columbia, and for years the government has carried on its job of treating this terrible disease, and ameliorating, so far as medical science and humanitarian i sm may do, the sad lot of its afflicted wards.
The origin of leprosy in Canada is somewhat obscure, but it is likely the following is the cause. Eighty years ago a Scandinavian vessel was wrecked near Tracadie. Its crew was rescued and given shelter by the Acadians of the village, and they remained there for some time. Some years later the disease appeared among those who had been active in the rescue, and today seven of the inmates in the Tracadie lazaretto are descendants of those patients. In addition to these, there is one Icelander, one Chinese, and one patient of French and Scottish descent.
The lepers are visited quite freely
Continued on page 42
Continued from page 15
by friends and relatives who take the them fruit, cakes and various other delicacies, and they lead contented and fairly happy lives. Although segregated of necessity, there is nothing in their environment which stresses that fact, and they are left as free from restraint as a proper supervision will allow. The same applies at the leper station on Bentinck Island. Here, the patients seven Chinese, one Russian Jew and one Doukhobor, are housed in cottages, each with his own room, clean and comfortable. They do light work, if they are able, attend to their quarters, do their own cooking, keep poultry, tend their gardens and hold little socials among themselves, or with occasional visitors.
The curative treatment they receive is the most modern that can be obtained, and that it is not in vain is shown by the fact that occasionally the disease has been arrested, and in some cases, has disappeared, and the patient has been allowed to go home.
The healing of the afflicted recognizes no national boundaries, and the blessedness of mercy is universal, for the grave drugs needed in the treatment of leprosy are supplied free by the Surgeon-Director of the Leprosy Investigation Station at Honolulu, which is maintained by the United States Government.
The Harvest of Vice
T^AR more dreadful than leprosy be" cause more widespread and less easily recognizable, is the ghastly scourge of venereal disease. The Department of Health realizes that effective control of this source of social pollution is a matter of vital importance and, consequently, a division of the department, working in co-operation with each individual province, is concentrating its efforts upon this problem. The known cases of venereal disease under treatment by physicians and at clinics totaled, last year, 29,721, and, in the opinion of the Department of Health these are outnumbered by the cases unknown and unreported.
There are in Canada to-day, fifty-six free clinics for the treatment of venereal diseases as well as additional centres for examination and treatment in hospitals, child welfare clinics, maternity clinics, day nurseries and other institutions of a like character.
The government also fights the evil by means of widely distributed literature, lectures, educational films and the giving of expert advice to parents. It makes, in addition, an annual grant to each province provided the province, itself, agrees to expend an equal amount for the work.
Books and pamphlets are issued free of charge to medical men, young men and women, seamen, ships’ captains and surgeons. The assistance of the police is enlisted in tracing and controlling known carriers of the disease, and increasingly stringent enforcement of legislation bearing upon the evil is a powerful weapon in the hands of those responsible for seeing that Canada’s reputation for good health and virile citizenship does not suffer.
Protection Against Quacks
nPHE pathetic readiness of the afflicted man or woman to try ‘a bottle of this’ or ‘a box of that’, has been responsible for a measure of suffering which is, blessedly, unimaginable. The Proprietary or Patent Medicine Act is administered by the Department of Health, and many a Canadian hypochondriac may be thankful for it, for it is a most potent check upon the activities of quack medicine manufacturers and vendors. The British Pharmacopoeia is the foundation upon which the
Continued on page 44
Continued from page 42
manufacture and sale of medicines in Canada is set, and Canadian legislation in this respect is the best in the world outside of France. It is worth noting that no medicine in this country may claim to be a ‘cure’. It may be a remedy, and thus be advertised and labelled. But the word cure must not appear, on pain of confiscation of the product, and prosecution of the manufacturer.
Medicines—by which is meant in addition to bottled remedies tonics, headache powders, pills, liniments, salves and so on —must be properly labeled; and before a medicine is registered, licensed, and placed upon the market, the manufacturer is required to submit to the Department of Health a sample of all labels, wrappers and literature, cartons and advertisements.
Preparations containing potent drugs such as strychnine, arsenic or carbolic acid, must emphasize these on the label, with a definite scale of dosage, and no medicine may contain narcotics for internal use. It is forbidden to include cocaine in any preparation either for internal or external treatment, and the sale of remedies for venereal disease in Canada is illegal, as are all abortifaciens, or compounds to bring about abortion.
Patent medicines containing alcohol in excess of two and one-half per cent, must be medicated to a degree that the physiological effect of the other ingredients will neutralize or prevail over the surreptitious kick, and medicines violating this are confiscated and destroyed.
One of the gravest problems with which the Department of Health is confronted is the control of the distribution and sale of narcotic drugs. The frightful menace of narcotic drug addiction was so graphically and powerfully presented in a recent article which appeared in MacLean's Magazine that it is not necessary, here, to further dilate upon it. Suffice it to say that the Canadian government requires that importers of narcotic drugs be licensed, each licence application being dealt with on its merits, that all wholesale druggists and importers must furnish to the Department of Health a statement of sales to retailers, dentists, veterinary surgeons, and physicians, at the end of each calendar month and that retail druggists are obliged to give the Department data on sales of narcotics on prescription.
By this means, the department is able to maintain an accurate check on the importation, supply, and consumption of narcotic drugs in Canada, and can, where excessive figures are encountered institute an investigation.
Combatting Vocational Diseases
TLLNESS affects us in so many vital
ways, economically, as well as physically, that health might be said with perfect truth, to be the hook upon which our standing as a nation is suspended. There are the normal hazards which every individual must meet, and which take a large annual toll of our population, and there are conditions in many industries which affect the health of the workers, with consequent loss of economic efficiency.
Wood alcohol affects the eyes of persons engaged in the making and finishing of picture moulding; heat attacks the vision of tin plate workers; steel hardening carries the danger of lead poisoning; lead arsenic, silica, calcium, benzine, and carbon monoxide, introduced into the systems of workers, cause disease and death; tuberculosis fastens upon men employed in quarries and mines; those engaged in ore smelting and refining risk exposure to arsenic and cobalt dust, often with fatal results, and nickel rash annually claims its victims.
It is most important that occupational diseases should be controlled, and protection given those engaged in industrial pursuits, because ill-health of the worker
not only adds to production losses, and affects the supply of labor for certain types of industry, but causes intense suffering to the victim and inflicts hardship upon his dependents, through the loss of his earning power. Many of the provinces are engaged upon chemical research to reduce or banish these dangers, assisted by the federal government Department of Health.
Our Food Policemen
BUT the one special branch of the Department of Health’s work which comes home to each one of us is that of the Laboratory of Hygiene. Here is a little illustration of the kind of work it does.
You are going home after your Saturday night shopping but you still have the Sunday roast to buy, and sausages for the Sunday breakfast. Perhaps you have forgotten them, and you stop in frent of the window of a butchewith whom previously you have not dealt. His joints are fresh-looking and bright colored; his sausage glows with healthy pink, and you go in to buy. But, somehow, those Sunday meals lack somethmg of the appetizing quality you had anticipate!. The roast is —well, not inedible, perhaps, but somewhat tough and stale; and the sausage— it looked so nice, of course, but it seemed to be tainted. It probably is, because, like the bloom on the cheek of the flapper, the bloom on the meat was placed there by artificial means—it was treated with sulphide of soda, to conceal the fact that it was not all that fresh meat should be. But if you took that meat to your local health authority or the federal Department of Health it would introduce a little excitement with the butcher’s virtuous life.
Cocoa butter no longer is used to adulterate dairy butter. The government stopped it. It also stopped the sale of coffee ‘compound’ as coffee, not because it was harmful, but because it contained only fifty-one per cent, of coffee, and the balance was ground chicory, peas and beans, and you were not getting the worth of your money. The same applies to chicory compound. Pepper compound may be pepper and ground pepper-shells, and clove compound ground cloves which are exhausted—that is, from which the oil has been extracted.
Dr. J. A. Amyot, the Deputy Minister of Health for the Dominion states that there is no compound of anything in the food or drug line which has the value of the full article, and if you are paying coffee prices for coffee compound or nutmeg prices for nutmeg compound, you are being done. All such compounds must be labeled, or you must be told that you are buying a compound. Otherwise the merchant is liable under the legislation governing the Food and Drugs Division.
There are government laboratories at Montreal, Halifax, Ottawa, Winnipeg and Vancouver for the testing of foodstuffs. Preservatives and coloring matter are investigated; adulterers of foodstuffs are prosecuted. Every sealed package must have the contents printed on the label. For example, the use of pectin— favored by some jam manufacturers because it supplants the use of a considerable quantity of fruit in jam of heavy consistency—must be announced on the label. There is nothing harmful about pectin, but people paying for pure fruit jam expect what they pay for, and the department sees that they get it. Glucose, because of its low price and ability to resist crystallization, is favored as a sweetening by some manufacturers—but its presence in quantity lessens the quality of the jam, and so must face the world on the label.
Giving Canadians the Right Start in Life
IASTLY, what is the Department of u Health doing for posterity? For those who are born under the flag of its country?
For the baby of to-day who will be, in a few short years, the hopé of the Dominion to-morrow. Nothing spectacular, perhaps, nothing to make a smashing head line for a yellow newspaper, but a work which is, nevertheless, infinitely important.
Briefly, its work is that of education; and in a country of such vast dimensions as Canada such work is vitally important. For, consider the immigrant mother; what means has she to learn the most scientific methods of child rearing, nay, the most elementary facts concerning the care of infants, according to Canadian standards? So, the Government works hand in hand with such organizations as the Canadian Council of Child Welfare, Child Protection Officers, Women’s Institutes, the Red Cross, the Imperial Order Daughters of the Empire and the nursing orders to see to it that Canadian citizens shall have a fighting chance in the first few months oí their citizenship.
To this end it collects statistics upon maternal mortality and—what is much more important—devises means of combatting it. By every known instrument of propaganda it spreads abroad among the women of Canada the facts regarding such
subjects as nursing, diet, training, care of the pregnant mother, and, in short, all of the steps, infinitely precarious and puzzling, which mark the progress of the Canadian from babyhood to adolescence.
Of great help in this work of educating an immigrant and pioneer population has been the series of ‘Little Blue Books’ written by Dr. Helen McMurchy, chief of the Division of Child Welfare. They are eminently practical little books bearing such titles as: The Canadian Mother’s Book, How to Take Care of the Mother. How to Take Care of the Children. How to Take Care of the Father and the Family. There are dozens of them and not one but has achieved its object of imparting to Canada’s immigrant women some idea of what the Dominion considers a fair start for its infant population.
So, from the cradle to the grave, this Dominion of Health Department of ours is eternally asking Us to stick out our tongue for inspection or offer our wrist for pulse measurement. If Canada has a reputation among her sister nations for a citizenry upstanding, broad-shouldered, red-blooded and virile this same ever watchful branch of the Government’s Civil Service has done much to build it up.