It is only by education constant watchfulness, the prevention of indiscriminate spitting, and in many cases by the removal to a hospital, and thus isolating the consumptive, that we can ever hope to control the disease. The Great White Plague p. 31
One hundred and ten years ago, Wychwood Park resident William Gage was among the visitors celebrating the opening of his brainchild, The Toronto Free Hospital for Consumptives.
Located between Toronto Junction and Weston village, it occupied 40 acres of woods by the Humber river across from the Lambton Golf course. There, one could enjoy croquet along with other slow-paced outdoor amusements, nutritious meals and accommodation in quaint re-purposed streetcar cabins. To be admitted, one needed only to present a document from the city’s medical officer of health stating that you were in the last, terminal stage of tuberculosis.
The only treatment for pulmonary tuberculosis or “consumption” prior to the discovery of antibiotics was bed rest and fresh air. Sanitariums were designed to provide the conditions for a patient’s immune system to fight the infection on its own. In Toronto, if you were in the latent and early stages of tuberculosis you had a good chance of recovery and were sent north to a sanitorium in Gravenhurst. Being sent to Weston was a bad omen.
The “white plague” posed a danger to everyone but in late nineteenth and early twentieth century it was particularly associated with the urban poor. William Gage, who had made a fortune in the printing of textbooks, chose to make it the object of his philanthropy. In the 1890s, he spearheaded the creation of Canada’s first free sanitarium in Gravenhurst. The boast of the Muskoka Free Hospital for Consumptives and the later Weston hospital, to which in 1913 was added the Queen Mary Hospital for Tubercular Children, was that no patient would ever be turned away.
Duke of Connaught and Sir William Gage at the ceremony to lay the cornerstone for the Free Hospital for Tubercular Children, Weston 1912 (hospital board member James L. Hughes is among the dignitaries)
Before universal health care, it was members of the Protestant church, notably Methodists such as Gage, who raised funds for institutions for the needy, ill and dying. Their missionary drive fueled many successful Toronto charitable along with capitalist enterprises.
Moved by the plight of at-risk children,Toronto’s society ladies through the Imperial Order of the Daughters of the Empire (IODE), held numerous fundraising teas and in 1913 opened a “preventorium”. Children were transplanted from the noxious city to the healing environment of North York.
The sanitarium cure: fresh air, sunlight, well ventilated, sanitary rooms and a nutritious diet represented the antithesis of conditions in Toronto’s downtown slums. No one believed these were prevalent until a vigorous public health crusade, that included photographic documentation, exposed the dark cracks of the city.
caption: Toronto Daily Star, April 4, 1914 p. 7: THESE MEN ALL SLEEP IN THIS SMALL KING STREET ROOM All these foreigners—Macedonians mostly—sleep in this small room on King street west. The photograph taken by the Toronto Health Department and the men were bribed, like children, to sit still by the gift of a picture which they are holding in their hands.
Mapping the Underclass
On his appointment in 1910 as Medical Health Officer, Dr. Charles Hastings launched an anti-tuberculosis campaign. Legislation was passed requiring all doctors to report cases. Nurses were sent into homes of the poor to evaluate the living conditions, teach the housewife how to clean thoroughly, and provide scant rations of eggs and milk to the most needy.
The misery was geographically charted with addresses cross-referenced with maps. Dates on the photographs served as benchmarks of what was considered either a temporary or a permanent and unacceptable state. Hastings used the Inspector nurses as the female “warm and fuzzy” shock troops who referred the gravest cases to isolation hospitals, put the family on watch and marked the most dire spots for the heavy artillery of infrastructure improvement or demolition crews to follow.
Index cards, maps, charts and monthly bulletins distributed through schools were the tools of the modern public health department. The city had eight district centres that kept tabs on infectious disease outbreaks and provided disease screening, check-ups and preventive health workshops.
Spit and Dust
It was understood that the illness spread through the tubercle bacilli in the spray of coughs, hallmark of the consumptive, or the farther travelling sneeze droplets. The common male custom of spitting in public places, in spittoons or on the floor provided opportunity for the deadly microbes to survive in porous, dark and damp surfaces such as the rough wooden floorboards of factories or workshops. Once it dried and turned into a powdery dust, the bacteria re-entered the air and took up residence in the lungs.
Beyond occupational environment hazards, the run-down, crowded, airless and dirty living arrangements of the urban poor were ideal disease incubators.
“Refrain from spitting and keep an easy to clean-orderly environment,” was the message of the department of health. This space of hygiene extended beyond one’s kitchen and yard to the community. Everyone was entrusted with the responsibility for monitoring, reporting and aiding afflicted family members and neighbors who posed a threat to public welfare.
The disease is communicable, but infection is easily prevented. “No spit, no tuberculosis.” The medical health officer asks all those who recognize the conditions to “get together” and make such an arrangement as will encourage aid from all sources… Toronto Daily Star Nov. 28, 1910 p.8
In a speech titled What the Housewives of Toronto Can do for the City Dr. Hastings outlined their responsibility in checking the spread of tuberculosis and other diseases. ‘…incessant cleanliness was largely dwelt on, especially the washing of the hands in a more thorough manner than is generally practiced.’ (The Globe, May 19, 1914 p.5)
Tuberculosis, explained a popular Victorian health manual, was a disease that attacked the essential “the purifying apparatus” of the body. In Toronto, heavy public investment in the city’s sewer and water filtration system provided a neat parallel with the education campaign to control the dangerous emissions of nose and throat.
A zealous, alert mindset began to take hold as the public absorbed the way disease spread. It was now understood that public and private health were interdependent. This was reflected in the preoccupation with the public school classroom which, in grouping the have and have-not children, was a flash-point for communicable disease outbreaks. The teacher as a potential agent of infection and arbiter of the quality of classroom air suddenly took on a somewhat dark form in parents’ minds.
“WHITE PLAGUE HITS TORONTO TEACHERS. Poor Ventilation of Schools Said to be the Cause. INQUIRY IS TO BE MADE.” was The Globe‘s sensational headline to a February 24, 1912 article alerting Toronto readers to the fact that three teachers diagnosed with tuberculosis were in the classrooms. On asking the chief medical inspector for public schools, Dr. W. E. Struthers what the cause for the teachers’ condition was, the reporter was told “Teachers, especially lady teachers do not properly ventilate the rooms. They don’t use the windows as they should.” The city’s MHO, Dr. Hastings, raised further alarm by sharing an interesting statistic, “A number of sanitariums and public health officers…claim that twenty percent more teachers than any other occupations become victim of the disease.”
Ventilated, sun-filled and un-congested space was pronounced as indispensable to the health of all citizens. Anti-tuberculosis manuals such as The Great White Plague set standards for healthy domestic interiors and encouraged parents to monitor the teacher’s use of window sash and shade.
The Forest School in Victoria Park and later High Park, was organized by the Department of Education in 1912 to transplant “delicate” children from the classroom and into the open air. The school doubled in size the following year to 100 pupils, three teachers and a nurse. As an administrator commented to The Globe on January 7, 1913, “The results are very gratifying as it means so much of educational value to parents and children preventing disease and especially tuberculosis.”
The Limitation of the Sanitarium Treatment Model in Toronto
In 1911 Dr. Hastings advocated for a series treatment facilities exclusively for Toronto residents. These included a central dispensary close to the poorest downtown wards which could serve as a clearing house, referring cases to sanatorium, hospital or home care, an isolation hospital close to the city and an outdoor tent camp for men with dependent families who would not submit to sanitorium care. At that point, Toronto hospitals were addressing the problem of isolating patients with pitched tents outside their doors.
He made the case that the hospital could handle cases at a lower cost than the stipend that the city paid the Gage-founded Muskoka and Weston institutions for each Toronto patient. Moreover, he argued, it had been proven that the most difficult to treat were the vagrants, the “feeble-minded” and those who wanted at all cost to remain close to home. The front-line workers who made treating these cases possible was a team of public health nurses under the direction of Eunice Dyck, City Tuberculosis Visiting Nurse. In an illustrated feature, Dyck, who is credited with pioneering a new model of public health delivery, outlined the combination of grit, expertise and empathy that was at the heart of her work.
Every week-day morning at 9 o’clock eighteen young women meet in a room on the ground floor of the City Hall in Toronto, and plan their day’s work of relieving the sick and suffering in the city. They are the city nurses, employed by the municipality to assist and advise those who are not capable of looking after their own illness. At the head of them is Miss Eunice H. Dyke, who entered the service of the Medical Health Department in June 1911… Up to the time of Miss Dyke’s engagement only one nurse was employed by the city. She worked in connection with the Tuberculosis clinic at the General Hospital. The authorities realized that more nurses were needed to cope with the situation and Miss Dyke was employed to visit tuberculosis patients in their homes. Eighteen Nurses Employed There was a clause in the health act making it compulsory for doctors to notify the Medical Health Officer of tubercular cases. Miss Dyke got in touch with the doctors of the city and visited the cases wherrver it seemed necessary. In 1911 only three physicians made it a practice to report cases. Now over three hundred do so, and as a result it is necessary to look after the work which was formerly done by two. Fifty-eight new cases were reported last month. According to Miss Dyke, many tubercular patients come here from the old country in the belief that they will be benefited by the Canadian climate. When it happens that these immigrants become a charge upon the city they are deported, but many of them take the cure in their own homes. The city nurses are willing to help them do this, and some of the patients have made excellent progress towards recovery. The outdoor sleeping quarters constructed by some of the consumptives are most ingenious in their arrangements, and would be a great credit to any sanatarium. …
below: photo illustrations and captions from article above A typical shelter at a patient’s home A POOR FIGHTING CHANCE IN SUCH SURROUNDINGS The upper picture shows a typical family of children compelled to live in one room, while their mother is out working all day. Lower picture shows apartment over store, which rents for ten dollars a month, and where a family of five children and two adults eat, sleep and have their being. TAKING THE CURE IN HIS BACK YARD A patient from the West Indies struggling against fate under conditions not favorable to his recovery.
Tuberculosis history and the Wychwood Barns neighbourhood
William Gage was one of the earliest residents of Wychwood Park. His home can be seen on the Davenport embankment west of Bathurst street. The entrance is on Burnside Drive, a subdivision named for his wife, Ada Burnside.
By following stringent requirements for isolation and ventilation some tuberculosis patients were permitted by the city to live in open-air additions or backyard tents. Public health nurses monitored the required sanitary conditions and diet. Suburban market garden yards such as the one seen below near Christie and Pendrith streets, south and east of the present-day location of Fiesta Farms, were considered ideal, giving the patient access to fresh fruit and vegetables as well as a large lot.
Health Department photographs documenting the improvised arrangements for a patients home care create a startling contrast with those depicting conditions in the slums. The tuberculoid patients are at times identified by name and allowed to pose while the photos of the very poor are typically generically labeled “occupied interiors, slums.” The clever design adaptations of tent living quarters are noted in captions and family members pose alongside the patients or hover outside the tent. The documentation confers a degree of dignity deprived of inner city residents in their representation as problems of the government. The images below celebrate middle class family bonds and resourcefulness. They suggest how through contemporary lens the backyard vignettes were counterpoint to the reality of tuberculosis in the slums.