A^ .%. -,%.. e.. ■\t>^^v, ^> Hiotographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 is'A Q>< CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. H Canadian Institute for Historical Microreproductions Institut Canadian de microreproductions historiques 1980 Technical i ^d Bibliographic Notes/Notes techniques et bibliographiques The Institute has attempted to obtain the best original copy available for filming. Features of this copy which may be bibliographically unique, which may alter any of the images in the reproduction, or which may significantly change the usual method of filming, are checked below. U Coloured covers/ Couverture de couleur □ Covers damaged/ Couverture endommagde D D D D D D Covers restored and/or laminated/ Couverture restaur6e et/ou pellicul6e □ Cover title missing/ Le titre de couverture manque □ Coloured maps/ C artes g^ographiques en couleur Coloured ink (i.e. other than blue or black)/ Encre de couleur (i.e. autre que bleue ou noire) □ Coloured plates and/or illustrations/ Planches et/ou illustrations en couleur Bound with other material/ Reli6 avec d'autres documents Tight binding may cause shadows or distortion along interior margin/ La reliure serr^e peut causer de I'ombre ou de la distortion le long de la marge intdrieure Blank leaves added during restoration may appear within the text. Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajoutdes lors d'une restauration apparaissent dans le texte, mais, lorsque cela dtait possible, ces pages n'ont pas 6t6 filmdes. Additional comments:/ Commentaires suppl6mentaires: L'Institut a microfilm^ le meilleur exemplaire qu'il lui a 6t6 possible de se procurer. Les details de cet exemplaire qui sont peut-dtre uniques du point de vue bibliographique, qui peuvent modifier une image reproduite, ou qui peuvent exiger une modification dans la mdthode normale de filmage sont indiquds ci-dessous. □ Coloured pages/ Pages de couleur □ Pages damaged/ Pages endommag^es □ Pages restored and/or laminated/ Pages restauries et/ou pellicul^es 0''1>ages discoloured, stained or foxed/ Pages d6color6es, tachetdes ou piqudes I I Pages detached/ D Pages d6tach6es Showthrough/ Transparence Quality of prir Quality indgale de I'impression Includes supplementary materif Comprend du materiel supplementaire Only edition available/ Seule Edition disponible I I Showthrough/ I I Quality of print varies/ I I Includes supplementary material/ I I Only edition available/ Pages wholly or partially obscured by errata slips, tissues, etc., have been refilmed to ensure the best possible image/ Les pages totalement ou partiellement obscurcies par un feuillet d'errata, une pelure, etc., ont 6x6 filmdes 6 nouveau de fapon d '-btenir la meilleure image possible. r~V^This item is filmed at the reduction ratio checked below/ I n/I Ce document est film6 au taux de reduction indiqu6 ci-dessous. 10X 14X 18X 22X 26X 30X / 12X 16X 20X •Wi^ 28X 32X The copy filmed here has been reproduced thanks to the generosity of: National Library of Canada L'exemplaire filmd fut reproduit grdce d la g6n6rosit6 de: Bibliothdque nationale du Canada The images appearing here are the best quality possible considering the condition and legibility of the originel copy and in keeping with the filming contract specifications. Les images suivantes ont 6t6 reproduites avec le plus grand soin, compte tenu de la condition et de la nettetd de l'exemplaire filmd, et en conformity avec les conditions du contrat de filmage. Original copies in printed paper covers are filmed beginning with the front cover and ending on the last page with a printed or illustrated impres- sion, or the back cover when appropriate. All other original copies are filmed beginning on the first page with a printed or illustrated impres- sion, and ending on the last page with a printed or illustrated impression. The last recorded frame on each microfiche shall contain the symbol -^ (meaning "CON- TINUED "), or the symbol V (meaning "END"), whichever applies. Les exemplaires originaux dont la couverture en papier est imprim^e sont filmis en commengant par le premier plat et en terminant soit par la dernidre page qui comporte une empreinte d'impression ou d'illustration, soit par le second plat, selon le cas. Tous les autres exemplaires originaux sont filmds en commenpant par la premiere page qui comporte une empreinte d'impression ou d'illustration et en terminant par la dernidre page qui comporte une telle empreinte. Un des symboles suivants apparaitra sur la dernidre image de cheque microfiche, selon le cas: le symbole — »> signifie "A SUIVRE", le symbole V signifie "FIN". Maps, plates, charts, etc., may be filmed at different reduction ratios. Those too large to be entirely included in one exposure are filmed beginning in the upper left hand corner, left to right and top to bottom, as many frames as required. The following diagrams illustrate the method: Les cartec planches, tableaux, etc., peuvent dtre film^s d des taux de reduction diffdrents. Lorsque le document est trop grand pour dtre reproduit en un seul clichd, il est filmd d partir de Tangle sup6rieur gauche, de gauche d droite, et de haut en bas, en prenant le nombre d'images ndcessaire. Les diagrammes suivants illustrent la mdthode. 1 2 3 32X 1 2 3 4 5 6 OUR RACE AND CONSUMPTIVES.* SIR JAMES GRANT, K.C.M.G., M.D. Consulting Physician to Their Excellencies, Lord and Lady Minto ; Consultant to the General Hospital, Water Street and St. Luke's Hospitals. OTTAWA. The great problem staring us in the face is, What course of action is most judicious to stay the spread of consumption? So alarming are the present results, that conferences on this subject are being held in mfost of the enlightened centers of the world. History points out that no race of human kind has yet obtained a permanent foothold on this continent. The Asiatics trace back their life history so far that it is like a geologic epoch. Those who descended from the Ptolemies are still found cultivating the rich alluvial banks of the Nile. The race that peopled Northern Europe when Greece and Rome were in their infancy still retains its hold, and exercises a powerful influence throughout the world. An important fact, and one worthy of consideration, is, that races have been born on this continent, lived and entirely disappeared, leaving as records of their past history mounds in the West, vestiges in Florida, and traces in other directions, which give an undoubted indi- cation of at least two extinct races. Thus far the in- formation is wanting, which would clear up the causes why these races have entirely disappeared. It now re- mains to be seen if the Anglo-Saxon race will prove itself equal to the occasion and be more fortunate in estab- lishing a lasting foothold on this continent. Climate * Read before the Canadian Medical AsBociatioi i, September, 1900. and civilization require a physique and brain-power equal to the occasion to meet successfully the trying de- mands of the present age. The enthusiasm of the Canadian people in assisting in the protection of British interests in South Africa was placed beyond doubt by the rapid equipment of fully 3000 men, who entered the field, and displayed bravery not surpassed in the history of the Empire. As a result many valuable lives have been lost, by the sword and disease; but it is most appalling to reflect on the fact that over 3000 deaths by consumption were recorded in the fair province of Ontario in 1898, and yet our people are not aroused to this great fatality, now assuming such alarming proportions. The seeds of this disease lurk in our country, in our l.onio«, in our places of business, in the food we eat, in the water and the milk we drink, and in the air we breathe, spreading disease, fatal in its re- sults, and producing a most disastrous influence on the present generation. As a profession, it is our duty to guide and direct public" opinion as far as possible, in order to place the whole subject in a clear and comprehensive form, so that common-sense co-operation may be aroused, and an active interest taken by all classes of the community, to stay, as far as possible, the alarming spread of con- sumption, the "white plague." For many years medical opinion was divided as to the communicability of tuberculosis, but we are all con- tagionists now, since the remarkable discovery of Dr. Koch, in 1882, that consumption of the hmgs is caused by the introduction of a living germ, the bacillus tuber- culosis, into the system of a previously healthy person. To-day his theory that tuberculosis is a communicable and preventable disease is accepted and verified, two facts which can not be too strongly impressed on. the public mind. Heredity was the accepted opinion for many years, exercising a soothing influence on some by the prospect of escape from consumption. Nothing is ' more certain or conclusive than that no one does, or can, inherit consumption. The offspring of consumptive parents receive the infection from without, before they can become consumptives, thus giving fresh hope and spirit to the parents known to be consumptive. a In 1888 and 1890 two British Hoyal Commissions were appointed to make investigations in regard to tuber- culosis, and the result of their deliberations was as fol- lows ; 1. Consumption is a contagious disease. 2. Contagion is in the form of a living germ. 3. This living germ can grow and propagate only in the body of man or some of the lower animals. 4. The principal source of infection is the dried ;^puta from the lungs of persons already suffering from tlie disease. The sputa becoming dry, the tubercle germs float as particles of dust in the air, and are thus in- haled. 5. The other source of infection to man is from eating the flesh and drinking the milk of tuberculous cattle. Cooked meat destroys infection, and is not as dangerous as raw milk containing tuberculous matter, and more particularly if the animal has well-defined, ulcerated udders. Dr. Clifford AUbutt* has published the opinion, that there are instances of prolonged use of tuberculous milk by many persons, old and young, without ill conse- quences, and this immunity depends on the constancy of the defensive machinery of the body. In 189() a third British commission was appointed, composed of eminent medical men and veterinary sur- geons, to inquire into the most advisable and desirable means for controlling the danger through the use of the meat and milk of tuberculous animals. "The housing and general sanitation of cattle require special care and attention. Tuberculin should be supplied free by gov- ernment to all owners of cattle, so that their herds could be examined at stated intervals by the tuberculin test. The infected a,nimals should be treated according to the most advanced principles, either by isolation or by kill- ing. Local authorities ought to take samples of milk offered for sale within their districts, and vendors should be required to give information of the source from which the milk is supplied." These methods are now in force in England, to asist in stamping out "bovine tuber- culosis," and protecting the public, as far as infection is concerned. 1 British Med. Jour., Oct. 28, 1899. The tuberculin test has been the subject of considera- ble controversy, and the following facts should be kept well in mind : Dr. Watson*, president of the State Board of Cattle Commissioners, Concord, N. H., states: "We believe that a majority of the cattle reacting to the tuberculin test are not diseased to an extent that requires their slaughter for the protection of the public health." The policy of slaughtering all animals that reacted on tuber- culin has been entirely abandoned, as, after the most careful inquiry, it is believed that a majority of the cattle reacted on by the tuberculin test are not diseased to an extent that requires their slaughter for the pro- tection of the public health. Much depends on the care- ful and thorough examination by skilled veterinary sur- geons, as thus the danger of infection from either tuber- culous meat or milk would be reduced to a minimum. Tuberculin does not reveal the degree of infection and is not as reliable a test as "as at first supposed. Solomon, in 1893, admitted^ tha^, tuberculin was a great aid to diagnosis of tuberculosis, bat not infallible, and might lead to errors. There are instances on record in which tuberculosis existed and the animals did not react to tuberculin. In all such investigations, in order to promote health in cattle as well as man, the opinion ar- rived at by the highest authority is, that sanitation ranks first. Dairymen should be registered, and an inspector appointed for a specific area of country, to be under the control iof the local government or a provincial bureau of cattle commissioners, to make reports at stated inter- vals, as well as issue printed circular directions to dairy- men, milk venders and cattle dealers, for their guidance and general direction, and all animals for food supply should be inspected before they are sold. Some such system carried into effect in Canada would reduce tuber- culosis to a minimum, and do much to strengthen the belief that the Dominion is a center of health, happi- ness and prosperity. Too much stress can not be placed on these facts, in order that the public, as a whole, may be aroused to the great importance of a general knowl- edge of the subject, as such would in time give direction 2 Public Health Report for 1898, Vol. zziv, p. 149. 3 TrauB. American Pub. Health Assn. to governmental and special efforts of scientists, who should not be single-handed in public health efforts. In May, 1900, the regius professors of Oxford and Cambridge spoke with all the responsibility of their office, an the communicability of consumption and its prevention, fully impressed with the fact that from 66,000 to 70,000 die annually from the disease in Great Britain, more than double the fatality of the entire British force at present in South Africa. Clifford Allbutt epitomized the preventive meas- ures: an active crusade against the three D's — damp, darkness and dirt. In clearing the public of these evils, the standard of general health would be raised to a higher level, and what is needed in Canada is thorough organization. At the last session of the legislature of Ontario a permissive bill was unanimously passed, the result of the labors of the Anti-Consumptive League, of Toronto, providing for the erection and maintenance of a sana- torium for consumptives in each municipality, or group of municipalities, in the Province of Ontario. This is a most progressive move, in keeping with the advance- ment of the day, and one which reflects much credit on the local authorities of Ontario. The history of medical opinion as to the communi- cability of tuberculosis is somewhat remarkable. Ville- min was ridiculed as to his ideas of infection, but we are ail contagionists now, and Villemin's name stands out as one of the greatest men of his time, true scientist in the widest and most comprehensive sense. Considering the antiquity of the belief of contagious- ness of consumption, it is remarkable the length of time that elapsed before active measures were thought of to stay the progress of the disease. That consumption was contagious was known to Aristotle, who stated that the breath of consumptives was poisonous to those about them. In the second century, Galen announced the same idea, and warned the people that it was dangerous to live intimately with sufferers from consumption. In the fifteenth and sixteenth centuries, Baillon, a cele- brated French physician, and Montano observed the frequency of consumption in those who attended phthis- ical patients. In 1682 the celebrated Morga^i ex- pressed the same opinion. At Nancy, in 1750, the fur- 6 niture of a woman who died of consumption was pub- licly burnt by order of the magistrates. In 1754 the Grand Duke of Tuscany sought council from the Flor- ence College of Physicians as to the infectiousness of consumption, and a legislative enactment for the pre vention of consumption was issued in 1782 by Frederick 1\^^., King of Naples. Thus, in the medical history of Europe we are enabled by records- to trace very marked activity in the line of defense against the infectious character of consumption. The one great source of contagion is the sputum of the consumptive patient, and particularly in its dried state. Fortunately, all those who inhale or ingest tubercle germs do not contract consumption. Much de- pends on a lowered state of the system, rendering it tit soil for its development. The surroundings of the indi- vidual limit greatly the infectious character of this dis- ease. Much of the immunity from consumption de- pends on the care, prudence, and v.atchfulness exercis^ed to promote a healthy state of the system, and to counter- act any disposition toward a lowering of normal vitality, by careful observation and action, both as to external conditions or surroundings and the internal workings of the system, the very fortifications set up by nature to guide, direct, and preserve health. AH interested in tuberculosis should be alive to the fact that it is a preventable disease, and as a most de- sirable precaution against its spread, those laboring un- der the disease should use a metal sputum cup, which, with contents, can be thoroughly boiled, and thus act against infection. Strict quarantine should be exer- cised against the importation of foreign consumptives. Connecticut Medical Society Report, 1899, states: "Every building where large gatherings frequent be- comes a source of danger, unless precautions are used, for where can a large gathering be found that some con- sumptive does not frequent ? Theaters, churches, school- rooms, with vitiated air and packed doors, our homes where consumptives live, the mill, the office, the sleep- ing car, hotels and cottages, in all health resorts where consumptives congregate, and even the public telephone and drinking cup, may become sources of infection." Ship-owners should be careful that berths holding several passengers should not have even one of these ii \l consumptivps. Once our people are aroused to the fact that thousands die annually who might have been saved by preventable means, then timely care will be taken, and the necessary measures carried out, to reduce the death-rate to the smallest margin possible. As to the medical treatment, the opinion now prevails that we have no specific for consumption. Dr. Boding- ton, of Sutton Coldfield, England, was the first to ad- vocate the o])en-air treatment of consumption, and in this line of action Dr. Henry Bennet, Edinburgh, advo- cated vigorously the open-air treatment in the Riviera. To th' fresh-air life, liberal feeding was added, the free adn»..Jstration of cod-liver oil, and in this, Hughs- Bennct was quite noted. The Adirondack cottage sanatorium for the treatment of incipient pulmonary tuberculosis, under Dr. Trudeau, has accomplished much good and practical work. In round numbers, the result from all sanatorium treatmont is estimated at about one-third cured of those who re- mained a reasonable term, from three to nine months ; and what can be more satisfactory than the fact that absolute cures do occur? Marked increased activity is evident b^ the congresses held in various parts of the world. Last year Berlin had a most successful meeting, at which Canada was represented by Dr. Farrel, of Halifax, to whom we are indebted for an excellent report. This ye&\ Naples has done likewise, and next year a congress will be held in Tjondon, under the presidency of H. R. H. the Prince of Wales. If we inquire into the practical outcome so far, we will find that many able speeches have been delivered, much enthusiasm excited, resolutions passed, associa- tions formed, and the state called on to provide the requisite machinery for carrying out the necessary san- itary measures. Lord Salisbury in 1898 said: "You must be content with preaching the salutary doctrine you hold, and must not think of applying it with the secular arm." So now, in England, the protection of the people, in these matters of health, actually rests with the municipal and local authorities. In Italy, fortunately, matters are somewhat different. Professor Baccelli, who is also an authority, as statesman and scientist, and as president of the Congress at Naples, an- 8 nouncjed that the Italian government prepared a law concerning the prophylaxis of infectious diseases, in which tuberculosis figures conspicuously. Persuasion alone is not sufficient, but compulsion must be used. W.e shall look forward with much interest to the out- come of this progressive measure, under the guidance of so eminent an authority. The education of our people in methods necessary to counteract the spread of tuber- culosis would assist materially all other efforts in the same direction Efforts should be made by the school, the church, the councils, and in every way possible, to inform the masses as to the vast moment of this serious malady, and as to the manner in which their united co- t peration would prove of service. Tuberculosis has become a really national disease, and is widely spread. The Provincial Bureau of Public Health doubtless will have an increased appropriation and additional special experts on this disease, that every means should be taken to stay the progress of tubercu- losis, without which our efforts would be futile and the results anything but satisfactory. A central bureau of health can not be thoroughly equipped without a chemical and bacteriological labora- tory. Such are indispensible in the present advanced state of science. The Dominion of Canada indicates a vigorous and healthy growth in this direction. Meetings like the present tend to strengthen and develop the power of public opinion ih aid of the cause of science, and we trust that by jur'^'cious enterprise and intelligent energy the practical result will be that the soil and bacilli of tuberculosis will rapidly disappear. 150 Elgin Street. Ottawa. CHICAGO AvmicAN Mbmcal Association Phebs 1900