I intended, at an earlier stage in preparing for tonight, to review the history of public health in Manitoba, review its present state, and to predict its future. However, I might paraphrase George Bernard Shaw who excused himself for writing such a long letter by stating that he did not have time to write a short one. I did not have time to prepare a short talk on the past, present, and future of public health. Instead, I will "browse" through public health in Manitoba with particular emphasis on earlier days.

One excellent source of such information will not surprise you. It was an article entitled The Development of Public Health in Manitoba published in 1934 by Dr. Ross Mitchell.

Annual reports from the City of Winnipeg Health Department are available from 1908, and some earlier figures are quoted in these. In August, 1908, the American Public Health Association met in Winnipeg, no doubt at the instigation of Manitoba's first full-time Health Officer, Dr. A.J. Douglas of the City of Winnipeg Health Department. Numerous papers given at that Convention appeared in subsequent issues of the American journal of Public Hygiene.

I am going to quo te some statistics from these early reports, but as the population was continually growing, I have calculated the rates and applied these to the 1966 Canadian census figures for Greater Winnipeg -508,759. This, I think, gives us a more realistic impact of these illnesses on the community.

We all know that the most striking changes are in the reduction of infant deaths and in the deaths from communicable diseases. The 628 infant deaths of 1910 would mean 2,400 infant deaths in Winnipeg last year, 200 a month! Infant deaths accounted for 35% of all deaths, compared to 6% today. 30% of these were due to acute gastrointestinal disease, 18% prematurity and congenital defects, and 8% acute infection diseases.

Now I shall refer to a few specific conditions.

Tuberculosis was the greatest killer of those days. By 1909 standards we would expect 626 deaths this year instead of 27 in all of Manitoba in 1967. In his 1910 report Dr. Douglas noted an eventful year:

"The past year has been one of very marked progress in the fight against tuberculosis. Of prime importance has been the opening of the Provincial Sanatorium for incipient cases at Ninette. This excellent institution has been filled with patients from the very beginning up to the present time. So great has been the demand for admission there that the authorities cannot pick and choose their cases as they would desire to, and many patients have to be taken in who are in the advanced stages of the disease and who are more or less unsuitable for sanatorium treatment.

" It should be possible to obviate some of this difficulty when the City gets its new hospital for advanced cases .........."

Dr. Douglas went on to describe the notification from the Winnipeg General Hospital, discontinuing the admission of such cases to the "old hospital on Emily Street" and the prompt action of the City in erecting a 35bed hospital in Riverview which would soon be opened as a temporary facility until the new $75,000 hospital was completed.

It was recognized that milk spread tuberculosis and other infection diseases, and yet in 1908 only 12% of the milk sold in Winnipeg was pasteurized. Only the Crescent Creamery Company and the Agricultural College pasteurized milk. Cows were tuberculin tested on a voluntary basis only. 70% of the few tested were positive and no compensation was offered for condemned cattle. Manitoba is now free of bovine tuberculosis.

Scarlet Fever, too, was a great killer. We would have experienced 356 deaths in Metro alone, compared to two deaths in all of Canada in 1966. Dr. Douglas reported that the cause was unknown. Actually, 3,480 cases were reported, but this would be equivalent to 13,300 cases today. So many cases required hospital care that a temporary hospital was set up in the "old main building" at the Exhibition grounds. The City supplied the building and paid expenses, and the General Hospital supplied nurses and attending staff. The building was destroyed by fire on October 18th, 1908, within 1/2 an hour but fortunately, all patients were removed in safety. This event in part lead to the subsequent construction of the King George Hospital.

Typhoid Fever was one of the worst scourges of the Red River. Dr. R.M. Simpson, Chairman of the Provincial Board of Health, and Dr. Douglas prepared a joint paper on Typhoid for the 1908 meeting of the American Public Health Association, and Dr. J.S. Pierce, assisted by Dr. D.A. Stewart (interne) reported on a study of 4,605 typhoid cases admitted to the Winnipeg General Hospital between 1882 and 1908.

Dr. Simpson attributed to Dr. O'Donnell a description of Red River Fever in 1870 and its similarity to typhoid. Dr. O'Donnell reported that it was more common in newcomers, and Drs. Pierce and Stewart confirmed that 30% of cases had been in the country less than a year, and 49% less than two years.

1905 was the worst typhoid year. The 1906 cases would be 12,100 today! And 248 deaths would be 1,575 in Winnipeg! We had one death from typhoid in all Canada in 1966. The average hospital stay was said to be 37.8 days. 25% of all cases occurred in September, and this was consistent every year. By doing a little arithmetic we could calculate that as 25% occurred in September the average daily occupancy would be 3,811 cases in that month. Imagine the impact of this on our present 3,986 beds!

As the water supply was good, spread was attributed to pit privies and flies. Vigorous campaigns were begun to extend water and sewerage lines and to encourage screening and other fly-control measures. The 1910 report tabulated 1,352 existing privies, with Elmwood leading the parade with 538! This classical program of education and sanitation, largely in the hands of non-medical persons, is an example of the role of engineers, inspectors, and the community in general, in disease eradication and the saving of lives. The virtual disappearance of typhoid deaths is not due to immunization, or improved treatment, but to the true primary prevention of disease.

We could also expect 58 deaths from Whooping Cough, (non in 1967) and 88 from Diphtheria (3 in Manitoba, 1966.) Antitoxin was supplied free. Dr. Douglas lamented "As in other years, most of the fatalities occurred in children under five years of age, and nearly always in those whose ailment had been either unrecognized or untreated so long that they were practically in extremis when proper curative measures were resorted to." He felt that practically all cases could have lived with early and adequate antidiphtheria serum.

Smallpox was not a common cause of death after vaccination was made compulsory in 1876. Annual reports of 1893 and 1894 indicated one death each year, and none in 1895. In 1908 Winnipeg had 50 cases (215 in today's population) but no deaths. Two-thirds of the cases occurred in January. Dr. Irving Cleghorn, part-time Medical Officer of Health at Baldur, reported in 1908:

"I might briefly describe one instance in which I had an outbreak of smallpox, principally among halfbreeds in the Rock Lake District ... On my first visit of inspection I found ten cases in seven homes, and inside the next nine days, fourteen more developed... making twenty-four in all.
"The district covered an area of 8 square miles, containing 11 infected homes, and necessitating a drive of ten to eighteen miles for me on each visit.

" I vaccinated all those exposed and immediately place the whole settlement under quarantine.

" At the close I personally supervised the cleansing and disinfecting of all homes ... result -one death, with no further outbreak."

The old reports speak of poor housing, overcrowding, air pollution and some indication in the change of thought in the references to "foreigners", and an item in Winnipeg's 1908 report states:

" The prosecutions for light-weight bread total 27, mostly amongst Jewish bakers, who frequently try to take advantage by cutting weights."

In 1910 it was reported: "There is not as yet any modern fullyequipped lodging house for these foreignborn laborers, such as the Men's Own and Coffee House, provided for English speaking men of the same class."

Dr. Ross Mitchell, in 1934, reported that The Public Health Act of 1893 had 41 pages and 124 clauses, and was revised in 1911 to 118 pages and 443 clauses! Today we have failed to progress as you might have predicted. We have 17 pages and 46 clauses.

As to costs of public health, the earliest report which I came across was 1929 when costs were $273,260. Today the same services cost $6,916,000.

Finally, I thought you would be interested in a quote from a report of a study on health services made for the provincial legislature in 1932:

"The last fifteen years has been a diminution of the number of men practising in rural Manitoba. One factor as the cause of this, of course, is that transportation is better, automobiles are in general use, and a great many rural people... go to the nearest city and hospital for treatment. As a result the general practitioner in the country is often only called in cases of emergency, and this has the further tendency of keeping well trained medical men in the cities.

"A survey of the medical men practising in the country shows that there are very few recent graduates that are taking up this work. If they do, it is only for experience before specializing."

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*President 1967-68 of the Winnipeg Medical Society.

"Address to Winnipeg Medical Society annual meeting, April 22, 1968

Reprinted from Manitoba Medical Review February 1969

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