Throughout the 19th century, tuberculosis – also called phthisis or consumption or TB – was a leading cause of death in the industrialized world. Treatments at this time focused on bed rest, a nourishing diet, and fresh air. Canada’s first tuberculosis hospital was the Muskoka Cottage Sanatorium, opened in 1897 at Gravenhurst, a location chosen for its clear air.

The Muskoka Free Hospital for Consumptives was built on the same site in 1902, the first free tuberculosis hospital in the world. These centres were dedicated to assisting people in the early stages of lung disease; more advanced cases were refused or sent home. Patients spent 10 to 12 hours of each day in the open air, regardless of the weather.

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Interior view of Kendall Pavilion of the Muskoka Cottage Sanatorium, showing arrangement of glass front. Illustration from The Muskoka Cottage Sanatorium [pamphlet], [ca. 1928]
National Sanitarium Association fonds
Reference Code: F 1369-2-0-2, MU 2772
Archives of Ontario

Illustration from the Sixth Annual Report of the National Sanitarium Association for 1902-1903
National Sanitarium Association fonds
Reference Code: F 1369-1-0-1, MU 2772
Archives of Ontario

The Provincial Board of Health carried out a concerted public awareness and prevention campaign against tuberculosis, producing and distributing printed pamphlets, lectures, displays and travelling exhibitions. The picture below shows a travelling exhibit in a railway car.

Tuberculosis Exhibit in a railway car, [ca. 1905]
Public Health Nursing photographs
Reference Code: RG 10-30-2, 3.05.1
Archives of Ontario, I0005199

The Provincial Board of Health also sponsored a 1921 silent film entitled “Her Own Fault”, in which “the girl who fails in life’s struggle” meets her downfall because of poor diet, late hours, and a penchant for fashion sales. She is soon hospitalized with tuberculosis, while her opposite, “the girl who succeeds,” is promoted to forewoman at the factory.

The pamphlets below, produced by the Canadian Tuberculosis Association, informed the public about many aspects of the disease.

Pamphlets published by the Canadian Tuberculosis Association, [ca. 1940-1944]
Scrapbook re mass x-ray surveys 1944
Reference Code: RG 10-145-2-2
Archives of Ontario

As well as public awareness and prevention, the other direction of the government attack on tuberculosis was to identify carriers of the disease and stop its spread. In 1923 a travelling chest clinic surveyed school and pre-school aged children in Dundas-West Flamborough to find cases of tuberculosis and collect chest disease data.

Staff at the Tuberculosis Clinic, Hamilton
Department of Health, 1919 (detail)
Public Health Nursing Branch
Black and white print
Reference Code: RG 10-30-2, 1.13.7
Archives of Ontario, I0005272

Two men viewing a chest x-ray at a Board of Health laboratory, [ca. 1928]
Public Health Nursing photographs
Reference Code: RG 10-30-2, 1.4.27
Archives of Ontario, I0005238

In subsequent years other groups were targeted, including miners, psychiatric hospital patients and nurses, Native Peoples, immigrants, and convicts, as the government intensified efforts to collect information. Chest clinics were established in Ottawa, Belleville, North Bay, Toronto, and Timmins – eventually 23 places in all.

Video clip of high school students visiting
a chest x-ray clinic, Toronto, 1946
Jarvis [Collegiate Institute] dental and TB services
Walter Moorhouse fonds
Reference Code: C 231-18-0-8
Archives of Ontario

A Division of Tuberculosis Prevention was created in the Ontario Department of Health in 1934, and the programs to monitor and control the spread of tuberculosis were increased.

An important element in these efforts included the Tuberculosis Case Register, which was a sophisticated paper-based information system, with colour-coded forms, index cards, tabs, and other administrative tools to systematically collect, organize, analyze, and document comprehensive data about cases of tuberculosis in the province.

The local Boards of Health were the keepers of the tuberculosis case registers, which correlated information from family physicians, sanatoria, hospitals, clinics, laboratories and public health nurses about each case in their area. Special standardized forms were to be used for each reporting process and very specific instructions were provided for completing them.

Summary information from the register was sent to the Division of Tuberculosis Prevention and the Provincial Medical Officer of Health. Public health nurses visited each case and maintained files on the family and other contacts. This system allowed the tracking of all cases so they could be treated and followed-up, and also identified contacts for testing and treatment where necessary.

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Filing systems recommended by the Division of Tuberculosis Prevention in their publication "The Organization and Maintenance of a Tuberculosis Case Register", 1945
Tuberculosis Reports
Reference Code: RG 10-97-0-25
Archives of Ontario

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Tuberculosis mortality rate by county, 1945-1947, as shown in the report Tuberculosis
Control in Ontario as of March 1948, prepared by the Division of Tuberculosis
Prevention for the Department of National Health & Welfare
Tuberculosis Reports
Reference Code: RG 10-97-0-25
Archives of Ontario

Ontario Department of Health Mobile
Tuberculosis Testing Clinic, [ca. 1955]
Ministry of Health
Black and white print
Reference Code: RG 10-145
Archives of Ontario, I0005211

Ontario Department of Health Mobile
Tuberculosis Clinic on a bus, [ca. 1960]
Ministry of Health
Black and white print
Reference Code: RG 10-145
Archives of Ontario, I0005212

The Division also encouraged and supported communities in providing free mass x-ray surveys of their entire population. It published a detailed instructional report on how to organize the survey, with sections on publicity, door-to-door canvassing to obtain appointments, operation and set-up of the x-ray space, and of course, samples of the necessary forms and paperwork. The mass surveys aimed to reach 82 percent of the people in an area, and it was estimated that 800 people could be x-rayed in a day with one x-ray machine, to be borrowed from the Division.

The first Ontario community to provide mass x-rays was Timmins in 1944, closely followed by South Porcupine and Schumacher. The Mayor of Timmins was the first person x-rayed.

Scrapbook re mass x-ray surveys
Reference Code: RG 10-145-2-2
Archives of Ontario

Being found free of TB was a point of pride to be used to commercial advantage.

Newspaper advertisement, Timmins, 1944
Scrapbook re mass x-ray surveys
Reference Code: RG 10-145-2-2
Archives of Ontario

Native Peoples had a high incidence of tuberculosis. The Ontario government assisted the federal Indian Department by surveying Treaty Indians. Monitoring and treating cases of tuberculosis in Native Peoples was complicated by administrative issues such as the differences between the handling of cases in Treaty versus non-Treaty Native Peoples and the difficulty for some individuals in remote locations to return for repeat check-ups.

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Letter from the Medical Superintendent
of the Fort William Sanatorium chest
clinic to a doctor in Port Arthur, 1940
Fort William Sanatorium patient case files
Reference Code: RG 10-96
Archives of Ontario

The Division mapped and charted the progress of the disease, displaying the falling death rate with pride.

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The decline in Tuberculosis mortality 1900-1970, as shown
in the report The Epidemiology of Tuberculosis in Ontario (prepared from the Tuberculosis Register by the Chronic Disease Section Epidemiology Service), 1970
Tuberculosis reports
Reference Code: RG 10-97-0-9
Archives of Ontario

Ontario’s tuberculosis mortality rate decreased steadily, down from 160 per 100,000 population in 1900 to 0.6 per 100,000 in 1980. The introduction of antibiotics and generally higher standards of living led to a dramatic drop after the second world war. However, the government’s implementation of systematic programs to prevent, control, and monitor tuberculosis was also significant. By finding facts and documenting them in standardized formats that could be organized and analyzed and followed up, the government records proved an effective weapon in the war on tuberculosis.

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