HISTORY * PROMENADE DANS LE PASSE
Toronto Free Hospital for Consumptive Poor The
Peter Wilton A lthough Toronto's West they were "taking the cure" by Park Hospital is one of getting fresh air. Ontario's finest rehabilitaSir William Gage, the subject tion and chronic care facilities, it of one of the archives' most promhad a much different function in its early years, when it battled the "white plague." In 2 years it will celebrate two significant events: its 90th anniversary - it was built in 1904 to provide care to people with advanced tuberculosis - and the 50th anniversary of streptomycin, the drug that brought the "white plague" - tuberculosis - under control. Although the hospital's 10.9 ha site now carries many signs that it is a rehabilitation, not acute care, facility, it hasn't forgotten its past. It has set aside an archives room to honour the physicians and volunteers who literally risked their lives to help people who were afflicted with a disease that had a 45% mortality rate. The early pictures clearly illustrate the hospital's humble origins; so does its original name, the Toronto Free Hospital for Consumptive Poor. In those early days male patients slept in converted trolleys, while females slept in the renovated farm house that also served as the administration office. The archives is a treasure trove of information and artifacts, containing everything from cornerstones of the early buildings to the croquet set that the patients used when Peter Wilton is a freelance writer living in Willowdale, Ont. 1812
CAN MEDASSOCJ 1992; 146(10)
inent pictures, played a key role in the hospital's founding. His persistence and financial contributions in the 1 890s led to the Archives ofOntario (ACC 14662-28)
TB patient in converted horse-drawn trolley LE 15 MAI 1992
founding of the Sanatorium Association; the first Canadian sanatorium, Ontario's Muskoka Cottage Hospital, opened in 1898. It was geared toward patients in the early stages of tuberculosis, when the disease was believed to be less contagious. Patients were expected to pay for their care. A second sanatorium, the Muskoka Free Hospital, opened in 1902 and accepted patients who could not afford to pay for treatment, but did not admit people suffering from advanced TB. The Sanatorium Association recognized that there was a void to be filled - a Toronto-area sanatorium that could look after chronically ill patients - and the Toronto Free Hospital for Consumptive Poor was opened in 1904. Before its opening, families looked after their own. It was believed that plenty of bed rest and fresh air was the cure for tuberculosis, and throughout Toronto and other communities tents and glass houses were put up in backyards to try to maximize the amount of fresh air patients received. The lack of formal institutional care often meant that several members of a family would contract TB. Sanatoriums helped prevent the spread of the disease by separating the tuberculosis patient from the rest of the community. When sanatoriums were established at the turn of the century, there was an immediate decline in the number of TB cases. From the beginning, the Toronto Hospital for Consumptives - "Poor" was dropped soon after the facility opened - wanted to offer help to the helpless. It accepted children as patients almost immediately - previously, no hospital or institution would accept a child with advanced TB. The hospital kept expanding and the number of patients steadily increased. There was a setback in December 1910 when a fire deMAY 15, 1992
stroyed most of the hospital, but from the ashes rose greater buildings, funded by private citizens and the sanatorium's drive to have the hospital rebuilt. One of the most interesting buildings of the postfire period is the Queen Mary Hospital. Built in 1913, it was designed specifically for children with advanced tuberculosis and was the first facility of its kind in Canada. The archives has pictures of these young patients; often, there would be several children from the same family. The hospital was also unique because of its opening-day celebrations: an elaborate system hooked up via underground and underwater cable allowed the Queen, who was in Buckingham Palace, to press a button that rang a bell to officially open the new hospital. Both the bell and the Queen's button are on display in the archives. The archives has a large display of early surgical tools used to combat tuberculosis. Pneumothorax was one of the most common procedures - doctors believed that an affected lung would improve and the spread of the disease would be slowed with the lung at rest. Between 1917 and the 1950s, thousands of these opera-
tions were performed. Today, there is some doubt that the painful procedure provided any benefit. In 1929, the year that marked the 25th anniversary of the Toronto Hospital for Consumptives, Dr. W.J. Dobby, then physicianin-chief, wrote a candid report on its successes and failures. He reported that there was still a 45% mortality rate; in those first 25 years, only five patients who were discharged were totally free of TB. This was not a reflection on the facility or its staff, but on the disease. For patients, the hospital offered more than just hope for a better life - it also provided sanctuary from a world that was hostile to them. It is easy to understand why Canadians reacted to tuberculosis with absolute terror. At the turn of the century the disease had an annual mortality rate of 200 per 100 000 people. As was the case with plagues of past and present, patients were often blamed for contracting TB. As is the case with AIDS today, many Canadians felt the victims got what they deserved, that they were facing the wrath of God. The public fear of these patients made it difficult for sanatoriums to get Archives of Ontario (ACC 14662-6)
"Taking the cure" at Toronto's Free Hospital for Consumptive Poor CAN MED ASSOC J 1992; 146 (10)
1813
deliveries, or to get rid of garbage: nobody wanted to touch anything relating to tuberculosis patients. This forced the Toronto hospital to become virtually self-sufficient. The patients grew its vegetables in the hospital gardens, and they also ran a large piggery and hen house that not only provided a steady diet of fresh meat and eggs but also a way to get rid of much of the food-related waste. As a result, the Toronto sanatorium became a closed world in which the patients and staff lived, worked and played on the hospital grounds. This provided strong bonding among patients and staff, and many lifelong friendships and marriages developed because of a stay in the sanatorium. The major breakthrough in the treatment of tuberculosis occurred in 1944, with the successful use of streptomycin. This, combined with other drugs that
were used to prevent the patient from developing immunity, became the first truly effective tool in the battle against TB. At the same time, surgical techniques for removing tuberculosis-related scar tissue and lobes began to develop. The Weston Hospital, as the Toronto Hospital for Consumptives was by then known, used these as effective tools; during the 1940s thousands of spinal fusions and lung operations were performed there. The effectiveness of new drugs and surgical techniques soon had an impact. In 1960 the Muskoka Cottage Hospital and the Muskoka Free Hospital, which by then had been combined, were closed and the patients sent to the Weston. By the early 1970s, the number of tuberculosis patients had declined to such a degree that the Sanatorium Act was repealed and the Weston Hospital became a
chronic care facility. New programs were added. The hospital's focus began to switch to the development of artificial limbs and programs for amputees. Eventually, the nursing school was closed and the building became a psychiatric hospital. In 1978, the name was changed to West Park Hospital. Today, it has 29 beds for TB patients and is the only ongoing tuberculosis unit left in Ontario. Many of the beds are occupied by recent immigrants who have arrived from countries where tuberculosis is still a problem. Although the disease can now be treated on an outpatient basis, one type of TB has developed that does not respond to streptomycin. The number of cases of this type of tuberculosis is on the increase. As a result, the white plague cannot be totally dismissed as a disease from another era.m
BECONASE Metered dose aerosol (intranasaf beclomethasone dipropionate) BECONASE Aq Nasal Spray lUP_EW1 b0atnt of pernnia and seaonalaiegc rhinis py reaponive to conveoal treatment. Tb delay recurence of nasal polyps folluing po wctomy. Prevon of incrase in ai of recurrng polyps. U _A1WNUWSUt Paentawth acte or quiscenttubercubos or unteted fungal, bacril, and vira infecions. f In pe_ents pruslon high doses of steic sterods, transr to ECONASE may cas wi smflptom such as trednss, aches and paintand depresion. In se cas, adrnal iffic may occur, ne thetemponyrsumplionofsstecstrolds. Saety of usein prgnancyhas notbeenestablished. Admnistraionof drugsdurlng pregnancy~shoudonlybeconsideredithemexptdbenellttothemother isgrerthuaypabletskhut
PUITIOUt Replaing ae1c serod wfth BECONASE has to be gradual and caully supervid. Guidelines under "Admiristration" shoud be olowed. Coticosterds may maksokmsdgns of infon and new uno 4ermtherw. plteadrenalfuncionandhemtoogcalstshoulbp assd. ink~nemayq~peaD.e sed_c oetolnbeclnonhasbeenobrddudngcoSerodthe hesanenhn doftef mandt mw f ds.ho. d bcus ncojuncionwiFcorddin *__. toinbrm onp~hntswF ueutlys ansof profr coeid use. DurngBECOMASEthrapy, theposslilyof atrophicrhnitsand/orpharya candidiasisshoulbe eptin mind. Fluorocabn pronts maybebhaeousifdeberatey oofaerosolsprashasbght aboutcadi abused. Inhasionof high lartwdcefects, and eendeath, clallyundercondltonsof poxda. Hivr, edenceatteststotheretvsy ofaaemsdsowhen _ 1e h ibseepdmardlsaodamd wihti nasal mucous membn andare onsstent with what one would pect from applng a topical mod to an aleady inflamd memb. Other lese*Uq-ta*flSlmeisie seatoat, cough, headache. dIziness, nausea, leargy, and stomach pains. When patients are transferred to BECONASE from a systemic steroId, allergic condions such as asthma, * w wth no prs tic steid use - WO apions (0lmcg) In each nostrl twice dail Madmum - Adults: 12 appicatonsiday; chdn: 8 appaiosay When used consuitrartly am~teIiS WdSlydpoehod dnota,eedmwd mum WlnndSlyr e ddoseofbecdomethasonedlpr nte (1000mcg). Safeyand efficayof BECM SEin underBtysasof age enjS e e has n tents,mqvbeinsrceto tablinhaaonsatrgulariterwsand not, as wth othernasalsprs,asthyfee. neces. Theyshould w >be dperdsonreur pP niefncSN l" intonoetIcomr inistn edi oppoS enodlandacSaero5c orspMaywhiiinprighognose, with mouth losed. Inthe presence of ccvnasal mucus for2to3dasRprtorBECONAME. Careful atttbeion mutbe nto pat prusly d for crsbnor ue,fat uoea tedr mtaftosreachthuedact0n.In suchaes,uses o prolonejrfpecfodfl ismlooortldhrolwhenbad~dtoBECOKME. Iniiall, BECONAEand theseccoricosterodmbeg~nconomitantly, whilethiedosefthe ktrisgradualdecreased. Usual rate r 1$0Si o(peduvn of wi1 th(Wiindhis (oree n n athnolmSdinmtesfteNgSlrlIsuncise*emoiOn. In childrn overyeagma the teofwtdraoml _ w ofe symic sterd should be sblerapprudst 1Dmg of is lmn dof p is*ridve y8r day under clos superon. I co pew sn I notle, in chlidr..ffwilhdrwal symptome w, the pwrvo dose of the sstemic steroid should beresumd for a week before further and 20 d adults 10 deyshn ery prdnbone(or eeflery decuwaseIsaSSsE ciotaneiropenQ .200do ner BECONASEA -Su_nin amber glasbottb 50 mcg b_ .MIU ME -Med4|enr _eleinp swilheadofvh tite*OanSsV*fl_pewi Snepi4~sflIvedmg$UUsagbeSsrlmethueM*qisWSpq~20thefl Pre*etXnefl Sflfll~uliensudpharmacs onr e. Forad i AqS p 'on cel aIMedical Infrmaton at 1400484051, Monday to Fnday be_lptRsM.U8.t*p.m. EWE ~jflfl. 1.ws Jes W f om B 10w 1St Dseases Ltudy, Data on Fil, Blm Canada lo, May 131. Rensprm'or wWs a aaacE;F..Nlns, PA, l$erpw_ FLE. EOfke J.Cn nt prophltcttntof ragwed[ poflimRdueed . pp iconse Pamdu p MIph Cv nc., Ma1 1. d R 3Mua -', JA f**na Beconasuh uflequutheA$ alaresferwdtrauedrso the t groupof compnIes. 1Canaa Inc. Producteuhhqrtsedblatopl*iraandphernnsteUpo request. (indicated for the tam nt of perennl and seasonal allec rhialis unesponsive to conventional treatment) .
^ . - jb&
.mIITS T S
1
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- : - ~~~~~~~~~~~~~~~~~7
s
E L I E F y RRELIEF,
*J
ONLY L Y YOU U ( NoY O
CAN
C A N
(beclomethasone dipropionate aqueous suspension)
P R E S C R I B E.
Toronto Free Hospital for Consumptive Poor The
Peter Wilton A lthough Toronto's West they were "taking the cure" by Park Hospital is one of getting fresh air. Ontario's finest rehabilitaSir William Gage, the subject tion and chronic care facilities, it of one of the archives' most promhad a much different function in its early years, when it battled the "white plague." In 2 years it will celebrate two significant events: its 90th anniversary - it was built in 1904 to provide care to people with advanced tuberculosis - and the 50th anniversary of streptomycin, the drug that brought the "white plague" - tuberculosis - under control. Although the hospital's 10.9 ha site now carries many signs that it is a rehabilitation, not acute care, facility, it hasn't forgotten its past. It has set aside an archives room to honour the physicians and volunteers who literally risked their lives to help people who were afflicted with a disease that had a 45% mortality rate. The early pictures clearly illustrate the hospital's humble origins; so does its original name, the Toronto Free Hospital for Consumptive Poor. In those early days male patients slept in converted trolleys, while females slept in the renovated farm house that also served as the administration office. The archives is a treasure trove of information and artifacts, containing everything from cornerstones of the early buildings to the croquet set that the patients used when Peter Wilton is a freelance writer living in Willowdale, Ont. 1812
CAN MEDASSOCJ 1992; 146(10)
inent pictures, played a key role in the hospital's founding. His persistence and financial contributions in the 1 890s led to the Archives ofOntario (ACC 14662-28)
TB patient in converted horse-drawn trolley LE 15 MAI 1992
founding of the Sanatorium Association; the first Canadian sanatorium, Ontario's Muskoka Cottage Hospital, opened in 1898. It was geared toward patients in the early stages of tuberculosis, when the disease was believed to be less contagious. Patients were expected to pay for their care. A second sanatorium, the Muskoka Free Hospital, opened in 1902 and accepted patients who could not afford to pay for treatment, but did not admit people suffering from advanced TB. The Sanatorium Association recognized that there was a void to be filled - a Toronto-area sanatorium that could look after chronically ill patients - and the Toronto Free Hospital for Consumptive Poor was opened in 1904. Before its opening, families looked after their own. It was believed that plenty of bed rest and fresh air was the cure for tuberculosis, and throughout Toronto and other communities tents and glass houses were put up in backyards to try to maximize the amount of fresh air patients received. The lack of formal institutional care often meant that several members of a family would contract TB. Sanatoriums helped prevent the spread of the disease by separating the tuberculosis patient from the rest of the community. When sanatoriums were established at the turn of the century, there was an immediate decline in the number of TB cases. From the beginning, the Toronto Hospital for Consumptives - "Poor" was dropped soon after the facility opened - wanted to offer help to the helpless. It accepted children as patients almost immediately - previously, no hospital or institution would accept a child with advanced TB. The hospital kept expanding and the number of patients steadily increased. There was a setback in December 1910 when a fire deMAY 15, 1992
stroyed most of the hospital, but from the ashes rose greater buildings, funded by private citizens and the sanatorium's drive to have the hospital rebuilt. One of the most interesting buildings of the postfire period is the Queen Mary Hospital. Built in 1913, it was designed specifically for children with advanced tuberculosis and was the first facility of its kind in Canada. The archives has pictures of these young patients; often, there would be several children from the same family. The hospital was also unique because of its opening-day celebrations: an elaborate system hooked up via underground and underwater cable allowed the Queen, who was in Buckingham Palace, to press a button that rang a bell to officially open the new hospital. Both the bell and the Queen's button are on display in the archives. The archives has a large display of early surgical tools used to combat tuberculosis. Pneumothorax was one of the most common procedures - doctors believed that an affected lung would improve and the spread of the disease would be slowed with the lung at rest. Between 1917 and the 1950s, thousands of these opera-
tions were performed. Today, there is some doubt that the painful procedure provided any benefit. In 1929, the year that marked the 25th anniversary of the Toronto Hospital for Consumptives, Dr. W.J. Dobby, then physicianin-chief, wrote a candid report on its successes and failures. He reported that there was still a 45% mortality rate; in those first 25 years, only five patients who were discharged were totally free of TB. This was not a reflection on the facility or its staff, but on the disease. For patients, the hospital offered more than just hope for a better life - it also provided sanctuary from a world that was hostile to them. It is easy to understand why Canadians reacted to tuberculosis with absolute terror. At the turn of the century the disease had an annual mortality rate of 200 per 100 000 people. As was the case with plagues of past and present, patients were often blamed for contracting TB. As is the case with AIDS today, many Canadians felt the victims got what they deserved, that they were facing the wrath of God. The public fear of these patients made it difficult for sanatoriums to get Archives of Ontario (ACC 14662-6)
"Taking the cure" at Toronto's Free Hospital for Consumptive Poor CAN MED ASSOC J 1992; 146 (10)
1813
deliveries, or to get rid of garbage: nobody wanted to touch anything relating to tuberculosis patients. This forced the Toronto hospital to become virtually self-sufficient. The patients grew its vegetables in the hospital gardens, and they also ran a large piggery and hen house that not only provided a steady diet of fresh meat and eggs but also a way to get rid of much of the food-related waste. As a result, the Toronto sanatorium became a closed world in which the patients and staff lived, worked and played on the hospital grounds. This provided strong bonding among patients and staff, and many lifelong friendships and marriages developed because of a stay in the sanatorium. The major breakthrough in the treatment of tuberculosis occurred in 1944, with the successful use of streptomycin. This, combined with other drugs that
were used to prevent the patient from developing immunity, became the first truly effective tool in the battle against TB. At the same time, surgical techniques for removing tuberculosis-related scar tissue and lobes began to develop. The Weston Hospital, as the Toronto Hospital for Consumptives was by then known, used these as effective tools; during the 1940s thousands of spinal fusions and lung operations were performed there. The effectiveness of new drugs and surgical techniques soon had an impact. In 1960 the Muskoka Cottage Hospital and the Muskoka Free Hospital, which by then had been combined, were closed and the patients sent to the Weston. By the early 1970s, the number of tuberculosis patients had declined to such a degree that the Sanatorium Act was repealed and the Weston Hospital became a
chronic care facility. New programs were added. The hospital's focus began to switch to the development of artificial limbs and programs for amputees. Eventually, the nursing school was closed and the building became a psychiatric hospital. In 1978, the name was changed to West Park Hospital. Today, it has 29 beds for TB patients and is the only ongoing tuberculosis unit left in Ontario. Many of the beds are occupied by recent immigrants who have arrived from countries where tuberculosis is still a problem. Although the disease can now be treated on an outpatient basis, one type of TB has developed that does not respond to streptomycin. The number of cases of this type of tuberculosis is on the increase. As a result, the white plague cannot be totally dismissed as a disease from another era.m
BECONASE Metered dose aerosol (intranasaf beclomethasone dipropionate) BECONASE Aq Nasal Spray lUP_EW1 b0atnt of pernnia and seaonalaiegc rhinis py reaponive to conveoal treatment. Tb delay recurence of nasal polyps folluing po wctomy. Prevon of incrase in ai of recurrng polyps. U _A1WNUWSUt Paentawth acte or quiscenttubercubos or unteted fungal, bacril, and vira infecions. f In pe_ents pruslon high doses of steic sterods, transr to ECONASE may cas wi smflptom such as trednss, aches and paintand depresion. In se cas, adrnal iffic may occur, ne thetemponyrsumplionofsstecstrolds. Saety of usein prgnancyhas notbeenestablished. Admnistraionof drugsdurlng pregnancy~shoudonlybeconsideredithemexptdbenellttothemother isgrerthuaypabletskhut
PUITIOUt Replaing ae1c serod wfth BECONASE has to be gradual and caully supervid. Guidelines under "Admiristration" shoud be olowed. Coticosterds may maksokmsdgns of infon and new uno 4ermtherw. plteadrenalfuncionandhemtoogcalstshoulbp assd. ink~nemayq~peaD.e sed_c oetolnbeclnonhasbeenobrddudngcoSerodthe hesanenhn doftef mandt mw f ds.ho. d bcus ncojuncionwiFcorddin *__. toinbrm onp~hntswF ueutlys ansof profr coeid use. DurngBECOMASEthrapy, theposslilyof atrophicrhnitsand/orpharya candidiasisshoulbe eptin mind. Fluorocabn pronts maybebhaeousifdeberatey oofaerosolsprashasbght aboutcadi abused. Inhasionof high lartwdcefects, and eendeath, clallyundercondltonsof poxda. Hivr, edenceatteststotheretvsy ofaaemsdsowhen _ 1e h ibseepdmardlsaodamd wihti nasal mucous membn andare onsstent with what one would pect from applng a topical mod to an aleady inflamd memb. Other lese*Uq-ta*flSlmeisie seatoat, cough, headache. dIziness, nausea, leargy, and stomach pains. When patients are transferred to BECONASE from a systemic steroId, allergic condions such as asthma, * w wth no prs tic steid use - WO apions (0lmcg) In each nostrl twice dail Madmum - Adults: 12 appicatonsiday; chdn: 8 appaiosay When used consuitrartly am~teIiS WdSlydpoehod dnota,eedmwd mum WlnndSlyr e ddoseofbecdomethasonedlpr nte (1000mcg). Safeyand efficayof BECM SEin underBtysasof age enjS e e has n tents,mqvbeinsrceto tablinhaaonsatrgulariterwsand not, as wth othernasalsprs,asthyfee. neces. Theyshould w >be dperdsonreur pP niefncSN l" intonoetIcomr inistn edi oppoS enodlandacSaero5c orspMaywhiiinprighognose, with mouth losed. Inthe presence of ccvnasal mucus for2to3dasRprtorBECONAME. Careful atttbeion mutbe nto pat prusly d for crsbnor ue,fat uoea tedr mtaftosreachthuedact0n.In suchaes,uses o prolonejrfpecfodfl ismlooortldhrolwhenbad~dtoBECOKME. Iniiall, BECONAEand theseccoricosterodmbeg~nconomitantly, whilethiedosefthe ktrisgradualdecreased. Usual rate r 1$0Si o(peduvn of wi1 th(Wiindhis (oree n n athnolmSdinmtesfteNgSlrlIsuncise*emoiOn. In childrn overyeagma the teofwtdraoml _ w ofe symic sterd should be sblerapprudst 1Dmg of is lmn dof p is*ridve y8r day under clos superon. I co pew sn I notle, in chlidr..ffwilhdrwal symptome w, the pwrvo dose of the sstemic steroid should beresumd for a week before further and 20 d adults 10 deyshn ery prdnbone(or eeflery decuwaseIsaSSsE ciotaneiropenQ .200do ner BECONASEA -Su_nin amber glasbottb 50 mcg b_ .MIU ME -Med4|enr _eleinp swilheadofvh tite*OanSsV*fl_pewi Snepi4~sflIvedmg$UUsagbeSsrlmethueM*qisWSpq~20thefl Pre*etXnefl Sflfll~uliensudpharmacs onr e. Forad i AqS p 'on cel aIMedical Infrmaton at 1400484051, Monday to Fnday be_lptRsM.U8.t*p.m. EWE ~jflfl. 1.ws Jes W f om B 10w 1St Dseases Ltudy, Data on Fil, Blm Canada lo, May 131. Rensprm'or wWs a aaacE;F..Nlns, PA, l$erpw_ FLE. EOfke J.Cn nt prophltcttntof ragwed[ poflimRdueed . pp iconse Pamdu p MIph Cv nc., Ma1 1. d R 3Mua -', JA f**na Beconasuh uflequutheA$ alaresferwdtrauedrso the t groupof compnIes. 1Canaa Inc. Producteuhhqrtsedblatopl*iraandphernnsteUpo request. (indicated for the tam nt of perennl and seasonal allec rhialis unesponsive to conventional treatment) .
^ . - jb&
.mIITS T S
1
-il
- : - ~~~~~~~~~~~~~~~~~7
s
E L I E F y RRELIEF,
*J
ONLY L Y YOU U ( NoY O
CAN
C A N
(beclomethasone dipropionate aqueous suspension)
P R E S C R I B E.
