Mr. CRERAR:

I have not the dental service for Assiniboine and Qu'Appelle renerves. I gave it a moment ago for Broadview. I can have that information also supplied to my hon. friend, if he so desires.

Mr. PERLEY:

I should like to have it. In respect to the hospital at Fort Qu'Appelle, I understand that good work is being done there in respect to tuberculosis cases gathered from all the reserves within a hundred miles or so; they are handling all the carrier cases, I understand. How many patients are there in the hospital at the present time? Is the present accommodation sufficient for the patients who are there or who should be taken there from the different reserves? Further, is there any likelihood of an extension or additional wing being built to accommodate the patients who should be taken care of?

Mr. CRERAR:

No; extension of the

hospital at Fort Qu'Appelle has not received consideration. I am not at the moment very familiar with the question. The average number of patients per day is 66. The number of days' treatment in the hospital in 1938-39 was 24,372. I hope the committee will understand what is meant by that. For instance, for one patient in the hospital it would mean 24,372 days; for two patients 12,186 days. In my judgment this hospital is one of the most efficiently operated that we have .in the whole Indian service.

Mr. PERLEY:

How many are on the hospital staff in addition to Doctor Simes?

Mr. CRERAR:

I believe there are six nurses and a matron.

A question was asked by the hon. member for Fraser Valley (Mr. Barber) regarding dental services in British Columbia. In the fiscal year 1938-39 Doctor F. E. King, of Vancouver, for work at St. Mary's residential school mission, was paid $183, and at St. George's residential school at Lytton, $131.25. As far as the department is aware, there is no practising dentist at Lytton. Doctor A. R. Baker of Vancouver, for individual extractions for Indians at Vancouver, was paid $25.50. Otherwise all dental work in 1938-39 was done by dentists living in the districts in which it was required.

Mr. BARBER:

At Mission City, near St. Mary's school, there are two dentists, and also up in the district near Coqualeetza there are several. But the work has been done, I understand, by Doctor King, who travels from Vancouver to Lytton. So that the local dentists throughout the district are not getting the work except in cases of emergency, when they do it in many cases for nothing.

(Mr. Perley.]

Mr. CRERAR:

I do not know the total cost of dental work for the Indians in the districts mentioned by my hon. friend.

Mr. BARBER:

They were very small.

Mr. CRERAR:

At any rate the total amount drawn by Doctor King was S314.25.

Mr. MacINNIS:

Is there any increase in the vote this year for preventive work in relation to the incidence of tuberculosis among the Indians? It is very heavy, and, I believe, increasing.

Mr. CRERAR:

We expect to be able to appropriate out of the total vote about $75,000 more than last year.

Mr. MacINNIS:

I believe British Columbia is the province which has been most affected so far as tuberculosis among the Indians is concerned. At the last session of the provincial legislature the matter was discussed under the estimates for the health branch. Doctor J. D. Hunter, one of the members of the legislative assembly representing the city of Victoria, stated that there were 2,600 cases of tuberculosis among the 24,600 Indians in British Columbia, which is more than one out of every ten. Because of lack of money the provincial health branch is restricted in its activity, and the $60,000 provided by the provincial branch for health work among the Indians was considered by Doctor Hunter to be, as he termed it, a mere fleabite, in dealing with the whole problem. Hon. G. M. Weir, the provincial secretary, agreed with Doctor Hunter that the situation was exceedingly serious, Doctor Hunter made the further statement that the large amount of tuberculosis among the Indians made it more difficult to deal with that disease among the white population. I think it was generally conceded that until tuberculosis in the Indian reserve was got under control it would not be possible to reduce the death rate from that disease among the whites.

I have before me the votes and proceedings of the legislature of British Columbia for November 21, 1938, in which are recorded two questions and answers. The questions were asked by Mr. Winch, member of the legislature for the constituency of Burnaby. The first of the questions was as follows:

1. What arrangements, if any, have been made between the dominion Department of Indian Affairs and the provincial Department of Health relative to the treatment of Indians suffering from tuberculosis?

The answer is fairly long; I shall not take the trouble to read it, but it gives a summary of the arrangements made between the federal

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Department of Indian Affairs and the provincial health branch. The second question was:

2. Do such arrangements assure to the Indian population tile same degree of tuberculosis control-i.e., examinations, treatment, hospitalization, follow-up and preventive service

as is furnished by the provincial government to the white population?

The answer given by the provincial secretary was just one word-an emphatic "no." In the matter of health the Indian population, who are wards of the dominion government, should receive at least the same care as the rest of the population.

In the votes and proceedings of the legislature of British Columbia for October 31, 1938, I find a question on the same subject asked by the same gentleman, Mr. Winch, and replied to by the provincial secretary. The question was:

What was the death rate from tuberculosis during the fiscal years 1936, 1937 and 1938 for whites, Indians and orientals, respectively?

To that question this startling reply, so far as it affects the Indians, -was given:

Tuberculosis mortality rates per*100,000 population, fiscal year 1935-36: whites, 54*5;

orientals, 124-4; Indians, 648-4.

Mr. MASSEY:

Is that for the whole of Canada?

Mr. MacINNIS:

No, just British Columbia. In some provinces it is a little worse and in others it is much better. The reply continues to give the figures for the other years:

Fiscal year 1936-37: whites, 49-5; orientals, 110-7; Indians, 826-3.

Hon. members will notice that while for orientals and whites the death rate has fallen, among the Indian population there has been a considerable increase. The figures continue:

Fiscal year 1937-38: whites, 45-8; orientals, 119-9; Indians, 885-7.

There is a further increase in the Indian population. Something should be done to deal more effectively with what is evidently a very serious state of affairs.

I have in my hand the bulletin of the Canadian Tuberculosis Association for the month of December, 1938, in which there is a report of a conference which took place in Ottawa about January 1, 1939. On this occasion the subject of tuberculosis among Indians was considered. Part of the report is as follows:

Attention was drawn to the very wide variation in the proportion of patients treated

in the different provinces. Taking the number of patients treated in proportion to the number of deaths during 1937, they are as follows:-

That is, treatment for tuberculosis and deaths from tuberculosis.

Province Death from tuber- Number of patients under treat-Nova Scotia.. .. culosis, 1937 .. 14 ment, 1938 5New Brunswick .. .. 10 18Quebec.. - . . 47 27Ontario .. 116 73Manitoba .. 164 56Saskatchewan.. .. .. 90 93Alberta .. 136 43British Columbia.. .. 228 58

Saskatchewan has the best record of any Canadian province. It will be noticed that in Nova Scotia, which has only a small Indian population, and in Manitoba and Alberta, for every patient receiving treatment there have been three deaths. In British Columbia the situation is still worse; for every patient receiving treatment there have been four deaths. The report continues:

This shows that treatment of Indians is particularly lagging in British Columbia, Alberta and Manitoba. The committee in their memorandum suggested that this should be overcome by treating an additional 200 Indians, for which provision could be made to some extent in the general hospitals. It was the conviction of t'he committee that construction of beds for the treatment of tuberculous Indians should be carried out particularly in British Columbia and Alberta and that additional funds would be required to provide a minimum program that could hope to be effective.

It was suggested also that every attempt should be made to provide supervision and segregation on the reserves, and that a demonstration should be made of one or more reserves as to the practicability of treating cases in small buildings for this purpose on the reserves.

Suggestions were also made regarding the pupils to be admitted to spreaders' schools.

The value of prompt admission of patients to sanatoria when diagnosed was pointed out, as otherwise they are apt to be lost track of and the advantages of early diagnosis wasted, while the disease continues to spread.

What I have read indicates a serious state of affairs, and the department should take immediate steps to cope with this menace. As long as we have a high incidence of tuberculosis among our Indian population it will be that much more difficult to eradicate the disease among the white population. I believe the minister realizes the seriousness of the situation. The increase of $75,000 is encouraging, but if we had a greater increase immediately, the amount required in future years would be much less. The disease is contagious and carried from person to person. I have heard of many reports, which I have not investigated, of the bad economic conditions that prevail on the reserves. The extent

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to which tuberculosis is found among the Indians is an indication of these conditions. As everyone knows, the disease develops because of lowered resistance from insufficient nutrition. I urge upon the minister that he take active steps to deal with this matter, the urgency of which is admitted.

Mr. CRERAR:

I agree with what the hon. member for Vancouver East (Mr. Maclnnis) has said about the seriousness of tlje tuberculosis problem among the Indians. Until a few years ago no special effort was made to cope with this problem so far as our Indian population was concerned, but in 1937 I was successful in getting a small vote passed by the house w'hich permitted surveys to be made of several schools. The surveys indicated that many of the Indian pupils were afflicted with tuberculosis. In the following year the amount was increased to $250,000 or $275,000. The expenditure of that money was carried out most carefully. We had the advantage of the advice of the provincial authorities who have to do with the tuberculosis problem. One of the most outstanding men to-day in this field of medical work is Doctor Ferguson, general superintendent of sanatoria in Saskatchewan. The late Doctor Stewart of Manitoba was also an outstanding authority, and I may say that much of the encouragement, indeed the inspiration of the department in attacking this problem, was received from him.

It is most gratifying to hear commendation of this vote and the suggestion that it should be much larger. I should have liked to see it much larger, but the present discussion indicates the way of human progress. Four or five years ago it would have been a rare occasion indeed to hear any request, either in this house or in a provincial legislature, that appropriations be made to meet the tuberculosis problem among the Indians. I think public opinion is definitely fixed in connection with this matter. First, there is the humanitarian point of view. As the hon. member for Vancouver East has said, the Indian is the ward of the state and the state has an obligation not only with respect to health but with respect to other matters. Then there is the second and perhaps more practical reason, that efforts to clear up tuberculous infection among the white population was to a large measure nullified by the infection among the Indians. It wTas found that infection was being spread from the reserves to the whites in the adjoining districts. I remember the eloquent speech which the hon. member for Renfrew South (Mr. McCann) (Mr. Maclnnis.]

made two years ago when this first small vote was under consideration. I should like to see the vote increased and the work expanded. Perhaps some think we have proceeded rather slowly, but we want to be certain that we are working along the right lines.

As I have stated, the initial vote was expended upon survej's of the schools, carried out in cooperation with the tuberculosis clinics in the different provinces. I should like to pay a tribute to the provincial authorities for the splendid cooperation they gave and are giving in connection with the surveys of the schools, and indeed the whole problem. Last year surveys were made of a few reserves in order to obtain information as to the degree of infection on the reserves. As a result of consideration given to the matter by the medical men concerned, we are establishing a small tuberculosis hospital at a place called Fisher Branch in Manitoba. We shall be able, when we get the results from this hospital, to check the costs and the success of the treatment against the treatment of patients, for instance, in the sanatoria of the various provinces. It is a problem which has interested me greatly, and I am delighted to see the interest which has been aroused in it throughout the country. I am also very grateful to the medical profession for the assistance which it has given to the department practically throughout the whole dominion.

Mr. MacINNIS:

I wish to thank the minister for his very encouraging words. The department of health in British Columbia made an extensive survey in 1936-37, probably with the assistance received from the federal government, and it was ascertained that many Indians on the reserve had died without receiving any treatment whatsoever.

I have in my hand a bulletin of the Canadian Tuberculosis Association for the month of December, 1938, which contains a short table giving the tuberculosis deaths for the whole of Canada and the death rates from the disease amongst the Indians in the various provinces in 1936-37. I should be very glad to put this on the record for the information of hon. members, if I might be allowed to do so. The death rate among the Indians shows an alarming state of affairs, as the minister says.

The CHAIRMAN:

By unanimous consent.

Carried.

Mr. MacINNIS:

Thank you, Mr. Chairman. The tables follow:

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Tuberculosis Deaths in Canada, 1936-1937

Canada

Prince Edward Island.. ..

Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

Rate per

Total deaths 100 ,0001936 1937 1936 19376,763 6,650 61-4 59'961 65 66-3 69-9485 457 90-3 84-3357 383 82-0 87-02,890 2,769 93-3 88'31,327 1,315 36 35-4420 426 59-0 59-4279 296 29-9 31-5382 339 49-4 43-6562 600 74-9 79-9

Deaths exclusive Rate exclusive

of Indians of Indians

1936 1937 1936 19376,015 5,845 55 53-160 65 65 69-9478 443 89 82-2348 373 80 85-12,847 2,722 92 87-11,217 1,199 33 32-5259 262 37 37-3205 206 22 22-2224 203 29 26-6377 372 52 51-1

Deaths and Death Rates for Indians, 1936-1937

Population

Deaths population 1931 census1936 1937 1936 1937 Prince Edward Island 233Nova Scotia 14 350 700 2,191New Brunswick 10 500 625 1,685Quebec

Ontario 47 349 382 12,312110 366 386 30,368Manitoba 164 1,045 1,066 15,417Saskatchewan

74 90 496 600 15,268Alberta 136 1,073 906 15,258British Columbia

185 228 755 930 24,599Canada 805 639 688 117,331