By far the most exciting – and anticipated – part of my job this summer as a research assistant at the Laurier Centre for the Study of Canada was working in an archive for the first time. Most history majors during their undergraduate studies encounter primary sources only in curated, post-production, digitized formats, such as sourcebooks and databases, as the classroom offers few opportunities to handle these documents themselves. Thus, having the opportunity to digitize the medical records of tuberculosis patients, collected in the early years of the National Sanitarium Association, was quite special.

Established in 1896 to build hospitals for tuberculosis patients (known as sanatoria) and to spearhead a public health campaign against the disease, the National Sanitarium Association was at the forefront of preventive measures against the disease in English Canada in the early twentieth century.[1] Over the next several decades of providing care to individuals afflicted with tuberculosis, the organization produced thousands of patient documents that serve as a rich textual record of daily life within each of the institutions it supported. In sifting through boxes blanketed in dust to digitize a seemingly endless stream of files, I was moved by the stories that I could piece together. Parts of the individual patient experience shone through, rather than the anonymized, unknowable, silent victims of tuberculosis that we commonly encounter in histories of the disease. Interwoven between stories of personal tragedy and hardship, anecdotes left behind by doctors and sometimes patients on scraps of paper reveal endearing, light-hearted fragments of daily life. These documents also provide clues to these patients’ lives before their admission to the sanatorium, including place of birth, occupation, and, in some cases, their immigration to Canada.

Disease rarely fits into the public memory or national mythology of immigration histories in Canada. The simplified stories told to me in elementary and secondary school described long voyages aboard steamships, interactions with immigration agents, and travel by rail to their final destinations. Beyond the financial strain it placed on less affluent newcomers, these stories hardly revealed the true precarity of their journeys. Only this summer was I first exposed to the public health measures that coincided with, and often overshadowed, their journeys to Canada. Though this may have been only a brief passage in the primary sources, it speaks to many of the public’s contemporary anxieties towards newcomers.

Concerns over immigration and disease in Canada were not entirely new by the turn of the twentieth century. Throughout the previous century, across British North America and later the Dominion of Canada, quarantine stations like Grosse Île in Québec and others along the east and west coasts were established to mitigate the risk of disease transmission to the public from sick travellers.[2] By 1902, Canadian authorities had implemented mandatory medical examinations to screen all immigrants for physical ailments before entry into Canada.[3] Regardless of how rigorous the Dominion’s efforts may have been to mitigate the potential hazards of epidemics and the threat to Canadian communities, these institutional policies had limits. As historian David Monteyne notes, the coastal quarantine stations established by the Canadian government could only monitor passengers for physical symptoms for the duration of their internment.[4]

But what of those who had not displayed symptoms before their entrance into the Dominion? Many of the key initial indicators of tuberculosis, like weight loss, appeared benign to medical observers at ports and piers before more serious symptoms manifested.[5] It was in this context that many of the patient files I found related to immigrants admitted to a sanatorium following their entrance into Canada. In some of these files, I found fragments of correspondence between the staff of National Sanitarium Association hospitals and immigration agents regarding these individuals.

One file that caught my eye was that of John B., a young Scottish man in his twenties, who was admitted to the Toronto Free Hospital for Consumptives in 1921.[6] As I reached the final pages of his medical file, interspersed with medical charts and examination papers, was information regarding his immigration status in Canada. Alongside a notice of deportation were several letters between the chief physician, W.J. Dobbie, and immigration agents, inquiring about the young man’s condition and whether he had contracted the disease before he arrived in Canada.[7]

The fate of John following his discharge from the hospital is uncertain. Those removed from institutions by immigration officials were often taken to their port of arrival and held in detention hospitals until a return voyage could be secured in accordance with Canadian law.[8] Much of his last days in the country would most likely have been spent in a British section of the detention infirmary in pier buildings like those in Quebec City or Halifax, constructed during and immediately following the First World War.[9] However, beyond the records of the Department of Immigration and Colonization, it would be impossible to glean this information from the documents present.

While the details of this young man’s story are unique, the framework behind Dominion officials’ inquiries into the patients of the National Sanitarium Association appears to reflect the experiences of immigrant tuberculosis patients at these institutions. In another instance, Peter Z., a Ukrainian man in his twenties, was admitted to the Toronto sanatorium in 1916, only a few years after entering the Dominion.[10] Over the course of the next decade, he was repeatedly reported to immigration officials by the staff of the hospital to have him deported. Suffering from tuberculosis of the knee and hip joints, he would remain at the institution until 1929 before taking “French leave” without notice.[11]

What initially drew my eye to Peter’s file was a typewritten letter from Dobbie to the Department of Immigration and Colonization, dated when Peter attempted to apply for naturalization in 1926.[12] Dobbie sharply criticized the seemingly lax approach of immigration agents in allowing him to stay in the country and of the department’s ineptitude during the war years.[13] These letters also contain many of the prejudices of the sanatorium staff, including contemporary ideas about immigration, foreigners and race, blurring the lines between compassionate care and perceived societal obligations. This is evident in Dobbie’s repeated appeals to immigration officials to relieve the public of the responsibility for funding Peter’s care by advocating for his deportation.[14] In this case, the staff of the Toronto Free Hospital for Consumptives may have taken it upon themselves to screen for immigrants with tuberculosis who had escaped initial detection upon their arrival to Canada.

Following the First World War, immigration came under renewed public ire. Primarily, the criticism of the arrival of sick immigrants into the country seemed to reinforce the belief that other nations had used the Dominion as a repository for their undesirable citizens.[15] Based on the tone of many notes in the archives, it appears that much of this sentiment was shared by the Toronto sanatorium staff, who viewed patients’ inability to work as a public burden. While the motive behind Peter’s departure is lost to time, the tone of many letters in his file suggests that the staff’s animosity did not remain confined to confidential notes.[16] Consequently, these prejudices against him as a seemingly unproductive immigrant may have been among the many factors that influenced his decision to leave.

For many Canadian histories of migration, Canada is often viewed as the “final destination,” even though for some, it was only a temporary stop. This was the case for Issac Y., a Chinese student admitted to the Toronto sanatorium with an unspecified type of tuberculosis around 1921, roughly three years following his entrance into Canada.[17] Much of the textual record left behind included a note from a staff member to Dobbie, informing him of the man’s intention to return to China.[18] Given the sparse record, it is not known where Issac had been studying previously or for what his training was preparing him. However, his stay in Canada aligns with broader developments in Chinese intellectual culture during the Republican period (1912-1949). During this period, there was renewed interest in social and political reform, prompting some to travel and study abroad in hopes of returning home to join the political and technological elites of the fledgling Republic of China.[19]

Regardless of his motivations for leaving China, his experience of arriving in Canada, aside from the medical examination, would undoubtedly have been vastly different from that of the patients previously discussed. Since 1903, the Chinese Immigration Act levied a head tax of $500 for each individual arriving from China.[20] Much like other Chinese immigrants, Issac would have been issued a “Chinese Immigration 5” document upon paying the tax, which served as proof of payment and recorded his picture and personal information for identification.[21] However, given the difficulties of tracing his movements following his discharge from the institution, many questions remain unanswered. Why did he choose to return to China given his tuberculosis diagnosis? What happened to him once he returned home? Who, ultimately, was Isaac Y.? While the answers to many of these questions will likely never be known, these lines of inquiry truly encapsulate the unknowns of working in an archival setting.

Of course, there are many more stories in the National Sanitarium Association fonds than just the three noted here. However, it becomes clear that the collective narrative of immigration to Canada during the twentieth century hardly captures their complexities. Despite those with pre-existing cases of tuberculosis comprising a fraction of the total number of immigrants arriving in Canada during this time, these documents are important in understanding these individuals not as mere vectors of disease, but as people.

While the voices of these historical actors may be lost to time, their records reveal the diversity of sanatoria, with individuals from all walks and at all stages of life, from across the world. Furthermore, these institutions serve as a microcosm of broader demographic and social developments within Canadian society, which include the attitudes of staff and other patients as well as the ideas circulating throughout Canada over disease, disability and the idea of what was a ‘useful immigrant’. Thus, with every patient file opened, new lines of inquiry open as the silences of these histories are slowly pieced together.

Notes

[1] Katherine McCuaig. Weariness, the Fever, and the Fret: The Campaign Against Tuberculosis in Canada, 1900-1950 (McGill-Queen’s University Press, 1999), 8-9.

[2] Mark Osborne Humphries, The Last Plague: Spanish Influenza and the Politics of Public Health in Canada (University of Toronto Press, 2013), 16, 29.

[3] David Monteyne. For the Temporary Accommodation of Settlers: Architecture and Immigrant Reception in Canada, 1870–1930 (McGill-Queen’s University Press, 2021), 204, 207.

[4] David Monteyne, 53.

[5] McCuaig, The Weariness, the Fever, and the Fret, 4-5.

[6] Patient file of John B., 7001, Box 556, Series 9, F-1369, Archives of Ontario.

[7] Patient file of John B., Archives of Ontario.

[8] David Monteyne. For the Temporary Accommodation of Settlers, 210, 216.

[9] Ibid., 222-223.

[10] Patient file of Peter Z., 3962, Box 769, Series 9, F-1369, Archives of Ontario.

[11] Patient file of Peter Z., Archives of Ontario.

[12] Patient file of Peter Z., Archives of Ontario

[13] Patient file of Peter Z., Archives of Ontario.

[14] Ibid., National Sanitarium Association Fonds.

[15] McCuaig, The Weariness, the Fever, and the Fret, 48-49.

[16] Patient File, Peter Z. National Sanitarium Association Fonds.

[17] Patient File of Issac Y., no. 6417, n.d., F-1369, Series 9, box 769, National Sanitarium Association Fonds, Archives of Ontario, York University, North York, Ontario (hereafter cited as Patient File, Issac Y. National Sanitarium Association Fonds).

[18] Patient File, Issac Y. National Sanitarium Association Fonds.

[19] Charlotte Furth, “Intellectual Change: From the Reform Movement to the May Fourth Movement, 1895–1920,” in The Cambridge History of China, eds. John K. Fairbank (Cambridge: Cambridge University Press, 1983), 323.

[20]  Lily Cho, Mass Capture: Chinese Head Tax and the Making of Non-Citizens (McGill-Queen’s University Press, 2021), 6.

[21] Ibid., 17.