The shadow within the shadow

By land or by sea

In the spring of 1866 the “cholera” steamship, SS England, left Queenstown on the southern tip of Ireland, bound for New York with a full complement of immigrants, mostly German and Irish. The SS England was new and fast and her specifications complied with the ventilation and space-per-passenger requirements dictated by the Shipping Act. When she departed Ireland her passengers had clean bills of health, and there were no reported cases of cholera in Great Britain at the time. Despite these positive predictors, a virulent epidemic of cholera swept through the passenger section of the ship during her transatlantic passage. There were 40 deaths at sea, and the crew was so incapacitated that the captain believed the ship could not proceed to New York. Halifax, NS, was the nearest port.

The SS England was placed under quarantine off McNab’s Island in the mouth of Halifax Harbour where an understaffed, temporary quarantine station was set up. Several days later, Dr Tupper, Premier and Medical Health Officer of Halifax, was called in to see a sick girl on a thought-to-be unrelated matter. She lived with her parents in a cottage close to the harbour. Upon questioning, Dr Tupper discovered that the mother had beachcombed a piece of fine canvas several days earlier and had made a petticoat out of it for her daughter. A short time later the daughter had become ill. Dr Tupper suspected cholera.

He returned to the City Hospital (later the Victoria General Hospital), had an isolation ward prepared, then drove the horse-drawn ambulance back to the cottage where he picked up the child and her parents.1 Mother and daughter later died in the isolation ward; the father survived. Dr Tupper surmised what would later be proven: the agent that caused cholera could be spread via infected material from those with the disease and that this same agent could survive in cold water. His inference resulted in the orders he gave in his dual capacity as Medical Health Officer and Premier of the province. Those who died in quarantine on McNab’s Island were to be buried there—no one was to be buried in the harbour. The following was written by Dr Tupper to Dr Charles Gossip on April 25, 1866. Dr Gossip became the quarantine officer on McNab’s Island when his predecessor, Dr John Slayter, died of cholera during the epidemic:

I am further directed to again call your attention to the necessity that exists for the greatest care in enforcing the destruction of all bedding and clothing as there is strong reason to believe that cholera has already been communicated to this city by infected clothing floating to the shore. Complaints are coming from Herring Cove, Dartmouth and all quarters on this matter in relation to which much excitement exists. It is fully believed that the bedding from the Hulk Pyramus has been thrown into the Harbour within the past two or three days and if pestilence is thus extended, I need not tell you a fearful responsibility will rest upon those who have permitted such an act to take place. It is also said that clothing and bedding is now lying around the beach on the Island. Do not fail to exercise the utmost vigilance and energy in this matter.

Your friend, C. Tupper2

As a result of these forceful public health measures, Halifax was spared any further deaths during the cholera quarantine.

Ahead of all games

Was Dr Tupper ahead of his colleagues in his management of infectious disease?

Contagion and non-contagion were the 2 contemporary theories concerning the spread of disease. Those who subscribed to the contagion theory believed that disease was spread from person to person and that transmission could be airborne. When sick people were closely confined, the air would become virulent. The non-contagionists believed that disease was spread by “noxious effluvia” in the air that produced disease in humans when the conditions were right. Both theories were helpful. The contagion theory resulted in quarantine measures, less crowding, and improved ventilation on immigrant ships. The non-contagion theory led to improved sanitation, including water and sewer management. The scientifically correct explanation, “the germ theory” that Tupper inferred in his observations and actions, was not proven until later in the 19th century, when Dr Koch and others linked specific organisms with specific diseases, incubation periods, and modes of transmission.

Was Charles Tupper well prepared for the practice of medicine?

He began his medical apprenticeship in 1836 at the age of 15, with Dr Benjamin Page of Amherst, NS. The next year he studied at Horton Academy in Wolfville, NS, (not far from Acadia University) and continued his medical apprenticeship with Dr E.B. Harding. Then, in 1840, he began his medical studies at the University of Edinburgh in the United Kingdom, which was considered at the time to be the best medical education in the Western world. Tupper excelled in his medical studies. His Professor of Midwifery, the renowned Dr James Young Simpson, recommended that Tupper receive one of the university’s gold medals for his graduate thesis, “The Mechanisms and Management of Parturition.”3 Dr Tupper was not awarded the gold medal, but recognition from Dr Simpson—the future obstetrician to Queen Victoria and the man who pioneered the use of chloroform during childbirth—was a substantial professional compliment. Upon his return to Amherst in 1843, Dr Tupper established a busy practice, which included a large part of Cumberland County, his future political base.

Medicine within politics

Dr Tupper continued to practise medicine in Halifax despite his substantial political and government responsibilities. He used his political influence to further medical education with his introduction of a resolution in 1863 to found a medical school as part of Dalhousie College. In 1866, he used his position as Premier of Nova Scotia to ensure the public would be protected from events like the recent cholera epidemic by passing an act to update quarantine regulations and giving the government of Nova Scotia authority to purchase a quarantine station in the Port of Halifax.4

Dr Tupper’s move to Ottawa, Ont, did not mark the end of his medical career; he continued to practise medicine in the capital city and later, when he was in opposition, in Toronto. Dr Tupper was keenly interested in providing national standards in medicine and to that end, in 1867, he was elected the founding president of the Canadian Medical Association. To ensure the fledgling association did not founder, he was elected for 2 more successive terms.

Dr Tupper’s political legacy is impressive. As Premier of Nova Scotia he passed the Education Act, which provided the first free, nonsectarian schools supported by direct taxation in British North America. He was one of the Fathers of Confederation and fought a very difficult battle to bring Nova Scotia into the new Dominion. As federal Minister of Railways and Public Works in 1879, he presented a resolution in the House of Commons, proposing development of the Canadian Pacific Railway. He and his colleagues accomplished this vital transportation link, which also symbolized Canada’s dominion from the Atlantic to the Pacific oceans. He was the Canadian High Commissioner to the United Kingdom for 14 years and his political career reached its zenith when he became Canada’s sixth prime minister in 1896.

Sir Charles Tupper had a colonial, national, and international career that was crucial to the creation and development of the Dominion of Canada. His medical career and medical influence, however, were also very impressive—unfortunately, they have been overshadowed by his own great achievements in politics and largely forgotten.