Sickness in the 19th century
Illness, sickness, and sanitary conditions were very different when the house of industry and refuge was built, and went through different changes during the houses lifetime.
Prior to the British North America act of 1867 which established the Dominion of Canada, health care was limited and provided locally, often in response to epidemics such as cholera, smallpox or typhoid.  Though public health reforms were developed in Britain under the poor laws, there was no equivalent in Canada. The constitution act of 1867 declared that provinces were responsible for establishing, maintaining and managing hospitals, asylums, charities and charitable institutions. The first Public Health Act was passed in 1873, Ontario’s first board of health was established in 1882, and in 1884 the province appointed its first medical officer of health. By 1886 there were 400 boards of health in operation throughout the province.  the “Bacteriological revolution” of the 1880s brought Understandings of the nature of diseases and their origin and transmission. This sparkef in the needs for public health, and the realization communities could do something to prevent the spread of disease. 
Various scholars, physicians and community members in Ontario advocated for what was known as “Sanitary reform”. Their main goals were to build waste management systems and to reduce the impact of infectious diseases in Canada. This knowledge specifically uncovered vile sanitary conditions among institutions that housed those suffering from mental distress, as well as sanitary conditions among the dwellings of the poor in urban centres.
Among these scholars was the writer Edward Playter, a physician from Toronto. As with many during the sanitary movement, he had come to realize that medicine was more than just prevention of sickness, and also included the promotion of health. In the 1876 edition of Edward Playters “The Sanitary Journal”, .an article was published entitled “A Description of the Pestilent Condition Of The Toronto Lunatic Asylum In 1853, And The Means Adopted To Remove It.”. The article addresses a cholera outbreak that took place at the Toronto Lunatic Asylum in 1853, and the actions taken by medical superintendents and the board of directors at the asylum to determine the cause of this outbreak. Doctor Playter points out that their analysis of the air being clean and odourless did not determine the underlying problem of the houses uncleanliness. The building was further examined and a “discovery of the most foul and enormous cess-pool that perhaps ever existed under any large building” was made in the basement of the building. It is concluded that these conditions are resulting from poor contracting of the building, and a lack of connection of the basement drains to the main sewer. As well, a lack of free circulation of air beneath the floors and in the basement contributed to these “pestilent” conditions. Changes were made to the building, removing the waste, fixing the drainage systems, and improving ventilation, and the health of the inmates improved greatly. As is concluded in the article, after these changes were made the “Perforating dysentries, intractable diarrhoeas, and the whole typhoid family of deadly complications, ceased to perplex the medical staff”.
Publications of The Sanitary Journal can be read on Canadiana online, here
Another sanitary journalist in Montreal, Doctor J. T. Reid, discussed the effects of lack of sanitation among poor populations. In his 1898 writing “ The Physical Sufferings of the Poor Viewed From a Sociological and Sanitary standpoint”, Doctor Reid addresses the harm of overcrowding in city centres, correlating this overcrowding to bad conditions of health . He states that lack of ventilation and lack of purification of water contribute to the insanitary conditions faced by the poor in these city centre. It is identified that “there is often scanty clothing, improper and insufficient food, together with debilitating anxieties and worries which are the concomitants of poverty…the general health of the living is much impaired, and that the death rate is much higher than that of those in more fortunate circumstances”. Doctor Reid challenges the idea that insanity or mental illness is often wrongly attributed to alcohol usage, he rather argues that the “chief increase of insanity has been amongst the poor”. Reid presents a comparison in London in 1896 where the increase of “pauper lunatics” is by 700 in one year, compared to no increase in “private lunatics”  . The full writings of Doctor J.T. Reid are available on Canadiana online, here
Immigration was believed to be a main cause of illness in Canada, the increase of immigration to canada from other countries bringing both assumed and legitimate concerns for disease. The increase of the cholera epidemic in Canada, mainly from Irish immigrants, produced a belief that there was a link between immigration and disease, and that immigrants were contributing to “uncleanliness” . This is discussed in relevance to the Waterloo house of Industry and refuge in the Waterloo County Minutes in 1870, where the physicians report recommends “considerable discretion”  when admitting emigrants or those not from the waterloo county to the poorhouse, discussing an emigrant who contracted disease on ship to Canada and potentially bringing this to the poorhouse.
Sickness at the Waterloo House of Industry and Refuge
In 1886, in the Waterloo Township, the council found it “expedient and necessary” to set up a board of health. The bylaws of the township began to set forward standards of cleanliness for farmers, food vendors, keepers of hotels and restaurants, as well as procedures in case of infectious disease . In 1894, Dr. HG Roberts, medical officer of health, reported above-average cases of typhoid fever, dysentery and diarrhoea throughout the township. There was an outbreak of typhoid fever in the Bloomingdale area in 1895, where over two dozen victims were in the hospital within a week  .
The Waterloo House of Industry and Refuge housed many individuals due to sickness and illness. A rough extrapolation of the logbook shows approximately 170 inmates housed for “sickness” and 65 for “illness”. Of those who died from sickness or illness at the poorhouse, it was very common for inmates to die from “consumption” or tuberculosis, from “Dropsy” now referred to as edema, and from paralysis.
Hospitals established in the 19th century often treated those of the poor or lower class, the middle class preferring to be treated by their personal physicians in their home. It is argued by Shortt that at the time, hospitals were instruments of social control, which not only rescued the physical health but the moral character of those who were accessing them  . The Berlin-Waterloo Hospital was opened on July 12, 1895, with 50 beds available for patients. Before the opening of the Berlin-Waterloo hospital, people at the House of Industry and refuge who were sick were sometimes tended to by the keepers, by visiting doctors or nurses, or sent to the Galt Hospital. The East Wing of the house of industry and refuge had specific rooms set up as hospital wards. The first inmate to be sent the Berlin Waterloo Hospital was Mary Brown in September 1895. Mary was a mother of 4 year old Oliver brown, and was pregnant at the time. She gave birth to her second Son Walter Brown at the hospital. Oliver was sent to the Mennonite Orphanage, and Walter was either sent to an orphanage or adopted out. You can read Mary’s full story here (link)
In 1871 a Pestilence house, referred to as the Pest House, was built on the property of the House of Industry and Refuge, “immediately North East from the Orchard”. The Pest House served as an isolation hospital for treatment of inmates with contagious diseases. Richard Sharpe and his children are an example of inmates who were housed at the pest house, due to being infected by small pox as listed in the register. You can read their story here. The pest house is the only structure from the House of Industry and Refuge that remains today, and is currently a residential home in Kitchener
There was one physician assigned to the house to care for the sick at the house, who received a salary of $200 yearly, which increased to $300 in 1920, $500 yearly in 1926, and then $600 Yearly in 1931. There were five different Physicians who worked at the house, Dr. John Walden, Dr. Joeseph Webb, Dr. Henry Lackner, Dr. J. H Harvey , Dr. A.T. Lurner
A yearly physicians report regarding the House of Industry was made to the Waterloo County, and was recorded in the county’s annual reports. These reports compounded the rates of those treated for illness at the house, and made recommendations on the sanitary conditions at the home. The report also summarized if there were any epidemics of the house. The reports were scattered over the years of 1870-1884, and appeared to cease after 1884, where the last full report was written by Dr. H. G. Lackner. In the first 1870 report, Dr. J. Walden reported visiting the house 96 times over the course of the year, and reported that out of the 158 inmates in the house, 78 were receiving treatment. Dr. Waldens later reports, in 1877- 1879, discussed the admittance of those to Lunatic assylums, and often reported that the average age of death was above “four score and twenty years”, which was the average age reported in the bible (70.) The average age of death for these years varied from 76 to 78. Dr. Walden often lamented in his reports “there is an increasing tendency to pervert our usefulness into that usually to be found in a lying-in hospital” and would deter those in the county from sending sick people to the poorhouse. The committee minutes in 1880 discuss a charge held against Dr. Walden for the alleged neglect of an Inmate by the name of James Milligan. James was admitted to the poorhouse on September 31 1880, listed as “sick and intemperance” and stayed there for 10 days until discharged. In 1881, Dr. Walden was asked to resign by the standing committee, as discussed in a letter by Israel Bowman
“Between you and I, poor Walden was quietly asked to hand in his resignation at the Meeting of Committee on the 7th inst – poor fellow. he came to the meeting in such a state that the Committee was fairly compelled to take the action they did – of course the understanding is outside that the resignation was voluntary on his part.” (Letterbook March 16th 1881)
The Minutes of the standing committee report that Dr. Walden submitted his letter of resignation, which was accepted on March 15th 1881 by the committee. Dr. Joseph Webb was then appointed in a temporary position in his place, and was later replaced by Dr. Henry Lackner.
In his time as physician, Dr. Lackner submitted two published physicians reports in 1883 and 1884. In 1883, Dr. Lackner reports that “I may state that although various epidemics of contagious diseases have been prevailing throughout the county, as well as in the adjacent town of berlin, with the combined work of the inspector, keeper and matron, we have been able to keep epidemics from our door by the strictest attention to the sanitary conditions, as far as available, as well as to the scrupulous cleanly condition in which the premises have been kept” (County Minutes 1883 pg. 44)
In 1884, Dr. Lackner reports an abnormal number of falls taking place in the house, stating
“One man named Conrad Long was admitted with a comminuted fracture of the leg in May, After his leg was completely cured and he considered himself able to regain a livelihood he returned thanks by absconding from the house in November. One Female inmate fell and fractured two of her ribs, but she has also fully recovered.” (County Minutes 1884 pg 39)
He also reiterates the need for those in the county to admit sick people to local hospitals, rather than poorhouses. This 1884 entry was the last Physicians Report published in the county minutes.
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