R. G. Ferguson

Following his graduation Dr. Ferguson was appointed Assistant Medical Superintendent, Acute Infection Hospital, Winnipeg. From here he went to the Fort Qu'Appelle Sanatorium intending to stay for six months. He remained for 31 years. He was a skilled administrator with a knowledge of economics and the ability to analyze the dire challenge presented by rampant TB infection in the community. Native populations were particularly susceptible. In 1917 the Province of Saskatchewan had the nation's highest incidence of tuberculosis with a rate of 50 cases per 100,000 population.[4] Dr. Ferguson saw quickly that the only way to deal with this situation was to provide diagnosis, treatment and hospitalization at no cost to the patient. This was a huge political challenge. Dr. Ferguson persisted in his efforts, working patiently to gain support from TB sufferers, the public, members of the medical profession, and, last but not least, politicians. As one of three members appointed by the Provincial Government to form the Saskatchewan Anti-Tuberculosis Commission in 1921 he wrote the entire report.[5] Nineteen of its 22 recommendations were implemented. Chief among them was making the cost of diagnosis and treatment of TB a public responsibility. Upon Ferguson's death in 1964 then Saskatchewan Minister of Health Minister Allan Blakeney said, "The introduction of diagnosis and treatment of tuberculosis at public expense was one of the early and essential steps in developing a program of health services for all."[6]

In October 1928 Ferguson gave a landmark presentation entitled Tuberculosis Among the Indians of the Great Canadian Plains[7] at the 14th Annual Conference of the National Association for the Prevention of Tuberculosis at British Medical House, London. It established him as an international authority on TB. Later on the same trip he attended the Council of the International Union Against TB (CIUA) where the double barred cross of Lorena was adopted as a symbol of the worldwide fight against TB.[8] A further achievement in 1928 was integration of the native population into the sanitorium. Saskatchewan, under Ferguson's guidance, was the first province by eight years to fully integrate the native population into sanatoria. Previously they were segregated.

Ferguson found an ally in incoming Premier James G. Gardiner, and on 1 January 1929 the Saskatchewan Sanatoria & Hospitals Act was passed. Saskatchewan became the first province in Canada to make tuberculosis treatment free to all who needed it.

At the time Dr. Ferguson began his career at Fort Qu'Appelle, BCG vaccination was, controversial. This grew to a fever pitch in 1929 when 270 infants in Lubeck Germany were vaccinated with a vaccine which was supposedly BCG but which turned out to be virulent tubercle bacillus. Seventy seven children died of tuberculosis. The idea of introducing live tubercle into the human body was considered dubious from perspectives of both health and morality. However, the reality in 1926 was that natives were ten times more likely than non-natives to die from tuberculosis. And the risk of BCG vaccination was theoretical; not proven. Dr. Ferguson felt it was justified. He was so convinced of the value of BCG vaccination that to prove its safety he vaccinated his own children, before vaccinating anyone else.[9]

In 1932 Ferguson received approval to begin BCG vaccination of newborn infants in the Fort Qu'Appelle Health Unit, and an increase in his annual National Research Council (NRC) grant for BCG research which, remarkably, was renewed for 21 consecutive years. In collaboration with Austin Simes, a former classmate now working with native populations nearby, Ferguson embarked on a long-term studies of families of equal status with respect to living, social and economic conditions likely to impact health outcomes. In spite of some questions concerning "randomization", the Panel on Tuberculosis of the NRC Associate Committee on Medical Research recognized Ferguson's and Simes's study as "the most scientific trial of BCG yet made".

In 1937 the Ministry of Indian Affairs introduced drastic funding cuts to medical care. Ferguson considered Indian Residential schools to be the battleground in the fight against tuberculosis and sent an angry letter to the Minister protesting the cuts and warning the Government that some of the worst conditions were to be found in the Prime Minister's own riding of Duck Lake, Saskatchewan. He advocated for the conversion of Residential schools into TB sanitoria. Ferguson later wrote a private letter to the President of the National Research Council,

"I feel it would be unwise to initiate human experimental work among Indian children who are direct wards of the Government, and for which reason they are not in a position to exercise voluntary cooperation. Furthermore in case of difficulties arising the Government itself, could not be without responsibility."

The funding was not only restored but increased, however, the request to convert a Residential school into a TB hospital was ignored leaving students with active TB in Residential schools wards of the government.

Ferguson's study also demonstrated, for the first time, that due to the number of deaths among vaccinated infants which were not related to tuberculosis, " poverty, not tuberculosis, was the greatest threat to Native infants."

RG Ferguson and wife Helen with six of their seven children outside the family cottage on Echo Lake in the Qu`Àppelle Valley July 1940. Clockwise from RGF, Margaret, Robert, Sheelagh, David, Patricia, Honey.

Statistics alone provide evidence of Dr. R.G. Ferguson's lasting impact on the fight against tuberculosis. In 1917 the Province of Saskatchewan recorded a rate of incidence of 50 per 100,000 of population. The death rate for Saskatchewan's First Nations infants in their first year was even more appalling: in 1936 it was still 1,603 per 100,000. By 1948, the year Ferguson retired, the death rate was down to 17 per 100,000. These impressive numbers are the result of Ferguson's two-pronged attack. First, he established access to free diagnosis and treatment, and second, he established BCG as a safe and effective vaccination.[9]

Statistics alone, however, do not measure Ferguson's full influence on public health policy. He charted a course that would not only guide the direction of treatment of tuberculosis, but that would inspire health coverage plans across the country for generations. In 1935, one of his contemporaries Dr. Norman Bethune, who himself had contracted tuberculosis, attempted unsuccessfully to organize a Montreal Group and extend this concept and introduce a free health care system across Canada.[3]

On his retirement in 1948, the person voted through the English language branch of the Canadian Broadcasting Corporation to be "the Greatest Canadian", T.C. Tommy Douglas, who had been both Premier and Minister of Public Health from 1944–48, said of Ferguson:

“Not before in the history of this province has there been such a universal expression of regard for one man. Few men have the opportunity in their lifetime to give such service as Dr Ferguson has to his generation and to his age. Still fewer would be so successful in rising to the opportunity.”[10]

Paradoxically, Ferguson's legacy was articulated as early as 1917 in his speech on the opening of the Fort Qu'Appelle Sanitorium:

"When we think of the future of this institution we do not think of its building and equipment, but rather of an idea, a force, a group of associations and a locality with its hopeful traditions, glowing with prestige and confidence in the cure of the disease. We would like to think of it as a medical centre, where is available every facility for the diagnosis and treatment of tuberculosis, where a sick man may get every chance to regain his broken health and return to a sphere of usefulness as a citizen. We want it to be an educational centre where the facts about a disease are being accumulated for public use; a centre where sufferers may come to get an education in regard to a disease, may learn its cure and prevention. Last of all, we want it to have the atmosphere of a home where those who have fallen ill with the disease may come to rest and receive the encouragement and direction necessary to win a hard fight."[11]

Dr. R.G. Ferguson, Sept 1948, Dr. JM Uhrich, Dr. RG Ferguson, Premier TC Douglas, Dr. F. Munroe, All Ministers of Health during Dr. Ferguson's career.

It is testimony to his vision and tenacity that he achieved exactly what he set out to achieve.