A Short History of the National Sanitarium Association (NSA)

The White Plague (An early name for tuberculosis)

TB has been around for a long time. The disease was found in Egyptian mummies between 4,500 and 5,000 years ago and the Roman writer Hippocrates described it about 2,500 years ago. Dispelling the myth that Europeans brought TB to the new world, the disease was found in Peru in the 10th century. TB, a leading cause of mortality in the 1600s, has killed more people than wars or famine.

The first sanitarium opened in Germany in 1854 and the long march to a cure began when German Robert Koch isolated the infectious agent - tubercule bacilli - in 1882. By this time, it was widespread knowledge that TB was preventable, not directly inherited and infectious.

William Gage and the Birth of the NSA

No one knows why William Gage became obsessed with TB and its prevention, treatment and cure. An athletic farm boy who grew up in Brampton, Gage knew many families which had been devastated by the White Plague. In later life, he talked about a local blacksmith who was the only survivor of a family of 14.

Gage ultimately became a successful businessman and the president of W.J. Gage Publishing, the creators of the famous “Dick and Jane” readers. He was knighted for his philanthropic efforts in 1918 and he died in 1921.

For whatever reason, Gage went on a personal crusade to establish the first TB sanitarium in Canada. In 1894, he offered city of Toronto $25,000 to build one but there was no action. At a meeting at The National Club in 1895, those present were determined to find a site.

Interest in this project grew rapidly and culminated in the creation of The National Sanitarium Association in 1896 to collect and administer funds. The president was Sir Donald Smith (Lord Strathcona) and the secretary was William Gage. The newly formed association had two purposes: to build sanitaria and to fund research. It immediately began to raise money for its work.

One of the first donors was Sir William Osler who donated $25 in 1898 saying it would be his annual gift to fight TB. At the same time, his wife raised money to support nurses who visited homes of people with TB - the first home service for the disease in the world.

Canada’s First Sanitarium

Spurred by a $10,000 offer from the town of Gravenhurst, (which was combined with Gage’s initial $25,000), the NSA built Canada’s first sanitarium in Muskoka. The “Muskoka San” was the first in Canada, the second sanitarium in North America and the fourth in the world. In its early days, the sanitarium charged a fee for service but in 1902, the Muskoka Free Hospital for Consumptives opened, the first free hospital in the world.

The Battle in Toronto

The NSA worked constantly to build a sanitarium in Toronto for advanced cases and for education and research. But efforts were met with opposition from local residents. Many myths persisted about TB such as it was a disease of the poor and that it was hereditary.

In 1901, the NSA obtained an option on property near High Park but it was abandoned because of opposition from residents.

Next, they got eight acres near Bathurst and Wychwood (just outside the city limits) but a quick bylaw was passed making it mandatory that the hospital had to be 150 yards from “habitation.”

A third option on property in North Toronto was also abandoned due to the concerns of residents. It was clear that an attempt to build a sanitarium was being met with one of Canada’s first cases of NIMBYism (Not in my backyard).

Fed up with the delays, for the second time Gage put his money where his mouth was and in November 1903 he personally bought the Buttonwood Farm, 16 km north and west of the centre of Toronto. On this property, the NSA established the Toronto Free Hospital for the Consumptive Poor on 40 acres on the Humber River. As was said at the time, the site was perfect because of the “purity of the air”.

The farmhouse on the land became the doctor’s quarters, the patient’s dining room and the chapel. A wing was added to the building for beds.

The NSA handed the operation of the hospital over to a Board of Trustees but, the organizations remained closely attached until 1974 when the NSA transferred the property to the hospital. However, the association remains involved with the current West Park Health Care Centre with two positions on the hospital board and with ownership of the property should it cease to be used as a hospital.

Looking for Money

After founding the Toronto Sanitarium the NSA refocused its attention to raising money. The sanitarium needed private income to supplement government grants from Toronto and Ontario. This came in the form of individual donations and revenue from creative women’s club activities.

In 1904, a Danish postal clerk, Einar Holboell , invented special stamps (or seals) at Christmas time. Like Gage, he was deeply moved by the children who were suffering and he wanted to do something about it. Working in the post office, he thought that people might buy a special stamp if they new the proceeds were going to help suffering children. And he was right!

By 1908, the seals idea had come to Canada and by selling them to their family and friends that year, kids raised $6,000. The money was earmarked for TB.

The seals idea continued to grow and a special campaign undertaken by kids in 1922 and 1923 raised $28,000 for a new school wing at the hospital.

For many years, the NSA was involved in the annual Christmas Seals campaign. At its peak, the campaign raised over $5 million in 1977.

Transition to Research

With the introduction of Streptomycin in 1944, the disease went into dramatic decline. The Muskoka Sanitarium was sold. But new forms of TB continue to crop up and the disease remains a concern. At the forefront of the battle against the new strains of TB is West Park Health Care Centre. This centre, the continuation of the first Toronto Sanitarium, on the Humber River near Jane Street and Lawrence Avenue in northwest Toronto provides a link to the beginning of the NSA in 1896.

In the 1950s, the NSA began to invest in research and in 1974, when the NSA transferred the operation of the hospital to an independent board, investing in research became the NSA’s only activity.

In keeping with its pioneering past, the NSA’s research funding is at the cutting edge of respirology. The association makes large multi-year grants (up to $1 million) for projects making it a significant grantor in the field. Its insistence on funding pioneering work makes it a unique granting agency.





Gale, Godfrey. The Changing Years: The Story of Toronto Hospital and the Fight Against Tuberculosis. University of Toronto Press (for West Park Hospital). Toronto. 1979

Ryan, Frank. The Forgotten Plague. Little Brown. New York. 1992

Wherrett George. The Miracle of the Empty Beds: A History of Tuberculosis in Canada. University of Toronto Press. 1977

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