History of Nursing in Pacific Canada

Report of proceedings of the annual convention of the British Columbia Hospitals' Association. British Columbia Hospitals' Association 1926

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Room 109, 510 Dunsmuir Street, Vancouver, B. C. Officers and Executive Committee of the British
Columbia Hospitals' Association for the
Year 1926-27
Honorary President—The Hon. Wm. Sloan, Provincial Secretary, Parliament Buildings, Victoria,  B. C.
Honorary Life Members—Dr.  M.  T.   MacEachern,  American  College  of
Surgeons, 40 East Erie St., Chicago, 111.
J. J. Banfield, 327 Seymour St., Vancouver, B.C.
President—George Haddon, Business Superintendent, Vancouver General
Hospital, Vancouver, B.C.  -
Efcret Vice-President—J. H. McVety, 714 Richards St., Vancouver, B.C.  .
Second Vice-President—R. A. Bethune, Secretary, Royal Inland Hospital,
Kamloops,  B.  C.
Treasurer—Miss   G.   M.   Currie,   R.N.,   Superintendent  North   Vancouver
Hospital, North Vancouver, B.C.
Secretary—E.  S. Withers,  General Manager. Royal  Columbian Hospital,
New Westminster, B.C.
Members of the Executive Committee in addition to the above:
For Vancouver Island—Dr. G. S. Pearce, Superintendent, Provincial
Royal Jubilee Hospital. Victoria, B. C.
For Vancouver—Rev. Father O'Boyle, 646 Richards St., Vancouver,
B.C.
For Coast Mainland—G. S. Marshall, Director, North Vancouver Hospital, North Vancouver, B.  C.
For Fraser Valley—R. L. McCulloch, Chairman, Abbotsford-Sumas-
Matsqui Hospital, Abbotsford, B.C.
For Yale-Cariboo—M. L. Grimmett, Director, Nicola Valley General
Hospital, Merritt, B.C.
For Okanagan—G. Binger, Secretary, Kelowna General Hospital,
Kelowna, B.C.
For Kootenay West—Miss A. McArthur, Superintendent, Kootenay
Lake General Hospital, Nelson, B.C.
For Kootenay East—Mother Nazareth, St. Eugene's Hospital, Cranbrook, B.C.
For Grand Trunk Pacific—J. H. Thompson, Prince Rupert, B.C.
CONVENORS OF STANDING COMMITTEES, AND THEREFORE
MEMBERS OF THE EXECUTrVE COMMITTEE:
"Medical   Affairs—Dr.   F.   C.   Bell,   General   Superintendent,   Vancouver
General Hospital,  Vancouver,  B.C.
Business Affairs—George McGregor,  Director,  F
Hospital, Victoria, B.C.
rovincial
Roya
,1 Jubilee
Nursing Affairs—Miss C.
pital, Duncan, B.C.
Black,
Superintendent,
King's D
aught
ers'
Hos-
Constitution and By-laws-
-G.
E.
Wilson, Central
Building,
Victoria,
B.C.
Municipal Affairs—R.  R.
Vancouver, B.C.
Burns
Director, Vancouver General
—5—■
Hospital.
1 ■ ^mm 1 *Mwmmmmmmmmmmt\nmn*m u i                     ■HBSBB <
Officers, 1925-26
Honorary President—The Hon. Wm. Sloan, Provincial Secretary, Victoria,
B. C.
Honorary Life Member: *—Dr. M. T. MacEachern, Chicago.
President—Dr. G. B. Brown, Nanaimo, B. C.
First Vice-President—George Haddon, Vancouver, B C.
Second Vice-President—H. W. Birch, Prince Rupert, B.C.
Treasurer—J. H. McVety, Vancouver, B.C.
Secretary—E. S. Withers, New Westminster, B.C.
EXECUTIVE  COMMITTEE:
C. E. Wilson, Victoria
Rev. Father O'Boyle, Vancouver.
Miss G. M. Currie, North Vancouver
R, L. McCulloch, Abbotsford
R. A. Bethune, Kamloops
G. Binger, Kelowna
Miss A. McArthur, Nelson
Mother Nazareth, Cranbrook
J. H. Thompson, Prince Rupert
CONVENORS  OP  STANDING  COMMITTEES:
Medical Affairs Dr. F. C. Bell, Vancouver
Business Affairs S. C. Burton, Kamloops
Nursing Affairs Miss Harrison, Prince Rupert
Constitution and By-Laws C. H. O'Halloran, Victoria
Municipal Affairs J. J. Banfield. Vancouver THE CONVENTION
The Ninth Annual Convention of the British Columbia Hospitals'
Association was held in the Auditorium of the Vancouver General Hospital on September 9th, 10th and 11th, 1926.
The following institutions were represented by one or more delegates:
St.  Luke's  Hospital,  Powell River
St. Paul's Hospital, Vancouver
Vernon Jubilee Hospital
West Coast General Hospital, Port Alberni
Lourdes Hospital, Campbell River
Penticton General Hospital
Vancouver General Hospital
Prince George General Hospital
Hazelton General Hospital
Kootenay Lake General Hospital, Nelson
Armstrong General Hospital
St. Eugene Hospital, Cranbrook
St. Mary's Hospital, New Westminster
Hollywood Sanitarium, New Westminster
Bute Street Hospital, Vancouver
Chemainus General Hospital
Chilliwack General Hospital
Cumberland General Hospital
Kelowna General Hospital
King's Daughters' Hospital, Duncan, V.I.
Matsqui-Sumas-Abbotsford  General Hospital
Nanaimo General Hospital
Nicola  Valley  General  Hospital,   Merritt
North Vancouver General Hospital
Provincial Royal  Jubilee  Hospital,  Victoria
Prince Rupert General Hospital
Royal Columbian Hospital, New Westminster
Royal Inland Hospital, Kamloops
Roycroft Private  Hospital, Vancouver
St. Joseph's General Hospital, Comox
St. Jospeh's Hospital, Victoria
The following Women's Auxiliaries were represented:
St. Paul's Hospital, Vancouver
Chilliwack General Hospital
North Vancouver General Hospital
Royal Columbian Hospital, New Westminster
West Coast General Hospital, Port Alberni
Hazelton General Hospital
Matsqui-Sumas-Abbotsford  General  Hospital
Nanaimo General Hospital
Prince George General Hospital
St. Luke's Hospital,  Powell River    .
Vancouver General Hospital
Provincial Royal Jubilee Hospital, Victoria
St. Joseph's Hospital, Victoria
St. Joseph's General Hospital, Comox, V.I.
liiLoixrdes General Hospital, Campbell River The following public and professional bodies were represented:
Provincial Government
British  Columbia  Medical Association
Graduate Nurses' Association of B. C.
City Council, Vancouver
Provincial Fire Department
University of British Columbia
B.  C.  Catholic Hospitals
Saanich Health Centre
MORNING SESSION—Thursday, Sept. 9th
The meeting was called to order at 10.40 a.m. by President Dr. G. B.
Brown. The Chairman stated that a report of proceedings and accompanying bulletins were available at the Registration Desk for all members
who were not already possessed of same and it was resolved that these
minutes be considered as read and adopted.—Carried.
The President made some opening remarks regarding the action of
the Executive in changing the place of the convention from Prince Rupert
to Vancouver. He said that it was a matter which had been given very:
serious thought by the Executive and explained that the reason for the
change was due to the fact that the Programme Committee had found it
impossible to get suitable contributions to the programme at Prince
Rupert, and further that it had been found that so many of the hospitals in the province would be unable to be represented at such a distant
point both as regards time and the money involved. He expressed the
opinion that the executive of the association had done excellent work in
the past year and made a special reference to the amendments to the
hospital legislation that had been made effective at the last session of the
Provincial Legislature. He said that some questions had already been
referred to the arbitration board provided under the Act and that the
executive had attended at Victoria before the arbitration board regarding
the municipal assessment for the care of new-born babies, following
upon which a ruling had been made in favor of the hospitals, and he
also mentioned the fact that the claim of Esquimalt that they should be
immune from the assessment for the care of men in the Garrison had been
supported by the arbitration board.
The Secretary's report was read and adopted.
Sept. 9th, 1926.
To The President and Members of
The British Columbia Hospitals Association,
Mr. Chairman, Ladies and Gentlemen:
In submitting the report of the Secretary for
is little for me to say that will not be dealt with
President and Chairmen of Committees.
Your  Executive   Committee  have  held  seven
year, one in Nanaimo, one in Victoria, and five in Vancouver.
In addition to the incidental correspondence carried on during the
year, circular communicattions have been sent to all hospitals in the Association on the subjects of the 19 25 amendments to the Hospitals Act;
the appointment of a Hospital Inspector, and the proposed pooling of
delegates' travelling expenses.
Miss Harrison of Prince Rupert, who was elected Convener of the
Committee on nursing affairs, resigned from  that position  due to  herj
—8—
the past year
in the report
thereof  the
meetings   during  the!
—I absence in the East, and Miss Gray, of the University of British Columbia,
accepted the position in her stead.
Mr. O'Halloran of Victoria, is unable to attend this convention on
account of business reasons, and Mr. Haddon of Vancouver will report for
the Committee on Constitution and By-laws of which Mr. O'Halloran was
convener.
Doubtless considerable interest will be displayed in the report of Mr.
Banfield for the Committee on Municipal Affairs, and it is interesting
to note that enquiries have been received from other provinces in the
Dominion, who are favorably impressed with the form of legislation now
in effect in British Columbia. Furthermore it is a noteworthy fact that
I am advised that the Union of B. C. Municipalities propose to make no
requests for amendments to hospital legislation for at least another year.
A regular attendant and active worker in this association is unfortunately absent from this convention in the person of Mr. A. P. Glen of
Ladysmith, who is on a tour of England. He carries with him a letter
of introduction to hospital executives in the Old Land, and I have no
doubt that at next year's convention we shall be privileged to reap some
benefit from his experiences.
Respectfully submitted,
E.  S. WITHERS,  Secretary.
The Treasurer's report was read and adopted and satisfaction expressed at the excellent financial statement.  (See page 10).
At this stage of the proceedings Mayor L. D. Taylor arrived and
made an address of welcome to the delegates. He apologized for having
been detained on other business and assured the delegates of a hearty
welcome from the citizens of Vancouver. He said that many conventions
are held from time to time in the City of Vancouver and said that this
convention, in view of the work that it represented was the most
important of them all.
The Rev. Father O'Boyle also welcomed the delegates on behalf
of the B. C. Catholic Hospitals' Association. He expressed the opinion
that the executive had acted wisely in transferring the convention to
Vancouver and suggested that it might be wise if the Association were to
adopt Vancouver as its permanent convention city. He said that he
thought that the proceedings of our conventions were not given sufficient publicity and thought that if more were done along these lines
that we might expect a greater degree of public support and sympathy.
He also urged the delegates to take advantage of the opportunity offered
to attend the Provincial Exhibition at New Westminster.
The President, in reply to the aforesaid addresses of welcome expressed gratitude of the delegates for a kindly reception and in the rest
of his remarks he spoke very well of the generous support that the City
of Vancouver grants to their own General Hospital.
A Resolution Committee was appointed as follows:
Mr.  Binger
Mr. Birch
Mr. McGregor
Mrs. Steele
Mrs. King
Miss Currie
Sister Superior of St. Joseph's, Victoria
Mr. McVety
Mr. Bethune.
The President reserved his appointment of scrutineers.
A Nomination Committee was appointed as follows:
Mr. McGregor
Mrs. Brown
Mr. Carrington.
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> CONFERENCE OF WOMEN'S AUXILIARIES
Mrs. Sehl of the W. A. of St. Joseph's Hospital, Victoria, was appointed to act as chairman.
Mrs. McCuaig of Campbell River spoke of the work of her Auxiliary
and said that they had been organized since 1922 and since that time
had raised the sum of $3255.00, which was spent for the purpose of providing linens, equipment for operating room, etc.
On behalf of Mrs. Steele of the W. A. of St. Paul's Hospital, Vancouver, Mrs.  Wilkes reported as  follows:
Mr. President, Ladies and Gentlemen:
I beg to submit the following report of the activities of the St.
Paul's Hospital Ladies' Auxiliary, and in doing so I will incorporate the
report of the year's work which was read at our annual meeting this
year.
We meet every Tuesday afternoon throughout the year, from two
to five o'clock. Our work for the past few years consists chiefly in reclaiming the used gauze, which has been sterilized, as by doing so we
save the hospital from twenty to twenty-five dollars each week, according
to the size of the basket.
We also serve tea to the members and at this hour we usually form
a committee of the whole and discuss ways and means of serving the
hospital in the most helpful way. At these discussions Sister Superior
generally comes in to visit us, and by her helpful advice and suggestions
we find out in what way we can be most helpful. We always enjoy this
pleasant social  intercourse.
In addition to the activities noted in the annual report, the auxiliary
takes up a collection for Christmas cheer for the poor who are under
the care of the Sisters.
Respectfully submitted,
(Mrs.)  C. J. WILKES.
ANNUAL  REPORT  LADIES'   AID   OF  ST.   PAUL'S  HOSPITAL
FROM APRIL 15th, 1925, TO MARCH 30th, 1926
Officers for the year:
Mrs. I. Mostyn, President
Mrs. J. A. Bourque, Vice-President
Mrs. J. F. Burns, Secretary
Mrs. M. Gill, Convener of Work
Mrs. P. Bunyan, Convener of Refreshments.
May, 1925—Visitors' Day: Committee appointed to show visitors
around the hospital as follows: Mesdames Steele, Wilkes, Howie, Welch,
Wakely, Thompson, Dinahan, Burns and Mostyn.
June 16—Unanimously voted that the Ladies' Aid of St. Paul's Hospital convene a corner for Kwannos Club (Waes 'O') tag day, as they
agreed to take a corner for our tag day.
June 20th—Annual tag day under convenership of Mrs. I. Mostyn.
Total amount received  $3619.25.
June 23rd—Rev. Sister Superior had a surprise for the ladies at
this meeting in the form of ice cream and all sort of good things.
These sweets tasted all the better as Sister Superior served them with
her own hands.
—11— July  25 th-
totalled $19.60.
-Convened  a   corner  for  Kwannon   Club   tag   day.    Box
August 20th to 22nd—Annual convention of British Columbia Hospital Association. Mrs. D. Steele and Mrs. Wilkes represented our Ladies'
Aid and duly reported on same.
March 16, 1926—Letter of condolence sent to Mrs. R. O. Howie.
An offering was made by the ladies for -masses for the late Dr. Howie.
March 26th, 1926—Unanimously voted that the Ladies' Aid have
an election of officers on Tuesday, March 30th, for the years 1926-27,
also that a bazaar be held in aid of the hospital in September. Arrangements to be made later. Average attendance for the year, fifteen. Total
box collection $56.33.
Concluding, I would like to state that I have thoroughly enjoyed
working with the ladies, especially our president, Mrs. Mostyn. What
work we did undertake during the past year, Mrs. Mostyn spared no efforts to make it a success, and it has never been my pleasure to work
with a more conscientious and whole-hearted worker.
Yours very sincerely,
MRS. J. F. BURNS,
Secretary.
Mrs. Phillip A. Wilson of the W. A. of the Vancouver General Hospital reported as follows:
In the absence of the President I, as First Vice-President of the
W. A., V. G. H., welcome you not only to Vancouver, but to this conference held here at the General Hospital.
Social service work is along the same lines everywhere but we find.;
that as the city and hospital grow that our work changes in many ways
and needs experienced workers more and more.
I for one rather regret that I can do so little personal work any
more, but am thankful that I can realize how very much better it is to
have these trained workers leaving the executive and financial departments to our Auxiliary.
We have now a nurse in charge—a nurse who devotes mornings to
the outdoor clinic—a half-time secretary, besides one or more students
who are taking the University course in social service training.
Then we are fortunate in having volunteer workers who distribute
books and magazines which usually come to us from a call put in the
daily press.
The family condition is carefully studied—counsel and encouragement are given—physical defects and diseases are corrected and more
ample  relief given where necessary.
Since the family is the foundation of the social order, special efforts
are made to keep the family intact and to reunite families which have
been scattered by sickness, unemployment or any other cause.
A fair degree of specialization is taken here in the family cause,
the Kiwanis Big Brother movement, the work among the T.B. patients
by the Kiwanian Club. The Rotary has a fresh air camp for T.B. children,
besides starting a clinic and providing a fine building and other good
works. We are pleased to note that the I.O.D.E. preventorium for T.B.
children  is  assuming  a  definite  shape.    Fresh   air  camps  such   as  the
—12— Alexandra Orphanage camp at Crescent, relieve the home tension, improve the health of mothers and children and afford opportunities of
teaching home and family problems.
The Gyro Club has provided splendid playgrounds in congested
districts and many other service clubs are doing excellent work.
But how to finance our work is our great problem.
Vancouver is growing fast and, though a healthy city, as it grows
the hospital grows too, and in consequence so our social service work
grows and the need of funds is larger.
We pride ourselves on how very modern Vancouver has become.
We know the General Hospital is as modern as any hospital on the continent and we try to do our social service work in the method most
approved by modern ideas but back of it all the way money is collected for
charity here is a long way behind the times.
The canvas system is all wrong—and I am ashamed to tell outsiders
that we still collect our main funds through tag day collections.
Some successful way has to be devised, whether it is called community chest, associated charities or by another name, whether it is obtained by government grant or by a direct personal appeal where an
explanation can be given what the money is needed for and how it will
be used, but a new plan must be put in force, maybe a big general
drive and a proper division made of the results and not rely on the same
small band of women, growing less each year, to stand on the corners
soliciting funds and practically begging for money.
We need at least $5,000 a year to carry on our social service work in
the General Hospital alone. I have with me the financial reports for
1924 and 1925 for anyone to see who wishes to read how our money has
been spent.
Our tag day results have diminished from over $7,000 before the
war to less than $2,000 the last two years, proving that tag days have
lost their appeal to the people and that their day is past.
The ciy is growing and, in consequence the hospital, and our work
is increasing and the great question is—how are we going to raise the
money needed to help these unfortunate members of our community—
to buy artificial limbs, teeth, eyes, family supplies, clothing, etc. I ask for
suggestions:   How can we modernize  the collection of charity finances?
Mrs. A.
lows:
D.  Mclnnes of the North Vancouver W. A.  reported as fol-
Our Auxiliary has a membership of seventy. Our object is to furnish
ptlijfi linen for all wards excepting the Red Cross and the infants' wards.
fLast year in addition to linen we aided in the .purchasing of sterilizing
isquipment.
Funds are raised by memibership fees, an annual afternoon card
party, a ball, and a tag day. Receipts last year, including special grants
from the city and district towards the sterilizer amounted to $1453.00.
We supplied during the year 603 articles to the hospital and have
undertaken to increase that number considerably this year. We own
three sewing machines, and also own the dishes for our entertainments.
An important side of our work is done by the hospital visiting com-
gmittee, who distribute magazines and small treats in the open wards.
The committee also decorates the hospital at Christmas and Easter.
—13-^ When National Hospital Day was observed by the hospital authorities, the Auxiliary provided refreshments for the guests.
We have a good attendance at the monthly meetings which combine
sewing, business and an interval for tea. We feel that the members enjoy
their afternoon work.
Mrs. Hopkins of the W. A. of the Royal Columbian Hospital, New
Westminster, said that during the past year their Auxiliary had raised*
about $1400, about $1200 of which was raised by a carnival held in the
Armouries. She said that she had been asked to attend this convention
in order that she might learn from others present of some means whereby to raise money. She stated that the Auxiliary supply all patient's
jinen in the Hospital and a basket of fruit and Christmas cheer to each
patient in hospital on Christmas Morning. She also said that if funds
permitted they tried to do something to make the Nurses' Home more
attractive.
Mrs. Dack of the W. A. of St. Joseph's Hospital, Comox, reported as
'ollows:
I beg to submit the following report of the St. Joseph's Hospital Auxiliary of Comox, B. C.:
Receipts for the year were as follows:
Garden fete  $ 777.80
Whist   drive    .  61.35
Whist drive   59.00
Dance at headquarters   400.00
Dance at Royston   168.40
Stall at the exhibition   87.00
Dues  paid    35.90
Donations    .  103.10
Interest     14.77
Value of Produce Day   250.00
Total    $1,957.32
Expenses:
One electric ironing board   .  40.00
One electric ironer  125.00
Five new tires for ambulance   80.00
One extractor and motor for laundry    1,156.07
Linen for hospital   434.07
Sundries          86.00
Total    $1,921.14
Mrs. La Pierre of the W. A. of Chilliwack Hospital reported as fol-
It is indeed a pleasure for me to submit a report from the Chfllia
wack Hospital Auxiliary" for the past year, as it is a real live organization
with a membership of one hundred and  twenty and while our  regular
meetings are nearly as well attended as we would  wish, still we have'
only to suggest ways and means of either increasing our funds or making!
goods into hospital supplies and we get a whole-hearted response.
We have a hospital capable of taking care of 27 adults, 8 babies!
cots, but at times we have had more than these all full at the one timej
and we also have two infants' cots, having eight private wards, two|
public and two semi-private wardsand in 1925 admitted 486 patients.
Our objective last year was to secure an X-Ray machine for our hos-;
pital, and to raise the necessary funds we put on a three-day house to
huose canvass in both town and country, and we were more  than  de-:
—14— lighted to have sufficient funds to purchase and install an up-to-date one
at a Cost of $2160.00. Later we bought a case-room bed for $195.00 and
for the year our linen and other hospital supplies came to $9 68.00,
which is about our yearly average.
To raise these funds we have several societies who each year contribute $25.00 toward the upkeep of a ward in the institution, the volunteer fire-brigade give us the entire proceeds of their annual Easter ball,
at which the Auxiliary supply and serve the refreshments, which was
also the case for a dance given by the G.W.V.A. A local musical organization gave a concert under our auspices and from all three we got nearly
four-hundred dollars. We tried to get a Mile-of-Coppers but they count
up very slowly so that with an entertainment we put on in a new
store one afternoon, our total funds were only $400.00. At our local -
Fair each year we serve meals in a building we own at the Fair grounds,
and this is one of the best years we have had for some time as we will
clear over $410.00, our expenses in that connection being about $250.00.
This year we are working to get sufficient to purchase a new operating
table, and again emphasises the fact that we all do better work in a
happier frame of mind, when we hold out a good objective.
Each year by supplying the empty jars, the hospital is well provided with good home canned fruit from friends both in the city and
the municipality. Each week fresh vegetables, fruit and flowers arrive
in large and small donations and are acknowledged by the Matron
through the local press.
Mrs. Downie of the W. A. of Matsqui-Sumas-Abbotsford Hospital, Abbotsford, reported that their Auxiliary had a membership of 40, which
held monthly meetings with an average attendance of 20. She said that
their chief means of deriving income was by holding bazaars and dances,
by. which means during the last year they had raised $700 net. Their assistance in the past year to the Hospital had been $1000 towards the construction of a sun room, $54 for awnings and also the necessary linens and
cutlery, and further than this they made direct donations of funds to the
Board of Directors. They said that they had also found that a hospital
birthday party provided a good means of raising funds. .Their auxiliary
attended the Hospital every two weeks for the purpose of sewing and repairing linen.
"Mrs. Burde of the W. A. of the West Coast General Hospital, Alberni, said that their auxiliary were always active but that they had been
experiencing some difficulty in securing funds for their work due to
the fact that their institution is not in debt.
Mrs. Brown of the W. A. of Nanaimo Hospital, said that they had
been laboring under discouraging conditions. She said that their auxiliary had raised $20,000 for the purpose of helping in the completion
of their new hospital but this work was now held up because a by-law
recently put before the people had been voted down by a small majority
of 34. She said that their activities had been entirely confined to this
object.
On behalf of Mrs. Sehl of the W. A. of St. Joseph's Hospital, Victoria,
'.Mrs. Gouard reported as follows:
This Auxiliary has now ended its fifth year of existence. The past
year has been marked by the usual earnest activity of its members and
a great deal of work has been accomplished in assisting the Sisters of St.
Ann in maintaining the high standard of efficiency and equipment, for
which St. Joseph's has always been noted.
Regular weekly sewing meetings were held each Friday from September to June, at which meetings the ladies made up all the materials
required for the hospital work. In all 17,718 pieces were made and
marked by the auxiliary.
—15— In addition the ladies carried out a tag day, a sale of work, a linen
f-hower, a ball, acted as hostesses at the reception at St. Joseph's on Hos-
piial Day, purchased twenty Fowler bed springs and presented a bursary.
Some discussion took place on the foregoing reports.
In response to an inquiry as to the-reclaimation of gauze Mrs. Gouard
of St. Joseph's Hospital, Victoria, explained that at St. Joseph's Hospital
they reclaimed their gauze, thoroughly cleansing and sterilizing it and
pulling it out.
announcements were made by the Secretary:
(1) That a number of commercial and technical exhibits were
available for inspection, and urged the delegates to take advantage of the
opportunities offered.
(2) That His Honor Mr. Justice Murphy would be addressing the
delegates this evening and that all should make a point of attending.
(3) That Dame Maude McCarthy, formerly matron in chief of Queen
Alexandra's Nursing Service is a distinguished visitor in town and will
be present at a luncheon at St. Paul's Hospital today and will also attend
rome of the sessions.
(4) That a photograph of the delegates attending the convention
will be taken outside the auditorium at 12.30 p.m. tomorrow.
(5) That the Royal Columbian Hospital, New Westminster, invites
the delegates to luncheon on Saturday following upon which they will
be the guests of Dr. J. G. McKay of Hollywood Sanatarium at the Provincial Exhibition, and in order that the necessary arrangements may be
made the delegates were asked to sign their names on a sheet on the
bulletin board at the register desk.
(6) It was requested that papers and discussions should not exceed
ilie time allotted so that there may be no dislocation of the programme.
On adjournment at 12.30 p.m. the delegates attended the luncheon
at St. Paul's Hospital on the invitation of the Mother Superior. An excellent table was set and was enjoyed by the delegates. The President
of the W. A. of St. Paul's Hospital, welcomed Miss Mau.'.c McCarthy to St.
Paul's Hospital and expressed pleasure at her presence during the hospital
convention and presented Miss McCarthy with a beautiful bouquet of
roses.   Misss McCarthy made a suitable reply.
Dr. W. B. Burnett delivered an address wherein he emphasized the
fact that the first and last function of the hospital is the care of the
patient, and said that the activities of the hospital, its organization and
finance must serve to that end. Dr. Burnett was in happy vein and urged
that those engaged in hospital work should develop and maintain a
cheerful attitude. Dr. Burnett's impressive enthusiasm in his subject,
and his ability to intersperce his remarks with appropriate witticisms
held the unwavering attention of his audience throughout.
AFTERNOON SESSION—Thursday, Sept. 9th
by   expressing   pleasure  at
The  Chairman  opened   the  proceedings
seeing Miss McCarthy present.
For the Committee for Constitution and By-laws Mr. Haddon stated
that the matters submitted to the committee for attention were:
—16— 1. Proposed extra financial assistance from the government for
the care of infectious cases.
2. Proposals re a state health insurance policy resulting from the
•paper written by Mr. S. C. Burton.
3. The proposal to pool the travelling expenses of the delegates
to the convention.
Regarding the additional assistance for infectious cases, it was moved
by Mr. Haddon, seconded by Mr. Cook and carried that this matter be
referred to the resolution committee to bring in a report to this convention.
Regarding the provincial health insurance policy it was moved by
L-Mr. Bethune, seconded by Mr.  McGregor that the resolution passed at
last year's convention be reiterated with the exception that instead of
being referred to a special committee it be referred direct to the executive.—Carried.
The Chairman of the Committee for Municipal Affairs, Mr. J. J. Ban-
field, reported as follows:
Ladies and Gentlemen:
At the last convention of the Association held at Nanaimo, B.C., I
had the pleasure of reporting upon the activities of this committee, with
particular reference to legislation affecting municipalities, with a proposal which would secure a more equitable basis of payment between
the municipality and  the  hospital.
The convention, at that time, endorsed the proposal submitted,
namely, that a new basis be established whereby the municipalities would
be charged a per capita rate for the number of days treatment accorded
patients, irrespective of whether the patients paid their bills or not, or
whether the patients were private or indigent. It was felt that this
-basis of operation would be the most equitable means of securing aid from
the municipalities, and would overcome the friction which existed between the municipal councils and the hospital authorities. It was pointed
out to you that the committee had previously discussed the plan with the
executive of the Union of B. C. Municipalities, who agreed to the
principle, as well as with the Provincial Secretary, the latter promising
support to new legislation in the event of the hospitals, in convention, and
the municipalities, in convention, agreeing to the same.
The hospitals having agreed, it was necessary for your committee
to appear before the convention of the Union of Municipalities which was
held later in Victoria. On account of the executive of the union having
previously agreed to the principle proposed, and having promised to
submit the same to the main convention with its recommendations for
adoption, your committee naturally concluded that the plan would be
approved of by the municipalities without any undue opposition. However, as reported to the hospitals in a memorandum forwarded to you on
December 5th, 1925, your committee received such an unsatisfactory reception that it was necessary to appeal to the provincial cabinet when the
3ntire situation was discussed. Your committee used every effort to arrive at an amicable arrangement and having followed to the letter the
understanding arrived at between the executive of the union and the
provincial secretary, and having explained the circumstances to the
members of the cabinet, it was agreed by them that the hospitals were
entitled to protective legislation. A special committee was appointed from
the municipal committee of the legislature, then in session, with in-._
structions to bring in a report with recommendations along the lines of
the proposals  suggested.
The committee composed of representatives of the Provincial House,
of the Municipalities and of the Hospitals, endorsed the principle adopted
—17— by the convention at Nanaimo. The Act now in effect was approved, and
while minor defects will require adjusting from time to time, your committee is convinced that legislation has been enacted in British Columbia
which  is  a  credit  to   the  province,  and  for  the   benefit  of  the   muni- -
cipalities and the hospitals.
To Mr. Bryan, M.L.A., of North Vancouver, the Committee extends
its sincere thanks for the interest shown and his desire to aid the hospitals,  as well as  to other members of  the  House  who  supported  the
islation, and who saw the necessity for a change in the then existing
legislation.
Respectfully submitted,
JOHN J. BANFIELD,
Chairman of Municipal Committee.
Resolved that the report be adopted and that the hearty thanks of
the convention be extended to Mr. Banfield and his Committee.
The Sister Superior of St. Joseph's Hospital, Victoria, objected to
that section of the legislation whereby a municipality may select any one
hospital within its own area to the exclusion of any other hospital, stating
that as the result thereof the City of Victoria refused to pay bills rendered by St. Joseph's Hospital. It was explained by Mr. Banfield that
this section was not part of the legislation due to representation from the
committee of the Hospitals' Association but was the result of conditions
existing between Vancouver and North Vancouver, where, under previous
legislation, so many patients were cared for in the Vancouver General
Hospital, and charged to the City of North Vancouver when they should
lave been cared' for in the North Vancouver Hospital.
Mr. McVety also gave an explanation of this situation and referred
to the original requirements of the Hospitals' Association as represented
to the last convention and stated that the committee representing the
association had carefully presented their case to the Legislature as instructed by the convention.
Regarding the pooling of the travelling expenses, Mr. Burns moved
the adoption of the principle and that the same should be referred to the
committee on constitution and bylaws. Seconded by Mr. Bethune.—
Carried.
Mr. McVety suggested that he found there were many delegates
present who were willing to apply, the pooling principle to this present
convention and on inquiry it was found that there were 17 hospitals represented who were willing to do this.
It was therefore requested that those desiring to participate in the
pool should submit a report of their travelling expenses to the Secretary
and a statement of the pool could thereupon be prepared.
session then adjourned.
—18— EVENING SESSION—Thursday, Sept. 9th
A very interesting and instructive address was delivered at a public
gathering in the auditorium by the Hon. Mr. Justice Murphy of Vancouver, in which he gave a very comprehensive survey of hospital conditions
in general and those in British Columbia especially.
At the conclusion of his address he was tendered a very hearty
vote of thanks on the motion of Dr. H. W. Riggs, seconded by Mr. R. R.
Burns.
MORNING SESSION—Friday, Sept. 10th
This session was under the auspices of the committee on medical
affairs with Dr. F. C. Bell in the chair. Dr. H. E. Young, provincial
health officer, gave an address bearing especially on preventative
measures in nursing.
PREVENTATIVE MEASURES IX NURSING
The functions of the hospital are:
First, care of the sick;
Second, the training of those who care for the sick and,
Third, the prevention of disease and constructive health building.
For a hospital to occupy itself with the care of the sick without
contributing anything to the prevention of disease is to fail in its duty
to the community, and to me it seems that the present duty of the
hospital is to try and co-relate the first and third functions of the hospital—the care of the sick and the prevention of disease.
In this respect it is difficult when it comes to the individual patient
to tell when the care of the sick ends and the prevention of disease
begins.
From the community standpoint, "how to keep the hospital beds
full," should read "how to keep the hospital beds empty," or how to reduce patients needing bed care to a minimum.
The public expects the hospital to be modern, possessing first class
equipment, rendering efficient and cheerful service, and a carefully chosen
personnel. With such an equipment it can be said to be serving the community in such a way as a hospital by itself should, but do its obligations cease at this point? If so, then the hospital is not serving the
purpose that it should to the community.
The hospital in this conception is self-contained and does not function with other agencies in the way which would enable it to perform
-Jts duty in regard to the prevention of disease. The various agencies of
all kinds, particularly voluntary, that exist at present should be in intimate relation with the hospital. The hospital should be the centre for
all health activities in its city or district in addition to carrying out its
first function, that is, the care of the sick. How far are our hospitals in
British Columbia acting other than being self-contained institutions?
If we are going to follow out the community idea of devising means of
keeping the beds empty, then the reports that are coming to the government from the different hospitals should be able to show the existence
of a spirit of co-operation with voluntary agencies in furthering preventive measures.
Conditions favorable for the enjoyment of good health are the right
'   —19— ■
\
of all our people and it becomes the duty of the state to provide safeguards against preventable diseases.
It is the duty of the state to employ all its agencies in carrying out
its duty in regard to the providing of safeguards and in this connection
the hospitals should be one of the most important agencies through
which this can be effected, but it seems to me that this, one of the chief
agencies, has been entirely neglected from the government point of view
and the work that should be performed by the hospital has been neglected
from the hospital point of view.
As regards preventive medicine the government agencies are making
real progress but they are as yet unable to secure the co-operation which
they should from the hospitals and from the medical profession. They
are receiving the support of the community but in an inarticulate way
and it seems to me that one of the real functions of the hospital would be
to take a lead in the matter of bringing about the co-relation of all
agencies.
The hospital holds the key to the public health situation, and must-
answer for a reasonable acceptance of responsibility and the great need,
therefore, is for the formation of some plan of co-operation as between
the  community  and   the  hospital.
Dr. Young in closing his address remarked that we cannot eradicate
disease by curing it and that it was the duty of the hospitals as health
centres to extend their efforts further than this.
Mr. McVety asked Dr. Young for his opinions on the practical application of the principles which he advocated and in reply Dr. Young
stated that considerable public health work is being done by the different
organizations and as a result there was considerable overlapping of
labor, and he considered that the hospital should act as a central point
and a clearing house for educational and nursing care following the
various voluntary and other organizations. He advocated the following up
of obstetrical work and considered that a complete record should be kept
throughout the growth of the child through his years of youth to the
end that he may become a useful citizen in the community, and remarked
that the availability of such records would be of great service to the child
should he for any reason have to appear in the juvenile court, or when
leaving school was endeavoring to secure employment, and he said that
he was sure that if the hospitals entered into this phase of work that
they would undoubtedly get assistance from the government.
Dr. H. W. Hill, director of the Vancouver General Hospital laboratories, read a paper on "Points in the treatment of infectious diseases
in small hospitals":
POINTS   ON   THE
HANDLING   OF   INFECTIOUS
THE  SMALL HOSPITAL
DISEASES   IN
The handling of infectious cases in the small hospital as a problem
of hospital planning and administration was presented to me on behalf ot
a small hospital in the Fraser River Valley during the past year. The
exigencies of ordinary hospital routine had impressed upon the board of
directors that some provision for infection should be made, notwithstanding that the hospital was not intended for contagious cases. Specific
difficulties then arose as to remodelling, or adding space for infectious
cases to a hospital not designed for contagious cases.
The advice given was: (a) not to build a separate small house or
pavilion; (b) to add the required space at any convenient side of the
existing building; (c) to have no internal access to the new space from
within the hospital, but only by an external verandah; (d) to furnish,
water, electricity, gas, heat and plumbing from the hospital plant; (e) to
have a separate toilet, bath, etc.,  within the addition;   (f)   to  keep all
—20— dishes used by infectious patients in the addition, washing them there;
(g) to put all laundry into a bag which should be boiled or otherwise disinfected and then passed into the ordinary hospital laundry.
Miss M. F. Gray, assistant professor of nursing, added the admirable
item of an observation window from the main hospital looking into the
addition, so placed that the patients' beds could be kept in view.
Where such an addition does not exist or cannot be added, or to meet
emergencies where still further space is needed, every small hospital
should be provided with a high-walled tent, of one of .the many cheap,
yet good types, now available. Such a tent, with a permanent wooden
floor, ready set up in the hospital grounds, can be erected by one person
in a few minutes, provided with bed, oilcloth floor, and toilet facilities
in another few minutes, and an oil or small coal stove in winter; and be
just as useful, convenient and satisfactory as any elaborate building.
Both Dr. H. E. Young, provincial health officer, and Dr. F. C. Bell, superintendent Vancouver General Hospital, endorsed these recommendations.
• This particular instance seemed of sufficient interest to be discussed
in-detail as an example of the widespread and often insistent need of
isolation facilities in small hospitals. Too often. I think, a small hospital
13 planned with a view wholly to non-infectious diseases, the striking fallacy of which is this—that no hospital, small or large, however strictly
planned or conducted as a non-infectious hospital, ever succeeds in excluding infectious cases completely. This is true even if we restrict the
term infectious, (quite improperly) to the ordinary run of "children's
diseases," for such "children's diseases" continually crop up as the result of patients entering the wards for non-infectious diseases or accidents and then developing diphtheria, scarlet fever, measles, mumps,
etc., a few days later. When we include in the term infectious all the
diseases properly belonging under it, such as septicaemias, pneumonia,
even impetigo and the itch, we find from our own V. G. H. statistics that
we must expect in the general hospital about 34 per cent, of our total
admissions to be infectious; if we have contagious wards, about 40 per
cent. In other words, our figures indicate that the so-called non-infectious general hospital does not exist. It is a figment of the imagination, since one-third at least of the cases treated therein will be in the
ordinary course infectious, despite all efforts at excluding infection; and
about 4 0 per cent, of the deaths; 50 per cent, if contagious wards be
added.
These figures I shall proceed to substantiate with the object of
establishing as a radical and fundamental rule the principle that no
general hospital, even when contagious cases are not to be accepted,
should be planned or operated without definite and efficient provision
both in the hospital plans and in the administrative organization, for the
isolation and care of infectious cases arising within the hospital or now
accepted (such as septicaemias, pneumonia, etc.,) without due consideration of their infectious character.
What I am trying to show is that a general hospital which announces
that it does not accept contagious cases and considers that it therefore
need make no provision for their care is making two glaring mistakes,
first, in believing that the announcing of their policy will prevent the
entrance of contagious cases, such as scarlet fever, diphtheria, etc., and
second, in considering that such contagious cases thus nominally excluded cover the whole list of diseases for which isolation and strict
aseptic technique are required. Our figures show that contagious diseases
in the restricted sense, scarlet fever, diphtheria, mumps, impetigo, etc.,
may be expected to develop in the ordinary so-called non-infectious medical and surgical wards to the extent of roughly about 1 per cent, of the
total admissions;  whlie as already pointed out the so-called non-infec-
—21— tious medical and surgical cases are in fact practically about 33 per cent,
infectious, i.e., pneumonia, »epticaemias, etc.
As a matter of fact, the definite acceptance by a hospital of contagious cases does not add contagious cases to the extent of more than
6 per cent, of its total admissions. Under non-acceptance rules, about
1 per cent, or about one-sixth as many contagious cases must be provided for in any case.
May I emphasize this point again thus—the difference between a
general hospital which accepts contagious cases and one that refuses them
is not that the latter receives none but that it reduces their receipt by
five-sixth.
Now for our data, the figures kindly supplied by Dr. F. C. Bell. In
1925, to the Vancouver General Hospital 14,000 patients (round figures
only are used) in all were admitted; about 850 were admitted to the
contagious wards as suffering from scarlet fever, diphtheria, etc. These
may be dismissed from consideration for our purposes.
The remaining 13,000 patients were admitted to the non-contagious
wards and yielded about 150 eases where contagious diseases were
suspected or developed, i.e., requiring isolation. A number of these thus
isolated failed to materialize as contagious; but in about 140 contagion
definitely developed, i.e., in about the proportion of 1 per cent, of the
total admissions.
Of the 140 definitely contagious cases, 16 were diphtheria carriers,
requiring isolation but not treatment; the remainder were actually sick
persons, including smallpox, chickenpox, scarlet fever, diphtheria, mumps,
whooping cough, erysipelas, impetigo, scabies and Vincent's angina.
Patients yielded these cases to the extent of 102; nurses and other
employees the remainder, about 20. Hence four-fifths of the cases were
amongst patients, one-fifth amongst the staff. Amongst the staff, overwhelmingly the greater percentage was amongst nurses.
.  The sources of the contagious  cases thus  developing  in  the  noncontagious wards were:
(a) Cases brought in for operation, developed contagion:,
Examples:
Eye injury developed smallpox,
Hammer toe developed smallpox,
Fractured femur developed mumps.
(b) Cases   brought   in   for   miscellaneous   non-contagious   diseases;.;
developed contagion:
Examples:
Pleurisy in an adult developed chickenpox,
Pneumonia in a child developed scarlet fever,
T. and A. case developed whooping cough,
T. and A. case developed chickenpox,
Man in plaster cast developed scarlet fever.
(c) Cases brought in while suffering contagion, not recognized:
Examples:
Diagnosed bronchitis really had whooping cough,
Diagnosed influenza really had smallpox,
Diagnosed broncho-pneumonia really had whooping cough.
Secondaries   from   the  above,   amongst   patients   and   amongst
staff:
Examples:
Neurasthenia developed mumps,
Dislocated hip developed chickenpox,
Scarlet fever developed chickenpox,
Tuberculous hip developed diphtheria,
Rheumatic fever developed chickenpox. (e)  Post-operative scarlet fever and erysipelas:
Examples:
Operative case developed post-operative scarlet fever,
Otitis media developed erysipelas, •
Mastoiditis developed erysipelas.
Summary
Every hospital is bound to have some contagious cases develop, at
least to the extent of 1 per cent, of the total admissions, and should Be
equipped for them.
Every hospital is bound to handle infectious cases, not commonly
classed with contagious cases, but requiring isolation in a modern hospital. These occur to the extent of one-third of the total admissions. The
tendency of the really modern hospital is to give every patient a separate
room so far as possible. Ideally, at least one-third of all admissions should
be so provided. Even the smallest hospital should have adequate provision
for some of these cases.
Turning now from the needs of the small hospital—of every hospital
—for proper isolation rooms to handle the inevitable uninvited infectious
case which develops in the hospital, let me also urge such space as a
need of the community, to handle the uninvited infectious case which
develops in the small crowded home, in the hotel, boarding, house, logging
camp, etc. These cases every community has—these cases every community should provide for. Even space enough for one case is immensely
better than for none. The addition, or even the tent, already suggested,
will meet this demand also. A hospital which proposes to meet community
needs should help in this particular.
I think also that every hospital, including the smallest, that undertakes to train nurses should have at least one isolation room and take
at least an occasional case of infection in order to be fair to the nurse
in her training.
In discussing the function of the hospital as serving the community
needs in infections as well as in non-infectious cases, I would include very
definitely indeed the temporary care of tuberculosis cases. A general
hospital is no place for the permanent care of tuberculosis, with a view
to cure. But the incipient tuberculosis case for diagnosis and observation, and the advanced case, pending its admission to a special tuberculosis hospital or sanitorium should find temporary but entirely proper
quarters at the local hospital. Here again provision by an addition to the
permanent building, will meet the needs adequately.
Public health cannot be better served by the hospital than in the
general field of preventing spread of infection by affording proper isolation and good technique for such cases; and by the education of the
public in care of infection which such provision will afford. Public health
tries to prevent sickness. When public health fails, the cases that slip
through its fingers become a hospital responsibility. When the hospital
fails, the cases that slip through its fingers become an undertaker's responsibility; and may incidentally produce other cases which may go the
same way.
Co-operation with public health, with the welfare of the community,
with the ultimate reduction, even abolition of infection, requires that the
hospital regard infection as one of its real pressing problems and that
the hospital take active steps to aid in its suppression.
The surgeon and the obstetrician have been fully impressed with the
seriousness of infection to the race. It is time that the internist and the
1 take as earnest and as practical a view of infection.
—23—
general hospital (In discussion,  the request was made  that the  Incubation  periods
of the more common infections be added to this paper in order to supply
the data on which it might be determined whether a case of infection
had received as infecMon before or after admission to the hospital.    Thisf
table follows here):
INCUBATION PERIOD OF COMMON INFECTIOUS DISEASES
H. \V. Hill, Sept. 11, 1926.
INCUBATION   PERIOD        PRODROMAL PERIOD
(r irst    symptoms    to
Disease. (From exposure to first symp-        typical   symptoms, ■<!
toms) i.e., rush, etc.)
Minimum.      maximum.        Usual.    Minimum. Maximum.
Smallpox   (severe).... 10 days 14 days       12 days 3 days 4 days
Smallpox  (mild)     12 days 21 days      — 3 days 6 days
Chickenpox     14 days 18 days      14 days — 1 day
Scarlet fever  5 days 7 days         5 days 1 day 2 days
Real measles   9 days 11 days      — 3 days 4 days
German  measles    14 days 16 days      — — 1 day
Mumps    14 days 25 days       19 days — 1 day
Typhoid  fever   5 days 23 days       14 days 7 days 7 days
(about)
Paratyphoid   3 days 14 days      — 3 days 4 days
Diphtheria    1 day 5 days      — — 1 day
Whooping cough   7 days 14 days      — 7 days 7 days
Tuberculosis              3 months 12 months— about 3 years
Rabies    3 weeks 3 months 40 days 1 day 7 days
Tetanus    7 days 14 days      10 days
Mr. McVety asked what steps a hospital should take to avoid the |
spread of infection and in reply Dr. Hill stated that the only sure way I
would be to isolate all  patiei ts on admission to  the hospital until the
incubation period of all communicable diseases be passed, but said that
the only practical way was the use of individual rooms for every patients
in  hospital  and  added  that  without.a   doubt   this   should   be   done   in
the care of children.   He said that there were many forms of infection
besides those generally considered as communicable;  for instance pneumonia, has some infectious characteristics.   He said that over 1,000,000
deaths took place every year, 86 per cent, of which are due to infection!
and added that 10 per cent, of people die from heart disease which is, as
a rule, the eventuality of infection. He also said that to provide properj
hospital care it was necessary to set up a proper nursing service so that:
cross infection might be avoided. Dr. Hill said that it would be an unquestionable economy if public monies were expended for the purpose of
obviating infection, in view of the fact that $300,000,000 are spent eachi
year due to disease and death.
Dr. H. A. Murphy of Kamloops, the immediate past president of the
B. C. Medical Association delivered an address entitled "The Hospital
and the Medical Profession," in which he dealt very fully with the relations between the two and their mutual responsibility.
Mr. A. Thomas, provincial fire marshall, delivered an address on
the subject of "Safeguards every hospital should establish for the prevention of fire." He spoke of the many disasters which accrue from care-
essness where fire is concerned. First of all he advocated the establishment of good housekeeping conditions, care in avoiding the accumulation
of litter, and general cleanliness. He said the next requirement was goods
construction and added that proper facilities should be provided for the I
closing off of drafts especially in elevators and dumb waiters so that
should fire start the drafts that feed it may be shut off. He recommended
that furnace rooms should be provided with metal deors which should be
kept closed at all times or else should open with a metal cord fitted with
—24— a fuseable link which would melt under excess heat and automatically
close the door. He said that the walls of the furnace room should be
covered with metal lath and this in turn should be covered with cement
and further than this that a wet sprinkler system should be installed.
Lastly he said that a hospital should provide proper fire protection facilities and recommended the installment of soda and acid extinguishers.
Where there are oil fires, all electrical equipment, or any where there
may be grease such as in the kitchens, he recommended the installation
of carbon tetra-chloride extinguishers.
Mr. Thomas assured the delegates that his department was prepared
to render the hospitals advice and assistance at all times.
In response to an inquiry Mr. Thomas stated that it was his opinion
that a fire alarm system should exist in all hospitals. Mr. Thomas was
asked to provide the hospitals with particulars of his recommendations
in writing.
Dr. A. S. Lamb, Provincial Health Inspector, delivered an address
on some points concerning the inspection of hospitals and opened his
remarks with a reference to recent amendments to the Hospitals Act
and the points which had been referred to the Arbitration Board for decision and explained the reasons that the board had for arriving at their
findings.
SOME POINTS  CONCERNING  THE  INSPECTION
OF HOSPITALS
On my appointment as Hospital Inspector in December, 1925, the
first thing that naturally presented itself was "What shall my duties
be?" To get some inspiration I first turned to the Hospital Act to see
what was there set down and found as follows: Part II., Private Hospitals,
Sec. 11, No license shall be granted unless the house is approved by the
Inspector, etc., etc. Sec. 17, Sub-Sec. C, A license may be revoked if in
the opinion of the Inspector the premises are unsanitary, etc. Section 18,
Sub-Sec. 1, No structural changes shall be made without approval of Inspector. Sec. 22, Inspector has the right to examine any house suspected
of being used as a hospital.
Part III. General provisions, Sees. 25 and 26, The Lieutenant-Governor may appoint an Inspector and all hospitals receiving Government
aid shall be open to inspection, such inspection to include the records and
finances of the hospital.
Sec. 31, Sub-Sec. 5, The Inspector appointed under this Act shall
be one of a board to decide any questions in dispute between hospitals and
municipalities. Sec. 33 and 34 have to do with the granting of aid or
withholding of. same on recommendation of Inspector to orphanages,
refuges, etc.
You will see, however, that in all cases mentioned above duties of
Inspector are more or less in the nature of an intelligence officer for
the department of the government under which hospitals come, and does
not account for the fact that the Hospital Association was rather insistent
on the appointment being made.
In further considering this matter then, I felt that all hospitals
would have problems in common, such as finance, also that each hospital
would have its individual problems to solve. I could conceive that an
official that became conversant with these individual problems and
found out how one hospital disposed of them might be of great assistance
to others in solving theirs.
Hence I decided that in addition to inspection of hospitals from the
standpoint of condition of building as to cleanliness, sanitary conditions,
fire hazard,  equipment and countless 'Other incidentals,  that as  far as
—25— possible I would at the same time endeavor to meet with the boards of
management, at their regular meetings when possible, or even at one
called specially for that purpose. When a full board was not possible, then
some committee from the board. These meetings I must say have been
most enjoyable and profitable to me and I trust have been of some benefit to the boards from whom I have had the most whole-hearted cooperation.
While discussing hospital boards, let me say—something that no
doubt has been discussed already many times—that I believe hospital
boards are altogether too large in most cases. Indeed I might say in almost every case.
It seems the smaller the hospital, the larger the board in many in- ,
stances. For a ten to twenty bed hospital doing an annual business of
say as many thousand dollars, having a board of anywhere from ten to
twenty members meeting monthly, seems to me a great waste of time
and energy, to say the least. Certainly a board of that size cannot function
as satisfactorily as a smaller one, more difficult to get decisions, etc.,
etc. I know the reply to this is, "It is necessary to have these large
boards to give representation to the different sections of the community
to kepe up interest in the hospital. There may be something in that argument if you do not pay too great a price for it. The government has set
a good example in the last two years by only appointing one representative instead of two as formerly, except where hospitals are incorporated
by special Act of the Legislature, and where the number is thus fixed
by statute.
This matter of keeping the people interested in the hospital is also
used in many cases as an excuse for doing all the buying for the hospital
in the home town, distributing the orders around the different places of
business. The principle of buying at home is one with which I heartily
agree, but a hospital board is dealing with public moneys and unless the
local man is willing to quote wholesale prices plus a reasonable profit 1
do not feel that the board is justified in doing business that way. I believe there are cases where more money could be saved by buying in the
cheapest market, than is raised locally for hospital purposes at the present
time.   Here again the price may be too great.
Finance was mentioned as one of the problems common to all hospitals. There is some evidence of improvement in this connection, for in
1924 out of 63 hospitals (public, I mean, in the sense that they receive
government aid) 29 showed a deficit, while in 1925 o.„ of 64 only 26
showed a deficit. We are hoping that for 1926 the working of the amendments to the Hospital Act passed at the last Session will make for still
greater improvement. There are some hospitals, however, that this
amendment gives very little relief to, and those^are the ones situated in
unorganized districts entirely, or situated in a small municipality surrounded by a large unorganized district. Here is where the claims for
special consideration by the government arise and I would like to state
that my experience has been that they usually receive very sympathetic
consideration provided the board is functioning properly, and the people
of the community are showing a co-operative spirit.
Let me here tender this deserved mead of • praise to the Ladies'
Auxiliaries.' In many small places this community spirit is largely
demonstrated through the activities of the ladies' auxiliaries. Often the
success or otherwise of a small hospital depends upon a good wide-awake
auxiliary.   More publicity should be given to their work.
Appointment of representatives on the board?
This leads me to the point I wish to make about hospital finances.
This amendment to the Hospital Act by which municipalities pay in proportion to number of cases treated is the entering wedge I trust to a demand for a hospital tax.   In that I believe lies our only hope of relief
—26— from the difficult financing of the present day. Our government or any
government is not likely to adopt such a method until such time as there
is a public- demand for it.   It is up to us to create that demand.
In addition to the making of financing easier, it would make for
greater efficiency in that hospital facilities would be more-widely used
and the great middle class would be put on a par with the opulent and
the indigent! The opulent gets ali that is going because he can afford
to pay, the indigent because he never expects to pay; but the middle class
endeavour to get along without X-Rays, laboratory tests, etc., for fear he
will never be able to pay.
Specially interested as you know me to be in tuberculosis, you could
hardly expect me to allow this opportunity to pass without some reference to this subject. It is required of all hospitals receiving government
aid to make suitable provision for advanced cases of tuberculosis. I would
like that hospital boards would interpret this provision liberally so that,
on occasion, the earlier cases might be received as well. It is often a great
injustice to a far advanced case to be sent many miles to a sanitorium,
even if the sanitorium is in a position to handle same, away from friends
and loved ones, but all are agreed that for the sake of the remaining
members of the family, especially when said family includes small children, segregation of the advanced case is necessary. But let us suppose a
case is diagnosed in the early stage. Application is made to the sanitorium, but that institution like the Vancouver General Hospital, and
most others, is overcrowded. Perhaps a delay of from three to six months
takes place. Home surroundings are not such that much can be done
there. Perhaps before admission to sanitorium a case has progressed to
one moderately or far advanced, and chance of permanent cure is gone
forever. Under supervision in a general hospital during that waiting
time, the case may be doing just as well as if in sanitorium and getting
some good advice as to how to live which, after all, is the great essential.
I know that many hospitals are prepared to do just what I have suggested, but there are others who have not reached that stage and it is to
these latter that I direct my appeal.
There are just two matters I would like to touch on lightly as regards nursing. One has to do with training schools and the other private
hospitals. In reference to the former, we all know what an important
part of nursing and treatment dietetics is today. Do these smaller training schools, too small to have a full time dietitian and too large to be
affiliated with one of the larger hospitals for such courses, get the
training in this line they should get, and if not, would a travelling dietitian giving an intensive course in each of these hospitals, solve the
problem?
As regards private hospitals, I believe they are eligible for membership in this Association, so this matter may rightly come up here.
Many of these private hospitals, especially the maternity homes, give_a
course in maternity nursing of from 6 to 12 months, at the end of which
time a certificate is issued. Of course this gives them no standing in the
nursing profession. The question in my mind is whether these girls are
being exploited in some cases or not, and also whether they would come
under that class in which a little knowledge is a dangerous thing.
There is a considerable demand for a less highly trained nurse
than the present R. N., and one that can be engaged at a smaller salary.
There is also the young girl who is very, anxious to be a nurse, but has
not the high school training necessary to be accepted by the Standard
Training Schools. What is open to her except some such condition as
above. I would be the last person to suggest lowering standards, but it
is information I am looking for.
—27— Due largely to the efforts of the Graduate Nurses' Association, there
is a new spirit manifested as regards the housing of the nursing staff.
Not so many years ago, and in some cases still, the nurses' quarters
were provided in that part of the hospital that was not fit or could not
be used for patients. Now all this is changed. Most of the hospitals with
training schools have a separate building for the nurses' home. True,
some of them leave much to be desired, but the right spirit is being
manifested. With no other class of people is it so necessary to assure
good living surroundings, on account of the association when at work.
The least requirements of such a home would be that it would be sufficiently removed from the hospital to permit the nurses to relax when
off duty, and to enjoy themselves in natural and reasonable pleasures
without disturbing the patients in the hospital. Social and recreation
rooms should be provided as well as* sleeping porches. In fact, accommodation should be as nearly as possible like that found in a good Canadian
home. All this is not only necessary for the health of these young girls,
for I am speaking more particularly of training schools, but efficiency
both in their daily routine and also in their studies is dependent upon
it. The same should apply to hospitals employing only graduate nurses,
but then we feel that the graduate nurse is quite capable of looking after
herself.
I am very glad to tell you that the Provincial Secretary and his department are prepared to consider nurses' homes as an integral part of
the hospital—something they have not always been prepared to do—and
as such are prepared to give sympathetic consideration for any requests
for aid in building or improving existing inadequate quarters much the
same as if it was any other part of the hospital.
Many improvements in general hospital situation have been made
during the year. New hospitals have been opened at Trail and Greenwood. The hospital at New Denver, closed for some years, has been
purchased by a community hospital board, and will be reopened shortly.
A new maternity department has been added to the Penticton Hospital.
Campbell River Hospital has reopened under the care of the Sisters of
St. Anne. Nanaimo has a new hospital in course of construction—not
before it was badry needed.
Extension laboratory facilities have been provided at Kamloops
Hospital through the co-operation of the Provincial Board of Health, as
well as less pretentious facilities at Kelowna. Nelson is still discussing the
building of an isolation hospital by the municipality. In addition lesser
improvements in building and equipment have been made by many hospitals.
Practically all of these involve some grant from the government
and in many cases I have been instructed by the department to make
investigations to see if suggested additions were required. In all cases, I
think, I have been able to report favorably and some assistance has been
given. In fact there have been so many such cases that when another one
was suggested to me a short time ago, I said, "For heaven's sake, postpone that till next year for I fear the government will fire me at the
end of the year as being a public nuisance."
In conclusion Dr. Lamb expressed his thanks to Dr. Young, Dr. Bell
and Miss Randal in the carrying out of his work as hospital inspector.
In discussing the paper, Miss Randal said that a start had been made by
the Graduate Nurses' Association in providing the services of a travelling
dietitian for small hospitals and said that Miss Kinney was now doing
this work, her travelling expenses, etc., being paid by the hospital requiring her.
Mr. Haddon spoke of the fact that some municipalities claimed exemption from the per diem assessment provided in the Hospital Act on
the grounds that they are the chief contributors in their own territory
—28— and discussion ensued on this subject. Dr. Lamb said that he thought
that it would be quite easily decided in any case where argument arose
as to whether or not the municipality was the chief contributor.
The session then adjourned and were provided with an excellent
lunch in the convention hall at the invitation of the chairman and di-
-rectors of the Vancouver General Hospital. At this lunch there were more
than 100 people present and some very profitable discussions ensued
as a result of a round table dealing with questions which had been
placed  in  the  question  box.
AFTERNOON SESSION—Friday, Sept. 10th.
This session was under the auspices of the Committee of Nursing
Affairs with Miss Mabel F. Gray, R.N., of the University of British Columbia in the chair.
Miss Ruth Yeandel read a paper prepared by Miss A. L. Boggs, R.N.,
superintendent of the Royal Inland Hospital, Kamloops, on the subject of
WHAT RESPONSD3ILITIES DOES A SMALL HOSPITAL ACCEPT
IN ESTABLISHING A SCHOOL OF NURSING?
It would be well if every small hospital which establishes a school of
nursing could realize the responsibilities it is assuming when it takes this
step; and having decided to avail itself of the advantages, (real or
otherwise) that go with the training school, it should definitely plan to
discharge the responsibilities that are inseparable from it. Now, for the
purposes of this paper the general understanding of the term "small
hospital" will be sufficient without defining it as one of so many beds,
since the problems confronting it are not peculiar to the small hospital
as such. Are they not rather the problems of the large hospital, but
more aggrevated in the case of the smaller institution, because of less
adequate facilities for meeting them? Yet in the last analysis do not
most of these problems in the case of either small or large hospitals
revolve about financial wheels? Even though this admission at once puts
them in the class of difficult propositions it seems as though, if the
small hospital is justified in establishing a school of nursing, there
must be a satisfactory solution of the problems thus introduced.
What are some of the responsibilities of the small hospital in carrying on a training school? One of the first things that suggests itself is
material for training. It is difficult to think of a satisfactory school
without an accompanying hospital that will provide a real training for
the nurses, not, only when it is full but at all times. There would seem
to be a very grave danger in attempting a training school where the
number of patients is very small or subject to very great fluctuations,
or in a community where the experience a nurse gets in an industrial
centre is lacking. Is there opportunity for the nurses to get the varied
experience that they should have both in fairness to themselves and to
their future success in their chosen profession and to the community at
"large where their work will be done, and which is justified in expecting
that nurses have been adequately trained to do the work that they undertake. This difficulty has been overcome in a considerable measure by the
affiliation with larger hospitals, but even so, it would seem that the
small hospital desirous of establishing a school of nursing should consider carefully whether the size of the hospital and the variety of the
cases passing through it are such as to give a reasonable guarantee of a
successful training in so far as that depends on this factor for desirable
—29— results. Any policy that looks on the training school as providing a
cheap supply of nurses without keeping in mind the responsibility that
the school owes to the nurse, is a policy that can hardly be justified.
There can be no training school worthy of the name nor likely to
achieve any permanent measure of success that does not have its aims sufficiently high so that it will not be willing to send out nurses from its
school who have not had a fair equivalent for the training they would
have received from the same time spent in a larger hospital. Even the
fact that it might be possible to get pupil nurses would not seem to
justify the training school in taking advantage of their poor judgment
in deciding to train there, or of peculiar conditions that might make it
seem necessary for them to forego training in a more distant centre.
Where a school of nursing has been established it should be what its name
implies and fitted to teach the pupils who came to it their profession.
The fact that it is mutually advantageous that the pupil's tuition should
be paid in service rather than money does not alter the situation. The
pupil is paying for a training that she is entitled to receive, and if she
is willing to accept an inferior training the school, if willing to give the
inferior training, should certainly not charge the pupil as much as she
would pay in a larger hospital; in other words, it should return to the
pupil month by month a larger proportion of the money equivalent of her
services. And since a training school is established as a permanent
institution it should be put on a firm foundation for success, viz., an
honest return in training for the faithful and exacting service demanded
of the nurse.
Granted that the hospital has the material to give the pupil nurse an
adequate training, there comes up the question of providing the accommodation for the nurses in a self-respecting way. A good nurses' home,
convenient and comfortable enough in its furnishings and surroundings
so that it will be, at least, a fair substitute for the homes they have
left, is a necessity. Moreover, as a part of the home there should be
class and demonstration rooms, properly equipped for skilful successful
work. In addition, there are other things that can only be classed
as real essentials for girls at this age. They need to get the recreation
to which they have been accustomed; need it now, perhaps, more than
ever.
Even if the small hospital finds itself prepared to undertake the
responsibility of providing adequate facilities for the training of its nurses
and sufficient and suitable accommodation for their needs, there are
still responsibilities it should be prepared to accept. The name of "School
of Nursing" should bring prominently to mind the fact that there is
teaching to be done. Who is the one best fitted for this necessary part
of the pupil's training? The superintendent, in the majority of hospitals, is much too busy and should not be expected to undertake this
work. Members of the medical staff are busy men, and though willingly
undertake courses of lectures to the pupil nurses, a call at the last minute
may necessitate the cancelling of a scheduled class. It seems quite
obvious that if the teaching is to be done it is not likely to be accomplished very satisfactorily except by one who can give her full time to
the course of instruction. The fact is being recognized more and more
that not only is a good preliminary education necessary for the nurse, but
that during her hospital training she should receive the very best instruction that it is possible to give in order that she may be competent
to meet the problems which come to her in the nursing world. The instructress has the opportunity of studying her pupils, helping them in the
solution of their difficulties, and following up in the wards the instruction given in the classroom. She will attend the doctors' lectures,
reviewing them in class, and explaining details.
Unless the hospital provides these very important means of education
the nurses will have to be deprived of them. Anything that detracts from
the welfare of the nurse lowers the quality of service she renders to the
—30— hospital, and in a hospital of all places, the service needs to be of the
best. Unless the community is prepared to accept the responsibility of
looking after the welfare of the nurses both in the way of living accommodations and in other respects it is not yet ready to launch a training
school.
When Florence Nightingale organized the first training school for
lay women, she was socially as well as scientifically revolutionary. She
placed candidly before the public its obligation to train women to meet
a very obvious need which had been brought about by the development of the science of hygiene and of surgery and the organization of
hospitals. Strange as it may seem, though other vocational and professional education for women has attracted the interest of the educator
and philanthropist, serious consideration has been almost entirely absent
from the training for this pre-eminently woman's profession. The nurses
themselves, with great labor and in spite of serious opposition have
secured for the pupils in training schools some advance in the educational
opportunities offered to them. The position accepted for so many years in
this profession that the training school pupils exist to nurse the hospitals, and only incidentally to prepare a profession has not changed
to any material extent. The hospitals' interests are served by it and the
conditions inherent in establishing and supporting a professional or vocational school are notoriously absent. Kindliness and pride in the pupils
are found, interest in their personal happiness is not unusual but a
recognition that the school of nursing is in reality an educational institution to equip its pupils for a dignified and important profession is
almost lacking. It is pertinent that attention should be drawn by boards
of managers and the faculties of training to the fact that the functions
of the trained nurse have enormously expanded. She is the nurse for the
whole community in its public health measures to as great an extent as,
up to a few years ago, she was almost exclusively private nurse for the
individual.
Important issues are in the hands of the nurses and they with notable exceptions are ill-prepared to use these opportunities for the fullest
benefit of society. The training schools and those in charge of them
should read the times. Those who govern our hospitals should recognize
that, in the interests of public health it is imperative that the training
schools should be so constructed as to attract steadily a number of
educated and able women, women "with heads as well as hearts" as
Pastor Wagner  described  them".
A paper was then read by Miss Laura Timmins, R.N., of the Social
Service Department of the Vancouver General Hospital, on "Hospital
Social Service":
HOSPITAX.   SOCIAL  SERVICE
Among the various departments of the larger hospitals in America
is one about which I am sure very little is known—this is the Social
Service Department. The work is steadily becoming so large that we are
forced  to  recognize  its  importance.
As yet social service is in its infancy. In 1888 the Children's Hospital in San Francisco had certain of its nurses visit the homes to instruct
the parents in hygiene and to supply extra diet and other necessities.
The work which began in the Massachusetts General Hospital, under the
direction of Dr. Richard Cabot, 18 years later and which was called
"Social Service," recognized the importance of the inter-relation between
the social and medical care of its patients. This idea has spread until now
a department such as this has been established in three hundred institutions in Canada and the United States, the number of workers depending on the size1 and demand of the hospital.
—31— The meaning of the term "Social Service" is a bit hard to define,
it may be said to be the practical application of the ideals of chivalry to
the conditions of modern community life. It represents the conscious
effort of the stronger to help the weaker; of the fortunate to help the less
fortunate; and in the aspect in which we are chiefly concerned, the
efforts of the well to help the sick.
This afternoon I shall try to tell you of the work of the Social Service Department of the Vancouver General Hospital whcih I represent,
and which was first started in 1910. In 1920, the social service department was re-organized and established with the substantial aid of the
women's auxiliary to the hospital, whose interest and co-operation has
been unfailing.
In addition to the indoor department, we have as well the outdoor
or outpatient department. Here we have the patients who are unable to
afford a private doctor and who come to the various clinics according
to the nature of their ills, for free treatment. They receive when needed,
the full treatment the hospital affords. Laboratory, X-ray, hydro therapy,
and its branches, and pharmacy. The patients are always referred by
a known organization, private doctor, or the case is investigated before
the patient is admitted. Some of the organizations who co-operate and
send in cases are: School Nurses, City Relief, Child Welfare, Mothers'
Pensions, Crippled Children's Association, S. C. R., Red Cross, V. O. N.
Co-operation oils the wheels of the machinery of social welfare and without it work of this kind cannot be done satisfactorily.
The work arising from the outpatient department keeps us very
busy, for we cannot expect medical aid to wholly bring relief, if the
social conditions are poor. Supposing a patient needed a surgical appliance and would not say he could not afford it, but did without the
most necessary foods to buy the needed brace, thus ruining his health in
general. It is our place to see that these appliances are had for the
patient, and in doing this, we in return, ask for donations from organizations, interested in the patient, to pay for it. Also we have a good deal
of follow-up work, seeing that the doctors' treatments are being carried
out in the homes, or visiting, regarding home conditions as to whether a
child would be more benefited in hospital.
We spend a good deal- of time gathering information from various
sources, of cases attending the Psychiatric Clinic. Information of this
kind takes a very round-about way of getting, as few people will admit
any sub-normality in their family. However, very often a friendly chat
will disclose many things they never meant to tell, which after all are
only used to benefit the patient.
Home visits bring about a kindly relationship unobtainable with
some patients in hospital walls and stiff uniforms. One afternoon was
spent recently in locating the family of an outdoor patient living in
Burnaby, who was admitted to hospital for treatment, possibly a serious
operation. The patient, a little Armenian womian with searching black
eyes, it may interest you to know, was one of the Armenian refugees,
driven from their homes by the Turks. She had told us of the dreadful
hardships endured during that long tramp to safety, and the doctors
believe that a good deal of her present trouble is due to that. We found
after a good deal of questioning, some idea of where to find the huS-^
band. After walking a good distance down a road no car could traverse,
we found him digging in his garden with his two small children following
him about. He expressed his gratitude in broken English, in our letting
him know of his wife's condition, and kept saying to the children "no
mother." However ws hope they will have their mother back with them
again, soon. These eases from the outdoor, become social service cases
when we have other things to do for them than medical service.
—32— There are two graduate nurses in the department, who have taken
the required post graduate course at the University in public health work,
as well as a nurse-in-training; sometimes a University student taking the
combined nursing course, and a stenographer. I must not forget to
mention our Ford car which is after all our best social service worker.
This car may be seen almost any afternoon laden with bundles of clothing,
magazines, diabetic scales, crutches, mattresses, perambulators, wheelchairs, patients or babies all going somewhere to fill in a necessary place.
We are the means of bringing babies from the infants' hospital to the
main hospital fo rspecial treatment—of taking home mothers and new
babies from hospital, and taking patients from hospital down town to
offices for various reasons, such as orthopaedic shoes, glasses, and immigration offices, as the case may be.
Each day the entire hospital is visited and the patients have a
chance to ask for little favors they wish done, such as a telephone call
to their home; a letter to be written; telegram sent; or a request to visit
a home to reassure a mother that the woman sent in to care for the
household is looking after the children well; that the pre-school age
children are not on the streets. All these are little things to us, but are
most important to the mother. The thought of perhaps an operation or
a long stay in the hospital is quite enough to worry the average person,
so we try and keep the mind relieved as much as is possible.
Last week we had through the co-operation of a busy organization
here, a patient sent back to her home in the East. This patient came to
Vancouver on a rather haphazard mission, was out of funds and took
work as a domestic. She was unable to carry on at this, on account of
dizzy spells, and was the cause of a good deal of worry to her employers,
in this way she could not hold a job. We brought her into hospital where
she was thoroughly examined and the condition was found to have existed
from childhood, and would in time be serious enough to make her an
institutional case. As the mother of the patient lives in the East, and is
quite an old lady and still working as a domestic, insisted upon coming
West to visit her daughter and perhaps stay, we felt we should act at
once, or we would no doubt have two cases for the care of the province
in a short while; so finally the mother was convinced of the inadvis-
ability of her coming all this distance, and the daughter seemed to
like the idea of going home, so we gathered together her belongings
and took her to her train. Transportation was supplied by the fore
mentioned organization.
Among the demands made on this office are the homes to board
babies and children. These homes are under the supervision of the
City Child Welfare, and the babies boarded are taken to the well baby
clinics at stated intervals. Very often we have babies in the hospital,
whose mothers have no place to take them to, and at her request we
take them out to board until other arrangements are made. The baby
may be awaiting its own home or perhaps a home with a perfectly new
set of parents, who adopt the baby legally as their own. To protect the
foster parents, we have a routine regarding adoptions. We have a physical examination of the baby; a Wasserman, or blood test; complete history of parents, or as much as possible, and an intelligence test dojie on
the mother. Then, to protect the baby we ask for two letters of recommendation from the foster parents, as to their suitability to adopt a child,
from two well known people. The mother's consent papers are made
out on proper forms in our office and signed before a notary public, so
that the mpther of the child and the foster parents never meet and do
not know even the name of the people taking the child. We try to place
a child in as suitable environment as possible.
Layettes can always be had for the baby whose mother has been
unable to get one ready herself.
—33— In the case of the unmarried mother, we find it very hard to really
advise her what to do about the child, even when we know that the child
must be perhaps most considered. To talk with a mother regarding
parting with her baby is not an easy thing to do, although you know
there is little chance for the baby. If there is a possibility at all for a
baby to remain in its own family, we do everything to keep its inheritance.
When a foster mother is new on her job and uncertain of how to
handle a young baby, a nurse from the department goes along to give
instruction on the scientific methods of bathing an infant and preparing
his formula. This we find; helps very much in giving satisfaction to the
mother, and is only what a new baby would expect. From .time to time!?
we receive messages from people to say how pleased they are with the
baby and what a difference it has made in their home, sometimes a baby
sister or brother is added to the family, also from this source.
I must not forget to mention some of the amusements of the
patients during their stay in hospital. On a number of wards are Victrolas
and we are constantly being asked for a change of popular records,
needles, repairs, and tobacco for the patients whose only enjoyment is
their old pipe, as they sit on the grounds, and as well, the ever popular
cribbage board. At times we have persons with cars call and take a '
number of patients for a motor ride. The patients who have been in for
a long time very much enjoy seeing a bit of outside. This means in a
number of cases an entire set of clothing to be supplied from our store
room, as perhaps the patients were admitted in a cold season and this
is a hot day.
A few mornings ago we had a telephone message from a doctor
asking us to place a child of two years whose mother had died during
the night, leaving a baby a few hours old. The father had no one to leave,
the child with, even to make the funeral arrangements, so after telephoning around a bit, we were able to place little Walter in a good home
in an hour. On visiting him later, we found the child had a heavy chest.1
cold, and was in poor condition generally, so brought him to the hospital
clinic for laboratory tests, and to be outfitted with warm clothing. He is
being brought to the clinic regularly and his condition is improving
steadily. The father wishes him to stay on indefinitely at his new home,
and we are well pleased with the way things have turned out.
One morning we made a hasty visit to the mother of a little girl
from our ear clinic, who needed an operation done at once. It was necessary to have the mohher's consent, hence the visit.
It is very difficult to tell of the work without mentioning cases, as
we can have no special routine. We take, like Murphy, whatever comes
along.
We have as a protege of this department, a splendid little fellow,
12 years old, who was found by a former worker, living in a most deplorable condition, six years of age, 'unable to talk coherently, and unable to walk on account of ricketts. He was living with his aged grandmother, supported here and there by his father, and deserted by his
mother. He was made a ward of ours, and has had years of treatment -
for his deformed condition, and has been boarded and sent to a school
where he can be given more than ordinary instruction and his reports
are most satisfactory. He feels that he belongs to us naturally, and we
are hoping that some philanthropic person with a big heart will come
along and offer him a real home, something he has never had, and
make him a useful citizen of Vancouver in later years.
We have been very busy collecting our people for the Crescent Beach
Camp, sent by the Alexandra Orphanage Fresh Air Fund.   We sent fifty
—34— mothers and babies along with those from other organizations this summer. You would hardly believe that there could be such a difference in
color and expression on childrens' faces in two weeks, when they arrive
back again with their pails and shovels. We are providing cars to take
these families to the station.
We have in our office a very good library containing books of various
types of reading material. We have all the books catalogued and the
name and number is taken of all books leaving this office. The patients
who are up and about come to the office themselves and for those who
are in bed, we have a magazine and book wagon, containing three tiers,
this is taken to every ward two ot .three times a week, and the patients
in bed may choose what they want. If a book is asked for that we do
not have, we try and get it from some source. This work is done entirely
by voluntary help, and is very much appreciated indeed. The books and
magazines are donated by friends of the department and I might say
that we have plenty of room on our shelves for the more modern books
that have been read by the family, but are not wanted for the home shelf
particularly.
The amount of service required for any hospital depends entirely on
the size of the town and the hospital. The smaller hospitals no doubt are
doing a good deal of social service work, never dreaming that they are
doing any more than any thinking person would. There are always
organizations and individuals ready to extend the helpful hand but the
idea is to get it on a working system. No matter how isolated the town
may be, there is always the Red Cross to appeal to for aid, as well as
church organizations and the municipality. A women's auxiliary formed
of interested women in any community is a great asset to a hospital for
a group can do much more than an individual.
A little start in this line of work is the beginning of something
larger. Any hospital would enjoy a library, and what hospital could do
without the little errands, messages, letter writing, always done by somebody.
I do not quote our department in the hospital as a model by any
means, but it is much easier to speak of some tangible thing, and ideas
may be taken from and added to.
If there are any questions regarding this work I should be very
pleased to answer them.
Miss K. W. Ellis, R.N., superintendent of nurses, Vancouver General
Hospital, read a paper on "A review of the modern trend in nursing and
of nursing education." Very animated discussion arose from Miss Ellis'
paper in which Sister Gabriel made many criticisms of existing conditions.
A REVIEW OF THE MODERN TREND OF NURSING AND
NURSING  EDUCATION
A subject worthy of much discussion is suggested by the title of this
paper and it is a privilege to have the opportunity of introducing it upon
an occasion such as this, when all those most vitally concerned in the
solution of its problems will be represented. Nursing today may be classified as "Bedside" and "Community" nursing.
The term "bedside nursing" is understood to include all branches involved in arranging for the bedside care of the patient—institutional and
private duty nursing, as well as teaching and administration—while
"community nursing" embraces public health, social service, industrial
nursing and the various types of preventative work.
—35— A few years ago the bedside nurse was, as the term implies, one
Immediately concerned in the bedside care of her patient, her responsibility extended to assisting with the routine work of the ward and incidentally preparing herself to impart instruction to others. Most of her
knowledge was gained from her practical experience on the ward, there
was little, if any, class room instruction. It was not until some years
after training schools were established that the private duty nurse came
into existence, and at first her duties were carried on under the direct
supervision of a medical student who remained in the home and performed many of the services now delegated entirely to the special nurse.
Changes have taken place gradually and what a contrast the situation
of today presents, with the increasing tendency to place more and more
responsibility on the nurse. Not only is the nurse expected to have a
thorough knowledge of the general care and treatment of patients,
technique, etc., to a far greater extent than heretofore, but she is required to be familiar with special treatments and tests, which with rapid
advancement in medical science have become to be regarded as part of
the daily ward routine, these not only absorb a great deal of the time
and attention previously devoted to the actual care of the patient but call
for additional instruction, if the student is to have the required understanding of such procedures as: fractional test meals, lumbar puncture,
aspiration, and the various kidney and blood tests which necessitate such
careful and constant attention on the part of the nurse, who in addition
is to be prepared to undertake the keeping of accurate records, now
regarded as such an essential part of hospital routine.
We cannot deny that the present day student, who goes out from,
the training school properly equipped to meet the demands made upon
her, must have acquired during her course of training knowledge, of a
technical nature and otherwise which nurses some years ago gained only
by hard earned experience, and often after graduation.
In addition to this much more frequent are the calls for nursing
"specialities." Repeatedly does the request come for a nurse who understands the care of diabetes, is conversant with metabolism work and the
administration of insulin, one who is proficient in the nursing care of
eye, ear, nose and throat cases, who have had experience in radium
treatment or X-Ray, and so on. Nurses are today being called upon to
fill positions which but a short time ago were closed doors to them, may
not this be recognized with appreciation as an indication of the increasing faith in the ability of the nurse on the part of the medical
profession?
Just how much special training should be included in the general
nursing course is a subject of controversy and must necessarily be somewhat dependent on conditions which exist in the individual training
schools. It is, however, generally considered that while these must be
classified as "specialities," a student should have some knowledge of the
theory of X-Ray, massage, physiotherapy, anaesthesia, urine analysis, and
various laboratory tests, in addition to the general nursing subjects, in
order that she may give intelligent co-operation in obtaining the required
results. Mental hygiene is also a subject it has of late years been felt
most essential to add to the nursing curriculum. The need for preventative medicine is emphasized more and more in all branches of work and
nurses are constantly being called upon to aid the physician by assisting
in teaching and advising the public; although this subject is being extensively dealt with in schools today does not the opportunity of giving
further instruction frequently fall to the lot of both the graduate and
pupil nurse?
"Community Nursing" in all its phases is a work for which special
training is essential and in spite of this fact it is absorbing many of our
nurses today.   Doubtless because it affords such wide and diversified op-
—36— portumties of interest and in addition presents the probability of more
attractive living conditions, shorter hours, higher remuneration than
available to those who have not had the benefit of special training, and
also allows for more freedom from responsibility in hours off duty.'
Fifteen years ago an eminent physician, when speaking to a group
of nurses said, "On looking over the history of nursing, I ha\o been very
much struck with the rapid expansion of the work entrusted to nurses.
Anyone who works in a hospital realizes that a transfer of routine from
the physician to the nurse is still going on and this may account for an
occasional misunderstanding, perhaps, as to what is a nurse's duty and
what is a physician's." This same physician added, "Thus far nurses have,
for the most part, been content to be general practitioners of nursing, but
already some have begun to specialize, and it needs only half on eye to
see that the near future will be marked by an extension of this tendency
to specialization in nursing. The time is fast approaching when we shall
have nurses who attend chiefly or solely obstetrical cases, others who care
only for pediatric cases or for nervous and mental cases, only for fever
or operative cases, and so on. Nurses who desire successfully to specialize
will be compelled to acquire unusual training and experience just as is
the specialist in medicine." This prophecy did not, and could not, include the world-wide changes that were to be wrought by the great war,
changes which so materially affected all organziations but most essentially the medical and nursing; its fulfillment, however, is the answer
to the question so often asked as to the necessity for increase in the
curriculum taught in schools of nursing. The attempt to carry out the
standard curriculum with all the changes and advances in nursing education is today occasioning much discussion and deeply perplexing those
who are responsible for its application. It is impossible for any immediately concerned with hospital administration to be indifferent to the fact
that an ideal solution of the problem has not yet been arrived at.
Many suggestions have been made to further this end, it would,
however, be a digression from the subject of this paper to enter here into
any detailed discussion of this phase of the question, but mention may be
made of the shorter course for nurses, group nursing, consecutive eight
hour duty, employment of nurses and ward assistants for general duty
to relieve the student of much of the routine work of the ward; it has
even been predicted that the day may come when schools of nursing will
be as schools of medicine, when the student nurse will no longer be
an apprentice in any sense of the word. Nursing education is undoubtedly
undergoing a process of evolution and it is apparent that many of the
solutions suggested involve the question of finance. Schools of nursing require support and surely are just as much the responsibility of the
community as are schools established for other educational purposes.
Can the hospital be expected to bear this responsibilty as well as to
finance the general working of the institution?
It is most true that the immediate problems of the hospital is the
care of the patient of today but it also includes the care of the patient of
tomorrow, the necessity of this is recognized in a measure, by the
emphasis being placed upon the research work carried on in the laboratories which exist in connection with all the larger institutions. Just
as much does this obligation apply to the preparation of the nurse of tomorrow in caring for the sick of today and tomorrow, the object for
which the hospital exists, the education of the student is not a secondary consideration and is one which must be accomplished without sacrifice on the part of the patient.
There is no doubt that nursing, as well as other conditions of life,
must inevitably be affected by the trend of modern times, is not the profession at this time suffering in an attempt to meet some of the rapid
changes. To keep alive to these changes, to be ready, not only to make the
necessary adjustment today, but to be prepared to meet the conditions of tomorrow is the responsibility of the profession and in order to enlist
sympathetic consideration of their problems nurses must now and always
cherish their standards and ideals and render good and faithful service,
when for the future we need not fear.
Mr. McVety referred to remarks made by Dr. Murphy in his
address regarding the employment of the pupil nurse's time taken up with
the performance of menial duties and expressed the opinion that these
duties were a necessary part of the nurse's education, to which Miss
Randal replied that too much was expected of the pupil nurse in the
performance of domestic duties in the hospital and considered that any
instruction along these lines should not be a part of the institutional
training. Mr. McCullough expressed himself in support of Miss Randal's
views.
Miss Ellis in speaking on this subject, expressed the opinion that
some of the ward duties of a domestic nature should be done by the
pupils in so far as it was necessary to their training.
Mrs. Wilkes, speaking from the lay viewpoint, said that ,so many
girls are not trained in their own homes to perform necessary domestic
duties and considered that it was necessary that they receive instruction
along these lines in the hospital.
In response to an inquiry from Mr. McGregor regarding that portion
of her paper dealing with technical training Miss Ellis expressed herself as not favoring the plan of central training schools apart from the
practical training provided in the hospital.
Regarding the nursing curriculum, Dr. Riggs pointed out that there
is a certain fundamental of nursing beyond which there is specialized
nursing in a similar manner to what appears in the training of a medical
man and considered that a general education, if necessary, could be
covered in a course of two years or two years and three months which
could be followed by an extra course along specialized lines.
Miss Ellis replied that the increase in nursing requirements was
chiefly due to demands made by the medical profession not only in the
knowledge expected of graduate nurses but also in pupil nurses.
Many other delegates participated
intensely interesting.
in this discussion which proved
Mr. Geo. Haddon, first vice-president,
Brown, had unfortunately been called
announced that the president,
back to Nanaimo on business.
MORNING SESSION—Saturday, Sept. 11th
Mr. George Haddon, First Vice-President, occupied the chair, and
expressed the regrets of the President, Dr. G. B. Brown, that he was
unable to be present, as he had been called away on business.
Mr.  Binger  reported  as
On behalf of the Resolutions  Committee,
follows:
With regard to the resolution re infectious cases which was passed
at the last convention held in Nanaimo, and which was referred to the
attention of this committee, we beg to report that after consultation-
with Dr. Young it is understood that the Provincial Health Department
will pay one dollar per day for each nurse employed iby the hospital
nursing infectious cases in isolation wards.
—38— With regard to the resolution as to a Provincial Health Insurance
Policy passed at the last convention held in Nanaimo, the committee
recommends that this resolution stand and that the words "with power
to act" be added.
That a very hearty vote of thanks be extended to the following:
To the Directors and Staff of the Vancouver General Hospital
for their kindness and hospitality in entertaining the delegates, for
the use of the auditorium and the splendid way in which the convention was handled.
To the Sister Superior of St. Paul's Hospital for their hospitality.
To all those who have so kindly contributed papers and that the
Secretary be instructed to convey the same to them.
To the President, Board and Staff of the Royal Columbian
Hospital for their hospitality.
To Dr. J. G. McKay of Hollywood Sanitarium, New Westminster,
for his invitation to attend the New Westminster Exhibition.
To the Press for their kindness in reporting the proceedings of
the convention.
Moved by Mr. McVety, seconded by Mrs. Wilks, and carried, that
the report be adopted.
Dr. Proud of St. Paul's Hospital, spoke of trouble now being experienced with the customs department in connection with the importation of laboratory and X-ray apparatus for hospital purposes, which had
always been duty free, but which are now being classified as dutiable.
A breast pump that had been purchased had also been charged as dutiable. On the motion of Mr. Bethune, seconded by Mr. Binger, and carried,
it was resolved that this matter be referred to the incoming Executive.
The treasurer, Mr. McVety, reported that the cost of travelling expenses to each delegate participating in this convention figured out at
eighteen dollars and thirty-five cents ($18.35). On the motion of Mr.
McVety, seconded by Mr. Marshall and carried, it was resolved that
the report -be adopted, and that statements be rendered to the hospitals
concerned and adjustment made thereafter.
Dr. Bell explained, in order to avoid any misunderstanding, that
the paper read by Miss Ellis, was, as its title conveyed, a review, and
must not necessarily be interpreted as recommendations.
Miss Lumsden, of the "Canadian Nurse," invited the Association to
make use of that publication, to contribute articles and to subscribe to
the magazine.
A discussion ensued as to the place of the next convention. On
motion of Mr. Birch, seconded by Mr. McCulloch and carried, it was resolved that the place and date of the next convention be left to the
executive.
—39— The question of the manner in which the report of proceedings shall
be published was left to the executive.
The Chairman appointed Dr. Pearse and  Mr.  Birch as scrutineers
for the election of officers which resulted as follows:
Honorary President—The  Hon.  Wm.   Sloan,  Provincial  Secretary,  Parliament Buildings, Victoria, B.  C.
Honorary Life  Members—Dr.  M.  T.  MacEachern,  American  College  of
Surgeons, 40 East Erie St., Chicago, 111.
J. J. Banfield, 327 Seymour St., Vancouver, B. C.
President—George Haddon, Business Superintendent, Vancouver General
Hospital, Vancouver, B. C.
First Vice-President—J. H. McVety, 714 Richards St., Vancouver, B. C.
Second Vice-President—R. A. Bethune, Secretary, Royal Inland Hospital,
Kamloops, B. C.
Treasurer—Miss  G.  M.  Currie,  R.N.,  Superintendent,  North  Vancouver
Hospital,  North Vancouver,  B.   C.
Secretary—E. S. Withers, General Manager, Royal Columbian Hospital,
New Westminster, B.  C.
Members of the Executive Committee in addition to the above:
For Vancouver Island—Dr. G. S. Pearce, Superintendent, Provincial:!
■   Royal Jubilee Hospital, Victoria, B. C.
For Vancouver—Rev. Father O'Boyle, 646 Richards St., Vancouver.
For  Coast  Mainland—G.   S.   Marshall,   Director,   North   Vancouver
Hospital, North Vancouver, B. C.
For Fraser Valley—R. L. McCulloch, Chairman, Abbotsford-Sumas-
Matsqui Hospital, Abbotsford, B.  C.
For Yale-Cariboo—M. L. Grimmett, Director, Nicola Valley General
Hospital, Merritt, B.  C.
For   Okanagan—G.   Binger,   Secretary,   Kelowna   General   Hospital,
Kelowna,  B.   C.
For Kootenay West—Miss A.  McArthur,  Superintendent, Kootenay
Lake General Hospital, Nelson, B. C.
For Kootenay East—Mother Nazareth, St. Eugene's Hospital, Cranbrook, B. C.
For Grand Trunk Pacific—J. H. Thompson, Prince Rupert, B.C.
CONVENERS OF STANDING COMMITTEES, AND THEREFORE
MEMBERS OF THE EXECUTIVE COMMITTEE:
Medical Affairs—Dr. F. C. Bell, General Superintendent, Vancouver General Hospital, Vancouver,  B. C.
Business Affairs—George McGregor,  Director, Provincial  Royal Jubilee
Hospital, Victoria, B. C.
Nursing Affairs—Miss C. Black, Superintendent, King's Daughters' Hospital, Duncan, B. C.
Constitution and By-laws—C. E. Wilson, Central Building, Victoria, B. C.
Municipal Affairs—R. R. Burns, Director, Vancouver General Hospital,
Vancouver, B. C,
—40—  Constitution and Bylaws
Article 1—Name.
The name of this Association shall be "The British Columbia Hospitals' Association."
Article 2—Purpose.
(a) To serve as a means of intercommunication and co-operation
for the hospitals of this Province.
(b) To increase the efficiency of all hospitals in the Province by
establishing and maintaining the best possible standards of
hospital service.
(c) To stimulate and to guide intensive and extensive hospital
development.
(d) To develop on the part of hospitals a sense of responsibility
to the community with respect to education in health matters
with special emphasis on the training of nurses.
(e) To keep the people of this province informed concerning hospital problems and to serve as a means of communication
between hospitals and those in authority in provincial and
municipal affairs.
(f) To frame from time to time suggestions for additions to, or
changes in legislation affecting hospitals.
Article 3—Membership
Members shall be all persons connected directly or indirectly withj
hospitals paying the membership fees hereinafter mentioned,  and such
members shall be classified as follows:
(a) Honorary
(b) Individual
(c) Institutional
(d) Auxiliary
Honorary members shall be those persons who are held by the As-I
sociation to have rendered conspicuous service in the hospital field.
Institutional  membership  may be held  by  any hospital,   public  or
private, carrying on work within the province.   Institutional membership,
shall include all members of Trustee Boards or Boards of Directors and
all persons holding executive positions in hospitals having membership in
the Association.
Individual membership  shall
11 ' ""'           who   a.i c   iiut   iiitiiuucjis  -ui    irnsLte   .DOttruoj
who   do   not   hold   executive   positions   in
.i.n;,,... ^aiuvoiKiu.cj  0^01*  be all  persons  connected  directly or
indirectly with hospital work who are not members of Trustee  Boards
or   Boards   of   Directors
hospitals.
or
Auxiliary Membership.—The senior  Auxiliary or  Women's  Organ-a
ization duly recognized as such by the Board of Directors of the institution it serves may be admitted to corporate membership, provided  the I
hospital with which it is associated is a member of the B. C. Hospitals'
Association.
—42— Article 4—Officers.
The officers of the Association shall be:
Honorary President
President
First Vice-President
Second Vice-President
Secretary
Treasurer.
The Executive Committee shall be composed of twenty members, as
follows:
(a) The Officers of the Association
(b) The Representatives of the Districts hereinafter mentioned
(c) The Conveners of the Standing Committees.
The following districts must be represented on the Executive Committee, viz., Vancouver Island, Vancouver, Coast Mainland, Fraser Valley,
Yale-Cariboo, Okanagan, Kootenay East, Kootenay West, Grand Trunk
Pacific.
Article 5—Fees
Membership fees shall be due and payable on the first day of July
in each year, as follows:
Honorary Members (no fee).
Institutional Membership shall be payable according to the following scale:
(a) Hospitals of ten beds or under, per annum $  5.00
(b) Hospitals of eleven to twenty beds, per annum   10.00
(c) Hospitals of twenty-one to fifty beds, per annum  15.00
(d) Hospitals of fifty-one to one hundred beds, per annum....  20.00
(e) Hospitals of one hundred  and one  beds and  over,  per
annum  25.00
Individual members shall pay a fee of five dollars per annum.
Auxiliary membership fees shall be one-half of that paid by the Institution with which it is associated.
Article 6—Election of Officers
Election of Officers shall take place at the Annual Meeting each
year, and shall be by ballot. All officers .shall be elected for a term
of one year.   Institutional members only shall be eligible for office.
A Committee on Nominations consisting of three members shall
be appointed annually. Two of these members shall be designated >by
the- Executive Committee, and the third, who shall act as convener,
shall be appointed by the President. No member of the Executive committee shall b.q-jelig&ble to serve upon the Nominating Committee. It shall
be the duty of the Nominating Committee to request and to receive
from the members of the Association the names of>i.persons suitable to
%hcHa office in the Association. Two weeks prior to the Annual Meeting
the Committee shall prepare a list of all persons so nominated for the
information of the members attending the Annual Meeting. Nominations
shall be permitted from the floor at the Annual Meeting.
Article 7—Committees, Executive and Standing
(a) The Executive Committee shall transact the business of the
Association during the year and shall report to the Association at the
—43— Annual Meeting, or to Special Meetings when necessary. It shall act in
the capacity of a Membership Committee and shall pass upon all ap-.
plications for membership in the Association. The Executive Committee'
shall also act as a Legislative Committee for the purpose of considering
legislation affecting hospitals.
(b) Medical Affairs. The Standing Committee on Medical Affairs
shall consist of five members, the Convener of which shall be elected by
the Association at the Annual Meeting. Its duties shall be to investigate
and report upon all matters relating to medical service in hospitals.
(c) Nursing Affairs. The Standing Committee on Nursing Affairs
shall consist of five members, the Convener of which shall be elected by
the Association at its Annual Meeting. Its duties shall be to investigate
and report upon all matters relating to nursing in hospitals.
(d) Business Affairs and Accounting. The Standing Committee
on Business Affairs and Accounting shall consist of five members, the
Convener of which shall be elected by the Association at the Annual
Meeting. Its duties shall be to investigate and report upon all matters
relating to business administration and accounting in hospitals.
(e) Constitution and By-Laws. The Standing Committee on
Constitution and Bylaws shall consist of five members, the Convener of
which shall be elected by the Association at its annual meeting. Its duties shall be to receive, consider and report upon all proposed amendments of, additions to, and deletions from the Constitution and Bylaws of
the Association.
(f) The remaining members of the Standing Committees shall be
appointed by the Executive Committee at the meeting immediately following the Annual Meeting.
Article 8—Meetings:  Time and Place
The time and place at which the Annual Meeting and Convention
shall be held may be decided at the regular meeting of the year preceding
or may be left in the hands of the Executive Committee with full power
to act. Special Meetings may be called from time to time by resolution
of the Executive Committee. Fourteen days notice in advance of the
holding of said meetings shall be sent to each member of the Association.
The Executive Committee shall meet at least once a year. It shall
meet when called upon to do so by the president of the Association or at
the request of any five members of the Association.
Article 9—Quorum
Ten per cent, of the institutional membership shall constitute a
quorum of the Association at its Annual Meeting or at a special meeting.
Five members shall constitute a quorum of the Executive Committee.
Article 10—Amendments to Constitution and By-Laws
The Constitution and Bylaws may be amended at any regular meeting of the Association by a two-thirds vote of members present, providing
that notice of motion has been given prior to the meeting to the Committee on Constitution and Bylaws.
Article   11—Resolutions
No resolution affecting the general policy of hospitals holding membership in this Association shall be presented at any regular or special
meeting of this Association unless the same shall have first been present-
—44— ed to the Executive Committee in writing. No action affecting the general policy of said hospitals shall be taken until the question has been
referred to all institutional members, unless the question at issue shall
have been unanimously agreed upon by the delegates present at said-
meeting.
Article   12—Voting
In any matter of business or policy requiring action by vote of the
Association, voting of institutional members shall be in proportion of
one vote for each five dollars ($5.00) of membership fee: thus an institution paying five dollars in membership fee shall be entitled to one
vote, and so forth. One delegate shall be entitled to record the entire
vote of the hospital represented by such delegate.
The combined delegation of any institution or auxiliary body shall
agree among themselves as to how that institution or auxiliary body
shall vote. No institutional or auxiliary vote shall be divided on any
question. If time for deliberation is required by a delegation of an institution or an auxiliary body before casting a vote, the chair shall postpone the taking of a vote for a reasonable time. After postponement for
such a purpose there shall be no further discussion of the question before taking a vote upon it.
Honorary Members are not entitled to vote.
Individual members shall not be entitled to vote at the Annual
Meeting or at any subsequent meeting of the Association unless the
membership fee shall have been paid at least thirty (30) days prior to
the holding of the Annual Meeting.
Auxiliary bodies are entitled to half the number of votes cast by
the institution with which it is associated.
Votes by proxy will not be allowed.
Article IS—Pooling of Delegates' Expenses
(PARTICULARS TO FOLLOW).
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