History of Nursing in Pacific Canada

Report of proceedings of the annual convention of the British Columbia Hospitals' Association. British Columbia Hospitals' Association 1923

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 Hospit^Associal^n
Including the proceedings of the
Sixth Annual Convention held at
Penticton, B.(a|ji
August 28th and 29th, - Jf$22:
A.  H. Timms.  Printer   -itEREr Vancouver, b. c W&8n$&   AS8lMILiA.'rM>
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I MANUFACTURERS   OF  ABSORBENT COiTriPN^RI^
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Absorbent Cotton,  Gauze,' Gauze  Bandages, Sanitary  Napkin*,
Adhesive ^plaster,  Cello  Dressing
Ether, Chloroform, Etyyl.'Chloride, Nitrous Oxide and Oxygen
, in. cylinders
Messrs. Stroyan & Foster, Ltd., 744 Hastings Street, W.
Tel. Seymour 4606
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*.J:'re<luirements.>vs  OFFICERS, 1922-23
Honorary President -Hon. J. D. MacLean, Provincial Secretary
President   H.  C.  Wrinch,  M.D., Hazelton
First Vice-President Charles Graham, Cumberland
Second Vice President _ J. T. Robinson, Kamloops
Secretary.—Miss E. Johns, University of British Columbia, Vancouver
Treasurer Mrs. M. E. Johnson, Bute St. Hospital, Vancouver
EXECUTIVE  COMMITTEE
B.  A.  Bethune, Kamloops.
Dr. G. Bell Brown, Nanaimo.
Rev. Father O'Boyle, Vancouver.
Miss J. F. MacKenzie, Victoria.
Miss A. MacArthur, Nelson.
Miss C. Black, Prince Rupert.
George Binger, Kelowna.
Dr. M. T. MacEachern, Vancouver.
George McGregor, Victoria.
E. S. Withers, New Westminster.
STANDING COMMITTEES
Dr.
Dr.
Dr.
Dr.
Di
Medical   Affairs
G. S. Purvis, New Westminster.
W. Arbuckle, Vernon.
A. S. Monro, Vancouver.
D. M. Poyntz, Victoria.
H. E.  Murphy,  Kamloops.
Nursing Affairs
Miss K. B. Stott, New Westminster.
Miss K. W. Ellis, Vancouver.
Mrs. M. E. Wilmot, Kelowna.
Miss Pauline Rose, Nanaimo.
Miss E. Clark, Vernon.
Business  Affairs
R. B. Leders, Vancouver.
R.  B. Woods, Nelson.
L. F. Morrisey, Merritt.
R.  Sargent, Hazelton.
T. Mordy, Cumberland.
Accounting
E.  S.  Withers,  New  Westminster.
G. T. Carver, Victoria.
G.  R. Binger, Kelowna.
George Haddon, Vancouver.
Constitution and By-laws
George Haddon, Vancouver.
Miss E. Johns, Vancouver.
Peter Black,  Chilliwack.
Dr.  H.  R.   Storrs,  Vancouver. Delegates in Attendance at the   Sixth   Annual   Convention,
August 28th, 29th, 1923, Penticton, B. C.
Name Representing
Brown, Mrs.  G. Bell   Nanaimo  General   Hospital  Women's  Auxiliary.
Brown, Dr. G. Bell  Nanaimo General Hospital.
Ball, Louis  Vernon Jubilee Hospital.
Ball, J Kelowna General Hospital.
Bethune, R. A Royal Inland Hospital,  Kamloops.
Binger, G. R Kelowna General Hospital.
Banfield, J. J Vancouver General Hospital.
Boggs, Miss A, L Royal Inland Hospital, Kamloops.
Brown, Miss K Cumberland General Hospital.
Cross, A. H Chandler and Fisher Co. Ltd.
Carrington, A. R Nicola Valley General Hospital,  Merritt.
Carr-Hilton, E. W King's Daughter's Hospital, Duncan.
Creese, H. H Summerland Hospital.
Clark, Miss E Vernon  Jubilee  Hospital, Vernon.
Clayton, W. B Penticton Hospital.
Fletcher, C. J B. C. Medical Association.
Frederickson, H. T Victor X Ray Corporation.
Fisher, O. E Penticton Hospital.
Gibson, Mrs. E. E Penticton Hospital Womens' Auxiliary.
Gillies. Dr. J. J Nicola Valley General Hospital, Merritt.
Glass, J. H Penticton Hospital.
Grimmett,  M. L Nicola Valley General Hospital,  Merritt.
Goward, Mrs. H. A 3t. Joseph's Hospital, Victoria, Ladies' Auxiliary.
Haddon, George  Vancouver General Hospital.
Hamilton, Dr. J Queen  Victoria  Hospital,  Revelstoke.
Harwood,  Jos Vernon Jubilee Hospital.
Hinch, R. W Ingram and Bell Co. Ltd.
Inglis, Mrs. G. H Summerland   Hospital  Women's   Auxiliary.
Johns, Ethel   Dept. of Nursing, University of B. C.
Johnson, Mrs. M. E Bute St. Hospital, Vancouver.
Keddell, Herbert . .'. Penticton General Hospital.
Keddell, Mrs. R Penticton Hospital "Women's Auxiliary.
Kirkpatrick, J Penticton General Hospital.
Knight,  Mrs.  E.  B -.Women's    Hospital    Aid,    Vernon   Jubilee
Hospital.
Knight, Mrs. J. G Women's    Hospital    Aid,    Vernon    Jubilee
Hospital.
Leslie, Mrs. A. M Summerland Hospital, Ladies' Auxiliary.
Lipsett, Mrs. R. C Summerland  Hospital  Ladies'  Auxiliary.
Lipsett, Dr. R. C Summerland Hospital.
Mellor,  H.  C Summerland  Hospital.
Millar, Rev. J. Fergusson..Penticton Hospital.
McCosh, A. G Kelowna General Hospital. McCulloch, R. L Abbotsford-Matsqui-Sumas Hospital.
McBwen, Dr. M. D Hedley General Hospital.
McGregor, George  Provincial Royal Jubilee Hospital, Victoria.
MacKenzie,   Mrs.  E Kelowna Hospital Ladies' Aid.
McVety,  J.  H.    Vancouver General Hospital.
Neville, Dr. J. D St. Paul's Hospital, Vancouver.
Prevost,   C B. C. Stevens Co. Ltd.
Pope, T. A Penticton Hospital.
Randal, Miss Helen  Graduate Nurses' Association of B.  C.
Rendell, Mrs. G. A —.Salmon Arm General Hospital.
Rhodes, W. A Vernon Jubilee Hospital.
Robertson,   George   Capt... Penticton Hospital.
Robinson,  J.  T Royal Inland Hospital, Kamloops.
Ross,  Mrs. Rosamond' Summerland  Hospital  Ladies'  Auxiliary.
Rowcliffe, Mrs. M. L Kelowna Hospital Ladies' Aid.
♦
Sister   Columkille   St. Paul's Hospital, Vancouver.
Sister Mary Gabriel  St. Joseph's Hospital, Victoria.
Sister Mary Mark  St. Joseph's Hospital, Victoria.
Sister Teresina  St. Mary's  Hospital, New Westminster.
Smith,  Mrs. H.  W. D Penticton  Hospital  Women's  Auxiliary.
Stott,  Rev. John  Enderby General Hospital.
Swift, Mrs. T. A M.S.A.  Hospital Women's Auxiliary.
Swift, Dr. T. A Matsqui-Sumas-Abbotsford Hospital.
Trood, Miss M Chief Dietitian, Vancouver General Hospital
Tyrrell,   Arthur    Royal Inland Hospital, Kamloops.
Watkins, Miss S. A Hazelton   Hospital,   Hazelton.
Walker,   P Office of the Provincial Secretary.
Williams, Parker   Workmen's Compensation Board.
Wilmot, Mrs. M. E Kelowna General Hospital.
Withers, E.  S Royal    Columbian    Hospital,    New,  Westminster.
Wrinch, Dr. H.  C Hazelton Hospital, Hazelton.
Wood, Lawrence  Penticton Herald.
Yeandle, Miss Ruth Nurse in-Training, Vancouver General Hospital. GDhtiuarg
*
As this report goes to press news has been
received of the sudden death of Mr. J. T. Robinson,
President of the Board of Directors of the Royal
Inland Hospital, Kamloops. In him the Association loses an untiring friend and helper. He was
a charter member and his interest in hospital
service was not confined to his own institution but
extended to the province at large. The Association tenders to his relatives its most respectful
sympathy. FOUEWOl
As a measure of economy no court stenographer Teas employed during the sessions of
the convention. The reports of discussions
are, therefore, not verbatim as in former years.
So far as possible the secretary has endeavored
to summarize these correctly and she hopes
that any errors will be condoned in the circumstances. The Convention of 1923
The Sixth Annual Convention of the British Columbia Hospitals
Association was held at Penticton, B. C, August 28th and 29th„ 1923.
The spacious rooms of the HSgn School were placed at the disposal of the Convention and proved an ideal Convention Hall. In
addition to floral decorations magnificent displays of fruit proved a
source of temptation not to be resisted by the delegates.
The following Institutions were represented by one or more
delegates:
Abbotsford-MatsQ'ui-Sumas Hospital, Abbotsford.
Bute St. Hospital, Vancouver.
Cumberland General Hospital, Cumberland.
Enderby General Hospital, Enderby.
Hazelton General Hospital, Hazelton.
Hedley  General Hospital, Htedley.
Kelowna General Hospital, Kelowna.
King's Daughters Hospital, Duncan.
Nanaimo General Hospital,  Nanaimo.
Nicola Valley General Hospital, Merritt.
Penticton Hospital, Penticton.
Provincial Royal Jubilee Hospital, Victoria.
Queen Victoria Hospital, Revelstoke.
Royal Columbian Hospital, New Westminster.
Royal Inland Hospital, Kamloops.
Salmon Arm General Hospital.
Summerland Hospital.
St.  Joseph's  Hospital,  Victoria.
St. Mary's Hospital, New Westminster.
St. Paul's Hospital, Vancouver.
Vancouver General Hospital.
Vernon Jubilee Hospital.
The following Auxiliary bodies were also represented:
Hospital Auxiliary—St. Joseph's Hospital, Victoria.
Ladies' Auxiliary—Summerland Hospital.
Ladies' Hospital Aid—Kelowna General Hospital.
Hospital Auxiliary—Penticton Hospital.
Hospital Auxiliary—Abbotsford-M&tsqui-Sumas Hospital.
Women's Auxiliary, Nanaimo General Hospital.
The following public and professional bodies were duly represented :
The Provincial Government.
The Workmen's Compensation Board.
The Graduate Nurses' Association of British Columbia.
The British Columbia Medical Association.
The Department of Nursing,  University of British  Columbia.
The following firms contributed interesting and instructive
exhibits:
Canadian Hospital Supply Co., Ltd., Vancouver,
Chandler and Fisher Ltd., Vancouver,
Ingram and Bell Ltd., Calgary, Alta.
B. C. Stevens Co., Ltd., Vancouver,
Victor X-Ray Corporation, Vancouver. The . experiment was made this year of reducing the duration of
the convention from three to two days. Material involving lengthy
discussion such as the amendment of the constitution took up a great
deal of the time and attention of the delegates, and, as a result the
time available for the remainder of the program was very much
curtailed. The get-together luncheons afforded opportunity however jj
for the discussion of problems for which no time could be found
during the regular sessions.
The luncheons were, as usual, a pleasing interlude in the serious
work of the convention and full advantage was taken of the presence of Dr. M. T. MacEachern to ask all manner of questions ranging from the discipline of the nursing force to the consideration of
the best type of  dish washing machine.
Community singing, under the leadership of Mr. E. S. Withers
surpassed in volume of sound all previous attempts of this Association and was voted an unqualified  success.
The local committee on arrangements, especially Mr. O. E.
Fisher, Mr. Herbert Keddell and Mrs. H. W. D. Smith were untiring
in their efforts to make the Convention a success. The kindly
hospitality of the citizens of Penticton was greatly appreciated by
the delegates. The public reception was much enjoyed and the
drive around "The Benches" gave the visitors an opportunity of
seeing for themselves something of the magnificent resources as
well as the beauty of the Okanagan district.
An enthusiastic welcome was .extended to Dr. M. T. MacEachern
who, at considerable personal inconvenience, attended the sessions.
In spite of his greatly enlarged field of endeavor he still retains his
old interest in and affection for the British Columbia Hospitals
Association.
It was also a source of pleasure to the Association that the
President, Dr. H. "C. Wrinch of Hazelton was once more able to be
present. His firm but kindly direction of the meetings was very
much appreciated. His thoughtful and inspiring presidential address was one of the features of the convention and is given in
full in the body of this report.
MORNING SESSION, TUESDAY, AUGUST 28th
The president, Dr. H. C. Wrinch called the meeting to order
at 9:40 a. m. He cordially greeted the delegates present and expressed himself as being delighted at the representative attendance.
He referred regretfully to the absence, through illness of Miss J.
.P. MacKenzie, Superintendent of Nurses of the Provincial Jubilee
Hospital, Victoria, and also to the loss by fire of the Columbia
Coast Mission Hospital at Alert Bay.
In the absence of the Reeve, Mr. E. J. Chambers, Councillor J
Kirkpatrick extended a very hearty welcome on behalf of the citizens  of  Penticton.
The Annual address of the President was then delivered by
Dr. H.  C. Wrinch. PRESIDENTIAL ADDRESS
In attempting to prepare an address that might be expected to
be a report of the year's activities of the hospital world, or even of
the institutions of our own little province there has been brought
most forcibly home to me a realization of the utter impossibility
of adequate presentation of the subject by one situated in a somewhat remote corner of so very extensive a field. This so impressed
itself upon me that, since a personal visit to each point was out of
the question, I felt my only recourse was to enquire of our people
by letter, and from information thus obtained pass on to this convention the latest views from  all corners of our territory.
It is a matter of great regret to us all that so many of our institutions find it impossible to send a representative ,to our annual
gathering. There is so much of inspiration to be gained, as well
as practical help to be mutually received, from such a coming together of men and women engaged in a common work that the
loss is indeed great to all when some of our people are unable to
attend. Those in attendance lose the benefit of the experience of
the absentees, together with their- potential contribution leading to
the solution of our common problems; while the absentees themselves miss the same thing, together with the inspiration and helpfulness   of  the  personal  touch   of   such  a  convention.
Probably nothing could more forcibly emphasize the character
of the problems under .which many of our hospitals are laboring
than some of the replies returned to the question: How many delegates from your institution may we expect at the convention at
Penticton? Following are some of the replies: "Hospital too small."
"Impossible to send any." "Impossible to send any I am
afraid." "Unable to send any, we regret very much." "Cannot
come without obtaining a substitute," etc. Between the lines
it is not difficult to read of financial stress as an underlying
obstacle in all too many cases. Other replies present, as vividly
as in a mirror, the picture of a faithful worker trying single-handed
to carry on the many-3ided work of a small but invaluable institution serving faithfully scattered population in a remote point of
our extensive province. Some of us know of such workers and of
their inestimable value to our pioneer settlers and people. We
may well uncover our heads and say: All honor to them! But we
wish they were here. And we wish too that some means might be
devised to remove the financial obstacle where such has kept away
others of our members.
Our provincial government opce provided travelling expenses to
enable its medical health officers to assemble in convention. Can
anyone question that it would be money equally well spent if it could
be made to bring together at reasonable intervals the executive
heads of such of our hospitals as cannot otherwise attend?
This is a matter which deserves very serious consideration
by our convention.
Another question submitted to our hospitals elicited a valuable
response. The question was: What subject or matter would you
particularly like brought up at our convention? Classifying the
answers received it was found that 80 per cent were bearing directly
upon difficulties in financing. This fact indicates in a nutshell
a  cond't^cn  of  affairs   anything  but   satisfactory.     It   is   almost   a
9 tragedy, when *we remind ourselves that the prime duty and opportunity of hospitals is the care of the sick. Surely our principal,
if not our entire efforts, should be devoted to devising ways and
means for the better carrying out of this object. And in the light
of the constant and rapid progress that is being made in medicine
and surgical methods, as" well as the increasingly elaborate means
of diagnosis being continually developed, our whole time both in
convention and in our administrative offices, could without doubt
be most profitably engaged in seeking to adapt as many as possible
of  these  advancements  to  our local  conditions  and   circumstances.
Such a course would lend to rapidly bring up our efficiency
to the highest pitch, and would provide for our people the service
they ought to receive, and have a right to expect. But how are we
to develop our service by increasing equipment, when we are continually hampered by shortage of funds to provide merely the bare
cost of maintenance and the irreducible minimum overhead expenses. The revelation of the response to this enquiry is the sufficient apology of your programme committee for giving the question of finance so prominent a place on the programme of this convention.
But to return to the question: One hospital asks for "The modification of the annual report to the inspector of hospitals so that
the date forwarded to the department monthly can be transferred
to the annual report without a redistribution and thus save a
very great deal of work." There is room for profitable discussion in
this matter. Without doubt the inspector of hospitals could in
discussion with the executive officers or secretaries, as he visits
the institutions, obtain enlightenment that will enable him to
better appreciate the burden some of these persons are carrying
and to devise a measure of relief of the situation.
Another hospital asks for discussion of provision for greater
accommodation for incurables so as to relieve smaller hospitals •
of the burden of providing for them. It is not stated whether
relief is desired in the matter of accommodation or of finance.
Perhaps the provincial government is preparing, now that it has
taken over the Marpole Annex from the Vancouver General Hospital
for this purpose to draft incurables from outlying points to that
centre. Perhaps during the convention we may be able to receive
some light on this subject.
Yet another hospital suggests: That all hospitals should have
uniform regulations in regard to treatment of staff in case of
sickness. This is a subject that might be conveniently taken up
by  our  question  drawer.
Returning to the consideration of the 80 per cent of replies
bearing upon the subjects of finance. Forty per cent of these
asked specifically for a consideration of the subject of distribution of liquor profits. Twenty five per cent suggested the broad
subject of hospital finance. Fifteen per cent put their suggestion
in the form of government assistance to hospitals. Other suggestions were: government aid for smaller hospitals for pathological laboratories, and increase of Workmen's Compensation
Board rate for hospitals.
Commenting upon the eighty per cent of replies, which bear
particularly upon the subject of finance, it is not my thought to
introduce any discussion upon them at this point, or in this paper.
Provision for that is' made elsewhere in the programme. The purpose here is merely to reveal to the convention before our discussions begin how -large a place this matter of finance  occupies in
10 the mind of our hospital officers. Also in this manner only could
I introduce the views of some who we very much regret are unable  to  be present during these sessions.
You will notice that immediately following this number on the
programme, we are to have a report from the secretary upon the
working of the amendment of the Liquor Control Act insofar as
is affects the hospitals of the province to the extent to which
they are benefitted by receiving a portion of the profits arising from
the sale of liquor by our government. This may elicit very considerable discussion which may lead us to believe it as a matter
of great importance. It should be distinctly borne in mind however,
that it is important to us only because it has been selected by our
government as merely the source or origin or moneys used by them
(the government) to carry out their obligation to assist in providing
financial aid by imeans of which the hospitals are enabled to function in their all-important duty of providing for the care of the
sick' in our community.
Were it not for this fact, a consideration of disposal of profits
arising from the sale of liquor could not in any manner be permitted
a place on our programme.
Indeed, in the opinion of the writer of this paper the discussion
of that particular subject could quite fairly be eliminated, and in
substitution therefore a consideration of the question of by what
amount should the per capita per diem allowance to hospitals by
the provincial treasury be increased in order to enable them to'
maintain a reasonably efficient service. It is to be observed that
in the eyes of the administrators of the surplus derived from this
source by our provincial government, the amount to be received
by hospitals has been removed from the question of uncertainty
in which it stood when, a definite Per cent of such surplus was
designated to the purpose of hospital aid. By an amendment to
the act bearing on the matter, passed a't the last session of the
government, this form of hospital aid was definitely fixed at a
per capita per diem rate of 25c. The only possible way in which
this 25c could fluctuate would be in a downward direction if the
income from which it is derived should be insufficient to cover
that amount. The experience of the working of the act has abundantly proven that the possibility of such a fluctuation is exceedingly
remote.
Since this is the case, this convention may decide, after ascertaining the facts to be revealed by the report of the secretary bearing
upon the matter, to discuss the very pressing matter of the solution of the present financial difficulty hampering so many of our
hospitals from the broader standpoint of simply an increase of the
per capita grant, leaving it to the wisdom and judgment of the
department of finance of the provincial government to decide from
what source such increase may be derived.
But there is a very much broader aspect of hospital finance
that merits—I will put it more strongly—which demands consideration by this British Columbia Hospital Association, unless we are
willing to step from the van to the rearguard of hospital administration. Already several of our sister provinces have by statute
placed tlie boards of many of their hospitals in the enviable position of freedom from the burden of devising ways and means of
meeting financial obligation. These are provided by equitable assessment upon those to be served by each hospital. The people,
subject to assessment for upkeep of such hospitals are safeguarded
from being exploited by the hospitals, by close oversight and check
11 of    the    hospital's    activities,    by    careful    government    appointed
supervisors.
This is not the place or time for details. What some have
done, others may do. I hope before the close of this convention
you will take steps towards obtaining data from which plans for
hospital finance along these broad lines and adaptable to our local
conditions can be prepared and submitted to our government authorities to be made effective as soon as possible.
To change the subject to that of nursing, and looking farther
afield, it is of interest to note that following up some of the suggestions of the notable report of the committee on nursing submitted to the American Hospital Association last year, Yale university is introducing an advanced course of study leading to a degree in nursing. In this connection it is co-operating with the New
Haven hospital, which will be expected to arrange for elimination
of a portion of routine nursing work to enable them to reduce the
period of hospital training of this class of pupils from thirty-six
to twenty-eight months. The University course will include the
subjects of field work, community nursing, and public health problems, and is intended to prepare the graduates to enter at once
upon these special fields of work. This is surely a splendid conception, and one we may hope will develop to a successful issue,
and be multiplied by as many times as there are special centres
where such a work can be put into effect. The side of training
that will provide for community nursing is one that we may well
hope will find a solution that will bring skilled nursing to the door
of the masses who cannot avail themselves of it under existing conditions.
Our secretary could have just ground for sending me to eternal
Coventry if I failed at ithis point to suggest that it was not necessary to travel to the Atlantic seaboard to discover a modern university course of nursing.. We have had such a one in successful
operation for several years in connection with the University of
B. C. and the Vancouver General Hospital. There appeared, however, to be certain features in connection with the course above
referred to which warrant bringing it to your notice.
A somewhat different form of advanced nursing training was
advocated by the president of the National League of Nursing Education at the convention in Massachusetts two months ago. Her suggestion was to carry out alternating periods of practice and theory in the
nurse training course.    This is not submitted as a recommendation.
A new movement has been inaugurated in Toronto university
in putting on a course in hospital administration for executives.
The course was twelve days in length and was attended by 68
persons. Again it should be noted the Vancouver University is
offering a somewhat similar course in the form of a post-graduate
session for nurses. Either of these courses would be of great value
to anyone holding, or desiring to hold, administrative positions in
hospitals. The time is long passed when it could be conceded that
merely a diploma as nurse or doctor was a sufficient qualification
for a hospital superintendent.
Among the most notable events in the recent months, has been
without doubt the development of Insulin treatment of diabetes by Dr.
Banting, of Toronto. We are proud that to a fellow Canadian belongs
the honor of this outstanding benefit to mankind. Following the
discovery comes the necessity for proper tests to . be applied to
patients to be treated, and preparation of carefully balanced food
rations, which become an essential feature of the treatment by this
12 remedy if it is to become successful. These tests and treatments
are so delicate and elaborate that success can only be expected
when they are carried out by expert laboratory workers, supplemented by careful and accurate dietitians. Here again we discover
the value to both doctor and patient of thoroughly trained hospital
workers.
During the time of the great expansion of hospital service that
has taken place within recent years, it has been discovered that the
real scope and value of the modern hospital was understood by but
a small portion of our people. It was found too that as people have
obtained more intimate knowledge of the work being done by the
hospitals, their interest has been aroused, and they have availed
themselves more readily of the service of the hospitals, both for
themselves and for their friends. Our hospitals have no desire
to conceal anything of their workings except of course matters of
purely personal concern to patients.
The hospitals in fact in most instances belong to the public,
who have a right to know what they stand for, and how they are
equipped for carrying out the objects for which they have been
created.
To this end it has now become a recognized duty of the hospital that it should, by whatever means may be found possible, make
itself known to the people of its recognized constituency. To
accomplish this many hospitals have a publicity bureau or committee. The results are astonishing. The phenomenal success of
Hospital Day is a striking example of the readiness of the public
to co-operate with their own institution in developing a broad basis
of fellowship and mutual good feeling.
Readers of the Modern Hospital have no doubt followed with
interest the series of four articles that have appeared in the last
four issues of that periodical, in which the writer in a most practical
manner discusses this very important subject. He suggests a threefold method of approach under the subjects of: First—Writing—this
more particularly through the press, using photos where possible,
to depict to those who find even reading a too strenuous pastime,
the inside working of the hospitals and staff. The press has
always shown marked courtesy to hospitals and can be depended
upon to give prominence to anything we offer them Other methods
that readily suggest themselves and that are thoroughly discussed
by the author are the giving of addresses on such occasions as
may be found possible, and thirdly, the developing of an attitude
and habit of friendly courtesy toward all correspondents who provide opportunity when making enquiry as to terms, accommodation,
etc.
It may well be borne in mind that there will be an inevitable
and favorable reflex to every institution, as it sets itself to display
its wares to the public; for the very effort to do this will stimulate
it to see that it has something worth while to present to its people.
There are perhaps two reasons that should not be ignored that
emphasize the need for publicity being more urgent now than
formerly. In the first instance we find ourselves confronted and
attacked by a more or less organized propaganda on the part of
many irregular and unqualified practisers of the healing art. It becomes our duty then to place information in the hands of our own
people, that they may be equipped to refute the specious arguments
offered to them by those seeking to belittle the work of the regular
profession.   This applies to hospitals as much as to practitioners.
A further reason for it lies in the fact that these invaders of
13 the field of regular and legitimate practice, have lost no opportunity
of pouring contempt upon us and our methods. Knowledge of the
actual facts, by disinterested parties, who can discredit the belittling efforts of our opponents, is the best equipment we can give
them with which to meet such objectors. We may thus overcome
prejudice by establishing confidence and combat ignorance by a
dissemination of knowledge of actual facts and results accruing.
We are abundantly satisfied that the treatments and methods
we are using are fully in line with the most approved teachings
both in medicine and in surgery to be found in the whole hospital
field today. Since therefore we have in our hands the best there
is for our people, we are distinctly shirking our responsibility if
we allow without challenge any and every unqualified charlatan to
brazenly claim pre-eminence in any phase of medical or hospital
service.
The unparalleled effrontery of these self-styled healers in their
misleading statements and extravagant claims by means of which
they lure very many over-credulous persons from the path of safety
in itself constitutes a demand that the legitimate and scientific
exponents of the healing art use every reasonable measure to expose
the baseness of those who for mere monetary return would without
compunction trade in the very health and life-blood of our people.
This report is presented with profound apology for its crude
form, and in sincere hope that it may aid in directing the thought
of the convention into channels that will eventuate in bringing our
institutions a little way along the line leading to the highest efficiency our several local conditions will permit..
REPORT OF THE SECRETARY
Mr. President: Members of the British Columbia Hospital Association.   The report of the secretary is submitted herewith:
Meetings  of the   Executive  Committee:
Meetings of the Executive Committee have taken place as follows:
On August 31st, 1922, at the close of the Convention, at the Royal
Columbian Hospital, New Westminster. On November 14th, 1922,
at the Empress Hotel, Victoria. On May 21st, 1923, at the Bute
Street Hospital, Vancouver.
The minutes of these meetings are referred to in another place
and need not be dealt with here.
MEMBERSHIP
The  membership   of   this  Association  is   as  follows:
Institutional members in good standing  _ .'  50
Individual members in good standing   53
Four hospitals previously included in our official list have closed
viz: Chase Hospital, Silverton Hospital, Slocan Hospital, and the
Avenue Private  Hospital,  South Vancouver.
No communication whatever has been received from the following hospitals during the past year, viz: Chilcotin Hospital Alexis
Creek, Grandview Private Hospital, Vancouver, Quesnel Hospital,
and   Ymir   Hospital.
Fifteen  hospitals  are  still  included  in   the  secretary's   mailing
14 lists though they have paid no fees,  in  the hope that they might
be induced to join the Association.
CORRESPONDENCE
Correspondence as shown by the files dealt with the following
subjects:
(a) Routine  business  of  the  Association.
(b) Presentation of resolution respecting amendments to the
Liquor Control Act, to the Provincial  Secretary.
(c) Correspondence with the Department of the Provincial
Secretary regarding the care of the incurably ill and other matters.
(d) Correspondence with the Federal Commissioner of Taxation
regarding the remission of sales tax to hospital.
(e) Publication of the Annual Report.
(f) Hospital Day.
(g) Questionnaires dealing with hospital personnel, and with
the administration of the amended Liquor. Control Act.
(h)    Arrangements for the annual convention,
(i)    Miscellaneous.
A total of 1250 communications was issued from the office of
the secretary during the past year.
I wish to record my deep sense of obligation to the secretaries
of the various hospitals. Their prompt and courteous response to
the numerous communications sent them has been of the greatest
assistance and is much appreciated.
All of which is respectfully submitted,
Ethel Johns
Secretary.
Report of the Secretary summarizing replies received to the
Questionnaire concerning the effect of the amended Liquor Control
Act on hospital finance and administration.
Mr. President and Members:
Acting upon instructions received from the Executive Committee the following questions were forwarded to fifty-eight
hospitals in this province not distinctly listed as privately owned
institutions.
(1) What is the amount of the check recently received by you as the
amount accruing under the amended act for the past six months?
(2) What was the amount received during a similar period under
the old act?
(3) Does your present revenue from all sources meet your operating expenses?
If not, what is the amount of your deficit?
(4) What revenue do you receive from the municipality in which
you are situate?
(5) Does the present liquor legislation work to the advantage of
your institution?
If not what changes would you suggest?
15 Forty five replies were received which may be classified as
follows:
Hospitals receiving less money under the amended act .... 20
Hospitals receiving more money under the amended act.... 22
Did not answer  the question       3
Total   45
Hospitals reporting deficits on the year's operation   24
Hospitals reporting no deficits   15
Did not answer the question       6
Total   45
Hospitals receiving municipal  aid    17
Hospitals receiving no municipal aid   19
Hospitals in unorganized districts      5
Did not answer the question      4
Total   45
Of those receiving assistance the following classification may
be  made:
Receiving sixty cents per day for all patients resident in the
province         2
Receiving grants of money not based on a per capita bas/s 11
Receiving free water, light and rent      1
Receiving free water but paying taxes      1
Receiving grant in  lieu of payment of accounts of indigent
patients    »      1
Receiving payment of accounts of indigent patients      1 -
Receiving a money grant but turning over share of
liquor profits  to municipality       1
In favour of the present act:   (eight gave very qualified
approval)       19
Against   present   act       20
Did  not  answer  question   _     6
Total  45
The following suggestions for change were made:
Four hospitals desired to revert to the old plan, the money to
be paid direct from the Provincial Government and npt through the
municipality.
Five hospitals preferred the old plan with payments made upon
a per capita basis.
Six hospitals urged that a larger proportion be paid to smaller
hospitals than is paid to large hospitals for the following reasons:
(a) Maintenance costs are lower in large institutions since
they can purchase to better advantage.
(b) Smaller hospitals are obliged to treat a larger number
proportionately of indigent patients from unorganized districts. One
hospital estimated that 50% of all its admissions came from unorganized   districts.
(c) Liquor sales are larger in proportion in smaller towns.
One hospital stated that in six months $25,000 was spent in this
way with the result that the local merchants were obliged to carry
outstanding accounts from year to year as a consequence of this expenditure.    Six  hospitals  recommended  that  the  resolution  as   pre-
J sented to the Committee on Law Amendments  by the Association,
viz.  that
of the liquor profits be paid  to  hospitals  direct  Sn
a per capita basis be carried  out and  that no  'joker'  such as the
twenty five cents per day per patient clause be inserted.
Three hospitals recommended that the Provincial Government
be responsible for the payment of the accounts of indigent patients
from unorganized districts.
Three hospitals recommended that the rate paid by the Workmen's Compensation Board be increased in amounts varying up to
five dollars per diem.
One suggested that the government per capita grant be increased.
One hospital suggested that the hospitals be supported by taxation of persons resident in the district served by the hospital in
question.
One hospital recommended that 50% of the liquor profits be
paid toward hospital maintenance, but specified that this recommendation did not apply to Company Hospitals or to those having
other  sources  of income.
Signed, ETHEL JOHNS, Secretary.
N. B. Discussion of this report was postponed until the afternoon session, but for convenience a report thereof follows.
DISCUSSION    OF    REPORT    OF    REPLIES    TO    QUESTIONNAIRE
Mr. McCulloch, of Abbotsford, maintained that the members of
the government to whom he had spoken believed that 25 per cent of
the liquor money had been allocated to the hospitals, and it was not
until- two or three weeks after the change was made that they found
it was only 25c per patient day instead of 25 per cent.
Mr. O. E. Fisher said, in the case of Penticton the change practically cut the amount received from the government in half.
It was stated that under the old arrangements, after certain deductions had been made from the liquor profits, fifty per cent of the
total was retained by the provincial government and the other fifty
per cent distributed to municipalities, some of which put the entire
amount received into their treasuries instead of turning over one-
half of the sum received to the hospital in addition to their usual
grants. What was wanted was to request the government to distribute direct among the hospitals 25 per cent of the total liquor
profits.
Another speaker thought .this proposition was only one which
should be used as a "stop-gap." He thought some practical scheme
should be devised whereby the money provided by the government
would permit of free general ward treatment of patients, and those
who wished to pay could have private wards.
Several delegates deplored the necessity of discussing liquor
profits in connection with hospitals.
Mr. Geo. McGregor, of the Jubilee hospital Victoria said there
was no doubt that the hospitals had met with opposition from the
municipalities. They might as well admit it. It was unfortunate, but
it-appeared that the municipalities needed money and they thought
that peor'e would not let the hospitals close their doors, and therefore the hospital boards could look out for themselves. He did not
think there was a proper understanding between the hospital boards
and the municipal authorities.    These should be brought closer to-
17 gether. He suggested that the government be asked to send an auditor
around to go over all the books and ascertain if the money is being
spent right or whether there was need for economy along certain
lines.
Dr. J. H. Hamilton, of Revelstoke, said the revenue of the hospital
there had been cut from 6.0 to 60 per cent.
Mr. Grimmett, of Merritt, suggested that the liquor profits be
merged into the government's general funds and a per capita grant
made to hospitals. He urged that a resolution be passed and presented
to the government by a strong delegation, asking that all aid be from
the consolidated revenue fund on a per capita basis, and that such
grant be large enough to allow the great hospital work to be carried
on without the hospital boards being in fear of having to go to the
government at the end of the year for assistance to cover a deficit.
At this point the secretary's report was referred to the resolutions committee with instructions to bring in a report and resolution
on hospital finance.
Mrs. M. E. Johnson, treasurer of the association reported that
for the first time in the history of the organization it was possible
to show a clean sheet. The annual statempnt showed that receipts
amounted to $1,362.03, disbursement, $1,283.87, leaving a balance of
$78.16, which, together with amounts just received made a total on
hand that day of $173.66. It was suggested toy the treasurer that more
advertising space be sold in the report books to aid finances. This
report was adopted.
REPORT OF THE TREASURER
RECEIPTS
Amount on hand, July 1922   $ 101.68
Amount received, per hospital fees  .'.... 680.00
Amount received individual membership  1  53.00
Amount received government grant   200.00
Amount received Woman's Auxiliary    15.00
Amount received 1922 exhibitors' space   140.00
Amount received 1922 advertising space in year book  172.50
Total receipts  $1362.18
EXPENDITURES
To  Cash
Roedde's account, due 1922   $ 432.48
Official stenographer 1922 convention   100.00
Secretarial work, August 1922—July 1923   275.00
1922 convention expenses  _  33.40
Secretary's expences to Victoria   9.00
Office   expense    j  11.41
Evans and Hastings, Stationery, bill heads  26.13
Stamps  70.40
Exchange   on   checks      4.45
Printing, convention report books  i 321.75
$1284.02
Balance   on  hand            78.16
Total $1362.18
Some discussion followed on the question of convention reports
and the concensus of opinion appeared to be that it was a waste
18 of money to publish all convention speeches verbatim. It was also
thought advisable to keep in touch with and send reports to all
the small hospitals in the province, even though they have never
paid their dues to the association.
Appointment of Committees—The following were appointed
members of the Nominating Committee: G. R. Binger, Kelowna;
Dr. G. Bell Brown, Nanaimo; Mrs. M. E. Johnson, Vancouver.
The following were appointed members of a Committee on
Resolutions: J. J. Banfield, Vancouver; E. S. Withers, New Westminster;  J. Tyrell, Kamloops;  M. L.  Grimmett, Merritt.
Mr. George Haddon presented the report of the Committee on
Constitution and By-laws. This was taken up clause by clause and
provoked a very animated discussion, which lasted until the meeting
adjourned for luncheon.
AFTERNOON SESSION, TUESDAY, AUGUST 28th
Following the calling of the meeting to order discussion of the
proposed amendments to the Constitution and By-Laws was resumed.
Clauses in the bylaws regarding election of officers, committees,
times and places of meetings and other points were considered and
discussed at considerable length, some of them being referred back
to the committee for redrafting. These included one clause under
the heading of membership, dealing with the membership of auxiliary
organizations.
Another point which provoked much discussion was that of voting, the recommended change making it necessary for the combined
delegation of any institution to agree among itself as to how the
institution or auxiliary body would vote. This also was referred
back to be reconsidered.
The following paper, written by Dr. R. W. Irving of Kamloops
and read in his absence by Mr. J. Tyrell of Kamloops was next
upon the program.
THE   HOSPITAL   OF   THE    FUTURE    IN     RELATION    TO    THE
GENERAL   MEDICAL   PROFESSION
Hospitals in the early days of Greece and Rome were very
crude affairs associated with the church for the care of the very
poor who clamored at the doors for food and for certain medical
attention. The early history of the large English hospitals shows
that they were a combination of a poor house and a home for incurables. They were carried on by voluntary contribution as well
as the voluntary work of certain medical men who devoted a portion
of their time each day to do their charity work. Naturally the
medical profession found it a convenience to send large numbers of
their indigent cases to these institutions in order to be rid of them.
We see certain reflections of this today in the resistance the
medical men meet from people from the old country when advised
to take medical treatment in the hospital. They prefer a nursing
home which means that they wish to go to a pay institution and have
the selection of their own physician. The hospitals in this country
are a combination of the indigent institution with a pay nursing
home. This makes it a rather more difficult institution to finance
and govern.
When surgery, antiseptics anaesthetics developed to the stage
of requiring considerable outlay in equipment, the hospital became
a big factor in the doctors' practice.    He was unable to carry on
19 the financial strain to meet the demands of science and it became a
useless waste of money to duplicate these equipments in any com-
muity. Patients likewise demanding the very best of attention
realized the necessity of being cared for in the best equipped institution. More particularly patients who were able to pay insisted
that the institution should lack nothing that will promote their cure.
•
The result of this desire for concentration of work naturally
increased the number of doctors per patients in the hospitals and
definite work along the various lines. Specialists began to develop
and each of these began to demand a department of their own.
While this was going on the general practitioner who was recommending his cases to the hospitals found that they were passing out
of his care thus losing his connection and naturally depleting his
income. A good deal of hard feeling developed towards those
"closed" institutions where only the staff could care for the cases.
This lead to the forming of private institutions where special
lines of work could be carried on and we have orthopedic hospitals,
maternity hospitals, eye and ear hospitals, tuberculosis sanatoria
and private hospitals for the nervous and insane. Many of these
latter institutions were run by lay persons, nurses and others as a
means of livelihood.
This has lead up to a hospital situation in this country where
a great many varieties and grades of work are carried on outside
the recognized general hospital which receives government support.
An effort has been made in America through hospital standardization
to raise the standard of all general hospitals and thus correct the
deficiences that created the need for special institutions to care
for the public.
We have reached the stage where the public is demanding
that all institutions whether large or small should be able to give
the best possible service to those who are sick. While there will
always exist the private institutions well conducted serving a most
useful purpose in. the community, viz., caring for those who want
privacy, extra attention and wish to be associated with the name
"private." Our chief interest in a general way is to make sure
that our public institutions serve the community in the most efficient way. To do this it would become necessary to have certain
ideals observed in the development of the hospital plan for the
province.
The first and most important consideration is as in all business
to have sufficient revenue from some source of a permanent nature
that at all times the standard of food, equipment and staff may be
kept to the highest point of efficiency. This income must come from
the whole population as the time is long past when voluntary contributions can be counted upon in any way. The people have not got
the money to give freely enough and have lost a great deal of the
desire to show their philanthropy along these lines. It therefore
becomes the duty of some governing body of the people to collect
by means of taxation sufficient funds to meet these demands throughout the country. It equally becomes the duty of the government
to distribute these funds in an equitable manner. There has been
too much tendency in the West for the large institutions to starve
the small institutions in the government grants.
Following upon the adjustment of financial arrangements which
are so keenly under discission at this meeting It becomes easy for
these institutions to equip themselves sufficiently for their particular
work..
20 When the government is distributing these funds it becomes
necessary for them to inspect and see that the funds are properly
administered and for this reason government inspection should be
instituted. This inspection should be carried on by some one
appointed by the government, outside of political influence and
with a good medical knowledge as well as having a business training.
The necessity for these qualifications will be seen in that inspection
is not complete unless it embraces medical treatment to see that
it is modern, scientific and thorough; that the nursing is sympathetic,
attentive and carried on with a view to details; that the business
management is economical and carried along business lines.
One of the essentials of the ideal hospital is that this service
should be given to the public at actual cost. When the revenues are
assured the profit that has to be made from private wards and pay
patients in order to cover the losses on non-pay patients could be
eliminated. The medical profession has the keenest sympathy for
Boards of Management who have struggled on year after year trying
to give service to the public, meeting the criticism of the public
and carrying large book accounts for indigent cases.
The hospital of the future must be open to every medical practic-
tioner legally qualified, who could be removed from the staff of
the hospital by the Board of Management for unprofessional conduct
or for inefficient work as passed upon by the inspector. This leaves
patients free to engage whom they wish and to make their own
financial arrangement with their doctor. Under no condition should
any appointments be made to the nfedical hospital staff through
political influence. We would consider it would promote efficiency
to have medical representation in a small way on the Board of
Management. In the smaller hospitals we would consider it wise
in all cases to have the medical staff select their own representatives.
The question of the medical practitioner and the nursing training school is a vital one and it may not be within the province of
this address to introduce the subject but as one who is engaged
in teaching as well as employing trained nurses, I may be bold
enough to say a few words even at the risk of receiving severe
criticism. The very praiseworthy improvements in (the nurses'
curriculum have a tendency to be carried too far to meet the demands of the public. It would appear that the three years course
originally was introduced by large hospitals to keep up their staff
to a sufficient number and to save money by employing undergraduates at cheaper salaries than the graduates. It appears that
there is a general feeling among the medical profession that a two-
year course intensive with emphasis on teaching is sufficient to make
a good general nurse if she is going to be a nurse at all. The public
today outside of institutions need good general nursing, not
specialists. As the course now stands every nurse has to take a
considerable length of time in say, surgery, whether she is naturally
adapted to that class of work or whether she ever intends to use
it. The result is that a surgical nurse in charge of an operating
room is constantly worried training a large percentage of nurses
of whom she knows she cannot make surgical nurses. The surgeon
is at the same time having his work delayed by inefficient assistance.
The same applies to maternity and to the other special branches.
What the public want, are not those who are particularly suited to
institutional work but those who in temperament, tact and general
knowledge, are particularly suited to a home. It seems to me that
by emphasizing in the training schools by those teaching a-proper
selection of nurses for various courses and taking these as postgraduate  courses  in their  third  year  that  the  need  of  the  public
21 will be more efficiently met. I do not depreciate in the slightest,
the value of an advanced and University training and believe that
it should be one of the special qualifications for nurses who hold
responsible hospital positions but I fear that "higher education"
is causing us to lose sight of the great value of primary education
from the standpoint of the public needs, the practicing physician and
the nurse whose chief motive is to do good to the general mass of
the people.
As this country develops it is quite evident that more nursing
centres will have to be established where a nurses' club is carried
on where nurses are at the call of the physician and where good
remunerative salaries are guaranteed by the government. The patients
must be educated that they are to pay according to their financial'
ability but no person because of financial stringency must be refused
nursing assistance. There has been enough demonstration of this
in various isolated localities to prove its great value to the community and I am sure that the medical profession as a whole strongly
supports the Red Cross, the health centres, the various clinics under
proper supervision so as not to pauperize the people as they realize
the  great  benefit the  public  receives.
In summing up the main points, from the standpoint of the
physician, that a hospital should keep in mind are, viz.
A department of government, say of health, whose chief duty it
it to standardize all hospitals large and small.
Government to aid in the collection of monies and to see that
these  are  properly  administered   through   a   Board of  Management
for each hospital along similar lines to that of our educational
department.
j To provide the public and the medical profession with a class
of nurses who have a good general knowledge of nursing, dietetics
and who are willing to work.
To provide institutions that are well equipped to give the most
up-to-date treatment and to have such institutions open to all
qualified medical men.
While throwing out these few suggestions I do so, fully realizing
the difficulties that are ahead and the amount of education of the
public necessary to reach these ideals, but looking over the whole
hospital situation as it stands today, I am quite certain that only
through the persistent efforts of hospital boards, staff managers and
philanthropic bodies can the crying needs of the public be sufficiently
met.
EVENING MEETING, TUESDAY, AUGUST 28th
The evening session opened with a discussion of the administration of the Workmen's Compensation Act in so far as it affects
hospitals. Mr. O. E. Fisher, President of the Board of Directors of
the Penticton Hospital opened the discussion. He pointed out some
of the difficulties experienced in Penticton in connection with high
operation expenses and said the local board could not operate on
the $2.50 allowed by the Workmen's Compensation board. He said
he knew something of the operation of the Compensation board
from three aspects, and thought hospitals should be in a position
to say what it cost them to handle such patients and receive remuneration accordingly. The Penticton hospital board had carried
on considerable correspondence with the Compensation Board, but
it was unsatisfactory, and the local board suggested that the Compensation Board pay the $2.50 and allow the hospital board to collect an additional 50c. This did not meet with the Compensation Board's
approval and the local board decided to try and collect the full
fee and allow the Compensation Board to pay the patients. Under
these arrangements the Penticton hospital incurred a deficit of $194,
but it would have incurred a deficit anyway.
The Compensation Board had claimed that it was not bound to
pay anything, and in some instances it had refused to pay for the
full time during which patients were in the hospital on the ground
that they should have been discharged sooner. The hospital, however, could not discharge a patient. That was a matter to which
the doctor had to attend.
He hoped there would be a free and full discussion of the matter
as it was a vital one.
Mr. J. H. McVety said the same difficulties had been experienced
in the Vancouver General Hospital. It was quite right, as- Mr. Fisher
said, that the Compensation Board claimed that it did not need to
pay anything for patients, but in most cases a contract existed
between the board and the hospitals, because the act provides that
the Compensation Board shall furnish or provide medical aid and
that implies that they shall pay. The intent of the act was that
the board supply the medical aid and therefore the responsibility
for the care of the patients rests on the Comaensation Board.
He pointed out that the Compensation Board, as Mr. Fisher said,
was not only refusing to pay for patients on the ground that they
had been kept too long, but in some cases they maintained that too
much medicine of an expensive nature had been administered and
refused to pay for it. If the Compensation Board chose to discipline
the doctors, who were their agents, that was one proposition, but
the hospitals were bound by every law of the land to give the treatment called for by the doctors. The doctors of Vancouver were not
inclined to put up with the conditions even if they had to go to
the legislature about it claiming that no medical referee appointed
by the Compensation Board should be able to interfere between the
doctors and  their patients.
Other delegates agreed that the Compensation Board was becoming too arbitrary and that the $2.50 paid was insufficient.
Mr. Parker Williams, of the Workmen's Compensation Board,
said he had often said things about the board when things had not
gone as he wanted them to, but he had never said quite so much
in criticism as he had heard that evening. Arbitrariness seemed to
be the chief charge brought against the board, but Mr. McVety
knew, as well as anyone, that the act went rough-shod over the
rights of individuals and groups. There was no other legislation
which was so drastic. It was full of arbitrariness. He explained
that the surplus of $3,000,000 is earmarked for the payment of dues
to widows and orphans in the province. He did not wish to minimize
the problems of the hospitals in connection with the payments
received, but he would say that if other members of the community
were as good to the hospitals as the Compensation Board, the
hospitals would not have such severe problems. He then dealt with
the charge that the board refused to pay for all the time some
patients are in hospital, pointing out that the Compensation Board
worked on the principle that it was not responsible for what the
doctors do. In the cases of some single men he maintained the
hospital was more a boarding house than a hospital. The Compensation Board's contention was that it was not called upon to
pay for anyone's mistakes. So far as the $2.50 was concerned, he
took it that the matter was not such a pressing one as it appeared
23 and that the Compensation Board was the one organization in the
province which was paying its way. From figures at the last
convention the average cost per patient day was $3.35, and the
Compensation Board was paying $2.50 and the cost of extra service,
such as serums, massage, etc. The amount paid, therefore, on the
average patient day by the Compensation Board would be equal
to more than the average cost per patient day.
Further   discussion   was   postponed   until   the   morning   session.
Dr. M. T. MacEachern, president-elect of the American Hospital
Association, and associate director of the American College of
Surgeons in charge of hospital standardization for the North
American continent, delivered a most interesting address, illustrated
with numerous lantern slides on the work which is progressing
among larger hospitals and gradually extending to the smaller
institutions.
In opening, he explained that the entire continent is being
covered by an organization, the aim and object of which is standardization, and the day is coming when all hospitals must account in
results for the money expended by them.
He complimented the B. C. Hospitals Association on being the
most active organization of its kind on the continent, remarking
that it justified its#existence by generally getting something.
One out of every ten persons on the continent, he said, wants
and seeks hospital treatment once each year, and in Canada there
are 25,836 hospital beds to handle 836,000 patients.
In addition to the general hospital beds there are also in
Canada 20,000 beds in the mental hospitals maintained by the
governments, which are stinting no money to make them comfortable,
and almost side by side with the mental hospitals, erected at great
cost, one sees the poor little general hospitals struggling along,
handicapped because of financial  stringencies. .
Hospitals, the doctor maintained, have got to be placed under
efficient Inspection and visited by inspectors 'before whom the
boards of management can lay their problems and receive constructive advice. His organization, he continued, is making a
study of all hospital problems, and will give to any hospital the
benefit of knowledge obtained by research work free of charge.
It is working out the problems which increase the hospital's overhead and load of debt.
It has been found, he stated, i that there should be one bed for
every 2000 head of population for tubercular patients, and every
community should have from five to seven beds for general patients
for every 1000 of population. The average throughout Canada was
one bed to every 347 people. But in B. C. conditions were better,
there being  one bed  for  every  141  people.
There had not been found any satisfactory solution outside of
endowed hospitals, of the problem of finance, and if one could be
worked out it would be a fine thing. Another problem which he
mentioned was being worked upon was the transportation of the
sick. This, he said, included the proposition of the hospitalization
of
the country and other matters.
In  giving  more  details   of  the  question   of  standardization,  he
stated:
The   hospital   standardization   movement,   though   yet   in  its   infancy or childhood  in years, has reached far beyond  its  adult age
24 in influence and development. Today it takes its place as the
greatest hospital movement that the world has ever experienced, or
possibly ever will. Backed up by 6,291 of the leading surgeons of
this continent and embracing almost 2,000 hospitals with an approximate bed capacity of some 250,000, and an annual turnover of
5,000,000 patients, means the standardization movement is a powerful
force in the hospital field today.
This programme through annual competent survey or checking
up aims at establishing and maintaining in our hospitals an organized
personnel to work as a group in the best scientific manner for the
patient, and the necessary up-to-date efficient facilities and intelligent recording of all data and other varied essential requirements
which will induce 'a focusing on the patient' of all the hospital
services as will secure (1) the most accurate, early, and competent
diagnosis; (2) the most efficient treatment; (3) the best results
obtainable. Four main objectives are desired on the results obtained: (1) the lessening of the patient's days' stay in the hospital,
more rational and active applied treatment; (2) the eliminating of
incompetent and unnecessary surgery through improved means of
diagnosis, more conscientiously recorded data with a proper cneck-up
and control, and a hospital equipped with all the necessary
diagnostic facilities; (3) the reduction of infections and complications through better technique and care of the patient;
(4) the lowering of the hospital death rate which results through a
more thorough study of the case and better supervised and applied
treatment. It is interesting to find that the average hospital death
rate which has been .generally from thirty to forty or fifty per
thousand, has been declining in many instances where institutions
have been operating strictly under the principles of hospital standardization. Many instances show a falling of the death rate to
twenty or thirty or less and in some cases as low as ten or twelve
per thousand patients, which is indeed very good.
All the above are being accomplished very noticeably in standardized hospitals. What a great thing it is to industry if the days'
stay of each industrial patient can be reduced one or two days in
each illness. What a great comfort it is to our people to know that
they can go into certain hospitals where their condition will be
better studied and all data recorded; through this, often an operation
avoided or done under conditions surrounded with the maximum
•efficiency and safety. What a great -thing to the world to find that
the former usual average death rate per thousand patients has been
reduced to thirty, twenty or even less. All this must inevitably
follow conscientious application of the principles laid down in the
programme.
Possibly the greatest accomplishment to stimulate better results
is the realization that there must be a physical accounting, through a
physical balance sheet in the hospital each month, just the same as
there is a financial balance sheet. Both of these statements must
be duly audited, the first by the staff or medical auditor, the second
by the financial auditor,  or so-called  chartered  accountant.
Hospitals heed no longer proceed in the dark or in mystery.
There is a practical standard they can follow, based on service to
the patient, a service so broad as to involve every person who has
today anything to do with the patient. All must think and act
in terms of the best service to the patient.
The purpose of the Hospital Standardization movement is to
present the de'tailed programme of this standard to all hospitals of
fifty beds and over in Canada and the United States. Hence, for
five years in both countries .the programme has been presented to
25 the hospitals in a clear, simple comprehensive and practical manner.
It has been presented in person by hospital experts sent out from
headquarters, and already all hospitals in Canada and the United
States of one hundred beds and over, have 'been reviewed and reported on for the fifth time, and those of fifty to one hundred
beds, twice. The visitor looks over the hospital, analyzing its
service in terms of the standard laid down. He assists the hospital
management and governing board in getting the programme well
under way if they so desire, because, after all, it must be remembered
that this is a voluntary movement, and it is for the hospital to
accept or reject as they wish. It is a service offered to all hospitals
without costing them one cent, for the whole programme is financed
through   philanthropic   endeavor.
All institutions reaching the standard are admitted to the list
of 'Approved Hospitals,' published annually all over the continent,
and this year the announcement will be made on October 22nd
from Chicago, where the Congress of the American College of
Surgeons will be in session, dealing with matters pertaining to
hospital  service,  scientific  medicine  and   other  matters.
The list of 'approved' hospitals is today found to be a decided
advantage to persons choosing institutions to go to when ill, to
governmental, municipal and philanthropic todies when responding
to requests for financial assistance, to medical students - when
seeking interneships, and to parents when selecting a training" school
for nurses for their daughters to train in. Indeed, it is now being
recognized more and more  as a hospital guide for many purposes.
Today there is absolutely no excuse for any hospital not being
able to conform to the principles as laid down. In fact, if they do
not they are not hospitals, as the requirements laid down in the
programme are just what distinguishes a hospital on the one hand
from a hotel, rooming house or boarding house, on the other hand,'
because it lays down the principles of a fundamental, scienuiic
service which insures every patient that enters therein an early
and. competent diagnosis, intelligent and effectual treatment, the
return to health in the shortest possible period and through the
most comfortable manner, with the best results that are humanly
possible to obtain. This means the sending of the patients back
to producing capacity as quickly as possible and thus add to the
national wealth of the country through such production.
The popularity and acceptance of the programme is well illustrated by the following figures showing tjie progress of the movement
between the years 1918 and 1922. Up to 1921 only hospitals of 100
beds and over in Canada and the United States were reported on.
In 1918, out of 697 such hospitals, only 89 were eligible for the
approved list. In 1919, this number increased to 198. In 1920 there
were 407 on the list and in 1921 no less than 579 had reached the
goal. In 1922 for the first time hospitals from 50 to 100 beds were
listed and the complete figures for that year showed that out of
the 811 hospitals of 5.0 to 100 beds, 342 or 42 per cent met the
standard and out of 812 hospitals of 100 beds and over 677 met the
standard or 83 per cent. This year all general hospitals of 50 beds
and over reaching the standard, will be listed again on October
22nd and from present indications splendid progress will be  made.
Finally, this whole movement, to accomplish its high ideals of
service to the patient, desires to stimulate all-round co-operation,
co-operation amongst the officials and various members of the
hospital staff, co-operation amongst the members of the governing
body, co-operation amongst the doctors attending the hospital, and
26 co-operation amongst and between the various groups interested
' or connected with the institution, all working as one consolidated
whole, having one common objective or perspective—-the patient,
the best care of the patient socially and scientifically, for after
all the patient, in terms of restored health, is the product of the
big human repair shop known as the hospital.
MORNING SESSION—WEDNESDAY. AUGUST 29th.
The meeting was called to order at 9.30 a.m.
The discussion on the question of payment of fees to the hospitals
by the Workmen's Compensation Board was continued.
Mr. McGregor asked if it was the feeling of the board to ask hospitals to treat patients at less than cost. In reply to this Mr. Parker
Williams said according to recent statistics issued by the provincial
government it would be seen that the board was paying what was
equal to the cost in well  organized and  conducted  hospitals.
Mr. Fisher asked if the hospital board shtiuld provide the
matron with a chart showing length of periods the various patients
were allowed to remain in the institution, but Mr. Williams said
there was no suggestion of anything of that kind being done.
Passing over the question of whether or not $2.50 was
sufficient to cover costs, Mr. Williams pointed out that hospital
boards are receiving grants towards maintenance from the provincial
government, and if the proper proportion of such grants was applied
to compensation patients it would be found ample to cover costs. He
also maintained that if compensation cases were segregated they
would be found to cost less than many other kinds of cases.
Mr. Robinson, Kamloops, congratulated the people of the province on the men who constitute the Compensation Board. He suggested that the time had come when the association should ask the
government to appoint a minister of health in charge of all health
matters, including the operation of the Compensation Board, and to
appoint competent inspectors to visit all hospitals and cover in their
inspection financial matters, nursing and all other operations.
This was considered a valuable suggestion by the delegates.
Mr. McVety said in reply to Mr. Williams, that it was a question
whether the Board was justified in penalizing hospitals on account
of the mistakes of medical men. The Compensation Act, he said, was
put into force for the purpose of paying doctors, patients and hospitals
for industrial accidents. It was never intended, he said, that per
diem grants from the government be applied for to make up the
payments of the Compensation Board to the actual cost of treating ,
patients.
Mr. McGregor suggested the convention go on record as asking the
Compensation Board to pay $3.00 per day for patients. In seconding
the motion, Mr. Fisher proposed that circulars be sent to all hospitals in the province, notifying them that the resolution has been
passed, and that $3.00 per day will be charged for the patients of the
Compensation Board.
Dr. MacEachern said on a survey of cases in general hospitals
in Canada it was found that compensation cases were practically all
surgical cases and were among the most expensive to handle.
The resolution was  passed.
27 The election of officers followed, resulting as follows:
Honorary President, Hon. J. D. MacLean, Victoria.
President, Charles Graham, Cumberland.
1st Vice-President, George Haddon, Vancouvee.
2nd Vice President, E. S. Withers, New Westminster.
Treasurer, Mrs. M. E. Johnson, R.N, Vancouver.
Secretary, Miss  E. Johns, R.N., Vancouver.
Executive Committee—Dr.- H. C. 'Wrinch, Hazelton; George
McGregor, Victoria; Dr. G. Bell Brown, Nanaimo; J. J. Banfield,
Vancouver; Rev. Father O'Boyle, Vancouver; George Binger, Kelowna; J. H. McVety, Vancouver; J. T. Robinson, Kamloops; M. L.
Grimmett, Merritt; R. A. Bethune, Kamloops; Miss J. F. MacKenzie,
Victoria.
The following paper was then read by Dr. J. D. Neville, Vancouver:
CATHOLIC HOSPITAL PROGRESS AND IDEALS
To the casual observer the Community Hospital is a rather
important building well designated, where there are a number of
sick people more or less carefully nursed, and where doctors treat
them and where nurses are trained.
The virtues of such an institution are variously characterized
by the attention, efficient or otherwise, received by some relative
or friend, who was unfortunately at some time or other cared for
within its  walls.
Next to this rather casual acquaintance the observation is
made that said Hospital may have an influence upon the annual
tax notice, or has to be considered in the disposal of public funds,
and also that it runs behind financially, and makes occasional or
frequent demands for assistance.
Until one is placed carefully on his back, for a more or less
prolonged period in such an institution, or becomes one of its staff,
or a member of its executive board, such person's knowledge of its
inner workings, its benevolence and service, its difficulties and
struggles,  is limited.
Most people are too extremely wrought in the pursuit of their
own occupation, or other domestic requisites to study, even in a
general way, something of hospital administration and service.
Hospital administration and administrators are usually so largely
engrossed in their own particular hospital endeavour as to give
insufficient study and thoughtful consideration to allied endeavours,
and are prone to become narrow in viewpoint .with the usual unfortunate sequences. Thanks, however, to such occasions as these, with
frequent interchange of ideas, and also to hospital standardization,
such conditions, the product of individualism rather than policy, are
radually disappearing. Governing bodies in the past have not given
sufficient study in some instances to the various hospital administrations, methods, policies and ideals, and have been prone to err in
their estimation of the amount of public service rendered by such
institutions. While some hospitals, and particularly Catholic hospitals, have been perhaps inclined to deny themselves sufficient
publicity to warrant a more detailed knowledge of their service, and
better consideration of their claims for public recognition.
It is important that those of you here assembled, also governing
bodies and those in authority and control, as well as the public at
large, should have more than a passing knowledge of the magnitude
and world-wide importance of hospital work in general.
28 It is equally important in order that the- excellent objects ot
this Association should be fully attained, that those representing
the various - component administrations should attain more than a
common knowledge of each other. By such means alone can you
secure hearty co-operation and attain ideals in unison and sympathize
with each other's endeavours.
It is not my intention to criticize or compare or enter into
controversial discourse regarding the various modes of hospital
administration; but in accordance with my humble ability, I am going
to endeavour to tell you something of Catholic history, progress and
ideals. In so doing, it is my wish to convey to you a true conception
of the work being done by Catholic hospitals, the quality and scope
of such work, avoiding superlativism and lack of sympathy for
other institutions, but claiming a wider recognition than their
designation as private institutions proclaims.
It is to Pope Innocent III. early in the 13th century, that we owe
the modern city hospital as we have it at the present time, with
its main purpose to care for the ill and injured, whose friends were
not in a position to care for them. The deliberateness with which
he set about the establishment of the mother city hospital of the
world is a striking characteristic of the. genius of the man and an
excellent illustration of the practical character of the century of
which he is so thoroughly representative. Having satisfied himself
of the necessity of establishing such institutions and having summoned Guy de Montpelier, famous physician of his time to Rome, he
founded the Hospital of the Holy Spirit in Borgo, near St. Peters,
where it still exists.
This was the mother modern hospital of the world. Visitors
to Rome saw it and could not fail to admire its humanitarian work.
Bishops from other parts of the world in their official visits to
Rome, admiring the policy under which it was conducted, on returning home organized institutions of the same kind. How many of
these were established in Europe is hard to determine. Virchow,
the German physician and historian, speaks of over one hundred
of such institutions in Germany alone in his time, while in France
and Italy the movement lost no impetus.
origin at this time,
revenue  producing
In Paris the still existing Hotel Dieu had
a  fully  endowed  institution  existing  largely
property, with which it had become possessed by bequests.    There
aFe no records of special revenues voted by the city or king.
In England the movement was no less acute, at least as far as
records go. These records refer mainly to London, and show that
the work of Innocent III. and his enthusiasm was felt in the English
capital. The still famous St. Bartholomew's Hospital of London had
been in the 12th century a priory, which took care of the poor and
ailing, but at the beginning of the 13th century became more frankly
a hospital in the modern sense of the word. St. Thomas'
Hospital, which remains to this day a great medical institution,
also Bethlehem, Bridewell and Christ's Hospitals along with the first-
mentioned constituted the five royal hospitals of London.
How much all this- hospital achievement owes to Innocent III will
be best appreciated by Yirchow's account of the German Hospitals
and this historian is not likely to exaggerate the beneficient influence
of their originators. He speaks thus: "The main cause decisive in
influencing and arousing the interest of people in hospitals at that
time was papal enthusiasm in the matter. The beginning of their
history is connected with Innocent III. who made the boldest and
farthest reaching attempt to gather interest in the movement. By
the establishment of such institutions he thought to bind humanity
29 more closely to the church. In so doing he turned his eyes sympathetically., upon the poor and sick and aided the helpless and
neglected of the streets, and saved the illegitimate children from
death in the waters. iVirchow further states that hospitals for
housing purposes had existed amongst the Arabs "and Buddhists in
the distant East, but it must he recognized and admitted that it
remained for Innocent III. to establish institutions for the study,
isolation and cure of those suffering from  diseases.
About this time were established throughout Europe the famous
hospitals for the care and treatment of lepers and through their successful hygienic, sanitary work was brought about the complete
obliteration of leprosy in the middle ages and furnished the first
example of the possibility of eradicating disease by isolation and
segregation.
Later Honorarius III. established hospitals exclusively for the
treatment of erysipelas, a prevalent disease of that time, with
consequent reduction in the contagion radius of the disease.
Prior to the Reformation 77 hospitals existed in Scotland—a
lesser number, but proportionately as many in England, Ireland,
Spain, France,  Italy, and many of the  smaller provinces.
A word as regards construction of hospitals at this period.
They varied in capacity from 6 to 2,000 beds. An endeavour
was made to admit plenty of air and sunlight. A location by the
bank of the river was preferable, while the importance of being on
the outskirts of the city, away from noise, and where air was pure,
was recognized, while on other occasions smaller hospitals were
erected in the centre of the city so as to be within reach of the
poorer classes. The main ward of Santo Spirito of Rome was 409
feet long by 40 feet wide.
The chief administrator of each hospital was appointed by the
Bishop, such administrator being a monk, a priest, or qualified layman. iCertain regulations of management, usually that of the order
of St. John of Jerusalem, prevailed. These provided that the administrator, rector or master, besides being general superintendent was
responsible for all hospital property, and money deposited for safekeeping. It was also his duty to receive patients and assign them to
their proper place in the hospital.
Rich and poor, soldiers and citizens, Jews and Mohammedans
alike must be admitted. Hospital attendants were at times obliged
to go into the streets and search for the maimed and injured. The
regulations provided that the sick should never be left without
attendance; that the seriously ill be removed to a private room,
while similar provision was made for maternity patients. That due
attention was paid to cleanliness and comfort is evidenced by records
of baths, bed-linen and heating by means of fireplaces and braziers.
Not content with the above-mentioned regulations, the hospital
authorities of Ireland provided further requirements in keeping
with Irish thought and sentiment. These known as the Brehon-laws
provided that amongst other things, hospitals shall have at least
four doors, be free from debt, and there must be a stream of water
traversing its middle. That whosoever inflicted bodily injury upon
another had to pay for his maintenance in case he required hospital
attention. That dogs and fools and female scolds be kept away from
the patients, lest they be worried.
During the earlier hospital history, medical and surgical treatment was administered partly by ecclesiastics, but as medical
schools and universities developed, this was entirely removed to the
hands of  the  specially  trained  physicians  and  surgeons.
30 Hospitals at this time, as today, were not° self-supporting, and to
meet expenses they were commonly endowed with lands and revenue
bearing property, while in certain countries special taxes provided
revenue from oil, wheat and salt. Private donations, bequests and
charitable associations assisted in revenue, as today. A very important requirement of all such hospitals, then as now, was the
Chapel, a provision for the celebration of religious duties of patients
and attendants.
With the Reformation, hospitals suffered much by the upheaval,
and many passed out of existence as such, or became under the
control of the State or Sovereign, while others clung to their original
status. Nevertheless Hospital progress in these ages received a
severe setback, which, however, only served to stimulate at a later
date, a more intensive movement, and marks the beginning of
secularization of hospitals and various other modes of administration
in existence today.
It is worthy of note that the general requirements of Hospitals,
as to design, location, management and regulations, etc., of that
period differ only in detail to the present-day administration, but
that detail so marks the value of experience, study, science, co-operation and sacrifice that the end results of the labors of those institutions must of necessity ill compare with that of the modern twentieth
century hospitals. Due credit, however, must be given to the endeavour of that period for its sincere effort to alleviate the sufferings
of mankind, in accordance with their enlightenment and the limited
progress of science.
The charitable and ecclesiastical aspects of such institutions
were as prominent then as today, and the unselfish and untiring
efforts of the attendants therein lacked nothing in zeal in endeavouring to maintain the historical relationship between the Church and
the art of healing.
Coming nearer home, the first of the Churches' hospitals to be
established in America was built in the city of Mexico, about 1524
A. D. While the first to be erected in the United States was in
1663 on Manhattan Island. In 1639 the Hotel Dieu at Sellery, near
Quebec, marked the beginning of the hospital movement in Canada.
This institution pas later moved to Quebec, where it still stands.
In 1644 the Hotel Dieu of Montreal was founded by Jeanne Mance,
and it must be remembered that for two ienturies it was the only
hospital  in   Montreal.
Founded for the poorer class, it was from the beginning endowed
with funds and lands so that patients we're admitted without charge
and given all medicines, care and treatment throughout a period of
250 years.
This briefly sketches the earlier history of the great movement
which today is spread throughout the length and breadth of the
world.
And, indeed, there are few corners of civilization or even areas
where the light of Christianity is scarcely known that the service
of the Sister's Hospital is not within a reasonable distance of travel.
Statistics of many of such hospitals throughout the world are not
wanting, but for practical purposes I shall confine my remarks to
the United States and Canada, these countries being within our
observation.
There are today in Canada and the United States, 700 Catholic
Hospitals. These 700 Hospitals constitute more than 50% of the
beds of all hospitals in these two countries.    130 different orders
31 of sisterhoods control and supervise these hospitals with a combined
total of 20,000 Sisters ministering to the sick and a similar number
of lay nurses. About four million patients pass through their doors
each year. This strength alone makes it apparent that there is a
full warrant for a separate and independent Catholic Hospital' Association, of which I shall speak later. This strength warrants
the request for a wider recognition of Catholic Hospital service
and  a  broader  consideration   of  their  charity.  '
As in the earlier history, before mentioned, their doors are open
to all regardless of creed, poverty or wealth. For their continued
growth and progress, there can be no other satisfactory explanation
than the tireless, patient, whole-souled, devoted service of the Nuns.
There is no salary list for the Sisters, no earthly financial reward,
every dollar saved by their relentless efforts goes to build, repair,
or improve an institution for humanity. Those who for controversial
reasons maintain that Sisters receive no salary, are indeed proclaiming  a  terrestial  truth.
The centre of our Sisters' hospitals, whether architecturally or
figuratively is the Chapel. Here all corridors must converge. Holy
Communion, meditation and prayer give the Sisters strength and
courage for their lives of sacrifice and devotion. Unfortunate indeed
is the nurse who loses reverence for sacred things, and who can
look with cold indifference upon a body hopelessly wrought with
disease, and a soul crying for light and comfort. The Chapel and
spiritual side of sisterhood, and the sweet influence of religion
have ever been the means of dispelling the nervous gloom of patients
so dangerous to their well-being, and physical recovery, while countless thousands of souls have been strengthened or saved as a result
of the influence of hospital environment. To Florence Nightingale,
who spent considerable time in the Sisters' Hospital of Paris, are
attributed   the   following  words:
"I appreciate the strength of religion in work for the sick, I
do believe that religious motive is essential to the highest kind of
nursing."
She attributed much of her success in the Crimean War to the
help she received while with the Sisters of Mercy.
Thus briefly, to sum up, the ideals of a Sisters' Hospital, teach
us that a diagnosis that fails to find room for disease cause in the
soul is incomplete. That it is not enough to prevent a baby from dying
without the sacraments; it is not enough to abstain from abortion
and abortive measures, or the wanton destruction of the organs of
generation, but that there 'should be a whole-hearted co-operation
in administering to body and soul.
To turn now to the purely scientific aspect of their work. In
the past sisters had only to be good housekeepers, and kind and
patient nurses, but with the revelations in medical science in the
last few years, hospitals have grown into pathological, bacteriological
and dietetical laboratories, and this calls for more trained workers
and skilful technicians. The Sisters are endeavouring as speedily
as possible, to rise to the standard of requirement. Practically
every floor- of a Sister's hospital today is supervised by a trained
and graduated Sister. Many of the laboratories and X-Ray departments are solely in the charge of one of their number, specially
trained in the work. Not because they excell, but rather because
of the difficulties of securing permanent and competent technicians,
and also for economic reasons. Their policy as regards scientific
development is to lack nothing in their equipment, within reason,
to aid the physician in his diagnosis and treatment, but especially that the patient, the most important individual in the field of
activity, should have the benefits of the most up-to-date methods
for the study of his case and the hastening of his recovery, With
this end in view, and after due consideration it was decided some
five years ago that it would be in the best interest of scientific advancement, to co-operate with the American College of Surgeons in
the hospital standardization scheme. This step has done much to
lighten the burden and encourage the Sisters to greater undertakings, and has been a great influence for the betterment of their
hospitals, and has placed at the disposal of this influential and
capable body of surgeons, their whole fund of resources and equipment, in co-operation with others, in order that the standard of
hospital progress throughout the continent should be in unison
and upon a sound,  economical, and  scientific basis.
To date approximately 200 of their hospitals have qualified for
membership in the standardization scheme, and are co-operating in
its  advances.
Another important step, far-reaching in its achievements, was
the organization of the Catholic Hospital Association of the United
States and Canada. This was accomplished in the year 1914, largely
through the efforts of the Reverend Father Moulinier, its great
founder and president. Its purpose is to help the Catholic Hospitals
of the United States and Canada to study the whole complex problem
of hospital management and institutional medical service. The principles on which it was founded, and under which it will endeavour
to consistently develop, is progress in the development and application of medical science for the well-being of humanity under the
guidance of the true and proven principles of ethics and Christianity.
11 is represented in its membership by hospitals, doctors, Sisters,
nurses and chaplains, and has grown from a membership in 1915
of 42 'hospitals, and 23 individual members to a present-day membership of over 500 hospitals, and 1600 individual members.
The work of this Association in many respects duplicates and
intensifies that of the. American College of Surgeons, but is intended
to cover ground not specifically touched upon in their plan of procedure, such as the shaping with precision and exactness, the ethics
of Catholic Hospitals and the medical men practicing therein. Eight
annual conventions have been held to date, and the strength and
enthusiasm as a result of its successful operation, has shown no
abatement, while every phase of hospital development is being
strengthened and improved as a result of its existence. Subsidiary
organizations, State, District and Provincial, of the parent association, have been organized, and these in turn hold their annual conferences where problems peculiar to their own district or subsection are discussed.
A great step forward in the activities of this Association, was
the establishment and issuance of its official monthly magazine,
Hospital Progress, a journal devoted to the furtherance of all the
aims and purposes of the association and embodying the best interests
of the Catholic Hospitals of the two countries. Its first issue was
the May number 1920, and since that date has grown in power and
influence and is today a worthy addition to any hospitals' literary
collection. An executive committee has charge of its publication,
while the Editorial Board is made up of this committee, and contributing editors from the various parts of Canada and United States.
It is the intention to so enlarge the scope of this journal that
this board of contributing editors will cover every section of the
countries mentioned and  every scientific worker interested in con-
33 stitutional care of the sick, will if possible, become one of its contributors  or readers.
This magazine is published by the Bruce Publishing Company
of Milwaukee,  and is self-supporting.
The plan by which this great body of Catholic Hospitals purpose
growing in scientific efficiency, and keep pace with medical advancement and scientific research, is to establish on the Continent as
many as required, consistent with economic measures of high-grade,
centrally located schools, for the training of Hospital superintendents,
teachers, nurses, laboratory technicians, record-keepers, dietitians,
and  social workers from amongst the  Sisterhoods.
These schools, one at least already under way, will be so located
and managed that the religious life and training will go hand in
hand with the most advanced scientific ideas for their life's work.
This briefly states the history ideals, purposes, and activities, in
a general way, of Catholic hospitals and their Hospital Association.
Their records of achievement for the well-being of humanity have
not been equalled, let alone surpassed by any single or combined
effort on the continent or I may perhaps add, throughout the Universe.
They have been the pioneers in the work of collectively caring
for the sick and the homeless. The charity of the Sisters is an
all-embracing one, and their success is their fidelity to their twofold charge, namely, personal salvation, and the constructive alleviation of human ills, mental and physical.
While their institutions are, and ever will be private owned
institutions, their demand for public recognition as a result of public
service rendered, is being heeded more and more throughout the
continent and almost without exception, wherever their hospitals
exist, and where the requirements necessary have been fulfilled,
they have been accorded a large measure of public consideration
and treatment, which is so justly coming to them. Much credit has
been justly given Sisters' Hospitals for their efficient financial
success. This success varies a great deal in different institutions
and localities, and has been somewhat erroneously ascribed to the
saving of salaries paid in other institutions. If we will for a moment consider the cost of training from a raw recruit for the Sisterhood, to her full development as a qualified nurse, and manager
of a floor or other hospital department, together with all the incidentals of maintenance, including sickness, insurance for ill health
and also provision for old age maintenance, it may be ascertained
that when all has been considered, that the salary is not so much
the factor, but rather that the Sisters consecrate their lives to economy
in management, and to specializing in their particular duties.
Since I am now on the financial question, you may pardon the
introduction of some rather pointed statistics as regards public
service. I will not make general reference but be specific and near
home.
Had the government of British Columbia been paying to St.
Joseph's Hospital of Victoria a grant of 45c per hospital- day, for
the period of ten years preceding 1923, they would have paid to that
institution during that period of time $160,000. During the year
1922 alone, under similar conditions, they would have paid to the
St. Paul's Hospital of Vancouver, the sum of $30,000 covering 62,880
hospital days. These sums of money would of necessity, have to be
spared from the public treasury. During the year 1922, St. Paul's
Hospital gave 10,924 hospital days free treatment to indigent patients,
while St. Joseph's Hospital gave 4,155 such days' treatment.
34 Of the patients admitted to these hospitals during that year,
15% alone were of Catholic faith. These statistics which I have
quoted, though limited, are purely local and within easy means of
daily observation but differ in no wise to the general policies and
ideals throughout the continent and  universe.
It may be justly stated that the Sisters are conservative in
adopting new and unproven policies and principles, but it must
also be admitted that their onward march and progress is steadfast
and solid. Centuries of experience and pioneer endeavour have
taught them the fundamental principles of conservatism. Ample
time and due consideration 'enter into their undertakings, and it
is seldom that they have cause to  retrace their footsteps.
Hospital standardization, with its many requirements, has done
much to acquaint the public with the magnitude of their unpro-
claimed accomplishments, both past and present.
This and inter-association and co-operation with other Hospital
Associations great and small has done much to broaden their ideas,
and enable them to accomplish things in cohesion and unified purpose,
much more now than in the past. ,
It must ever be remembered, however, that the Sisters are
bound by faith and tradition, to the fundamental principles of the
Church. Their conduct in each order is governed by the laws
adopted by their respective founders, and the enlightened supervision
of their superiors, and their purpose which though similar to the
natural scientific purposes of other hospitals, must and shall ever
differ materially in a large and important field of ethical and
ecclesiastical activities, both on the part of those who minister
and those who are ministered to.
For this reason I bespeak for them a measure of consideration
and forebearance, in all deliberations and concerted efforts for
co-operative advancement. For whatever may be the difference in
the interpretation of hospital administrative ideals, let us in the
true sense of charity, give the Sister's Hospitals credit for a sincere
endeavour in the past and present to accomplish many things for
the physical, social, ethical and religious well-being of mankind.
Their hospital walls are eloquent with the story of the sufferings
of the first great Physician and Healer, their banners are emblazoned with the symbols of charity and benevolence. May they
ever continue to develop in resourcefulness and enthusiasm to bear
aloft the flaming torches of Science and Truth.
To conclude, I trust my rambling remarks, though perhaps not
of sufficient practical interest to a gathering of this kind, they
nevertheless, have been offered with the object of further informing
public opinion of the vast amount of work being done by the Institutions whose cause I have endeavoured in a small measure to uphold,
the story of whose ministrations have been in the past too reserved
and too unproclaimed.
AFTERNOON SESSION, WEDNESDAY, AUGUST 29th
The meeting was called to order at 2 p.m. The choice of time
and place of the next Annual Meeting was the first item of business.
A cordial invitation to meet in Victoria was tendered by Mr.
George McGregor, President of the Board of Directors of the Provincial Royal Jubilee Hospital and by Sister Mary Mark, Superior
of St. Joseph's Hospital. Mrs. H. A. Goward representing the Ladies'
Auxiliary  of St. Joseph's Hospital also assured  the  delegates  of  a
35 hearty welcome. The delegates voted unanimously for acceptance
of this invitation and the. Executive Committee were empowered
to select a suitable date and make all arrangements.
A Round Table Conference on Nursing Affairs followed, Mrs.
M. E. Johnson, R.N., Superintendent of the Bute Street Private
Hospital presiding. Miss K. B. Stott, convener of the Committee
on Nursing Affairs was unfortunately not able to attend the convention but her report which follows, formed the basis of discussion.
Miss Stott is the secretary of the Committee on Education of the
Graduate Nurses Association of British Columbia and her report
dealt largely with the activities of that committee which is concerned with the educational aspect of nursing in this province.
Report  of  the   Convener  of   the  Committee   on   Nursing   Affairs.
The Educational Section of the Graduate Nurses Association of
B. C. was formed in October, 1922, its purposes being the advancement of nursing education in this province. Membership to the
section was open to superintendents of hospitals, head nurses, ward
supervisors or any nurses interested in nursing education.
The objective set by the section were: (1) Revision of the
standard curriculum for schools of nursing in B. C. and (2) a
summer school course in connection with the University of B. C.
Both these undertakings represented a great deal of work on the
part of various members of the section. The revision of the curriculum was undertaken as it necessitated so much detail work
that it would take some months to complete it. Conditions in
schools of nursing in B. C. have undergone a great deal of change
since the curriculum., was first drafted several years ago, so much
so that it was felt that the curriculum was inadequate and of little
help, and the revision has been undertaken with a view to making
it of much more assistance to the training schools of our own province and to set such standards as would enable our graduates to
become registered in other countries, without which, graduates of
our province would be seriously handicapped in their profession.
This revision is now nearing completion and will be printed and
distributed to hospitals within the next few months. For those
of you who may be members of governing boards, or directors of
hospitals, some of the important features might be presented here.
Hospitals conducting schools of nursing are required to have 15
active beds consisting of medical, surgical, obstetrical and pediatric
services; adequate facilities must be provided for the instruction
of the students in all subjects required in the curriculum. This
would include a suitably equipped class room for demonstrations
of all nursing procedures and lecture room. It is preferable that
two rooms be provided for these purposes. The demonstration room
should be fully equipped at all times with such instruments, utensils,
appliances, etc., as are used in the hospital ward and may be used
by the pupils for practise in various proceedures. Provision must
be made for the teaching of subjects such as chemistry, bacteriology,
cookery, drugs and solutions, etc. If suitable laboratory facilities
cannot be arranged for in the hospital for adequate instruction in
these subjects, the hospital is advised to make arrangements with
a high or technical school in the vicinity for use of a laboratory
where such instruction may be carried on.
A library must also be provided consisting of copies of the
modern nursing text and reference books, nursing and hospital
periodicals and such general literature as would be educational.
For nurses residence a separate building is the first essential.
Single   rooms   are   strongly   recommended   but   where   this   is   still impossible the requirements are that rooms be well lighted and in
sufficient number to prevent overcrowding. Basements and dormitories in upper stories are no longer considered. Special provision
must be made for night nurses to ensure undisturbed sleep during
the day. This is possible only when rooms are arranged for this
purpose. The dining room must be a well ventilated clean room
in which a sufficient quantity of wholesome well cooked food is
properly served. A suitable room must also be provided for social
recreation - for  the  students,  simply,  but  attractively  furnished.
A teaching force must be  maintained sufficient to conduct the
specified instruction   consisting of  a   superintendent  or  director  of
nursing   who  is   a  registered   nurse  of   this   province   and   capable
ently administering the affairs o fthe school and of directing
A full time instructor must be
of compete]
the nursing service of the hospit
maintained by every school of twenty-five students under her supervision; graduate nurses in charge of such services as operating room,
maternity departments in school of twenty-five or over; a dietitian
and  a  staff  of  medical  and  other lecturers.
Candidates wishing to enter an approved school of nursing must
present certificates of two successful years of high school or its
equivalent, must be between twenty and thirty-five years of age;
shall present a certificate of good health; should be admitted in
groups at stated intervals. The course shall cover a period of three
years including instruction and practical experience in the services
already mentioned. Schools of nursing which do not afford such
instructions shall not be registered as approved schools unless
provision is made for such services as may be lacking by affiliating
with a hopital granting such privileges.
Schools of nursing will be required to keep records of the
physical condition, character and efficiency of each student as well
as a complete resume of the nurses instruction in various subjects,
number of classes and rating in each and a record of the length
of time devoted to various services during the complete course of
training. Beside the requirements set forth for schools of nursing
the announcement will include a general outline of topics required
and recommended to be followed, an arrangement of the course, a
recommended list of text books; regulations governing examination
including the registrar's instructions to candidates. The instruction
required in the revised  curriculum is approximately  300 hours.
In dealing with such an important matter the section submitted
the details of the requirements to all superintendents of Training
Schools throughout the province asking for suggestions on any of
the points then under discussion before being passed by the Educational Section. The arrangement of the curriculum and outline of
subjects set forth in the announcement will undoubtedly prove of
valuable assistance to the superintendents of the Nursing Schools
in the Province.
The Second Objective: The summer school course at the University of B. C. was arranged for and directed by Miss Johns. It had
afforded an opportunity for graduate nurses to obtain instruction in
administration of hospitals and teaching of nursing principles and
methods in schools of nursing. It covered a period of six weeks from
July 9th to August 17th. The course in administration included such
lectures as hospital financing and accounting, purchasing methods,
legislation affecting hospitals, hospital management in special departments and many other valuable topics for the hospital administrator. The instructors course included observation of classes in
various nursing procedures, conducting of lecture in' nursing subjects. lesson, plan, etc. In both of these courses we are very much indebted
to the hearty co-operation of the Vancouver General Hospital, without
which, this work would have been almost impossible. As Miss Johns
is present with you she will be only too willing to give you more
valuable information regarding the accomplishments and results of
the summer school course than I am in a position to give.
Respectfully submitted,
K. B. STOTT
Convener of Committee on Nursing Affairs.
The report of the committee on Constitution and By-Laws which
had been referred back for further consideration was then presented.
After considerable discussion and several amendments the report
was adopted. The amended Constitution and By-Laws in their final
form will be found on page
A Round Table Conference of the Hospital Auxiliaries followed,
Mrs. H. W. D. Smith of Penticton presiding. Her introductory remarks were as follows:
Mr. Chairman, Ladies and Gentlemen—I have been requested to
introduce the subject of Women's Auxiliaries. For any organization
to be a success, there must first be a need for such an organization.
Undoubtedly such a need exists under present hospital conditions.
One of the necessities for a successful auxiliary is a loyal working
executive, headed by a tactful organizer. Of course, I am speaking
of the perfect auxiliary.
How do you elect your officers? This is important. Sometimes
no thought is given before hand we just re-elect -the old officers
because it is easiest or appoint the lady next to us because we like
her, with no thought as to her ability to fill the position; and too
often a position is accepted without a conscientious resolve to not
only hold the position but to fill it. Do you conduct your meetings on
parliamentary lines, opened on time and put through in a businesslike manner?
It would be interesting to know just exactly what the different
auxiliaries supply to the hospitals. We attend to the linen and
kitchenware, to the comfort of the nurses and sometimes help with
other things as furniture, etc.
I do not think any of us are satisfied with the method by which
money is obtained for pur purpose. Many of us feel hospitals should
be directly under the control and support of the government. No
doubt that will come and at present we are anxious to know of any
new method whereby the long-suffering public can be induced to
part with more dollars.
Tag-days and sales have been successfully used over and over
again, so some other method would be eagerly welcomed by most
of the Women's Auxiliaries.
A report of the work accomplished by the Matsqui-Sumas-Aib-
botsford Hospital Auxiliary was given by Mrs. F. D. Swift as follows:
The Matsqui-Sumas-Abbotsford Hospital Auxiliary has been in
existence two years in November 1923. During that time they have
raised in round figures forty five hundred dollars from two bazaars,
dances, garden fete, a tag-day and donations from different organizations  in the district.
All this money has been spent in furnishing the hospital with
the exception of $374.88 which is still in the treasury in bank and
38 $200 given the Hospital Board for beautifying the grounds.
We are fortunate in having co-operation between the neighbouring
institutes and lodges and our Women's Auxiliary, without which our
effort could not have met with such success.
We are young and small but with the kindly feeling prevailing
in the community we hope to grow and widen this movement for
good, which we have undertaken.
Mrs. George Bell Brown gave an interesting account of the
activities of the Auxiliary of the Nanaimo Hospital. She stressed
the importance of incorporation as giving a sense of responsibility
to members of voluntary organizations and described the participation
of her group in the celebration of Hospital Day.
Mrs. H. A. Goward representing the Auxiliary of St. Joseph's
Hospital, Victoria, outlined the work of that organization. She
mentioned the publication of a descriptive booklet giving information
concerning the hospital as being a valuable contribution made by
the Auxiliary.
Mrs. Gerald McKenzie, president of the Auxiliary of the Kelowna
General Hospital, told of the work of that body. She emphasized
the importance of conserving linen supplies and stated that the
auxiliary paid part of the salary of a person whose duty it was to
count and repair all linen returned from the laundry before it
was  used on the wards.
Discussion of the arrangements for Hospital' Day followed.
Several delegates described methods of interesting the public and
all were agreed that no attempt should be made to collect money
for the hospital in connection with the celebration of Hospital Day,
but that an effort should be made to interest and instruct the public
in hospital service.
On motion, Dr. H. C. Wrinch was appointed chairman of the
National  Hospital  Day  committee  for the province.
The report of the resolutions committee was then presented
and was discussed at considerable length. It was amended to read
as follows and adopted.
REPORT    OF   THE   COMMITTEE   ON    RESOLUTIONS
WHEREAS certain of the monies granted to the hospitals of
the province by the government are derived from the profits realized
from the sale, of liquor pursuant to the provisions of the Liquor
Control Act;
WHEREAS this convention is much opposed to receiving monies
in aid of the work carried on by the hospitals of the province earmarked as being a portion of the profits resulting from the sale
of liquor as aforesaid;
AND whereas the hospitals of the province, if they are to
properly and efficiently carry on .their work, must receive from the
government grants considerably exceeding in amount the moneys
now being paid to them by the government out of said consolidated
revenue fund and said liquor profits;
AND whereas it is the opinion of this convention that a commission should be appointed by the government for the purpose
of securing strict inspection and supervision of hospitals;
NOW THEREFORE this Convention resolves as follows;
1. That the only proper method of granting aid to the hospitals
is by paying out of the consolidated revenue fund monies on a per
capita basis but only to such hospitals as comply with the provisions
39 of the Hospital Act and such other Provincial laws and regulations
as are applicable.
2. That the aid to be granted by the government on such basis
be as follows:
That fifty cents be added to each of the amounts fixed by
Clauses B. C. D. E. and F. of Section 4 of the Hospital Act.
3. That the government enquire into the desirability of appointing a commission and establishing a bureau as herebefore recited
for the purposes mentioned.
4. That owing to the increased number of hospitals now receiving government aid, no aid be given towards the erection of
new hospitals or additions to existing hospitals until full investigation has been made as to the necessity of such proposed erections
or  additions.
5. That Section 7 of the Hospital Act should be amended so
as to provide that the Clerk of the Municipality shall within seven
days of the receipt of the notice mentioned in Clause 3 thereof
send to the Clerk of the Hospital, notice by registered post that
such patient was not a resident of the Municipality within the
meaning of the Act if such be the case. Provided that should such
last mentioned notice be not sent within such time it shall be
presumed the patient was  a resident of the Municipality.
Discussion of the Report of the Resolutions Committee centred
round the question of hospital inspection. The urgent need of
competent constructive criticism of hospital management was pointed
out by several delegates. Mr. P. Walker, representing the Department of the Provincial Secretary assured the convention that the
government had this matter under advisement.
It was the sense of the meeting that some attempt should be
made to approach the Union of B. C. Municipalities in order to
bring about a better understanding of hospital problems. The
president strongly urged that definite steps be taken in this connection and ■ it was decided to instruct the incoming executive
accordingly.
Mr. E. S. Withers, New Westminster, brought to the attention
of the convention correspondence between Mr. D. McL. Anderson
and governmental authorities concerning the payment of succession
duties on legacies accruing to hospitals. The feeling of the delegates
was that such duties should be remitted to hospitals. The following resolution was then put to the meeting and passed unanimously.
"That the Provincial Government be requested to provide for
exemption of succession duties on legacies accruing to hospitals
under the wills of deceased persons similar to that provided in the
Ontario  Succession  Duties Act."
On motion of Mr. George Haddon, Vancouver, seconded by Sister
Mary Mark, Victoria, Dr: M. T. MacEachern was made an Honorary
Life Member of the Association. Hearty applause marked the
passing of this motion.
Votes of thanks were passed to the following:
The local committee of arrangements, especially Mr. O. E. Fisher,
Mr. Herbert Keddell and Mrs. H. W. D. Smith. Dr. M. T. MacEachern
Mr. Lawrence Wood, assistant editor of the Penticton Herald; Mr.
Parker Williams, representing the Workmen's Compensation Board;
Mr. P. Walker, representing the Department of the Provincial Secretary; Mr. Fletcher, representing the B. C. Medical Association, and
the retiring officers.
The convention then adjourned to meet in Victoria in 1924.
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Ladysmith   (Wellington)   Coal,  Ladysmith,  B.  C.
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BEST BY GOVERNMENT TEST
48

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