History of Nursing in Pacific Canada

Report of proceedings of the annual convention of the British Columbia Hospitals' Association. British Columbia Hospitals' Association 1922

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 The Columbian Co., Ltd AS AGENTS FOR SOUTHERN ASEPTIC
LABORATORIES WEARE ABLE TO SELL
YOU COTTON DIRECT FROM THE FACTORY AT A VERY MATERIAL SAVING.
WE CARRY AT ALL TIMES A FULL
LINE OF SURGICAL INSTRUMENTS, RUBBER GOODS, GLASS AND ENAMEL WARE
AND FURNITURE OF HIGHEST QUALITY.
PRICES CHEERFULLY QUOTED. DROP
pSF'AJSD SEE U8&XONG DISTANCE AS»
MAIL ^OI^g|RS DESPATCHED^ SAME
D!A^v;vi|80 ORDER TOO^ SMALL OR TOO'
LARGE.
REID BROS., of Canada, Ltd,
788 Duusmuir St., Vancouver, B.C.
Phone Sey. 4802 Will no doubt be glad to learn that we now carry sufficient
stock in our Vancouver office to take care of their needs.
The encouragement given to this thoroughly Canadian industry has been somewhat astonishing. This explains its
rapid stride to the success it has attained.
We can give you very attractive prices on the following all
"CANADIAN MADE" goods:
CHEMICALS
ETHER for Anaesthesia in 1 lb. and % lb. tins. B. P.
Ether in 5 lb. tins or 100 lb. drums.
CHLOROFORM tor Anaesthesia in 1 lb. and  % lb.
tins. B. P. Chloroform in 100 lb. drums.
ETHYL CHLORIDE in 60 and 100 gram tubes.
NITROUS OXIDE and OXYGEN in cylinders).
HYPODERMIC AMPOULES.
PITUITARY EXTRACT in 1 and % cc. for both Obstetrical and Surgical.
Hypodermic Ampoules of all sorts.
SURGICAL DRESSINGS.
^ADHESIVE PLASTER, 5 yds. x 12 ins.
VALOR CELLO DRESSING    (superior and cheaper
substitute to oiled silk).
ABSORBENT COTTON, GAUZE,
SANITARY NAPKINS
Manufactured by
Canada Chemical Works Co., Ltd.
552 Beatty St., Vancouver, B.C.
Telephone Seymour 967  Name Representing Address
Banfield, J.  J Vancouver General Hospital, Vancouver.
Beardmore,  Mrs.  M Roycroft Hospital, Vancouver.
Bethune, R. A k Royal Inland Hospital,  Kamloops.
Binger, George  Kelowna Hospital, Kelowna.
Black, Miss C General Hospital, Prince Rupert.
Bligh, Miss E Penticton  Hospital,  Penticton.
Breeze, Miss E B. C. Graduate Nurses' Assn., Vancouver.
Brown, Dr. G. B General Hospital, Nanaimo.
Brown, Mrs G. B General Hospital, Nanaimo.
Brown, Miss M Cumberland Hospital, Cumberland.
Brown, Peter J Chilliwack Hospital, Chilliwack.
Burde, Mrs. R. J West Coast Hospital, Port Alberni. -
Burnett, Dr. W. B Vancouver General Hospital, Vancouver.
Carey, J. N C. N. R. Medical Assn., Vancouver.
Campbell, Miss K Abbotsford Hospital, Abbotsford.
Carver, G. T. ____ Provincial Royal Jubilee Hospital, Victoria.
Clark, M. S. ...".'.'. B. C. Stevens Co., Vancouver.
Cook; E.  M Chemainus Hospital, Chemainus.
Darby, Dr. George  R.W. Large Memorial Hospital, Bella Bella
Darby, Mrs. George  R.W. Large Memorial Hospital, Bella Bella
Davidson, Mrs. Grace  Trail Hospital, Trail.
Day, E. L Chandler  <&  Fisher  Co.,  Vancouver.
Day, Miss Margaret  St. Paul's Hospital, Vancouver.
Dinalian, Mrs. Thompson..St. Paul's Hospital, Vancouver.
Doherty, Miss M St. Paul's Hospital, Vancouver.
Drake, S. J Provincial Royal Jubilee Hospital, Victoria.
Drew, Dr. George  Fraser Valley Medical Assn., New West-
Minster.
Dutton, Miss M. L St. Paul's Hospital, Vancouver.
Ellis, Miss K. W Vancouver General Hospital, Vancouver.
Frederickson, H. T Victor   X-Ray   Corporation,   Vancouver.
Forrester, Mrs. J Royal Columbian Hospital, New Westminster.
Glen, A. P General Hospital, Ladysmith.
Gouldburn, Miss E Lady   Minto   Hospital,   Ashcroft.
Graham, Charles „ Cumberland   Hospital,   Cumberland.
Grant, L. S Office Specialty Co., Vancouver.
Gray, A. Wells  Royal Columbian Hospital, New Westminster.
Gray, Mrs. A. W Royal Columbian Hospital, New Westminster.
Gray, Miss L. Scott Chilliwack Hospital,  Chilliwack.
Haddon, George  Vancouver' General Hospital, Vancouver.
Hanbury, Mrs. John  Vancouver  General  Hospital,  Vancouver.
Haskin, Miss Cosae Vancouver.
Hay, Don G B. C. Stevens Ltd., Vancouver.
Hilton, E. Carr  King's Daughters Hospital, Duncan.
Hogarth, Miss M Provincial  Sanitorium,   Tranquille.
Innes, S. M C.P.R. Medical Assn., Vancouver.
Johns, Miss E Dept. of Nursing, U. B. C, Vancouver.
Johnson; Mrs. M. E Bute St.  Hospital, Vancouver.
Johnston, J. J Mayor,  City of New Westminster. Name Representing Address
Kerr, Miss Grace Ladysmith  Hospital,  Ladysmith.
Leders, R. B ...Vancouver General  Hospital,  Vancouver.
Lee, Mrs. Edgar  Vancouver General Hospital, Vancouver.
Leggatt, Miss J Vancouver  General  Hospital,  Vancouver.
MacAllister, Miss L Graduate Nurses Assn. of New Westminster
MacArthur, Miss Ann  Kootenay Lake Gen.  Hospital, Nelson.
McCulloch, R. W. Abbotsford Hospital, Abbotsford.
McGregor, George -     Provincial Royal Jubilee Hospital, Victoria.
MacKenzie, Miss J. F. —. Provincial  Royal  Jubilee Hospital.
McKinnon,  Miss  Isobel.... Regina General Hospital, Regina, Sask.
MacLean, Hon. J. D Provincial   Secretary,   Victoria.
McMartin, J.  D Office  Specialty  Co.,  Vancouver.
Macmillan, Miss M. P Vancouver General Hospital, Vancouver.
McVety, Mr. J. H ...Vancouver  General  Hospital,  Vancouver.
McVety, Mrs. J. H Vancouver  General  Hospital,  Vancouver.
Millar, Dr.  D. J .Workmen's Compensation Bd., Vancouver.
Monro', Dr. A. S Vancouver  General  Hospital,  Vancouver.
Moore,' Miss L Hazelton  Hospital,  Hazelton.
Morrice, Miss J Provincial Sanitorium, Tranquille.
Muirhead, A .— B. C. Stevens Co., Vancouver.
Munro, D. A C.P.R. Medical Assn., Vancouver.
O'Boyle, Rev. Father  St. Paul's Hospital, Vancouver.
O'Halloian, Dr.  C - St.   Joseph's   Hospital,   Victoria.
Owen, Rev. Cecil  Vancouver General Hospital, Vancouver.
Parfitt, J Provincial Royal Jubilee Hospital, Victoria.
Pineo, Miss Nell       West Coast Gen. Hospital, Port Alberni.
Ponton, Dr. T. R Vancouver  General  Hospital,  Vancouver.
Poyntz, Dr. L. M Provincial Royal Jubilee Hospital, Victoria.
Purvis, Dr. G. S Royal Columbian Hospital, New Westminster.
Randal, Mis-s Helen  B. C. Graduate Nurses' Assn., Vancouver.
Raney, T. K Reid Bros., Vancouver.
Robinson, J. T Royal  Inland  Hospital,  Kamloops.
Robson, Mrfi. C. E Vancouver General Hospital, Vancouver.
Rose, Mrs. J. B Vancouver General Hospital, Vancouver.
Rose, Miss Pauline       General Hospital, Nanaimo.
Sargent, R. S .Hazelton  Hospital,  Hazelton.
Simpson, Mrs. M. P. ..' Royal Columbian Hospital, New Westminster.
Sister Charlss St. Paul's Hospital, Vancouver.
Sister  Joseph  St. Mary's Hospital, New Westminster.
Sister Louis  St. Mary's Hospital, New Westminster.
Sister M. Bertholde St.   Joseph's  Hospital,  Victoria.
Sister  II.   Clarissa        St. Paul's Hospital, Vancouver.
Sister II.  Leone  St. Paul's Hospital, Vancouver.
Sister M. Ludovic  St. Mary's Hospital, Dawson, Y.T.
Sister Mary Mark  St.  Joseph's Hospital,  Victoria.
Sister Maxima  St. Paul's Hospital, Vancouver.
Sister II. Nazareth  St. Mary's Hospital, New Westminster.
Sister Mary St. Hugh  St.   Joseph's   Hospital,   Comox.
Smith, Mrs. H. W. D Penticton   Hospital,   Penticton.
Stairs, Miss E Royal Columbian Hospital, New Westminster.
Steeves. Dr. H. C Mental Hospital, New Westminster.
Steils, Mrs. K. A "."...St.  Paul's  Hospital, Vancouver.
Stinson, Miss L. P Nicola Valley Gen. Hospital,  Merritt.
Storrs,  Dr. H.  R St. Paul's Hospital, Vancouver.
Stott, Miss K. B Royal Columbian Hospital, New Westminster.
Swanson, Miss E Royal Columbian Hospital, New Westminster.
Taylor, Miss D. M St. Paul's Hospital, Vancouver.
—6—  The Convention of 1922
and thirteen, thirty hos-
bodies   were   duly   rep-"i
The Royal Columbian Hospital afforded the most generous hospitality to the Convention.    A large ward was transformed into an
ideal   auditorium   and   the   adjacent   corridors   and   service   rooms!
served admirably for the display of exhibits.
The total registration was one hundred
pitals having delegates present.
The   following   public   and   professional
'resented:
The Provincial Government.
The Workmen's Compensation Board.
The B. C. Medical Association.
The  Fraser Valley  Medical  Association.
.  The Vancouver Medical Association.
The Graduate Nurses' Association of B. C.
The Graduate Nurses' Association of New Westminster.
The Graduate Nurses' Association of Vancouver.
The C. N. R. Employes' Medical Association.
The C. P. Rl Employes' Medical Association.
The Women's Auxiliary qfxthe Vancouver General Hospital.
The Women's Auxiliary of the Royal Columbian Hospital.'
The Women's Auxiliary of the North Vancouver Hospital.
The Women's Auxiliary of St. Paul's Hospital, Vancouver.
The Women's Auxiliary of the Nanaimo General Hospital.
The following firms contributed interesting and instructive exhibits: Chandler and Fisher Ltd., Vancouver; B. C. Stevens Co., Vancouver; Victor X-Ray Corporation, Vancouver; Office Specialty Co.,
Vancouver;  Reid Bros., Vancouver.
The Convention was characterized throughout by the frank and
friendly spirit which pervaded all discussions even when these were
of a somewhat controversial nature. The Get-together luncheons
were most enjoyable and the community singing of the members,
while not above criticism from a musical point of view, lacked nothing in verve and enthusiasm.
The Question Box conducted during the luncheons by Mr. R. Mc--
Culloch provoked both interest and amusement.
Much of the success of, the entire Convention was due to the efforts of Mr. E. S. Withers, Miss K. Stott and Dr. G. S. Purvis, who;
constituted the local committee on arrangements.   They left nothing;,
undone which might contribute to the comfort and happiness of all1:
*who attended.
Any account of the  Convention  which  omitted mention  of the
chairman, Mr. George McGregor, would be incomplete.    Called upon,
at very short notice to act in a presidential capacity, his good hum-
-ored but firm direction of the sessions went far to preserve that,
spirit of fair play and friendliness to which reference has already,
been made.
MORXIXG  SESSIOX:   TUESDAY,  AUGUST 29TH
The opening meeting of the Convention of the British Columbia
Hospitals Association took place on Tuesday morning, August 29th
at 10 a.m. at the Royal Columbian Hospital, New Westminster.
Mr. George McGregor, President of the Board of Directors of the
Provincial Royal Jubilee Hospital and 1st Vice-President of the B. C.
—8— FRospitals Association, occupied the chair. He extended a hearty
Iwelcomexto the delegates in attendance and expressed his regret at
the unavoidable absence of the President, Dr. H. C. Wrinch. A letter o*f greeting from Dr. M. T. MacEachern, the retiring secretary,
was read by the acting secretary, who was instructed to express to
I him the sincere gratitude of the members of the Association for his
valuable services in the past.
The following committees were duly appointed:
Nominating—Miss K. Stott, New Westminster; Mr. R. A. Bethune,
Kamloops; Mrs. M. E. Johnson. Vancouver.
Resolutions—Mr.   E.   W.   Carr   Hilton,   Duncan;   Mr.   G.   Binger,
c'Kelowna;  Miss J. F. MacKenzie, Victoria.
The acting secretary then read an excerpt from the minutes of the
'Executive meeting held on Monday, August 28th prior to the opening of the Convention, dealing with a proposed change of programme as follows:
"Resolved that owing to the fact that Mr. E. S. H. Winn, chair-
'man of the Workmen's Compensation Board, cannot attend the session on Thursday afternoon, August  31, that the consideration of
this topic and that of Government Liquor  Control  shall  be trans-
I ferred to the Wednesday afternoon session when Mr. Winn will be
'■ present.    Should further discussion of either of these topice be found
necessary it will be re-opened on Thusday at the time planned in
the original programme."
CHAIRMAN—That resolution is open for discussion. It is an
absolute necessity for Mr. Winn to be here. I know it will be of
some value to this association meeting. And I do not see anything
■ else we can do. I may say that so far as the Liquor Act is concerned it will not be closed on Wednesday. We agreed on that. Some
delegates will not be here on Wednesday to discuss that matter and
:it would be unfair to close the discussion before Thursday.
MR. BINGER—I move that the resolution be adopted. Mr. Bethune seconded.    Adopted unanimously.
Mr. George Haddon, managing secretary of the Vancouver General
Hospital then took the chair and introduced the general topic of
■Hospital Finance with the following address:
It gives me much pleasure to preside at the opening session this
morning. I have been -asked to make a few remarks which would
lead up to a discussion on the subject of Hospital Accounting, with
particular reference to the present Government plan.
Hospital  Accounting  appears  to  me  to  have  always  been  sidetracked in favor of the medical and nursing branches, but we are
are last beginning to realize that a proper system of books is just as
JBSseritial or as vital as any other section of hospital work.
It must be gratifying, therefore, to those of us who are mostly
interested in the financial end of hospital work, to have this subject
given an important place on the programme this year.
The hospitals in British Columbia were never more in need, than
at the present time, for a system of bookkeeping which would enable
them to better understand their financial position. When I say "to
better understand" I do not wish to infer that we cannot tell whether
we have a deficit or not, that is probably the easiest part of our
work, but rather to have a proper statement which would enable us
to intelligently compare our work from month to month.
Within the past few months, the Provincial Secretary's office secured copies of financial statements from various hospitals, to be
used by the Government for compiling a statement for uniform reporting by hospitals receiving aid from the Government. After
evidently much consideration, a form was issued, of which you, no
doubt, are very well acquainted.    The  Government issued no in- structions as to how the form was to be compiled, but rather left
it entirely to the individual hospital to work out its own set of booksV,
to enable it to complete the statement as best it could under the
circumstances.    In some cases the statement could be compiled approximately correatly, but in others it must have worked a hardship
by reason of the fact that the books showed only a daily cash record -
of income and disbursements, without any segregation of the accounts under the various headings asked for, and, in addition, the ■
books would be kept by honorary officers who would not have the
time to work out the detail required.    The Provincial Secretary did
instruct, however, that the statement should show actual receipts "r
and actual disbursements, which,, on the face of it, would not permit
of an intelligent comparison between hospitals such as the Government evidently desired.   There appears to be a difference of opinion
as to the proper method of compiling a statement, whether Income !
agaigst actual receipts, or Expenses against actual disbursements,.."
should be followed.    There is a vast difference between these headings, which might lead to considerable misunderstanding.    For example, some hospitals show only a cash statement for the month,
such as the actual money received and the actual  disbursements-
made, while others show the actual earnings for the month and the
actual expenses incurred for that nionth in which the statement applies.    You can easily see the difference between the two.    Where I
one hospital will not receive its  Government grant for  say two
months, it does not enter into the business of the month in which it
is earned, and likewise the disbursements in some cases are made
months after the goods are actually purchased and used, as a result
of which the actual running or true condition of the hospital for
the month does not appear.    Then again, what is there to show
that all hospitals distribute the same items under the proper headings?   The statement prepared by the Government was, no doubt,
taken to a certain extent, from the one in force in the Vancouver
General Hospital, which has been used for some years, and has given
perfect satisfaction.     If it were compiled  in  the  same manner as^;
followed in the Vancouver General Hospital, it would possibly be of~
some use to the Government for comparative purposes,  but until
such time as the Government provides the books and lays out a
proper system to suit the conditions in each hospital, it will be impossible to secure accurate statements for comparative purposes.
At the first convention of this association held in 1917 I had the
pleasure of reading a paper on "Hospital Accounting," suggesting
the compiling of a uniform system for hospitals in B. C. which would
permit of an intelligent comparison being'made of the work of all
hospitals, which was not possible at that time, nor is it possiblSf
today. I have somewhat changed my mind since, because I realize
that conditions are so vastly different in the various hospital centres, that the information secured from one hospital would be practically useless in comparison with another, e.g., in some districts
hospitals are burdened with water rates, taxes and various other;
overhead expenses, whereas, others may be fortunate enough to
escape these. Some hospitals have honorary officers who look after
the books, buying, and other details. In the Catholic hospitals the
salaries are very much reduced, perhaps no salaries paid at all. Then
again you have the private hospitals where only graduate nurses are
employed, and these private hospitals are not exempt from taxes,
water rates, and a fair comparison is not possible. H owever, as
the Catholic hospitals and private hospitals do not come under the
Government grant, the discussion on the Government plan wilV
naturally not apply to these, but it only goes to demonstrate how
difficult it would be to compile a nuiform system which would be
applicable to all hospitals, small or large, Catholic, Protestant or
Private. It might be possible, nevertheless, to grade the hospitals)
for approximate comparative purposes, as follows:
—10— Public hospitals over 200 beds; Public hospitals under 200 beds.
Catholic hospitals. Private hospitals. However, this is a matter
for discussion.
The discussion at this session, therefore, should be kept entirely
to business administration and finances. There are different sessions for discussion on the famous Liquor Profit question, on Workmen's Compensation, etc., and it will facilitate matters considerably
if you will kindly refrain for encroaching on these subjects. This
is to be quite an informal and frank talk, and it is hoped that all the
delegates, from the small as well as the large hospitals, will enter
into the discussion most freely.
We will first have a paper from Mr. Carr Hilton, secretary of the
Kings Daughters Hospital, Duncan, B.C. on "Auditing, Administration and Finance in Smaller Hospitals."
ADMINISTRATION AND FINANCE IN SMALLER HOSPITALS.
In submitting this paper I fully realize that conditions in respect
to our hospital could not always apply in a general way, fundamentally speaking though we are all, more or less, in the same box.
Administration: Administration and finances are, to my mind,
indissoluble. The keeping down of expenses in the various departments necessitates very careful supervision by the Matron or Housekeeper. Provisions, fuel and drugs are the chief items requiring
careful watching. We do most of our buying at home and we get a
great deal of support from our own people in the district. We find it
impolitic to go outside except perhaps in the matter of drugs. These
we can and do buy in Vancouver, Toronto and Montreal in bulk and
get a considerable reduction over local stores. The Matron orders
her requirements both in drugs and equipment under the supervision
of a Doctor who is on the Board of Directors. Any extraordinary expenditure is always brought before the Board first. Great care, has
been exercised for years in equipping the hospital: the purchase of
an X-Ray machine, large sterilizer for instruments, large sterilizer
for dressings, etc., being made by degrees and on long term payments. We are so well equipped now that our Matron feels the little hospital can handle anything. In the old days when we were
sparsely equipped and a serious surgical case arose, it was a matter
of taking Mahomet to the Mountain, but nowadays the Mountain
often comes to Mahomet.
Auditing and Accounting: I will now deal with auditing and accounting as between the Government and the hospital. The return
introduced last April eliminates the long detailed list of patients,
but more actual bookkeeping is now necessary in segregating the
accounts of the various departments so as to enable the Government
to make a comparative statement. Now any extraordinary increase
can be detected at a glance. We have at our hospital a double
checking system covering monies received and disbursed. The
Matron, at the time a patient leaves the hospital, or before, renders
the account. Failing payment at sight, the secretary follows up and
collects where possible and pays into the Bank. The treasurer then
at the end of every month takes all Bank books and the secretary's
books and makes up the financial statement to be submitted to the
Board. This system works well and we never experience any trouble
at all. The Matron is allowed so much petty cash each month to
meet minor calls and the secretary checks up and adjusts the amount
on the last day of the month. We have a very large area to serve
and I find that 28 per cent, of the Government grant last year went
to cover patients who were unable to pay from unorganized districts.
General Financing: There not being levied a special per capita
tax, it behooves each hospital to, as far as possible, get into touch
with all residents. In this respect a "drive" throughout the district
is the best plan.    Last year  The  Scattered Circle of the  King's
—11— Daughters organized thoroughly and canvassed the whole area which
the hospital serves. The objective was $1200 and we actually collected $1567. Wb had headed up what this money was required
for and each subscriber listed his or her name with the amount.
Tag days, flower shows (in conjunction with which is run a Badminton tournament), Clock golf, sales of work, garden parties, amateur theatricals, the children's annual fancy dress ball, etc, are all
ways of augmenting the exchequer. We also have life and annual
subscribers with an insurance benefit attached which considerably
reduces the fee in case of a prolonged stay in the hospital. In districts where logging camps, etc. operate the assessment of $1.00 per
head on the employees for sick insurance is of great benefit to hospitals as the logger is a pretty healthy individual and, as a rule,
only comes through accident which is covered by the Workmen's
Compensation Board. I do not for one moment wish to criticize-
the Workmen's Compensation Board which is a splendid institution.
But I should like to see the $2.50 now allowed raised to $3.00 per
day. In view of the great advance 7in drugs and dressings this latter amount would be more adequate. To nurse, feed, warm and
generally to care for a patient it costs us about $3.00 per day, so
that the $2.50 allowed by the Board, plus the 50c Government grant,
only" just covers.
And now comes what I consider a very important matter, the
relationship between municipalities and hospitals. A better understanding is needed. A hospital is different from everything else;
it is not in the field for gain, it is not a dividend paying concern, it
is not in any sense of the word exacting from the Government or the
public what it should not. A Bank can refuse an account but a -
hospital cannot refuse a patient, whatever the circumstances. Of
necessity, we are compelled to do any amount of charitable work,
and from what I can see it is performed in all hospitals in a thorough and efficient manner, the nurses doing all in their power to'
alleviate the suffering and restore a patient to the normal state.
Lastly I will deal with the liquor profits, i The Act says: "One half
thereof shall be placecl to the credit of a special account in the
Municipal Treasury and shall be paid thereout only for maintaining or granting aid to hospitals in that municipality, or for such
other purpose of municipal expenditure as may be approved by the
Lieutenant-Governor in Council."
When the Government passed the Act I do not think it was intended to leave a loophole for municipalities to do otherwise than
pay the 50 per cent, over direct to the hospitals, but here is
the trouble. In several cases the municipalities are using this
50 per cent, to pay claims-by hospitals for indigent patients when in
reality they have to pay these claims anyway. Also the annual
grant has been dropped. I contend, and I think you will agree with
me, that this liquor profit should be additional revenue/ The municipalities are benefiting considerably by this further ncome and I
cannot see why the hosptals should not have an equal share. Adjacent municipalities without a hospital should be made to contribute
apportion of liquor profits to a hospital which although not in that
muncipality, serves the community. We want all the help possible
to carry on effectively.
I thank you Mr. Chairman, Ladies and^Gentlemen, for your kind
attention.
MR. CARR-HILTON added—There are many municipalities getting money from the liquor fund and in many cases they are allocating it to a special fund and applying it to pay off their indebtedness.   In some instances they will not pay us anything.
CHAIRMAN—That will come up for discussion later.
MR. BINGER (Kelowna)—Would it be in order to ask a question
about the government forms we have sent in?'
—12— CHAIRMAN—It is quite in order.
MR. BINGER—As far as I can see, the information the government asks for respecting the per capita cost is absolutely useless.
It does not in any way show what the per capita cost represents.
.For instance, you pay a lot of bills one month. You may have four
hundred patient days. That per capita is made up on that amount.
The only way to get at the per capita cost is by getting your overhead charges divided and taking your bills or accounts and calculating them on the number of patient days. As it is now I cannot see
that it is any good at all.
MR. HILTON—That is the point I made in my remarks. The
hospitals make out statements each month of actual disbursements
made. That is what the Government have asked for. One month
you may incur considerable expense which you cannot meet for
months hence, and on the other hand you may be in a position to
pay two or three months accounts in one month. Mr. Withers may
have something to say on the question of whether the per capita
cost should be figured on a month's expenses or a month's disbursements.
MR. BINGER—I think the only way is to get the yearly per
capita cost calculated on the number of patient days, not what
ought to have been expended when you were working on a cash
basis. This per capita cost as shown here as far as I can see does
not show the per capita cost at all.
MR. HADDON—You mean as requested in their letter?
MR. BINGER—Yes, they are not very clear and I cannot see the
good of it.    The actua^l expense and "receipts, it says.
MR. HADDON—In filling in the form you will treat each month's
business as distinct from another month. Your form will show the
actual receipts and expenditure during that month. That is what
the letter states. You do not then have the correct per capita cost.
In one month you may pay off two or three accounts which will increase your per capita cost.
MR. BINGER—It does not even up.
MR. E. S. WITHERS (New Westminster)—There is a lack of
uniformity. If you remember, the Government sent circulars around
to all the hospitals with a tentative statement and asked for our
opinions thereon. I believe you sent criticisms yourself, Mr. Chairman. I know I sent a letter of four pages of criticisms. Some of
the items were a long way astray. I know that in the majority of
cases no action was taken as a result of our criticisms. I think they-
should have invited us to take the thing up with the hospital department in Victoria. In the matter of disbursements; there is the
one thing where there is room for uniformity. Some hospitals are
putting in their disbursements such purchases as they make during the month. Other hospitals, such as yours, which is on a larger
-scale, their disbursements will mean their estimated expense during
the month. They will take what is distributed from the stock. That
gets away from uniformity. So far as the receipts are concerned
some are putting in actual cash receipts which is the proper way.
Others are putting through money which is not actually received,
such as the government per capita grant and the Workmen's Compensation Board payments. There is a lack of uniformity. That is
the point I want to make. We do not understand what the actual
cost is. The question should be put up to the government in a definite form from this association as to what we are expected to do
and what is expected from us.
MR. HADDON—1Do you mean, Mr. Withers, that the government
grant for one month should be included as income or revenue for
the month in which, it is earned or for the month in which it is
received? .
—13— MR. WITHERS—For the month in which it is received. It is a
cash statement.
MR. HADDON—That is the point I make. If you show anything
you  must show either your receipts or revenue.
MR. WITHERS—I will tell you what I did here, which is a better way of showing the transactions for the month. You want a
statement of earnings to do it properly separated entirely from the
other.    Your earnings do not represent your cash receipts.
MR. HADDON—You are quite right.
MR. WITHERS—With regard to the government grant you might
have some delay in payment, but ninety-nine times out of one
hundred that government grant will come in a month after it was
earned and you are not going to be very far astray there. On the
other hand, you must have actual receipts if you have actual disbursements. If you are going to have earnings you must have purchases. It practically involves two statements and you cannot get
away from it.
MR. BINGER—It would be very easy for the government to say
whether they want the cash statement or otherwise.
MR. HADDON—I think that is where they have fallen down in
not saying what they wanted. They say "for income and expenses."
They do not say receipts and disbursements. If they had said that,
the thing would have been all right.
MR. BETHUNE (Kamloops)—In Kamloops we record our actual
cash receipts and our expenditure. We interpreted expense as expense for the actual outlay made in the month. The government
should keep that statement very simple or in a small hospital we
would need to put in additional office help.
MR. HADDON—In your earnings so far as the patients are concerned what would you call actual receipts? Would you include
earnings from the government and the municipality you know you
are sure of?
MR. BETHUNE—No, those receipts would change from month
to month. iS^f!
MR. WITHERS—To what department do you charge orderlies?
MR. HADDON—To the nursing department.
MR. WITHERS—I wonder whether every institution does the
same thing?
MR. BINGER—So far as I am concerned I put it down as orderly
salary, likewise the housekeeper's salary, and mention that is what
they are and leave it to the government to work out the cost.
MR. HADDON—There is where difference comes in between the
different hospitals. One hospital treats a certain item under quite
a different heading from that of another hospital. There should be
an effort made to get all these items under the one head, all the
commodities in the hospitals under a plan and decide under what
headings these items should be treated. Until that is done, until
they get a system that would work in with all hospitals, you cannot
attempt to work it properly.
MR. WITHERS-—I would suggest that all those who have any
comments to make on this mateer should submit their suggestions
to me as chairman of the accounting committee. I would then-
suggest that the accounting committee make their representations
to the government at Victoria for such changes or alterations as
are necessary.    I move that.
Mr. Binger seconded.    Passed unanimously.
Mr. E. S. Withers, New Westminster, spoke briefly on purchasing
methods. All I want to do is to suggest some plan in connection with
purchasing methods and to tell you what our methods are, and to
—14— Egby and arrive at some conclusion as to what our purchasing methods ought to be for each one of us. Are we satisfied with them?
If not, why not? What can be done to remedy them? So far as our
present purchasing methods are concerned there are not many of
Its who are very well satisfied with them. It strikes me that one
of the most important things in connection with the purchasing is
the item for provisions. It is probably overlooked by some what an
important item that really is. But when you come to consider that
It is 35 per cent, of our cost and our total outlay it is evidently some-
thing that we have to grapple with seriously. So far as this hospital
is concerned we buy all our provisions by tender. We call for
tenders on form's once a month and as a matter of interest I am going
to pass round the forms we use. I think the headings we have got
are very important. Difficulties have arisen on different items as a
result of which we put these headings in on those tenders. For
those who are buying by tender I think they may be of some service
to them. I would just like to pass them around for anyone's use.
When we get our supplies in, an accounting is taken. All pur-
chases we have recorded on index cards. We have a card system for
Everything that is purchased, butter, eggs and whatever it is, and on
Hiat the date of the purchase, the name} from whom purchased, the
quantity, the unit price, the invoice total. That takes care of the
purchase. Then we have the distribution on a card, that is, the
amount distributed and to what department it has been distributed.
That gives us the balance and shows us the stock on hand which is
ruled off every month so that we are always pretty well aware where
sre are at so far as the stock is concerned without going around and
checking up the stock. So far as the distribution is concerned, we
elaborate still more on that. You may think we elaborate too
much. But I can tell you it is well worth while. We have the
means of checking up waste under such a system as this and to
locate where the waste is. I would also like to pass this sheet
around so that you may all see it. As a matter of interest I would
>^ike to say that so far as we are concerned the actual cost of the
provisions delivered into the storeroom shows us a cost of 45c a
head. So far as we can see that is not a bad figure. If there are
■Sospitals that can figure on better lines I would be glad to hear
them. You can see from that that it is a very important phase of
the expense of the hospital. It is one of the great things in connection with the maintenance problem. We are buying all our groceries
and supplies of that kind locally, but not from choice. I think the
thing is not right and we should not continue any longer. There are
some institutions I know that are able to buy wisely. I would like
to say right here and now that I do not think there is any merchant
who should require to make any profit out of an institution like a
hospital. That is, if the hospital can buy the same goods from the
wholesaler or better still, from the producer if possible.
If we can buy our milk from the cow we should be allowed to do
so rather than pay the middleman. We are not here to make a
profit, we are here to give service, but the cost of commodities at the
present time is excessive. We have got to cut down that cost because people cannot afford the rates, but cannot do it if we cannot
buy the way we want to. One of the reasons why we cannot buy the
way we want to is our financial status. We are all carrying big deficits and it is because of that that we cannot buy right. But I
really think that that works in inverse ratio. That one of the reasons
we have these deficits is because we have been restricted from buying properly, so I think it works both ways. I do not know what
can be done in these respects about carrying these big deficits but
I think that possibly some method of circularization by the hospital
association that we are in unity with the idea that we should be
able to buy from the wholesaler or the producer if no merchant
stands in our way.   If we show more unity in that respect w emight
—15— get somewhere.    There has been something said in previous years
about the establishment of a central purchasing bureau.    I have notj
much to say on that.    It will have its advantages undoubtedly.    But
I see a good many disadvantages.    It would require a good deal of-
thinking about.    The only thing I would like to mention is  such
items as sales tax, stamp taxes, etc.    Ought we to pay those taxes
and all others which come out of our very slim revenue all the time
which does not amount to a great deal of money but always helps:
to keep us down?   It seems to me the Dominion Government oughtl
to do it in the usual way.   An application should be made to Ottawa:
and the money ought to be refunded.    I do not think the government ought to want revenue from the hospitals.    The same thing-
on the revenue taxes.    There is an increased tax there.    It is not;*
very much.    But still it all helps.    And the same remark applies to
that.    I do not see why something should not be done as from this
association to petition Ottawa on representations of that kind.   That
is all I have to say and I would like to hear some discussion.
MR. HADDON (Vancouver General Hospital)—In connection with
the sales tax, so far as the General Hospital in Vancouver is
concerned it costs us $400 to $500 a month, the sales, stamp and
other government taxes. I am going to call on a few of the delegates to explain the system in their respective hospitals. Mr. Graham is here from Cumberland. I do not know if he heard the discussion that has taken place in connection with this subject. Perhaps he would like to explain the operation of his purchasing methods.
MR. CHAS. GRAHAM (Cumberland)—I do not know that I have
a great deal to say.    I did not hear the discussion.    I heard somaH
thing about what constituted cost and disbursement and so forth.
It has occurred to me that there is only one wa,y in which you can
get at the exact cost, and that is to take your earnings and yo^B
actual expense for that particular period and balance the one againstp
the other.    That is the only system by which you can arrive at any
definite  cost.     You   cannot  bring  last  month's  earnings  into  thj3
month's receipts.    Probably you will make a lot of purchases this
month that you did not use and you therefore cannot get the per
capita cost.    The only way to reach a proper conclusion is to take
your earnings irrespecitve of your cash receipts.    The earnings are
the only thing on which to base the per capita cost.    All the industrial concerns of any kind calculate their figures on their actuafB
earnings.    IS they have any uncollected bills they deal with them.
But their statements are based on their actual earnings.    So far as
Cumberland hospital is concerned I cannot give you very much information  on  the  purchasing  methods.     Our, matron  in  charge -l&a
the purchasing agent with the exception of possibly a few things'"!
which we secure in large quantities such as dressings and gauze.
The price of course depends on the market at the time.    The rest
of the actual purchasing is done by the Board.    We buy at the
retail merchants' figures.   We have only a small town.   There are
three retail merchants in the town and we give them each an account
monthly.    The rest of our supplies are got where we can get the
best value for our money.    The only thing we buy outside of the
town is drugs.   We get better rates from the various drug companJJ»ti
and we buy our supplies in that way.    So far as our financial methods are concerned they are probably carried on under a different
system from the majority of the hospitals.   We have a large cor- I
poration there which  constitutes  probably ninety  per cent,  of the
people of the district, all employed by one company.    They have a
system known as the medical fund whereby these men pay monthly
to this fund.    That gives them  medical and  surgical and hospital
treatment.    The; hospital has an agreement with the medical fund
whereby the hospital furnishes all treatment to their members free
of charge to the individual member.    We have a contract.    We fig-
—16— ured it out on the number of days' treatment given to patients, and
the rate of payment would be established accordingly, and this has
been of great advantage to the members of this fund. The result
was that the number of our patients was considerably increased. We
found we could not carry them and we had it increased. We now
furnish these men with hospital service for the sum of $1000 per
month. It worked out last month at a cost per patient of $1.89 per
day. I think they were perfectly well satisfied and I think they
will go on the same way this year. We have now had it in force
for three years. We found it "gives us a fixed income. We know
what our income is from these men and we know what the government grant is going to be. We have to watch our expenditure
so that we keep within the figure and we try to do it. For the last
four years we have not gone to the bank for money. At the present
time we are still in the same position and we hope to be able to
continue. There men are simply insured against sickness. They
are carrying their own medical fund. There is no connection between the hospital and the medical fund except the form of a contract. We give hospital treatment in the public ward. When a private ward is necessary for his recovery he is furnished with one
free. If his friends want a private ward for him they pay the hospital the difference between the public and the private ward. -We
find that that has worked put satisfactorily. I think you will find
in a number of the hospitals in British Columbia, especially in the
industrial towns where they operate on the same basis of agreement
with the doctors as we have, that the hospitals get along all right.
MR. HADDON—I am sure we have listened with great interest
to Mr. Graham's remarks. I would like to ask Sister Mary Mark of
St. Joseph's Hospital, Victoria, to speak.
SISTER MARY MARK—I am sorry I have not sufficient information.    The secretary looks after finance.
MR. HADDON—Perhaps some of the other Sisters would speak.
SISTER JOSEPH—We buy in our own town as far as possible.
As far as the drugs are concerned, we buy them -from the big firms.
MR. HADDON—Who is your purchasing agent?
SISTER JOSEPH—The Sister Superior.
MR. R^B. LEDERS (Vancouver General Hospital)—My remarks*
would be along the lines of Mr. Withers. There are two points that
I have made a note of here. One way mentioned by Mr. Hilton. He
said that they bought their provisions from the local merchants.
Mr. Graham says they buy from three local merchants in turn. I
think if the uniform tender such as Mr. Withers has used were sent
to these three particular merchants that a saving would be effected.
We realise that the smaller hospitals in the smaller centres cannot
■buy to the same advantage as the larger hospitals. This tender system is a much better one and I have an exhibit here that anyone can
see. It shows that we handle all our commodities under the tender
system. We start off and send out tenders for fish, meat, eggs, ice,
poultry, butter and other things. That is, a complete file for one
month. We also have a file of our grocery tenders. For the month
of June we effected a saving, not much, but still a saving, of $15.
The fact that we saved $15 will show you what can be done by the
use of the tender system. We have three sets of figures and if you
will look at them you will see that one merchant cut his price on a
certain commodity. The next merchant had a greater stock of
another commodity and he cut his price on that. We got a cut price
all the way through. Where merchants make a big effort to secure
the contract you make an additional saving of from $7 to $10. You
will make that saving right the way through and also a saving in
the total. At the first year's convention of this association I read a
paper on the standardization of hospital equipment and supply and
also touched on the central purchasing bureau.    That might not be beneficial in some respects but I think on the whole, taking the J
larger commodities such as gauze and cotton, I think if the com-]
mittee could be got together to discuss this thing right through from j
A to Z you will find that a big saving could be effected for the
smaller hospitals.   There is one item in connection with the shipping
of gauze or cotton.    I bought some cotton in Montreal at delivered 1
price in Vancouver. When the cotton arrived an additional freight
bill was sent to me.    It turned out that that merchant had not
packed the cotton according to railway regulations.    Therefore they
had to charge a higher price.    I just mention that to show you that
all these little details would bring a saving in the end.    I think that
is all I have to say unless some questions are asked.
MR. HADDON—Are there any other members who would like
to speak On this subject?   Or any questions they would like to ask.
MR. COOKE (Chemainus)—In Chemainus the firms give us ten
per cent, discount for nearly everything they carry.
DR. GEORGE DARBY (Bella Bella)—We can buy 150 lbs. of
cotton in Montreal cheaper than we can buy in Vancouver. We can
get it delivered at my hospital for less than we can buy it in Vancouver. If we had the benefit of this all the time it would be a
great help. In regard to the provisions, and local storekeepers,
there is one small hospital I know of has had a very hard time up
pur way especially in buying from the local dealers. I have gone
right past the local men and they are contributors to our hospital
and they do not mind you buying the provisions wholesale. I do not
see that the local dealers' should charge more than the wholesale
rates. If they charged that, that would be absolutely satisfactory.
With a ten per cent, discount that would make them all right. But
in any place where the merchants and the people are behind the
hospital I should think they would be satisfied with the freight
charges and a small handling charge plus the wholesale price.
MR. J. T. ROBINSON (Kamloops)—I have listened for the last
few minutes to the discussion that has taken place on this question
of purchasing. I am sorry I was not in earlier but I cannot say I
am in accord with what I have heard for the last half hour. I believe the hospital should be part and parcel of the community. I
think the hospital should guard and protect the interest of the community just as much as any citizen, just as much as any merchant or
business man. I am a merchant myself. I am not in business to
derive any benefit from a hospital. I think that every community
should build itself up and in building itself up, it will be building
up the hospital. I think the purchasing should take place in the
town where the hospital is situated. We have had no trouhle in
Kamloops. We always work satisfactorily with the town merchants. We call for tenders every month on the lines that we require. We get good low prices, prices that are just as good as if
we tried to buy through a central purchasing agency or from the
wholesaler: By buying that way we get good prices and receive the
support of the merchants of our town. And I would be downright
ashamed of myself if I advocated any system by which we would go
ontside the community to buy the requirements for our hospital. I
want to say that when we come to discuss financial affairs that Mpe
will be able to say that the Royal Inland Hospital is run at a lower
per capita cost than any other hospital in British Columbia. Because we give it attention and we try to be proud of our institution.
I would say by no means go into any central purchasing agency for
the purpose of buying supplies. Adopt a policy whereby you are
going to save money within the town but make your appeal to the
people and you will get their support.
MR. GEORGE MacGREGOR (Victoria)—I agree with Mr. Robinson. The fault I have to find with the hospitals in the past is that
they have been run too much along the lines of charity.    What you
—18— want to do today is to bring it down as much as possible to a business basis. We will have to come down to that in the end and you
wjll find that the lines that you have been following in the past have
not by any means been business lines. It is up to us to see thai there
is a sound financial business basis in the future. There should be
no favoritism.    All supplies should be purchased on tender to the
p>est advantage. If there were a form of tender sent to each hospital and a call for tenders made the same as by corporations every
month it would be to our advantage and I think we should go on
record in regard to that, as I am sure it would be much better. You
take groceries. One firm will tender on one item and another firm
will tender on another and you will find you have not got any tender
at all. The only thing I can see is if you have all the sales people
combined together they may charge you more than they ought to.
That is not where we-lose out. I do not believe that is the fault of
the hospital in the purchasing. I have come tothe conclusion that is
not so. You will find the hospital purchases fairly reasonable. Pur-
Chasing gauze and cotton elsewhere, I suppose that is universal all
over particularly now that the supply is better than it was.
At one time it was a serious matter but time should not be occupied
^talking about that. But what I would suggest is to have a uniform
tender to send out to the merchants for the supply of goods to the
different hospitals in British Coluhibia. I quite agree that we should
not go to any merchant and ask favors. I think it would have a bad
effect. What we want to do is to elevate the hospitals to the high-
:6st institutions in our midst. Unless we do that, we will have a
poorly managed institution.
MR. HADDON—What you mean is that there should be standards of various items so that they will know what they are getting.
I would like to hear from Mr. Peter Brown of Chilliwack.
MR. PETER BROWN (Chilliwack Hospital)—It strikes me from
the various papers that have been given, that the hospitals are not
sufficiently subdivided in the arrangements we are making. We
talk about the government form. What you tell us about Vancouver
^111 not apply to New Westminster and certainly will not apply to
us and will not apply to the smaller hospitals. All this discussion is
from the individual point of view, so that we really need more
standardisation about hospitals in various classes. With regard to
the purchasing of our supplies we can use the tender form that is
suitable for New Westminster hospital. But what about the little
hospital with a meat bill of $40 a month? A mail would say I
cannot do this. I do not think that a small hospital of ten or twenty
beds is going to be ahead by having tender forms issued every
month. I do not think we can adopt any better system than we have.
What we do is to take a list of requirements with which we go to our
merchants for the various lines of provisions, meat and coal and we
.ask them to give us a tender at which they will sell us and at what
discount by paying over sixty days. They give us a reasonable rate
and we have had as high as 15 per cent, off our meat bill. Our superintendent is the purchasing agent and the bills come in each month
in which the person supplying the goods shows the invoice price and
the discount. It strikes me that that seems to be a satisfactory plan
which a small hospital might adopt. I would like to make the statement that I feel we should have more subdivision in regard to standardisation. We should put our hospitals injto five divisions. When
you come to this question you have many things to consider. One
hospital has its laundry. Another hospital sends its laundry work
away. You may say it pays to do the laundry in the "hospital. In
some hospitals it would not pay at all because they cannot pay for
the services of a professional laundry man. If we could get some
scheme for ten, fifteen, twenty, fifty or one hundred beds we might
have satisfactory arrangements under one form for all the hospitals.
—19— MR. HADDON—There is one question that I would like to ask  |
Mr. Robinson: what is your per capita?
MR. J. T. ROBINSON—$1.70 per day. We have the largest hospital of any town of 5000 population in Canada. We average 80
patients a day and our hospital days are between 30,000 and 40,000.
So that we have no srfiall hospital. It all goes back to the question
of management.
MR.  HADDON:—1 am sure we would like to  have for  the in-  j
formation  from  the  various  hospitals  and  especially  a  statement  j
from the Kamloops hospital to see why we are running high, or anything that would benefit us.    There are two points made here.    The
question of the sales and stamp tax by Mr. Withers. The resolutions
committee may take this up.    Early this year the Board of the Vancouver General Hospital took the matter up with Ottawa but noth-  j
ing has been done up to date.   There is the question of the Purchasing Bureau if you wish to discuss that any further.    A resolution re  i
the sales tax is in order now. .
MR. E. S. WITHERS (New Westminster) —I would make a motion that application be made by the association to the authorities  j
at Ottawa that a remission be made of all stamp taxes.
The Kiwanis Club of New Westminster arranged a joint luncheon
which the delegates -most thoroughly enjoyed.
Mr. J. J. Johnston, the president of the club, delivered a cordial
and witty address.of, welcome and a delightful musical programme
was rendered by members of the club.
Mr. George McGregor spoke briefly on the aims and objects of the
Association and .urged the co-operation of its members in Hospital
work.
The programme was concluded by the following ten minutes' ad-
. dress by Miss E. Incledon Johns:
I have just ten precious minutes in which to speak of the subject,
that to many of us is the most engrossing in the world, Hospitals,
sol will-waste no time by way of introduction.
Florence Nightingale once wrote a pamphlet still regarded as a
classic, entitled "Nursing, What it is and What it is not." The negative side of her argument was by far the most illuminating. May I
then very humbly follow her example, and speak of Hospitals, what
they are, and With even more emphasis, what they are not?
First they are not' what men think them. In any gathering of
business and professional men, except of course the Kiwanis Club,
who being a select group, would never think of admitting members
who are ignorant of such vital questions as Hospital Service, there
are almost sure to be three members present who express their
opinion'of hospitals in some such words as this: "Oh, yes, the Hos-
, pital, that place always has a deficit. Why can't the directors finance better? If I ran my business the way they do that unfortunate
institution, I'd be bankrupt in a week. A regular sink for money, I
call  it."
Now let's hear the second: "Depressing places hospitals, never
been in one in my life, wouldn't go round one for worlds, nothing but
sickness and suffering.
■ And now .the third: "We took Tommy there to have his tonsils
out. Don't think much of their nursing service. The night nurse
simply wouldn't stay beside the poor child as she should, seemed to
have a lot of patients out in what they said was the public ward that
kept her running all the while. She didn't seem to realize how much
attention Tommy should really have."
—20— At this point a more kindly critic interpolates:
"Well, it seems as if we had to have them." Yes, you have to have
them, just as you have to have some sickness and suffering in this
mortal world of ours.
So let us see whether we can't explain hospitals a little. That
should not be hard to do in such an audience as this. Your very
name Kiwanis has a kindly sound to me. Perhaps because long ago
as a child I lived on an Indian Reserve and spoke Ojibway, and the
name that the men gave their best and nearest comrade with whom
they hunted and fished was "Neche-kiwanis" which meant literally, the friend that goes home with me. And so we hospital folk
are going to ask you to go home with us to our hospitals for a minute or two, and see them through our eyes. Does it seem strange
to you that we should think of the hospital as home? And yet it is
that to us and perhaps to many that sojourn with us long enough
to know us a little. Henry Vandyke speaks of Home as "that place,
In which, when you have to go, they have to take you in." There is
not a hospital in this province to which those poignant words do
not apply more or less. When you have to come, 'we have to take
you in, whether you can pay the reckoning or no. Perhaps that is
the answer to our first questioner. Perhaps that is why the dir-'
ectors, never can quite strike a balance between income and expenditure.
You see, we cannot choose our guests. Some are costly to entertain and stay long. They go home well and strong perhaps, and
ready to pay if they could, but our modern industrial system, with
"the honorable exception of the • Workmen's Compensation Act has
this curious anomaly, that, when money is most tragically needed
the earning power of the individual ceases. It is one of life's little
^Ironies. Some of our guests are not even decently grateful, but
write letters to the papers about us. We don't usually answer.-
What is the use? The public doesn't understand hospitals. That is
where we have failed in the past, we have not tried to explain ourselves.   But we are learning.   That is why we are your guests today.
Now let's take the second member: He says he has no use for
"'hospitals, nothing but sickness and suffering there, never went
through one in-his life, doesn't want to. -Something teils me that he-
is a crusty old bachelor, who has never peeped into the nursery with
1j|ts rows of little white cots, each with a human rosebud in it as
healthy and as happy as can be, or taken a shy look at the young
mothers or he would not say that. Certainly he has never met a
proud but embarassed young father coming up with a big bunch of
flowers. As for the Children's Ward, he has never so much as
peeped in, or he would have seen perhaps a child who had been
■^crippled taking his first eager lessons in walking as a result of
modern scientific surgery, impossible anywhere but in a well equipped modern hospital. The crooked made straight and the rough
places plain. He never saw the Eye Department, or perhaps he
might have been privileged to see what I did: The bandages taken.
off a case of cataract, a man who had not seen the light of day for
twelve years. He was only a poor Galician emigrant, but a mighty
decent man and a good worker on the land in his youth. When his
eyes beheld once more men as trees walking, he knelt down, and
solemnly making the sign of the Cross, he kissed the kind hand
that had healed him, not for a price either. Oh, we hospital people
have our moments I tell you, that make the rest of it worthwhile.
Our critical friend says he has no use for hospitals. But is he sure
that he will never come tb what Stephen Paget calls that sharp
point of consciousness where the surgeon, the anaesthetist, the nurse
are his best friends. When he must close'his eyes and give himself.
np to these three, in that hospital for which he has no use. Or
harder still, must he resign wife or child to the care of those of
whom he knows nothing and in whom he has no confidence?
—21— And now that third questioner:    The father of Tommy with the
tonsils.    One of our guests who did not quite like us.    Why was it-,
that he went away dissatisfied? Did he expect too much or did we,
give too little? Perhaps the truth lies somewhere between the two.
Perhaps if we hospital people had only known it, we lost a good op-.
portunity of making an ally of Tommy's father, just because we were
too pre-occupied with our own concerns to give him the human sym-;,
pathy he missed.    We hospital Marthas, so anxious, so cumbered!
with much serving, forget that better part sometimes.   We have stilfi
much  to  learn  about our  cherished  work.    We are  only  on  the
threshold of education.    Only a few of us realize that our hospitals
are, or should be, schools.    Schools of health, with teachers worthy
of their calling.
And so, Neche-kiwanis, we have gone home with you and shown
you I hope, four things that you will promise to think about:
First: that we must take all who come whether they can pay their
reckoning or no, whether their stay be a day or a year. If we have
a deficit that is our lookout, though why one doesn't quite see.
What about the community of which you yourselves are a part, who
insists that we must shoulder the burden, and yet fails to provide
the wherewithal?
Second: that hospitals are as much a place of health and hope, of
life and birth, as of suffering and death, yes, and a thousand times
more.
Third: that hospital workers are men and women (I nearly put
the women first because there are so many of us in it, and between
you and I it is really our job) who are human beings like your-.
selves struggling with a heavy task, and making lots of mistakes
no doubt, but keeping the wheels turning somehow. Let me remind
you that the people of British Columbia would know it • to their
sorrow if those wheels suddenly stopped turning.
Fourth: that hospitals of the best type are centres of educatiom
in that most vital of subjects, the preservation and restoration of
health,   that  health   of   body   and  mind  without  which   all  other
earthly gifts are meaningless and vain.
Will you not lend a hand? You could interpret us to the community of which you form so important a part, if only you could
yourselves come to understand.
It needs only understanding: for when the desire cometh it is
a Tree of Life.
TUESDAY AFTERNOON SESSION—AUGUST 29TH
General Conference on Nursing Service.
The  convention  re-assembled  at  two  o'clock  in  the  afternoon.
Miss  K.  W.  Ellis,  R.N.,  Director  of Nursing,  Vancouver  Genenj||
Hospital, presiding.
Mr. George MacGregor—This session will take up a great deal
of the time on Nursing. I ami' glad to see some of the men here and
I am sorry that there are not more. My opinion is this—that Nursing is the most important part of the hospital. Without Nursing
you cannot have a hospital. You might possibly have a boarding
house but that would not constitute a hospital. I think' the more
we directors knpw about that part the better it will be for the hospitals at large and the better for the nursing system. There is no
room for dispute or controversy when it comes to Nursing. I think
you will agree with me that we will have to pay more attention than
we have been doing in the past so far as nursing in the British Columbia hospitals is concerned.    I speak" now more in regard to the
—22— training school. No hospital that is not properly equipped for training should be allowed to have a training school. You might think
that that is severe.    If I am wrong, it is for you to contradict me.
I We should not take a young woman for three years if she is not
properly equipped for nursing. If we take her the result may be bad
from beginning to end so far as the hospital is concerned. You
spoil the reputation of your hospital and of the training school.   You
i spoil the reputation of the nursing fraternity which we have no right
to do.   I do hope that all directors present will pay particular atten-
i tion to what takes place this afternoon and take part in the discussion.
Miss Ellis—We have an hour and a quarter for the discussion
: of nursing problems.    I will ask Miss Randal to open the discussion.
Miss Helen Randal, R.N., Inspector of Training Schools for the
Graduate Nurses Association of British Columbia then read the following paper on: "Training School Conditions in British Columbia."
Training School Conditions in British Columbia.
In speaking to the members of the Hospital Association of Brit-
■ ish Columbia I feel that I can reach men and women, hospital trus-
i tees, doctors and nurses—people most interested in the conditions
of their Training Schools and the betterment of them. In speaking, then to you, I feel and hope that you want me to speak of things
as they are, with no idea of presenting conditions in either too glow-
: ing nor in too pessimistic a manner, and in such a way that you will
understand them and my point of view concerning them, discuss
i them carefully and to some effect.
The standing of a hospital in a community is really rated by the
efficiency of its nursing.    The finest hospital buildings—the splendid work done by the finest staff of doctors obtainable is nullified
if the quality of the nursing and nursing staff is below par.    A hos-
I pital may be graded as "Class A." by your Standardization Commit-
[ tee, but will be far below that in the eyes of the public if the nurs-
[ ing is not of the very best.
One of the most mis-used words in the hospital vocabulary, and
generally too in the community, is that of Training School and eq-
L ually that of student or pupil.    To use either of them pre-supposes
I school, personnel, teaching and supervisory, equipment, curriculum,
I hours of study and, as it is a residential school,—proper housing
and equipment.
We shall see presently just how short we fall, in many places in
[ the claim of conducting schools for student nurses.
Financing the School—One of the most usual replies to any sug-
I gestion of the need for improvement in school conditions is the time-
I worn but ever available one of lack of financial backing to carry out
I these improvements. Very seldom is the suggestion given that the
I Board does not see the value of these changes but "there is no money." I am always told, which is perfectly true, that the hospitl
I must look after its patients first, which is its proper function—and
I when that is done, and often hot adequately done at that—it is the
I deficit, unfortunately which stares the Board of Trustees most fre-
I quently in the face—and the school again waits without the re-
1 quired help asked for.    The false note in these, statements comes
■ first in the idea, very fixed with some hospital boards, that because
patients must be looked after that this must necessarily be done by
] pupil nurses. Our Schools were started in every case so far as I
I know with the conscious thought that the hospital was helping the
I need of the outside community for graduate nurses while there was
I not expressed, more than likely not even recognized—the sub-con-
I scious idea that they were getting cheap labor. Cheap labor they
I were certainly getting and were in many cases using the name of
—23— "school" most incorrectly.    Those—and unfortunately the idea dies j
bard—were times of apprenticement—not of Training Schools with
student nurses.
I am always told too that the Government must take the responsibility for at least a large part of the maintenance of these schools.
To answer the question of where the proper source is which will
furnish the money to maintain schools is difficult.    But there are
several pertinent points to be considered.     Before the schools or
hospitals maintaining them are in any position to ask either the]
Government or the Community to finance them they should be able
to state definitely just what the school and pupils cost them and j
what they are worth to the hospital for their services.    So far as
I know there is not a hospital in the province which .knows, even j
approximately just how the balance stands between the cost and
value to them of their school.    One can hardly expect the Government or any other body  to seriously consider the claims of these
schools  till such  information  can  he  had.     The  present   plan of
spreading the income of the hospital, its grants from various sources, j
etc., over the whole plant with no separate plan of cost accounting,
would be, I think, rather a plain showing that real business efficiency was not present.   In many hospitals this*is done in part—but
I can find no showing in detail of the value and cost of the training ]
school.
Cost accounting, with  proper budget for the school would give
startling information as to present conditions as to what the bricks I
are that the Superintendent of Nurses and her staff are required
to make without the straw required.   This matter has been much in
my mind since I began visiting the training schools of British Col- j
umbia and when I saw clearly that there was no knowledge of the
business standing of the school, and when in Seattle I found that
this very matter was taking much time and attention from our con- J
freres in the United States, I found that this was an international j
need and not a local problem.    A short time ago when talking to a
busy Superintendent on this matter, I was told that with the demands now made on the hospital office by Government returns, drug
returns, etc., that without specially trained office assistance it was
out of the question to place any such burden as the cost accounting J
.of the training school—one of the departments of the hospital—on ]
them.   Still, I think that if business men feel that this is a most im- ]
portant feature of the successful running of a business, then if hospitals wish to show the public and the Government that theirs is a
business enterprise conducted as a business should  be,  then cost I
accounting and a proper budget for the school must be installed.
However, that, after all, is for the business men of this Conven-j
tion, and will probably be discussed by them fully. The obvious fact j
remains—and till it is arranged for, progress will be slow and un-1
certain—with no special sum. for housing, equipment, teaching or I
supervision of the school arranged for. Just as little as can be j
accepted is given the school (to use the accepted name( for its
support.
That the Community should be roused and given full opportunity J
for knowledge about the school and its place with its needs—that it I
should be considered as a school and given support outside of the j
hospital purse is, I think a self-evident fact. That this is getting to
be the feeling of the public mind is shown by a quotation I will give I
from the "New Republic" of July 12th, 1922: |
"We devote public appropriation and endowments to the main- j
tenance of law schools, engineering schools, business schools, j
and schools'of journalism. Is it not an astounding thing, when I
one thinks about it, that nursing should have been regarded as j
less of a public service than any of these? It can hardly re-1
main so regarded, in a country whoch has attained to equal I
franchise."
i When one considers that large sums have been granted and donated to women's colleges, professional schools of medicine, law, art
and agriculture and to technical schools all over the country and the
school for nursing quite forgotten, isn't it time that the community
was interested in these schools and a plan of publicity, using every
avenue of doing so, be started. Echools of Nursing should be financed, at least partially by the state and be included in the system
of vocational education.
Education—It seems quite clear that the time is here when nurs-^
ing education must be considered as education and not something in
the interest of either public or private hospitals. The hospital wards
furnish the clinical material for the school and obtain the services
of the students while doing so. It is therefore necessary that sufficient departments of the hospital cases are provided to give the
student practical training in the care of surgical, medical, gynaecological, obstetrical and, pediatric cases. We do provide that in this
province  through  affiliation.
The theoretical training must provide a curriculum to be followed, proper teaching facilities and teachers, equipment and times
for study.
General Conditions—With the rapid increase of hospitals in the
province, each small town wishing to have its own hospital—and
casting its mind on a training school as the means of staffing them-—
communities should call a halt and count the cost—consider the
advisability of splitting their possible hospital income in half and
doubling their expenditure by the placing of too many hospitals in
a given area and with a certain number of inhabitants in that area.
In this aspect, I am only concerned with those which maintain training schools and here, more than in any other part of the hospital,
does the shortage of income, patients, accommodation, etc. exist.
In several places these schools only do exist because, whether rightly or wrongly, the Board think they cost less than graduates to staff
the hospital. Two reasons given me for the change proposed from
graduate staff to pupil nurses was in one case that the Superintendent "thought the pupils would be handled more easily" and in
the other the plan was suggested in order to save hiring a maid to
do the housework! Can you call these two hospitals "Training
Schools?
Personnel—After finances—the greatest problem presents itself—
that of personnel. The common practice of the hospital board asking for the services of what should be the best trained and most
highly qualified of the women in the nursing profession, is to advertise in the daily papers, ask for no further references from her
training school, no questions of her qualifications outside of- her
general training, of her experience in similar positons, not if she is
a good teacher, administrator, house-keeper, book-keeper, operating
room supervisor, if she is physically capable of holding responsibility
at least twelve hours each day of each week as we often ask of her—
but simply take it for granted that her diploma for her hospital
training covers all that. In even the large classes of the largest
hospitals there are only a very few who have executive ability—and
these Boards don't often make inquiry as to the standing of the
hospital from which she graduated. When, as I say, the board
chooses their chief executive officer in this fashion, and more often
than not they get a splendid woman who spares neither time nor
energy to make the school as nearly what it ought to be, with little
or no help except the acceptance of the charity of the medical men
in the vicinity who lecture to the school whenever they can find the
time and quite without considering what their qualifications as a
teacher are either. What can you expect when teaching is thus haphazard,—no equipment, etc. One of the most discouraging features
of my annual visit to the schools is to find a change—a new nurse
charge.    Boards seem unable to realize the loss to the hospital that
—25— frequent changes make. It is a disaster to the pupils if she has
been the right type of woman and as truly as the nursing and the
nurses of a hospital make or mar the reputation of the hospital, so
does the personality and ability of the Superintendent bring in or
keep out patients and make or lose friends for the institution.
If she is the right woman, a determination on the part of the
Board to give her something like an adequate salary, with increase
each year of service, with sufficient holidays and above all pleasant
living quarters would be money in the hands of the hospitals by
lessening the chances of getting a woman whose possibility for
harming the hospital is incalculable. I had hopes, and it was hoped
by many more that when the University of B. C. started its combination course leading to a degree as well as hospital certificate -
that help would be given the training schools in the province by
providing them with trained teachers and executivevs from the
graduates of this, course. The difficulty of finding just the right woman for these posts has been great. To my sorrow I find that the
three nurses graduating in 1923 are all planning to enter Public
Health Nursing. Why? I cannot think that public health nursing,
valuable as it undoubtedly is, has such an attraction for the nurses
—as such, but till we realize that nurses are only human after all
and that the lure of freedom of responsibility as soon as hours of
duty are completed, pleasant living quarters away from their work,
• good salary with probable increase yearly should look pleasanter
than the present conditions of the Institutional staff nurse, with
poror salary compared with duties asked for, with time off duty to
be spent in living quarters consisting most generally in a small single
- bedroom with no sitting room specially for her nor private, bath
facilities—with the responsibility of teaching with no time for
preparation—no equipment—of facing refusal when absolute school
requisites are asked for—do we wonder, when this is the outlook
of the Superintendent of nurses in many hospitals that the field is
not more luring. That there are very many redeeming features in
the training school life with all its hardships I would be the last.
to deny. But to see so many keen, bright interested women broken
in health shows that improvement of the conditions in which the
responsible officer of hospital and school lives must be changed. A
separate home for her and her staff with pupils' is ah absolute necessity if we want results without breaking down splendid material.
I could cite case after case where increase of illness and loss of
time on the part of students and staff are the direct result of continuous strain living always within sound of the patients or at best
where the least noise coming from the nurses disturbs the patients
and so silence has to be the rule of life in the nurses' quarters.
On "Hospital Day" when the public is invited specially to see for
themselves ^what the hospital really is, are they given an opportunity '
of knowing just *what accommodation is provided for those nursing
their sick ? I d<^ not believe for one moment that if the community
could be reached-—if the Boards interested themselves in proper and-
continuous publicity, that such conditions as do exist in all but the
very few hsopitals of this province would be tolerated. I am certain that not a community would allow nurses to be crowded together when a single room for each nurse is the minimum that
should be given, with no chance for recreation indoors or outdoors
—no room where the slightest sound of music disturbs patients and
where the general housing conditions are not what they themselves
would wish for one of their household. In Saskatchewan, I am told
that provision must be made for a separate nurses' home before
permit for a hospital will be given.
With these conditions which I have brought out, I feel that it is
only fair to see what way the G. N. A. of B. C. can help you to
change them.
We hope through the office of the association to help you with the problems of your schools and to get the best women obtainable for
positions for you. A confidential bureau is suggested where reports
of nurses leaving institutions may be sent in—and also reports of
conditions in hospital and school which the nurse found there.
Many reasons—many of them which would doubtless surprise the
Boards—for the many changes of staff come to this office—and if
the office is used as it might be several solutions for problems might
be found.
The presence of the Superintendent of Nurses at all Board meetings will help you all very much. No one is more interested than
she is in the smooth running of the hospital, and she can furnish
'expert advice on points which appear to the layman and often to the
physician too trifling to bring up to her afterwards and which
have a larger bearing than the Board can guess. We hope too,
through the Nursing Education Committee of the G. N. A. of B. C,
with Miss Johns as its convenor to have further help for you in the
problem of your schools. Special training in institutes, Summer
schools, etc. will all be presented to your Boards in time.
We hope to help you with the teaching of your students in some
of the most modern ways of school extension. In this respect, I may
say that we got very little encouragement from the answers to the
questionaire sent out last year to all the training schools as to their
need and wish for a travelling Instructor. The responses boiled
themselves down to the statement that they would be pleased to
accept the services of such a teacher for certain subjects—-if we
would do the financing of such service!
In bringing up all these points—all important ones that need far
more discussion than can be given them today, I have to bring out
most strongly the encouraging fact that there has been a steady
improvement in the schools since I first visited them, in the acknowledgement on the part of the Boards of Trustees that a school is
part of their responsibility, that there is a demand for better preliminary education and physical health before accepting students, a
keener desire on the part of Superintendent and students to carry
out the curriculum and to prepare the students for the R. N. examination. With the affiliation so generously provided for by the
Vancouver General Hospital and the Royal Jubilee Hospital and the
examinations of the nurses under the Registered Nurses Act, we can
- safely state, that with careful supervision of the material we take
into our schools, with the proper financing of our schools and competent staff, we are second to none in providing for the small training schools of our province. I was asked in Edmonton at our Convention if I thought our training schools were better or worse than
in provinces east of us, and I could only tell them that we had one
great advantage over all of them except possibly Quebec, in that,
through visiting and inspecting them all, we knew our worst points,
and, once knowing we are in a fair way to rectify our errors.
You will doubtless hear something about the report of the Rock-
feller Commisison which is being presented to us through our pro-
fessional journals. To us as nurses it is specially interesting in that
it really gives little that is new to us who have been considering the
situation of today. The really striking and important point, to me
the most promising also, is that out of all the members of that
Committee only six were nurses, and it shows conclusively to me
that the general'public, if we can only reach them, do not want anything but the best and that the educational side of the hospital and
i&ts relation to the pupil nurse demands a source of income for and
the proper trained persons to direct and teach in them.
I do trust that these points which I have brought up will be considered earnestly and to effect by your interested body. The Graduate Nurses Association of British Columbia is always ready to cooperate with you. in giving help and advice. With your increased knowledge of conditions will come increased
community publicity and I am not afraid to guarantee that the
people of this province will be behind every effort for betterment in
your training schools in connection with your hospitals where their
daughters .will seek first class professional education.
HELEN RANDAL, R.N.
MISS K. STOTT,-Superintendent of Nurses, Royal Columbian Hospital, New Westminster—Miss Randal has brought out the fact that
pupils nurses mean more to the hospital than we think. Do we realize'and-appreciate the responsibility that we are accepting when we
take in these probationers? We are taking from these young women
three of the best years of their lives, the best service they can give -
in these three years. What are we prepared to give in return? I
think it is too bad that some people do not realize a little bit more-
what the training-of nurses means. They do not know what education a nurse is expected to have. They do not know whether the
people who teach them, can teach themNor not. If they get through
their examinations some of them are lucky. How it was done they
have very little idea. I think we cannot say that we have done our
duty towards them until we do something that will be of benefit to
them educationally.   .
MISS BLACK (Prince Rupert)—I think that the inadequate provision we make for these pupils is somewhat discouraging'especially
in small hospitals. Personally I teach myself and help the doctors
in the lectures. I am trying this year to get the high schools interested and I think they are going to give lectures on Chemistry. We
are trying in every way to live up to the proper standard.
CHAIRMAN—Is there anyone else who would offer some solution to the problems of the smaller hospitals in the way of giving;
instruction to the pupils?  ■
MISS McKENZIE (Victoria)—I think the only way we can possibly obtain the assistance required is by having travelling instructors.    Some of us realize that that is the only solution.
CHAIRMAN—Might I ask if it was in the form of a questionaire
that this suggestion was made?
MISS RANDAL—I have spoken to several hospital directorates.
A year ago we had a very excellent woman with a great deal of experience.    But the responses were very discouraging.
CHAIRMAN—What was the chief objection?
MISS RANDAL—The objection was chiefly:  "No means."
CHAIRMAN—Purely financial.
MISS RANDAL—Some of the superintendents thought that the
suggestion'Was a reflection on them and thought this scheme was an
impossibility, but the lack of means was the chief objection. They
did not seem to be very definite about what subjects they wanted
taught. I did not get a reply from any hospital asking what their
share of the expense would be and what they would do to help." .
CHAIRMAN-—Personally I feel there might be objection on the'
part of the superintendents to have the instructor allotted to them.
Might I ask some of the Sisters from the Catholic hospitals to give
an expression of opinion on their point of view on the subject?
SISTER MARY MARK (Victoria)—We did not know whether
there had been some definite programme drawn up. If we had known
we would have been better prepared to give a proper answer. I
think we are all interested but we have no clearly formulated ideas
of what would be the best course. With us the Sister in charge
gives instruction with the exception of dietetics.   -We- had a salaried instructor to give lectures on that.    Demonstrations were given by
the Sisters who are registered nurses.
MISS RANDAL—A questionaire was sent out and the question
was asked—what subjects would you like taught? If they have not
the time for the preparation of courses, the superintendents of nurses
"cannot, without assistance, teach a class of young women and bring
them up to the standard to today. Where you have a hospital where
there are at least thirty beds you should have one woman whose chief
duty is to act as instructor. !»S$jJ
MRS. M. E. WILMOT (Kelowna)—At the present time our school
is quite young. Our doctors have given lectures and we have the
assistance of a Domestic Science teacher. Then we have a lecturer
on Chemistry. So that I feel we are quite capable of carrying on
.under these circumstances.
MISS RANDAL—May I say one word more about teaching. And
the question of lectures by the doctors. The president of one Board
with whom I came in contact was a layman. He said that they very
much regretted that the Board did not sufficiently recognize the fact
that they were accepting the charity of the physicians in the neighborhood. They were taking the time of busy men who could only
give a short time. Many of these doctors were not teachers and he
felt that funds must be set apart which would guarantee proper
teaching by qualified teachers.
MRS. WILMOT—Some of our doctors were teachers -before.
•They are pleased to do this and they have not failed us once.
CHAIRMAN—I am afraid Mrs. Wilmot has the same feeling as
Mr. Robinson had on the central purchasing plant. 1 am quite sure
the doctors are very interested. At the Vancouver General, they
are generous in giving their time and not only that but they are
quite jealous of anyone else taking that office from them. 5
MISS RANDAL—If you are going to have suitable doctors they
should be paid.
MR. BINGER—I have spoken to our directors, and not only has
every one of them asked to be allowed to continue their lectures but
they enjoy their work. Three of them are absolutely splendid men.
I expect you know who they are. Their lectures are greatly appreciated. We are not asking any charity but they think it a privilege to be allowed to lecture to the nurses.
MR. CHAS. GRAHAM (Cumberland)—It perhaps takes a great
deal of nerve on the part of a man to criticise. I think the system
of training schools is wrong. I do not think you are going the right
way. There is no other profession in the whole world that does its
technical training in the way it is done by the nursing profession.
And until the nurses realize it and are trained in the same way as
the medical men, as the professional men are trained you will never
-have'properly trained nurses. I agree with a great deal Miss Randal
has stated in her address. It is a difficult matter to get trained
nurses and properly equipped training schools under the present
method of training. I do not agree that any director should think
that pupil nurses are cheap labor. I hold the opposite view. I think
pupil nurses are the most expensive labor you could get. I have had
some experience and I want to say this, I do not want to have more
experience of training schools. I do not think any small hospital
has any right to have a training school. We have hot the facilities
for proper training schools. I think nurses ought to be trained
under some system the same as the medical man. They ought to go
to school and take two years of theoretical training and then do as
•the doctors do, go into a hospital and learn the practical side of the
business. Once you get down to that point, you will find that our
nurses are as easily trained as are the professional men or women
in any line of business.  That is always how I have felt on this busi- ness and I thought this would be a good time to bring it up. Those
are my personal views on the matter, that just as soon as you get
your training school on a somewhat similar basis, the better it will
be. Let them have the technical training and let them go into the
hospitals for as long as you think they need practical training. At
the present time a girl is lost in the work. The other girl is too
busy to explain to her. She ought to know that before she goes in.
As graduate nurses come to realize this the better things will be.
CHAIRMAN—I think that to a certain extent we have realized it.
You are practically advocating our Combined Course.
DR. BROWN (Nanaimo)—I have heard a great deal said about
what should be provided. I was told to come over here. They sent
me for this meeting. I came over to listen and learn. The doctors
are working for their own good. They get results from the training
of the nurses but the poor Board are sacrificing a great deal of their,
time and their energy on behalf of the community. They have only
got the funds that are given them and these are given in a very
niggardly manner. We are optimists or we would not be on the
Board. The Boards are trying to handle the thing in the most economical manner for the benefit of the community, without embarrassing the whole place. The last time I saw Mr. MapGregor he was
putting up a wail because the funds were so short that the Board
was not able to buy milk and meat and bread for the hospital. If
that is our condition how ean we provide these other things that are
necessary? There is no use admitting a patient unless he is given
something to eat. We will have to have a different system of administering hospitals. We ought not to be dependent on-> the people who are willing to serve as hospital directors and make personal
sacrifices, and take up their time. They get nothing out of it. They
serve, and do the best they can with the funds. I might be the finest philanthropist out, if someone else provided the money. The
Boards are in that position. They will do the work if the community will supply the means. , But we are sometimes faced with a
very^ peculiar condition, not only do we not get encouragement, but
we are continually damned by the community. They criticise the
hospital and they criticise-us. We have tried to pay our bills; we do
not like to stand people off. If we cannot pay our bills we cannot
do these things that Miss Randal speaks of. We do not get one
cent in Nanaimo from the city of Nanaimo. They cut it off when
the profits from the liquor came in. We want to give good training
to nurses. When we take in girls it is up to us to see that they get
the training thoroughly and that we send them out well equipped
and occupying positions in which we will be proud of them. But if
we follow the line outlined by Mr. Graham we should find it very ,
difficult.   The Boards have to cut their coat according to their cloth.
MISS RANDAL—I would like to know whether they are quite
helpless in this matter. What effort have the hospital Boards made I
to bring the question of training schools before the community? Do
the community know the conditions in the Nurses' Residence? What
education are you giving them? Do you have a regular programme
of publicity outlined each year at the beginning of the year? I feel
sorry for the Board. I listen to this every time I go to Nanaimo.
At the same time I do not think they have interested the people of
Nanaimo.
DR. BROWN—I do not think Miss Randal appreciates the amount
of unremunerative work already done by the Board without doing
the publicity work as well. We must understand that these people
are putting in a lot of time and not getting anything fro it.
MR. McCULLOCH (Abbotsford)—This is not a discussion on
finance. It is a prayer meeting. We did not come here to hear
about the poor Board. We want it known that we at least are going
to stay with the job.   We are going to work and we have a $30,000
—30— hospital at Abbotsford already. We have done that in 14 months.
If every man on every Board went around wailing, "We are in debt"
what about it? We are not going to be in debt always. If there was
a little more optimism we would get away with it. I agree with Mr.
Graham in this respect. It happened to be my fortune to be secretary of an association requiring nurses. We came to the conclusion that the nursing profession ought to have a technical training
first. In the nursing profession we do not find the-best element
that can be got. With a degree system it would be far better. I
know some nurses and I do not know how \ they got through high
school. Under a new system we could get a better class, of women
and they would get a higher salary. I I am tired of this talk of lack
of finances and of things going to the dogs.
DR. BROWN (Nanaimo)—I like the optimism of youth. It is
the finest thing out. But they have got to go up against the real
thing yet.
MR. GEORGE-MacGREGOR (Victoria)—In listening to the discussion this afternoon I came to the conclusion that we all agreed
on one thing: we want to see the nursing profession attain a high
standard. I see one great obstacle in the way. I know our training school has difficulty in getting the right type of girls to
train. Personally I do not see why you cannot continue the present
system. If there are hospitals that are not properly equipped there
should be some government official who would make an effort to see
that they are not permitted to conduct training schools. If you
produce the goods in your hospital you will get the money. I am one
of those who believe that. If smalL hospitals have young girls in
training and are not equipped as they ought to be, it is a detriment
to every hospital in the province, because the public at large will
judge her as having been trained in this province of B. C. I heard
too that the very best nurses in the province today are being turned
out in small schools. The question is—What kind of nurses do you
want turned out? It is for you to decide and bring your views to
the powers* that be. If you want to make a change I think the directors will be very agreeable. I am not saying they are capable of
judging. Still, they have common sense, and the majority of them
are business men. And the majority have had experience. I feel
that the central school would not succeed in British Columbia. Because I do not believe the people have the means to put their girls
through. I want to state that if there are any schools in the Province in connection with public hospitals that are not properly equipped they should be closed and if need be, forced to eliminate that
part of their work.
DR. GEORGE DARBY (Bella Bella)—I cannot remember receiving Miss Randal's questionaire. So far as I am concerned I have
one of the smallest training schools in the province and I am very
loth to give it up. If I give it up I am going to have trouble in
getting graduate nurses to come to my hospital. When I have tried
to get a graduate nurse it has been a very difficult matter to get one
unless I get a girl from my own institution or from another small
• hospital. It seems to me if we had an instructor to come to us and
help to teach certain subjects we would be only too glad to have her
come and that would help us out very nicely. This central school
is a good idea but it is largely theoretical so far. It is a long way
off. What are we going to do now? I do not want to keep up my
training school any longer if I cannot do justice to the girls we have
there. The course we have is working out very nicely. I would
like to get some ideas about having this instructor visit us. Unfortunately we have not had a visit from Miss Randal. And this is my
first trip to civilization in 15 months. I am sure I could scrape up
the money for some equipment and to help to pay this instructor.
It keeps me busy scraping up money as it is. But I would certainly
do my share. MISS RANDAL—The point is this—You have never put anything
into the budget for the school. That must be taken into consideration and worked out. If the community supports you, you will have
no great difficulty in doing so. As it is now, we are trying to send
a teacher to give an intensive course, not perhaps in all subjects but
in some that we feel the superintendent could not carry on herself.
Perhaps the travelling instructor would stay a month or six weeks
at each place, having the superintendent arrange her work so that
she might have time with the pupils. That is what we hope to do
when the travelling Instructor is available.
DR. BROWN (Nanaimo)—One strong point brought out is that
instruction is needed in dietetics. Even the small hospitals will
agree with that. If there was an instructor of dietetics it would do
a world of good in the small hospitals.
MR. BINGER—I would think it would be easy for Miss Randal
to size up the situation and see what is wanted.
• MISS RANDAL—I have done that.
MR. BINGER—You have not visited us.
MISS RANDAL—I visited your hospital. Dr. Darby's is the only
hospital I have not visited.    But I shall be with him presently.
MR. E. S. WITHERS—I am wondering whether Miss Randal and
the Board of Directors would get in direct touch.
MISS RANDAL—Each time 1 make my first visit the superintend-
'ent of nurses says that she will notify the Board of Directors. I
'Cannot notify them myself.
MR. E. M. COOK (Chemainus)—Miss Randal has sometimes met
.with our Board. She gives them ideas they had not before. This
discussion takes in two points. The first is the ideal. We must ever
keep that before us. There is another side. The nurses who have
been trained in our small hospitals have splendid qualities I am
sure that is true. I know some of them. The work done by the
nurses in the small hospitals has been, first class up till now. But
we must keep the ideal before up and work for it. Our friend, Mr.
Graham's ideal is good but it is too good for us now. In Cumberland
they have been born in a day but these other hospitals have been
born a good many years. You have not the difficulties that some
of us have had. And these difficulties are still with us. Dr. Brown
is a neighbor of mine and.we know a few things that we wish we did
now know, but we are glad we.have been able to do what we have
done.
MISS J. MORRICE (Tranquille)—Has the plan of a travelling
instructor been tried in this province?
MISS RANDAL—Not in this province.    In California it has been,
satisfactorily done.    These young women did not do it under the
auspices of any association but independently.    It has been exceedingly profitable to the hospital as evidenced by the results of the
improved teaching.
.   MISS MORRICE—I think it has been done on the prairies.-'
CHAIRMAN—I am afraid our time is up for our discussion of
nursing problems. We did not arrive at a definite concluSio'n but
be had an opportunity to exchange ideas. I think a good many of
us have probably had the question of a travelling instructor put before us this afternoon better tha^i we have had it explained in
Writing. I am glad to say that public opinion is much more in
■sympathy with us in trying to raise the standard of our training
schools than it used to be. Most of us realize that it is largely
•a question'of money.
MR. MacGREGOR—If it should be the wish of the nurses to
bring in a resolution to the Resolutions Committee they can do so.
—32— The conference then closed and was succeeded by the General
-Conference on Medical Service. Dr. George Drew, of New Westminster, presiding. He introduced Dr. L. K. Poyntz, Radiologist of the
Provincial Royal Jubilee Hospital, Victoria, B.C. who gave the following paper on "The Status of the X-Ray in Smaller Hospitals."
The Present Status of X-Rav and Its Relation to the Small
General Hospital.
L. K. Poyntz, M.D., L.M.C.C, M.B.A.R.P.
Director Department of Radiology, Jubilee Hospital, Victoria, B.C.
Twenty-six years ago Sir William Crooks, an English Physicist, in
experimenting with electrical discharges in partally exhausted tubes
made the rather interesting observation that if a sheet of cardboard
coated with certain chemicals was held near his experimental tube
while the current was flowing that this cardboard or fluorescent
screen would light up or become luminous with a greenish phosphorescent light. This work attracted the attention of other scientists,
and so it was that Professor Roentgen of the University of Wurz-
burg began experimenting along similar lines. Working late one
night in his darkened laboratory with a similar screen hanging on
the wall, he enveloped his glass tube entirely in black paper, so that
the light from it was entirely obscured. To his utter amazement he
found that the screen lighten up just as though the tube had not been
covered. So that it was at once apparent that some rays must be
passing from the tube through this black paper which he had considered was opaque. His curiosity was immediately aroused, and on
going over to examine it he was astounded to find that the bones of
his hand were clearly depicted on the screen. He made repeated
tests and found that it was no optical illusion but an actual reality.
Here he realized that he had discovered some new form of energy
that differed from ordinary light in that it was quite invisible to
the eye and yet with its aid he could see clearly through his hand,
his books, and other things that were opaque. He tried to account
for the unusual properties of his newly discovered rays, but could
not, so when he made his announcement to the world in December,
1895, he described this phenomen that he had witnessed and to
these new rays, the nature of which puzzled him, he designated by
the algebriac formula "X", meaning unknown. So that is how the
x-rays happened to receive that name. In many quarters, however,
the name of this scientist is coupled with these rays and so we have
Roentgen rays or x-rays, which are the one and the same thing.
This most spectacular announcement arrested the attention of not
only the scientists, but the whole thinking world, and it was a matter of months only before scores of interested persons had constructed similar apparatus and saw for themselves the peculiar
properties of rays it emitted. And so it was that some of the keenest minds settled down to unravel this mystery that enshrouded this
new discovery. So that today, but twenty-five years since the discovery, we have learned a very great deal about x-rays and in reality they are no longer the unknown quantity, for volumes have been
written on the subject and today there are investigators in every
■Civilized country intent on delving further into this science, and each
month, actually, new applications are being discovered for it.
Just a brief reference to the physical nature of x-rays may assist
you in a fuller appreciation of s.ome of the effects of them. We are
all so thoroughly familiar with the manifestations of ordinary light
that it gives us really no concern, but when one considers that an
ordinary sunbeam is not just a simple shaft of homogeneous rays,
but rather is composed of a bundle of seven visible varieties, red,
green, orange, yellow, blue, indigo, and violet, and these when fused
—33— produce white light. The component parts of sunlight can be readily
separated and individually examined. This analysis reveals that
light is nothing more than vibrations of the ether. If these vibrations are at the rate of 4 62 billion per second, a disturbance of
created, which we through our sense of sight appreciate as red light.
If the vibrations are at the rate of 7l3 billion per second, violet
light, and corresponding rates between give these other colors of
the spectrum. If we go below these rates of red light we find we.
have rays of radiant heat or, on the other hand, if we have a rate of
vibration ust faster than those which cause the-sensation of violet'
we have the ultra violet rays, which though invisible, yet are more
active in their effect on the photographic plate than visible light.
On again let us go further; say, for octaves higher up the scale, and
we find we have vibrations which have a frequency of no less than
250 million million per second, and these vibrations, as might reasonably be expected, have different properties from the slower vibrations that compose the visible spectrum.
One feature of these rapid vibrations is that they will penetrate
through matter regardless of color, transparency, or even their density. These are the x-rays. But they have other properties, as well.
They will affect a sensitive photographic plate as ordinary light
does. A fluoroscopic screen is held in the path of these rays and it
is caused to light up or fluoresce as it is called. They have other
physical effects, but as these are not of interest to us at the moment
we will not dwell on them, as we are concerned here chiefly with the
medical application of the rays rather than their physics—though
anyone working with the rays should be conversant with their physics—not only for the protection of themselves, but also for the protection of the patient and the apparatus.
We have seen that these rays do penetrate through mattef and do
affect an ordinary sensitive photographic plate—so now If we place
a plate beneath some object, say your hand, and then direct the
x-rays onto'it, or as it is called "expose" it, on developing the plate,
if the exposure has been correct, we find the image of the hand imprinted on the emulsion of the plate. The bones stand out sharply
defined and even the structure of their interior is plainly visible.
The flesh and nails too may be distinctly seen. This is because of
the fact that the more dense structures have stopped or absorbed
a greater proportion of the rays than have the lighter structures.
In other words we have in the plate an absolute and mathematically
exact record or register of the. varying densities of the structures
through which the rays have passed. This is your radiograph—or,,
if you wish, your x-ray plate, or film, and this radiograph contains
a vast store of information, just as an encyclopaedia does, but its
medical value depends absolutely and entirely on the ability and the
experience of the person who attempts to interpret it. Just here a
very important point arises which not only deserves but demands
emphasis. For the sake of example, we will suppose that you were,
say, a lawyer—or really anything that you wish—but wfe will allow-
that you are thoroughly conversant with your particular work—you
know your job and know it well. Let us suppose then that I came
along with a book on your own subject written, say in Greek. I
ask you to read it off to me. You do not blush and fumble and
bluff, but without apology or embarrassment you frankly and honestly state that you do not know Greek, therefore cannot interpret
this article. You have not fallen in my estinTation at all—because
no one individual can know all things,' and the Greek language is
merely one of the things that you did not know. If, however, this
article is translated into a language that you do know, then you
can discuss it thoroughly and intelligently. Now the same thing
applies elsewhere. I may be1 a qualified physicion—absolutely familiar with medicine, but I have never studied Greek, and so could not
understand: an article written in Greek.    And in precisely the same
—34— way, ff I have not studied x-ray interpretation, it is just as foolish
and as misleading, and, in fact, dishonest, to try and bluff an attempt at reading something that I do not understand, especially
when some person's health or even life may depend on that guess.
When a patient comes for an x-ray examination he comes for an
examination and not for a picture. I am free to admit that oftimes
he does not even get a picture, but if he does not get what he pays
for, then the transaction is a dishonest one. He does not come for a
plate nor should he receive one. What he wants is an examination
and an opinion, but an intelligent and honest opinion. If he comes
for that and pays for it and thinks he gets it, and actually does not
ge\-it, he is being defrauded, that is, cheated. Whoever does this is
gaining money under false pretenses and under the most despicable
conditions. For when a man has the misfortune to be ill, surely
that is ndtthe time to fall on him and defraud him on the assumption that yoiLare doing him a service. Right here let me say that
some of the practice that is going on in this score is deplorable, for
it is much better that a patient should not have any x-ray exposure
at all than a pretense at an examination with most likely false and
unfounded deductions that may mislead a confiding patient and his
physician. This misplaced confidence may nevertheless cost him
weeks of suffering, maybe a needless operation, or even his life. For
a long time the public have been reposing confidence in medicine and
things medical, but they are beginning to doubt and some of their
doubt is well founded.
If I have shown that it is necessary to know the language to interpret a book, it must be obvious that the interpreter should, or rather,
must, understand the subject of this book, else his translation would
be useless or even foolish, .consequently it follows that to interpret
x-ray findings one must by long experience understand the idioms
and intricacies of the shadows depicted on the plate, but must be
medically trained and understand especially his anatomy, pathology
and physiology when they are reduced to shadows. This requires
experience, and experience probably gained at considerable cost to
many an unfortunate patient, but the greater the experience the few-
et should be the errors. So therefore it should be clear that the
ordinary physician or surgeon despite the fact that he has a medical
training cannot correctly read x-ray findings unless he has given this
branch much time and diligent study. That being so, how utterly
absurd it is to expect, let alone allow, anyone but a physician to
attempt to interpret such technical findings. Yet I can cite you
many instances where a layman in attempting x-ray work is very
free to offer his opinion. This happens, "too, with many technicians,
nurses and others who try to read medical findings without a sufficient knowledge of medicine.   Now maybe this is going on in your
(.Institution and it may never have occurred to you in this light, but
think for yourself, is it or is it not charlatanism? If this sort of
Wackery is tolerated by you knowingly, you are just as culpable as
the one who does the guessing, because the patient has reposed in
you a confidence and you have abused that sacred trust.
Well, we are getting along. We know now what x-rays are, how
they were discovered, who discovered them. We know some of their
properties, and some of their applications in medicine, and we should
realize now that the interpretations of x-ray findings is the really
. important part of the work.    Because the sroutine work naturally
^divides itself into two sharply defined branches, the work of the
Radiographer, or technician, which consists of the manipulation of
Jhe instruments, the exposing and developing of the plate or, briefy,
the technician's work is the production of the finished plate and it
it here that the duty of the Radiologist begins—the reading of the
plate.
So far we have been dealing entirely with radiography. Let us
for a moment turn to Fluoroscopy.     By this I mean taking ad-
—35— vantage of the fact that the x-rays' light up certain chemical screens
and objects placed behind these screens can be readily seen. This '
method has many advantages and at the same time certain limitations. By fluoroscopy one can watch organs in motion, the behavior
of the heart, the expansion of the lungs, the contraction of the stomach, the passage of the food through the intestinal canal, and so on/
This method should be used with caution, because in fluoroscopy one
must interpret the various shadows as they appear. There are reasons for this: The detail on the fluorescent screen, because of its
greenish hue, is not so readily appreciated by the eye as the black
and white of the photographic plate and so the finer detail therefore is missed. If one is not thoroughly familiar with the method
too much time may be spent in the screening and a dangerous burn
may result. With the screen method there is no record for future
reference, and one cannot secure the benefit of another's opinion on
the findings. The making of a permanent record in the form of a
plate has many advantages. It is a record admissible to court. It
may. be kept for comparison of progress. If one is not certain of
the deductions made it may be sent away for some other opinion. It
allows you to sit down for hours, with a lens if you like, to study it.
There are few examinations where at least one plate should not be
made for your own protection as well as the patient's.'
Now there are many and diverse examinations that can be made
by means of the x-ray. Some of these should be done in every hospital. In other words every hospital should be equipped for certain, routine examinations and again there are other examinations
that are too complicated or even dangerous in unskilled hands, and
so should be left to the specialist. In the first group I would say
every form of bone examination may be made in the small general
hospital. Chest examinations, for gross things like effusion, emp-
yaema and similar conditions; dental examinations and so forth.
But gastro-intestinal work, chests for early involvment, pneumoperitoneum, ventricleography, and such things, should not be attempted, except by one qualified by training and experience.
Of course there are certain x-ray findings that are so glaringly
obvious that anyone can see them at a glance, but it is not the matter of making a positive diagnosis that requires skill so much' as
giving a negative report. I mean it is often very easy to spot a
line of fracture in the shadow of a bone but it is more difficult to
make the announcement that no fracture exists, or that there are
no stones in the. gall bladder, or that there are no abscessed teeth, for
example. A negative opinion must never be given on a single piate,
but may be proffered only after a careful scrutiny of the part from at
least two different jungles, but let it be emphatically understood
that here too often much reliance'is placed on an x-ray report. There
are undoubtedly certain things which are revealed by x-ray examination and where one is absolutely justified in maintaining an opinion,
despite the fact that the stand is not corroborated by the other evidence. If certain shadows are misinterpreted and an erroneous conclusion is reached, do not be so fallacious in your statement as to say
that the x-ray showed nothing wrong, or that the x-ray showed some-
' thing wrong which turned out to be incorrect, because what actually happened was that the person who interpreted it did not appreciate the significance of the shadows and so gave a wrong
report. So that I would point out at the risk of repeating that the
value of the report is in direct proportion to the ability and the experience of the reporter.
There are many cases where an x-ray examination is not indicated. There are some cases where it is a valuable aid to diagnosis.
Again, there are cases where its use reveals a condition that had not
even been considered, and so where its use is dispensable.
Before going on to the matter of'treatment by this agency, there
are some points that hold for you at least passing interest.    You
'''*£& —36— must know that this work is attended by certain dangers which
should be given careful consideration. First, there is the danger
from electrical currents. The ordinary hospital or office equipment
is around 50,000 to 100,000 volts, and as these currents will jump,
inches through the air, precautions must be taken to guard against
shocks. During the past few months almost a dozen deaths have
been reported as a result of electrocution. So every care should be
taken to avoid these by proper installations and constant watch.
But particularly by an avoidance of a false security born of familiarity. Just here I would mention that the type of machine that is
being supplied now without a rectifying motor is particularly dangerous and more especially the dental type where one side of the
high tension is grounded. The second danger is from the x-rays,
themselves. When the tube is in operation rays are being given off
in all directions and in quantities far in excess of the actual needs.
This is a source of positive danger to all persons who are constantly
near and therefore adequate lead screening should be provided to
absorb these undesirable rays. The person chiefly concerned here
is the operator himself. He should never under any circumstances
use any part of his body to give a demonstration in fluoroscopy.
Many pioneers have lost their lives this way.
Another constant danger is that the patient should receive too
much rays. It is allowed that working with the tube at twenty-
inches one may give 2500 milliampere seconds to a skin area with
safety, but this amount should not be exceeded. So therefore before any exposure is made one should ascertain whether or not the
patient has been rayed during the last month and proceed accordingly. Remember that the courts have ruled that if more than one
person exposes a patient to x-rays and this patient develops a burn,
it is the last man who is to blame because the first operator may
have stopped at the point of skin tolerance and that one brief exposure given by the second operator was actually the cause of the
damage. In a similar way the time used-in fluoroscopy should be
carefully checked, keeping in mind the probability that plates may
be desired.
Now we have spent probatdx too long on the diagnostic branch
of x-ray. Let us now turn to the application of x-rays in the treatment of disease, and while this may appear to you at the moment
as being of secondary importance, I want to go on record to the effect
that the discovery of the .effect of x-ray in treatment in the light of-,
recent developments has placed it as one of the greatest achievements made in the history of medicine. Before we start talking
treatment, however, let us once more go back and review the method
that we are working with, so that we may understand more readily
the reason why we could or should expect results and why we actually do get results. You already know that x-rays pass with ease
through the body and it has been found that in passing through they
produce certain effects. The effect depends on several factors. A
very important one is the nature of the tissue traversed. The skin,
for instance, will stand only a certain amount of raying before it
suffers what is called a "burn," but the mucous membranes will not
stand nearly as much as the skin does, or, again, fat and bone and
muscle will stand very much more than does the skin, so that in the
normal healthy body we find that there is what is described as a
selective effect of the rays. So that the dose for the same effect
varies for the different tissues. That is to say, a certain beam of
x-ray passing through the body, may not cause any apparent effect
on one tissue, and yet result in definite changes in another tissue.
It is common knowledge that lymphoid tissue like the tissue composing the tonsil, is very susceptible to x-ray. This allows one to
direct a beam of x-ray from the outside through the neck and cause
the tonsil to "melt" away without any appreciable effect on the skin
or muscles of the neck.    So that a new and extremely satisfactory
—37— method of treating tonsils has been developed and is being used very
extensively in the larger centres. The writer has been using this
method now for some time with results that are indeed gratifying.
So that now having learned that from the various tissues showing
varying degrees of sensitivity to the effect of the rays, I would point
out that another very rational factor comes into play, and that is
the condition of the tissues, whether diseased or healthy. Let us,
for the sake of illustration, imagine three individuals. One a full
grown healthy man, the second a man who is debilitated because of
sickness, and the third an infant child. Now, let us imagine that these
three persons are subjected to exposure in a snow storm. Which
of the three do you expect would survive? There can be no question that the unanimous opinion would be that the healthy man
would stand more exposure than would a sickHiran or a new born
infant. So in x-ray treatment this same principle holds. Diseased
tissue obviously will not stand the amount of bombardment that
healthy tissue will. Therefore coming back to the tonsil again, as
an example, it has been found possible to administer the correct dose
of x-ray with such precision that only the diseased tissue is caused
to disappear, leaving a healthy functioning tonsil. But, it may he
carried further, and the tonsil reduced to normal size.
Now the application of the illustration of a new born child. Here
may I digress for a moment to briefly describe to you what a cancer actually is. Your body, as you know, is composed of thousands
of small units called cells. These cells are of many different kinds.
Each has its own particular duty to perform and each is essential
to the welfare and economy of the organism as a whole. Of course
these cells become worn out and must be replaced. But replacement goes on constantly in the healthy body so that always there are
available cells for the particular task in hand. But now for some
unknown reason these cells may change their characteristics and
concentrate their energy and efforts in reproducing themselves,
rather than performing any useful function as a result of this whenever the cells divide to form two new cells, these new cells immediately prepare to divide again and produce each two new cells, and
this goes on until a lump or, as it is called, a tumor is formed. During this process they require nourishment and they give off secretions which are poisonous to the body. These are, strictly speaking,
new born cells, and a feature about them is that they do not attain
adult characteristics, either in appearance or in function. They are,
therefore, in a way like the new born infant-—not capable of standing much abuse and more sensitive to bombardment with x-rays than
are normal cells. So that they may be destroyed by a dose of x-rays
that does not harm normal tissue.
The treatment of disease by x-ray is therefore a sane process,
based not only on scientific reasons, but corroborated by actual
results. But a point that must be understood is that in treatment
unless a correct dose of x-ray-is delivered to the diseased part, one
does not accomplish the desired result, and so today the medical
literature is teeming with records of failures due chiefly to the fact
that the use of this method has not been entirely in the hands of
persons qualified to administer it, and also because of the fact that
the apparatus used has not been of sufficient capacity to allow of the
delivering of the required dose within the depths of the body, and
further many of the cases subjected to x-ray seem to have been surgical failures first. It was to study this work that last year I made
a trip to Germany and other European countries and here I found
that definite cures of cancer were being achieved. But for this
work their equipment was vastly superior to ours, and whereas on
this continent two years ago the highest powered apparatus was capable of delivering only 140,000 volts the transformers used in Germany were delivering 240 and 280 thousand volts. Toronto General Hospital has installed one of these new equipments and they are
—38— obtaining similar results there to those claimed in Germany. The
only other equipment of this type in Canada we are fortunate in
possessing in the Jubilee Hospital in Victoria. Treatment' by this
form of intensive raying is accomplished by the combined methods
of x-ray and Radium.
The question arises here "should the smaller hospitals have equipment of this nature?" And to this I would answer' emphatically,
"No.". For the reason that we are dealing with new sources
of danger. The electrical currents run into figures that a
few months ago were considered impossible. For example, our one
new machine at the Jubilee has a capacity of 300,000 volts, while
the total voltage of our combined transformers'runs into 820,000
volts. But equipment like this is would be impossible and unnecessary to duplicate in every country town, and aside-from1 the'matter
of cost such instruments should be in the charge of someone who
understands them or else dire misfortune will result. But nevertheless there are many conditions that can be treated and treated
satisfactorily by smaller apparatus. ■ For instance there are numerous skin conditions, tubercular glands, goiters, and such things
that may be relieved by properly administered x-ray treatment in
•competent medical hands. But the matter of treatment especially
is an extremely technical and highly complicated subject and should
be attempted by a physician qualified in this particular branch and
one who realizes not merely the benefits but who also knows the
dangers incidental to the method.
Now from what has been said the impression may have inadvertently been created that a claim is being'made that as a result of
this new advance in treatment, especially in the treatment of cancr,
that we have a method that will cure all cases. If any such erroneous impression has been gained let me correct it at once because
such is not the case. But the results that I do claim and the statement that I do make is this: that this method is not any longer an
experiment, but has already demonstrated that in selected Cases
better results and more cures may be obtained by it than by any
other known method. I am not voicing merely my own opinion in
this matter but quoting men, who by virtue of an intimate acquaintance with the method, know. Now, in further explanation let me
say that I do not mean by this to decry surgery at all.
Surgery has its place and there are certain types of cases where
surgery will accomplish infinitely more than radiotherapy will. For
instance, in the treatment of cancers of the mucous membranes, of
the mouth, stomach and rectum, the results by x-ray are not neatly
so good as in the treatment of similar conditions of the skin', the
bowel other than ctomach and rectum, cancer of the breast, or
cancer of the uterus. In fact so good are the results in cancer of the
uterus that some Gynaecologists today who are interested in the
welfare of their patients refuse operation and subject this type of
case entirely to x-ray and radium treatment, and with better results
than the former method. As an actual instance of this I would cite-
Professor Opitz, who since 1916 has not performed a single operation for cancer of the cervix but in that time has had all his cases
treated by radiotherapy and of the first thousand eases so treated
not one single case has failed to show improvement and in every'case
that was considered operable a cure seems to have been effected.
By this I mean that all signs of the disease have entirely disappeared. I mention this merely to intimate to you the strides that have
been made and the results that have been achieved by this method,
but as this is not of any immediate importance to you as a Hospital
- convention other than the interest that it must hold, there are
three other items that I would like to mention. The first is the question of the ownership of tha x-ray plate. It has been claimed that
the patient pays for it and therefore owns it. This is wrong. What
he pays for is an examination and an opinion, and as the plates are
—39— incidental to the examination and do not belong to patient they
should not be given to him any more than his chart should be given
to him when he leaves the Hospital. There are reasons for this—
among others: when I examine the plates I always give a wrrfteh
opinion of my findings. Now, then, if later my diagnosis is disputed,
I want to have the evidence of these plates to substantiate this
opinion. Second: if the patient receives these plates they are of no
value to him, but out of curiosity and for the novelty of the thing
they are shown around his friends. Some "wise" individual will
undertake to interpret them and of course he will do it wrong. At
the same time will not hesitate to assert that the diagnosis already
made is not correct, so that the patient is caused worry and alarm.
Another reason: these plates are valuable from the standpoint of
ones collection either for reference in the subsequent examination
of the same patient or for comparison with other cases.
Then there is the matter of charges. In certain cases a charge is
made at so much per plate. This of course is not right. Again I
would repeat that the patient is not buying plates, and to illustrate
this point let us suppose that I am a third rate Radiologist. I will
probably require twice as many plates to get an opinion as a second
rate man, and probably three times as many as a first rate Radiologist would do. Should I therefore charge in direct proportion to
my ability to read them? You do not judge eggs merely by the price,
because.one good egg is worth a dozen bad ones. And just so here.
An erroneous opinion that leads to wrong treatment, a needless operation or perhaps another month in bed is dear at any price. When
a properly conducted examination by a competent observer may lead
to the discovery of conditions that when corrected result in the
restoring of the individual to health the value of such a service
cannot be estimated in dollars and cents. So then let me reiterate again that the value of the x-ray examination and therefore
the charge for it should be in direct proportion to the ability of the
examiner.
In closing I would like to intimate to you an innovation recently
made by the Canadian Radiological Society of which I am secretary,
and that is the establishment of a Bureau of Consultation for the
very purpose of providing a source of authentic information to Hospitals and Physicians who desire it. Questions regarding treatment
or problems relating to the installing, the maintaining or the operating of your x-ray department may be submitted for an entirely
disinterested opinion by men who are particularly qualified to give
you an opinion.- This is being done without question of charge because it is the wish of the Society that this, a perfectly honorable
method, may be kept clean, free from charlatanism and quackery and
to this end we ask your aid in preserving this method without blemish for the benefit of humanity and especially suffering mankind.
DR. GEORGE DREW, (New Westminster)—I am sure we have
lisetned with great interest to this paper. There are some of us
who commenced the practice of medicine before the' X-Ray was
discovered so that it is of double interest to us. We feel deeply
indebted to Dr. Poyntz and, without asking for a form'al vote of
thanks on behalf of the Association and Medical Profession, I wish
to tender our best thanks to him for the valuable paper that he has
given us. As to my presence this afternoon I feel it an honor to
be asked to preside. I wish on behalf of the Fraser Valley Medi-'
cal Association to greet you and to extend our most cordial welcome. I feel deep regret that I am only filling the place of the
president of our Association, who unfortunately cannot be here at
present as he is seriously ill. We all feel deeply for Dr. Rothwell
and we hope he will make a speedy recovery.
Dr. A. S. Monro of Vancouver then read the following paper on
"The Patient, the Link of Co-operative Effort between Physician and
Hospital."
—40— The Patient must always-be considered as the only reason for the
existence of the Hospital. Without the sick there would be no necessity for the Hospital. Therefore around the patient revolve all
the activities of both physician and hospital directors.
Upon the acceptance of this fundamental basic fact will depend the
relation of physician and hospital to the patient.
The integrity of the social and economic fabric of society as constituted today depends upon the soundness or fitness of the individual or unit of which it is composed.
Impairment of function, from accident or disease, in the individual rendering him incapable either in whole or part of carrying
on his particular part in the social and economic life of the community impairs to varying extents' the efficiency of the community as a
whole.
The result of this impairment may affect apparently only himself but is seldom so limited—it usually affects a much wider range
involving his immediate relatives or dependents and very often the
whole community.
The consequence then of disease or accident in an individual may
be most far reaching and extend over many years, and affect the
whole future of many individuals.
How important then becomes the question of how such impairment of health may be restored or relieved with the minimum loss
or damage to all concerned?
Upon the physician and hospital largely falls the onus of this
important duty, and with a full realization of this ever in mind the
end results obtained will undoubtedly reach their maximum degree
of efficiency.
With all these factors, physician, patient and hospital, working
in complete co-operation to attain their objective viz: restoration
of maximum function, the best results no doubt will be accomplished.
The part assigned to the physician in this work is extremely important. He is the director for the time being or the patient's destiny and is looked upon both by the patient and the public as the
responsible factor in the restorative process.
Upon his degree of professional fitness—the attention he gives to
every detail of diagnosis and treatment and the personality displayed, will depend very much what the result on the patient will be.
The obtaining of a complete history of the case cannot be too
much emphasized. This alone will often give the clue to the real
underlying cause of the disability.
This-is too often not sufficiently well done to be of real value.
If the attending physician is faced with a complex condition requiring specal advice and consideration, he should hot hesitate
to call in to his assistance as many consultants as are necessary in
order to arrive at a correct interpretation of the symptoms.
Whether the patient is poor and has no friends should make no
difference—use every means at his disposal to arrive at a correct
diagnosis as upon that depends the correct treatment.
The diagnosis having been worked out on the basis before mentioned, the next matter to engage the attention of the physician is
the treatment, as upon the correct application of the right therapy
depends very much the end results.
The Physician should at all times recognize the fact that certain
cases demand the assistance of his colleagues if the best treatment
possible is to be given his patients. A frank confession of his
"limitation" in this respect will undoubtedly lead him to call in his
confreres to assist if he desires to serve his patient to the best of
.'his ability.
—41— By giving the patient the fullest service in the manner outlined
only can the physician conscientiously feel he has done his full
duty in the matter.
The Hospital is the agency by means of which the patient is
enabled to have all the diagnostic procedures and treatment carried out for his benefit.
To this end the hospital management should ever keep in mind
this important duty that falls to them.
The hospital should aim at maintaining a nursing staff—^each
member of which is fully embued with the necessity of "getting the
patient well." This implies in addition to the well recognized standard of professional attendance a display of those qualities of mind
and heart, and for want of a better term usually spoken of as "the
personal touch."
In promoting the well being of many patients this is of as much
or even more importance than the carrying out of the ordinary
routine- attendance. •
A nursing service of this kind is of prime importance to the
physician if he ia to obtain the best results possible n his work.
The modern, up-to-date hospital of today must provide adequate
laboratory facilities and these must be used fully by the physician
'if he hopes to obtain the maximum beneficial results in this treatment.      ,
The hospital therefore is charged with the responsibility of providing such laboratory facilities if its patients are to be properly
served. A hospital in many respects may be considered as a special
type of hotel. The same elements that make for the popularity of
a hotel apply to a hospital. The service given—and that includes
besides the medical and nursing attention, the food, beds, linen, and
general attention to all the many minor details that minister to the
comfort of the patient are the deciding factors in the minds of both
patient and public as to whether the hospital is filling its place or
not in the life of the community.
What about the patient—what role does he play in all this?
He has or should have but one object and that is to be restored
to health if possible. To that end he should afford the physician
the fullest and freest opportunity of obtaining all particulars bearing on his case when the history is being taken.
He should lend his active co-operation in the procedures necessary
in making a diagnosis as upon the correct interpretation of his sym-.
ptoms will depend the decision of treatment.
In the carrying out of treatment the patient can lend most valuable aid to both doctor and nurse by loyally endeavoring to assist
them in the work undertaken and in displaying a determination to
get well through the agencies used and by hearty co-operation make
the work of recovery easier for every one.
Lastly the patient should not forget his obligations to both physician and hospital as is so often the case but where good service has
been rendered him should feel it his duty not only to say so but to
compensate doctor and hospital for the services rendered.
I wish to express my very great appreciation of the honor
done me in asking me to address this meeting. Having had
a long and intimate acquaintance with hospitals I suppose there is
something I could tell you, something of interest in regard to this
ever present question of the non-paying patient. A great many
patients are in the public wards who should long ago have been dismissed. They should have had their cases more quickly diagnosed
and they should have been got out of the hospital. They should not
have been permitted to get into that frame of mind when they feel
that the hospital is a good place to stay for the winter.   They should
—42— be made to understand that the nurses and the management have
'done their best for them and that they should be removed from the
hospital. We have got many patients in the hospitals who are using it as a boarding house. It is through this class of patient that
the deficits occur. The patient should be taught that the hospital
cannot afford to keep him there and there should be no question
about his discharge as is so often the case.
CHAIRMAN—I am sure we are all very much obliged to Dr.
Monro for his paper. It brings to mind the personal experience of
many of us. I observe Dr. Wilson's name coupled with this discussion.
DR. GEORGE T. WILSON, (New Westminster)—After the manner in which Dr. Monro has so fully covered this subject there is
very little left for me to say. There are one or two points I would
like to bring up as forcibly as I can. It is very hard in these days
to get the proper aspect. We look at our hospitals, we go into them,
we see the splendid staff, we see the vast rooms, and we think it is
a wonderful place. The personal element that Dr. Monro mentioned
is the all-important thing in the hospital and I believe we are going
to get away from the present hospital system and get down to the
smaller hospitals with more collaborating centres. You have heard
the modern use of the X-Ray, how imperative it is that thoroughly
trained men should run that machine and how some do it who are
not trained. Instead of helping they are bringing it into disrepute.
If we can get our hospitals to get that personal touch with the
patient—-and I believe the smaller hospitals are capable of doing
that better than the larger ones—we will have accomplished a good
deal. At the same time we must give large hospitals the best of
equipment in order that we may send special cases to them. After
all is said and done the patient does not come to the hospital to get
a diagnosis. They come there to get cured. It does not matter
what they are* suffering from. If they get rid of it quickly and
permanently they are satisfied. A patient judges the results and
you cannot get results without getting in personal touch with the
patient. The patient is the hardest person in the world to please.
They go into a hospital and expect to get first-class accommodation
as though in a first-class hotel. The same personal attention to all.
We have to do the best we can to accomplish what we can for them
and while many of them are not satisfied, yet I think the majority
are amenable to reason and realize that the best possible is being
done for them. Very often we have patients from institutions who
say that nothing has been done for them or that the doctors and
nurses are not inclined to do anything for them. Some of the best
hotels in the country are trying to cater to their patrons in every
way from the time they go into the hotel and meet the clerk at the
desk until they pay their bills. The patient has got to be welcomed
to the hospital right from the time he comes to the office, until he
goes into the ward, by the head nurse and by the manager of the
hospital if necessary right on to the time he leaves it, knowing that
the hospital is there to serve him. I think if that was done everything would run much more smoothly.
DR. BROWN, (Nanaimo)—Dr. Monro mentioned people staying
in the hospitals longer than they should. In the outside districts we
are forced by the police to take in patients because they have no
place to put them. They find an old man and send him to the hospital because there is no room in the old men's home. We kicked
against this but there was nothing to be done. We cannot put them
any place and what are we going to do? It is a very serious matter. There should be some way that the province should take care
of this sort of patient. They are boarding there and some have been
there quite a number of years. We would like as a hospital association to get that problem solved. There should be some sort of
a home for incurables.    It should not be the work of the hospital
—43 — because they are not getting hospital treatment. Their food is being
carried to them. Every day they are attended to but they are getting no medical treatment. I would like to see something done in
the matter.
CHAIRMAN—This is an important subject which affects the welfare of the whole community. I am sure there are others who caD
give us some suggestions.
MR. COOK (Chemainus)—Can we do more than refer it to
the Resolutions Committee?
CHAIRMAN—I happen to have had experience with the public
and ^the medical profession long enough to have observed the development of the hospitals and of many things that did not exist
when I commenced the practice of medicine. I cannot help having
impressed on me the conditions obtaining in some of our hospitals,
in Dr. Monro's paper he stated that some patients are kept in
the hospitals too long. Of course he lives in Vancouver. We, here
in New Westminster in the Royal Columbian Hospital, find a few
that have been in more than two or three months. It is a question
of most vital importance, it is one of the things that help to swell
the deficits that our hospitals are confronted with. I do not think
it is possible for us to solve this question this afternoon, but it
would be quite in order for a committee to be appointed to look
into the matter and present a resolution to the government. I do
think if we could get into more personal touch we would not have
so many difficulties with patients, I must admit that it was only
after spending spme weeks in a hospital that I thoroughly realized
what it meant to be sick. Perhaps I thought I was never going to
be sick. But by and by it happens to us. We lie by and have the
nurses to look after us. It is this sort of thing that makes us more
sympathetic to our brother and sister and is a bond of sympathy
that is inherent in every creature.
The afternoon session then adjourned.
EVENING SESSION—TUESDAY. AUGUST 29TH
The evening session took place in the Knights of Pythias Hall,
commencing at 8 p.m. The Invocation was pronounced by the Rev.
Cecil Owen. Mr. A. W. Gray, President of the Board of Directors
of the Royal Columbian Hospital, New Westminster, occupied the
chair.
The presidential address took the form of a written communication from the President, Dr. H. C. Wrinch, which was read by Mr.
R. S. Sargent of Hazelton:
To the Members of The British Columbia Hospital Association,
assembled in Convention at New Westminster, August 29-81, 1922:
My dear Friends,—Having been honoured by you by appointment
to the office of President of our Association for the year just closing, I feel that I must at least offer you a message of apology for
absenting myself from this convention. In doing so let me state
that were it only from a sense of obligation and duty I would most
certainly have been present had it been possible. Our conventions
have always been a source of so much profit to myself, and the
pleasure of meeting so many friends deeply interested in problems
of mutual concern has been so increasingly great from year to year
that the compelling cause of my first absence from these conventions makes it a matter of deepest personal regret.
Had the privilege been mine of attending this year I wished to
have suggested for your discussion several matters that appear to me
of no little importance. Fortunately we have a very able and far-
seeing Programme Committee.   A glance at the comprehensive char-
—44— acter of our programme abundantly.emphasizes this statement. You
will have no lack of material for profitable discussion for a convention of much more than three brief days. Although this is our
fifth annual gathering, many of the problems with which we have
wrestled year by year are far from being settled. But that material
progress has been made none can deny. This means that many of
our problems appear on our programme from year to year. They
are perhaps disguised by appearing in a slightly-different form, or
being approached from a new aspect, but they are of necessity essentially the same. It is only by frequent review, and getting the
most recent viewpoint of these vital questions, that we may expect
to keep our institutions abreast of the times.
-It may appear that our frequest discussions on the matter
of finance have been fruitless, that they have not "got us anywhere"
yet. Yet this is hardly an accurate criticism. It is true our chief
legislative body has not yet brought down a Bill providing means or
measures whereby the hospitals of our Province can carry on with
comfort all year knowing that all legitimate and reasonable costs
of operation will be met by a fair cost distribution upon the people
served.   But they are moving.   As evidence of this we have:
1. An official inspection of our hospitals.
2. W.e have had issued to us a new and more detailed form for
making our reports to the Government.
3. We have the Government's acknowledged recognition of the
necessity of provision of more financial assistance from the
Public Exchequer in the fact that a portion of the profits
under the present Liquor Act are ordered to be handed to
certain hospitals, which is being done.
4. We have within the past few days, seen issued to the public
press, from the Department which officially controls the government aid to hospitals, a statement evidently compiled from
the new hospital report forms that have only been in use since
April 1st last.
These features have all developed during the lifetime of the B. C.
Hospital Association. We believe it is not too much to claim that
our organization has been a prime factor in obtaining such recognition.
The fact also that the statement from the Department of the Provincial Secretary, above referred to, gives prominence to the fact
that the hospitals are continuing to carry on their "beneficient work
even though at a loss, and that as a consequence they are becoming
more and more heavily loaded with debt, may be taken as official
recognition of the fact that "something has to be done about it."
A little analysis of this situation might help to clarify the view.
1. The Government is aiding hospitals; therefore it must approve of them and their work or it should not aid them.
2. The Government believes the hospitals are needed by the people or it would not use the people's money to aid them.
3. The Government after it has more thoroughly-inspected these
hospitals, which it had been previously assisting because its
people needed them and after giving them a further measure
of financial aid, and then having a more detailed and uniform
report of their work and standing submitted to itself, finds
them not solvent, and unable to live and carry on within their
present means.
This is the situation brought down to date.
Some interesting queries suggest themselves:
1.    Should the Government close the hospitals because they are
following  an  impossible  course  which  will  inevitably  land
them in bankruptcy?    Or
—45— 2. Should the Government withdraw its aid rather than be a
party to such unbusinesslike methods?    Or
3. Should it, through its inspectorate insist upon a cutting down
of expenses, showing each hospital how'it can do so?    Or
4:    Should it ask the people how they want the hospitals handled
and then carry out their wishes, as it is endeavoring to do
In the handling of liquor, a matter of much less vital concern to thiybody of the people than is the hospital service? Or
5.    Should it without the expense of going to the people, provide
by statute for the careful carrying on of hospitals under close
and competent Governihent supervision, and after  allowing
them to make a very small charge to the patient, provide the
remaining funds, by equitable means "from the people as a
whole, as is now being carried on to a very considerable extent
in Alberta and Saskatchewan?
$.    What do the people want?
7.    Is there any other feasible way of providing hospital service
for our people?
A good generous proportion of our programme has always been
allotted to. the consideration of the question of nursing our patients.
And inasmuch as nursing constitutes one of the principal factors in
the cure of our patients it should certainly come in for its share of
consideration.
The fact that while the hospital requires the nurse in order to
carry out its function and obligation to the sick, the nurse at the
same time requires the hospital in order to obtain her training,
makes the question of their mutual relation a somewhat complex
one. In order to arrive at satisfactory adjustments the question
must be approached from the most broad and sympathetic standpoint
on the part of each.
A notable contribution to this subject has been made since our
last convention. It is the report of a commission which was appointed in 1919 by the Americal Hospital Association for the purpose of enquiring into the whole subject of Public Health Nursing.
In 1920 the scope of this commission was extended to include nursing in all its phases. This made the work of the committee an exceedingly arduous one. They were not prepared with their report
for the 1921 convention, but issued it in May of the present year.
It is very comprehensive, and certainly very fair in its discussion
and recommendations.
This committee found the requirements of the nursing situation
and the manner in which they are attempting to be met, so varied
that in their recommendations for consideration they provide for
three classes of nurses:
1. The Bedside Nurse, well trained in both theory and practice,
having Spent 28 months in training with as much as possible-
routine work eliminated so as to give sufficient time for both
theory and practice in the shortened period of training.
2. The Specialized Nurse, who after completing the above course
takes special training to fit herself for public health work,
. supervision of nurses, dietitian, instructress, superintendence
of hospitals, technician, or any specialized form of work. Much
of this special training would be provided for by university
courses.
3. A less fully trained worker who would be available for chronic
or less critical classes of sickness. This one'would be known
as the Nursing Aid or Trained Attendant.
The committee's report will be considered by some as too radical, but is so evidently well worked out and digested that whether
one agrees or not with their views as a whole the report will take its
—46— place as a classic, and as being the most thorough presentation of the
subject that has yet appeared. It will be of the utmost interest to
us all to watch the reception of the report by the American Hospital
Association when it is submitted at its convention being held in
Atlantic City next month.
Hospitals of the lesser capacities, the management of which in
many cases is in the hands of matrons who are recruited from the
ranks of graduate nurses, will welcome the recommendation of the
commission of nursing that specia courses should be given for train-'
ing of hospital executive officers. There positions require men and
women of wide business capacity as well as skill along medical and
general institutional lines. Anyone capable of filling them may
rest assured of a position whenever they desire it. A good executive
officer even when exceptionally well paid is an economy for any
institution.
It is a great satisfaction to have seen such a general adoption of
the idea of ::May 12th, Hospital Day" by our hospitals. The success of last year was a great stimulus to preparation for a more
carefully prepared celebration for the second occasion. From all
quarters reports came that it was well received wherever introduced.
People outside those officially related to the hospitals were ready
with help often without being definitely approached for it.
The welcome so universally extended to the Hospital Day plan
may be taken as conclusive evidence of the existence of a well developed sympathy with hospitals and their objects on the part of our
people, who only need to be given a reasonable opportunity and
they will vie with one another to help their hospitals.
Growing out of this idea has come the suggestion that our Association might well consider the wisdom of appointing a standing
"publicity committee." This committee could from time to time
supply the press with information of general interest to the public
concerning developments in hospital or nursing work and methods
' at any time during the year. It is a noteworthy fact that our papers
are most sympathetically inclined towards our work and have always
co-operated with us.
Your Executive Committee have felt very keenly the loss of our
first president and the prime mover in the organization of the Association. We had depended so greatly upon Dr. MacEachern's energy
and resourcefulness in carrying along the work, especially of the
Annual Conventions, that it has been very hard trying to do without
it. It is to be hoped that his engagement with work outside the
Province may be only temporary so that we may again find his
help available.
While we regret losing even temporarily the valued assistance of
. a single ope of our workers it is incumbent Upon us to so carry oh
the work left in our hands that the results will give .unmistakable
evidence that the issues at stake are too great to be allowed to lapse
because of removal of one or another individual. When one steps
out of the ranks another must pick up the thread and push forward.
This message is submitted in the sincere hope that this Fifth
Annual Convention of our association will be the best yet, and more
far-reaching than any in its beneficial results and in its contribution
to the health of the people of our Province.
H. C. WRINCH, President. ...
Hazelton, B.C., August 22, 1922.
The Mayor of New Westminster, Mr. J. J. Johnston, extended a
very cordial welcome to the visiting delegates. He spbke of his own
long experience as a hospital director and emphasized the necessity
of a sound plan for financing hospitals.    He also mentioned the
—47— harsh criticism to which hospitals were subjected by persons who
understood little or nothing of the difficulties encountered by hos--
pital administrators. Throughout his address he displayed sympathetic understanding of the whole hospital problem.
Mr. A. W. Gray, President of the Royal Columbian Hospital, then
addressed the meeting as follows:
First on behalf of the Board of Directors of the Royal Columbian
Hospital it-is my privilege to welcome you to this city. In doing soi
I may say that we as a Board of Directors are proud of the record
that we have established for the hospital. While we have had criticism such as all hospitals receive, I believe that criticism is of some
assistance. Probably the knocks that we are not entitled to are the
ones that hurt. I was pleased to see that there was a suggestion
that a more active propaganda be conducted in connection with
hospital work to ensure support from the public. We are in a
peculiar position. If we attempt to collect from the patient he gets
sore. If we do not collect, the others get sore. I think most people
are quite willing to pay. But it is extremely hard, no matter how
honest the patient may be in his endeavor to pay. The cost to the
public ward patient is in my opinion out of all proportion to what it
should be. I want to mention things in connection with this. People who object to the large deficit of the hospitals necessarily forget,
that a hospital must be fully equipped. They also forget that you
have to have a staff that will take care of the peak load. The time
comes when the number of patients goes down. Still, we must retain our staff and necessarily our per capita cost goes up. These
are things that no Board can prevent. I remember one case in -
particular, the mother of a family of seven. The people were not
able to pay. There was a fighting chance to save her. We had-
three special nurses on that case. We did not save her but we had
the satisfaction of knowing we had done everything possible for
her. We knew that the last days that woman spent on earth, that
we made it easier for her and I think that is the work the hospital
should try to do, to give efficient service to the patients. The rich
person is not the only one who should get good treatment. We
should give fair and reasonable treatment to everyone. Our deficits in hospitals are extremely large. If it had not been in past
years for the active co-operation and for the splendid work of the.
Women's Auxiliaries where would we have been today? As a Board
of Directors we Pwe a debt of gratitude we cannot repay for the
splendid work not only for raising money but in making articles,
we appreciate the work of the Women's Auxiliaries in connection
with our institutions.
Dr. T. R. Ponton, Medical Superintendent of the Vancouver General Hospital then spoke on Hospital Standardization:
I regret very much that Dr. MacEachern is unable to he
with us tonight, because as the father of this association,
and as the father of the Western Canada Hospital Association,
he must be personally known to most of you. Hospital Standardization means putting in a systematic and logical form the chaotic,
ideals which have to do with the care of the sick, it is a crystallisation of these ideals. There is nothing new in standardization. It has
been going on for years. It goes further than the crystallising of
these ideals. It provides for a linking up of our work so that we-
can demonstrate to ourselves and to the world in general that we are
endeavoring to live up to those ideals and are meeting with a measure of success. Modern medicine has advanced to the stage that, in
order to properly diagnose disease there must be laboratories of
all kinds available. Not necessarily available in the hospitals, but
they must be available so that diagnosis may be carried out and followed by proper treatment. I need only mention one branch of
laboratory work to illustrate that, and one disease of that particular
—48— branch. Let me speak of diabetes. It is not many years ago that a
patient, in whom diabetes was diagnosed was doomed to a life of
misery during which he must eat certain food knowing that the
only release from his misery was death, and that it would come
sooner or later if he disobeyed the commands to observe a strict
diet. What is the picture at the present time? The patient is
diagnosed as having diabetes and his body is made a chemical laboratory. A certain amount of food is put into his body. His blood
is examined carefully, after a time it is definitely determined what
he can take in the way of food. That patient is discharged from
hospital with the assurance that if he follows the strict regime of
diet that he can be practically cured. In fact, I am not sure but
Gthat some men are claiming he can be cured. At all events, he may
live to a ripe old age. This illustration is sufficient, I need not
speak of the different kinds of laboratories. You all know of
them. I do not mean to say that every hospital should provide
the elaborate service required to carry on such a programme. But
I do mean to say that every hospital can and should support laboratory service to do the emergency work required in that hospital and
should have affiliation with a larger laboratory so that the more
detailed technical work might be done in any emergency. No small
hospital can afford elaborate laboratory service and if they could,
they have not got the necessary personnel. So that the small hospital must carry on and overcome the handicap by making an arrangement with a larger laboratory.
Having provided all that is required for the care of patients the
hospital must provide a record of its transactions. No business
man and no business department of a hospital would begin to run
the business side of its work without correct business records, and
yet hospitals all over the country are attempting to run without any
record of what they are doing. This is very inconsistent. , A medical record unfortunately is a technical document which must be
written largely by the medical men. It is quite true that some hospitals are succeeding in getting pretty good medical records made
by the nurses. But they come to a point where they must have a
medical man writing the record of the physical examination of the
patient. It is here we meet with difficulties. The Medical Record
should be as complete as possible. It should contain the family
history of that patient, his personal history up to the time he presents himself for treatment, a report of his condition at the time, a
report of his treatment as it is carried on and all the details and
results of the treatment, and finally a report of his condition after
his discharge and further a follow up to show how he has progressed
afterwards.
That record serves two purposes. It serves for the medical audit
of the hospital. More important still in a great many cases it serves »
for the use of the patient, should he afterward become ill and I find
in my own work that as, medical records are becoming more known
they are becoming more and more used. Where we had perhaps one
record a week asked for in 1919, we have three a day at present.
In fact it keeps one of my girls busy searching records which the
medical men want.
I Another point is that df staff organization. That means all the
medical men practising in the hospital formed into a group for twjt.
purposes: first, to insure that their work is ethical towards each
other and towards the patient, and second, that they might look to
their assets and liabilities the same as you do in business. The assets are the patients discharged from that hospital improved. The
liabilities are the patients unimproved or who have died. They
study their assets in order to see if they can get greater success than
in the past. They study their liabilities in order to try and decrease them. For that purpose the Americal College of Surgeons,
the organization which has been the prime mover in this work took
—49— the definite policy of informing the hospital world and the general
public as to what their ideals of Hospital Service were and to show
how their ideas could be carried out. There was no attempt to
coerce. In 1914, Dr. MacEachern foresaw what w*as coming. The
result was that he prepared for it. He was hampered during the
war • by various things and for those four years, allowed his idea
to lie dormant. In 1918, with the declaration of peace he was able to
carry on actively, and only lacked the medical record system of the
hospital.: We established that in 1918. That was the final unit
of his system. This was the first hospital standardization work done
in Canada. In 1919, the Minimum Standard was formulated' and
published. In 1920 and 1921 systematic visiting of hospitals in
Canada was started. Some, may remember I visited all the hospitals
of B. C. Once more B. C. put it over the rest of the continent, this was
the first work done an any of the hospitals of less than 100 beds,
the first work systematically done. In 1920 I visited Manitoba,
Saskatchewan and Alberta hospitals of 100 beds or_ over. In 1921
I visited all the hospitals of Canada from 50 beds up to 150 and 175
and carried this work through Canada. , My visits to the hospitals
in Canada have shown me that -each province has its own peculiar
difficulties and- it -might be of interest t.o this province to know
-what its difficulties are and how they have been met.
New Brunswick has the best system of laboratories I have seen
anywhere. They have in Frederieton a Central Laboratory for the
province. Their system is such that with this and the small laboratories that in the -small hospitals the work is done very efficiently.
It is checked over by one good man. In Prince Edward Island there
are two hospitals of 60 beds and these are working well together.
They proposed when I was. there last summer to establish a separate
laboratory, in each one, not identical with the other, so that one
would lack what the other would supply. In that way each one
would have its own individual laboratory. They would be under
the control of one man. Ontario has a series of Public Health institutions all through the province. Unfortunately the Western
part of Ontario is so isolated that they Jare practically Without laboratory service. Manitoba outside of Winnipeg has only two hospitals of over 50- beds, Brandon and Portage. In Winnipeg, two of the
hospitals are connected w.lth the University. Saskatchewan and
Alberta you know about. Their hospitals are a long distance apart.
Each one has its own laboratory and some use the provincial laboratory: ^^-^
I wish to speak On the other phase of Standardization, the staff
organization side. I am afraid we have to confess that the biggest
obstacle we have had to our progress has been my.own profession.
That is due not to any lack of sympathy. It is due to the fact that
we are ari unsystematic body of men. We cannot face the drudgery.
Some men are doing it .more and more all the time and I think you
will see in-a short time, that the medical men will take the idea up
more and more. British Columbia is away to a start ahead of Canada. 'The result is that it leads Canada at the present time.' We
have the same difficulties as to travelling distances. ' We have two
provincial laboratories in Victoria and Vancouver but Prince Rupert
and Hazelton are isolated from; them. I have no doubt that, as the
country develops and the demand for it justifies the, expenditure,
that the provincial government will establish branch laboratories both
in the interior and at Prince Rupert or somewhere in the north. ■ In
the meantime I do not see how, Prince Rupert can become a standard
hospital. They have^gone into it very earnestly and carefully. They
cannot afford to put in such a laboratory as is necessary, and they
are isolated from the others. The result is I do not think they can
make any advance. The same may apply to some of the interior but
not so much so because they can get the use of the American laboratories.    I would like to emphasize that British Columbia is leading
—50— Canada. This is largely due to the foresight of Dr. MacEachern in
"starting the work and in organizing this association. We have got to
maintain that lead until we attain one hundred per cent, approved
hospitals. When we attain that, we may be content to let some
oher province catch up to us. We have then got to develop further
ideals of our own so that we may always have something to work
for.    Unless we do we will go back.
The Rev. Cecil Owen, official host of the Vancouver General Hospital, then delivered the following address:
"The Spirit of the Hospital"
My subject is a very happy one and yet not altogether an easy one.
It is particularly difficult in this way, that a great deal of what I
shall say you have heard a great many times before. The hospital
spirit is something that every hospital possesses already. But laymen should have that spirit much more largely if the hospitals are
to be supported and receive the help they need. To begin with, we
are realising that the spirit is the making of almost anything. If
you have not got the right spirit in a hospital you lack the very
heart of the whole thing. The great names in the past have got us
the hospital spirit. That spirit came from such names as Florence
Nightingale and others who commenced to see how much women
were interested and who grasped the fact that we do not live for
ourselves but that the strong should help the suffering and those in
need. One of the greatest drawbacks of our hospital work is the
fact that we are so constantly hampered by shortage of funds. If
you have a shortage of nurses and of the necessary- equipment it
naturally  affects  the  spirit  of  the  hospital.     You  cannot  get.the
. best work from people when they are overworked. It is a most essential thing that laymen should try to study hospital life and the
needs of the hospital more than they do.    I do not suppose there is
I a man who has served on a hospital committee but has been amazed
to find out the number of things they did not dream of before. A
large amount of suffering goes on in a large hospital. They never
dreamed there were so many cases of suffering and distress.    One
. of the great difficulties is that a very large proportion of these are
unable to pay. You look over the list of names and you see "unemployed" on every sheet. We know exactly what it means. We
know a large proportion of those who come to the hospital are
unable to pay for this reason.
The spirit of the hospital is the spirit of men and women who have
learned that they are not going to be paid for their work.    I was at
r my work a few days ago, when a boy was brought in one night to
have a double mastoid operation. The doctor arrived after 11
o'clock.    He knew- perfectly well there was no possible hope of pay-
;ment.    The father had deserted the mother and children.    Something
: happened at 4 o'clock and the doctor was back again and I saw him
leaving the hospital at 8.30 in the morning after the third visit to
the boy. The head nurse had been there from 11 until 2.30 and
she was back at four o'clock and she was on duty as usual at seven.
That is the spirit of the hospital. There is a human being who needs
you. The doctor and nurse are at their call. I do not suppose
there is a harder worked person in the world than a nurse. They
start before most of us think about it. I constantly see them going
off their work at 7 and 8 o'clock and after a long heavy day. That
is part of the spirit of the hospital. The druugery is part of it too.
Physicians receive remuneration from some of their patients, but
the paramount-spirit of the hospital is that most take a case just
as willingly as if it is never likely to pay a cent.    It is that kind of
spirit that makes humanity and gives us the glorious joy of service.
It is a most essential thing that the training of nurses should in-
.clude a knowledge of what that spirit really means.   There are many
—51— people who are turned out as nurses who are hopeless.    And there
are others about whom patients simply cannot say enough praise. We
cannot emphasize too strongly the value of their work.    We know
that everyone who pays taxes would like to see a suffering person cared for.    They would not want the hospitals-to be compelled'
to refuse because they have not sufficient funds. I am glad to hear
one- other point stressed, that is, Publicity.    Let the public know.
Newspapers should be constantly informed.    Give them all the information you can.    Have a regular supply going to them.    It iS:
only when you keep the public informed that they realize the great',
value of the work that is being done.
It is one of the most wonderful things to see a hospital where
lives are constantly being saved. I see people coming in with hardly
a chance of recovery. A few weeks afterwards they go out with
health and strength. I see far more go out restored to health and
strength than otherwise. I counted five in one day as hopelessly ill,
and they recovered. The public needs to know of this work and of
the spirit of the hospital which inspires it.
The meeting was then addressed by the Honorable J. D. MacLean,
Provincial Secretary:
Mr. Chairman, ladies and gentlemen,—At the outset I wish to express to you my appreciation of the honor you have done me in ask-'
ing me to be present with you this evening. I also wish to express to
you my appreciation of the fact that you have made me for the last
few years an honorary officer of your association. I regret I will:
not be able to spend more time with you. It was my intention to
have arrived this morning. But at the last moment I could not
get away. So sonsequently I have been unable to be present withy
you until this evening. You haveTiad a pretty full programme and
you still have a full programme before you. And while i had intended speaking at some length I do not feel that I would be doing
justice in keeping you here for any considerable length of time. So
that I will do the best I can to concentrate into a shorter time some
of the suggestions I had to make at this evening's meeting. You are
to be congratulated on the attendance that you have. Let me congratulate you personally on behalf of the province for the great
work the Hospital Association and the Hospital Directors and the
Hospital Secretaries and Superintendents are doing in this province. Let me particularly congratulate you, those who are doing
this work free, those who are doing it voluntarily and I now refer
particularly to the boards of directors of the various haspitals.
Perhaps there is nothing so marked in our modern civilization as is
the attempt made on the part of individuals who devote more and
more time outside of their usual avocations to the giving of public-
service and giving of it free. Reference has been made tonight tx£
the fact that Hospital Boards and hospitals generally receive criticism of various kinds. I can assure you that as a public man I can
sympathise with you in the criticism you receive. Because I do not
escape that. In fact you would feel lonesome unless you had a
little occasionally. I can assure you further that as far as I am
concerned in my public capacity I never resent criticism, which is
honestly made. But one of course becomes peeved if the criticism
springs from unfair motives. However, I am pleased to say we have'
very little criticism of that kind. As you know in recent yeara
there has been a great deal of talk on hospital finance. It is my
intention this evening to devote some attention to that subject. Some
of the suggestions that have been advanced to alleviate the present;
condition have been that the province should be divided into hospital /districts and that there should be a tax, a land tax imposed on
these various districts. Now that plan exists in Alberta where they
have municipal hospitals. And those hospitals are maintained by a
tax of three cents an acre on their land. But we in this province,
have found out, those of us who are property or land owners, that
—62— the land in this province seemed to be carrying as much taxation
as it will probably stand. At least those who have given attention
to that phase of our public life maintain that that is so. That our
lands in this province are taxed now as. heavily as it is possible to
tax them. The next suggestion has been that there should be a poll
tax imposed on every person over the age of 21 years and that this
money should be devoted to hospital purposes. Now, that has been
advocated in various ways. First, that the provincial government
should impose that tax second, that power should be given to the
municipality or various hospital areas to impose that tax. My observation has been this, that notwithstanding the fact that that
suggestion has many attractive features, I am of the opinion that
public opinion has not been sufficiently crystallized on that subject
to make a move in that direction wise or desirable. That is my
observation. If that is a suggestion that appeals to the Hospital Association of this province, I think it is one that is going to demand
considerable attention on your part in order that it may be carried
out successfully. There have been various suggestions made as to
who should be responsible for the financial support of the hospitals.
Those of you who have taken an interest in hospital matters! have
heard very many suggestions. You have heard first of all that
hospitals should be a matter for the individual who is sick, that it
should be a private matter. That suggestion has been made. Then,
it has been suggested that it is entirely a state matter, that the state
should look after these things. And there have been other suggestions that the local unit, like the city, should look after its sick in
the way of hospital accommodation. Let us try and analyse these
various proposals to see whether there is any particular virtue in any
one over another. And, in order to do that it seems to me that you
have to ask yourself the question: what is a hospital? What are its
uses?    What are the purposes of a hospital?    Well, generally we
imight say that a hospital was an institution where persons get diagnosis and every care and treatment medical and surgical. How is
the necessity for these brought about?. For instance let me use an
illustration. A man, driving a car recklessly, injures himself. I
would suggest that the treatment of that individual is purely a
matter for the individual himself.    I am just using that, as an il-
' lustration and and a good many similar illustrations will occur to
us. Then let me give you another. We might have an impure
supply of drinking water. Whose responsibility is that? As you
know,   impure  water   or  impure   milk   lead   to   certain   contagious
'diseases like typhoid. Whose responsibility is that? Under our
system of government the supply of water in a municipality is the
duty of that municipality. So that illnesses of that kind are to some
extent the responsibility of the community. Then consider infectious
diseases and such diseases as tuberculosis and others. We say that
the individual and the state each have their responsibility in so far
as the financing of hospitals is concerned. That it, if we place the
responsibility on the individual or the community from a financial
point of view. What should be the line of procedure? What should
be the proper policy? Should hospital support be individual or
private? Should it be municipal or by the state? In my judgment
it should be the duty of all three. Because all three are responsible
for producing the patients that enter that institution. Therefore I
am of the opinion that all three should, to a greater or less extent
contribute to the support of the institution. I could go on and discuss with you how hospitals are supported in Great Britain or in
Frence and Germany.    Suffice it to say that in the old land—gen-
' erally I am speaking now of Great Britain—that the most common
way of supporting hospitals is that a large number of hospitals are
treated very generously with endowments and donations. Then of
course in Britain there are the purely imperial state hospitals.
Then there are entirely private institutions.    Then you  have con-
' tagious hospitals where the expense is borne by the county. - So that
—53— you see in the old land they call on these various sources in order to
help their hospitals. In France, each municipality has a hospitalof
its own. Then there are the private hospitals the same as we have
in other lands. In the United States the situation is very largely the
same as in Canada. Let us refer to how hospitals are maintained in
Canada. Let us take a few examples. Go to Ontario as being one of
the oldeat provinces. There is very generous support, in the direc- ,
tion of hospital buildings through contributions and bequests from
wealthy individuals. The same is true of the Royal Victoria in Montreal and others which receive large gifts from the wealthy of that
city. That is, as far as the buildings are concerned. As far as the
buildings in Western Candda are concerned, as we proceed westward, we seem to find the municipalities and governments are becoming more interested in the erection, of hospitals. What about
the maintenance? In Ontario the hospitals are maintained by fees,
by grants from the municipalities and in the Province of Ontario, the
provincial government makes a grant for the maintenance of indigent patients in that hospital. They do not give a grant such as we
do in British Columbia for every patient who is in the hospital. One
part of the Ontario act is that the grant by the provincial government is never larger than the grant given by the municipalities in
which the hospital is built. Now we get along to Western Canada,
to the prairie provinces and the mode of support is very similar. In
Manitoba for maintenance, the provincial government gives 25 cents
per patient per day. In Alberta and Saskatchewan they give 50
cents. In addition to the smaller areas they have what are known
as municipal hospitals. Not one of those provinces make any contribution towards the building of the hospitals. Now, with us in
British Columbia, on the other hand what are we doing? It is necessary that the hospitals' directors should realize what is being done
in this province as compared with other provinces in order that you
may know where we are or whether we are as generous to our hospitals as the hospitals observe the requirements, as generous as the
other provinces of Canada. In British Columbia, we average 63
cents a day. So that in so far as our per capita grant is concerned
it has always been larger in this province. This is not a new thing.-.
It has always been true that there has always been a generous grant,
from the government towards the assistance of hospitals. What
abo«t the building? We are the only province in Canada that have
had at any time made any contribution towards the erection of hospital buildings. The only province that has given financial support
to the erection of buildings. How does that contribution work out?
Today we have in British Columbia fifty-five state-aided hospitals.
These hospitals collected last year $2,046,000. Where did this money
come from? It included private and public ward fees, Workmen's
Compensation and the monies collected from patients in the fornr~
of fees which averaged 54 per cent, of the receipts. The government grant was 21 per cent. The municipalities gave 14 per cent.,
donation 3 per cent., and miscellaneous S per cent. That is the
way the hospitals have been financed in this province. I could go
on and tell you how the money was expended. What about the government's share? I have been speaking up to the present of general
hospitals, state-aided hospitals, comprising fifty-five hospitals in
this province. But in so far as hospital work is concerned, the government contributes' one and a half million dollars a year. That
includes mental, tuberculosis and general hospitals. Ten per cent, of -
its revenue goes to hospitals either of one kind or the other. Now,
why am I pointing this out to your attention? I am pointing this
out to you to show that suggesting that the government should contribute more generously than they are doing is a difficult matter.
The other needs of the province have to be taken into consideration.
I emphasize the fact that I think you will agree with me that your I
municipalities should make some contribution towards the support
of your hospitals'.    It is a municipal service is it not?     Your cities
— 54— would be a sorry place in which to live unless you had a public hospital. Let us .see what they are doing. When I am speaking this
way I do not wish to be misunderstood. I am not criticizing' the
municipalities in this province because they are not making more
generous contributions. Our municipalities have got into financial
difficulties the same as we did eight to ten years ago when we
thought if we owned a lot ten or twelve miles from the city we were
millionaires. The municipalities are seriously hampered for funds
atthe present time. What did they contribute last year? They contributed two per cent, of their collections for the support of the hospitals. And the reason why more has not been given is because
they have not been able to do so. Yet at the same time you will
agree with me if a hospital is to be of public service so far as the
•municipality is concerned something must be done. Are the municipalities of the other provinces. more generous than they are in
B. C? I have taken the statistics for various cities in Western Canada for the year ending December 31, 1919, as it is rather difficult
to get the latest. The city of Edmonton received money both from
the provincial government and the municipality. Regina received
fronvboth sources. Edmonton received 79 per cent, from the municipality. Regina received 60 per cent; from the municipality. The
Vancouver General Hospital received money from both sources and
47 per cent, came from the municipality. So that you see our municipalities are not more generous than they are in other parts of
Canada. Before concluding I wish to refer to the financial section
of the Liquor Control Act. During the last session of the legislature
provision was made that 50 per cent, of the profits from the sale of
liquor should go to the municipalities and that that 50 per cent.
should be divided into two parts, half into the coffers of the municipality and the balance to be distributed to the hospitals in that municipally. Now the act has not worked out satisfactorily, that section I mean. . Because some hospitals are situated where there is no
municipality at all. In other cases there are certain municipalities
surrounding the municipality where the hospital is. I am proposing
to the government and we willNpropose to the legislature at the coming session that that section be altered. Our proposal is that a
certain percentage of the profits be set aside and placed in a fund
to the credit of my department, and that money shall be paid out
from that fund on a per capita basis to the various hospitals. So
that the hospital that does the work will be the hospital that will
get that grant. This will be in addition to all existing grants and
allowances that are made at the present time. The decision as to
what that percentage will be has not been decided. We notice you
have a certain deficit in your hospitals and we regret that you have
that deficit. It is nothing new to me because I have been hearing
about it for the last few years. I just want to point out a few things
to you. The hospital secretaries will remember the questionaires.
I know, they were unpopular as they gave a great deal of work. But
I want to say to the Boards of Directors here that I have nothing
but good to say of your hospital secretaries in 90 per cent, of the
cases. Any request we have made-^and sometimes they were unreasonable—the hospital secretaries have done their best to Gomply
with them. But I want to assure the secretaries that when we are
asking for this information we had an object in view and that was
to try and get some information on the condition of our hospitals
in B. C.
We got a good deal of information about hospitals. First of all
we know there are over 3000 hospital beds in British Columbia. We_
know there are five hospitals with over 100 beds and five with 50~
to 100. In other words there are ten hospitals in B. C. that have
over-50 beds each. Five were operated without any loss according
to their own report. In the course of a few days the secretaries will
get a tabular statement showing the per capita daily cost as exp- ressed on that sheet. That cost is found in such a way that
it would not give you the exact situation. But I have taken five
principal services which have been given, by the various hospitals,—provisions, fuel, medical and surgical staff. I have obtained
information on the cost of each of these services. It was rather
remarkable that when you reduced these costs to a unit basis,
to find the difference that exists. For instance, we divided our hospitals into certain classes, one having from twenty to fifty thousand
hospital days. What did we find? That for these five services
the per capita cost ranged from $1.96 to $3.25. Now that is a. very
great spread. In the next group of hospitals from ten to twenty
thousand hospital days we find that spread was from $2.03 to $2.65
and in the smaller hospitals $1.38. I am not pointing these things
out to make invidious comparisons. I am pointing them out for one
reason only to call attention to the fact that if your per capita cost
is high, you should find out the reasons for it. If your per capita
cost is high, and it is high for some reason that can be remedied,
you are to blame. My only object in pointing out the great spread of
$1.29 in one class of hospital, 62 cents in the second, and $1.38 in
the third class is the different spreads.
Clearly this is a matter of importance that might receive more
attention on the part of the hospital directors. The subject of hospital finance is of great importance to the people of British Columbia and to the directors of hospitals and it is my only excuse for
keeping you up to this time.
After a hearty vote of thanks to the speaker the meeting adjourned.
MORNING SESSION, WEDNESDAY, AUGUST 30.
Mr. George McGregor presided. This session was devoted to
business. The minutes of the Executive Meetings held throughout
the previous year were read by the acting secretary and approvd.
Referring to the question of the redistribution of the province into
hospital areas somewhat along the lines followed by the British Columbia Medical Association the Chairman, Mr. George McGregor,
asked that a committee be appointed with instructions to report to
this convention as to the advisability of such a step being taken.1
The following delegates were appointed to serve on this committee:
Mr. E. M. Cook, Chemainus, (convenor); Mr. R. S. Sargent, Hazelton; Miss Ann MacArthur, Nelson; Mr. R. B. Leders, Vancouver,
and the acting secretary.
The report of the acting secretary followed:
"Mr. President, Members of the British Columbia Hospitals
Association:
Appointment—The Acting Secretary was appointed to offibe at a
meeting of the Executive Committee held in Vancouver on April 22,
1922.    Her actual duties commenced on July 1st, 1922.
Meetings of the Executive Committee—Three meetings of the
Executive Committee have taken place since the last Annual Convention, as follows: July 19th, 1922, at Kamloops at the close of
the convention of 1921, April 22nd, 1922 at Vancouver, and August
28th, 1922 at New Westminster. The minutes of these meetings
have been dealt with and need not be referred to further.
Membership—The official list of Institutional Memberships comprises sexenty-eight hospitals. The large majority of these are in
good standing. The More Maternity Home has ceased to exist, and
the Bella Coola Hospital has withdrawn. Ten others have made no
reply to communications sent to them during the year, but are still
being carried on the books In the hope that they will respond later.
Individual memberships number twenty-two.
Correspondence—Correspondence,   as   shown  by   the  files,   dealt
—56—
-.«. with such subjects as hospital finance, National Hospital Day, publication of the Annual Report, finance of the Association itself, and
arrangements for the Annual Convention. Numerous hospitals
wrote letters of enquiry concerning specific problems which were
duly answered. During the last two months, almost five hundred
communications have been issued by the Acting Secretary.
Publicity—Excellent work in this connection has been done by
the retiring secretary, Dr. M. T. MacEachern. As a result of his
untiring efforts, the activities of this Association have been recorded in the outstanding magazines dealing with Hospital Administration, and in the daily press.
Conclusion—The constantly changing personnel of hospital staffs
and directorates constitutes a serious problem to the officers of this
Association. It would be of the greatest assistance to the incoming secretary in preparing a correct and adequate mailing list if
those in attendance at this convention would give to the Acting Secretary the full names and addresses of the following officers of
their institution: President of the Board of Directors, Secretary of
the Board of Directors,. Medical Superintendent, Managing Secretary, and Superintendent of Nurses. If the Association is to fulfil
its true function, close touch must be maintained with the membership as a whole. Your co-operation will therefore be greatly appreciated.
All of which is respectfully submitted,
ETHEL JOHNS, Acting Secretary.
The report of the Treasurer was then presented by Mrs. M. E.
Johnson, Vancouver.
THE BRITISH COLUMBIA  HOSPITALS   ASSOCIATION.
Statement of Receipts and Disbursements
For the period from  1st June,  1921  to  1st July,  1922.
RECEIPTS.
Cash on hand 1st June, 1921  $      88.15
Membership Fees, Etc.—
Institutional    | $700.00
Individual         24.00
Exhibits  .•   110.00
Government Grant   250.00
  1,084.00
$1,172.15
DISBURSEMENTS
Secretarial Work  $ 287.55
G. A. Roedde—Stationery, Printing Reports, Etc  571.62
'Typewriter Expense   88.20
Stamps and Exchange  41.00
Financial Committee—Mr. Robinson   61.50
Pinchbeck & Pinchbeck Co $     5.50
Omineca Herald      15-.25
  20.75
$1,070.62
Cash on hand, 1st July, 1922       101.53
$1,172.15
Vancouver, B.C., 15th August, 1922.
Certified Correct.
BUTTAR & CHIENE,
Chartered Accountants
-r-67— :W
MRS. M. E. JOHNSON /Vancouver)—I am sorry to give a report
of a deficit. Still there is something to encourage us for there has
been a much larger response from the hospitals, fifty-one having
p&id their full fees for the year. A great many are small hospitals. There are one or two larger hospitals I would like to see come
in. We have received nothing from them but we hope they will
come in. Two hospitals have written me saying they were in rather"
a disorganized condition at the present time but'expected to be in a
better position next year and that they will be coming in next year.
I trust by the end of another year that the financial report will show
a balance in our favor instead of a deficit. I move the adoption of
the report and in doing so I would like to suggest that a letter of
thanks be sent to Buttar and Chiene, the chartered accountants, who
have audited our accounts every year free of charge. ^^
DR. BROWN—I second the motion. Do you count the unpaid
accounts as an asset?
MRS. JOHNSON—No.
The motion was earried.'
Reports of Committees were then called for as follows:
-.    Committee on Nursing Affairs:      &«&-*
Mr. President, Members of the British Columbia Hospitals
Association:
On behalf of the Committee on Nursing, I beg to report as follows:
Marked progress has been shown in the province in the past year
in nursing affairs, especially in relation to Training Schools. The
number and quality of women applying for training has materially
improved, and the report of Miss Helen Randal, Inspector of Training Schools for the Graduate Nurses' Association, is upon the whole,
very encouraging as to the conditions which obtain in the schools
throughout the province.
In an endeavor to get those primarily interested in the education
of nurses into touch with one another, a committee of the Graduate
Nurses' Association of British Columbia is in process of organization, which will devote its energies to the consideration of educational problems. The present convention affords an excellent opportunity of consulting with superintendents and instructors. from
various parts of the province, and in my capacity as convenor, I am
taking the liberty of arranging for a Round Table Conference to be
held at a convenient time for the consideration of the best methods
of procedure. A committee such as this, working in close co-operation should be able to render good service, not only to the Graduate
Nurses' Association, but to this Association as well. ■
Respectfully submitted,
E. JOHNS, Convenor Committee on Nursing.
The report of the Special Committee on Finance (Mr. J. T. Robinson, Kamloops; Mr. J. J. Banfield, Vancouver; Mr. George McGregor,
Victoria), was presented by Mr. J. T. Robinson.
You will remember at your annual convention in the city of
Kamloops last year that a special committee on finance was appointed. It consisted of Mr. J. J. Banfield, a member of the board of the
'Vancouver General Hospital, Mr. MacGregor of the Victoria Jubilee
Hospital, and myself. ,A meeting was held in July of last year and
later on, I think it was in August, I got into communication with-Mr.
Banfield with regard to our duties in connection with that special
committee as affecting the hospitals of the whole province. He had
a consultation with Dr. MacEachern and it was decided that as it
would involve considerable work that some arrangement should be
made for at least the travelling expenses of those who had to come
—58—    " from the outside. After some discussion I visited Vancouver, At a
personal conversation with Mr. Banfield on the matter it was decided
we should get into touch with Dr. MacLean, the provincial secretary,
and arrange for an interview. Mr. MacGregor was telephoned and
agreed to it. Some time in September the three of us visited Dr.
MacLean at Victoria by previous appointment with him. We received a most hearty welcome.' We did not go there with any cut and
dried proposals. We went there with an open mind. And, as we
explained at the time we came over to discuss the hospital financial
situation in general and try to help them to arrive at some conclusion as to the best means of helping the hospitals. We as a committee placed the details before the provincial secretary. We pointed out how hard it was to maintain a small hospital. We pointed
out to Dr. MacLean the fact that during war years most of the hospitals had got behind in their financial affairs and I appealed to
him to try and do something towards putting the hospitals on a
proper financial basis. The doctor received our suggestions in the
.most kindly manner possible. He was very sympathetic with us. I
left with the idea that the doctor was going to lay before his colleagues a scheme by which the accounts of the various hospitals
would be audited and he was to suggest to his colleagues that they
grant sufficient money to wipe off the indebtedness. Also it was
discussed, and I was under the injpression it was agreed to, that he
y/ould increase the per capita grant ten or fifteen cents a day. At
the time we left we clearly understood Mr. Banfield was to draw up
<a report in writing that was to be sent-to Mr. MacGregor and myself
and that was to be forwarded to Dr. MacLean. From that day to
this I have never heard a word about that report. I have not had
an opportunity of seeing Mr. Banfield and I do not think that event-
.ually it would have made any difference.    Because I understand that
-the matter was considered by the cabinet at Vancouver and that they
came to the conclusion that they should help the hospitals by means
of the surplus money from the liquor profits. I was delighted last
night to listen to Dr. MacLean. It w&s lucky for us that he was
over here. And I was more than agreeably surprised at hiSG.statement made from the platform last night. If we can get what Dr.
MacLean said last night carried out by an act of parliament then
our troubles from a financial point of view are solyed. If you will
take the nine months of the distribution of the liquor surplus and
compare that with the hospital condition during the same period in
■B5 C. you will find that if the distribution took place on a per capita
basis that each and every hospital would receive 81 and a fraction
of a cent per capita. That amount I feel certain would put every
hospital in first class financial condition and with care in the
management of the hospitals we should have no trouble in wiping
out the deficit. After the meeting last night I accompanied Dr.
MacLean to Vancouver. We had a long conversation over matters
in general. He told me that his colleagues have already agreed to
have the act changed so that the money will be paid on a per capita
basis. In discussing the situation in that regard we felt there would
be some opposition from some of the municipalities but the doctor
says he feels certain that his colleagues in the cabinet and the supporters of the government will to a large extent see this point and
vote for it. I have every reason to believe that after further discussion with the leader of the opposition in the legislature, that we
.will get their support and hearty co-operation in this matter. So I
believe from what Dr. MacLean said last night it would be only a
short time that the matter can be solved and solved in such a way
that the hospitals will not have this eternal financial worry, that we,
have been going through for many years. I want to issue a warning
this morning. We have got to run our hospitals on business principles. Dr. MacLean was absolutely fair and right when he told me
that the hospitals of B. C. received far more generous support than
«hey did in any other hospitals from their provincial government.    I
—59— know this is an absolute fact. Because last year before you visited1'
Kamloops I made it my business to look into the matter with the
hope of being able to give you some information. In May, 1921, I
had letters written to provincial secretaries. I also wrote to the
sjenretary of state for the State of Washington and of Oregon and
Idaho. Most of them sent letters and a printed financial statement
and details of how they contribute to the hospitals. When I compared them with the generous support that our provincial government gave I could not say very much. I repeat that B. C. hospitals
receive far more generous support from their provincial government
than any other hospitals in any other province, or of the states to
the south of us. This act was put on the statute books twenty-seven
or twenty-eight years, ago when Mr. J. D. Prentice Was finance minister and it has been continued down to the present. There are certain municipalities that are not contributing as much as they should.
Take the liquor control act. Half of the total profits goes to the
municipalities, and that half is sub-divided, half to be used for
hospital purposes, and the other half for general purposes. But
what do we find? We find that some of the cities where they have
given a grant to their hospital, they have used that money to pay
the grant. That is not the intention of the act. The act intended
that this money go to the hospital in addition to what is given from
the municipal funds. Take in the outlying rural places. I know of
a great many rural municipalities which instead of using this money
to assist the hospitals in their own district, use it to build roads and
to reduce the school tax. If Dr. MacLean carries out his intention
things will be different. What we should do here today is to pass
a resolution asking that the government will enforce the policy laid
dow\n by Dr. MacLean last night in regard to the distribution of the
profits of the sale of liquor, and that it be distributed by the provincial secretary on a per capita basis to the hospitals. In other
words, the hospitals that do the work well will get that share of the
money that they are entitled to. I am prepared to move a resolution along those lines just as soon as we can get it properly worded.
Dr. MacLean wishes us to do so and I hope it will go through unanimously by this association because it is the solution of our difficulties.
DR. BROWN—I think our trouble is more with the municipalities
than with the government. If our municipalities gave us anything
like the proportion of support that the provincial government does
we would be all right but the majority seem to shirk their responsibility as a body. We find them trying to dodge out of it. Kamloops is deserving of special mention. I believe they give their full
grant. We find other municipalities want to hold it up and collect
interest on it. We never get the interest when they do hand it over.
It is one of the discouraging things that the boards have to meet.
Until we can control that we cannot arrange budgets. There was a
budget regarding the finances of this association. We have the
power to levy the amount on each hospital but we have not, as
boards, power to levy any amount that will cover the expenses of
the hospital. It is pretty hard tp lay out a budget until we can do
that.    It is the municipalities that are to blame.
MR. E. S. WITHERS (New Westminster)—The Liquor Control
Act is coming up later on and I do not think there is any use going
into that at present.
MR. MORDY  (Cumberland)—There is one point I want to ask
about in the statement of Mr. Robinson, that these liquor profits
would amount to 81 cents per capita.    I do not know how he works,
it out.
MR. ROBINSON—I wish you would arrange to have thi^ discussion completed this afternoon. I will try as soon as I can to get
down town and possibly get a lawyer to draw up that resolution ber
—60— cause it is going to form the basis of what is going to be discussed
in the legislature. I would like to see the report adopted to give ns
the opportunity of introducing the resolution.
CHAIRMAN—I am sure last year the hospitals as a whole had a
sffSty per cent, deficit. It should be made known that the municipalities have not done what is right by their hospitals. For a city
or municipality to take hospital money is wrong. Did you ever hear
of such a thing? There is not a country not even Russia where
they would take hospital money. I am-ashamed of my own province. For a municipality to spend this money on any other purpose,
that is the limit.
The report was then received and adopted.
The Report of the Committee on Accounting was given by the
convenor, Mr. E. S. Withers:
I want to repeat what was said yesterday about the form of accounting. In view of the steps taken by the government to establish a uniform system of accounting there is nothing for this committee to report, but if any delegates will turn suggestions as to the
government form in to the accounting committee they will be considered when that committee get together. I told Dr. MacLean that
in due time he would be hearing from us with some suggestions as to
changes.    I think that is about the only way w>e can get anywhere.
CHAIRMAN—That disposes of the special agenda this morning.
I want the resolutions committee to report progress. If you have
any resolutions they might be handed in.
MISS JOHNS—There is a letter that should be brought before
the association.
MR. E. CARR HILTON—There is a letter to the resolutions committee from Mrs. Smith of Penticton extending an invitation to the
' convention to meet next- year at Penticton.
CHAIRMAN—Any report from the nominating committee?
MRS. JOHNSON—The nominating committee is to meet this afternoon and I would like to announce again that we would be very
glad to have the names, of any representatives from the different
districts whom you would like to have represented on your executive and as officers, so that the committee may be guided in this
matter. It is rather embarrassing for the committee to have to
'. Select one name for each office. We would like to see a long list
so that we may get the free choice of the association for the positions of officrs next year.
CHAIRMAN—I want to supplement what Mrs. Johnson has said
I by saying that if you have nominations from the floor of the house
you will not have the right officers. So that it is up to you to see
that the province as a whole is represented thruogh different districts. This is really a Cosmopolitan convention. The next thing on
the agenda is with regard to the plans for Hospital Day. Have you
any suggestion to- make along these lines. It is very, important. It
is part of our propaganda that should be used in the best way possible. In our own hospital there are more visitors than on any other
day.
MR. McCULLOCH (Abbotsford)—May I say a word on that. I
have found generally we are far too modest. It surprised me last
week on looking over the paper to find out if there was any mention
of the B. C. Hospital convention to find that it was in the society
-column. We want to be more spirited about our publicity. We want
to boost our hospitals.
MR. WITHERS—National Hospital Day is one of the finest
things out. We have not done enough towards giving the public
information in connection with our hospitals. There has been a
good deal of talk on that line but we cannot impress this on our-
—61— selves too stroffgly. National Hospital Day is a great opportunity.'
I honestly think there is an opening in this association for the establishment of an educational committee. That is, an educational
and publicity committee. That comittee could get together and
formulate plans for a National Hospital Day so that we could all
work on the same lines. Some of us are looking for ideas as to how
to proceed. In this city we threw the hospital open for a few hours.
We interested the Kiwanis and Gyro clubs to the extent that they
came out to the hospital and I think that was quite a boost for the
hospital. It interested people in the work of the hospital. We had
the clubs' Union Jack flying and^we had bands playing and about
200 people outside the hospital in a short time, a thing that has
never happened before.
MRS. G. BELL BROWN (Nanaimo)—We invited the Red Cross
people.    We refused to take money and we entertained them.
MR. J. H. CARVER (Victoria)—We had over one thousand people there last year. We demonstrated every department of our
hospital and it was considered a great thing.
CHAIRMAN—I want the convention to go on record in regard to
Hospital Day. Another thing I want to impress on you is, don't
forget Hospital Sunday. We must never get away from the spiritual
side of the hospitals. If we lack anything we lack on that point.
The spiritual side of the hospital and other matters go together.
Every denomination should be asked to hold services on Hospital
Sunday and I am sure they will be only too pleased to do so and it
ought to be done. I wrould like to see Hospital Day go strong and
Hospital Sunday too. Not so much for finances, but to bring them
before the public.
DR. BROWN—Our first hospital day was a surprise. There was
great enthusiasm. The children came in and sang songs. It was
run by the Women's Auxiliary. We had visits from some public
men,and they were behind the hospital movement.
MRS. SMITH (Penticton)—Wre did the same thing. The place
was opened for inspection and we had a most successful day. We
found it created a great deal of interest.
MISS J. F. MacKENZIE (Victoria)—The Daughters of the Empire invited the public. We had the thing going all day. We also
gave an exhibition in our tuberculosis department.
CHAIRMAN—I want to get something on record that next year
all hospitals observe Hospital Day.
MR. WITHERS—I would like to see the appointment of an Educational committee and would make a motion to that effect.
Miss Mackenzie seconded. ■
MR. T. MORDY—Is there a publicity committee?
i: MISS JOHNS—There is no standing committee on publicity. You
will remember that the president in his paper suggested that such a
^committee should be appointed. Would it be possible co combine
the functions of the committee to cover the arrangements for Hospital Day. It would seem to be one of the functions of that com- I
mittee?
MR. T. MORDY—I was going to suggest that two committees
should.be combined to cover the scope of both publicity and education.
MR. WITHERS—That is what I meant to say—-publicity and
education.
Mr. T. Mordy seconded the motion which was passed unanimously.
CHAIRMAN—If they fall down it is going to be a very serious
matter.
MR. McCULLOCH—Is that going to.be a standing committee?
—62— CHAIRMAN—Yes.
MR. T. MORDY—I make a motion that that be referred to the
nominating committee.
CHAIRMAN—It is not necessary.
MR.  T.  MORDY—It is a standing committee.
Mr. McCulioch seconded.    The motion was passed.
CHAIRMAN—The next iteSm is the publication of the annual report and the financing of same. You, no doubt want to ask questions on that matter as to what it will cost.
MR. T. MORDY—The question of advertising is one that deserves
attention. Most of you will remember-when we ran our last hospital concert four or five' years ago. We never had any occasion to
have one since. We made a clear $500 by advertising before the
doors were opened. I fail to see why a report:such as the B. C.
Hospital Association annual report cannot be carried to a certain
extent on somewhat similar lines. There are a number of firms who
supply the hospitals throughout the whole province and I am quite
confident that those firms will be only too pleased to pay for advertising in the.report that will bring a little grist to an association like
this.    I would suggest that a committee should handle that.
MISS JOHNS—May I say that I know something of the publishing of the report from my association with Dr. MacEachern. He
took the entire responsibility, and it was a very heavy one, of getting
that report out. Whether that service should be expected from a
secretary perhaps, overburdened already with heavy duties is a
question especially if the assembling of advertising material is to be
included. At the same time I think advertising could be obtained.
However, I am quite sure the reason it has not been done up till
now is simply that the mere assembling, the editing and preparation
of the report is a momentous task. Saw
MR. T. MORDY—I can endorse what Miss Johns has said. The
question of assembling advertising matter is a task that ought, not
to be put on the secretary who has to compile that report. It should
be given to some independent firm or rather to firms that make a
specialty of that and who will collaborate with Mi?s Johns' in the
report. It is far too much for her to attend to.
' MISS JOHNS—I do not know that I am going to have that responsibility next year.
CHARIMAN—The convention will decide. It was talked over by
the executive on Monday night. The report mi^ht be printed in a
"condensed form. Of course that means more work to edit it, and to
cut it down to save expense. I am in hearty sympathy "with that.
It must be handled very carefully. It must be someone with experience to do that. However, it is up to the convention' and 'we -want
to dispose of this now.
MR. J. T. ROBINSON—I am going to move that a committee of
three with Miss Johns as chairman be appointed to publish the report and cut out everything except the essence. i*i*JAi£
CHAIRMAN—Miss Johns may hot be the 'secretary.
MR. ROBINSON—I do not care in what position she is.
'  MR. WITHERS—I question the feasibility of appointing thr.ee on
that committee.    It is hard to get three1 persons together:    One of
.the most important things in connection with the publication of a
.report is the speed with which it can be done and anything that will
speed this report up should be done.
MR. ROBINSON—Make is a committee of two.  ■
CHAIRMAN—There is a  suggestion that Mr.  Withers and  Miss
Johns be appointed.
This was agreed to.
—63— CHAIRMAN—Do you want to go on record as regards advertising?
MR.  McCULLOCH—I make a motion we  do.
CHAIRMAN—Give them power to act as they see fit.
Mr. Graham seconded and the motion was passed.
CHAIRMAN—The next item is to arrange for the secretarial
work for the coming year. Perhaps first of all the treasurer will
give us an idea of the budget.
MRS. JOHNSON—Last year the amount was $287.55. At the
close of our last Novembre meeting it was decided to pay $25 a
month for secretarial work. That was paid to Miss Henry up to
April. There was little secretarial work done in May, June and
July, so that we did not pay anything during that time. We have
stenographic work for this convention which will cost us more than
that. So far as the expenses are concerned they have been from
$1000 to $1200 each year. We have had to pay $500 for the report
which is a big slice out of our income. And for the secretarial work
it is absolutely necessary we should at least pay $25 for the month.
The reason the report was not out earlier last year was because we
■had a large deficit. We paid that deficit and it took us to the first
of the year because some of the fees were slow in coming in. It was
the first of the year before we could get out the order for the new
reports. And this, year if we cannot finance by advertising the
executives of the hospitals should send in their fees earlier. I would
like to move that we pay $25 a month for secretarial work.
Mr. Binger seconded and the motion was passed.
CHAIRMAN—How much do you want to vote towards printing
the report?    We should leave that in the hands of the committee.
MISS JOHNS—The association should state how much so that
it will bind the committee to a definite limit.    We will try to keep
the expenditure down as much as possible.    But to go ahead with
no definite idea except the assurance of the goodwill of the asso-/
■elation as to what we must spend is not good business.
CHAIRMAN—I agree with that.
MR. T. MORDY—I think the committee should go to the limit of
the expense of previous years, five hundred dollars.
CHAIRMAN—Not exceeding that.
MISS JOHNS—What about help from the government in this
respect? That should not be left to the committee. Last year they
contributed $250, half of the cost of publishing, and the year before, they paid the whole amount.
MR. McCULLOCH—I believe the better proposition is to go to
the government for a sum of money for convention expenses. I do
not think the government would refuse to give us $250 for convention expenses.
CHAIRMAN—We should have something definite in this matter.
MR. T. MORDY—I made a motion to limit it to $500.
CHAIRMAN—What the committee want is to be relieved of any
responsibility that the association go on record as to what they
should spend.
DR. BROWN—They wish authority to publish the report and I
think they are entitled to it. I would second that motion. It does
not mean to spend that amount.
The motion was carried.
CHAIRMAN—Now in regard to approaching the government for
money in connection with the convention.
DR. BROWN—I agree with Mr. McCulloch., We should not ask
for any specific part of the convention, but should ask it for the
support of the convention as a right. Because it is not for the benefit of any individual but for the benefit of the province as a whole.
—64— We find it is economy in operating the hospitals and restoring the
£sick so that they can earn money. It is perfectly justifiable to ask
the province to share some of the expenditure.    I would move that
the secretary be instructed to write the provincial secretary for assistance or a ggrant for hospital convention expenses.
MR. McCULLOCH—I second that.    The motion carried.
MRS. JOHNSTON—We have always had a motion passed each
year authorising the treasurer and the secretary to sign cheques. I
would like to move that motion.
MR. MORDY—Seconded.    The motion was adopted.
,   CHAIRMAN—The next is the constitution and bylaws.
MRS. JOHNSON—I would like a notice of motion to have the
last clause of article 4, section B, deleted when it comes up at our
next business session.
MR. McCULLOCH—Might this not be a good time to take us this
matter of dividing the province into sections.
MISS JOHNS—This is a matter for the chair.
CHAIRMAN—There has been a committee appointed to deal with
tit and we would not want to override them.    If you wish to bring
that in, it would be all right t ogive a notice of motion.    I think
(t would be well for that committee to bring in a report in regard
to the change in the bylaws.
This concluded the morning session.
AFTERNOON SESSION: WEDNESDAY, AUGUST 30TH
The session commenced at 2 p.m., Mr. George McGregor in the
chair. Problems associated with the Workmen's Compensation Act
came up for discussion. The following introductory remarks were
made by the chairman:
As you know, yesterday a special arrangement was made to change
the programme to meet our friend Mr. Winn. He was only available
this afternoon and we could not allow this convention to pass without having him here. The balance of the programme after hearing
from him will deal with the disposal of the liquor money. The discussion on that question cannot be closed today because we do not
want to create ill-feeling with anyone. What is your pleasure in
regard to Mr. Winn. Have you any questions to ask or do you want
him to address you?
MR. E. S. H. WINN, Chairman of the Workmen's Compensation
' Board—Miss Johns extended an invitation' to me to be present, and
.1 could only come today by reason of appointments made five weeks
ago. The programme has set aside a session for the di£Cussion of
the Workmen's Compensation Act so far as it applies to hospitals.
I thought that last year that matter was so fully covered that there
I would be no necessity in my taking up your time again. \ve believe
in taking every opportunity possible to meet with those with whom
we come in contact in a business way and endeavoring if possible
to meet their particular difficulties. If there is anything in which
• you think I can help you, I wll be only too glad to do so. As I explained on a previous occasion, we have 300,000 files and %t would
be an impossibility for any one individual to handle them. I am
only prepared to deal with the broad principles. If there are any
individual cases you would like to hear about at a later date we will
be very glad to get these files and go into them.
CHAIRMAN—Those who wanted Mr. Winn here have now an
opportunity of bringing forward anything pertaining to some one
department of the Workmen's Compensation  Board.
MRS. R. J. BURDE (Alberni)—I have been asked to find out why
so many of our accounts are cut down a certain number of days by
—65— the Workmen's Compensation Board when our doctors assure us that
the patient should be kept in the hospital.   What the board want to
know is what they can do about it when the doctors say the patient
is unfit to go out of the institution and yet the bill is cut down two^
or three days or perhaps longer.
MR. BINGER (Kelowna)—That is the only question I wished to
ask Mr. Winn.
DR. BROWN—I was told to bring up the same matter.    The patient is sent in for treatment in the hospital.    He had to have treat--
ment that could only be given at the hospital.    The board and the
superintendent have no right to turn these people- out.    And the
Workmen's Compensation Board cut down the bill and we do not
know where we are getting off at.    We have the Workmen's Compensation Board in Vancouver telling us they won't pay for it after
the patient is gone and we would like some redress.    It has put the
hospital in rather a peculiar position because we cannot keep track
of the patient.    We wrote to them and they told our secretary we-
ought to be very glad they paid us for any hospital work at all as'
that is not included in the medical treatment.    That is the reason '
that they give that they do not need to pay for it.    I say the medi-^
cal treatment does include hospital work.
MRS. SMITH (Penticton)—The chairman of our board asked me.
to submit the following statement:
The Workmen's Compensation Act of B. C.
This Act, and its operation by the Board, has a most important
bearing on the finances of the hospital. The fundamental basis of
the hospital is service to suffering humanity and the relief of distress, but to those who are directly in touch with the management
of these institutions their operation cannot be disassociated from the
commercial aspects that are necessary to their existence.
The, objects of the Act are (1) to reduce to the lowest possible
minimum the loss of productive time to workers through physical
disability and the education of workers and employers as well as the
general public, to the fact that physical disability from every cause:
may be reduced. (2) The reimbursement for time lost and for medi-.
cal and hospital fees incurred through acqidents.
There is no doubt that the Board have many problems,, unknown
to hospital authorities, but it is felt that the Board might work with
the hospital authorities and assist them more than is at present ap-'
parent.    This applies specially to the question of rates allowed by
the Board for treatment of patients.
The Board has very wide powers in making its assessments and
collecting revenue, heavy penalties being incurred if the assessments^
are not promptly paid, but appear very arbitrary when it comes to
paying hospitals the fees true. They say "The Board is not forced
to pay fees of their patients direct to the hospital, but if the hospital
will accept $2.50 a day they/will do so, otherwise the Board will-'
pay the patient and the hospital must take the risk of collecting.;
anything at all."
This is the lever the Board uses to force hospitals to accept $2.50
a day whatever it may cost, and it is only by united action by hospitals that any change in policy of the Board can be brought about,"
at least so it would appear.
Some months since the Penticton Hospital circularised most of the
hospitals in B. C. on the subject and the replies received generally
agreed that^the rate was too low. One or two answers stated they
were quite satisfied as their own public rates were lower than $2.50;
but the point really is that the Board should pay an amount equal- ,
ling actual cost less the government grant. It has only recently been
pointed out by the Provincial Secretary that the annual deficit of
—66—
jjii last year's working of hospitals was
increase their rates.
jreat that hospitals should
The following, figures are taken from the government report and
are the average of all hospitals'in B. C:  Average daily cost per
| patient, $3.35: less average government grant, 57 cents: $2.78. If
we include Vancouver the average daily cost would be about 25 cents
more or $3.60.    We must not, however, overlook the fact that these
' costs do not include any rent or taxes as the hospital buildings are
| municipal owned and are also not taxed.    Were rent included the
-daily cost would be at least 50 cents greater.
It will be seen from the above figures that each day a Workmen's
I Compensation Board patient is in hospital the hospital loses money
which has to be made up either from municipal funds by taking the
'already too heavily taxed land, or by begging on the street, tag days,
etc., methods which, to say the least, are not in keeping with the
I dignity of the hospital.
We have been told that the Board will not arrange different rates
with each hospital, but this does not appear a reasonable stand to
take as the operating costs of hospitals must vary according to circumstances.
The Penticton Hospital authorities considered the matter so important that they refused to t; any more W. C. B. patients at
$2.50. They are therefore charging the patient their public rate
of $3.50. This works a hardship on the patient as an offer was made
the W. C. B. of $3.00 if paid by them, but this offer was refused.
It also causes the hospital more trouble in collecting fees, gives them
-occasional bad debts and is an incentive to the bad character patients
to evade payment even after receiving their compensation from the
Board. However, if all hospitals would take the same stand the
W. C. B. would doubtless be reasonable and re-adjust their rates.-
The plea of the,W. C. B. that the cost of living is coming down and
that therefore hospital fees should be reduced is not borne out
by experience. It is hoped that some definite action will be taken
by this convention.
MR. BINGER—It appears to me that the rate of two and a half
dollars a day for men who have had bad accidents is far too low.
The Workmen's Compensation Board allow us the operating room
fees provided the man is in the hospital under a week. His anaesthetics would amount to little indeed. The man who is in the hospital
for a long time who has had a serious accident, his dressings and
anaesthetics account come to a large sum. That is where the hospital loses money and I think some allowance ought to be made in
.cases of that kind by the Workmen's Compensation Board. I do not
object to $2.50 a day because that is the public ward rate but I
' think to have everything included in that is a very poor policy.
With regard to the cutting down of the bills we have had that done
"to us and I have no doubt Mr. Winn remembers the letter he received
from me.
CHAIRMAN—Have any of the Sisters got anything to say? I
know it affects you as well and we will be delighted to hoar from
you.
SISTER JOSEPH We have asked the Compensation Board for
more money and we have had a letter back to the effect that the
patient has stayed in the hospital too long. The cost of anaesthetics
and dressings is not covered by the amount paid us.
MR. T. MORDY—In connection with this we have had the same
experience at Cumberland. There is one thing I would like to"
know. I do not know whether it is possible for the Compensation
Board to do it but I think it would help us materially if it is possible. We know that in many cases, patients are apt to regard the
hospital more or less as a convalescent home and stay there and
—67— impose on the hospital beyond their time. But the report from the
doctor goes through to the Workmen's Compensation Board and they
judge from the doctor's report how long that patient ought to be in
the hospital and they advise us after the patient is gone. If it were
possible for them to advise us before the expiration of the time when
that patient is due to go out, that he ought to leave the hospital at
a certain date, then the patient would leave the hospital or understand that we would collect the balance from him. That is one
thing which would benefit the hospital. We would not be left with
unpaid bills on our hands and with no means of reaching the patient
afterwards.
MR. E, S. WITHERS (New Westminster)—I would like to speak
on that. I have had many a discussion with Mr. Winn on that same
thing and we do not seem to arrive at a satisfactory conclusion.
For instance it occurs with us particularly where bills have been
reduced in the case of patients who have stayed in the hospital too
long. There is a monthly report from which the Compensation
Board requires from every hospital at the first of every month.
It seems to me that that form might be checked up to see whether
those persons named thereon, due to the diagnosis stated thereon,
are staying in the hsopital too long or not. Although we may be
able to get in touch with our patients afterwards, they are very
loth to pay the bill and claim it is the duty of the Compensation
Board to pay it. It is hard to explain to them that they should
have gone home. I think some suggestions upon that point would
be very welcome.
CHAIRMAN—I will ask Mr. Winn to answer some of the questions that have been put to him.
MR. E. S. H. WINN—It would appear that the sole complaint
against this most unfortunate Workmen's Compensation Board is
the question of the reduction of accounts. I hoped each of you
/would have read your last year's report which goes into that matter
very clearly and fully. The underlying viewpoint was to bring home
to you the relative position of the Workmen's Compensation Board
and the hospital. There is this feature to be remembered, that is
that the Board has no control over, the patients. Has not now, and
never had. Neither had the employers under the old system any
control. And yet today you want us to solve your particular troubles. That is not possible. The point is this, that we can only deal
with the situation as it is brought up to us. And it cannot be
brought up to us until the matter is there to bring-up. I think it
would be true to say that 90 per cent, of the cases for which you are
now paid by the Board, you were not paid for under the old regime.
When you stop to consider that the average workman today in this
province is paid less than $86 a month you will get some idea of the
impossibility of his paying a hospital bill. The amounts we pay to
you are from monies collected from these same workmen on a cent a
day basis. In so far as the cutting down of accounts is concerned I
endeavored on the last occasion I spoke to bring to your attention
cases where you could not help but admit that there was absolutely
no need for that particular workman being in the hospital such a
length of time. I could tell you of instances of men staying two"
weeks in the hospital when a tip of the finger was clipped off, and
of these men being permitted to do so by the doctors. The medical
men should be subject to discipline. And if you take up the case of
the average doctor he will agree in every single case that we have-
allowed him a greater amount than was necessary for the work done
in the hospital. Another thing I have said on many occasions is
this—that if at any time there is a dispute we have never hesitated
to refer that case to a committee of three doctors and let them decide. We make that offer today. If at any time you are dissatisfied
with the allowance we make to you, we will refer the case to a committee of three  doctors and they  will be  furnished the complete
—68— piles.    On occasions where the proper evidence has been produced
i.we have never hesitated to allow the. additional amohnt. So that it
does seem to me that you are asking us to change a situation over
which we have no control. If we ask a man to leave the hospital
you tell us to mind our own business, and we have been told so
.before now. Another thing we have been accused of is lack of cooperation with the hospital. From time to time where patients have
failed to pay the hospital accounts we have assisted the hospitals in
^'collecting from these men. A statement was made by someone that
we refused to put things in writing.   He is in error.   We have never
Refused to put anything in writing, or to record anything that we
would say verbally. I am not going to argue with the lady from
Penticton, she did not write the article. In so far as it refers to
our offer to pay $3.00 a day, the Board never undertook to pay that
amount.    I challenge the production of any correspondence wherein
£we offered to pay more than to any other hospital. I personally
advised them we would not pay more than $2.50 a day. We had to
pay Atlin more than that once but that was the only one. In so far
as Mr. Mordy's statement is concerned about notifying you when a
-;patient should be let out of the hospital there are lots of patients dis-
charged from hospital from one to two weeks before our board
knows they are in the hospital. We have had no knowledge that the
patient is in the hospital. Claims are not required to be made in
such a way and it is a quite frequent thing to find that no payment
is made for eight or nine months after the accident. And it is quite
a common thing not to hear from the doctor for two or three months.
Often a man declines to say he is under the Workmen's Compensa-
tion Act and it is frequently through our efforts that the hospital
finds that they are compensation cases. The reports we receive from-
he hospitals are not received within two months after they are due.
In connection with Port Alberni we suggest that the doctors take up
the case with us and justify their rates and if they can do so we will
be glad to pay them.    We are intensely desirous of co-operating with
iyou in every way.    We know some of your difficulties and we want
■ to help you. But there is one important point and it is this, Dr.
Purvis told us about it at the last convention, and that is that the
medical superintendent or matron should keep tab on the patient.
She knows whether the patient is receiving hospital treatment. If
she tells the doctor that unless the patient is discharged the hospital   cannot  collect   from   the  Workmen's   CoCmpensation   Board,
I surely the doctor will discharge him forthwith. If on the other
hand the circumstances are such that the patient must stay we will
be only too glad to pay the amount. Our Board is the trustee of
these funds. They are paid by the workmen. You may be told
about reserves. The Board has no reserves except to pay for the
cases that actually happen. If a man is killed, sufficient money
"must be paid to the widow and children. Or if a man loses an arm
or a leg we have to pay a certain amount each month for a long
time. So that in any accident that involves permanent disability,
the law requires a certain amount of money in reserve for that particular case. I had a letter from Penticton telling us we were
getting rich on reserves and that we should use this money for
hospitals. We want you to understand these things about our
Board or you will have a wrong idea about us. We believe in
getting together in these matters. The only thing I can suggest
is that you should get your superintendent to watch these particular patients and check them up with your doctor and make your
doctor give the true reason why that particular patient is there.
When the doctor knows there are going to be difficulties with the
\ case he will be particularly careful. Because the doctor does not
do the right thing or because you may include some charges which
are not justifiable it does not follow that we should have to pay.
CHAIRMAN—I hope Mr. Winn has made his case clear to you
—69 — all. There is one thing I wish to refer to. Mr. Winn stated how
they arrived at the number of days the patient should be in the,
hospital.    I would ask Mr. Winn how this rs done.
MR. WINN—The law of averages suggests to us that a patten®
should not be in the hospital longer than a certain time and we",
allow the maximum. But often they are in very much longer and it,
is not right we should pay fro that time.
MRS. SMITH (Penticton)—We only asked permission of the
Board to collect the additional 50 cents. -
MR. WINN—I thought you said we offered three dollars. We
are under instructions to give you no permission.
DR.   DARBY—What  about   contract  patients?
MR. WINN—There is a certain section by which you can approve of a particular plan. That plan takes care of the whole
situation. Take the C. P. R. and C. N. R. employees: all these men-
are under an approved plan. They have an organization of men
who handle' their own situation. The association pays for the men's"
hospital treatment. If there is a dispute we adjudicate on that
dispute.
DR. BROWN—I would like to ask you how that plan works out
compared with the Workmen's Compensation?
MR. WINN—It is very satisfactory. The railway employees are
carrying on a health insurance scheme and it is working well and
is being adopted by large employers. It is realized that the average
workman cannot afford to pay doctors' feer but under this scheme
he is provided for.
MR. GRAHAM (Cumberland)—I can probably give a little information. We have a plan which is approvved by the Compensation Board. The employes have an organization known as the
medical fund. It is controlled by the men themselves through a
board and they engage doctors and they pay them a Certain salary".
They must furnish all the medicines required for the treatment of-
the patisnts. They must furnish the members with hospital treatment, both in the local hospital and if it is necessary for them to go
away for special treatment they furnish them transportation and
pay the bills of the hospital where they go for this treatment. I
may say it works out exceedingly^well, to the benefit of all parties
concerned to the men and the hospitals and the doctors as well I
believe. The fees amount to the sum of 72 cents every two weeks"
and they find it very satisfactory. That takes in the Workmen'!®
Compensation Board. That board pays no bills for these men at all
and they pay nothing to the board.
DR. BROWN—Does that include sickness?
MR.  GRAHAM—That includes  everything.    With  regard  to thej
Workmen's Compensation Board we have had considerable experience with them for the last five years.    I do not think the trouble -
is with the Board at all.    The trouble is  with  the  doctors.     The
doctors will not discharge a man when he is ready to be discharged.
If the man says he does hot want to go the doctor lets him stay-
there and the hospital suffers.    I speak from experience of our own
doctors and I think they are all alike.    If the doctors discharged
these men we would not have this difficulty of collecting accounts I
from the Board.    One thing we cannot lose sight of and that is that |
the hospitals are getting more money for casualty and accident cases'J
than they ever got during the old regime.
MR. WINN—I want to thank  Mr.  Graham  for his  kind  words, j
Last year we paid the hospitals $215,133.51.    If you take 90 per
cent, of that away you will find that $200,000 was paid to you that
you would not be getting under the old regime. That calls for a little favorable comment.    As the chairman pointed out we pay thj|
doctors in the hospitals on the basis of services rendered.    I am not -'going to suggest that the doctor would attend a man a certain number of times to get more payment, although doctors are the same
I as lawyers.    In the grocery store you may get a little short weight.
Nevertheless they get paid on the number of times they necessarily
attend.    We cut the doctors too.
MRS. BURDE (Port Alberni)—May I say in defence of the West
Coast, that the last case Dr. Morgan got his fees and we got paid for
only three days.
MR. WINN—That is very easily answered. The chances are that
tthat man should not have been in the hospital more than a day or
pro. I would love to present that case to three medical men and I
.think they would say it was two days too much.
MR. WITHERS—I would like to say that the Workmen's Compensation  Board is the finest institution in the country and  it  is
being operated to, the advantage of the hospitals.    I have always
found in dealing with the Board that we can always get "the greatest consideration from Mr. Winn, and his medical referee and the
(Staff.    I would like to go on record on this.    With reference to
■ the medical men it seems to me as Mr. Winn says, the medical men
are on the other side as a rule.    I do not know why.    If some things
"were charged to their accounts that might meet the situation.    I do
not know whether Mr. Winn would like to take that up with the
medical men.    There is one thing I would like to ask.    In the case
of a man leaving the hospital with his account unpaid, there is still
-55 per cent, of his wages still coming to him.    I have made appli-
I cation to the Board to try and get these cheques forwarded to us
-so that we can get our hands on them and get something from
Mhem.    But that apparently could not be done.    I wonder if their
wages cannot be garnished?    A man was in the hospital and we told
him his time was up and that he should go home.  He said he would
rather stay where he was and pay his'own bill and we could not of
course throw him out.  He left the hospital in due time and when we
.got after him to pay his bill he said the Compensation Board would
look after that.    We put it in the hands of a collector and we are
going to garnishee his wages.    If we could get some of the 55 per
I cent, before he spends it it would be a nice thing.
MR.  WINN—The unfortunate part is that you could do nothing.
'. We have forwarded cheques in favor of the workmen to you, but we
! cannot make out his cheque to you.   And in every single case where
fiji is possible for us to help you we have done it.    Under section 14
of the Act, the position is set clearly and the only thing we can do
for you is to send the cheques in fayor of the workman to you.
DR. PURVIS—May I say a word with regard to the medical side?
: Having had a certain amount of hospital experience and now that I
am out in the world I probably am in a position to know a little bit
of both sides.    I will admit when I was in the hospital I knew the
need there was to check up patients.   I found that those in charge of
' the hospital would see that the nurse in charge "of the ward followed up the dressings that were being given to the patient.    If the
patient  remains   longer   than   he   should   then  you   get   into   difficulties, but I think 99 per cent, of the doctors will assist in presenting that.    When liquor prescriptions were written in  B.  C. by
doctors there was more or less of a scandal.    The medical men took
it up and found that 3 per cent, of the medical men signed 90 per
cent, of the prescriptions.
That is an absoute fact. A question was asked about how the
doctors got paid for their visits. Let us say there are one per cent,
of the doctors who will carry on dressings longer than they should.
I have never met a man in Westminster doing more dressings than
he should. There are patients in the hospitals who should not be
there, but they are there because they have no place to go. I think -
"the hospitals should go to the doctor and report that case and us-
—71— ually the doctor will get the patient out. I do not think that the
doctors are keeping the patients in the hospitals to get extra remuneration.
MR. GRAHAM—I do not think the doctors are keeping the patients in for making money. The majority of the men in industrial
occupations have a contract with the doctor.
DR. BROWN—Was a human being ever satisfied? Never. We
are not satisfied with what the liquor vendor hands us. But we have
heard from time to time that the hospitals are in better condition
since the introduction of the Workmen's Compensation Act.
DR. DARBY—What should we do in the upper country hospitals where a patient comes forty to fifty miles just for a simple little
thing such as the end of his finger being snipped off. There is no
place for him to stay. He either goes into the hospital or we turn
him out and let him shift for himself at an Indian village. He has to
go that distance whatever it may be. The injury may mean only a
few stitches. But you do-not like to send him home and he probably has to wait a week in order to get the steamer back. It may
mean two weeks before he is alright. He can stay at the hotel or
rooming house. There is no necessity to stay in the hospital but in
a case like this as he is a long way from home there is no place to
stay except the hospital. Can we charge that man and make him
pay or should we charge it up to the Compensation Board?
MR. WINN—It is a very common situation in this province. The
camps aro located miles from the hospital. These men are often
times given hospital accommodation when it is boarding house
accommodation they need. Sometimes he does not require further
hospital treatment and we can only pay for the days that are necessary. There are some of these cases that look rather hard and
cruel, but we pay 5 5 per cent, of the man's wages to him and that is-
supposed to be for the purpose of maintaining him during his dis- -
ability.
DR. DARBY—The disability is the time he is laid up.
MR. WINN—We pay the hospital for medical treatment and an
allowance for maintaining him. You want to charge us for maintenance as well as for the hospital treatment. In other words he is
getting h's maintainance allowance plus hospital allowance when he
is only entitled to hospital allowance.
MR. WITHERS—With regard to Dr. Purvis' remarks.    I do not
agree with him in one thing.    The doctor attending the patient in
the hospital n being paid for his job and I do think the responsibility
falls on him.   We may help them by reminding them but we cannot"
assume any responsibility.
MR. BINGER—We have instructed our matron to mention any of
these cases and remind the doctor that they should go out when
they are fit. And I know cases when'men have been kept overtime
I think the number of days treatment will show as a rule we did not
overcharge.
MR. V/INN—We have discussed this very situation with the
other. Canadian Boards and we are adopting their practice pretty
well. There are still differences of course. We are doing more
work than any board in Canada. We give a fair allowance. The
only way conditions can be improved is by getting together and
discussing them.
CHAIRMAN—;We have had a very interesting discussion on this
matter. The more we have Mr. Winn with us the better we understand each other.. We are fortunate in having a man like Mr. Winn
at the head of the Board.
MR. WINN—May I extend an invitation to those who have troubles to visit us so that we may discuss them.
J MR. E. INNES (Canadian Pacific Medical Association)—I represent the largest body of workmen in B. C. We have altogether in
our association six thousand employes of the Canadian Pacific Railway Company. We provide medical care, medicine and hospital
treatment for them and for their families. We are not so fortunate
as Mr. Winn as far as the hospital is concerned, because once a
patient is put in the hospital by our doctor we have got to fight un-
* til he is put out. - We have the same difficulties as Mr. Winn has.
Our doctors put patients there when it is not necessary and the hospitals do not protect us. We had a case of a man in the hospital
with a hurt finger, the doctor said "Go to the hospital." The result
was that we were losing money. We are paying 100 cents on the
dollar and we are going to pay our way.
So far as we can see this association has been formed for increasing the cost to the general public. I have no doubt you are
doing a lot of good, but the cost of the hospitals is going up to such
an extent that the average workman cannot pay it and he is going
to throw up his union and take charity. I heard a lady from Penticton say the hospital expenses are $3.50 a day and she is getting
three dollars from our association. How can a man getting $85 a
month pay $3.50 a day to the hospital? He cannot do it. I was
agreeably surprised to hear that the Cumberland Hospital is run
for $1.75 a day. We are paying $2.50 a day all over the province.
If it is cut to $1.75 or $2.00 we are prepared to pay and keep our
self respect. So far as discharging a patient is concerned the
onus is on the hospital and the hospital is assuming the responsibility and should tell the doctor that the patient should be discharged.
We have patients who have been left in for weeks. The doctor wants
to make a good fellow of himself. All he does is sign a slip. This
makes a boarding house of the hospital, a purpose for which it was
never intended. We have had cases where a man sustains an injury and instead of going to the hospital goes to town and wants us
to pay his hotel bill. We have been asked tp pay a woman for the
accommodation of her child in the hospital.
MRS. SMITH (Penticton)—We built our hospital when we had
only a small population. We have over $4000 and we are building
a nurses' home containing six rooms. We were forced to take that
over for maternity cases. We hope to pay it off next year. Until
we do that, our expenses are larger than they would otherwise be.
MR. J. T. ROBINSON (Kamloops)—I listened to what Mr. Innis
had to say and I must take exception to some of his remarks. We in
Kamloops have had very pleasant relations with the Canadian Pacific employes. The case he mentioned of the child and the mother
I do not know anything about. But when he says that it is up to
the hospital to discharge patients I take the opposite view. I believe the patient under the Workmen's Compensation Act practically
selects his own medical man. The other matter is different altogether because the C. P. R. Employes Medical Association select
their own doctors. Our doctors in Kamloops would take exception
if we were to tell them when they were to take a patient in and
when to discharge him. I as president do not take any responsibility and I will >not permit my matron to discharge any patient from
that hospital because I am not competent and she is not, to say when
the patient should be discharged.
MR. J. COREY (Canadian National Railway Employes Medical Association)—I am in charge of the Canadian National Railway employes medical association. In 1918, when we formed our association we got different rates in the different hospitals and tried to
carry on. But they increased the rate from time to time. We met
the raise each time thinking the day was coming in the near future
when it would decline. But that day never came. The men's wages
have been reduced and they are going to reduce them again. Therefore it is impossible for this association to go back to those men and
—73— ask them to pay a higher rate for hospital attention than they were'
paying in war time when the rate was away up.   My system has been
to ask the co-operation of the doctors we employ.    I will say in 90
per cent, of the cases we have had the co-operation of the doctors.
I have asked fer the co-operation of the hospitals and if we had
co-operation all round we could make this association a success,
make the hospital association a success and make everything a success. Ninety-eight per cent, of the cases sent to the hospital under
the Workmen's Compensation Board are surgical cases, and 85
per cent, of the cases sent in the hospitals by the association I represent are medical cases. Therefore, we should have a lower rate.
There is just this much about it, we cannot afford to meet any further increase. We expected there would- be a decline in the rates.
I have heard what has been said about the Compensation Board trying to help the hospitals in different cases when the patient would
not pay his bill. I put the matter up to our association to see if
we could collect the money for the hospital aAd it was collected and
not only in one particular hospital but in other hospitals. We have
been criticizing the medical profession pretty hard but I am going
to say this much. They are not what you try to paint them. We
have satisfaction from 90 per cent, of the medical men in the province. We had a case where there was a little slip but we soon rectified it.
But we cannot do without co-operation. We have to have an organization where we can band together and help one another but if
you increase the rates we will have to disband for we cannot pay
them.
MR. S. MONRO (President of the C. P. R. Employes Medical As- .
sociation)—I cannot say much more than what Mr. Innis, the secretary, has stated in the address he made you. We are all working
on similar lines. One thing has not been brought up. The hospitals
of B. C. continue the increase of rates and it will be necessary for
our organization, if we intend to continue to pay the patient for the
number of days he has been in the hospital to let the hospital collect from the patient. It is the only alternative we can see. $2.50
is our maximum and it is about all we can stand. It is only with
the co-operation of the doctors and the hospitals that we will be
able to carry on. Surely the railway associations ought to be treated better than that. We pay one hundred cents on the dollar and
you get your money in thirty days. That should be a jpaying item
to the hospital. This should help our your overhead expenses. We
must have your co-operation "if you want to be paid promptly.
MR. A. P. GLEN (Ladysmith)—We figured out a plan whereby -
we could overcome some difficulties. The doctor was hired by the
hospital and the hospital was not being run to suit the association.
We paid our subscriptions to the hospital and took the control of
the hospital out of the hands of the people who were running it.
So that now we run our own hospital. If the doctor keeps a man too
long we put him out.
MR. MORDY—Mr. Corey and Mr. Monro mentioned certain
things. Mr. Graham omitted to mention he was our leader four
years ago in our first efforts toward educational propaganda. We
have kept along these lines since with the result that at the present time the employes, the hospital and the board are three units of
one and the same organization. The interests of each are the interests
of one and all. He also omitted to state that the thousand dollars a
month contributed while apparently a fixed amount is not entirely
so. The agreement is that the thousand dollars a month will be
paid by the medical fund and that once every three months a committee of three from each organization meets. They go over the
costs of the hospital, they work out the per capita cost, also the
number of patients from the medical fund who have been treated
—74— in the hospital during the three months. If the total cost of these
patients is more than a thousand dollars per month the medical
fund pay the hospital in excess. If it amounts to less we refund. I
am pleased to say last year we were under the pleasant necessity of
refunding one month's subscription. We gave them back one thous-
I and dollars. I am also happy to say that' the medical fund have a
hospital committee and visit the hospital frequently. Anything that
they see to be capable of improvement they mention either to the
matron or the doctor or the hospital board and it is at once taken
up and discussed and if it is worth acting upon it is acted upon as
soon as possible. They are the backbone of the hospital. Without
co-operation the hospital could not exist at all. There are many
communities in which there is not a working population such as we
have. But I believe there are places in which hospital policy such
as this could do a lot of good.
The discussion then terminated.
Discussion on the allocation of moneys accruing to hospitals under
the Liquor Control Act was opened by Mr. J. T. Robinson, Kamloops, who submitted the following resolution:
WHEREAS it has been found that the present method of distribution of the profits derived from the sale of Government liquor has
not operated to the best interests of the hospitals concerned;
AND WHEREAS it is considered that the said profits should be
distributed to the various hospitals according to the number of
days' treatment rendered by the said hospitals respectively;
NOW THEREFORE be it resolved that we, the members of the
B. C. Hospitals Association in convention assembled do request the
Government of the Province of British Columbia to amend the Government Liquor Act, being Chapter 30, statutes of British Columbia,
1921, by repealing sub-section (b) of sub-section 1, of section 108 of
the said Act and by substituting in lieu thereof the following:
Sub-sec.   (b)     One-quarter of the net amount shall be apportioned  and  paid to  the  several  municipalities  in  the
Province in proportion to the respective population;
and
(c)     One-quarter of the net amount shall be placed to
the credit of a special account under the contral of
the Provincial Secretary and shall be paid thereout to all hospitals in the Province rendering public services, and which are subject to Government
inspection in proportion to the number of hospital
days' treatment rendered by the said hospitals respectively.
Mr. Carr Hilton seconded the adoption of the resolution.
MR.  J.  T.  ROBINSON   (Kamloops)-^This  is  a  hurried  draft  of
what we want to convey to this convention.    The principle is expressed in this resolution and I think it clearly sets forth what we want: I
am not going to take you over the history of what I told you this
morning.    But I am going to call your attention and particularly
those who were present last night at the public .meeting to what the
provincial secretary proposes.    As you understand, the present Act
- provides that half of the net profits derived by the government from
the sale of liquor shall be used and placed in a consolidated fund.
The Act also says that the other half is to be given to the municipalities according to  their population.    That half is to be divided
and 25 per cent, is to go to the hospitals of the province, those hospitals that are prepared to open their doors to people whether they
can pay or not and are subject to the Hospital Act of B. C.   We have
found in the working out of that Act that it is not fair to the hospitals as a whole.    Some of the hospitals are in a district surrounded
by municipalities without hospital facilities.    Any of these munci- palities may contribute their 25 per cent, to the central hospital.
But take two instances I am going to give you as illustration. Let
me call your attention first to the town of Hazelton. It is not a municipality itself but there is a hospital that does not receive one cent
from the profits. Take the town of Cranbrook. There is the
Sister's Hospital there. They receive the usual government aid.
But Cranbrook, situated as it is in an unorganized district re- •
ceives only 15 cents per hospital day during the nine months the
distribution of the liquor profits has taken place. Take the city of
Kamloops. We have as I told you yesterday, the largest hospital of
any city of from five to six thousand population. The largest of any
place of that size in the Dominion. We have not a municipality within 60 miles of us and in the last nine months we received only 22^
cents on a per capita basis. Take Salmon Arm. They have a nice
little hospital and they deserve all the credit that is coming to them.
They have a small hospital and few beds. We do more work in
Kamloops and yet Salmon Arm gets, more money than we do. So
that you see it does not work out in any shape or form and the only
way is to grant money to the hospitals according to the number of
hospital days they have.
This resolution I think is very clear in its wording as far as that
is concerned. You must realize that while we may do our work in
a certain way it has got to go before the Legislature of B. C. which
is made up of 47 members. If this resolution goes through here and -
the government are able to make a statute that will amend their
present Act then in future we will get the money on the basis of
population and on the number of days' service we have given in the
hospital. The city of Cranbrook has 14,566 hospital days. Their
population is 2,725 and they draw down, 15 to 19 cents per hospital
day. Let me speak of Enderby. They have 497 hospital days with,
a population of 783 and the proportion is $1.60 per hospital day.
North Vafacoucer: 5,393 hospital days, a population of 7,652 and
their proportion under the present act is $1.25. Now come to Mission. I do not know whether there is anyone here from Mission.
(A voice "Yes"). They had 2,299 hospital days with a population
of 3,500 and they draw down $1.50. If it was distributed on the
per capita basis every hospital in B. C. would receive 81 cents for
every hospital day. You can see how it will work out if wfe can
carry it through. If we can get that through there is no reason why
every hospital should not be in an excellent financial condition in a
short time. Because with the reduced cost of living and the more'
economical management of our hospitals—and I want to emphasize that again. I think every hospital with a greater per capita cost
per day than $2.50 to $2.75 a day is extravagant. I think with this
new idea that we will get along very well. I want to point out one
thing. You will notice that this resolution does not refer to the
B. C. Hospital Act which gives us the per capita grant under that
Act. This liquor money is in addition to the present grant. I want
to point out further that this resolution does not relieve the municipalities of their responsibilities towards hospitals. Because there
is an Act in this province by whch each hospital can sent a bill to
the municipalities and get two and a half dollars for every day a
man-is in the hospital. This is a recent Act of two or three years
ago. And those of you who are surrounded by organized munk
cipalities can collect for every person who cannot pay.
MR. REID (Victoria)—I want to rise in support of the resolution.
Fortunately or unfortunately I can speak both from the municipal
and the hospital side. The Royal Jubilee Hospital in Victoria should
be supported by the three municipalities surrounding it. It was supported by Victoria last year and by another-municipality. The other
two municipalities took the money and diverted it to other purposes. This money got into their hands and was used for a purpose
for which it should not have been used.   The only way in which this
—76— mOney can be safeguarded is suggested by this resolution which
provides that the municipality does not directly handle it. Let it
come directly from the government to the hospitals and be paid on
^a per capita basis. I feel proud that our municipality paid their
amount. For that reason if for no other the money should be
handled in the way the resolution suggests.
MR. McCULLOCH (Abbotsford)—It is all very nice to talk from
the standpoint of Kamloops, Ladysmith and those hospitals that are
paying their way. But unless we get the liquor money we cannot
pay our way. The greater part of the trouble in the upper districts
is that the patients cannot pay and won't pay. The good patients go
to Vancouver. If Ladysmith, Kamloops and other hospitals are
doing as well as they say they are, I cannot see why they take this
money. The resolution should be so worded that it would grant aid
to those who require it. I do not want to give Kamloops anything
more than they need.  \
MR. MORDY—As far as the liquor profits for Cumberland are
concerned we have been in receipt of the enormous amount of 14
cents. So that we are not exactly relying on the liquor profits, but
I am thoroughly in accord with the resolution. We have started
out on right lines but there is perhaps, something in the wording of
the resolution that might be altered. I would like to see the wording of the last sentence altered. Instead of being subject to government inspection I would like to suggest that all those in receipt
of it should be subjected to government inspection. In that way,
private hospitals would be inspected. At present they are not government inspected and therefore cannot apply for this money. I
think those institutions that are rendering a public service have a
right to public money if they are willing to subject themselves to
government inspection. There is another point; the question of
giving this to the hospitals on a per capita basis. While that would
work out apparently very satisfactorily we must not overlook the
public- work that is being done by the large hospitals such as Vancouver General, which has special departments. These departments
are an absolute necessity. They are an impossibility in the smaller
institutions. In other words the large hospitals are doing this work
and paying for it and the small ones are getting the benefit of it.
I therefore think there should be a small percentage allowed for
each special department.
MR. ROBINSON-—There is a special grant for laboratory work to
the Vancouver General.    So it is with the Jubilee Hospital.
REV. FATHER O'BOYLE—My presence on the executive is due
to the fact that I represent the Catholic hospitals of B. C. And they
have come into this association in order to contribute what they
can. When this matter of the distribution of the funds of the liquor
sales came up there" was considerable stir in Vancouver and a difference of opinion. Some of you who know me know I say what I
think. I wish that the Sisters would speak a little more, in fact
what I am going to say now is the opinion of some of the Sisters. I
will say this( that if that clause in the resolution "hospitals in the
province rendering public service" includes such institutions as
St. Paul's in Vancouver and St. Joseph's in Victoria, I would be
particularly in favor of it. Because I think our institutions would
welcome government inspection. I think they have nothirig to lose
by that. Notohly that, I think that when the matter is fully represented to them they will not have any objections but will be willing to show how their money is being expended. Many of our hos-
' pitals are looked upon as jerkwater affairs and there is a tendency
on their part to have nothing to do with other institutions. I know
that the Sisters are willing not only to have government inspection
but 1.0 have representatives on their board.    They have nothing to conceal. All they can show is a deficit. They cannot even establish a sinking fund. I am using all my influence in that direction.
If we do not work together what is the use of having^an association?
I know this is the time to speak your mind. Some of you may not
agree with me. You may think the Catholic hospitals should stand
on their own feet. I say they have, that they are doing public work.
They are willing to have their work inspected by representatives of
the people. That is the way we are acting nowadays. I am told
that the Sisters have in this province seven hundred hospital beds.
In Victoria they give 32,000 days' treatment a year. It saves the
city $15,000. St. Joseph's saves half that amount a year. About
the same thing happens in St. Paul's. If that is not a public service I do not know what is. He would be a narrow-minded man who
would object to their getting a share of the liquor profits. I am-
glad to see the stand taken by the mover of the resolution and the
view taken by those who spoke to the motion. That- last sentence -
is somewhat ambiguous. I know these private hospitals are rendering public service. They are receiving no public money except an
occasional donation which amounts to nothing. They are not considered by the municipal councils. Still they are rendering a public service. And they are doing it without any distincton of class or
creed. The Sisters will tell you that perhaps seventy per cent, of
the nursing staff is non-Catholic, and more than half the patients.
The Sisters are all Catholic I think. That has never been investigated, but they do not make any distinction. They profess to provide a certain atmosphere which sometimes is lacking in a civic hospital. But while the civic hosptal can give them something of the
spirit of development sometimes it has to learn lessons of economy
from them.
The Sisters lay great stress on one thing which should not be forgotten in any hospital. That is the spiritual side whether the patient is Protestant or Catholic. If a man is in the throes of death or
seriously ill, there is something more than medical attention needed. The Catholic institutions may overdo that point. They may be
saying their prayers when a leg is being cut off. We want more
religion in the civic hospitals and in the religious hosptals, a ilttle
more scientific progress. Do not let Us haggle about the sWag.
.When we have accepted ths money whether it be tainted or not, as
old General Booth said "I will take it and wash it in the tears of
the penitents." Let us take it and let us divide it up as I think this -
resolution states fairly, on the basis of the work done for the people
in the community in which we live. I would like to have the views
of the mover of the resolution as regards the public service rendered by St. Paul's and St. Joseph's.
MR. SARGENT—Might I ask the speaker to tell us why the hospital in Victoria that he speaks of did not get the per capita grant?
CHAIRMAN—If Father O'Boyle wants to answer that he may do
so.
FATHER O'BOYLE—I would refer that to Sister Mark or Dr.
O'Halloran. I really do not know. It may be that they have not been
authorized to do so.
SISTER MARY MARK—We have never been offered it. We
would be very glad to accept it.
MR. SARGENT—I am not against the Sister's hospital getting it.
I am not criticizing it. I do not wish to be considered in the light
of taking exception to their not taking it. But according to our
Hospital Act I do not think the Sister's reply is quite fair. As you
know we have a Provincial Hospital Act. When the Sister says she
has not been offered it she is not quite right.
- CHAIRMAN—She does not mean it in that way.
—7 8— SISTER MARY MARK—We had never put in a request. Perhaps
my answer was a little short. We shall be only too gratified to accept it. We never have been looked upon as a public hospital although our services should be recognized as such. The Holy Cross
hospital refused the per capita grant, and the hospital in Toronto
refused it. I think every hospital from coast to coast refused it
with the exception of one in Victoria receiving government help.
One of our hospitals last year received a bonus of $100,000. Everywhere the Sisters hospitals are being recognized today. I think Vancouver and Victoria are the only exceptions. It may be our fault
because we have not tried to make enough effort to obtain this. We
are trying this year to remedy that.
MR. SARGENT (Hazelton)—That is the point I wished to bring
out, or perhaps the point I thought advisable to discuss, i spoke in
favor of this resolution of having the profits distributed so that they
will go to the hospitals rendering public service. I think it is a
mistake that the Sisters hospitals do not try to get the per capita
grant. It is quite simple to get it. Any hospial whether private or
public can avail itself of this grant by simply throwing their books
open for inspection by the province. I should think if the Sisters
wished to avail themselves of the per capita grant and the liquor
profits they should also avail themselves of the old grant. The
country carKquite afford to assist all hospitals of all denominations
and I would be very glad to see this resolution put in such a way
that it would take care of the Catholic hospitals as well as the
others. I do not think from the feeling of this meeting that there
will be much objection to this resolution going through as it stands,
but I would like to point out that inthe case of Hazelton we get
nothing at all. So I hope you will take into consideration a case of
that kind when this resolution comes to be decided on.
MR. CARVER (Victoria)—I think we should bear in mind what
has brought this situation about. For several years public hospitals
have been dealing with deficits. We have applied to the government
who have come through with some relief. Now the private hospitals
■ want part of the relief that has come. Let them comply with the
' law and come in if they want it. Every hospital including the
Sister's can get this if they will do so.
FATHER   O'BOYLE—Provided  they  give  public  service.     Take
for instance the case of the hospital in Cranbrook which is managed
by Sisters.    Their books are open.    I cannot see any difference be
;tween them and St. Paul's.    Provided St. Paul's is willing to do the
same thing as the Sisters in Cranbrook.
MR. CARVER—The point cannot be lost sight of that we are all
in the hole this year.
MR. GRAHAM—I think the resolution with the exception of a
little change as mentioned by Mr. Mordy fully meets the requirements. I do not think any exception should be taken in any way.
The profits should be applied on the per capita basis. There is no
question whether a hospital is in the hole or making money. There
.is no question about the per capita basis. I speak as a non-Catholic. The Sisters' hospitals are just as much entitled to the government grant and to get a share of the liquor profits as any other
.hospital in B. C. I certainly feel that this association will be derelict in its duty if it attempts to except from the provisions of this as
regards to these hospitals. I do not think my friend from Penticton has any reason to worry about the objections, judging from the
wail Victoria is always making about making the hospital pay and
the wail we hear from others. With regard to private hospitals
getting in their claims, once they put in their claims they are no
longer private hospitals. They will be dealt with on the same basis
and their books must be open the same as others.
—79— CHAIRMAN—We want a full discussion on this, that is why I
will not allow this to go to a vote tonight. We do not want to ask
if they are Catholic or Protestant. "We are cosmopolitan in our
methods. I want you to be quite frank. If you have any fault
to find it is that the Sisters do not talk enough. I hope the Sisters
know they are welcome to say all they wish.
MR. REID—It was my intention when I rose to second the motion
to say that all those who would some in would be entitled to this,
money and also to the per capita grant.
MR. ROBINSON—I do not understand the Chairman's remark
that he does not want to bring the question to a vote today. It is
necessary for me to be in Kamloops on Friday. To do so I cannot^
be here tomorrow and I think that the matter should be brought to
a vote today. As the mover of the resolution and as one who was
in Eastern Canada who has lived in this Western country twenty-six
years I feel that we are out here in a harmonious spirit. Let us get
away from this little denominational spirit that has characterised
too much the people of the East and probably in some sections of
this country. Those who fought our battles in France and Flanders
were not asked what religion they were. If a man was seriously
hurt and felt he required spiritual comfort he accepted anyone who
• happened to be there. This spirit I want to see in the West. And
in drawing up this resolution, I feel we should be big enough to
help any hospital be that hospital Protestant or Catholic so long as
it looked after suffering humanity and opened its doors and said
come in if you are sick. If you have money we expect you to pay
and if you have not money we will look after you anyway. In that
spirit this resolution was drawn up. Let me say something further.
You are overlooking a very important fact in that resolution. The
resolution asks the government to distribute the money on a per
capita basis. That is the main clause of the resolution. It says no
matter what hospital so long as it is open to government inspection
so long as it has a proper nursing staff and is prepared to open its I
doors to the charitable case as well as to the paying patient. Father
O'Boyle spoke along that line. And I would like to say in reply-
that I feel and I know the other party feel the same way. I have
friends of the Catholic persuasion, but apart from this we feel the
Catholic hospitals are entitled to share in the proceeds of the sale
of liquor.    Let me ask you to put this resolution.
CHAIRMAN—In answer to-Mr. Robinson, I wish to say we do not
want to break faith by changing our programme. I think you will
give me credit for being impartial. But as I said there are some no!
ready to speak.
MR. ROBINSON—Will they be here tomorrow?
CHAIRMAN—That does not interest me at all.    There is a resolution passed that this vote would not be taken today and I would
ask you not to insist.    Of course I am only the Chairman and youI
can do as you like.
MR. ROBINSON—Let me call your attention to another convention in Vancouver. The Conservative pariy held a convention where
important changes were made in the programme. I think we can
follow that precedent.
MR. WITHERS—I would like to point out that this programme!
was drawn up and distributed some considerable time before to all
the hospitals.    I am speaking as Chairman of the Programme Committee and if we pass this resolution, despite what was  done in
another convention, we have broken faith with any hospital that*3
intended to be here for the discussion;    I think.the matter should_
be open for discussion as settled on the programme.    I was the one I
who went with Mr. Robinson this inorning.    As a matter of fact he
—80— jj^rent with me. We saw a solicitor and I had some share in drawing the resolution up. It was our intention unquestionably to make
that resolution open so that all public hospitals—and that is a very
comprehensive term—should benefit in this. I think there is no
doubt that this resolution will be carried as it is worded. But I
do think that its further consideration should be left over till
tomorrow.
MR. GRAHAM—That may be" all perfectly true.    Bue we.have
already set a precedent ourselves.    There may be some who do not
want to stay over and I see no reason why a vote cannot be taken
on that resolution right at this time.    I move it is the opinion of
^this meeting the vote be taken now.
The secretary read the minutes of the meeting of the executive
held on the first day.
■ MR. MORDY—I will move that this meeting records that it is not
necessary to wait till tomorrow to approve this resolution.
CCHAIRMAN—It is already before the house.
MR.   ROBINSON—The  matter  is  very  simple  and   is   the  usual
■ parliamentary procedure. In order to bring the matter before you
clearly, I move that the Chair be not sustained.
CHAIRMAN—Then I rule that the vote be not taken. I am quite
prepared for any motion before the house.
1 MR. ROBINSON—I know your feelings in the matter exactly. The
resolution passed yesterday morning leaves a loophole if necessary.
I think it is the wish of the people of this convention that the vote
be taken now. I move that the action of the chair be not sustained.
"Mr. Graham seconded.
MR. LEDERS (Vancouver—I do not think it is fair to take the
vote now on account of your action when Mr. Haddon was in the
chair yesterday. This has to be discussed tomorrow afternoon. As
I represent the largest hospital in the province we should not be
treated in this way. Mr. Haddon had not arranged to be here this
afternoon.
MR. ROBINSON—Vancouver is twelve miles from here and some
of us are hundreds of miles from home.
MR. LEDERS—I would like my objection spread on the minutes.
CHAIRMAN—The motion is shall the chair be sustained or not.
This vote was then taken with the following result:     For the
motion, 32;  Against the motion,  17.      This motion was declared
^carried.
CHAIRMAN—The motion now before the house is the resolution submitted by Mr. Robinson. Are you ready to vote on that
question?
MR.   MacCULLOCH   (Abbotsford)—Can  we  talk  against  time?
■ Well I am going to talk. I just say now that Vancouver is not with
you. Some of the smaller hospitals of the upper country are not
with you. And it is going to become a very interesting situation for
the B. C. Hospitals Association. We all like to take our defeats
gracefully. As far as this question of the liquor money is concerned
we are at issue.    We in the upper country feel this about it.    We
I intend to boost our Association but we expect to get a fair share.
We feel we should have something to say about this money. If a
plebiscite were taken of the hospitals of the upper country I believe they would not agree to a per capita grant.
DR. BROWN (Nanaimo)'—It was known for some timet-hat there
—81— was a great deal of trouble about the liquor money. It is coming
out now. As far as the Vancouver! Generad Hospital is concerned,
Vancouver is within a short distance. Some of us are here at great
expense.
CHAIRMAN—You should not bring in the Vancouver General.
DR. BROWN—We do not want to have Vancouver brought over
us. We are here to exercise our free will as a hospital association.
We are here to exercise a free spirit and do what we think is best
for the institutions.
MR. MORDY—Mr. MacCulloch has stated that when this matter
comes up on the floor of the house, that it will meet with a large
measure of opposition from the smaller hospitals up country and
possibly from the Vancouver General Hospital. I do not know a
measure that did not meet with opposition. But what I would like
to know is are these smaller hospitals and the Vancouver General
sufficiently interested to go to the House and put up the opposition-
on the floor of that House? How about this matter that has been
advertised for this convention to deal with weeks ago. Mr. Haddon
was'unable to be here today but is to be here with us tomorrow. At
the same time we are all assuming that as soon as this resolution
passes this meeting the whole thing is finished and we are going to
have our share of the money.
MR. ROBINSON-—If it is coming down to voting proxies we had
better withdraw the resolution because that is not the spirit in
which we want to approach the government. I discussed this mat- ■
ter with the minister last night and I felt that what we want to do
is to strengthen the hands of the government so that they will deal
with it in an intelligent manner. We do not want to get in any rows
over the thing. We want all the support we can get. We, from
Kamloops have three delegates here. We may be entitled to have a
dozen votes but if we have not harmony our work will be of no
effect. I was told this financial matter was the one thing above all
others that this convention was called to deal with. We have a
good meeting here today. Personally I would like to see more rep-
resenatives from the Va'ncouver General here.
MR. WITHERS—Mr. Robinson appeals for unanimity. I appeal
for the same thing. It is wrong for this Association to go to Victoria with a resolution that has not been passed unanimously.. If ,
it is voted on today we know it is not going to be unanimous. There
is only one way of getting an unanimous vote and that is by voting
on the resolution tomorrow.
to  withdraw my  motion-,
MR.   ROBINSON—I  am- quite  willing
leaving it on the table till tomorrow.
Mr. Reid, who seconded, agreed.
CHAIRMAN—I think that is one of the wisest things you ever
did.   I did not want to break faith with any hospital and that is why"
I forced the issue and you were taking the responsibility.    When the
meeting ruled against me then I am not responsible.
MR. GRAHAM—I have an objection to the business being laid
over till tomorrow. The question of liquor profits should have been
left alone. The whole proposition is in such shape that it will be
impossible to handle it.
CHAIRMAN—That was covered the first morning.
MR. MORDY—I would like to draw attention to the final sentence
in article 12 which states distinctly that votes by proxy will not be
allowed.    Only the members present can vote.
DR. BROWN—I do not think that that applies to hospitals. Hospitals are entitled to so many votes.
-^82—
jj :   MR. MORDY—I absolutely stand en the position I have taken.
The meeting then adjourned.
At the conclusion of th eWednesday afternoon session a most delightful entertainment was accorded the delegates by the Board of
Directors of the Royal Columbian Hospital.
Motor cars were in attendance which conveyed the guests to the
Burquitlam Country Club where supper was served followed by an
jfijformal dance.    Dr. George Drew officially welcomed the members
of the Association all of whom greatly enjoyed this pleasant break in
the strenuous work of the Convention.
EVENING   SESSION:   WEDNESDAY,   AUGUST   80TH
This session was devoted to the discussion of Economy. Dr. G.
Bell Brown, Nanaimo, occupied the chair.
An introductory statement was made by Mr. R. B. Leders, Purchasing Agent, Vancouver General Hospital, entitled "Hospital Waste."
HOSPITAL  WASTE.
What does Webster say about waste?    To bring to ruin, to destroy.
I intend to be brief, citing a few incidents which have come to my
knowledge from observation, visits to other institutions and conversations with officials from different parts of the country.
The following will not apply in the same degree to the smaller
hospitals.
First consider the use of gauze. Are the doctors when doing a
dressing careful? Until such time as there is co-operation.of the
doctors and special nurses, waste cannot be avoided.
Do the nurses when making up the ether masks in the Operating
Room, for instance, take care to place the gauze in the frame carefully, to avoid waste?
Absorbent Cotton
Is the proper consideration given this commodity? Do we not
use a good grade of cotton many times when a cheaper article, such
as Cellu Cotton, or a second grade, could be used to advantage, and
in some cases better results obtained. Compare prices. I do not
quote actual, but comparative prices. Good grade, say 40c, second
28c, or Cellu 31c. Ask your jobber for prices, and you will get ah
idea of what you can save.
What extraordinary uses zinc oxide adhesive is put to. Nurses
^mend their boots, paste notices, frame cards, parcels for postage
have been strapped with it. I will say that the manufacturers advertise that all these things can be done with it, but why should the
hospital have to pay for an article which is used so lavishly. Why
not instruct the nurses in its proper use.
How many times have we seen a note scribbled on a printed form
that costs anywhere from $2.25 to $25.00 a thousand.
I have seen mustard plasters made on temperature charts. What
do they cost, even if you have your- own cut or stone, which your
printer keeps only for your use.
The unnecessary changing of shelf paper, when dusting and turning ever would do, when you consider newsprint (which is the trade
name) costs eight to ten cents a pound, what saving could be affected by consideration.
Using hospital stationery for personal correspondence. Why
should the citizens pay for my letter paper and envelopes, and is it
according to Hoyle? .
—83— You will also find from time to time new record forms are
thought to be necessary. After these have been in use a short time
it is found that the form does not just suit the requirements. It is
then discarded or used for memo pads.
What do we find has happened when a table or stand cover comes
back from the laundry badly stained, some one had carelessly handled iodine or an ointment.
Again someone has carelessly left an indelible pencil in a pocket,
result, perhaps a whole washing is more of less affected.
I have seen pillow slips used as clothes bags and uses of that kind.
If an accident happens the ink bottle, a hand towel is taken to
wipe it up. Almost every day towels are picked out of the garbage
pails.
Did it ever occur to you that to use a fork for a cork screw, a
knife for a can opener or screw driver, was a comman occurrence.
I have seen many. Then again the poor unoffending spoon is distorted out of all recognition and used for hot oil or something of
that kind.
The poor teakettle is left on the gas stove without sufficient
water. The Head Nurse sends it down to the Steward leaking.
When questioned as to what happened, replies, "I cannot understand
what happened. I only got it the other day." Foot tubs, urinals,
solution basins, all meet the same fate, coming in contact with a
harder surface, the enamel is chipped or seam sprung, and has to
be renewed.
From the number of renewals and very large accounts for this
commodity, there is an evidence of carelessness in handling dishes.
If the person responsible for the maids would stay within hearing
distance of the ward kitchen and hear the way. things are handled,
I consider there would be only one result: namely, the removing of
the maid and lessening of breakages. No one is held responsible,
therefore the proper care is not exercised.
I venture to make a recommendation, get your Women's Auxiliary to give you a mechanical dish-washer. One may be seen in
operation at the Y. W. C. A. in Vancouver.
'On one occasion, one doen metal chart backs were found in the
garbage can. What conclusion is^one to come to? Were they sent to
the incinerator by mistake or without thought as to whether they
could be washed and painted and made as good as ever?
Day after day perfectly good articles such as -towels, pillow slips,
etc., are found, as referred to previously, knives, forks, salt and
pepper shakers.,
A big expense is incurred yearly by the habit of eating between
meals. I have heard the point debated, but could never be convinced
that this is good business.
The laborer working hard with pick and shovel cannot leave his.,
work to do so, then why a person at a less laborious task?
"When you consider the-number of nurses, orderlies, cleaners and
staff in all departments, if say one hundred of these were to eat an
apple, orange banana, or a few biscuits a day, what would the total
cost per year mean. What would the manager of a Grocery DeparjS
ment in a Department Store think if his clerks took a bar of chocolate from the shelf and ate it?
Economy should be the watchword, and the reasoning such as
this, when using an article, no matter what, Gauze, Cotton, Food
stuffs,  would  I  be  lavish .or  otherwise  if  I  was  paying  for  th|§S
article myself?
—84— Miss Grace Kerr, Superintendent of the Ladysmith General Hospital, then dealt with the subject from the nursing point of view.
ECONOMY   FROM   A   NURSE'S   POINT   OF   VIEW.
Nurses and other'workers in the hospital can do much to promote
economy by being observant, painstaking, and careful. It -is more
economical to purchase a good quality of food, and to see that it is
properly cooked, and daintily served. A little consideration of patients' likes and dislikes often prevents food being returned untouched and thrown into the garbage pail.
The turning off of gas and electric light when not in use. Sometimes a nurse will forget a catheter that is put in to boil with the
result that the catheter is destroyed and the basin scorched.
Mattresses and blankets need special care. These ought to be
well protected when in the vicinity of wounds or drainage.
Rubber goods require special care. They should not be over
boiled, they should be kept free from oils and greases and not punctured with pins or sharp instruments. Rubber sheeting ought not
to be dried on hot radiators.
Watch must be kept on all stationery supplies, nurses ought not
to use history sheets for note writing, nor any other purpose than
' that for which they are intended.
The plumbing ought to be respected. Taps should not be left
running, especially those supplying hot water.
Leaking taps ought to be reported and repaired promptly.
Great care should be taken that, no rags, newspaper, etc., are
allowed down drains, this often causes a good deal of inconvenience
as well as expense to the hospital.
Mr. J. J. Banfield, a member of the directoriate of the Vancouver
General Hospital, indicated the point of view taken by Boards of
Directors as follows: j
I have the honor to represent a hospital which shows an annual
deficit of about $100,000.00. It-may appear that economy is not
considered by its directors, but the fact is that economy is considered. The heavy deficit is caused by various departments maintained for the benefit of the public. We are offering a greater
service in our departments than the public are paying for, and the
amount of returns received from the Government and city are not
sufficient to meet their proportion of cost.
That the question of economy in management, and change of organization will require to be considered by the directors of our
institution is quite apparent.
Through a period of years we have our departments running on a
standardization basis. The standardization that we have adopted
placed our organization in the front rank on this continent but from
an economic point of view the organization is too expensive for the
community. To manage a hospital and make money is beyond the
knowledge of the directors of the Vancouver General Hospital.
Judging from an advertisement which I have read, it remains for
St. Paul's .Hospital of Vancouver to show a surplus, and to one
of their representatives should be given the handling of a subject
dealing with economy.
I note that this subject will be dealt with by the doctors, nurses,
and the business managers, and they will discuss matters affecting
their various departments. The directors of a hospital are governed by them and as they discuss the various departments, the directors may receive some pointers as to economy. In a humble manner
we might suggest to the doctors that the class of medicine pres-
—85— cribed to the patients is too expensive and that the institution cannot
afford to pay for medical experiments, and that they should adhere
to the British Pharmaceutic standard. Should any hospital make
this recommendation there is no doubt that the medical men would
immediately co-operate as they are only desirous to have their
attention drawn to economy. For the surgical department, we might
suggest that the surgeons purchase their required instruments to
operate with, and in this way help hospital economy. We might
also suggest that as the hospital centralizes the work of the doctors
and is practically a clearing house for the-patients that they contribute an annual fee towards the institution and thereby help to
economize. As. directors, we would be at once assured that these
suggestions are not practical, and the simple unsophisticated dir-
ectors would immediately reply: "carry on."
There is one suggestion that might apply to the Vancouver General Hospital, as we are an open hospital and have over two hundred doctors attending patients and following them into the public
wards, thereby taking up the time of our nursing staff and house
men, that it might be in the best interest of economy if the public
wards were closed and a medical man paid for this special work.
This suggestion would no doubt be opposed by the medical men, but
from an economical point of view would work to the advantage of
the hospital.
Now in regard to the nurces: This is a branch where economy
might be instituted with the co-operation of the nurses. Suppose
that th3 nurses offered to organize a sisterhood of nursing, and give
their services free for the benefit of humanity, and the betterment^
of the race. This would effect a great economy. I feel confident
that this tuggestion only needs to be drawn to the attention of
the nurses, then there will be no. further requests for increased salaries, but all will work for the love of the profession and our hospitals would be immediately relieved of heayy charges and from an
economical point of view would help to put the hospitals of our
Province on a proper financial basis.
Regarding the business managers, they will tell you of their
troubles in collecting accounts in order to satisfy the impatient merchants who furnish the necessary requirements for the patients. ,
The one saving that could be introduced and which comes immediately under the business managers is that of the dietician, who
daily orders all the luxuries of the season and the choicest cuts of
meat for a special patient, orders squabs and frog legs in order that
the patient may be satisfied. If all those luxuries were cut out,
economy could be effected in hospital administration.
In reviewing economy from a director's point of view, and from
my experience of 20 years on the Board of the Vancouver General
Hospital, I can say that there js no waste and that co-operation
exists in securing economy in all departments and that the troubjg'.
is not there. It is in the allowance from the Government, the city
and from patients, not being sufficient. The great loss comes from
non-paying patients in our public wards. We are operating public
hospitals and economy does not weigh against the general good.
Public hospitals were not organized to make money. The first consideration is good work. Economy must not impair efficiency.
Hospital directors keeping these points in view, and also keeping
their institutions free from political and personal influence confer,
a benefit upon humanity.
Dr. W. B. Burnett, Vancouver, speaking from the doctor's standpoint, said:    It has been pointed out to you that the hospital is nog'
run as a money making institution.    Thank God, money'is not the
world.    Today we believe that community ser-
the highest function to which any one can apply himself. -
—86—
biggest thing in the
vice The hospital represents that idea in an organized form and it is the
pioneer in that idea. But unfortunately some people have been
laboring for many years under a delusion and say that a deficit is
a disgrace. ' What does a large deficit mean?    Simply and solely
Tthat the hospital is short in its accounts? No. These institutions
are doing a tremendous amount of public service for which they
are not recompensed. A question as to how that deficit should be
met. One or two suggestions have been made. For instance it was
suggested  that the doctors and nurses might  use  a  certain  gauze
'which would save a tremendous amount. I will admit that I have
thought for a long time that expensive gauze was frequently used
when cheaper materials would do. I also admit on my own behalf
that there is a certain tendency to use more material than could
be got along with but I honestly believe that the real waste is very
.slight indeed. The amount of gauze that is soiled and thrown away,
the amount that is used unnecessarily is really quite an amount,
but the percentage of. waste for the service rendered I think is
really very small. The question of the use of standard drugs has
more or less seriously.been suggested. You all know, there is no
doubt in the world, that there is a tendency to use more expensive
things than we should. Speaking of adhering to the pharmacopeia
in the use of drugs is all very well, but it is so very conservative
that it is always a little bit behind. Other preparations are constantly in use different to the standard of a few years ago. No doctor
in private practice pretends to adhere to the pharmacopeia in the
use of drugs. Fortunately there is a great decrease of the use of
drugs today because we find there are many other means of helping a patient rather than the drug method. It was suggested that
there was an enormous waste in the kitchens but I really believe
.It is very slight compared with the average home, and I believe the
. breakage in the hospital will compare very favorably indeed with the
ordinary home. True it is enormous in a big institution, it comes
to a lot of money but when you consider that people must work
rapidly it is not high, relatively speaking. A deficit to an institution like the Vancouver General or St. Paul's is not altogether
a detriment to the hospital. It is said that the nurses are not giving their lives for the good of the thing. Cerainly not. How could
they? B ut I think any business man who will compare the service
which he gets from his staff, even his trained staff, with that rendered by the nursing staffs in hospitals, he would be very glad to
swap. There are two or three things I would like to suggest from
the medical standpoint in which economies might be practised in
I the hospital. The amount of hot water that is wasted around the
average operating room represents a great amount of fuel in the
furnace room. That is not quite the fault of the doctor or of the
nurse. Taps are constantly flowing in the operating room, for a
regular deluge of water must flow in order to get a fair mixture as
to temperature. That is absolutely unnecessary. It can be prevented without any difficulty at all by a half-competent plumber,  or
"better still, by a man with a little common sense and a monkey
wrench. All our taps are so arranged that, when, you turn on the
hot water, there is so muchmore hot than cold that there is no such
thing as getting a mixture. The fuel which is used to heat the water
amounts to quite an item in the course of a year. Then the question
of soap. I want to suggest that St. Paul's Hospital probably gets
along with one-third of the soap the Vancouver General uses. Why?
Because the soap St. Paul's uses is used and the soap at the General
goes down the sink. That is not the fault of the nurses. That is
the fault of the proportion used in mixing it. The soap I have seen
used in three hospitals up country is not the proper kind. The
great bulk of the soap goes down the sink. Another point I wish
to raise is this: Hospitals frequently refuse patients because they
have not a private ward when it is asked for.   And they are put into
| the public ward if they are admitted at all because there are not
—87— sufficient private rooms to accommodate the patients. Thus a source
of revenue to the hospital is lost. You have no right to expect
revenue frm the public wards. If a patient wants a private ward he
should get it. The hospitals ought to go ahead along that line.
When the hospital misses an opportunity to please someone who is
prepared to pay more than the ordinary the management is to
blame. The hospitals have no money for building funds and the
thing drags along until some day something happens. What do they
do? They enlarge their public ward space and the private ward
patients are neglected. I think the most expensive ward we have
is $8 a day. In the States and in Eastern Canada there are many
where the rate is from $12 to $15 a day. And if anyone is prepared to pay that because he is getting something better why not let
him do it? It doe3 not cost very much to provide a private ward.
It pays for itself many times over.
MR. GEORG*E MacGREGOR (Victoria)—A note was struck tonight that was not dwelt on long enough. My experience in public
hospitals is that the directors, as a board, do not function as they
ought to function and do not use enough energy. I do not know
whose fault it is. I speak now particularly of the larger centres,
though I understand some of the smaller centres are in the same
fix. I am not going to mention any hospital in particular, but I
am sure it applies to nearly every hospital. For the last fifteen or
twenty years they have not had accommodation for people willing to
pay for it. The private hospital was given an opportunity and it
made good. We as public hospitals have no kick coming. The
private hospitals spent the greatest amount of money and took the
most trouble. Let me tell you now, and I.want to be frank about
it, that the time has come for the directors o bring pressure o bear
and to try to place the public hospital where it should be. We are
to blame because we have not taken enough interest in regard to
private accommodation for those who are able to pay for it. There is
no other business in the Province of British Columbia that has
been so neglected along the lines I have mentioned. The public
hospitals have had a great opportunity but have taken no advantage
of it. There are a great many wealthy people in Victoria. They
get sick and some of them come to our hospital. Up to last winter
the question was: what were we going to do with them. We must
as directors take that responsibility. We must have accommodation
for private patients.
MR. E. S. WITHERS—As you know I am not prepared to discuss
this question in an official way. But there are one or two things,
that occur to me. First ,the architect of your hospital has got a
great deal to do with the practice of economy in the hospital. There
are thosj who are considering construction in this province at the
present time. To them I would say: do not fall for any pretty plans,
that an architect may draw up. That does not mean everything by
any means. In some respects we have a nice hospital here but there
are sonic things that occur to us now that we know could have been
improved upon had we known a little more at the time of construction. The practise of economy depends in some measure on
the layout of the institution. Centralize your work as far as possible frcm an administrative point of view. See that your kitchens
are so located that you can transport your food easily to the ward.
You will then find that you can economise in the staff necessary to
do the work in your kitchen. You can economise in your nursing
staff who must transport the food to the patients and you can econ-'
omise also by getting the food to the patients, hot. Because when
that food is not served hot it is not eaten, half the time, and thel.
patients are not benefited. I think the matter of serving the food
properly is a very vital one. I wish we had more money to spend on
food carriers. There are some I noticed advertised in the hospital
magazines  that look to me the ideal thing.     I think  Victoria is1
—88— thinking of getting something like them. That is a new phase of
economy but it is economy just the same. Then again when you
are visiting your garbage cans it won't hurt to dip your head into
the refrigerator. Take a look there. See that the requisitions sent in
by your nurses, are being made out with some degree of intelligence. There is a grave tendency on the part of the nurses to
order bread for say a dozen patients, when six of those patients have
gone home. The consequence is that bread goes to the ward and
eventually you wjll find it in the garbage can. I think a close observation of your refrigerators is going to assist in economy. Mr.
Leders referred to eating between 'meals. Of course we do not want
to restrict our patients or nurses or to be niggardly, that is the last
thing in the world we1 should do but at the same time you have to
watch things. Otherwise you will find a lot of waste goes on
through the too prolific use of certain foods such as oranges which
will be handed round to every one Who wants them at any time of
the day. We restrict that by service from the diet kitchen. The
same thing with milk. You will find when you requisition a supply
of milk there is a large supply throughout the day in the various
wards and in the refrigerator next morning you may find the milk
sour.    These things are well worth watching.
MISS RANDAL—I have had great pleasure in listening to these
remarks as I see many hospitals in British Columbia. I think that
one of the greatest sources of waste in hospitals is the poor grade
of article supplied. Now that is particularly true along food stuff
'lines. You will find, as I have, many times that the butter and
eggs are not what they should be. In this question of food, those
who have spoken have not taken the view that food often takes the
place of other forms of treatment. The operating room, the most
spectacular feature, of the hospital, gets everything it wants. But
for the patients throughout the hospital especially the medical and
the chronic patients, the provision of suitable food is most important.   '
MISS MacKENZIE (Victoria)—I think if we taught our people in
the kitchens and our graduate nurses, the proper amount of food
that should be ordered for a number of patients, such as butter,
milk, cocoa and eggs, there would be more economy exercised. You
will find they will take pleasure in ordering the proper amount.
- MR. CARVER (Victoria)-—I believe we realize that we have got
to buy the best of food as it is the most economical. We get the
best and it is better and cheaper in the end. We have very capable
officials and we have confidence in them. We drop in to see how
things are going on. We cannot quite compare a hospital with our
business, we have to take care of the sick and give them the best
we can.
MRS. SMITH (Penticton)—We try conscientiously to keep down
expenses.
MR. BINGER (Kelowna)—It would be rather interesting to hear
from the housekeeper of the hospital we are in.
MRS. SIMPSON (New Westminster)—I am sorry I am not prepared to speak on the subject. I look over the requisitions from the
wards. I see that a certain number of patients is to be provided for
and I use my own judgment what, to send up. There is very littty
waste.
CHAIRMAN—In Nanaimo our orders are to give the best food to
the patients.    We pride ourselves on that.
DR. STORRS, St. Paul's, Vancouver—Speaking of soap, we have
a very good way at the hospital of using soap yith very little waste.
- As perhaps most of you know it is a thick green soap and sometimes
—89— it does not flow at all, but what you take is used and it does not
go down the sink. I agree with everything that vjas said about waste
of hot water.
DR. DARBY—How many patients have you to have before you can
use a dish washer to advantage?
CHAIRMAN—I am very glad that question has been asked because I am interested in that. If some person has information to
give we will appreciate it.
MR. MacCULLOCH—If I have my way I would not have a dishwasher. There is not a dishwasher in the market that is a commercial success for a small hospital.
MISS RANDAL—I have found the Crescent washer satisfactory.
In a small hospital I should think that it would be a waste not to
put it in. Hotel keepers have assured me that a perfectly marvellous saving was effected.
MISS MacKENZIE—I visited a large hospital in San Francisco
and large hotels and they were all satisfied, with dish washing
machines.
MR. HADDON—In the Vancouver General we have a dishwasher
and it has been operated ten years. It is rather inadequate now.
We have a dishwasher for the main dinging room that accommodates
approximately 250 nurses. The washer referred to is the one mentioned by Miss MacKenzie.
DR. BURNETT—I want to mention the question of alcohol. I
believe the hospitals can buy it cheaper than the druggists can. At
the same time a great deal is used in hospitals and a good deal is
being wasted. Nobody seems to have recognized that it costs a
great deal of money. Could not a saving be effected by using some
denatured alcohol? There is one other thing, that of eating between
meals. I do not know who eats between meals except the nurses.
Regarding this there is a difference of opinion. I want to say a
word for the nurses especially for nurses who are on duty at night.,
It is impossible for them to have regular meals and if a nurse is not
allowed some privilege in this connection it is a great hardship.
The discussion on Economy was then concluded and Mr. George
MacGregor took the chair. He referred to the accident which had
taken place in the mines at Cumberland and which bad necessitated
the departure of Mr. Chas. Graham and Mr. T. Mordy from the convention. Dr. Brown moved a standing vote of sympathy which was
passed unanimously.    The meeting then adjourned.
MORNING  SESSION:   THURSDAY,   AUGIJST   31
The session commenced at 10 a.m., Mr. George MacGregor presiding. The report of the special committee appointed to consider
the wisdom of re-distributing the province in order to assure representation on the Executive Committee to every district, was called
for and was submitted by the convenor, Mr. E. M. Cook (Chemainus)
as follows:
Your Committee suggests that the item in the minutes adopted at
this Convention, to divide the Province into districts for representation on the B. C. Hospital Association Executive be adopted, so that
all sections of the Province shall be represented on the Executive.
The districts suggested are similar to those proposed by the B. C.
Medical Association, viz., Vancouver Island, Vancouver, Coast Mainland, Fraser Valley, Yale-Cariboo, Okanagan, Kootenay East, Kootenay West, Grand Trunk Pacific.
(Signed) E. M. Cook, R. S. Sargent, A. MacArthur.
Mr. Carr Hilton seconded the motion.
—90— DR. BROWN—I would like to speak to that because I think that
theoretically this is a fine thing. There are a great many things
that theoretically are fine but when they come into practice they
" fall down. One difficulty is getting people to come from far off
parts of the province at attend meetings of the Executive and failing their attendance we cannot get the Executive to function in a,
correct manner.    Our province is an expensive one to travel through.
MISS JOHNS—In the short time I have been acting as secretary
I have already sensed, I do not know whether the rest of you have,
a certain feeling on the part of a few that there is tendency to centralize a large part of the work of this Association in the larger
centres, in Vancouver particularly. Victoria is also accused. Dr.
MacEachern and I thought there was a great deal to be said for
making it impossible for any part of the province to feel slighted in
the matter of representation on the Executive. It would seem to
me that a quorum could be secured in Vancouver or Victoria without great expense. On the other hand I do not wish to impose my
view upon this meeting though possibly the secretary is better able
to judge than anyone else concerning the feeling of some of the
members that a great deal of the business is stereotyped and prepared beforehand and is more or less cut and dried. That impression could be done away with if each district were obliged to have
their representatives on the Executive.
DR. DARBY—It is very nice to have representatives from every
district as evenly as possible, but this is the first time that I have
been able to get away. If others have the same trouble as I do
little or no progress could be made. I think representation has^ been
divided very well. We have Dr. Wrinch as president and he is one
of the furthest away and he has managed very well judging from
the progress of the Association. Outside of the nursing staff at
Bella Bella I am the only one to represent that hospital.
MR. CARVER (Victoria)—Possibly these districts could be represented by increasing the executive.
MISS JOHNS—The constitution calls for an Executive of ten.
If there were a re-distribution the number would not be increased:
CHAIRMAN—-The more I see of this the more I think it is the
proper thing to do.    Each district will have to appoint their own
member on the Executive.    If they do not attend to it, it is their .
own lookout.
MISS JOHNS—Is not a.n amendment necessary? It could not be
done before the next convention.- 3y^£
The report was adopted.
A general conference on Domestic Management and Personnel
then took place, Miss Ann McArthur (Nelson) presiding. The following paper was read by Mrs. M. P. Simpson, housekeeper of the
Royal Columbian Hospital on the Management of Domestic Personnel:
My experience as housekeeper in the Royal Columbian Hospital
for the past three and a half years has not been at all disagreeable
owing to the fact that I have always had the co-operation of the Superintendent of Nurses and of the Manager, and have had absolute
control of my department. When engaging domestic help I tell them
as near as possible what I expect of them and will not allow any
rowdyism. I treat them in a motherly way instead of as a slave
driver for the day of slavery is past, and a kind word with a little
praise where it is due goes a long way in getting better work and retaining help longer. When I meet them down town I speak to them
and if they are on the car, sit beside them, and by so doing make
them feel I have an interest in them.    I am very sure that they are
—91	 just as necessary in a hospital/as a nurse or anyone else, for we are
all servants when paid for our services. If a housekeeper keeps
changing her help frequently there certainly must be something
wrong with her for surely some of them must be some good. So my
advice is to change the housekeeper. Since coming here I have had
vrey little trouble with domestics owing to the fact that the working
conditions in this hospital are second to none. In the first place,
the helpers have comfortable living quarters and it is the duty
of each maid to keep her room clean, the bathroom being cleansed
every day by each maid in turn, a notice to that effect hanging in
the bathroom.
Every ward kitchen has a set of rules giving the daily and special duties pertaining to the maids' work, thereby saving any friction
with the nurses. At one time., a maid would report ill when there
was very little the matter, probably tired from being at a dance, so
a notice was posted in the domestic dining room that anyone ill
must be reported at once and taken to the ward. That had the
desired effect for they were just about as much afraid of going to
the ward as if they were going to have the bubonic plague. Now
they are really ill before staying off duty.
We are working on the eight hour day basis, that is giving three
hours off every afternoon. Bach maid has an afternoon a week and
every other Sunday afternoon and is relieved of her work by a
maid designated for the purpose. As an encouragement for help to
do their work well and retain their positions, the Directors of the
Hospital allow any domestic two weeks' holidays wiht pay after they
have worked here one year. They also give the employees a dance
at Xmas, providing music and refreshments, which they all enjoy.
Just to bear out my statement that the working conditions are
appreciated, we have 17 out of 2 6 employees who have been here
from 2 to 5 years, and would'have more but five maids were married
last year, which goes to show that some men are good judges of
efficient maids.
MISS TROOD (Vancouver General Hospital)—I have been asked
to speak on dietetics and the dietetic departments of hospitals both
in the larger and the smaller hospitals. Let me first of all outline
the work and its duties and responsibilities. It is a department that
is closely connected with all other departments; so it is necessary to
have the closest co-operation of the superintendent and the nurses.
Each hospital has problems of its own which must be solved, but
the kitchens seem to be most satisfactory if centralized. The food is
prepared in our central kitchen and then in a larger hospital of over
one hundred beds it should be distributed tothe serving kitchens.
In this way the food can be handled much more economically. Any
food that is left over can be used in some way and it is nbt necessary
to have as many employes. For a hospital of over a hundred beds
it. is satisfactory to convey it to the wards by means of dumb waiters
or a food wagon. In the smaller hospitals it usually seems to be
more satisfactory to have it served direct from the kitchen. During
the service hours it is necessary to have additional help and nurses
who are taking their practical training in dietetics, should be there
to assist. Let me refer to the teaching. It is necessary that the
nurses have some training along this line to enable them to cooperate with the physician, from the metabolism standpoint. Then
again a nurse may be called on to prepare a meal. It is very essential that they know the fundamental principles of cookery. This
should be an important part of the curriculum. They Should take
this up in their probationary period and then as they go to their second or third year they will know more and they will he more ready
to co-operate. We look upon the training in the diet kitchen as
laboratory work in which the nurses have the opportunity of learning more of the work and putting it into practice.    The importance
—92— of metabolism work cannot be over-estimated, and I realize that in
the smaller hospitals it constitutes a serious problem. How is that
problem to be met? The study of food is a study in itself, but it is
sometimes necessary in the small hospitals for the lady superintendent to have charge of many things though it is better to place the
kitchen in charge of a person who has made a study of it. Of
course you will realise that in the Vancouver General Hospital we
have a limited staff and prepare from four to five thousand meals a
day, it would be impossible to give a course including chemistry,
bacteriology aiid the study of foods. We endeavor to give the pupil
nurses some training along this line, and we hope before long to
give them more than they are getting at present. We also have a
post-graduate course for pupil dietitians. With regard to the help '
I have found that the secret of handling domestics is to give each
one responsibility. Make each one feel that he or she is part of the
institution and that their work is important.
MRS. SIMPSON-—I agree with Miss Trood that they should be
given more responsibility. It would be better for them and for the
hospital.
DR. DARBY—How much Oriental help is used in the kitchen?
MISS TROOD—At the Vancouver General no Oriental help.
MR. CARVER—About a year and a half ago we had a Chinese
staff at the Jubilee Hospital in Victoria. We thought it could not be
replaced but now we have a white chef second to none and we could
not get better service.
MR. BINGER—I am afraid I am going to be in the minority. Since
I have been 'secretary of the Kelowna Hospital we always tried to
get white help. We got so sick of it that we came to the conclusion
that we would employ Chinese labor. Since the Chinese have been
there, there has been great satisfaction. The cooking has been
better and the work has been done better and the place has been
kept scrupulously clean.
DR. BROWN—We have no Chinamen. We think it is possible to
live without them.
MRS. SIMPSON—Do you pay the Chinese in Kelowna the same
wages as the whites?
MR. BINGER—Yes.
The discussion then concluded and Mr. George MacGregor took
the chair.
Dr. H. C. Steves, superintendent of the Provincial Mental Hospitals, read the following paper on "The Care of Mental Diseases in
British Columbia."
Mr. Chairman, Ladies and Gentlemen of the British Columbia
Hospitals Association: It is indeed a pleasure for me to come before you with the subject of the care of Mental Diseases in British
Columbia, for it shows me that you in hospital work, and we hope
also many persons not actually in hospital work, have come to recognize the mentally ill as persons actually ill and in need of treatment and the institutions provided for their treatment as special
hospitals where proper facilities are provided for treatment and not
as places where the mentally ill may be safely disposed of and forgotten.
You as hospital executives will be interested to know how the
staff of our mental hospital is organized and for this purpose I have
brought our organization chart for your inspection. You will see
that it is not essentially different from the General Hospital although
perhaps a bit differently arranged and slightly different terms used
in designating positions.    Our staff at the present time consists of
i*tuH—83— six physicians and myself and two hundred and eightly of a staff.
You can readily see that there are, therefore, many staff problems
alone to meet and that the person who keeps harmony between departments must have, at any rate, occasionally, some difficulties to
overcome.
Our Mental Hospital is working under some handicap at the present time oWing to the spreading of our organization. With a portion of the organization at the old hospital in New Westminster, a
portain at Essondale, and a portion at Saanich, you can readily see
how administrative problems would be increased. We hope, however, that this will be remedied in the not distant future and enable
the whole institution to be brought together at the new hospital site
at Essondale.
As the general hospital is frequently the first one to receive a
mental case it seems fitting that I should briefly remind you of the
legal requirements for the admission of a patient, to the Mental
Hospital. I would especially ask you to note these requirements as
they are very important indeed and, without complying with them,
a patient cannot be admitted to the Mental Hospital. Improper attention to these requirements forces us to refuse admission of the
patient and often cause much unnecessary inconvenience and annoyance. The patient must be examined and certified as insane on
regular certificates in form "B" of the Mental Hospitals Act by two
regular physicians.actually in practise; form "C" giving general information concerning the patient and his condition and requesting
his admission must be completed by the nearest relative or person
who is responsible for the patient and lastly, and most important
of all, is the magistrate's order of committal in form "A." Without
this order we cannot admit a patient so that it is very important
indeed that this form should never be forgotten. Our mental hospital law provides for the care of the feebleminded under the same
provisions and by the same process of committal as the insane and it
is therefore unnecessary to make alterations in the committal forms
to cover this type of case. Feebleminded children are cared for in
a separate unit of the hospital apart from the mentally ill, but unfortunately, owing to the crowded condition of the hospital, we are
unable to segregate the adult feeble-minded.
The mental hospital being purely a provincial hospital receives
only residents of this province, but by special arrangement with the
Dominion Government, the mental cases from the Yukon. I would
ask you to keep this point in mind as it not'infrequently occurs that
visitors from Alberta and adjoining provinces become ill and are
sent to us instead of being directed to return to their own province
for  treatment.     There  is  no  arrangement  between  provinces  for"
officially removing  patients  and  this  province is  not  infrequently
saddled with the 6bligations of other provinces by officials committing cases to our hospital which rightfully should be sent to their
own hospital for care.
During our hospital year ending March 31, 1922, we had under
treatment 2137 patients; 1606.45 daily average in residence. Of
these 47 8 were admitted during the year. It may be of interest to
you to know something of the origin of these cases. The facts
brought out here may assist you to understand why our Dominion
Immigration authorities are-endeavoring to scrutinize the immigrant so closely and perhaps one of the reasons why they are not
rushing headlong into a wide-open Immigration policy. Only 35.9
of our admissions were born in Canada; 21.6 were born in England,
10.7 per cent, born in Scotland, 7.3 per cent, from the United
States with almost all other countries contributing lesser quota to
make up the total. Do these figures not impress you with the fact
that our country should carefully seleet its immigrant?
—94— How  Are  Mental  Cases  Treated?
The days of custodial care of the insane with little hope or thought
of their future has happily passed forever and in its place has
come the Active Hospital where the insane are received as persons
ill, and not possessed of devils. Upon arrival at the hospital they
are received by a physician who, whenever opportunity permits, gets
a full history from the escort. The patient goes to the receiving
ward, is bathed and put to bed. He then receives a thorough' physical examination by the physician, all physical defects are noted
and treatment instituted to correct them. Samples of blood and
urine are examined in all cases and spinal fluid; X-Ray and other
special examinations made in cases where there is any indication
that it will reveal anything pathological in the patient. In addition
to this" work of the general hospital type the special work of a mental
hospital is carried on. The physician obtains details of the patient's ancestry, of his own life, occupations, his movements from
place to place, his hobbies, likes and dislikes, his ideas and his
reasons for them; if he has delusions, what basis are they founded
on and what element of truth do they contain, in fact, an effort is
made to completely know the physical makeup of the patient and to
learn his mental make-up—to know the whole patient better than
he knows himself. This takes much time, patience and persistent
effort for many cases are very difficult to win and the friends very
diffident and evasive in assisting.
When the physical condition is satisfactory and sufficent study-
of the patient has been made to form some opinion of his condition
our greatest therapeutic agent in mental illness, viz., occupation, is
invoked-—an occupation suited to the physical strength, mental
health and mental powers of the patient is sought and here begins
the return to health of those cases which recover. The pharmacy
of the mental hospital is then not the shelves filled with pills and
powders but the place where patients may be occupied, interested,
forget their troubles both real and imaginary in the pleasures and
interests of their new-found work and friends. To this end a mental
hospital must provide every conceivable type of occupation and in
our hospitals you will find this exists. You will find our patients
.taking medicine in the carpenter shop, shoe shop, tailor shop, machine shop, sewing rooms, blacksmith shop, bakery, kitchens, .corn
fields, flower gardens, on the baseball field, tennis court, concert
hall, at the movies and a very great many other places where the
constant thought is to improve the health of the patient and return
him to society, a useful citizen. - This is not always an easy task and
one which receives much unfair criticism from persons not familiar
with the Hospitals. You are welcome to visit the Hospitals at any
time and learn for yourselves.
What Are Our  Results?
I have no doubt that many of you without thinking would answer what can they be, but when I remind you that our statistics include the feeble-minded, which might be paralleled to the advanced
malignant disease in a general hospital, you will have to admit that
our results are perhaps not so far behind those of your excellent general hospitals.
Last year we discharged recovered 96 patients; improved 135;
that is, 48.3 per cent, of our admissions were cured, or helped sufficiently to return to a place in the community. In addition, 43
patients were discharged unimproved, either going to other institutions or private care. We thus discharged 57.32 per cent, of
our admissions last year. The death rate will also compare favorably I think. Last year this was only 5.33 per cent of the number
under treatment.
There are many other features of interest and importance to be
—95— gleaned from a study of the statistics of our hospital and I would
like to direct your attention to a few of these. I think the most
important of all is the fact so clearly shown that patients' get the
best results when placed under treatment early. Those cases ill
less than one month prior to admission show by* far the greatest
percentage of recoveries and clearly demonstrate the great advant-i
age from early treatment. Any steps which can be taken to familiarize the public with the work and results of the modern mental hos-x
pital and to dissipate the old traditions so fixed in the minds of
many will react most favorably in building up a confidence in the
hospital and react beneficially upon the patients.
A second fact which opens up a very broad field and one which I
cannot attempt to discuss today is that relative to the feeble-minded.
It may startle you to know that 11.9, almost 12 per cent, of our patients last year were either idiot or imbecile. Hopeless cases, forever a care on society, these represent only the cases which were
difficult and troublesome at home, there are many others in our
province. Does not such a condition demand action, public education and measures to prevent the continuation of such a state of
affairs?
Again, akin to this class of case is the frank mental case in which
heredity and hereditary predisposition - are predominant features
49.7 per cent of all admissions last year were suffering from either
manic depressive or dementia praecox psychosis; diseases in which
heredity is a most outstanding feature. Should not these facts be
publicly known  and  their  serious  import  understood?
Again in the toxic types of mental illness much could be avoided
if the people knew and understood. General Paralysis of the Insane,
a mental disease due only to syphilis, either untreated or insufficiently treated, laid low 20 persons who were brought to us last year.
It is a fatal disease which could have been prevented by proper
treatment had the patient known and understood these thirigs years
ago, when treatment would have been of some avail. The Public
Health Department of this province under the splendid and energetic direction of Dr. Young, is putting forth every effort to place
matters of this kind before the public and he should receive every'
coroperation and support from those of us who understand and realise the grave importance of his work.
In closing let me remind you that the mentally ill of this province
go to hospital just as do the physically ill, that, although it requires
time, results are obtained, and that we at the hospital are always =
glad to see hospital people and professional people and lay people
who are interested and will gladly devote our time to familiarizing
you with the hospital and its operations.
A very hearty vote of thanks was tendered to Dr. Steeves for his
valuable address. The report of the Committee on Resolutions was
called for and submitted by Mr. E. W. Carr Hilton (Duncan).
Mr.   Carr    Hilton—There    are    three   invitations   for    the    next;
convention^Penticton, Chilliwack and Kelowna.    There is also a
resolution submitted by Mr. Mordy and Mr. Graham that the con-,
vention  be  held in  rotation in  New Westminster,  Vancouver  and
Victoria.
The motion to have the convention in rotation in the three cities
mentioned was defeated and Penticton was selected as the meeting*
place for the next gathering. The dates were left in the hands of.
the executive committee.
Mr. Carr Hilton then submitted the following resolutions:
(1) That the great regret of the Association at the inability of
Dr. MacEachern to be present be expressed to him together with due
appreciation of his great service to this Association.—-Carried.
(2) That the great regret of the Association be expressed to Dr.
—96—
J Wrinch regarding his inability to be present on account of sickness,
in  his  family.     His  thorough  knowledge  of  hospital  affairs,  his
unfailing tact and his sound judgment in dealing with technicalities
has made his absence felt.—Carried.
(3) That the Federal authorities be approached with the request
that all stamp and sales taxes be remitted to hospitals and that a
copy of this resolution be forwarded to hospital associations in
other, provinces for their endorsation.—Carried.
(4) That the provincial government be petitioned to make pro-
vision for the care of patients who are incurably ill and that the
.   hospitals be relieved of this costly responsibility which is not the
functon they were created to fulfil.—Carried.
Mrs. M. E. Johnson spoke in support of her notice of motion to
amend the constitution so as to provide for corporate membership
for hospital auxiliaries.
MRS. BROWN (Nanaimo)—There is only one way we can manage
that. Our membership fluctuates from one year to another. I
would suggest we pay $10 for. every fifty members or fraction of
fifty and vote accordingly. The auxiliaries do not realize the responsibility they are taking in collecting money. Our auxiliary is
incorporated unde^r the" Friendly Societies Act. We have collected
about $16,000 for our hospital building fund. We do not let it lie
-in the bank. We invested it in government bonds and are drawing
$700 a year interest. To do_ this we have to report every yean to
the government and send reports to the hospital board. It does not
seem fair that we should not have a vote. I do not want to become
an individual member because I am representing the auxiliary at
Nanaimo. I do not know whether other auxiliaries feel the same
way but I think that all the auxiliaries should become incorporated.
To collect public money we must account to the public for every
1   cent.
CHAIRMAN—The proper course is to refer this to the Committee
on Constitution and Bylaws.
MRS. M. E. JOHNSON—I think it is in order to delete that clause
and for the auxiliaries to bring in a motion.
MISS JOHNS—It will be necessary in any event to amend the
constitution.
DR. BROWN—How long would it take to do that?
MRS. M. E. JOHNSON—By a two-thirds vote at-a regular meeting.
DR. BROWN—I think we should wipe out this disability. If it
is in order to make a motion to amend the constitution, I will do it.
The further consideration of the matter was deferred, and the
meeting adjourned for luncheon.
AFTERNOON SESSION: THURSDAY, AUGUST S 1ST.
The meeting was called to order at 2 p.m., Mr. George MacGregor
presiding.
CHAIRMAN—The scrutineers will make a report.
MR. S. J. DRAKE—Some of the largest hospitals have no representations on this list of nominees for the Executive and I would like
-to ask that the nominating committee meet again.
CHAIRMAN—I think Vancouver should have a representative on
the Executive because most of the business is done in Vancouver.
•   MR. DRAKE—I move the nominations be re-opened.
Dr. Brown seconded.    The motion carried.
—97— MR. DRAKE—I move Dr. Ponton be added to the list. Mr. E. M.
Cook seconded.—Passed.
Mr. R. A. Bethune nominated and Mr. Carr Hilton seconded the
name of Dr. MacEachern.—Carried.
The nominations were declared closed.
A general conference on the Organization and Functions of Women's Auxiliaries then took place, Mrs. John Hanbury, President of
the Women's Auxiliary of the Vancouver General Hospital, presiding.   She delivered an introductory address as follows:
Auxiliary Societies for any philanthropic work should be organized only for the purpose of meeting a real need and in response to
or in anticipation of a request from the Board of Directors.
Throughout Western Canada and very generally in the East too,
I believe, the formation of a Women's Auxiliary (and- often of a
Girl's Auxiliary) follows closely on the arrangements to open a Gen;
eral Hospital in the community; the responsibility of providing the
linen and its renewal usually being undertaken by the women. In
addition to this we often find one or two other specified objects such
as maternity work, social service, flowers or other necessities as
they'may be required by the Board.
It seems to me the first requirement for a successful voluntary
organization of this type is that it be directed and controlled by an
Executive whose members thoroughly understand its functions.
Some simple constitution should be agreed upon so that all members may thoroughly realize the conditions under which they are
working and the object of their association, which is usually to raise
funds or supplies for some particular department of the hospital
work. Organized on this system there is no reason why even a
small group of voluntary workers should have any trouble in fulfilling their mission.
The functions of each organization will depend on the purpose for
which it has been formed which should be clearly stated in the beginning, but is often lost sight of in later months.    As a general!
Hospital aims to provide for the needs of all classes  of the community, its auxiliary membership should be open to all women of .
good character on payment of the small annual fee agreed upon.
Because the appeal of the needy sick is always a touching one
we find many women eager to work in an organization banded together to further the needs of a hospital. But just because they are
so zealous for its welfare we sometimes find that these voluntary
workers are not an unmixed blessing. I have heard more than
once in my experience the voice of the member who thinks we
should correct the whole administration of the hospital; forgets
the object of our being; spreads dissention among the members and
-so defeats our very purpose—to be a real helper, an auxiliary. She
has strong ideas of her own and is filled with good intentions, but it
often takes tactful care from a strong Executive to smooth the rough
places.
Nowhere in the world are discipline and system more essential
than in hospitals and when we find these over-zealous souls attempting to upset both in various little ways we at once have friction between the hospital matron and the organization whose sole
purpose should be to assist her in every way. If there are real
wrongs to be made right or improvements made in the service ret&!,
dered by the institution such questions can always be adjusted in a
heari-ro-heart conference between the President (or her representative) of the Auxiliary and the Matron or Board of Directors of the
hospital.
When we have bur organizations working with the unselfish pur-
-v-98— pose and high ideal of service to the community with no thought of
personal recognition, then only, shall we attain our object, viz., to
be a real auxiliary to the hospital of our city.
MRS. A. W. GRAY  (New Westminster)—In our Auxiliary work
used to be done at the homes of the members.    It was found that
that was not a good plan.    It depended on the enthusiasm" of the/
Rbiuhtary workers whether or not the work was ready for hospital
use.   I undertook to try and find a room to be used as a sewing room.
The next thing was to find a sewing machine.    We got two of them
and we had no lack oV workers and afterwards we added another
.-machine.    Then the question arose as to who would do the sewing.
§We found that the work was being carried on only by the enthusiastic few.    Interest was therefore, diminishing.    We decided there
should  be  more women  directly interested in hospital  work,  so  I
"decided we might bring the matter before the ladies' aids of the
^various churches and they responded very willingly.    NeaTly every
ladies' aid sent someone every month to help.    Then a few of the
Jfother philanthropic societies came and volunteered their help.^ So,
gas far as the actual sewing went we had no difficulty.    We have
•twelve to fourteen societies giving us help each month.    The committee in charge undertakes to see that there is plenty of work waiting for the sewers.    It is very surprising how much sewing can be
Jdone in an afternoon.    We often have eight ladies in an afternoon
J"and you would be surprised at the work they do.    The work is ent-
ffered in a book and turned over that evening to the matron of the
hospital, so that she has not to wait any time.    The great difficulty
I have encountered is in raising money. We have in New Westminster
an annual tag day but you know everyone is tired of tagging and
; that it is rather an undertaking to get enough ladies to stand on the
corners and beg     I often wish the men would take up this work
-so that" they would know what it is like.    Our tag days'provide us
*%ith a few hundred dollars.    Then we have other sources of revenue,
iffthe hospital directors could provide funds to buy the linen I know
the ladies would give their time and energy to the work.    The auxiliaries could then branch out a little and take a more personal interest in the patients.
REV  FATHER O'BOYLE—I act in a peculiar capacity as director
Of the Catholic Hospitals of B. C.    I am a sort of a link, a liaison
tifficer     I do not know much technically about hospitals, but on account of my association-with Catholic Hospitals I am quite willing
Sto work with all other hospitals on any platform except religion.
Sometimes I may be criticized by my own people as being too Protestant.    But here surely we can all work together.   My duties so tar-
have been in connection with getting the Catholic Hospitals classified and showing they are just as good as the civic institution     i
;twould mention two with which I am familiar, St. Joseph s of Victoria
and St. Paul's of Vancouver which have been classified A. 1 by tne
American Association of Hospitals. " It is a good thing to have an
Institution of this kind in your midst even though they are apt sup-
"fported by public money.    They save many lives and contribute to
the public welfare.    Now I have been put down for a speecn on
"auxiliaries.    My experience of auxiliaries has largely been along the
lines of church work.   What the ladies possess in energy and initiative, they sometimes lack in discipline.    If you want to give me a
cold perspiration, talk of a bazaar.   At the same time if we wish,
to raise money in church work it is the women whodo it       - isu-/
Avomen who have the initiative and who are able to sell articles at
one hundred time their value.   Every hospital has its trouble0.   wnat
hospitals^ should get, is support and encouragement.    There are two
ways to help.    One is not to knock and the other is to give something to carry it along.    The auxiliaries can do so by systenratized
effort and by keeping the atmosphere of the hospital comfortable
and happy.
— 99- Mr. A. P. Glen (Ladysmith) seconded.
CHAIRMAN—I want to go on record this afternoon as saying
that it is not right that the women .should have to work the way they
do. I am a firm believer that we should have a tax to support hospitals as we have for the public schools and I hope some day that will
be a feature of our taxation system and then the hospitals-will not be
in the humiliating position they are in today.
MRS. G. BELL BROWN (Nanaimo)—As we stand now I do not
think our auxiliary is a part of the association.
MRS. JOHNSON—I was in hopes we might be able to have our
auxiliaries as institutional members.    I gave notice yesterday.
MISS JOHNS—I am quite sure that the president and every member is anxious that the auxiliaries become corporate members. It
is merely a question of ways and means. I wonder whether it is
possible to have some suggestion that would be of assistance to the
Committee on Constitution and Bylaws. They would then have
something to go on.
DR. BROWN—I would move that the B.
admit auxiliaries as corporate members.
C. Hospital Association
At this point Mr.
After some discussion the motion was passed.
MacGregor again took the chair.
DR. BROWN—I move that the question of fees be left to the executive and that they be not greater than the fees paid by the assoP
ciated hospital.
Mr. E. S. Withers seconded.   The motion was passed.
Th ereport of the scrutineers was presented to the meeting and
the following officers were declared elected:
Honorary President—The\ Honorable J. D. MacLean, Victoria.
President—Dr. H. C. Wrinch, Hazelton.
First Vice-President-—Mr. Charles Graham, Cumberland.
Second Vice-President—Mr. J. T. Robinson, Kamloops.
Treasurer—Mrs. M. E. Johnson, Vancouver.
Secretary—Miss E. Johns, Vancouver.
The following were elected members of the Executive Committee:
Mr. R. A. Bethune, Kamloops; Miss Charlotte Black, Prince RuperOT
Dr. G. Bell Brown, Nanaimo; Mr. George Binger, Kelowna; Dr. M.
T. MacEachern, Vancouver; Rev. Father O'Boyle, Vancouver; Mr.
George McGregor, Vict6ria; Miss J. F. MacKenzie, Victoria; Mr. E. S.
Withers, New Westminster; Miss Ann MacArthur, Nelson.
Discussion regarding the allocation of moneys accruing under the
Liquor Control Act was then resumed.
MR. J. J. BANFIELD (Vancouver)—I have an amendment to the
resolution. It is so important that I feel the delegates will not feel
inclined to give a final vote on it today, without first having the consideration of the directors of the hospitals. Might I read to you
the purpose of this organization.
The objects of the B. C. Hospital Association are:
To serve as means of Intercommunication and co-operation
between the hospitals in British Columbia;
To establish, maintain and improve standards of hospital
work;
To promote the efficiency of all hospitals in the Province;
To stimulate intensive and extensive hospital development;
To make all hospitals of more community service.
This is somewhat of a controversial character and as the Chair^
—100—
(a)
(b)
(c)
(d)
(e)
JJ man aptly stated, there must be community of purpose.    I will read
you the amendment I have drawn up.    It is as follows:
I Moved by J. J. Banfield, seconded by E. S. Withers:"
THAT WHEREAS the question of the disposal of the Liquor
Profits is liable to promote a discussion of a controversial nature,
AND WHEREAS the primary purpose of this Association is to
promote harmony among the hospitals in British Columbia,
AND WHEREAS this matter is of such importance that the Boards
of Directors of the various hospitals should have an opportunity to
■'discuss the same and to offer an opinion,
THEREFORE BE IT RESOLVED that an"expression of opinion
be obtained from all the" hospitals in British Columbia as to the
"advisability of the following amendment to the liquor Act, viz., by
repealing Sub-section (b) of the Sub-section 1, of Section 108 of
the Government Liquor Act, and by substituting in lieu thereof the
following:
Sub-sec. (b) One quarter of the net amount shall be opportioned
and paid to the several municipalities in the province in proportion to the respective populationrand
(c) One quarter of the net amount shall be placed to
the credit of a special account under the control
of the Provincial Secretary ana> shall be paid
thereout to all hospitals in the Province rendering public services, and which are subject to Government inspection in proportion to the number of
hospital days' treatment rendered by the said
hospitals respectively.
AND BE IT FURTHER RESOLVED that the Boards of Directors
of these hospitals be requested to discuss this matter at the earliest
possible date and file their opinions with this Association not later
than November 1st, and that copies of said opinions be forwarded
to the Provincial Secretary for his information and guidance.
" MR. E.  S. WITHERS—This is in line with the  attitude  I took
yesterday that we should make this vote unanimous.
The amendment was then put to the meeting and was carried
with one dissenting vote.
It was then put to the meeting as the original resolution and was
carried unanimously.
Mr. E. W.-Carr-Hilton reported on behalf of the Resolutions Committee as follows:
That the Provincial Government be asked to reduce by say 20
per cent, the price of all liquors purchased by hosuitals.
Mr. E. S. Withers suggested that the resolution be amended as
follows:
That the Provincial Government be asked to reduce by say, 20
per cent, the price of all alcohols and liquors purchased by hospitals.
—Carried.
The following were elected members of the Committee on Constitution and Bylaws—Miss E. Johns, Mr. George Haddon, Mr. Peter
Brown, Dr. H. R. Storrs.
On motion of Mr. E. W. Carr-Hilton the following votes of thanks
were passed unanimously:
To the Mayor of New Westminster.
To the Board of Directors of the Royal Columbian Hospital.
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-106—
_J The name of this Association shall be "The B. C. Hospital Association."
Article 2—--Purpose.
It shall be the purpose of this organization:
(a) To serve as a means of intercommunication and co-operation.
(b) To establish, maintain and improve standards of hospital
work between the hospitals in British Columbia.
(c) To promote the efficiency of all hospitals in the province.
(d) To stimulate intensive and extensive hospital development.
(e) To make all hospitals of more community service.
The officers shall be:
Honorary President.
President.
First Vice-President.
Second Vice-President.
Secretary.
Treasurer.
Executive Committee of Ten.
Article 4—Membership
The members shall be all persons connected directly or indirectly
with hospitals paying the membership fees hereinafter mentioned,
and such members shall be classified as follows:
(a) Institutional.
(b) Individual.
(c) Honorary.
(a) "Institutional" membership may be held by any hospital,
public or private, carrying on work within the province.
Institutional membership shall include all members of its
trustee board, anoVall persons- holding executive positions
in the institution.
"Individual" members shall be all persons connected directly or indirectly with hospital work who are not members of trustee boards or holding executive positions in
hospitals, and shall include attending doctors, nurses and
members of hospital auxiliaries.
"Honorary" members shall be any persons who have ceased to take an active part in hospital work after years of
faithful service.
Article
-Election of Officers.
This shall take place at the annual meeting each year, and shall
be by ballot.   All officers shall be elected' for a term of one year.
Article 6—Executive Committee.
The Executive Committee shall be composed of the officers and
ten other members, elected from the Association at the annual meeting.
—107— -Article 7—Quorum.
Five members shall constitute a quorum of the Executive Committee, which shall meet at least once a year, and at other times at
the call of the chairman or any five members. Ten per cent, of the
members shall constitute a quorum- of the whole Association. The
Executive Committee shall carry on the affairs of the Association
during the year and report to the Association at the annual meeting.
Article 8—Meetings, time and place.
The annual meeting of the Association shall be held at the time of
the hospital Convention, notice of which shall be sent to each member one month in advance. The place at which the annual meeting
and convention shall be held will be decided on at the regular meeting or convention of the previous year.
Article 9—Amendment to Bylaws.
Bylaws may be amended at any regular meeting by a two-thirds
vote of members present.
Article 10—Recommendations.
All recommendations and suggestions must be sent in in writing
to the Secretary of the Association, who shall lay same before the
Executive for discussion and consideration previous to the annual
meeting each year.
Article 11—Membership  Feles.
All hospitals within the province paying the following fees shall
be entitled to membership in this Association:
1. Hospitals of ten beds or under, $5.00 per annum.
2. Hospitals of ten to twenty beds^ $10.00 per annum.
3. Hospitals of twenty to fifty beds, $15.00 per annum.
4. Hospitals of fifty to one hundred beds, $20.00 per annum.
5. Hospitals over one hundred beds, $25.00 per annum.
6. Individual and honorary membership fees shall be $1.00 per
annum.
Article 12—Voting.
In any matter of business requiring action by vote of the Association, voting of institutions shall be in proportion of one vote for
each $1.00 of membership fee: thus, a hospital paying $5.00 membership fee shall have five votes, and so forth.
The combined delegation of any hospital shall agree among themselves as to how their institution will vote. No institutional vote
shall be divided on any question. If time is required by a delegation
of any institution before casting its vote, the chair shall postpone the
taking of the vote for a reasonable time. After postponement for this
purpose there shall be no further discussioh of the question before
taking vote upon it.
Individual and honorary members shall each have one vote.
Votes by proxy will not be allowed.
DATED at Vancouver, B.C., this 28th day of June, A.D. 1918.
—108-  The Beaver Soap Co.
Specialists in Laundry Supplies
and Laundry Machinery
Agents for the Beaver Laundry Machinery Co., Ltd.,
Toronto.
Manufacturers   of   High   Grade   Laundry   Machinery
Get particulars of our Institution Laundry Unit.
Pacific Coast Representative: D. F. Gorrie,
1013 Metropolitan Bldg. Vancouver, B. C.
Phone Seymour 2688
Mrs. M. E. Johnson
Bute Street f
Private Hospital
MEDICAL, SURGICAL AND
MATERNITY CASES
786 Bute Street
Vancouver, B.C. -Addresses-and Discussions— Page
Annual Address of the President  -  44•■'
Address by the Honourable the Provincial Secretary   52
Address of Welcome  a
Address by the Director of Catholic Hospitals in B.C  77
Address to the Kiwanis Club  20
Care of Mental Diseases in B. C  93
Dietetics    9 2
Domestic Management and Personnel *  91
Economy from Various Points of View  85
Finance and Accounting  9
Hospital  Standardization  4 8
Hospital Spirit   51
Hospital Waste  33
Liquor Control Act ; -75, 100
Patient, Physician and Hospital  40
Purchasing Methods  14
Railway Employees Associations   73
Training School Conditions in B. C -  23
Women's Auxiliaries  98
" Workmen's Compensation Act    65
X-Ray  .-.  33
Reports—
Report of the Secretary   56
Report of the Treasurer   57
Report of the Committee on Nursing Affairs  58
Report of the Committee on Finance  58
Report of the Committee on Resolutions  101
.Miscellaneous—
Introduction  -  8
Constitution and By-laws   107
List of Exhibitors   8
List of Delegates in Attendance  5
List of Hospitals in British Columbia   103 x
Officers and Standing Committees 1922-23   4 

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