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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 Fourth Annual Convention of the
Hospitals of British Columbia
Held at Kamloops, B. C.
in the High School
on July,  6th,  7th and 8th
1921  Held at Kamloops, B. C.
in the High School
on July,   6th,   7rh and 8<h
1921
±
G. A. Roedde, Ltd.. Printer*. Vancouv
1922 The British Columbia Hospital Association was
formed following the convention held in Vancouver,
June 26th, 27th and 28th, 1918.
The objects of the B. C. Hospital Association
(a) To serve as a means of intercommunication
and co-operation between the hospitals in
British Columbia;
(b) To establish, maintain and improve standards
of hospital work;
(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. OFFICERS FOR 1920-1921
Honorary President Hon. J. D. MacLean, Victoria
President   Dr. H. C. Wrinch, Hazelton
First Vice-President   Mr. George McGregor, Victoria
Second Vice-President  Mr. R. A. Bethune, Kamloops
Secretary  Dr. M. T. MacEachern, Vancouver
Treasurer  Mrs. M. E. Johnson, R.N., Vancouver
Miss E. I. Johns, R. N., Vancouver
Miss M. P. MacMillan, R. N. Kamloops
Mr. Charles Graham, Cumberland
Dr. W. E. Wilks, Nanaimo
Miss L. S. Gray, R. N., Chilliwack
Mr. G. R.  Binger, Kelowna
Mr. D. G. Stewart, Prince Rupert
Rev. Father O'Boyle, Vancouver
Miss J. F. MacKenzie, R.N., Victoria
Mr. E. S. Withers, New Westminster
OFFICIAL  SECRETARY  FOR  THE  CONVENTION
Miss  Frances  Henry
OFFICERS FOR 1921-1922
Honorary President  Hon. J. D. MacLean, Victoria
President   Dr. H. C. Wrinch, Hazelton
First Vice-President  Mr. Geo. McGregor. Victoria
Second Vice-Precident   Mi\R7*it Uetnune, Kamloops
Secretary   Dr. M. T. MacEachern, Vancouver
Treasurer   Mrs.  M.  E. Johnson,  R.N., Vancouver
EXECUTIVE
Miss E. I Johns, R- N. Vancouver
Miss M..P. MacMillan, R. N., Kamloops
Mr. Charles Graham, Cumberland
Dr. W. E. Wilks, Nanaimo
Miss L. S. Gray, R. N. Chilliwack
Mr. G- R. Binger, Kelowna
Mr. D. G. Stewart, Prince Rupert
Rev .Father O'Boyle, Vancouver
Miss J. F. MacKenzie, R. N., Victoria
Mr. E. S.  Withers, New Westminster STANDING COMMITTEE :.
Standardization:
Business—Mr. J. T. Robinson, Kamloops
Mr. L. E. Morissey, Merritt
Mr F. T. Williams, Victoria
Mr. R. B. Leders, Vancouver
Mr. R. B. Woods, Nelson
G.  S.  Purvis,  New Westminster
W. Arbuckle, Vernon
H. H. Murphy,. Kamloops
H. R   Storrs, Vancouver
L. M. Poyntz, Victoria
Miss E. I. Johns, R.N., Vancouver
Miss K. Stott, R.N., New Westminster
Miss P. Rose, R.N., Nanaimo
Miss A. McArthur, R.N., Nelson
Miss E. Bligh, R.N., Hazelton
Accounting Committe
Mr. E. S. Withers, New Westminster
Mr. G   F.  Carver,  Victoria
Mr. G.  R. Binger, Kelowna
Mr.  G.  Haddon,  Vancouver REPORT
WEDNESDAY, JULY 6th,  1921
IC.OO a. m.
The first session of the fourth annual convention of the B. C~ Hospital
Association met in the High School,- Kamloops, 13. C-, on Wednesdav, ]uly
;6th, 1921, at 10:00 a.m, Dr. H. C. Wrinch, President, presiding.
DR. H. C. WRINCH, Hazelton—
I cannot tell you how pleased 1 am to see such a splendid attendance
here at the beginning of this convention of our Hospital Association. You
| know, some of us were very divider.;: about calling a convention away in
this central point' of British Columbia. We wer; afraid we could not
get the people to come so far for the reason that we were not able to get
the people to come to the city from here. We are satisfied now that it was
a wise move—your presence here assures that. We are delighted with the
attendance. The convention will mean to us largely what we each put into
it. Our committee has made the programme as practical as possible and
we want you all to discuss each paper freely.
The first paper on our programme is by Miss Jessie A. Morrice, R. N-
on "The Nursing Care of Tuberculosis Patients."
MISS JESSIE A. MORRICE, R.N., Tranquille—
It is not necessary for rrre- to say anything to you about the value of a
nurse, or the 'nurse training; though we often forget that without the
careful conscientious nurse, there would be no hospital. In no field is the
nurse more needed than in the care of tuberculosis patients. We are told
that one-tenth of those who die, die of tuberculosis and of these fifty per
cent are between the ages of seventeen and thirty-five, so the field of work
is very wide.
In this vast country of ours the nurse is invaluable and her work,covers
so much ground. In the old days we had the "Hospital" and the "Private"
Duty" nurse; now, with these, we have "Public Health" and "School
Nurses," "Social Service," "Community Centre" and the District nurse
of the City, and the nurses who, in our Mission hospitals thirty or forty
miles from a doctor, are in their small hospitals doing wonderful work.
These in their daily work see hundreds of people, especially children and
young people, that no doctor has seen or will see, unless some one calls
his attention to them or advises them to "see the doctor."
We have in British Columbia a law that each municipality must take
care of its own tubercular cases, and every hospital receiving a grant
must take these cases—a splendid law. But how many of our hospitals
have suitable accommodation for tubercular cases ? I speak from experience, for I have had these patients in both the large and small hospitals,
and I am sure I voice the thought of every hospital superintendent when
I say that it is with a feeling of absolute dismay we admit a tubercular
patient to the hospital. None of our small hospitals, and few of the
large, are planned to take them, and practically every case that goes to
the hospital is an advanced case- We could not possibly take suspect or
incipient cases and give up any of our usually crowded quarters to them
for three to six months.
How many of our nurses in training ever see a patient who is treated as
a suspect or incipient case? Speaking recently to one of our most prominent  hospital   superintendents,   she   said:    "To   me  the  tubercular   case   is
5 what we see in Ward O at the Vancouver General Hospital, and most.
nurses feel the same." Nearly every nurse regards the tuberculosis case .
as hopeless. What we need is the nurse who has been so taught that she I
will realize as a pneumonia case, left till a day or two before the crisiSS
or a case of septic infection allowed to run on for a week or more without care, is practically hopeless, so is the tubercular case. My plea is for~
a nurse who will be able to assist us to "catch them early," one who wiljj
be able to recognize the danger signal and give the warning that will put.
the patient under a doctor's care, or give the advice that will be of use
to those who are out of reach of a doctor.
The care  of the  suspect or  incipient  case,  is  so   simple,  one  feels   the
very simplicity makes it harder for the patients to "take the cure."
It has been felt by everyone that the Public Health and District
nurse should know and understand something, not only of danger to
others of the Tubercular but should know how to advise him and watcji
over his case, for we all know it is not where it is done, or who does the)
work, but when and how the cure is undertaken.
If we could only get the cases early we would have so much less difficulty in effecting, not a cure, unless the case' is    really only a    suspectS
but in the incipient case, arresting the case and saving the patient.    Last
summer two t<-;ichfcis, about the same  age,  one in  tiis  city and  one  in a
small country  school, strangers to each other, had a little cold, a  slight
cough, feeling tired all the time, a pain in the side that hurt when drawa
ing a deep breath.    The  city teacher was  advised  to  take a holiday, get
away  from  school,  change    of  scene    and  environment    would    do    her
good.     She   went   away,   did   a   little   mountain   climbing,   played   a   littljj
tennis, went for a few long walks, ate a lot of eggs and drank lots of mila
supposedly a  sure cure.    She went  back to  school  still  tired,  and  brok|J
down, later went to the Clinir and tried to get into the -Sanatorium    bug
there was no  room.    Finally,  she was  admitted and  is    making    a  good
fight on a long uphill road, but hers will be an arrested case.    The little !
country teacher came in contact with a nurse who had had a few months
Sanitorium experience: she advised her to see our former superintendent,
and was advised by him to take the cure.    Pretty hard to' give up a lonM
looked for holiday, but she did;  she put in two hot months  in bed,    and
when   school  began,  with  fear  and  trembling we  saw her  start  back  trj
her duties.    But she had learned to take the cure, had learned the hard lesson  of resting.    This  summer  she  shows  no  active   disease,   she  finished
her school year in better health than for a long time, and has gone happily off for her much delayed vacation, still knowing to take the cure.
You, of course, understand what I want. Every nurse while taking
her training should be given two or three months in Sanitoria that she
may have an opportunity to observe, not only the treatment of the casejs
but the case. That she may see the suspect and the incipient case and
learn how to advise, learn how simple is, the cure if begun in the very
early -stages, learn that three months in the beginning will do more than
three years at the end of the three months, if the case is allowed to run.
The nurse who has been trained in Sanitoria to care for the suspect and
incipient case, will know how to care for the advanced case in the hospital, the home or in her Public Health or District work. The patient :w
nearly always hopeful, but the long days and nights are hard to bear,
and we need a nurse who is helpful and hopeful and who can understand.
A nurse who understands the simple precautionary measures of cleanliness and carefulness, who realizes it is useless to sterilize a cup or a
spoon and then throw cigarette ends, fruit pits, soiled handkerchiefs etc
carelessly about, useless to cough into a loose handkerchief and then allow that portion to come in contact with fingers or clothing. A nurse
who understands, and who can help the patient and family to understand
that to rest means rest every day. not a good jolly time today and make up
for it tomorrow, not rest today and then just for once go to a dance or a din-
6 ner, not even a long motor ride or a game of tennis. I saw the wreck of
four years of cure by one long hard game of tennis. So we need the nurse
who knows "The Cure" rest and simple food, rest and cleanliness, rest
and carefulness, always and everywhere rest- And when she has herself
found out these truths she will he able to teach her patients so they may
know that doctor and nurse are of little use unless they take the cure. No
one can do the work but the patient; their recovery depends on themselves. Mdny apparently very bad cases do recover a large amount of
strength and are able to carry on in a normal, if careful life. It takes
;■ time and care. The nurse can teach them that no child should be kissed
on the lips, that no one should drink from a glass and then allow another, especially a child, to drink from it. That the mother must not taste
the food and then use the same spoon for the child. That the family
must sleep in the open if possible, but in any case must have fresh .air;
that plain simple good food is necessary, not over-crowding, not dozens
of eggs and quarts of milk, but a sufficient amount of good nourishing food.
Teach the use of folded gauze, the sputum cups and pocket flasks, the use
of fire to destroy infected material. Teach the fact that a tuberculous patient
is never a cure, but is an arrested case, and may, with care, live a
long, happy and useful life. But he must take the cure, must rest, must
live the careful life—careful for himself and for others.
One reason for the need of an educated nurse, is, as l say, the inside
field they cover, the people with whom they come in contact, and the growing
confidence of the public in the nursing profession. We are told we have two
hundred and fifty children in the Province who have incipient tuberculosis and another two hundred and fifty among our Indian children. How
many of these could be saved if the School nurse and the Mission nurse
understood the idea of the cure.
My plea is why wait until, when a year, or two years, after she has
finished her training, a nurse decides she will do public health,- district or
school nursing, or decides to go to some of our Mission hospitals or community centres, thirty, forty or fifty miles from a doctor, then give her a
hurried course of lectures wonderful though they are to the nurse who
knows really so little of the work But, why waste the years, why wait,
why not, during her training send the nurse to the Sanatorium which is
under the care of the Province, whose duty it is, therefore to care for all
tubercular cases and who will be glad to do anything to relieve the
patient, save the family, and at the same time lighten the burden of public
expense by caring for the patient in the early stage, and what is more,
preventing the spread of the disease.
Therefore, send the nurse in training to the place where she sees the
suspect and incipient case, finds out how simple is the cure; where she will
get also the benefit of the weekly or semi-monthly lecture which in every
well regulated Sanitorium is given to patients and staff. Also, she would
have special bedside instructions, have instruction in the laboratory, and
see the work in the X-Ray room. We do not promise to make her perfect
in the work of the laboratory, but to give her some idea of that side of
the work. We could not teach her to do the X-Ray work—our apparatus
is too valuable, but have her given some instruction that she might see
the rapid advance of the disease and the slow cure, and so know why it
is so essential to "catch them early." Help her most of all to feel that
"just a cold" if continuous, that tired feeling all the time, and so many
minor ills, are the little things that need attention—the foxes that spoil
the vine; the signs of one of the most appalling diseases our new country
has to face.
Now I hear your objection and that of the parents of the pupil; they
object to the nurse being exposed to the danger of infection. May I be
allowed to say—there is less danger of infection among two hundred
patients in a properly conducted sanitorium than with two in your public
ward of the hospital.    Also,  may I  say.  if you  send  your  nurses  to us,
7 those who came could teach the rest in your school how to treat the case,
the little things that make for safety.
Another thing, something must be done and that soon, to protect oui*
nurses, not those in Sanitoria but those in general hospital work. There
are too many cases developing among nurses. Our average of nurses among
women patients is too high. What is the cause? Who is reasonably
responsible? What can be done? Are the hours too long, food not sufficiently nourishing, or is the nurse too tired to eat; are her sleeping
quarters what they should be? Has she with her twelve-hour day either
time or inclination for recreation? Here is a suggestion which would, of
course have to be taken very carefully into consideration: would it be
possible to send some of these young nurses to the Sanitorium for light
duty, possibly save the-nurse, and at the same time educate her? A rash
proposition for me to mike, but something must be done to save our nurses
as, well as the general public from this disease.
DR. H. C. WRINCH. Hazelton—
That is a very excellent and practical paper and I hope will elicit free
discussion.
DR. L. G. HOULE, Kamloops—
It has seemed to me that in the past our general hospitals have been
shirking, to a large extent their responsibility with regard to the tuberculosis question. We know that they have their problems of lack of accommodation and financial difficulties and that sort of thing, but is tuberculosis not as important a disease problem as any of those which the
hospitals are at present meeting. Tuberculosis is the cause of a very
large proportion of the deaths in every country. It is not necessary for
me to emphasize to a body of people who are dealing professionally in
medical matters the amount of tuberculosis that exists in the country and
the seriousness of the whole question. Up to date there seems to have
been an attitude displayed 'On the part of the general hospitals that tuberculosis is not a part of their responsibility or that it is the last of the
diseases to be taken care of by the hospital- i The attitude has been too
general: "let the sanitorium do it." The sanitorium is doing a very useful
work all over the country. Up to date I think the anti-tuberculosis effort
has been largely confined to the work it is able to do, but after all, it is
only one link in the chain of anti-tuberculosis effort The sanitorium has
its limitations. The trouble has been that too much has been expected
of it and the results have beenv disappointing. The tuberculosis death
rate has been reduced on this continent materially and the sanitorium
has had a very important part in that reduction, but not infrequently we
hear the question raised as to whether the present machinery for dealing
with tuberculosis is accomplishing the work that is to be expected of it- I
th;nk that too much is being expected of the sanitorium. The sanitorium is
primarily adapted to the treatment of cases of disease which have been
discovered sufficiently early for some benefit to resu't from the period of
treatment. The sanitorium is a highly special ized institution, located usually at a distance from sections of population and particularly applicable in the Province of British Columbia, and in my opinion should be reserved entirely for the treatment of favorable cases of tuberculosis, the
hopeful case for which something can be done. I am very glad to see that
the provincial institution, since it has been taken over by the government
is being held more and. more for that type of case. The government, I believe, is taking the attitude that only favorable cases are to be admitted.
In the past it has not been possible to take that point of view for the reason that according to the terms of the Anti-Tuberculosis Society made
with the government in view of certain financial assistance that was rendered the institution, the Society agreed to practically not refuse any
type of case, for the reason that the government was at that time finding
difficulty in providing for these more advanced cases.   That greatly handi- capped the policy of the institution, inasmuch as many cases for. which
nothing could be hoped had to be taken in for lack of other accomodation,
with the result that the institution practically became filled with this type.
There are patients there now who have been there years; there is one who
has been there nine years; simply filling up the beds and keeping out pati
ents who should have them and for whom something might be hoped in
the way of rest cure. The difficulty with the present machinery for dealing with tuberculosis is that all the effort is being concentrated in more
or less one direction in this country. There is a great deal of good work
being done in Vancouver by the Rotary Clinic. That is very promising.
A great amount of effort and money is being spent on the one institution
•In Tranquille—there is not too much accommodation, but I do think that
it would be highly beneficial if the other side was more emphasized, J and
as I said in the beginning, if the hospitals assumed greater responsibility
for tubercular cases. After all the way to cope with any problem is to
get at the cause.   When Dr. Grogas went to Panama to organize the work
"there he went into the cause of things, and wiped out the malaria and
yellow fever by attacking the mosquito which is responsible for the disease, and the result was that the United States Government put him in
charge of the medical work. In tuberculosis the cause of the prevalence
of the disease is undoubtedly the spread of infection from the open case
of the disease which is expectorating in public places and in the home,
and, which to my mind, should be institutionalized to a greater extent than
is being done at present. That is the cause of the disease, the origin of
the persistence of the infection. I do not think the sanitorium is the place
to institutionalize that patient. There are many cases who are not suitable for sanitorium treatment and many others who are suitable for whom
accommodation cannot be found, and those people very often are the
heads of large families living under congested conditions; also, they may
be well enough to do but simply unfamiliar with the necessary precautions they should take to prevent the spread of infection. The ideal way,
but perhaps not practical, is to deal '■with tuberculosis as other great
plagues have been dealt with: by the absolute isolation of all cases of the
disease. That is, of course, out of the question, because of the enormous
number of people who are infected—it is purely a matter of guess work to
say how many cases there are in this Province, no survey has ever been
made, but I would hazard the estimate that there must be probably one or
two thousand at the very least, active cases. Many of these are potential
carriers of the disease    The difficulty is that the hospital lacks accommo-
• dation for the number of cases that present very often.   Then again they may
-not have suitable accommodation, they have not proper wards for the treatment of tuberculosis I agree that tuberculosis should not be treated in
general medical wards with other cases, but I do think that with a little more
appreciation of the responsibility of the general hospital with regard to tuberculosis they would find a ward or corner for the treatment of a certain
number of cases of tuberculosis I believe in the province of Saskatchewan
they have ruled that all hospitals receiving government aid must accommodate ten per cent, of their beds to tuberculosis. Ten per cent, is a reasonable basis to start on Provision for the necessary separate accommodation
for the disease is essential, and there should also be, I think, provision for
the sterilization of dishes, used by the patients, with steam. With those
two difficulties met I see no reason why tuberculosis could not be satisfactorily treated in our gereral hospitals There is just one other obstacle
or excuse, that is that the attendants in those hospitals are not familiar
with the treatment of the disease and therefore are not able to protect
themselves very often from infection. Miss Morrice has suggested a way
out of that difficulty, and I may say that the question of a certain period
of the nurse's training to study tuberculosis in sanitoria was considered
some years ago by the sanitorium. Dr. Vrooman. the then medical superintendent, it was, who first brought the matter forward. He began, I
believe,  to  sound  the various  hospitals  in  the province  on  the matter of haying their undergraduates spend a certain part of their three years in
the sanitorium, and circular letters were sent out to the various hospitals
in the province, that then had training schools, and replies received. As I ■
remember it, only two or three regarded it at all favorably, others raised
objections and some were frankly against any idea of this being carried out
but that is more or less I think what we expected because it takes a long
time to get an idea like that into practice. I am hoping that after the paper
that' Miss Morrice has just given this morning this meeting will feel
somewhat differently toward the question. The matter, of course, of arranging or deciding as to whether the nurse should go during her undergraduate training to the sanitorium or whether it should be after she has graduated, how long should be spent etc., are matters for the future, but the
principle of having all nurses given some special training in tuberculosis
I think should be generally accepted- It is commensurate with the importance of the tuberculosis problem. Tuberculosis, as 1 said earlier, is
as much entitled to the attention of the general hospital authorities as is
any other disease, and looking at it from the public health point of view
it is a far more important disease than many of the cases which are treated in the hospital. A man gets appendicitis or heart disease, goes to the
hospital, takes up a bed there, gets treatment, whereas one with tuberculosis is denied admission, and which is the more serious problem from the
standpoint of the general public health? The man with tuberculosis perhaps dies and infects before he dies probably a dozen—we do not know
how many, whereas in the case of heart disease, or appendicitis, if the patient
lacks attention he is the only one who suffers. Another -advantage
of the training of undergraduate nurses in the sanitorium is, I think,
along the lines of propaganda. The number of nurses we estimated that
it would take to staff the sanitorium, if undergratuates, each spending
two months in the institution, was in the vicinity of about forty. Forty
nurses would pass through the institution during the year and that would
mean fort)' tuberculosis missionaries being sent out all over the province.
That is no small matter; education on the subject of tuberculosis is next
to provision of accommodation for advanced open cases which cannot and
should not be accommodated in a sanitorium.
Dr. Charles Whit, who is a Canadian and is at present in France as
chief of the Tuberculosis Section of the American Red Cross, writing in
one of the recent, numbers of the Physicians and Medical Students Journal said:
"The question of teaching undergraduate physicians having Deen solved, -
an   attempt  was   made   to   secure   teaching  instruction   for   undergraduate
nurses.    This was a more difficult problem, but we finally- arranged with .
three of the large general hospitals in the city to send their undergraduate
nurses for six months during their three years of training to the hospital of .
the  Tuberculosis  League.    The   attempt  failed,  which tyas   distressing  at
that time, but amusing to look back upon.   The first three classes were with-
drowh because the physicians on the staffs of the general hospitals warned
the directors of their institutions that their nurses would become infected
with  tuberculosis   in  any  institution   devoted  to the  care  of  this   disease.
Not discouraged  however, we next offered postgraduate courses for nurses.
These were successful from the start and were conducted with excellent
results  for  nine years—up  to  the  beginning of the  war,  when* the  great
draft on the supply of nurses of the country brought this work to an end.
Since the war we have made a new start, and in conjunction with the
University we have renewed our former attempts which met such failure
thirteen years ago. We now have classes of forty undergraduate nurses
taking training in tuberculosis work, including bedside care, home instruction
and public health administration. In addition to this, the facilities of the
hospital are used by the Public Health Nurses' Association of the community!
for instructing its workers and regular employees in the problems connected
with this malady.   The classes are in groups numbering sixty nurses in all.
Undergraduates have been chosen for instruction because of the difficulty
10
--*— of conquering the almost insurmountable barriers to the mind and interest of
those who have already been granted diplomas for their life's work.
The -mortality rate in Pittsburgh is one of the lowest among large
cities. For 1909 the rate of all forms of tuberculosis per 1UU,U00 was 117.5.
Whether it is due to this type of work I am not sure, but at least we have
the satisfaction today of knowing that so widespread through the community is the knowledge of how to care for tuberculosis that we seldom meet
with the distressing circumstances which confronted us a few'years ago.
It has been the only persistent effort made here for the past thirteen years."
I hope that some good will result from this paper and discussion in
the establishing of the principle of requiring all undergraduates in the
training schools of British Columbia to spend a certain amount of time
during their training in the Provincial Sanitorium at Tranquille.
MRS. J. CHARLOTTE HANNINGTON, Ottawa—
I would like to say a few words with regard to this paper as to the
care of tuberculosis patients in the homes in district nursing. I do not
think I have ever heard a paper on the care of tuberculosis that interested me
as this one has by its extreme simplicity and the valuable points. As to
her emphasizing the need of the education of the nurse—I think we are
finding this out, that a woman to do successful district nursing must be
educated in this special line in her training school. What we find in district nursing is this: the nurse goes out into the district and there she
finds the majority of her incipient cases, and unless she can recognize
these—they are hiding from the physicians, especially mothers, they do
-not want to admit that they are afflicted with this disease—the nurse
should come forward, she must have this necessary training and it must
be given in the hospital. She must not only care for but educate the people in the home- If the nurse has not this very necessary education how can
she give that necessary instruction in the home? She must have practical
bedside care in some institution where it is carried on, in such a way that
she is qualified then to go out into the homes of the people and above
all, to educate the people in the prevention and the cure, to prevent the
spread of the disease.
MR. J. T. ROBINSON, Kamloops—.
A committee of three should take this up, go over all this information, and thereby be able to submit a report to this convention at some
future session, say tomorrow or the following day, on the tuberculosis
problem and how other provinces handle  it, also the financial  side.
In regard to the paper. 1 want to congratulate Miss Morrice on such
an excellent paper, and I want to say that if it is a sample of the papers
that are to be read here and the discussions that are to take place, then
you justify certainly your existence as an Association, as I believe the
work of discussing questions such as Miss Morrice has brought before us
•today is one that this organization can give the very best attention to.
Speaking as a layman, as one who has been associated with hospital
work some twenty-two or three years, I may say also associated as a
director and as a life member of the institution at Tranquille, I feel that
what Miss Morrice has said in her paper is something that we all, as laymen or professional people, in the interest of health can take up and act
on to the advantage of the whole province. Now what I want to say is in
regard to the treatment of tuberculosis in general hospitals: We, here,
are situated in what is spoken of as the "dry belt" and where for a number of years people have been advised to come who are afflicted with
tuberculosis. I believe the climate is alright, but climate alone is not going
to cure tuberculosis—it has got to be treated in the sanitorium or hospital;
but the point I want to make is simply this, that the general hospitals,
as I know them in British Columbia are not built in such a way that
tuberculosis can be treated to the best advantage. Take our own general
hospital here—it is the largest hospital in Canada in a town of five thous-
ll and population. We have a good institution, we have a training school
there^ and I want to say that we flatter ourselves that we- have a very
excellent executive staff, but our institution is so laid out that it is next to
impossible for us to treat tuberculosis there. True, we look after two or
three, but at the same time, if this was to be carried out in the general hospitals the government must come to the rescue and advance enough rnoney
to attach an addition to the hospital so that tuberculosis cases could all be
confined to that particular wing. If that was done, in order that dishes
etc. would not be mixed with others, then I think it could be carried on
successfully, but not otherwise. There is also the" other important point
raised by Miss Morrice,. that of training of nurses. In my long association
with hospitals, there are very few of. the graduate nurses we have been
able to get who understand or know anything about tuberculosis, and I think
if it is to be effected that cases are to be looked after in general hospitals,
then the suggestion is made that the Sanitorium act as a training school
for British Columbia, and make it so that every nurse taking the course in
the general hospital should be- given three months, either as post-graduate
or three months, before finishing her training. If the nurses are trained so
the-" are able to look after tuberculosis patients, and hospitals remodellled or
additions built as I have suggested, then I see no reason whv we could not
have them in a general hospital. At present it is impossible, it is not only
a menace to our nurses but to other patients.
DR. H. C. WRINCH, Hazelton—
The poor nurses, they are loaded down with all kinds of stuff they
should, and should know of course, but has it occurred to us just where the
instructions for the care of the patients in the hospitals are coming from. Are
the nurses given authority to go on and carry out treatment, or are they
under the direction of the doctor? The doctors should have all this know-"
ledge at their finger ends. If ten per cent of deaths is due to tuberculosis,
surely our doctors should be able to give direction as to treatment.
Announcements made by Dr. M. T- MacEachern:
Get-together luncheon at 1.15 p. m.
Word received from Hon. J. D. MacLean that he would
be unable to attend, also wire from Miss E. I. Johns regretting her inability to be present at the convention.
All delegates are welcome to make use of the Golf Grounds
Re the firms exhibiting, asking the delegates to spend as
much time as they could in looking over the exhibits.
The evening meeting will be held in the Methodist Church,
commencing at 8.00 p. m- sharp.
Invitation fronv the Royal Inland Hospital to inspect the
hospital from seven o'clock on Friday evening..
MR. J. T. ROBINSON, Kamloops—
I have gathered from the provincial secretaries of the various provinces of the Dominion and States of the Union, information as to how they
finance their hospitals, also information of how they look after tuberculosis,
and would like to place it at the disposal of the committee, from
which they might be able to glean a great deal of-information as to how this
question is handled.   '
Moved by Mr. G. McGregor, seconded by Dr. E. C. Arthur. THAT the
President appoint the committee. —Carried-
DR. H. C. WRINCH, Hazelton—
Next we have a paper by Miss L. S. Gray, Superintendent of the Chilliwack Hospital, on "Nursing Service in Hospitals employing Graduate
Nurses only."
12 MISS L. S. GRAY, Chilliwack—
I do not intend to make a "paper of this, but being interested in this
'service and having been in close touch with it in our own hospital for over
two years, I have wondered many times if other superintendents" of such
hospitals meet with problems in this particular line.
If the nurse is to carry out the wonderful pledge she takes when she
graduates, the care and comfort of her patient should be her chief aim and
object, so if good service is to be maintained a few points are worth considering and then an exchange of ideas might help   us all.
First—To what extent should discipline be maintained in the hospital
employing graduate nurses only? Should it be necessary to have rules and
regulations hung? That the superintendent have a code of discipline for
her staff of graduate nurses is obvious, otherwise there would be a lack of
that law of order which goes towards the smooth running of a hospital.
To go about this and not offend the graduate nurse's dignity is the difficulty.
Secondly—Methods: Should one method for each line of treatment be
adopted by the graduate.nurse in the hospital she is working in? That she
should adopt the methods of the hospital as far as.-possible seems in my
idea better policy, and what is of far greater importance—is better for the
sick ones under her care. In the smaller hospital the patient cannot always
have the same nurse treat him or her.
Thirdly—Salaries: Then, ;again, the question of salary; should there
be any grading? This has in some places, no doubt, been a vexed question.
My idea is that one of the staff, at least should be a little higher salaried—
if she be found capable. Then she is ready and willing at any time to take
the superintendent's place when off duty or on holidays. All cannot be
first and all cannot be left in charge, even if each. in her own individual
way shows herself capable. Is the nurse who has had many years experience and shows herself capable, not worthy of a higher remuneration and
responsibility than the nurse just newly pledged and who has yet to prove
her capabilities?
Fourthly—Staffing of hospitals employing graduate nurses only, is a
difficult question also and must be arranged, not only with regard to the
" numbers, but according to the range of disease, emergencies, maternity
work etc. in the neighborhood where the hospital is situated. For instance
the agricultural district does not have the emergency cases that a mining
district has and yet the range of disease in the first mentioned may be more
varied and might call for an extra number of staff for the same ayerage of
patients. A hospital with a smaller number of beds might need a larger
staff in proportion to a hospital with more beds
Many more points might be raised. I have merely thrown out a few
suggestions for discussion and should very much like-to have the ideas and
exchange Qf opinions of others who have experience along this line.
DR. H. C. WRINCH, Hazelton—
Discussion on this paper is to be opened by Mrs. Johnson.
MRS. M. E. JOHNSON, VANCOUVER
Miss Gray has charge of a public hospital with graduate nurses; I
have a private hospital with graduate nurses. I have just about the same
problems, and I find that a certain amount of discipline has to be maintained even with a graduate nursing staff, yet it is very much less than
that with pupil nurses. As far as salary is concerned, my operating room
rnrse I make head nurse and she is responsible when I am not there; I pay
her a larger salary than the others. Then I have three nurses on the same
salary doing the same work. I may say that my nurses are all on eight-
hour duty, which necessitates another nurse on the staff, but I find that the
routine work is so much better and I am relieved myself. As to methods,
there is one thing about conducting a private hospital—it is for the interest
13 of the one in charge, and I always try to impress on the staff that our
patients must be satisfied; in order to make it a success we must send them
away with the best nursing care.
MR. G. BINGER, Kelowna—
Might I ask Mrs. Johnson how many beds there are in her hospital?
MRS. M. E. JOHNSON, Vancouver-
Twelve.    And I can take care of fifteen patients-    I have four graduates  and two  attendents;  a  maternity  ward  with  accommodation  for  ten
babies.
DR. H. C. WRINCH, Hazelton—
In the absence of Miss Johns, Mrs. Johnson has consented to take her
place. We will ask Mrs. Johnson for the report of the Committee on Nursing Problems of British Columbia, especially dealing with the questionnaire
sent out during the current year.
Report on Questionnaire regarding Teaching Conditions in Training
Schools in British Columbia <
Questionnaires were sent to twenty hospitals in the Province which
were reported to be conducting training schools. Only ten replied as follows :
Nanaimo General Hospital, Nanaimo
Nicola Valley General Hospital, Merritt
St. Joseph's Hospital, Victoria
Hazelton General Hospital, Hazelton
Royal Inland Hospital, Kamloops
Queen Victoria Hospital, Revelstoke
St. Joseph's Hospital,  Comox
Royal  Columbian Hospital,  New Westminster
Prince Rupert General  Hospital,  Prince Rupert
Kootenay Lake General Hospital, Nelson
An analysis of replies follows:
Regarding Affiliation
Hazelton General Hospital: suggested that the period of affiliation be
reduced from one year to eight or six months.
Nicola Valley General Hospital: objected to affiliation on the ground
-that it removed the pupils from the hospitals during the most useful period
of their training. This hospital also urged that the period of affiliation be
reduced to six months •
The following subjects were recommended to be taught during the affiliation year:
Nursing in diseases of the Eye, Ear, Nose and Throat
Gynaecological nursing
Obstetrical nursing
Dietetics
Dispensing
Operating Room service
Pediatrics
A suggestion was made that the affiliating period be changed from the
senior to the intermediate year.
Arranging for lectures and Classes
Enquiry was made as to whether difficulty was  being experienced  in
making satisfactory arrangements for teaching certain subjects.    Six replied
that they had no difficulty and three stated they had.   Dietetics was especially
mentioned as being a difficult subject to teach satisfactorily.
Travelling Instructor
14 The question was asked; as to whether the services of a travelling
instructor who could remain at each school for a month or six weeks and
teach certain subjects would be of assistance. Five replied that they
approved of such a plan. Two stated tfiey could not use such a person, and
three expressed no opinion.
Lesson Plans
It was suggested that lesson plans setting forth the method of presenting
each  subject might be of use.    Nine  expressed themselves  as approving.
One was doubtful .
Uniform examination in Basic Subjects
The question was raised as to whether uniform examination papers
could be sent for all schools in the Province in the basic subjects. Eight
thought this possible, one disapproved and one did not answer.
Regarding a Short Course in Training School Administration and Teaching
Six expressed themselves as heartily approving of such a course, two
were doubtful, one would be unable to attend and one gave no reply. A
most thoughtful answer to this question was sent from St. Joseph's Hospital, Victoria, and is quoted in full:
"I believe a course in administrative work would be valuable as a
normal course is good for a teacher, but only those with natural administrative qualities should be allowed to take it.    No amount of training
"will make some people capable of managing more than one person."
Respectfully submitted,
E. I. JOHNS, R. N.
Member of Committee on Nursing Problems
in British Columbia
DR. H. C. WRINCH, Hazelton.
I wish more hospitals would answer the questionnaires sent out.
The report of the Committee on Standardization will have to be passed
over as the committee did not find it possible to gather anything worth
while taking your time.
The discussion on the papers just read on these nursing problems is set
for this afternoon under the chairmanship of Miss MacKenzie of Victoria,
and it was thought that we might probably run on into the subjects for the
next session because there are a large number which we cannot possibly
get through.
Miss J. F. MacKenzie, R. N- Victoria, presiding.
MISS J. F. MACKENZIE, Victoria-
There are a great many phases to this question which we would like
settled, particularly the length of affiliation. Possibly I had better explain
just what affiliation is. There are a number of small hospitals throughout
British Columbia on Vancouver Island and on the Mainland, who are not
able to give a full course of instruction to their training school, and arrangements have been made with the Vancouver General Hospital on the
Mainland and with the Provincial Royal Jubilee Hospital on the Island for
affiliation. I have found out that two years is the shortest time I can possibly go through in taking those pupils. The superintendent has too much
to do, consequently the pupils go on with a very meagre amount of training. I cannot do it in less than two years. The Vancouver General Hospital has one year. In the paper read today some recommend eight months
I cannot possibly see how you could crowd in the subjects that have been
recommended to be taught-    I think it is impossible.
MISS H. RANDAL, Vancouver
I- would like to enlarge a little on what Miss MacKenzie has said about
affiliation. The great need for affiliation was not felt only in theory; in
small hospitals they do not have the clinical material necessary. The reason why we started this affiliation scheme was to give the pupil who entered
15 the small hospital an equal chance with the pupil who entered the larger .
hospital.    We  thought we  were helping the  smaller  hospitals  as  well  as I
the   nurse.     The   graduate   nurses, were   sponsors   of   this   affiliation.     If
you want the right material in your training school you must give a fair
equivalent for the young woman's time she spends in that institution.   In my
opinion you are not entitled to claim three years of a young woman's Ufjg
without giving her the equivalent.    I think it help's the small hospital.    In
that way they can bring in young women and give then the necessary training.    1  consider  a  young woman  who  has  spent  two  years   in  the  small
hospital and one in the large is a better all-round nurse than the nurse who
trains  in the  large  hospital.    One  of the  great  weaknesses   in  the  small
hospitals is the few medical cases they get.   These affiliated students have
done remarkably well.    These young women going back with the diploma
of their small hospital is going to bring in more pupils in- that hospital and
create a better feeling all round.
MISS J. SCOTT GRAY, Prince Rupert-
Could there be  any  method of  exchange?    Could the  larger hospital'
pupils not have a short time in the smaller hospitals, because very  often
graduate nurses who are trained  in the large hospitals are not very well
suited to the work in the smaller hospital where they take up work?
MISS H. RANDAL, Vancouver—
I think that is the idea, that is what
could be done if one will only start it.
we are working for.    I think it
MISS J. F. MACKENZIE, Victoria
I am quite in line with Miss Randal. I am always glad to see an affiliation pupil come in because they are a perfectly splendid example for my
own girls.   They are often more capable than our own.
MRS. J. CHARLOTTE HANNINGTON, Ottawa—
I am particularly interested in this question of affiliation. The Victor-.■
ian Order of Nurses when I first took charge of it, had about thirty-five'.'
small hospitals ranging from seventy-five down to ten beds.    In many .of |
these there were training schools, which were merely exploiting a body of 1
very valuable young women.    These training schools were all removed and-
there are no training schools now  in hospitals under, thirty beds     Where
the removal of training schools of this size would work a hardship we have
resorted to the affiliation scheme.   There is a great deal of credit    due the
British  Columbia   Graduate  Nurses'  Association   for their  forward  movement in affiliation    In the East it is more difficult; in Northen Ontario- you. ]
have a number of small hospitals that do a perfectly, invaluable work, who J
serve a-large country    The work they do is away beyond what we- can esti-'j
mate in number of beds.    We were anxious to get affiliation which would-
not  send  the nurse into the  large' city from  which  she would not return
again.     The experiment of Miss Boscoe was entirely satisfactory in    the
Kingston  General Hospital.    Her answer was "You can send as many as
you want, they are having a very wholesome effect on our nurses; they do
not want the nurses to come in from the small hospital and out do them."
We can get affiliation with almost any medium-sized hospital.    We prefer
them.    Hospitals in Winnipeg will do anything to help the smaller hospit-
als in the proper training of their pupil nurses.   That is what we want—the;
best possible person to go out into the outer districts with the    necessary,
knowledge.    I wish the nurse in the large hospital could go out  into the
small hospitals that are doing very good work—she would be a much.better |
nurse when she is throush and much more valuable to the community .than j
she is today.    I hope affiliation will be gone into by this-very progressive-
organization.    The time has come when we must send our nurses to some
hospital such as the King George in Winnipeg, where they get such a trainS
ing as they do under Miss Martin and the rnedical men in connection with!
16 that hospital.    Training in King George's is three months, given either to
under-graduates  or  graduates.    They pay  the nurse's  travelling expenses.
MISS J. A. MORRICE, Tranquille
The Winnipeg General Hospital also sends their    nurses    to the    King
Greorge, they get an excellent training there.
MISS H. RANDAL, Vancouver—
I think this principle of'sending pupils from the large hospitals to the
smaller might very easily be started, by not commencing on too large a
scale. I think it could be managed in the second year, when she could take
the place of the one whose position she is taking. One of the objections is
that the nurse is taken away from the small hospital during her third year.
At the end of her second year the nurse in the small hospital is really more
capable of taking charge than the nurse in her second year in the large hospital—she has been thrown on her own responsibility.
MRS. M. E. JOHNSON, Vancouver—
We have a large Tubercular hospital in British Columbia and I would
like to see a training school there.    I do not know whether    it has    been
gthought of or not.     I do not know how many nurses they have there.
MISS J. A. MORRICE, Tranquille—
At present we have fourteen.
MRS. M. E- JOHNSON, Vancouver-
Why not have a training school in the Tubercular hospital and then
send the nurses to the general hospital for six months, and the nurses in the
the general hospital go to the Tubercular hospital for the same length of
time. I think it is necessary that there should be a training school in our
. Mental hospitals in order that we could give our graduate nurses an all-
round experience. There is no more danger in a nurse taking care of patients
in a tubercular hospital than there is in a general hospital, in fact, not
so much.
MISS H. RANDAL, Vancouver—
In Quebec this year the question was brought up as to making the
third year hroader than it has been in the past. There was a feeling that
the third year should be allowed them to go to Mental and Tubercular hospitals; then we would have what we want, a real nurse. It is not fair to
send out these young women with only a limited knowledge of surgery,
medicine and obstetrics, without giving them an opportunity to have a
course in Tuberculosis and Mental nursing.
Mr. J. T.  ROBINSON, Kamloops—
Looking at it from the financial standpoint—the directors of the hospital which I represent take this view. After the second year the nurse is
just becoming valuable to the hospital, we must consider the financial end,
she is able to relieve the graduate nurse. It is, perhaps, the wrong way to
look at it but we have to face facts—that we are short of money. The directors feel if they can give the training, that the nurses should take the
three years course in the small hospital. If you take them away after the
second year it means that you have to have more graduate nurses—therefore, the expense goes up considerably, That is the stand they take: that
if the small hospital can give the required training and fit them for their
service as graduate nurses that they, the small hospital, ought to be able
to give the full course.
DR. E. C. ARTHUR, Victoria—
I feel very strongly that every institution, big or little, should not be
permitted to give the. nurse her whole training; she should have experience
in more than one school, whether it be large or small.
11 MRS. J. CHARLOTTE HANNINGTON, Ottawa—
I do not think it has been proven by those hospitals who have tried affiliation that it does effect the efficiency of the hospital to allow their nurses
to go out and affiliate with the larger hospital. I think they have been benefiting rather than losing—they bring to that hospital a great deal more,
than they take away. The whole thing, as the directors of the hospitals
told Miss Randal when she saw them a few months ago, is a question of
finances; if they could get the money they are willing to further the interests of the hospital, and until they get the money they cannot do anything
and they have to hold tight.
MR G. BINGER, Kelowna—
I think it would save the small hospital expense in any case, because
we should have to have fewer graduate nurses and more probationers, and
thus make the work all round easier for everybody, provided we have the
proper accommodation for a training school and send our nurses for the
final year to one of the larger hospitals. I think as far as finances are concerned, it would help us out a great deal.
MISS J. F. MACKENZIE, Victoria
The next point for consideration is: Uniform examinations and basic
subjects-
MR. G. BINGER, Kelowna—
Is there not a regular form of examination paper for every nurse in
the Province?
MISS J. F. MACKENZIE, Victoria—
That is only for registration. Some training schools, as I understand
it, give a full set of examination papers at the end of the three years. At
the end of each lecture, after that course is finished, I give an examination
and the subject is finished with.
MISS H. RANDAL, Vancouver—
I think the question has been discussed quite freely as to the advisability of having uniform examinations, not only in the third year, but for each
year. That takes time. In the wording of our Act we have arranged that
this can be done -for their final year, but the one examination may do if the
hospital boards so wish and the examination committee agree. It seems
that we ought to treat this subject in a broader light than we have in the
past, and if the ordinary schools in everyday life require that there should
be uniform examination, then we ought to do the same thing. It will take
time and consideration as far as the final examination is concerned, but I
do not think there will be much difficulty.
DR. H. C. WRINCH, Hazelton—
In regard to examination: someone suggests that examination be set
bv the school at the end of the course of training; those are the registration or council examinations?    Are there two examinations?
MISS H. RANDAL, Vancouver—
At the present time each hospital has its own final examination and the
council sets its examination.
DR. H. C. WRINCH, Hazelton—
Is the nurse expected to take her own hospital examination as well as
the councillor's examination? Must she present a certificate to the Examining Board that she has passed her school examination before coming up
for council examination?
MISS H. RANDAL, Vancouver—
At the present time she has only to show.a certificate that she is with-,
in six months of graduation, then she can take the examination.
18 MISS J. F. MACKENZIE, Victoria—
I would suggest that you ask each of the schools what they consider
a fair examination for each year, now that you have put the curriculum
practically on a uniform basis.
MISS H. RANDAL, Vancouver—
I feel that there is a great deal that should be left to the Graduate
Nurses Association, because really) we put the Act and the curriculum
through. If the Association desired to- make any recommendation I think
it would be alright. The training school in this way would have an idea
of the subject matter they would be able to cover and they could tell
whether they could give the necessary training.
DR. H. C. WRINCH, Hazelton—
I have been looking over an announcement from the Graduate Nurses'
Association to the hospitals in regard to examinations. 'It seems to me that
examinations and regulations for examination should come as an order
from the body that has the power to grant the certificates. We are told
that it is being considered. It has been decided and arranged that we ask
for suggestions. I feel that this order should come from that body. I think
we should pass a resolution asking them to submit to us a schedule of examination and ask opinions of the training schools, not that we have any
right, but if they feel it would help them we would be very glad to make the
recommendation.
MISS H. RANDAL, Vancouver—
I know that it was not definitely stated, I asked the opinion of the hospital boards. The general opinion was in favor but it was not put through so
definite instructions could not be sent out to the training schools this year.
Dr. H. C. Wrinch, President, resumed the chair
DR. M. T. MacEACHERN, Vancouver—
The discussion so far has resolved itself into definite phases: one in
which it is desired that the nurses from the general hospitals go to the
sanitorium, and that Tranquille should establish a training school whose
pupils should go in turn to the general hospital for training. This is going to impose a great deal on our nurses. Not every girl wants to take up
'llhis special course.
DR. E. C. ARTHUR, Victoria—
You do. not excuse any nurse from going through the operating room.
For the same reason I think that no nurse should be excused from going
through the tuberculosis training, for her own protection as much as anything else—she does not know how to protect herself.
MR. G. McGREGOR, Victoria—   \
Are not all hospitals receiving government aid compelled to look after
tubercular cases?
DR. H. C. WRINCH, Hazelton,
Yes.
MR. G. McGREGOR, Victoria—
As far as I can see. if general hospitals have to send their pupils to the
sanitorium—would it not have the effect of keeping girls out of training
in that hospital ? If the tubercular wards are not what they ought to be it
seems to me that they should be put in a condition they should be; it comes
down again to the question of finance. If the government forces the hospital to take these patients, the hospital should be properly financed. If the
pupil and graduate are not properly trained to take care of -these,patients,
then there must be .something wrong with their training. It is a very
serious state of affairs.
19 *4.
DR. H. C. WRINCH, Hazelton.
I was a little surprised at the remark made some time ago: that the
nurse should be taught that tubercular dishes should not be mixed up witfl|
general  dishes.    There  are much  more  dangerous    diseases.      They    are
taught from the very beginning the protection of themselves  against theses
diseases.
Mr. G. McGREGOR, Victoria-
There is one suggestion I would like to make:    I think the supervisor-^
of the tubercular wards should have a special training.    Now, just where
this supervisor would get a special training, would have to be no doubt, from
a sanitorium or a hospital specially-for that purpose.  -I think out of fairness to the general hospital the supervisor should have a special training.
MISS J. F. MACKENZIE, Victoria—
I do not think the trouble has been so much the training they have re-;'
ceived in general hospitals, but the patients are not properly    segregated.
We have a very good tubercular ward and a supervisor who has had special
training.
MRS. J. CHARLOTTE HANNINGTON, Ottawa—
The hospital at Weston has had one of the greatest struggles of any in!
Canada.   Miss Dixon undertook to train nurses there.   They said she could I
not properly train nurses in a tubercular institution, and they are still doing
what I said before: having to go to the United  States to  get    affiliation
Weston is one of the few hospitals that gives an absolutely splendid training
which is so necessary in Canada.    I think the point is not that the nurse
should be trained to protect herself from  infection from this  disease, bua
that the nurse should be taught during her training to be able to interpret
to the people the care that is needed in tubercolosis, that simple care that
Miss Morrice told us about this morning; it is so simple that none of us
know it.   The majority of nurses when they meet a tubercular case knoil
how to prevent infection but they do not know how to treat the patienjj
MISS J .F. MACKENZIE, Victoria—
That is the difficulty in hospitals exchanging pupils. I have had parents
come to me and say: "Don't you put my daughter there," but I have
told them that I have never put a nurse in that deparment yet who has not
gained from ten to twenty pounds.
Adjournment for get-together luncheon at 1.15 p. m.
Afternoon Session^— Wednesday, July 6th, 1921
Round Table Conference "A"
conducted by Miss J. F- MacKenzie, R.
Victoria, B- C.
N.
I think it would be a very good thing. I do\
In wha.t way wwld the instru&S
Travelling Instructors:
MISS P. ROSE, Nanaimo—
As far as I am concerned
find difficulty in having dietetics taught
tors be managed in going around?
MISS J. F. MACKENZIE, Victoria—
We have not quite worked that out.   We have several plans.   We have'
so many hospitals that are in no way prepared to pay a dietitian, or have
dietetics taught.   We could have a combination, of trained nurse and dieti-
tiaru and ha."ve her spend a, certain number of weeks in each place, go from
place to place.
MISS H. RANDAL, Vanoonver—
We have discovered that there is a very decided need for travelling in-i|
structors; not only in "dietetics but in other subjects.
20 "MRS. J. CHARLOTTE HANNINGTON, Ottawa—
Isn't one of the most important points with reference to this travelling
instructor the economical one? You have so many little hospitals who cannot supply this information. Isn't that a principal point—besides the nurses
getting this instruction, its much the more economical way? Perhaps
larger hospitals would use these instructors and make it easier for the
Smaller hospitals.
MISS J. F. MACKENZIE, Victoria—
That was one of the points, yes.
MR. G. McGREGOR, Victoria—
If you tell us where to get the money we are right with you.   Anything
we can do for any small hospital we are only too pleased to do it.   I do hot
see why you should not have travelling instructors.    I heard the  remark
made today that any hospital taking a girl for three years who cannot give
&er the proper training, is robbing her of those three years. I see no reason
Bjjhy you should not have one, and every advantage in having one.
Moved by Dr. MacEachern, seconded by Mr. Binger,
THAT the B. C. Hospital Association endorse the principle of travelling instructors, which has been proposed by the B. C- Graduate
Nurses' Association, and will do everything they can to support it
when it can be found to be carried out in a practical and working
manner.—Carried.
DR. E. C.   ARTHUR, Victoria—
•   I would beg leave to move a resolution in reference to the uniformity of
examinations:
RESOLVED THAT The B. C. Hospital Association approve of the
principle of uniform basic examinations for the training schools,
and would suggest that a plan of same be submitted to the train
ing schools by the Graduate Nurses' Association of British Columbia.
Seconded by Mr. Henry Woods.
Carried.
tolSS J. F. MACKENZIE, Victoria-
Living conditions for staff and pupil nurses in British Columbia hospitals is the next phase of our round table conference.
MISS H. RANDAL, Vancouver—
In making my survey of the training schools I have seen a great deal of
the housing conditions of the staff and the pupils in this province and they
run to extremes (as we do in most things) from the very comfortable in
every sense of the word, to conditions which should not be permitted in any
hospital or in any place where women are expected to work and do their
very best for the institution. The great fault lies in the fact that when hospitals are built the one thing thought of is the number of beds for the patients.
As a rule the building committee had not considered that the patient
required anything but a bed to sleep in and accommodations for the nurses
almost lost sight of. The only satisfactory condition for nurses is a separate
home. The idea of having nurses in wings, basements and various parts
of the hospital proper does not tend either to the fitness of the nurse
or to the good care of the patient. She has to have proper recreation, she
must have a chance to laugh and sing. Nervous breakdowns are traced to
being so near the patients at all times. I know that you can go through
your training and leave the training school a stronger and better woman in
every sense of the word than when you went in, but you have to have proper
living, housing and Working conditions. Two nurses in a room is hot
right. One may be of a studious nature and the other rriay Wish to have a
.good time.    Food is a great source of complaint, the monotony of-it, not
2i always served as it should be. I do wish you would thoroughly understand^
that you cannot have good work done and cannot have good nurses unleijsH
"you provide them with a suitable home.
DR. E. C. ARTHUR, Victoria—
I wish Miss Randal had just gone a little farther and made that apply
to  the  hospitals  that  do  not have training  schools  and  that  house  theiM
graduate nurses in the cellar and in the attic, which is perhaps not equalrjB
bad, but it is certainly objectionable.
MR. G. McGREGOR, Victoria—
Who is responsible for these conditions?
MISS J. F. MACKENZIE, Victoria-
Boards of Trustees.
MR. J. T. ROBINSON, Kamloops—
.   I think the Board of Trustees in most hospitals do a large amount of
work that the people possibly do not appreciate.    It is alright to suggest
certain things but it is another thing to get the money required to run a
general hospital.    I do think if we are going to have efficiency in our hospitals and particularly in our training schools, we have got to provide suitable accommodation for those who are nursing or training in the hospifaB
but in dealing with this question we have to look the matter fairly    and
squarely in the face.   In this up-country we live in an unorganized distritjH
—for sixty or seventy miles there is no municipality around here. Most oa
you have seen the Royal Inland; as I said this morning, it is the largest!
general hospital in Canada for a population of five thousand.   A great number of our patients come in from the unorganized district and we have to
provide extra equipment and accommodation to take care of them. I hold
that in this province of ours, having the most wonderful resources of an]a
province in the Dominion, we could go to the Government at Victoria, show
them what we are doing in the way of looking after the public health of
the community in this or in other districts and show, them that it is absolutely necessary to have a nurses' home.    I-think the Province of British
Columbia has resources enough to pay for the accommodation that is most
rightly asked  for.    I  believe  that nearly  every  hospital  board  in   British
Columbia has been working overtime in order to keep the finances and the
conditions of their hospitals up to a standard, and yet we are face to face
. with a dead wall when we. ask for money -to -build a nurses' home-   When I
-went to the Government and asked for help they told us that not one dollar
would be contributed to a nurses' home.
MR. G. BINGER, Kelowna—
I endorse the last speaker most emphatically.   If you' want to build a.
nurses'  home  and  go to  the  Government  for  assistance  they  say:    "We
cannot help you."
DR. H. C .WRINCH, Hazelton
While I am ever ready to shoulder on the trustees or directors, all the
responsibility of financing the.hospital, I wish to show them that we appreciate very heartily the position of the trustees and the work that they do
without remuneration at all; it is the most disinterested work that is .dona
for the hospital. I will never be a party to building another hospital without having a nurses' home as part of the plan, and whether or not we get
the nurses' home that we should have, we can at least make that resolution,
and never start a plan without having a nurses! home part of it. It is more
than a disgrace, it is a hardship, I wish we could get a solution to this
difficulty.
22
p-^MJ^ Round Table Conference "B" Conducted by Mrs. M. E. Johnson,    R -N.
Vancouver, B. C.
Registration and Examination of nurses in British Columbia from a Hospital
Point of View
MRS. M. E. JOHNSON, Vancouver—
.Registration for nurses reports from all over Canada,and the United'
States show that the interest taken in young girls training for nurses is not
the interest that was shown ten or twenty years ago.     The object of the
provincial registration of nurses is to safeguard those who have qualified'
by graduating from an approved training school and are entitled to register,
and to protect the .public from inadequately trained nurses.    When a nurse
has registered, that is a guarantee to the public that she. has  graduated
from an approved training school.    She may not be a competent nurse but
Jshe has had the training to make her one.   Many nurses who are not entitled to register may take excellent care of the sick, but they are not supervised in any way.   Let us hope the day may soon come when every one who
practises the profession of nursing in any capacity will be under some law
JG>Yrhich will recognize them for what they are and prescribe when and how
they may practise.
In regard to the hospital point of view: I wrote several letters to superintendents of training schools of from thirty to two hundred and fifty beds,
and the replies showed that they felt that examination and registration
of nurses in British Columbia would be an incentive to all training schools to
give the very best training to nurses that was in their power to. give, affiliating with larger schools when necessary. There is a- satisfaction in feeling
that their graduates are approved and competent to accept positions requiring executive ability or to give intelligent care to private patients.
I'want Miss Randal to tell us about the first provincial  examination
j that was held this year.   The Nurses' Board is practically the same as the
Medical Association.
MISS H. RANDAL, Vancouver—
Before I speak ahout the first examination I would like to explain the
Board. It is not obligatory for the nurse to register. We would like to-
have it so because it is to the advantage of everybody. The Examing Board
is composed of two doctors who are appointed annually by the College of
Physicians and Surgeons of British Columbia, and four nurses . Our idea
has been ever toward standardization  from the many requirements of the
• smaller hospitals. The larger hospitals will look after their own qualifications pretty well. We have always wanted to help the nurses graduating
from the small hospital, and .the small hospital itself. In speaking of the
Examining -Board,  the  four  nurses  are   chosen  by  the  Graduate "Nurses'
^Association from four different parts of the Province—all women who are
well qualified to act. We impress upon them that we do not want it to
be an examination that a medical student would pass, that it would not
disqualify any one from the small hospital. We had thirty-two nurses
write on the examination this year. Results were remarkable., showing
that the examination was very fair and what we w""t to prove that they
were well trained. The average marks would be about seventy-five. The
highest mark was eighty-five and one-half. All passed excepting one.
which is rather doubtful hut who, I think, will pass. We always have to
start a thing then work up, find out our deficiencies then correct them.
DR. H. C. WRINCH, Hazelton—
"There is no profession or course of training leading to fitness in some
useful position in life that is beset with so many difficulties as that of preparation as at present laid down for the degree of R. N. in our Province."
"More is expected of a young woman taking this course than of one in
preparation for any other sphere of usefulness."-
23 The foregoing are two very strong statements that demand explanation,
but they are made advisedly and after very careful consideration.
The nurse in training is required to prepare within the period of three
years for difficult examinations in the principles and theory of many highly -
technical subjects. At the same time and for the same period she must be
employed almost continuously under very close supervision in the performance of exceedingly strenuous and highly exacting work for the full time
working day for six and one-half or seven days every week She is in
the unenviable position of being obliged to satisfy two masters, each
demanding faithful performance of duty in two. very different methods of
% endeavor. She has entered upon her training with her mind set upon the
lofty and noble purpose of spending three years in fitting herself to render
services to her fellows that rank with the purest and best of which human
endeavor is capable. She has perchance read of the life of Florence Night*
ingale and of the mavellous success that followed her first brave efforts to
relieve the sufferings of the wounded soldiers of the Crimea, ending with
the account of a great nation heaping laurels upon her grave and immortalizing the memory of one of the noblest women who ever lived. She"
borrows from nurse friend a text book upon the high ethics ot the nursing
profession, another describing the marvellous structure of the hun:an bod,^
a third upon the properties. and action of certain medicines, the effect of
one or other of which may be expected to give instantaneous relief to
every ill that flesh is heir to. Her ambition is fired, her determination
made—she must become a nurse. She applies for admission to a good
training school, is accepted aqd presents herself for duty. It is at this
point the embryo nurse meets her two masters and begins to realize the
difficulties of the course she has chosen. Under closest supervision by
nurses of more or less greater experience than herself, she is kept actively
employed for a sufficient number of hours every day to use up almost
every atom of physical energy in her body, leaving her when evening comes,
glad to throw herself upon her bed in absolute relaxation of every tired
muscle. But during the day, upon or on perhaps two occasions, she has
hurried from ward to lecture room, listened to a lecture and then hurried
back to her busy work. Now, at the end of the' day, in a tired condition of
body and mind, she must take up her text book and endeavor to store in
her memory facts and data upon which within the fixed time she must
write an examination. At the end of three years of this uninterrupted round
of mixed physical and mental effort, she comes up for examination in these
highly scientific subjects and is expected to give a good account of herself.
To do justice to such a course under such circumstances is a physical
impossibility.
As one of the task-masters the hospital takes the point of view that its
patients must receive adequate nursing service. The hospital exists for
that purpose. It must have it. The hospital believes that three years is not
too long a time for pupil nurses to spend in a hospital in becoming thoroughly
and safely conversant with methods and practise of nursing as it is required
in carrying out treatment according to the present practise system of
medicine and surgery.
The hospital has been accused of exploiting the pupil nurses, of some- "
times availing itself of their services to nurse its patients without giving
them an adequate return. This, as hospital executors, we resent. The hospital is anxious to see its nurses do well and succeed. It is willing to have
its wards used as teaching ground for a useful and highly, scientific and
humanitarian service. It is willing to keep sufficient trained nurses to give
the practical teaching to the nurses in training, in fact it has to do it for its
own self protection and to ensure that its' patients receive the service required. It is willing to have its routine more or less upset and inconvenienced
as is necessarily the case in order to teach beginners in nursing. But the
hospital is beginning to question whether it is quite fair that it should be
expected to furnish board, lodging, laundry, uniforms, classrooms, teaching
24 ..pparatus, paid instructors with a monthly allowance, and all required time
for study up to the full time of graduation of its pupil nurses into a so highly
developed as that of nursing has become under the curriculum laid down by
advanced nursing organizations. In other words the hospital is beginning
to wonder whether it is not being exploited itself rather than the reverse. The
hospital, in exchange for what it affords the pupil nurse of practical experience in its wards, together with other forms of emolument above referred to,
believes that it is entitled to the service of its pupils for the time necessary
for them to become thoroughly conversant with practical nursing methods.
It believes in good training of nurses, both practical and theoretical,
Ewith thorough examination upon the work taught, and in registration of
those who satisfy the required standards. But it believes that more time is
required to be given to lectures and to study to fit the pupils for examinations upon the subjects laid down for them than can reasonably or possibly
be expected of the hospitals during a three-year course.
■  The suggested solution of the deadlock involved in these two points of
view is this :
1. Delete from the curriculum to be followed during the three years
practical course in the hospital as many as possible of the more theoretical and more advanced studies now in the course.
2. Make the practical teaching z.{ thorough and as complete as can
possibly be done within the three years.
3. At the end of the three years let the nurse be examined by the school
in which she has trained and given their diploma ?<? a "Registered
Practical Nurse." Upon this certificate the nurse will be legally qualified to do private nursing in home or hospital and to receive the highest
fees paid for such service. She might also hold executive positions in
private hospitals or general hospitals not operating training schools, if
they choose to engage her.
4. Provide a course of study covering the subjects deleted as referred
to above from the course to be taken in the hospitals. This course of
study to be taught by lectures in some teaching institution and to cover
a period of from three to six months, in a manner similar to the
course of normal training for the teaching profession. The examination at the end of this course of teaching shall admit the successful
candidate to the diploma of "Registered Executive Nurse" (or some
such designation.)
5. Hospitals operating training schools shall be required to engage only
,   nurses holding the present degree of R. N- or nurses holding the last
mentioned certificate of Registered Executive Nurse, for any of those
positions  on  the:r  staff for    which graduate    nurses  are  at    present
required, and in which positions the nurses had to do with the training
of pupil nurses.
I am aware that this proposal is somewhat new.     We have had the
question of practical nurse brought up in this convention, we discussed it
previously but never got anywhere with it.   We have a standard held up to
Us and towards which we are aspiring, that of a   highly trained   young
woman.
MRS. M. E. JOHNSON, Vancouver—
I wrote a number of the superintendents of training schools of d'Se^nf
sizes, to know how registration and examination would affect them, and I
would ask Miss Stott of New Westminster to speak for her school.
MISS K. STOTT. New Westminster--
At first the  nurse  thought of examinations' as  a  terrible  bugbear.    I
£jnight say in our training school I do not think it as proven so at all. The
Standard  curriculum  with  registration was   a  wonderful  help.    With  the
curriculum we have to govern Us now the pupils find it very much easier.
I know, having charge of a school. I find it very much easier to arrange
28 The examinations are not the terrible bugbear we expect them
MISS P. ROSE, Nanaimo—
My sentiments are about the same as Miss Stott's. I find nurses are
taking more interest in their studies since this examination has come up,
and I think the doctors are taking more interest in teaching the nurses. In
our hospital the doctors are going deeply into it, going above, I may say,
our hopes altogether. I find it is helping them .greatly in every way...
MISS A. MACARTHUR, Nelson—
I am of the same opinion as Miss Rose.
DR. M. T. MacEACHERN, Vancouver—
I think, Dr. Wrinch, that the university provides the total course as
referred to.
DR. «. C. WRINCH, Hazelton—
No, the idea of my proposal was to reduce the study laid down for the
nurse within which time she is required to get her practical training, also
for her somewhat wide theoretical knowledge, which, to my mind is almost
impossible. Any other course of study requires a lot of theoretical and
practical work at the same time we require it in the present course to work
physically after a fairly full day, and we also require them to get up a
course of theoretical training. My suggestion was to teach as little as
possible of the theoretical Work, eliminate some of the higher subjects of
study which she might take at her- option later on after she has completed
her practical training- in other words, a course very similar to that of the
teachers' profession, for those who desire to go on with the teaching later
or fill executive positions as, teachers, dietitians -etc.
MISS H. RANDAL, Vancouver-
Shorten her hours-—I think that is the idea if you have the eight -hour -
duty of actual work in the wards, then the nurse has the proper time to do
her study without encroaching on  her night.
DR. H. C. WRINCH, Hazelton—
In answer to that I would say that my consideration'is for the nurse.
I do not want to see a lot of young women being crowded more and more
with theoretical work while they are doing heavy practical work continuously . I expected this would meet with criticism. It is not with any idea
of gaining for the hospital any more of the nurse's time ; it is suggested
for your consideration-     I am quite prepared to have it criticized.
MISS H. RANDAL, Vancouver-
Can you tell us off-hand what you consider the extra subjects taken in :
that should be left off?
DR. H. C. WRINCH, Hazelton—
I do not propose to go into that
The  lectures by specialists  that the
hospital • where there  are  specialists
cannot get at the ordinary hospital.
MISS H. RANDAL, Vancouver-
Was she able to get the full course and diploma with the three year's
work? That was the point. I -wanted to bring out.
MRS. M. E. JOHNSON, Vancouver—
Is it your idea to have the nurse take the three year's gourse and not
take the provincial examination?
DR. H. C. WRINCH, Hazelton—
My idea is not to have her take the.provincial examination. She would
take the practical examination at her own school under the provincial regulation. Qik'MSsi, iPSsi-- ..-:-.,-,
26
I have not the curriculum beside me.
nurse  can only  receive  at the larger
ecturing to the  nurses,  such  as  she MRS. M. E. JOHNSON, Vancouver—
The examination is not compulsory now.
MISS K. STOTT, New Westminster—
I think the report that the Registrar gave us today, that average marks
were 75 per cent., speaks not too badly that the course cannot be too extensive, when this is the first examination.
DR. H. H. MURPHY, Kamloops—
I want to say to Dr- Wrinch that I am with him absolutely. It is a
fine thing to see those who are in charge of training schools at the present
time stand up and tell us that they handled that course and handled it
easily, and I believe they did; but there is not one of those superintendents
who will come to us and tell us they are getting the same class of pupil
nurse as they got in their day. The difficulty is too, I believe, that we try
to turn out a specialist instead of a general practitioner. I believe that there
is an opening for nurses turned out with the same necessary knowledge,
but I view with a great deal of alarm the increasing length of time required
to become a nurse, when at the end of that time you are only prepared to
pay her $30.00 a week. In proportion to the work and time she puts in I
consider she is very inadequately paid at the present time. At present in
the Royal Inland Hospital we take routinely every pupil nurse and give
her a course in the operating room. We have a paid nurse in that department who stands by and supervises. The nurse goes on green with everything concerning the operating room, including the technique and by the
time we have her trained to be of some assistance she goes to the maternity
department or to the third floor. A pupil nurse who has had her operating
room training and who at the end of that time is allowed to take charge of
certain minor operations, knows what sepsis and asepsis means, but may never
expect to be placed in charge of a major operation or abdominal section
for instance. I am not asking for one minute to lower the standard that
any nurse may attain to, but if a girl wishes to take up special work in
surgery or dietetics I believe in her going ahead and taking that course as
a course of after study, and I believe that the standard we are raising at
the present time in our training schools is one of the factors that is holding
- us back. I do think it is something we cannot lightly cast aside without
a very adequate discussion.
MISS K- STOTT, New Westminster—
The last speaker said that today we have not as good material in our
training schools. As far as I am concerned I consider that I have if anything better material than I had two or three years ago in my training
school.
DR E. C. ARTHUR, Victoria-
Does that apply both mentally and physically?
MISS K. STOTT, New Westminster— Z^jtyjH w^fe/'^F^^
Yes. SpsSs
MISS J. F. MACKENZIE, Victoria—
I have at the present time eight nurses with teaching certificates, physically fit also.
MISS J. A MORRICE, Tranquille—
The nurse with the hightest qualifications is the one that is most wanted.
DR. H. H. MURPHY, Kamloops—
The best nurse that I ever had was a graduate of two years standing.
She graduated from a small hospital. She kriew enough to do absolutely
what she was told; she would stay up day and night^h.e^ney.er knew when
she was beaten. I would like to know if there is as high a standard of pupils
applying now as there was ten years ago. Are they as good or better type
mentally, morally and physically?
27
"SSL MRS. M. E. JOHNSON, Vancouver—
The nurse is really expected to know more now. It seems, necessary
that their curriculum should be a little broader than it was fifteen or twenty years ago. There are more specialties now than at that time, but as I say,
there is more demand.
DR. H. H. MURPHY, Kamloops
Some of the superintendents are in the fortunate position of finding the
morale of their class improved and I am glad to hear it. I am speaking of
the general standard and I merely asked for an expression of opinion.
MISS H. RANDAL, Vancouver-
Speaking  for  the  Province  of  British  Columbia—in  going  around    I
have gone thoroughly into their work ,and I think nc hnve fully as high a
standard entering training schobls today as we; ever had.
DR. H. H. MURPHY, Kamloops—
I am glad to hear that. Don't you think raising the standard will
increase the calibre of the applicant?
MR. G. McGREGOR, Victoria—
Perhaps providing_better accommodation and shorter hours will increase
the number of applicants.
MRS. M. E- JOHNSON, Vancouver—
During five years of war there was difficulty in getting applicants, but
in Canada since the war is over that has improved very materially. I
believe hospitals are having a good many applicants and there is very little
shortage. I think in the United States they are having some difficulty but
they have increased their work so in the United States and called for so
many public health nurses that that is the reason for the shortage there.
MR. J. T. ROBINSON, Kamloops—
I am not in favor of lowering the standard, but this is the point: in
travelling through this vast Province of British Columbia there are certain
places along the coast, sparsely settled and scattered, and those are the
people that are doing pioneer work, they have a very hard time to make
both ends meet; their lives are just as precious as yours or mine. I want
to know if we cannot provide some solution by Which those people would
get the benefit of a better class of nurse that probably would not be so
highly trained as the standard set, that would go out there and nurse those
. people. They cannot afford to hire a nurse at $30 or $35 a week. Could
we not provide some way to give them this service? The medical man is
fighting an uphill battle alone, he goes out and treats his patients but has
no one to help him.
MISS H. RANDAL, Vancouver—
I think the Red Cross peace programme and the Victorian Order of
Nuises is assisting in that.
DR. M. T. MacEACHERN, Vancouver—
Dr. Young will answer that in his address tonight.
MRS. M. E. JOHNSON, Vancouver—
■ In sending a nurse out there she would have to be efficiently trained,
Would it be wise to send her out there where she has no supervision and
more responsibility if not fully and properly trained?
MR. J. T. ROBINSON, Kamloops—
I think the people in the outlying districts would take it as a very great
favor if you could solve that problem. .
2$
*4. MRS. J. CHARLOTTE HANNINGTON, Ottawa—
For twenty-two years the Victorian order of Nurses for Canada has
been doing that work. You can understand that one organization in a field
as large as Canada does not get very far, the reason being that we lack
workers, but I think if there is one place that needs the highly trained
woman it is in the outlying districts. It is the small hospital that provides
us in many cases with the worker. She is very sympathetic towards the
needs of the rural communities, especially in obstetrical work. We are '
losing hundreds of young mothers and hundreds of thousands of babies in
Canada every year because we are not taking care of them. We must have
women of a very fine character, good education and very highly trained to
go out because when we want a doctor he may be fifty miles away. I will
give you an instance: a nurse in Saskatchewan in a faraway district
discovered five cases of Small Pox. If she had not been a thoroughly
educated woman and a very highly trained nurse, all that would have got
ahead of her- We should see, as citizens of Canada, that pioneers have at
their disposal thoroughly good highly trained women, and some way must
be found to finance them. These nurses are not extravagant in what they
demand; they must have a place to live in. In' speaking of accommodation,
I cannot help- but think of some of the places our nurses sleep in. Transportation is another thing. A Canadian nurse will go anywhere you send
her if you give her a comfortable place to live in, a car to travel back and
forth in and a reasonable salary.
Round Table Conference "C" conducted by Miss Pauline Rose, R. N.
Nanaimo, B. C.
Institute in British Columbia for Superintendents of Hospitals and Training
Schools
MISS P. ROSE, Nanaimo—
I am afraid this is a subject I do not know really very much about and
I am going to call on someone to tell us what they know of it.
MRS. M. E. JOHNSON, Vancouver-
Miss Johns has handed me her remarks on this subject, which are    as
follows:
R"3arding a  short course for  Superintendents of Nurses,  Instructors  and
Staff Nurses in Hospitals
In April of this year the writer attended the convention of the American
League of Nursing Education in Kansas City. Considerable discussion took
place concerning ways and means whereby a short course of instruction
ecu!,! It given to the group mentioned above without the necessity of their
travelling long distances involving expense and prolonged absence from their
duties- At present the only opportunity for instruction along these lines
which is available in Canada is at McGill University, Montreal. Several
nurses from different parts of the United States described the various
experiments that are being made in this connection.
The fo'lowii-R plans aie now in operation or are in process of bci'ig
arrang' 1,
(Al institutes
In some states the local chapters of the League of Nursing Education
were conducting institutes lasting from three days to a week. The co-oper->
ation of the local hospitals was enlisted and a series of lectures was arranged. This plan gave some good results but it was felt that tlu- time was too
sK>vt and the work too superficial to iustify >ht expense involved
(B) Some of the universities where departments of nursing existed
were offering or arranging to offer a short course varying in duration from
three to six weeks.   This included lectures, demonstrations, excursions to the local hospitals and numerous conferences. Those who had attended courses
of this kind were wejl satisfied with the help they received. They stated that
the expert educationalists attached to the university staffs had been very
helpful in relation to problems of teaching, such as lesson plans and planning curricula.
In British Columbia there appears to be great need of some such course
as that outlined above. The replies to the questionnaires sent out by the
special committee of the Association were almost unanimous in approving
such a plan and a number of the younger graduate nurses also feel that
they would be willing to avail themselves of such a course if it were possible to arrange it under the auspices of the Department of Nursing in the
University of British Columbia.
Superintendents of nurses all over this Province will agree that it is
increasingly difficult to obtain assistants who are capable of directing and
teaching others. The truth of the matter is that few of them have had
either the instruction or experience which fits them for real responsibility.
It is suggested therefore, that steps be taken by this Association to consider the formulation of such a course, and if deemed advisable, that the
University be approached concerning the same.
Respectfully submitted,
E- JOHNS, R. N.
MISS P. ROSE, Nanaimo—
I took this up from a different standpoint from the one Miss Johns
has taken. I thought if the superintendents could get together, meet at
certain times to discuss their different problems—that is the point I thought
was to be brought up. Miss Johns thinks the University should give a
certain course.
MISS J. F. MACKENZIE, Victoria—
I have taken the same viewpoint as Miss Rose, from the programme.
I thought it possibly meant a conference of two or three days where you
could discuss various training school problems. The other came up in my
mind also and I think we should have in the University of British Columbia
a course for nurses who wish to take teaching.    Our nurses need it badly.
DR. H. C. WRINCH, Hazelton—
It has occurred to me that we might have something in the nature of
an institute for discussion amongst hospital superintendents or matrons,
perhaps in connection with our annual hospital convention, a day or two
before or after the session. We must not make these conferences too
numerous- I would suggest that it be referred to the standing committee
on nursing, and may be. worked in at next year's convention.
MISS J. F. MACKENZIE, Victoria—
I think possibly the proper time would be the time of the annual me'et-
■ ing of the Graduate Nurses' Association, when all the nurses are present
at. that time.
MRS. M. E. JOHNSON, Vancouver—
I think when this round table conference came up there was a question
asked as to how training schools in the province could be brought more
closely in touch and. mutual understanding. I think if we had a travelling
instructor going.around from one school to another it would help to keep the
schools in touch, also our Graduate Nurses' Association. Then, if we could
have an institute conducted along similar lines as the teachers' course is
conducted now. it would help to bring our hospitals more closely in touch.
MISS P. ROSE, Nanaimo—
That would be open to the superintendents as well .as those who. wished
to take up institutional work?
30 DR. M. T. MacEACHERN, Vancouver-
Yes. It might be well, as far as our Association is concerned, to leave
it in the hands of our Nursing Committee as Dr. Wrinch has suggested, or
to have a committee from the Nurses' Association to confer with us, as it
concerns nurses mostly.
MISS J. F. MACKENZIE, Victoria—
I would second Dr. Wrinch's motion then, that we refer this matter to
the standing committee on Nursing in our Association, with the understanding that they would act in conjunction with the Council of Nursing.
Round Table Conference "D" conducted by Mrs. M. E. Johnson, R. N.
Vancouver, B- C.
Affiliation Problems:
MRS. M. E. JOHNSON, Vancouver-^-
We had this subject up this morning. I think Miss Bligh of Hazelton
has a paper on the question of "affiliation.
MISS E. BLIGH, Hazelton—
In attempting to say anything on the affiliation of training schools from
the viewpoint of the small hospital. I realize that every available means
should be provided to teach and instruct our pupil nurses in the career upon
which they enter.
The small hospital assuming the care of the sick, owes to the community
the highest standard of efficiency possible. An accident case, to whom the
matter of a few hours is life or death, the obstetrical patient who is
obliged to enter our small hospitals owing to the fact that she is unable
to procure the services of a graduate nurse, look upon the small hospital
as a responsible institution. Therefore, the hospital must render the best
of service by providing intelligent care and nursing.
I Hospitals with a training school should be able to treat and care for
all cases, both medical and surgical, in order to provide the nurses with
every opportunity during their training in all branches of the work. Therefore, the hospital has a large contribution to make to the education of the
nurse in furnishing the field for her practical work.
The introduction of affiliation in our training schools, necessitating a
two-year course only, coupled with the shortage of applicants for training
is a complex problem, which- today confronts our small hospitals, which
are absolutely essential in the rural communities. In order to meet the
requirements of an accredited training school in a small hospital the usual
studies, lectures and demonstrations are given so that at the end of two
years we may stand ready to turn over our nurses to a larger school in
order that they may acquire a broader training through a more ample and
widespread experienec-
. Affiliation from the point of view of a small hospital h'?-> marked disadvantages. The knowledge and experience of our third year nurses is absent;
we have to'rely on the second year nurse for the same duties in connection
with the operating room and obstetrical wards that in the larger hospitals
are entrusted to the third year nurse. This necessitates a special effort to
teach and instruct for this branch of nursing towards the end of the first
year, in order that we may safely entrust the' nurses with the care of these
cases and the duties connected with the operating room. Is it fair to the
nurses to demand extra studies, as well as the practical work, and expect
them to be as proficient and capable as the third year nurses in our larger
hospitals? What of the surgeons in the small hospitals? They too, hope
for good results and expect adequate trained assistants in their work. This
assistance has too often to be entrusted to nurses who have not completed
their lectures and demonstrations in surgical and obstetrical technique. If
this system of affiliation is to continue under the present arrangements, the.
31 small hospital will be obliged to supplement the loss of the third yea»
nurses by the employment of graduate nurses in '-order to measure up to the
standard of efficiency of our larger hospitals, otherwise the probabilities
are that the better class of patients will crowd to the larger hospitals where
more skillful nursing may be obtained.
Another question is raised provided our small training school cannot
continue. Is it possible for the larger schools to admit and train a sufficient -number of nurses to meet the increased demand for -the graduate nurse
which would necessarily be made by the small hospitals ? On the other
hand, how many of our small hospitals are on a sufficiently sound financial
basis to stand or produce the greatly increased expenditure which would
be necessary by the employment of the graduate nurses?
If it is found necessary for the nurses of the small hospital to have
the widespread experience of the larger hospital, would it not be possible
to introduce some system of exchange, whereby the third year nurses of the
larger hospital may have the advantage of the more practical and individual experience afforded owing to the closer relationship with the patients
and the duties connected with our small hospitals?
MRS. M. E. JOHNSON, Vancouver—
This opens up the subject again for discussion.
DR. H. C. WRINCH, Hazelton—
You know, I believe we gain more by not patting ourselves too much-
on the back and just telling one another how well we are doing things and
• I\ow well they are running-
In regard to the matter of affiliation, I find that the universal opinion
expressed was that affiliation was good, but I cannot find that we heard
from any hospital that was on the other side. I gather that the feeling
of satisfaction came from the nurses, from one viewpoint, who went from
the smaller hospitals and also the larger hospitals who received these well
developed girls as assistants to their staff. It is not purely selfish on the
part of the small hospital who have spent two years in primary work and
who are now able to take care of the more elaborate and more difficult work
which has to be carried on. We must nurse these serious cases and they
must be nursed by nurses of less than two year's experience when they
affiliate    in    the    third       year. Therefore,    we     crowd    more     into
their    third    year. After    having    crowded    into    their    two    years
as much as they can get in the first two years., they go on
to the third year work into the hospital with which they affiliate, hardly
knowing what they shall take up, so there is-ihe difficulty. This may be met
"in more than one way. The paper suggested it could he met by the hospital
with which they affiliate sending back to the small hospital a nurse of equal
standing, and give the small hospital an equivalent of what they give up,
if the pupils in the larger hospitals are willing to do that. The public ask
us: don't .you think you are hurting the hospital by giving up your third
year pupils, and the Board ask us the same question. I asked the superintendent of a large hospital if he could refer to. us any candidates and he
said: "Well we have plenty, but we cannot persuade them to go out." In
the same way they cannot obtain the third year pupils for us. I think if
they did they would have a i.-ioader Ua.in.ing. Jf we fo'low that que-tio i
out we must have a nursing commission that will he the Niirsuu' Council-'
All applicants for nursing in the province shall he referred to this commission, which will say to these candidates: "Vancouver General needs fifteen or
thirty on the first of such and such a month; Kelowna needs so many. After
you have spent so much time there then you will proceed to affiliation where
told." Then the commission would supply other? to take their place. That
would be a fair arrangement. We are going to seriously mix up the training when affiliating. I admit that this is not compulsory with small hospit-'
als and may not be necessary. We have an expression already from the
medical profession.    I  know of  cases where  the medical  profession  has opposed the affiliation of nurses from the medium sized hospital     because
they were going to "lose the more qualified nurse.-
DR. M. T. MacEACHERN, Vancouver—
Dr. Wrinch wants the larger hospitals to send their nurses to the
smaller hospitals in exchange on the affiliating "system. If the smaller
hospitaLcannot give the third year to their own pupils, how can they give
it to the pupils from the larger hospital?
MISS H. RANDAL, Vancouver—
Dr- Wrinch's hospital is not a fair demonstration because his hospital
is not really small.   In speaking to him when I was up there about affiliating his pupils, I said I thought .it was not necessary, and he said he thought
s-the training would do them a great deal of good.
DR. W. ARBUCKLE, Vernon—
A short while ago, we in Vernon had that question put up to us to send
our pupil nurses to the Vancouver General Hospital. I am speaking as
Dr. Wrinch, from the hospital point of view ordy, not with respect to the
advantage to the nurse. Just about the time we thought they would be of
some use to us we would have to send them away for the reason that the
eiiurse would get a better training in operating room and in maternity work.
I cannot see' that. Until" a few years ago we ran a training school in Vernon with a matron and two graduate nurses, and our third year pupil
nurses took operations in the operating room completely by themselves,
abdominal work and all other major work. In the maternity department
third year nurses  were  left with  maternity  cases—no  other  nurses  there
tkt all.    In that three or four months they would get thirty or forty cases.
sHow many graduate nurses that a big hospital turns out can take a big
operation after they graduate? We have had nurses from big hospitals after
a three year's course had to confess that they never took a maternity case
by themselves or were never in the operating room themselves. There are
certain things they would pick up in Pediatrics, but on the whole I do not see
jteery much advantage in it.
MR. G. BINGER, Kelowna—
I think the only thing that the nurse in the small hospital does not get '
is the "isolation experience in infectious diseases that they would get in the
largi        'spital, otherwise I think that any training school can teach them
just as.much.as they provide in a larger hospital.   They get more experience
and do more on their own initiative.
MISS E.BLIGH, Hazelton—
I would like to ask if the curriculum Was as fully complete when affiliation commenced as it is now?
MISS H. RANDAL, Vancouver-
Yes, just the same, but we felt we did not have the clinical material
to give them.
DR.H.d. WRINCH, Hazelton—
There is a phase of our form of affiliation which has beer) suggested
that might help us and that is, that the affiliating nurse might go to the
large hospital during her second year instead of her third year. It is the
experience that we are depriving the hospital of, that is the note of contention. I can see where that might work out to the advantage of the small
hospital and I do not see why it would interfere materially with the work
of the larger hospital- d give them those subjects which the smaller
hospital cannot supply, then let them come back and complete their course
in the small hospital. That would be much more satisfactory to the small
hospital-
33 MISS H. RANDAL, Vancouver—
When affiliation was suggested the difficulty was with the big hospitals
not the small ones; it was the big hospitals who thought they were putting
themselves out in affiliating. It was the small hospital that really seemed
to want It. Are you going to have a training that covers all the clinical
material that is covered by the Nurses Registration ? The point is: if you
have the material for a training school, you do not need to affiliate. If you
have not, what are you going to do?
DR. M. T. MacEACHERN, Vancouver—
I may say that when this question came up a few years ago the large I
hospitals felt they were extending a helping hand to the smaller hospitals
in training their nurses. Some wanted a certificate from our institution
but we insisted that they have their own. Now we give them a certificate
that they have spent a year in our hospital. Affiliation, I think, is one of
the best things ever introduced. The nurses who are going through withjl
this course as far as I know, have been pleased and satisfied. Possibly they
do not get the individual responsibility that Dr. Arbuckle says they get in
the smaller hospitals; at the same time it is compensated for by a larger
range of clinical material. She goes away a bigger and broader woman,
just the same as here, we go away bigger and broader from having rubbed
up against each other. I think it is a decided advantage to those training
schools who are not so fortunately placed as others. It is obviously our
desire to clear away any difficulties in the way of affiliation in the province
and we only want those hospitals to take advantage of it who want it. Of
course there are disadvantages to the hospial, but there are lots of advantages. I think you will get a better class of applicants to take nursing in'
your hospital if you give them the necessary advantages.
DR. H. H. MURPHY, Kamloops—
I fail to he able to reconcile all the statements about it . Miss RandaD
tells us that under the Graduate Nurses' Association if you are not able
to give training in all the departments then your pupil nurse cannot become
a registered nurse. Dr. MacEachern tells us that you do not have to affiliate unless you want to. It seems to me that once the standard is set if the
small hospital is not giving the .necessary instruction, then the choice of
affiliation has been taken away from them. It is no longer a question of
choice, you must either give up your training school or affiliate.
MISS H. RANDAL, Vancouver-
It is not compulsory that a nurse should register,    but if she does not.
register of course she cannot have R -N, after her name.
DR. H. C. WRINCH, Hazelton—
If the larger hospitals would consider the matter of having affiliates .
take affiliation  in the second year instead of the third, I  see where that
would solve a good many of the difficulties arising.   Could the Association I
give that consideration?
MRS. M. E. JOHNSON, Vancouver-
One suggestion Dr. Wrinch made as to whether it was possible to have j
a central bureau of nursing where all applicants in the province could apply
and be located in certain hospitals.   I think that has been tried in the United
States and .has worked out very well.
MISS H. RANDAL, Vancouver—
In the various  army  schools  they formed, the    nurses  were    sent to;
various hospitals to take their course.
MRS. M. E. JOHNSON, Vancouver—
I think that is one point that can be taken up by the Nursing Council. I
There was also a question this morning about affiliating with Tubercular
and Mental hospitals.
34 MRS. J. CHARLOTTE HANNINGTON, Ottawa—
What care is given to patients at the Mental Hospital in British Columbia?
MRS. M. E. JOHNSON, Vancouver—
By attendents, I believe. I think I am right in saying they have no
graduate nurses.
MRS. J.  CHARLOTTE HANNINGTON, Ottawa —
What training do those attendents have?
MISS K. STOTT, New Westminster—
They have no graduate nurses there.   I think they have hopes of establishing a training school in connection with the Mental,Hospital and a good
ideal of instruction is-now being given attendents and I think they intend
i.to give a certificate of two year's training.
MRS J. CHARLOTTE HANNINGTON, Ottawa—
I  do not  think there  are  many such  institutions  in  Canada.    I  had
occasion to write perhaps the highest authority on Mental diseases in Canada, to know where I would put a patient who required modern treatment
an-1 I received an answer that there were several places; there was an insti-
■pition at Guelph, but this specialist did not know of any other organization
in Canada that gave modern treatment  for mental  cases  which     covered
EUrsing as well as medical care.   It does not seem to me a very progressive
Eftitude on the part of Canada to have in our mental hospitals.   After all,
■when we go out into either private practice or public health work so much
does depend on the mental condition of the patient; and in social service
■york it is almost necessary to have a knowledge of mental hygiene.   I see no
better place than in British Columbia.
DR. M. T. MacEACHERN, Vancouver—
Referring again to the ,need of giving special training to nurses in
tubercular nursing, probably it could be recommended that a training
school be established at the Provincial Sanitorium, Tranquille. As I under-
has a supervisor from Miss Dickson's Sanitorium in Weston. I do not see
stand it today, the hospital over on the Island has very good quarters and
■why they should have to send their nurses to Tranquille. In Vancouver we
intend to open very shortly a hundred bed institution which will be up-to-date in every respect, one floor for incipient cases for transfer to Tranquille, the middle floor for moderately advanced, and the lower floor for
i&nuch advanced cases. We intend to put it under resident medical supervision and also under competent nursing supervision. We should be able
to handle our training school, whereas a training school of three hundred
would clog up the Sanitorium. It would meet the needs of the rest of the
province. I think it would be proper for us to recommend that nurses
should have training in mental hygiene also. I do not know whether I am
prepared to recommend a training school or not at the Provincial Mental
Hospital. I understand they built a nurses' home and it looks as though
they are trying to start a training school there.
DR. H. C. WRINCH. Hazelton
I will move THAT the matter of the Provincial Sanitorium establishing a training school, and the question of affiliation be
considered and be referred to our nursing committee for
conferring with proper authorities, when general hospitals
were so arranged that they could handle the cases-
Seconded by Dr. MacEachern.
MR. J. T. ROBINSON, Kamloops—
I believe Mayor Burton wished to speak
he will be here in a minute or two.
35
on this question and I think I oppose any further cases of tuberculosis being admitted to general I
hospitals unless a separate wing is'built or other accommodation provided.
DR.  M. T. MacEACHERN, Vancouver—
We are obliged to look after them, according to government regulations I
MR. G. McGREGOR, Victoria-
Hospitals that were equipped might be swamped with cases and those I
that were not prepared to take them would not take any-
Adjourned to meet again at 8.00 p. m.
Evening Session, Wednesday, July 6th, 1921, 8.00 p. m.
Public meeting held  in the Kamloops Methodist Church
Dr. H.  C. Wrinch, President, presiding
Meeting opened by prayer.    (Pastor of the Methodist Church)
DR. H. C- WRINCH, Hazelton—
We are glad to see so many present tonight. We are glad to welcome!
you and hope you will find it-both interesting and instructive. I will call-1
on the Mayor for an address of welcome.
MAYOR S. C. BURTON, Kamloops—
Mr.  Chairman, Ladies  and Gentlemen:
I can assure you it  is a very.great pleasure tonight to welcome the-
delegates of the fourth annual hospital convention to the City of Kamloopsj
It is especially pleasing because among those delegates are quite a numbejs
of ladies.   It is not very often we have'ladies visiting our conventions here.
It/is also usual for the Mayor of the city to present the keys of the city t|S
the members of the convention. I am rather interested to see what use thei
adies in this convention will make of the keys of the City of Kamloopsa
On Friday night I will tell them just what use I think they have made OS
them.   I want to tell the ladies, also the gentlemen, that the City is open to
all  of them.    I- hope they  will  have an  enjoyable time     and  if  there  is
anything the citizens of Kamloops can do towards that end they will-only bej
too glad to do it. I think it is very appropriate that Kamloops should be
chosen for the convention. Kamloops is a hospital city. We have in the Royarl
Inland Hospital the largest hospital away from the Coast, and in addition
we have the Sanitorium at Tranquille.    The latter institution  is probabl|8
the most up-to-date of any in the Dominion, the last word in the treatment
of tuberculosis. Tomorrow we will have the pleasure in taking you all dowM
there and I am certain you will be all very much interested in what you see
there.   We a'so want you to look over our own hospital and we will be glad
to have your criticisms and comments if you feel we deserve any.   We have
something like a population of five thousand five hundred and a hospital of
102 beds.    In addition to that we have a large outside territory—I  thirila
it is about the second largest hospital territory in British Columbia.    For
that reason we have been compelled to build a rather larger' hospital than!
is usual in a city the size of Kamloops-    Our convention at this time musts
be of great assistance to municipalities and I want to say a few words from
that  point  of  view.    First  of  all,   as   regards  tuberculosis.    The   fact  of
having a sanitorium within such a short distance of Kamloops has advertised the  fact that we have a  splendid climate  for the treatment of  that
disease, and the result is that we get many patients from all parts of the
Dominion and from all parts of the United  States as well, who come to
Kamloops for treatment.    I  am  sorry to say that a  good many of those
patients are unable to pay for the treatment personally, and as'you know|
Tranquille Sanitorium.will not admit any patients outside -the Province of
British   Columbia.    These  poor   indigent  patients   drifting   into   Kamloops
for treatment for tuberculosis very often fall on the City, or on the Provincial Government if they happen to be outside the radius of the city.    I can
give you en instance of how Kamloops is affected by those cases. About six
36 months ago a doctor sent a patient to Kamloops who was in the last stages
of the disease. As you know, in the Hospital Act-, anyone who- has been
living in the city for thirty days becomes a city patient and the city is liable
for the keep of that patient. In the case of the patient I am speaking of
Mere was only one thing to do—we simply paid his fare back to Toronto.
There are many similar cases. There is a point this convention might take
up With a great'deal of usefulness to the City of Kamloops: Patients from
other provinces coming into British Columbia should have credentials with
'Jhem or money to show they are able to pay their way or have somebody
behind them who can do it for them, and it seems to me the Governments
could work between themselves so that if a patient from their province
came to this province the Government of the province from which they came
should make provision for their keep while here. It is a great shame that
we should have to stand the/expense of them, it is a hardship on the
community.
Regarding hospital financing, this is the most serious question the
hospital has to face today- It is also a serious question for the municipality. At the present time there are four sources from which hospital revenue
is derived: patients' fees, donations, assistance from municipalities and
government grant. The government grant today is 50c per capita, the same
as it was in 1910, notwithstanding the great increase during the last several years in the cost of patients' keep. I have advocated for many years the
iysystem of a hospital tax whereby everybody in this province needing hospital attention could secure it without the great expense it entails at this time.
If a tax of this kind was imposed it would mean the hospital would be
placed in a good financial position. The hospital runs along for several
years, gets a number of thousands of dollars in debt, the directors meet,
decide they will send a delegation to Victoria to ask for a government
grant. They interview the Government, try to prove to them that their per
capita cost is lower than any other in the province, that they are not extrava-
gent, that they are entitled to $15,000.00. It is not pleasant to have to go to
Victoria to ask for a government grant. I do think it is up to the Government, with the assistance of the municipality, and also with suggestions
from this convention, to form some scheme whereby hospitals can know
that their finances w'ill be looked after, then there will be no need to worry
as at present. The present system is not fair on the merchants of the town
or anyone carrying on business with the hospital. I know in many cases we
have had to let our bills run for two, perhaps three years. That should not
be, the hospital should be able to pay cash for its provisions, drugs etc.
When bills run it means a bigger expense, interest etc. Merchants cannot
be expected to carry a hospital without having some increased cost for the
goods.
As you have some very interesting speakers after me I am going to be
very brief. Just one thing I want to call your attention to: when you go
to Tranquille tomorrow take notice of that large'tract of land on the left
hand side. In this district providence is very good to us-- in respect to
sunlight, and splendid soil, but we have to assist providence by pumping
the water to put on the land. Our hydro-electric system of Kamloops is
supplied through water pumped. All that land out there was just sagebrush land once.
As I said, I hope the delegates will have a very enjoyable time. There
is only one remark I have to make about the programme: you have
too much work—I would like to have seen more recreation. Perhaps some
can stay over and if so, we will be glad to provide the motors for you. I
hope you will all have such a good time you will not want to leave us.
DR. H. C. WRINCH, Hazelton—
We have next the privilege of listening to an address by Mr. J. T.
Robinson, Chairman of the Board of Directors, Royal Inland Hospital,
welcoming the convention on behalf of the hospital.
37 MR. J. T. ROBINSON, Kamloops—
His Worship the Mayor has practically voiced the very remarks I had to*
make, On behalf of the Royal Inland hospital I am very pleased that this
convention is being held in the City of Kamloops and I hope that your stay
in our City will be so profitable that at an early date when you are again
arranging for a convention you may remember the City of Kamloops. I-
hope that during your stay here you will be able to pay a visit to the Royal
Inland Hospital, it is an institution of which we are all very proud. As
I told you, we' boast of having the largest hospital of any town of its size
in Canada. I am pleased tonight that my good old friend Dr. Young is here
because I want to pay him a compliment. I think there is a great deal of
credit coming to Dr. Young in regard to the Royal Inland, because it was
largely through his good graces and through his kindness that the Government finally came through with sufficient money for us to build the institution. I am pleased to see him here tonight and I hope he will feel such a
friendly wave for the city of Kamloops that he will assure us that there
-will be $40,000 placed in the treasury for the nurses' home.
I am glad to see so many outsiders here tonight; even our citizens
see what we are doing and what I told you tonight—that this hospital of
ours is classified as A-l. I think we have something to boast of in the City
of Kamloop's. I hope not only the visitors, but the citizens will attend the
hospital and help to entertain. On Friday evening there is an entertainment
at the Royal Inland. We hope you will all be there. We will be glad to
give you a good time.
DR. H. C. WRINCH, Hazelton—
On behalf of the medical profession  of your  City we  will  have  the'v
privilege of listening to Dr. H. H. Murphy in an address of welcome.
DR. H. H. MURPHY, Kamloops—
I am very pleased to join with the Mayor and Mr. Robinson in welcoming you to Kamloops. We all felt sure when we heard that you had made
this choice that you wmiid find this a successful convention. I understand
tonight that you have more hospitals represented than you have had at any
previous convention. Holding- your convention here signifies your appreciation of the oosition the Royal Inland Hospital has attained to in this provincS
It is a compliment to the Board of Directors, and for the benefit of those not
directly connected with the hospital. I will say that these men are giving
their time gratis to a duty well performed. Not only is it a tribute to the
directors of today, but since the first director was appointed, December 9th,
1884, when a directors' meeting was held to decide on the building of the
hospital at Kamloops. The actual cost of the first hospital building was
$3,677.24, and that you will realize how quickly it became a real hospital,*
I might mention that at the first annual meeting one year later there was a
deficit of $335.00. The first medical superintendent was Dr. J. C. TunstallS
then followed Drs. S. Lambert, A. S. Munro. A. P. Proctor, and the last in
that system was Dr. J. S. Burris, who is chief of the profession in
Kamloops. In 1900 a wing was added and in 1912 the hospital was moved
up to the present grounds. This Hospital Association exists ,as I understand it, for the purpose of unifying the hospitals of this province, for rais- J
ing their standard of efficiency, for solving the difficulties that are common
to all the hospitals of the province, and those special ones, that may be due
to special location or geographical limits. Speaking of the difficulties, j
the question of finance and the question of securing pupil nurses arises.
As regards the question of finance, everyone feels that before
the autumn legislature meets there will be some definite policy of government aid to hospitals decided upon, and I have heard that this Association
does not leave Kamloops until they have definitely formulated some scheme
that will be the result of constructive discussion amongst its members,
that it will be so thought out and worked out that it will be beyond
criticism and I  expect you  will appoint a delegation to present that    at
38 Victoria in such a way that it will become the keynote of the government
policy . There is one thing I feel the hospitals of this province must do
before they ccmld look to government aid to solve their financial problems,
and that is, that the hospital might be put on a cost plus basis. At present
in the Royal Inland the public ward rate is $2.00 per day, the same as when
it opened in January, 1886, and I feel, to a certain extent, the government
of this province is quite right when we go and ask them for money, they say:
"You have not got your hospital on a business basis, you are giving away
to people for $2.00 a day what is costing $2.70 to produce, and you are
I looking to us to carry the burden.
As regards nursing problems, I am asking you to lay aside the
I theoretical side, the spirit of self-sacrifice, the spirit of idealism and the
| spirit of altruism which separates it very largely from the work-a-day
world. When you pause to consider for a moment two girls who are starting
out in life : one is entering a business career and the other nursing, and
at the end of a few months the one girl is ready to take up her work and
can go just as far as her ability will let her. The nurse spends three years
and graduates to \ take up nursing. .At the most she- gets $35-00 a week.
Twenty years ago she was getting $20.00 a week, when $100.00 was considered a good salary for a professional man. The solution lies in certain
changes in training—it lies in shortening the hours, in equipping our
hospitals with labor-saying devices, 'and in giving our nurses in our hospital i
all the assistance that can be given to relieve her of the work of that ■
building. When I came to British Columbia in 1912, thanks to Dr. Young,
| who is with us tonight, this province was famous, not only in its own bound-'
aries, but throughout Canada, for its educational system. I believe through
the guidance of The British Columbia Hospital Association convention
meeting regularly in the upper country and the coast, that it will come to
stand in the forefront of Canada and the world for its hospital system, for
the care of the sick, for the fineness of its nursing, for the general good
equipment of the whole hospital system throughout the province. In 1283
a man named Al Mor donated to the city of Cairo a hospital fully equipped.
When the hospital was ready for opening he said: "I finance this institution
for the soldiers, for the people of my equal, for people beneath me; for men,
women and all." This, ladies and gentlemen, is the hospital ideal. I believe
that ideal will foster and develop in British Columbia.
DR. M. T. MacEACHERN, Vancouver-
Mr. President, ladies and gentlemen :
It affords me great pleasure to accept on behalf of the Association the
words of welcome which we have received tonight. They hardly need to
extend to us such a welcome because they have demonstrated that already.
The speakers tonight are important men in this community; His Worship
Mayor Burton is a busy man in State affairs but is attending our convention
and taking an active part—it is very pleasing to have men like him take part.
Mr. Robinson belongs to a body of men whom we all very highly respect. We
criticise our directors, perhaps, once in a while, but we should not; they
are men who are doing the work for the love of it. I want to pay a word
of tribute to the Board of Directors of the Royal Inland Hospital. The
spirit which they display is most gratifying to one who is interested in
hospital affairs. I spent a' week end here recently and I found that all the
directors made it their duty to visit the hospital Sunday to disperse words
of cheer to the staff, and the spirit which I saw around the institution
impressed me very much indeed. The same thing applies to the medical
profession as represented by Dr. Murphy here tonight. The' professional
men of the City are taking care of the professional work in their City, they
are interested in their hospital. On behalf of the Association to these
gentlemen I want to express our thanks and appreciation of these words of
[ welcome. The only thing we have had to restrict is the kindness of
Kamloops to entertain us. Our bringing the convention to Kamloops was
an experiment but this proves beyond doubt that it is a very great success
39 and I 'feel that this is going to be the most important convention of all
We are taking up the nursing problems, medical services in our hospitals
perhaps the most important of all, hospital finances, and tonight that
subject is going to be discussed.
McGregor,
Provincial   Royal
took the chair
Jubilee   Hospital,
President
Victoria,
MR. G. McGREGOR, Victoria—
I may say when I- heard the convention was to be held here my point •
of view was quite skeptical in regard to the success of it. I think it is
well advised for the Hospital convention to meet once on the Mainland and
once in the Coast cities, then there will be no jealousy or dispute in the
matter I think that is a good attitude to take, then you have a policy to
follow. I have much pleasure in asking Dr. WrinCh, our ■ President to
address the meeting.
DR. H. C. WRINCH, Hazelton—
Ladies "and Gentlemen:
I would gladly have been excused had I had my choice. The privilege }
of presiding at a number of the sessions and -taking part in the discussions
has seemed quite sufficient, but the word of our -Programme Committee is
law. It is customary that the President should present an address on
somewhat of a review. I hope it will not take too long because the address
of the evening is yet to follow, and when that speaker .comes to the floor
we want to give him all the time he wishes
In- the endeavor to prepare this paper that may be expected to open
for your consideration the principal features of interest to the hospital
world, more particularly as they affect the hospitals of our Province and
their work at the present moment, as well as their development for the
future, one is overwhelmed by the wide range of subjects to be covered
and by many aspects and points of view from which each subject may
be apprdached and discussed.
It may be noted that the institutions of our Association are not limited in scope of service to small or special classes of people, as are
associations of members of some individual professions, trades, corporations or special interests of varying character. Our hospitals have a very
vital connection with and interest in the individuals of all classes of every-!
community. They must be prepared to render service to anyone of any
class at any hour of the day or night. And while it may be claimed that the
nature of the service to be rendered is limited to the requirements of health
or physical and mental well-being of the individual, yet the possible methods
of deviation from health _are so numerous and varied and the methods of
endeavor towards restoration to health are still more numerous and varied,
that the service to be expected Of the modern hospital is almost unlimited in
range and  possibilities.
Hospital work moreover, must be considered from various standpoints:
one naturally thinks first of the patient, who goes to the hospital in the
hope and expectation of being relieved of his suffering. Obviously he is
of the opinion that the hospital exists for that particular purpose. And
in the main he is right in that assumption. The subject must therefore
be viewed from the standpoint of the patient and due consideration given
to his requirements as to accommodation, food, nursing and medical or
surgical attendance.
To supply all this requires an army of attendants of varied qualifications training and experience, who in their turn must be provided with j
accommodations, food and service together with means, materials and
facilities for rendering their particular service to the patient. This
involves problems of administration requiring executive ability of the
highest type in order that the various services may be co-ordinated and the
whole force work harmoniously and effectively to bring about the desired
40 result to the patient. Hospital administration also, therefore becomes
a subject of the highest importance. But the patient looks upon the medical
or surgical service he is to receive when in the hospital, as of prime
importance. This must be received at the hands of the practitioners who
work in conjunction with the other services more directly under control
of the hospital, executive. There must, therefore, be carefully prepared
arrangements whereby the physicians' services shall be available as
required for the patients, and means provided for carrying out the special
treatments advised for them.
Again, because diseased persons are assembled in greater numbers
pn hospitals than anywhere else, for the reason that they can there best
receive the care they require, the hospital becomes the ideal place for
physicians-in-training to obtain the experience that will fit them to render
the best service to which their present and future patients are justly
entitled. Hospital work therefore must be considered, at least in the large
institutions, in its capacity as an educational agency. This, of course,
must be accomplished without prejudice to the interest and well-being of
the patient.
, . The same principles must hold in relation to providing nursing service
for the patient, and on the other hand and at the same time, taking in the
. raw material and turning out fully trained nurses capable of going into the
homes of the people in time of sickness, producing order out of chaos,
inspiring the patient with hope and the other members of the family with
.cheer and confidence that all is not yet lost because the light of the home, '
or perchance  its  majnstay,   is   sick.    Yet  another  very  important  department  with  its  own  peculiar  problems  is  found  in  the  very  commonplace
duty of feeding the multitude of patients and "attendents in and abbut the
hospital.    The  principle enunciated by the  great  general  who  stated that
PMEvery army travels on its stomach" is quite as applicable to the hospital
army as the military. There is this distinction, however, that the army
stomach asks very few questions, taking its rations three times a dav (if
it can get them) or philosophically tightening its belt another hole or two
whenever the issue fails to get through. The hospital stomach, however,
,L<}uite a different affair, which demands individual consideration and must
in many cases be petted, cajoled and made love to as many as six, eight or
even ten times a day.
But underlying all the problems suggested in connection with these
various phases and departments of the hospital work, and the additional
problems incidental to their correlation without friction, is the one upon
the successful solution of which depends the success of every other interest
and responsibility of the hospital. This is the matter of finance. Just here
it is sufficient to remark that in our province we have by no means yet
.-arrived at its successful* solution.
Out of the innumerable subjects for the profitable consideration of
this convention, suggested by this brief review of the hospital complex,
time will only permit of sjggestions upon a few of the apparently more
important. It may well happen that at the close of this imperfect presentation, one and another of the delegates will ask; why has no reference been
made to this, that or the other very important issue of the day. In acknow-
8 the "justice of such criticism my only apology will be the impossibility of reviewing or even touching upon all the salient features of so
Extensive a subject within the limits of a single discussion.
Just here, in looking qver the events that have transpired since we
were assembled one year ago, we are sadly reminded of the uncertainty of
human existence. We have to bow to the inexorable decree of the great
reaper, and to record our sense of deep and irreparable loss in the passing
beyond the bounds of time of two of the most valued workers of this
association. Mr. R. S. Day, of Victoria, was probably one of the most
widely known men in the province. He was one who had only to be
known to be deeply beloved.    For many years he was  Chairman of the
41 Board of Directors of the Provincial Royal Jubilee Hospital, Victoria,
B. C. and was regarded as a father and a kind friend of all in that
institution. He was present and took a most active part in the organization of this association and never missed its sessions since. He was
elected to the office of first vice-president of the Association at its first I
convention, and held -the position continuously until his death. He was
one we could ill afford to spare. Dr. R. W. Large, superintendent of
Port-Simpson General Hospital, was one who had taken a warm interest
in the affairs of the Association since the idea of the organization was first
mooted. He was prevented from attending its sessions until last year, but
on that occasion contributed greatly to the interest of the gathering, and
was given an important place upon one of the permanent committees. It is
with a feeling of deepest regret that^we give expression to our sorrow that
these valued associates will be no more with us.
Perhaps the most far-reaching -event of the year in the hospital world, |
and certainly the most spectacular, was the remarkable rapidity with j
which the Hospital Day suggestion spread the length and breadth of the
continent within the short period of about six weeks. It culminated on
May 12th in an almost universal observance of the day by the eight
thousand hospitals of the two countries. Our executive have endeavored
to obtain information from our hospitals showing how they observed the
day and indicating the results that have so far accrued to them from the^
effort. We regret that these reports have not so ~far been returned in
sufficient number to enable us to tabulate results with any certainty that
they would accurately represent the true situation. What we do knowJ|
however, is that the idea of a "National Hospital Day" caught the :
hospitals and also the public, and that it "ran like wildfire." Some
institutions and communities were not satisfied with a day, but spread
their event over a week, and in some cases even more than that. The feature
of this event which augurs most for the future of the hospital situation,
was the readiness and even enthusiasm with which the general public
accepted the challenge and rendered invaluable assistance in making it so
widely successful in each community or hospital centre. It is surely an
event that has come to stay. It is fraught with such wide possibilities of
value to the hospitals that we would urge every institution to make early i
and thorough preparation for its observation from year to year, so that it
may count for the most possible in establishing and developing the spirit
of enthusiastic co-operation between the public and the hospital, which has
already reached a point never before attained. In larger centres where
there were several hospitals, reports brought out the pleasing fact that
the former attitude of rivalry or aloofness has been replaced by a relation
of friendly co-operation among the whole group. So prompt and thorough
was the response of the public to the appeal of the Day that it would seem
that conditions are almost reversed, and instead of the hospitals making
strenuous appeals to an irresponsive or lukewarm public, the latter are
urging and pressing the hospital into a broader and more aggressive policyy-
of moiv direct and general support from resources under public ?contiol.
It behooves us as hospital workers not to be found lagging behind the
friends outside the walls of the institution who. have man-fested such a
readiness to co-operate with us.
For several years past the problem of financing our hospitals has
been growing more and more acute. The point has been reached where at
least seventy-five per cent of them in this province are working under
an incubus of a constantly recurring deficit for ordinary maintenance. Do
what they may it has become impossible to give reasonable service and
provide for its cost out of usual legitimate sources of income. And in this
condition our province does not differ from other provinces of the Dominion
or States across the international boundary. The condition is practically a
universal experience. There is not the time within the limits of this paper
to discuss why or how this condition has come about.   The causes of the
42 increased costs are natural and justifiable. Many and various have been
the efforts made by hospitals to supplement' the income from legitimate
sources. Money thus obtained has been applied to reducing accumulated
debts, and the situation has been relieved for the time, only to recur
again and  again  and be again  dealt with  in  a    similar    unsatisfactory
^manner. Even these special efforts are becoming increasingly difficult and
we are less productive of result from year to year. It has been thoroughly
proven  that  it  is  impossible  for  those   only    who    receive  the    hospital
j service, to meet the full cost of maintenance of the institutions. There
remains but one means by which the reguirements can be met. It is so
simple, so absolutely fair and reasonable that one wonders that it has
not been adopted long ago. A hospital tax apportioned in an equitable
manner and levied upon our whole population, would provide a reasonable
equipment and cost of maintenance that would make the hospital service
available for everyone needing it and would bear heavily upon none.
These facts were made quite clear at our last year's convention.
Conditions were closely observed by your Executive until time for their
business meeting in February. It was seen that the only change was that
matters of hospital financing were becoming increasingly difficult and had
reached a time where some hospital boards were even considering closing
their hospitals or handing them over to the government or the municipality.
The Executive asked as many hospitals as possible to send delegates to
meet them in special session to formulate a definite presentation of the
situation to the provincial government then in session and from them
seek advice and relief.
A careful analysis  showed that in a very large majority of hospitals
I the management were struggling with an adverse disproportion between
income and expenditure, which they were unable to -remove. In the few
instances where expenditure did not exceed income, it was admitted
because the institution was doing without some equipment or was neglecting necessary repairs and was seriously handicapped in its service on
account of not having funds to keep themselves up to their proper state
of efficiency.
Your Executive obtained an audience of the Executive Council and
presented the following memorial bearing upon this very serious situation:
WHEREAS the public hospitals of our province have almost without
exception come to the point where they are confronted with heavy
deficits or else are seriously handicapped in their work from lack of
suitable buildings, equipment or staff.
AND WHEREAS this very grave condition has supervened in spite
of every effort having been made to provide sufficient funds by all the
usual methods,
AND WHEREAS under these conditions it is obviously only a matter
of a. very short time before further credit will be refused the hospitals
by banks and tradesmen,
AND WHEREAS it is inconceivable that such a contingency should
be permitted to occur,
WE, The British Columbia Hospital Association, respectfully turn to
your Honorable Body with the following proposals as the only reasonable solution to our problems,
Firstly— That the Provincial Government be requested to disburse
forthwith the deficits of the public hospitals of British Columbia
until such time as a better and more permanent financial policy for
financing said hospitals is adopted,
Secondly— That the present scale of per capita grants from the
Provincial Government be doubled until such time as a measure is
brought in providing for a more permanent and adequate system of
financing hospitals.
43 Thirdlv— .That the Government be requested to bring in a measure at I
the .earliest  opportunity -to  provide  by a  universal   basis   of  taxation-
for  the   adequate   financing  of   all   hospitals   receiving  aid   under  the
"Hospital Act."
In presenting the memorial the delegation made it quite clear to the I
Premier and ministry, that the case for the hospitals could not be met by
any slight modification or increase of the present per capita grant, but
that in their estimation its only solution was by a revenue to be derived
directly from the people, that is to say, a hospital or service tax. They
expressed also their firm conviction- that such a tax would meet with the
approval of the people of our province.
This memorial has been taken up and endorsed by various representative organizations of the province and has been followed up since. No
definite announcement has yet been made as to what the government's
future policy towards hospitals shall be. We are becoming more and more
certain that a hospital tax would be acceptable to all thinking people and
believe it to be the only permanent solution of this most serious bar to
efficiency  of  our  hospital   service.
The standardization of our hospitals has been receiving much attention
_during the past two years. At first sight it may have appeared to many
as too visionary a matter to be worth considering by the rank and file
of our hospitals. But, like many another advance movement, as it
becomes better understood, opposition or indifference fades away, and its
earlier critics become its most ardent_advocates. At first it was planned
to endeavor to introduce it only in hospitals of 100 beds or upwards. Now
it is being carried into hospitals of half that capacity. There is no
reason why many of its essential features should not be made
effective in every hospital in the land. In its operation it can be productive
of nothing but good results. The putting into effect of the principles of
hospital standardization is doing more than any ..other agency has done
or can do to raise the standard of the medical service in the hospitals.
Each attending physician or surgeon as he sees the record of his work,
together with the progress and results accruing, and then compares case
with case in his own practice, as well as in comparison with those in
the service of other attending practitioners, is automatically impelled to
the laudable endeavor to_use every available means to obtain still better
results from month to month and from year to year. These principles,
faithfully carried out, may be safely trusted to continue to produce the
very best results in the successful treatment of our patients
Problems in regard to our nursing service, like the nurses themselves
are always with. We are glad to have them, in fact could not do
without them—that is the nurses, not the problems. We are glad that the
nurses attend the conventions so faithfully. It is only by considering the
various questions from the standpoint of the nurse, as well as that of the
hospital, that we may hope to work out a satisfactory basis of operation.
A very large proportion of our programme this year is devoted to the
nursing question. And rightly so. If, by devoting the entire time of this
convention to the consideration of this phase of its work a satisfactory
basis of adjustment could be reached, the time would have been well spent
indeed. The nursing question in this province is in a state of transition.
We are feeling our way, as is the case in other provinces. We believe
we are as advanced as any and that eventually we will evolve a system of
practice and training satisfactory to all the varied interests concerned.
But we realize that the task is by no means an easy one and may yet take
more time than we like to think.
I am prepared to admit that some of the pictures presented in this
address are by no means rose colored, but to have made them such would
have been at variance with true conditions. Notwithstanding this, I would
hasten to record my conviction that we have abundant cause for congratu-
44 lation upon the advancement made in hospital methods and conditions
during the recent past. But it is- no time for sitting in placid and self-
satisfied contemplation of what has been accomplished. Much yet remains
10 be done. Fellow delegates to this fourth annual convention of the
British Columbia Hospital Association, the responsibility is upon us to add
our quota to the further improvement of hospital conditions in our
province.
MR. G, McGREGOR—
I am sure we are highly indebted to Dr. Wrinch for his able address.
As he says, some of it is not rosy and some of it is. I am sure the Association appreciates a man of his type being their president.
resumed the chair
Dr. H. C. Wrinch, Presiden
DR. H. C. WRINCH, Hazelton—
It   affords   me   great   pleasure   to   ask   Dr.   H.   E.   Young,   Provincial
Officer of Health, Victoria, B. C, to address you on "Health Tax."
DR. H. E. YOUNG, Victoria—
Before coming on the platform tonight I remarked to Dr. McEachern
that it was a great pleasure to come to Kamloops. I have always felt
myself a welcome visitor, but I said it was especially pleasant since I was
in a position now that they could not go after me for money.   As time passes
"we change our views, and I am also glad to note    that age is    having a
.sobering effect on Mr. Robinson; it was only $40,000 00 he asked for tonight.
Mr. McGregor has answered the question for me by defining my position
in the Government—I have not got control of the purse-strings.
I take exception'to Mr. McGregor placing the responsibility on the
Government. You are the government and whatever the government does
is simply giving expression to public opinion that may be properly
represented, and it rests with such bodies as yours representing the hospital
interests of British Columbia to so present your case to the Government as
will demonstrate to them the fact that you arc presenting the public opinion
of British Columbia, that the minds of the people have become imbued with
your ideas and that through yau as a mouth piece are asking the government
to-give effect to them.   Health tax means a health service to all, if you are
; agreeable to that idea, to so organize the finances which are devoted to
health work in British Columbia as to distribute the burden in a more
equitable manner to produce better results ultimately, and to carry on the
work through a sense of duty, devoting their time to management of hospital
affairs.
When I was asked to say something on the question of "Health Tax"
I accepted with a great deal of mental misgivings, because I know that there
is nothing at the present time that will instinctively place people on their
guard, than to approach the question of what, on the face of it, may mean
increased taxation. With an enormous national and provincial debt to be
met by the present and succeeding generations, and knowing that we, the
great mass of the people, are the ones to pay, a paper on how to decrease
taxation would undoubtedly be received with approval, but I hope to show
-you that what a "Health Tax" means is the plan usually adopted by all
business men, and that is, to spend money in order to save money.
You as a convention, are more immediately concerned in the question
of the administration of the hospitals of the country ,and in connection with
the hospitals you are feeling the effects of increased cost of maintenance;
the increased cost of equipment; the greater demand for hospital space on
the part of the public, without a corresponding i;        ise in your im and
with the knowledge that there is no realization on the part of the public
as to what their demands for increased hospitalization means to you.
Voluntary   contributions,   which   formerly   could    be   relied  upon    in   any
' financial emergency, have become woefully meagre, owing to the great
demand upon  the people by the present taxes  levied to pay our national
45 debts, and hospitals are forced to depend upon Governmental and Municipal
aid to supplement the income from the patients.
There never has been any definite scheme upon which Governmental
and Municipal assistance was granted, except that in some instances a per
capita grant was made, but this grant was based upon running costs as
applied fifteen or twenty years ago, and there has not been any attempt on
the part of the authorities to readjustment of these grants to meet the
increased costs of the hospital.
In British Columbia a very decided effort has been made during the
past year to convince the authorities that if the hospitals are to be conducted upon modern and efficient lines some means will have to be devised to
meet the increasing cost.
A Government appropriates within the limits of the funds available,
largely according to the apparent popular demand for each of its activities
and until our people generally become awakened to the absolute and relative
value of health work our legislature cannot be expected to grant the funds
necessary on a reasonably adequate scale.
I may be allowed to digress here to discuss the phase of the question
that appeals to the Government.
With the great advances in medical science necessitating the enlarge-'
ment of our hospitals by an increase of the number of departments,
involving increased cost for the installation of expensive apparatus together
with the higher salaries necessary to pay experts to look after these departments, and also from the fact that the people are patronizing the hospital
to a much greater extent than in former years, the Government is being
forced to recognize that, at the same ratio of increase in cost of maintenance
and increase in number of patients, the hospitals would become such a
burden on the general revenue of the country as to prevent the Government
from financing them on the same basis as they are being financed, and it is
becoming more apparent to all governments that the question of hospital
support must be dealt with in a radical way
Now, as Public Health work affects all the people, it appears logical
for it to be conducted essentially as Governmental business. The establishment and maintenance of reasonably adequate governmental health agencies
properly co-ordinated to function in a common-sense businesslike way in
every community in Canada is so logical, in fact, that its realization
eventually may be expected. That the cost of Public Health activities be
met with funds obtained from equitable taxation of the people seems right.
. We have been depending upon the voluntary organizations for assis-
tanc, but do not lose sight of the idea, and the Government is alive to the
fact, that this work will pass, and pass very rapidly to the tax payer. The
underlying principle that must be emphasized at present is this: We must
secure the co-operation of the people *by admitting them to the management
of their own affairs, with the handling of their own finances, always wifht
the idea predominant that this work must be made self-sustaining, they will
adopt the easiest way of making it so by instructing the Government to
impose a voluntary tax which will be known as a "Health Tax," just exactly
as we impose a school tax today Six percent, of a community are alawys
in need of medical attention.
Fifty years^ago taxation for education was just beginning to be
discussed and met with great opposition. The fact that the state owed an
education to every child was disputed, but in looking back it seems impossible to say that there ever should have been a thought of opposition. And
has it paid? Has it paid our nation to have spent the millions that it has
done to educate the children of our state? You have only to look around at
the virile population of Canada to get your answer, and the arguments that
were used against free education are being used today against the imposition
of a health tax that will provide for a mentally alert people, the physical
body that should go with the active mind.
46 Is  it  good  business  to   spend,  as  the  Government  today  is   spending
about three million dollars a year for educating the rising generation that
is one-third physically  defective?    Not only  is  the  Government  spending
that amount but there are other millions being spent by the municipalities
■for the schools.
If we are to get the best return from our educational system we should
be able to produce a generation that will be physically able to give effect
to their mental attributes, and we have to confess that as a nation we are
below par. One-third of our men were rejected as being unfit to fight. If
they were not fit for the army they are not fit for civilian life, that is, they
are not an asset to the state because they can barely do more than support
themselves, and there is no thought of their being able to produce anything
over and above their own support to increase the national wealth.
We are allowing the children to grow up to become charges upon the
state. In other words, we are not preventing physical defects and the result
is that last year we spent for hospitals, insane asylums, industrial schools
and care of the sub-normal, a million and three-quarters of money from the
Government revenue of the Province, besides what the municipalities
spent.
It was shown that 80% of the men who were rejected as being
unfit to fight, could have been cured of their defect if they had been looked
after when they were children. In other words, we are spending millions
of dollars trying to cure defects and keep people alive who are not an asset
to the state ,when we could, by judicious investment, prevent this waste.
In other words, the question of a health tax resolves itself into the question
of Prevention versus Cure.
Our hospitals are overloaded with cases of disease that should never
have reached the hospital, simply because we failed to recognize the fact'
that the human being is the greatest national asset we have.
If we are to increase our wealth by developing our national resources,
our forests and mines, we must have men fit and able to carry on the work.
Every man who is earning has at least three to five dependents. If he
cannot work he becomes a burden upon his friends or upon the state and
those who are dependent upon him lose all the advantages that should belong
to them. Not only are they a direct burden upon the taxes, but they are an
economic loss from the fact that they cease to be producers. How can this
be remedied? By an extention of the knowledge of what prevention means.
We paint our houses, we repair our automobiles, we patch our clothes and
shoes to preserve their usefulness, and we do this as soon as there is a
suspicion of wear, yet we neglect to patch ourselves.
When I speak of health tax, I do not mean the tax to be applied to
hospitals alone. I mean a sum of money to be raised through the medium
of the health tax that will provide for the care of the child through childhood and on through life.
The advance in medicine has been such that we can detect the beginning
of disease and so order our lives that we can prevent the disease developing
We can increase the usefulness of a man's active life from ten to fifteen
years. This .means the expenditiure of money in the establishment of larger
and better hospitals, fully equipped with all the modern departments,
manned by experts to be paid by the state; the establishment of health
centres, which will act as clearing stations for the hospitals, acting as a
sieve, and providing treatment for many cases which need not go to the
hospital. Many of our bed cases in the hospitals are cases that should not
be there.
In the diagnosis of the~cases medical men require the help and assistance
of these highly developed special departments. The average man cannot
afford to pay for this, but he has a right to it and the state should provide
such facilities that your family practioner can send a patient to the central
hospital to have his diagnosis completed when he is in doubt.   A million-
47 aire can afford it, a charity patient can get it, but the graat majority of the
tax-payers, who abhor charity, do not get it although they are already
paying for it.
The hospital should be built and equipped and the salaries of the
permanent staff paid by taxation of the people. A part of the. taxation
should fall on the state at large, while another portion should fall upon
the people of the community concerned. The equipment and tacilities should I
be furnished for men and women to be able to have an examination of
themselves made at least once a year for the detection of the beginning of I
disease. In other words, prevention should be the key note to the whole'
scheme.
What   is   the  use   of  building  expensive  sanitoriums   for   tuberculosis;'
when the beds  are crowded with patients whom we know have not    the -
slightest chance of living.   The time to treat tuberculosis is in its incipient -
stage and the state  should provide  facilities  for  the  detection  of Tuberculosis in that stage.    Our Sanitorium at Tranquille is costing hundreds of
thousands of dollars and the burden will increase, but there is no appreciable decrease in the number of cases of Tuberculosis
I may' illustrate the soundness of the business investment of such a i
health tax by quotintr a sum of money spent in connection with our Insane-:
Asylum at New Westminster.
Twenty-five per cent, of the cases at New Westminster are due to the :
effects  of  Veneral   Diseases.    There  are  sixteen  hundred  patients   in  the
asylum this year.    Ten per cent, of these, one hundred and sixty, are due I
to the effect of acquired Syphilis.   They cost the country, at a low estimate,
$400.00 per year each.   That is, one hundred and sixty patients cost the tax •
payers of this Province each year $64,000.00.   Now, we know from experience
that the average life of these patients is from ten to fifteen years. In order
to be on the safe side, I will say that we are providing for these patients for I
eight years.   Multiply $64,000.00 by eight and you have $512,000 00 actual cash
outlay by the taxpayers to support these one hundred and sixty men for the -
eight years, added to which is the economic loss to the Province of these
men as producers, and to which you may add the cost of the maintenance of
their dependents.   At a very low estimate it is costing the Province between
three-quarters of to one million dollars for the eight years.
The Government has established clinics for the treatment and care of
Veneral Diseases. My Department has been criticised for the expenditure
during the past eighteen months of between thirty and forty thousand dollars^
for the establishment of these clinics. Yet, if we had these one hundred and
sixty cases when they became infected we could have cured them at an
average cost of $50 00 each. In other' words, for an expenditure of
$8,000.00 I could haye saved the Province three-quarters of a million
dollars.   Does prevention pay?
What I am spending for these clinics is practically a health tax.    The
figures that I have given you cannot be gainsaid, and  if the    particulars ;
apply in the case of the  insane, how much  more    do they apply    to the
hospitals in general in our Province.
Why cannot the people of British Columbia recognize a business'
proposition the same as men who are engaged in money-making schemes!
have recognized it?
The Metropolitan Life Insurance Company is a cold-blooded business
organization. They are running their company to make money. They derive ;
their income from the amounts that their policy-holders pay them, and thej
longer they can get the policy-holder to live the more money they get from
him, The policy-holder bears the same relation to the prosperity of the
company that the citizen bears to the state. The Metropolitan some years
ago recognized that their success depended upon the longevity of their
policy-holders, and they established a Department of Welfare work which
" has cost the company hundreds of thousands of dollars.    They convinced
48
J I themselves that it paid. Their policy-holder is visited by a health worker
once or twice-a year. They-have published the results lately of their efforts,
judging from a business point of view as- an 'investment: ■ They say that
between 1911 and .1-919 there was a reduction of. 2.8 deaths, per thousand
in the company's: experiences. That meant the saving of .27,500 lives during
the year 1919. The actual saving in death, claims..was.oyer $5,211,000,00. If
we assume that only one-half of these'were clue to welfare' work we may
state that as a result'of the' campaign which the: superintendents, agents
and nurses carried'on,'there was a saying of $2,605,625:00' in 1919 to the
company. Does it pay? The statisticians of the company compared their
death rates with the general registration of deaths 'of the country as a
whole. In the .women policy holders it was shown'that the reduction in the
death rate 'was 12 per' cent. Between the ages of twenty-five and thirty-
four, the child-bearing period,' female industrial policyholders "showed'a
reduction in the death rate of twenty p'er cent, whereas in the general
registration the reduction was only 3 per cent". - That is, the saving of.life
amongst the policy holders under the preventive measures was' five times
greater than in the' general public, who had' not been looked after. ' Such a"
difference cannot' be explained by chance, but rather by the very effective
work of the nursing service.
■ If the Metropolitan Company, who are not doing this from any human- -
itarian  motive, but  for cold-blooded business  reasons,  can produce    such
results, why cannot the pe.ople. demand that the Government.shall produce
the same results amoungst its citizens?
The Government is willing to do so but it must have the means. The
Government is paying today as much of the consolidated revenue as it-can
possibly pay out and to meet the increased demand for hospitalization there
must be more means provided. This will mean reorganization of the hospital
system. This can be done by the imposition of a health tax.'which will mean
ultimately saving millions of money by reducing taxation; increasing the
length of life; increasing the productive capacity of the" human asset;
decreasing sickness and misery, and bringing about'-the culmination of
national prosperity,' produced by a happy, healthy,  contented'people.
My establishment of the Venereal Clinic for British,'.'. Colurfib^ai.'is.'.'a
health tax, but it is coming out of the consolidated revenue/ iJ'jn'.'Vth'e-
Workmen's Compensation- Act the employer and the government,..! are
contributors, why cannot you do' the same thing in a he.aljh; tax ,for the
general purpose and take everybody and, as Dr. Wrinch said tonight, make
it an equitable tax and have no dodgers: "If you-'are gbing*to-'put your
hospitals where they should be, provide increased equipment and increased
efficiency with increased facilities for trainihg. your nurses, incidentally
you will soon bring about the proposals made by Dr. Murphy' tonight,
which are very good indeed in regard to the nursing service. Divide your
country into districts, make your hospital' a centtfSitfiYS the state provide
the more costly part of it from the. consolidated revenue. Tax your people
;-who are in that district to maintain the hospi'talin that shape, and everybody
will contribute. If it is logical to take the children and. examine them
once a year and discover- defects, why is it not just as logical to go into
the home and say: How are you feeling? Are. you-fit to continue your
responsibility as parents? Are you able to carry on these children until they
become self-sustaining? What will be the answer: Give me a chance; tax
me. I want to see these children grow up as they should. Health tax means
prevention of disease, in the last stage a comfortable home and place to
die in—that is what a hospital should be, for the care of them, not to go
through the wards and see people who should be active in the business of
the community.
I thank you.
DR. H. C. WRINCH, Hazelton—
It is entirely unnecessary for me to say how much we appreciate Dr.
49
	 Young's paper.    We thank him most heartily for the effort he has made in
coming to us and giving this splendid paper.
We would like to have opinions on this subject. It is a big question,-
the most important that has been presented for a long time.
DR. M. T. MacEACHERN, Vancouver—
I do not think I can add anything to what Dr. Young has said, and all of
you who have listened to our minutes of meetings during the past year will
realize that The British Columbia Hospital Association has been most active
in moulding the health policy for the province. I want to congratulate Dr.
Young on his excellent paper. I believe that the health tax, as he has outlined it, is a solution to hospital and other questions of an economic
nature. With regard to the influenza question, it is true that if we had had
our hospitals, our facilities and staff ready for that we could have saved a
tremendous amount of money in our province. The Influenza epidemic
is the most serious thing that ever came in our day. Such things as that
may come and we must be prepared to meet them. I am glad the Hospital
Association is real active in its affairs; it is making itself heard and is
going to make itself heard on hospital finances. There is no question but
that we should present a policy at the coming meeting of the legislature.
The time is ripe when we should have a showdown on this and it is up to
our Association to take the lead in it.
I am going to seize this opportunity to announce to the people that
you are welcome to come to all our meetings in the high school or here,
and to tell you that tomorrow night you will have two of the most interesting
talks on our work, one particularly will show you the lumber industry in
this province. Possibly you have never seen it before through the lantern.
The other will tell you about the tremendous national movement that Dr.
Wrinch has mentioned, hospital standardization . British Columbia hospitals
led all of Canada last year and every State in the Union, in having the
highest percentage of hospitals of one hundred beds and over meeting the
requirements of standardization, and this year the competition is more
keen than ever, and we hope to have every hospital of fifty beds and over
in the list. Tomorrow night we are going to run over all the hospital
standarization movement, and whether you come from a five or five hundred
bed hospital, we want you behind this movement, and we want everyone in
this province to demand that the hospital standardization is in some live
way adopted in every hospital.
DR. H. C. WRINCH, Hazelton—
I think we will defer further discussion on this until tomorrow or the}
next day.    We will not detain you any longer tonight.
Meeting adjourned— to meet the following morning at 9.00 a. m.
THURSDAY, JULY 7th, 1921, 9.00 a. m.
Miss K. Stott, R. N., New Westminster, presiding
Nursing Questionaire:
1. Should each nurse-in-trainihg have a room to herself?
Ans.    It is most desirable that each nurse-in-training should have a room
to herself.    Failing this, not more than two should occupy one room,
due provision being made for proper space, air, light and sitting room'
accommodation.    The   dormitory   system   of  four,   six  or   more,   was ;
condemned.
2. What time should be allowed a nurse-in-training for illness?
Ans.   Three weeks appeared to be the period most generally adopted.
3. What length of holidays should be given the following:
(a) Official nurses on staff?
(b) Graduates or head nurses in charge of wards or doing floor duty'3
(c) Nurses-in-training?
50 Ans.    (a)    One month,
(b) One month.
(c) Three weeks."
4. What should be ah average salary for each of the following:
(a) Superintendent of hospital of 75 beds who is a graduate nurse ?
(b) Graduate nurses in charge of wards or floors in any hospital?
(c) Nurses-in-training in any hospital?
Ans.    (a)    A minimum of $100.00 per month with room, board and laundry.
(b) $75.00, $80.00 arid $85.00 per month respectively, for the first,
second and third year salaries, with room, board and laundry.
(c) An allowance (not a salary) of $8.00, $10.00 and $12.00 per
month respectively for first, second and third year, with room, board
and laundry.
5. Should the superintendent of nurses be the final authority in disciplinary
.   matters and the consequences to be meted out?
Ans. Yes, but it is deemed advisable to always consult with the superintendent or superior officer responsible for the hospital, and if there is
no such person other than herself, she may confer with the member of
the Board to whom such matters are usually referred.
engage  and  allow  to  nurse therein
e in a general
and    different
6. Should  our hospitals  only
nurses as have the R. N?
Ans. Hospitals should only engage registered nurses, but under the
present British Columbia Nurses' Registration Act it is not compulsory
that every graduate nurse be registered, and therefore, they cannot be
prevented from nursing in hospitals if they are properly qualified.
7. Should twenty-four hour duty for special nurses be allowed in hospitals ?
Ans.   No.
8. Should the hospital furnish the nurse-in-training with uniforms, books,
I   stationery and shoes, in addition to board, room and laundry?
Ans. Many hospitals furnish uniform material, text and note books, while
others furnish only uniform material. It is generally agreed, however, that hospitals should supply uniform material, text and note
books at least.
9. What is a reasonable proportion of patients to each nu
hospital, considering both day and night separately,
types of cases, such as private, semi-private and public?
Ans. One nurse to every two and a half or three patients. A distribution
as follows works very well:
Day Duty—One nurse to every five patients in public ward,
One nurse to every three patients in private ward,
Night Duty—One nurse to every ten patients in public ward,
One nurse to every five patients in private ward.
What is the best division of duty hours for nurses in order to establish an eight-hour day system?
Four groups as follows:
Group No. 1—7.00 a. rrf. to 7.00 p. m. with four hours off.
Group No. 2—3.00 p. m. to 11.00 p m.
Group No. 3-7-7.00 p. m. to 7.00 a. m. with four hours off
Group No. 4—11.00 p. m. to 7.00 a. m.
This combination seems to work out best of all and give an overlapping service, thus minimizing disturbance to the daily ward routine.
51
10.
Ans Morning Session, Thursday, July 7th, 1921 — 10 a. m.
Dr. H. C. Wrinch, Hazelton, President, presiding
is  the  report  of tjg;;
DR. H. C. WRINCH, Hazelton—
The  first  item  on  our  programme  th
Medical Committee on standardization.
Dr.   McEachern   reported  for   Dr.   R.   H.   Mullin.   that  the   Committee I
had no report to make.
DR. H. C. WRINCH, Hazelton—
Now we have a paper by Dr. G. S. Purvis, Superintendent of the Royal 1
Columbian Hospital, New Westminster, on "The Hospital and the Medical
Staff.'*
DR. G. S. PURVIS, New Westminster-
James Drake, M. D., Fellow of the College of Physicians and of the
Royal Society, England began the preface of his new system,-of Anatomy, I
which was printed in London after his decease, in the year 1907,. as follows:
"It has been customary for authors (even of the highest repute.and the
most conscious of their' own worth and abilities) to offer something to their
.readers in justification, or by way of apology at least, for their undertaking I
to take off the imputation of presuming to be wiser than the  rest of the
world to, and for whom; they wrote.    What was. decent modesty  in such
men is perhaps necessary in me.    The .meanness of the whole performance [
may seem to call loudly for an apology."
Mr. Chairman,-Ladies and Gentlemen:
I will merely leave out the word "perhaps" arid continue my story .
The definition of the word "staff" as outlined in the minimum standard I
by the American College of Surgeons is as follows :
1. That physicians and  Surgeons privileged to practice in the hospital be I
organized as a definite group or staff.    .Such organization has nothing t
to do-with, the question as to whether the hospital is ''open" or "closed"!
nor need it affect the various existing types of staff organization.    The
word staff is here defined as the    group of doctors who practice in the J
hospital inclusive of all groups such as the "regular staff,", the "visiftKI
staff," and the "associate staff."
2. That membership upon the staff be restricted to physicians and surgeons j
who are (a) competent in their respective fields and (b) worthy in char- I
acter and in matters of professional ethics; that in this latter connection
the practice of the division of fees; under any guise whatever, be prohib- |
ed.
3. That the staff initiate and, with the approval of the governing board of
the hospital, adopt rules, regulations and policies governing the professional work of the hospital; .that these rules,. regulations and policies
specifically provide:
That staff meetings be held at least once each month.
hospitals the departments may choose to meet separately.)
That the staff review and analyse  at regular intervals the clinical
experience  of  the staff in  the various  departments  of the  hospital.
such  as  medicine,  surgery  and   obstetrics;   the  clinical   records    of
patients, free and pay, to be the basis for such review and analyses.
The rules and regulations regarding the staff of the Royal Columbian"!
Hospital,   and   accepted   by   the   Fraser  Valley   Medical   Society,   read   as
follows:
. Physicians and surgeons practising in
New Westminster, B. C .having organized
meetings, adopt the following rules :
52
(a)
(b)
(In large
the Royal  Columbian  Hospital
as a staff, and holding regular
J 1, Case records of all  patients  treated in this hospital shall be taken  in
V'aii accurate'and careful way, an'o filed in.an accessible manner
2, .That, the membership, of .the staff be restricted .to. physicians . and
surgeons (a) competent in their respective fields, (b) worthy-in .character
and in matters of professional ethics, and that the practice.of divisional
,-fees be condemned :
3, That the staff; with the approval of the governing -board of the hospital,
adopt rules and'regulations and policies governing the professional work
• of the hospital, these rules, regulations and policies specifically provide
(a) that a staff meeting be held at least once a-month, for the purpose of
reviewing and analyzing experiences of the s:aff in the various departments of the hospital, (b) that special laboratory facilities be available
for studies and diagnosis of. patients, these facilities to include at least
chemical, bacteriological,' serological, histological, ' radiographic and
fluoroscopic.
I am going to tell you a .few points: we have,been up against in our
hospital, the duties the staff should perform, with what success we have
met, and through what we .have passed and last of all, the ideal co-op-
Cration we ultimately .expect to obtain.
■ The'du.ties of .the staff should be.to supervise the class of work done by
all physicians- and .surgeons who. practice in.that hospital. They should
have a, constructive policy constantly before them and keep .in mind first
and always—the patient, and should dispense their advice with this in view.
It should be-their, privilege, or I should say, :their duty,■ to examine the
hospital analysis.sheet from month to month and to-see that every patient
is getting proper treatment. If a mistake in treatment has been mader^to
have a free discussion on the subject, and the man who committed the
•mistake should- be glad to- receive suggestions from the staff in an open-
minded manner and not in a spirit of antagonism.
If a series of infection occur it should be discussed with those in charge
of the institution and with their co-operation traced to its source and'elim-
inated at once. In fact, anything pertaining to the better care and treatment
of the patients should be their aim: However, I do not think' any Staff
should presume to overstep their rightful duties and pass judgment on
matters which they know little or nothing about, because in the words of
Bacon: "There is nothing makes a man suspect more than to-know little."
I From the beginning we have been enthusiastic over the minimum' standard for our hospital.
Our great mistake at the Royal Columbian Hospital during the first
year of standardization has been to hdve a staff too cumbersome for any
practical value. We held our staff meeting 'on the same evening as that Of
tfie'Fraser Valley Medical Society. Our first duty was supposed to have been
an open discussion' on the monthly analyses report. We had ' several
enthusiastic and helpful discussions which were of real practical value:
T?his', however, was not always- the case, as there was usually an interesting
paper on some medical or surgical subject, which took up most of the
evening and in consequence the staff discussion suffered.
Fee Splitting
I The staff of our hospital passed a resolution condemning the division
of fees.' This, 1 think, in our community is sufficient, because from close
observation of relations between the city and country' doctors I have never
discovered any evidence of commercializing the profession. I do" not know
of any cas'e being slated for operation by any stfrgeon, or a case referred
to him,-or brought in'by'a couritry doctor'.without first carefully examining
the patient by himself, and when possible, in consultation.
Records ||JS
...Our records have been somewhat cumbersome .during..the past year,
because  in  ordering forms  I was  new  in the  institution,' the  system was
6§ new, and so, of necessity, there has been a certain amount of duplication
and overlapping in forms that can be eliminated. The hospital, as well as
any business organization, requires a strict account of all financial expenditure and receipts, also a financial audit. The medical case record system
is the health audit of our institution. At the end of each month our
statement shows the number of patients admitted and discharged from each
department, the result of treatment in cured, improved, unimproved,
admitted for diagnosis only, to return for secondary operation, died and the
cause of death in each instance, also the number of maternity cases, normal
and otherwise. It is the essential duty of the staff to see that every man
practising in the hospital keeps his .records up-to-date.
HISTORIES
We have a competent record stenographer on duty from 9.00 a. m.
until 5.00 p. m. whose duty it is to take down in shorthand detailed histories,
reports of operations and so forth, from the visiting physicians and surgeons
of all cases that pass through our institution. The medical men having
made their physical examination, received their laboratory and X-ray reports
and having made a diagnosis or at least a provisional diagnosis, all they
have to do is to sit in an easy chair and tell it to the stenographer. She does
the rest. Yet, there are some who invariably make the excuse; "I am too
busy." A man who is too busy to write a full and accurate history of
every case entrusted to his care is, in my humble opinion, too busy to
practice medicine. One man made the remark1 that his histories were of
very little value to himself or anybody else. Granted, but wherein
lies the fault? If we would pause; for a short time and look at the
histories written in such minute detail by the late Sir Wm. Osier,
how many of us would have the presumption to say we are too
busy to write histories? Deep down in their heart I think every physician
and surgeon recognizes the benefit of keeping histories and all he requires
is a little persuasion on the part of those who are in charge of the records,
with the earnest co-operation of the medical staff. If he has not made a
physical examination and does not know sufficient about his patient to write
a history, then he has not been giving to the patient the care that he or sljg
has a right to expect.
The idea, I shall but set down briefly. The staff should be made up of
men big enough to overcome all petty jealousies, who would always work
for the best interests of all patients, who would give the best that they
have towards creating a stronger spirit of good-will and co-operation
between all branches of the profession, also a greater co-operation between
the hospital and the profession. The staff should have regular monthly meetings and consider the analysis sheet in conjunction with the histories, laboratory and x-ray reports etc. If they should discover any mistakes in judgment
in the treatment of patients, histories not fully and properly written, they
should call a meeting of all the medical men, and especially invite the one in
question, and have an open discussion on the case at point. If this were
done without prejudice everyone concerned would benefit, and the same
error in judgment would not likely occur again. Likewise, if they discover
a particularly interesting case, well written up, sound judgment shown in
the treatment etc., would not everyone benefit from a discussion of such a
The day should be passed when men of the medical profession are
always at loggerheads with themselves, and with the institutions in which
they do their work. When the staff becomes a real advisory committee to the
hospital executive in connection with the welfare of the patients, and the
executive heads are willing to accept that advice and act upon it as far
as is compatible with the best interests of the hospital, then the staff wttl
enter upon a real sphere of usefulness.
I am sorry that I have wandered over the whole field of standardization
but from my limited experience I did not feel that I could stick to my text
and give anything of practical assistance.    Once more apologizing for this
54"
p feeble effort, and trusting that a discussion of this paper will bring out some
points of value.
Houle, of Kamloops,    on
DR. H. C. WRINCH, Hazelton—
We will now have a paper from Dr. L.  G.
"Medical Records in our Hospitals."
DR. L. G. HOULE, Kamloops—
I cannot hope to offer anything original on a subject which has already
been treated so exhaustively before this Association by Dr. T. R. Ponton
of The Vancouver General Hospital at the last two annual meetings.
Perhaps, though, I may be allowed to review the problem of hospital
records very briefly in the hope that some useful discussion will develop as
the result of another years' experience in getting a satisfactory system
working especially in the smaller hospitals which lack the services of an
interne.
... fs. '
There is no one, I think, who will deny the great value of permanent
medical records in every hospital. Good organization and system are indis-
pensible to the smooth and efficient operation of any institution. But it is
not alone the hospital that benefits by having satisfactory records kept of
all its patients; to my mind the advantage to both physician and patient
is still greater if the records are seriously and carefully kept as they should
be. It is my own experience, and I think there are many who will agree with
me, that I am apt to be a good deal more careful about my diagosis and the
steps leading up to it if I sit down and write a permanent record of the case,
and thereby the patient and all concerned are benefited. The average
medical man, however, who is engaged in general practice, finds so many
seemingly more pressing and more agreeable things to occupy his time
that he is inclined to evade his responsibility in this respect. This is especially apt to apply to the practitioner of many years standing whose hospital
training and case reporting days are well removed, and who has formed
certain habits of work. It would therefore seem advisable not to undertake
too ambitious a system of records at the beginning, especially in the smaller
institutions where internes and medical stenographers cannot be provided,
lest the amount of clerical work required discourage the busy doctor and
entirely defeat the object desired.
At the Royal Inland Hospital the records adopted are anything but
elaborate and yet, I think, answer the hospital standardization requirements
fairly well. They are as follows:— A combination register-ledger in which
general data concerning the patient is entered on admission and a serial
case number assigned which is placed on all his records. Later, when the
patient is discharged the amount of his account and any deposit made on
same is entered on the same line as the rest of the information, under debit
and credit columns. This book contains an alphabetical index according
to name. There is also made out a summary card containing personal
information, dates of admission and discharge, diagnosis and result. This
card is kept in the ward while the patient is in residence. The remainder of
the record consists of a b. i. d. chart on which the highest and the lowest
temperatures are recorded each day; also the urinalysis reports. This chart
is kept in all cases. A four-hour chart is used only in cases running a
temperature above normal. There is a sheet for standing orders and
another for daily medication and nurses' notes. A history form with
spaces allowed for recording the history, physical examination, progress
notes, operations or other special" reports, diagnosis and result, is used and
is practically the same as that suggested by Dr. Ponton as a summary
sheet. It consists of a single sheet and is placed on the face of the chart
and kept there until completed, when it is moved to the back, so that the
doctor sees it every -time he takes up the chart. In this way he is constantly
reminded of his responsibility until he has filled it in. The usual forms
for enumeration of clothing and valuables are also used.    When a patient
55 is-discharged all records are returned to the office where the fnedical man
in charge of the case enters the final diagnosis and result on the summary
card and history sheet and the whole is filed away, in a bolder.. ■'
,  A ino.rS.thTy: meeting of the medical <staff -at which .-all deaths,; infections
occurring in hospital and cases of special.interest are -reviewed;: furnishes •
a further stimulus to the keeping of satisfactory records. ;i*S>^
Altogether, it would seem if we are willing1'to'make a little'extra effort
to cultivate the-" habit'of'keeping these records-it Would become less and
less of a -burden 'and merg'e eventually- with the general routine of -work.
*t^fiaVe; someone go over the .records when the patient; is discharged,
and see: if any of the blanks'are'.left'unfilled, and if. so, have the attending
physicians, fill them in. 'S.pmebhe should" be' responsible to see . that the
records are completed 'before, filing away.
DR H. C. WRINCH, Hazelton—
In tliis connection in the: Royal Inland-Hospital-exhibit room you can
see a full display of- all.these, charts.
Announcement re special exhibits by exhibitors.
DR. H. C. WRINCH, Hazelton—
Our next paper is one from Dr. G. Fi Strong, Assistant Superintendent
of The Vancouver General Hospital, on "Laboratory Service in Hospitals of
less than One Hundred Beds.'"
DR. G. F. STRONG, Vancouver—
Iri the past few vears. the hospitals- of our continent- have been most
thoroughly impressed with the'Importance of laboratory work, and recognizing this and the niany difficulties connected with carrying out the service, I
have been prompted to present this brief paper, designed to set forth in as-
practical a manner .as possible the', essential minimum laboratory service
which should be found in everyhospital caring for the'sick. It presupposes
co-operation between'the large and. small'hospital laboratories, especially
in relation to the training of technicians and the perfoffning of'certain
complicated technique which cannot'be carried but'in the smaller.laboratory".
The laboratory service probably represents our most efficient aid in
proper diagnosis, and "includes besides the Clinical' Laboratory-^-the X-Ray,
the Electrocardiograph, the Respiration Calorimeter arid other such instruments. I shall consider only the Clinical Laboratory and shall outline the
requirements of such in a hospital'of less than one hundred beds. Twill
try to set forth the-fundamental and- minimum service which every hospital
should give. Larger hospitals should'have a much more highly organized
laboratory ■department  than  that which-1  arri  describing.
The ObjeC- of any laboratory service is, of course, to aid directly in
making or-confirming a proper-'diagnosis, thus' so'guiding the treatment
that the patient "maybe returned to heaith'1iri':the shortest possible time and
in the'best possible condition to be of use ia the community.
MUST HAVE CO-OPERATION
There are. certain essential . requirements, that- any laboratory must
fulfill. - It's-, work must be accurate, the clinicians-must be able .to depend
absolutely on the. -laboratory, reports... It must -be-so organized and. maintained-, that it. can report- its' findings, promptly. The service ■ must, be
accessible to all- ■ The laboratory depends for its .existence on the.intelligent
use of: its facilities, by. .the clinicians. . Such use-can. only .come, when the.
clSpiGiajks. are well acquainted,-not-only with the laboratory procedures and
their constant improvements:-but.fwith-:the technicians, who arc carrying
Out" these procedures. Close ,-co-operatjori, therefore, ■ is-to the advantage
of all.
m |fpj , EXAMINATON. OF URINE
• The 'laboratory- must-he > equipped'to. examine urine. The examination
must include the determination -of specific gravity/ and' the reaction,- the
tests :for-albumin and" sugar and. the microscopical examination of the
sediment. Specific-.gravity- is especially important- in certain- forms - of
chronic nephritis in which this factor tends-to become fixed. Albumin is
most commonly found in the riephritides also it is-'especially important as ari
early indication of- renal trouble • in pregnancy. It is' sometimes necessary
to determine the amount-of' albumin excreted.' This c&n-'be done with a
sample from a 24-hour specimen. Sugar is present in-a nuMber'brcOnditions.
Its continued presence in the urine is •uSually-'dfegrtOsfic of diabetes- mellitus:
In-some conditions it is'desirable-'to know the amount of'sugar excreted
each day and this is easily determined.
-:The nature of the sediment,'as determined by microscopical examination,
is'very helpful in diagnosing acute infections'of the" kidneys,' ureters' and
bladder," and the chronic nephritrdes. The examination of the sediment
for tubercle bacilli" is the only positive-test for tuberculosis of the: kidney:
Sediment for . xamination is best collected by eeritrifuging a freshly-voided
specimen. It may be Obtained by allowing -the urine to Stand for some
time, but the centrifuge offers a much quicker" and more' certain means of
collecting all the sediment. There are many cheap and efficient centrifugeiS
on the market; some run by water power, others by electricity, and others
by hand: Of the other than routine tests, the most important is: the test
for diacetfc acid. This subtance is important when it can be take'ri as a
sign of acidosis and,'in the treatment of diabetes mellitus, it is quite ,-e^S's'eri-
tial that it be tested for daily. Another test that might be demanded in
certain cases is the test for.bile. Though this is by no. means as simple
as the previously'named test, it may be done in the'small laboratory and
the results will occasionally justify the effort.
I do not beleive that the other, more complicated urine tests, such as
the one for urea, diastase, total nitrogen etc., should be attempted. There
are very few cases in which these .'tests are absolutely necessary for a
diagnosis, and in such event'the cases had better be. sent to the more fully
equipped laboratory center.
There are the functional'renal tests however, which; must not be overlooked. The phenolsulphonephthalein test. is., the most, important simple
test we have to give us an accurate idea, of renal.iunction. The technique is
extremely simple- and the result .very valuable. Another- functional test that
fifc/exremely useful is the. Mpsenthal test or a modification of it For the
small hospital the simpler technique of the .so-called two-hourly test is
more apt to.be properly-carried out and is quite as valuable in its results.
BLOOD EXAMINATIONS.
The first requisite for a blood examination is. a technician who can
count blood corpuscles with accuracy. The degree of, error of such count
must not exceed four per cent. Such proficiency can only be attained by
practice; for this reason, a non-medical technician.'Who is able and willing
to.spend a.great deal of time at this work is.superior to a physician.- Next
it, is necessary to have .a properly standardized, hemocytometer and a
reliable microscope. The most important test in the majority of cases, is
a whiteapd differential count. This is. essential in acute surgical conditions
especially, those involving e abdomen.- The red count and the examination
of-.the...red. cells in a blood smear,, to determine .any abnormalities of
morphology .and .to.detect the presence of any abnormal red cells, is of
importance, in. the. anaemiaes, .as: is also the. estimation -of the.herhoglobin.
contents: p.f. the .blood. This latter determination is. done in many. ways. The
Simplest, and perhaps the best method-for, small laboratories, is the so-called
Tallquist..method;,which .is also the cheapest means available. For. more
accurate results, especially in low hemoglobin findings, a more-, accurate
apparatus must be used, such as the.,3ahli Hemoglobinometer.    A complete
57 blood count, consisting of a red and white count, a differential, an examination of the morphology of the red cells and a determination of the
hemglobin, might well be done as a routine on medical cases. Where time
for such a complete examination is not available the following procedure
is helpful:— It has been found that for practical purposes, if the hemglobin
is above 75 per cent, and if the case is not one of anaemia of some form,
the red blood cells will always be within normal limits. Also, it has been
found that in non-acute conditions, if the white cell count is within normal
limits, a differential is not necessary. Thus, in many cases, a practically
complete blood examination may be performed by determining the hemglobin
and the white cell count. A blood count, when not an aid in making a
positive diagnosis, is helpful in ruling out certain diseases. The examination of blood smears for parasites is essental, especially in districts where
maleria is encountered.
Blood cultures should not be attempted because proper incubating
facilities cannot be installed owing to the relatively large expense. By
"relative expense" I mean that in considering laboratory equipment we
must consider the use that will be required of such equipment. For example:
an incubator can be obtained at less cost than a microscope but a microscope is absolutely essential and will be used at least once for every
hospital case, whereas an incubator might not be needed except for one case
in ten. An incubator, then, is relatively more expensive than a microscope.
Serological work, including Wassermann tests, Widals etc., should be
handled in the large divisional laboratories. Blood chemistry is also somewhat too complex to be attempted without a skilled technician specialjS
trained in this work; besides, the apparatus required is too expensive for the
small hospital.
BACTERIOLOGICAL EXAMINATIONS
For the bacteriological work there must be facilities for the examine
ation, microscopically, of sputum and discharges of various kinds. Further
than this, the small hospital should not attempt to go, as it involves the
expense of proper media and incubators. There should be the necessary
stains for examining smear's for tubercle bacilli, gonococci and the organisms of Vincent's angina.
PATHOLOGICAL EXAMINATIONS
The pathological work cannot be done in the small hospital on an
adequate scale. The surgical pathology should by no means be neglected
on this account. Tissue removed at operation on which a pathological
diagnosis is required, can be sent to larger institutons for a report by txfc
pathologist. The tissue so sent, if large and thick, should be cut serially into
thin slices so that it will be well hardened. If small, as appendices etc., it
should be left intact. This material should be sealed in a small bottle
containing a preserving and fixing solution and mailed promptly to the
central laboratory. The cost of this service should be met by some flat
rate based on the bed capacity of the small hospital.
SPINAL FLUID EXAMINATIONS
A laboratory of any size must be able to examine spinal fluid—a cell
count and the determination of the gobulin are the important tests. The
Wassermann on the spinal fluid should be done, with the rest of the
serological work, in the central laboratory. The cell count is performed
by means of the hemocytometer used in blood counting, with the difference
in the degree of dilution used. An increased count always indicates
inflamation of some kind. In the acute forms of menigitis there is a high
count of mostly polymorphonuclear cells; in the chronic fqrms, tub'ercuJeuS
and syphilitic, there is usually a lower count and the predominating type
of cells is the mononuclear. In syphilis of the brain and cord, as well as
syphilitic meningitis, there is an increased cell count. Globulin also usually
means inflammation.
58 EXAMINATION OF STOMACH CONTENTS
The examination of the stomach contents after a test meal, is frequently
very important and should be done more often. The use of this simple test
will sometimes obviate the necessity of an X-Ray examination, thus saving
the patient time and money. This is specially to be remembered in those
institutions without an X-Ray outfit. The routine examination of stomach
contents collected one hour after an Ewald or similiar test meal, consists
of the determination of the degree of digestion as judged from macroscopic
appearance; the estimation of the amount of free hydrochloric acid, of the
total acidity, of the presence of lactic acid and of occult blood, and the
Boas-Oppler bacilli. These tests are quite easily done and do not require
'.^technical skill nor elaborate equipment. The results are valuable, not only
in gastric disease, but in general disease with some secondary functional
or organic gastric disorder.
EXAMINATION OF FECES
The examination of feces is so simple as to require a mere mention,
and yet it is an invaluable diagnostic aid. The examination should be
made macroscopic and microscopic in the search for parasites or their ova.
Occult blood may be important in chronic intestinal cases. The presence
of unusually large amounts of fat points to some disturbance of the external
secretion of the pancreas.
This completes the list of laboratory examinations that may properly
be made in the smaller hospital. I have outlined these tests only very
briefly, as it has been my intention merely to suggest the possibilities and
limitations of the small laboratory rather than discuss laboratory technique.
Any small text on laboratory methods will give in detail the above mentioned tests.
CO-OPERATION BETWEEN THE SMALL AND LARGE
LABORATORIES
The small hospital laboratory becomes, then, in a sense, an outlying
branch of the large laboratory. The smaller laboratory, as it grows in
volume of work, would be able to take more and more of the necessary
procedures unto itself, thus finally becoming an independent unit with a
complete staff. The plan of large central laboratories co-operating with
the smaller hospitals in the execution of the complicated tests, offers a
solution to the problem of furnishing proper means for correct diagnosis
in the small isolated hospitals. This whole scheme, of course, applies
principally to the small hospital in the small city, town and district, where
a larger bed capacity is impossible and where facilities should be afforded
the clinicians for goqd work.
LABORATORY TECHNICIANS
As to the means for providing such laboratory service, I am convinced
that, wherever possible, the non-medical technician should be employed.
In view of the fact that in the larger centers it has been found advantageous
to use non-medical workers, it seems to me even more imperative that this be
done in the small hospitals. The objection that the expense of such
technician will be too great must be met. In the hospitals of fifty beds
or more, such a technician can be provided who will also look after the
case records and the X-Ray department. For the smaller hospitals it will
frequently be possible to train a ward nurse to perform these simple tests,
while at the same time she might carry on some ward work. The nonmedical full-time laboratory worker is, of course, the ideal towards which
all hospitals should strive, as it is only when their laboratories are in such
hands, directed, naturally, by the physician in charge, that they will achieve
the best results. The interpretation of the results of laboratory tests must
rest with a graduate in medicine. The technician fit to carry on this sort
of work should be trained in one of the large laboratory centers where it
is possible to work under the supervision of the highly paid physicians whq
59 have specialized in laboratory technique. , Technicians having had such
training' are competent1'.to "properly' carry out this laboratory technique.
Accuracy and' speed 'can 'only be attained by loiig practice under' proper
supervision, and bbtn'accufac'y and 'speed, are essential in a"laboratory
technician. It is riot to "be expected that4 graduate physicians can- be
employed'for such "work—Lthe remuneration would be too low and the work,
too mechanical 'to', justify them in"such 'expenditure of tifne. Technicians
for 'this work' can o.iily be properly trained "in the larger hospital labora-
toriesj arid in this'connection I .may'add' that there has beeri inaugurated a
technician's course at the Vancouver General "Hospital that will fit a nurse
to do the laboratory technique'as.'o'lrtlined, also the"necessary X-Ray Work,
as well as giving her a fundamental knowledge' and experience "in" connection
with' medical records, particularly as to obtaining, classifying and 'filing
same. A graduate nurse, after such a course, extending overmen rnoriths,
during which time she spends, two months on records, four months on
laboratory work and four months on X-Ray work, should be the ideal person
to handle, these three" services which are so essential in all hospitals "today.
. COST OF.LABORATORY.SERVICE
: ::.'"The cost .of a laboratory service as.I have outlined will, of course, vary
with the size of the hospital. The minimum initial cost should not be over
$300.00,. which I hav.e:.itemized in the attached list. The cost of upkeep of
the-,equlpment and supplies would.be between $50 and.$60.00 per.year. The
salary .of. the . technician would amount, tq $100.00 per month and keep
(which would.mean-'$135.00 per month). This would bring the total cost
per..month to about, $140.00, which amount could, be reduced in proportion
to the time so spent, if the technician was working part time on records or
other services.
The cost rhight be met in two ways; firstly, by making a charge for
each-laboratory test; and secondly, by collecting a flat rate of so much
from each patient per.day.. The latter of these is, I believe, preferable.
The former tends to lay a. heavy burden on the few that need a. great deal
of laboratory-work, while the second plan divides the burden so that it is
really, not felt by anyone, yet it is no injustice because all patients will
benefit by the .laboratory service in the hospital. For example: in a
hospital averaging- fifty cases per day,' there, are fifteen hundred treatment
days-each month; a- flat rate of 10 cents per day will yield $i5Q.OO per month,
or more than enough to provide such laboratory service. In those smaller
hospitals not maintaining a full-time technician, the tost would be proportionally, less.
This, therefore, sets forth, briefly, the fundamental and ■ essential
minimum laboratory service which should be found in every hospital desiring
to do competent work and to fake good care of their patients. From such
a basis can be developed a much larger and more highly organized' laboratory
system- as the institution grows in size, till finally, the various departments
such:'as pathology, bacteriology, serology; clinical microscopy, blood chemistry etc.,- are each-: organized, having a Competent ■ director and staff and
giving an efficient maximum service to all hospitals.
LIST OF EQUIPMENT FOR LABORATORY  FOR  HOSPITALS  OF
100 BEDS OR LESS.:'.
1  gross test tubes,  5.x%, without  lip  .i ,...'.'....,	
1: gross itest tubes, ,8x1, for. urines , -,-i-v—-.	
Tincture bottles, xx glassware, ground glass,. stoppered, 12-4 oz.
Tincture, bottles,, xx glassware, ground, glass,'stoppered, .12-6 oz.
Flasks, .Erlenmeyer,. 4.  "100. c.   c...',.;,....'.   '
Flasks, I Erlenmeyer,..4    250.. c. c. ..-,.,..->.-,'
Flasks; Erlenineyer., 4   500 c. ,c i	
Flask's,.'Erlenmeyer, 2-1000 c. c.  -■	
3  Evaporating dishes,  diameter 3  in, ..
60
3.00
7.00
1.80
2,20
.60
.60
1.00
1.20
1.50
Jt 2-lbs.   assorted   glass   rods .'. 50
2-lbs. assorted glass tubing ii;.;;.::.i &£;}:«:    .50
2 Burettes, Moher She'lJbeck, capacity 50 c. c. Grad. 1/10 with "
pinchcock ._..: :....:::-; ...:.-..'.:     2.40
Pipettes, grad 1/10 c. o. to tip, 6    1 c. c ...'....'...:::.•. .,_...-.-_it-...k..     2.10
-   "- 4     5 c.  c- -■...;.-...'. isiM       1.60
"' " " 4   10 c.  c. ....' :      1.80
Pipettes,   volumetric,   3     5   c.   c '.'.'. :..:.       .66
3    10   c.   c i /. 75
"     %    " 2   20   c.   c.   :      - .80
■2   25   c.   c'.    : : ' 90
W^\ 2     S0    C'     C'    J         1M
Cylinders, measuring, 2    10 c. c..'. 65
: " 2   50 c. c .-.:       1.00
2 100   c.   c _       1.10
2 500 c.  c      2,20
6 T. K.  Dropping bottles, capacity 60 c.  c      1.50
2 gross  microscopic  slides        3.00
2 oz. coverslips, sq. 24 m.m '.      2.(
2 Well slides  50
2 Buntzen burners (or equivalent, depending on gas supply)       1.00
2 Iron Tripods, 3 inches in diameter 80
4 Pieces wire gauze with asbestos, 4 inches sq 56
1  Centrifuge   ; .:.    45.00
1  Hemacytometer   '. '.:    24.00
1 Hemoglobinometer, Sahli  S      875
1 Hemoglobinometer, Tallquist ..    2.50
2 Esbach Albuminometers       1.50
2 Urinometers with  cylinders       2.00
1 Microscope,  B. & L,  B.B.H. or equivalent   156.00
2 Casseroles, capacity  150 c. c -      1.20
2 Forceps, dissecting, with fine points  —       1.00
2 Forceps, dissecting, medium heavy, straight points,  115 m.  m. long    1.20
2 Forceps, coverslip       2.00
4 Pencils  for  writing on  glass   (Blaisdell)    20
1  Colorimeter   (Dunning)         7.50
1 Platinum loop '.       1-50
Total Expense $300.57
NOTE: This includes equipment only; supplies are not included. -
DR. E. C. ARTHUR, Victoria—
I was just looking at that centrifuge you have on display,, which seems
to be equipped for electrical operation. Now, there are several hospitals
in this province where they have no electric light or gas, .where their only
lighting is. by oil lamps—so that cannot be applicable. However, I wish I had
had notice of this when I was preparing, some of these forms in the
adjoining room, I could have given you the number of hospitals, approximately correct, that have no laboratories at all today, and some of them
are comparatively larger hospitals in the interior. There are several of the
hospitals that have no laboratory facilities of any kind, where.all the work
that is done is done in the office of the local physicians. The same applies
to X-Ray. There are several hospitals without an X-Ray plant. Another
thing, as Dr. Strong mentioned, there are many places where the physicians
are not qualified to do more than the simple laboratory work. When I
say that I am not casting any reflections on the local physicians, they have
not the time and have not had that training to do blood counts and things
of that kind, but there is a distinct, tendency to improvement in this matter.
Some of the hospitals are endeavoring and are succeeding in establishing
small laboratories, they are making a beginning. Several hospitals are
mak'.rg an effort to keep records that were not doing so last year, they
61 may not be the best, but it is astonishing what good records are kept in some
of the small hospitals that depend on the local physicians; they are so busy;
they cannot write them, but in nearly every case "cannot" means "will not."
They can all keep some records if they want to, but it looks today as though
it will only be a few years till all these fellows will be shamed into it and
we will have certain records kept in every hospital. Now, there is another
thing, even in hospitals where reasonably good records are kept there are
many that have not proper provision for filing. They get records but what
is done with them? Well, at the end of the year they are put away in a
box somewhere. Some day or other perhaps they will get proper filing
systems and we will have those records filed. They cannot do it at the
present time. There is just one other thing, in this province you all know
the distances are so great, the means of communication so limited in many
instances, that we are greatly in need of more fully equipped hospitals,
for instance: there are, I suppose, only two or three hospitals in the province
that have properly equipped laboratories. Now these are needed in several
places in .the interior. I hope the day will come when we will have something, not like the scheme of district hospitals, but where Kamloops, Nelson,
Cranbrook, and Prince George will have well equipped laboratories to
which the smaller hospitals round about or the physician that is practising
away out alone perhaps away from any hospital, can send his specimens
in a short time and get a quick return—that is very much needed. But even
in the last two years I can at least say there is a distinct improvement
noticeable in both these lines, and I hope that in another two or three years
we will get very much better results and greater improvement.
DR. M. T. MacEACHERN, Vancouver—
I am particulasly anxious to put something over to you that you can
take home. Dr. Purvis has absolutely put the responsibility in the right
place when he says the doctors in the community should take a constructive
interest in the hospital to make it efficient, that they should stand only for
good work in that hospital, that they should get together and co-operate.
We know perfectly well throughout this province when we go to the small
places there are differences between medical men that should not be. We
want the medical men in all the small places to pull together, to pull for
their hospital. They may have to do laboratory work in their office.
Recently we have established a technician's course for nurses in the
Vancouver General Hospital. The nurse starts in the records office, takes
instruction under our record clerk who teaches her the different forms, filing,
how these records are secured; she then goes to the operating room and
Watches how records are secured there; then to the X-Ray department and
to the laboratory, takes a special course in admitting patients. She spends
two months in the medical records, three or four months learning to do tests I
in the laboratory, and the remainder of the ten months in the X-Ray, and
I warrant you we can send her to any hospital in the province and she will
give excellent service. She can do fhe X-Ray work but the doctor will
have to interpret the plates. The value of the records is that the hospital
will do better work and the medical men will inevitably do better work.
It is decidedly to the advantage of the doctor to write proper histories and
make  good examinations.
DR. H. C. WRINCH, Hazelton—
There is a matter I want information on: the relation of the doctors to
the Board. There is no use denying the fact that the Board and the doctors
do not see things alike. It is easy where you have a number of doctors—
they can have an advisory board, but where there is only two or three
and they are antagonistic to the Board, what is the practise in regard to
the doctor having a seat on the Board—as a member of the Board or in an
advisory relation to the Board? The Board, when they begin their work do
not know much about hospital work and need advice. What should be
his relation and if there are several, would you advise or approve of several
doctors having a deputation or representatives to meet the Board?
62 MR. J. A. BROWN, Cumberland—
We in Cumberland have one of the doctors on the Board and find it
a great help. I believe in small hospitals if that was practised it would
be a great help to the Board.
DR. G. S. PURVIS, New Westminster—
We have two representatives from the medical staff on the Board with
full rights, and find it of very great assistance. They are elected by the
Medical Society and have full standing with the -Board.
MISS P .ROSE, Nanaimo—
We have two doctors on our Board and one on the House Committee.
MR. J. A .BROWN, Cumberland—
Our doctor is on the House Committee too, appointed by the Board.
.MR. L. E. MORISSEY, Merritt—
We in Merritt have a doctor there as member of the Board, although
he is not eligible for any committee work nor does he have a vote, but is
there in an advisory capacity.
MR. J. T. ROBINSON, Kamloops—
In Kamloops our custorn has been that no doctors are allowed on the
Board, in fact we would not have them on a bet, we do not want them. We
found for a number of years that they did not work harmoniously in connection with hospital matters, but within the last two years they got together
and formed a Medical Association and they have a rule by which one of
their members are sent to the Board meeting every month and whenever
required, and if they have any suggestions they bring them before the Board
and any matters from a technical or medical point of view. We find that
works out very satisfactorily; we have the utmost harmony. The doctors
work in co-operation with the Board and the Board runs the hospital on
what we hope are business lines. 1 am in favor of an act being passed
that neither doctors or ministers have a position on a hospital board at all,
because I think it creates more or less friction. Let your board be a purely
business board run on business lines^ and if they want techincal advice let
the doctors in the city get together and advise them accordingly . I believe
running a hospital is like running any business—it must be on a business
basis.
DR. E. C. ARTHUR, Victoria—
Sometimes I think hospital boards need advice when they do not want
f&
MR. G. McGREGOR, Victoria—
At the present time we have four doctors, full members of the Board.
Sometimes they are alright and sometimes they are a perfect nuisance;
they are not good business men. I think it is necessary to have them, I
think it should be compulsory that every board should have a medical man
at least we find them very valuable. I contend they ought to be thtre. It is
up to the Medical Society to put the best men the- have there. I think it
tends to more harmony.
MR. G. BINGER, Kelowna—
We find the best way is to run our own show and if we want any advice
we go to the doctors and ask them. They are very willing to say what they
want and are always wanting something . We try to keep them off the Board
but do what we can to help them out in any way possible. We think the
proper way to run the hospital is in a businesslike manner.
DR. E. C. ARTHUR, Victoria-
Thirty years ago when we were organizing the Kootenay Lake General
Hospital I was one of those who had the drafting of the constitution and.
bylaws, and it was a provision in the bylaws that no physician could be
63 on the Board. That is still in force. There were only two of us and we
were, as usual, not particularly good friends'," and neither -wanted the' other
on -the board. I do riot think that it is a good plan-in- the. smaller.places for
medical'men to; he on the. board, but they should be consulted, and .nearly
always, in my experience, there is apparently the.'-best' possible 'conditions
existing between the medical men and the hospital board....... ,
DR. H. C. WRINCH, Hazelton—
■ The medioal.men are desirable to the board then in an advisory capacity.
MR. J. T. ROBINSON, Kamloops—
Might I suggest that in a town the size of Kamloops the board be1 fun
on purely business lines and -that their doctors organize in an association
such as we have and follow the same lines. , In that way L think, there
will be the utmost harmony and will work most efficiently to the advantage
of the hospital and'the health in general of the community.
DR. M. T. MacEACHERN, Vancouver—
.'-'Lwould suggest that a committee of three be appointed, one doctor'from
the Medical Association and two from the Board of Directors, and peruse
very carefully the literature you will get so that you can work out a more
constructive policy  in  hospital  standardization.   ;      rrt.'j'i-.
ANNOUNCEMENTS: Re get-together luncTTeon, and trip to Tranquille.
Meeting adjourned to meet again at 2:00 p. m.
AFTERNOON SESSION  'jg|
THURSDAY, JULY 7th, 1921—2.00 p. m.
Dr. G. S. Purvis, New Westminster, presiding
Round Table Conference "A" — Anaesthesia- in hospitals:
DR. G. S. PURVIS, New Westminster—
I will ask Dr. W- Arbu.ckle of Vernon, for his paper on "Anaesthesia
in  hospitals."
DR. W. ARBUCKLE, Vernon—
I have been asked to open the discussion on anaesthetics and I propose
■ doing it by giving the  routine we follow at the Vernon Jubilee Hospital
and some of the troubles we have.
To begin with, we try to get our operation cases in the' rnorning of tuf;
day before the operation. This allows all the prepartion to be done in the
day time and the patient can have a good night's rest before the operation'.
This giving a patient a big dose of castor oil late at night and then waking
them up at five in the morning, if perchance they have gone to sleep, to
give them two or three enemas is'- a poor preparation for a long anaesthetic^
Our patients for ten o'clock operation are not disturbed until six o'clock
and then just a simple enema is given. One half hour before the anaesthe^tC;
morphine and atropine are given hypodermjcally. This we have found does
away with the struggling when the patient is going under and there is no
filling up with mucous as is so Often seen in ether cases.
As to choice of anaesthetics, we have none. We give nothing but ether.
There has not been an ounce of chloroform used in our operating room for
years. We use ether on an open mask. An ordinary open mask with four
thicknesses of gauze wrapped around with warm moist towels. Thestt
towels are frequently changed so that no frost gathers on mask. For some
time we have been starting with fifteen to twenty drops of ethyl chloride
which puts the patient under quickly and smoothly. We used to think
we could not give ether to some of our patients, to .old. people, .to young
children and to those with a chest condition—but we gradually got into the
habit of giving ether to all cases and so far have never had cause to regret
.it.   Looking back to the days when we gave chloroform and chloroform and
64 ether mixtures and ether by Clover inhaler and different cone methods, we
certainly have less trouble, in the operating room now'than'we had then.
We rarely give a patient a stimulant on the table and we practically neVer
have to do artificial respiration. What we do get are chest complications, a
case of pneumonia now and then, and quite a number of cases that have a
rise in temperature, a troublesome cough and a nasty expectoration. We
do not know if we have more of these cases than we should have but we
certainly have more than we wish to see. We have done everything to
guard against this complication. The moist towels around the mask are
kept warm so that the patient is never breathing through a frozen mask.   We
■jhave tried dry masks, changing them frequently. We used to Use Squibbs
ether entirely but on account of the cost we began to use cheaper makes,
and then switched back to Squibbs again and we could see no difference.
Our patients are kept well covered on operating room table, our operating
room is warm, a dry gown is always put on before .patients leave the operating room, and they are wrapped in extra blankets on way to 'the ward
and put into a warm bed and a nurse stays to see that they are kept covered
until they are"completely out of the anaesthetic, and yet we get these chest
-.troubles. Fortunately we have* never had a fatality from a post operative
chest complication but we have had cases that gave us a great deal of
concern and certainly it is a most troublesome thing for the patient. A
long abdominal incision and a short hacking cough is not a pleasant combination. Now, these cases that get chest complications are not patients
that some might think choloroform would be ;i er anaesthetic for than
ether—they are not case's that give a history of chest trouble, they are generally long abdominal cases with a clean history as far as their chest is
concerned.
.Now I do not want you to get the idea that all our post operative cases
get pneumonia or some other chest complication, for they do not The
percentage that do get chest trouble is very small. But it is the one thing
about anaesthetics that we are not satisfied with and we will be glad to
gain from the experience of others here something to help us with this
problem.
DR. C. J. WILLOUGHBY, Kamloops—
While I quite agree with Dr. Arbuckle on his use of ether as used in
the Vernon Hospital, and I think we all agree that ether is the best all-
round anaesthetic we can use'for hospital purposes, of course the question
of economy arises. As far as anaesthetics are concerned it depends a great
deal on the patient, as well as the anaesthetic; if the patient is able to pay
for the anaesthetic why cannot the Jiospital provide that anaesthetic. I
think Gas-Oxygen is the ideal anaesthetic. We only use it in cases where'
patients are able to afford it; the patients are given the option of having
it. We figure the cost of Gas-Oxygen runs us between $7 and $10 an hour—
the average operation does not take longer than an hour, and if a patient
is Ivilling to pay the extra the hospital can well clear itself in charging a
good fee for Gas-Oxygen anaesthesia. There is no doubt in chest cases
that Gas-Oxygen is a very fine anaesthetic. There is also another very
fine anaesthetic—Cotton Process ether. We tried it out and had some startling results. We took it up with the hospital and they decided to put it
in. The cost is about 75 cents quarter pound can. It is more expensive than
Squibbs. There is no irritation, no mucous, and nausea is very much
decreased. I feel very strongly in favor of Cotton Process ether. We use
the Clark gas apparatus.
DR. G. S. PURVIS, New Westminster-
Do you. use Morphia and Atropin with the Cotton Process ether?
DR. G. J. WILLOUGHBY, Kamloops—
Yes,  I  always  like  to  have  Morphia  and  Atropin  given  before    the
operation.    It does away with excitement and produces a better condition
on entering the operating room.  ^;;,<
65 DR. M. T. MacEACHERN, Vancouver—
I think a very important point that Dr. Arbuckle made is the fact that/,
they prepare their patients as well as they can before operation. They get
them in the hospital ahead of time and try to get. them adjusted to hospital
conditions. I believe a large number of people have bad results on account'
of not being in long enough before operation to get hospitalized. It is advantageous in every respect. Gas-Oxygen is certainly the most satisfactory
anaesthesia. There is a new machine out, the McKesson, which seems to
be very efficient saves a great deal of gas—being regulated by an automat-
tic valve which opens and closes with the respiratory act. It is splendid for
maternity work. The tendency is to stick to the old methods. With the
apparatus and the methods that Dr. Arbuckle has outlined a great deal
I think, depends on the anaesthetic as to the kind of anaesthetic, as well
as the patient, as to the after result. The point I got up to make, however
was the fact that Dr. Arbuckle emphasizes the need of preparation before
anesthesia and the need of getting the patient adjusted to conditions. I
would like to ask whether the patient should be anaethetized in the operating
room or before going in.
DR. W. ARBUCKLE, Vernon—
We have never had much trouble with patients going under; they are
covered up and do not see anything.
DR. G. J. WILLOUGHBY, Kamloops—
I feel where it is possible that an anaesthetic room is a big advantage
In preparing for an operation there is a lot of work going on, with nurses
rushing around. The quieter it is around the easier it is for the anaesthetist
to put a patient off, it means a good induction, and a good induction means
-a good anaesthetic.
DR. G. S. PURVIS, New Westminster—
I think that is a very important matter. I think those of us working
around anaesthetics do not look at it sufficiently from the patient's point of
view. Anyone who has an anaesthetic and had it in the operating room
where everyone is bustling around, and had to have another, would prefer
to have it before entering the operating room. I think the patients appreciate an anaesthetic room to a great extent.
DR. G. H. WILLOUGHBY, Kamloops— S
I think it has a great deal to do with the climate. I am sure that any
person coming from Vancouver, who started to give anaesthetics here
would notice a great difference, the reason being the tremendous evaporation here—-you have-to use twice as much anaesthetic to get the same
results as in Vancouver.
DR. G. S. PURVIS, New Westminster-
Is there any discussion on training nurses to give anaesthetics?
DR. W. ARBUCKLE, Vernon—
I think- the nurse should have some idea as' to giving anaesthetics;
nurses leaving the city and going to the small places very often have to
give anaesthetics. I think it would be a splendid thing for every nurse to
have an idea as to the methods of-giving an anaesthetic.
DR. R. W. IRVING, Kamloops—
Our office nurse has been giving anaesthetics for five years and very
satisfactorily, more so than a medical man. It seems advisable to have
nurses in the outlying districts thoroughly tra' in anesthetics. I know
it works out very satisfactorily and there is precedent to justify this. At
the Mayo Clinic they give anaesthetics and give them satisfactorily. I
think it is something that is going to grow. I think it is advisable. The
surgeon is responsible for everything in the operating room.
66 DR. M. T. MACEACHERN, Vancouver—
Our surgeons have ruled otherwise, they claim the anaesthetist is
responsible for the condition of the patient.
DR G. J. WILLOUGHBY, Kamloops—
Our rule here is that the surgeon is in full charge and responsible for
everything that goes on in the operating room.    What is the legal status?
DR. R. W. IRVING, Kamloops—
- The journal of the American Medical Association reported a legal
action taken against a surgeon for something that happened in the operating
room. I believe at that time a nurse was giving the anaesthetic, and the
courts in that state held that the surgeon was entirely responsible for all
that took place in the operating room and he had to bear the responsibility
of the anaesthetic.
DR. W. ARBUCKLE, Vernon—
Morally, the surgeon is responsible for the operation, the anaesthetist
for the anaesthetic, and the nurse for the technique.
MRS. J. CHARLOTTE HANNINGTON, Ottawa—
So many of our nurses have to go out into country places where very
often they have to assist the doctors and they are the only ones who can
assist them. If a nurse has to give that anaesthetic without any training
she naturally is nervous, her nervousness is conveyed to the doctor, who
has responsibility enough, and to the patient. It seems to me one thing
the nurse should have is some simple instruction and enlightenment on the
fundamentals of giving an anesthetic. It is a mean thing to go up against
if you have not some confidence in yourself.
DR. G. S. PURVIS, New Westminster—
A nurse in her training takes a certain length of time attending patients
taking anaesthetic. I know several nurses who trained as anaesthetists and
there were none better.
DR. H. C. WRINCH, Hazelton —
Dr. Willoughby mentioned finding a difference in patients taking
anaesthetics, especially in heavy climates; we have the same condition in
the North. I usually have an assistant and invariably they find a difficulty.
Have you developed any particular method of technique that will overcome
that any more than usual?
DR. G. J. WILLOUGHBY, Kamloops—
I think that the most trouble in giving anaesthetics in the dry belt is
allowing too much air. The more air you allow in the less ether you are
going to get, and the closer you wrap your towel the more ether you are
going to get. Two or three layers of gauze, good hot towel, wrapping that
round the mask, leaving less than a square inch open. Do not wrap the
towel around until you get the patient fairly well started.
DR. E. C. ARTHUR, Victoria—
I will not have anybody dictate to me what anaesthetic I am going to
use.    When a  surgeon asks  me  to give  an  anaesthetic  I  decide  what it
will be.
DR. G. S. PURVIS, New Westminster—
Don't you think any anaesthetist should have the privilege of choosing
whatever anaesthetic he wants?
DR. R. W. IRVING, Kamloops—
I think any man who knows anaesthetics and has studied them at all
must have his choice, because one man is successful in one method and
another in another. I have known men who are apparently just as safe
and sound in using chloroform as ether; it depends < fir training, experience and power of observation.
67 DR.H.C. WRINCH, Hazelton—
I hold that the anaesthetist should
have his choice of anaesthetics."
DR. G. S. PURVIS, New Westminster—
We have trained anaesthetists—men who do nothing but give anaesthetics all the time; I should imagine they would be responsible for the
patient, that is, the anaesthetic end of it.
The next subject on our programme is ''Tuberculosis problems and our
general hospitals." We were to have had a paper by Dr. M. A. Archibald
of Kamloops but regret he is not here.
DR. M. T. MACEACHERN, Vancouver—
The discussion yesterday brought out one fact, that is: that under
existing legislation in the Province of British Columbia general hospitals
receiving a grant from the government are requested to give one-tenth of
their bed accommodation to advanced tubercular cases of that municipality
that is, in the Royal Inland Hospital, for instance, you should devote ten
beds to advanced tubercular cases, if you live up to the Aqt. Mr. Robinson
told us this was impossible, that you can only take two. It resolves itself
into this,— we are obliged to do it but we have not the accommodation—
tubercular cases having to be segregated, especially the advanced cases.
Hospitals have not the separate accommodation. Again, hospitals that have
separate accommodation, it is usually improper and inadequate. Another
point is the fact that our nurses are not getting training in tuberculosis.
First is our obligation to do this work for our government; the second
point is we have not sufficient accommodation, and the third point is that
the accommodation we have throughout the province is inadequate and
improper, not fair to the patients and certainly not fair to the staff,
because owing to the unsanitary conditions which exist in wooden buildings
the staff is exposed to greater dangers.
MAYOR S. C. BURTON, Kamloops—
I imagine the reference to the condition in connection with the per capitSe
grant—that we have to treat a certain number of tubercular patients, we
have to do it— but as an ordinary layman I object very strongly to it. -^t.
take the view that we in Kamloops Hospital, for instance, are not in a
position to do justice to our patients. The same applies to the nurses, they
have not had that special class of training, and further, we cannot
give the patients the open air treatment which is so very necessary. We
have a couple of balconies we can make use of, but beyond that we cannot
go, and it seems to me if the government insists on us taking that class of
patients, they have got to assist us in making provision to accept them. The
idea of giving nurses certain training in tuberculosis is a good one I am
glad to hear that it has been practically decided upon at the session yesterday. 1 think we should go further, in this tuberculosis question too. we
ought to take some action to prevent that class of patients coming into the
Province. It seems to me ridiculous that we should go to the extent of
providing a sanitorium for treatment, yet patients can come in here
indiscriminately and swamp the accommodation we have. All patients
coming into this city should be compelled to report to our medical officer—
if they do that the district nurse could take charge, visit and instruct therrij
that would remove a certain menace from the rest of our citizens. I may
say we have been very fortunate indeed in keeping our own citizens clear
of tuberculosis. I have been here some twenty-four years and I can only
recall two cases who contracted the disease in Kamloops who were bona
fide residents of the City. That, of course, is a compliment to the climate.
I am afraid of these patients coming from all parts of the country—they
expectorate on the streets. I do wish the government would formulate
regulations regarding these  cases  coming from  other provinces.
DR. R. W. IRVING, Kamloops—
You are dealing with a subject which has been very near to me for a
68 good number of years. It was on the 10th of November, 1907, that I came
to Kamloops to open a sanitorium and at that time the work in tuberculosis
in this country was just in its infancy,'being fostered through the early
stages by the late Dr. Fagan, Dr. Procter and Dr. Stevens of Vancouver
and several others, and since that time the people of British Columbia have
made wonderful strides in handling the situation. They are taking a great
step when they suggest tuberculosis becomes a subject to be handled by
?jffie government. The situation becomes, to my mind, not one that should be
dealt with by an Association of this kind which is dealing with general hospital work, but becomes a broader subject, one to be dealt with by the Health
Department of the Province. That is' being demonstrated in Manitoba,
Saskatchewan and other places. The stand to take, I should say, would be:
we will not handle tuberculosis, and put it up to the government and the
Provincial Health authorities. Tuberculosis is too big a thing for us to
handle in our smaller or even our larger hospitals. I may say that all
advanced tuberculosis cases should be handled near at home. • I think Tranquille should be reserved for the incipient cases, where those who have an
opportunity of getting well will receive the benefit. . Every hospital should
have near it a separate building constructed and operated by the Health
Department, directed by the Board, but in no way associated with or interfering with the management of the general hospital.
MR. G. McGREGOR, Victoria-
Judging from the remarks, it appears to me that hospitals taking care
of tubercular cases should receive greater assistance from the government
for what they are doing. I consider that Kamloops must be very fortunate
when they haven't any cases of tuberculosis in their hospital; in fact, they
never made provision and therefore, cannot look after them. If the government forces advanced cases of tuberculosis on general hospitals they should
be paid for same, because they cost more to keep. Make the government
realize the fact that they should pay for those advanced cases of tuberculosis
out of fairness to the patient so that the hospital can give them every attention they want. The directors know, perhaps more than others, that
it is a very, expensive part of the hospital, particularly when you have a
separate building—-you have to have a special graduate nurse, also night
nurse to take charge, and many other extras, arid in all it becomes very
expensive. 1 maintain. that the. government does not provide sufficient
money to run those institutions.
(Here Dr. MacEachern explained to Mayor Burton the arrangement
decided on yesterday to train nurses in Tranquille Sanitorium).
DR. J. KEARNEY, Tranquille—
As the man in charge of Tranquille Sanitorium. I do. not feel' that I
can let the resolution pass without challenging it regarding affiliation of
Tranquille nurses with'other hospitals with a view' to giving nurses expert
training'in tuberculosis work. At the present time it is quite impossible.
It is not practical, we could not have girls out at Tranquille who have not
attained a high standard of professional service and dignity. We are dealing
with some one hundred and twenty to' one hundred and fifty male -patients;
sometimes our discipline is not as good as it should be. It is not fair to the
hospital or to the nurse to have to carry on the duties which should onjy
be carried ori- by a riurse who Can maintain perfect discipline in the ward.
.The question of tuberculosis nurses as applied to the nursing profession in
general is not as important as one would imagine. After all, the principles
of ordinary every-day cleanliness is the essential part—if we ask a man to
be clean and if he is clean, that is all we expect. A nu/se at Tranquille,
if Tranquille were an ideal sanitorium,- which probably it will be when
problems are settled, has primarily one object in view, and that is the question of discipline. A'sanitorium is a place where cases of tuberculosis are
tilceri in and treated.   The primary duty of a. nurse is discipline.
I am opposed to the resolution passed yesterday.
69
m Moved by Dr. H. C. Wrinch, seconded by Mr. G. McGregor,
THAT   this   Association   memorialize   the   Provincial   Government   in
regard to the requirements made of all hospitals receiving government
aid that they must be prepared to receive tubercular patients, showing
the injustice of the present regulations in their effect upon many such:-
hospitals, and asking that regulations be modified so as to safeguard the
interests of both patients and hospitals involved, by making provision
for adequate    and separate accommodation,  and a further increase in
the per capita grant to meet the full cost of care of such patients.
The resolution was referred to the Resolution Committee. -
DR. L. G. HOULE, Kamloops—
I would like to see the convention go on record, representing as it
does, the various hospitals in the the province, as recognizing the propriety
and importance of providing in their hospitals for advanced cases of
tuberculosis. Up to now I do not think that has been the case, I think most
hospitals have taken the stand, or at least a great many of them, thaS
tuberculosis is a problem for the sanitorium and no business of the hospitajR
That, I think, is not the correct way of looking at it. It is true that
practically all of the hospitals lack suitable accommodation. The idea
would be to have scattered over the country at intervals institutions for
the care exclusively of advanced cases of tuberculosis. It is a matter of
economic administration to have these institutions administered by the
staff of the general hospitals of the province, where it is as a separate
building or separate wing or ward. I think it would go a long way to
clarifying the matter if that could be included in this resolution—a clause to
the effect that the Association recognizes the fact that tuberculosis in the
advanced stage, not being a sanitorium matter, should be treated in the
general hospital but that at the present time, owing to lack of proper
facilities for the care of these cases, that matter is a difficult one to carry
out, and suggesting possibly that the government furnish further assistance
as part of the tuberculosis campaign in British Columbia, instead, for
example, of adding more and more beds to Tranquille, let Tranquille be
cleared out of beds for ill cases and let them be taken care of in the general
hospitals and in order to provide accommodation of that kind let the government spend or vote money for the assistance of the hospitals in providing
this kind of accommodation.
Dr. H. C. Wrinch reread the resolution with additions,
Motion  Carried
DR. G. S. PURVIS, New Westminster—
I will ask Dr. J. J. Gillis of Merritt, to discuss the question of "Infections  in our hospitals."
DR J. J. GILLIS, Merritt—
I cannotMalk on infections—we have no infections in Merritt. We do
meet with infections occasionally, fortunately we have a low grade infection
that does not cause very much trouble. I have lived in British Columbia
nine years and have never yet seen a virulent form of cellulitis or infection.
The last case I saw was at the Royal Victoria Hospital, Montreal, the
ordinary form which we call staphylococcus infection. Of course now and
again we get after operation what is ordinarily known as a stitch abscess
—sometimes we blame the catgut, but I think if we look into our own
technique we will find there is some little fault in the technique which
causes such infection. I know some of the cases we had of low grade
infection, where we blamed the catgut, were later investigated and no cause
found.    In those cases I think the fault was our own.
DR. M. T. MacEACHERN, Vancouver—
The doctor has opened the subject. There may be a few questions
you would like to ask—that is the idea of this conference. Regarding
cases coming into the hospital contracting scarlet fever, measles, etc.   It
70 • would also be interesting to know of any hospitals which keep track of
post-operative infections. Though the doctor says his infections are minor,
I think he Will agree with me that they keep the patient in the hospital from
five to ten days longer. If it is a charity case it is a burden on the hospital.
If it is a pay case it is a national loss, because that patient is not back to
productive capacity as soon as he or she should be.
DR. E. C. ARTHUR, Victoria—
We asked that question in our annual report and all the information we
received irom something like forty-five or fifty of these hospitals is tabulated
under the heading Medical, Surgical and Maternity infections. I may Say
we did not get information from very many.
DR. G. S. PURVIS, New Westminster-
Staff meetings are a mighty good thing for tracing out these infections.
We, in our hospital, had a colon infection, we followed it up, talked it
over with the surgeon operating. He said the appendix was twisted around
the cojpn and was not sure whether the end of the appendix was cut or not.
In* operating he might have nicked the colon. We blame the catgut for a lot
of things I think we should not.
DR. J. J. GILLIS, Merritt—
There is just one thing—I was down East six weeks ago and I noticed
that most of the large hospitals are paying more attention to keeping a
heavy sterile sheet over the instrument tray. I do think in a certain
proportion of the cases that we get a little infection from the instruments,
for example: the doctor uses the needle, throws it down on the table on
an ordinary towel which is not sterile. That was done in Montreal and
certain cases of infection were traced back to that and they are now using,
I understand, a 'very thick linen sheet that the needle will not pierce.
Dr. H. C. Wrinch, Hazelton, presiding
MEDICAL QUESTIONNAIRE:,
1. Why should unqualified maternity homes be licensed by the government
.  and patronized by the general public?
Ans. Unqualified maternity homes should not be licensed by the government
or patronized by the public. The Act of Parliament respecting this
matter should specify definitely such conditions as will insure competent personnel, proper and safe accommodation, with good facilities
and equipment. The present regulations in British Columbia make it
far too easy to start hospitals and it is hoped that more stringent
regulations will be adopted.
2. Should not the public ward be abolished in hospitals?
Ans. No, but the public ward of 6. 8, or 10 beds is more desirable than
the large ones of twenty or thirty beds which today are found in many
hospitals.
3. Should not each doctor be responsible for the complete medical record
of the patient and this record be left in the hospital?
'.-Ans. Yes, he should either do it himself or see that it is done by someone
else.
4. How far is the Board of Directors or Trustees responsible for the kind
of work done in the hospitals?
Ans. Though not legally, yet the Board of Directors or Trustees of any
Hospital is morally responsible to the public to see that each and
every patient treated therein receives competent care so as to bring
them back to health if possible in the quickest and most comfortable
manner. They must make sure that all the work carried on is efficient
and that good results are being obtained.   They are responsible to the
71 public for supplying . good accommodation, proper facilities and
equipment, and above all, a competent personnel as the staff of the
hospital. Usually the Board of Directors or Trustees is spending public
funds, therefore they have an obligation to fulfill, to see that such funds
are spent in the best possible manner.
5. What   cases,   other   than   the   so-called   infectious   diseases,   should   be
isolated  in  general hospitals ?
Ans. Typhoid   Fever,   Pulmonary   Tuberculosis,     Anterior     Poliomyelitis,
• Epidemic   Gerebro-Spinal   Meningitis,   Contagious   skin   diseases      as
Impetigo,    etc.,     Erysipelas,    Lethargica    Encephalitis,     Septicaemia,
Tonsillitis, Venereal  Diseases,  Ophthalmia, Trachoma,  suspects  of  all
' kinds,^mental   cases,   drug   addicts,   alcoholics   and   cases   which     are
obnoxious owing to odor, appearance etc.
6. What is  the  minimum  laboratory  work that  every hospital  should be
prepared to carry on?
Ans. Urinalysis;  Blood  examinations,  as  white  and  red  cell  counts     and.
haemoglobin; smears for Bacteria; examination of spinal fluid; examination   of   stomach   contents;   examination   of   feces;   preservation   of
tissues for pathological investigation elsewhere.    For further informa-
tioli regarding this question see Dr. G. F. Strong's paper delivered at
the morning session.
7. Could   a   graduate   nurse   acquire   sufficient   knowledge   and   trainings
anywhere in eight or ten months to fit her to carry on the laboratory)
X-Ray and medical record work necessary for a hospital of less than one ;
hundred beds?  '
Ans. Yes, the Vancouver General Hospital offers a course of ten months^
apportioned as follows,' medical records 2 months, X-Ray 4 months' >
laboratory 4 months: This would give sufficient knowledge to under-J
take the work in a hospital of one hundred beds or less. ,.7-.This course, i
we understand, is at "present limited to candidates from British Columbia!.
8. How can better relations and more co-operation be established between
our hospitals and the medical profession?
Ans. It should not be necessary to-ask a question of this kind.    However,
it is unfortunate that in some" instances we do not find the best co-oper
.ation between the medical profession and the- hospital
are a few-suggestions: -.
The followingS
1st, -The hospital should offer the  doctor  an  efficient  service  for    thei
treatment of his patient.
2nd. The  entire hospital staff.should'manifest-a- keen interest, in- the
patient's welfare.
3rd. There   should   be   conferences .at   tegular   intervals, between, the||
doctors and the hospital authorities.    The' attending doctor should;;
be  consulted  in  hospital  matters,  and  indeed,  the  appointment  of"
advisory committee's for different phases' of the work 'will developj
a more constructive  interest:   '
4th A thorough understanding between the hospital authorities and the::
doctors, with a frank co-operative spirit.
9|How.can weincrease the interest _of-' the profession- and the community
in hospital standardization?
Ans. Keep.hospital > standardization before all constantly in its actual
. application. Use every occasion, to carry it home to both-the doctors
- and the people.in the community and apply it most, strictly in th<S
hospital. The,placing of literature :in their hands from time to time
will help to get the interest worked up. One of the best methods is to.:
have a standardization committee corisisting of - professional and lay
members.
72 10. Should a monthly report be sent to the Board of Directors or Trustees,
and, if so, what should it consist of?
Ans. Yes.  Monthly  report to  the  Board  of Directors  or  Trustees  should
indicate the following:
(a) Volume of work done during the month in each department.
(b) Results obtained.
(c) Special consideration of.
1. Unimproved
2. Deaths
3. Infections or untoward results.
(d) Investigation made,
1. Professional care of patients:
2. Administration problems and complaints.
(e) Recommendations
TRIP TO TRANQUILLE SANITORIUM
Sharp at 4.00 p. m. a large number of motor car's were waiting at the
Kamloops High School to take the delegates and their friends to Tranquille
Sanitorium. A most enjoyable ride was participated in by all through
the vast areas of .irrigated farms on both sides of the-Thomson River. The
^delegates and friends were received .by the medical superintendent. Dr.
J-. Kearney, and the superintendent of Nursirig, Miss J: A. Morrice. After"
making .a careful and interesting inspection of this splendid institution all
assembled in the dining room at a very enjoyable dinner. At the, close of
the dinner a very hearty .vote of thanks to the management of Tranquille
Sanitorium- was ably moved by the President, Dr. H. C. Wrinch, and
seconded by the Secretary, Dr. M. T. MacEachern, and- most unanimously
carried. All returned home immediately after to be present at the evening
session in Kamloops. The trip and visit was declared by all to be one of
great  enlightenment  and pleasure. sSsffe
EVENING SESSION
THURSDAY, JULY 7th, 1921, 8.00 p. m.
Held in the Kamloops Methodist Church
Dr. H. C. Wrinch, President, presiding
.   Session opened with invocation-.hy.J^eY;.'.;Mr. H'inchcliffe, Kamloops,
DR. H. C. WRINCH, Hazelton—-,-
I must apologize, the gentleman-who should have given the address
on Hospital .Standardization has. been detained; fqr.some reason, and Dr.
MacEachern has kindly consfenfedT,fft7give usfa"ff^jW'6rdsif6n this subject.
DR. M. T. MacEACHERN, Vancouver— "--J-6fc-^g§|j
Ladies and■ Gentlemen : ' Dr. H.. R: Storr.s, Superintendent of St. Paul's
Hospital, Vancouver, promised to be,present tonight to deliver this address.
He has not arrived'so far,, and therefore, you have to listen to me with quite
an unprepared "address . ggMj
"Hospital standardization-Vis^'a' local, nMioha^S/arid-'' international movement which has been goirig ori all over"the continent during the past five or
six years.. It is* a standard of hospital service.-guaranteeing the patient
competent diagnosis,-efficient treatment and the. best results possible. This
is-a very moderate and reasonable offer inasmuch as today we recognize
that every man, woman and, child has the • right to be" well Health and
production are important economic factors hi' the -community life and being
so, it is incumbent on us to return the sick to productivity in the quickest,
most efficient and comfortable manner. Hospitals, business or commercial
concerns must render a good service, otherwise they cannot succeed in the
light of present-day knowledge and demands.
73
?!|S The movement we are discussing tonight commenced through a need I
for better hospitals, better service and efficiency therein. Investigation of
recent years revealed the fact that hundreds and even thousands of the
hospitals on this continent were merely boarding houses for the sick, and
some of them indeed not very good at that. Appalling revelations were
made by experts who gathered information through personal visits to
hospitals, through correspondence and consultation with hospital superintendents, trustees, doctors, nurses and others. A mass of data was thus
assembled by the American College of Surgeons. This was all analyzed, and
out of it grew up the minimum requirements for hospitals as embodied in
the five requirements or clauses which are well known to you all. To sum
these up in a very few words, these clauses demand that every hospital
have an organized staff of medical men, ethical, honest and competent,
who shall meet monthly to carefully-and seriously analyze the medical work
of the hospital and see that it is up to the degree of quality, to see that
every patient has the opportunity of receiving a careful and competent
diagnosis, efficient treatment throughout with a final objectiye being reached
of the best results obtainable. They shall so scrutinize the work that they
will be able to explain all infections that have occurred, why cases wereS
discharged unimproved, and finally, they shall investigate every case of
death in order that their judgment may be guided as to whether or not the
hospital and the doctor is doing everything possible to safeguard the health ■
of the patient. In short, this means a medical audit inaugurated and
carried on by the medical staff, which should become an important factor
in the success of every institution of this kind. All hospitals, from time
immorial, have had financial audits. The question now arises: why not
a medical audit?
The analysis of what has transpired in the past shows that this great;?
movement is the inevitable expression of clear thinking minds inspired by~.-
the    best    interests of the patient.     Members of the American College    of
Surgeons  realized  that  they,  as  a body  of men,  must  do  something    to
improve   medical   practice,   scientific   medicine   and      especially     surgery. I
Recognizing hospitals as their workshops, they have been good enough to
crystalize  this  splendid  movement  into  a  definite  clear-cut policy to     be-
presented to every hospital on this continent.    They have not only done so
in theory but they are carrying it out in practice through their field works
and further, they are financing a great deal of it themselves personally.   The
programme has, therefore, quietly and humbly for eight years been at work,
particularly active during the past four or five years.    To say the least, it
has revolutionized hospital service in eight thousand institutions in Canada I
and the United States, and is bringing better service to the patient.
This standard lays down or implies certain requirements and these may'
be  divided  into  three  main  divisions:
Firstly— Medical organization, as  already stated.    It demands that the
staff be  ethical  and   competent  men  who  are  allowed  to  practise  in  the-
hospital.    These  men  must  cast   aside   all  bickerings   and  jealousies   and
must be willing to meet together at regular intervals in the so-called staff
conference,  for the purpose  of group  study and to  review  and audit thj|
medical work of the hospital . This means a great deal to the'success ofi
the work of the institution, but such study cannot be carried on without
the necessary data, and hence the second requisite was necessary and that:
brings me to the question of medical case records.
Secondly— Medical case records. The medical case record, as you all
know, is an orderly, systemized, simple, practical description of everything!
that bears on the case so far as illness is concerned. The record reveals!
past illnesses, family history, how the present illness commenced, descrip- ,
tion of the illness, examination of the patient and a record of every!
special examination made. It is a story of the patient. It is only right
to expect that every patient should have all this data put down. It is;
impossible for me to go into the many advantages of such a record, but'
74 let me mention a few. It is of great importance to the patient, to the doctor,
the hospital and to the community at large. It is the basis of review or
analysis of the work of the staff. It means better diagnosis through better
study of cases, and thus more comprehensive treatment. When a person has
to write down all they do or all they find, they will be more careful what
they do. It is a most valuable document in case a patient returns to the
institution for further treatment or goes to another hospital where it is
difficult to make a diagnosis. The former data may in many cases help
arriving at a correct conculsion in subsequent cases. Such recorts embody
sound data for scientific research. From the hospital standpoint it is most
important medico-legally in case of court action. It is a means of stocktaking of the work of the staff and a gauge as to how the hospital organization is really functioning. Many other advantages of the medical case
record could be enumerated, which time and space does not permit, but all
our institutions today must regard the care of a patient more or less
incomplete and liable to be incoihpetent without the record to fall back on.
Thirdly— Laboratories and special treatment facilities. The need of
laboratories and special treatment facilities is to assist the doctor in making
and. in confirming his diagnosis and in supplying the most modern and
effectual treatment. There are several kinds of technical laboratories today
such as x-ray, clinical, pathological, bacteriological, serological, blood
chemistry and other important branches which are rapidly developing, such
as Basal Metabolism and Cardiology. These departments are all necessary
' to assist the doctor in making a more accurate and competent diagnosis.
Likewise there are several kinds of special treatment facilities and departments, such as the physiotherapy with its various branches, the x-ray with
its various branches, the cliriical laboratory through its serum, the operating
rooms, radium etc.    These, therefore, are the requirements:
(a) Staff organization for staff review.
(b) Medical records.
(c) Laboratories.
In fact no hospital can exist as such, without these three things.
How is this programme being presented to the hospitals? Briefly, in
this manner: The College sends out specially selected visitors to cover the
field. These are young men of experience, having certain personal and professional attainments. They must have a pleasing personality, they must be
tactful and diplomatic. They must not go as detectives or spies but as
persons willing, prepared and anxious to help the hospital, without a tendency to force anything on them. They must have something to present to
the institution and show them how it can be used to their advantage. They
must bring the programme to the hospital and help to have it introduced-
To do this they must hold conferences with the superintendents, boards of
trustees, doctors and others interested. Having covered the locality, the
special visitor reports to headquarters at Chicago. Further follow-up is
carried on. When the review is completed a list is published at each annual
meeting showing all the hospitals which have met the standard requirements.
In the introduction and carrying out of the programme some difficulties
have been met but these are very few. Occasionally we meet a doctor
opposed to the programme. We do meet apathy and a desire to follow the
line of least resistance in some places, as well as opposition to changing the
custom of doing things. In some instances trustees have been afraid of
extra cost. This, programme does not cost extra money but means in the
long run a saving to the institution.
The movement up to date has made considerable progress. Three
surveys have been made as follows, 1917-1918, 671 hospitals of 100 beds and
over in Canada and the United States visited, 89 meeting the standard. 1918-
1919, out of these 671 hospitals 189 meeting the standard. 1919-1920, out of
these .671 hospitals 404 meeting the standard.    In 1920-1921  of these 671
75 hospitals it is hoped that some 600 will meet the standard. It is pleasing to
note that many of the medical associations in Canada are endorsing this
movement. The Ontario Medical Association, one of the strongest units
in Canada, is most enthusiastic over the promotion of this programme, likewise the Canadian Medical Association endorsed it at the last -meeting in
Halifax.
The Canadian survey has been carried on this year by a Canadian and I
162 hospitals of fifty to one "hundred beds will he visited by September 15th.
This message of better service and better care of the patient has been carried
to every one. A good showing is expected. There has been a splendid
response from all, especially the smaller hospitals. There is this year, to
say the least, a renewed interest in Canadian hospital affairs,1 and I believe
more marked progress—will be made in our institutions .
The advantages of such a program as mentioned are numerous :
(a) To the patient— it means better and safer diagnosis with better and
safer treatment, a shorter illness, a better final result and a complete
record for future reference if required.
(b) To the doctor— it means better work, more intensive study of all his
cases,  greater stimulation to scientific research  and  advancement,
and a much larger clientele, because such a procedure demonstrates
clearly to the patient that jthe doctor is taking more interest and *
better  care of his  case.
(c) To the Ijospital— the trustees know how. their money is being spent
because they have a better means of stock-taking. They know how
they are discharging their duties to the community. It means a
b6tter confidence in the hospital, giving better health protection to
all, thus being a national advantage from an economic standpoint.
The future outlook of hospital standardization points clearly to the
fact that many hospitals now Inefficient will either meet the standard or
close- up. The public are being rapidly educated to such a point that they
will not go to.any hospital-which is not meeting. theMJtandard. Money will
not be available for such hospitals as do nof meet the standard as laid
down. Municipal and provincial governments will not contribute towards
the support of hospitals that cannot meet the requirements. At the same
time the movement carries a great deal of propaganda which will educate
the public to a more constructive interest in' hospitals for the future,
DR. H. C. WRINCH, Hazelton—
I  think you  will  all  agree  with  me  that we  are  fortunate  indeed in
having one so well able to step in and give us such a concise review of the I
conditions of this -wonderful movement.    We do not aoeept any apologies
from Dr. MacEachern, "but we thank him for his kindness of heart in helping us out on the programme and giving-us such a splendid addressi
'We 1 another address now,- illustrated, by Rev. J. Antle.'   Mr. Antle
iS' Superintendent' of the Columbia  Coast Mission,  having-" three or'   ;four   -
. hospitals, out oil our coast, doing work in a quiet way, equal'in value to the   .
work done by the celebrated Dr. Grenfell in Labrador . We have often'ferMsj
that  we hardly gain  credit  for what'we- do;—our ■ mission  boards 'or  our
various'organizations   working   along   that   dangerous   British   Columbia
coast,-i-h; isolated   - ns,  mining  camps,  fishing  camp's  and lighthouses,
are doing just as noble .work as that-being done on the Eastern coast.    I'
think it is worth our while to.get a -glimpse of that and learn that we are I
doing our share,' and I know that yOu will  listen  to Mr. Antle  with the
greatest pleasure.
REV. J.. ANTLE, Vancouver—
.■ Before.I; begin my little story, which is going to be my contribution to
this convention I would- like to say how pleased I am to be a member of
your Association. I. lost,a whole day yesterday because a man came down
from here and I asked him if it was warm in Kamloops and he said:   "It's
76 ?m
as hot as Tophet
did.
up there," so I stayed in Vancouver.    I am sorry now I
While the Columbia Coast Mission is under the auspices of the Anglican
Church, iKis. incorporated, and "its hosptals are open and undenominational
First of all there is the holding of the religious services. Then there is the
social, chiefly hospital work, the rendering- of services, and it is about -the
rendering of services, not the holding of services, that I am going to talk of.
I am going to divide that into two parts. First, there is the logging indus-
ijg.try, the chief industry on the coast and the other is the hospital work
a*mong the loggers and settlers, and in order to introduce you to the industry I am going to take you a trip up the Coast. Some years ago there was
four thousand men working on this part of the Coast and the nearest
hospital from fifty to two hundred and fifty miles distant. I was a clergy-
I man in Vancouver, and what stirred me up was the fact that once when the
.weekly boat came" in it had four dead men on board. One died waiting for
• 'the boat to come, one" died in an open boat, and two died on the boat coming
down. It was possible to have saved the lives of all of them if they had had
surgical attention within a reasonable time after the accident. This stirred
me up, as I said, to make an effort. The Diocese of New Westminster and
the Diocese of Columbia were consulted. After two years these two Dioceses
BJunited to form the Columbia Coast Mission . In 1905 the first boat was built
called the "Columbia." It was equipped for medical and surgical work with
library and arrangements for church work. It had also a doctor on board.
In the same year the first hospital was built at Rock Bay. Not long after
this hospital was burned and a new one, the present St. Michael's Hospital,
was erected. Shortly after that a call came from Van Anda, a mining district, and the Columbia Hospital was erected and equipped there. Later still
another hospital was erected at Alert Bay, in the heart of the Indian and log-
"ging district. Two years ago the lumbermen of Drury Inlet, in the Cedar
District combined to raise funds to build a small hospital at Cariboo Bay.
In 1910. the first Columbia being too small, a new boat was built, fully equipp-.
ed with hospital X-Ray and other modern appliances for rendering surgical
and medical aid on the Coast.
There were two conditions we found on the Coast which we had to
fight, and fight to the finish, namely, the liquor traffic- and the social evil
in the way of Indian encampments of women at almost every important
■logging camp on the CoaSt. The former was a very long and hard fight,
on account of which the Mission has suffered a considerable amount of
unpopularity amongst those engaged in the traffic, but the result has been
definite and final.
In the second case the situation was cleared up in a year.   The authorities were  interviewed and every possible  influence brought to bear    and
within one yea.r there -was not a  single encampment of that kind on the
. Coast, nor has there been one since.
The Mission has stood from first to last for the well-being of the
lumberman and the settler on the Coast, both physically, intellectually and
spiritually.
Mr.  Antle's  address  was   illustrated  by  a  beautiful   series  of  colored
slides showing the logging and mining industries and hospital activities of
the Coast, in fact Mr. Antle was told by the head of the Forestry Department in Ottawa that his was the finest set of slides in Canada of the devel-
I  opment of the lumber industry in British Columbia.
DR. H. C. WRINCH, Hazelton—
I cannot find words to express my satisfaction and pleasure at having
been permitted to listen to the address describing the work that has been
done on our Coast, and I believe that you will endorse what we now know
to be true.
77 DR. M. T. MacEACHERN, Vancouver—
We would like to have everybody come down .at nine o'clock tomorrow
morning. We are starting our business session and it is very important for
people taking part in the business programme to listen to the minutes of our
emergency and executive meetings held last February.
DR. H. C WRINCH. Hazelton—
I want to express our indebtedness to Mr. Day, manager of Chandler
& Fisher, Limited, for loaning us the lantern and operating it for us
tonight; it is part of his exhibit in our convention hall. I wish to also
expcess our- appreciation to the pastor of the church for giving us the use of
it for the evening.
Meeting adjourned at 10.30 p.m.
MORNING SESSION,  FRIDAY, JULY  8th,  1921, 9.30 a. m.
Dr. H. C. Wrinch, President, presiding
DR. H. C. WRINCH, Hazelton—
This is our business session, and we will ask the Secretary for the
minutes. You all have copies of the annual report and minutes of last
year's meeting are contained therein. We cannot read them all over again
today—you should have done that through the year.
Moved by Mr. G. McGregor, seconded by Mr. G. Binger,
THAT the minutes be adopted as presented.
Carried.
Minutes of Emergency meeting held in Victoria, read by the Secretary
as follows:
MINUTES of Emergency Meeting of the British Columbia Hospital
Association, held at the Empress Hotel, Victoria, on February 11th, 1921,
at 10.30 a. m.
Dr. H. C. Wrinch, President of the Association was in the chair and,
in opening the meeting explained that this was the annual meeting of the
Executive but in sending out the notices it was deemed advisable by the
Executive to call an Emergency meeting of the. Association to discuss the
distressing financial conditions most of the public hospitals in British
Columbia were facing.
There were present the following persons:
Dr. H. C. Wrinch, Hazelton; Dr. W O. Rose, Nelson;. Mr. Anketell-
Jones, Chemainus; Mr. E. M. Cook, Chemainus; Mr Smith, Chemainus;
Mr. Henry Woods, Vernon; Dr. G. S. Purvis, New Westminster; Mr. E. S.
Withers, New Westminster; Mr. Thos. Mordy, Cumberland; Mr George
McGregor, Victoria; Dr. H. B. Rogers, Victoria; Dr. E. C. Arthur, Victoria;
Miss Jessie F. MacKenzie, .Victoria; Sister Mary Mark. Vic.'or-a : Sister
Mary Good Shepherd, Victoria; Sister Mary Kathleen, R. N., Victoria;
Mr. Chas. Williamson, Victoria; Mrs. H. A. S. Morley, Duncan; Mrs. L-
H. Hardie, Duncan; Mrs Anne Mathieson, Duncan; Dr. Brown, Nanaimo;
Mr. A. Foreman, Victoria; Mr. Crawford, Victoria; Mr. Wells Gray, New
Westminster; Mr.'Menzies, Comox; Dr. M. T. MacEachern, Vancouver;
and others who did not register.
The meeting was fairly representative. References of regret were made
by many regarding the death of two very valued members of the Association,
Mr. R. S. Day of Victoria and Dr. R. W. Large of Port Simpson, both of
whom had died.during the past year. The President made very appropriate
remarks as to the great service and life of usefulness these two men had
lived, and especially in its application to hospital work. '
78 Moved by Mr. McGregor of Victoria, and seconded by Mr. E. S. Withers
■ of New Westminster, THAT a resolution of sympathy be sent by the Secretary to Mrs. Day on behalf of the Association.
Carried.
Moved by Mr. McGregor of Victoria, seconded by Dr. R. B. Rogers of
Victoria, THAT a resolution of sympathy be sent by the Secretary to Mrs.
"Large at Port Simpson on behalf of the Association.
Carried.
Certain correspondence was disposed of at this juncture, none of which
had any particular business arising therefrom.
The question of hospital financing was introduced at this time by the
chairman who stated:
Firstly— That the present method of financing hospitals in British Columbia was unsatisfactory and inadequate to meet present day
needs.
Secondly— That almost every public hospital in the Province was facing
a very serious financial crisis.
Thirdly— That unless financial assistance was forthcoming the hospital
could not carry on.
FourtMy— That the Association should make an earnest and emphatic
appeal to the Government today for more assistance
He also announced that the Secretary had asked for a conference with
the Government for 11.00 a. m. the next day .
Mr. McGregor of Victoria, spoke very emphatically on the whole question of financing, and though much along the same lines as Dr. Wrinch, in
addition pointed out.
Firstly— That the Government places certain obligations and additional
obligations from time to time on the hospitals without providing
additional financial assistance.
Secondly— That there is no extravagance in our hospitals today but, on
the other hand, a good deal of living without things that are
necessary,  in  order  to  make ends  meet.
Thirdly— That we must most emphatically impress the Government with
our case that action be taken.
At this juncture Mr. Anketell-Jones of Chemainus, asked Dr. MacEachern to report recent interview with the Government, and Dr. MacEachern -
reported as follows:
"A committee from The Vancouver General Hospital recently interviewed Hon. J. D. MacLean and Hon. J. W. deB. Farris concerning
hospital affairs, and laid before them the distressing financial conditions of other public hospitals in British Columbia, This was
admitted by them, and especially by Mr. Farris, who had learned much
about the hospitals in the Province during the recent election campaign in various parts of the Province. It was therefore unanimously
conceded by the members and the committee that financial affairs in
our province had reached a serious climax. Our request for further
assistance was at first distinctly declined by Dr MacLean.. After
various discussions, suggestions and arguments, it was intimated by
our committee that the hospitals could secure assistance from the
Government without additional burden on the consolidated revenue
by using the new revenues or a portion thereof, such as the increased
motor revenue or the Moderation revenue when established. In regard
to the latter it was pointed out to be a very popular method of disposal
of profits from same. It was pointed out to them how all the per
capita  allowances could be increased at least twenty-five  cents per
79 day,   with   no   additional   burden   to  the   Government.      This   would
assist  our  hospitals  in  future  financing.    Both  Hon.  Dr.   MacLean
and  Hon.   Mr.' Farris  approved  of the  suggestion  and  promised  to-
give it consideration and  support.    The question of an  hospital tajiS
was  also  outlined  but  Dr.   MacLean - stated  that  nothing  would be-
done at this session but promised that at the next legislature a bill
of some nature would be introduced to put the hospitals on a sound',*
financial basis."
Mr.   McGregor,   Chairman   of  the   Provincial   Royal  Jubilee   Hospital,
Victoria, stated how very serious finances were hi their own hospital and "
cited the instance of the milk supply, when members of the Board had to
give their personal bonds to the dealers in order to keep the supply up.
Mr. Woods, of Vernon, thought the per diem allowance should apply..tra|
beds rather than patients, but was not supported in this suggestion.
Mr.   Mordy   of   Cumberland,   thought   money  should   be  provided   for I
hospitals in a similar manner to that of schools.   He stated-that CumbeTlandS
Hospital was free from debt, but this was only possible by depriving them-J
selves of many things they should have, as for instance, better staff accommodation.    He  explained the  system  in  Cumberland, an  industrial  centre,
where each person pays $1 50 per month  for hospital  and  medical  attendance.    It is an approved scheme working in -with the-Workmen's Compensation Board, and has been very satisfactory.
Dr. Brown of Nanaimo, spoke, of their hospital, stating that it was in j
bad condition for buildings and accommodation, though financially sound.
The latter was due in a great measure to the fact that the people there were
educated up to paying their hospital bills, but besides these there were so -
many transients, chronics and incurables that additional burden was made
financially on them. Much money, in their case, was needed at once for
buildings and improvements. He emphasized the need of sound business
principles in our hospitals.
Mr. Williams of Victoria, spoke on this matter also, showing that fees
from patients were  now  at -their limit,  the  municipalities would  not  giye^
further   assistance,   and  more  obligations   were  being  constantly  assigne'dU
hospitals.    In Victoria the Board would soon have to resign and turn thej
hospital  over to the municipality or  the  Province  if the present  state-of
affairs continued.
Several others present expressed themselves along similar lines and the
meeting was, agreed unanimously that action of an earnest nature was.
needed.
Finally a committee was appointed to bring in a report based on the'
lines as discussed during the morning.
Moved by Mr. Anketell-Jones of Chemainus. seconded by Mr. Mordy.:
of Cumberland, THAT a committee of five, appointed by the chairman
bring in a report on the matter for presentation to the Government.
CarriedS
The chairman named the following for the committee:
Mr. G. McGregor, Victoria.
Mr. E. S. Withers, New Westminster.
Mr. T. Mordy, Cumberland.
Mr. Menzies, Comox.
Dr. M. T. MacEachern, Vancouver.
The meeting then adjourned to meet again at 2.30 p. m. when the com-.
mittee would be prepared to report.
80 Meeting was called to  order by the President,  Dr.  H.  C. Wrinch,     at
2.30 p. m.
The findings of the Committee were discussed and they were briefly
as follows:
Firstly—   That almost all the public hospitals in the Province were facing
a serious financial crisis and must have immediate relief.
Secondly— That the present per capita grant was not sufficient to  carry
on with and there  should be  an  immediate increase  in same.
Thirdly—   That there  should be  some definite financial basis worked out
for the future and this possibly best in the form of an equitable
tax.
Accordingly the committee brought in the following report to be
submitted to the Government, which was adopted by the meeting and ordered-
submitted to the Government.
.To The Hon. Premier Oliver,
and members of the Executive Council,
Of the Government of British Columbia.
. Gentlemen:
At a meeting of The  British  Columbia Association held yesterday  in
Victoria   the   following   resolutions   were   passed   pertaining   to   hospital
^financing :
Whereas   the  public  hospitals   of  our   Province   have   almost   without
exception come to the point where they are confronted with heavy deficits
or else are seriously handicapped in their work from lack of suitable buildings, equipment or staff.
And whereas this very grave condition has supervened in spite of
every effort having been made to provide sufficient funds by all the usual
methods :
And whereas under these conditions it is obviously only a matter of a
| very short time before further credit will be refused the hospitals by banks
"and tradesmen.
And whereas it is inconceivable that such a contingency should be permitted to occur:
We, The British Columbia Hospital Association, respectfully turn to
your Honorable Body with the following proposals as the only reasonable
solution to our problems:
Firstly— That the Provincial Government be requested to disburse forthwith the deficits of the, public hospitals of British Columbia
until such time as a better and more permanent financial policy
for financing said hospitals is adopted:
Secondly— That the present scale of per capita' grants from the Provincial
Government be doubled until such time as a measure is brought
in providing for a more permanent and adequate system of
financing hospitals.
Thirdly— That the Government be requested to bring in a measure at the
earliest opportunity to provide by a universal basis of taxation
for the adequate financing of all hospitals receiving aid under
the "Hospital Act."
Respectfully submitted,
On motion of Mr. Mordy, Cumberland, seconded by Mr. Anketell-Jones,
Chemainus the following committee was appointed to interview the Government :
Dr   H C. Wrinch, Hazelton; Mr. G. McGregor, Victoria;  Dr. Brown,
j Nanaimo; Mr   E.  S. Withers, New Westminster; Dr. G.  S. Purvis.    New
Westminster;   Mr.   Williams.   V-V'-oria;   Mr.   Foreman,   Victoria;   Mr.   W.
Gr-u-. New Westminster; Dr. M   T   ^-cEachern, Vancouver. It was also recommended that as many as- possible of the others not on
the committee accompany the delegation .
Other  business  came  before  the  meeting  and  was  taken  up     before -
adjournment .
Appointment of First Vice-President to fill position left vacant by the
death of Mr. R. S. Day:  .
Mr. Geo. McGregor, Victoria, and Mr. Charles Graham, Cumberland,
were nominated, and the result of a ballot showed Mr. McGregor elected.
Mr. McGregor made a few appropriate remarks, referring to the horlbrS
conferred on him and his realization of the responsibility he was assuming!!
Informal discussion followed concerning The B. C. Hospital Association, place of the next convention meeting, fees, programme etc. The chairman endeavored to get the suggestions from the general meeting that would
be of benefit to the Executive in making its arrangements. Many valuable
suggestions were adduced and noted.
Mr.   Cook  of  Chemainus,  introduced  the  discussion    concerning    the--
Workmen's  Compensation  Board,  stating that some of the hospitals were
having a little trouble now and again in a fair settlement of their accounts;
also that the fees paid were not the same all over, and in many cases inadequate to pay for the cost of service rendered.
Many present brought up difficulties they were having and particularly
referred to the Workmen's Compensation Board refusing to pay hospital bills
on the grounds that the patient was in too long.
This was considered very unfair because the hospital could not discharges
the patient—that was entirely up to the doctor in charge. It was felt by all ■
that there should be a better acquaintance and understanding between ths|
Workmen's Compensation Board and the hospitals in our Province To thajl
end Dr. MacEachern stated that he was arranging for the Workmen's '
Compensation Board to be represented at the- next convention, where all
these matters could be cleared up. This was heartily approved of.
Several other matters came up, these particularly bearing on fees and
contract prices in hospitals. The committee promised to leave time on the
programme of the next^convention for a thorough discussion of same.
On motion of Mr. McGregor, seconded by Mr. Anketell-Jones, the
meeting adjourned.
Moved by Dr. E. C. Arthur, seconded by Mr. G. McGregor, THAT the
minutes be adopted as read.
;%.«f5? Carried.
Minutes of the Executive meeting- held in Victoria, read by the Secre-_
tary as follows:
Minutes of the Executive meeting of The B.  C. Hospital Association
held in Victoria at the Provincial Royal Jubilee Hospital on February lltfifl
1921, at 8:00 p. m.
Present: Dr. H. C. Wrinch, President;'Miss J. F. MacKenzie, Victoria;-
Mr. Geo. McGregor, Victoria; Dr. H. B. Rogers, Victoria; Dr. G. S. Purvtll
New Westminster; Mr. E. S. Withers, New Westminster; Mr Henry Woods
Vernon and Dr. M. T. MacEachern, Secretary.
The meeting was called to order by the President to discuss particularly
the' coming convention.
It was shown by the plebescite taken from the various hospitals thxm
Kamloops was the choice, and it was moved by Mr. E. S. Withers, seconded
by Mr. Geo. McGregor, that Kamloops be selected for the coming annual
convention.
Carried.
Moved by Mr. Geo. McGregor, seconded by Dr. H. B. Rogers, that the'
convention be held on Wednesday, Thursday and Friday, July 6, 7, and 8th,
1921. Carried.
82 - Moved by Miss J. F. MacKenzie, seconded by Dr. G. S. Purvis, that the
usual division of the programme be carried out this year, Nursing, Medical
Business and that convenors of sections be appointed to prepare the programme. It was further suggested that as far as possible all the papers
come from outside of Vancouver and Victoria.   This was approved by all.
Moved by Miss J. F. MacKenzie, seconded by Mr. E. S. Withers, that
Miss E. I. Johns of Vancouver be convenor of the Nursing section.
Carried.
Moved by Dr. H. B. Rogers, seconded by Mr. McGregor, that Dr. G. S.
Purvis of New Westminster, be convenor of the Medical section.
Carried.
Moved by Miss J. F. MacKenzie, seconded by Mr. G- McGregor, that
Mr. E. S. Withers of New Westminster, be convenor of the Business section.
Carried.
In connection with the coming convention the following suggestions were
made:
■ That the  committee  appointed  should  bring  in
Accounting.
a  report  on  Hospital
That the following subjects, particularly should be discussed: Purchasing, Collections, Workmen's Compensation and contract work, hospital
standardization, nursing problems including affiliation etc.
'  It was thought advisable to not have much entertainment but provision
might be made for an afternoon and evening only.    A trip to Tranquille
Sanitorium was suggested.   It was felt that as much time as possible should
be given to the work of the convention so that all would have a   profitable
Barne.
It was considered that Kamloops should supply sufficient accommodation for all the delegates and that the local committee would take care of
that.
Many other valuable suggestions were made regarding the convention
such as the following: That all sessions be open to the public; that, if
possible, two interesting meetings be held at night, when the public would
be specially invited; that the programme be limited in number of papers
and a good deal of time given to round table discussion ;■,that the hospital
people in the province be written to immediately with a view to having
them send in any suggestons and subjects for the queston drawers.
A wire was received from Dr. W. A. Young, Editor of the Hospital
World, Toronto, asking that his journal be made the official organ of the B.
C. Hospital Asociation. After discussion, moved by Dr. H. B. Rogers,
seconded by Dr. G. S. Purvis, that we adopt the "Hospital World" as the
official organ of our Association.
Carried.
In adopting this motion Dr. MacEachern urged that the hospital people
of the province manifest their good intention and interest in this by supporting the journal with articles, and assist in every possible way to make it
more interestng.
Discussion arose over the question of fees and it was clearly shown
that the hospitals were not paying, up as they should, and as a result a
deficit would again occur this year. It was suggested that the hospitals be
written regarding the meeting held in Victoria, pointing out the splendid
work the Association is doing by way of laying their claims before the
government, and even for such alone the Association should have all the
financial assistance that is necessary.
Meeting Adjourned Moved by Mr. G.  Binger, seconded by Mr.  G. McGregor,  THAT the
minutes be adopted as read.
Carried.
MR. G. R. BINGER, Kelowna—
Do you not think it advisable, if we are so hard up for funds, to draw
on the hospitals who have not paid their fees?
DR. H. C. WRINCH, Hazelton—
I would be sorry to do anything to antagonize them.
Report re interview with the government.
DR. M. T. MacEACHERN, Vancouver—
We interviewed the government the day following the emergency
meeting according to our instructions, together with a large representation
from the Association which remained over. As usual, we had a very courteous hearing. The subject was introduced by our good friend the President,
and I had the honor and privilege of introducing the resolutions and Mr.
McGregor and others spoke to them. Our case was presented clearly and
in a businesslike manner. The Premier gave us his stock-in-hand reply, as
we expected, but nevertheless, I think they realized that we were up against
it and needed assistance, but as to how to get it—he did not give us much
encouragement; he told us the people of the province were not willing to
pay. However, he said it would have consideration but he could not make
us any definite promise. The Union of B. C. Municipalities asked our
Association to accompany them a few days later, and we did—Mr. McGregor
of Victoria, Dr. Purvis of New Westminster, and riryself, and again we
presented the case on behalf of the hospitals with the Union of B. C. Municipalities, as they were interested in hospitals and education. The Union,
of B. C. Municipalities have absolutely fallen in and adopted our recommendations. The matter was taken up with them the day previously and
they were heartily in accord with our recommendations. Other organizations took it up, such as the United Boards of Trade of the province, and
presented the case. Now, the only result of all this is the clause in the
Moderation Act expected to give temporary assistance, with which you are
all familiar.    It reads as follows:
One-half of the net amount shall be apportioned and paid to the"
several municipalities in the province in proportion to their respective population, and of all moneys so paid to each municipality one-
half thereof shall be placed to the credit of a special account in
the municipal treasury, and shall be'paid thereout only for main--
taining or granting aid to hospitals in that municipality, or for
such other purposes of municipal expenditure as may be approved
by the Lieutenant-Governor in Council.
That is all that has been done, but I feel the coming legislature wilt*-
possibly deal with this question in a sympathetic and businesslike manner.
The greatest constructive interest we had was from Mr. Farris, who spoke
with a desire to do something and I think it is through him that we have
obtained even this small help which is so problematical. The rank and file
of the members were all very much in line.
MR. J. A. GILL, Kamloops—
Would that affect rural districts, such a^ outside of Kamloops in regard
to the liquor revenue.
DR. M. T. MACEACHERN, Vancouver—
If you are a municipality you would get your proportion according to
your population. The Act says: "Municipalities," so that eliminates unorganized  districts.
84 DR. E. C. ARTHUR, Victoria-
There  are four  or five outside of company hospitals  that are not  in
municipalities—Princeton,  Campbell  River  and  Quesnel,  that  I  can  think
of.
MR. G. R. BINGER, Kelowna—
A great number are in municipalities and have outlying districts which
are served by them,
REV. MR. HINCHCLIFFE, Kamloops—
I think if the Secretary had fully explained the Act in regard to the
profits our friend here would .not have troubled to ask his question. In the
the first place, all the permit money goes to the government. In the second
place, from the proceeds that accrue from the sale of liquor the government
first of all bolsters up the Reserve Fund—they may put all the credit to that
fund, any amount, all the proceeds if they think fit, then the balance is to
be divided fifty-fifty between the municipalities and the hospitals, and I
thmk it would be very unwise for any municipalty to look forward to any
assistance from the working of that Act, this year at any rate.
DR. H. C. WRINCH, Hazelton—
Regarding hospitals outside of municipalities, have they to be at the
mercy of the government in regard to the share in the proceeds? I assume
where profits when derived from this unorganized district would be turned
directly into this fund, they would be divided between the government itself
and the district, the same as if that district was organized.
Correspondence read by the Secretary.
DR. H. C. WRINCH, Hazelton—
We will ask Mr. Binger for his paper on: "The present inadequate
method of financing hospitals."
MR. G. R. BINGER, Kelowna—
There is an old adage which says great minds think alike. I am going
to change that slightly and say,great minds and a small one think alike,
for I am afraid that this paper is simply a repetition of the sentiments which
have already been expressed in a much more able manner than I am able
to express them. However, such an important subject cannot be rubbed
in too strongly so I will adminster a little massage.
Mr. President, ladies and gentlemen:
I feel it a great honor to have been asked to read a paper on what,
I am sure you will all agree, is the most vital question which faces our
hospitals at the present time, and I am only sorry that it is not in the hands
of one more competent than myself to put the case before you. However,
I hope that it may lead to a full disscussion of the situation and that some
plan will be evolved which will help us out of our present very difficult
position.
Every year makes it more difficult for the directors to make ends meet.
The great advance in the science of medicine calls for more efficient equipment of our hospitals and higher salaried staff. The cost of all supplies is
double and in many cases more than double what it was in pre-war days,
which, of course, has necessitated the rising of the rates to patients, until
at the present time they are almost beyond the means of many who would
like to enter the hospital where they would receive the proper care and
attention which is necessary and which they are unable to get in any other
way. These people either, go into the hospital and do not pay or are treated
at home, where in many cases their surroundings are anything but what
they should be. This is altogether wrong. It is not fair on the hospitals
9"hichare at the expense of attending and feeding such patients, and it is not
fair on the patients who might suffer for the rest of their lives from not
being able to afford to pay for the necessary cure and attention.
85 The greatest asset any country can have is a strong healthy population
and this can only be secured by taking care that everything possible is done
to keep the -standard of health at the highest possible level. Who should be
responsible for seeing that sufficient funds are forthcoming to enable the
hospital to give.this service? We at once say the government. Who are
the government? You and I, Ladies and Gentlemen, and every taxable soul
in this Province.
At present the very small minority of the population do not pay one
cent to the upkeep of the hospitals, whereas everyone should pay their share.
I would not advocate free treatment for those who are able to pay, but
some system of taxation which would meet deficits and thus prevent the
present very wrong system of making the merchants wait for their money.
A very important question is: where is the money to come from for
additions', improvements, equipment, etc.? Take the case of our own
Kelowna Hospital. The population of the district has increased to such an
extent that our accommodation is altogether inadequate. We have had to
turn the nurses' quarters into wards and rent a house which at any moment
may be sold. It is an absolute necessity to have a nurses' home, which to
properly accommodate our staff, would cost, at least $10,000.00. Our
maternity wing is far too small and we have to refuse patients, and have no
facilities for the isolation of infectious cases. There are a hundred and one
things we want to do and SHOULD DO but are not able. Doubtless there
are many hospitals in the province in the same position.
. We cannot expect to make the rates high enough to pay for all this and
are lucky if the cash received from patients, contributions and government
grant put together enable us to pay our bills.
Some of us may, by dint of careful management, show a profit on the
yearly working, but alas this profit is only on paper; it walks out of our
doors with the patients who do not and never will pay their bills. If the
hospitals are situated in a municipality an allowance of $2.50 per day can be
collected for indigents, but there are very few who can really be classed
as such and the great majority of the non-payers would be very indignant if
their accounts were sent to the authorities for payment. I was told that the
government grant is given to meet such cases, but it is quite inadequate and
only helps to enable us to meet our obligations for upkeep.
The general public do not understand how much it takes to run a
hospital and judging from the small attendance at the annual meetings, do
not seem to want to understand it, and the work and expense falls on the
few regular subscribers, and until it is made compulsory for all to give
their support and pay their share I can see no daylight ahead. At one time
I thought that government ownership would be the only solution but have
since come to the conclusion that there would be too much red tape and a
host of government supporters would be clamoring for positions and this
would greatly increase the expenses. I think the present system of local
directors, who give their services free and are men who know local conditions, and who should be chosen from the level-headed business men of the
district (by business men I do.not mean only professional men and merchants but the rancher who has shown by the way he has conducted his own
business that he has business capabilities) with proper government supervision, would be the best and cheapest way of management.
The government supervisor or inspector should make himself thoroughly
conversant with the needs of each hospital he visits, and see that only such
expenditures as are necessary for efficient service and accommodation for
patients, are made. The present system of inspection is futile. The inspector
comes in and spends perhaps half an hour in the hospital and goes away
without knowing anything about local conditions. He does not know if the
accommodation is sufficient for the population the hospital serves and the
nature of the work done by the staff and, therefore, cannot say if the
hospital is over or under-staffed.
86 Then we come to the question of finance, and this is the real question
that we have to consider. We all know that our municipalities are in the
same financial straits as we are and that very little help can be expected
from them from funds at their command. The Federal and Provincial
governments appear to be in the same position and for political reasons
are unwilling to put further taxes on the people, but to enable the hospitals
to give efficient service it is absolutely necessary that everyone should be
taxed and the sooner the government harden their hearts and tax everyone
who is taxable, the better, as sooner or later this will have to be done or
some of us will be forced to close our doors. The system of drives is wrong
on principle—some give liberally and the majority reluctantly put their
hands in their pockets, bring out a dollar or two and think they have done
their share. A drive tides over present difficulties perhaps,, but what is
wanted is a steady income, something that the directors can depend upon in
order that they may feel secure. A director who is worth his salt worries a
good deal when accounts cannot be paid and he sees many things left
undone which should be done.
I will not keep you much longer as the time is only too short to get
through the business which is before the convention and will just suggest
what may be a remedy if properly worked out; but the details I will leave
Tto those more competent than I am to deal with.
Briefly, my plan would be along these lines : that the government be
urged to form hospital areas or municipalities and that a tax of one per
cent, be levied on all incomes without any exceptions, this tax to cover
schools and hospitals. For residents it could be collected in the same way
as the school taxes are at present; and for the transient the employer would
deduct one per cent from the wages of the employee. Thus it would catch
every class and would work no further harship on the present tax payer,
as the school tax would be reduced by the inclusion of those who now go
gaily through life without helping to support either schools or hospitals and
their name is legion.
Doubtless there are many present here today who have other and probably better solutions to offer, but the main point is that something has to be
done and that without delay, to relieve the hospitals of British Columbia
from the financial difficulties under which they at present suffer.
I will now conclude by thanking you for the attention you have given
me and trust that a way out of our present state of chaos may be found
before we leave this convention.
DR. H.  C. WRINCH, Hazelton—
We are going to hear all the papers ,then open the discussion on all at
one time, as the discussion very often overlaps. Having the papers before
us makes the discussion easier and better In every way. We will ask Mr.
Henry Woods to present his paper on "Standardization of financial and
other records in our hospitals."
MR. HENRY WOODS, Vernon—
After two years experience in hospital work, I feel assured that it
would be another big step towards hospital efficiency if there was a recognized uniform system of keeping financial and other records in our hospitals.
By records, in this instance, I do not mean medical records but statistical
and permanent records which do not, at present come under the hospital
standardization scheme.
All hospitals from time to time require information to make comparisons,
either with the previous year's business or the workings of other hospitals.
The government requires at the end of each year certain information which
I doubt could be given accurately unless a uniform and thorough system
;is installed. It is no use having the information in books unless the same
is tabulated and summarized at the end of certain periods.
87 A very valuable and useful reference book could be provided for each
hospital and a systematic recording made in it at the end of each month of
all ^operations and transactions connected with the institution so that if at
any time information is required this book will furnish every detail at a
glance. At the end of each year the workings of every hospital in the
province might be,published. This would be an interesting reference for
the directors of the various hospitals who at present know very little of the
workings of any other hospital but their own.
To obtain the information for compiling these records it will be
necessary for each hospital to keep accounts and patients' particulars on
standard prescribed forms. These forms will have to be .drafted to meet
all requirements and along practical lines with the maximum of information
and a minimum of work, because a small hospital has usually to rely on
one person to keep all these records.
I would suggest a committee being appointed comprised of a representative body from the large and small hospitals "and the government representative, to go into the matter and draft the necessary forms and books.
Included in this committee there would have to be at least two qualified
■ accountants with hospital experience, because it appears that in quite a
number of our hospitals the accounting is anything but satisfactory.
Referring again to the annual government return, I think that all the
required information could be given if the government would state what
they are going to require at the end of the year. This would give the secretary or person in charge of records something to work on. The method at
present adopted is that a single form is sent to all hospitals by the Provincial
Secretary at the close of the year, asking for information which it was not
previously known would be required. The result is that a great many
hospitals are unable to furnish all the information and the government
return is incomplete.
Regarding previous year's records in hospitals, the result of not having
a thorough system is that very useful information is not obtainable. Presumably, whoever was doing the work did not see the use of summarizing anything other than that which affected the annual statement and director's
report. They were not to blame because it takes a long time to become
familiar with the efficient working of an institution and persons newly
taking over the work have had little to help them: This difficulty would
be overcome by the means I have suggested, namely, a uniform system of
keeping financial and other records.
DR. H. C. WRINCH, Hazelton—
We are glad to have with us this morning Mr. E. S. H. Winn and Dr. G.
A. B. Hall of the Workmen's Compensation Board. I would like to tell
them that- the Association desires to work in the utmost co-operation with
the Workman's Compensation Board. I have not discovered any spirit of
antagonism whatever or on the part of the hospital, towards the Board. I
think, indeed, down in our hearts we believe we have the best Compensation Board in Canada. I was on the other side of the line'at the Mayo
Clinic when they were discussing their Compensation Board. I wish I
had had the courage to get up and tell them something about our compensation Board.
I will ask Mr. Winn to present his paper on "The Workmen's Compensation Act and our Hospitals."
MR. E. S. H. WINN, Vancouver—
Any difficulties that have arisen between the members of your Association and the Workmen's Compensation Board during the past four and a
half years have been due, we believe, to misapprehension as to the position of
the Board in'its. relation to the hospitals. In practically every case these
difficulties have disappeared when the Workmen's Compensation Act was
more fully understood. According to the various Courts of Appeal in several Provinces and
States where it has been discussed, the Workmen's Compensation Board
adjudicate among other things upon the rights to compensation of injured
workmen engaged in a limited number of industries covered thereby who
have met with accident arising out of and in course of their employment.
It is created by a special Act of Legislature and has been held to be a Court.
It is well that we should understand how the moneys are collected,
with which to carry out the Act's requirements. There are two main
divisions, first, that relating to Compensation, and secondly: that relating to
Medical Aid. The moneys for payment of Compensation are collected
entirely from employers by means of assessments based upon a percentage
of payroll, the amount of the percentage being dependable upon the hazard
of the particular industry in which the employer is engaged. The moneys
collected for Medical Aid are collected from the workmen, the employer
deducting from his employees' wages the sum of one cent for each day or
part of a day worked. If the amount collected is insufficient for the
requirements, then the Act requires the employers to supply the deficit.
It is therefore generally true to say that the employers pay Compensation
and the workmen pay for their own Medical Aid. You are alone interested
in the Medical Aid branch.
The Board, under Section 21 of the Act, has authority to furnish or
privide injured workmen with such medical, surgical and hospital treatment, transportation, medicine, crutches and apparatus, including artifical
members as it may deem reasonably necessary. A very general consideration
of the Act will convince you who have a knowledge of the industries outlined therein that,
(1) There are many workmen not covered by the Act.
(2) That the Board has no authority to compensate for any accident
which may happen to those outlined in (1).
(3) That there are a great many disabilities suffered by workmen
arising out of their employment that the Board has no authority
to deal with.
Assuming that a workman engaged in an industry covered by the Act
meets with an accident arising out of and in course of his employment
the Board, under Section 67 "has exclusive jurisdiction to enquire into,
hear and determine all matters and questions of fact and law necessary to
be determined in connection with compensation payments and the administration thereof," and_ in dealing with compensation the term is deemed to
include medical aid. In other words, the Board is created for the purpose
of administering.
(1) Funds collected from employers for the payment of compensation.
(2) Funds  collected from the workmen for the payment of necessary
- doctors   and   hospitals   and   for   expenses   relating   to     necessary
medical treatment.
Under the Act the workman has the authority to select his own doctor
and his own hospital. The doctor and hospital are therefore appointees of
the injured, workman and the position of debtor and creditor exists between
these parties. This condition existed prior to the coming into effect of the
present Act and still exists with this additional condition, that the Board
has supervision and control which they may exercise if they consider the
workman is not being treated properly. The hospital's right of collection
for hospital services rendered is still against the patient. The Board, may
however, pay the doctor and hospital when it is proved that the disability
is a compensable one and that the services rendered were necessary. It will
thus be seen that the Board in handling medical aid is a third party that
pays out of a fund collected from the workmen such amounts as may be
deemed a fair charge for the-services rendered. Under the old system the
workman would sue his employer for compensation, medical and hospital
expenses.    If the court allowed the claim it would by its judgment order
89 the employer to pay the amount to the workman, who would then pay his
doctor and hospital. Our position is not different to the courts under the
old system; we are in effect a particular court for the handling of a particular class of cases. In order to meet the convenience of all parties concerned we* pay the doctors and hospitals direct in place of through the
"workman as was done under the old system. If a hospital wished the old
system continued we would pay the workman and he in turn would pay
the hospital.
The question naturally arises as to when an injured workman is entitled
to be a hospital patient and, if so, the period of time that he is entitled to an
allowance for hospital services. After consulting a number of our prominent medical men and hospital superintendents the Board adopted this broad
definition: "A hospital case is one where proper and sufficient treatment^
cannot be obtained outside."
When an account is presented for hospital services, the whole file is
carefully examined by the medical department, which in turn, report its
findings to the Board and an award is accordingly made. If objection is
made to the amount awarded the whole matter is reconsidered and if
necessary the complete file is then submitted to a committee of leading
medical men engaged in practice in the class in which the case comes under.
Their opinion is then considered by the Board. In every single case so
submitted it has been found that the hospitals have received more than these
men considered was a maximum allowance. Our main difficulty with you
seems to be whether or not the patients are remaining in the hospitals an
undue length of time. It is agreed that the patients should not remain in the
hospital when they can be treated as well outside, or as an outpatient . To
permit any other course to be adopted would be placing the hospitals in the
infirmary class or making them boarding houses. Because a patient has no
home to go to is not sufficient justification for allowing him to remain in
the hospital. If that were permitted the general effect would be an additional
award to the workman who does not have the cost of a home to maintains
Compensation is paid to a workman for his maintenance during disabihtil
and if a single man is permitted to remain in the hospital when he should
be an out patient he is getting his board as well as his maintenance allowance. Last year an approximate daily average of 147 workmen were in
hospitals. Should each patient remain one day longer than necessary, you
will get some idea of the amount of unnecessary cost. Back injuries and
hernias present two of our chief difficulties. Under the conditions prior to
the coming into effect of this Act, the Employers Insurance Companies looked
upon this class of injury with doubt, the medical practioner suspicion,
the lawyer with uncertainty and the court with an open mind as
the circumstances permitted. Many surgeons of the very highest standing have stated that the vast majority of the alleged sprained-back conditions are undoubtedly due to constitutional disturbance. From a perusal of
the records of other Boards and court cases it would appear that that has
been the general experience. The Board is often puzzled by conflicting statements and contradictory reports. It is only by careful examination of the
file in each particular case that one is able to give even an approximate
opinion as to whether or not the workman is suffering from a personal injury by accident arising out of and in course of his employment. Then
again, a great many medical authorities seem to agree that hernia may very
rarely, if ever, be due to a single strain. The study of statistics on this subject
forces one to the conclusion that not one in five hundred cases of hernia is
due to injury by accident arising out of and in course of employment.
We would therefore strongly advise the members of your Association that
in the case of alleged strained back or hernia there is a possibility of the
Board disallowing the claim.
90 It may be of interest to you to know that we have disbursed for hospital
services since January 1st, 1917, the sum of $368,098.59. Also, over $135,-
000.00 has been paid for X-Ray, laboratory and special nursing, making a
total of over $503,000-00. There has been disbursed for medical aid, which '
covers doctors, hospitals, drugs, as well as surgical apparatus and artificial
members, a total of $1,269,332.75 during the four and a half years of the
Board's operations.
The members of the Board and their Medical Department have, we
believe, visited practically every hospital in the province in an endeavor
to explain the workings of the Act and advise as to how certain difficulties
might be overcome. Our reception has at all times been most pleasant and
we believe that after such visitation our respective obligations were better
understood As the Act becomes better known the troubles will become less
each year. This has been particularly noticable in the case of the hospitals.
We wish to express our appreciation of the opportunity granted us of
explaining the general effect of the Workmen's Compensation Act where-
applicable to hospitals. We also wish to tender our thanks for your hearty
co-operation in the past and express the hope that it may continue.
Since coming into the Assembly Room this morning I have been asked
why it is not possible to use some of the present reserves for the payment of
, increased amounts to hospitals. With your permission I should like to
explain what the reserves of the Workmen's Compensation Board really
mean, as such a question is an evidence of misunderstanding. In all cases
where pensions have been awarded to dependents of workmen who have been
killed, or pensions awarded to workmen whose injuries have resulted in
permanent disability, the present value of the pensions for their expected
term has been placed in reserve and the funds invested in government
securities in accordance with the requirements of the "Trustee Act," as is
required' by the Workmen's Compensation Act. By this means the entire
present and future cost of all accidents which happen in any year is borne
by the employers who were engaged in industry in each of the several
classes in that year. No burden therefore, is thrown upon the employers
in future years on account of past accidents.
After four years operation of the Act the reserves made up in this way
amount to $1,715,854.02. This amount includes an item of $15,000.00 per'
year, now amounting to $60,000.00, which has been set aside as a catastrophe
reserve against a possible catastrophe that may occur and which may not
be attributable to or be a proper charge against any single class of industry.
The amount of the whole reserve may be expected to increase yearly until
such time as the expiration of pensions occur as frequently as pensions are
awarded. The investments are therefore made in as long term bonds as are
available for purchase. In other words, we have taken out of the general
Accident Fund, that is, the fund from which all compensation is paid, and
placed in the Reserve Fund the capitalized value of each accident so that we
be able to pay the monthly pension to dependents and permanently disabled
workmen. In the ordinary case of accident where the workman is able to
return to work we pay him in full, but where the workman leaves dependents or when he is permanently disabled we are enabled by computation
from Tables of Expectancy and Disability Degree Tables to say just how
much that particular accident is going to cost. We therefore pay for that
accident by withdrawal of the amount necessary from the Accident Fund
and placing it in the reserve. In effect the placing of the amount in reserve
is paying for the cost of that particular accident.
DR. H. C. WRINCH, Hazelton—
We must thank Mr. Winn for that frank and complete presentation
of the attitude of the Board . Personally, I am very glad of that last explanation he has made regarding the surplus they have put away.   They provide
91 for permanent compensation. What becomes of the surplus when the -workmen dies before the period of expectation ? Does it remain there or is it
put back in the General Fund to help relieve the present situation?
MR. E. S. H. WINN, Vancouver-
No, the amount is allowed to remain in the Reserve. The law of average
deals with that situation. One must necessarily have a number of cases
before the law of average actually prevails, however. In some cases the
dependent may die ahead of time, in others he or she may considerably
outlive his or her expectancy. Our Table of Expectancy takes care of that
situation.
DR. G. S. PURVIS, New Westminster—
I would like to add a word of appreciation of what the Board is doing. :
Personally, I have had the privilege of meeting Mr. Winn and all our
difficulties have literally vanished. However, there is a point I would like
to raise—that of the patient remaining in the hospital for a certain length
of time and the Workmen's Compensation Board not allowing the claim.
Personally, I think the doctor in charge of that case should be the man to
look to, because if I had a patient in the hospital and the authorities came
to me and told me I would have to get him out I would not Ithank them,-
The principle we work on is this—I do it once, a month: have a list of the
names of the Workmen's Compensation patients in the hospital, go through
and look over their histories and if I think a certain patient would be just
as well outside I report to the doctor, discuss it with him, ask if he cannot
get. that patient out. There are times in my opinion, that the patient would
be just as well out but the doctor does not see fit.
MR. E. S. H. WINN, Vancouver—
• I think that is about the only real difficulty you have. That is why I
tried to lay emphasis on the viewpoint that we were purely and simply an
adjudicating body; that the contractual relationship of the doctor and patient
and of the hospital and patient still exists. Your right of action is against
that particular patient. Your hospital board in that case should say: this
patient is going to have to pay. That is going to bring home to the doctor
that he is putting you in a wrong position. You bring that up to the doctor
and it just means when the case isturned out you can say: "I told you so,"
and I think you will find that he is not going to be in that position on
more than two or three occasions. There is no better way of working it out.
There is one hospital that has a great deal of trouble in getting the men
to leave. It is a beautiful hospital, fine sun rooms with pianola, victrola,
card games going on. We visited that hospital and advised the matron
that there were at least seven men that should not be there. We came back
two months later and found four of these men still there; we told her we
could not pay for them. ■
MR. H. WOODS, Vernon—
In regard to the case described, is the case referred back to the attending doctor before the claim is disallowed?
MR. E..S. H. WINN, Vancouver-
No, we feel that it is a matter between ourselves and the docter. When
it comes back to the hospital the Secretary or the Superintendent can get
in touch with the doctor and the matter can be sent back to the Board. If
the additional time can be justified when you take it up with the doctor
and the information comes back to the Board, then we can possibly allow
the claim. That is what I have tried to drive home—that we are an adjudicating body, that there is no direct relationship, so that I say to you: take
it up with the doctor, furnish us with additional information and we can
deal with the matter.    It is up to you to supply the informatipn.
MR. H. KEDDELL, Penticton—
We have had a number of cases where reductions have been made.   The
92 patients   attending  the   hospital   for
first time it happened I took it up with the Workmen's Compensation Board
and they at last came through with the difference, hut I have never been able
to get them to do that since. I have one case here for instance, an account for
$20.00 which they have only passed for $12.50, and we have had several
others. There is one point which I think the Workmen's Compensation
Board ought to take into consideration and that is the question of dressings.
Many of these cases require quite a lot of dressings, and the $2.50 rate that
we get barely covers the cost of maintenance, so I think the Board ought
to take that up, because at the present price it is quite a serious item and
especially when we run the chance of getting reductions made on our
accounts.
DR. W. ARBUCKLE, Vernon—
In sending some accounts they were sent back and the Board deducted
eight or ten days off them.   We showed them to the doctor—in every case
we wrote the Board and explained matters fully and I think every account
fwas paid.   It is just as Mr. Winn says, they do not have sufficient information.
MRS. A. MATHIESON, Duncan-
Is   any   allowance  made  for   out
treatment ?
MR. W. S. H. WINN, Vancouver-
Yes.
MR. G. McGREGOR, Victoria—
The hospital I represent had a real fight with the Board, but we have had
no disputes since and our business dealings have been a real pleasure ever
since that and I think out of fairness it is my duty to mention the Jubilee
Hospital had several disputes at long distance. I think Mr. Winn will
agree that we have been particularly good friends ever since. I can see the
point of view in regard to cutting off the bills, that is causing all the dispute.
I take the same stand as the others. However, there are two sides—we
have to consider the Board as well. They are protecting the employers.
I think in most cases the Workmen's Compensation Board might give a
little more consideration before they cut the bill in two. They have not the
information, but I suppose the idea is to make sure at first and if they get
the information later are willing to adjust it.
MR. G. R. BINGER, Kelowna—
There is one thing Mr. Keddell brought up and that is the question of
dressings and operating room expenses. I am sure that you will acknowledge $2.50 is not sufficient to cover the expenses. I think if you ask any
hospital doctor or matron they will tell you that $2 50 will not be sufficient
to care for a man and his operating room expenses also.
DR. J. J. GILLIS, Merritt—
With regard to a doctor sending a patient to the hospital—if he considered this patient was a case under the Workmen's Compensation Act, the
patient is in say a week or ten days and you discharge him. The bill
is sent to the Workmen's Compensation Board—they decide it is not a
compensation case, the man has gone, probably left the country. Is there
any provision made by the Board to pay the hospital in that case:
MR. E. S. H. WINN, Vancouver—
We are absolutely without authority to pay it. If it comes under the
Act we have authority to pay the bill. If there is any doubt apparent at
an early stage we always try to advise the hospital and medical men of that
so they may endeavour to collect their own bills.
DR. J. J. GILLIS, Merritt—
The reason I ask was at the present time I Wrote Dr. Hall regarding a
man who was working and lifted a heavy stone or rock and by so doing
98 sprained his back—he had to quit work right then. That is a man that you
know would not put up a story, and after he has been discharged a week or
two the bill is sent in and turned down by the Borad. I do not know but I
think there ought to be some provision made for the hospital. Of course,
the doctor has lots of money—he has to lose that, but the hospital is a
charitable institution and we have to provide for it.
DR. H. C. WRINCH, Hazelton—
Could not the Board perhaps notify, even before giving a decision,
that this case is one they will at least question, so we may have recourse
against the patient before he leaves; or a list of questionable cases sent
around to the hospitals?
MR. E. S. H. WINN, Vancouver—
We have taken a great deal of testimony on strained backs and examined many reports. The general concensus of opinion is that ninety-nine
percent of the alleged strained conditions are due to Myalgia, etc. In
regard to Dr. Wrinch's suggestion, we have considered from every view
point and have taken the matter up with like bodies who have this same
difficulty, but without result. The thing to us is so clear that it cannot be
handled in the way that you would like to see it handled and we would like
to handle it. The Board is an adjudicating body and has to carry on the
same way. When you consider strained back cases you hear only one side.
We hear the employer's side, plus possibly the witnesses present— we have
more data. I want to tell you the case referred to by Dr. Gillis has been
allowed.   It is the last case we dealt with last night.
MR. J. T. ROBINSON, Kamloops—
I wish to compliment the speaker on behalf of the Royal Inland Hospital on our experience with the Workmen's Compensation Board and those
who are a'dministering it. Our experience has been very satisfactory and
we have only had to call their attention to a matter to have-it adjusted. I
wish to make that public statement on behalf of our Board. However, 11
wish to disagree with Mr. Winn on one point. Throughout the whole of his
address he has been using the term "adjudicating" and assuming the position
that it was solely in the position of a court. I take issue to his policy.
We neither admit nor discharge a patient—our lady superintendent does
not admit or discharge a patient, neither does our Board of Directors nor
our Secreta.y admit or discharge a patient; patients are admitted solely by
the practising physician in that hospital and they are discharged when the
doctor thinks they are fit. Therefore, if the doctor admits that case under
the Workmen's Compensation Board and if that case should remain there
five or six weeks, then why should the hospital be penalized for keeping
that patient? I want to get Mr. Winn back to the administration part of
his duties. You can easily see what a hardship it would work on our hospital
if we went along and kept a patient in the hospital say three months and
then the Board would only pay us for three weeks. It would not be fair to
the hospital and that is the point I want a little more light on.
MR. E. S. H. WINN, Vancouver—
I still contend and in support of my contention I refer you to the Courts
of Law of British Columbia, Alberta, Manitoba, Ontario, Nova Scotia and
the States of New York and Massachusetts, where it has been held that
Workmen's Compensation Boards are specific courts, created as specific
courts of adjudication on damage or compensation cases in the case of injury by accident arising out of and in course of employment. Your rights
ase the same as in the case of a general patient; you are the creditor, the
workman is the debtor. That condition existed before our Board came into
existence and it still is the same. You still have the right of collection
against that person. If you admit a patient who is not under the Workmen's
Compensation Board and if he remains too- long, what do you do ? Collect
from the doctor?    No.   You collect from the patient.
94 DR. H. H. MURPHY, Kamloops—
It seems to me there are arguments on both sides. A certain number
of cases come to us absolutely unidentified. A man says he pays to the
Workmen's Compensation Board. As far as I know the Compensation Board
has no mark of identification for their patients. If in some wav we could
have a definite indentification of injured workmen-possibly issued to those
hiring men and covered by the Board, certain identification slips that would
be signed by the workmen in the presence of the foreman, then the
doctor could ask for his signature. At present a man comes down with a
broken leg, tells us he is covered by the Compensation Board. We admit
him under the Compensation Board and we report him and what ever
the difficulty is, I have know the man to be well and out of the hospital
and gone dear knows - where before we had word from the Compensation Board that that man was not covered by the Act. The other question
that sometimes arises is over men remaining longer in hospital, has been
that very same question of delay in identifying a claim and a certain
amount of slowness in the workmen's money cqming through.
MR. E. S. H. WINN, Vancouver—
My paper dealt with that last question. He wants the Board to become
a charitable institution, because the man has not the means to pay. He
wants to turn the hospital into a hotel; that is in fact what some of those
unfortunate conditions mean, where he has not any money, no place to go
and no identification. Thirty-five percent of accidents met with are not
met with in the course of employment, they may be either going to work, at
home or coming from work. We would like to be able to identify these men
as being under the Act—it would clear up possibly twenty-five percent of
our difficulties. When a man comes into the hospital you should say: this
man is a debtor, he owes me for his treatment, but if you get the money
from the Board you are so much ahead. The municipalities and unorganized districts have to look after their indigent cases—there are many cases
you cannot charge the Board with.
MR. J. T. ROBINSON, Kamloops—
What percentage of the amount is paid by the employer and what
amount by the employee?
MR. E. S. H. WINN, Vancouver—
I explained that the fifty-five percent compensation is money contributed
by the employer—no part of the Workmen's Compensation is collected from
the workmen. The money we pay to the hospitals and doctors is mon,ey
the man himself pays; in other words, that is his contribution to the Act;
he pays for medical aid and the employer pays compensation.
MR. J. T. ROBINSON, Kamloops—
Would it run forty percent employees and sixty percent for employers?
MR. E. S. H| WINN, Vancouver—
We have disbursed about $7,000,000.00 during the past four and a half
years.
MR. J. T. ROBINSON, Kamloops—
How much of that has been received from the employees and how
much from the employers?
MR. E. S. H. WINN, Vancouver—
Roughly speaking $6,500,000.00 collected from the employer and say
$750,000.00 from the workmen.
MR. J. GILL, Kamloops—
It costs a patient $3.00 we will say for argument, without incidentals
added to that.   How is it that you only allow $2.50 per day?
MR. E. S. H. WINN, Vancouver—
What is your ward rate?
95
- MR. J. GILL, Kamloops—
$2.00 per day.
MR. E. S. H. WINN, Vancouver-
All right then, that man, if he were not under the Workmen's  Compensation Act would pay you $2.00.    If he were an injured workman and
came in you would charge him $2.00 . We pay you $2.50.
MR. J. GILL, Kamloops—
That is alright. We are giving the patient the benefit of the 50c we
receive from the government.
MR. E. S. H. WINN, Vancouver—
These men are now paying something. Some of them never paid
before.
DR. H. C. WRINCH, Hazelton—
We must not forget we have another member of the Board present.
We appreciate the patience of Mr- Winn, and while we are thinking
more of this I am going to take the liberty of asking Dr. Hall to address
you on the medical side of the work.
DR. G. A. B. HALL, Vancouver—
With reference to some of the points raised during discussion of Mr.
Winn's paper, I feel some of these points should be further dealt with.
The gentleman from Penticton complaining of the cutting of hospital
accounts, I fear is not conversant with all the facts. There are many matters
of detail come into the office and are dealt with which vthe Chairman, Mr.
Winn, does not see. It has been our practise when dealing with accounts
which we feel are excessive, to communicate with the doctor in attenadnce
on the case. We have invariably endeavoured to pursue a line of education;
the Act was new to every person when it first came into force. We found
only by writing numerous letters and pursuing a campaign of education,
could the best results be obtained.
The gentleman from Penticton who spoke, said they took up a few cases
which were allowed, but latterly they have not been. The reason for that
is, when the first few cases found were being kept in the hospital longer
than necessary, we wrote the hospital board, also the doctor, pointing out
this overstay in hospital, and advising- that if it continued the account
would be cut down, but inasmuch as they evidently had been laboring under
a\misapprehension, our recommendation to the Board was that the account
in this instance be allowed, and the Board, in the goodness of their heart, as
Mr. Winn has said, allowed the account. As this went on for a few times
and no attempt was made to have the patient discharged at the proper time,
we decided not to reconsider the cutting down of the account, and I think
you will admit that was only fair and reasonable.
It has been stated that cases are admitted and discharged by the attending
doctor. We know that is a fact. We also know there are many cases left
in hospital too long. If you discuss this with the doctors outside, nine
times out of ten the doctor will tell you that he often leaves a patient in
too long. The tendency is in this direction. The matron of a hospital
knows when cases are not receiving treatment that would justify them
remaining longer. It is quite in order for her to speak to the doctor in
attendance, bringing to his attention the fact that if they remain too long
there is a possibility of the account being refused by the Board. Any
matron who is capable of being a matron has had sufficient experience and
is quite competent in the large majority of cases, to know when patients
are being kept in hospital when they might just as well be out, and if the
doctor be aproached in a proper manner he will take no offence. Every
hospital should have rules governing the institution if it is going to be
successful in its operations, and discipline is just as necessary in a hospital
as it is in school.   Doctors have remarked to me: VWell, we need disciplin-
96 ing at times, as we are only human." After all, it is simply a matter of
co-operation between the doctors and the hospital authorities, and
particularly if the hospital wants to discharge them. ,The hospital
authorities can very easily explain that the Board will not pay the account
if the patient remains in longer, as he can be treated just as well on the
outside, and they can also advise them that the Act only permits the Board
to pay for necessary hospital care. We have invariably stood by the hospital
and members of the medical profession. We have heard hospitals being
hauled over the coals. I read a letter from a patient who was complaining
He stated he was in the hospital forty-two days and in that time he got beans
forty-three times. It is as I have already stated, that only by hearty cooperation results can be obtained. We have always tried to be fair and I
will say that the medical department have been advised by the Board on
numerous occasions that they want us to give a claimant the benefit of a
doubt, and we have invariably done so in our recommendations to the
Board. It does not matter to us whether the man or the hospital is paid,
and it would be much easier for us to pursue the line of least resistance,
but we cannot forget that our reputation is at stake and that the Board are
trustees of funds and that they look to us us be fair between man and man and
that is what we invariably try to be. If the information on file is not
sufficient we try to get it, but if at a future date further information is
■given which puts a different light on the subject we hope we are big
enough to say "Alright, a mistake has been made and we will correct it,"
and which we have done heretofore.
I think Mr. Chairman, this is all I have to say and I thank you for
the oportunity of being present. ,
DR. E. C. ARTHUR, Victoria—
I visited a certain hospital where this "bean" man was. There is no
hospital having better meals than this hospital, that is, while I was there.
DR. H. C. WRINCH, Hazelton—
In a case where- a patient was in for treatment of fractured Clavicle,
he wanted to remain longer than the attending" surgeon thought was usually
paid by the Compepsation Board, so the account was rendered for a longer
time, but he agreed if thev did not pay it he would. I see now that it is
hardly a right position for the hospital to take, it might cast a reflection on
the hospital in concurring in the patient remaining too long.
MR. H. KEDDELL, Penticton—
1 would like to know whether the Workmen's Compensation Board
would not consider the question of making some stipulated allowance for
dressings.
DR. G. A. B. Hall, Vancouver-
There is one point Which has come up in regard to dressings. I think if
the hospital boards would meet the doctors more frequently and discuss
points with them th»- might get results. There is the question of some
doctors using more dressings than required. Nine-tenths of the dressing
is wasted, and if this point were brought to the attention of the doctors
speaking generally, not referring to any particular one, they would not feel
hurt about it.    I think if that was done a very great saving might result.
MR. G. R. BINGER, Kelowna—
I do not think an hospital would ask to be paid for material that
is wasted, and I think the matron should see that the doctor does not use
extra dressings; still, for the ordinary dressings that are used the $2.50 per
does not pay for that and the anaesthetic—that is another thing, when
going in the operating room we get nothing for that at all. Our public ward
rate is $2.50 per day, which is not one cent too high.
MISS J. SCOTT G1? A.Y. Prince George—
Our public ward rate is $3.00 per day,
97
ind we find the $2.50 does not cover maintenance up in Prince George where everything is so expensive.
I think in smaller hospitals they find $2.50 is not sufficient, when dressings^
are not paid for and operating room expenses are very heavy.
DR. H.    C. WRINCH, Hazleton—
■  The question raised as to increasing the rate of payment I understand |
involves a matter of policy that has been set and partly principle. That we
cannot discuss very much just here.   We are all affected by it.   I remember
when the last increase was announced it was distinctly stated that it wasj
to cover all the dressings, operating room expenses and so on and we accepted it on that understanding; and until the policy is changed I suppose we
cannot get any further in discussing that phase of it..
Adjourned—to meet at 2:00 p.m.
AFTERNOON SESSION
FRIDAY, JULY  8,  1921—2:00  p.m.
Dr. H. C. Wrinch, President presiding
DR. H. C. WRINCH, Hazelton—
We will have the report of the committee on accounting first.
Report on Hospital Accounting by Mr. E. S. Withers, New Westminster
the secretary in the absence of Mr. Withers, as follows:—
To Dr. M. T. MacEachern,
Secretary, B. C. Hospital Association,.
Vancouver,  B.C.
Dear Dr. MacEachern,
I had fully intended being present at the B.C. Hospital Convention at
Kamloops, but unfortunately circumstances will'not permit me to leave my
post at the present time. I hope that you will have a successful and benefical
gathering and would be glad if you will submit the following as a progress
report on behalf of the committee on accounting appointed at last year's
session.
Whilst we have not had a meeting of the committee, I have been in
consultation with both Mr. Carver and Mr. Haddon and have given the
matter considerable thought during the year and some results have already
accrued. We have been in touch with the Provincial Secretary's department
who have also been giving the matter their attention with the idea of obtaining a standardized system of accounting so that they may receive comparable monthly reports from the various hospitals of the province. I have
also received considerable assistance from the Chairman of the Finance
Committee of my Board who has taken a keen interest in the compilation
of a comprehensive statement for the information of the Board Of Directors.
Since the first of the yean- a quantity of my printed material and books
were used up, and I had to make further provision, and consequently took
advantage of this fact to put into practice methods which I had been considering for some time past, and for your information I am enclosing herewith a copy of the last report submitted to our Board of Directors, and
pages 8 and 9 thereof will show you my present method of distributing
expenditures, which is, I think, the most important feature of the accounting
problem. This method has been adopted as a proposed method of standardization for the province. In preparing this form I took into consideration
the fact that each hospital has already its own method of accounting. The
system in use will always vary to some degree according to the one who is
responsible for that department.
The Vancouver General Hospital cannot, of course, be taken as a crjyB
erion of accounting as it should be established throughout the various hospitals  of the province, - but they are a large  institution  with  considerable
experience and have a system already established, arrived at through many
years  of  advancement  and  enlargement.  I  believe  that  their  methods  of
98 accounting have proved adequate and efficient, and it would therefore not
be reasonable for us to advocate the installation of systems of accounting
for the purpose of standardization which would conflict with and create
a big uphea\al in the carefully planned system of that large institution which
it has taken many years to build up. I think, therefore, that we must utilize
their experience as a guide and establish a standardized system based as far
as possible on their principles, and it was with this end in view that the
accompanying form was prepared. It will be found to conflict in no particular with the Vancouver General Hospital, and can, I think be modified to
suit the conditions of all hospitals of various proportions in so far as standardization is at all possible, but it must always be remembered that any
figures from any hospital or any department thereof, mean nothing whatsoever unless we know some details as to the expenditure of that hospital or
that department. For instance, suppose you receive per capita costs of the
surgical and medical departments, it will convey nothing to you unless you
know what service this department is rendering, and yet a per capita cost
by departments is very valuable information, so long as the necessary details
are supplied and the proper means thereby provided for a basis of comparison. Under these conditions any item may be added or deleted from a
department without detracting from the value of the statement from a standardization viewpoint. This is, I think, the result at which we wish to arrive,
and the method of arriving at these results is entirely a matter for the
individuality of the accountant.
For the information of those interested I am sending you herewith some
sheets which I have just had printed for use in this office) After my monthly
accounts have been checked and certified, they pass through a voucher
journal. This is a loose-leaf book in which the accompanying sheets are
contained, and on perusal of these forms you will see that the monthly
statements for the information of the Board of Directors can be prepared
directly from this voucher book, and I may say that I have found this
method valuable. ,
Since putting this system into force I have received a draft form for
monthly report which it is proposed shall be furnished to the Provincial
Government by all hospitals in receipt of government aid. This draft
was received only last week, and I Have not yet had time to give it my
careful attention, but believe that the hospitals of the province have all
received copies of this draft, and doubtless it will come in for discussion at
your business session. I notice, however, that they have adopted the
departmental system, and in fact based this report form largely on the
system in force at the Vancouver General Hospital.
This report is of necessity only one of progress, and if you so wish,
and the other members of the committee are agreeable, we will continue to
work on the matter, in conjunction with the accounting department of the
Provincial Government, and in due course I think a system can be evolved
which will be satisfactory to all parties concerned.
Yours faithfully,
E. .S. WITHERS.
DR. M. T. MacEACHERN, Vancouver—
I would like to move the adoption of this report, and issue instructions
to this committee to continue this work.
DR. E. C. ARTHUR, Victoria—
I would be pleased to second that motion, and in doing so I wish to state
that Dr. MacLean has been working on this, and several others, for the last
two months as far as I know. At the present time this is what is likeljy
to happen: Dr. MacLean does not wish to interfere with any system fn
yogug. but is preparing a form or annual report we will say. I do not know"
iust how often they may want the information, they may ask yearly, quarterly
or monthly, but it is based on the Vancouver General Hospital system. We
do not- care how a hospital -keeps such accounts so long as they can give the
information asked for under the various headings on the forms.    I doubt
99 that copies have been sent out to all the hospitals but I do not know that
it has not been done. I think the committee should continue its work
because I believe that sooner or later it will be necessary to have practically
a uniform system of accounting as well as a uniform system of reporting.
DR. H. C. WRINCH, Hazelton—
You have the motion regarding the report of this committee on Hospital
Accounting. There is a lot of work being done. I wish we could spend more
time in consideration of it, but it is a matter that has to be worked out by
the hospitals in association with the government before any of us feel like
going to the expense of adopting it, so we will not lose any time but
instruct the committee to continue working on this.
Motion carried.
We have two other papers that have been prepared for us. We will get
them before us and they will then be in our report, which by the way,
is a most valuable affair. It is a report of the proceedings with the papers
and discussion upon them. I will ask Mr. Leders for his paper on "Purchasing in Hospitals."
MR. R. B. LEDERS, Vancouver—
At the first convention of your Association I read a paper on: Standardization of Hospital Equipment and Supplies, and last year one on:
Buying by Contract. As an illustration, if you will recall the last paragraph of my last year's paper, "Storage of Eggs." A contract has been
made this year as follows: 200 cp. have been placed in cold storage at a
price 3c below the present day market value, on these conditions; to be kept
until such time as we consider the market conditions warrant the.withdrawal
and use, same to be candelled, graded No.l and 2, fan dried and stamped
on the day of delivery, thereby insuring against loss or shrinkage.
I also mentioned canned fruit and vegetables. We have bought our
year's supply at opening market price, and are protected against any decline,
and have this year after very careful consideration, had all goods packed in
gallon tins. By so doing fewer cans are handled, both in the storeroom
and kitchens, or one for every four, as formerly.
As a Canadian organization, let me urge you to consider the advisability
of these points in connection with your buying: First, whenever possible,
patronize your local supply house; Second, a British Columbia house;
Thirdly, a Canadian house. Let me qualify this, not a Canadian agent from
an American house, but a purely Canadian firm registered in Canada.
Fourthly, goods purchased in Great Britain. The above is mentioned for
these reasons: an article was ordered from one of our local houses, which
had to be secured in England, and during the placing of the order and
arrival of goods it was found necesary, owing to a demand for the same
article, to purchase another immediately if possible. An Eastern house
was communicated with and one secured at a cost of $8.00 higher than the
one ordered through the local house. Some people have an idea that the
local house charges "the long price" to use the term, but our experience is
different.
I  will  quote  an  article which came to  my  notice  a   short  time ago,
"Giving the salesman a square deal."
Some   purchasing  agents   foolishly   regard   a   salesman   as   their  .
natural enemy, but luckily these are in the minority.   For a number
of years I was buyer for a concern in the East, till one day fate put
me on the road, calling on the very class of men to which 1 formerly
belonged.
"It was right there that I resolved, if I ever returned to the fold
I would try to make the lot of the visiting salesman easier. Fate
did place me again in the buying position and the lesson I learned
was indeed a-good one. If a purchasing agent wants to know just
how it feels to be on the opposite side of the desk, let him take a
short trip on the road.   The salesman is not the only loser by the re-
100 X
fusal of some buyers to look at his wares. It is also well to remember that when a salesman comes to town there is usually several-concerns that he can sell to, while, on the other hand, there is only one
concern the purchasing agent can buy his line from.
Some men make it a practice to see only the old favorite salesmen,
and a new man has no chance to sell a bill. This is not by any
means fair to the hard-working salesman.
Every purchasing agent knows that to buy goods carefully and well
is one of the secrets, also the buyer who is forever trying to secure
a lower price must give way to the man who knows the market and
who is not afraid to back his confidence with goods selected. A
good buyer knows when to stop buying as well as he knows when
to buy; over-buying is one of the mistakes of most buyers. He
must know the seasons and prepare a little in advance. He must
know what is going on in the market, in other words, he must be
on the job.
A purchasing agent who Will give each man a pleasant smile and
a hearty handshake, who looks at as many lines as possible and
who tries to act like a gentleman, will be favored by salesmen when
they have goods to offer. It goes almost without saying that the
pleasant buyer gets first chance at the plums', where the 'grouch
surely Will be overlooked.
Buying the right goods at the right time is the supreme test of
ability. The up-to-date purchasing agent must not alone know
local conditions but conditions the country over, thus he must have
a wide range of observation and know what is going on in the section far removed from his own. He watches the market and is
always ready to look at samples of all salesmen who have goods
to offer. He read's trade papers and the various sources of infor-
, . mation devoted to the goods he buys. A buyer cannot learn this
over night nor can he acquire a buyer's sense without many errors,
made, as a rule, in good faith, but costly in the extreme.
A true gentleman, of course, will treat every salesman with cour—
■ tesy, but men who are the very soul of honor and are as gentle as
can be with the general run of humans, freeze up when they see
I 'the genus salesman and become men of ice and. stone.
Some concerns have a rule that the purchasing agent can only
be seen in certain hours. It is such a foolish rule that makes a
salesman spend days in the city that could be worked in hours. This
is the unjust part Of it all. A salesman calls at a concern that has
for its buying hours say from 9:30 to 11 o'clock. He gets in town
at 9 a.m. and goes at once to the paint that has this rule, finds there
several men before him at 11 o'clock finds that he has wasted the
day and has not seen his man and. thus is compelled to wait over
until the next day at a loss of time and money."
In connection with the last paragraph, I might say I have a rule and
live-up to it ninety-nine times out of a hundred, for this reason, that I not
only fill the position of purchasing agent but act as a steward as well, so
that I cannot consider the other man more than myself or I would; not
get a day's work done. The salesman is on. the road for the good of his-
house and has to take his chance of finding the buyer engaged or otherwise.
He is not considering you. My regulation is this : two afternoons a week,
Tuesday and Thursday from 1:30 to 5 p.m'
An Eastern .salesman called about two months ago and after selecting
from the catalpgue some articles which were not in stock in Vancouver;
on, his positive assurance that same could be shipped immediately on receipt .by his firm of the order, a requisition was prepared and the order
grven. Six weeks passed and nothing came to hand. A week later a portion
of the order arrived and several articles not according to selection, which,
of course, had to be returned. Then again, a representative of another
house, when given an order gave certain discounts which were later dis-
101 puted by his head office and were not granted.    This is mentioned to substantiate my suggestion of patronizing the local houses.
DR. H. C. WRINCH, Hazelton—
We will now have the report of the committee re financial data.
MR. J. T." ROBINSON, Kamloops—
I tried to find out how other provinces and states in the Union had
financed their hospitals, but owing to a long absence from home I was
unable to take up the matter personally.
I want to say today that the committee which you so kindly appointed
met for a few minutes and we realized that the subject is so large that it would
take far more time than this committee has at their disposal to go into the
matter, and this is our conclusion: that this Association appoint a commute of two or three for the purpose of cooperating and discussing with
the authorities at Victoria this whole financial question because it is the
most important thing we have to deal with and one we have got to face;
sooner or later. There were several reasons why the committee could not
report—we had not time and there was a lot of data we could not obtain.
Discuss it with your hospital board and they think the patients' fees should
provide sufficient to carry on; the Government think the Municipality should
provide the necessary money and vice versa. This question is such that we
have to go to the root of it. I think the province of British Columbia
deals fairly with the whole matter of hospital and health matters, to
I probably the best of their ability, and yet there is big room for improvement
It is just a question of how we are going to bring about that improvement.
Some have suggested a special tax, but when we discuss it with the provincial government they assume the attitude that the municipality should do
it, and the municipality assume the attitude that the provincial government
should do it. I think a healthy community and citizens is the greatest asset
a country can have. What is the best method? It is very"difficult because
our province is so scattered. I think that probably seventy percent of our
people reside down around Vancouver, Victoria, New Westminster and
Nanaimo, and what may be satisfactory for them there is not satisfactory
in the separate districts in this great province. Those of us who live in said
communities should be prepared to forego to some extent some of the
luxuries we enjoy and give to those in less fortunate districts some of the
advantages we have. I have attended many conventions but I am safe in
saying you have displayed a large amount of common sense and a large
amount of intelligence. It is our special duty to see that the people in the
less favored districts are given the accommodation where they feel their
health can be looked after if the condition arises.    I am going to move,
That this convention appoint a committee of three to go into
the whole matter of finances, and to cooperate and discuss it
with the powers that be at Victoria, the committee to gather up
data then go before the legislature.
Consider it from the point of view of how best you can serve those
under less favorable conditions. I ask you to deal with this from that
point of view and if you do you will help others to arrive at some cOJJj
elusion, and I hope they will meet in the best posible manner and solve this
great problem of financing.
DR. M. T. MacEACHERN, Vancouver—
I wish to second Mr. Robinson's motion. I think it is a good motion,
but I want to tell you very truly that I have been endeavoring for three or
foUr years to get information by correspondence from our hospitals and
cannot do it. I think the Hospital Association could and should, I think
it is their duty, to submit plans of reorganization of finances that we want
—if we do not want it do not submit anything. The government,has a
right to ask: what do the hospitals say about it. I think we should decide
on a plan here or leave it in the hands of a committee, some machinery for
arriving at a conclusion.    If you hospital people will carry on as efficient
102 correspondence as you do discussion at the conventions, we will handle it
that way, the cheapest way, it will not cost you anything; if you do not
we will have to get six, eight hundred or a thousand dollars to make the
trip around the province in order to make it efficient, or our third choice:
do it the best we Can by correspondence and not get very much,
Motion carried.
DR. E. C. ARTHUR, Victoria—
I wish to support the charge that Dr. MacEachern made about the
difficulty of getting replies from hospitals. The blank lines on the sheets
in the adjoining room will support everything he said. Very recently the
Provincial Secretary had a questionnaire prepared which he sent to the
premiers of all the provinces of Canada and to several of the States, asking
for information as to how the hospitals are financed in these various provinces and states. A good many replies have been received, others are coming, and his instructions to me when I left were to return to Victoria and
prepare the information thus gained. It is the intention to take up the
question at the special session in November. I think that it would possibly
be a very wise act for this Association at this meeting to name a committee,
the best and strongest you can name to which the government could apply
for a representative opinion, and which also could present the views of
this Association on various points to the government when the matter
comes before the House.
MR. J. A. GILL, Kamloops—
I would suggest that the committee deal with it here and get something
concrete to submit to the government.
MAYOR S. C. BURTON, Kamloops—
I was very pleased on Wednesday night to hear Dr. Young's address
on the question of the hospital, because I am satisfied in my own mind-
that the only solution to the hospital financial question is by means of a
hospital tax. I take it that was an answer from the government of its
policy. In connection with this matter I would like to say that this is an
exemplification of the old C.P.R. system tried in the Kamloops Hospital some
seventeen years ago—we got a number of the C.P.R. employees to give and
we made all arrangements where each employee paid so much to the hospital,
married men paid $1.25, single men $1.00; we gave them free hospital treatment for themselves and their families, and the arrangement was so successful we made several thousand dollars profit. After that we tried another
means, a hospital tax of $10.00 per annum. There was a weakness about
that, we found only those inclined to sickness would pay that tax—the
healthy man would not bother, consequently we lost money. My idea is that
every adult over eighteen years should be taxed something like $1.00 a
month, which would provide their hospital treatment in a public ward.
If they wanted better treatment and private accommodation they would
provide for that personally. The government has promised the hospitals a
proportion of the tax from the sale of_Jiquor. I am afraid, however, that
is a very small crumb. Dr. Young favored the scheme of hospital districts
similar to school districts. "The school district is formed by making certain
boundaries withi" - reasonable distance of the school, and all landowners
in that district are taxed for school purposes. That would orobably not
work out for hospitals and there is a further weakness which I can cite—
in one district there were thirty-three children attending school, and out of
tliat there was only one man sending children to school who was paying
taxes. If the province is divided into hospital districts the question arises:
how will you equalize the revenue for the hospital? You w''l have a small
district with a small revenue and you may have a big hospital in that
district. It seems to me the only way would be to have the government
collect the tax as a whole and find some method of distributing the revenue.
I would like to see this meeting endorse the principle of a hospital tax today.
If we endorse the principle and appoint a committee to meet the government
we should arrive at some definite conclusion.
103 DR. M. T. MacEACHERN, Vancouver—
I heartily endorse Mayor. Burton's suggestion. We have told the
government that we recommend a hospital tax and 1 do not think we can go
back on it. I want to tell you, however, that this scheme that has been
evolved in British Columbia has been printed nationally and internationally
and has been considered all over Canada and the United States, and I may
say they all approved of it as the best and only way to run public hospitals.
I think we could have this committee appointed and in the meantime
endorse a hospital tax. I would suggest the committee exist to carry -along
this principle, and further suggest that the Hospital Association send to the
hospitals through this committee or through the secretary, a questionnaire
and with it a full description of what is meant by hospital tax, with such
questions as: Are-you in favor of hospital tax? Are you in favor of the
present status of hospitals continuing, and' what other suggestions have
you?
DR. H. C. WRINCH, Hazelton—
We did'present this and a recommendation was read in our meeting
this morning,- showing that we distinctly and clearly asked for a hospital
tax for the support of hospitals and did not approve of each local hospital
being supported by its own district.
MR. E. S. H. WINN, Vancouver—
I am very glad indeed to have the opportunity of speaking on this
matter, I believe I can throw some light on it. As far as. I have been able
to see I have yet to find any. tangible proposition put before the government.
It is all very well to c^ll it a health or hospital tax, but until you are able!
to devise some method of handling this subject, then and then only' are you
going to get results. You want to collect from the men who are n6t now
contributing one cent towards hospitals assistance. There has been some
objection to the proposition Dr. MacEachern talked about; the other scheme
he talked about is purely and simply a health insurance scheme." Your
hospital is only eight percent of the total cost—you must deal- with: the
whole thing.' Ist'hat'not necessary? If we'talk about health and preventive
measures'the preventative measures are not worth.a whoop unless you have
power behind' to force them. What I suggest you should do is: evolve some
scheme" whereby, you will cover the whole field—it can'be'Covered in the
way the Compensation Board covers it. I think to handle it in that form you
are getting right down to business. Y'ou men who have the' desire, and
ability to see it is carried out, bring forward a scheme 'along the lines of the
C P.R. 'Association, which has justified itself. They say all employees get all
the services necesary. If such a scheme is capable of being handled by a
lot of men'who have not given the subject the thought you have, how much
more so can you handle it who have given it so much thought. Notwithstanding the capitalistic System, we believe you have the right viewpoint and
^we are prepared to carry it out. You have'the accident happening' iri the
course of injury, you have the accident happening outside, then y6u have
the sickness, yet; no difficulty is incapable of solution, and so if one part
is successful, surely with a little sound common sense you are 'going to
make the two parts equally successful. We have been handling this approved plan for the past four years.
DR. M. T. MacEACHERN, Vancouver—
Your health insurance report, has it ever been submitted or considered?
MR. E. S. H. WINN, Vanouver—
It has been submitted to the Provincial Secretary and no doubt will be
brought down by the next session.
DR. M. T. MacEACHERN, Vancouver-
Mr. Winn says that labor is opposed to a hospital tax.   I believe labor
is in favor of such a tax.
104 MR. E. S. H. WINN, Vancouver—
I want to say that I have talked to possibly severity unions over this
matter and frankly,' I do feel that I am in close touch- with the average
man in this province. I do want to tell you that I believe Dr. MacEachern is
in error when he thinks the people are going to stand primarily for that.
They will not support the hospital tax. Our health insurance is confined to
those who are earning a limited amount of money. The idea would be over
and above that. The consolidated revenue funds should stand outside of
tHirt to take care of the balance. Health insurance will practically cover
every single worker and salaried person in the province; the land owner,
bank manager and others are outside of that.
MAYOR D. SUTHERLAND, Kelowna—
Is the health tax supposed to be an income tax, poll tax, or real property tax, or the health tax as Dr. Young has mentioned?
DR. H. C. WRINCH, Hazelton—
Our hospitals are covered under Mr. Winn's scheme. We want to reach
ut to those who are not under salary'- I like the Workmen's Compensation
Board scheme as far as it goes, but it stops at five o'clock. We want a man,
if he breaks his arm after five o'clock, to be provided for as well. Take
those who have an income but are not landowners. We could catch'them on
the payroll, poll tax,'or voters' list. Dr. Y'oung's scheme is even broader,
providing from the prenatal period till the time w'e are put away for all
time.
MAYOR D. SUTHERLAND, Kelowna—
I am pleased to find that the matter has entered discussion on specific
lines. There are certain lines of taxation which we can eliminate. Personally, I am a municipal man. being connected with municipal work for sixteen
years, and I know what the municipality can and cannot stand. First of all,
you may eliminate any tax which, will be a further burden on real estate
within the boundaries of municipalities, because at the present time,, if we
use the legal term of insolvency,' there are very- few municipalities in the
Province of British Columbia which are solvent, most of them owe a large
amount of money, something like $5,000,000 to their Sinking Fund; they
are up against it badly, they will apply to the _goye,rnrnent for some means
that will relieve them of the heavy taxation on real property which we
have at the-present:time:'' As'you'know, in most of our municipalities the
land .is going back to the' city—in our own little city over two thousand
lots have gone back with taxes—we are getting no further revenue from
these,'and that processes continuing every'year. The same applies to every
city, so briefly, any scheme that will put additional burden on the people
within the boundaries of municipalities must be eliminated. 1 think the
government, realizes that. In the second place, I think the question of a
poll tax must be eliminated because the working man will never starid for
a tax which is equally as large on him as on the man of wealth We have
today working men with large families who have only probably five to
seven:months-work in the year—it would be Impossible for them to pay a
tax as I said" equal to that which the wealthy mari pays. Therefore, we must
eliminate anything in the'form of a poll tax. I think it is in this respect that
the municipalities at their convention erred in going before the government
and asking for a tax along these lines; although I was aware of that delegation I did hot approve of it and cannot see how the government could
support it and in 'taking- the attitude they' did they have been severely
censored for it. At the present I can think of no other form excepting an
income tax, not on the lines of the present Federal or Provincial government tax, but an income tax which would apply to all salaries and wages
collected and passed through some machinery like the Workmen's Compensation Board, where the employer has to make the' payment In that way
it will be impossible for the. taxpayer to evade payment and you will get
a proportion from everyone, otherwise the tax will not reach to every man
that earns a salary or gets any wages.   I am only talking along broad lines.
105 Any proposition would have to be taken up in detail, but what I wish to make
clear in discussing the matter is, that two phases have to be eliminated,
that is,—additional burden on taxpayers and the matter of poll tax—equal
amount imposed on everyone.
MR. G. McGREGOR, Victoria-
There is one thing certain, directors cannot run the hospital without
some money. The biggest difficulty has been that a deficit has occured during the war. I think the biggest fault lies with the government because the
hospital authorities have been after the government and telling them they
were running behind and did not see anything that would prevent thai
running behind. I want to state this, that the most unfortunate part of the
hospital business is that you are treating men who are down and out and I
do not think the hospital authorities get enough sympathy along those lines.
It is true that the Workmen's Compensation Board looks after, them while
they are working, that is very fine; our contention is that it does not go
far ^nough. I claim that something should be done to see that the man
with a large family is taken care of in the time of sickness. I claim we
have not received sufficient support from the powers that be, we hospital
people. We have sympathy for these men, women and children who are
not able to pay; how can we make them pay when they are not able to
pay. The municipalities have come through, and it is high time; they paj
us $2.50 per day. The government is not assuming their duty, they are not
making the necessary provision. I claim they have a right to increase
their allowance, just as the municipalities have increased theirs. It is our
duty to formulate a policy to set down to the government to provide for the
people. We are prepared to assist the government in every possible way to
make this scheme most practical. We have a certain population in British
Columbia that does not apply to any other province in the Dominion of
Canada, that does not pay a cent. We have them around our- hospitals, and
why should the working man be obliged to pay for them who are working
and earning a wage, why should they get away without paying a tax of
some sort ? I refer to the foreign element. I would like to see something
done of a concrete nature to take back to our Boards.
DR. H. C. WRINCH, Hazelton—
We can appoint a committee but we must give them something constructive to work on.
DR. M. T. MacEACHERN, Vancouver-
There are three propositions before us: the hospital tax, presented by
some hospital people; health insurance, presented by Mr. Winn, and health
tax presented by Dr. Young. These three interests must get together and
decide what is the best in the interests of the majority. Any committee
taking this up should get closely in touch with these other authorities and
decide what is the best to cover the whole situation. I would "like to see
an emergency meeting receive the support of this committee before it is
presented to the legislature.
MR. G.  McGREGOR, Victoria—
I think the most popular tax would be the health tax. It starts with the
child before it is born and continues to the grave. Regarding health
insurance, it only applies to the wage earner, that is from eighteen to sixty-
five roughly. I do not look at health insurance as broad as the health tax.
I think in health insurance the worker has the right to be treated free of
charge in the most scientific way. The working man would endorse the
idea of a health tax, that is their idea, that they are entitled to free treatment of • a scientific nature for themselves, their families and everybody
else.
MR. G. R. BINGER, Kelowna—
Would a tax like that take us out of the hole and give us enough money
to make necessary improvements, pay our debts, etc.?
106 MR. J. T. ROBINSON, Kamloops—
I think from the discussion we have heard that it justifies the committee
appointed and tho resolution passed. Several have discussed this important
question and I do not believe that there are two who have agreed in the
main as to how the extra tax is to be put on or how the extra revenue is to>
be obtained. I am rather leery about asking the government for any special
tax. In sending a resolution asking that the picture shows be taxed and
that the money be used for certain purposes, what was the result? I think
I am safe in saying that the City of Kamloops has never benefited from that
taxation. We do not want to make class legislation. What I suggest is
this: that this organization appoint a committee of two or three and that
we might add to them, that the Union of B. C. Municipalities be asked to
appoint a committee of equal number, then they can go before the government and discuss it and see if we can arrive at some solution by which the
whole Of the people are going to benefit and not only one class. What I
want to guard against is the government passing back to the municipality
the responsibility.
MAYOR S. C. BURTON,, Kamloops—
The Union of B.C. Municipalities passed a resolution last year that the
government take over all schools and hospitals.
MR. WM. MANTLE, Kelowna—
I think the Association should appoint a committee. If we keep on
putting this off they can always find fault with them. For instance: the
Dyking and Drainage systems—the case went on until the government had
to put them on their feet properly. The same might apply in the case of
hospitals.
DR. H. C. WRINCH, Hazelton—
Is that as far as we can go, to appoint a committee with open powers?
MAYOR D. SUTHERLAND, Kelowna—
If you are going to bring the municipality into it it would be better to.
mention the executive rather than a committe of three, because the executive
generally work together as a whole and it is not at all likely that they would
appoint a special committee from their executive. I would suggest that this
committee be made a little larger and that the executive be mentioned; in
that way you would have an equal number representing municipalities and"
hospitals.
MR. R. B. LEDERS, Vancouver-
Would it not be well for the committee to be appointed then meet the
emergency, meeting of the convention ?
DR. M. T. MacEACHERN, Vancouver—
I am still sticking to my point—I think when you have three interests it
is better that they all get together. They should get the views of the health
insurance side, health tax side and work together to that end; a joint com-,
mittee, if possible, would be of great value, consisting of some from the
Hospital Association, some from the Union of B C. Municipalities, Mr.
Winn, if he would act, and Dr. Young, all together at a round table conference ; because the municipalities, the hospitals and the government are the
three bodies concerned, and I think a joint committee such as that would
be a good thing to talk it over, and so not talk in different directions, then
by autumn consolidate and get something that is good for everybody; invite
Mr. Winn, Chairman of the Workmen's Compensation Board, Dr. Young,
Provincial Officer of Health, to meet committees from the Hospital Association and Municipalities, to discuss the whole problem at a date to be
fixed—allowing sufficient time to have the conclusions submitted to them.
MR, E. S. H. WINN, VaneoBfer—
Might I be permitted to suggest that labor be represented, be. requested
to attend that round table conference.    You. are suggesting a tax on these
107 men who are already overburdened with taxes—I think they shoud be represented and if they were invited you would get their support.
MR. J. A. BROWN, Cumberland—
I heartily endorse Dr. MacEachern's view. I happen to be a member of
the Board of Directors of our hospital at Cumberland. I am also an alderman and am mixed up in labor as well. I am not a business man, I am a
labor man. I do not see any necessity of calling any labor organization into
this matter at all, I think labor is thoroughly represented, both in municipalities and hospital boards, and to carry out what has been suggested by
Mr. Robinson's motion will go deep enough into the matter.
MR. G. McGREGOR, Victoria—
To get over Mr. Winn's suggestion, I would suggest that at this round
table conference if we want the view of any other body we can ask for it.
MR. J. T. ROBINSON, Kamloops—
• If the resolution carries and the committee meets and carries out the
work they are supposed to do, when the report is ready copies can be sent
to every hospital represented here and also the municipalities will no doubt
see that their unions are notified.
Moved that the Secretary and Chairman appoint the committee.
Carried.
Business Session 4:00 p.m.
Resolution from the Nanaimo General Hospital, read by the Secretary,
as follows :—
The undermentioned subjects for discussion at the annual hospital convention -were submitted by a special committee of the Board of Directors of
the Nanaimo General Hospital,—
On account of the difficulty, due to lack of experience which the
promoters of a new hospital or renewal of an old one, have in taking
•advantage of improvements in the planning of construction and other advances in general architecture, materials used, cost of same etc., which are
continually being gained from time to time by the different hospital organizations throughout the province;
And whereas, the government of the province is in a position to
collect this information by the present system of hospital inspection and
other sources,
Be it therefore resolved that this Association request the Department
of the Provincial Board of Health to undertake the planning of all new
hospitals in British Columbia.
After discussion, moved by Miss J. F.  MacKenzie, seconded by Mr.
G. R. Binger,
THAT this resolution be tabled.
Carried.
REPORT OF COMMITTEES
Report of Committee on Constitution and Bylaws:
Notice of Motion for change in  Bylaws    submitted for    consideration
at the previous annual convention, as follows :—
Article 4 — Membership
Shall be of three classes, as follows,—
(a) Institutional
(b) Individual *£&&<;       IFJtr* ¥.*£■
(c) Honorary
(a) "Institutional" membership may be held by any hospital, public or
private, carrying oh work within the province.   Institutional members
shall include all members of its trustee board, and all persons hold
executive positions in the institution:
108
hip
ing (b) "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 :
(c) "Honorary" members shall b'e any persons who' have ceased to take
an active part in hospital work after years of faithful service.
Article 11 — Membership fees
All hospitals within the province paying the following fees shall be
entitled to membership in this Association :
1. No change
2. No change
3. No change
4. No change
5. No change
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 to 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 shall vote. No institutional vote shall be
divided on any question. If time is required by a delegation of any
institutipn before casting its vote, the chair shall postpone the taking
of the vote for a reasonable, time. After postponement for the purpose,
there shall be no further discussion of the question before taking vote
upon it.
--Individual and honorary members shall each have one vote.
Votes^ by proxy  will  not  be  allowed.
Moved by Mr. G. McGregor, seconded by Mrs. M. E. Johnson.
THAT the Constitution and Bylaws be adopted as amended.
Carried.
Report of Resolution Committee:
Read by the Secretary as follows:—
The committee had three resolutions before them:
1. Resolved  that  we,   The   B.   C.   Hospital  Association,   recommend   the
establishment of a Training School for Nurses in Tranquille Sanitorium,,
where nurses may secure this special training, and that arrangements for
affiliation be made by which other hospitals  in the province can take
advantage of giving their nurses training there along these lines.
Your committee, after due consideration and after hearing the objection
of Dr. J. Kearney, Superintendent, recommend that this matter be
dropped and the resolution withdrawn.
2. Resolved- that The B. C. Hospital Association, while heartily approving
of and recognizing their obligation to care for the advanced Tuberculosis patient in general hospitals, impress upon the government the
present inadequate and unsuitable accommodation available for segregating and treating these cases as they should, and would request that
such steps be taken by the government to meet the needs before this
obligation can be carried.out.
Committee approved.
3. Resolved that The B. C. Hospital Association recommend to the government that all private maternity hospitals should only be commenced and
operated when certain conditions are met with, such as will insure
the patient competent and safe hospital care, and involving such consideration as prooer and safe accommodation, efficient and necessary facilities and competent personnel.
Committee approved.
109 Moved by Mr. G. R. Binger, seconded by Miss K. Stott,
THAT the report be adopted as a whole.
Carried.
Report of Committee on Development:
This committee has no report to make.
Report of Committee on Time and Place of next Meeting:
This committee recommends as follows:—
That the time of meeting be left to the Executive.
That the  place  of  meeting  be  Victoria   (if  the  new  wing  to  their
hospital be sufficiently advanced), otherwise  Nanaimo  or  New Westminster, and in case of choice, a plebescite to be taken as was done
last year.
Moved by Mr. G. McGregor, seconded by Dr. E. C. Arthur,
THAT this report be adopted.
Carried.
Report of Committee on Officers for the coming year:
The committee have not made many changes in the officers:
Officers
Honorary President  Hon. J. D. MacLean, Victoria.
President    ,.._ .JDr.   H.   C.   Wrinch,   Hazelton.
First Vice-President Mr. Geo. McGregor, Victoria.
Second Vice-President  %  Mr. R. A. Bethune, Kamloops
Secretary  _  Dr. M. T. MacEachern, Vancouver.
Treasurer  „ _ _ Mrs. M. E. Johnson, Vancouver.
Executive Committee
Miss E- I. Johns, R.N., Vancouver
Miss M. P. MacMillian, R.N., Kamloops
Mr. Charles Graham, Cumberland
Dr. W. E. Wilks, Nanaimo
Miss L. S. Gray, R.N., Chilliwack
Mr. G. R. Binger, Kelowna
Mr. D. G. Stewart, Prince Rupert
Rev. Father O'Boyle, Vancouver
Miss J. F. MacKenzie, Victoria
Mr. E. S. Withers. New Westminster
Standing Committee on Nursing Affairs:
Miss K. Stott, R.N., New Westminster
Miss P. Rose, R.N., Nanaimo
Miss E. I. Johns, R. N., Vancouver
Miss Ann MacArthur, R.N., Nelson
Miss E. Bligh, R.N., Hazelton
Standing Committee on Medical Affairs
Dr. G. S. Purvis, New Westminster
Dr. W. Arbuckle, Vernon
Dr. H. H. Murphy- Kamloops
Dr. H. R. Storrs, Vancouver
Dr. L. M. Poyntz, Victoria.
Standing Committee on Business Affairs:
Mr. J. T. Robinson, Kamloops
Mr. C. Williams, Victoria
Mr. L. E. Morissey, Merritt !
Mr. R. B. Leders, Vancouver
Mr. Henry Woods, Vernon
Standing Committee on Constitution and Bylaws:
Dr. H. E. Young, Victoria
Dr. H.  C. Wrinch, Hazelton
Mr. M. L. Grimmett, Merritt
110 Moved by Dr. M. T. MacEachern, seconded by Mr. J.. A. Brown.
THAT this report be adopted as a whole.
The  hospital Accounting  Committee  as  it  stands  would  be    included
in that report.—Carried.
Treasurer's Report
This report was read by the Secretary:
STATEMENT OF RECEIPTS AND  DISBURSEMENTS
For year ending May 31, 1921.
Receipts
Cash on hand May 31st, 1920 \ $ 159.70
Membership Fees, etc.
Institutional    .. $ 645.00
Individual and Special      109.00
Canadian Medical Exhibits     310.00
Government Grant     500.00
 — $1,564.00
$1,723.70
Disbursements
1920 Convention—
Stenographer  -.  $25.00
Mrs. McDonald  (Cafeteria)    _  34.00
Dominion Photo Company  ^    6.63
 $65.63
Rent of Ball Room (Victoria) for Executive Meeting $    15.00
Rent of Typewriter  * _       74.00
Stamps and Exchange  _ —- _       62.30
G. A. Roedde, Stationery, Printing Reports, etc  1,418.62
Cash on hand May 31, 1921  _       88.15
BALANCE SHEET
As at May 31, 1921
Assets
Cash on hand  g .$ 88.15
Balance _ g  372.39
$460.54
Liabilities
3alance of bill for printing $460.54
BUTTAR & CHIENE, Chartered Accountants.
Moved by Mayor S. C. Burton, seconded by Miss K. Stott, THAT the
report be adopted as read.—Carried.
The Secretary requested that the Executive Committee remain in
Kamloops for part of another day in order to dispose of certain business
in connection with the Association.
Mrs. J. Charlotte Hannington, Ottawa—
I wish to announce that the Victorian Order of Nurses of Canada, who
are now undergoing reorganization, have decided to do away with their training centres, to turn over the training of nurses to Universities of Dalhousie,
McGill, Toronto, Manitoba and British Columbia, and that they are going
to bonus  each nurse .who takes  that  course $400.00  for taking it  in  the
111 University, on condition that she stays with the Order a year afterwards.
They are going to make provision in the University of British Columbia for
fifteen to twenty nurses. Would any nurse in the province wishing to take
this course apply to Miss Brown, who is head of the Victorian Order of
Nurses in Vancouver; her address is 1250 Broadway West, or get in touch
-with one of the nurses in your community connected with the Order.
A vote of thanks was moved by Miss J. F. MacKenzie, seconded by
Mrs. M. E. Johnson, to the following:
Board of Directors, Royal Inland Hospital
Miss M. P. Macmillan, Superintendent. ^S*"?
Local Comittees
Mayor of Kamloops
Citizens of Kamloops
Tranquille Sanitorium and Officials
Medical Association of Kamloops
Press of Kamloops
School Board of Kamloops
Mr. T. R. Hall, Principal of the High School
Mr. Batzold and Board of Trustees of the Methodist Church
Exhibitors
Those who took part in the programme
The Secretary
Buttar & Chiene, Auditors
Miss Frances Henry; Official Secretary
Woman's Auxiliary of the Royal Inland Hospital
Officers  on  Committees for last year
And others.
DR. M. T. MacEACHERN, Vancouver—
This is the best convention we have ever had, it has outclassed the fa
Victoria and Vancouver conventions. It is "wonderful when the Mayor of
. the City can find time to attend our sessions. We want to thank the 9
members of the Boards of Directors for their attendance at the meetings. 1
Certainly, with the exception of the vote of thanks to' the Secretary, I U
endorse the vote of thanks most sincerely.
MAYOR S. C. BURTON, Kamloops—
I am sure I appreciate the kind words that have been said and I would I
like the citizens of Kamloops to know just how the delegated have felt ■
towards the City on their visit here. We had certain misgivings at the time I
the convention was arranged, chiefly on the point of weather. I think the i
only thing that has troubled us was the mosquitos at Tranquille. Let me
say it has been a pleasure indeed to have had you here. I have thoroughly ||
enjoyed the sessions. Kamloops will only be too happy to have you here
again.
Announcement re visit to the hospital and dance tonight, by the Sec- H
retary, Dr. M. T. MacEachern.
Mr. G. McGregor, Victoria—
With regard to the business tax, I think the most unfair tax we have M
to put up with is that tax.   We are chariable institutions and are not able
to carry ourselves in the way of finances, and I think if the proper repre- M
sentation was made to the government at Ottawa they might see their way I
clear to  refund that tax to  hospitals.    Scientific appliances  sales  are all
refunded.
Moved by Mr. G. McGregor, seconded by Mr. R. A. Bethune, THAT
the proper government authorities at Ottawa be asked to refund the'sales 1
tax to hospitals on all purchases to be taken from the invoice.—Carried.
The  Secretary  announced  that  the  members  of the  Executive  would M
meet here tomorrow morning at 10 o'clock.
The meeting adjourned.
112 ENTERTAINMENT
The delegates and their friends were the guests of the Board of Directors
and Superintendent of the Royal Inland Hospital, Kamloops, for the
evening. The hospital was thrown open for inspection from 7:00 p.m. on
and a large number availed themselves of the opportunity of seeing this
splendid institution. The convention came to an end by a most delightful
dance given by the Board of Directors and Superintendent of the Royal Inland Hospital on the hospital lawn. This was one of the most delightful
occasions many ever experienced. The convention was brought to a close
by the singing of the National Anthem, and all left for their homes that evening or the next day, and were loud in their declarations that it was the best
convention ever and that the Kamloops people could not be surpassed for
their hospitality.
Another very successful feature of this convention, which we must not
pass over without special mention, was the get-together luncheons daily at
the Leland Hotel. These were exceedingly popular and each day increased in numbers, till finally more space had to be acquired. The community singing introduced on the last two days did much to ^promote enthusiasm and better fellowship and acquaintanceship.
Minutes of Executive meeting held in the Kamloops High School on
Saturday morning, July 9th, 1921.
There were present: Dr. H. C. Wrinch, Hazelton, Miss M. P. Macmillan, Kamloops, Miss J. F. MacKenzie, Victoria, Mr. R. A. Bethune,
Kamloops, Mr. G. R. Binger, Kelowna, Miss L. S. Gray, Chilliwack, Mrs.
M. E. Johnson, Vancouver and Dr. M. T. MacEachern, Vancouver.
Appointment of Special Finance Committee—
Dr. Wrinch and Dr. MacEachern, who were asked by the Association
to appoint a committee to take up hospital finance, named the following
committee:
Mr. J. T. Robinson, Kamloops.
Mr. J. J. Banfield, Vancouver.
Mr. G. McGregor, Victoria
Dr. H. C. Wrinch, President, and Dr. M. T. MacEachern, Secretary, by
virtue of their officers would also be on the committee.
The Hospital Association is expected to take. the initiative. A full
report will be made to the Association as necessary.
Association Finances—
The Secretary stated he would send around a detailed financial statement to all the hospitals.
Moved by Mrs. M. E. Johnson, seconded by Miss L. S. Gray,
THAT the Secretary be requested to make clear all the different
types of membership  as  provided  in  the  amended  By-laws,  and  that
individual fees equal in amount to institutional ■ fees be secured from
each hospital community.—Carried.
Budget for 1921-1922—
The Secretary presented the following budget for the year:
Printing annual report  $ 600.00
Secretarial   services       300.00
Incidentals (Stationary, stamps, etc.)    200.00
Total money needed  - $1,100 00
Moved by Miss J. F. MacKenzie, seconded by Mr. G. R. Binger,
THAT the budget be authorized and that the Secretary be given
authority to pay $25.00 per month for secretarial assistance.—Carried.
113 Re Printing Report—
Dr. MacEachern stated he was going to endeavor to get the government to print our report this year. The Executive heartily endorsed this
suggestion.
Typewriting Machine—
The purchasing of a machine was discussed, as the annual rent almost    i
amounted to the value of the machine.   This matter was left to the Treasurer,
Mrs. M. E. Johnson, and the Secretary, Dr. M. T. MacEachern, both of
Vancouver with full power to act.
National Hospital Day and Hospital Sunday—
Members of the Executive reported their experience with the day and
all were most pleased.   Many had gained financially by such a day.
Dr. MacEachern explained Hospital Sunday.
It was moved by Miss J. F. MacKenzie, seconded by Mrs. M. E.
Johnson,
TH^lT the  executive  recommends  to  all  hospitals  that  National
Hospital Day be observed annually as a day of hospital propaganda,   I
and that all hospitals also endeavor to observe Hospital Sunday, the   ']
Sunday previous to National Hospital Day.—Carried.
Hospital Produce Day—
The continuance of this was heartily endorsed and the Secretary was
instructed to remind all hospitals of it this year.
Report of Proceedings to Magazines—
Dr. H. C. Wrinch agreed to send on report of convention to the Hospital   I
World, Toronto, and also to the Hospital Management, Chicago.   Dr. M. T.
MacEachern agreed to do likewise for the modern Hospital, Chicago.
Annual Meeting of Executives—
The Executive Committee will not meet this year unless urgently J
necessary. It was stated that the standing committees could handle the |
programme for next year.    This was agreed.
Division of Province into Hospital Districts—
^The division of the province into hospital districts, similarly to the I
medical profession proposes, was discussed. Dr. MacEachern brought this I
up and suggested the following districts—
Victoria and  Island
Vancouver and Coast Mainland
Fraser Valley
Cariboo-Yale
Kootenay East
Kootenay West
Grand Trunk Pacific
He pointed out that each  district could nominate officers  and  a member |
for the Executive, and thought it would develop more interest.   The Execu- 1
tive approved of this and it was moved by Miss J. F. MacKenzie, seconded j
by Miss L. S. Gray,
THAT the division recommended by the British Columbia Medical \
Association be adopted by The British Columbia Hospital Association, |
and  that they be  asked  for nominations  each year,  either before or 1,
at the convention.—Carried.
Hospital Inspection—
.Several comments were made on this, and it was felt that the present |
system should be altered. The hospitals of our province want constructive I
help in their difficulties and someone to consult with. The Executive felt J
that if the inspector could spend two or three days in each hospital, meeting 1
the staff and the board of trustees, they could solve a great many of their I
problems. An inspector who should of necessity be a man of extensive j'
expert   knowledge   in   connection   with   hospital   work,   could   be   of   real ji
114 New List of Hospitals—
It was suggested a new list of hospitals be secured from the government.
Drawing for Fees—
Several thought that members of the Association, should be drawn on
for fees each year. It was finally decided to warn them first and later draw
on them if necessary.
Meeting adjourned.
EXHIBITORS AT CONVENTION
Chandler & Fisher, Limited.
B. C. Stevens Company, Limited.
Ingram & Bell, Limited.
Business Questionnaire:
1. Should the hospitals of British Columbia adopt May 12th as
National Hospital Day?
Answei—Yes; as^a day of hospital propaganda, inasmuch as the public
needs education on hospital problems and advancement.
2. Should all hospitals publish annual reports?
Answer—Yes.
3. What should be the average charges for the following:
(a) Public wards
(b) Semi-private wards
(c) Private wards
(d) Operating  Room
(e) Anaesthetic
Answer—
(a) $2.00 to-$2.50 per day.
(b) $3.00 to $3.50 per day.
(c) $4.00 to $6.00 per day.
(d) $5 00 to $10.00.
(e) $10.00.
4. Should  the  superintendent of the hospital  attend  the  meetings
the Board of Directors or Trustees?
Answer—Yes, always.
Can  a   common  basis   be  established   for  the   computation   of  per
capita in hospitals so that it may be of some comparative use?
Answer—Y'es, if a nroper standard of cost-accounting system be es*ab-
she-1. The b-.s:.s of oer capita could be as follows : Cost of all services
T:e"t. win or without rega'rd for such matters as depreciation, taxes,
water J7!toi. s'nkin.sr fund, interest on investment or other expenditure. A
common basis could be worked out in this respect. However there must
be taken irto consideration the kind of service that the hospital renders to
the patient, this must be more or less uniform.
6. What special economies are British Columbia hospitals effecting today wh:ch are worth while?
Answer—Several hospitals in the province are carrying out certain
ecoromies such as gauze reclamation, linen conservation and reclamation,
food conservation and various other economies which may be touched on in
a further rqiind table conference.   Further, some of the most valuable assis-
115 tance to the hospitals during the past year and which has meant a great I
economy to them has been,
First—Produce Day, which is usually set for a day in September,
when all the hospitals are recipients of donations from the rural communities, especially of potatoes, fruit and other produce which can be
utilized to great advantage by the institution. This is an annual day
amongst hospitals in British Columbia, and during the past year or
two has met with splendid response.
Second—Several hospitals, especially near the fruit district, ;jmt 1
down all their canned fruit for the year. This is carried out usually I
by the women in the community or the Woman's Auxiliary.
Third—The Woman's Auxiliary, as organized in various hospitals, I
have been most valuable in raising money, supplying linen, equipment
and other very necessary supplies for the hospitals.
7. Should staff, other than nurses, live in or out of the hospital and
which is the most economical for the hospital ?
Answer—Some hospitals find it more desirable to have all their staff,
other than nurses, live out, relieving them thus of a great deal of extra
equipment and trouble. However, it is generally conceded that it is more
economical to keep the entire staff living in. This is impossible in many
hospitals  owing t'o lack of accommodation.
8. What is the most desirable color scheme for walls and ceilings in
a hospital?
Answer—The most desirable color scheme for walls and ceilings in a
hospital appears to be a cream or buff shade or light green. In British
Columbia, where- we have a great deal of rain, the light buff or cream_walls
and ceilings is the most generally used.
9. Can hospital equipment be standardized to the advantage of all our
hospitals?
Answer—Yes.
10. Can the hospitals of British Columbia adopt uniform salary schedule and also a uniform length of vacation with pay for their employees?
Answer—It might not be possible to adopt an absolutely uniform
schedule, but one more or less uniform could be arranged with a degree
of variation for certain conditions. Such a schedule would serve as valuable
information to all our hospitals and would be a working basis for each of
them.
116 DELEGATES
Name
Representing
Address
Antle, J	
Arbuckle, Dr. W	
Atbuckle,- Mrs. W.
Archibald, Mrs. M.
 Columbia Coast Mnssion....Vancouver,  B.C.
 Jubilee   Hospital Vernon, B. C.
 Jubilee   Hospit il     Vernon, B. C.
G Royal Inland Hospital Kamloops, B. C.
Archibald,   Marjorie Royal Inland Hospital Ka
Arthur, Dr. E. C F
amloops, B C.
Inspect'r of Hospitals Victoria, B.C.
3arnhart, P.
Jell, J. K	
A..
 ?oyal Inlinl Hospital Kamloops, B.C.
 Royal Inland Hospital Kamloops, B. C.
Beswick, G. T Saskatoon Hospital  Saskatoon, Sask.
Bethune. R. A Royal  Inland Hospital   Kamloops, B C.
Binger, George R Kelowna   Hospital    Kelowna, B.C.
Blackford,   Mrs Royal  Inland Hospital   Kamloops, B C.
Blair. Miss Helen Royal  Inland Hospital   Kamloops, B.C.
Bligh, Miss Eva Hazelton Hospital  Hazelton,  B.C.
Doggs, Miss A General Hospital  Penticton, B.C.
3renton, H. 1
Capt.
Miss
Miss
Miss
S. C.
Mrs.
Brown,
3rown,
3urnell
3urton,
3urton,
3urton.
Carver,  G.  F..
Cerry, J. A	
Clark, Miss C.
Cla
Royal Inland Hospital  Kamloops, B C.
John A Cumberland  General Hosp. Cumberland, B.C.
Mary Cumberland  General Hosp. Cumberland, B.C.
M Royal  Inland Hospital   Kamloops, B C.
Isobel ; Royal  Inland Hospital   Kamloops, B C.
(Mayor) Royal  Inland Hospital   Kamloops, B C.
S. C Roval  Inland Hospital   ''amloops, B.C.
Prov.  Royal Jubilee  Hosp."1'-'-i-ria,   B.C.
Vancouver.   B.C.
ubilee   Hospital    Vernon, B.C.
arke, Miss Helen Royal  Inland Hospital
Dalgleish, N. S..
amlooos,
_.>yal  Inland Hospital   Kamloons, B C.
Jay, Edward L Chandler & Fisher, Ltd Vancouver,   B.C.
Dmwoody, Miss L Cookstown Hospital  Cookstown, Ont.
Edmonds,   Miss   B Royal   Columbian  Hospital N. Westminster,
Fenwick, A. H Royal  Inland Hospital   Kamlooos, B C.
itzpatnck,  Miss Kootenay Lake Gen. Hosp... Nelson,  B.C.
Gillis. Dr. J. J Nicola Valley Gen. Hosp...Merritt, B.C.
^'11, James A Royal  Inland Hospital    -is, B C.
Umldburn, E. H Lady Minto Hospital  Ashcroft, B. C.
L*ray, Miss J. Scott Prince George Hospital  Prince George,
^ray, Miss L. Scott Chilliwack Hospital Chiliiwack, B.C.
L>reen, P. W Reid Bros, of Canada Ltd...Vancouver, B.C.
u ii       '       "^' ^ " Workmen's Comp'n Board-Vancouver, B.C.
Hall, Thos. R Royal  Inland Hospital  Revelstoke. B.C.
Hamilton, Dr. J. EL...'. Queen  Victoria   Hospital.... Kamloons, B C.
lannmgton, Mrs. J. C Victorian Order of NursesOttawa, Canada
Hawthorne. Miss M Royal Inland Hospital _ Kamloops, B.C.
£**• D- G ; B.  C.   Stevens Co.  Ltd Vancouver,   B.C.
Henry, Miss Frances Vancouver Gen. Hospital....Vancouver.   B.C.
Hmch   R. N Ingram   &   Bell,   Ltd Calgarv, Alta.
Hirjchcliffe.  J ; __ - .Victoria. B.C.
r!1' Miss Louisa Royal  Inland  Hospital  ......Kamloops, B.C.
Inland Hospital  Kamlooos, B C.
Royal Inland Hospital     Kamloops,   B.C.
Royal Inland Hospital    Kamloops,  B.C.
"Kamloops,  B.C.
B.C.
B.C.
Holt. Mi
ss   Sarah Re
Houle, Dr. L. G
Houle, Mrs. Lester
Hunt, Charles L.
Irving, Dr. R. W.
Royal Inland Hospital
117
Kamloops,  B.C. Name
Representing
Address
Johnson, Mrs. M. E    Bute Street Hospital     Vancouver, B.C.
....   Tranquille  Sanitorium  ....   Tranquille,   B.C.
....   Penticton Hospital ._ _.   Penticton,   B.C.
Kearney, Dr. J. A.
Keddell, Herbert ....
Lammers, W. J  Chase Hospital    Chase,   B£.
Lammers, Mrs. W. J  Chase  Hospital  _  Chase,   B.C.
Leders, R. B  Vancouver Gen. Hospital.. Vancouver,   B.C.
Lister, Miss Anna D  Queen Victoria Hospital.... Revelstoke, B.C.
Loyst, Miss A _  Tranquille Sanitorium   Tranquille,   B.C.
McArthur, Miss A  Kootenay Lake Gen. Hosp.
MacEachern, Dr. M. T  Vancouver Gen. Hospital
McGregor, Miss F  Royal Inland Hospital	
McGregor, Geo _  Prov. Royal Jubilee Hosp.
McGregor, Mrs. Geo  Prov. Royal Jubilee Hosp.
MacKay, Miss F.  Royal Inland Hospital	
MacKenzie, Miss J. F.  Prov. Royal Jubilee Hosp.
MacKinnon, Mrs. A  Cumberland Gen. Hosp	
MacKinnon,  Alastair    Cumberland Gen. Hosp	
MacMillan, Miss M. P. .. Royal Inland Hospital	
Manley, Miss   Royal Inland Hospital	
Mantle, Wm. "J  Kelowna  Hospital  	
Mathieson, Mrs. A  King's Daughters' Hosp	
Meighen, Mrs. A  Royal Inland Hospital	
Miller, Mrs. H. N  Royal Inland Hospital	
Morrice, Miss J. A. .   Tranquille Sanitorium .......
Morissey, L. E  Nicola Valley Gen. Hosp...
Muir, Miss S  Royal Inland Hospital	
Murphy, Dr. H. H  Royal Inland Hospital	
Murphy, Mrs. H. H  Royal Inland Hospital	
Nelson, B.C.
Vancouver,   B.C.
Kamloops,  B.C.
Victoria,   B.C.
Victoria,   B.C.
Kamloops,  B.C.
Victoria.   B.C.
Cumberland,  B.C..
Cumberland,  B.C.
Kamloops, B.C.
Kamloops,  B.C.
Kelowna,  B.C.
Duncan, B.C.
Kamloops,  B.C.
Kamloops,  B.C.
Tranquille,   B.C.
Merritt,   B.C.
Kamloops,
Kamloops,
Kamloops,
B.C.
B.C.
B.G:i
Nelson.. Miss Vera     Queen Victoria Hospital..
• Norfolk, Miss Vera    Roval Inland Hospital	
Preston, U. A _    Radium Chemical Co	
Purvis, Dr. G. S    Royal Columbian Hosp	
Randal, Miss Helen     B.C. Grad. Nurses' Ass'n..
Reid,   Mrs    Chase  Hospital  	
Robinson, J. T _..   Royal Inland Hospital 	
Rose, Miss Pauline    Nanaimo Gen. Hospital....
Sheldon, Miss L. P    Nanaimo Gen. Hospital....
Sister Mar^ Dorothea     St. Ann's  Convent 	
Sister Mary Priscilla     St. Ann's  Convent 	
Smith, Miss G. A    General  Hospital  	
Stephens, Dr. H. F. D    King's Daughters' Hosp...
Stinson, Miss L. P Nicola Valley Gen. Hosp.
Stirling,  Mrs.  C. J Salmon Arm Gen. Hosp.
Stott, Miss K ..._ Royal Columbian Hospital.
Strong, Dr.  G.  F. ..." Vancouver   Gen.   Hospital.
Sutherland, D.  (Mayor) ....Kelowna   Hospital   	
Swanson,   Miss   M Royal  Inland Hospital 	
Taylor, Miss H.  S Royal Inland Hospital 	
Thorn, Miss  Public Health Nurse	
Tyrell, Mrs. A. M Royal Inland Hospital 	
B.C.
B.C.
B.CX
Vjckers, Miss Norah Royal Inland Hospital  Kamloops,   B.C.
Revelstoke, B.C.
Kamloops,  B.C.
San   Francisco,  Cal
N. Westminster, B.C.
Vancouver, B.C.
Chase,   B.C.
Kamloops,  B.C.
Naniamo,   B.C.
Naniamo,   B.C. ,
Kamloops,  B.C.
Kamloops,  B.C.
Campbell River, B.C.
Duncan, -B.C.
.Merritt,   B.C.
.Salmon Arm, B.C.
.N. Westminster, B.C.
.Vancouver,   B.C.
.Kelowna, B.C.
.Kamloops,  B.C.
.Kamloops,
.Kamloops,
.Kamloops,
Wells, Miss Blanche  Royal Inland Hospital
Whitecross,  Alexander  Tranquille   Sanitorium
Willits, P. B  Kelowna   Hospital   ,....
Willoughby, Dr. C. J Royal Inland Hospital
118
...Kamloops,   B.C.
...Tranquille, B.C.
. Kelowna,  B.C.-
..Kamloops, ,'B.O.
m Wilmot, Mrs.  M.  E Kelowna   Hospital    _... Kelowna,  B.C.
Wilson,   Miss     Minneapolis, Minn.
Winn,  E.  S-  H Workmen's Comp. Board ..Vancouver, B.C.
Woods,
Wrinch
Wrinch £
CONSTITUTION and BYLAWS
—of—
THE B. C. HOSPITAL ASSOCIATION
Article l—Name.
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.
Article 3—Officers.
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"- memberships 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, and
all persons holding executive positions in the institution:
(b) "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 :
(c) "Honorary" members shall be any persons who have ceased to
take an active part in hospital work after years of faithful
service.
Article S—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.
120 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, out 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 annual 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 of each year.
Article 11—Membership Fees.
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.
Hospitals of ten to twenty beds, $10.00 per anunm.
Hospitals of twenty to fifty beds, $15.00 per annum.
Hospitals of fifty to one hundred beds, $20.00 per annum.
Hospitals over one hundred beds, $25.00 per annum.
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 membershio fee shall have
five votes, and so forth.
The combined delegation of any hospital shall agree among themselves
as to how their institution shall 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 discussion 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.
121 *
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