March 21, 1932

LIB

Pierre-François Casgrain (Whip of the Liberal Party)

Liberal

Mr. P. F. OASGRALN (Charlevoix-Sague-nay):

I shall try to be brief in my remarks, Mr. Speaker. The discussion on the resolution has been going on for some time; I never thought it would be so lengthy. The consensus of opinion among the members of the house seems to be in favour of the adoption of this resolution and I am pleased that both members from the maritime provinces and members from the province of Quebec on the government side are willing to support my motion.

There is one thing I should like to point out, however. Although the hon. member for

Maritime Fisheries, Quebec

Dorchester (Mr. Gagnon) has discussed this question in the way he has, and launched upon an attack against what he 'Called the bad administration of the fisheries in the province of Quebec due to the fisheries having come under the control of the provincial government in recent years, he seems to be not quite in accord with the Minister of Finance (Mr. Rhodes), who this afternoon stated that nothing had been taken away from the fishermen of the province of Quebec, because they had still the right to avail themselves of the various provisions that are on our statute books, such as the federal grant of seventy-five per cent for refrigerators for bait, and the regular grant of thirty per cent for other refrigerators which are necessary for fishermen. The difficulty is-and it is the reason for this motion-that the fishermen in the province of Quebec, and more especially on the north shore of the river St. Lawrence, are in a very unfortunate situation at the present time, having had a poor catch of fish for the last few years; therefore they are not in a position to avail themselves of any such grants or to contribute in the proportion which the law requires before they can obtain these refrigeration facilities. The consequence is that last year and the year before the provincial government has had to do practically everything on its own account in the way of establishing these refrigerator plants on the north shore of the river St. Lawrence in my county. As far as other laws on the statute book of which fishermen might take advantage are concerned, they are not in a position to do so, and since the administration of the fisheries was entrusted to the provincial government in 1922, it has had to do everything on its own account. The revenues derived from the fisheries by the provincial government, I am informed, although I have not exact figures, amount to hardly one per cent of the amount which the provincial government is spending nearly every year on the fisheries of the province, which is $300,000. When the provincial government was entrusted with the administration of the fisheries in 1922, it was due to the fact that it was desired to avoid the difficulties that had prevailed before with respect to licences in interior waters and also in deep and salt water down the lower part of the gulf. That is one of the reasons why the provincial government took over the administration of the fisheries as they stood within the limits of the province of Quebec. Now if the administration of the fisheries by the government of the province of Quebec has been bad, although my hon. friend from Dorchester claims that the

blame should be laid at the door of the provincial government, surely the same blame should be laid at the door of this federal administration when we find conditions obtaining in the maritime provinces as they have been represented by the hon. member for Gloucester (Mr. Yeniot). 'Conditions there do not seem to be much better than in the province of Quebec. If the federal administration did not do well in turning over to the provincial government the administration of the law, not the rights of the fishermen, as was suggested by the hon. member for Dorchester, I say, Mr. Speaker, that this government is here to settle all ills. They were elected to give better and more efficient administration, to settle all existing difficulties, to bring back prosperity, happiness and plenty to all. As I have said, I am merely asking that they give the necessary help to the province of Quebec, and I have given my reasons.

I wish to touch upon another point-and for this reason I hope hon. members will hear me a few moments more. The hon. member for Dorchester says we have been absolutely silent for the past eight years, that nothing has been done since the administration of the fisheries was turned over to the government of the province of Quebec. I was not a member sitting for the county of Saguenay on the north shore of the river St. Lawrence when the administration of the fisheries was transferred to the provincial government of Quebec. I was then sitting for the county of Charlevoix-Montmorency. In that district there were not very many fishermen, and the conditions affecting the deep sea fisheries did not obtain there as they do now on the north shore of 'the St. Lawrence. Since the year 1926 I have represented in this House of Commons the county of Saguenay on the north shore of the river St. Lawrence, and have been deeply interested in the fisheries. I have been working much more than my hon. friend from Dorchester would lead the house to believe. If he were to refer to the royal commission which investigated the fisheries of the maritime provinces and the Magdalen Islands he would find that on March 20 in the year 1928 the hon. member for Charlevoix-Saguenay appeared before the commission and presented a brief in the interests of the fishermen along the north shore of the St. Lawrence. At pages 85 and 86 of the report of that commission, issued in the year 1928, my hon. friend will see that the commissioners took cognizance of certain remarks that I made at that time in the interests of the fishermen in my constituency. I shall not take the time to read all the comments contained in this report,

Maritime Fisheries, Quebec

because theTe are many paragraphs which might not be of interest to all hon. members. There are certain points however to which I think I should direct the attention of the house. At page 86 of the report I find the following:

In marketing the fish products of the Gaspe peninsula and the north shore of the gulf of St. Lawrence, most of which is without railway-communication, and is completely isolated during many months of the year, shippers have to rely upon subsidized steamship services performed under contract by the Clarke Steamship Company.

Then, further on in the report I find the following:

Accordingly, there is a demand for improvement in the service performed by the Clarke Steamship Company. We recommend a consideration of the existing contract with the view of affording to this section of the country more adequate transportation facilities.

Mr. Speaker, this is a matter entirely within the jurisdiction of this parliament and the Department of Trade and Commerce. Following the report to w'hich I have referred endeavours were made successfully to secure an enlargement of the subsidies so that adequate facilities, such as refrigeration services in the boats of the Clarke Steamship Company, might be had on the north shore of the St. Lawrence. I am told that such service was extended to the boats of the same company plying between Quebec and the Gaspe peninsula.

I find in the report the further paragraph:

Railway freight and express rates are also complained of in that portion of the Gaspe peninsula which has railway connection.

Railway facilities are under the control of this parliament, and are matters of which this government should take cognizance. In the report a further request was made for harbour improvements or shelters for shore boats on the Gaspe peninsula. At the same time I appeared before the commission, I mentioned that such facilities should be afforded to people along the north shore of the river St. Lawrence.

If hon. members in this house or people outside the house would look at some of the estimates tabled in the years 1928, 1929 and 1930, they would surely find out that your humble servant has not been remiss in the discharge of his duties, because on many occasions I was rebuked by hon. members who then constituted the opposition, and was taken to task even by some members in my own party, because I was asking for too many improvements, such as wharf accommodation, dredging, and harbours, to benefit the fishermen on the north shore. The government implemented part of this report of the commission by paying attention to some of the requests made and by improving facilities at many points along the north shore. That is true more especially at a place called Tunday river, where a wharf was needed, and at Bredor Bay, near Labrador, where similar work was necessary. Many little harbours and breakwaters have been built to help the fishermen, and to implement the report made by this commission.

There is another paragraph in the report dealing with matters which might well be developed by the Department of Fisheries in the province of Quebec. I refer to the grading and inspection of fish, the establishment of a technological and biological laboratory for experiments, the institution of a bureau of information, a scientific study of the oceanography of the river and gulf of St. Lawrence, the migration of the different species of fish, the making of fishing charts, the adoption of a policy of subsidies for cold storage plants, fish canning factories, drying establishments and reduction plants. I think the provincial government in Quebec, which now looks after the administration of law's concerning the fisheries, has begun to deal with the matters here mentioned in the report. As I stated previously the amount required from year to year is far greater than the province of Quebec can afford to spend. The need is always increasing, and there is the added reason that in the years 1930 and 1931, the catch has been small along the north shore of the St. Lawrence. A large amount of the money which might have been divided to help the services mentioned in this report was given by way of subsidy or relief to the people along the north shore of the river. That was the condition obtaining before the relief measures were passed two years ago in this House of Commons.

So, Mr. Speaker, although hon. members opposite may want the country to believe that the hon. member representing Charlevoix-Saguenay has not discharged his duty, it is quite clear they are not stating the facts. Since I have represented that constituency I have given my best attention to the needs of the fishermen. If in the years 1929 and 1930, the government was not approached to secure the relief now described in the resolution, it was because conditions at that time were not so bad. Our markets had not been closed, and the fishermen were in a position to dispose of their product at reasonable prices. To-day they are in a much different position, and it is for that reason this resolution has been introduced before the house.

Maritime Fisheries, Quebec

This afternoon I was pleased to hear the hon. member for Queens-Lunenburg say he was going to take this matter up with the government with a view to helping the fishermen. Apparently three remedies were suggested. The first was a bonus to be given to the fishermen; the second, trade treaties, and the third, the stabilization of currency. If some of those remedies could be applied, fishermen not only in the province of Quebec but also along Atlantic and Pacific sea coasts would receive some benefit.

If we are soliciting federal assistance, it is so that there may be established on the coast of Gaspe, and possibly on the north shore of the St. Lawrence, biological and experimental stations from which the fishermen would be able to obtain information required, such as meteorological reports. Such reports should be printed in the French language. May I call the attention of the house to the fact that two-thirds of the fishermen in the province of Quebec are French, and they cannot take full advantage of all the valuable work that has been done at the biological stations if the results of that work are not translated into French. These stations are far away, and the fishermen cannot go to St. Andrews and Halifax from their own towns or villages on the north shore of the St. Lawrence in order to obtain information. I have in my hand a letter which I addressed last year to the Department of Fisheries, asking for a number of publications which I thought might be of interest to the fishermen in my district. I found that the French edition of a pamphlet entitled "Dried Cod Fisheries" was almost exhausted. Who is to blame for that?

These things should not be allowed to go on if we really want to help the fishermen in Quebec. Measures should be taken also to develop our fish trade more than it has been developed in the past. This might be done by .[DOT]educing the cost of transportation and creating local markets for our fresh fish. If this were done it would be of great help to the fishermen in my constituency.

I did not introduce this resolution because I wanted to play politics at all, as the hon. member for Dorchester suggested; I did not bring up this matter at the request of any person in the provincial government. As I said in my opening remarks, a similar resolution was adopted by the provincial house, after being introduced by the local member for my county, and I thought it behooved me to lay the case before this house with regard to the fisheries of Quebec. I think a bonne entente might be arrived at, and by coopera-

tion and conference between the two governments the little troubles that have existed in the past may be ironed ,out and we might start anew in order to help the fishing industry in Quebec as it should be helped.

Topic:   EDITION
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CON

Edgar Nelson Rhodes (Minister of Finance and Receiver General)

Conservative (1867-1942)

Mr. RHODES:

I suggested to my hon.

friend that while his resolution was not unacceptable to the government in its present form, it would be more acceptable if he amended it by substituting the words "the greatest possible" for the words "a greater" in the third line.

Topic:   EDITION
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LIB

Pierre-François Casgrain (Whip of the Liberal Party)

Liberal

Mr. CASGRAIN:

I have no objection to

amending it in that way if it will then be acceptable to the government.

Topic:   EDITION
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CON

Edgar Nelson Rhodes (Minister of Finance and Receiver General)

Conservative (1867-1942)

Mr. RHODES:

It will be quite acceptable.

Motion (Mr. Casgrain) as amended agreed to.

Topic:   EDITION
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NATIONAL HEALTH

PROPOSED PROVISION FOR MEDICAL EXAMINATION AND MEDICAL RELIEF

LIB

John Power Howden

Liberal

Mr. J. P. HOWDEN (St. Boniface) moved:

That, in the opinion of this house, the government should take into immediate consideration steps which would: (a) provide for

periodic medical examination of the Canadian people; (b) afford medical relief for those suffering from disease.

He said: Mr. Speaker, without casting any reflection on the debate that has just concluded, one might mention in passing that it has been rather fishy. I hope the subject I seek to place before the house to-night will not bring out any political arguments but that the attitude of last year will be the attitude of this year also.

Last session, Mr. Speaker, it was my privilege to present to this house a resolution similar in principle and meaning to the resolution I am moving to-night. It was very well received, generously considered and not unsympathetically criticized. Of the seventeen members who spoke to the motion all but three either spoke in favour of the resolution or of the principle which it sought to establish. The right hon. Prime Minister (Mr. Bennett), however, opposed the -motion and stated at some length his reasons for doing so. He said it was a purely academic resolution, and with that statement I have no great fault to find, unless the right hon. gentleman meant to infer that the idea could have no practical application. If that was what he meant, of course I do not agree, because my purpose in bringing the matter before the house was not to precipitate a highbrow debate, but

National Health-Mr. Howden

rather in the hope that some time Canada would adopt a measure of public medicine which would assure the people of this country of succor and relief in times of ill health, and as far as possible immunity from disability caused by disease.

At that time the Prime Minister stated that probably the greatest objection to the resolution was that it would wipe out medical service as it existed at the present time and would completely eliminate private enterprise in medicine, thus destroying the initiative of medical men. He did not say so at the time' but I rather fancy he meant that this would occur quickly. I had no idea that my innocent looking resolution might become such a force for disruption and revolution, but not wishing to abandon what I considered to be a good cause I have brought forward the resolution again to-night in a form which I hope will be more acceptable to the government.

This is quite an important matter, Mr. Speaker, and it deserves a fair amount of consideration. I understand quite a number of our members wish to speak to the resolution, if possible, so in order to set forth the situation as clearly as possible I should like to refer quite freely to the written text I have before me.

It would seem rather anomalous that we should try to preserve and prolong life in Canada at this time when, if it were not for relief measures instituted by various governments, we would have many thousand of our people underfed, hungry or actually starving. It might be said that the more rational procedure would be to find some means of quietly doing away with about one third of our population, that is, that part which has no visible means of support. Thereby we would summarily and effectively dispose of that sorely vexing question of unemployment. Something of the same idea is hinted at bj' Sir Andrew Rae Duncan and one of his colleagues in a report I have before me. This report points out the somewhat antagonistic interests of the individual and the state in a time of illness. Each time a sick person recovers it is but against the time he will sicken again and further burden the state. If in the meantime such person has been the means' of begetting other life, and the offspring, like the parent, be of inferior mental and physical stamina, also subject to illness and requiring an undue amount of care and medical attention, the state in rendering the service which saved the parent has thereby largely added to its own responsibility and expense, and in the report the wisdom of this

is mildly questioned. Were it not better to let the fittest survive and the devil take the hindermost? There is a good deal to be said in support of this, Mr. Speaker. Such a principle obtains in the life of all wild species and all primitive or aboriginal peoples and when given a reasonable show they seem to do pretty well. Since fewer would survive there would be less unemployment, and since chiefly the stronger would survive it would be the means of building up a strong and virile nation and perhaps saving us a good deal of trouble and expenses. In the history of civilization there was a time when imbeciles and other subjects of hopeless infirmity were smothered, drowned or whatnot, but fortunately, or otherwise, civilization has advanced to the stage where such procedure is no longer practised, where each individual human born is accorded a right with his brother to survive and afforded the same opportunity to a fairly substantial degree. Probably it is just as well that it is so, Mr. Speaker, for by some strange turn of fate the ugly duckling becomes a handsome drake; the puniest member of a flock or litter lives to outdo the more thrifty .members; undersized, delicate children often become sturdy specimens of adult life, and on the other hand the world's greatest accomplishments in art, science, literature, in commerce and in war have been achieved in many instances by men of frail make-up, at times the subject of wasting disease and altogether below the average in ordinary physique. It would almost seem that the frail form is given the better brain by way perchance of compensation.

Therefore civilization and society being as they are, we must adopt the only alternative and endeavour to modify our social structure so as to minimize unemployment on the one hand and eliminate as far as possible the existence of disease and the causes of defective manhood on the other. In the last session of parliament, Mr. Speaker, I had the honour to present to this chamber a resolution reading:

In the opinion of this house a measure of federal state medicine would be in the best interests of the Canadian people.

On that occasion it was suggested that the weaiLth of any land could be obtained by labour and labour only, that efficient labour could be the product of only a sound body, that therefore the wealth of a nation depended on the health of its citizens and that as Canada was a land of stern realities only those of strong physique and stern resolve could hope to prevail. But, Mr. Speaker, we are not all strong

National Health-Mr. Howden

in either body or mind:. Unfortunately a very large number are defective either mentally or physically or both, are either chronic invalids or rapidly succumb to illness and become a government charge or a burden to their relatives. Under the heading "Canada, is at War" the Canadian Social Hygiene Council issued a pamphlet containing some facts which the house would do well to consider. Let me quote:

Every year thousands of Canadians die of diseases which could be prevented.

It then asks a pertinent question:

Why are these diseases not prevented?

It states further:

During centuries man has acquired the habit of regarding disease as unavoidable. To-day the average man-even the average statesman -retains that medieval attitude. Leaders of the people must come forward to save the thousands of Canadian lives that are lost every year through diseases which could be prevented if a nation-wide organized effort were made to prevent them. Most splendid work is being done by health departments in various parts of Canada. The following facts and figures will show that their work must be united in a great national offensive against the common enemy-disease-which is silently and undramatically wasting our lives and our money. Canadians have shown how they can fight against a human foe. Disease is in our midst

a far more dangerous enemy. In organizing to fight it we have everything to gain and nothing to lose. But we must develop in the minds of our citizens a sense of individual responsibility if nation "health-mindedness" is to be achieved.

It would appear that one person out of three dies ahead of his time of diseases that could be prevented. Canadian statistics dealing with sickness indicate that over half of all disabling illness could be prevented!

Sound, authentic estimates show that from two to three per cent of the population is continuously on the sick list. Of these, between 91 per cent and 96 per cent are ill enough to be disabled. So that about two per cent of our population is always too sick to work.

Public health officials agree that sickness costs the people of Canada over $311,000,000 a year. Almost nine-tenths of this is a direct charge upon the individual.

Later on the report, dealing with diphtheria and other diseases, states:

Diphtheria has killed 1,200 Canadians-mostly children-in a single year. Yet the toxoid treatment against diphtheria, if applied in a nation-wide drive against this disease, would completely wipe it out in a very few years.

Typhoid fever takes 1,111 lives annually. Yet during the Great war not one Canadian soldier died of typhoid. This is one of the most readily preventable of diseases. During the war, the authorities protected the lives of the troops by means within the reach of everyone. Are Canadian lives less valuable in peacetime?

Tuberculosis destroys about 7,764 Canadians every year. Yet with proper health machinery, it could be absolutely eliminated.

Cancer ends 7,912 Canadian lives every year. Periodic health examination frequently reveals this terrible destroyer in its incipient stages, when there is an excellent chance of curing it. Universal periodic health examination would make the cancer death rate dwindle sharply. The public must be led to conserve health by adopting the physical examination scheme.

Heart disease is responsible for the staggering total of 11,775 deaths a year in Canada. Periodic health examination frequently reveals the causes of heart disease, or the disease itself in its early stages.

Maternal mortality-1,295 mothers die each year in child-birth. Proper prenatal care would reduce this appalling total.

Venereal diseases-Canada's successful attack upon these diseases points the way to success in dealing with others. Thanks to a nationwide, well-organized and perpetual campaign against venereal diseases, recent surveys in Toronto and Winnipeg showed that these^ cities have the lowest incidence of venereal diseases of 17 cities in which similar surveys have been made on this continent. These rates will be still further reduced when the public attitude towards all diseases has been modernized by proper education and leadership.

At this point I would appeal to the Minister of Pensions and National Health (Mr. Mac-Laren). I understand that the dominion grant to the provinces has been discontinued. It has been the custom, for a number of years now to make a grant of some $200,000 a year to be divided among the various provinces to aid them in fighting the venereal evil. I have just quoted the results of this fight in Toronto and Winnipeg, and certainly they have been amazingly successful. This year apparently the government does not feel justified in making the grant. The discontinuance of the grant is a verjq very serious matter, and I appeal to the minister and to the government as a whole to continue the grant for another year. The pamphlet continues:

There is one solution. Periodic health examination-a periodic and thorough overhauling by a competent physician. To induce people to adopt this solution is a task demanding prompt and constant attention of health authorities, thoughtful citizens, and statesmen.

Disease strikes from coast to coast. It is a national menace and combating it a national problem. Dominion leadership is needed, because at present there is no uniformity of health management. In some places health is well safeguarded. in others, deplorably neglected. Cooperation between the dominion and the provinces in a concerted attack upon venereal disease has proven the value of maintaining a united front against disease. Not until this unity is achieved in attacking all diseases, can we expect a rapid change in the present unsatisfactory disease and mortality rates.

National Health-Mr. Howden

This brings me to the pith of my argument, which is that Canada should institute, either federally or with the cooperation of the provinces, a periodic health examination of the citizens, yearly or as often as may be found desirable, and that all illnesses discovered at such times or at any time should receive intelligent medical attention and treatment. I am willing to admit that this is a big order and there are many difficulties in the way. There is first the constitution, and it seems as though this can do or undo whatever the government in power may desire, and the people of Canada have nothing much to say. The men who made it have all passed on and I doubt if they are greatly concerned about the Canadian people at present. Meanwhile, we are here trying to live useful lives and to see that the greatest good for the greatest number pertains. If any government wished to provide periodic health examinations and sick treatment for the Canadian people, they could very soon find a way, the constitution notwithstanding. After all, parliament is allpowerful.

The matter of expense is preeminent. As stated before, the estimated cost of sickness in Canada is S311,000,000 annually, no doubt largely a direct charge. Even at that, many sick persons receive poor or indifferent attention while others are charged unfair and exorbitant fees. Many of those in remote districts are not able to receive professional treatment at all. The Endicott Johnson corporation, an American manufacturing concern, has a medical system by which it supplies complete medical care for its 16,000 workers and all their dependents. The cost of this service is .$400,000 annually, one and one quarter cents per pair of shoes turned out. The service must reach at least 30,000 souls, and it is extended to cover every medical attention from infancy to old age. The staff consists of twenty-seven whole-time physicians and includes one general surgeon, one eye specialist, two throat and nose specialists, one pediatrist or child specialist, three dentists, two pharmacists, one masseur, one X-ray technician and fifty-one trained nurses. They have also maternity hospitals, an isolation hospital, chemical and bacteriological laboratories and a convalescent home. It is hardly reasonable to compare a service of this kind with a system of state medicine where the cost might be greater or less, but supposing it was one-half greater, say $180,000,000 yearly, Canada's health bill would still be far below the estimated cost of $311,000,000 and certainly the benefits to be derived would warrant a greater 41761-84

cost than we have at present. Let me enumerate some of these benefits.

At present there are in Canada several thousand regularly qualified medical men and many other So-called doctors, in all probably a greater number than is actually required, many being of doubtful value or benefit. Under state medicine there would be just as many doctors, nurses, masseurs and druggists as were actually required and practitioners of doubtful value would be eliminated.

At present there are in many towns and cities more doctors than are needed, while many rural communities are entirely without medical service. Under state medicine every community would be part of some health district and the service would reach every family in the land.

At present doctors are competitors of each other and economic pressure makes professional ethics farcical and impossible, largely to the cost and undoing of the patient. Under state medicine there would be no need for ethics; professional cooperation would predominate.

At present doctors in general are poorly paid, fees are irregularly collected and the financial interferes constantly with the professional side. Under state medicine doctors would be paid suitable salaries commensurate with their ability and work. They would strive to secure advancement and would not be harassed with the anxiety of ill-health, a penniless old age or lack of income. These matters would be taken care of by the state.

At present the medical profession thinks the rich and well-to-do should pay for the services rendered to the poor, but the rich resent being penalized in this manner. Under state medicine all men, rich and poor alike, would receive the best we have to offer.

At present the people consult physicians only in the instance of a known or obvious ailment and often when the disease is well established. Under state medicine preventive medicine by periodic health examination would overcome this evil and would supplant largely the system of curative medicine now pertaining.

At present consultations with specialists are expensive and frequently too long delayed. Under state medicine consultations would be free and there would be no cause for delay. Suspected cases of cancer, tuberoulosis, and so . on, could be promptly diagnosed and given a chance of recovery.

At present people spend millions yearly in self-prescribed and counter-prescribed medicines, often of no value. Under state medicine there would be no patent medicines, nostrum or other drug traffic.

National Health-Mr. Howden

At (present the medical service is hindered by lack of public confidence, the economic interest of the doctor and the patient being largely opposed. Under state medicine the economic interest of the doctor and the patient would coincide and the service would give full confidence.

At present surgery is often employed only as a last resort and is denied the chance to do its best. Its use is denied to many because of the fees demanded, while others refuse it because of suspicion of the surgeon. Under state medicine surgery would be used where indicated and without delay because there would be no suspicion on the part of the public.

At present owing to lack of official control of surgeons and other specialists, a large number of unnecessary and more than pooriy performed operations are carried out, with a much larger death rate than should be the case. Under state medicine no incompetent man would be allowed to operate.

Topic:   NATIONAL HEALTH
Subtopic:   PROPOSED PROVISION FOR MEDICAL EXAMINATION AND MEDICAL RELIEF
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CON

George Spotton

Conservative (1867-1942)

Mr. SPOTTON:

Who will decide?

Topic:   NATIONAL HEALTH
Subtopic:   PROPOSED PROVISION FOR MEDICAL EXAMINATION AND MEDICAL RELIEF
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LIB

John Power Howden

Liberal

Mr. HOWDEN:

The decision probably

would be in the hands of a suitable board who would allow only such men to practise as were found to be fully qualified.

At present under haste in delivery, lack of proper knowledge and occasional contact with intercurrent infection causes the untimely death of many hundreds of mothers yearly. Under state medicine a woman would be delivered in a well-equipped lying-in hospital where no contact with other infection could occur. The work would be done by a specially trained obstetrician and haste would not be a factor. ' '

At present a doctor who is once qualified and licensed has a free hand to practice medicine as he likes. He may be negligent, reckless or utterly behind the times and still continue to practise with impunity. Under state medicine his work would be supervised by a board of examiners and he might be retired from the service because of ignorance and incompetency. He would not only have to pass his examinations but he would have to maintain his standing or drop out.

Lastly, at present any physician can announce himself as a specialist without having taken spocial training. Under state medicine no one would be permitted to pose as a specialist without first satisfying the board of examiners as to his qualifications. *

These, Mr. Speaker, are some of the advantages to be gained by a system of state medicine. They by no means exhaust the list, but others are more or less intricate and technical and not of a nature to appeal to the chamber. I would, however, pause to rMr. Howden.]

say that the greatest benefits to accrue are that sickness would be largely nipped in the bud; that hundreds of cases of unsuspected, incipient or criminally hidden disease would be brought to light; that all would receive the best treatment and that the great mass of citizens who desire to pay and who do pay their way in life, would not be faced on every occasion of sickness in their homes with a money outlay that might cripple them financially for months or even years. A prominent doctor in Winnipeg said to me a few days ago that sickness caused an almost impossible expense, even in a doctor's home, where there are no doctor's bills to pay, and from this remark one can readily appreciate the position where a family is faced with a bill for medical attention in addition to other expenses.

I have no wish at this time to estimate the cost of illness, but I would venture the opinion that each birth in a family of moderate circumstances entails an expense ranging from $100 to S300; that a laparotomy, meaning an abdominal section, means an expense ranging around $500, and that few protracted cases get away with an expense of less than twice that amount. The disadvantages are of a dual nature: first, the difficulty, though not a very serious one, of divorcing people from the use of a family doctor; and, second, the difficulty of finding the best or even a satisfactory method of applying the principle. In the first case not much need be said. Family doctors are like family preachers. For one reason or another they are changed from time to time, and in the case of doctors, often by the family itself. If the Canadian people of either high or low degree find that they are being given careful, courteous and intelligent service, they will soon overcome their aversion to not having always the same family attendant. On the other hand, the more fastidious can always retain one man by prearrangement or some slight extra expense.

The second matter is not so easy of manipulation. It is not part of my responsibility in presenting the resolution to submit a plan of practical application. Parliament, as we are frequently told, is all powerful when its members are in complete accord. It is the business of the government to evolve means of applying principles adopted by the house, and I think a way can be found which could be worked out on a provincial or a federal, or, as with old age pensions, on a provincial and federal basis, preferably the latter. In any case there would have to be statutory legislation from the dominion house so as to create a uniform national system. Indeed, parliament

National Health-Mr. Howden

would have to do no more than create the machinery, the operation of which could be left to the provinces. In such a case, parliament would have to pay the cost or at least contribute a portion. Since parliament has power to collect taxes from any source or by any means and to allot them to whatever legal use seems wise, there should be no difficulty in this regard.

In discussing a similar resolution last session, the Prime Minister stated that to give practical application thereto would mean to sweep away at one stroke all existing medical service. Nothing was further from my thoughts. I claim that parliament, at a comparatively small cost, can provide for a periodic health examination of all the Canadian people, and, further, can furnish succour and medical aid in time of sickness without disturbing present conditions to any great extent. That the movement would ultimately eliminate present-day forms of service, as stated by the Prime Minister, and bring about a system by which the state would become the employer and the doctors the employed, I venture to hope and believe. The hon. member for Medicine Hat (Mr. Gershaw) stated in last year's debate that this effect would slowly come about by an extension of existing service units, but why wait for this in the face of the unsatisfactory condition existing at present? The health of the general public is one of the prime objects of statecraft, and the securing of it is tire duty of all.

If I may for a moment revert to the Prime Minister's remark on the occasion of the previous debate, I should like to say that after carefully reading his observations I decided that they hinged on three points of objection. The first was that the application was almost overnight. It seemed to me the objection was there would be a sweeping change from the present system of medicine to one whereby the state would become the employer and medical men would become the employees of the state. As a matter of fact, I cannot see any great reason why such a condition should not be brought about. That is really the idea of the resolution. But that such a condition could be brought about suddenly is very improbable, practically impossible and certainly most undesirable. A sudden change from one system to the other would undoubtedly cause a great deal of confusion, much unfairness to medical men throughout the country and probably a very poor service for a while. There is, however, no danger of such a change being brought about suddenly. My suggestion would be just to initiate a measure somewhat along the lines 41761-845

of the compensation board legislation, and I think the Prime Minister would see the people taking to it, as they say, like a cat to milk. If we can just make the start, the opening, I do not think we would have much trouble in educating the people to state medicine which would give them very much better service.

The second point was the destruction of medical initiative, destruction of the incentive that causes medical men to strive to excel in their work and lives. I wonder whether the Prime Minister knows that in most of the great European centres the men who have done the best work in research and who have blazed trails in medicine, pathology and surgery, the men who have accomplished the greatest successes, have quite frequently been so poor both before and after their successes that they have not been able to afford the ordinary comforts that obtain in the home of an artisan.

Not so very long ago I was talking to another medical man in Winnipeg who had just come back from a post-graduate course in Europe. He told me that he and a number of other men who were taking the same course one day were on their way to the hospital where the clinic was being held when they saw the man whom they expected to lecture to them in a few moments, trudging along the street carrying a parcel. They later learned that this man, although he worked about twelve hours a day at surgery, was a writer of some note, and was one of the most successful operators in Vienna, was actually too poor to take a tram and that he carried a lunch of bread and cheese to work every day. Just imagine one of the foremost teachers and operators in Vienna, probably in Europe, walking to work and carrying his lunch! I wonder whether the right hon. gentleman knows that an army officer, Ronald Ross, of the Royal Army Medical Corps, while receiving but small pay, discovered, by his initiative and effort alone, the cause of and freed the west coast of Africa from a disease that had rendered it well-nigh uninhabitable. Another officer of the British army, also on low pay, Leichman, during the South African war initiated research and developed a vaccine for typhoid fever which he perfected during the war, and so rid the army of this scourge which was killing the soldiers by the hundreds.

Here is an instance from the United States. After the construction of the Panama canal had been discontinued for over twenty years, Major Gorgas, an American army officer on small pay, went into the district and after a certain amount of investigation discovered the causative factor in the great death rake

National Health-Mr. Howden

from malaria in the canal zone. Work on the canal had been discontinued because men would not go in there and face the tragic death rate from malaria, but Gorgas discovered that mosquitoes were responsible for the transference of the malarial virus, and very soon he had treated the swamps and sluggish pools with oil and destroyed the mosquitoes, and thus made it possible for men to go in there and complete the building of the Panama canal. I mention these four instances, a noted teacher and professor in Vienna, and three humble army officers, who initiated and perfected these great works.

I do not think the right hon. the Prime Minister need have any fear of destroying the incentive to medical research. I do not believe that either he or all the legislators in all the legislatures and parliaments all over the world can ever destroy the initiative and incentive to medical research which springs from the desire of truly great men to learn the truth so that they can serve their fellow men.

The third point which the Prime Minister raised last year when a similar resolution was under discussion was that neither the doctors nor the people were ready for such a step. May I say this? It has been calculated that the average medical man in Canada and the United States earns an income of about $3,000 a year. Some, of course, run very much higher, some doctors earning from fifteen to twenty thousand a year, but the income of the average doctor is about three thousand dollars, and out of that he has to pay office costs, automobile expenses, and so on. In the United States at the present time the federal government employs several hundred doctors on a yearly basis. They start with a salary of 82,500 to $4,000; at the end of a number of three-year periods they are required to take examinations, and if they fail to pass they are dropped from the service a year later. If they pass the examinations successfully they eventually receive a salary of about $7,000. I think I can speak for the medical men of this country, Mr. Speaker, when I say that if they could figure on a permanent yearly salary of anywhere from $5,000 to $7,000, they would be ready to go into a salaried scheme of this kind.

The matter has been taken up by provincial governments and medical societies all over Canada. Quite recently the local medical association in the city of Winnipeg, where I grew up, and to which I largely belong, took this matter up and the local government is investigating it at the present time. The medical association of Manitoba found nothing to object to in this scheme after having

(Mr. Howden.]

investigated it, and they submitted to the provincial government a series of principles which they think ought to be followed.

I shall not detain the house by reading them. I merely wish to state that the medical association is fully in accord with a movement of this kind and would be glad to see it brought about. I should like to read again the words of the Prime Minister-

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CON

Pierre Édouard Blondin (Speaker of the Senate)

Conservative (1867-1942)

Mr. SPEAKER:

The hon. gentleman's

time has expired.

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CON

George Douglass Stanley

Conservative (1867-1942)

Mr. G. D. STANLEY (East Calgary):

May I congratulate the hon. gentleman (Mr. Howden) upon his very excellent presentation of the argument from his standpoint in regard to state medicine. His resolution as it appears on the order paper reads as follows:

That, in the opinion of this house, the government should take into immediate consideration steps which would: (a) provide for

periodic medical examination of the Canadian people; (b) afford medical relief for those suffering from disease.

A rather interesting application of the provisions of the first section of this resolution as applied to a legislative body may be found in the records of the legislative assembly of upper Canada back in 1810, when there was a very early application of state examination applied to certain legislators in that assembly. On March 2, 1810, they were checking up on some of the absentee legislators from the assembly. May I read the record as it appears?

March 2, 1810:

On motion of Mr. M'Lean, seconded by Mr. Gough, resolved that the Speaker be directed to order medical assistance to attend on Benjamin Mallory, Philip Sovereign, Joseph Willcocks, John Roblin, John Wilson, and James Wilson, and report the state of their health at the bar of this hon. house.

The Speaker, having put the question, a division took place; the names being called for. they were taken down and are as follows:

"Yeas-Messrs. M'Nabb, Frazer, Burritt, Marcel, M'Gregor, Baby, M'Lean, Gough, Elliott, G. Wilson, and Secord.

"Nays-Messrs. Howard. Rogers and Lewis.

"The Speaker did then order Doctors Richardson and Lee to visit those gentlemen and inquire into the state of their health, and report the same to the house as soon as possible.

"Doctors Richardson and Lee came to the bar of this house and did acquaint the Speaker that, in obedience to his orders, they had called at the lodgings of several of the members absent from this house, in consequence of indisposition. and have the honour of making a written report on the state of health of Joseph Will-cocks. James Wilson. John Wilson and John Roblin. Esq's., which report is as follows:

"Mr. Speaker, we have seen and examined Mr. Willcocks. Mr. James Wilson, Mr. John Roblin and Mr. John Wilson; are of opinion from Mr. Willcocks' statement, and from his

National Health-Mr. Stanley

present state, that it would not be proper for him to attend the house this day. Mr. James Wilson states that he has taken medicine this morning: but we think (if it is absolutely necessary) he might attend in his place. The other two gentlemen complain very much, but have taken no medicine. We think they might come to the house. Whether they would be able to remain, 'tis impossible to say. Those gentlemen all say they think they will be able to attend to-morrow. We are of the same opinion.- (Signed) R. Richardson, W. Lee."

Mr. Speaker, if such examinations were made of absentees from this house hon. members might find it very inconvenient. I am sure the hon. gentleman will not press his resolution that far.

The general question of the socialization of medicine is very interesting and important. When one goes back over the history of the development of scientific medicine, and the application of socializing efforts made by the state and the medical profession, one comes to the conclusion that in the present state at which it has arrived scientific medicine must not stand still. We cannot stay where we are; we cannot go back; we must go forward. The development of scientific medicine in our country must proceed; there is no question about that. In our minds the ideal condition is one when all citizens shall have available to them all that is necessary in scientific medicine to relieve their ailments. For many years such an ideal has been before our minds. In fact if we go back to the early days of history, back to the prophet Isaiah, we find he said:

There shall be no more thence an infant of days, nor an old man that hath not filled his days; for the child shall die an hundred years old.

Since that ideal was set up progress was very slow. During the last fifty years however great strides have been taken; we have an ideal towards which we may direct our efforts. Many difficulties, with which I shall deal as I go along, stand in the way.

May I say first and foremost that in regard to scientific medicine and all that the term includes, jurisdiction rests exclusively within the realm of the provincial legislatures. Therefore to-day, despite what the hon. gentleman opposite may have said a few moments ago, while state medicine may promote an academic discussion of an educative nature that is worthy of a place in this house, legislation in this regard must rest with the legislatures of the various provinces.

I think the general statement is contained in the two clauses of the resolution now before us. Scientific medicine as we have it to-day might very properly be divided under two

headings, namely preventive and curative. True, to a very considerable extent they overlap, but in a general sense the division is correct. State medicine, using the term broadly, implies that all the health activities which could be extended by the state, whether they be of a preventive or of a curative type, should be extended as a public utility. That, I presume, would be a fair definition of the term "state medicine." However, as the term is used frequently both in private conversation and on public platforms, it carries an entirely different meaning. It is almost always confined to the curative side and overlooks the preventive. Conversations and addresses from platforms would seem to imply that the state has some mythical bottomless purse from which funds may be supplied to give to the citizens everything in medicine for which they may ask. On the other hand infrequent mention is made of taxes or contributions necessary to pay for such services rendered.

Personally I am in favour of state medicine, have always said so and still say so. I refer however to state medicine following a safe and sane progressive program built upon the firm foundation laid during the years. I am not in favour of any undertaking which would ignore what the state has done in years past. I am not in favour of "kicking over the checkerboard" and entering into some mysterious experimentation, but am in favour of that which is safe, progressive and working towards an ideal.

When we consider the question of jurisdictions what do we find? The provinces in this dominion have authority to deal with any of the health activities, either of individuals, groups, organizations, societies or municipalities-in fact, all the health activities are within the jurisdiction of provincial legislation. Therefore the proposals embodied in the resolution certainly come within the jurisdiction of the provinces. Health measures undertaken by the federal government are of a restricted nature, dealing mainly with the administration of the opium and Narcotic Drug Act, of pure food laws, proprietary medicine acts, the examination of immigrants, marine hospitals, and the administration of grants given to certain eleemosynary organizations. Whether federal health activities can be extended is a matter which in a few moments we will consider.

In a general way preventive medicine, as we understand it, is almost exclusively within the jurisdiction of the state, whether it be the municipality, the province or the dominion. Preventive measures which are taken by

National Health-Mr. Stanley

various health organizations, having to do with groups of individuals, belong exclusively to the state. Heretofore, speaking in a general way again, curative medicine, which is that part of medicine which brings the physician into close and intimate relationship with his patient, has been left almost entirely to the individual physician. In a very general way that has been the position in the application of scientific medicine in Canada.

What have been the activities of the state, in general terms? They have been preventive, of course, dealing with groups of individuals, with sanitation, with food and water inspection, with the inspection of schools and school children, with the administration of health regulations, with the questions of quarantine and isolation, with the administration of hospitals, with medical education, with nursing training and other activities of this nature. Last but not least it has to do with what we might call pure science in connection with scientific medicine, or in other words the scientific medical research work carried on in our hospitals and universities. I think all these can be very properly included in the activities of the state; so when we talk about state medicine I think it unfair for us to leave aside all that the state is doing with so much success and such energy and at such great cost, giving the people to understand that the state has not been doing anything and that it should launch out into a new line of activity which heretofore has not been included in the term "state medicine."

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LIB

Jean-François Pouliot

Liberal

Mr. POULIOT:

I am following my hon.

friend very closely, and I wonder if he would be kind enough to tell us if in his province there are county sanitary units.

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CON

George Douglass Stanley

Conservative (1867-1942)

Mr. STANLEY:

I will come to that in a few moments. The result has been that the state has specialized in removing the causes of sickness and decreasing the number of cases of sickness throughout the country, and in this work the state has met with very considerable success. I should like to quote just a few statistics to show how much has been accomplished during the last thirty years, which is the length of time I have been privileged to practise medicine. I was interested to find out just what has been done in this regard, and I find that in that period of time the mortality in cases of typhoid fever has been reduced from 313 in a million of the population to 16 in a million of the population, and during the last two or three years I think it has been almost completely eliminated. In measles the mortality has been reduced from 134 in a million of the poplation to 25; in

tuberculosis it has been reduced from 1,754 in a million of the population to 647; in scarlet fever it has been reduced from 96 in a million of the population to 19. As a matter of fact, if you consider any age period up to sixty-five you will find that during the past thirty years the mortality has been very considerably reduced. In the period under five years of age it has been cut in two, and in the period from twenty-five to thirty-five it has been reduced until now, in relation to the previous mortality, it stands as six does to ten. To summarize the mortality from all diseases, in that period of time it has been reduced from 17,195 in a million of the population to 12,343. So, as a matter of fact, preventive medicine and its application by the state has reduced mortality and brought about a remarkable saving of life throughout the country.

Now I should like to go one step further and say that the best authorities are thoroughly convinced that the progress which will be made in scientific medicine and in the reduction of mortality will be made in preventive medicine to a very large extent. So we have this situation, that while some progress has been made in curative medicine, the outstanding success in scientific medicine is that which has resulted in the reduction of mortality which has been effected by the preventive measures handled almost exclusively by the state. In the next fifty years we look to the state to accomplish, through preventive medicine, almost all that will be accomplished. No doubt there will be some advance in the line of curative medicine, but not the advance we might hope for.

There we have the situation. The fact, then, is that the state has concentrated upon preventive measures and has met with success. Naturally we must ask this question: Will or can the state-using that word to include all health activities and all state agencies- continue to concentrate on preventive medicine if it divides its efforts and undertakes curative work? I am not answering that question; I am simply bringing it up for your consideration. More than that, can the state undertake to keep up the preventive work it has been carrying on, and in which we look forward to great advances? Can the state continue to finance those obligations and at the same time undertake to finance the curative work of which the hon. member has been speaking? If the state is to divide its activities, or to divide the finances presently used in the work, it will mean disaster to the splendid work that has been done and is to be done in preventive measures. That is a

National Health-Mr, Stanley

question we will have to decide, but it cannot be decided in this house in a legislative way. It must be decided by the taxpayers and contributors in the various provinces. So While we are discussing this academically, and in a profitable way I believe, at the same time we must leave to the various provinces the answers to these questions.

Now, let us look into the possibilities of the future. There is a very promising outlook for preventive medicine. There are some great obligations for the state to undertake. I shall not attempt to outline all of them. I shall deal with two or three only. For instance, heart disease; I have already given some statistics which demonstrate what the state has already done in the reduction of mortality from various causes. Unfortunately when we come to diseases of the heart we find that the mortality figures have been getting progressively worse and worse. The same remark applies to cancer, and this disease is now receiving very serious consideration from scientific medicine. Diseases of the heart is the greatest single cause of deaths in our country. Unfortunately the mortality, as I say, is increasing each year. One out of every seven deaths is the result of some disease of the heart. Two persons out of every hundred have this disease. In the .examination of recruits for the United States army three out of every hundred were found to suffer from this disease. In 1929 pneumonia caused 1,430 deaths, cancer 960, tuberculosis 930, diseases of the heart 2,664 to the .million of population. Going back over the thirty years to which I have already referred, in 1900 the mortality from diseases of the heart was 1,374 to the million of population; during that period the mortality has almost doubled.-2,664 to the million of population.

I have no doubt that the hon. gentleman who has introduced the resolution (Mr. Howden) desires that some effort should be made to broaden out the federal Department of Health by co-ordinating the activities of the Provincial Departments of Health. In that I am quite prepared to agree with him. I make this suggestion. Here are two diseases, the mortality from which is increasing by leaps and bounds. What is required in this country is not so much treatment of individual cases, but Tather a broad national coordination in respect to all the cases throughout the country. Then take cancer; scientific medicine has not yet located the cause of this disease, but certain very important principles of treatment have been laid down which give promise of considerable assistance in the control of this disease.

Here is a field for preventive medicine during the next few years. The Canadian medical association, in common with similar associations in other countries, is undertaking to make a national survey in regard to cancer. All members, I am sure, have been keeping in touch with the work in the various provinces, including Ontario, Saskatchewan and Alberta. The trouble is that so far there has been no correlation of data, no clinical information of any value to those who are trying to determine what steps may be taken to overcome the increasing mortality. The same remark applies to diseases of the heart. We -can 'divide heart diseases broadly into three groups: first, that which we understand fairly well and know how to treat; second, that which is debatable among the profession; third, that of which the profession knows very little or practically nothing. I am sorry to say the third is the largest class, and a class in which the mortality is thought to be increasing. Clinical data is very badly needed, data that may be correlated so that it may be of practical use in a national way in our efforts to find successful preventive treatment for this disease.

May I point out that the federal department of Health can very well broaden the scope of its operations along these lines. For instance, we find certain information sadly lacking. We want to know: What are the causes of these diseases of the heart that are increasing so rapidly? What are the various types of these diseases? What is the natural history of each individual type? Which of these types is preventable? How is it preventable? Which of these types is increasing, and why is it increasing? What are the regional distributions of all the various types of this disease? What has climate to do with diseases of the heart, and what types are affected by various climates? What is the proper treatment for these diseases? What is vocational guidance accomplishing? What influence have social and economic surroundings on these diseases? This and other information has never been brought together. Scientific men who are enthusiastic about promoting the overcoming of this great cause of mortality in our country are thoroughly convinced that the greatest necessity is the bringing together from all the hospitals in all sections of the country, from all universities, from all medical men, even those located in the most outlying regions, the fullest information in a uniform way. The efforts of the departments of health could be extended along this line.

National Health-Mr. Stanley

May I give one illustration to emphasize this point? During the period of the war when the United States undertook to bring together large numbers of their soldiers to send overseas, an influenza epidemic started and ran rampant through the camps. A large number of those who had influenza developed pneumonia, and many of those who had pneumonia developed empyema, or pus in the pleural cavity of the lung. In many cases the usual operation was performed but resulted in an alarmingly high mortality; so much so that a commission of skilled surgeons and physicians was appointed to find out what could be done to reduce this terrific toll. The advantage which this commission had was that these men were grouped together in the camps under the closest survey, their case histories were available and the coordinated and correlated efforts of all the physicians were before the commission. The result was that in a few weeks it discovered just exactly where the difficulty lay and when and how an operation could be successfully performed. The mortality rate dropped immediately to what had been considered before as the normal rate. I will not go into the details other than to point out the significance of the work of that commission in regard to this one disease.

This is what medical and scientific men want in regard to heart diseases. The cases are spread all over the country and isolated, but the information should be brought together and correlated, so that correct conclusions could be reached, and made available to the profession. This work could be undertaken by our federal department of health, as far as its guidance and financial burden is concerned.

After all, the greatest cause of sickness is poverty. We have here an economic problem which cannot be overcome by treating those *who are sick. For illustration; a village may be overtaken with an epidemic of typhoid fever because the water supply is contaminated; it may be humanitarian for the state to send in a physician to treat each individual case, but it would be vastly more humanitarian for the state to send in its sanitary men to purify the water supply. The state's activities should be directed towards removing the causes of disease, and poverty is the greatest. As St. Augustine said: Thou givest bread to the hungry; but better were it that none hungered, and that thou had'st none to give him.

The Registrar General of England and Wales recently divided the deaths during the past year into five groups-employers, foremen, skilled workmen, unskilled workmen and com-

mon labourers. In general terms, he found that the mortality from all diseases was fifty per cent higher in groups four and five than it was in groups one and two. In the case of tuberculosis and pneumonia, the acute and chronic diseases of the lungs, the index figure for groups one and two runs from 40 to 80 while the index figure for groups four and five runs from 110 to 160. Poverty, unemployment and disease are not three problems; they are one problem or three aspects of the same problem.

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CON

Pierre Édouard Blondin (Speaker of the Senate)

Conservative (1867-1942)

Mr. SPEAKER:

The hon. gentleman's

time has expired.

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CON

Arthur Edward Ross

Conservative (1867-1942)

Mr. A. E. ROSS (Kingston City):

Mr. Speaker, the motion before the house is one of vital importance to any state. I may not have the time at my disposal to state my reasons, but I must say I am wholly in accord with the conclusions of the last speaker (Mr. Stanley), namely, that this motion as it stands at present will not rectify the situation we have to-day. It is perhaps a step in the right direction, containing as it does the suggestion of a better medical service for the people at large. I think it was Disraeli who said that "public health is the foundation of the happiness of the people and the power of that state."

If we look back over what has been accomplished by the medical profession as a whole and by the state, I think we must come to the conclusion that our present position hardly could have been reached or attained under a state system of medicine. A state system of medicine can be defined as a system approved of or supported by federal, provincial and municipal authorities; we are in that position to-day and we have not attained the success we would have liked to attain.

The history of medicine show's that man to-day is in the same position in which he was some 350,000 years ago; man's paramount thought is to search for health, and this he has been doing for thousands and thousands of years. There is no question that when man came upon this earth he found the causes of disease here to meet him, and from that day to this he had been in constant contact and conflict with disease and has made a continuous effort to overcome it. The accumulation of man's experience in this fight against disease has been written down and we should take care now that a similar situation will not arise in the future as has arisen in the past.

It is thousands of years since man first laid down systems of sanitation and medical science. We are not the first people who

National Health-Mr. Ross

have faced this situation. Five or six thousand years before Christ there were systems of medicine; there was state medicine. The Assyrians in their time had a system of state medicine under which free attendance, free service was given to the people at large, and we are just about coming to that situation to-day. But what they had accomplished thousands of years ago was practically wiped out by one great event, the fall of the Roman Empire; when the Goths and Visigoths came down upon what was the civilized world, at one fell stroke they wiped out all that was then known of medicine. The libraries, the accumulation of knowledge, were destroyed, and humanity went down into a thousand years of the deepest and grossest system of magic, mystery and superstition. After that what happened? Plagues and epidemics swept over the world. Italy at one time lost half of her population; Florence, with a population of 130,000, lost 100,000; France lost three-quarters of her population; Germany lost 1,240,000; England lost half her population and only about one out of every ten in London survived those epidemics. Such was the situation that prevailed without a system of medicine.

But just after this thousand years of darkness we leaped at once into three centuries of the finest invention and the greatest progress the world has ever seen. That brings us to the situation we have to-day. From the sixth to the sixteenth century we had all these plagues and epidemics. Then following the sixteenth century there was for three centuries the most wonderful progress in the development of medicine. The eighteenth century saw a development of magnificent hospitals, without which we would never have attained to what we have to-day. We had Westminster hospital in 1720; Guy's in 1727; London in 1740, and Middlesex in 1745. In that one hospital, Guy's, there were discovered three diseases: Addison's, Bright's and Hodgkin's.

The heather then was afire with the formation of those hospitals and the medical science developed rapidly. I should like to point out to the mover of the resolution (Mr. Howden) and to the house that the question is not so much what you will accomplish by the proposal as it is a matter of eliminating, if you insist on a system of state medicine, the possibility of the discovery of things that have produced the wonderful medical development so far attained. Virchow lifted pathology to a high place and led to the fight against a bacilli and bacteria. In the old days the idea was that through the will of God certain demons entered the body; to-day we know

that it is certain bacilli that have caused the trouble. The discovery of that was due to pathology. Then there was the discovery of the microscope, which gave another great impetus to medical science and stimulated the investigations into the development of animal life. The discovery of the microscope brought about the germ theory. From the germ theory we had at once the discovery of anthrax and hydrophobia by Louis Pasteur, the tubercle bacillus by Robert Koch, syphilis by Paul Ehrlich, and, in our day, diabetes and insulin by Banting. These discoveries gave the medical service such an impetus that the medical men are now in the position that they are challenging youth to give them the opportunity of preventing sickness and disease. The few men I have mentioned have made it possible for the medical profession of today to say to every country: Here we are, ready to prevent disease from overcoming your people. So Disraeli was well informed when he said: Public health is the foundation of the happiness of the people and the power of the state. That is the position in which we are to-day. We have all these discoveries: the X-ray, the microscope, the knowledge of the germ theory, the preventives against germs, and we have them ready for the service of the people.

How can we give the people the benefit of this medical service? The mover of the resolution had in mind the fact that in the last three centuries medical science has developed to such an extent that, with the exception of two or three diseases mentioned by the last speaker, we can challenge any disease there is. In the face of such wonderful things as the medical profession has to offer, what have we in the way of organization to deal with conditions? The last speaker has referred to many things. Let us study this organization, just as the hon. gentleman has suggested. Some have said: Well, this is a provincial matter; what is the province doing? I think you can sum it up by saying that as a matter of organization it is a horrible mess. The provinces look after hospitals, clinics, drug stores, laboratories of all sorts; health departments of many industrial firms; private organizations, tuberculosis associations, visiting nurses' societies, maternal clinics, infants' welfare, venereal diseases. The provinces control public health in the way of communicable diseases, collection of vital statistics, water supply, disposal of waste and sewage, diagnostic laboratories, inspection of factories, state of medical colleges. The federal department control the inspection of food markets, narcotics, immigra-

National Health-Mr. Ross

tion inspection, army and navy medical stores, and marine service. Surely it must be admitted that this incongruous mess in what is called state control or assistance is very unsatisfactory in the face of the wonderful discoveries to which I have referred.

What is the answer? What can we do? I agree with the last speaker that we cannot by any such resolution as this, calling for state medicine and the examination of individuals, accomplish very much. If you want to inaugurate a system of state medicine that will bring every physician under the control of the state, then I contend that you will wipe out the great discoveries I have mentioned- the invention of the microscope and all the appliances that are now available. The physician to-day finds himself in the position of being unable to give to the people all the services they should have in the war against disease. We cannot with just one resolution come to the ideal situation. The mover of this resolution (Mr. Howden) deserves the commendation of the house for bringing before it such an important question, but I do not see that such a system as he advocates would be practical. I believe that to-day we have in the federal Department of Health the nucleus which would enable us to take the next step, and that is the coordination of all the forces in the state which are contending against disease. There should be some control of these forces, which now are like comets, flying through the air and getting nowhere. If there was a department with power to take all these different agencies in hand and coordinate the forces that are at work in the activities directed against disease, we could accomplish a great deal for our people. We could endeavour to coordinate the industrialists who are finding it to their advantage to put into practice some of the theories that have been advanced, and coordinate also the private capitalists who might wish to place at the disposal of the state for the welfare of the people the money that would help in this great work.

What is the use of going on as we are at the present time? The province of Ontario is engaged in a fight by itself against cancer. In the army, in the last great war, we came to this conclusion. In the early stages we would send a battalion to attack. Then we got a little stronger and said: We will try a brigade. If that was useless and we were losing men, we would try a division, and finally we got to the stage where we sent in a whole army. If you are going to attack anything, attack it with all the forces that are

available, and there should be some power in this country that should be able to coordinate all the forces that are now available and concentrate them upon an attack, a cannonade on this one objective.

The situation to-day so far as the British North America Act is concerned is antiquated. Preventive medicine is no longer a provincial or a municipal matter. The speed of transportation is such that an epidemic can spread very rapidly, and yet we are perhaps attacking this thing as they would have done in that thousand years of darkness which I pictured. The only protection from disease that people had then was flight, and kings, 'legislators, aldermen and physicians, all took advantage of it. What was the result? Their flight only spread the disease further. In those days they had no protection other than separation and isolation, but to-day we have science. Nevertheless the development of transportation has made the possibility of the spread of disease greater than it ever was before. For instance, in South Africa in a little tribe of three hundred thousand people a disease known as sleeping sickness developed which wiped out that whole tribe, and in a few short years, owing to the ease with which people can move about, the disease had spread all over the world. To-day an epidemic can be spread across this continent in a very few days, so that the question of prevention is no longer a provincial one. It has developed into the larger question of federal protection. Here in the federal government we have a department which perhaps we do not think very much of, but which nevertheless covers all the work I have mentioned, and in it we have the nucleus of a department than can be of great use to our people. This is not only a national question, but an individual one. Do you know, Mr. Speaker, that at the time of the Roman Empire the expectation of life was only about twenty-one years? To put it in the language of the scientific man, a child born at the time of the Roman Empire had a prognosis of life of twenty-one years. Let us trace that expectation of life down through the ages. In the dark ages the expectation of life was twenty years; in the sixteenth century, twenty-one; in the seventeenth century, twenty-six; in the eighteenth century, thirty-five; in the eighteenth century and a half, forty; in the nineteenth to the twentieth century, fifty. The expectation of life, according to insurance companies, has reached the high point to-day of from fifty to fifty-one years. So this question is not only of national but of individual importance. Every man should be glad to

National Health-Mr. MacLaren

know that this prognosis of life has been more than doubled since the time of the Roman Empire.

The situation to-day is this: the medical profession finds itself in the position that it is no longer able to give the people the benefit of the wonderful discoveries that have been made in the last three centuries, and the hospitals are finding it a difficult matter. As the mover of the resolution says, perhaps in the very near future it must devolve upon the governments of this country, provincial and federal, to provide a better medical service to the people than they have had in the past. My conclusion is, with regard to the latter part of the resolution at least, that it is our duty to provide medical service and to prevent disease, and that can be done only by the coordination of all the forces that are now at work fighting against disease and which are responsible for the wonderful progress that has been made up to this time.

Hon. MURRAY MaeLAREN (Minister of Pensions and National Health): I think that a number of members proposed to take part in this discussion, but time is unfailingly moving on and unfortunately we in the house shall not have the benefit of hearing them speak on this important subject. The mover of the resolution (Mr. Howden) has proved his faith and enthusiasm by again bringing forward this year the subject of state medicine. One must recognize that the object of his speech to-night, as it was of his speech of last year, is the amelioration of the health of our citizens. We appreciate the truth and the importance of the hon. member's statements regarding health. We recognize that good health is a boon, and we are familiar with its full meaning. On the other hand we know the distress, the grief, the loss and all the disastrous consequences that are wrought by disease. Therefore anything we can think of to add to the health of the nation and curtail disease is worthy of our best effort and attention.

The hon. member for St. Boniface has in his resolution brought forward two distinct propositions. One is the periodic examination of the people, and the other the provision of medical treatment for those requiring it. May I say first that periodic examination is a big question, and I would say the same about the provision for medical treatment. I cannot help thinking that the mover might have proceeded with one phase of the matter and left the other until a later time. Little by little is a sound motto in matters pertaining to health and medicine. However, his enthusiasm

has induced him to bring both measures before us.

I should like to draw the attention of hon. members to the fact that I am not aware of any country which has adopted a system of periodic examinations. I know of no country on the face of the earth where such examinations are made. I do not argue that for that reason we in Canada should not think of attempting such examinations, but I do suggest that the course adopted by other countries should make us pause. We find countries in Europe leading in scientific advancement which have not adopted the principle set out in the resolution. Those countries, have done magnificent work, yet I can think of no place where periodic examinations have been adopted. I learn that a London physician named Dobell-I believe we are all familiar with the Dobell solution-about seventy years ago proposed periodic examinations.

Topic:   NATIONAL HEALTH
Subtopic:   PROPOSED PROVISION FOR MEDICAL EXAMINATION AND MEDICAL RELIEF
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LIB

John Power Howden

Liberal

Mr. HOWDEN:

I should like at this point to interrupt the minister. I suggest to him that in many provinces of Canada there is periodic health examination. In those provinces there are district health nurses who make primary examinations, and in cases where diseases are found a doctor is called. That is a provincial matter.

Mr. MaeLAREN: Quite so. My point, however, was that there was no state, in the broad sense of the term, where these examinations have been adopted. Two years ago periodic examinations were suggested by the Canadian Medical Association and as a result four life insurance companies adopted the suggestion. They were assisted by the Canadian Medical Association, and the federal Department of Pensions and National Health provided literature. The result was that the Canada Life, the Sun Life, the London Life and the Confederation Life are now carrying out at their own expense periodic medical examination on their risks. However that is a very long way from the country at large accepting such a program.

After all we must to a considerable extent begin with ourselves, and examinations must be voluntary. I should like to ask how many hon. members in this chamber undergo periodic medical examinations. At the present time many people in Canada are aware of the benefits to be derived from such examinations, but I venture to say a very small percentage take advantage of them. I am simply pointing out, however, that the procedure suggested

Income Tax Exemptions

by the resolution has not been followed by other countries, and that enormous organization, effort and expense would be required.

I am afraid time will not allow me to go further into detail. I should like to indicate however that although this is a matter which might well be brought to the attention of hon. members and the country generally, it does not lie within the purview or jurisdiction of the federal government; the provinces are wholly responsible, and I cannot help but think that in the end they will hasten the advancement of the suggestions brought forward by the mover of the resolution.

Topic:   NATIONAL HEALTH
Subtopic:   PROPOSED PROVISION FOR MEDICAL EXAMINATION AND MEDICAL RELIEF
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At eleven o'clock the house adjourned without question put, pursuant to standing order. Tuesday, March 22, 1932


March 21, 1932