Mr. MARTIN:

Is the hon. member referring to the return tabled the other day?

Mr. BLAIR:

Yes. The lack of hospital accommodation is apparent to any person who has tried to obtain a room in a hospital

during the last few years. In an attempt to cut down on overhead expenses, hospitals have found it necessary to reduce their staffs, and the nurses are overworked. Unless patients can afford special nurses, often they do not receive sufficient attention. It is estimated that in all branches of the nursing service the shortage of professional nursing personnel now stands at 8,700. Of these, 7,000 are needed for all types of hospitals; 1,200 are needed for private duty, and 500 are needed for public health.

In regard to the question of beds, I quote from an article which appeared in the Globe and Mail of May 27. It is a dispatch from Niagara Falls; and this is the common thing we hear all over Canada in regard to hospitals:

Niagara Falls, May 27. Major Robert Buckner, 'business manager, told the Niagara Falls hospital trust tonight that the women's ward in the new wing has been closed for lack of nurses. "It may be necessary to close the men's ward in the new wing," he added.

The shortage of nurses today is due to the fact that the rate of increase in the number of nurses graduating has not kept up with the rate of increase in the demand for additional nursing service. The rate of admission to hospitals, according to the population throughout Canada, has greatly increased over the pre-war rate. In Ontario hospitals, the admission rate is more than sixty per cent higher than in 1931. In the event of an epidemic such as influenza, our position in Canada would be hazardous. We must remember that in the influenza epidemic of 1918 we lost 30,000 people in the Dominion of Canada. This is something we simply could not cope with at the present time.

Environment, especially during childhood, is a requisite of health. Unsanitary houses providing poor shelter are conducive neither to health nor to good citizenship. The ratio of sickness is higher in the slums than where the people are well housed.

There are widely different standards of health between one province and another. Under section 91 of the British North America Act, the health of the people is the individual responsibility of each province. There is an inequality in various fields such as public health or tuberculosis control as between provinces, and as between urban and rural areas of provinces. At this time it would be impossible to tabulate all the requirements of an adequate public health program for the dominion.

I hope I shall not be accused of advocating expenditures. I do not think there is one

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member in the house who would consider it an extravagance to spend money where human life is at stake or for the relief of suffering.

I have discussed the necessity for research and the lowering of the mortality rate in cancer, preventable diseases, maternal and infant mortality, and tuberculosis. I have drawn attention to the serious shortage of hospital beds and trained personnel. Again I refer to the fact that the cost of sickness is becoming beyond the means of many people. The solution of these urgent health problems is, therefore, an adjustment among all the provinces and the dominion. The two largest provinces have not yet reached an agreement, although the premiers of those provinces have requested another dominion-provincial conference.

In view of the situation I have described regarding the over-all health picture in the dominion, the Minister of National Health and Welfare (Mr. Martin) should be the first to raise his voice in demanding a renewal of the dominion-provincial conference. If by the calling of another conference the life of even one child of a Canadian citizen could be saved, then there should be no hesitation. A grave responsibility rests upon the federal government.

Mr. MARTIN:

I am sure we have all listened, and with great profit, to the address we have just heard. Let me say at the outset to the hon. member that the temper of his observations and the constructive nature of his suggestions are in keeping with the kind of cooperation which, as an eminent member of the medical profession, he has given to me since I became Minister of National Health and Welfare. While there may be one or two points on which it may be expected that we shall have different points of view, I want him to know that I shall follow with great interest, not only the speech he made tonight, but also the excellent speech he made in the house early in the present session of parliament.

I would not be doing my duty if in my first observations respecting the estimates of the Department of National Health and Welfare I did not pay what I think the committee generally will recognize as a deserving tribute to my predecessor, the present Minister of National Defence (iMr. Claxton), who took over this department when, on the welfare side, there were new assumptions of responsibility which might well have taxed the ingenuity, energy and imagination of any man given that particular portfolio. Might I add that, while the w'ork of this department is not such as to engage the headlines, it is extremely important and complicated. Mj1- daily expedience confirms my earlier judgment of the great contribution my predecessor has made in-this department.

The hon. member who has just spoken has pointed, and quite properly, to the general health state of this great country of ours. He will not think me unfair, I hope, if I add that in his statement he did not draw the lines which, ag Minister of National Health and Welfare, I must draw in respect of the constitutional distribution of powers and responsibilities of the federal government with regard to many of the matters he has discussed. But I do agree with him, and I say to the committee that, while we spend a great deal of time in the discussion of many matters, perhaps there is no field of governmental endeavour on the federal level which touches so directly the welfare of the people of Canada as does this department.

The hon. member referred to arthritis, and perhaps later in the estimates I shall have more to say about this specific item. But I may tell him-and I announce now-that the technique we employed early in January in calling together here in Ottawa, the capital city of our country, those who were interested in cancer control, will be employed again when all the authorities, governmental and professional, in the field of arthritis, are called within a very few months, to see if we cannot provide some coordinating authority to carry on in the field of arthritis; as I ultimately hope to show we did and have done in the important field of cancer.

I am sure hon. gentlemen will regard what I am now saying not in any sense as an expression of political partisanship, because I hope we can follow the lead given by the hon. member who has just spoken in looking at this matter as one which should not divide us on a political basis. Through the officers of my department I have had an opportunity of consultation with Lord Horder who, as hon. members will know, is one of the outstanding authorities in his profession in the rheumatic field, and who has in Great Britain set up a number of investigational clinical centres for the treatment of this malady.

Likewise, Doctor Wallace Graham of Toronto, an eminent physician in this particular field, has also been in consultation with the department. These two sources, to whom I have referred, together with the Canadian Rheumatism Association, will be the basis of a conference which, I hope, will lead to an examination of all the possible avenues available to bring about some relief in respect of this painful affliction.

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Mr. MacNICOL:

May I ask if the medical departments of the provinces cooperated?

Mr. MARTIN:

Every one of the provincial departments of health cooperated. I was anxious to learn from them, as I am sure every hon. member would be, whether or not our maximum effort was being put forward to eradicate this disease or whether, as I suggested a moment ago, we were only making a piecemeal attack on a great national hazard. I learned that -what has often been referred to as the war against cancer was not a total war. The campaign was, in reality, a series of local attacks, many of them magnificently fought, nevertheless not capable of justifying the designation of an all-out national campaign.

There was the lack of research workers, the lack of laboratory facilities, the lack of coordination of effort, and particularly the lack of the instruments, material and human, by which we could at least say that we were putting forward our best effort. It became apparent as well that the public conscience was uneasy and that the time was ripe to mobilize our entire efforts in some sort of unified or coordinating command or body. The moment had come, it seemed to me, and it seemed to them, when a concerted, well-organized and a properly directed attack on cancer should be pursued. It was generally recognized by those who wrere there, men like Doctor Charles Best, one of the great collaborators and co-discoverers of insulin, and Doctor Collip and others that I could mention who have

made a contribution in one field or another in medical scientific research, that no advance could be made until we had some sort of intelligence report. They canvassed the problem from every angle, and after two days of full discussion preceded by ex parte reports and submissions, we were able to arrive at a full measure of agreement. First of all, there was a discussion as to what was being done in the field of education. We reviewed the extent of scientific research at present being carried on at the universities. We heard reports about the facilities set up in the provinces for diagnosis and treatment of sufferers of cancer, and we inquired into the reasons why so few young men were willing to devote themselves to full-time investigation of the causes and cure of malignant growths.

Then our attention was turned to the urgent necessity for assessing the whole problem by means of surveys and the need for adopting some form of uniform reporting, not only of deaths from cancer, but also the data about cases that have been diagnosed, treated and saved from dying. Lastly, and perhaps of most importance, ways and means were explored by.which an adequate campaign against cancer could be waged. The conference moved unerringly towards one objective. When we talk about the problem of unity in this country I think of medical men and laymen from all provinces working together so that problems in Canada may be solved. I think, for instance, of Doctor Simard of the university of Montreal, and I think of Doctors Vezina and Bergere of Laval collaborating with men like the former dean of the School of Medicine of the university of Western Ontario, Dean Hall, now president of the university; I think of men like Best and Collip and the dean of McGill and so on, all working toward a common objective.

Mr. POULIOT:

And Doctor Adelard

Groulx and Mayor Camillien Houde of Montreal.

Mr. MARTIN:

One had the impression there of what could be done to meet the objectives of the hon. member for Lanark (Mr. Blair), that this is a problem which should engage our full cooperative effort on all levels of government and of all classes in the community.

We moved unerringly forward to a single objective, namely, that we should formulate and direct a national cancer control programme. It was decided to set up a body that is now known as the National Cancer Institute of Canada. May I say at once the word "institute" may conjure up in the minds of

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some the idea of brick and mortar. That, I can say, is not and was not the intention of the founders of the institute. That sort of thing may come later, but an effort will be made first to try to bring about in the three avenues I have mentioned some control of this dreaded disease. No one can guarantee that the efforts of the institute and the work that they may project will succeed; but we should be able to say, I trust, after some years of experiment with this particular technique, that we have done all that we know how as human beings to try to meet this problem.

The institute, I may say, as a result of their own decision is a non-governmental body, non-profit making. The men and women who had come from all parts of Canada decided that it would be better to have this institute modeled along the lines perhaps of the Imperial Cancer Institute in Great Britain and corresponding bodies in the United States which are non-governmental. There was, however, proper acknowledgement of the part which both provincial and federal governments made in initiating the conference. It was thought that cancer control is dependent upon many factors; first, that there is a serious shortage of young scientists in Canada who are qualified or trained in the technique of cancer research. This includes both men and women in, laboratory or clinical investigation teams. The reason, is apparent. Young graduates in medicine, biology and the physical sciences find that they have to make a living after graduation. This they cannot do on the grants which are available to them through various organizations at present sometimes dispensing aid to research. The universities in many instances are not sufficiently endowed to pay adequate living allowances. The national research council has its responsibility and I am sure, when the problem is canvassed, as it is being canvassed, that body will show and continue to show its deep concern and interest in the problem. The final result, however, is that our young graduates, particularly, those with a bent towards research, are being directed sometimes in other quarters and elsewhere where they are provided with the necessary conditions under which they can give their full attention to investigation without worrying unduly over clothing, shelter and food. The National Cancer Institute plans to do something about this state of affairs.

Second-and this concerns physicians and their patients directly-there is a need for reviving the excellent undergraduate and post-graduate educational programme begun by the Canadian Medical Association before

the war. The war made it necessary to abandon temporarily these lectureships throughout the country. Personnel was simply not available with over three thousand doctors in the service.

The founders of the institute declared their belief that the universities, and the medical schools which are actively engaged in cancer research will recruit more research students who have an increasing awareness of their responsibility to professional education. Doctors will be even more enthusiastic in making early diagnosis and in keeping accurate studies of their patients and making close contact with the special treatment centres so wisely provided throughout the provinces.

It w-as the opinion of the conference that some uniform system of reporting cases and deaths should exist throughout the provinces, and steps will be taken to explore this question as it was explored at the last meeting at the Dominion Council of Health. It is thought that, with every physician contributing to cancer research in this way, the problem of cancer control will attain its true perspective.

Third, it is obvious that physicians can diagnose only the cases of those who come to consult them. This is where the splendid work of the Canadian Cancer Society comes into proper focus. As I have said, this organization deserves the warmest praise of everyone in Canada. They have persistently presented to the people the opportunity and the benefits of early diagnosis and the necessity of medical examination.

One of the conclusions of the conference was that the Minister of National Health and Welfare, as one of the trustees of the King George V cancer fund, should address himself to the trustees of the fund to see if the fund could not be placed at the disposal of the cancer institute to enable it to carry on its work. I regretted having to intervene when the hon. member for Lanark was speaking, but I am sure he will agree that I should have intervened to indicate clearly that this cancer fund was in no wise under the control of the government, but that the Prime Minister, the Leader of the Opposition, the Chief Justice of Canada, the Minister of National Health and Welfare, Professor Boyd of the university of Toronto, and one gentleman representing the insurance bodies should be approached as trustees of the fund to see if the claims of the institute for financial assistance did not deserve attention. I may say that the motion moved by the Prime Minister and seconded by the leader of the opposition reflected the determination of the trustees of the fund to see that every initial opportunity was given to the cancer institute to carry on

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its work. That has been done. A sum of money on a three-year basis has been turned over by the trustees of the fund to the cancer institute. The president of the institute is Doctor Blair of Saskatchewan; the vicepresident is Doctor Simard of Montreal. Then there is Doctor Low Little, an eminent physician of Guelph and lately of the Department of National Health, who has taken over the active secretaryship and direction of the organization.

Mr. TIMMINS:

How much has been turned over to the institute on a three year basis?

Mr. MARTIN:

Four hundred and fifty thousand dollars. The idea is to give #150,000 each year for a three-year period. At the end of the first year the directors of the institute are to appear before the trustees and indicate how they have expended1 the funds.

I simply make this observation and I say this as one who has no official connection now with the institute. My part in it was humble, that of calling a conference together and giving it an opportunity, by virtue of the particular portfolio which I hold, of trying to bring about some decision in the field of coordinated activity and effort.

Mr. HACKETT:

How much is in the fund?

Mr. MARTIN:

Approximately $490,000 I think, but the institute has been given $450,000. I now speak not as a member of the institute because I am not, but as one who is anxious to see the institute do its job so that no stone will be left unturned. It is important that the beginnings be sound. Whatever assistance comes from the dominion or provincial government-and I am not now making any statement with regard to contributions; that I will do at the proper time- it will be recognized, I am sure, that whatever assistance is given a large sum of money will be needed over the period, and there will be large sums needed if the research projects contemplated by the institute are to be undertaken.

One of the great avenues of assistance will be not only from official but from private sources. I can say at this juncture without in any way breaking confidences that already individuals in this country have shown themselves anxious to make their contribution toward the remedial efforts of one of the greatest maladies known to man, and whenever the institute makes its decision as to the form and nature of its appeal I am sure it will find all groups in this country anxious to make the work of the institute a notable success.

The future of the institute is in the hands of the professional and lay men in this country interested in this problem. I can only say at this juncture that I have exhibited, and I say this humbly, on the part of the department a real interest and a determination to see that we do everything to try to meet this problem.

I think the other matters to which the hon. gentleman referred can be dealt with as we proceed. I want to thank him again for giving me an opportunity to make a statement which I think is of great importance and to say to him how much I appreciate the kind of contribution he himself made tonight.

Mr. TIMMINS; I am sure the committee thanks the minister for his remarks in respect of cancer and the programme of the government with regard to the national cancer institute. There arise out of his remarks some questions with which I should like to deal.

It is quite clear that the King George V silver jubilee cancer fund contains at the present time only $490,000, and the minister stated a few moments ago that $150,000 a year is to be turned over to the institute in each of the next three years. I presume that this money will be used, for the most part in educational work, with a good portion of it being used for research, because that seems to be the matter with which the cancer institute will mostly concern itself.

Mr. MARTIN:

I do not quite agree with that statement of the functions of the institute as declared by the institute. I just want to make that reservation.

Mr. TIMMINS:

I have before me a return which was made by the minister's department on the 29th of May, in which the question was asked as to the annual expenditure in 1935 to 1945 through the national research council directed at finding the cause and cure of cancer, and the answer given in the return had this to say, among other things:

Any person qualified to direct medical research and having the required fundamental laboratory facilities at his disposal-

Mr. MARTIN:

If the hon. gentleman will permit me, he is referring to something else altogether. I was talking about the institute. He is now referring to the medical division of the national research council. [DOT]

Mr. TIMMINS:

Yes.

Mr. MARTIN:

I do not like to interrupt my hon. friend's statement. I perhaps did not state clearly the aims and objects of the institute. They are:

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1. To coordinate and correlate the efforts of individuals and organized bodies with a view to reducing the morbidity and mortality from cancer in Canada.

2. To aid in establishing and maintaining or to establish and maintain fundamental research activities in the field of cancer.

3. To assist in the training of prospective scientists who may be interested in the field of cancer research by the award of fellowships for this purpose.

4. To collect, assess and disseminate scientific knowledge and material relating to cancer.

Mr. TIMMINS:

I thank the minister for his interruption. The return to which I am referring has to do with applications made and taken care of by the national research council. During the period of some ten years it appears that the national research council spent some $4,364 on cancer research. I would ask the minister this question. Is it not to be assumed that the duties of the national cancer institute will override the former powers and the former work of the national research council in respect of cancer? Will the cancer institute take over the work which formerly the national research council did in regard to cancer?

Mr. MARTIN:

To some extent, with the cooperation of the national research council.

1 regret to have to say that my colleague the Minister of Veterans Affairs has an important motion to make and has to leave before eleven o'clock. I trust the committee will allow him to intervene at this time.

Progress reported.

Mr. MACKENZIE:

Under standing order 45, I should like to move, seconded by the Minister of National Health and Welfare (Mr. Martin):

That the house meet at 3.30 p.m. on Wednesday, June 11, notwithstanding standing order

2 in relation thereto.

That is in order to give our colleagues in the House of Commons an opportunity of meeting our distinguished visitor.