Right Hon. W. L. MACKENZIE KING (Prime Minister):: Mr. Speaker, before we begin the afternoon's proceedings may I be permitted to say to my right hon. friend the leader of the opposition (Mr. Bennett) how sorry I have been to learn that because of an impaired condition of his heart he has found it necessary to inform his party that he will not be able beyond a few months to continue to hold the position of its leader which position he has held during the past ten years. I know this expression of regret will be equally felt by all hon. members, and I hope that the right hon. gentleman will permit me to express this feeling toward him on behalf of the house.
I have often marvelled that my right hon. friend found it possible to assume the great amount of work he has undertaken, knowing something of the tremendous strain which, as leader of a political party, part of the time leader of the government and part of the time leader of the opposition, he has had to endure. Knowing how completely my right hon. friend's life has been devoted to public affairs, how conscientiously he has performed his duties as leader of his party and in the house, I can imagine how distressing it must be to him to feel that, because of the condition of his health, he is obliged to relinquish some part of those duties. In the decision which has become imperative he has my sincere sympathy.
I would express the hope that with release from extra strain, and some of the exacting burdens he has borne my right hon. friend's health may be speedily restored; that the

Civil Service-Special Committee
greater freedom thereby assured, may serve to increase and prolong the enjoyment of his days as well as afford opportunities of useful public service in other ways which otherwise might be denied.


Right Hon. R. B. BENNETT (Leader of the Opposition):: Mr. Speaker, I am sure it is not expected that I should do more than thank the right hon. gentleman (Mr. Mackenzie King) and those associated with him for the very kind observations he has made touching my own relations with the party with which all my life I have been associated. I realize that the strain of five years of stress left an effect upon me, but my general health has been far better during the last few months than it has been for some time. Unfortunately that is no index as to the condition of one's heart, and I was told last year that I must abandon these duties that I have been endeavouring to perform. I was slow to believe that that might be necessary, for reasons which I dare say the right hon. gentleman can understand and every hon. member of this house will appreciate. Nevertheless, a general election being within reasonable sight, I was told that it would be quite impossible for me to carry the burden and strain of such a time. So I felt it was my duty to acquaint my political friends with that fact.
I am not delivering any valedictory; that will be left for another occasion. But I would be less than human if I did not express to my right hon. friend my very warm appreciation of his kind thoughts which, as a matter of fact, he expressed in a letter which he sent to me yesterday. I am deeply sensible of the kindness with which the house has received his words of sympathy, as well as his words of regret. I can only say, Mr. Speaker, that I would like to thank the house for this manifestation of good will, which, perhaps, if it had been expressed in more strenuous times, might not have been necessary at all.


Mr. JEAN FRANCOIS POULIOT (Temis-couata):: Mr. Speaker, as one who never agreed with the policies of the right hon. gentleman who has just spoken, I heartily join the house in extending to him my very best wishes for happiness, good health and a full enjoyment, of life outside the house.



CIVIL SERVICE


[Stage Direction]
Mr. JEAN-FRANQOIS POULIOT (Temis-couata) moved concurrence in the first report
of the special committee appointed to inquire into the operations of the Civil Service Act.
Hon. CHARLES A. DUNNING (Minister of Finance):	I intended to refer the other day
to the provisions of this report, to which we are now asked to give concurrence, dealing with the printing of evidence to be taken before the special committee appointed to deal with civil service matters, but the chairman of the committee was not present at the time. I should like to call attention to the great expense which would be involved in producing what I am sure would be a second Hansard for a considerable number of days.
I do not know how we should deal with it in the house, but surely some discrimination could be shown as between evidence of real value given before the committee and that great volume of other evidence and discussion which will not help to clarify the issue but which may even help still further to confuse it. In the interests of economy I do hope that the committee will endeavour to make some arrangement to make unnecessary the production of a voluminous and continuous Hansard.
Jean-François Pouliot: I regret very much that
the Minister of Finance (Mr. Dunning) did not mention this matter before, because I feel sure we could have come to an amicable understanding. First of all, let me say that the evidence given before all other civil service committees has been published for the information of hon. members. I am not in a position at the present time to state just what evidence will be given this year; that matter is to be discussed to-morrow morning by a subcommittee which is to draw up a kind of agenda of the witnesses to appear before the committee. We had voluminous reports of the proceedings of the committee to investigate the prices of farm implements, and the same is true of other committees. I submit respectfully that the printing of the evidence of this committee which is to deal with matters of interest to all members of the House of Commons is deserving of consideration. I realize that some members will never look at the reports that will be published, but even if only ten or twenty members read them, I submit it would be useful to have them printed. I do not want to have any restraint placed upon the relevant evidence that may be given, but I believe the members of the committee are in earnest in their intention to ask only pertinent questions of the witnesses; therefore, the evidence will be much shorter and less costly.


William Lyon Mackenzie King: Might I suggest that
Canada Evidence Act

this motion be allowed to stand until the chairman of the committee and the minister have had an opportunity of conferring.
Motion stands.



PENITENTIARY ACT AMENDMENT


[Stage Direction]
Right Hon. ERNEST LAPOINTE (Minister of Justice) moved for leave to introduce Bill No. 36, to amend the Penitentiary Act.
He said: The purpose of this bill is to harmonize the provisions of the Penitentiary Act with those of the criminal code with regard to the computation of the time served by convicted prisoners who are detained in gaol pending the determination of appeal.
Motion agreed to and bill read the first time.


[Stage Direction]
Right Hon. ERNEST LAPOINTE (Minister of Justice) moved for leave to introduce Bill No. 37, to amend the Canada Evidence Act.
He said: This bill involves three changes in the act. The first amendment is to make a wife or husband competent and compellable witnesses for the prosecution in charges of theft by either the husband or the wife of the property of the other while living apart. This is a special offence under section 354 of the criminal code. The other two changes are for the purpose of avoiding cost in proceedings. The first is to permit proof by affidavit of the sending of a notice or an order by any branch of the public service instead of compelling witnesses to go from Ottawa to all parts of Canada to make that proof. The other amendment is for the same purpose but with regard to banks. It is to permit proof by affidavit that there is no account where a cheque has been issued, if such be the case. Under the law as it is, it is permissible to prove by affidavit that there is an entry on the books of a bank, but there is no permission to prove the negative. This is to make both the same.
Motion agreed to and bill read the first time.

[Stage Direction]
(Questions answered orally are indicated by an asterisk).

Mr. CHURCH:: 1.	Has the attention of the government been called to the evasions of income tax in Canada by wealthy evaders who have left Canada?

2.	Is the government aware of several rich millionaires moving to the West Indies and other places outside Canada, with their wealth, to escape taxation, and, if so, what action has been taken?
3.	What has been done to effect such a proposal and for a registration system to check evasions, and will any select committee be appointed to go into the matter?
4.	Is the government aware that scores of wealthy Canadians are taking up residence in the Bahamas in order to escape tax levies?
5.	Will any register be established of income tax?
6.	Is any list of delinquents published in the blue book form, or has the auditor general asked leave to cheek up same?
7.	Will correspondence, if any, between the auditor general and the Department of Justice on this subject, be tabled?
8.	What action has been or will be taken in the matter ?
9.	What does Ontario pay federal government for collecting its income tax, or is it collected at cost?
10.	What steps are being taken to amend either (a) the criminal code; (b) the Immigration Act, or other statute law, to prevent Canadians in Canada crediting all their assets to companies they own or control and then escape income tax by investing surplus abroad?
11.	Have any representations been made by the government of Ontario to either jointly with federal power or separately take action herein, and will all correspondence, if any, be tabled?


Mr. ILSLEY:: 1.	The words "evasion" and "evaders" are not precise. If they be taken as implying default under the Income War Tax Act, the answer to the question is in the negative. If they refer to persons who have left Canada, wholly abandoned their residence in Canada, and are permanently resident abroad, the answer is in the affirmative.
There are such persons. They are, however, not within the purview of the Income War Tax Act. They are required to pay only in respect of income which has its source in Canada, in the same manner as other nonresidents of Canada who have the source of their income within Canada.
There are a number of persons, said to be well-to-do, who continue to maintain a residence in Canada but who also have a residence abroad in which they spend a considerable portion of their time. The government is not aware that any of these persons evade their Canadian income tax liability. They are all liable to income tax on the total income from whatever source derived throughout the world, whether directly or through the holding of shares of personal corporations incorporated abroad, because they have a residence in Canada, which brings them within the purview of the law whether they are personally in Canada or not.

Questions
Therefore there are two groups of persons,-
First, those who have a residence in Canada and also may have a residence abroad, and
Second, those who have no residence at all in Canada and reside wholly abroad.
The government is not aware in either case of evasion of the Canadian income tax law. The former pay, as stated, on their total income from all over the world. The latter do not evade, they simply are not within the purview of the income tax law as residents of Canada. They only pay, as all nonresidents of Canada throughout the world pay, namely on the income which has its source within Canada or on the profit, if any, from the carrying on of any business in Canada.
2.	The government is aware that some persons give up their residence in Canada and take up residence outside of Canada, just as some persons give up their residence abroad and take up residence in Canada. Persons leaving Canada move into jurisdictions some of which have higher and some lower taxation laws than exist in Canada. The government is aware that some persons said to be well-to-do have left Canada and abandoned all residence therein.
3.	A tax roll continually amended so as to keep it up to date is maintained in the income tax division showing all persons resident, ordinarily resident or carrying on business in Canada and as such liable to income tax.
4.	The government is aware of a number of Canadians who have taken up residence in the Bahamas and other places and who at the same time maintain a residence in Canada. Such persons continue to pay tax in full as residents of Canada on their total income from sources throughout the world, even though they be personally absent from Canada for a substantial portion of each year.
The government is aware that some Canadians give up their residence in Canada and reside entirely abroad. Non-residents of Canada throughout the world are not liable to Canadian income tax except in respect of income that has its source in Canada.
5.	See answer to Number 3.
6.	If by "delinquents" is meant those who are delinquent in filing income tax returns, the tax roll section of the income tax division requires the filing of returns and if not filed the delinquents are prosecuted for failure so to do.
If by "delinquents" is meant those who do not pay their taxes in full, the collection section follows up the outstanding amount, demanding payment from the taxpayer and may enter upon such legal action as may be necessary to effect collection. All ledger accounts are open to the auditor general for checking purposes.
7.	See Auditor General's Report-1937, Vol. 1, p. 253, et seq.
8.	Answered by Number 7.
9.	At the rate of 880,000 a year.
10.	Steps were taken, to prevent personal companies incorporated abroad from being used to minimize taxation by requiring all persons resident or ordinarily resident in Canada who owned, directly or indirectly or through trusts, shares of companies incorporated in any part of the world outside of Canada, when the income of such company is derived from interest, rents, royalties, dividends or other similar income, to declare under the Canadian law in their individual income tax returns the income of such company or companies, whether the same is or is not in fact distributed, and as well all personal income from whatever source derived and to pay tax on the combined income. This was passed in 1926 applicable to 1925 and subsequent years. Any person who files a false return is subject to prosecution under Part 15 of the criminal code. No further steps are being taken to amend the acts referred to in the question.
11.	No such representations have been made, therefore there is no correspondence to table.


OTTAWA PUBLIC WEIGH SCALES
Mr. DOUGLAS (Weyburn):: 1.	When was the last inspection of public weigh scales in the city of Ottawa?
2.	What were the reasons of said inspection, and, (a) the number rejected; (b) the number passed ?
3.	Has the department adopted methods to reduce the capacity weighing of the Ottawa public weigh scales from 20,000 to 13,000 pounds?
4.	If so, (a) what method has been used; (b) how many scales have been affected; (c) on whose authority was such action taken; (d) what was the reason for such action?
Mr. EULER;
1.	January 18 to 22, 1938.
2.	Request by city officials for quarterly inspection. (a) three (passed after minor adjustments); (b) eight.
3.	Answered by 4 (a).
4.	(a) The travel of the main saddle poise was restricted by a stop block; (b) Six; (c) No authority involved

suggestion by the department acted upon by the city; (d) To keep excess truck loads off the lighter scales.
Questions


GREAT BRITAIN AND ITS EXTERNAL AFFAIRS- BRITISH WHITE PAPER TABLED IN LONDON
Mr. CHURCH:: 1.	Will the government prepare another white paper similar to the one they issued regarding Italy and Ethiopia, giving all correspondence in relation to the government of Great Britain and its external affairs, as far as related to Canada since the last white paper was issued here?
2.	Would it be possible for the government to secure copy of the British white paper said to have been laid on the table by the Prime Minister in the House of Commons, London, to-day, covering foreign affairs with references as they relate to the dominions in this matter?
3.	If these two white papers are prepared or received by the government, will they be laid on the table of the house and a copy distributed to the members?


Mr. MACKENZIE KING:: 1.	It is not considered practicable to furnish a document of the scope suggested.
2.	Copies of the white paper tabled in the House of Commons at Westminster March 2, by the government of the United Kingdom, which dealt with defence questions, will be available in the library of parliament shortly.
3.	Answered iby No. 1 and No. 2.
. CHEESE SENT TO DROUGHT AREAS


Mr. THOMPSON:: 1.	What quantity of cheese was purchased by the government and shipped to the drought areas in the western provinces?
2.	From whom, or from what organization was this cheese purchased?
3.	What price per pound was paid for same?


Mr. GARDINER:: 
Mr. DESLAURIERS:: 1.	Is Mr. B. Foisy who has worked in the post office at Montreal for the last six or seven years the same individual who has an office at 60 St. James St., Montreal?
2.	Has he refused regular employment in the post office?
3.	What is his monthly salary?


Mr. EULER:: 1.	Mr. B. Foisy, a part time postal clerk in the Montreal post office, is a notary and is registered with the notary board.
2.	Yes.
3.	Mr. Foisy is paid at the rate of 45 cents an hour for each hour worked. His earnings from the post office for the months of December, 1937, January, 1938, and February, 1938, were as follows: December, 1937, $25.42; January, 1938, $2.47; February, 1938, nil.


Mr. DESLAURIERS:: 1.	Is Mr. P. E. Bisson, who is temporarily employed at the Montreal post office, the same individual who occupies a regular professorial position in the college Jean de Breboeuf?
2.	Has he refused regular employment in the Post Office Department?
3.	What is his monthly salary? '


Mr. EULER:: 1.	Mr. P. E. Bisson, a temporary part time postal clerk in the Montreal post office, was formerly a teacher in the College Jean de Breboeuf but is no longer employed as a teacher at this college.
2.	Yes.
3.	Mr. Bisson is paid at the rate of 45 cents
an hour for each hour worked. His earnings from the post office for the months of December, 1937, January, 1938, and February, 1938, were as follows:	December, 1937, $71.10;
January, 1938, $29.27; February, 1938, $32.17.


Mr. DESLAURIERS:: 1.	Is Mr. Aurele Brisebois, an employee in the Montreal post office, proprietor of the pool and billiard room, known as the "Montreal Silent Club," located on Mont Royal street, near Papineau street?
2.	What is his monthly salary?
3.	In what year did he pass his examinations?

Questions


Mr. EULER:: 1.	As the department had no information, inquiry was made at Montreal and it has been ascertained that Mr. Aurele Brisebois of the Montreal post office is the proprietor of the pool and billiard room known as the Montreal Silent Club.
2.	$110.
3.	October, 1928.


Mr. DESLAURIERS:: 1.	Is Mr. F. X. P. Labelle, an employee of the Montreal post office, the same individual as Doctor Paul Labelle, residing at 4174 St. Denis street, Montreal, having a dental office at that place, and actually a dentist on the staff of St. Luke's hospital?
2.	If so, what salary does he receive from the Post Office Department annually?
3.	How many times during the past six months, if any, has he been replaced in his postal position?
4.	In what year did he pass his examinations?


Mr. EULER:: 1.	F. X. P. Labelle, postal clerk of the Montreal post office, is a qualified dentist.
He resides at 4174 St. Denis street, Montreal, but is not a dentist on the staff of St. Luke's hospital. According to his own statement, he practises dentistry in his spare time and his remuneration from this source approximates $100 a year.
2.	$1,740 a year.
3.	Mr. Labelle has been absent from duty four times during the last six months on account of illness for a total of seventeen days.
4.	September, 1927.


Mr. BLANCHETTE:: 1.	How many government subsidized private flying clubs are there in the dominion, and where are they located?
2.	How many members are enrolled in each of these clubs?
3.	When was each of them founded?
4.	What is the amount of grants whiah each received in, 1936 and 1937?


Mr. HOWE:: Information Concerning Light Aeroplane Clubs
1.	2.	3.	4.Member-	Year in	Amounts paidNames of light	ship as at	which club	each club inaeroplane clubs	Dec. 31,1937 was founded grants 1936-37	Aero Club of B.C	.. .. 94	1929	$ 279 39Brandon Aero Club	.. .. 60	1931	720 00Brant and Norfolk Aero Club	.... 80	1930	700 00Border Cities Aero Club	.. .. 87	1928	1,408 59Cape Breton Flying Club	.. .. 144	1930	353 15Calgary Aero Club	.. .. 67	1928	1,720 00Edmonton and Northern Alta. Aero	Club..	.. .. 145	1928	2,100 00Fort William Aero Club	.. .. 63	1929	760 00Halifax Aero Club	.. .. 73	1928	578 85Hamilton Aero Club	.. .. 170	1928	1.779 43Flying Club of Kingston	.... 86	1929	1,300 00Kitchener-Waterloo Flying Club.. ..	.. .. 37	1932	398 00London Flying Club	.. .. 82	1929	1,100 00Moose Jaw Flying Club	.. .. 66	1928	2247 00Montreal Light Aeroplane Club.. ..	.. .. 138	1928	564 40Ottawa Flying Club	.. .. 120	1928	1,122 96Regina Flying Club	.... 86	1928	1,891 38St. Catharines Flying Club	.. .. 57	1929	586 45Saint John Flying Club	.. .. 74	1929	300 00Saskatoon Aero Club	.. .. 90	1928	1,557 22Toronto Flying Club	.. .. 601	1928	2,001 30Winnipeg Light Aeroplane Club.. ..	.. .. 378	1928	2,935 18Totals	.. .. 2,798	$26,403 50Note.-In addition to the above	amount	paid in grants,	$5,000 was	granted to theCanadian Flying Clubs Association.	
Questions


Mr. HANSELL:: 1.	Is the airport at Coleman, Alberta, a government project?
2.	If so, how much did it cost?
3.	Was the work on this airport a government relief project or was it done by contract?
4.	Has the work been completed?
5.	If not, when is it expected to be completed?


Mr. HOWE:: 1.	Yes.
2.	S98,334.52 (31-12-37).
3.	Expenditure of $75,707.53 under unemployment relief. Expenditure of $22,629.99 under civil aviation division. (All work done by day labour).
4 and 5. All work proposed for present has been completed.
Note: Re No. 4. Grading and surfacing completed. Boundary markers, circular markers and fencing erected. Building completed for radio-meteorological services. Field suitable for high-speed aircraft.


Mr. CHURCH:: Will the government consider summoning another interprovincial-dominion conference on the whole subject of Income tax levies with a view of restoring this tax to the municipalities in whole or in part?


Mr. DUNNING:: This question relates to a matter of policy and it is not usual for the government to make statements on matters of policy in giving replies to questions.
income TAX-REFERENCE TO SUPREME COURT


Thomas Langton Church: In view of the triplicate income tax in Canada by federal, provincial and municipal authorities on the same class of personal property, will the government consider submitting to the Supreme Court of Canada, under the Supreme Court Act, a reference to clear up the whole question of jurisdiction on this form of taxation?


Mr. LAPOINTE (Quebec East):: No.


Mr. CHURCH:: 1.	Will the government refer for the opinion of the Supreme Court of Canada under the Supreme Court Act, a reference to the jurisdiction of federal power to levy, assess, and collect with interest, and penalties and distraint an income tax as agent for provincial authority?
2.	Will a stated case by way of a reference be made by the government on matters which conflict with the case of The King vs. Caron?


Mr. LAPOINTE (Quebec East):: 1.	No.
2.	No.


Thomas Langton Church: On January 27 and February 9, pursuant to an order of the house, a return was laid on the table in answer to my inquiry: "Has Canada approved, or been asked to approve, of the conquest of Ethiopia by Italy." In view of the statement yesterday by the Prime Minister of Great Britain that they have recognized this conquest de facto, has the government of Canada approved of the action taken since the return mentioned was tabled?


William Lyon Mackenzie King: The Canadian government is not aware of any statement made by the Prime Minister of the United Kingdom on March 2nd that the United Kingdom has recognized de facto the conquest of Ethiopia by Italy. A statement of March 2nd respecting this question was, however, made by the foreign office in connection with litigation at present before the courts in London. This statement is reported in press dispatches as follows:
His Majesty's government recognize the Italian government as the government de facto of the part of Ethiopia which they control, and according to their information the Italian government now is in control of virtually the whole of Ethiopia. His Majesty's government therefore recognize the Italian government as the government de facto of virtually the whole of Ethiopia.
The foreign office statement does not purport to indicate that recognition of the Italian government as the de facto government of the part of Ethiopia which they control has only recently been accorded. The de facto recognition, to which reference is made, may be considered to have taken place during the latter part of 1936 or early in 1937, when the governments of the United Kingdom, France and certain other countries, after securing from the Italian authorities formal assurances of the grant of adequate facilities, decided to reduce their respective legations at Addis Ababa to consulates.


Mr. JAQUES:: 1.	What is the total cost to date of the Rowell commission?
2.	What are the rates of pay and allowances (travelling and living) made to the commissioners, and the amount paid to date to said commissioners?
3.	What are the rates of pay and allowances of any kind to counsel and assistant counsel of the commission, and the amount paid to date to each such official by name, under these or other heads?

Questions as Orders for Returns
4.	What is the total cost to date for: (a) secretarial assistance; (b) clerical assistance; (c) preparation of stenographers' reports of proceedings of the said commission?


Charles Avery Dunning: The information asked
for in this question is given in an order for return tabled to-day, asked for by Mr. Edwards.


Mr. COLDWELL:: 1.	What were the number of home improvement loans and the amount advanced between March 1, 1937, and February 28, 1938, by provinces?
2.	What were the number of family units provided under the said Act between March 1,
1937,	and February 28, 1938, by provinces?
3.	What were the number of applications for loans from March 1, 1937, to February 28,
1938,	by provinces?


Mr. DUNNING:: 1.	Number	AmountPrince Edward Island.	. 384	S 101,337 .S5Nova Scotia	. 2,451	758,445.74New Brunswick	. 1,186	406,979.31Quebec	. 4,423	2,206,391.60Ontario	. 13,762	5.448,892.07Manitoba	. 2,050	780,697.70Saskatchewan	. 770	270,012.30Alberta	. 2,279	985,48922British Columbia.. .	. 3,192	1,021,5102730,497	$11,979,756.062.	If this question relates to the Home Improvement Loans Guarantee Act and not to the Dominion Housing Act, no information can be given. Many home improvement loans are for the purposes of converting single unit houses into multiple unit houses but the information regarding the total number of family units provided is not compiled.3.	Applications for home improvement loans are made in the first instance to chartered banks and other approved lending institutions and they do not report the number of applications received.


Mr. PURDY:: 1.	When do the United Kingdom-Canada trade agreements expire?
2.	Is the United Kingdom bound to renew these agreements if requested to do so by Canada?


Mr. MACKENZIE KING:: 1.	In accordance with the provisions of article 17 of the Canada-United Kingdom trade agreement it will remain in force until the 20th August, 1940. Unless six months before 51952-6S
the 20th August, 1940, notice of termination shall have been given by either government to the other, the agreement will remain in force until the expiry of six months from the date on which a notice of termination is given.
2.	No.
exchequer court cases


Mr. BLACK:: 1.	How many cases are actually under advisement before each of the honourable judges of the Exchequer Court of Canada?
2.	What are the parties in each of these cases ?
3.	How long have they been under advisement?
4.	If any case has been under advisement more than three months, what are the reasons why judgment has not been rendered before?


Ernest Lapointe: The government has no information.



QUESTIONS PASSED AS ORDERS FOR RETURNS


Mr. MacNEIL:: 1.	For what period, and with what rank was Joseph Philippe Roland Roy attached with a commission to the permanent active militia?
2.	What were the units to which this officer was attached?
3.	Were the annual confidential reports of his senior officers throughout this period favourable or unfavourable?
4.	Were any charges of misconduct made against him during service and upheld by formal inquiry?
5.	Under what authority, and for what reasons was this officer retired from the force?
6.	Did this officer request an official enquiry upon retirement in order to clear his record and character of any aspersions cast thereon? If such enquiry was refused, under whose authority and for what reasons?
7.	Was he granted full pay and allowances until effective date of retirement or any gratuity or pension to which he might ordinarily be entitled?
8.	At what rank was he retired?
vegetable oils


Mr. BARBER:: 1.	What is the amount in pounds of vegetable oil, not for food, imported into Canada during each of the years 1920, 1925, 1930, 1935, and 1936?
2.	Is any of this vegetable oil imported, not for food, processed and sold as shortening or for other edible purposes?
3.	How much vegetable oil imported, not for food was refined and sold as vegetable oil shortening during each of the years 1920, 1925, 1930, 1935, and 1936?



Questions as Orders for Returns
4.	How much Canadian inedible animal tallow, grease and oil, not for food, is manufactured into edible products?


Mr. HAYHURST:: 1.	How many tank steamers of vegetable oils (not for food) were brought into Canada in the year, (a) 1936; (b) 1937?
2.	How much shortening was made from imports of vegetable oils designated as (not for food) in, (a) 1936; (b) 1937?
3.	What quantity of vegetable oils for food in pounds was imported into Canada in the year, (a) 1936; (b) 1937?
4.	What quantity of vegetable oil shortening was produced in Canada in, (a) 1936; (b) 1937?
5.	How much vegetable oil shortening was made from imports for food purposes in, [a) 1936; (b) 1937?
6.	What is the average cargo of a tank steamer of vegetable oils?


DREDGES OWNED BY CANADIAN GOVERNMENT
Mr. HARTIGAN:: 1.	How many Canadian government owned dredges are there in Canada?
2.	Where are they located?
3.	At what amount does the government value them?
4.	How many Canadian government tugs are there in Canada?
5.	Where are they located?
6.	At what amount does the government value them?


RURAL MAIL CARRIERS
Mr. FERLAND:: 1.	During the current fiscal year, what is the
average rate per mile annually paid to rural mail carriers:	(a) in the whole of Canada;
(b) in each of the provinces?
2.	During the same period, what will be the cost of mail distribution by rural carriers?
3.	What would be the additional cost if all the rates for rural mail service below $35 per mile per annum were raised to $35?


FINANCIAL ASSISTANCE TO PROVINCES
Mr. PURDY:: 1.	What was the amount of financial assistance granted by the federal government to and/or in each province of the dominion for the fiscal year 1936-37, and also from April 1, 1937, to February 28, 1938, including any commitments not fully implemented?
2.	What were the respective amounts under the principal headings?


COST OF RELIEF-INCOME TAX COLLECTIONS
Mr. CHURCH:: 1.	How is the item one hundred millions, mentioned by the Minister of Labour as the cost if the government assumed and took over the total cost of relief in Canada, made up?
2.	If the amount spent as at present per annum under provincial agreements is deducted, what will the balance be?

3.	What is the total income tax collected in Canada for the last year of record?
4.	How much does Ontario contribute?
5.	What does the Toronto district contribute?
6.	How much is now spent on relief for all Canada?
7.	How much a year is spent on drought relief in Saskatchewan?



JAPANESE IMMIGRATION

William Lyon Mackenzie King: Mr. Speaker, on Friday
last the right hon. leader of the opposition (Mr. Bennett) inquired if it has been ascertained, as the result of the investigations that have been made, how many Japanese have entered this country illegally.
My right hon. friend proceeded to say that possibly the minister would be unable to give an answer at this stage. That is correct. The inquiries which have been proceeding have given a very considerable amount of information, but it would not be possible to give any definite or conclusive reply to the question at the present stage. One of the main purposes of establishing the board of review to which I referred on Friday is to procure this full information. I may add that as the result of inquiries by immigration officers and the Royal Canadian Mounted Police, 145 Japanese have been deported for illegal entry in the period 1931 to date.
Right Hon. R. B. BENNETT (Leader of the Opposition); Mr. Speaker, I was going to ask the Prime Minister, not knowing that he would answer my other inquiry to-day, whether or not the jurisdiction of the board of review will extend to the whole question of Japanese immigration and penetration into our country, or would it be limited, as a reading of his remarks might indicate? There is a good deal of interest in the matter, and I have been asked to ascertain, if possible, just what the jurisdiction would be in the premises.


William Lyon Mackenzie King: The board has been appointed to deal with the subject of illegal entries-


Richard Bedford Bennett: Only?


William Lyon Mackenzie King: Only, yes.
However, I would assume that in any inquiry directed to illegal entries, much information that was incidental thereto would be ascertained.



MOTIONS FOR PAPERS


Mr. MITCHELL (for Mr. Hansell):: For a copy of all letters, telegrams, correspondence, contracts, tenders and other docu-

State Medicine
ments in the possession of the government, dated during 1937, with respect to the proposed scheme under the Prairie Farm Rehabilitation Act, at Enchant, Alberta.



CHARGES AGAINST OFFICERS OF ROYAL 22ND REGIMENT

Mr. COLDWELL (for Mr. MacNeil):: For a copy of all orders, decisions, letters, telegrams, recommendations and recorded evidence relating to the court of enquiry held by the Department of National Defence in Quebec, August 24 to August 28, 1936, to deal with charges against officers of the Royal 22nd Regiment.


Mr. POWER:: Mr. Speaker, I am informed that the proceedings of the board of inquiry are of a confidential character and that the documents and memoranda relating thereto come within the category of privileged communications. I would therefore suggest that this motion be not passed.
Motion dropped.



DISALLOWANCE AND RESERVATION OF ALBERTA LEGISLATION

Major James William Coldwell: For a copy of all petitions, correspondence, and other documents, relating to the disallowance of the three Alberta acts (August, 1937), the reservation of the three Alberta bills (October, 1937), and the reports of the Minister of Justice on these acts and bills.


William Lyon Mackenzie King: Mr. Speaker, just before the motion is adopted, may I say to my hon. friend that, as he no doubt must surmise, there has been an immense amount of correspondence, much of which is communications from private individuals, and a good deal of it in the nature of what might be described as form letters, resolutions of social credit groups and communications from various bodies. It would take a long time to have it all copied, and I [DOT]assume it would be of little value to my hon. friend if it were; but if what he is really anxious to obtain, as I believe it is, are the important documents and everything that would really be relevant for purposes of consideration and debate, I should be very glad to have the order passed in that way. I might add that if my hon. friend wishes at any time to see the files for himself I shall extend a welcome to him in the Prime Minister's office, and I am sure the Minister of Justice (Mr. Lapointe) will in his.


Major James William Coldwell: I thank the right hon. gentleman for his suggestion. I am interested only in the important documents.
Motion as amended agreed to.
*1052-68}


Major James William Coldwell: For a copy of any instructions sent to the Lieutenant-Governor of Alberta in regard to the reservation of the three Alberta bills in October, 1937.


Ernest Lapointe: Mr. Speaker, there were no instructions sent to the lieutenant-governor of Alberta.
Motion dropped.



PROPOSED DISALLOWANCE OF ONTARIO POWER COMMISSION ACT. 1935

Major James William Coldwell: For a copy of all correspondence, petitions, and other documents, relating to proposed disallowance of the Ontario Power Commission Act, 1935, and any reports of the Minister of Justice thereon.


William Lyon Mackenzie King: Mr. Speaker, perhaps my hon. friend would allow what I said with reference to his previous notice of motion to apply also to this one.


Major James William Coldwell: I understand that.
Motion as amended agreed to.



STATE MEDICINE


Mr. DANIEL McIVOR (Fort William) moved:: That, in the opinion of this house, it is most urgent that state medicine be established in the Dominion of Canada.
He said: Mr. Speaker, I must admit that in introducing this resolution I do not feel as comfortable around my stomach as I did before dinner, but the motion is to be seconded by one who is thoroughly worthy, the hon. member for St. Boniface (Mr. Howden), my former family doctor.
I should like to say in opening that I am indebted for help on this big question from many sources. I of course have had firsthand information. We have also listened to many radio addresses; we have had information from health magazines, and from material disseminated by health boards throughout Canada. Many of our church leaders have also given us much help.
When one thinks of state medicine in any form, it certainly appears as a gigantic task. I can only say, in the words of the hon. member for Rosthern (Mr. Tucker), that we cannot expect to change our whole system at once, or even rapidly; we must do it gradually and be thankful for the success that we are getting.
State Medicine

A definition seems necessary at this stage. I would say that state medicine means this: a system of socialized medicine making available to all complete medical service at public expense.
This, Mr. Speaker, is a living question. It is a living question to those who see the need for it daily; it is a dying question to those who are afflicted and cannot get necessary medical care. State medicine is not a dominion question only, but is linked up closely with the provinces. Hon. Doctor C. M. Weir, provincial secretary for British Columbia, says it is necessary to have cooperation with the dominion government. We appreciate that, and I am sure the members from British Columbia and the other provinces are ready to say, in the words of Dickens, "Barkis is willin'."
There may be hon. members who think that because I am not a doctor I have no right to speak on this question. But I maintain I have every right to speak because of what I know, and because of the reality of the things I have seen, and because, too, of the number of times that I have seen the doctor do all he can, serve faithfully to the end, and then say to the minister: I have done my best, and I must now hand the patient over to you. I should like to give you an example of that. In the town of Souris two doctors were called in to attend one who was seriously ill. When they left I asked them if there was any hope, and they shook their heads. The finger nails of the patient were purple, his lips were purple, and his eyes were becoming glassy. His temperature was 105| and his pulse was over 140; he had the death rattle in his throat. I said, "I suppose I can put on all the mustard I like;" they said, "It won't hurt." So I stood in the door of that room; I asked the Great Physician to take charge, and I was willing to cooperate to the limit. We continued to apply mustard every half hour from then on to six o'clock in the evening, which was about eleven hours. Then the patient called out that he was burning up; and we were thankful to see when we took off the mustard that there was much sweat. I was going out to get him a drink of water, when he called to his wife, "Make that sky pilot stand in the door and thank the Great Physician." Therefore, Mr. Speaker, having afterwards given that man seventy-six hypodermics of digitalis, strychnine and camphor oil, I know a little bit about medicine. I believe I have some right to speak on this question because of my association with doctors who have given outstanding services to patients which have been much appreciated. But I would interject here that, being 
of course inexperienced in this house, I have been surprised that so many members advocate cures for the diseases of the body politic and leave altogether out of consideration Him who one day took from a lad five loaves and two fishes and with them was able to feed a multitude.
This proposal implies, first, all essential medical service requisite to the recovery and maintenance of complete health; all that is necessary to the complete well-being of the sick, both physical and mental, including examination, diagnosis, services of doctors and nurses; the benefits that can be secured from hospitalization; health education, preventive service, and a check-up of all those who are ailing. Second, it implies the socialization of medicine, government responsibility for seeing that such service is freely available to all, and that existing services should be utilized as far as feasible. It does not imply compulsory use of this service, neither does it imply that private medicine shall be prevented.
I should like to give a few statistics; this matter is not in my field, but I find it necessary to do so.
More than half the deaths at childbirth which could have been avoided are caused by deficiencies in medical care; so says the New York academy of medical care. More than half the sick in certain crowded centres receive no medical care whatever; so says the United States public health service. Only three teeth in ten now receive dental care-the rest just keep on decaying; so says the committee on the cost of medical care. And that same committee adds that only one person out of ten receives a doctor's annual examination, which any doctor would say is the right way to prevent disease, by nipping it in the bud. The committee concludes, after five years of research, that our tragic failure to make full use of our hospitals, nurses, doctors and dentists causes a vast amount of preventable economic waste, physical pain and mental anguish, as well as millions of needless deaths. .We need the benefits of prevention. The poet said that a fence at the top of the hill is better than an ambulance down in the valley. The remedy for this condition will not come through the individual doctor, who is often overworked and often underpaid, as will be shown a little later on; it will not come through the charity and the extra service of the medical man, or through committees. Let me quote from Mr. Greaves, who spoke lately over the radio:
For one thing, it seems to me extremely con-tributive to the issue that the commercial or profit motive should be, if utilized at all, relegated to second or indirect place. .	.	.

State Medicine
The direct profit motive should be eliminated, for it detracts attention from the full, hearty serving in the cause.
If the medical men did not have to worry any more about their salaries, that is if they were like the ministers in that respect, they would give far better service. Mr. Greaves continues:
Secondly, prevention and remedy of disease cannot be genuinely effected unless the public has at its disposal, and at a reasonable cost, everything which it needs for each individual case and which science has discovered for our hygienic benefit.
That is, they should have at their disposal in the cause of health those things which are needed to deal with the average case that comes to them for attention. Hon. Doctor Weir, provincial secretary of British Columbia, says that in Canada in 1930 five out of eight people of average means sufficiently ill to require the services of a trained nurse were unable to pay for these services. This statement is based on the evidence of 1,189 doctors. Also he says that in Canada in 1930, illness from sixty to ninety days in hospital bankrupted fifty per cent of the people of moderate means for periods ranging from two years to five years and over. In British Columbia in 1935, out of 9,000 heads of families on relief, 1,600, or about eighteen per cent, were suffering from partial disabilities, while additional numbers were totally disabled or were suffering from temporary difficulties.
From the Health League of Canada I quote:
Every year thousands of Canadians die from preventable diseases.
This health league has done a great deal to aid in the cure of preventable disease. The writer tells us that the success of vaccination made medical science think along new lines; that they have been exploring other fields and are doing great work. They tell us that one out of three dies ahead of his time. Professor Winslow of Yale university states that twenty-nine per cent of the deaths in the United States registration area are post-ponable; and we have the authority of the Health League of Canada for the statement that thirty-four per cent of the deaths in Canada, also could be postponed. Half of our disease, they say, is preventable. One hundred and eighty thousand Canadians are always sick; of these ninety-one to ninety-six per cent are ill enough to be disabled. So that 1-82 per cent and 2-88 per cent, or more than two per cent of the whole population, is always too sick to work; that is, two per cent of Canada's population, or 180,000 persons, are always on the sick list. The bulletin states:
Of the population pf Canada, thirty per cent are adult males; thirty per cent are adult females.
It is thus estimated that 54,000 adult males are continuously ill. This amount of illness would suggest that in the adult male population alone there are lost each year 16,200,000 working days.
Calculations show that, for every twenty males gainfully employed, there are approximately six females similarly employed. This would suggest that, in addition, the female population loses 4,800,000 working days per year.
Total loss per year-21,000,000 working days, at least fifty per cent preventable.
Superfluous loss per year-10,500,000 working days.
Converted into money, the annual cost of illness is estimated to be approximately $300,000,000. To this is to be added a much larger sum in the cost of postponable deaths. In the LTnited States this is said to be six billions annually, and in Canada it is on a corresponding scale.
Let us consider mothers' allowances for a moment. These are paid for the most part to young widov.' with dependent children. One province alone spends over two and a quarter million dollars a year for the relief of the distress of widows and orphans whose husbands and fathers in a large number of cases have died as a result of preventable diseases.
Referring to British Columbia again, I understand that different countries have adopted the voluntary system, while in others the contributory system prevails. The following countries have the compulsory system; Austria, Bulgaria, Chile, Czechoslovakia, Denmark, Esthonia, France, Germany, Great Britain, Greece, Hungary, Northern Ireland, Italy, Japan, Latvia, Lithuania, Luxemburg, The Netherlands, Norway, Poland, Portugal, Roumania, Russia, Switzerland, Jugoslavia. The voluntary system exists in the following countries: Argentina, Australia, Belgium, Finland, India, Italy, New Zealand, Palestine, Spain, Sweden, Switzerland, Union of South Africa, Uruguay.
May I read a note on one of the most progressive countries that have health insurance or state medicine: I refer to Northern Ireland, Northern Ireland came under the British scheme of health insurance in 1930, and in 1934 the various organizations there were unified by being absorbed in a single national health insurance society. The note reads:
Ireland came under the British scheme of health insurance in 1930. In 1934, the Irish societies were unified by all being absorbed into a single National Health Insurance Society. This unification is regarded as a preparatory measure with a view to the institution of a
State Medicine



193S

[Stage Direction]
State Medicine
health insurance the cost of medicine can be brought within the ability to pay of the family of moderate means.
State medicine would have other advantages. To the doctors it would reduce the cost of medical education and assure them of more adequate compensation. It would raise the standards of medical practice, and remove a certain type of competition. It would provide access to needed equipment, too expensive for the individual doctor to buy for himself, and time would be available to those specially qualified to engage in scientific and medical research. It would tend to remove what any doctor here knows about, the temptation, of a kind which comes to no other professional man, to slip into malpractice.
For the patient it would have the advantage of providing for one examination in one place instead of several, without interfering with the personal relation between doctor and patient. It would guide the patient promptly to the best treatment, and provide the hospital, nursing and convalescent care that are necessary, regardless of the patient's ability to pay. It would provide capital outside the medical profession to meet the cost of those unable to pay.
State medicine is logical. It is in keeping with the spirit of the times. We already have it to a considerable degree in such matters as the control of communicable diseases, sanitation, medical care for men in the army and navy and on the railroads and in many industries. They have their nursing staff and medical staff ready at their call. Furthermore this public care for health is constantly increasing. More and more provinces are taking over the field of preventive medicine in part or in whole. Medicine is a proper field for state control, being analogous to education, and applying even more universally than education. It has many things in common with fire and police protection, which are considered indispensable to public safety. There is a legal basis for the control of medicine by the state. The state has certain police powers aiming at the protection of national existence, the maintenance of right or justice, and the public welfare. Public health is an important factor in public safety.
From personal experience I know something about the need for state medicine. I worked on construction work in Calgary and I have seen men keeping themselves in shape with appliances but unable to do a decent day's work. I asked one of them: "Why do you not see a doctor and have that minor operation?" He replied:	"My wife and
children need the money more than I need the operation." I served as sky pilot in
southern Saskatchewan and saw farmers denying themselves what they needed, and sometimes their wives also suffering, because they were not able to pay for a necessary operation. In Winnipeg and rural Manitoba this need was evident to me twenty years ago, and the need is great at the head of the lakes to-day. Only this morning I had a man in the office who had to take his wife out of the hospital when she should have remained there, because he was not able to pay the $1.50 a day. I know that condition prevails in many other places.
Down in Cape Breton I was told by an efficient investigator that they have group medicine for those working in the mines. The men pay forty cents a week for cooperative medical service; they carry this themselves without the aid of the city or the state. But there are many people who live and die without proper medical care; children are born without a doctor and die without a nurse; children are undernourished and liable to all kinds of diseases, especially tuberculosis. I would like to give one or two instances from my own knowledge. One is the case of a mother in the city of Fort William with a boy, maintaining herself by keeping house, getting board for herself and son, and earning $20 a month. The boy developed a sore ear. She did not call a doctor, thinking she would save the expense. The result was that mastoid trouble developed and after protracted treatment she had a medical and hospital bill for over $400-this woman earning $20 a month on which to feed and clothe herself and her boy.
I was in our local hospital one day two years ago and saw something that made me decide that I would support anyone who would bring up this matter in the house. This man had seen me thirty years before, but apparently I have kept my youth a little better than he has; for he knew me although I did not recognize him. He said: "I want you to take me home." I said I would if he had the permission of the doctor and the hospital. The next day I got him home, took him out thirty-two miles and found there a cosy little home with four small children. In the bed was the mother with another happy little bundle four days old. I did not wonder that the man wanted to go home; there was no doctor there, and no nurse-just a little slip of a girl. My better half taught them first aid. I felt like rolling up that little bundle of happy possibilities and taking it home and training it as we thought it should be trained. I have seen farmers in our district suffering under the need for medical care, but, as one said to me, he would rather
State Medicine
[Stage Direction]
die than go into debt and allow his farm to be sold and leave his wife without a dollar. The other day I learned the story of a maid who was earning S10 a month; she became ill and was taken to hospital for an operation which cost S150 plus the hospital bill. When can she pay it? That sort of thing is very effective in driving people to certain shades of thinking.
I am convinced that it is the duty of ehris

tian Canada to look after her sick. That is part of the program laid down by the Great Physician when he said: Feed the hungry; clothe the naked; visit the sick and go to those in gaol. We cannot pass by on the other side and disregard that program and call ourselves a Christian nation.
I know there are many arguments against this proposal. You can get arguments against anything, as I have observed since I have been in this house. It is desirable that we should hear these arguments against state medicine or health insurance, both to show up any weaknesses as well as to demonstrate its strength. I know from reading the book of Job that the devil can justify his position, and from reading the book of Matthew that he can quote Scripture to serve his purpose.
I am not particular whether it is state medicine or some other form of medical care for our people so long as our government takes up this task. I have paid my tribute in another way to the right hon. leader of the opposition (Mr. Bennett) who has grown so much in my estimation as a man of ability and a fair-minded man; as one who shows great skill in finding the weak spots in legislation, as well as being willing to approve of what is good.
I think of the government as having intelligence and ability and willingness to learn, and with great resources at their disposal, willing to treat their fellow men as brothers. I think of the Minister of Pensions and National Health (Mr. Power), with his courage and readiness to be in the front line trench. I think of the Minister of Finance (Mr. Dunning) having the ability to find the money for every worthy cause, as he did in the case of pensions for the blind. I am convinced that these two ministers are not going to stand back or allow their fellow ministers to clothe themselves in priestly robes and take on sacerdotal airs and pass by on the other side while those who are sick are left to fend for themselves.
Knowing that Canadian health is Canadian wealth, we cannot afford to trifle with the physical and mental well-being of our citizens. In other words, it costs more not to have state medicine than to have it.
[Mr. Mclvor.l
Mr. J. P. HOWDEN (St. Boniface):: Mr. Speaker, if the motion requires a seconder, I should like to take that privilege. My first words must be those of congratulation to the mover (Mr. Mclvor). For a number of years we have been close friends, having lived for some time only a door or two apart on the same street. We have played together, hunted together, visited the sick together and gone to church together. The hon. member may not have been at my convention, but it was my privilege to be at his and later to congratulate him when the votes were counted. He apologized, in a way, for having brought the motion before the house; no apology need have been made. There is no doubt that the hon. member's incentive in bringing the motion before the house was his ingrained interest in, and sympathy and love for, humanity. May I congratulate him upon having revived the subject on this occasion.
What is state medicine? A great deal has been said in the United States and in Canada in the last ten years about state medicine, but I believe I have never seen the term defined. In fact, a questionnaire directed to Doctor Routley, Grand Secretary of the Canadian Medical Association, brought this response :
The Canadian Medical Association has not adopted any official definition of the term "state medicine" but it is my view that the council would likely be iu agreement upon the following definition:
"By state medicine is meant a system of medical administration by which the state provides medical services for the entire population, or a large group thereof, and under which all practitioners are employed, directed and paid by the state, on a salary basis."
I should say it would be sufficient to define state medicine as provision by the state or government for the medical care of the sick. This definition would be broad enough and elastic enough to fit any set of conditions, from the mere payment of medical fees to a medical man for services rendered to the state, to the complete medical service such as, so far, we see in only one part of the world-to me, the ideal condition

namely, state medicine as it is practised in Russia.
Is state medicine desirable? I ask the question, and seek to answer it in the affirmative, under three headings. I would say, yes, first because it would limit the spread of infection and the incidence of death, and, second, because it would eliminate the uneven distribution of the cost of medical services to the people. May I put it in another way: it would afford an adequate system of medicine to the wage earner and the low salaried man. The third reason is that it would

State Medicine
take up the slack between outlying districts, where there are no doctors, and the idle doctors which are to be found in comparative abundance in any urban centre.
Let me enlarge upon the first of these reasons, and point out that, although I had no collusion or cooperation with the mover of the resolution, I find that his remarks in this connection are along lines similar to those I propose to make. Repetition may be tiresome, and I shall endeavour in this particular to detain the house for as short a time as possible. I have said that state medicine would limit the spread of disease and the incidence of death, and to bear out my contention I shall repeat some of the statements of the hon. member for Fort William (Mr. Mclvor).
Every year thousands of Canadians die of preventable disease. Can anyone gainsay that statement? Secondly, one person in three dies prematurely of such disease. Over half of all disabling disease could be prevented. Three per cent of Canadians are continually sick. AH hon. members are pretty well aware by this time that sickness costs the people of Canada the estimated sum of 8311,000,000 yearly.
To give more detailed information, may I say that diphtheria has killed as many as 1,200 persons in Canada in one year; typhoid fever has killed approximately the same number; tuberculosis destroys about 8,000 lives every year, and cancer destroys approximately the same number each year. Heart disease takes a yearly toll of about 11,700 lives. Maternal mortality in Canada runs up to 1,300 yearly. Prior to the activity of the various governments, in cooperation with the federal government, the incidence of venereal disease in Canada was appalling.
You say, "Well, what of it? There are too many people, anyway; why not let them die? To hundreds of thousands of people we are giving not only medical attention, but food, clothing and shelter. At a time like this wrnuld it not be just as well to refrain from a discussion of state medicine? Why not wait until we balance the budget, and until we settle our railway and unemployment questions?" There is good reason for many of those questions, because every time we reclaim an invalid from a serious illness we do so against the time he will take sick again. If the person happens to be an indigent, dependent upon the state, each time we cure his illness we place a further burden upon the state. You may ask: "If he was no good in the first place, why not let him die?" Unfortunately many of these people are suffering from infectious disease and we must control infectious and contagious
disease as a matter of protection to others. Diphtheria, scarlet fever, typhoid fever and so on, not to mention the venereal diseases, which are the worst of all. are conditions that have to be controlled. If we must control them for our own safety we might as well make a job of it and control them for the sake of those who are suffering.
I have said that I believe state medicine is a good idea, because, among other things, it would eliminate the uneven distribution of medical costs. The cost of illness must be common knowledge to hon. members of this house. I think it is a fair statement that about four-fifths of the citizens of Canada enjoy incomes of less than 81,800 and that a large majority of the people would consider themselves very fortunate if they could be sure of an income of SI ,200 per year. A man with an income of SI .200 or $1,800 per year and who has a family to support usually has very little reserve. As a general rule he uses up one hundred per cent of what he earns.
I hope the house will not mind my discussing these matters in detail, but this is how it strikes me as a doctor. Should an ordinary case of sickness come along, such as a mild attack of grippe, this man goes to bed and calls in a doctor. Before he is well he owes his doctor and his druggist from $10 to $20. To many people, that may not seem much, but it is a lot to a man who uses up the hundred dollars he receives every month. If he has the misfortune to require the removal of an appendix, if he suffers from a strangulated hernia or something else that necessitates his going to hospital, he finds himself put back to the extent of a couple of hundred dollars. As a doctor I am meeting these cases all the time. A man with a family of three or four children who is receiving only $100 per month finds it quite difficult to pay a bill of $100. In this connection I should like to refer to some remarks I made in this house during the session of 1936. I said:
I believe it has been estimated that the cost of medical service to the Canadian people, largely a direct charge, is about $311,000,000 a year. On the other hand it has been estimated that the cost of medical service to the people of the United States is something over $3,500,000,000 a year, which figures out in both instances at around $30 a head. During the regime of President Hoover an inquiry was undertaken as to the cost of medical service to the people of the United States.
And again:
Before this inquiry was entered upon it was realized that there was a great deficiency in medical service to the American people, and on the other hand it is well known that medical
State Medicine

men are driving taxis and doing manual labour and institutional work for which they receive little or no remuneration. An inquiry was therefore set on foot; a survey was made of some 1,800 families in all economic grades, and some very interesting facts were ascertained.
And further down:
It was found that 52 per cent of the American people receive no services from a physician. I think these figures would largely correspond with conditions in this country. It was found that 79 per cent get no attention from a dentist, that 89 per cent receive no health examination or similar preventive service, and 62 per cent receive no medical, dental or eye care of any sort. These statistics are for the prosperous years of 1928-29. Conditions are indubitably much worse now.
On the other hand it was ascertained that although many doctors have good incomes, one-third of all the physicians in the United States had incomes of less than $2,500, even in 1929. More doctors were found in the $1,000 to $2,000 class than in any other. It was also found that 16 per cent of American families spent less than $10 a year for medical service; forty-six per cent spent less than $40 a year; four per cent spent more than $500, and one per cent spent more than $1,000.
A further argument I advanced at that time was:
It will be readily apparent that those who spent only $10 a year were not a matter of great importance, or even the $40 class, but for the four per cent whose expense for medical service was over $500, and that one family out of a hundred which was called upon to bear an expense of over $1,000, it was a very serious matter.
We must realize the impossibility of the ordinary family undertaking to cope with such a condition. I stated that there are means by which these matters could be easily taken care of. These services are costing the people of the United States approximately 130 per year, but it was found that for $36 per year the entire population could be given adequate medical service by bringing together those who lacked medical service and doctors who are idle. This is my second reason for supporting state medicine.
My third reason is consideration for the forgotten man, the doctor. We hear a lot about the forgotten man, but I submit that the doctor has been forgotten as much as anyone in the last thirty or forty years. In my previous remarks I stated that medical men were driving taxis and doing manual work in American cities, and I know for a fact that there are many medical men in Canada who have absolutely nothing to do. This is the case even though conditions have improved. Another matter that should be taken into consideration is the fact that the young men who graduate to-day in medicine are far superior to those who graduated thirty-five years ago. The training they are given

to-day is far better. A young man entering medicine to-day must have a high standard of learning before he takes up the study of medicine; then he must put in four grilling years at college and one or two years in a hospital. I have no hesitation in saying that to-day the young interne in the hospital takes technical operations in his stride that would make the older practitioner in the country stop to take his breath before he wrould attempt them. These men are first class professional mechanics. They take on blood counts, spinal punctures, gastric irrigations and syphonage, things that many of us would not attempt without sending our patient to a hospital. Here you have these young men, turned out of the universities at the end of five or six years with a first class training, and with nothing to do. Why? Because in different communities, sparsely settled, the people cannot afford to support a doctor, and the consequence is, on the one hand, the people must go without medical attention, and, on the other, these young men with medical training must go without work.
I have referred to my own early experience -not outstanding at all; just the usual thing. After graduating I moved across from Winnipeg into a district that was starting as a workmen's suburb. There was no difficulty about getting work to do; I always had plenty of it. Morning, afternoon and night, and often all through the night, I was working; but like Old Mother Hubbard my cupboard was often quite bare, or pretty nearly so. I used to think in those days that if some authority, the state-I did not care who the state might be, whether the city council, the province or the government of Canada-would only come to the rescue in cases of that kind and give a man a decent living, he would go to his work with a better heart, and he would not have to go through such long gruelling hours of work without the burden of finance being settled. That is another thing that could be very readily cleared up if we had a form of state medicine.
Let us assume that state medicine is a good thing; let us assume that it is desirable in regard to all these things that we were talking about a little while ago,, these deaths from diphtheria, typhoid fever and what not. Assume that state medicine is a good thing. Then what is the next thing to do? Is there a member in this house that does not understand the significance of modern day medicine? Is there a member in this house, be he medical man or otherwise, that does not know the history of diphtheria, of scarlet fever, of typhoid fever? Is there anyone who does not know that the incidence of death from

State Medicine
diphtheria was reduced from eighty-six to six per cent with the discovery of antitoxin, and that with the discovery of the diphtheritic toxoid the death rate has been still further reduced? Is there anyone in this house who does not know that typhoid fever, which formerly in war time killed hundreds of thousands, more in fact than were destroyed by enemy attack, did not occur in the great war at all? Why? Because of inoculation. The same is true of smallpox. We never hear of smallpox to-day, or of cholera, although at one time the people dying in cholera epidemics were so numerous that they had to be carted away in wagon loads. But now it is unheard of in Canada. Why? Because from long years of vaccination and inoculation, from generation to generation, we are no longer susceptible. And the only common sense thing for us who are human creatures to do to-day, for human society as a whole to do, is to institute a regime that will insist upon inoculation and vaccination in every case.
Do you know, Mr. Speaker, that chicken-pox, which is the mildest of the eruptive fevers, so mild that we do not even bother to quarantine for it in this country, if it were to occur among the aborigines in the South Seas or amongst the Indians in the north would cause them to die like flies? Why? Because they have not been vaccinated or exposed to the disease. So we need inoculation and vaccination. You say we are getting it? Yes, we are getting it for certain diseases. You cannot send your child to school without getting him vaccinated for smallpox, and there is inoculation for scarlet fever and typhoid and all that. That is fine, and we can look forward with confidence to the human race in all civilized countries being probably immune in the next ten or twenty years to the most infectious fevers. I believe we can do so.
But there are more subtle and more destructive and more dread diseases than can ever be found in school clinics. I refer to venereal diseases, the incidence of which is ever so much greater even than measles-and that is going a long way. If we want to reduce these present-day figures, if we want to improve our figures of maternal mortality and so forth, there is only one way to tackle the problem, and that is to make regulations under which human beings will be examined from time to time. At such time as they are examined, they can be vaccinated and inoculated. Incipient cases of heart disease will be discovered, and measures will be taken from month to month to ensure the health of expectant mothers until the advent of the new life. By these periodic health examinations
the venereal terror-shall I call it that?-will not be able to hide behind a mantle of false modesty and shame. These things will be brought to light. These diseases will be attended to as sickness should always be attended to, regularly, definitely, and in the proper way.
It was mentioned a while ago that the children going to school are examined and inoculated. That is true, and conditions such as bad tonsils, bad teeth, bad eyesight, scrofulous glands and other conditions are recognized at the time of the examination. The child is prohibited from going to school until1 he is in proper condition; until, on the one hand, the case has been referred to a physician, and, on the other hand, the compulsory school regulations have been complied with by the parents. Then the absence of the child from the school leads to a nurse's visit to the home, and when she visits the home she ascertains the incidence of infectious fevers, scarlet fever, measles and what not. In that way a very fine work is being done by the school- nurses. Then when patients enter general hospitals nowadays, they are usually subjected to a thorough examination by the staff doctor, rechecked by another physician; so nothing is left undone, and a great deal of disease is thus brought to light.
The government also has its health regulations governing appointments to the civil service, but I greatly fear, Mr. Speaker, that the health examinations for civil servants do not go quite far enough, and that the certificate is all too loosely prepared by the examining doctor, whereas if a thorough examination were made on these occasions a great deal of hidden disease would be brought to light.
What has been done in the way of state medicine in other countries? We have heard a good deal in this chamber about state medicine, and I think we all know that they have had it in Europe for fifty years, Germany being the first country to adopt it, if I remember well. The Scandinavian countries followed, and England went in for state medicine in 1911, when it adopted the panel system, under which invalids and sick people generally are given free medical attendance, free dental care, free medicine, and sick benefits in the form of state insurance during illness.
I have mentioned Russia, and I have here a little book entitled Red Medicine. It was written by two eminent men, Sir Arthur Newsholme, K.C.B., M.D., formerly principal medical officer of the local government board of England and Wales, and John Adams Kingsbury, secretary of the Millbank memorial fund, formerly commissioner of public charities of the city of New York. Sir Arthur News-
State Medicine

holme has edited a number of medical works. He personally undertook a survey covering all the European countries and edited a series of studies called International Studies on the Relation between the Private and Official practice of Medicine with special reference to the Prevention of Disease. In volume one he discusses medicine in the Netherlands, Denmark, Sweden, Norway, Germany, Austria and Switzerland. In the second volume he deals with Belgium, France, Italy, Jugoslavia, Hungary, Poland and Czechoslovakia. In volume three he deals with England, Scotland, Wales and Ireland. He was entrusted with the special mission of making a survey of and an inquiry into the medical system as it operates in Russia. He and his associates travelled all over that country, visiting all the states and the large cities. His book is a very interesting one. He lays down a number of postulates as pertinent to the proper application of medicine. In general they coincide with those laid down by a group of medical men in the United States. I shall read these postulates and then state his observations.
1.	The health and therefore the hygienic and medical care of every person in a community is a matter of concern and responsibility not only for himself, but also for every other person in the same community.
2.	An organized community through its government is called on to concern itself with the practical application of all the known laws of health and of all remedial measures which will help in the restoration of health.
3.	There is a lamentable amount of inadequacy-
Listen to that.
-and discontinuity in the medico-hygienic provision for the community-
Very true indeed.

also that for a high proportion of the total sick, adequate medical care necessitates the organization of measures and of institutions beyond what the individual medical practitioner can provide.
To that I would say, "Hear, hear" without any hesitation.
4.	For a large section of the population, in all countries, the cost of sickness is overwhelmingly great. . . .
"Hear, hear," again.
The cost of hospital treatment is beyond the means of a large proportion of the total population.
5.	In order to supply adequate medical aid for all, either private charity, or provident insurance, or taxation . . . must be forthcoming in a continuous, even and adequate stream. No person should be allowed to die or suffer serious harm through the lack of shelter or food or medical aid.
6.	Economy and wisdom alike demand that each illness shall be investigated and treated socially as well as medically. . . .

7.	Treatment should be available to the fullest extent necessitated by the patient's illness, irrespective of his financial circumstances.
8.	Prevention is always more important than provision.
On those postulates concerning the application of medical science Sir Arthur Newsholme made a survey of all the countries of Europe. His findings are summed up in this final paragraph:
Measured against the postulates set out earlier in this chapter, it would seem fair to conclude that soviet Russia has, at least in many respects, come nearer to fulfilment of these postulates than any of the other countries studied by us or of which we have knowledge. Indeed, soviet medicine is largely based on the general propositions which are here enunciated as standards for adequate medical care of all people.
Now I am not advocating communism, and I am not a socialist particularly. But this is not the only book which contains reports along the same line; there are about a dozen such publications. I believe this writer to be beyond reproach; he is an English knight who has been intimately connected with the British government; he was sent to make a survey and an inquiry, and he made it. Russia is the only country of which we have knowledge where there is real, honest-to-goodness state medicine, one hundred per cent state medicine, the sort of state medicine which provides adequate coordinated care for all citizens of the country. The difference between state medicine and medicine as it is practised to-day can be explained in this way. Every one has heard of the Mayo clinic ; we know there are clinics in New York, Montreal and other cities, possibly in the civic hospital of Ottawa. When you adopt a form of state medicine, there is a clinic at the disposal of every man in the land; he does not have to depend on this or that doctor, however capable or however inadequate he may happen to be; a systematized, coordinated service of medicine has, therefore, that distinct advantage.
One not infrequently hears insinuations and suggestions to the effect that when you have a body of publicly paid medical men, you do not get results. Well, if one cannot get results from paid medical men, one should not get results from a paid civil service, or from paid preachers, to whom the hon. member for Fort William (Mr. Mclvor) referred, or from any man who has a guaranteed, assured salary, because those people do not need to care. I should like to read an extract which seems to me very much to the point:
It is frequently argued that whole-time salaried appointments are destructive of personal initiative and inhibitory to continued

State Medicine
effort. This incidentally is a grave and undeserved reflection on present whole-time officers in the medical and scholastic professions. The reflection is deserved in individual instances, and these instances in the aggregate may bulk somewhat largely, but in my judgment they form but a small proportion of the total. In these instances security of tenure of office reduces effort and short of this may and sometimes does stereotype and render static present methods of work.
But it cannot be said that the intellectual stagnation and moral lethargy, when they occur in officials, are their special possession. With these occasional accompaniments of a too sure livelihood may be compared the medical work of an occasional private medical practitioner in a poor district, his hurried interviews with his patients, his too frequent treatment of many patients without diagnosis, the pile of weekly medical journals which one can see unopened on his table, and the inability to attend the meetings of medical societies, still less to cultivate post-graduate work.
I believe that a regularly paid medical man, one who accepts a fee for regular service, is probably just about as dependable as the man who is driven to death with overwork and harassed by underpay, and I should be very much disposed to think that if such a man were given a living wage he would render very much better service to the state and to his fellow man.
I cannot possibly hope to conclude on this occasion; I shall have to wait until another time to say all that I have to say on the subject.


Mr. J. S. WOODSWORTH (Winnipeg North Centre):: There is no doubt whatever that the previous speakers have voiced the opinion of the vast majority of the people of Canada. I am sure we all appreciate the frank and forcible presentation of the hon. member for St. Boniface (Mr. Howden). I may say in passing that though he may not know he is a socialist, I have rarely heard the socialist case presented with greater force than he has put it before us this afternoon. It is a strange thing that though the majority of the members of the house are in general agreement on the desirability of much greater health service for the people of the country, nothing very much is likely to happen as a result of this debate this afternoon. It is passing strange that that should be so. In matters of this kind we in this house are, after all, little more than an academic debating society.


Richard Bedford Bennett: Hear, hear.


James Shaver Woodsworth: We all recognize to-day that something in the nature of state medicine is desirable, first of all on humanitarian grounds, and, in the second place, on the grounds of economy and efficiency; yet there are certain obstacles that stand in the
way, obstacles that are hardly understood by the general public outside, obstacles that make a great part of the work of the house quite futile.
I am very glad that this question has been introduced by a Liberal. The Liberals here have a majority of some one hundred members, and if they desired to do so they could give us action along this line to-morrow. There is no doubt about that, and yet nothing happens.
There are probably two difficulties that will be brought forward if we get to the point where the government must speak on this matter. One difficulty is the question of jurisdiction. The British North America Act will be brought out, as it always is, and we shall be told very clearly that this is a provincial matter and that the dominion government can do nothing about it. The British North America Act is for the government a very present help in time of trouble, that is, whenever action is required. And if, by any chance, the British North America Act is not sufficient, we have, of course, the financial difficulties, and it will be said to be inopportune at this particular time for the government to take action. Is that not really the situation in which we find ourselves?
Only this morning my attention was called to a passage in the Edmonton Bulletin in which the new Liberal candidate, Mr. R. C. Marshall, was said to have sounded the keynote of a progressive Liberal program. Among other things he advocates old age pensions for all requiring them at fifty-eight years of age or sixty years at most, and "adequate enough to assure a decent standard of living and not a mere pittance." He wants to make it possible for older men and women to get out of industry, knowing they will be comfortable in their declining years, and make room for the younger generation, and so on. I have no doubt that Mr. Marshall would like to get some votes, and this is something that is popular throughout the country. If a candidate can tell people that they are likely to get pensions at sixty, or better still at fifty-eight, he may get some votes. But I do not believe that this kind of statement is made merely for vote-getting; it is made because the people generally feel the need for social services of this kind.
What the hon. member for St. Boniface said of the ordinary man is quite true. Not only can he not get help in time of sickness, but a great many people as they approach the end of their lives, or at least the end of the working period of their lives, are in a state of great anxiety about the means of supporting themselves in their declining years. These
State Medicine

and other considerations give great concern to the people of Canada, and anybody who will advocate such measures as the one we are now discussing may be sure to receive support.
The thing I object to is that any man who is intelligent, any man who knows the workings of this house, will venture to get up on a platform at election time and promise that if he is elected he will bring about these reforms.
Mr. Marshall is appealing on behalf of Liberalism. If the Liberal party were honest at this time, it would repudiate the statements of the candidate at Edmonton. In parliament to-day we find ourselves in this difficulty. We are allowed by the government to go ahead with this debate, which may last the whole day; a great many admirable reasons for the adoption of state medicine will be put on Hansard; and then the whole proposal will be left in cold storage for another year or another two or three years, possibly until another election, when some other honest and earnest people will get up in the house and advocate a measure of this kind.
Is this sort of thing to go on indefinitely? I do not like to be dragged into party politics; but I say that when the government has a majority quite capable of putting through a measure of this kind, the least it can do is to tell the people of the country as a whole where it stands on these matters, and that it is or is not going to do anything about the question. That is the least that can be done to maintain anjdhing like political honesty in this chamber or in the country.
It is not my purpose this afternoon to give any lengthy presentation of this case. That perhaps can be better done by some of the medical men in the house. All I want to do is to assure the house that we in our group are heartily in sympathy with state medicine. It is just part of the program we should like to see adopted, by which the welfare of the community as a whole would be given first consideration.
I might place on the record a summary of the case for greater health provision for the sick by quoting a few brief passages from those who have given considerable attention to this matter. I have in my hand a pamphlet entitled Social Work and the People's Health, being the report of an address given by Miss Charlotte Whitton, executive director of the Canadian Welfare Council, before the Registered Nurses' Association of Ontario on February 5, 1936:
Extent and nature of the problem: At any time about two per cent of the working population are sick from one cause or another; at the date' of the 1931 census one out of every twenty-three workers had lost time in the year for illness, and the average lost time for this one worker in every twenty-three (that is over
[Mr. Woodsworth.l
four per cent) was over twelve weeks. Altogether for the whole working population an average loss of about ten full days per annum due to illness was recorded. On June 1, 1931, one per cent of all workers were off work due to illness. One reliable estimate reports about seventy per cent of all school children as suffering from remedial defects; about thirty per cent of persons from eighteen to forty years of age as incapacitated for arduous labour from ' largely preventable causes, and sixty per cent of those from forty to sixty years as in need of care for controllable if not preventable conditions.
And again:
Many of our people are not regularly employed, even in good times, because of the seasonal nature of employment. Sometimes as high as forty per cent of the working population will have some time off during the year, and this may run as high as twenty-four and twenty-five weeks for certain activities. It was estimated in the unemployment insurance calculations that 860,000 wage workers are seasonally or casually employed and that about 730,000 workers are occupied in agriculture.
It is manifest from these figures it is quite impossible that the ordinary insurance scheme would cover the needs of the great majority of the sick people of this country. Let me give another quotation:
Millions of dollars, hundreds of units and thousands of personnel are already an integral part of public health services or services so substantially aided by public funds as to fall justifiably within the category of publicly provided services. Thousands of qualified persons are engaged in private practice in medical, nursing, dental and pharmaceutical pursuits. Hospitalization services indicate the extent of Canada's existing investment in health. In 860 hospitals, 11,416 doctors are now members of staff or caring for patients, with 726 medical staff and 733 internes in full-time employment; 5,210 graduate nurses and 9,472 student nurses are employed. Annual maintenance costs exceed $38,000,000 and 51,577 beds are available for hospital patients. Fully twenty per cent of this care is given to non-pay patients, while thirty per cent to thirty-five per cent of all patients are indigent.
That gives some idea of the extent of the interest we have in this problem.
One more brief quotation from another pamphlet by Miss Whitton, entitled Britain's Social Aid and Ours. In Great Britain, where the hon. member for St. Boniface has said there is a thoroughly worked out scheme of health insurance, there is also provision for medical assistance for the indigent.
There is thus provided through the public assistance committees, which in Canada might be described as municipal social welfare committees or boards, a complete local service including institutional, and hospital, and outdoor relief and medical relief in their own homes for all persons who are in need thereof for causes other than unemployment, or who are not eligible for aid under unemployment insurance or assistance, health or pension plans.

State Medicine
In this country already medical men are beginning to work along the line of more systematic provision for the sick. I have before me a pamphlet containing a reprint of an article by J. A. Hannah, M.D., in The Canadian Doctor. It is entitled, The Development of a Voluntary Plan for Prepayment of Medical Services. This indicates that the medical men realize the necessity for a much more systematic way of dealing with the sick. There has been worked out a very interesting computation as to what it would cost if cooperative arrangements were made. I quote:
After extensive search and reading we were able to compile a table somewhat after the
following:
Home calls-1 per person per year
at $3	$ 3 00
Office calls-1-5 per person per year
at $2	 3	00
Surgical operations-0-08 per person per
year at $50 each	 4	00
Hospital care-1-3 days per person per
year at $3.50	per day	 4	55
Drugs	 50
X-Ray	
1	00Administration	
2	00Total for medical	care	$18	05Dental	
4	00
Nursing-0-5 per person per year at
$5 per day	 2	50
Total	$24 55
Now, Mr. Speaker, it would seem that if it were possible that some arrangement could be arrived at, either a voluntary or a state arrangement, by which we could ensure that people could be taken care of for $24.55 a year and the doctors receive adequate maintenance. this would be highly desirable in the interests of the public.


Charles Gavan Power: If I may interrupt, I suppose my hon. friend knows that there is some such scheme in force in Toronto at a fee of $24.


James Shaver Woodsworth: Yes, I understand
that. I think that fee was based on these calculations.


Charles Gavan Power: It is operating in Toronto to-day.


Richard Bedford Bennett: There is one at less than that in Calgary.


James Shaver Woodsworth: Undoubtedly if we had it under state control and on a very wide scale, that sum could be brought down considerably. I believe in some Scandinavian countries it is down to something like $16 per person.
I should like further to present to the house a few considerations which have been advanced in a memorandum of the health league of Canada and which seem to me to
summarize the situation very well. I quote three isolated paragraphs:
If the dominion would finance a program of health promotion similar to that established in the United States, under the social security program, local health needs could more advantageously be served, the dominion could retain supervision over conditional grants for health purposes, could approve projects to be undertaken by the provinces, and could coordinate the public health program for all of Canada.
Again:
As long as the dominion continues to regard public health as a matter solely of provincial responsibility, and refuses to recognize the national health aspects of child and maternal health, and of such diseases as tuberculosis, cancer and venereal disease, the general improvement of public health of the nation will be retarded.
And still again:
The federal government should not only assume its responsibility in this field of public service, but also should plan, finance and supervise the administration of a comprehensive national health program. In carrying out such a program the cooperation of voluntary organizations will continue to be of prime importance.


Charles Gavan Power: 'What is the date?


James Shaver Woodsworth: I am afraid this memorandum is not dated, but it is of recent date. It came to me along with several resolutions passed recently which, I believe, Should be placed on record. The first, from the Canadian Medical Association, says:
Whereas venereal diseases constitute a problem of major importance; and
Whereas Canada, for eleven years, had a most effective plan for the control of venereal disease involving dominion and provincial cooperation and organized education; and
Whereas, in 1932, the division of venereal disease in the dominion government was dissolved and grants to the provinces for this purpose cancelled, also grants for educational purposes discontinued only to be restored in part; and
Whereas three regional conferences held in 1931, as well as the Dominion Council of Health, at a meeting held in December, 1931, all recommended that the scheme be extended and grants increased;
Therefore be it resolved that the dominion government be memorialized, and asked to reestablish the division of venereal diseases in the federal Department of Pensions and National Health; to reinstate the grants to the provinces; and to make adequate provision for educational purposes throughout Canada to the end that the Canadian scheme be once more put on an effective basis.
This resolution was passed at Ottawa in June, 1937.
It would seem to me that although we are not likely to have anything like a comprehensive scheme of state medicine, the least the government could do would be to comply with the terms of this resolution.
State Medicine

One other resolution along similar lines, which seemed to me a reasonable one, was passed at the annual meeting of the Canadian Public Health Association held at Ottawa on the same date. It states:
That whereas the venereal disease problem is a matter of national importance, previously dealt with most efficiently in Canada by a carefully coordinated scheme involving cooperation between the dominion and the provinces, financial and otherwise, and carried on by virtue of the existence of a venereal disease division in the dominion Department of Health, assistance to organized education and propaganda;
And whereas three conferences of clinicians called by the dominion government in Edmonton, Toronto and Montreal in 1931 made various recommendations, practically none of which have been carried out;
And whereas the Dominion Council of Health in December, 1931, endorsed these recommendations urging continuance of grants and extension of the scheme,
Therefore be it resolved that the dominion government be memorialized and asked to reinstate the grants to the provinces, to reestablish the division of venereal diseases in the dominion government, and to make adequate provision for educational purposes throughout Canada to the end that the Canadian scheme be once more put on an effective basis.
I commend these resolutions once more to the attention of the minister.
Sometimes we have been inclined to think that Canada is in the very forefront of development. As a matter of fact, in matters of public welfare Canada lags far behind. The hon. member for St. Boniface, who preceded me, told of some of the achievements in soviet Russia. I was reading only a few days ago a book entitled, Social Work and Legislation in Sweden, published by the Royal Social Board. This is a survey, published by order of the Swedish government. I wish I had time to place some of the facts contained in the book before the house; but in view of the long list of speakers, I shall refer only to the work itself. As I look over the paragraphs. I am delighted to think of what could be accomplished in Canada, and what actually is being accomplished in other countries.
The following headings and subheadings will indicate the variety of subjects discussed: Social Insurance:
Accident insurance.
Sjckness benefit funds.
National pensions, children's allowances and compensation for blindness.
Pension funds, endowment insurance societies, etc.
Relief and pensions for seamen.
Hygiene and Care of the Sick:
Organization of public hygiene and care of the sick.
Private organizations:
The Red Cross.
Swedish Public Baths Association.
[Mr. Woodsworth.J
Hygiene and Care of the Sick-Concluded
Combating national diseases:
Tuberculosis.
Venereal diseases
Diseases of the teeth.
Cancer
Care of the abnormal:
Mental disease.
Care of the mentally deficient.
Care of epileptics.
Cripples.
The blind.
The deaf and the deaf-mutes.
It may be all very well to have instituted within the last few days a trans-Canada air service; it may be all very well to boast of our natural resources, and of the enormous sums being piled up by certain individuals and corporations in Canada, but I suggest it would be a great deal better for Canada if we could boast that no unemployed man or no sick person goes neglected. Canada might then be laying the foundations of true national greatness.
I hope that to-day, as has so often happened, the government will not close the debate by pointing out jurisdiction and financial difficulties which may lie in the way. I do not ask that the whole of medical aid should be brought under a centralized agency, but I cannot see that there is any reason why the dominion government could not have an active health department which would help to coordinate the work of the provinces and municipalities, which would undertake certain types of work common to all the provinces and, above all, which would give financial backing to the various schemes already under way.


Mr. H. R. FLEMING (Humboldt):: Mr. Speaker, in listening to the speech of the hon. member for Fort William (Mr. Mclvor), I found it difficult to determine the intention behind the resolution appearing on the order paper. Does he mean complete socialization of state medicine, or does he mean the extension of state influence and control in the health field? It is difficult to find uniformity of opinion, even among medical men, on the question of state medicine. I take the term to mean a system under which the state would assume responsibility for all medical men, under which all those engaged in medical services would be employees of the state.
As state medicine has been widely discussed and as the subject is of vital importance, it is essential that we should keep in mind the distinction between socialization of medicine, which I have interpreted state medicine to mean, and other forms of cooperation in the health field, such as health insurance.

State Medicine
Therefore, when I say I am opposed to state medicine, it does not mean that I am opposed to government participation in the health field. It would be ridiculous for me to take that attitude. For many centuries governmental and public authorities have been forcibly removing from communities those who were suffering from contagious diseases. At the present time we have our municipal, provincial and federal health services. I believe that few doctors, if any, object to this in principle. The Canadian Medical Association at its last convention held in the city of Ottawa endorsed the principle of health insurance. Canada has lagged behind most of the countries of the civilized world in this respect. There is no country in the world to-day which disclaims all responsibility for the care of the sick. I understand that some forty countries have some form of state insurance or have assumed other responsibilities.
The only country that has state medicine according to my interpretation is Russia. The system in Russia may look good on paper, but if we consider the figures published by the League of Nations we find that that country is the focal point of typhus infection for all Europe. In 1883 Germany made it compulsory for all those earning less than a certain income to carry a form of state insurance, but the state contributed nothing to the insuring societies or organizations. In England the employer, the employee and the state all contribute. Austria adopted a system in 1888; Hungary adopted one in 1891, and it spread to other countries of the world until, as I said before, forty countries have some form of state insurance. In most of these countries no one concerned is satisfied with the way in which the system has worked. The main failure seems to be not so much bad organization, the inertia of the doctors or the failure to realize the importance of preventive medicine, as the inability of the countries to provide funds to ensure adequate medical services.
The cost of illness in Canada is $23 per capita yearljr. For the state to assume this responsibility would mean the staggering sum of $253,000,000 added to the annual taxation, and there would be no assurance that these costs would not be greatly increased when the medical services were free. This estimation does not take into account the extension of preventive medicine or of medical research. I should like to quote Hon. Dr. J. M. Uhrich, Minister of Public Health for Saskatchewan. He says:
But remember: Somebody will have to pay for it. Do not let anyone run away with the idea it is not going to cost anything. Money 51952-69
does not grow on gooseberry bushes, and the only way such services can be paid for is out of the pockets of the people themselves.
The consideration of a state scheme o' insurance is ruled out by the British North America Act. Under that act the federal government was given jurisdiction over quarantine and the establishment of marine hospitals, and to the provinces was given jurisdiction over hospitals, asylums and charitable institutions. Public health was not a matter of concern to the framers of the British North America Act. The broader jurisdiction in the health fields was given to the provinces, and the provinces have accepted full responsibility from confederation down to our own days. In the matter of public health the dominion has been able to cooperate with the provinces. The privy council of Great Britain found that part IV of the Employment and Social Insurance Act, which was passed by this house some years ago, was unconstitutional, and at the present time the house is circumscribed on this particular subject.
However, I should like to make a few observations on the question of medical services in Canada. First of all, let me register my objection to a system or scheme of state medicine. It has never been established that any fundamental fault is to be found in the system under which we are working. There is no evidence of widespread neglect of those who need medical care. The medical system as such is not responsible for all conditions and it cannot cure all diseases. Sickness is due to many causes outside its province. A system of socialized medicine would bring many serious disadvantages. Medical services can best be advanced by other and less radical means. The financial aspects of medical care can be met acceptably in various ways without socialization. Wider and more effective use of medical resources could be effected without socialization, and a realization of better social and economic conditions would facilitate more adequate medical care. Socialization would not be practical from any point of view, particularly under the democratic system.
Some of the disadvantages of socialization are that the quality of medical service would tend to deteriorate. There would be a tendency to standardize treatment, and routine and perfunctory work would result. The incentive to do good work would be removed and personal responsibility would be lowered. The old relation between the doctor and the patient would be destroyed; competition would be removed and medical progress would be obstructed. There would be less interest in work, less professional interest, and research

State Medicine

and recognition of new forms of treatment would be hindered. Greater frequency of periodic health examinations would not bring expected good because they would be superficial and careless. Socialized medicine would tend to increase the number of faddists and quacks; for dissatisfaction with established forms of treatment would drive many to seek other forms of relief. It would result in an enormous bureaucracy with all its disadvantages.
As far as the public is concerned, it would tend to break down self-respect, self-reliance and pride; it would discourage thrift and individual responsibility for one's well-being; it would encourage feigned illness and treatment of many trivial disorders.
My experience as a municipal doctor bears me out in this statement. Many times I have been called twenty miles out in the country for some trivial ailment. The patient could very easily come to the doctor's office. One other abuse was very common. In free hospitalization a patient would ask to be taken to hospital for a common cold. Why shouldn't he go to the hospital? It was free. They paid taxes. The onus of compelling the patient to stay at home was on the doctor. And what excuse could be given if the patient subsequently developed pneumonia?
There is yet another angle. Need I point out to the house the difficulty of Canada competing in world markets if saddled with the financial burden of medical care?
My main objection, of course, is to the doctor becoming the paid employee of the state; for I object whole-heartedly to regimentation and bureaucracy in the care of the sick.
Our medical service is not perfect. Doctors in Canada make no pretence that it is. We have fought persistently to make it better. We have made great strides in the control of communicable disease. In the past twenty-five years the profession has increased the expectancy of life on this continent by fourteen years. Medical service has vastly improved and been extended. I quote the Hon. Doctor Uhrich, Minister of Public Health for Saskatchewan:
We have fought numerous battles with death on many fronts and have won signal victories. Eighty-five years ago, one out of every four Irish immigrants who came to Canada died of cholera; to-day we do not know it as a cause of death in Canada. We have so far eliminated smallpox as a cause of death that, whereas formerly whole villages fell victims to the scourge, we had in 1931 only three deaths in a population of ten million.
We have defeated death on a dozen fronts; we have pushed him back from trench to trench.

I think, Mr. Speaker, it is safe to say that no one in Canada need suffer needlessly at the present time for want of medical attention.
Yet the system of medication has failings, and we as doctors would be foolish not to admit it. Perhaps it is the fault of the "system" or, more properly speaking, the conditions under which we have come to work. I can appreciate that the sponsor of this resolution (Mr. Mclvor) has seen these failings, has seen that health conditions could be improved, and has jumped to the conclusion that state medicine is the solution. I say "jumped" to the conclusion, because I do not believe that if the intervening stages had been carefully thought out or if the idea were given the practical test, the idealism which has prompted this resolution would be realized.
I intend to vote against it because I believe it would benefit in the end neither the doctors, the patients nor the general public. No better reasons could be found. I will say this, that I feel confident if the members of my profession were convinced that the last two named parties would greatly benefit, they would be the first to advocate state medicine; for I must say for my fellow practitioners that they are, as a whole, the highest-minded group of men one could be privileged to meet.
We hear so often in the house of a distinguished member of the bar; that so-and-so was a brilliant jurist, an outstanding lawyer; or we read in the papers of counsel in the court room pleading some case. He has all the surroundings that people like to read about, a crowded court room, judge and officers of the court in their robes of office. But look at the picture of the medical doctor in a lowly cottage on the frozen plains of Saskatchewan- miles from civilization-his only light a coal-oil lamp, rendering the greatest service that mankind can offer, saving some poor creature from death, or alleviating pain and suffering- and the public know nothing of it; this house hears nothing of that.
The record of the profession will bear me out. We have realized to the full that our business is to deal in terms of human life. Is there any other profession which has a more consistent record of public service?
Anyone who knows the work of the Canadian Medical Association is fully aware that it is always seeking to improve as well as to maintain the ethics of the profession, while at the same time endeavouring to raise the standard of practice. We have crusaded for health; we have been in the vanguard in trying to improve social conditions; we have given in great measure of our time and energy that the sum total of human happiness might be increased.

State Medicine
For these reasons it could hardly be charged that the doctors are thinking only of selfinterest if they disapprove state medicine. I cannot speak for all the members of my profession; but as a medical man knowing something of medical practice, I can truthfully say I am firmly convinced that state medicine-particularly under present conditions-is not the solution of our health problems. It just wouldn't work out.
There are certain things the state can do. There are certain things it has done in the past and could continue and extend in the future. There are other activities which could be properly assumed as a public responsibility. I am thinking of research and health insurance, for instance. But within certain limits it should be confined. The source from which medical practice flows, from which it derives its force, is individual effort, and the service is essentially one of personal relationship between doctor and patient.
I have admitted that community health service has failings, that it could be improved. One of my chief objections to state medicine would be that you cannot institutionalize personal relationships. Every doctor realizes it is of primary consideration, if a cure is to be effected, that the patient have full confidence in the doctor.
Under the state system, I am afraid, the tendency would be for too much of the work to become routine investigation, as doctors are only human. People would become human guinea-pigs, instead of patients who are paying for a service and have the right to demand it. The doctor, moreover, would depend for his livelihood no longer on his reputation for efficiency, ability and service, but on his ability to please his superiors, or perhaps the politicians. At the present time a doctor lives by his ability and is recompensed accordingly. Under a state system there is every reason to believe he might be able to subsist or become successful by his ability to "wangle." Nothing could be more disastrous to the medical men themselves, as well as to public health, than that the ability to play politics should determine their rate of promotion. Much as we dislike to admit it, that is the tendency in public service.
What disaster would we not be courting if we permitted our health service to be inoculated with the deadening drug of indifference? That is what we are risking if we take the service from personal initiative and rob proven ability of its just rewards.
There can be no question in the mind of anyone who knows human nature that a state system would kill a doctor's initiative. At the present time, if a government, federal, pro-51952- 69J
vincial or municipal, employs 82,000 a year men, it obtains $2,000 a year service.
I cannot see how any state system could make provision for the greatly varying abilities of doctors. It cannot be done on the basis of preparatory training, even as regards the initial salary; for of two men with identical training one may be a "washout" and the other a very capable doctor. Will it be possible to give the majority of work to the competent doctor under a state system? The energetic doctor, who would probably be the capable doctor, would probably do the majority of the work. But if he saw his fellow "washout" getting an equal salary, I fear for both morale and efficiency. Besides, I would wish to know pretty definitely "who" or what was to be the determining factor in a doctor's salary or rate of promotion before I would give any support to a state scheme.
Even for the competent physicians who were sincerely endeavouring to perform their duties, I am afraid cases would become routine assignments instead of a labour of love. The doctor would not have to stake his reputation on every case; he would have to perform only his "duty". He would be robbed of the incentive of doing his very best for the patients under his care. And may I stop to ask this question:	Who is to assume responsibility
for malpractice, let alone the unavoidable casualties? The responsibility for any person who dies while under state care, any case which does not prove satisfactory to the patient or relatives, would be laid at the door of the government.
Now governments have been blamed justly and unjustly for many things; but is any government prepared to assume responsibility for all the ills of mankind? That one fact alone is enough to make most hon. members vote against this resolution. Imagine a government being turned out of power because an influenza epidemic started during its regime; or one of the members of the house trembling for reelection because the Jones family's myriad members blame a government doctor because little Johnnie isn't getting well fast enough! At that, it might stimulate a campaign for eradication of disease. But until Canada became a disease-free area, I tremble for a parliamentarian's existence.
If hon. members are willing to assume all these responsibilities, to shoulder all the ills of mankind, I wonder if they would consider whether the sacrifice they are ready to make for the public would be really worth while.
I have pointed out that the service which could be expected from a personnel of state doctors would not be of as high a type as under individual competition, because initia-
State Medicine

tive would be killed, incentive to do best work gone, while the dead wood of the personnel would remain. For these reasons alone the public would not be getting the best service, to which it is entitled, and which it is imperative it should receive.
As I suppose every hon. member knows, sickness is a convenient excuse for avoiding many things. Our medical knowledge is not and never will be sufficient for us to say definitely whether a man is sick or not. We can say that there is nothing organically wrong with him, but we cannot say that there is nothing wrong with him. The mere fact that he wishes to complain of sickness means that there is some maladjustment in his make-up; even laziness could be considered to be that. At any rate, it is a bad habit, and state medicine would assuredly be imposed upon.
The healthy, of course, for their own protection must always care for the sick. This is one of the -easons why it is easy for people outside the medical profession to stimulate interest in public health. But I am concerned now with the fact that in recent years the burden of payment for medical services has fallen upon the middle class. The rich can afford to pay for it and the poor get it free. That is one of the difficulties of our system. We might be in a better position if we had adopted the Chinese system of paying the doctor so much to keep us well. But the Canadian system has been that doctors are called in only in the case of sickness. As was pointed out this afternoon, doctors themselves have assumed the responsibility of keeping people well by wholesale vaccinations and inoculations against the various infectious and contagious diseases. For years we have fought to improve public health.
There is still another phase of the question. As mentioned before, the burden of medical costs falls upon the employee in the lower wage brackets. Because he cannot afford a proper diet or because of the general conditions under which he lives, he is more often ill than those who are living under better conditions. In his budget he does not make any provision for the event of sickness. He will not say, "This year I am going to break my leg," or "Next year I am going to have my little boy's appendix out." Customarily he works upon the assumption that he is going to be perfectly well. And sickness is a very expensive proposition.
Whether or not health insurance should be compulsory is a debatable point. Personally I would favour a compulsory plan because it would not be as expensive as the voluntary plan. I should, however, like to see federal

responsibility for the unemployed and indigent, because there is little doubt that we are approaching the time when relief will have to be assumed as a national responsibility, also health insurance for at least those in the low-wage brackets. I should like also to see the government give extensive grants for preventive medicine and for medical research. In that manner we could safeguard and improve the health of our people without recourse to state medicine or the socialization of medicine.
I plead with all hon. members. Do not give ear to those who would take away from the medical profession their individuality and self-respect. With that assurance I am sure that the medical profession will re-pledge ourselves to the public service and well-being.


Mr. J. K. BLAIR (Wellington North):: While I favour state medicine to some extent, I do not believe it is the duty of this government to deal with the problem in an expensive manner; it should remain with the provinces, just as in the case of relief. This government does not administer relief; it is controlled largely by the provinces and subsidized by the federal government. The provinces know better the conditions in their localities. I believe the same is true with regard to medicine. There are occasions, I believe, when the dominion government could properly subsidize the provincial governments for some purposes. For instance, many cases of confinement are not paid for. I am sure that every doctor in this chamber can find, on looking through his books, as many as six confinements in one home, for none of which he has been paid. I do not think that should be so. The difficulty is that one cannot tell whether a person is indigent. It is said that we should prove indigence and put in a bill; but this involves a great deal of trouble, and it seems to me that in the rural districts the doctors should be entitled to receive compensation in respect of confinements which after two years have not been paid for.
The second proposition brought forward was a payment of two dollars a month per capita. Hon. members must realize that this would involve an expenditure of $264,000,000, no small amount for the Dominion of Canada. Another movement that is on foot is to centralize maternity work in the larger hospitals. That is a sad mistake, because the maternity mortality in hospitals in such cities as Toronto has been very high. That point has been taken up; I have mentioned it for four or five years; now the city of Toronto will not furnish a report of its maternity mortality; at any rate I have tried for the last three

State Medicine
years to get it, and because of my habit of announcing what it is they refuse to give it. The maternity death rate is much lower in the rural districts, in the towns and villages, than in the cities.
A service which I regard as extremely important is the provision by our provincial government of a travelling clinic for tuberculosis; it also has a free clinic in all our hospitals which diagnoses cases of tuberculosis and of venereal diseases. In my opinion people should be required to get a certificate of health before they are married. I know of many instances where a tubercular patient has gone away to get married; I know also of not a few instances where patients suffering from other contagious diseases, including venereal diseases, have got married. These things are disgusting; there should be some way to prevent them, by requiring a certificate from the superintendent of the hospital or some other doctor, after an X-ray has been taken, guaranteeing the patient's freedom from the disease. This would mean much to our civilization; it would keep many people out of our asylums and prevent other serious consequences.


Mr. D. G. ROSS (Middlesex East):: I have been deeply interested in the debate that has taken place this afternoon. I followed carefully the remarks of the mover of the resolution (Mr. Mclvor) and what was said by the hon. member for St. Boniface (Mr. Howden). One could sense the view that would be taken by the hon. member for Fort William, who moved the resolution, inasmuch as he is a fisher of men. He kept his argument on that plane and I do not think it did him any harm. I was greatly taken by the remarks of the hon. member for St. Boniface. There is no question about it, he has made a great study of this whole problem and he speaks from a wealth of experience as well as from his heart. He left a deep impression on me, and, I believe, on the house.
Like the hon. member for Winnipeg North Centre (Mr. Woodsworth), I lack the necessary equipment to speak from a medical point of view; but I wish to tell a story about one disease in Canada, a story that may encourage a good many people. I am going to discuss briefly a subject that has never, to any extent, -occupied the attention of this house. It has received scant attention, not because it is not of vital importance but because, since it deals with a matter of public health, it is primarily a -responsibility of the provinces. I refer to the prevention and treatment of tuberculosis. In Ottawa, the federal Department of Health and the Canadian Tuberculosis
Association undertake the collection, correlation and publication of statistics bearing upon this subject, and upon these statistics I wish to base my few remarks.
I first became interested in tuberculosis while visiting the Queen Alexandra sanatorium situated on the outskirts of London, Ontario, and in my constituency of Middlesex East. This sanatorium, one of the largest in Canada, and -probably -one of the largest on the north American continent, houses 600 patients in all stages of the disease. Such a large concentration of his fellow citizens brings home forcibly to the visitor the seriousness and extent of this malady. His Excellency, Earl Grey, at one time Governor General of Canada, dedicated the Queen Alexandra sanatorium on April 5, 1910, but in studying the history of the institution we must go back a few years. In 1908 the late Sir Adam Beck and Lady Beck, realizing the urgent need of providing some means of caring for those suffering from tuberculosis, stressed the importance of a sanatorium as a centre from which to combat the disease in that district, and under Sir Adam's leadership some twenty -prominent citizens of London were instrumental' in organizing in 1909 the London Health Association. The board of directors as elected at the first meeting were: President, the Hon. Adam Beck; Vice-President, Mr. J. B. Smallman; and Honorary Secretary-Treasurer, Mr. H. E. Gates, with seventeen directors.
There followed the establishment of clinics and the examination of contact cases. Many children were found to have been exposed to the disease, and the question of caring for them presented a serious problem. It was not safe to put them with adult patients; for some were suffering from the disease in an advanced form. Certainly a preventorium for children was urgently needed. The London Health Association, discharging the heavy duty of the sanatorium, asked th-e members of the Women's Sanatorium Aid Society to assist them by raising the sum of $10,000 for the erection of a building. The society was given three years in which to raise the fund; but they worked so successfully -that it was raised in fourteen months, and in June, 1914, the preventorium-, with -beds for thirty children, was officially opened by Sir John Gibson, lieutenant-governor of Ontario.
Then came the world war. The first soldier patient was admitted to the sanatorium in 1915. By the end of the following year the number of those being treated was fifty-one, and the buildings soon became crowded to
Slate Medicine

their utmost capacity, necessitating emergency accommodation. In 1918 the Marion Beck nurses' residence was donated by Sir Adam and Lady Beck as a token of thanksgiving for the restoration to health of their daughter. In 1921 Lady Beck passed away. Sir Adam died on August 15, 1925. Much sorrow was felt when these deaths occurred; for these good people were the essence of self-sacrifice, charity and goodness towards their fellow men.
Mention should also be made at this time of the erection of the veterans' memorial building, which was a gift of the Byron sanatorium branch of the tuberculous veterans' section of the Canadian Legion, B.E.S.L., as a tribute to those men who during the period of their own illness had unselfishly given of their strength to help others. One-half of the building contains a rest room for the use of visitors to the sanatorium, and the other half is used by the officers of the Byron branch. On the occasion of the dedication and the opening ceremony, held on November 23, 1930, the Hon. Colonel Murray MacLaren, then Minister of Pensions and National Health, was present and officiated.
For some years the quarters provided for the members of the staff of the Queen Alexandra sanatorium who were engaged in active work in connection with the field of tuberculosis research had been most inadequate. Through the generosity of Mr. W. L. Mara the Mara laboratory was founded. This laboratory is most modern and up to date from the point of view of scientific equipment and X-ray apparatus, and it was erected as a memorial to the Mara family. Doctor J. G. FitzGerald, dean of the faculty of medicine of the university of Toronto, officially opened the building on October 28, 1932.
The area particularly served by the Queen Alexandra sanatorium comprises the counties of Middlesex, Elgin, Lambton, Kent, Huron, Perth and Oxford, although patients are admitted from any county in Ontario. Clinics for the free diagnosing and examination of contacts and suspected cases are conducted as follows: In London, at the Victoria hospital, twice weekly; at the Westminster hospital, three times weekly, ex-soldiers only; at St. Joseph's hospital, weekly; and monthly in Ingersoll, Goderich. Sarnia, Stratford, Chatham and Woodstock. These clinics, which require the services of two full-time senior staff physicians, and one half-time stenographer, are financed through the sale of Christmas seals in the counties mentioned. In addition to the diagnostic clinics there are four outpatient clinics a week, as the sanatorium to which patients previously treated in the sanatorium return for their pneumothorax treat-
IMr. Ross (Middlesex).]
ments. An average of seventy-five patients a month receive these treatments. The sanatorium property consists of 543 acres of land, and it is necessary to rent an additional 150 acres. An accredited herd of 180 holstein and jersey cattle and a flock of some 3,000 white leghorn hens provide the milk and fresh eggs so essential in the diet of the tuberculosis patient. The sanatorium has its own pasteurizing plant; a large garden produces fresh fruit and vegetables in season. For some time now the sanatorium has been administered under the very able leadership of Doctor D. W. Crombie, medical superintendent.
That is the statistical part. I have some personal touches which may be of interest to hon. members. As the sanatorium is situated in my riding, I have had opportunity time and time again to visit it, and have had many discussions with the staff physicians. These lead me .to the comforting impression that much has been done and is being done to stem the ravages of the white plague. Among those interested in the disease there is an appreciable feeling of optimism as to what may be done in the future, both in the treatment of the individual patient and in prevention. This feeling of optimism appears to be growing. As a layman I am struck by one outstanding fact, so obvious that the mention of it seems like the utterance of a truism, that is that tuberculosis is preventable.
Tuberculosis is an infectious disease. It is caused by a known organism called the tubercle bacillus, wThieh has been recognized for about fifty years. This germ is transmitted from the diseased to the healthy. Inasmuch as the disease is caused by a known organism, it differs from the so-called degenerative diseases. Being caused by a known agency, tuberculosis should theoretically be preventable. In spite of this, however, there were 6,591 deaths from this disease in the dominion in 1936. This is not said in criticism of the agencies which are engaged in antituberculosis work. To them goes our warmest praise; for they have waged an unremitting battle against the plague and have used to the utmost all available weapons against it. There are many medical, social and economic factors which make the struggle for the prevention of tuberculosis much more difficult than the campaigns so successfully directed against other infectious diseases, such as diphtheria and typhoid fever, which used to take such great toll of human life but now are relatively rare. However, in spite of difficulties it is evident that real progress has been made towards conquest of the disease.

State Medicine
The 6.591 deaths from tuberculosis in 1936 represent a death rate of sixty-one per 100,000 of population. This is in marked contrast to the situation only five years ago. In 1931 there were 7,628 deaths from this disease, representing a death rate of seventy-four per 100,000. In 1926, five years before that, the death rate was eighty-six per 100,000. Comparative figures for the dominion are not available before 1926, but the fall in mortality in the last fifteen years has been remarkable. Prince Edward Island cut its death rate from 145 in 1921 to sixty-six in 1936; Nova Scotia from 134 to eighty-nine. In Ontario the death rate over this period fell from seventy-one to thirty-six. From these figures comes the comforting assurance that the struggle against tuberculosis is meeting with substantial success. Nevertheless one cannot view with equanimity the fact that even yet this disease, which on the face of things should be preventable, each year wipes out in the dominion enough people to populate a good sized town.
The question of treatment and that of prevention are closely interrelated. Discussion with sanatorium physicians reveals the fact that more patients than ever before are having their disease successfully arrested and being returned to useful and normal lives. Rest treatment, which time has established as the only successful cure, has of late years been increasingly aided by various forms of surgery which are employed to assist the diseased organs in their recovery. It is now possible to bring about lasting cures in many cases where previously all that could be looked for was a temporary prolongation of life. Indeed the evolution of the treatment of tuberculosis forms one of the most interesting and satisfying chapters in the history of modern medicine. Furthermore, adequate treatment means the isolation of those who are infectious, and the permanent and satisfactory arrest of the disease means that the patient is no longer a source of danger to his community. It is not claimed that the tuberculosis sanatoriums are the sole factor responsible for the fall in the death rate. They play a large part; but the cause of the decline in mortality probably rests on a broader basis, namely, the increase in public awareness of the disease, its causative factors and means of prevention. The community which is tuberculosis-mind'ed is the one which will show decreasing incidence. That community will employ the greatest number of anti-tuberculosis weapons, among the most effective of which are the sanatoriums. It appears, therefore, that the community which employs these special hospitals to the utmost will also be found to be making full use of other measures, such as stationary or travelling
clinics, milk pasteurization, observation of contacts, separation of children from infectious adults, and all modern methods of health education.
This conclusion is endorsed by a study of dominion statistics. Several natural factors influence the incidence of the disease. For example, the maritime provinces have always shown a higher incidence and death rate than the prairie provinces. This may be due to several causes, including the differences in density of population, standards of living, housing and climate. Thus the wide scattering of the prairie population and the known antiseptic value of intense sunshine on infectious material may do much to keep infection under control.
If we discount these natural factors which may cause variation in incidence, it is evident from our statistics that the number of sanatorium beds in a community can be used as a criterion by which to judge the extent of its anti-tuberculosis work.
In Ontario the movement for the establishment of tuberculosis sanatoriums was early in its inception and sturdy in its growth. Thirty-one years ago Sir William Gage built in the Muskoka district the first Canadian sanatorium, which still exists as the Muskoka Hospital for Consumptives. In 1936 Ontario had 3,205 beds for the treatment of the disease. Concurrent with the increase in the number of beds has been an increase in public interest, in the formation of private and governmental clinics, governmental and municipal examination of contacts, pasteurization of milk, and public education in matters of health. The total governmental, municipal and private cost of operating tuberculosis sanatoriums in Ontario last year was $2,250,551. When we consider that the death rate in Ontario last year touched its lowest point of 36 per 100,000, it is difficult to conceive of any better way in which two and a quarter million dollars could have been spent.
What can the dominion government do to further the struggle against tuberculosis? I hesitate to make any concrete proposal; I am aware that the matter as it affects the dominion is in goods hands in the ministry of health and the Canadian Tuberculosis Association. Would an increase of knowledge, interest and appreciation on the part of the house lead to material encouragement of their efforts? More public education as to the increasing curability of the disease and its prevention is essential. The power of publicity in these matters is enormous. Last spring the premier of Ontario made a speech on the subject which received wide publication, and I am informed by sanatorium physicians that
State Medicine

in the two months following that speech these sanatoriums had great difficulty in admitting the number of patients who clamoured for treatment. Therefore it is evident, from a study of the course of the disease in the last quarter century, that the time is fast approaching when a full and concerted effort on the part of all concerned would reduce tuberculosis from the terrifying position given to it by Sir William Osier as one of the "captains of the men of death" to an insignificant place in the mortality tables of the dominion.
At six o'clock the house took recess.
After Recess
The house resumed at eight o'clock.


Mr. JOSEPH NEEDHAM (The Battle-fords) :: Mr. Speaker, may I first place on record the resolution under discussion:
That, in the opinion of this house, it is most urgent that state medicine be established in the Dominion of Canada.
The resolution is very broad. It does not indicate how state medicine should be established, or whose direct responsibility this duty would be. All hon. members are aware that the provinces have a large share in the control of the health of our people. We also recognize that there is a federal department of health. I take it the resolution contemplates cooperation between the provinces and the dominion in the establishment of a system of state medicine. Just how far the authority of these respective governments should extend is perhaps one of the points which will have to be settled. We know, however, that each is or should be directly concerned with the health of the people.
Perhaps the state should have the first concern, because the state must realize, perhaps more directly than do the provinces, the value of citizens. In a time of war the federal state has a claim on every citizen and should have the first responsibility of seeing that every citizen is kept in the best possible health. All hon. members realize that while a_ healthy person is an asset to a state, a sickly person is a liability.
Then we may analyze the question from another angle. The federal state is directly concerned with matters of war and armament. We might ask ourselves this question: What is the use of providing defence unless we have healthy citizens to use the defence equipment? I say it would be far better to spend less money on armaments and more on the health of the population, even though

such health expenditures be considered from the standpoint of war preparation. It should be of at least equal, or possibly of greater concern to have healthy people than to have armaments.
From the evidence brought forward this afternoon it seems clear that those countries most progressive in the construction of armaments are the countries giving the greatest attention to the health of their people. This is not a political issue, nor is it a claim whereby one class may benefit more than another. The benefits derived would be for the good of the whole dominion. If such a scheme could be worked out, I feel we would go a long way towards creating a happy and contented people, because it is impossible to enjoy life while in a state of imperfect health.
May I make particular reference to some of the arguments adduced this afternoon by the hon. member for Humboldt (Mr. Fleming). I clearly recall that the same arguments were advanced when state medicine was proposed in Great Britain, and I believe they have been advanced in every country where the subject has been discussed. I believe his argument that everybody with a sore finger or a sore toe would run to a hospital, if medicine and hospitalization were free, is not well founded.
I recall that in 1917 and 1918 the municipality of Round Valley granted free hospital accommodation ,to its citizens. Two years after the system was inaugurated a new council rescinded the provision. I was secretary during the period, and I know that fewer patients from the municipality went to the hospital during the two years hospitalization was free than during the time the people had to foot their own bills. If necessary, I could produce proof of my statement.
I shall not take time to place statistics on record, because I believe sufficient were advanced this afternoon. IVe did hear, however, that each year $311,000,000 is spent in treatment of disease while only $7,000,000 is spent for preventive purposes. I find that in Ontario, $54,846,349 was spent on sickness in one year, and $834,502 was spent on public health. It would seem safe to say that there is room for investigation in connection with preventive medicine, and to ascertain whether or not sickness cannot be arrested in the early stages. On many occasions persons may have to pay $300, where $30 should have been sufficient to prevent the illness.
For these reasons I say we should have a health program for the whole dominion worked out cooperatively between the provinces and the dominion. We often hear it said that human life is the most valuable

State Medicine
asset the dominion has. That value is enhanced if human life is in its full vigour of manhood or womanhood. The American Medical Association have stated that state medicine is any form of medical treatment provided, conducted, controlled or subsidized by the federal or state government. So, in a degree, at the present time, in quite a number of the provinces we have state medicine, and especially in connection with the operation of sanataria and the subsidizing of hospitals and doctors.
A royal commission was appointed in Saskatchewan in 1921, and its report showed that sixty-five per cent of the school children were infected with tuberculosis, and that seventy-five per cent of the students in the normal schools were in the same condition. In 1934 only fourteen per cent of the school children and seventeen per cent of the normal school students of Saskatoon were infected. Ninety thousand school children were examined in British Columbia and eighty-three were found to be medical defectives.
I should like to pay tribute to what has been done by the school nurses in some of the provinces and also to the efforts put forth by some municipalities to provide dental and medical care for school children. When a report is sent home that a pupil requires certain treatment, quite often there is the problem of financing to be solved. I know of one instance where a school nurse visited a school and recommended that two girls should have their tonsils removed. Neither set of parents considered the matter to be sufficiently urgent; it was thought that it could be left until holiday time. In both instances the girl was dead before the holidays. The fear of having to pay a doctor's and hospital bill is what keeps many back.
Reference was made this afternoon to what other countries are doing along this line. Sweden presents the nearest approach to state medicine. The system there is on a non-eompulsory basis and most of the people take advantage of it. A room in a publicly owned hospital costs seventy-five cents a day as compared with $7.50 a day in a privately owned hospital. An appendix operation costs only $8. Sweden rightly boasts of the most inexpensive yet most efficient health service in the world. We can all make a comparison between those costs and what we have to pay in our own community.
The National Health Insurance Act was passed in England in 1911. This was a compulsory scheme for all workers receiving less than $1,250 a year. The average contribution by the worker is about eight cents a week, the employer paying a like amount and the
state, the balance. That scheme has been in operation for many years, and it offers a guide as to what is beneficial for a country. A patient is permitted to have his own doctor, and the doctors have as much freedom under the scheme as they had formerly. I should like to quote Lloyd George in this connection. In July, 1933, he said:
The scheme of national health insurance which I launched in 1911 has now been in operation for twenty-one years. It has firmly established itself as a permanent feature of our social life and has proved of incalculable benefit to the nation. While its main features have remained unaltered it has been added to and adapted by successive governments of every party colour and used to serve as a basis for further developments of social insurance which are steadily raising the standard of life of our people and increasing their security and happiness.
Doctor Routley, secretary of the Canadian Medical Association, visited Europe last year. Speaking on February 7, 1938, at the convention of the association held here in Ottawa, he stated that Lloyd George had told him that such social security measures as state medicine and health insurance had kept Great Britain from revolution in the past few years. State medicine has been in operation in England since 1911 and it has proved its worth. More than 18,000,000 people in the British Isles have benefited from the free health services.
I should like to touch briefly upon what has taken place in New Zealand. As a memorial to King George V, the government decided last year that a fund should be created for the establishment of permanent health camps. Public appeals and government subsidies produced approximately $850,000. Last year half a pint of milk daily was made available to all school children, both public ijnd private. What a boon to agriculture such a scheme would be. Of course, we are glad for what has been done and for what is being done. Lord Bessborough and his lady appealed for a fund to be known as the King George V silver jubilee cancer fund. This fund has made it possible to do great work throughout the dominion.
I should like to turn now to my own province. I want to give all credit possible to the provincial government and the municipal authorities of Saskatchewan for what has been done in connection with state medicine, hospitalization and control of tuberculosis. That province is now seeking to lead the world in cancer treatment. The only thing that keeps it back is lack of funds to complete the program. I have read carefully the addresses of the present Minister of Public Health, Doctor Uhrich, as well as the reports
State Medicine

of the state medical association. With the cooperation of the dominion government it will take only a short step forward to have state medicine in that province. There is a provincial statute which permits any municipality to engage a doctor. The last report I have is that of 1935, and it shows that there are fifty-four full-time and fifty part-time municipal doctors. Prior to that time I had never known of a municipality that had gone back on the scheme after once engaging a doctor. The scheme must have proven itself in that province. There are twenty union hospitals brought about by the cooperation of two or more municipalities. In this way a hospital is established, and in many cases the hospitalization is free or almost free.
I have often wondered why Ontario was so greatly concerned in the quints, those five little girls at Callander. But we see what medical care and attention has done for them. They are no more valuable than my child or yours; but because the state could commercialize them, it was worth while. I say that the state should commercialize every citizen of this dominion in order that they may render to the state the highest possible service; and it would really in the end be the best possible investment this country ever made, to produce the strongest, most virile race possible on this part of the north American continent. The state has all the means at its disposal; we have the equipment; we have the willingness of the people, and if anything stands in the way, this government should be able to remove any difficulty.


Mr. PIERRE GAUTHIER (Portneuf) (Translation):: Mr. Speaker, will you allow an unfortunate victim of the poor acoustics of this chamber to make an effort to have his voice reach you-and enunciate a few arguments against the resolution moved by the hon. member for Fort William (Mr. Mclvor) -which all of us cannot approve-and in favour of personal and private initiative aided, financially at least, by the public authorities.
If the convictions of the hon. member for Fort William are as deep, as strong and as vibrant as bis voice, the combined arguments of those who do not share his opinion will hardly suffice to make him change it. I am not accustomed to speaking English in this house, but in the hope of convincing the hon. member by speaking his language, I may be permitted, Mr. Speaker, to continue my remarks in English.
(Text) I know that the motion before the house is important; but I am one of those who do not share the opinion of the hon. member

for Fort William (Mr. Mclvor), and I know that if a law were enacted by this parliament establishing state medicine throughout Canada, it would not be as welcome in the country as he thinks it would. I admit that in some countries state medicine is in operation. I have read interesting books on the nationalization of the medical art. Perhaps I should use the word "socialization," for in some special regions it would be more correct. In reading those pages, one is inclined to look upon the results obtained there as very encouraging, almost perfect in fact. Clinics for children, mothers, and men, whatever may be the disease, endangering their lives, are under the surveillance of skilful trained nurses and eminent doctors; chemical and physiological researches are carefully carried out, and serums freely and widely applied. But we do not need state medicine to obtain all these good results. Read the history of medicine and you will find that the works of Pasteur, Harvey, Carrel, and the discovery of Doctor Banting, are not to be attributed to state medicine. Their discoveries were due to the personal initiative of these individuals. Their genius could not wait for the establishment of state medicine.
I agree that the government in many instances should be prepared to help private initiative, to render it more effective for the welfare of the people. Nothing can be too costly when the health of the nation is at stake. If there is a capital that should be jealously taken care of, it is the human capital, and in the past this protection was easily obtainable by private initiative, very often helped by the public purse. Nobody can convince me that the old system has failed or that the medical profession has not successfully served the needs of the people, that it has not met the demands of the populations in various countries of the world. Is there not any other means, sir, of helping the people than by nationalizing or socializing everything? Have we come to the pass in this world where the individual is looked upon as incapable of any personal effort, too weak-minded to produce by himself what society expects from him, so interested in the word money as to convert even his own talents, his self-sacrifice and devotion towards others, into nothing but money?
Let it be understood that I am not imputing to the mover of the motion thoughts and motives which are not his. To come to the point, I want to bring to the consideration of the house what is now the general tendency in many parts of the world, and, I am sorry to say, in different parts of our own country, and that is to impose on the state a general

State Medicine
control of human activities in every domain. I shall not go further on that line except to say that if this opinion should prevail in the world, it should leave the medical art alone, and leave to the patient the freedom and satisfaction he enjoys in the choice of his own doctor.
I shall not quote any statistics; I do not need them, as they cannot express or even help to make clearer the argument which I wish to use against the establishment of state medicine. I intend to bring into this discussion, however, the results of my personal observations as a general practitioner. For seventeen years I have been in constant contact with the patients whom I have had the opportunity, and I must say the pleasure, of treating for various ailments and diseases. One cannot be directly associated with sick people for many years without learning what qualities they desire in their medical man. State medicine may have and probably has many appealing sides and many advantageous issues for some people. I do not believe, however, that it can replace the genuine satisfaction which is brought to anyone jealously keeping his freedom in the choice of his own doctor, his family doctor, whether he is a general practitioner or a specialist.
State medicine may appeal even to an important part of the medical profession, anticipating the day when every treatment, every pill, every look at a wound will surely bring a monetary compensation. But this same important part of the medical profession, practitioners or specialists, would, I am proud to believe, hesitate to favour a law enacted by parliament which would change this present noble and self-devoting profession into a part of the state mechanism. One may say that devotion does not always bring food to one's family. I agree that that is true. But every doctor can say this, that his first clients were not always rich people; poor people called upon him during the first days of his career; poor people were the ones confident enough to try his skill, his medical judgment even though it were from pure necessity. Anxious to do well and to do good, to bring the happiness that follows physical and moral relief, he answered the call. After a few weeks the young doctor already had a fragment of practice. The poor people who were his clients spread their satisfaction in the vicinity; rich people acquired confidence and began calling the new doctor. Indirectly the free treatments were bringing food and happiness-happiness through success and devotion-to himself and later to his family, when he acquired one.
But what if this young doctor is state-salaried? What sentiment develops in his mind? Absolutely different will be the link between the medical art and the people in general. He will regard himself merely as one obliged by law to give treatments. Will the moral obligation on his side, this consoling and disinterested devotion towards the human being in need of medical care, remain strong enough? Can anyone say that later on, in the course of time, all sensitiveness will not depart from his mind and be replaced by a series of numbers, all alike, to which he has to attend in series at certain times of the day or of the week, whether it be a specially urgent disease or one of those emergency cases so frequent in general or special practice? The medical man cannot be indifferent to his patients. He cannot look at them as he looks at things. If he does, it is no longer the medical art; it is crude materialism in its operations, expressions and results.
I know the danger of materialism for those who spend their time in fighting against matter, especially for those trying to put an impenetrable w'all between their physiological and psychological knowledge. Why open a door to this sometimes disastrous danger? As I said, on the patients' side the result cannot be any better. They will be trained to see in t'heir doctor the man in some way imposed by the state. Because if we appoint one, two or three doctors for a special district, the patient will have to take one of these on account of certain regulations that .the administrating board will have to impose in order to have at least a seeming control.
Can the state act successfully without depriving the individual of the sacred right of freedom, even if he is poor, in the choice of his own doctor, his family doctor, the one he thinks is the best, in. whom he is absolutely confident? I do not think so. And if you destroy between the doctor and his patient this certain amount of ease, sympathy and confidence absolutely necessary for the success in many many cases-so important sometimes to produce, in certain maladies, what you would look upon as a miracle-if you ignore the link between the medical art and the people whom you have accustomed to look upon it as part of a mechanism operated by the state, you lower the level which this art has obtained, and in doing so, you do not render a service to society.
My apprehensions are not futile and my words are not delivered in view of a political advantage. I am giving the house my point of view on the matter. To .tell this chamber my admiration for the admirable part doctors have played since the opening up of this country, would be superfluous. The public in
State Medicine

general, the women in particular know what doctors have done from the largest cities to the most remote lands.
Some doctors may find state medicine a gift of Providence. They may find practice too hard at times, the evenings too long, the profession in itself ungrateful, especially when the pay is small, in some instances nil. I have been through all that. It is sometimes hard, not only for the doctor, but for his family, and I might say, for his creditors also.
Though doctors have not been the only ones to suffer in this world, I think they have suffered more than any one in any other profession. But who in this world has never experienced want, in the different stages of physical or moral life? I do not wish to prove that necessities in life are to be absolutely forgotten. I only want to say that there is more in life than stingy personal interest, more than monetary or material considerations.
I said, sir, that private initiative could be greatly helped by public powers. This brings me to the last part of my remarks, to a suggestion I desire to be accepted in every part of this land. As a member of the Quebec legislative assembly I witnessed the birth of what are called the "health units." They represent in the highest degree the help that public authorities can obtain in promoting private medical initiative without the establishment of state medicine. They prove that state medicine is not needed to help us to perform wonders. Thirty-five units are under operation at the present time, and they certainly give satisfactory results. They are operating in rural districts, the cities having their clinics, dispensaries and so forth, subsidized by the provincial government. I know' these organizations cannot be perfect; they are man-made. But they give the best results. I should say they are the most nearly perfect corps a province or a country could have.
They have met with strong criticism on the part of both the doctors and the public; but having proved themselves absolutely necessary they will, and as a matter of fact I believe they do, meet with general approval. The great utility of these units lies in the tracing and prevention of diseases and in the education of the general public by literature, clinics and lectures to mothers and children. The official doctors pay special attention to young mothers. Neither the doctors nor the nurses are allowed to practise. They have strict orders from the department to direct to his own family doctor anyone who needs care, and a sanitary inspector sees that the law is carried out in regard to public septic nuisances.

In the territory covered by the units between eighty-five and ninety per cent of the children from birth to the age of five are immunized against diphtheria. Since the establishment of these health units, infant mortality has fallen from 200 to ninety per thousand births. The doctors who head the units have special degrees from the university of Toronto or the university of Baltimore.
What I have outlined here represents the results which have been obtained without state medicine. The spirit that led to the establishment of these units was the desire to help both doctors and public, and the proper functioning of the units is sure to accomplish the end in view. The Rockefeller Foundation gave wonderful financial assistance to the provincial government, and the people of the province are grateful to that institution. I have read in the press that the thirty-sixth health unit will be in operation in Drummondville on the first of May, and others shortly in Wolfe and Richmond counties. I am glad to see that the Quebec provincial Minister of Health is giving his attention to the establishment of these health units. I congratulate the provincial government upon its continuation of what was begun by the former government of the Hon. Mr. Taschereau.
I do not yet know what view our' federal Minister of Health has on this question of state medicine; but I have absolute confidence in his judgment, and I believe that he will deal with the question from the standpoint of the interests of the Canadian people as a whole. I ask this chamber to examine the question thoroughly before urging upon the government the establishment of state medicine. State medicine may have a brilliant side, but it cannot replace the absolutely necessary links between the people and the medical art. I have dealt with but one side of the question, and that imperfectly. Others, I am sure, will present special arguments against the proposal for state medicine.
(Translation.) After the efforts I have just made in the language	of Shakespeare in order that all members of the	house	might understand the sole
point that I wished to emphasize to-night, that is the moral aspect militating against the establishment of state medicine. I hope hon. members will carefully consider the system in force in the provinces of Quebec and New Brunswick. I remember quite well that at the birth of sanatory units in Quebec-and I see here a few of my former colleagues of the Legislative Assembly who can corroborate my statement-strong objections were heard from medical organizations and from the public.

State Medicine
As I stated a moment ago with great difficulty in a language not very familiar to me, sanatory units have proved themselves, to my mind, the only effective means of preventing the establishment of state medicine in Canada, in the event of the Minister of Pensions and National Health (Mr. Power) favouring such a measure. There are doubtless doctors who would prefer state medicine, but it has a defect which slips too easily into the life of the doctor and which both the public and the doctor should combat by all possible means, that is the spirit of routine. To my mind, and I speak from an experience of seventeen years, state medicine is the surest means of developing this spirit in the practice of medicine. For this reason, for the public good and in order to maintain the medical art at the high level to which it should be maintained in this country, we should take every means to repel this danger and to prevent the introduction and development of this routinism which, I repeat, so easily creeps into the practice of the medical profession.
A doctor's life is not a bed of roses. It is not pleasant to leave a warm house at two o'clock in the morning in twenty-below-zero weather, in order to bring relief to a patient. It does not always appeal to everybody and to every doctor. But there must be somebody to do it, and it must not be forgotten that our country has developed and is still developing as a result of the devotion to duty shown by all classes of its population. Therefore the doctor is ever ready to do his duty. In remote districts where he cannot reach his patients easily and quickly and where the population is not large enough to support a doctor, the state should help the doctor to live and to provide the sick with the medical care essential to every human being.


Charles Gavan Power: The resolution which we have been debating all afternoon reads as follows:
That, in the opinion of this house, it is most urgent that state medicine be established in the Dominion of Canada.
To a layman confronted with a resolution of that kind, the first difficulty is to get a real definition of the terms employed. I have listened carefully during the afternoon in order to understand exactly the definition of state medicine, at least in the minds of many of those discussing it. I took the trouble to read in the pages of Hansard debates that have taken place on this subject during recent years, in order to see if they contained a definition of state medicine. I found that on many occasions several hon. members had stated the purpose of state medicine. My
predecessor the Hon. Doctor Sutherland on one occasion said:
The ultimate purpose of any plan is to make available for every Canadian the full benefits of curative and preventive medicine, irrespective of individual ability to pay, and, at the same time, to assure the practitioners of medicine and others associated in the provision of medical care a reasonable remuneration for their services.
My good friend the hon. member for St. Boniface (Mr. Howden), with the idealism which characterizes him, has on former occasions when bringing a similar resolution to the attention of the house, depicted state medicine as a modern utopia. Doctor Stanley, who was member for Calgary East in the parliament which sat here from 1930 to 1935, and who took a great interest in all these matters, stated that he was unable to define just what state medicine was. Under those circumstances I thought it advisable, as a layman, to seek counsel from those who might be best qualified to know, so I asked some of the officers of my department to telegraph to the secretary of the Canadian Medical Association to ask him what definition he would give of state medicine. This definition has already been quoted by the hon. member for St. Boniface this afternoon. It is as follows:
Canadian Medical Association has not adopted any official definition of the term state medicine, but it is my view that council would likely be in agreement upon the following definition. By state medicine is meant a system of medical administration by which the state provides medical services for the entire population or a large group thereof and under which all practitioners are employed, directed and paid by the state on a salary basis.
That is to say, state medicine would be a system whereby medical service would be available to all citizens, and all the medical workers-if I may so express myself-doctors, nurses, dentists, orderlies, etc., would be paid and directed by the state.
On the other hand we have been talking this afternoon of a system described as health insurance, which is cognate to state medicine. But health insurance differs from state medicine, as I understand it, in that it implies a contribution of some kind by the beneficiary and does not necessarily mean that the doctor or medical worker will be in the employ of the state. So the definition I am told should be this, that state medicine means free treatment of all citizens, with payment of the doctors by the state, whereas health insurance means treatment of those who have contributed, :by doctors paid, either by fees or on a capitation basis, to look after people who intend to be beneficiaries under the scheme.
Slate Medicine


Mr. MAYBANK:: Do they not all belong to one party?


Charles Gavan Power: No; apparently they do not. Apparently even within that country only a small minority of the inhabitants belong to the party in power. But they have gone about their institution of state medicine in a manner that will perhaps appeal to a great many of us. They have more than any other country institutionalized treatment. Domiciliary visits and care are almost done away with. Patients of all kinds and all classes are brought to the state clinics and the state dispensaries. Maternal care is given almost entirely in hospitals. Infectious and communicable diseases must be reported and hospitalized under very heavy penalties. Every effort is being made to bring those whose health is not absolutely perfect under the control of some institution or another. Doctors are all in the pay of the state, with perhaps the exception of those who look after foreigners visiting the country, and perhaps a few who are allowed to give consultations and receive fees. Hospitals are all free, with the exception perhaps of the abortoria, which are considered to be luxuries.
When the revolution broke out and it was decided to organize state medicine on its present basis, they proceeded by way of intensive propaganda among all classes of the state. They impressed the citizens of Russia with the idea that it was a patriotic duty to bring about cleanliness, sanitation and good health. Typhus was a foe to be combatted almost as mueh as the armed foes on the borders of the state. By means of this propaganda I think it can he established that a great deal was accomplished along the lines of sanitation, cleanliness and health. Lenin himself is reported to have said, "Either socialism will defeat the louse or the louse will defeat socialism." Apparently the louse was conquered.
Doctors are all on state wages. They are obliged to go to the section of the country to which they are ordered. If they do their work well, they may get an increase in salary, and if they do it badly, the least that can happen to them is that they will get a decrease in salary.
In bringing about these reforms they were faced with the problem of having very few doctors. A great many of them, on account possibly of their circumstances and perhaps of their political affiliations or sympathies, were either sent into exile or liquidated, so that when 51952-70
the commissariat of health was established in 1918, it was necessary to proceed to the formation of a corps of doctors. This was done by taking from among the ranks of the working men or their children those whom they considered best qualified to become physicians. They were trained in the state training colleges and universities, paid a wage during the time of their training, and sent out to do the work which could be allotted to them.
I think there is this to be said in favour of the system, that if it works-and it does on paper-it will certainly correct a condition which we have in this countiy, and which certainly requires some improvement. There will be a better distribution of medical men throughout the country. There can be no question that one of our difficulties from the standpoint of health is the almost impossibility of getting a young medical graduate to go out and establish himself in the remoter districts where the chances of obtaining a livelihood are difficult, but where he is sure of one thing, hard work, and very little return for it. The soviet union is endeavouring to correct such maladjustments as that. It is endeavouring to provide also for convalescence, and for nurses. It is endeavouring to bring to its people the realization that health is one of the most important things for it to look after.
I have laboured this Russian experiment because I imagine that is the goal which is being sought by all or most of those who are asking us to institute state medicine in this country. After all, if what we read to-day is all true, it would be an ideal kind of state medicine.
I forgot to mention a moment ago that the costs of their system of state medicine are taken not out of what would be equivalent in Russia to our consolidated revenue or out of any central fund, but out of the costs of industry, all industries, of course, being managed and operated by the state. It is simply that much more money added to the payroll; it works out that in each locality or each industry a certain amount is added to the cost of the operation of the industry, and that amount goes to pay the cost of state medicine. It is almost impossible, I believe, to get any exact figures; but Sir Arthur News-holme and John Adams Kingsbury, who wrote the book entitled Red Medicine, figure it out at something like eighteen per cent of the cost of the payroll. Professor Sigerist, who w'rote from a different viewpoint, figures it out at about six per cent of the cost.

State Medicine

Perhaps we should also take into some consideration the basis on which all this is founded. The basis, I should say, was a purely materialistic one, and hardly humanitarian. The soviet state wants to look after its citizens for the same reason in all probability as the owner of slaves on a southern plantation wished to look after his slaves

because he needed them to work for him. I do not say that with any intention of disparaging those who might wish to urge on us the adoption of that system; but I believe, in the light of what we have been able to ascertain, that humanitarianism is the last thing of which the leaders of the soviet state would wish to be accused. As a matter of fact Walter Duranty, a writer whom I was reading recently and who is, I believe, fairly sympathetic to communism, expresses the view that he is surprised that mental cases were not shot out of hand because they were no longer of any use to the state. Whatever may be the motive -and I merely give my opinion when I say that I do not believe it is humanitarian so much as materialistic-the fact is that there is one country in the world where there is state medicine.
I suppose that what we must next consider is whether state medicine as they have it in Russia could be adopted in this country. I doubt very much whether the people of Canada would stand for it, and I do not think the Minister of Health has the authority under the British North America Act to shoot the doctors in this country. I fear it would be impossible to establish any absolute and complete system of state medicine without first taking some steps to liquidate a great many members of the medical profession. I doubt whether the medical profession as such is in favour of such a system. As a matter of fact the Canadian Medical Association has strongly disapproved state medicine although, as I said at the beginning of my remarks, I believe it approved health insurance.
Now with regard to our people. We have some kind of state medicine here. We had during the war. When we were in the army we were looked after-personally I think some of us were very well looked after-by doctors employed and directed by the state; but I would ask almost any hon. member who served during the last war if he was satisfied with the medical treatment which was handed out to him by the medical officers. We have state medicine in another respect; we have it in the department which I administer, that of pensions. Every pensioner theoretically and legally can be looked after by the state for his pensionable disability and also for other disabilities which are not pensionable. I

would hate to ask for a show of hands of hon. members to let me know whether any pensioner they ever met was satisfied with the treatment given him by the state doctor. Time after time hon. members have risen in the house to say that the doctor looking after the pensioner was incompetent; that he had maltreated the pensioner; yet these men were chosen at the beginning from persons who also had experience overseas and would be likely to have consideration for their comrades, and in later years they were chosen by the civil service commission.
My experience-and I give it for what it is worth-is that the very moment a medical man, in so far as pensions is concerned, becomes an employee of the state and is appointed by the state on a salary to look after the pensioners his usefulness disappears. Again and again men with good reputations, men who are known to be at the height of their profession, have joined the Department of Soldiers' Civil Reestablishment and the Department of Pensions, only to be told, when they gave any decision whatever which was not to the liking of the pensioner, that they were no longer any good and were paid by the government to prevent the pensioner from obtaining his just rights. So that, in my humble opinion, the people of this country themselves would not be satisfied with medicine directed, controlled and paid by the state.
The right hon. leader of the opposition (Mr. Bennett), dealing with a resolution which was not quite on all fours with this one but recommended that some form of state medicine be established in this country, said, in 1931:
How many hon. members have considered the implications of that resolution? How many have considered its effect upon the existing provincial organizations, medical and otherwise? How many realize that it means the entire disbandment of the medical associations of the country of private practitioners, and the substitution therefor of the state as employer of all the medical men of Canada? How many have considered that? Yet that is what it means. . . . Are hon. gentlemen prepared to say yea to that? Do any of them desire to say yea?
On that occasion, after a somewhat prolonged discussion, the majority in the house voted against any form of state medicine. I have no difficulty in concluding that, if state medicine means what I think it does, if it comes within the definition which I have been told must be given to it, the house will not be ready to give support to the resolution. However, I desire to congratulate the mover of the resolution and to thank him for putting it before the house. We have

State Medicine
had a full, frank and free discussion of a number of matters related to state medicine. We have discussed health insurance, and I believe the people of the country and hon. members themselves have come to know that there is much more that can be done along the lines of improving the health of the people.	[DOT]
With respect to health insurance, already in three provinces of Canada there are health insurance schemes on the statute books. There is a very complete scheme in Alberta. There is another one in British Columbia. Neither of them has yet been brought into effect. In the discussion on this health insurance scheme of British Columbia the question of jurisdiction naturally came up, and Mr. Weir, Minister of Health of British Columbia, at the meeting of the provincial premiers held in Ottawa in 1935, stated:
My opinion is that it would be a grave error for tile dominion government by amendment to the British North America Act to relieve the province of the major responsibility in health matters. The true role of the federal government in the health field, it seems to me, is to supply leadership, to assist in the promotion of significant health movements. . . . Under section 92 of the British North America Act public health and health insurance fall within the jurisdiction of the provincial legislatures and it is essential that they should remain so.
With respect to the other provinces, my friend and leader, the hon. Minister of Justice (Mr. Lapointe), has dared to suggest to certain provinces that we might, with the assent of the provinces, add two words to the powers conferred upon the federal government by the British North America Act, and he has met with such a storm of revilement and abuse, in one province at any rate, that . I fear that were I to ask that province to add two more words, "health insurance," I would be submitted to the tortures of the rack and the boot, and perhaps eventually boiled in oil. In any case, I personally have some respect for the political views which I acquired in early youth. My earliest impressions of politics were the campaigns of Laurier and Mercier, who were provincial right-ers. They believed in provincial rights, though it is only fair to state that a great many of those who are in favour of provincial rights to-day are not composed of those elements of the population that favoured Sir Wilfrid Laurier in 1896.
I doubt very much whether at the present time it would be possible to get the assent of the provinces to the proposal that health insurance should be completely turned over to the federal government. As I have shown, British Columbia is opposed to it, having a
51952-70i
health insurance scheme of its own. Alberta would be opposed to it, because it has a health insurance scheme of its own. But there is no doubt whatever that there is need for better medical facilities in Canada. We have boasted and we shall probably continue to boast of our advance in medical research and medical science; but it is all too true to state that only eighteen years ago, in 1918, 30,000 Canadians lost their lives in the influenza epidemic, and only last year between 5,000 and 6,000 people in one province alone were attacked by infantile paralysis.
Too many lives are lost in childbirth; too many children and mothers die; and irrespective of jurisdiction, provincial or federal, too many people are dying of the degenerative diseases of middle age. We have not as yet been able to find a cure for cancer, or even the cause of it; and tuberculosis, though it has been controlled to some extent, is still a menace within our borders. Mental diseases require a great deal of care and involve a tremendous expense to a large section of the population. Venereal disease, though something has been done in that direction, is far from being under control at the present time. The cost of sickness is altogether too great; the cost of prevention and cure under the present ill-adjusted system is altogether beyond reason.
In a country like ours, with a. climate such as we have, the most equable climate in the world; with a people sprung from the sturdiest stocks in Europe; with scientists at least as learned as those in any other country; with universities producing young men who are capable of leaving Canada and holding high positions throughout the world-with all these advantages we can achieve a great deal. But I believe that we can achieve it less by regimentation as it exists in some other countries than by coordination of our people in the way of science and by coordination of the work of the universities and of government. I believe we can succeed less by coercion and more by cooperation among all those bodies, municipal, provincial and federal who wish to bend their energies towards the task of making this a better and a healthier nation. The federal Department of Health is ready and willing to do its share.
Mr. J. A. MARSHALL (Camrose); I find it rather difficult to follow immediately the Minister of Health (Mr. Power) because he has dealt effectively with this resolution from the standpoint of the government. I believe I am safe in saying that the policy of the government will not deviate very much from the path which it is following at the present time; nevertheless I want to empnasize
State Medicine

the fact that hospitalization and medical services are problems which at the moment are pressing very heavily upon municipalities.
I congratulate the mover and seconder of the resolution on the splendid manner in which they have presented the case for state medicine. It seems to me that there are to-day some Liberals who are becoming more socialistic than the socialists, but I realize that the mover of the resolution (Mr. Mclvor) has been actuated by the very highest motives, because he has come in contact with cases of suffering which require medical attention, and, very often, hospitalization.
There is one very good virtue about the resolution, and that is its brevity; it is short and to the point. There is no preamble which would perhaps confuse rather than clarify the motion itself. It states in the briefest of terms that state medicine be established in the Dominion of Canada. I hope the hon. member for Fort William will not feel disappointed when I say that I am not prepared at present to support this resolution. Not long ago the hon. member for Huron North (Mr. Deachman) said we should all seek for the truth. I say in all sincerity that I am seeking for the truth in this matter. I have wrestled with this problem for many years, but I am not yet convinced that state medicine is the solution. If, however, the hon. member can convince me that we can bring hospitalization and medical services to the people of this country without increasing taxation, I am prepared to study the matter from that angle.
There are many questions which one might ask himself in connection with a problem such as this. Would state medicine tend towards greater benefits to the people of Canada? Could a form of state medicine be worked out that would be satisfactory to all the people of Canada? Should we have state medicine for all or for part only of our people; and, if only for part, where should the line be drawn? What is wrong with the present system that we should change it? Finally, would state medicine mean political control, with all the evil influences attached thereto ?
Opinions enunciated here this afternoon and evening have not convinced me that state medicine is the solution of the problem. The study of the question of affording proper medical care to our people has occupied my attention for many years. They say that fools rush in where angels fear to tread; I am not a doctor, but I have had a great deal to do with matters of this sort as a municipal secretary in one of the rural sections of Alberta. For years it has been my 
pleasure and privilege to serve a council which is second to none in its earnestness and sincerity of purpose in grappling with this problem. I have seen good men give up on account of the strain involved, because the problem of hospitalization and medical care is becoming greater and more difficult as time goes by.	[DOT]
While my remarks deal entirely with a rural municipality, they chn be applied with equal force as well to urban municipalities in Alberta, Saskatchewan and Manitoba. Ten or twelve years ago we were worried very little with hospital and doctors' bills. In those days the taxpayers had the money to take care of these social services. Then came the years when farmers had poor crops, and prices for what they produced were low. They found themselves able perhaps to pay the interest on their mortgages and hold back sufficient to keep their wives and families during the winter, but few if any kept enough back to provide for medical attention or hospital bills. So the demands on the municipalities became more frequent and persistent. On many occasions I have found myself in the unhappy position of having to decide whether hospitalization of a man or woman or child was of greater or less importance than a decrease in the mill rate. Time after time I have held out the hope that taxation could be reduced, only to find that hospital bills and doctors' bills came in faster than taxes.
I have known municipal councils to grapple with this problem for days on end, only to be driven to the inevitable conclusion that if they were to meet these demands, an increase in taxation could not be avoided.
I wonder how many hon. members know what it means to have the responsibility of refusing or granting hospitalization to a [DOT] suffering human being. If more of us had some of this practical experience, we would be more apt to find a solution of a problem which is bearing very heavily indeed upon the municipalities. I would suggest that hon. members take time this coming summer to visit the municipal offices not only in their own immediate vicinity but in distant parts of the dominion, drop in to the council meetings and listen as the councillors discuss these problems. I think we would come back to the house at its next session determined to deal effectively with this problem. We would tell this government to hasten on with their program.
But with all this experience behind me, I say that I am not yet sure that state medicine is the cure. It was my experience in grappling with these problems in a municipal office that caused me to renounce my

State Medicine
allegiance to the Liberal party and join the ranks of those who believe that a solution can be found only through the new economics.
I am told state medicine was introduced into Germany around 1883, yet only forty or forty-five per cent of the people of that country are covered. I am informed, further, that state medicine was introduced into England in 1911; yet only thirty-five per cent of the people of that country are covered.
Many people are asking this question: Should we have state medicine on a contributory basis? I think we should ask ourselves the question as to how such a scheme would work. In a scheme of this kind I believe there would be three parties to the contract, namely the employer, the employee and the state. The employer would contribute his apportionment to a fund. Naturally, he would not take it out of his own pocket; it would come from the funds of the firm or corporation. and it would be reflected in an increase in the price of goods.
The employee would contribute his portion from the pay envelope he would receive either every week or every month. That would mean a reduction in the purchasing power of the consuming public, and there would he a further spread between prices and purchasing power. The state, as the third party to the contract, would contribute its share. No doubt the money of the state would be borrowed from a financial institution and the money thus borrowed would have to be repaid with interest. The state, in turn, would tax that back from the individuals, both employer and employee, and we would again have a further increase in prices and a further decrease in purchasing power.
If that is what a proposal of this nature means, then I must say I am emphatically opposed to it.


Mr. DOUGLAS (Weybum):: Would not the money collected go out in wages and doctor bills?


Mr. MARSHALL:: Part of it would. Finally, I think the Minister of Pensions and National Health (Mr. Power) hinted during his observations that this is more or less a matter for the consideration of the provinces. A week ago I would have agreed with him, but to-day I am not so sure of the matter, in view of the decisions handed down by the Supreme Court of Canada in connection with the legislation passed by the Alberta legislature. I am just wondering what powers a provincial government actually has. I thought for a time that a legislature elected by a majority of the people in a province was supreme; now I am not so sure that that is so.
As has been shown in the house this afternoon and this evening, the medical profession are not agreed as to whether or not socialized medicine is a cure. Not long ago in the senate of the United States the Hon. J. Parnell Thomas said this:
Those advocating socialized medicine and similar reforms always soft-pedal the little matter of where the money is coming from. The people are led to believe in such catch phrases as ''costs could be distributed according to the ability to pay" or the cruder version of the same idea, "soak the rich." Schemes for soaking the rich invariably end in soaking the poor. So if the American people want to accept socialized medicine, let them do so with their eyes open.
Then he continues:
You ask: Can anything be done to make the purchase of medical care easier for the people? Yes, there is much that can be done of a fundamental and practical nature. As you have already seen, when the American people are bothered by their medical bills it is because they are bills and not because they are medical. In other words, the same people are bothered by meeting grocery bills, rent bills, and all other bills.
And I want particularly to draw the attention of the house to this last sentence:
The real solution of the problem would be to help these people pay their own bills, not tax others to do it for them.
I do not believe anyone has any right to rise in his place in this chamber and condemn any proposal without suggesting a remedy. Do not misunderstand me; I am heartily in favour of bringing to our people the best medical care, attention and hospitalization we can possibly give them, but it is the method by which this objective is proposed to be attained with which I am not in accord.
Under present economic conditions there is no other way with which I am familiar to bring these services to the people, than by the method of taxation. Taxes being at their peak, as they are to-day, it would seem quite impossible and inadvisable to consider taxing for this purpose.
Under the proposals of the Social Credit party the problem assumes a different aspect. As the Prime Minister (Mr. Mackenzie King) has said, we should take control of our currency and credit, and use it in terms of public need. I understand this parliament now has control of currency and credit, and I therefore believe that we should use it in terms of public need. The public need in this instance is hospitalization and medical services. Issue national money, and distribute it to the people in the form of national dividends. I know some hon. members will
State Medicine

smile at that suggestion; but if they will read the report of the commission set up to consider veterans' problems they will find that that board advocated a provisional economic allowance. What is the difference between a provisional economic allowance and a dividend? If we issued a national dividend or a provisional economic allowance to all the people of this country, I feel quite sure that we would not have to worry as to whether or not we should regiment the medical profession. It would seem to me the wrong way to tackle this problem would be to regiment the men and women engaged in one of the loftiest professions of the day. We should consider this matter very seriously and endeavour to find a solution at this session of parliament.


Mr. J. J. McCANN (Renfrew South):: said in giving his opinion on Part IV of the Employment and Social Insurance Act, which dealt with national health:
The sections included in part IY enact that the duties and powers of the commission under that part shall be exercised so far as may be found practicable and expedient in cooperation with any department or departments of the government of Canada.
He goes on to say:
By themselves the provisions of part II-
Which had to do with unemployment service:
-and of certain portions of parts IV and Y might be unobjectionable, but in my opinion they are so inextricably interwoven with the powers of the commission set up under part I and with the scheme of unemployment insurance referred to in part III that they must stand or fall according to the validity or otherwise of sections 15 to 38.
The whole thing was thrown out on that ground. The decision given by the privy council was somewhat along the same line. Their Lordships say:
In the present ease their Lordships agree with the majority of the supreme court in holding that in pith and substance this act is an insurance act affecting the civil rights of employers and employed in each province, and as such is invalid. The other parts of the act-
That would include part IV, which had to do with national health:
-are so inextricably mixed up with the insurance provisions of part III that it is impossible to sever them. It seems obvious also that in its truncated form, apart from part III, the act would never have come into existence. It follows that the whole act must be pronounced ultra vires.
From that I would gather that national health or any act with reference to national health, which the federal parliament might put into effect, of itself and standing on its own feet, might be within federal jurisdiction. After all, Mr. Speaker, health is a national problem, and the problem of health in British Columbia does not differ one iota from the health problem of Nova Scotia, nor does the health problem of Quebec differ from that of Ontario. Tuberculosis is one and the same disease whether it is in Nova Scotia or British Columbia. Silicosis is the same disease whether it is in Quebec or Ontario. National health knows no boundaries. The same problems occur from one end of the country to the other. Organized medicine has not taken a stand definitely with reference to health insurance or to state medicine. A majority of doctors is opposed to state medicine under its strict definition. It would mean that doctors would be controlled and

paid by the state. On the other hand health insurance would be a system whereby people in times of good health would budget for times when they were ill.
The Canadian Medical Association, which represents organized medicine in this country, made an illuminating submission before the royal commission on dominion-provincial relations. They gave a history of the medical profession from the time of confederation to date. They outlined the progress which has been made during that time. They pointed out, very fittingly, that when this country became a confederated state, what we know as public health was wholly unknown, was not so much as mentioned in the British North America Act; that we have at this time problems which were not then thought of and for which, consequently, no provision was made; and they submitted to the Rowell commission that due consideration should be given to meeting the problems of public health as they exist to-day. I shall not take up further time, as I understand some others wish to say something with reference to this matter. I merely want to put on record the opinion of the Canadian Medical Association with reference to health insurance. Very briefly it is this, that before any policy of health insurance is put into effect in Canada, the matter should be studied by a committee or a commission who would go into all the avenues of the subject, and that the medical profession would be very glad to cooperate and to give them the advantage of an intensive study which they have made.
Their stand with reference to health insurance may be summarized as this:	that
they have not authorized an expression either in favour of or opposed to the institution of health insurance in Canada. They are also of opinion that before health insurance is applied in any part of the dominion, a survey as recommended by the Minister of Pensions and National Health for Canada in 1935 and approved by a conference of ministers of health from the several provinces should be carried out. That represents the views of organized medicine in Canada, and I put on the record that I am opposed to state medicine, and would be in favour of health insurance only after a complete examination of that problem.


Mr. C. J. VENIOT (Gloucester):: May I congratulate the Minister of Pensions and National Health (Mr. Power), who is not a medical man, upon having made such an able presentation of the case for the department he so well represents; upon having clarified,

State Medicine
for the benefit of the house, the difference between two distinct terms, state medicine and state health insurance; and upon the worldembracing review which he gave of legislation on the subjects of health insurance and state medicine.
I was happy also to note that, in the various addresses presented here to-day, no criticism was offered against the ability or the honesty or the devotion of the medical profession in giving medical services to this country. The demand for health insurance does not arise out of any conflict between the medical profession and the public. The public desires to secure highgrade medical service and is quite willing to pay for such service. On the other hand the medical profession is eager to supply such service, but in return it expects a reasonable remuneration and satisfactory conditions under which to work and to live. It is because the public as a whole have confidence in the ability of the profession and recognized the profession's devotion to human welfare, that the majority of the public will accept leadership from the organized medical profession in devising ways and means of remedying the present situation concerning medical services.
The discussion of a subject of such importance as health insurance calls for placing before the house certain facts and considerations which have a serious bearing on the question and thus providing a proper orientation to any legislation which aims at supplying complete medical service to all the people of Canada. The Canadian Medical Association undertook to formulate such a plan as early as 1930. May I say briefly what the Canadian Medical Association is and means to the country?
In round figures there are 10,000 registered medical practitioners in Canada. They are grouped into various provincial medical societies, and these societies in practically every province are recognized as branches or divisions of the association. The business of the C.M.A., to use the abbreviation term of the Canadian Medical Association, is conducted through a council of approximately 120 representatives sent as delegates from the various provincial medical societies. These delegates in turn elect seventeen members to form the executive committee of the Canadian Medical Association, which carries on the affairs of the association during the year. The Canadian Medical Association meets once a year, generally in June, in annual session. The association as a body therefore represents and speaks for the medical profession of Canada; it is authorized to do so. One article of its constitution and by-laws includes the following
two items: first, the promotion of public health; second, the endeavour to assist in the advancement of medical legislation for the good of the public and the profession. Under these objects it would be fair to assume that the association is committed to engage itself actively in the consideration of plans whereby the state of the public health may be improved, also to consider ways and means of raising the standards and increasing the efficiency of medical practice in the common interest of the medical profession and of the public.
For this reason, namely, to improve the status of medical practice in Canada and to give better medical services, since 1930 the Canadian Medical Association has been making a thorough study of the question of health insurance. To that end, a committee was charged with the task of making a complete survey of health insurance in every country in the world as well as a complete study of all literature available on the subject. The committee on economics of the Canadian Medical Association was enlarged by a number of medical practitioners, the number being brought up to twenty-seven, with representation from every province in Canada. To implement and render more efficient the task which it imposed upon itself, it went as far as to send its general secretary to Europe to get first hand information on the question of health insurance as it is carried on in various countries which have adopted the system. The report of the secretary will be presented at the coming annual meeting of the Canadian Medical Association.
Prior to' that, in 1934, this committee on economics, charged with the special study of health insurance, presented a voluminous report of about forty pages, and my task tonight will be to endeavour to give the house, as briefly as possible at this advanced hour, a synopsis of the basic principles adopted by the committee on health insurance and approved by the Canadian Medical Association. With this object in view I shall quote extracts from the report in order to cover the ground as rapidly as possible, and in doing so I speak with the knowledge acquired as one of the members of the study committee of the Canadian Medical Association, who have been investigating health insurance since 1930. After reviewing legislation and literature, the report makes the following general observations :
In reviewing the causes which lead to a demand for health insurance, our committee recognized that there exists among the public considerable dissatisfaction with regard to the methods of medical practice. The expression of this dissatisfaction does not imply any
State Medicine

criticism of medicine or of the medical profession. Indeed it is the very contrary, because the dissatisfaction grows out of an appreciation of medicine and a desire to profit more fully by what medicine has to offer for the benefit of mankind.
The real problem arises out of the inability to pay for such medical services as are required. . . .
It would appear that the problem grows out of the following conditions:
1.	A change in our social organization under which the state has assumed increasing responsibility for the welfare of the citizens, as evidenced by legislation covering old age pensions, mothers' allowances, workmen's compensation, and so forth.
2.	The present individualistic system of medical practice is of long standing. It has not adjusted itself to the present social organization in which the majority are wage-earners with no resources beyond their weekly earnings.
3.	Medical facilities are not fairly distributed, and so some areas are deprived of essential medical services because the population of these areas is not sufficient to support the required medical services.
4.	The wage-earning population are often unable to pay ordinary fees, and are certainly not in a position to meet the costs of a long or serious illness. The wage-earner usually loses his wages when he is ill, at the very time when expenses are increased and the necessity continues for providing maintenance for his family.
5.	Medical care becomes a luxury rather than a necessity when the income provides only sufficient for food, shelter and clothing.
6.	The medical profession is expected to furnish medical care for the indigent-a state responsibility-without remuneration.
7.	Because of the cost of medical care, there is delay in securing care and a great deal of self-medication.
8.	Modern medicine is inevitably more costly, as seen in the development of hospitalization and specialist services.
9.	Modern medicine demands, in a percentage of eases, that consultant, hospital and other facilities be available if the patient is to receive the care required. This implies an actual correlation of existing services and making these services available to the patient through the family physician.
Our report is divided into three sections. The first reviews all health insurance legislation of other countries as well as all the literature that was available to us. Part II reviews the health legislation situation in Canada, and part III explains the Canadian Medical Association's plans for state health insurance in Canada. Here we are concerned chiefly with part II and part III. Part II reviews, first, the practise of medicine in Canada, its legal set-up and its development along individualistic lines; and, second, medical care as applied to the three groups of individuals who make up our population-the indigents, the middle class, and the well-to-do.

In supplying medical care to all three of these classes there are considerable deficiencies and shortcomings under the present system of medical practice. The medical care of the indigent is a distinct provincial or municipal responsibility as established by the British North America Act.
All provinces have made some provision for the medical care of this group of the population. Unfortunately, in general, the care of indigents in their own homes is left to the medical profession, although in some places a physician is paid out of public funds to give such care. When hospital care is required, a per capita per diem allowance is usually paid to the institution caring for the patient; but no fee is paid to the physician, it being argued iby some that the physician receives his reward through his hospital appointment. The medical profession is proud of its record of gratuitous service to those who are in need. The members of the profession in general are willing to give a certain amount of free service. Nevertheless, there is a general feeling that the profession is being exploited, and that governments are meeting their responsibilities for the care of the indigent at the expense of the medical profession. Free service should be entirely voluntary; but to assume that the medical profession will contribute one of the necessities of life, for the provision of which the state is responsible, is unsound in every way. It is interesting to note that physicians are not allowed to deduct from their taxable incomes, under the heading of contributions to charity, a sum equal to their free service.
In this connection, on the question of the treatment of indigents, may I add the following remarks. In New Brunswick there are 265 registered practitioners, or, to use round figures, let us say 250. In normal times there is not one physician in the province who each year does not perform at least $1,000 worth of medical work for which no entries are ever made in his books. That means a quarter of a million dollars' worth of free services given each year in ordinary times. During the time of the depression there was not one physician in the province who did not contribute at least $3,000 worth of services to the people of New Brunswick, -meaning a contribution of three quarters of a million dollars for New Brunswick alone, the smallest but one of the provinces. If we take the 10,000 registered practitioners in Canada, and allow that $2,000 was the minimum amount of free service which each contributed to the country every year during the depression period, it amounts to $20,000,000 each year,

State Medicine
and in the seven years of the depression it attains the enormous sum of about 8150,000,000 or approximately one-quarter of the entire amount spent by the federal, provincial and municipal governments to provide assistance to the unemployed.
Our committee has figures from the various provinces showing clearly that in ordinary times, outside contributions to hospitalization costs, provincial and municipal governments have not, in general, recognized their responsibility for the provision of medical care for the indigent. Furthermore it is regrettable to note that the federal government does not regard medical care as one of the necessities of life, otherwise medical care would have been provided for in the unemployment relief legislation, together with food, clothing and shelter.
I see, Mr. Speaker, that the hour of closing rapidly approaches, so I shall be obliged to pass over many of the considerations which I wished to present to the house. However, I should like to place on record a series of resolutions adopted by the Canadian Medical Association showing what it considers the fundamental principles necessary to be recognized in any scheme of health legislation which might be enacted in Canada. These are as follows:
1.	That in the provinces where health insurance is established it be administered under an independent health insurance commission, and that there should be close cooperation between this commission and the provincial Department of Public Health with a view to making full use of preventive services.
2.	That a central health insurance board and local insurance boards be appointed, representative of all interested, to advise the responsible administrative authority.
3.	That the professional side of health insurance medical service be the responsibility of the organized medical profession through the appointment of a central medical services committee and local medical services committees to consider and advise on all questions affecting the administration of the medical benefit.
4.	That the question of the establishment of local areas for health insurance administration be left to the decision of the individual provinces.
5.	That the whole province be served by adequate departments of public health, organized on the basis of provision of individual health supervision by the health insurance general practitioner.
6.	That there be a health insurance fund, and that regional officers to act as supervisors and referees be appointed, paid and controlled by the central board or commission.
7.	That medical care for indigents be provided under the plan, the government to pay the premiums of the indigent, who then receive medical care under exactly the same conditions as the insured person.
8.	That the plan be compulsory for persons having an annual income below a level which upon investigation by competent local authorities proves to be insufficient to meet the costs of adequate medical care.
9.	That the dependents of insured persons be eligible for the medical benefits.
10.	That there be offered, on a voluntary basis, to those with incomes above the health insurance level, hospital care insurance, and that this be administered as part of the health insurance plan, such hospital care not to include medical service other than hospitalization.
11.	That the only benefit under the plan be the medical benefit.
12.	That the medical benefits be organized as follows-[DOT]
(a)	Every qualified licensed medical practitioner to be eligible to practise under the plan.
(b)	The insured person to have freedom of choice of medical practitioner and vice versa.
(c)	The medical service to be based upon making available to all a general practitioner service for health supervision and the treatment of disease.
(d)	Additional services to be secured ordinarily through the medical practitioner.
(1)	(a) Specialist medical service.
(b) Consultant medical service.
(2)	Yisiting-nurse service (in the home).
(3)	Hospital care.
(4)	Auxiliary services-usually in hospital.
(5)	Pharmaceutical service.
(e)	Dental service, arranged direct with dentist or upon reference.
13.	That the insurance fund should receive contributions from the insured, the employer of the insured and the government.
(a)	Payment of the premium of the insured in certain proportions to be determined, should be made by the employee, employer and government.
(b)	AYhere an. insured person has not an employer or where it is not practical for the government to collect from the employer the government should pay in for that insured person what would be the employer's share as well as its own share of the premium.
(e) Where the insured is "indigent" or has been out of work long enough to come without the scope of the provisions of the act as relating to an insured employee the government should assume payment of the full premium.
14.	That the medical practitioner of each province be remunerated according to the method or methods of payment which they select.
15.	(a) That the schedule of fees in any health insurance scheme shall be the schedule of fees accepted by the organized profession in the province concerned.
(b) That all schedules of fees be under complete control of the organized medical profession in each province.
16.	That the contract-salary service be limited to areas with a population insufficient to maintain a general practitioner in the area without additional support from the insurance fund.
17.	That no economic barrier be imposed between doctor and patient.
State Medicine

18.	That the volume of work demanded from and the remuneration to members of the various professions be such as to assure a standard of service equal to or better than present-day standards.
May I conclude with a summing-up as follows.
For the last ten years there has been a growing demand in certain sections of Canada for some form of health insurance.
Conscious of this trend of thought the Canadian Medical Association made a thorough, world-embracing investigation of health insurance.
With this study as a foundation it has formulated definite plans for health insurance, acceptable to both the general public and the medical profession.
The Canadian Medical Association does not at the present time voice an opinion either in favour of or adverse to health insurance.
The Canadian Medical Association is strenuously opposed to any form of state medicine which would tend to regiment or draft members of the medical profession into the ranks of state servants, controlled and salaried by the state, thus destroying the personal relation between doctor and patient.
The medical profession demands that it be relieved of the burden of gratuitously supplying medical services to the great majority of Canada's indigent and unemployed.
The Canadian Medical Association advocates the broadening of the federal health department's field of activities along the lines suggested at the 1935 meeting of the dominion health council.
The Canadian Medical Association recommends that before any form of health insurance is enacted by any legislative body, a royal commission be appointed to examine the whole question of health activities and medical services in Canada.


Daniel (Dan) McIvor: Mr. Speaker-


Mr. SPEAKER:: I draw the attention of the hon. member to the fact that if he speaks now he closes the debate.


Daniel (Dan) McIvor: I wish to withdraw the resolution.


Walter Edward Foster: Is it the wish of the house that the hon. member have leave to withdraw the resolution?


Some hon. MEMBERS:: No.


Charles Avery Dunning: In view of the absence of unanimous consent there is only one alternative, that is to call it eleven o'clock.


[Stage Direction]
At eleven o'clock the house adjourned, without question put, pursuant to standing order.

Tuesday, March 8, 1938