Element of Hope: Radium and the Response to Cancer in Canada, 1900-1940 9780773572706

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AN E L E M E N T OF HOPE

MCGILL-QUEEN S ASSOCIATED

MEDICAL SERVICES STUDIES

IN THE HISTORY OF MEDICINE, HEALTH, AND SOCIETY

SERIES EDITORS: s.o. FREEDMAN AND J.H. CONNOR Volumes in this series have financial support from Associated Medical Services, Inc. (AMS). Associated Medical Services Inc. was established in 1936 by Dr Jason Hannah as a pioneer prepaid not-for-profit health care organization in Ontario. With the advent of medicare, AMS became a charitable organization supporting innovations in academic medicine and health services, specifically the history of medicine and health care, as well as innovations in health professional education and bioethics. 1 Home Medicine The Newfoudland Experience John K. Crellin 2 A Long Way from Home The Tuberculosis Epidemic among the Inuit Pat Sandiford Grygier 3 Labrador Odyssey The Journal and Photographs of Eliot Cunven on the Second Voyage of Wilfred Grenfell, 1893 Ronald Rompkey 4 Architecture in the Family Way Doctors, Houses, and Women, 1870-1900 Annmarie Adams 5 Local Hospitals in Ancien Regime France Rationalization, Resistance, Renewal, 1530-1789 Daniel Hickey 6 Foisted upon the Government? State Responsibilities, Family Obligations, and the Care of the Dependant Aged in NineteenthCentury Ontario Edgar-Andre Montigny 7 A Young Man's Benefit The Independent Order of Odd Fellows and Sickness Insurance in the United States and Canada, 1860-1929 George Emery and J. C. Herbert Emery 8 The Weariness, the Fever, and the Fret The Campaign against Tuberculosis in Canada, 1900-1950 Katherine McCuaig 9 The War Diary of Clare Gass, 1915-1918 Edited by Susan Mann 10 Committed to the State Asylum Insanity and Society in NineteenthCentury Quebec and Ontario James E. Moran 11 Jessie Luther at the Grenfell Mission Edited by Ronald Rompkey

12 Negotiating Disease Power and Cancer Care, 1900-1950 Barbara Clow 13 For Patients of Moderate Means A Social History of the Voluntary Public General Hospital in Canada, 1890-1950 David Gagan and Rosemary Gagan 14 Into the House of Old A History of Residential Care in British Columbia Megan J. Davies 15 St Mary's The History of a London Teaching Hospital E.A. Heaman 16 Women, Health, and Nation Canada and the United States since 1945 Edited by Georgina Feldberg, Molly Ladd-Taylor, Alison Li, and Kathryn McPherson 17 The Labrador Memoir of Dr Henry Paddon,1912-1938 Edited by Ronald Rompkey 18 J.B. Collip and the Development of Medical Research in Canada Extracts and Enterprise Alison Li 19 The Ontario Cancer Institute Successes and Reverses at Sherbourne Street E.A. McCulloch 20 Island Doctor John Mackieson and Medicine in Nineteenth-Century Prince Edward Island David A.E. Shepard 21 The Struggle to Serve A History of the Moncton Hospital, 1895 to 1953 W.G. Godfrey 22 An Element of Hope Radium and the Response to Cancer in Canada, 1900-1940 Charles Hayter

An Element of Hope Radium and the Response to Cancer in Canada, 1900-1940 CHARLES HAYTER

McGill-Queen's University Press Montreal & Kingston • London • Ithaca

© McGill-Queen's University Press 2005 ISBN 0-7735-2869-5 Legal deposit second quarter 2005 Bibliotheque nationale du Quebec Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-consumer recycled), processed chlorine free. This book has been published with the help of a grant from the Canadian Federation for the Humanities and Social Sciences, through the Aid to Scholarly Publications Programme, using funds provided by the Social Sciences and Humanities Research Council of Canada. McGill-Queen's University Press acknowledges the support of the Canada Council for the Arts for our publishing program. We also acknowledge the financial support of the Government of Canada through the Book Publishing Industry Development Program (BPIDP) for our publishing activities. Library and Archives Canada Cataloguing in Publication Hayter, Charles An element of hope: radium and the response to cancer in Canada, 1900-1 g4o/Charles Hayter. (McGill-Queen's/Associated Medical Services (Hannah Institute) studies in the history of medicine, health, and society; 22) Includes bibliographical references and index. ISBN 0-7735-2869-5 1. Radium - Therapeutic use - Canada - History. 2. Cancer Radiotherapy - Canada - History. 3. Cancer - Treatment - Canada History, I. Title, II. Series RC271.R3H385 2005

616.99'406423'0971

Typeset in New Baskerville 10/12 by Caractera inc., Quebec City

C2004-906191-7

To the memory of my grandfather, DR ROBERT THOMAS MANSFIELD HAYTER, M . B . E .

specialist in tropical diseases and expert in medical electricity and radiology.

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Contents

List of Illustrations ix Acknowledgments

xi

Introduction: The Cancer Crisis Today 3 1 "Cures of a Very Surprising Character": Radium and the Doctor 10 2 "Adorning Our Home": Radium and the State 34 3 "To the Relief of Malignant Diseases of the Poor": Radium and the Hospital 52 4 "The Worst Scourge of Civilized Mankind": Cancer Becomes a Social Problem, 1920—30 69 5 "A Proper Spirit of Cooperation": Cancer Progress in the West 87 6 Compromising on Cancer: The Uneasy Birth of Ontario's Cancer System 112 7 Seeds of Discord: The Politics of Radon Therapy in the 1930s 135 8 Country Interlude: The Rise and Fall of the Huron Springs Sanatorium

156

viii

Contents

9 Cancer from Sea to Sea, 1935-40: The Struggle for a National Program

168

10 Conclusion: Historical Roots of Current Problems in Cancer Control Notes 203 Bibliography 235 Index 261

186

Illustrations

1.1 Radium-containing needle 14 1.2 Radium applicators 14 1.3 X-ray of radium applicator 14 1 .4 Radium treatment of nasal cancer 15 1.5 Physician holding radium pellet 15 1.6 W.H.B. Aikins 18 1.7 Regression of cancer 30 1.8 Cancer of the lip 31 2.1 Joseph-Ernest Gendreau 36 2.2 Institut du Radium X-ray therapy apparatus 44 3.1 Steven Johnston 56 5.1 Earle Shepley 90 5.2 Shepley's organization of cancer services 91 5.3 Organization of the Saskatchewan Cancer Commission 5.4 Changes in cancer in Saskatchewan 107 6.1 Ontario's Cody Commission 116 6.2 Gordon Richards 120 7.1 Physician implanting radon seed 136 7.2 Radium emanation plant 137 7.3 Order form for radon seeds 139 7.4 Utilization of radiotherapy in Ontario 141 7.5 Geographic location of practice 141 7.6 Distribution of diagnoses 143 8.1 Alexander Moir 157 8.2 Huron Springs Sanatorium 160 9.1 British Columbia Cancer Institute 183

104

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Acknowledgments

During my training and early years in practice as a radiation oncologist, I became aware that despite the many contributions of Canadians to the field, there was little written about the history of radiotherapy or cancer control in Canada. I began by asking questions about the history of radiotherapy in specific locations and uncovered the stories of Dr William Roberts and his radium supply in Saint John, New Brunswick, and Dr James Third and his X-ray apparatus in Kingston, Ontario. In the early 19905 cancer care waiting times lengthened considerably, and patients began to be openly dissatisfied with many aspects of their treatment. This crisis prompted me to begin a more thorough examination of the history of radiotherapy and cancer control across Canada to see if I could uncover the origins of the current problems. This book is the result, and I am surprised and humbled to say that it has taken ten years to research and write. Throughout that time, I have received the generous support and help of many individuals and organizations. Chief among them is Associated Medical Services, Inc./Hannah Institute for the History of Medicine Program for their financial support which enabled me to consult archives, libraries, and government records from coast to coast. I am very grateful to my research assistant, Christopher Rutty, for his diligence and hard work in retrieving material. I also am grateful to my friend and mentor in medical history, Jackie Duffin, a superb role model whose activities have taught a radiation oncologist how to frame historical questions and evaluate sources.

xii

Acknowledgments

The following individuals and organizations throughout Canada gave invaluable assistance: Nova Scotia: Public Archives of Nova Scotia, Dalhousie Medical Library, Halifax Regional Library; Charles Armour, Peter Twohig, and Barbara Clow (Dalhousie University). Quebec. Denis Plante (University of Montreal Archives), Renald Lessard (Archives Nationales du Quebec), Denis Roy (Royal Victoria Hospital) , N. Blair Whittemore (Montreal General Hospital), Osier Library (McGill University), Jacques Sylvestre, Winifred Ross, Yvan Methot. I am grateful to Diana Fort, David Ingham, Cyril Danjoux, Veronique Benk, and Mark Lysyshyn for help with translation and explanation of French material. Ontario: Carolyn Heald and Jim Suderman (Archives of Ontario), Felicity Pope (Toronto General Hospital), Karen Teeple (City of Toronto Archives), John Fowler (Academy of Medicine), Jim Connor, J.J. Talman Regional Collection (University of Western Ontario), Caroline Ziegler (Ontario Medical Association), the Ontario Cancer Treatment and Research Foundation (now Cancer Care Ontario). Geoffrey Reaume assisted in data abstraction from the Ontario radon record, and Karleen Schulze and Lawrence Paszat provided statistical advice and analysis. For my work on Alexander Moir and the Huron Springs Sanatorium, I thank Trilby Want for research assistance and Egbert and Susie Faber, who provided hospitality, recollections, and a tour through the ruins of the Sanatorium in June 1996. Many others helped with information about Moir's life and work in Manitoba and Hensall, Ontario: Robert Cameron, Steve Mavers, Richard Stanbury, Robert Stanbury, Mabel Stanlake, Janeth Sangster, Audrey Kerr, David Stewart, Ruth McGill, Donald McGill, Moir and Carol Thomson, and Eleanor Fisher. Manitoba: Brent Schacter, Keith Jones, and Leonard Israels (Manitoba Cancer Treatment and Research Foundation), John Linford, Debbie Bride (Manitoba Medical Association), Jacqueline Nicholls and Ken Reddig (Provincial Archives of Manitoba), Audrey Kerr (University of Manitoba Faculty of Medicine), Michael Tennenhouse, Richard E. Bennett and Lewis St. George Stubbs (University of Manitoba Libraries), Rick MacLowick (Manitoba Legislative Library), Marie DeGagne (Manitoba Health), Jean Macdonald, and Ian Carr. Saskatchewan: Cheryl Avery (University of Saskatchewan Achives), Linda Mclntyre-Putz (Saskatchewan Archives Board), S. Brian Scharfstein (Saskatchewan Medical Association archives), Marian Brown (Saskatchewan Cancer Foundation), Dorvill Card (Regina General Hospital), Isobel Afseth (Saskatoon City Hospital), C. Stuart Houston, and David Shephard.

Acknowledgments

xiii

Alberta: R.E. Pow, Claude Roberto, and Wendy McGee (Alberta Provincial Archives). British Columbia: Sue Baptie (Vancouver City Archives), Stewart Jackson and David Noble (British Columbia Cancer Agency), Michael Gourlie (BC Medical Association Archives), David Mattison (BC Archives and Records Service), and Bob Gregory (St. Paul's Hospital Archives). Useful information was also provided by the American Radium Society, Patsy Gerstner (Dittrick Medical History Center, Cleveland), Pat McAulay (National Cancer Institute of Canada), Lynn Delgaty (National Research Council), Carole Seguin (National Archives of Canada), and Deborah Scott-Douglas (Canadian Medical Association). I also acknowledge the help and support of my colleagues at the University of Toronto, Queen's University, and Toronto-Sunnybrook Cancer Centre, particularly the heads of my departments (Bill Mackillop, Gillian Thomas, Bernard Cummings, Mary Gospodarowicz and Shun Wong) who have recognized the importance of historical enquiry by providing me with academic time to continue my research and writing. Additional colleagues who have provided special help include Cyril Danjoux, Larry Paszat, Gune§ Ege, and Ida Ackerman. Others who have supported in various ways my interest in this project include Violette Malan, the late Miguel Chiong, Sherry Mott, Rona Rustige, James Low, Robert Jackson, Marjorie Woodbridge, Rosalind Hayter, Jonathan Hayter, Annette Vatter, Bert Hansen, Paul Berman, Helen Pham, and Roger Robison. I am grateful to Sarah Wakely and Elizabeth Derraugh for their kind hospitality during research in Halifax and Winnipeg. I apologize if I have inadvertently forgotten anyone. I would also like to thank the two reviewers who, on behalf of McGillQueen's University Press, provided competent and constructive comments on my manuscript. One of these reviewers gave his permission to have his identity revealed, and therefore I am particularly grateful to C. Stuart Houston for his diligence in correcting historical and grammatical errors. I am also grateful to my editor at McGill-Queen's University Press, Roger Martin, for his guidance and support, and to other staff at the press including Kyla Madden, Joan McGilvray and my copyeditor, Rob Giannetto, whose thorough work clarified and enlivened many passages. Thanks are also due to Samuel Freedman and Jim Connor, the editors of the McGill-Queen's series on the history of Medicine, Health and Society, for their insightful comments. Portions of this book have been previously published as individual articles, and I am grateful to the editors of the following journals for permission to incorporate previously published material from these articles: "William H.B. Aikins: Forgotten Pioneer of Canadian Radiotherapy," Annals of the Royal College of Physicians and Surgeons of Canada

xiv

Acknowledgments

31 (April 1998): 155-58; "The Clinic as Laboratory: The Case of Radiation Therapy, 1896-1920 Bulletin of the History of Medicine 72 (1998): 663-88; "Seeds of Discord: The Politics of Radon Therapy in Canada in the 1930s," ibid., 77: 75-102; "Medicalizing Malignancy: The Uneasy Origins of Ontario's Cancer program, 1929-34," Canadian Bulletin of Medical History 14 (1997): 195-213; "Cancer: The Worst Scourge of Civilized Mankind," ibid., 20 (2003): 251-63; "Tarnished Adornment: The Troubled History of Quebec's Institut du Radium," ibid., 20 (2003): 343-65; "Historical Origins of Current Problems in Cancer Control," Canadian Medical Association Journal 158: 13 (1998): 1735-40; "'To the Relief of Malignant Diseases of the Poor': The Acquisition of Radium for Halifax, 1916-1926," Royal Nova Scotia Historical Society Journal i (1998): 130-43; "Compromising on Cancer:1 The Saskatchewan Cancer Commission and the Medical Profession, 1930-40," Saskatchewan History 54 (2002): 5—15. Every attempt has been made to locate and credit copyright holders of images included in this book. Any omissions or corrections would be gratefully received so that correct information can be supplied in future editions.

AN E L E M E N T OF HOPE

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Introduction The Cancer Crisis Today "Cancer treatment hospitals said overcrowded, outdated"1 "Treatment at clinic was more traumatic than having cancer"2 "Radiation delays hit 65% of patients"3 "Cancer patients' delays growing"4

Cancer, the "dread disease" of modern times, is a major health problem in every developed country in the world. By 1997 cancer had overtaken heart disease as the leading cause of death in Canada.5 Each week 2,800 Canadians are diagnosed with cancer, and 1,300 die of the disease. In 2004 an estimated 145,500 new cases of cancer and 68,300 deaths will occur in Canada. Based on current projections, 38 percent of women and 43 percent of men will develop cancer during their lifetime. Cancer is the leading cause of premature death in Canada, and it accounts for one-third of the potential years of life lost resulting from all causes of death.6 Of course, these statistics do not reflect the enormous burden of physical and psychological suffering born by cancer patients and their families. In most Canadian provinces, there are government agencies such as Cancer Care Ontario or the Saskatchewan Cancer Agency whose missions are to coordinate the fight against cancer. Yet as the headlines illustrate, these agencies have frequently been attacked for deficiencies in providing timely or coordinated care. The media reports are not sensationalistic, for there is now a large body of statistical evidence that illustrates the inadequacies of the cancer system. Radiation therapy, the use of ionizing radiation to destroy cancerous tissues, is an effective and widely used form of treatment for cancer.7 However, the most well-publicized problem has been the long waiting times for radiotherapy, which have resulted in patients being sent outside their home community and sometimes as far as the United States for treatment.8 Much of the work documenting the inadequacies of the cancer

4

Introduction

system in Ontario was performed in the i ggos at the Radiation Oncology Research Unit at Queen's University, Kingston, under the direction of Dr William Mackillop. In a now classic 1994 paper entitled "Waiting for radiotherapy in Ontario," Mackillop demonstrated that between 1982 and 1991, the waiting times for radiotherapy had lengthened to the point that few patients received treatment within the nationally accepted time interval of four weeks from referral to treatment.9 In addition to patients' increased psychological distress caused by waiting, such delays were likely to have an adverse effect on the outcome of treatment.10 In Ontario, the crisis over waiting times acted as a catalyst for public concern about many aspects of the system, and in the early i ggos the government undertook a full-scale re-examination which culminated in the publication of Life to Gain: A Cancer Strategy for Ontario in April 1994. The government identified many problems such as poor coordination of services, lack of consistent standards of care, variable access to care, and lack of community or consumer involvement in shaping cancer policy. A new provincial cancer agency, Canqer Care Ontario (ceo), was formed in 1997, but problems remained. Some Ontario cancer patients were routinely sent to the USA for treatment, and a political furor erupted when ceo hired a private company, Canadian Radiation Oncology Services, to administer after-hours radiation to ease pressure on waiting lists.11 Despite these measures, waiting times continued to exceed nationally accepted standards. These events provided the impetus for yet another inquiry, a Cancer Services Implementation Committee, which found that radiation waiting times were only one part of a larger problem of disarray and disorganization. The committee's report concluded that the Ontario cancer services system lacked integration and coordination.12 The problem of waiting lists is complicated by geographic inequities in access to the cancer system. This problem is largely a result of a disparity between a dispersed population and the highly centralized cancer system. Mackillop and his colleagues have also shown that between 1984 and 1991, the rate of utilization of radiotherapy after one year following diagnosis in Ontario varied from county to county, and not surprisingly the highest rates were seen in counties closest to cancer centers.13 Another frequently mentioned problem is the fragmentation of a patient's care. A person diagnosed with cancer may see a variety of caregivers in a variety of locations, and the communication among these caregivers may be poor. A person with cancer may see his or her family doctor for assessment of symptoms, be referred to a surgeon for diagnosis, undergo an operation in a community hospital, and

The Cancer Crisis Today

5

then be referred to a regional cancer centre for radiotherapy or chemotherapy. This fragmentation is illustrated by the distribution of money spent on cancer by the province of Ontario. Of the estimated $1.5 billion spent on cancer services, only 16 percent is accounted for within the "official" ceo system.'4 The remainder is spent on surgery in community hospitals, chemotherapy, and other aspects of care given in local communities. For a patient newly diagnosed with cancer, the path from diagnosis to treatment through this uncoordinated system of surgeons, hospitals, clinics, and specialists can be bewildering and frightening. Another problem is variation in practice in treatment of cancer in Canada. A person might expect that there would be consensus among doctors about cancer treatment and that patients suffering from similar forms of cancer would receive similar treatments regardless of where they live. In fact, recent studies have shown surprising variations in oncologic practice. In 1994 Iscoe et al. demonstrated large variations in surgical procedure in women newly diagnosed with breast cancer in Ontario.15 In spite of the evidence that breast conserving therapy (lumpectomy plus radiation) produces the same survival rate as mastectomy (removal of the whole breast), they found that the rate of breast-conserving therapy ranged by from 11 percent to 84 percent across counties and from 6 percent to 84 percent across hospitals.14 Variations in breast cancer practice have also been observed in British Columbia and Quebec.16 These variations are too large to be explained by factors such as differences in the extent of cancer at diagnosis. Such variations have also been recognized within the "official" cancer system. For example, Mackillop studied radiotherapeutic practice in another common cancer, non-small cell lung cancer, and found that from 1982 to 1991, among the seven regional cancer centers in Ontario, the proportion of patients receiving initial treatment to the chest ranged from 41 percent to 56 percent.17 The proportion of those receiving long, intensive treatment ranged from 30 percent to 68 percent. These differences are statistically significant. After reviewing radiotherapy practice in all Ontario, Dixon and Mackillop concluded that even modest changes in radiation dose prescription by doctors have the potential to change resource utilization and reduce waiting lists for radiotherapy.18 These problems and their wider recognition suggest that the time is right for an exploration of the history of Canadian cancer control programs. Quite simply, this book aims to unravel the historical threads of the current situation. Examination of past events can reveal issues and conflicts, which have undermined the effectiveness of cancer programs from the beginning and led to the problems of today.

6

Introduction

This book therefore traces the origins, establishment, and early development of cancer programs in Canada with a focus on the introduction of radium therapy and its effect in raising awareness about the need for government support of cancer treatment. Introduced to Canadian medicine in the first two decades of the twentieth century, radium was a powerful cancer therapy that seemed to do away with the need for extensive and often mutilating operations that were then the only successful cancer treatments. However, radium was very costly, and it was financially impossible for private practitioners or clinics to amass the quantities needed for effective treatment. Soon after its introduction, physicians made pleas for government purchase and availability in state-supported clinics. These demands for greater accessibility to radium occurred simultaneously with the recognition of cancer as a social problem that also required government support. The story of the formation of Canadian cancer control programs is therefore the story of a technology and a disease. The introduction of radium into medicine is one part of a much larger story of the rise of medical technology in the early twentieth century and the emergence of the modern technology-based hospital. But radium was more than technology: it was a seemingly magic element that became imbued with powers beyond its healing ability and transformed all those with whom it came in contact. For patients, it offered hope of healing where no healing had been possible before; for doctors, it was a powerful symbol of medical progress, prestige, and power; for hospitals, it assisted in a transformation of identity from charitable institution to a place of scientific and technological healing; for governments, it was a symbol of the level of their society's scientific and social advancement. Yet as the well-publicized illnesses of the radium-dial painters in the 19208 showed, radium also had the potential to be immensely dangerous to human health. In the pre-atomic bomb era, the enthusiastic response to radium by doctors, institutions, and the public was little tempered by the reports of its ill effects. The disease was cancer, which, as American historian James Patterson has shown, first emerged as a "dread disease" in the early years of the twentieth century. Fear of cancer was based on an increasing death rate from the disease: in Ontario, the rate increased from 70 deaths per 100,000 in 1914 to just over 100 per 100,000 in 1929. Like radium, cancer took on associations that transcended its reality. It came to be regarded as a sinister force that threatened and undermined both the physical and emotional well-being of the individual and the fabric of society. The mysteries surrounding its cellular origins and development in the body challenged the technological and scientific confidence of the early twentieth century. Urgent public health

The Cancer Crisis Today

7

measures were recommended to deal with this twentieth-century scourge. Cancer also had moral connotations: because it was most prevalent in developed countries, it suggested corruption and degeneration at the heart of Western civilization. It struck fear into the hearts of ordinary citizens and governments and shamed the medical profession, whose response was to suggest that it could be combated through the same type of public health campaigns that had been successfully used against infectious diseases such as tuberculosis. Radium was to be the central weapon in the war against cancer, and so in the 19308 the technology and the disease coalesced into organized cancer programs. The story of radium and cancer also reveals the evolution of state involvement in health care in Canada. One of the defining characteristics of Canada in the late twentieth century is its publicly funded health care system. Since the advent of medicare in the early 19605, Canadians have had access to a broad spectrum of state-supported medical and hospital services, an important component of which is the provision of care for persons with cancer. In the most populous province, Ontario, the cancer program provides the largest centrally managed radiation therapy service in the world. Other historians have written about the evolution of state involvement in health care in Canada,19 but the formation of these cancer programs and their role in defining state medicine has been previously neglected. For example, Jay Cassel's "Public Health in Canada," an overview of the history of public health in Canada, overlooks cancer. Various monographs and articles have explored the scientific and social responses to other diseases in the early twentieth century, most notably tuberculosis, venereal disease, and polio.20 As the morbidity and mortality from infectious disease began to decline after 1900, public health officials began to turn their attention to chronic illnesses such as cancer. Despite its significance as a health problem, cancer in Canada has remained relatively unexplored. A review of the published literature reveals a few articles on specific aspects such as cancer discoveries, technical breakthroughs, and accomplishments of individuals. The only previous full-length study of cancer is by Barbara Clow, who has examined the complex interaction between the state, doctors, alternative practitioners, and cancer sufferers in the 19308 in Ontario.21 There has been no previous exploration of cancer or radiotherapy on a national level. The cancer programs are of interest because they antedate the introduction of universal medicare by several decades, and they may be viewed as evidence of the focus on public health and social welfare during the interwar years and as early experiments in "state medicine." Indeed, the origin of cancer control programs in the

8

Introduction

bleak era of the 19305 challenges the traditional view of this decade as an era of stagnation in public health. Since they were introduced in an era when nearly all medical care was private, the cancer programs faced special challenges in eliciting support of the powerful medical establishment. Therefore, this book adds a new aspect to the historiography of societal and medical response to disease in twentiethcentury Canada. The period chosen for study is from the discovery of radium around 1900 to the Second World War. It may seem unusual that I have decided to. close the narrative part of this story in 1940, but by that time the majority of provinces had set into place cancer control programs whose philosophy and organization formed the template for today's systems. Although these programs vary somewhat from province to province, they consist of similar components which include programs of public education aimed at prevention and early diagnosis, screening of patients at high risk for the disease, centralized facilities ("cancer clinics") for the assessment and treatment of patients with cancer, and programs of basic and clinical research into the biology and treatment of human cancer. First suggested in the 19205 and 19305, these basic components have remained largely unchanged to this day. Because there have been no previous full length accounts of radium or cancer control in Canada, this book is predominantly a narrative history which will provide a chronological framework for further scholarship. It seeks to answer such questions as: When, where, and by whom was radium introduced to Canada? Who promoted its use? For which diseases was it used? How was its effectiveness measured? What were the sources and costs of the radium used in Canada? How was it distributed? Which provinces first became interested in radium and cancer programs? Who were the central figures involved? What were the important events and steps in the establishment of these programs? These questions inevitably give rise to questions of a more analytic nature: What made radium attractive to Canadian doctors? Why was it so rapidly accepted as a medical treatment? Why and how did hospitals become involved with radium? What social and cultural factors led to government interest in radium and cancer? What difficulties and struggles did governments face? What was the response of the medical profession? The first three chapters describe the introduction of radium to Canadian medicine and society. Focusing on the career of Toronto's William Aikins, chapter i explores the medical uses of radium and the factors that led to its acceptance as a medical treatment - factors that reveal much about physicians' responses to the emergence of

The Cancer Crisis Today

g

"scientific medicine" in the late nineteenth century. In chapter 2 the frame widens to include the societal response to radium as depicted in the background and establishment of the first state-supported radiotherapy clinic in Canada, the Institut du Radium in Montreal. The Institut was seen as a way of modernizing Quebec society, yet chronic underfunding and lack of clarity about its role undermined its success. Using events in Halifax, chapter 3 focuses on the role of radium and the radium "department" in defining the modern hospital. Yet these departments, which sprang up at hospitals across Canada, entrenched an institutionalized approach that would later undermine efforts at coordination of radiotherapy. Beginning in chapter 4, the focus shifts to cancer itself. Chapter 4 explores the medical and social factors which during the 19205 and 19308 led to the recognition of cancer as a public health problem for which state involvement was needed. Chapter 5 depicts the background and negotiations behind Canada's first cancer control programs, the Saskatchewan Cancer Commission and the Manitoba Cancer Relief and Research Institute, and shows how compromises born out of tensions with the medical profession weakened their authority. In chapter 6 the scene shifts to Ontario, where conflicts between the recommendations of a Royal Commission set up to explore a cancer program and the medical profession also created compromises in the organization of cancer care. Chapter 7 explores the use and control of radon in early cancer control programs and reveals the political tensions surrounding new cancer programs. Chapter 8 provides a "country interlude" in which the issues of state versus private medicine are illustrated on a "micro" level in the rural Ontario radium practice of Alexander Moir, whose private radium hospital was threatened by the government's plans. Chapter 9 widens the perspective to a national level and explores early efforts to create a national cancer control program for Canada. When the federal government shunned this responsibility, it was assumed by the medical profession, whose internal dissensions almost destroyed the process. The final chapter provides a brief synopsis of developments in cancer control since 1940 and then draws on material from earlier chapters to analyze three specific current problems in cancer care from a historical perspective: variations in access, variations in practice, and fragmentation of care. My aim is not to provide definitive solutions, but rather to provide a better understanding of how we got where we are. Just as psychological problems in adulthood can often be addressed by examining family of origin issues, so problems in health care organization and delivery can be better understood by examining their historical roots.

1

"Cures of a Very Surprising Character" Radium and the Doctor

During a visit to Paris in the spring of 190*7, prominent Toronto physician and medical editor William H.B. Aikins witnessed the impressive effects of a powerful new therapeutic substance, radium, on human disease. Aikins was an avuncular and respected figure in Toronto medical circles at the turn of the twentieth century. In 1895, he had founded a medical journal, The Canadian Medical Review, and later assisted in the formation of the Toronto Academy of Medicine, a professional and social organization for doctors. At the time, practitioners of Canadian medicine largely looked outside the country's borders for new ideas and inspiration, and in 1907 Aikins visited the Laboratoire Biologique du Radium, a centre for the study of radium established the previous year in Paris under the directorship of Louis Wickham, dermatologist and physician at Saint-Lazare Hospital. Wickham demonstrated a large number of patients who had been successfully treated with radium for such disfiguring skin disorders as keloids, lupus, naevi, cancers, and syphilitic ulcers. Aikins returned to Canada excited by radium's unique value as a therapeutic agent. It seemed capable of effecting healing of tissues in a way different from all other known therapeutic materials and could thereby achieve what he termed "cures of a very surprising character." Aikins invited Wickham to submit a report on radium to his journal, which was published in September 1907.' Impressed by the therapeutic powers of radium but aware of the limitations imposed by its high cost, Aikins immediately urged the trustees of Toronto's leading health institution, the Toronto General Hospital, to purchase radium to benefit Canadian patients.2

Radium and the Doctor

11

But the trustees of the hospital were not inclined to pay much attention to a private practitioner who conducted most of his work outside the hospital's walls. Foreshadowing later political conflicts that delayed or undermined the introduction of cancer services elsewhere in Canada, it was to be fourteen years before the hospital bought any radium. THE

DISCOVERY

OF

RADIUM

What is radium, and why did it attract the interest of physicians such as Aikins? Radium is a radioactive metallic element whose existence was announced by Marie and Pierre Curie in i8g8.3 At the time, Marie was a doctoral student at the Sorbonne, and Pierre was a professor at the Ecole de physique et chimie in Paris. As the topic for her research, Marie had chosen radioactivity, the phenomenon possessed by substances such as uranium of spontaneously emitting radiation. She observed that the amount of radiation given off by pitchblende ore was much greater than could be explained by the amount of uranium in the ore, and hypothesized that there must be a substance of much higher radioactivity than uranium in pitchblende. The existence of this new element (which the Curies christened radium from the Latin radius for ray) was confirmed in December 1898. However, it was four years before the Curies isolated a sample of pure radium from the pitchblende ore. Their Herculean labours in reducing many tons of pitchblende to minute quantities of radium by a painstaking and arduous series of chemical procedures became the stuff of scientific legend and led to a joint Nobel prize for physics in igog.4 The discovery of radium occurred in an era of rapid scientific and technological advancement, much of which was underpinned by new knowledge about various forms of electromagnetic radiation. In November 1895, Wilhelm Roentgen discovered X-rays, and by the turn of the century their magical property of revealing the hidden was being used in medical diagnosis as well as in the assessment of the integrity of metals, the inspection of baggage, and the checking of authenticity of paintings.5 A precursor to radium, X-rays had been found to have a destructive effect on tissue and were being used to treat disease.6 In December 1901, Guglielmo Marconi succeeded in transmitting radio signals across the Atlantic. Radium was yet another novelty of this radiation-propelled era. Scientists and public alike were fascinated by its mysterious properties, which included its ability to render other substances luminous, emit heat spontaneously, and give off rays that penetrated through several inches of lead. Radium could destroy the germinative power of seeds, retard the development of larvae, and cause tadpoles to transmute into "monstrosities." If it was

12

"Cures of a Very Surprising Character"

brought near the eye in a darkened room, a sensation of diffuse light was produced.7 Like other radioactive elements, its most intriguing feature was that the energy given off as radiation emanated from somewhere within its atoms, and this observation overthrew the century-old concept that the atom was the smallest, irreducible component of the universe. Before World War I would leave its indelible mark on history, investigations into radioactivity would cause a complete revision of physics and chemistry.8 THE INTRODUCTION

OF R A D I U M T O M E D I C I N E

The property of radium that attracted the interest of physicians was its ability to affect human tissue. Two years after the Curies announced the existence of radium in 1898, two German experimenters, Friedrich Walkoff and Friedrich Giesel, reported inflammation of the skin after radium exposure. In 1901 its biologic effects attracted wide interest when Henri Becquerel, the discoverer of radioactivity, accidentally burned himself with a tube of radium carried in his waistcoat pocket.9 In a display of sympathy mixed with science, Pierre Curie then carried out a self-experiment in which he produced a radium burn on his own arm. Becquerel and Curie's report on the physiological action of radium rays appeared in the Compte-Rendues of the French Academy of Sciences in the same year. The corollary of these observations was that radium might destroy diseased skin and allow its healing, and as a result Curie loaned some radium to Dr. Henri Danlos, dermatologist at the Saint-Louis Hospital in Paris.10 Danlos applied the radium in rubber and celluloid containers and found a beneficial effect on skin lesions such as those caused by lupus erythematosus. Reports of these experiments excited much interest among doctors, and within a few years small amounts of radium from French and German laboratories were being tested on a variety of human ailments in many different countries. The first North American physicians to obtain and use radium were Boston X-ray pioneer Dr Francis H. Williams, who obtained 100 mg in 1903, and Robert Abbe of New York, who experimented with intrauterine applications using radium from the Curies' laboratory.11 Two properties of radium were of great medical interest: first, its seemingly magical ability to melt and eradicate diseased tissue without cutting; second, the endless ways in which it could be applied to the human body. For external use, radium salts could be applied in flat applicators (called "plaques"), pellets, in radium impregnated bandages, or even as a radiferous mud. For internal use, it could be incorporated into capsules or needles for insertion into body cavities or tumours. In 1903 Alexander Graham Bell

Radium and the Doctor

13

suggested that tiny fragments of radium could be inserted in such ways into the very heart of a cancer.12 Radium salts could be dissolved in solutions for injection and ingestion, and its gaseous product, radon, also highly radioactive, could be inhaled.13 Initially, medical experimentation with radium was hampered by the meager world supply and lack of facilities to study its medicinal properties. It took 4.5 tons of Bohemian pitchblende to produce one gram of radium.14 In 1904 the French industrialist Armet de Lisle established a radium refinery in Paris and supplied radium to establish the first centre for the study of radium therapy, the Laboratoire Biologique du Radium, which opened in 1906. The Laboratoire included physics, pathology, and physiology laboratories, and studies of the therapeutic action of radium on diseases were carried out under the direction of Dr Louis Wickham. Even at this early stage, the commercial potential of radium was evident: in return for the supply of radium for experiment, de Lisle received a portion of the fee charged to each patient.15 The experience at the Laboratoire formed the basis of Wickham's textbook Radiumtherapy of igio. 16 Similar centres for the study of radium were established elsewhere in Europe: in Sweden, the Radiumhemmet (Radium Home) was established in 1910,1? and the following year King Edward VII convinced two wealthy friends to sponsor a Radium Institute in London after his own successful treatment for a lesion on his nose.18 By the end of the first decade of the twentieth century, the physical properties of radium were understood. Radium is the sixth member of a naturally occurring series of radioisotopes, which starts with uranium and ends with lead. As each isotope decays into its product, it emits various forms of radiation - alpha, beta, and gamma rays - which vary in their ability to penetrate the body. Within the series, radium226 was found to be the most clinically useful because of its emission of highly penetrating and potentially destructive gamma rays.19 In 1902 Ernest Rutherford's theory of atomic disintegration, based on his research done at McGill University in Montreal, became the accepted explanation for radioactivity of elements such as radium. He would later win the Nobel Prize in Chemistry for his work. Around the same time the medical profession started to construct a lengthy list of conditions that apparently benefited from radium treatment.20 Medical enthusiasm for radiation therapy resulted in numerous articles in the medical literature and discussions at medical meetings. By 1906 over eighty articles on radium therapy had appeared in the North American medical literature.21 This excitement over radium ran counter to the cautious, laboratory-based approach to therapy that was emerging at the turn of the century, and later parts of this chapter

F I G U R E S 1.1-1.5: VARIOUS FORMS OF APPLICATION

OF RADIUM

Figure 1.1 Radium-containing needle and tube for implantation into diseased tissue. Wilson, Radium Therapy, 13

Figure 1.2 Applicators for applying radium to the skin or body cavities. Wickham, Radium Therapy, 35

Figure 1.3 X-ray of pelvis showing radium applicator in vagina. Wilson, Radium Therapy, 131

Figure 1.4 Applicator for radium treatment of nasal cancer. Kergrohen, Radio et Curietherapie, 191

Figure 1.5 Physician holding radium pellet in forceps for application to skin with adhesive tape. Reprinted with permission of Kingston Whig-Standard

16

"Cures of a Very Surprising Character"

explore some of the cultural and professional factors that led to its remarkably rapid adoption as a medical treatment. RADIUM

COMES TO

CANADA

In Canada, medical interest in radium was initially slower than in other countries. Perhaps because the work had been done on Canadian soil, medical journals were quick to publicize Rutherford's work on the atom (the Montreal Medical Journal published an article by Rutherford on radioactivity in February 1904), but slow to recognize the therapeutic possibilities of radium. The first full-length discussion of medical uses of radium, by Wickham, appeared in the Canadian Practitioner and Review in December igo8.22 It comes as no surprise perhaps that the doctor who had been so impressed with Wickham's work in Paris the year before, William Aikins, edited this journal. In a 1909 editorial, Aikins complained that although his journal had attempted to impress the medical profession with the vast importance of radium, the receptiveness of Canada's surgeons had been "marvelously slow."23 Nevertheless, several Canadian doctors showed an interest in radium and visited the Laboratoire in Paris. Among them were Herbert Bruce, professor of surgery at the University of Toronto and later a key instigator of Ontario's cancer program,24 G. Sterling Ryerson, professor of ophthalmology at the University of Toronto,25 and G.E. Armstrong of Montreal.26 In Montreal, Dr Gilbert Girdwood, professor of practical chemistry in the Faculty of Medicine at McGill and a Canadian pioneer in X-rays, obtained a small quantity of radium from Rutherford, but it is not known whether it was ever used therapeutically.27 The first report of a medical use of radium in Canada appeared in the Canadian Practitioner and Review in December igog.28 The author was Dr Edmund E. King, a native of Brantford, Ontario, who received his MD from the Toronto School of Medicine in 1885. His long medical career included service in the field hospital of the Northwest Rebellion, and surgeon at St. Michael's Hospital in Toronto. His many non-medical interests included the position of chief judge of the annual baby competition at the Canadian National Exhibition from which, his 1930 obituary stated, his picturesque figure and apt remarks will be sadly missed.29 King was one of the first Toronto doctors to take an interest in radiology, and a year after Roentgen's discovery of X-rays, he published his own observations of radiation damage to the skin and hair of a young man who had been giving public demonstrations of X-rays.30 In his 1909 report, King described the case of a sixty-seven-year-old man with a cancer of the tongue so extensive that it was unsuitable

Radium and the Doctor

17

for operation. Thinking that the disease might respond to radium, he applied a tube containing radium against the lesion for five-minute sittings over several days. There was a noticeable improvement, and the patient, considering himself cured, disappeared for a month. At the end of that time, King was pleased to see that the tumour had regressed and began a further series of treatments to a residual area of disease. At this point the first recorded radium treatment in Canada terminated unhappily, for the patient, broke the radium tube by possibly biting it. King does not mention whether this resulted in accidental ingestion of radium. Despite this unfortunate event, King was pleased to see the marked improvement in his patient's condition and purchased another tube of radium. However, he published no further reports about the use of radium in treating patients. In the same month that King's article appeared, the Dominion Medical Monthly published an article by Graham Chambers, physician at Toronto General Hospital, extolling the virtues of radiotherapy for skin cancer and claiming that he had been using radium bromide for three months.31 However, he gave no details of any of the cases he treated. At least one other Canadian physician acquired radium in this era. Sterling Ryerson, professor of ophthalmology and otology at the University of Toronto, accompanied Aikins on his visit to Paris in the spring of 1909 and was induced to buy a small quantity for use in his eye, ear, nose, and throat practice. In 1911 Ryerson reported on the successful application of radium to a large skin cancer on the face of a sixty-yearold man (who was referred by Dr Langstaff of Richmond Hill) ,32 WILLIAM AIKINS: CANADIAN RADIUM PROMOTER Other Canadian physicians may have acquired small amounts of radium in the pre-World War I era, but they did not leave any records or reports of its use. The pre-eminent figure in Canadian radiotherapy before 1920 was William Aikins, who became an active practitioner and promoter of radium in Canada. Aikins was born in 1859 in Peel County, Ontario, into a family that played a significant role in Canadian political and medical history. His father, James Cox Aikins, was in Sir John A. Macdonald's first cabinet and later became Lieutenant-Governor of Manitoba; two uncles, Moses and William, were physicians, the latter Chair of Surgery in the Toronto School of Medicine.33 William Henry graduated in medicine from the University of Toronto in 1881, and like many physicians of his day, he pursued post-graduate studies in Europe. During this time he visited Vienna, Paris, Edinburgh, and London. It would have been an exciting time for a young medical graduate to be in Europe. In 1882 Koch discovered the tuberculosis

18

"Cures of a Very Surprising Character"

Figure 1.6 W.H.B. Aikins (1859-1924), founder of radiotherapy in Canada. Canadian Practitioner and Review 49 (1924): frontispiece

bacillus, and advances in anesthesia and antisepsis were allowing European surgeons, such as Theodor Billroth in Vienna, to carry out surgery on previously unoperated parts of the body.34 In 1883 Aikins established a general practice in Toronto and soon became a prominent figure in Canadian medical circles. After visiting the Laboratoire Biologique again in 1908 and 1909, he bought a small supply of radium and opened his own clinic, the Radium Institute of Toronto, at 134 Bloor Street West in igio. 35 The clinic was located a few blocks north and east of the university but a fair distance from the heart of academic medicine, Toronto General Hospital, on the edge of a middle-class residential area whose residents might be able to afford Aikins' fees. This became the first clinic in Canada to specialize in the new medical treatment of radiotherapy. Unfortunately, Aikins' casebooks and original treatment records do not appear to have survived. However, his position as editor of a medical journal gave him the unique opportunity to frequently publish case reports and observations on his use of radium. From 1910 to 1923 he made reports on 133 patients (81 women and 42 men), and the numbering

Radium and the Doctor

19

of the cases shows that by the end of 1923 he had treated over 3,200 patients referred from a wide area extending from Saskatchewan to Quebec. In 1914 his radiotherapeutic equipment included a radium plaque (a flat applicator coated with a varnish impregnated with radium) worth about $350 and a tube containing radium salts worth about $12OO.349 (October 1924): 482; CP49 (November 1924): 524-9. 532-3- Aikins, W.H.B. CJM&S 56 (November 1924): 171-5. - Aikins, W.H.B. CMAJ 14 (November 1924): 1132. - Aikins, W.H.B. Radiology 3 (December 1924): 517-8. - Clarkson, Frederick A. "Pioneered in Cancer Work." Toronto Star (31 January 1963)- Clarkson, Frederick A. "Canada Pioneer in Radium Use Treating Cancer." Globe and Mail (31 January 1963). - Cleland, Frederick A. UTMJ 11 (December 1933): 81-2. - Cleland, Frederick A. BAMT 7 (January 1934): 80-1. - Dickson, Charles R. "X-Ray Pioneer Dies." Toronto Star (n July 1938). - Dickson, Charles R. "Blind Soldiers Lose Friend ... Was Pioneer in Use of X-Ray." The Globe (11 July 1938). - Dickson, Charles R. BAMT n (August 1938): 294-5. - Gendreau, Joseph-Ernest. "In Memoriam: Joseph-Ernest Gendreau."L'£7m'on Medicale du Canada (November 1949), 1285-6. - Harrison, Frederick C. "Helped Develop Use of Radium for Therapy." Globe and Mail (9 September 1963). - Harrison, Frederick C. "Pioneer in Radium." Toronto Star (9 September !963)-

- King, Edmund E. "Noted Surgeon Dies of Infection." Toronto Star (29 April 193°)- King, Edmund E. "Prominent Surgeon, Col. Edmund E. King, Passes Suddenly." The Globe (29 April 1930). - King, Edmund E. BAMT 3 (June 1930): 14-16. - King, Edmund E. CMAJ 22 (June 1930): 894.

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!945Wilson, Robert. "A Recent Visit to Some Roentgen Ray and Radium Laboratories in England and France." CMAJ i (June 1911): 571-6. Wolff, Jacob. The Science of Cancerous Disease from Earliest Times to the Present Translated by Barbara Ayoub. Canton, MA: Science History Publications, 1989, and Jena: Gustav Fischer, 1907. Wong, D.T.W., and K. Munger. "Association of Human Papilloviruses with a Subgroup of Head and Neck Squamous Cell Carcinomas." Journal of the National Cancer Institute 92 (2000): 675-6. Wood, Francis Carter. "Recent Cancer Therapy." CMAJ 13 (March 1923): !52-9Wright, R.R. "The Place of Sciences in the Medical Curriculum." Queen's Medical Quarterly 8 (1903): 15-23. Wyeth, George A. "Endotherapy vs. X-Ray and Radium in the Treatment of Neoplastic Diseases of the Skin and Mucous Membrane." CL&P 71 (November 1928): 189-93. Zieroth, D. Nipika: A Story of Radium Hot Springs. Government of Canada: Minister of Supply and Services, 1978. Zubrod, C.G. "Historic Milestones in Curative Chemotherapy." Seminars in Oncology 6 (December 1979): 490-505.

Index

Abbe, Robert, 12, 19, 186 Academy of Medicine (Toronto), 10 access, problems in: 4, 131; historical roots, 197-8; see also cancer, current deficiencies in care Acme Machine and Electric, 188 Advisory Committee on Cancer (Ontario), 128-30 Aikins, William H. B.: 186; cancer advocacy, 74, 76; death, 19; entreats TGH to buy radium, 65; extols radium, 10, 16; lectures on radium, 19; life and career, 17-18; opens Radium Institute, 18; patients treated by,

23, 28-31, 75; president of American Radium Society, 19; purchase of radium, 18; radium equipment, 19; radium techniques, 24, 27; reputation in radiotherapy and medicine, 10, 19; visits Paris, 10 Alberta government: medicare, 184 Alberta Medical Association, 171 Allen, E, 136 Alport, E.B., 89 alternative therapy, 125, 134 Alvey, S.T., 62 American College of Surgeons: standards for cancer clinics, 102 American Radium Society, 19, 31

American Society for the Control of Cancer, 74, 76, 122, 169 Armstrong, E.H., 58 atomic theory, 13 Australia: cancer program, 84, 89-90, 118, 198 Banting, Frederick, *97 Bates, Lloyd, 188 Battle Creek Sanitarium, 158, 159 Bazin, A.T., 89; reviews Saskatchewan cancer legislation, 92; supports cancer education, 173 Beclere, Antoine, 35 Becquerel, Henri, 12 Belgium: cancer program, 83 Bell, Alexander Graham: and radium, 12

262

Bell, Gordon, 76, 94 benign conditions: use of radiotherapy for, H2-3' 154» l 6 2 5 see also birthmarks; Institut du Radium Bennett, R.B., 175 Bessborough, Earl of: inaugurates cancer campaign 175 Bichat, Xavier, 71 Biehn, Stanley, 127 Bigelow Clinic (Brandon, Man), 94 birthmarks: use of radiation, 142, 154, 154 n. 63; ill effects, !54~5 Black, V.E., 106 Blair, Allan, no; witnesses disputes in Vancouver, 181 Bloodgood, Joseph, 105 Brandon (Man): radiotherapy, 94 Brantford (Ont), 113, 142, H7 Brantford General Hopital, 122 breast cancer: adjuvant chemotherapy, 190; Canadian Breast Cancer Initiative, 201; changing attitudes to local treatment, 190; radical mastectomy, 20, 75, 190; radium treatment, 158 Britain: cancer programs, 84, 117, 118 British Columbia: criticism of cancer

Index services, 179; evolution of cancer program, 178-83; success of cancer program, 200 British Columbia Cancer Agency, 186, 192, 200 British Columbia Cancer Foundation (BCCF): anonymous donation, 182; formation and objectives, 180; hardship, 180-1; purchase of radium, 180; British Columbia Cancer Institute (BCCI), 182 British Columbia government: annual grant to BCCI, 182; declines request from BCCF, 180 British Columbia Medical Association, 180 British Empire Cancer Campaign, 84, 169 British X-Ray and Radium Committee, *54 Brown, Harold, 180 Bruce, Herbert: 186; attends London cancer conference, 84; criticizes federal government, 170; important speech on cancer, 85, 113; life and career, 85; role in formation of Ontario cancer

program, 112, 11314; visits Paris, 16 Burr, Ronald, 192 Burrows, Arthur, 89 Burton, E., 138 Busby, E.D., 162 Bush, Raymond, 192 Calgary: cancer clinic, 184; radiotherapy in, 183 Calgary Medical Society, 184 Cameron, Stewart, 147 Canada government: inaction on cancer, 169-71; rejects radium purchase, 169-70; see also Department of Health (Ottawa) Canadian Association of Radiation Oncologists, 189 Canadian Association of Radiologists, 189 Canadian Breast Cancer Initiative, 201 Canadian Cancer Society, 168, 171, 178; and Cancer 2000, 201; concern about variation in treatment, 197; formation of NCIC, 191; negotiations leading to formation, 175-8; role of John McEachern, 177-8; Canadian Coalition on Cancer Surveillance, 201

Index Canadian Medical Association: formation, 171; cancer committee, 171; interest in radiotherapy, 20, 92; interest in national cancer program, 168; negotiations with King George V Fund trustees, 176-8; reaction to King George V campaign, 175; suspicion of public involvement, 174; various proposals for national cancer program, 171-5, 197 Canadian Radiological Society, 183 Canadian Society for the Control of Cancer. See Canadian Cancer Society Canadian Strategy for Cancer Control, 201 cancer: alternative treatments, 134; changing concepts of, 71-2, 190-1; classification, 72; controversy over statistics, 77-8; current deficiencies in care, 3-5, 193-8; current statistics, 3, 192; death rates, 76, 192; definition, 46-7, 70; delays in diagnosis, 103-4, 1 ^2; detection and early diagnosis, 74; diagnostic methods, 71-2; early

recognition of deficiencies in care 131-2, 140, 167; early statistical reports, 131; fear of, 6, 78-9; history, 70-2; induced by radiation, 154; late nineteenth-century view of, 72; local theory of, 72, 73; metaphors, 79, 82; metastasis, 71; moral connotations, 7, 73; personal experiences, 80, 134; pessimism, 79, 130, 192; and poor hygiene, 72; possible causes, 72; prevention, 200; public education, 74, 77, 105, 132; research efforts, 191-2; societal response to, 69, 186; surgical treatment, 74-5; systemic theory of, 190-1 :ancer campaigns, 74, 82, 106, 169; King George V campaign, 175; see also Canadian Cancer Society dancer Care Ontario, 4, 186; weak authority, 195; changing foCUS, 2OO-1

:ancer clinics: see cancer organization; cancer programs; individual cities (e.g. Kingston) :ancer committees: see Canadian, Ontario,

263

and Saskatchewan Medical Associations cancer conferences: New York State, 82, 169; London, 84, H3 cancer organization: centralization and its problems, 117-18, 124, 130, 155, 193, !97-8' J99; European ideas about, 117-18; financing, 198-9; interest in national program for Canada, 169, 201; role of education versus research, 172-5; role of public, 173-4; variations across Canada, 168; weakness of Canadian programs, 1935; see also Claudius Regaud, Gordon Richards, Earle Shepley cancer patients: difficulty paying for treatment, 109-10, 148-9, 163; role in formation of cancer programs, 134, 201; suffering, 80, 148, i48r n. 31, 162 cancerphobia. See cancer cancer programs: Australia, 84; Belgium, 83; Britain, 84; France, 83; general elements, 8; lack of progress in Canada,

264

84-5; principles, 823; relation to medical profession, 87-8, 106-8, 193; role in formation of medicare, 7; Sweden, 83; United States, 83; see also individual Canadian provinces Cancer Remedies Commission, 134 Cancer Services Implementation Committee (Ontario), 4, !34- 195 cancer treatments. See alternative therapy, chemotherapy; cobalt therapy; radiotherapy; radium; radon; surgery Carson, J.E., 147 Case, James T., 158 Caskey, John, 189 centralization of health services. See cancer organization. Chalk River (Ont), 188 Chambers, Graham, 17 chemodierapy, 190, 195 Chevalier, Albert, 46 children, use of radiation: see birthmarks Chown, Bruce, 99 Cleland, Frederic, 123, 197-8 clinical trials, 25 cobalt therapy, 188-9 Cody, Henry John, 115 Cody Commission. See Royal Commission on the Use of Radium.

Index Colbeck, W.K., 127 Congo. See Zaire Connell, W.T.: member of Cody Commission, 115; summarizes cancer, 72, 74 control: of radium use in hospitals, 67; see also radium, radon Cook, W.J., 130 Cotnam, Dr, 169 Cox, Bert, 98 Cross, W.W., 184 Cross Cancer Institute, 192 Curie, Marie, 11, 26, 35 Curie, Pierre, 11; selfexperiment with radium, 12 Cutler, Max, 179 Danlos, Henri, 12 David, Athanase, 38, 41 Davison, R.O., 95; analyzes reasons for delays in diagnosis of cancer, 105; role in Saskatchewan radium purchase, 96-7 delay: in cancer diagnosis, 102-6, 132; in treatment, 4 de Lisle, Armet, 13 Department of Health (Ottawa): and Cancer 2000, 201; Dominion Council of Health, 170; formation, 169; formation of NCIC, 191;

reports on cancer, 169, 192 Department of Mines (Ottawa), 128 Depression: impact on cancer care, 109, 151, 163; public health during, 187 disease: cellular theory, 71; denning, 70; humoral theory, 70 doctors. See medical profession Dominion Council of Health, 170 Douglas, James, 83 Duane, William, 39, 40 Dufresne, Origene, 43, 80 Dunning, C.A., 88 Eager, William, 56 Edmonton: cancer clinic, 184, 192; radiotherapy in, 183, 184 education, about cancer: for doctors, 173; for public, 105, 132, 163 Eldorado Gold Mines, Ltd., 128, 165, 170, 189 empiricism: consequences, 196; medical, 25-32 Essex County Medical Society, 125 Essiac, 125 Etherington, Frederick: criticizes Cody Commission, 116; member of Advisory

Index Committee on Cancer, 129; radium use, 113, 127; sale of radium, 127 Europe: cancer programs, 117-18, 197 Evans, A. Maxwell, 182 Ewing, James, 40, 83, 100, 117 experimentation: medical, 21-2, 26 Fahrni, Gordon, 150, 173 Failla, Gioacchino, 39, 4*> 99' 137 Faulkner, J.A., 129 fear, of cancer. See cancer fees. See cancer patients; radiotherapy; radium Ferguson, Howard, 113 Ferguson, John, 73 financing: cancer programs, 198; see also fees; Institut du Radium Fondation Curie, 42, 45 Ford, Arthur, 115, 132 Forsell, Gosta, 117, 118, 197 fragmentation of care, 4-5; historical roots, 192-5; see also cancer, current deficiencies in care Frame, Mary, 157 France, 83 Fyfe, Hamilton, 116 Galen, 70 Gendreau, JosephErnest: antagonism

of surgeons, 100; attends international cancer conferences, 82, 84; life and career, 35; proposals for Quebec radium centre, 35-7, 76; reputation, 43; speech on cancer at Chateau Laurier (1935)' So-1 Gilmore, W.M., 152 Girdwood, Gilbert, 16 Godfrey, Forbes, 113 Good,J.W., 66 Gosse, Norman, 85 governments, involvement in health care See individual jurisdictions (Alberta, Canada, Ontario, etc.); medicare; Royal Commission Great Bear Lake (NWT), 128 Greater Vancouver Health League, 180 Guiou, Norman, 148, 166 Gurd, Fraser, 100 Halifax Visiting Dispensary, 53; bequest by James Hamilton, 54; conditions of purchase, 60; considers radium purchase, 55, 56~7> 59-6°; history, 54; purchases radium, 60; statistics on radium utilization, 64; and Victoria General Hospital, 64

265

Hamber, E.W., 182 Hamilton, James T.: bequest to Halifax Visiting Dispensary, 54 Hamilton (Ont), 123, 194; cancer clinic, 125, 195 Halsted, William, 20, 75 harmful effects, radiation. See hazards Harrington, E.H., 58, 60 Harrington, Ertle L., 89; constructs radon plant in Saskatoon, 98 Harrison, Bede J., 181; first director of British Columbia Cancer Institute, 182 Hawkins, A.C., 55 Haywood, A.K. (Montreal), 48 Haywood, A.K. (Vancouver), 179, 180

hazards, radiation: 32, 153-5; see a^° radiation; radium Heagerty,J.J., 170 Health Canada. See Department of Health (Ottawa) health policy: compromises in Ontario, 124-6; in Saskatchewan, 99-102 health service organization. See cancer organization

266

health service utilization: Ontario cancer clinics, 5, 131, 195; radium treatment, 68; radon treatment, 99, 150-1; Saskatchewan cancer clinics, 106, 111 hemangiomas. See birthmarks Henderson, George: life and career, 61; original design for Halifax radon plant, 61 Henry, C.M., 99, no Henry, George, 114, 116 Hensall (Ont), 157, 163 Hett, John, 20, 125 Hicks, Everett, 113, 142, 147, 194 Hippocrates, 70 Hoffman, Frederick, 76: visits Canada, 76, 80 Holy Cross Hospital (Calgary), 184 hospitals: bureaucritization, 66; evolution of role, 52-3; rivalry, 50, 194; see also individual hospitals (Royal Victoria, Toronto General, etc.) Hunter, John, 70 Huron Springs Sanatorium, 156, 183; benign conditions, 162; conception and construction, 158-9; decline, 163-5;

Index discouragement by government, 164-5; facilities, 159-60; grand opening, 159-60; patients admitted, 161-2; radium, 161 Imperial Cancer Research Fund, 169, 1 1 9 infectious disease: as model for cancer organization, 81 Institut du Radium (Montreal): allegations of favouratism, 49; and cancer mortality, 76; closure, 50; conflicts with city administrators, 46, 109; financial difficulties, 43-5, 198; government grants, 47; and Paris, 42, 186; move to Maisonneuve, 44; opening ceremony, 34, 41-2; opposition of physicians, 46, 47-8, 193; redefining goals, 45; a source of pride, 42-3; special analysis of cases, 46-7; statistics on patients, 42, 50; treatment of benign conditions, 46, 47, 150, 162; unsatisfactory physical environment, 43, 47 International Congress of Radiology, 154

Jackson, Alan, 147 Jackson, Stewart, 189 Janeway, Henry, 40 Johns, Harold E., 188-9 Johnston, Steven: and Halifax Visiting Dispensary, 56-7, 59, 60; interest in radiotherapy, 56; life and career, 55-6; report on radium department in Halifax, 62-3; and Victoria General Hospital, 57 Jones, W.A., 127 Kapuskasing (Ont), 148-9 Kellogg, John Harvey, !59 Kelly, Howard, 37, 55, 113, 142 Kelowna (BC), 192 Kenney, W.W., 60 Kenny, J.B., 60 King, Edmund E., 16-17 King,J. H., 170 King, Mackenzie, 175 King George V Silver Jubilee Fund for Cancer, 106, 168,180; launch, 175; fund raising, 175; negotiations with CMA, 1768; proposals for funding, 176; role in formation of NCIC, 191 Kingston (Ont): cancer clinic, 126, 193, 195 Kingston General Hospital, 113, 194

267

Index LaBine, Gilbert, 128 Laboratoire Biologique du Radium (Paris), 10, 13 Leacock, Stephen, 82 League of Nations, 186 Lee, Burton, 45 Leitch,John, 125, 137, 152, 164 Lessard, Alphonse, 46 Lindsay, W.S., 89 London (Ont): cancer clinic, 153, 156, 163, 165, 195; first cobalt treatment, 189; impact on Huron Springs Sanatorium, 165; scientific image, 166-7 Low, David, 95 Lyman, Warren, 122 MacCharles, Malcolm: Manitoba cancer advocate, 94 Macdonald, P.A., 135; control of radon in Manitoba, 151 Mackay, Hugh, 19, 94, 149; experience with radium, 150 Mackillop, William, 4 Macklin, Madge Thurlow, 78 Mader, Ivan, 59 Malcolmson, George, 183-4 Manitoba: radium in, 94 Manitoba Cancer Relief and Research Institute: control of radon, 149-52;

formation, 95, 186, 195; joint purchase of radium with Saskatchewan, 97-8; radon plant, 99, 136 Manitoba government: cancer legislation, 95 Manitoba Medical Association, 94, 152; conflict with MCRRI over radon use, 152 Massachusetts, 83, 118, 198 McClennan, John, 115 McCormick, Norman, 227 McCreary, S., 127 McCullough, John, 73; and Huron Springs Sanatorium, 163-5; member of Advisory Committee on Cancer, 129; and Ontario cancer program, 115, 121; receives radium, 138; role in radon control, 138, 146-9 McDonald, Ellice, 88, 97, 98, 100 McEachern, John, 171, 175; formation of Canadian Cancer Society, 177-8; interest in cancer, 171; negotiations with King George V Fund Trustees, 176-8 McGill University, 13, 40, 192 McGuffin, W.H., 183 McGuffin Radium and X-Ray Institute, 183, 184

McKay, Johnny, 186 McNeill, George, 165 medical profession: and state medicine, 123, 156, 184, 186, 193; see also individual medical associations (Alberta, British Columbia, etc.) medicare: Alberta, 184; doctors' reaction to, 123, 156, 186; evolution, 7, 186; health care prior to, 166; see also cancer programs Memorial Hospital (New York), 83, 100 metaphors, for illness:

79, 82 Miller, A.B., 191 Moir, Alexander, 19, 194; acquires radium, 157-8; addresses Cody Commission, 119, 167; biography, 156-7; death, 165 interaction with government, 163-5; patients, 158; training in radiotherapy, 158; Moncton (NB), 192 Montreal: radiotherapy in, 50; see also Institut du Radium Montreal General Hospital, 42, 48; control over use of radium, 67; declining profits from radium, 68; equipment, 66; opens

268

radium department, 49, 52, 53; statistics on radium use, 66-7 Moose Jaw (Sask), 106 Morgagni, Giovanni, ?i Moynihan, Lord, 114 Muller, Johannes, 71 municipalities: payment for cancer treatment, 46, 109-10 Munroe, Frederick Dennis: 87; cancer commissioner, 95; interest in federal radium purchase, 170; radio address on cancer, go; role in Saskatchewan purchase of radium, 96 Murray, W.C., 88 National Cancer Institute (USA), 191 National Cancer Institute of Canada (NCIC), 191, 192 National Radium Commission (UK), 118 National Research Council, 127, 191 New Brunswick: radiotherapy in, 189 Nicholls, A.G., 175 Nicholson, Daniel, 150 North Bay (Ont), 147 Northwest Territories, 128, 170 Notre-Dame Hospital (Montreal), 50 Nova Scotia government: agreement on radium, 61; initial

Index refusal to purchase radium, 58; puchase of radium, 53 Nova Scotia Medical Society: Cancer Weeks, 74 oncology. See cancer; cancer treatment Ontario Cancer Institute, 197 Ontario Cancer Treatment and Research Foundation (OCTRF), 132, 191 Ontario government: Advisory Committee on Cancer, 128-30; appoints cancer statistician, 131; attitude towards radium, 113-14; compromises on cancer care, 1246; deficiencies in program, 131-2; establishes cancer program, 126-9; establishes radon plant, 135; examination of cancer care, 4; formation of OCTRF, 132-3; plan for radium institute, 98; public cancer education, 132; purchase of radium from private doctors, 127, 163; re-evaluation of cancer program, 133; restricts private radiotherapy, 166 Ontario Medical Association: cancer

committee, 197; centralization, 198 instigates Royal Com mission on Radium, 115; reaction to Royal Commission report, 122-3; r°le in government cancer policy, 124-5, *93; Ottawa, 122, 123, 148; cancer clinic, 125, !95 Panneton, J.E., 50 Parry Sound (Ont), H3 Pater, Joseph, 191 patients. See cancer patients Payeur, Leo, 50 payment. See cancer patients Percival, Eleanor, 48; reports on effectiveness of radium, 67; training, 67 Peters, Vera, 75, 192; and breast cancer, 191 Pfahler, G.E., 43 physicians: attitudes towards therapeutics, 25-32; see also medical profession physics, role in cancer programs: 35, 61, 98-9, 136, 188-9 Pirie, Howard, 48-9; reports on radium use, 68; speaks on radiotherapy in Nova Scotia, 58 Pochon, Marcel, 128

Index Port Hope (Ont), 128 prevention, 200 Primrose, Alexander, 82, 119, 175; addresses CMA on cancer, 172; named to board of trustees of King George V Fund, 175 Princess Margaret Hospital, 192, 197 private practice medicine, 88, 94, 112-13, 127, 163 provincial rivalries, 88, 99 Prowd, Wesley, 19; criticizes Vancouver cancer facilities, 179; opposes distribution of radium, 181; proposal for Vancouver radium institute, 180; radium purchase in Vancouver, 65; statistics on radium treatment, 67; warning about Radium Beige, 96; withdraws from cancer activities, 182 public: role in cancer policy, 134, 173-4, 201; see also cancer campaigns public health, 69-70, 81, 199; during interwar years, 187 Quebec government: agreement with University of Montreal, 41; purchase of radium, 34, 38;

Saskatoon editorial, 88; social legislation, 38 Queen's University, 191-2 Quick, Douglas, 149 Quimby, Edith, 39 Quinn, F.P, 122 Quintal, J., 46 radiation: late nineteenth-century discoveries, 11; harmful effects, 153-5; persistent enthusiasm, 154; regulations, 154 Radiation Oncology Research Unit, 4 radioisotopes, artificial, 188 Radiological Society of North America, 183 radiology: as a specialty of medicine, 67, 189 radiotherapy: advantages, 20, 75; conflicts with surgeons, 127, 146, 151; empirical origins, 196; fees for, 59, 102; first Canadian university department, 191-2; origins and early history, 12-16, 20; technical developments, 186-7; variations in practice, 5, 24, 144, 195-6; waiting times, 4 radium: as alchemy, 26; allure for

269

doctors, 26; biological effects, 12, 22-3; in a "bomb," 127-8; bootlegging, 97; Canadian production, 128, 170; commercial value, 13, 32, 96; control in hospitals, 67; dialpainters' illnesses, 153; discovery, 11; early medical experiments, 12; fees for, 59, 102; first medical use in Canada, 16-17; general significance, 6, 10; hazards, 21, 67; losses, 67-8; manufacture, 13; medical enthusiasm for, 13, 20; modes of application, 12-13, 127; physical properties, 12, 13; prices, 96, 128; public interest in, 11, 20-1; reports of effectiveness, 67; response of Canadian physicians, 16; role in evolution of hospitals, 53; shortages, 127; variation in technique, 118, 196 Radium Beige, 96, 114, 117; opposition to joint Canadian purchase of radium, 97 Radium Chemical Company, 27, 55, 96, 128, 158, 182

270

Radium Emanation Corporation, 148 radium emanations. See radon Radiumhemmet (Sweden), 13, 83, 117, 120 Radium Holding Company, Ltd., 94 Radium Institute (London), 13, 84; policy on radium distribution, 149 Radium Institute of Toronto, 18-19, 23; cases treated, 23-4 radon: advantages in treatment, 39, 135; analysis of Ontario requisitions, 138-46; application techniques, 40; competence of doctors, 146, 149; control, 138; diagnoses, 142— 3, 150; distribution and delivery, 126, 138, 149; Halifax plant, 61-2; harmful effects, 154-5; inhalation, 13; Montreal production plant, 41; need for expert physicist, 135; patient demographics, 140; practitioners, 140-1; price, 138; role in cancer programs, 135; Saskatchewan plant, 98; source and production, 39; Toronto plant, 126, 129, 135;

Index underutilization in Manitoba, 150-1; variations in use, 144; Winnipeg plant, 136; Regaud, Claudius, 82; ideas on cancer organization, 117, 193, 197; radium technique, 118 Regina (Sask), 102 Regina General Hospital, 102; conflict with Saskatchewan Cancer Commission, 109 Regina Grey Nuns' Hospital, 109 research: cancer, 191-2; delay, 196-7 Richards, Gordon: 192; antagonizes surgeons, 100; attends London cancer conference, 84; concern about radiation harm, 153; criticizes radium supply and radon distribution, 127, 129, 147; first director of OCTRF, 133, 198; head of radiology at TGH, 65, 113; life and career, 65; member of Advisory Committee on Cancer, 129; plan for joint purchase of radium with Saskatchewan, 97-8; recommends full-time cancer specialist for Saskatchewan, no; reviews Saskatchewan cancer legislation,

92; role in Cody Commission report, 119-21; role in formation of Ontario cancer program, 112, 152; role in recognition of radiology as specialty, 189; views on cancer organization, 119, !93> 194- 197-8 Rider, Bill, 192 Robb, John, 123, 138; attends opening of Huron Springs Sanatorium, 159; policy on radon distribution, 147; role in Ontario cancer policy, 124-6, 146; travels with Cody Commission, 117 Roberts, William R, 19 Roentgen, Wilhelm, 11 Roentgen Society of Great Britain, 154 Routley, T.C., 123 Royal Alexandra Hospital (Edmonton), 184 Royal College of Physicians and Surgeons of Canada, 189 Royal Commission on Public Welfare (Ontario), 81, 114 Royal Commission on the Use of Radium (Ontario; a.k.a. Cody Commission), 24, 72, 89, 112, 144, 187, 192, 198, 201; criticism of activities, 117, 123-4; criticism

Index of membership, 115-16, 199; mandate, 115; membership, 115; reaction of medical profession, 122-3; reP°rt and recommendations, 121-2; role of Gordon Richards, 119-20; travels and observations, 11619, 196 Royal Victoria Hospital (Montreal), 42, 48; opens radium department, 49 rural medicine. See Huron Springs Sanatorium Rutherford, Ernest, 13, 16, 61 Ryerson, G. Sterling, 16, 17 Saint Boniface Hospital (Winnipeg), 149 Saint Joseph's Hospital (London), 158 Saint Michael's Hospital (Toronto), 115, 126 Saint Paul's Hospital (Vancouver): radium service, 65, 179 sanitaria, 159 n. 14 Saskatchewan Cancer Agency, 186 Saskatchewan Cancer Commission, 87, 113, 186; allegations of insufficient care, 108; collection of statistics, 103; development of

cobalt treatment, 188-9; establishment of cancer clinics, 99102; establishment of education program, 105-6; fees for treatment, 102; first commissioners, 95; first tasks, 95-6; improvements in early cases, 106; improvements in referrals, 110-11; lacking in authority, 108-9; legislation creating, 93; purchase of radium, 968; radon plant, 98-9; utilization of cancer clinics, 106 Saskatchewan government: cancer legislation, 87, 92, 93; interest in cancer, 89, 90 Saskatchewan health care: innovations, 93, 188 Saskatchewan Medical Association, 88; approves cancer clinics, 101; cancer committee report, 89; interest in radium and cancer, 89; proposes Canadian Society for the Control of Cancer, 169; relationship with Cancer Commission, 108 Saskatchewan Tumour Registry, 103, 111

271

Saskatoon City Hospital, 102 SaultSte. Marie (Ont), 124 scientific medicine, 21-2, 53, 166 Sellers, A. Hardisty, 131, 140; observations of Ontario cancer program, !95> !97 Shepley, Earle: career, 90-1; on cancer organization, 92, 100—i; elicits cooperation of surgeons, 100; radiotherapist to Saskatchewan Cancer Commission, 99, no; role in Saskatchewan cancer program, 90-2; tours cancer centres, 100; visits Montreal, 48 shoe-fitting flouroscope, 154 Shrum, G.M., 181, 182 Sigerist, Henry, 79 Simcoe (Ont), 147 Smith, G.W., 147 Smith, Ivan, 189 Soper, George, 82 Spas, 159, 160-1 specialization: medical, 189, 195 Stanbury, James, 158 Standard Chemical Company, 19 Starr, R, 81 State Institute for the Study of Malignant Disease (Buffalo), 83, 158

272

state medicine. See medicare statistics: cancer, 67, 131; see also cancer; Saskatchewan Tumour Registry Stephens, H.M., 108 Stewart, John, 74 Stratford (Ont), 152 Sudbury (Ont), 192 surgery: disadvantages, 75; excluded from Ontario cancer program, 125-6, 129, 193-4; history, 74; turf wars with radiotherapists, 127, 146, iS 1 . !9J Sweden, 83, 85 Sydney (NS), 192 Taschereau, LouisAlexandre: social program for Quebec, 38; speech at opening of Institut du Radium (Montreal), 34> 42 technology: and hospitals, 52-3, 64; and medicine, 6, 27; radiation, 188-9; see also radiotherapy, radium, radon, X-rays therapeutics: laboratory-based, 21-2, 25; medical antipathy, 27-8, 29; see also empiricism Thomson, J.W., 73 Toronto General Hospital, 10, 52,

Index 194; allegations of favouratism, 124; inadequate radium supply, 65; plan for radium institute, 113, 114, 123; purchase of radium, 65; use of radon, 142 Toronto Western Hospital, 68, 126 tuberculosis: as model for cancer organization, 81 Uhrich, J., 109 Union Miniere du Haut-Katanga, 96 United States, 83 University of Manitoba, 94: hosts radon plant, 136 University of Montreal, 40 University of Saskatchewan, 89, 98, 188 University of Toronto: hosts radon plant, !37 utilization. See health service utilization Vancouver Board of Trade Health Bureau, 180 Vancouver General Hospital: establishment of radium service, 65-6, 179; proposal for radium institute, 179; rival to BCCF, 181

Vancouver Medical Association: cancer committee, 179 variations in practice: 5, 132; historical roots, 195-7 Victoria General Hospital (Halifax): considers radium supply, 53, 57; financial benefit from radium department, 63; installation of radon plant, 62; media interest in radon plant, 62; modernization, 57; radium purchase, 57; statistics on radium treatment, 63 Victoria Hospital (London, Ont), 52, 163, 165 Virchow, Rudolph, 71, 72 Vivian, R.P., 133 waiting times: radiotherapy, 4 Waldeyer, William, 71 Wallace, Cuthbert, 118 Watson, T.A., 188 Wellesley Hospital, 114 Wickham, Louis, 10, 13, 16, 19, 186 Williams, Francis H., 12 Wilson, G.E., 130 Windsor (Ont): cancer clinic, 125, 195 Winnipeg General Hospital: radiotherapy, 94; tumour clinic, 149, 151

Index X-rays: discovery and early applications, 11; therapeutic action, 20; see also radiotherapy

Yale University, 190 Young, George, 133 Zaire: radium in, 96

273