Prelude to the origin of publicly funded medical care in BC

My interest in the origins of publicly funded medical care in BC, and Doctors of BC’s role in it, was renewed when the BC government announced a 50% reduction in Medical Service Plan premiums as of 1 January 2018. 

Dr Bradley A. Fritz’ article in the September 2015 issue of the BCMJ, “The origins of publicly funded medical care in BC and the BCMA’s contributions,” aroused my curiosity about the methods of compensation for medical services in the 1820–1910 era. 

In the first half of the 1800s the Hudson’s Bay Company dominated life and the fur trade in the West. The company paid their own physicians—the most famous was Dr John McLoughlin, who became the “chief factor” of the company for more than 20 years. Dr William Fraser Tolmie was also involved with the company’s business, with limited medical practice. Two surgeons, Dr James Kennedy and Dr Forbes Barclay, looked after the employees in the various forts. Dr John Sebastian Helmcken, the first well-trained physician of the time in the territory and also paid by the company, eventually settled in Victoria and while in private practice, he also became involved in politics. For these physicians the practise of medicine was often secondary to other occupations. 

In the latter part of the 1800s over 30 000 gold diggers and a few doctors were attracted to the gold fields of the Cariboo. Dr John Chipps was the first medical officer of Williams Lake Creek Hospital at Barkerville. The hospital’s financial affairs were precarious, and Dr Chipps consented to remain on duty without salary. With the decline of gold production the population of the area was reduced to a few hundred. The local government decided to subsidize Dr Hugh Watson. Cariboo Hospital records also show Dr A.S. Black of New Westminster receiving $780 (about $10 500 in current dollars) and Dr Brown $500 for medicines and a year’s service, but no details are available. 

Extensive mining and railway developments brought the Kootenay/Boundary region into prominence in the 1890s, and with the influx of workers, medical people also found their way to the new towns of Nelson, Rossland, Trail, and others. Two female doctors settled in the area: Dr Isabel D. Arthur in Nelson and Dr Annie Verth Johnson in Rossland and later in Nelson. I found no mention of their earnings. However, the earliest steps toward a medical insurance offering came about in this area when the few doctors there entered into contracts with employers to render all necessary medical and surgical attendance and hospital care for a monthly fee, usually $1 (the hourly wage was around 40 cents an hour), deducted from the payroll. Treatment of venereal disease, injuries outside of work, and specialist services were not included. 

In 1905 the smelting and mining companies in the Trail area also made agreements with local doctors to provide group medical care. 

In the Vancouver area the medical attendance records of the general practice of Dr Henry Evariste Langis in the late 1880s show that about half of visits were paid for by individual patients. The usual charge for a visit was $2.50. Charges for confinement varied from $15 to $20. Minor operations were $15 to $20; major surgeries cost $125. The doctor’s daybooks show quarterly payments for his services by the Ancient Order of Foresters, the Independent Order of Foresters, by the Hastings Mill Company, and most frequently by the railroad and public works company of Ironside, Rannie, and Campbell: this group provided both medical and hospital care for employees paying into a hospital fund.

In the Upper Fraser Valley the beginnings of a fee schedule made its appearance in 1912. Dr Peter McCaffrey came from Toronto and opened an office in Agassiz. His fees, according to his ledgers, were from $1 to $2.50 for an office visit, $15 to $35 for a major fracture, $5 for an anesthetic, $25 to $40 for confinement, $75 for a herniotomy, and $125 for an appendectomy. 

The first official fee schedule was published by the College of Physicians and Surgeons of BC in 1936. By that time the BC government passed legislation to establish insurance against the cost of sickness, but the legislation was not proclaimed a law yet because of opposition from BC doctors. What happened thereafter is part of BC’s and Doctors of BC’s history, described in Dr Fritz’ article. A worthwhile read. 
—George Szasz, CM, MD

Additional reading
Fritz B. The origins of publicly funded medical care in BC and the BCMA’s contributions. BCMJ 2015;57:293-295. 

Andrews MW. Medical attendance in Vancouver, 1886-1920. BC Studies 1978;40:32-56. 

Monro AS. The medical history of British Columbia – The period of gold discovery, 1849-1882. CMAJ 1932;26:88-93.

The medical men of the Cariboo. CMAJ 1932;26:225-230. 

Waldie AC, Bars Dimick H. The life and death of the CS Williams Clinic, Trail and Rossland, BC, 1922-1972. BCMJ 2000;42:161-162. 

Tolmie WF. William Fraser Tolmie, physician and fur trader. Vancouver, BC: Mitchell Press Limited; 1963.

This posting has not been peer reviewed by the BCMJ Editorial Board.