The doctor who won't take "NO" for an answer
By nagging cabinet ministers,editors,capitalists, his own colleagues and the general public to within an inch of their lives, Gordon Bates has singlehandedly won crusades in public health that have changed the lives of practically every Canadian
TO MOST people health statistics are pretty dull stuff which they can take or leave alone — by preference the latter. A notable exception is Dr. Gordon Bates, the seventy-year-old general director of the Health League of Canada. For forty years Bates has been responding explosively to figures, graphs and charts showing the fluctuations in our national health. “When people get sick unnecessarily or die before their time,” he says, “I get hopping mad. I’ve got to do something about it. I keep poking my nose into things.”
Bates’ nose-poking since 1916 adds up to a roughand-tumble career as a crusader for public health. His formula for getting results has been to frighten, shock, anger and educate. During World War I, for example, there were a hundred thousand cases of syphilis and eight times as many cases of gonorrhea in Canada. The scourge went unchecked largely because it was considered improper to discuss venereal diseases openly. Alarmed by this prudishness, Bates became the first Canadian physician to use the words syphilis and gonorrhea in public speeches. Furthermore, he kept nagging Toronto newspaper editors until they admitted the words to their news and editorial columns. He then questioned hundreds of victims and was able to bring home to the public the frightening story of how VD was destroying the lives of countless men, women and children. Prominent citizens replied by saying he was “sex mad,” and “filthy minded.” Joseph Atkinson, publisher of the Toronto Star, refused to attend his meetings and said they were “highly improper.” But his activities led to pioneer legislation in Ontario for the control of VD as well as the
A ROUGH-AND-TUMBLE CRUSADER .
establishment, of hundreds of clinics. Within a few years all the other Canadian provinces followed Ontario’s lead.
Bates is one of the most cantankerous enemies of raw, i.e. unpasteurized, milk, which spreads diseases such as typhoid fever, bovine tuberculosis, undulant. fever and septic sore throat. Largely because of his persistent badgering of health authorities, Ontario and Saskatchewan, as well as hundreds of municipalities, now have compulsory pasteurization. A vocal minority howled that Bates was a “dangerous radical” and that this measure would rear children wifh "weak bodies and weak minds.” The only results have been a dramatic decline in milk-borne diseases. In 1930 Bates formed a Diphtheria Toxoid Committee in Toronto to show that diphtheria could be banished by using immunization effectively. Opponents decried Bates as “a heartless vivisector, injecting filth into the veins of children.” They predicted an outbreak of cancer, heart disease and other afflictions worse than diphtheria. But within ten years Toronto Itecame the first major city in the world to experience a full year without diphtheria. Dr. Gustav Ramon, of Paris, discoverer of the diphtheria toxoid, remarked, “It took a Canadian to show us how effective the toxoid can be.”
It was Bates who succeeded in making a national issue of the fluoridation of water. He has flayed anti-fluoridationists as “lobsters,” “bad actors” and neurotics. Alma B. Allen, a Toronto music teacher, complained that when she phoned Bates, to suggest that fluoridation should be decided by a popular vote, he called her “a jackass and a fool.”
The anti-fluoridationists have treated Bates with equal vigo-. Dr. J. H. Johnson, a University of Toronto dental professor, lumped Bates with “Johnny Jump-Ups and self-appointed scientists” who don’t know what they’re talking about. Gordon Sinclair, the Toronto radio commentator, has described him as “a tired and ageing doctor whose ideas haven’t changed in forty years.” Others have described him as a “saboteur” and “a water poisoner.” In spite of these vigorous counterattacks Bates as usual seems to be winning. Fluoridation is steadily being introduced into more and more Canadian communities.
He Looks Meek But Hits Hard
At other times, with equally turbulent results, Bates has turned his guns on scarlet fever, small pox, accidents, drownings, sunburn, infant mortality, cancer, heart disease and alcoholism. A complete list of his personal demons would include practically all the ills that afflict the body and mind of man.
Bates doesn’t look capable of inspiring so much controversy. In appearance, he’s frail, meek and mild. He’s short (five feet, six inches), slight (one hundred and thirty-six pounds) and usually wears a dark double-breasted suit and a bow tie. He is white-haired, his face is rather impish and his blue eyes peer out from behind light tortoise-shell glasses. This general appearance is deceptive. In action, he is fast-moving, fast-talking, hard-hitting and quick to anger. “On occasion,” he says conservatively, “I am capable of moral indignation.”
Bates’ campaigns extend far beyond health. He’s probably the most energetic advocate of bilingualism in Canada. “It’s no wonder that many people in Quel>ec think we don’t like them,” he says. “We refuse to speak their language.” Bates takes French lessons and is the guiding light of two organizations that promote bilingualism. Recently he spent two months in France, perfecting his knowledge of French at the Sorbonne.
Another cause espoused by Bates is the mechanical superiority of the motor car of the pre-streamlined era. He drives a fabulous old bright-yellow Packard touring car. Custom-built for the Prince of Wales for use on his All>erta ranch, it attracts crowds wherever it is parked. Among other things Bates’ car is capable of blowing up its own trucksize tires as well as oiling and greasing itself. “It’s the most expensive Packard ever built,” says Jim Wilton, the mechanic who lovingly takes care of it. The car probably cost about twenty thousand dollars when it was built in the mid-Twenties. Bates first caught sight of the vehicle while driving past a used-car lot on Toronto’s Danforth Avenue in 1939. It was a case of love at first sight; he bought it immediately for $450.
But Bates reserves his main energies for health. He has a burning conviction that most of the 125,000 Canadians who die each year might have lived longer and most of the men, women and children who suffer from illness might have remained healthy. The magic key that would make this possible, he claims, is education. “We now have all kinds of ways of preventing illness,” he says, “but what good are Continued on page 93
BATES ALSO FINDS TIME IN HIS CROWDED LIFE TO ADMIRE OLD CARS AND FOOL AROUND WITH PAINTS
Continued on page 93
The Doctor Who Won’t Take “NO” For An Answer
CONTINUED FROM PAGE 15
health mies if people don’t know about them or won’t follow them?”
Bates often worries about the public’s irrational attitude toward illness. "People will gladly give millions to treat the victims of disease but they won’t spend thousands to prevent illness m the first place,” he fumes. He often illustrates this by describing a visit he made to a men’s service club several years ago. The club had two committees for boys’ work. Committee No. 1 operated a boys’ camp which served unpasteurized milk. Committee No. 2 provided splints, braces, special boots and invalid chairs to crippled children, many of whom owed their deformities to drinking raw milk. This club would not support Bates’ campaign for compulsory pasteurization. "We’ve lost sight of the maxim that an ounce of prevention is worth a pound of cure,” says Bates.
The agency through which Bates hopes to change this state of affairs is the Health League of Canada—a voluntary organization of 3,131 physicians and laymen. The Health League has had various names since its inception almost forty years ago but Bates has always been its director—a position that pays him nine thousand dollars a year. This is about a half of what Bates was earning when he was a physician in private practice as a young man, and about a third of what he might earn in a similar capacity now. He is philosophical about his income. "I sometimes think I’m an idiot,” he says, "but I could never resist the business of organizing to get things done that need doing.”
He Has iMillions of Words
The Health League’s annual budget is about a hundred thousand dollars, half of which comes from the Community Chest of Greater Toronto and the rest in the form of federal and provincial grants, donations, membership fees and the sale of health literature. With this money—which Bates regards as shamefully inadequate—the Health League puts out Health, a magazine with a monthly circulation of thirty-five thousand which is largely written by doctors; issues hundreds of varieties of health posters and pamphlets; sends releases to newspapers, magazines, radio and TV stations; sparks speeches, forums, panel discussions and deputations to public health authorities, and pays a staff of sixteen workers.::. In one recent week, the Health League’s headquarters, a ramshackle three-story former residence in downtown Toronto, mailed out eight million pages of health propaganda.
Bates is the kingpin of the organiza\ lion. He works in a large, sombre, old-fashioned office which was once a master bedroom. He sits perched at a large dark wooden table piled high with a clutter of papers. A constant flow of visitors is screened by Mabel Ferris, deputy director of the Health League, who has worked with Bates for more than thirty years and is also the managing editor of Health. Most of the visitors have a professional interest in health. They may include a social worker from Germany, a doctor in charge of venereal disease control in India, a medical health officer from rural Alberta. Directors of the Health League also drop in to chat. Consider-
ing its total membership, the Health League probably has more directors than any other organization in the world; there are more than two hundred, among them some of the most prominent people in Canada.
Bates constantly keeps in touch with his branches in Montreal, Quebec City, Regina and Vancouver. Once, the Health League had four times that number of branches, but many of the causes that Bates first espoused are now being cared for, in part, by voluntary health organizations and government health departments.
Much of Bates’ time is spent, pen in hand, writing editorials for Health, pamphlets, letters to the editor and speeches. He has delivered as many as three hundred speeches in three months.
Bates didn’t intend to spend his life as a public-health crusader. He was cast in that role by accident. In 1916 he was conducting a busy private practice as well as teaching pathology and bacteriology at the University of Toronto. He was one of t he few doctors at the time who could perform the Wassermann test to detect syphilis, and
was known as a specialist in venereal diseases. His services were constantly being sought by army medical authorities. Never one to keep his opinions to himself, Bates was soon criticizing the army for sloppy handling of the VD problem. "If you can suggest a better program, go ahead with it,” he was told by a high-ranking army officer. The upshot was that Bates joined the army in 1916 as a captain and was put in charge of VD control in military district No. 2, with headquarters in Toronto.
This was the dark age of venereal
disease. Since prudish ness decreed that the subject shouldn’t be discussed, people didn’t know the symptoms; even if they did, they were unaware of the necessity for early treatment. There were few clinics. Many victims who started treatment gave up before they were cured. In those days, the standard therapy for syphilis was Ehrlich’s "606,” an arsenic compound injection which had to be continued for months and perhaps years. Helped by the cloak of secrecy, infection spread like wildfire. About thirteen percent of first admissions to Toronto hospi-
tals were syphilitic; so were sixteen percent of the inmates of jails, thirtyfive percent of the patients in mental hospitals, twenty-five percent of the people in institutions for the blind. At Toronto’s Hospital for Sick Children, five percent of the children had inherited syphilis.
A routine checkup on a woman who entered the Toronto General Hospital with pneumonia showed that she had syphilis. Her family history showed her husband had died of the same condition; of her eleven children, seven were similarly affected.
As an army medical officer, Bates came face to face with the full dimensions of the VD problem. An entire floor of the old Toronto military hospital on Gerrard St. East was occupied by venereal cases. New cases were being admitted every day. "I felt helpless,” recalls Bates. "We were treating VD as an army problem when in reality it was a social problem.” To get his point across to army and civilian health officials, Bates carefully questioned five hundred syphilitic patients. He discovered that half the men had become infected by women whom they
had casually picked up in Toronto; the others had contracted the disease in various parts of Canada and in the U. S., France, Egypt, South Africa and Cuba. Some of the men had been ill for as long as two years.
The city of Montreal cropped up frequently in Bates’ investigation, so in 1917 he went there to study local conditions. He discovered that prostitution was highly organized. He made a whirlwind tour of the houses of prostitution, accompanied by Colonel M. Lauterman, VD control officer in Montreal. He had his eyes opened. In the downtown district surrounding the Montreal General Hospital (where twenty-six percent of the patients had venereal disease) there were five hundred houses of prostitution. Bates tried unsuccessfully to arouse local opinion in getting the houses shut down. Typical was the response he got from a highly placed church authority: "Why waste your time trying to close them? These houses have always existed and they will continue to exist.”
He had better luck in Toronto. He called a meeting at the city hall and invited a number of prominent citizens to discuss his findings. Sir Joseph Flavelle, the philanthropist, Fred Paul, editor of Saturday Night, Albert Smythe of the Toronto World and J. A. MacDonald of the Globe were among those who promptly accepted. But many others, like Joseph Atkinson, proprietor of the Toronto Star, refused. "That’s not the kind of thing to talk about in public,” Atkinson insisted.
At the meeting Bates described the seriousness of the VD scourge. A program of education must be launched, he said. Treatment must be made compulsory. Clinics must be provided. He attacked newspaper editors. "You fellows are largely responsible for the present mess,” he declared, "because of your refusal to discuss venereal disease in your columns.” Bates’ words impressed the Globe’s editor, J. A. MacDonald. "You will never be able to say that again,” he said. "Watch tomorrow’s paper.” The next morning MacDonald published an editorial using the words syphilis and gonorrhea. This was the first time they had appeared in a Canadian daily newspaper Emboldened by MacDonald’s lead, other papers began to discuss VD openly. They have done so ever since.
Sir William Hearst, then premier of Ontario, read about the city hall meeting and asked Bates to meet with his cabinet. At the end of a two-hour session Hearst said, "I want you to write a piece of legislation that will control the spread of VD.” No lawyer, Bates assembled a committee of lawyers, judges and doctors and with their help wrote the Venereal Diseases Prevention Act of Ontario. It became law in June 1918. It was the first legislation of its kind in North America and was soon to be widely copied. The act required that physicians report every case of VD to the local health officer. Patients had to continue taking treatment until they were cured; failure to j do so was punishable by a five-hundreddollar fine or a year’s imprisonment. Persons other than qualified physicians were not allowed to treat VD or advertise cures. This was to outlaw the army of quacks preying on VD sufferers.
With the act in force, Bates realized his task had only begun. Hundreds of patients were seeking treatment and there were no facilities for them. Through his committee on venereal disease in MD 2, he persuaded the federal government in 1919 to call provincial and army health officers together. Sir Robert Borden, then prime minister, was among those who attended. Also present, as a secretary,
Mackenzie King said “No” to Bates’ plea for money for health. At last he gave in
was a slim young man named Vincent Massey, later to become the governorgeneral of Canada. The conference bore fruit: Ottawa agreed to pay
$200,000 to the provinces to fight VD. These were the first federal health grants of the kind in Canada. Another result was the formation of the Canadian National Council for Combatting Venereal Disease. This was to be a voluntary organization, partly subsidized by the government, with Bates as the secretary. It was the beginning of the Health League of Canada, although the Health League name was not adopted until 1935.
With money and an organization, Bates flooded the country with posters, pamphlets and speakers. In 1921 he hired Mrs. Emmiline Pankhurst, the famous English suffragette who was then living in retirement in Victoria with her three children. Sharing the platform with Bates in hundreds of cities and towns, Mrs. Pankhurst pleaded with men and women to fight VD together. She knew how to handle interruptions. Once, a drunken heckler shouted at her, "Don’t you wish you were a man?” She shot back "Don’t you wish you were?”
A Big-Money Speech
In 1932 the Health League ran into a crisis: the federal government, without warning, discontinued its grant. Money had to be raised quickly. Turning over different revenue-producing schemes in his mind, Bates recalled The End of the Road, a silent film dealing with VD made during the first war by the U. S. government and the YMCA. Many people advised Bates against showing The End of the Road. "After all,” they said, "it’s silent and this is the age of 'talkies.’ ” But he persisted and more than one million Canadians saw the film. It influenced thousands of VD sufferers to take treatment.
Through exhibiting The End of the Road, Bates became involved in filmmaking. Columbia Pictures took him to Hollywood where he supervised the script and shooting of another VD film called Damaged Lives. Bates appears in the last thirty minutes of this picture, delivering a spirited lecture on VI). These two films netted the Health League $40,000—enough to tide it over the financial crisis.
Thanks to Bates, hundreds of VD treatment centres sprang up in Canada. The public was now fully alerted to the dangers of neglect. Because of these facilities and the advent of penicillin and other new drugs, the VI) problem has all but vanished. For the last seven years, the Health League’s Social Hy-
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giene Division has been virtually inactive. Bates says, "The old moral argument that we used to use in venereal disease, that the wages of sin is death, has exploded. Now you live a moral life because it’s desirable.”
While revenue from the films kept the Health League going for a few years, Bates felt the federal government had been mistaken in cutting off the league’s subsidy as well as the health grants to the provinces. He organized a committee and got an interview with Prime Minister Mackenzie King and his cabinet. "Health is a provincial matter,” said King. Bates would not admit defeat. He sent his committee home and stayed in Ottawa. For six weeks he worked twelve hours a day, pounding at the door of every member of parliament and senator. He succeeded in convincing all but two (ironically, they were both doctors) that it had been an error to cut off' the health grants. Not long after, King met Bates. "I was wrong about those grants,” he admitted. "The House is against me. How much do you want?” An offshoot of Bates’ six-week whirlwind campaign on Parliament Hill survives to this day. It is the Parliamentary Committee on Health made up of MPs and senators of all parties. Bates is the secretary.
According to Bates, the main task of a voluntary organization such as the Health League is to espouse an unpopular cause. For political reasons, governments are usually reluctant to sponsor certain measures—no matter how admirable—unless they are popular. The pasteurization of milk is an example. This was to be Bates’ next big crusade. In brief, the main facts about milk pasteurization are these: many diseases are spread by drinking unpasteurized milk. The source of infection may be a sick cow, unclean dairy utensils or unhealthy milk handlers. Pasteurization is a simple process by which disease-producing germs can be destroyed without affecting the nutrition in milk.
Before 1938, no Canadian province and relatively few municipalities had compulsory pasteurization. Bates was alarmed by this.He knew that between 1906 and Í933 there were at least forty -eight milk-borne epidemics in Canada. One of them—a typhoid fever epidemic in Montreal—led to five thousand cases of illness and five hundred deaths. According to Bates’ calculations, about ten thousand Canadians were getting undulant fever each year, some with fatal results, from drinking raw milk.
Bates began agitating for compulsory pasteurization in the early Thirties. In 1936, accompanied by the financier,
J. P. Bickell, of Toronto, and publisher Joseph Atkinson of the Toronto Star, he visited Premier Mitchell Hepburn of Ontario. "1 can’t bring in that law,” Hepburn said. "I’d be robbing myself of rural votes.” He was referring to j the fact that farmers and dairymen ; would resent pasteurization because it j took time and cost money. Hepburn | observed that he could advocate pas¡ teurization only if there was a strong j public demand. "Will you introduce j a law if I create the public demand for it?” asked Bates. Hepburn said ] he would.
For the next two years, working j through a committee under the chairmanship of Dr. Alan Brown, the Toj ronto pediatrician, Bates inundated j Ontario with anti - raw - milk propa'
“Millions are flirting with sickness and death—by drinking unpasteurized milk”
ganda. The campaign reached a climax at a dinner at the home of J. P. Bickell which was attended by Mitchell Hepburn, Sir James Dunn the financier and Dr. Alan Brown. At one point they were arguing about Bates and his fight for pasteurization. Brown said to Hepburn: "If you really want to know why we need pasteurization, come to the Hospital for Sick Children at eleven o’clock tomorrow morning.” At the hospital the next day, Brown took Hepburn through a ward where there were children with tuberculosis of the glands, kidneys and hones—the results of drinking raw milk. He turned to the premier of Ontario. "Mitch,” he said angrily, "if you had an ounce of guts this sort of thing would stop.” In 1938 Hepburn introduced a compulsory pasteurization law for Ontario, the first province in Canada to adopt such a measure. Cases of bovine tuberculosis are now seldom seen at the Hospital for Sick Children.
The Ontario law gave impetus to pasteurization all over Canada. In 1949 Bates worked with Premier T. C. Douglas of Saskatchewan to introduce a similar act. Earlier he was invited to Vancouver and engaged in a monthlong marathon of speeches and meetings. Pasteurization became the law in Vancouver within a month. Earlier, too, while in Saint John, N.B., Bates so successfully propagandized the local board of health that it enacted a pasteurization law within two weeks.
Bates is still highly vocal on pasteurization. He points out that eight Canadian provinces are without compulsory laws. Municipal laws are not good enough since raw milk filters in from surrounding areas. Hampered by lack of funds, the Health League has been unable to survey the milk situation thoroughly but Bates says millions of Canadians are still "flirting with sickness and death” by drinking unpasteurized milk.
It was Bates’ fight against diphtheria that earned him a world-wide reputation in public health. Because it is so contagious and so often fatal, diphtheria had always been one of the most feared diseases. Then, in 1925, Dr. Gustav Ramon, of France, discovered the anti-diphtheria toxoid. Injections provided almost certain immun-
ization against the disease. That was the year Canada, with a population of nine million, had ten thousand cases of diphtheria, resulting in thirteen hundred deaths. Yet, four years after toxoid became available diphtheria still continued to be a menace. In 1929 Toronto reported one thousand cases, including sixty-four deaths. "It’s plain murder!” said Bates. "Every one of those deaths could have been avoided.” In 1930 he set up a citizens’ Diphtheria Toxoid Committee, headed by John Patterson, a Toronto advertising executive whose only son had died of the disease. The committee spread the message that diphtheria could be banished by immunization. Clergymen preached it from their pulpits, teachers talked about it in their classrooms, children were sent home bearing pamphlets, posters blossomed forth on street corners. The crusade paid off in a spectacular way. The year 1940 passed—ten years after the formation of the Diphtheria Toxoid Committee —without a single case of diphtheria in Toronto. It was the first city with a population of more than half a million to achieve this distinction. Using the lessons learned in Toronto, Bates then organized a National Immunization Week which spread to every community in Canada. Diphtheria is no longer a serious menace. In 1953 in Canada there were only one hundred and thirty-two cases reported.
Bates is far less satisfied with the fight to vanquish whooping cough. The vaccine for whooping cough is not as effective as the toxoid for diphtheria. It is not a dramatic disease and it is difficult to get public support for research. He often compares whooping cough with polio. "Both diseases are equally prevalent, both diseases can have serious aftereffects,” he says. "Yet the money spent on whooping cough is infinitesimal compared to what’s spent on polio.”
On at least one occasion Bates personally intervened to change this situation. In 1951 the Canadian March of Dimes, interested in fighting polio, announced it was embarking on a public appeal for funds which might realize a million dollars or more. "This made me hopping mad,” says Bates. He felt they were out to raise a
ridiculously large amount, of money, considering the ottier tasks that were being neglected. He urged the publicin an angry editorial not to give money to the March of Dimes. The editorial appeared in Health Magazine and several daily newspapers a few days before the opening of the fund. Instead of collecting millions, the campaign barely took in enough to meet expenses. "I tried to ruin that campaign and 1 did.” says Bates The upshot of Bates’ outburst was that the Canadian March of Dimes was reorganized. Under a new board of directors it is now one of the most efficiently managed voluntary health organizations in Canada.
Bates’ most recent battle has been i with the anti-fluoridationists. It started in 1953. Hundreds of scientific reports j convinced him that adding sodium fluoride to the water supply was a safe and efficient method of preventing tooth decay. To make certain he was on the right track, he questioned ninetytwo of the leading medical schools in Canada and the United States: they
were overwhelmingly in favor of fluoridation. He let loose with a barrage I of pro-fluoridation facts via editorials in Health Magazine, pamphlets, letters to the editor. He spoke at dozens ! of meetings. His activities influenced the Canadian Medical Association to endorse fluoridation. He was merciless in his attacks. "You should knowbetter—you’ve only got one tooth left in your mouth,” he hurled at one Toronto anti-fluoridationist. The fight over fluoridation is still going on and
Bates is still in the thick of it.
How He Became a Crusader
By background, Bates is well pre: pared to join battle with the antifluoridationists or any other group that happens to be opposing his current cause. His father was a Hamilton eye, ear, nose and throat specialist; several other relatives were also doctors. After graduating from the University of Toronto medical school at twenty-one, he became the assistant of j ! Dr. Sam Cummings, a famous and wealthy Toronto surgeon.
Working with Cummings gave him enough leisure time to pursue other interests. To broaden his knowledge, he enrolled at the university as an arts student. "1 was meeting too many people who knew more than I did,” he explains. He also became a professional writer, contributing a weekly syndicated column on science to twelve Canadian newspapers. Later he gave these up to open a practice and to teach at the University of Toronto. It was when he joined the army as a medical officer in 1916 and came up against the VD problem that his crusading instincts were first aroused. "Since then,” says Bates, "it’s been one thing after another.”
In contrast to his public life, Bates’ private life is agreeable and calm. He has two daughters and one son, all married. None of them is in medicine. ¡ He lives with his wife and one of his j daughters in a seven-room house on a j hilly half acre in Moore Park in the central part of Toronto. When he’s not plugging health, he spends his time reading, painting, playing golf, gardening or keeping his car spick-and-span. He drinks milk, not because he likes it, but because "it’s good for you.” He also frequently gives up smoking because he thinks "it’s bad for you.” But, when working under pressure, he may smoke a pack of cigarettes a day. His own health, he says, is exceptionally good.
"That’s because I work so hard j trying to solve other people’s health I problems I’ve got no time to worry I about myself,” he explains.