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Origins and Early Beginnings of the Canadian Arthritis Society and the First Rheumatic Disease Units in Canada

The Arthritis Society of Canada, formerly the Canadian Arthritis and Rheumatism Society (CARS), has earned widespread respect as a model health care organization. As with some other successful endeavors the steps that led to its success are known only to a few, yet should be known by many.

As the widow of J. Wallace Graham, MD, FRCPC, FRCP, the Society’s founder and driving force, I have endeavored to define some of the major milestones in the early development of CARS and the setting up of the first rheumatic disease units (RDU) in Canada (Figure 1). My own experiences and memories have been confirmed and augmented by information in my husband's papers¹. In addition I have consulted minutes of the early meetings of CARS, which were fortunately not all destroyed by a fire in the national office in Toronto about 30 years ago. With all this material I have tried to be as objective as possible, but in the end, this is primarily a personal memoir of an exciting period in Canadian medical history.

Figure 1. Dr. Wallace Graham, MD, MRCP, FRCPC, FRCP, 1906-1962

1930.In the early 1930s Dr. Almon Fletcher was in charge of the medical teaching Ward H at the Toronto General Hospital (TGH) (Figure 2), where the first diabetic patients had been treated with insulin. Dr. Fletcher had been co-author, along with Sir Frederick Banting, Drs. Charles Best, J.B. Collip, and Walter Campbell, of the first clinical paper on the effects of insulin in 1922². In 1939, Dr. Fletcher and Wallace jointly published a paper on complications of diabetes mellitus³. As well as being a specialist in diabetes, Dr. Fletcher’s interest in arthritis had been aroused by his experience with post-dysenteric arthritis while serving as a medical officer in Salonika during the Great War. In 1928 he became a founding member of the American Committee for the Control of Rheumatism that in 1934 became the American Rheumatism Association (ARA), today the American College of Rheumatology⁴. In 1935 he became the first president of the Canadian Rheumatic Disease Association (CRDA), now the Canadian Rheumatology Association (CRA)⁵.

In addition to diabetic patients on Ward H, there were patients suffering from severe arthritis. Dr. Duncan Graham (no relation to Wallace) was the Sir John and Lady Eaton Professor of Medicine and Chairman of the Department of Medicine, University of Toronto, 1919–1947⁶, and he insisted that arthritis be kept as a specialty division of Internal Medicine. Dr. Fletcher published papers in 1930 and 1931 on diet and arthritis^7,8.

At this time focal infection of the gums was also suspected as a cause of rheumatoid arthritis (RA) and many patients were having all their teeth removed indiscriminately as a safeguard⁹. It was also generally believed at that time that gout did not exist in Canada¹⁰.

1936. My future husband, Wallace, returned from London, England, where he had gone, on the advice of Dr. Duncan Graham, to qualify for Membership in the Royal College of Physicians of London (MRCP). It was somewhat equivalent to the FRCPC degree that did not become well established in Canada until after the war. He was fortunate to have the Rt. Honorable Lord Horder, GCVO, MD, FRCP, as one of his MRCP examiners (Figure 3). In those days Horder was considered “the most outstanding clinician of his time.”¹¹ Bliss, in his recent biography of William Osler, records that in December 1919, when Osler was seriously ill, Sir Thomas Horder was called in “as a consultant of last resort.”¹² More importantly, rheumatism had always been a concern of Horder, who, after writing a book on rheumatism, was instrumental in the formation of the Empire Rheumatism Council, now the Arthritis Rheumatism Council for Research¹¹. He was chairman of the council from its founding in 1936 to 1953 and, as "the personality in British medicine best known to the general public," he worked successfully to overcome public apathy towards arthritis and rheumatism¹¹.

Figure 3. Lord Horder of Ashford, GCVO, MD, DCL, FRCP, 1871-1955; from BMJ 1955;20:493-4, with permission

On his return to Toronto in 1936, Wallace was appointed to the attending staff on Ward H at the TGH. Dr. Fletcher was in charge and Wallace worked closely with him with diabetic patients and also patients with arthritis and rheumatism. Having a degree in dentistry and medicine, with an appointment in both faculties, gave him a position of authority to attack the theory of focal infection as the cause of RA and curtail the practice of extracting teeth in an attempt to cure arthritis⁹.

1938. Wallace and I were married and an interest in the history and treatment of arthritis became very much a part of my life. I recall his real concern for some of the patients he was seeing who had been lying in bed at home, sometimes for years, receiving little medical attention. There was a negative feeling in the air that not much could be done for them. I remember him saying “Somebody has to do something about this.” Having been brought up in a manse, his good Presbyterian conscience bothered him.

1939. Since his return to Toronto in 1936 Wallace and Fletcher went regularly to American medical meetings and in particular to those of the ARA. They also worked closely together on Ward H at the TGH. During these years they began using gold salt injections in the treatment of RA and jointly conducted a major study on its use in controlling disease activity in these patients. Although written much earlier, this experience was not published until 1943 in the Canadian Medical Association Journal¹³.

In August-September 1939, war was declared in Europe.

1940. About this time Dr. Fletcher was diagnosed with tuberculosis and Wallace was left in charge of Ward H. He also had his own private practice. He worked long and late. I recall that from the beginning he had a strong, positive feeling that with proper early diagnosis and longterm treatment much more could be done for patients with various forms of arthritis.

1941. Wallace joined the Canadian Navy and was posted to HMCS Stadacona, a large naval hospital in Halifax. Apart from brief times at sea, he was treating active servicemen, some with acute forms of arthritis, as well as World War I veterans at Camp Hill Hospital, also in Halifax.

1942. Wallace was posted in charge of medicine to the large naval hospital, HMCS Avalon, in St. John’s, Newfoundland. He was also given permission to see private patients in consultation, many of whom had arthritis. All his experiences in the navy increased his conviction that with proper diagnosis and longterm care much more could be done to help those suffering from arthritis¹⁴. He often talked it over with me on his leave and was deeply concerned that something more be done for them.

1943. While stationed in Newfoundland, Wallace was posted on convoy duty to England in the corvette HMCS Hespeler. They were attacked by a submarine off the coast of Ireland, but fortunately were able to destroy it and safely continue in convoy to England. After a brief visit to London, Wallace was flown back to Canada in an empty cargo plane by the Royal Canadian Air Force. By chance, the only other passenger was an American army officer, Dr. Paul Holbrook of Tuscon, Arizona. He was returning to Hot Springs, Arkansas, to a new army and navy veterans’ hospital that had recently been set up to treat arthritis patients. They, too, were interested in longterm care. It was indeed a fortuitous meeting of like-minded physicians under strange circumstances. All the more remarkable because at the time Holbrook was President of the ARA, and served in that capacity for the years 1942–1946⁴.

Soon after his return to St. John’s, Newfoundland, in charge of medicine at HMCS Avalon, Wallace was promoted to the rank of Surgeon Commander. From this position he was able to get in touch with those in charge of the Department of Veterans Affairs (DVA) in Ottawa and urge them to consider opening a longterm intensive care hospital for Canadian veterans with arthritis and rheumatism.

1944. In response to his strong and well prepared case, Wallace was appointed as medical director in charge of a new DVA services hospital in St. Thomas, Ontario, for the specialized treatment of arthritis. I believe this was the first combined services hospital for army, navy, and air force ever established in Canada and was considered a major step forward in the cooperation of the three services. The unit opened in June 1945, and here Wallace had the opportunity to treat patients as he saw fit, providing accurate diagnosis and longterm treatment. He was also able to explore the use of penicillin in rheumatic fever¹⁵. Once the longterm care program was established as planned, he visited Dr. Holbrook at the Army and Navy General Hospital in Hot Springs, Arkansas, to see their treatment center. Dr. Holbrook was later invited to speak at important CARS meetings in western Canada¹⁶.

In Hot Springs he first met Dr. Philip Hench, the Director and Chief of Medical Services of the US Army’s rheumatism center there, who over the years became a close personal friend¹⁷ (Figure 4). At the time Wallace was there, the exciting news was that patients with RA who were either pregnant or had jaundice appeared to be free of their rheumatic symptoms. I recall this clearly as I, in his absence, had come down with jaundice in St. Thomas. Based on this observation Hench and his colleagues started inducing jaundice in patients with RA by administrating lactoferrin ¹⁸. It was also rumored that Luftwaffe pilots were being given adrenal extracts to prevent hypoxia at high altitudes. Despite waning interest in this idea after the war Hench and his biochemist colleague Kendall continued to explore the possibility that RA could be controlled using hormones¹⁸. Five years later Wallace and I were present at the Seventh International Congress on Rheumatic Diseases held in New York in 1949 when Dr. Hench presented the first paper on cortisone and received a standing ovation¹⁹.

Figure 4. Dr. Wallace Graham and Philip Hench, Hot Springs, Arkansas, 1945.

1945. When the war ended Wallace was back in charge of patients on Ward H at the TGH. He was also in charge of patients being moved from the St. Thomas DVA Arthritis Unit to the East General Hospital in Toronto while waiting for Sunnybrook Hospital for Veterans to open, which it did in 1948.

From 1945 on, postwar reconstruction was in the air. New medical schools were being opened across Canada. The estimated number of those suffering from rheumatic diseases was 600,000²⁰. The work hours lost took a heavy toll and the suffering in some cases was almost unbearable. Gout was diagnosed frequently. Wallace, after many attempts, finally persuaded Dr. Ray Farquharson, who had become the Sir John and Lady Eaton Professor of Medicine and Chairman of the department, 1947–1960, that rheumatology should be recognized in the department as a specialty similar to cardiology, neurology, or gastroenterology. I recall how delighted Wallace was at this decision.

1947. The CRDA, the organization of Canadian medical specialists interested in the rheumatic diseases, was reestablished after the war as the Canadian Rheumatism Association (CRA), with Wallace elected as president⁵. There was increasing awareness of the serious problem of arthritis across Canada and a strong feeling that some major action was required. From the CRA Chair he appealed to Ottawa for support to set up a national voluntary health agency for arthritis and rheumatism. It was obvious that it would need public as well as government support. He made at least two trips to Ottawa to see the Minister of Health, the Honorable Paul Martin Sr. The first trip was in June 1947 and the second in October that same year. He was well received both times.

Dr. Arthur Bagnall, the leading Canadian rheumatologist in Vancouver, was supposed to go with him in October, but instead sent Mary Pack, a remarkable lay person of indefatigable spirit and determination, who was dedicated to improving the care of those suffering from arthritis in British Columbia and who already had done a great deal to stir up national interest in their plight; she had previously obtained some 7000 signatures from all across Canada and sent them to the authorities²¹. I recall that she came to breakfast at our house and drove with Wallace to the airport on their way to Ottawa for this momentous meeting. The Ottawa meeting was attended by representatives of government, every medical school in Canada, and others representing professional associations of dentists, nurses, physiotherapists and hospital administrators, the DVA, service clubs, the Health League of Canada, and The Red Cross. It was a large, diverse, and dedicated delegation from many parts of Canada. Mary Pack, in her book, Never Surrender, reported that “Dr. Wallace Graham presented the case so well that there was no doubt it would be acted on.”²¹

On October 14, 1947, Canadian Thanksgiving Day, a resolution authorizing the Foundation of the CARS was passed. There was much rejoicing.

1948. A few months later, on March 14, 1948, The Society was incorporated. Those listed below were named on the patent as follows:

From the beginning it was recognized that training other physicians as specialists in rheumatology was of utmost importance in order to treat the large number of those needing specialized care. It appears close to the top of the aims of the newly incorporated society.

The first directors' meeting was held May 28, 1948, in the board room of the Medical Arts Building, Toronto, at 6:30 pm, with Wallace elected as president²².

Among the many important matters to be discussed was the appointment of an executive secretary. Appropriate advertisements for the office had been placed in medical and financial journals and several applications had been received. Both Wallace and Dr. Routley had interviewed, among others, Mr. Edward Dunlop, a distinguished war hero and Director of Rehabilitation for the DVA in Ottawa. He had been highly recommended by Mr. Lou Woods and other prominent people who knew him well. In spite of war injuries that left him blind his qualifications were impressive. In order to get to know him better, Wallace and I had taken Edward and his wife to our primitive log cabin near Uxbridge for a weekend. Edward Dunlop and Wallace sat by the fireplace and talked for hours while his devoted wife and I sat on the verandah or wandered in the woods and became good friends. It was a happy weekend and there was no doubt in Wallace’s mind that Edward Dunlop was an ideal choice for executive secretary. Later he was made executive director as more befitting the major role he played. The choice of Mr. Edward Dunlop was an inspired one (Figure 5). His subsequent leadership and contributions to the growth and national impact of our Canadian Arthritis Society program was enormous.

Figure 5. The Honorable Edward Dunlop, OBE, LLD, 1919-1981.

That same year at a directors’ meeting of CARS, Saturday, November 27, 1948, a letter was read from Lord Horder, Chairman of the Empire Rheumatism Council, stating that the CARS’s application for autonomous membership had been unanimously approved²³.

This made it possible to set up special fellowships for Canadian medical graduates at Taplow with Professor Eric Bywaters and Dr. Barbara Ansell, in Manchester with Professor J. Kellgren, and in Edinburgh with Professor J.J.R. Duthie (Gordon DA, personal communication). In the United States Drs. Walter Bauer at Harvard, Joseph Hollander in Philadelphia, and S.P. Rosenberg in Chicago were also interested in setting up special fellowships for Canadians²⁴.

The pressure on Wallace, as Medical Director of the newly formed Arthritis Society, to do something about the estimated 600,000 people suffering from the disease was enormous. There was not even a handful of specialists in rheumatic diseases in Canada at that time. Therefore, from the beginning he knew that training young medical specialists in rheumatic diseases was of prime importance. He attracted and enlisted support at the top level of business and the professions and his first national board of directors included, among others, Mr. J.A. Gairdner, Mr. Norman Urquhart, Mr. L.M. Wood, Dr. T.C. Routley, Professor J.B. Collip, Professor J.S.L. Brown, and Dr. Harvey Agnew.

1949. By now the combined services RDU, which had been set up at the St. Thomas Hospital and temporarily moved to the East General in Toronto, was established at Sunnybrook Hospital, with Wallace in charge. Originally it was for veterans only, but Dr. Hugh Smythe tells me that in 1963 the Wellesley Hospital was able to rent beds from Sunnybrook to treat arthritis patients who were not veterans. Although Wallace had planned the Wellesley unit, he died in December 1962, a month before the unit was established there under the direction of Dr. Metro Ogryzlo. This was while waiting for the opening of the RDU in the Wellesley Hospital in 1967. Earlier in 1965, when the University of Toronto took Sunnybrook Hospital over completely, it became the Sunnybrook Health Sciences Centre, open to veterans and non-veterans alike. From the beginning, Sunnybrook became the center for training a large and highly qualified group of rheumatologists, thanks to wise planning and funds raised by CARS.

As well as Sunnybrook, beds had been made available in 1960 at the Queen Elizabeth Hospital on Dunn Avenue, Toronto, for non-veterans needing longterm care for their arthritis. This was necessary because at the time the TGH authorities did not consider active treatment and rehabilitation for arthritis patients a priority. Wallace, who had always pressed for this kind of care for civilians, was put in charge. This added a heavy load on top of all his other responsibilities. This unit, according to Dr. Metro Ogryzlo in a Tribute to Wallace Graham at the Wellesley Hospital in 1963, was the first RDU in Canada for non-veterans (Ogryzlo MA. Wallace Graham Tribute, The Wellesley Hospital. Personal communication, 1965).

By 1949, CARS had become well established with an experienced board of prominent citizens. Mr. James A. Gairdner, a patient of Wallace’s, became the president at the first annual meeting. A major document, “Arthritis Plan For Attack,” was launched and distributed, and fundraising was well under way across Canada. British Columbia and Ontario were the first to set up divisions and eventually all the provinces had an active organization. It is generally agreed that the wise organizational structure of CARS on a provincial basis under a national board has been an important factor in its success²⁵. By now, well qualified physiotherapists and social workers had been added to the team effort.

CARS “Arthritis Plan for Attack,” some 16 pages in length, compiled mainly by Edward Dunlop and Wallace over many laborious hours, gave credit to Horder’s British report, which concludes as follows: The Society gratefully acknowledges the valuable assistance which it has received through its affiliation with the Empire Rheumatism Council. In particular, it desires to acknowledge the stimulating and practical suggestions contained in the Council’s Report “Rheumatism — A Plan for National Action” prepared by the Council’s Chairman, the Rt. Honorable Lord Horder, GCVO, MD, FRCP. From this, the Society has drawn much of its inspiration, and the material which it contains has been used freely in this Plan with modifications in detail suitable to the Canadian scene²⁶.

Although the Empire Rheumatism Council document was an enormous help, adapting it to the Canadian situation as well as nine provinces was a major achievement.

At a directors’ meeting of CARS, held February 12, 1949, Dr. Metro Ogryzlo had been proposed by Dr. Ray Farquharson for a fellowship²⁷. He had been Dr. Farquharson’s chief medical resident and working as a clinical investigator under Wallace, but needed more assured funding to support his growing family. The Clinical Scientific Research Committee, under Dr. Fletcher, and the Professional Education Committee, under Dr. J.S.L. Brown, had not yet brought in a final plan for fellowships, and funds had not yet been raised. Because of the brilliant record of Dr. Ogryzlo and the urgency of the situation, a fellowship was created.

This was to be the first of many fellowships awarded for career development of rheumatology researchers in Canada. Moreover, many more distinguished rheumatologists from across Canada received their early training at the Sunnybrook unit. Later the RDU at the Wellesley Hospital carried on this tradition. The Wellesley Hospital academic RDU had been planned by Wallace, but after his sudden death on December 14, 1962, Dr. Ogryzlo took charge when it opened a month later, in mid-January, 1963²⁸.

1957. On the invitation of Wallace Graham in Rome in 1953, the Ninth International Congress on Rheumatic Diseases took place in Toronto with many delegates from Europe, the USA, Mexico, Central and South America²⁹.

Dr. Robert Stecher from Cleveland, Ohio, was chairman. It was CARS and the CRA, and in particular Mr. Edward Dunlop and Dr. Donald Graham, past president of the CRA, who were in charge of organizing it, and Wallace and his committee were responsible for the selection of papers to be presented. He was convinced that by carefully reviewing and accepting only top quality papers the Toronto meeting would be a success, in spite of not offering the attractions of Rome, Paris, or New York. At this time he was also Vice President of the International League Against Rheumatism (ILAR) and president-elect of the Pan American League Against Rheumatism (PANLAR).

A highlight of the Congress was the presence of Dr. Philip Hench, who in 1950 had been awarded the Nobel Prize for his part in the discovery of cortisone¹⁹. To enliven the occasion, Scottish kilts had been rented for some of the American visitors and Dr. Hench wore his with amusement and grace (Figure 6).

Figure 6. Dr. Philip Hench and Dr. Wallace Graham, at the Ninth International Congress on Rheumatic Diseases, Toronto, Canada, 1957.

The major event at the congress was the announcement of the formation of the Gairdner Foundation for the purpose of “making international awards to the most creative and accomplished biomedical scientitists.”³⁰ Wallace was chairman of the medical selection committee for the next 4 years until his sudden death. Among those selected to receive a Gairdner Award of Merit in the early days was Dr. F.H.C. Crick, who went on to win a Nobel Prize for his work on the molecular structure of DNA. Moreover, many other Gairdner Award winners have been awarded Nobel prizes. The original documents and photographs of the Foundation are among my husband’s papers¹ (Figure 7). Mr. Gairdner was a patient of his and had severe arthritis as well as heart problems. Originally, the awards were to be primarily for areas of research related to arthritis and rheumatism and secondly for various forms of heart disease³⁰.

Later the Gairdner Foundation widened to include research in all the other areas of medicine, but no one requested the original documents and photographs in my possession. Wallace and Drs. Fletcher and Ogryzlo had died and the younger rheumatologists were probably not aware that I had them. To my surprise, as recently as 1998, Dr. John Dirks, former dean of the Faculty of Medicine of the University of Toronto and now the President of the Gairdner Foundation, came to see the material, particularly the original announcement and photographs. In 1998, to my delight, I was invited to the annual dinner of the Gairdner Foundation and greatly honored on my husband’s behalf. The 40th Anniversary of the Gairdner Awards in 1999 was a major event. A book was published, entitled The Gairdner Foundation: A Celebration, and presented to each of the guests30. It has many personal recollections of Mr. Gairdner, with photographs, as well as the details of the Foundation and those who have received awards.

Figure 7. Dr. Wallace Graham, Dr. James A. Gairdner and his son J.S. (Jock) Gairdner at hte announcement of the Gairdner Foundation Awards at the Ninth International Congress on Rheumatic Diseases, Toronto, Canada, 1957.

Looking back over the years it now becomes apparent that Dr. Duncan Graham’s farsighted plans to meet the need of future patients with arthritis have taken root and are flourishing. By advising Wallace to do his MRCP in London he had set up a major connection for Canada with the Rt. Honorable Lord Horder and the Empire Rheumatism Council. By appointing Wallace on his return to work with Dr. Fletcher he had set a chain of events in motion which have proven to be of invaluable help in improving the lives of those suffering from arthritis in Canada. This is further clarified by the fact that Professor Ray Farquharson, successor to Dr. Duncan Graham as the Professor of Medicine at the University of Toronto, had advised Wallace not to accept a chair in medicine if it were offered to him. He stressed the fact that his background had prepared him to make a unique contribution in the area of arthritis and rheumatism and that he was most needed there. Wallace had talked this over with me at the time, and although temporarily disappointed, he decided to take “The Professor’s” advice. The large number of patients’ letters that were received at the time of his death and the striking success of CARS and the RDU indicate that he had made the right decision. It has been interesting for me to have lived long enough to see how Dr. Duncan Graham’s plans have come “full round.”

Finally, the important role of the outstanding volunteers on the Board of CARS must be stressed and given much credit for its success. Over the years it has attracted distinguished lay and medical men and women, most of whom were already persons of considerable achievement in their own field. They have contributed much valuable time and experience and accepted major responsibility at both the national and provincial level. The early minutes of the CARS record their names. That there are now academic RDU in every teaching hospital across Canada attests to their wisdom, as does the money continually raised for research and fellowships.

To quote Mr. Bryan Vaughan (personal communication, October 1999), a board member of the early days and an old friend, “The Canadian Arthritis Society has a splendid history and has surpassed all expectations. The intangible ‘thrust’ that over the years has attracted top flight academics as well as internationally renowned lay persons to the society appears to remain fresh and flourishing.”

K.M. GRAHAM, BA, FCA
(Mrs. Wallace Graham),
Toronto, Canada

Address reprint requests to The Journal of Rheumatology.

ACKNOWLEDGMENT

1. The December 1962 obituary of my husband, Dr. Wallace Graham, written by the late Dr. Alan Walters, my husband’s friend and classmate, for the Toronto Academy of Medicine has been the source of much information. 2. Tapes were made available to me by Dr. Charles Godfrey of interviews he had with Mr. Edward Dunlop, the first executive director of The Arthritis Society, shortly before Edward’s death. Although these are disjointed, incomplete, and hard to follow, they proved of great interest. I have also called Mrs. Edward Dunlop on numerous occasions for help. 3. Mr. Bryan Vaughan, a contemporary of mine, who was one of the outstanding members of the early board of The Arthritis Society, has given invaluable help and encouragement. 4. Dr. Joan Harrison gave me much detailed information about her father, Dr. Almon Fletcher, who was a senior rheumatologist and a great personal friend and neighbor. 5. Dr. Donald Harrison was a careful and encouraging proofreader and I owe him a debt of thanks. 6. Mrs. Sharon McConnell, the Senior Vice President of Development and Communications of The Arthritis Society of Canada, made photocopies of the early minutes of the Society available to me. They were used extensively. 7. Telephone conversations with Dr. Hugh Smythe have been of great value. Photographs are from the Wallace Graham papers.

REFERENCES

1.Graham KM. Personal collection.

2.Banting FG, Best CH, Collip JB, Campbell WR, Fletcher AA. Pancreatic extraction in the treatment of diabetes mellitus. Preliminary report. Can Med Assoc J 1922;22:141-6.

3.Fletcher AA, Graham JW. Complications of diabetes mellitus. Can Med Assoc J 1939;41:566-70.

4.Smyth CJ, Freyberg RH, McEwen C. History of rheumatology in the United States. Ch. 1 and 2. Atlanta: The Arthritis Foundation; 1985.

5.Robinson HS. The Canadian Rheumatism Association. In: Morley TP, editor. Medical specialty societies of Canada. Toronto: Associated Medical Services; 1991:381-91.

6.Kerr RB, Waugh D. Duncan Graham, medical reformer and educator. Toronto, Oxford: Dundurn Press; 1989.

7.Fletcher AA. Diet and nutrition in chronic arthritis. J Am Dietetic Assoc 1931;7:1-5.

8.Fletcher AA. Nutritional factors in chronic arthritis. J Lab Clin Med 1930;15:1140-4.

9.Graham JW. Toxicity of sterile filtrate from periodontal pockets. Proc Roy Soc Med 1937;30:1165-72.

10.Graham JW, Graham KM. Our gouty past. Can Med Assoc J 1955;73:485-93.

11.Obituary — Lord Horder of Ashford. BMJ 1955;2:493-7.

12.Bliss M. William Osler. A life in medicine. Toronto: University of Toronto Press; 1999:472-6.

13.Graham JW, Fletcher AA. Gold therapy in rheumatoid arthritis. Can Med Assoc J 1943;49:483-7.

14. Fletcher AA. Dr. Wallace Graham: an appreciation. Can Med Assoc J 1963;88:222-3.

15.Walters A. Obituary, J. Wallace Graham. Can Med Assoc J 1963;88:104-6.

16.CARS Organizing Committee Minutes, October 26, 1949. The Arthritis Society Head Office, Toronto.

17.Hench PS, Boland EW. The management of chronic arthritis and other rheumatic diseases among soldiers of the United States Army. Ann Intern Med 1946;24:808-25.

18.Polley HF, Slocumb CH. Behind the scenes with cortisone and ACTH. Proc Staff Meet Mayo Clin 1976;51:471-7.

19.Hench PS, Kendall EC, Slocumb CH, Polley HF. Effect of a hormone of the adrenal cortex (17 hydroxy-11 dehydrocorticosterone, compound E) and of pituitary adrenocorticotropic hormone on rheumatoid arthritis: preliminary report. Proc Staff Meet Mayo Clin 1949;24:181-97.

20.Canadian Arthritis and Rheumatism Society. Arthritis plan for attack. 2nd ed. Ottawa: Canadian Arthritis and Rheumatism Society; 1950.

21.Pack M. Never surrender. Vancouver: Mitchell Press; 1974.

22.CARS minutes. Meeting of Directors. May 28, 1948.

23.CARS minutes. Meeting of Directors. November 27, 1948.

24.CARS minutes. Meeting of Directors. June 20, 1949: 7.

25.Godfrey CM. Tapes made in discussion with Edward Dunlop shortly before his death.

26.Canadian Arthritis and Rheumatism Society. Arthritis plan for attack. Toronto: Canadian Arthritis and Rheumatism Society; 1949:1.

27.CARS minutes. Meeting of Directors. February 12, 1949.

28.Ogryzlo MA, Gordon DA, Smythe HA. The rheumatic disease unit concept. Arthritis Rheum 1967;10:479-85.

29.Adebajo AO, Barnes CG, Caughey DE, Dequeker J, Gordon DA, Muirden KD. Rheumatology worldwide. Ch. 16, Section 1. In: Klippel J, Dieppe P, editors. Rheumatic diseases in rheumatology. London: Mosby-Year Book Europe; 1994:1-6.

30.Hulse E, Dirks J. The Gairdner Foundation: a celebration. Toronto: Gairdner Foundation; 1999:4.