by Dr. D.B. Tonks, which appeared in the Commemorative Issue, 40 years • 1956-96 of CSCC News 1996; 2.

The impetus for the founding of the Canadian Society of Clinical Chemists (CSCC) came from Montreal, from the late Dr. W.S. Bauld and the late Dr. E.H. Bensley of the Montreal General Hospital, and from Dr. A.H. Neufeld of the Queen Mary Veterans Hospital.  They were all senior laboratory staff leaders, well-known in Canada and outside of this country.  In the summer of 1956, these three medical scientists planned an organizational meeting of persons interestedd in clinical chemistry or medical biochemistry for October 17 of the same year.  They asked me (DBT) to participate by giving a lecture on the work that I and my staff of three had been doing since 1951 in the Clinical Laboratories of the Laboratory of Hygiene in Ottawa.  (Our division was directed by Dr. R.H. Allen, which chief was Mr. J. Gibbard.  Both are important to this story for their strong support, but will not be mentioned again).  We had established a Federal clinical chemistry laboratory at the Ottawa Civic Hospital at the request of Dr. M. Klotz, Chief Pathologist, and were carrying out proficiency testing programs in Canada in clinical chemistry, studying clinical chemistry methods comprehensively, and producing a loose-leaf manual of approved clinical chemistry methods.  I was also doing research in serology.  A discussion of these studies seemed to be appropriate for the purpose of the founding meeting in Montreal on October 17, 1956.

The new Montreal General Hospital had been opened in 1955, replacing the previous one.  On October 17, 1956, the laboratories had only recently been established and were beautifully and colorfully painted.  Our meeting was, I believe, held at night in the now-named Osler Amphitheatre.  Invitations had been sent out, and a good audience of 37 scientists attended with great interest.  The principal organizer was, I believe, the late Dr. Bill Bauld, a Canadian who had been trained in Scotland.  (Unfortunately he and his wife and two of his four children were killed in an automobile accident in the Maritimes in 1958).  The need and desire to form a society for clinical chemistry only, was strong, and an organizational committee was set up to create a national Society, and to plan a first Annual Meeting in Ottawa in the fall of 1957.  I was named as Chairman of the Local Organizing Committee for this meeting, and Drs. Bauld, Bensley and Neufeld were charged with arranging the scientific program and the business part of this important Ottawa meeting.

More could be said about the Montreal meeting, but one can refer to an article by Dr. Bensley in our CSCC News of February 1984 (“Twenty-five Years – A Retrospection”).  It is important to note, however, that other societies were being formed at about the same time (Canadian Biochemical Society, Canadian Federation of Biological Societies, Canadian Nutrition Society).  We had the moral support of the British and American Associations of Clinical Chemists/Medical Biochemists, and of the International Federation of Clinical Chemistry.  Several of us had attended their meetings previously.  I had become a member of AACC in 1953, and had visited Dr. Sobel’s labratory in Brooklyn in 1952 and 1953; he was one of the founders of AACC.

Much insight on the need for a Canadian society (to form Q.C. programs, standardize methods and assess instruments) was detailed at the International Congress of Clinical Chemistry in New York City, September 9-14, 1956.  Several of us attended the Congress, along with Prof. N.F. MacLagan, Dr. C.P. Stewart, and Prof. E.J. King of Great Britain, who just previously had visited Montreal.

The Committee formed at the Montreal meeting to plan the rapid organization of a Canadian Society of Clinical Chemists consisted of Dr. E.H. Bensley (Montreal), Chairman.  Dr. S.H. Jackson (Toronto), Dr. Jules Labarre (Montreal), Dr. D.B. Tonks (Ottawa), Dr. F.D. White (Winnipeg), Dr. A.L. Stewart (Edmonton), and Dr. W.S. Bauld (Montreal), Secretary.  Questionnaires were sent out to determine the views of others.  It was agreed that we should proceed, and the first national meeting, referred to above, was planned for the fall of 1957 in Ottawa.

This first National Meeting was held in the Medical Building of the University of Ottawa.  It was a great success.  The business meeting followed (34 attended) with Dr. Bensley as Chairman and Dr. Bauld as Secretary.  The previously selected Committee was approved for proceeding with the formation of a Canadian Society of Clinical Chemists, which was the name proposed by Drs. White and Neufeld, and accepted after much discussion.  The qualifications for membership were fully discussed; finally, Dr. Guy Nadeau, seconded by Dr. Bauld, moved that “any person actively engaged in the practice or teaching of clinical chemistry (or clinical biochemistry) may be eligible to become a member in the first year,” and that a committee be set up to rule upon applications received.  The following offices and officers were approved:  President, Dr. E.H. Bensley; Vice President, Dr. S.H. Jackson; Secretary, Dr. W.S. Bauld; Treasurer, Dr. Guy Nadeau; and Committee Members of Council, Dr. M.C. Blanchaer (Winnipeg) and Dr. R.H. Pearce (London ON).  Three sub-committees were established with designated Chairmen – Instrumentation, Dr. S.H. Jackson; Quality Control, Dr. D.B. Tonks; Methods, Dr. F. Moya of Halifax.  A membership was to be decided upon by Council.

The Society was on its way.  The second Annual Meeting was held at Queen’s University in Kingston on June 12-13, 1958, with Dr. Bensley as President and Dr. J.M.R. Beveridge as Chairman of the Local Organizing Committee.

The third Annual Meeting was held at the Hospital for Sick Children in Toronto on June 12, 1959, when Dr. S.H. Jackson was elected President, and I was confirmed at Secretary, a position I had taken on after Dr. Bauld’s death.

By Steven  J. Soldin at the CACB’s 25^th Anniversary

The lack of a Fellowship in Clinical Biochemistry, available to both PhD qualified and MD qualified individuals was of serious concern to several of us, and led to frequent meetings of the “local” group in Toronto in the 80’s.  I had been a member of the NACB before it became affiliated with the AACC and on becoming President of the NACB was instrumental in building the bridge with Ted Peters, the then President of AACC to heal the unfortunate rift between AACC and NACB and which ultimately led to today’s NACB affiliation with AACC.

Our initial efforts in Canada were directed towards attempting to convince the Royal College that they should broaden their certification program for Medical Biochemists to include suitably qualified PhD clinical chemists, analogous to the British system.  This negotiation continued for several years, but Drs. Gornall and McQueen and I realized that it was going nowhere.

We then redirected our efforts to gain the support of the CSCC.  This was essential as I did not want to see a similar rift occuring in Canada as had occurred in the US between the AACC and the NACB.  The approach was welcomed by the CSCC and we received major support from many but especially from Drs. Desjardin, Allen, Doug Gornall, and of course from the senior Dr. Allan Gornall, who had been an avid supporter from the outset.

The rest is history.  The Canadian Academy was born and has had outstanding leadership ever since.  Today Canada can be proud of the quality of those who pass the Canadian board exam thereby becoming credentialed to direct clinical chemistry laboratories in this great country and simultaneously becoming members of the vibrant Canadian Academy of Clinical Biochemistry.

Thank you for asking me to share these cherished memories.

By Dr. Andrew MacRae

The Scope of Clinical Biochemistry

Clinical Biochemistry is one of the medical professions. Specifically, it is one of the several subdisciplines collectively referred to as Laboratory Medicine. As the name implies, Laboratory Medicine constitutes all of the practices of Medicine that relate to laboratory investigations for the purpose of diagnosis and treatment of diseases. Whereas some subdisciplines of Laboratory Medicine deal with tissues, cells, or infectious elements, Clinical Biochemists are primarily involved in investigations of the biochemical constituents of the fluids of the body.

These investigations include qualitative and quantitative assessment of individual molecular elements of blood plasma, spinal fluid, urine and other body fluids. The amount of a substance in the blood or other fluid, or the nature of the substance, forms the basis for a diagnosis, or a medical assessment of the course of the disease or treatment. A simple example is the measurement of serum glucose levels, or “blood sugar”, in the diagnosis of diabetes.

There are several hundred different compounds that are measured, some more routinely than others. In each instance the quantity or the qualitative nature of the compound is related to a particular disease or disorder. It is the Clinical Biochemist who assesses the relationship of the compound to the disease, establishes the test for the compound, and issues the report to the Physician together with a medical interpretation of the findings.

The Origins of Clinical Biochemistry and its Role in Medicine

The practice of what is now called Clinical Biochemistry can be traced throughout the entire history of Medicine. Hippocrates (460-375 B.C.) referred to an early “test”, namely an inspection of urine, saying:

Bubbles floating on the surface of the urine denote affections of the kidneys,
and that the disease will be long. (Aphorisms, Section VII, Number XXXIV)

Hippocrates’ test of urine remains in medical practice today, although it has been transformed by modern knowledge and techniques. We now know that the bubbles referred to by Hippocrates are caused by protein, and an excess of protein in the urine indicates kidney disease. In modern medical practice we are not restricted to an inspection of the fluid as was Hippocrates; we measure the amount and nature of the protein in urine, the source of Hippocrates’ bubbles. This trivial example portrays the evolution and nature of Clinical Biochemistry. A “test” for bubbles by an ancient physician has been replaced by more specific tests for both the amount and nature of the causative agents in the disease, and the professionals who specialize in the discovery and testing of these causative agents in bodily fluids are Clinical Biochemists.

The ancients were restricted to assessments of the only available bodily fluid, namely, urine. In the period between Hippocrates and 1500 A.D., physicians made slow progress in discovering the various aspects of urine that could be used as markers for the causes and nature of diseases. Urine was assessed for its volume, colour, appearance, odour and weight. The original writings on the weight of a known volume of urine as an indicator of disease can be traced to the first century B.C. The instruments used in these tests were the matula (a spherical vessel with a long neck) for visual assessment and for measuring volume, and the pan balance for measuring weight.

By modern standards these tests and observations were rudimentary; however, in their day, they were often the most important means of making a diagnosis, and the same tests persist today, with only modest refinement. The names of several ancient diseases were based on the findings of the “laboratory tests” of the time.

Diabetes is an example of the role that, what we now call Clinical Biochemistry, had in the evolution of medicine. The word diabetes originates from the Greek word for syphon, and refers to the large volume of urine that is symptomatic of the disease. The “laboratory test” of the time was the measurement of the volume of urine produced by the patient. The test result, the observation of the unusually large urine volume, was the basis for the name given to the disease.

At a later time, a second test was added to further differentiate this disease. It was discovered that some patients with diabetes produced urine that had a sweet odour (and taste), whereas the urine from other patients with similar urine volumes was sour. Diabetes had to be further differentiated on the basis of this test result: diabetes mellitus (sweet) and diabetes insipidus (sour).

In more modern times, diabetes mellitus has been further differentiated on the basis of another biochemical test, namely the amount of insulin in the blood. Hence we have insulin-dependent diabetes mellitus, and non-insulin-dependent diabetes mellitus. Throughout the course of medical care for this group of diseases, spanning many centuries, the diseases have been named on the basis of the laboratory tests of the day.

The Evolution of the Profession of Clinical Biochemist

Several centuries ago, Physicians started to perform tests on blood. The earliest tests on blood were similar to those used at the time for urine, namely visual observation and weighing a set volume. Blood tests had the advantage that the fluid being studied was closer to the source of the disease, being the fluid that bathes the tissues, rather than the fluid that the body selectively discharges.

The first concepts of the chemistry of the urine and blood as a determinant of the disease were published in the 16th Century A.D., although these ideas were based on even earlier postulations dating to the first century B.C. Thereafter the scope of testing expanded substantially, albeit slowly, as did the discoveries. By the year 1600, the practice of distilling urine and blood was a new addition to diagnostic medicine. The aim of this latest test was to assess the salt, sulphur and mercury constituents of these body fluids. In the 17th Century, the laboratory contained improved apparatus including the thermometer. Fermentation studies led to theories of the role of carbon dioxide, and the role of acid and alkaline substances in digestion.

Throughout the Middle Ages, Physicians incorporated more tests in their assessment of patients, and some physicians began concentrating their practice on the study of these blood tests. By the 17th Century there were scientific centres wherein Physician/Chemists performed their research. A noted example was Gresham College which was centred in Oxford, England. This group of “experimental natural philosophers” later formed the nucleus of the Royal Society which was established in 1662. Robert Boyle was a member of Gresham College, and his publication in 1684 was a milestone in the evolution of chemical examination of blood as a diagnostic tool in medicine. John Locke, while still in his mid-thirties and prior to his fame as a philosopher, assisted Robert Boyle and performed distillation experiments on blood.

In more modem times, the work of Banting and Best seventy years ago is representative of the evolution of physicians into specialists in laboratory-based medicine. Sir Fredrick Banting was the surgeon turned biochemical theorist, and Charles Best was the medical student who tested the glucose content of blood and extracted the elusive insulin.

As this trend toward specializing increased, the extent of testing expanded, as did the use of sophisticated equipment replacing the basic senses used by the ancients. However, the fundamental nature of testing continues today to be both quantitative and qualitative assessments of biochemical constituents of body fluids.

Symbols associated with Clinical Biochemistry

The practice of Clinical Biochemistry is founded on the concepts of quantitative and qualitative testing, leading to a diagnosis. These concepts have been combined in the proposed motto for the Academy:

Quanto Qualique Diagnoscere

The symbols of the Caduceus for medicine, a urine flask for qualitative studies, and a pan balance for quantitative tests, could be combined in an appropriate manner in the Coat of Arms.

The Canadian Society of Clinical Chemists (CSCC) is the professional body from and within which evolved the Canadian Academy of Clinical Biochemistry (CACB). Since 1966, the CSCC has used the symbols of the twining snakes about the neck of a volumetric flask (see appended article from the CSCC Newsletter on the origins and meaning of the Society’s symbols). Since the CACB is a subsection of the CSCC, it would be appropriate for the CSCC symbols be part of the CACB’s Coat of Arms.

One suggestion seems quite appropriate: the twining snakes about the neck of the flask could arise from a double helix (the structure of the DNA molecule) within the flask. A pan balance could frame the flask, with the pans suspended on either side of the flask and the armature of the balance above the flask. The triangular shape of the armature of a balance mimics ancient Greek architecture, appropriate for an Academy. A final symbol, common throughout the history of Clinical Biochemistry, is light. The absorbance of portions of the spectrum of light has been used to describe the colour of fluids and their constituents, and the selective production of light-absorbing compounds is a long-standing principle used in quantitative testing.

PRESIDENTS OF THE CANADIAN SOCIETY OF CLINICAL CHEMISTS

MEMBERS OF COUNCIL

Canadian Society of Clinical Chemists

ESAD = Education and Scientific Affairs Division
PAD = Professional Affairs Division
PD = Publications Division

1956 to 1980-81

MEMBERS OF COUNCIL

Canadian Society of Clinical Chemists

MEMBERS OF COUNCIL

Canadian Society of Clinical Chemists

ESAD = Education and Scientific Affairs Division
PAD = Professional Affairs Division
PD = Publications Division

MEMBERS OF COUNCIL

Canadian Society of Clinical Chemists

Marcel C. Blanchaer (deceased)

Donald J. Campbell

Arlene J. Crowe

Regis Duffy

K.A. Evelyn (deceased)

Allan G. Gornall (deceased)

Gilbert Hill

Elizabeth Hooper

Sanford H. Jackson (deceased)

Matthew J. McQueen

Richard H. Pearce

Diana M. Schatz

David B. Tonks (deceased)

Derek Watson

Founding Fellows of the Academy

Canadian Academy of Clinical Biochemistry

1986 – present

¹1998-2003 Committee called Education & Research
²Position was Member-at-Large
³Position was Treasurer
⁴Completed term of R. Lepage
⁵R. Yatscoff chaired the committee
 ⁶Dr. Lepage completed Dr. Delvin’s term
⁷Dr. MacRae completed Dr. Dupont’s term as Member at Large

Dr. David Tonks was on Council during CSCC’s first 10 years, and he would assemble minutes of AGMs, Council meetings, etc. into mimeographed newsletters distributed to all members by regular mail, and numbered in Dr. Tonk’s handwriting in order from #1. When Dr. Russell Rockerbie was Editor and was able to obtain commercial sponsorship for professional printing of the newsletter (1973), he adopted the year of the #1 newsletter as Volume 1, and that explains why the volume number is two year behind the actual age of CSCC.