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PROVINCE OF BRITISH COLUMBIA THIRTY-SEVENTH REPORT OF THE PROVINCIAL BOARD OF HEALTH FOR THE YEAR ENDED… British Columbia. Legislative Assembly 1934

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 PROVINCE OF BRITISH COLUMBIA
THIRTY-SEVENTH REPORT
OF   THE
PROVINCIAL BOARD OF HEALTH
TEAR ENDED DECEMBER 31ST
1933
PRINTED BY
AUTHORITY OF THE LEGISLATIVE  ASSEMBLY.
VICTORIA.  B.C. :
Printed by Chakles F. Banfield, Printer to the King's Most Excellent Majesty.
1934.
PROVINCIAL LIBRARY
VICTORIA, B.C. Provincial Board of Health,
Victoria, B.C., January 31st, 1934.
To His Honour J. W. Fordham Johnson,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour :
The undersigned has the honour to present the Report of the Provincial Board of Health
for the year ended December Slst, 1933.
G. M. WEIR,
Provincial Secretary. REPORT of the PROVINCIAL BOARD OF HEALTH.
Provincial Board of Health,
Victoria, B.C., December 30th, 1933.
The Honourable G. M. Weir,
Provincial Secretary, Victoria, B.C.
Sir,—I have the honour to submit the Thirty-seventh Annual Report of the Provincial Board
of Health of British Columbia for the year ended December 31st, 1933.
The Annual Report of the Provincial Board of Health is primarily engaged in reporting the
statistics of communicable diseases which come within the purview of the Department, and, by
comparing the number of cases as reported from year to year, gauge the results of the work of
the Board. This is the general conception that the public has of our work, but as we progress
we have endeavoured to show the public that the number of cases of infectious diseases reported
is more a criticism of, not the Department, but of the conduct of the community itself in regard
to their non-observance of the law of the land.
Our whole effort has been directed along the lines of the awakening, in the public conscience,
of a sense of their responsibility, and that the results from the enforcement of the health laws
can only be brought about by co-operation on the part of the public. Governments may make
laws, but they can only keep a step or two ahead of what the public desires, and to get at the
desires of the public necessitates a long-continued propaganda in an effort to educate them to
their responsibilities. I am pleased to say that during the past few years there has been a
remarkable awakening of the public conscience in this matter. They are beginning to realize
what the individual as regards his relation to the community means, and as regards the efforts
he must make individually in the prevention of disease by attention to personal hygiene, the
education of himself and others in the idea of the prevention of disease as distinct from its
cause. The inculcation of this idea has been our aim, and our efforts have been to create a
broader outlook by the health-work as carried on by the Government.
Formerly it was the highest ambition of public-health workers to show each year a diminished morbidity and mortality rate from certain named diseases. If the Public Health Officer
could show that in a brief period of his incumbency he had cut the typhoid death-rate down to
one-fifth of its former proportions and had a steadily diminishing rate for scarlet fever or
diphtheria, he felt that he had done a great deal. But within the past few years we have had
a higher ambition. We have felt that we must deal with more than the negative side of health,
and that it was most distinctly within the province of a Health Officer to put forth every effort
to raise the vitality of every human unit in his community to the highest point of efficiency.
He must no longer be satisfied with the knowledge that from the result of his efforts a number
of individuals have survived who might have died from some preventable disease, but he must
also feel that he must lay a foundation for the robust citizens of to-morrow, and so our ideals
have advanced, taking in not only the previous field of sanitation, but also that of personal
hygiene.
How to reach the individual, however, has been the problem. Health Officers could not
personally supervise the daily life of each individual in the community, and he recognizes,
therefore, the necessity for educational measures, directed both to the end of securing better
understanding, and hence better support to the Health Department, and also to so educate the
individual as to furnish him with the knowledge of how to promote his individual health and
with the incentive to put that knowledge into effect.
That we are accomplishing our purpose is largely due to the fact that a sufficient number of
the citizens have become thoroughly interested, and through them, as individuals, organizations
have been reached, and public-health work in British Columbia is able to show milestones of
progress from year to year.
Our Public Health Nursing Service is probably the best example of the progress that we are
making in regard to the education of the public.
The plan carried out is a full health programme, beginning with prenatal work, followed
by infant-welfare, preschool, then school, until the child leaves the schools. This is the basis
of the work, and using this as the introduction into the home, the establishment of classes
amongst the older people, we are able to bring home to them the real purpose of a co-ordinated Z 4 BRITISH COLUMBIA.
plan; that is, the elimination of disease by study, research, and co-operative effort, based upon
our knowledge that common contagious diseases are spread chiefly by the direct transfer of
excretions from person to person.
The establishment of unified health service is the application of the knowledge gathered as
a result of investigations by many men in all countries, and its justification is probably best
expressed by quoting from Dr. Charles V. Chapin's address on " Science and Public Health "
before the American Public Health Association:—
" The science which can point to its achievements against smallpox, malaria, yellow fever,
diphtheria, typhoid and typhus fevers, tuberculosis, and a score of other diseases, as well as to
a rapid lengthening of human life, and especially to the saving of vast numbers of infants from
early death, need not be ashamed to acknowledge that some experiments have failed ; neither
should it hesitate to admit that we are still merely picking up pebbles on the shore of the sea
of knowledge, and that what is not known about maintaining and perfecting the health of
mankind is far greater than what is known. The opportunities for discovery are as great as
before the days of Harvey, Pasteur, and Lister."
We have endeavoured to show in our reports that the Health Board is appreciative of the
changes that have taken place in regard to the management of health matters. The essential
change is that " The old public health was concerned with the environment, the new is concerned
with the individual; the old sought the sources of infectious diseases in the surroundings of
man, the new finds them in the man himself." Our object is the awakening of the public
conscience and securing the encouragement of an intelligent public opinion to bring, through the
practical application of our health laws, the increased length of life, increased productive
capacity of the human asset, decreased sickness and misery, and bring about the culmination
of national prosperity produced by happy, healthy, contented people.
All of the above is expressed briefly in Sir Henry Newman's Report of the State of the
Public Health of Great Britain for 1932. as follows: " Lastly, and perhaps best of all, the
English people are learning more of the art of living. Twenty-five years of a school medical
service for five million children per annum must have created some health assets, must have left
some indelible mark of its benefit, upon three generations of school-children, of whom two-thirds
are now adults. In other words, the educational value of the maternity and child-welfare service
and the school medical service, taken together, is beginning to change the physical outlook of the
English people.    Out of this sort of thing a nation can be grown."
That we have succeeded in the work is shown by the extremely low death-rate of 1933,
which is all the more remarkable in view of the unfavourable economic conditions which
prevailed throughout the year and which seriously affected living standards of industrial wage-
earners and their dependents. There has been a steady decrease in the death-rate from 1912
to the present date. The decline in the crude death-rate has amounted to 71.1 per cent, in
twenty-two years, constituting a remarkable evidence of the persistent work of the health-men
throughout the North American Continent, but, perhaps more than any other single factor, the
protection given by the effective functioning of the health departments, the clinics, by the
generous treatment by physicians, and by splendidly organized health-work has operated to
conserve life and health.
The improvement which took place in the death-rate for all causes of deaths combined
reflects the substantial decline recorded for such important diseases as tuberculosis, pneumonia,
conditions arising out of pregnancy and childbirth, measles, whooping-cough, and diphtheria.
The downward trend in these conditions is apparently continued without let-up. The mortality
drop in tuberculosis is over 70 per cent, in twenty-two years, and this decline is still going on.
It has been practically continuous in the United States and Canada, and constitutes probably
the greatest single achievement, in public-health history. This decline has been reflected in all
parts of the country and has extended to all economic strata of the population. The outlook
for continued improvement in the future is very promising.
Twenty-two years ago 58.9 in every 100,000 died of either measles, scarlet fever, whooping-
cough, or diphtheria, instead of 7.4 per 100,000 who died from these diseases in 1933. In this
group the greatest interest attaches to diphtheria, for it is here that the largest reduction in
mortality has been accomplished. As a matter of fact, the rate has been cut in half in the brief
space of three years. Diphtheria shares with typhoid fever the distinction of showing what
can be accomplished in the control of a communicable disease. BOARD OF HEALTH REPORT, 1933. Z 5
The report from our Epidemiologist, which follows, comments on diphtheria, and one interesting point he brings out is that for three whole months during 1933 there was not a single
case of diphtheria reported in the Province.
In connection with laboratory-work, vaccines and antitoxins are sent out free on request,
and for the year 1933 the following have been furnished: 4.233 points smallpox vaccine, 3,710,000
units diphtheria antitoxin, 3,926 doses diphtheria toxoid, 52 packages Schick test for diphtheria,
191 packages 2 cc. (prophylactic) scarlet fever antitoxin, 130 packages 15 cc. (treatment)
scarlet fever antitoxin, 44 packages Dick test for scarlet fever, 807 doses scarlet fever toxin
(for active immunization), 852 doses typhoid vaccine, 264,500 units tetanus antitoxin, 49 packages 20 cc anti-meningococcus serum, and 12 doses pertussis  (whooping-cough)  vaccine.
There follows in our report the accounts from our Tuberculosis Officer, Epidemiologist,
Sanitary Inspector, and Laboratory Director, who give full accounts of their departments, and
I can recommend, a careful study of these reports to show the really worth-while results that
the Provincial Board of Health's policy as applied is bringing forth.
We cannot shut our eyes, however, to the continued effect of the depression. We are
grasping at straws very often and hoping against hope that the economic condition will change,
but a careful study of the figures of our people on relief shows that there is still fluctuation, but
this is seasonal. In the summer-time these people are moving from different parts of the continent in an endeavour to get seasonal jobs, but in the autumn they come back to the Coast and
its good climate, apparently in undiminished numbers. The Government of the clay has on its
hands a most disheartening work, but they are meeting it in an able manner, and the revival of
our mining and lumbering industries—two of our major resources—is encouraging. The high
price of gold has stimulated gold-mining, and has particularly encouraged the opening-up of old
workings that were closed when the price of gold was low; yet at the high price now they are
paying propositions.    This all goes towards helping us out of our dilemmas.
We are indebted to the co-operation of other departments, and particularly so to the continued courtesy and work carried on at our request by the Provincial Police. We wish to thank
them.
We append an account of approvals for sanitary works during the past year:—
Cemetery-sites approved.—Pender Harbour, Fort St. John, Edgewater, Rose Prairie, Port
Clements, Arras, Groundbirch, Stewart, Golden, and Colwood.
Sewage-disposal Systems approved.—New Westminster" (extensions).
Water-supply Systems approved.—Summerland (new pumping plant), Enderby, and Courtenay (new reservoir).
I would like, Sir, to express for myself and staff our congratulations on the fact that you
have assumed the office of Provincial Secretary, under which our Department belongs. We are
sure of your encouragement, and knowing the great interest that you have taken in health-work,
we feel that from now on we will be able to give greater effect to some of our policies. I can
assure you of full co-operation from the Provincial Board of Health, and in this connection I wish
to thank my whole staff for the work they have been doing. Our work has been more than
doubled. We have had to assume responsibility and duties owing to changes in the various
Acts, but the staff has met them in a manner I would expect as simply a continuance of what
they have always shown during the time they have been connected with us. I would like, Sir,
to draw this to your attention.
I have the honour to be,
Sir,
Your obedient servant,
H. E. YOUNG,
Provincial Health Officer. Z 6
BRITISH COLUMBIA.
GENERAL REPORTS.
EPIDEMIOLOGICAL REPORT.
Victoria, B.C., December 30th, 1933.
H. E. Young, M.D., CM., LL.D..
Provincial Health Officer, Victoria, B.C.
Sir,—I have the honour to submit herewith epidemiological report for the year 1933.
It is a matter for regret that the general financial depression has continued through
1933, with the result that it has been difficult or impossible to embark on any large programme
of investigation or prevention, owing to the decreased appropriations, both Provincial and
municipal, that have been available for such work. It has been necessary to keep travelling
and other expenses down to the barest minimum and to depend on correspondence as much as
possible rather than personal visits. However, in spite of such difficulties, I am pleased to
report that there has been no serious epidemic during the year, and the total number of cases
of reportable diseases has been reduced to less than one-half the figure of the previous year, or
10,507, as compared with 22,323. The high figure for 1932 was due mainly to epidemics of
influenza and measles which swept the Province that year; but these two diseases also accounted
for over 2,400 of our total for 1933, mostly during the early weeks, as the epidemics of the
previous year tapered off to a low point, although never quite to extinction.
During 1933, as stated, we had no epidemics of serious proportions throughout the Province
generally. On the other hand, a few diseases, notably scarlet fever, chicken-pox, mumps, and
whooping-cough, were fairly prevalent and were epidemic within certain areas.
One cannot pass without comment the fact that for three whole months during the year
there was not a single case of diphtheria reported in the Province, and these were not the
summer months, when a general lowering of all diseases is expected, but the months of March,
November, and December, when diphtheria, prior to the use of toxoid, always showed a high
incidence. Furter details regarding diphtheria and a few other diseases are given elsewhere in
this report under separate headings.
It is regretted that in the interests of economy it has not been possible to include in our
annual report many of the tables and graphs which it was formerly the custom to publish. To
any one wishing to make further studies of questions relating to reportable diseases of this
Province, however, detailed information from our files will be available on request.
Again I wish to express appreciation of the co-operation shown by members of the medical
profession, who have faithfully continued to make returns to this Department regarding the
incidence of reportable diseases. More than 92 per cent, of the weekly report-cards sent, out
from this Department are being filled in and returned. It is not very far from 92 to 100 per
cent., which is the objective we hope eventually to reach.
Reportable Disease Incidence by Months, with Morbidity Rate, British Columbia, 1933.
Disease.
a
rts
u
1
'£
<
r\
3
a
3
H-5
>>
3
ti
H
01
m
O
o
rn
Q
O
Morbidity
Rate per
100,000
Population.
Actinomycosis	
30
1
194
2
8
2
181
7
8
296
7
8
2
392
3
4
259
1
1
2
286
1
3
272
1
1
10
57
2
6
50
2
3
138
1
6
2
298
4
8
275
1
2
96
7
2,698
32
0 28
Botulism	
13 44
Cerebrospinal meningitis
0.98
377 87
Conjunctivitis	
4.48 BOARD OF HEALTH REPORT, 1933.
Z 7
Reportable Disease Incidence by Months, with Morbidity Rate—Continued.
Disease.
a
3
1-5
rO
91
fe
J3
Zr
ti
5!
Pi
•A
3
q
s
H5
>>
"3
1-3
bi)
S
rJ
&
m
O
>
o
r?
cj
OJ
fi
rt
o
hi
Morbidity
Rate per
100,000
Population.
3
5
1,349
104
57
1
10
10
5
40
7
9
76
4
134
4
1
6
1
122
1
176
39
2
5
2
1
1
36
12
54
77
5
79
3
28
22
55
86
15
9
1
1
39
13
6
123
3
94
7
1
5
32
16
10
145
1
14
9
1
17
7
6
9
147
9
62
5
1
2
63
18
11
127
3
5
2
1
26
5
1
26
82
9
64
6
6
133
92
9
79
5
8
1
1
75
6
1
43
76
8
1
90
4
8
27
131
1
1
48
8
6
1
2
45
3
1
24
98
4
1
116
2
1
2
13
13
2
10
3
5
2
17
31
25
74
4
1
27
1
1
11
11
39
6
30
3
11
5
65.
15
38
83
10
82
1
2
10
30
16
4
122
2
10
9
2
1
151
23
4
62
3
68
4
4
21
44
1
1
136
1
7
8
1
239
9
21
86
9
79
10
5
169
18
152
15
10
8
263
5
1
3
79
3
1
42
33
9
2
72
364
2,031
2
1
397
1,031
5
95
95
28
5
6
1,013
136
8
2
262
1,063
71
4
937
4.62
1.26
0.28
10.08
50.98
Influenza (epidemic)	
284.45
0.28
0.14
55.60
144.40
0.70
13.30
Pneumonia (broncho)	
Pneumonia  (unspecified)
13.30
3.92
0.70
Puerperal septicaemia	
0.84
141.88
Septic sore throat	
19.05
1.12
0.28
36.69
Tuberculosis	
Typhoid fever	
148.88
9.94
0.56
Whooping-cough	
131.23
Totals    ...
2,041
822
809
903
715
930
805
302
469
662
981
1,068
10,507
Rates for 1933 are based on an estimated population of 714,000.
ANTHRAX.
Of the two cases of anthrax which occurred, one developing in Vancouver was a case of
malignant pustule on the shaving area of the face, and a shaving-brush was suspected as the
source of infection, although subsequent laboratory examination failed to demonstrate the
organism in the brush. The other case was reported from Cranbrook, but no details could be
obtained.
DIPHTHERIA.
As previously mentioned in this report, marked progress has been made in the reduction of
diphtheria, the number of cases having been reduced steadily since 1929 from the high figure of
815 cases to only 33 cases for 1933. This is much the lowest diphtheria incidence that has been
recorded in British Columbia during the past fifteen years at least, and can be attributed to
only one thing—namely, the artificial immunization of large numbers of persons, particularly
children, by the use of diphtheria toxoid, large-scale administration of which was begun in 1929,
particularly in the City of Vancouver. That the disease still occurs in virulent type is shown
by the fact that 15 per cent, of the cases which occurred during the year proved fatal.
It is clear that the use of toxoid has been the means of saving numerous lives as well as
much unnecessary suffering, and, in addition, has been the means of saving thousands of dollars
to the taxpayers of this Province. The average morbidity rate for the previous fifteen years
was nearly 72 per 100,000 population, and at that rate we should have expected well over 500
cases of diphtheria instead of the 33 which did occur during 1933. At an average estimated cost
of $50 for each case, this means a saving of about $25,000 during the one year alone. LEPROSY.
Both cases of leprosy discovered during the year were Chinese, who had no doubt contracted
the disease before coming to this country. They were removed to the Lazaretto at Bentinck
Island.
MEASLES.
Measles reached a low point throughout the Province generally, over 300 of the cases being
in the Crowsnest area, which had been missed by the general epidemic of the previous year.
MUMPS.
This is a disease which is considered by some to be not highly infectious, but our experience
has shown it to possess a high degree of transmissibility. During the last five years we have
had an average of 1,473 cases reported annually. Unfortunately we have no method of immunizing against mumps, and on account of the negligible mortality rate and the few serious
complications which develop it is difficult to obtain proper observance of the necessary precautions to prevent it spreading.
POLIOMYELITIS.
Only five cases of poliomyelitis were reported during the year, and, rather curiously, none of
these occurred after the month of August. The weather during the late summer and early fall
was not what we would consider, unfavourable to the disease, and why the incidence has
remained so low during the last two years one cannot say.
SCARLET FEVER.
Scarlet fever has continued to give us considerable trouble in various parts of the Province,
the incidence being considerably higher than the previous year. All but a few of the cases have
been mild in type as far as can be ascertained, and cases have been noted in which sore throat
and general malaise with slight fever were the only symptoms. Other cases had only a faint
evanescent rash with mild throat symptoms, and it is often not until the development of scarlet
fever amongst contacts that such cases are detected. The very mildness of the disease has been
responsible for its continued prevalence and difficulty in control.
SMALLPOX.
Although eight cases of smallpox are included in our report, five of these were taken from
boats arriving from the Orient at William Head Quarantine Station and were isolated at this
point. Four of the cases on one boat were just beginning to develop suspicious symptoms on
arrival of the ship, which was more than three weeks out from an Oriental port—rather a
lengthy incubation period for smallpox. As the cases developed, however, and the diagnosis
became certain, the information was elicited that one of their comrades had a mild disease with
a few skin-spots about a week after leaving Shanghai and his illness was so slight that nothing
serious was thought of. There is no doubt that this mild case passed the infection on to the
other four men, all of wThom had the disease in a more severe form, ending fatally in two of
them.
The other two cases which occurred during the year were in the City of Victoria, both of
the purpuric type and both died. The first case was a small Chinese boy, and no contact with
smallpox could be traced. He developed the purpuric form of rash, making the diagnosis
difficult, and although a second case developed, we were fortunate that it did not spread further,
as a large proportion of the population of Victoria remains unvaccinated in spite of such
warnings.
As far as could be ascertained, the Chinese boy obtained his infection from infected articles
which had recently arrived from China.
Such outbreaks point to the need of continued vaccination and revaccination at reasonable
intervals in order to avoid smallpox.
TRACHOMA.
Out of the 262 cases of trachoma reported, 241 were Indians, 7 Orientals, and 14 white. As
last year, the large number is due chiefly to the survey that was being made of the Indian tribes
in British Columbia by Dr. Wall, of the Federal Department for Indian Affairs. BOARD OF HEALTH REPORT, 1933. Z 9
Eleven of the fourteen white cases were reported from Kamloops, Williams Lake, and
Vanderhoof, while the remaining three were from Cranbrook and Fernie.
TUBERCULOSIS.
The number of cases of tuberculosis reported has risen steadily during the last five years,
from 267 in 1929 to 1,083 in 1933. This is indicative of the increased activity throughout the
Province in tracing up contacts of known cases, and is partly due to the work of the Provincial
Travelling Chest Clinic and partly to the activity of the Vancouver Health Department, 800 of
the total cases being reported from the latter centre. In this way numerous cases are discovered during the early stages and given the proper advice and treatment, so that there is not
only a greater chance of cure in most cases, but also (which is probably more important) a
greatly lessened danger of transmitting the disease to others.
TYPHOID FEVER.
Most of the typhoid fever was in sporadic cases, obtaining their infection probably from
chronic carriers, although in these single cases it is very difficult to trace the source of infection.
One small epidemic occurred near New Westminster, in which all the victims were boys under
12 years of age, and our investigations showed that they had all been playing in the waters of
a small stream. A short distance up this stream two or more homes were depositing faecal
matter directly into this stream, and some typhoid carrier no doubt had used these toilets,
infecting the water with the typhoid organisms leading to the illness of several boys who became
infected during their play. No further cases developed after clearing up the unsanitary condition
mentioned.
A further small epidemic occurred amongst the Indians at Kincolith—the first case apparently becoming infected from some carrier during the fish-canning season (when Indians from
different villages congregate together), and subsequent contact cases developing. The disease
was brought under control by the use of anti-typhoid vaccine and the careful isolation of cases.
FOOD-POISONING.
It is seldom that cases of food-poisoning occur in this Province, but during the month of
September six cases occurred amongst Indian children near Vernon, three of whom died.
The Provincial Board of Health Laboratory at Kelowna was able to demonstrate the
causative organism as B. enteritidis, but the actual source of the infection could not be clearly
determined. Five of the six cases belonged to one family, and the other case was closely related
to the above family and there had been intermingling. The Indians live rather carelessly and
have a tendency to eat food improperly cooked, making such illnesses amongst them more
probable than amongst the white population.
ENDEMIC GOITRE.
The Report of the Medical Inspection of Schools for the year ended June 30th, 1933, shows
that 6.11 per cent, of the pupils, or 6,319 out of the total number of 103,412 who were examined,
were affected with goitre. This is an increase of 1.08 per cent. The three statistical areas
showing the highest incidence are, in the order named, Areas 10c, 8a, and 3, with figures of
21.46, 19.80, and 19.28 respectively. These three areas are comprised, roughly speaking, of the
areas of Peace River, Prince George-Williams Lake, and Okanagan-Kamloops.
As mentioned in my last annual report, efforts have been made to have iodine in the form
of palatable tablets administered systematically to the school-children where the goitre incidence
is high. In many of the schools iodine prophylaxis is now being used, and some of the School
Medical Inspectors have already stated that the results have been excellent, although it will take
a period of years to demonstrate fully the value of such treatment.
I have, etc.,
A. M. Menzies, M.D., D.P.H.,
Acting-Epidemiologist, Provincial Board of Health. Z 10
BRITISH COLUMBIA.
VANCOUVER LABORATORY.
Vancouver, B.C., December 30th, 1933.
H. E. Young, M.D., CM., LL.D.,
Provincial Health Officer, Victoria, B.C.
Sir,—I have the honour to present herein the annual report for the year 1933 of the Provincial Board of Health Laboratories at Vancouver, B.C.
The staff consists of Director (part time), Assistant Director and Chemist, Chief Bacteriologist, three technicians, two record clerks, a media-maker, two women cleaners, and a janitor
—twelve in all.
The total number of specimens done during the year are tabulated below:—
Examinations, 1933.
Out-of-town
Specimens.
City.
Total.
Animal inoculation	
Diphtheria virulence	
Blood agglutination—
T.A.B. Bang, 3 dil.  (or more)...	
T.A.B. Bang, 1 dil	
T.A.B.S.F. Bang, 3 dil.   (or more)	
Typhoid, 1 dil	
Sonne bacilli agglutination	
Cultures—
Aerobic	
Anaerobic	
Spinal fluid	
Typhoid group	
Diphtheria, routine	
Diphtheria, school	
Haemolytic strep	
Smears—
Gonococci	
T.B. sputum	
T.B. spinal fluid	
T.B. urine	
T.B. pleuritic fluid	
T.B., miscellaneous	
Vincent's angina	
Spirochaeta pallida	
Ringworm	
Faeces for parasites	
Faeces for occult blood	
Direct smear for diphtheria	
Spinal fluid—
Routine, count, globulin, Fehling's	
Protein	
Chlorides	
Sugar	
Colloidal gold	
Kahn—
Blood	
Spinal fluid	
Milk-count	
Milk, B. coli	
Milk-count and B. coli	
Water-count	
Water, B. coli	
Water-count and B. coli	
Convalescent serum—
Measles (treatments sent out, 5 cc. each).
Polio	
Vaccine, typhoid-paratyphoid	
Malarial smear	
Miscellaneous	
269
90
48
6
16
3
24
303
24
677
351
3
8
4
11
2
1
2
7
14
1
4
1,838
52
109
Totals..
406
9
6
1
2
53
4,368
44
16
1,168
24
300
162
1
43
3
144
6,366
220
404
5,790
4,230
3
48
5
18
667
27
126
39
4
44
31
165
18,687
631
1,420
10
248
4
5
2
68
61
16
1,437
114
348
168
1
59
6
5
168
6,669
220
428
6,467
4,581
6
56
9
29
669
28
128
46
4
46
45
1
169
20,525
683
1,529
416
257
41,167
4
121
45,535 BOARD OF HEALTH REPORT, 1933. Z 11
Besides the routine work, the staff has been engaged in the following special investigations :—
Miss V. Hudson:  Continuation of " B. coli in Milk."
Miss D. Kerr:   " Intestinal Flora of Seagulls."
Due to the increase in routine examinations and some changes in the technique, less time has
been available for special work during the year.
Respectfully submitted.
H. W. Hill, M.D.,
Director, Provincial Board of Health Laboratories.
SANITAKY INSPECTION.
Victoria; B.C., December 30th, 1933.
H. E. Young, M.D.. CM., LL.D.,
Provincial Health Officer, Victoria, B.C
Sik,—I have the honour to submit my Twenty-third Annual Report on general sanitary
conditions for the Province of British Columbia.
The year just past was remarkable for general good health and immunity from contagious
diseases, and some credit could be claimed for it as a result of years of sanitational propaganda
by this Department. This applies most especially to our industrial camps in the remote and
unorganized districts, where frequent inspection visits are made by the Provincial Police officers
and the writer.
It is pleasing to be able to report unmistakable signs that we are rapidly passing beyond
the depression. Logging camps are again as numerous as ever. Mills are busy. Employees
complain of low wages and employers complain of very low prices through foreign competition,
but all agree to the fact that industrial improvement is here. No complaint is heard of poor
food at the camps and accommodation in general is good. Occasionally we hear of insanitary
or overcrowded conditions, which are usually corrected without, recourse to Law Courts.
The remarkable mining development has necessitated much travel for the writer. New
camps and villages are springing up, and old towns like Barkerville are again " putting on airs."
Septic tanks, bath-tubs, and electric light are in vogue, and the residents at remote parts are
sceptical of their drinking-water until it has been passed upon by this Department. This is
welcome work, inasmuch as we are aware of the lack of water-borne sickness throughout the
Province.
Our nuisance department' has been engaged during 1933 with the suppression of industrial
odours and pollution of streams, and more work awaits us pending climatic conditions.
SUMMER RESORTS.
The numerous summer resorts scattered on our Coast and Islands were very well patronized
during 1933. These places are chiefly in unorganized districts and are visited by your Inspector
frequently. No sickness was reported, and the adult population at these resorts show hearty
co-operation in safeguarding water-supply and proper disposal of wastes.
FRUIT AND VEGETABLE CANNERIES.
The majority of these canneries are located in " sunny Okanagan." The departmental regulations enforced at these establishments have proved to be quite satisfactory. Train-loads of
processed and canned fruit and vegetables have been shipped from this Province and have,
through the excellence of flavour and care in packing, created a favourable demand from many
parts of the world. Grown, picked, and prepared under most exceptional climatic and sanitary
conditions, with Government supervision, it would indeed be difficult to predict the future limit
of demand for British Columbia food products. Z 12 BRITISH COLUMBIA.
SHELL-FISH.
The term " shell-fish " includes clams, mussels, cockles, scallops, shrimps, and oysters. The
latter, being by far the most nutritive and popular, merits chief attention.
The British Columbia Coast is proving to be a great surprise for those commercially or
otherwise interested in oyster-culture. A recent preliminary survey by your Sanitary Inspector
shows wonderful possibilities of almost unlimited areas lying along the shores of our many
inlets and islands between Queen Charlotte Sound and the 49th parallel. Ninety-nine per cent,
of these areas are immune from probable pollution.
One far-sighted and progressive canneryman canned some 300 cases of oysters during 1933.
with very gratifying results. These were subjected to our laboratory tests and in every test
proved highly satisfactory. In the past British Columbia has imported an average of 1,000 cases
annually for local consumption. From now on it is safe to predict that this importation will be
supplanted by the local and improved article, which is graded into three sizes—small, medium,
and large. They are grown in sheltered and clean water about 1 mile from the cannery-
Arrangements are already under way whereby the oysters will be gathered, washed, and
shucked under the most approved sanitary methods.
The cultivation and propagation of oysters require considerable patience, hard work, and
study, and occasionally the ideas of our experts will be jolted by a press report like the following
from a prominent local daily:—
"Seattle, Jan. 22.— (AP)—The oyster, whose normal food-supply was cut off for ten
months, during which it grew fatter day by day, furnished scientists a bivalve mystery here
to-day.
" Professor Trevor Kincaid, of the Department of Zoology at the University of Washington,
said it may change all existing ideas of commercial oyster-culture, since the oysters, perhaps,
have been silently spurning ' free lunches ' the producers offer to fatten them.
" Mystery deepens.—The professor, who gained fame in the oyster world by ' naturalizing '
Japanese oysters until they have become good North American mollusks, said he locked 100
oysters in a 6-foot tank of clear water, cut off their normal food-supply for ten months—and
they grew fatter every day.
" ' It is a mystery what they feed upon,' he said. ' I opened one after the period of " starvation " and found it delicious.'
" All these years, he said, the men who grow oysters for commercial purposes have watched
the food-supply around their oyster-beds very carefully, in the belief they needed dactoms, larvae,
algse spores, and other microscopic life.
" The oysters fooled the professor, he said, apparently by living on bacteria, despite the fact
that he had killed all the plant-life supposed to have been their diet."
It is safe to predict a surprisingly bright future for oyster cultivation in British Columbia,
and a good feature, welcomed by this Department, is the voluntary co-operation of our oyster-
growers to see that their future is not jeopardized by the slightest insanitary menace. Specimens of oysters and overlying waters are periodically taken from each area for laboratory tests.
Also surrounding foreshores and operating equipment are frequently inspected. In this connection, and with frequent calls for watershed investigation, the efficiency of our own laboratory
proves it a most valuable adjunct to this Department.
SALMON-CANNERIES.
Salmon-canneries on the British Columbia Coast had a fairly good season. The favourite
sockeye did not materialize as heavily as in 3932, but its loss was more than made up by heavy
runs of the edible spring, cohoe, and blueback. The general runs were steady throughout the
season, so that in the canneries no glut nor dearth in canning and cooking was experienced.
Whilst these canneries are under continued observation as to fish-handling and general
sanitary conditions, the operators appear to vie with each other as to the general sanitary condition and appearance of their canneries inside and out. Stale fish are never accepted. The
cutting, filling, and cooking is done by most ingenious machinery, scrupulously clean and free
from rust. From the time the fish leave the water to the period of packing for export, it is
handled in the most cleanly method and protected from any possible contamination.
The work of this Department has been carried on in a systematic manner, and I am glad to
report the existence of a hearty co-operation on the part of both employers and employees, which BOARD OF HEALTH REPORT, 1933. Z 13
means much in the evidence of improvement of conditions *in general, to merit commendation
from all sides, and thus making my work much pleasanter.
The departmental files should be consulted in order to obtain a better idea of the scope of
work carried on by the Sanitary Division of your Department.
I have, etc.,
Frank DeGrey,
Chief Sanitary Officer.
COMBINED REPORT OF TRAVELLING MEDICAL HEALTH OFFICER
AND INSPECTOR OF HOSPITALS.
Provincial Board of Health,
Victoria, B.C., December 30th, 1933.
II. E. Young, M.D., CM., LL.D.,
Provincial Health Officer, Victoria, B.C.
Sir,—I have the honour to submit my Tenth Annual Report as Travelling Medical Health
Officer and Inspector of Hospitals for the Province.    This report covers the calendar year 1933.
One of the outstanding events of the year was the annual meeting of the National or American Tuberculosis Association in Toronto, combined with the Sanatorium Officers' Association
and Tuberculosis Secretaries' Association. This was the first time this Association had met
outside the United States. An excellent programme had been prepared, and was carried out in
the commodious and comfortable surroundings of the Royal York Hotel from June 26th to June
30th. Present as guests from Great Britain were Sir Humphrey Rolleston, Emeritus Regius
Professor of Physics, Cambridge University, and Dr. Lyall Gumming, of Cardiff, Wales, both
authorities on tuberculosis and the latter particularly on silicosis. These two notables presented
several papers and took an active part in the discussion of other papers. I deem it a great
privilege, along with Dr. A. D. Lapp, to have been able to attend this meeting as representing
British Columbia. Also the week previous I was able to attend the annual meeting of the
Canadian Medical Association and the New Brunswick Hospital Association in St. John, N.B.
CLINICAL WORK.
For the tenth consecutive year I have the privilege of recording an increasing number of
examinations made at our clinics, this year reaching a grand total of 3,247, as against 2,989 last
year. This increase has taken place each year in the last few years in spite of the fact that each
year we have thought that the handling of more cases would be impossible. It has been made
possible this last year, however, by the increasing size of the clinics in the larger centres,
particularly in New Westminster, chiefly by the addition of many cases from Burnaby Municipality. This latter district was formerly served by the stationary clinic in Vancouver. Unfortunately, this has somewhat restricted our clinics in the less populous districts; in the East
Kootenay only one visit was made instead of two as formerly.
It will be seen that there has been an increase both in the number of new cases examined
and in the number of re-examinations, with a greater proportionate increase in the latter. This
latter condition is due largely, as stated last year, to the policy of our Sanatorium of discharging
patients as early as possible to their homes, in order to get a greater turnover, and thus give a
greater number of patients the benefit of Sanatorium treatment and education. The more
rapidly patients are discharged from sanatoria, the more cases there are for supervision of the
Travelling Clinic.
Then, too, I believe the standard of home treatment has greatly improved during the last
few years. With the increased interest of the medical profession in tuberculosis, " to a certain
extent fostered by clinics," aided often by Public Health Nurses, and with a full check-up, both
physical and X-ray, as frequently as possible at the clinic, excellent results have been obtained
in many cases. Z 14
BRITISH COLUMBIA.
While I am still strongly impressed with the advantage of at least a short Sanatorium
treatment, we must impress upon our patients the good results that can be obtained at home
under good conditions and if properly supervised.
The total number of examinations made during the year was 3,247. Of these, 2,017 were
new cases and 1,230 were re-examinations.
Comparative Report.
Year.
New Cases.
Reexaminations.
New T.B.'s,
Pulmonary and
Hylus only.
1923-24 	
240
342
390
478
377
701
1,222
1,629
1,915
703
2,017
40
36
40
178
290
557
694
1,074
419
1,230
114
82
1924-25	
1925-26	
1926-27       .   ..
109
1927-28	
110
1928-29	
1929-30  	
117
1930-31	
1931-32	
1932 (Aug. 1st to Dec. 31st)                  	
222
242
82
1933	
203
Totals	
10,014
4,558
1,544
Total number of new cases  10,014
Total number of new eases, hylar and pulmonary tuberculosis     1,544
Total number of examinations, old and new   14,572
The 2,017 new cases may be classified as follows:—
Positive tuberculosis—
Pulmonary     196
Hylus 	
Empyema 	
Bones  	
Peritonitis 	
Pleurisy 	
Mediastinitis	
Eye 	
Erythema induratum
Cervical adenitis      15
239
144
442
Suspects 	
Other chest conditions 	
Other diagnosis       272
Negative findings      920
2,017
The 442 " other chest conditions " in the above table include peribronchitis, bronchitis,
bronchial asthma, bronchiectasis, emphysema, pleurisy, pneumonia, empyema, lung-abscess,
silicosis, pneumoconiosis, mediastinitis, malignancy, foreign body in chest, and T.B. infection
but not disease.
A few facts in the above table require further comment. The total new positive T.B. cases
found in 1933 were less than the year previous, in spite of the fact that a much larger number
of cases were examined. This, we hope, is due to less cases developing. Whether or not this
is so, we know that it does show a greater searching-out of the cases that exist, and as these
cases practically all come through the family doctors, it shows a greater interest in tuberculosis
by them, something very gratifying that I have alluded to in former reports. I have always felt
that the smaller the percentage of positive cases found at a clinic, the more satisfactory the
clinic, as indicating the tendency to take nothing for granted. BOARD OF HEALTH REPORT, 1933. Z 15
The large number of suspects again calls for comment. For many of them it means some
physical findings or symptoms, such as slight spitting of blood, indefinite history of pleurisy
without any findings, etc., that would seem to justify a repeat examination. So we say that
we suspect that many of them are not tuberculous. This is further borne out by our findings
on re-examination. Of all the suspects re-examined last year, in only eleven cases was the
diagnosis changed—one to hylus tuberculosis, four to pulmonary tuberculosis non-active, and
six to negative.
Only three of fifty-four cases of pleurisy examined were put in the positively tuberculous
column; in two of them bacilli were found in the exudate. Of the other fifty-one, it was not
possible to distinguish between the tuberculous and the idiopathic—if there be such—with any
degree of certainty. Realizing that the great majority of them have a tuberculous foundation,
they are all specially listed, as described in last year's report, and are followed up from time
to time.
We are beginning this year to check up on all the pleurisy cases listed in our files. Up to
the beginning of last year we had over 1,000 cases. We are hoping for active co-operation of the
doctors in this.    We should get some information of value.
Amongst the non-tuberculous cases, one is struck by the number of cases of bronchitis (188).
Amongst the presumed cases of chronic bronchitis, we frequently find a chronic tubercular case
that has been the source of infection for others. The findings of a few such tubercular cases in
combination with bronchial asthma has stimulated the examination of these cases, until this
year sixty cases were examined.
Of the above new cases examined (2,017), 397 cases were examined not because of any
illness, but because of being, or living, in contact with some open case of tuberculosis. Diagnoses
in these cases were as follows: Positively pulmonary tuberculosis, 20; hylus tuberculosis, 4;
adenitis, 2 ; suspects, 52 ; bronchitis, 9; bronchial asthma, 4; peribronchitis, 3; pleurisy, 1;
T.B. infection, not disease, 13;  other diagnosis, 32;  and negative findings, 257.
The total number of contacts shows a considerable increase over last year. This is not
surprising, as all our educational propaganda has been to teach people that tuberculosis is
spread by direct contact for the most part, and if we are to get early cases we must go out
looking for them in families where the disease already exists. For every such case there is the
double problem—namely, "From whom did this case come (usually found in older .generation),
and to whom has the case already spread the infection (generally in the same or younger
generation)." Doctors, my own nurse, and Public Health Nurses are all on the alert for such
cases. Here the X-ray is of inestimable value in diagnosis. In addition, it is a permanent
record that can be referred to if anything should develop later.
Very gratifying is the fact that the number of positive cases among these contacts is both
actually and relatively lessened this year. This is one of the most interesting parts of our
work, as well as, I believe, the most profitable.
The report of cases returning for re-examination is as follows: Of 1,230 such cases, 491 were
pulmonary or hylar tuberculosis; T.B. bones, 2; suspects, 103; T.B. infection, not disease, 28;
tuberculous cervical adenitis, 7; tuberculous peritonitis, 7; 235 as various non-tuberculous
findings (the most important of which are pleurisy, peribronchitis, bronchitis, bronchial asthma,
bronchiectasis, pneumonia, mediastinitis, empyema, silicosis, lung-abscess, and emphysema) ;
and 357 as negative.
There were 360 contact cases who returned for re-examination, and of these 60 were found
to be pulmonary or hylar tuberculosis; T.B. bones, 1; suspects, 53; T.B. infection, not disease,
23; tuberculous cervical adenitis, 4; other diagnosis, 24 (including pleurisy, peribronchitis,
bronchitis, and mediastinitis) ;  and 195 as negative.
Many of the cases in these last two groups are the cases referred to earlier in this report as
having been in the Sanatorium and discharged, or having been treated at home entirely, or
general hospital and home. It is amongst these cases and in the search for contacts that our
work is unlimited and makes extension of our facilities so necessary.
Classifying the new positive T.B. cases (pulmonary and hylus T.B. only) according to
nationality, making 203 in all, gives us the following: Born in British Columbia, 56, of whom
9 were Indians ; other Canadian Provinces, 47 ; British Isles, 61; other European countries, 17;
United States of America, 8 ;  Peru, 1;  Japan, 1;  China, 5 ;  and doubtful, 7. Z 16
BRITISH COLUMBIA.
Of the 203 positive cases of T.B. diagnosis, 13, or 6.4 per cent., had resided in British
Columbia less than three years.    The origin of these is as follows :—
Under 1 year—
Other Canadian Provinces     1
British     1
Foreign    *     1
     Q
From 1 to 2 years—
Other Canadian Provinces 	
British  •.     4
Foreign        2
From 2 to 3 years—
Other Canadian Provinces   1
British  1
Foreign    ;  2
-    4
Total  13
This is a smaller percentage than formerly and does not represent actual conditions in the
Province. Most of the influx is to the City of Vancouver, which is not included in this report.
Relief cases will be referred to later.
NURSING AND X-RAY SERVICES.
As with the total number of patients, so the total number of X-rays were increased from
2,467 to 2,534; this in spite of the fact that we endeavoured to curtail the number of X-rays for
economic reasons.
The financial result of the Christmas-seal sale has been affected by the difficult tinles and
has fallen off slightly, so that the rt, ":s are not quite up to our expenditure. From this fund
is paid the salary and expenses o ne Clinic Nurse, X-ray films, and other X-ray expenses.
Also from this fund is supplied gauze and sputum-boxes to those unable to obtain them otherwise.
The health exhibit was put on again at the Vancouver Exhibition. This was made possible
by co-operation with the Vancouver Chest Clinic, their nurses assisting Miss Peters and thus
obviating extra paid help that we did not feel we could afford.
Comparative Report.
1928-29.
1929-30.
1930-31.
1931-32.
Aug. 1 to
Dec. 31,
1932.
1933.
991
290
701
117
10
93
479
1,779
557
1,222
186
34
137
863
2,323
694
1,629
222
25
137
1,245
2,989
1,074
1,915
242
21
119
1,533
1,122
419
703
82
15
48
553
3 247
1,230
2 017
Positive pulmonary T.B. (new)....
203
36
144
1,634
Chinese, British Columbia.
Year.
Deaths from
Tuberculosis.
Deaths,
all Causes.
T.B. Rate per
Cent., all
Deaths.
Population.
T.B. Rate
per 1,000
Population.
1922	
64
50
45
43
38
52
30
232
211
224
258
210
210
204
27.58
23.69
20.08
16.66
18.09
25.00
14.70
23,600
25,500
26,000
26,400
26,900
27,391
27,139
2.71
1927	
1928	
1 73
1929	
1930    	
1.41
1.89
1 10
1931	
1932	
■ BOARD OF HEALTH REPORT, 1933.
Z 17
British Columbia Indians.
Year.
Deaths from
Tuberculosis.
Deaths,
all Causes.
T.B. Rate per
Cent., all
Deaths.
Population.
T.B. Rate
per 1,000
Population.
1922	
99
151
175
170
164
165
189
370
524
497
540
491
512
531
26.76
28.81
35.21
31.48
33.40
32.22
35.59
25,694
24,316
24,316
25,107
25,107
25,107
24,599
3.85
1927	
6.20
1928 . .     	
7.19
1929	
6.77
1930       	
6.58
1931     	
6.57
1932     	
7.60
Japanese, British Columbia.
1922	
22
35
27
39
26
38
32
190
209
170
191
169
173
159
11.58
16.74
15.88
20.41
15.38
21.96
20.12
15,806
19,660
20,300
21,000
21,600
22,205
22,500
1.38
1927  	
1.78
1928	
1.33
1929	
1.85
1930  	
1.20
1931  	
1.71
1932     	
1.42
Races other than Chinese, Japanese, and British Columbia Indians.
1922	
322
315
386
363
392
387
314
4,115
4,806
5,019
5,408
5,530
5,219
5,256
7.82
6.55
7.69
6.71
7,08
5.9.  (
475,900
553,524
570,384
586,493
602,393
619,560
629,762
0.67
1927    	
0.56
1928	
0.67
1929 	
0.61
1930 	
0.65
1931  	
0.62
1932   	
0.49
British Columbia, all Races included.
1922	
507
551
633
615
620
642
565
4,907
5,750
5,910
6,397
0,400
6,114
6,150
10.33
9.58
10.79
9.61
9.68
9.58
9.18
541,000
623,000
641,000
659,000
676,000
694,263
704,000
0.93
1927 	
0.88
1928 ..	
0.98
1929 	
0.93
1030      	
0.91
1931	
0.92
1932  	
0.80
During 1933, 72 clinics were held and the total mileage travelled was 9,917. The total cost
of the clinic was $10,169.13, part of which was provided by the Provincial Government and the
balance from the Christmas-seal sale.    The cost per examination, including X-ray, was $3.13.
Since the nurse and the X-ray were added to our armamentarium in 1928, the total number
of patients examined has been 11,717 and the total number of X-rays made, 8,790. During this
time 398 clinics have been held.
THE EDUCATIONAL PART OF THE WORK.
This part of the work, as has been the case for some years, has not been up to what we
would like, due to lack of time. In addition to that carried on in the daily routine by personal
contact with many people, which by the way is by all means the most important, and the distribution of literature, there have been lectures to the following: Nursing staff (graduate),
North Vancouver General Hospital; Public Health Nursing class, University of British Columbia ;
three lectures to undergraduate nurses, Royal Jubilee Hospital, Victoria: two to nurses-in-
training, Royal Columbian Hospital, New Westminster; radio talk at Chilliwack; addresses to
Rotary Clubs at Fernie, Penticton, and Prince Rupert, also to Gyro Club at. latter place; clinics
on cases examined with doctors at Anyox, Prince Rupert. North Vancouver, Trail, and Rossland:
and interviews with manager at Anyox re silicosis;   with Bishop Schofield and Mrs. Ripley re Z 18 BRITISH COLUMBIA.
advisability of opening a school for T.B. Indian children that would otherwise be excluded from
school; also such allied meetings as attendance at lectures of Public Health Group in Vancouver ; interviews with Dr. Inglis re T.B. amongst relief cases; with Dr. Wodehouse in Vancouver re T.B. programme there;  attending annual meeting of the Tranquille Publishing Society.
HOSPITAL INSPECTION.
No public hospitals have closed their doors due to the depression, but some are having great
difficulty in financing. In many cases expenditures have had to be cut unmercifully, but due
largely to the loyalty of staffs, nursing and otherwise, I doubt if efficiency in any case has been
materially impaired. In some cases, however, this has been only possible by allowing repairs
and extensions to buildings and equipment to go by default, and this will ultimately have to be
remedied.
There has been very little new building and very little extension. A new hospital has been
built at Smithers by the Sisters of St. Anne, not before it was badly needed. Some additions
have been made at Bella Coola.
Private hospitals have had a difficult time financially, a few having had to go out of business.
Twenty-five inspections were made of private hospitals or buildings proposed to be used as such.
Thirty-seven licences have been granted during the year, including one new one. Four have
been refused licences.
While not many thorough inspections of public hospitals have taken place, Saltspring Island
being the exception, I have been in close contact with most of them through my clinical work,
and have discussed various hospital matters with presidents and secretaries of Hospital Boards.
In addition, I attended the annual meeting of the Mission Memorial Hospital Association; a
meeting of the North Vancouver Hospital Board along with Miss Randall for discussion of
graduate vs. undergraduate staff; with the president and other members of the Board and staff
of the Kootenay Lake General Hospital, Nelson; and also with the same officials at Trail re
payment for diphtheria cases.
I have had numerous interviews with Dr. Haywood, Dr. Mcintosh, and Miss Randall;
inquiry into the financial difficulties at the Royal Inland Hospital, Kamloops, a report of which
is on file; inquiry re Sunlight Clinic at North Vancouver. Also I attended the meeting of the
B.C. Hospital Association in Victoria, and some sessions of the New Brunswick Hospital Association in St. John, N.B.
GENERAL COMMENTS.
The change in the methods of handling tuberculosis in Vancouver has resulted in much
greater efficiency, I am satisfied. There is now co-operation of all the different departments
under the one head, the City Health Department. The lessened incidence of other infectious
diseases has made possible the use of part of the Isolation Hospital for tuberculous cases, thus
increasing bed capacity. This again relieved the pressure on bed capacity at Tranquille, so that
our waiting-lists have not been so long.
By referring to tables above it will be seen that there was a very marked drop in the death-
rate for tuberculosis in 1932 amongst the white population. I have reason to believe that the
same condition prevailed in 1933, although final figures are not yet available.
I do not see any evidence as yet of any increase in incidence of the disease that could be
said to be due to the effects of four years' hard times. This is due partly at least to the fact
that relief has been given so extensively. It may still show itself in later years. There is one
condition, however, that I can see great possibilities of danger, and that is the tuberculous cases
coming into the Province as transients that are breaking down here, many of them not being
diagnosed until they have been around crowded boarding-houses for some time, and even then,
if not ill, very little segregation carried out. These cases until isolated will be potential
spreaders of the disease. In addition, many of them are going to be a permanent responsibility
of this Province, as they are no longer transients. The same applies to chronic disease amongst
all the relief cases, but tuberculosis is infectious, while others, for the most part, are not.
I am satisfied that we are making progress in our fight against tuberculosis in this Province,
but our fight needs to be intensified, and in no line more than in my own of Travelling Clinics.
There is ample room for at least one more; in fact, it is urgently needed. I have put in the
total approximate cost of the clinic for the last year to give an idea of finances necessary for
such an extension.    Further, we will never have a complete programme here until all tuber- BOARDIDF HEALTH REPORT, 1933. Z 19
culosis services are co-ordinated under one head, preferably,  I believe, under the Provincial
Board of Health, whether supervised by a Commission or directly under Government supervision.
This does not mean that total costs should be borne by the Government, however. I have
not otherwise touched upon the financial aspects of the problem, one that I realize to be very
important at the present time.
Once again I would like to express to you my keen appreciation of the cordial co-operation
and helpful assistance at all times of yourself and staff in this special field of health-work, and
for much timely advice in connection with hospital-work, also to the Lady Superintendents and
staffs of hospitals for their assistance in making our clinics both convenient and efficient, often
at considerable inconvenience.
I have etc.,
A. S. Lamb,
Travelling Medical Health Officer and
Hospital Inspector.
VICTORIA.  B.C. :
Printed by Charles F. Banfield, Printer to the King's Most Excellent Majesty.
1934.
825-434-6911 

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