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PROVINCE OF BRITISH COLUMBIA FORTY-SECOND REPORT OF THE PROVINCIAL BOARD OF HEALTH FOR THE YEAR ENDED… British Columbia. Legislative Assembly [1939]

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 PROVINCE OF BRITISH COLUMBIA
FORTY-SECOND REPORT
OF  THE
PROVINCIAL BOARD OF HEALTH
FOR  THE
TEAE ENDED DECEMBER 31ST
1938
PRINTED  BY
AUTHORITY OF THE LEGISLATIVE ASSEMBLY.
VICTORIA, B.C.:
Printed by Chables F. Banfield, Printer to the King's Most Excellent Majesty.
1939. Provincial Board of Health,
Victoria, B.C., November 27th, 1939.
To His Honour E. W. Hamber,
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 31st, 1938.
G. M. WEIR,
Provincial Secretary. REPORT of the PROVINCIAL BOARD OF HEALTH.
Provincial Board of Health,
Victoria, B.C., November 27th, 1939.
The Honourable G. M. Weir,
Provincial Secretary, Victoria, B.C.
Sir,—I have the honour to submit the Forty-second Annual Report of the Provincial
Board of Health of British Columbia for the year ended December 31st, 1938.
Previous Annual Reports of the Provincial Board of Health have commented on " the
establishment of various branches of the Department to meet the advances in the application
of the principles of prevention as applied to public-health work." This report will continue
this procedure in the form of a commentary on the major highlights of the work.
Formerly it has been the custom to include complete reports of many of the Divisions
but this year, because of length and technical detail which accompany such reports, only
summary extracts will be included herein. The year 1938 has been one of continuous activity
and constant reorganization to meet new problems, and a perusal of some of the reports
referred to below will convince one of the many advances which have been made.
The Division of Vital Statistics continues to be perhaps one of the most important Divisions of the Health Department. It has been fittingly called " the workshop of public health,"
inasmuch as all phases of our work are interrelated to a greater or lesser degree with the
work of this Division. By having all records of all Divisions supervised by this Branch,
marked economies are possible as well as a uniform standardization. The summary report
will show some of the major activities in so far as administration of the Division of Vital
Statistics is concerned.
The Division of Tuberculosis Control has continued to function in an efficient and
thorough manner, and I would particularly commend a reader to Dr. Hatfield's complete
report in regard to the tuberculosis situation in British Golumbia. In this particular field
" every attempt has been made to co-ordinate the Division's work with other health and
welfare activities, and new health and welfare developments throughout the Province, such
as the Greater Vancouver Metropolitan Health Board, the Welfare Field Service, the Vancouver Social Service Department, etc." In regard to Indian work, a co-operative plan is in
effect between the Division of Tuberculosis Control and the Indian Affairs Branch, whereby
the Division of Tuberculosis Control undertakes work for the Indian Affairs Branch on
requisition from that Branch. So far this has been mainly diagnostic work, with a few beds
within the Division being used for the treatment of Indians. This is a definite advance in
relation to the tuberculosis problem, and it is sincerely hoped that this plan may be followed
up and enlarged upon in the near future. The complete report of the Division of Tuberculosis Control is published separately and copies are available to any one who desires them.
The Division of Venereal Disease Control has made marked progress during the past
year. An Advisory Council on Venereal Disease was formed in May, under the chairmanship of the Director, and consisted of representatives of related health and welfare services.
This Council has been of definite benefit in assisting to outline the policies and co-operative
plans of the Division. New legislation and some internal reorganization have gone a long
way to promote efficiency in the carrying-on of this phase of the work. Accurate and useful
records are an essential in any public-health programme and to this venereal disease is no
exception. As a result we now have a collection of statistics which helps to show the problem of venereal disease as it exists in British Columbia to-day. Dr. Williams's complete
report, of which copies are available, is published separately, but the extract below gives
some of the interesting highlights. It is needless to say that it is of vital importance that
the work of this Division continue unabated.
The Division of Laboratories, although heard about much less frequently, still forms one
of the basic pillars on which all public-health work is founded. Dr. Dolman, with his able
and capable staff, has built up a reputation in research-work which is international in scope.
The complete report of this Division is also published separately and I would particularly
point out the tremendous volume of work which is done.    The extract below gives one some HH 4 BRITISH COLUMBIA.
idea of the variety and types of tests which are carried on by the laboratory staff in their
overcrowded quarters. It is hoped that the latter condition may be remedied in the near
future.
The complete report of the Chief Sanitary Inspector is included and shows a continuance
of the close inspections which have been carried out in relation to the lumber, mining, and
fishing industries, as well as auto tourist camps and summer resorts. The shell-fish industry
has been the subject of continued attention this year, as it is realized that only by constant
and careful supervision, as well as education, of all people engaged, will a safe product result.
A table is included herein showing the number of reported cases of notifiable diseases.
The year 1938 was characterized by a small number of such diseases, there being only 13,869
reported for the calendar year. The effectiveness of the programme of immunization against
preventable diseases, such as diphtheria, is shown by the continued decline in the number of
cases. Only seventeen cases of diphtheria occurred last year. Poliomyelitis showed an
increase from twenty-six cases in 1937 to forty-three in 1938. Fortunately, however,
paralysis, when it did occur, was quite limited in extent in the majority of cases.
The public-health nursing-work has continued with excellent results. There have been a
number of changes of staff during the year, but in each case of a vacancy we have been able
to supply qualified personnel. The policy determined upon, in British Columbia, that only
trained personnel will be employed has at times given some difficulty in securing new staff,
but in general the results have shown the value of the procedure adopted. During the year
we were fortunate in having a Public Health Nursing Service established at Port Alberni,
and plans are under consideration for the developing of a similar service in the Quesnel
District and also the South Kootenay District.
The annual Refresher Course for Public Health Nurses was held in April. The majority
of the Public Health Nurses were able to attend and all derived much benefit from it. An
interesting programme was presented and the talks and addresses given were provocative of
much stimulating discussion.
As in previous years, the Department has given financial assistance in the matter of
dental care for school and pre-school children in certain of the rural and more remote areas
of the Province. During 1938 assistance in various ways was given to thirty-three centres
in the Province and more than 5,000 school and pre-school children received the benefits of
dental care. If it were not for such assistance the majority of such children would receive
little or no dental attention, with consequent detrimental effects on their health. It is indeed
gratifying to see the improved health which results when these deserving youngsters are
given the benefits of modern dental hygiene.
Each year that goes by serves to further emphasize the value of full-time health-work.
Only as the different areas of the Province become supervised by full-time Health Units will
the complete benefits of health-work and preventive medicine be realized. A complete report
of the work of the Fraser Valley Health Unit for 1938 is included. This report is typical
of the work that is going on in several districts throughout our Province.
The Greater Vancouver Area is one such district, in which almost 50 per cent, of our
population enjoys the benefits of full-time public health administration. The organization of
the Greater Vancouver Metropolitan Health Board and the local health services provided
have been described before. The work has been going steadily forward with the results
becoming more evident all the time. It is anticipated that a complete report will be available
in the near future. Included herein is an extract from the Annual Report of the Senior
Medical Health Officer, which gives a general idea of the scope of the work. It is a matter
of pride to the Department to be able to state that this unique health administration experiment has been favourably commented upon by a number of health administrators both in
Canada and the United States.
We are particularly pleased to be able to say that the spring of 1938 saw the beginning
of a Sylvatic Plague and Rocky Mountain Spotted Fever Survey in British Columbia, the
need for such a survey in our Province had been becoming more evident all the time. The
work was in the nature of a co-operative effort between the Provincial Board of Health and
the Dominion Department of Pensions and National Health. The Board was assisted by a
grant from the International Health Division of the Rockefeller Foundation. Valuable
assistance was also provided by the Entomological Branch of the Dominion Department of
Agriculture.    A specially trained field crew was employed and the bulk of the work carried BOARD OF HEALTH REPORT, 1938.
HH 5
out in the Southern Okanagan and Kootenay Districts. This survey will be continued during 1939 and it would appear that the results so far have justified the expense and effort
involved. Over 4,000 rodents and more than 6,000 rodent fleas were examined during the
season's work. During the months of August and September the survey crew carried out
rat collections in the seaports of Vancouver and New Westminster. Plague infection was not
found in any of the rodents or rodent fleas examined; and while this is encouraging it does
not warrant a relaxation of vigilance, since failure to encounter infection during any one
season or seasons does not preclude the presence of the plague bacillus.
I would like to take this opportunity of expressing to you, Sir, the thanks of all members
of the Board for the support which you have given to all of us in our work. Your encouragement has been a pleasure, indeed, and has gone a long way to assist in the advances which
are being made.
Thanks must also be expressed to the Commissioner of the Provincial Police. The unfailing efforts of his staff to assist us in the rural areas of the Province has been of tremendous
help and is much appreciated.
I have the honour to be,
Sir,
Your obedient servant,
J. S. CULL,
Acting Provincial Health Officer.
The distribution of vaccines and sera by the Provincial Board of Health continues to
show an increase in those required for preventive work and a decrease in the curative branch,
as is indicated in the following table:—
1938.
Smallpox vaccine (points)	
Diphtheria antitoxin (units)  	
Diphtheria toxoid (doses)	
Schick test for diphtheria (pkgs.).. 	
Scarlet fever antitoxin (prophylactic)  (pkgs.) —
Scarlet fever antitoxin (treatment)  (pkgs.)	
Dick test for scarlet fever (pkgs.)	
Scarlet fever toxin for active immunization (doses).
Typhoid vaccine (doses)   	
Tetanus antitoxin (units)  	
Anti-meningococcus serum 20 cc. (pkgs.)	
Pertussis (whooping-cough) vaccine (pkgs.).
4,650
4,689,000
1,793
64
841
281
60
437,000
82
126
8,631
2,600,000
2,991
58
357
151
51
863
461
1,398,500
73
52
5,817
4,181,000
3,767
89
880
324
248
2,637
1,044
774,000
117
46
10,321
3,719,000
6,934
70
378
230
179
2,087
1,426
691,500
112
74
12,634
2,606,000
6,814
98
444
272
302
4,251
4,090
920,000
65
460
We append an account of approvals for sanitary works during the year 1938:—
Cemetery-sites approved.—-Lillooet, Hatzic, Kamloops, Telkwa, Quesnel, Burnaby (Oak
View Burial Park extension), Naramata (private cemetery on Paradise Ranch), and Bella
Bella  (Meadow Island cemetery).
Sewage-disposal Systems approved.—Burnaby (extensions) and Trail (extensions).
Water-supply Systems approved.—Revelstoke  (renewals)   and Summerland  (renewals). HH 6
BRITISH COLUMBIA.
GENERAL REPORTS.
EXTRACT FROM ANNUAL REPORT OF THE DIVISION OF
VITAL STATISTICS, 1938.
POPULATION.
The population of the Province for the census year 1931 was 694,263. Estimates by the
Dominion Bureau of Statistics for the following years are: 1934, 725,000; 1935, 735,000;
1936,750,000;   1937,751,000;   and 1938, 761,000.
REGISTRATIONS.
The total registrations filed in the Division of Vital Statistics for the year 1938 numbered 28,465—an increase of 323 over 1937 and an increase of 6,247 over 1934.
Table A summarizes the total number of registrations of births, deaths, marriages, stillbirths, adoptions, and divorces for the five-year period 1934 to 1938, inclusive:—
Year.
Births.
Deaths.
Marriages.
Still-births.
Adoptions.
Divorces.
Total.
1934  	
1935          	
10,616
10,987
11,186
13,033
13,812
6,393
6,927
7,254
7.981
4,821
5,020
5,465
fi 232
230
232
236
254
259
158
183
80
109
134
264*
451
533
647
22,218
23,613
1936    	
24,672
1937            	
28,142
28,465
1938            	
7.455                   fi.158
* Act in force May 1st, 1935.
DOUKHOBOR REGISTRATION.
In accordance with instructions received in May, 1937, the Division has carried out the
registration of Doukhobor births in co-operation with the Provincial Police. During 1937,
1,241 births were registered—being 631 males and 610 females, while during 1938, 802 births
were registered—being 395 males and 407 females, making a grand total of 2,043 registrations filed, after full investigation by the Provincial Police and a special officer appointed for
the purpose of investigating these births.
ORGANIZATION OF THE DIVISION OF VITAL STATISTICS.
In September, 1938, an agreement regarding vital and public health statistics Was
reached between the Department of the Provincial Secretary and the Department of Trade
and Industry and an Order in Council was drafted which preserves and defines the rights
and responsibilities of both Departments.
In order to allow the Bureau of Economics and Statistics to proceed with its plans of
organization the Order in Council was given effect as and from the 1st day of October, 1938.
The mechanical equipment, together with six members of the staff trained in its operation,
was immediately transferred to the Bureau. The bulk of the punch-cards which were created
from the record system, although the property of the Provincial Board of Health, are kept
by the Bureau of Economics and Statistics. In this way the interests of the Provincial
Board of Health were protected while the wishes of the Government in having its statistics
centralized were also given effect.
With the transference of the responsibility for the Government's statistical service—
including mechanical tabulation—to the Bureau of Economics and Statistics, the Division of
Vital Statistics will be able to give its undivided attention to statistical analysis, preparation
of tables, charts, and other material for special studies, and annual reports for the various
Divisions of the Provincial Board of Health; to the registration of births, deaths, and marriages, and to the administration of the " Vital Statistics Act " and the " Marriage Act."
Reorganization within the Division of Vital Statistics will be completed by the middle of
April.
The Director of Vital Statistics carries the additional title of Supervisor of Medical
Records within the Provincial Board of Health.    As such he hopes to bring about a closer BOARD OF HEALTH REPORT, 1938. HH 7
correlation of the various record systems and further the work of reducing costs thereof to
the minimum of requirements.
LEGISLATION.
The amendments to the " Vital Statistics Act" provided for several major changes,
notably:—
(a.) The creation of a Marine Registry in British Columbia of births and deaths occurring on board ships registered in British Columbia ports while the ships were on the high seas.
(6.) The creation of a Division of Vital Statistics and the position of Director of Vital
Statistics; and the abolition of the office of Registrar of Births, Deaths, and Marriages, and
the titles of Registrar and Deputy Registrar.
(c.) The preservation of secrecy of registrations of births of illegitimate and adopted
children.
(d.) A search fee of 50 cents which covers the Province for a three-year period, instead
of for one district only, as previously obtained for 25 cents. The $2 search fee was limited
to searches of indefinite periods of time and place.
(e.) The extension of time for making a prosecution under the " Vital Statistics Act"
upon summary conviction to ten years.
The amendments to the " Marriage Act " also provided for several distinct changes,
notably:—
(a.) That District Registrars of Births, Deaths, and Marriages be notified of the publication of banns by the minister or clergyman.
(6.) The reduction of the waiting period between the application for and the issuance of
a marriage licence, or between the application for and the solemnization of a civil marriage,
from eight to three clear days.    The residence period remains unchanged.
(c.) That the waiting period of three days in the case of civil marriages might be
waived in cases of emergency or necessity.
(d.)  A further safeguard for the marriage registers in churches.
(e.) The production of a birth certificate or other proof of age in the case of all minors
contemplating marriage.
(/.)   Reduction of the fee for a marriage by civil contract from $10 to $7.50.
(g.) That a marriage licence shall only be issued or a ceremony performed upon production by both parties to the intended marriage, to the issuer of marriage licences, marriage
commissioner, or other person authorized to solemnize marriage, a certificate in the prescribed form showing:—
"(a.) That a standard laboratory test has been made in a laboratory approved by
the Provincial Board of Health of the blood of the party to the intended marriage with a view to the determination of syphilis:
"(6.) That the blood specimen was taken by a medical practitioner registered under
the ' Medical Act' within twenty days prior to the issuance of the marriage
licence or the solemnization of the marriage:
"(c.) That the result of the blood test has been made known to both parties to the
intended marriage."
Provision was included that, in the case of extreme urgency or need, the Registrar might,
upon obtaining the approval in writing of the Provincial Health Officer, authorize the issuance of a marriage licence without production of the above certificate.
Note.—The provisions for premarital blood tests for syphilis in the " Marriage Act " do
not come into force until proclaimed by the Lieutenant-Governor in Council.
EXTRACT FROM ANNUAL REPORT OF THE DIVISION OF
TUBERCULOSIS CONTROL, 1938.
GENERAL POLICY.
All new cases, all deaths from tuberculosis, all tuberculin tests are reported regularly
to the central office, together with all details of work being done in each institution, stationary clinic, travelling clinic, and rural pneumothorax centre. Complete statistical information on all phases of tuberculosis is compiled monthly, showing death rates for each area, HH 8 BRITISH COLUMBIA.
new cases found, ratio of new cases to deaths, known cases to deaths, occupational incidence,
age incidence, racial incidence, hospital days, bed turnover, etc. A continuous epidemiological study is thus carried on.
Standardization of Records.—All records used in the institutions, clinics, district nursing,
and social service departments are standardized. These, together with the X-ray plates, can
be transferred with the patient from one unit to another.
Reporting of Cases.—Physicians in the Province are required by the " Health Act" to
report every case of tuberculosis, irrespective of type.
Case-finding.—Case-finding methods being extensively used by the Division are as follows: (1.) All known contacts to every case of tuberculosis are examined as soon as possible
after diagnosis of tuberculosis is made on the patient and are then followed up for a period
of years.' (2.) Tuberculin testing surveys are carried out in both primary and high schools,
with concentration on the high-school students. University students, undergraduate nurses
are tested annually. All positive reactors are X-rayed. (3.) Industrial surveys—all underground workers in the Province must have a chest X-ray annually under the " Metalliferous
Mines Regulation Act." This allows the Division to be assured that all cases of tuberculosis
are rapidly removed from the mines. All films taken are referred to the Workmen's Compensation Board for careful examination for possible silicosis. (4.) An attempt has been
made to X-ray all school-teachers in the Province to make sure that no person is teaching
any group of children unless he has been pronounced tuberculosis free. Where several cases
of tuberculosis may arise in any specific industry, an attempt is made to see that all people
working in that industry are carefully checked. (5.) Special groups, such as families on
relief, those in receipt of mothers' allowances, those in children's homes, etc., are surveyed
from time to time.
Pooling of Beds.—All beds in the various institutions under direction of the Division of
Tuberculosis Control are considered as if they were all existing under the one roof. The bed
facilities of the Division are as follows: Vancouver Unit, 186; St. Joseph's Oriental Hospital,
52; Florence Nightingale Convalescent Home, 28; Tranquille Unit, 332; Victoria Jubilee
Unit, 40; Victoria St. Joseph's, 20. Total beds available for the treatment of tuberculosis
under the Division of Tuberculosis Control are 658, a ratio of 1.23 beds per death.
Diagnostic Facilities.—There are three stationary clinics, situated at Vancouver, Victoria, and Tranquille. These are open six days a week. Wherever necessary, bronchoscopic
examination is done. Genito-urinary service, eye, ear, nose, and throat examinations, ortho-
pasdic and dental services are available. These services are more readily available at the
Vancouver Unit where specialists' services are more readily obtainable. When a case of
tuberculosis is diagnosed, a Public Health Nurse in the district visits the home as soon as
possible after diagnosis. In urban areas the rule is to visit within forty-eight hours and in
the rural areas as soon as possible after the nurse receives the report. A detailed social
service investigation is made immediately upon diagnosis and an attempt is made to correct
the social conditions of the family, and to follow this up so that when the patient is discharged he will go to surroundings that will be conducive to maintaining his health. Contacts
are immediately sent to one of the clinics for examination and these contacts are followed up
over a period of years. There are four travelling clinics consisting of a doctor, a nurse, and
a portable X-ray machine. These clinics visit seventy centres throughout the Province at
regular intervals, examining cases referred by physicians and doing surveys in the rural
areas. In practically all areas there is either a Public Health Nurse or a Welfare Field
Service visitor who does the follow-up work between the visits to the clinic.
Rural Pneumothorax.—The previous preventive and treatment centres of the Division
of Tuberculosis Control have been discontinued and the rural pneumothorax service instituted.
Wherever a physician has received training in pneumothorax work he is given a pneumothorax machine. For those patients who cannot afford to pay anything for treatment he is
paid by the Division of Tuberculosis Control for each pneumothorax refill. At the end of the
year approximately forty centres were equipped to carry out this work. This permits earlier
discharge from institution.
Home Treatment.—As far as possible all new cases are admitted to an institution. The
cases after discharge continuing treatment at home are supervised by the public-health nursing service, patients coming to one of the clinics at regular intervals for examination or
treatment.    Medicine and supplies are given free where required. BOARD OF HEALTH REPORT, 1938. HH 9
Occupational Therapy, Vocational Training, and Rehabilitation.—Occupational therapy
is carried out in all institutions under the direction of the Division of Tuberculosis Control.
An attempt is made to give major attention to the vocational aspect of this work. Two
experiments on a voluntary basis are being carried out at the present time, one in Vancouver
and the other in Victoria. In each instance voluntary organizations have provided a workshop where patients after discharge may go and obtain work on a part-time basis, on a
monthly salary schedule. Since the inception of this work both these units have grown and
are proving invaluable in preventing breakdowns, building up the morale of patients and
reuniting families.
Educational Work.—The Division carries on a continuous educational public-health campaign amongst the general public. Pamphlets are published and distributed regularly to
schools, service clubs, and other organizations. Considerable literature is obtained through
the Canadian Tuberculosis Association and is widely used. The British Columbia Tuberculosis Society publishes a magazine each month called " Your Health." This is distributed
free to every tuberculous patient and has gradually been built up into a very worth-while
means of education. In the Division there is a large library of lecture material, including
diagrams, statistics, maps, charts, lantern-slides, and moving-picture films relating to all
phases of tuberculosis. This library is at the disposal of any member of the Division for the
purpose of public addresses. Exhibits are held at the various exhibitions throughout the
Province annually, and at the Vancouver Exhibition alone as many as 10,000 people are
contacted during the short period of that exhibition.
The Family Physician.—In all undertakings of the Division, every co-operation has been
received from the practising physicians throughout the Province. Wherever possible, patients
attending any of the diagnostic clinics are asked to bring a note from their family physician,
and a report on the result of the examination is sent to the physician. Examination at all of
the clinics is free. In every case cared for in institution, the patient's doctor is kept informed
as to the patient's condition, and is notified when the patient is to be discharged. Physicians
throughout the Province are encouraged to make tuberculin tests in their routine practice
from day to day.    Tuberculin is provided free to any physician.
Travelling Clinics.—One new clinic was added to the Interior, greatly facilitating the
diagnostic work in the rural areas. The Division now has four travelling clinics—one covering Vancouver Island, another covering the Lower Mainland and Coast, a third clinic centered
at Kamloops covering the Okanagan area and the Cariboo, and the fourth centered at Nelson,
covering the Kootenays. A change in organization was made towards the end of the year in
making one travelling clinic officer senior to the others. The officer now acts as supervisor
for all travelling clinics. This travelling clinic officer is stationed at Vancouver and carries
on the work through the Lower Mainland and Coast as far north as Prince Rupert.
Specialists' Services.—Full specialists' services are now available to tuberculosis patients
in institutions of the Division. It is apparent that surgery is playing an increasing role in
the treatment of pulmonary tuberculosis, and every attempt has been made to bring this
service to the highest possible level.
New Facilities.—A new operating-room was officially opened at the Tranquille Unit by
His Honour Lieutenant-Governor E. W. Hamber, on September 7th, 1938. This new room
brings greatly added facilities to this unit. The need is quite apparent from the use to
which this room has been put since its formal opening.
On February 23rd a new bronchoscopic room was formally opened at the Vancouver
Unit, this being built and equipped by the Municipal Chapter of the Imperial Order of the
Daughters of the Empire. Some very fine new equipment was added to both the Vancouver
and Tranquille Units, supplied by the B.C. Tuberculosis Society.
Rehabilitation.—Progress has been shown both in Vancouver and Victoria. In Victoria
through the interest of the Kiwanis Club the workshop has been improved and a salesroom
has been opened in the down-town area. In Vancouver a new addition has been planned for
the Vancouver Occupational Industries which, when completed, will allow the accommodation of seventy-five patients. Plans in both centres are working along the same lines—
namely, to give the ex-patients a definite job on a monthly salary—placing the whole scheme
on a commercial basis and removing as far as possible the charitable aspect.
Tuberculosis Amongst Indians.—In March, 1938, the Provincial Medical Director attended
a meeting at Ottawa called by the Hon. Mr. Crerar to discuss the problem of tuberculosis HH 10 BRITISH COLUMBIA.
amongst Indians throughout Canada. Every Province was represented. Some new funds
were made available for this work, but it is felt that insufficient money is available to carry
on an adequate tuberculosis-control programme amongst this group of the population.
Approximately 25 per cent, of all the Indians of Canada reside in British Columbia. The
death-rate from this group of the population remains very high.
Handbook for Nurses.—A handbook for nurses on diseases of the respiratory system and
special points in relation to tuberculosis control has been published by the Division and copies
distributed to nurses throughout the Province. Copies of this handbook may be obtained
from the Central Office of the Division of Tuberculosis Control, corner of Tenth and Willow
Street, Vancouver, B.C.
SOCIAL SERVICE  SECTION.
During the past two years there has been an influx of families coming to this Province
from other countries and other Provinces. These families come in the hope of establishing
themselves financially, but unfortunately a great number are forced to apply for assistance
and are found to be tuberculous and to require free treatment and hospitalization. Considerable thought has been given to this matter since the cost to the Province has become almost
prohibitive. There is the example of one family of five who arrived from the Prairies and
within one year the parents were both in hospital and three children in the Preventorium.
Over a period of sixteen months this family cost the Province $3,500 in hospitalization, free
treatment, and relief alone, and are likely to continue to be financially and medically indigent.
This is one of many similar instances that have made it necessary to return as many as possible to their former homes. To date eighteen families have been repatriated to other countries, three have gone of their own accord with encouragement or persuasion, and in seven
cases the attempt to return them was unsuccessful. In addition, twelve families have been
returned to their own Provinces, eleven persuaded to go of their own accord, and in sixteen
other cases the attempt was unsuccessful. In spite of the necessity of taking such measure,
it is felt that it works a hardship on some families and certain departments. The solution
would be a reciprocal arrangement between Provinces, with a uniform period required to be
eligible for free treatment and hospitalization.
REPORTS OF UNITS,
(a.) Vancouver Unit.
The out-patient clinic has grown steadily during the year and a number of surveys, eight
in all, were completed. It was decided to discontinue the survey of the primary grade school
children because the results were not commensurate with the work. It is noted in this connection that the number of positive reactors dropped from approximately 25 per cent, to 13
per cent., and no new active cases were found in the last survey. Figures of this survey are
available, page 50 of the Annual Report. In connection with the Vancouver School-teachers'
Survey, it is noted that 1,188 teachers were examined at the clinic and fifty-eight by private
physicians. Eight teachers were found to have old healed lesions and seventy were discovered
to have conditions other than pulmonary.
During 1938 there were 14,873 patients through the clinic as compared with 16,353
examinations in 1937. However, the X-ray section showed a marked increase in its work,
the number of clinic and in-patient X-rays totalling 11,239 in 1937 and 15,205 in 1938. This
was due to an increased number of oblique and special films, indicating a more intensive study
of cases. Clinic fluoroscopic examinations increased from 3,316 to 4,031 and institutional
examinations increased from 888 in 1937 to 1,041 in 1938. Electrocardiograms done in the
clinic in 1937 totalled 61 and in 1938, 300. This increase in the number of electrocardiograms
is accounted for mostly by the work done for the Venereal Disease Control Division. Until
December 2nd, 1938, a heart clinic was held for the Venereal Disease Control Division, now
patients are referred to the clinic for only X-rays and electrocardiograms.
The number of admissions and discharges to hospital was 442 admissions and 449 discharges, as compared with 429 admissions and 356 discharges in 1937.
(6.) Tranquille Unit.
From the standpoint of patients treated there has been little change. Our hospital days,
however, are down when compared to 1937, the figures being 116,734 in 1938 and 118,565 in BOARD OF HEALTH REPORT, 1938. HH 11
1937. This difference is due almost entirely to our ability to discharge patients who are
receiving pneumothorax treatment. As facilities are now available throughout the Province
for patients to receive refills the lessened number of hospital days in 1938 were represented
by pavilion beds from which ambulatory patients had been discharged. The statistics of the
institution will show some decrease in the average length of stay because of the earlier discharge of this type of patient.
(c.) Victoria Unit.
Further progress was made in organizing the up-Island Centres and travelling-clinic
work under our own part-time local nurses. This plan has proved very satisfactory and has
resulted in bringing the tuberculosis work throughout the populated area under complete
control to an extent which was impossible with only periodic contacts at the times of the
travelling clinic visits. The contact is now continuous over the whole territory and everything is attended to without delay. It can be said now, for the first time, that the tuberculosis problem of the unit is exactly known and well in hand. Moreover this knowledge of
the situation shows that the problem is not too great to be dealt with effectively and with
good prospect of bringing about real control of the disease in this territory. At the end of
the year all cases on the Island register were reviewed and tabulated as follows:—
(1.)   In hospital under the Tuberculosis Division      57
(2.)   At home, but under treatment or close observation  (not necessarily open)   140
(3.)   Inactive cases at home (all definitely closed)   506
(4.)  Total number of cases on Island register on December 31st  703
No doubt there are still some cases unknown to the Division but, with the present
organization, this number must be small and will become steadily reduced. Also, new cases
arise or move into the territory, but this seldom happens now without information which is
at once acted upon. Every one of the " active " cases is being attended to as well as circumstances permit and, although this does not include compulsory segregation of every open
case, each one who is at large is under close supervision and instruction. This is possible
only if time and money are not wasted on unnecessary attention to the larger number of
cases in which the disease is definitely " closed." But these inactive cases are not overlooked and every one of them has a definite appointment for re-check in the clinic and is
followed up if the appointment is not kept. It appears, therefore, that the tuberculosis
problem on the Island, from a public health point of view, is sufficiently limited to be amenable to thorough and effective handling.
(d.) Travelling Tuberculosis Clinics.
The demand for travelling-clinic service has grown tremendously and each year finds
new fields to which our efforts must be directed. Besides the regular consultation service
that was offered to the medical profession at the inception of the work, and which still is the
basis of our programme for the discovery of early cases of tuberculosis, the travelling clinics
have entered the following fields in all districts of the Province as case-finding methods
expand:—
(1.)   Large-scale tuberculin-testing programmes in schools and University.
(2.) Yearly examination of miners in quartz-mines, carried out right at the mines in
most instances.
(3.) Examination of Indians and supervision of Indian residential schools and pre-
ventoria, with routine tuberculin testing and examination of all new pupils.
(4.) With the establishment of pneumothorax-work in rural areas, close supervision is
carried out on all cases under treatment.
(5.) Follow-up work and home visiting in the districts by Public Health Nurse and
Welfare Field Visitors under direction of travelling clinic officers. This has increased the
number of contact cases being examined by the clinics and led to more examinations of latent
cases needing observation who would be inclined to get out of touch with the Tuberculosis
Division.
(6.) Interpretation of X-ray films for private practitioners. These films are sent in to
the various headquarters of the Division and suggestions for treatment are given when indi- HH 12 BRITISH COLUMBIA.
cated.    A considerable number of tuberculous cases are diagnosed in this way and earlier
treatment is enhanced.
(7.) Education activities. This phase of the travelling-clinic work is one of the most
important, especially in the outlying communities. To stimulate interest in the problem of
tuberculosis control the following methods are used:—
(a.)  Lectures to clubs, schools, and their groups:
(6.)   Personal interview with patients and families where tuberculosis exists:
(c.)   Distribution of pamphlets:
(d.)   Lantern demonstrations and motion pictures.
SILICOSIS EXAMINATIONS.
During the past two years the travelling clinics have been visiting most of the mining
areas in the Province to undertake the examination of those workers exposed to quartz-dust
in mines and mills. This year 2,264 examinations were done by the travelling clinic, which
is about 400 less examinations than in 1937. This is accounted for by the fact that no visit
was made to the Bridge River district and to the fact that at the outset most mines had their
complete staff examined, both underground and above-ground workers, which was not considered necessary this year. The operations of the Granby Consolidated at Princeton were
included in our work this year and we have had requests from Zeballos to undertake examinations there. The total examinations are bound to fluctuate as new operations open and
close and mining activities change from one centre to another. The importance of the work
in the control of tuberculosis can be seen in the fact that during 1937 there were fifty-one
cases of pulmonary tuberculosis and silico-tuberculosis found in the mines whereas in 1938
only nine new cases of tuberculosis were discovered amongst the miners. Eight of these
new cases were minimal in extent, one was moderately advanced. This speaks well for the
effective control that is being enforced through routine examination and for the rapidity with
which cases are brought under supervision when the disease develops.
EXTRACT FROM ANNUAL REPORT OF THE DIVISION OF
VENEREAL DISEASE CONTROL, 1938.
GENERAL POLICY.
Administration.—Increased activities in the various sections of the Division, together
with reorganization which resulted in a considerable number of changes, required the Director
to keep in close touch with the Provincial Secretary's Department and in particular with the
Provincial Board of Health. The Provincial Secretary, the Honourable Dr. G. M. Weir, was
kept informed of the work of the Division and showed a keen interest in the recent developments and a sympathetic attitude toward the numerous difficulties peculiar to the problem
of venereal disease control in British Columbia. Twice monthly during the year visits were
made to the offices of the Provincial Board of Health in Victoria to discuss with the Provincial
Health Officer, Dr. H. E. Young, the details of the numerous problems encountered. The
Director appreciated the frequent, kindly advice and assistance of Mr. P. Walker, Deputy
Provincial Secretary.
The intimate association of the work of the Division with that of the other sections of
the Provincial Board of Health necessitated frequent interviews with their respective Directors. The creation of the Advisory Council to the Provincial Health Officer facilitated the
consideration of mutual problems and improved the correlation of interdepartmental policies.
" Venereal Diseases Suppression Act."—The legal basis of venereal disease control in the
Province as provided in this Act was used more frequently during 1938. Mr. Oscar Orr,
Vancouver City Prosecutor, and Chief Constable W. W. Foster pointed out that their efforts
to co-operate with the Division were hampered by the fact that the Act did not provide the
power to examine individuals when in custody or under arrest, but only after commitment
for an offence. This matter was discussed with Dr. H. E. Young and Dr. H. M. Cassidy
and a recommended amendment forwarded to the Honourable Provincial Secretary. This
was accompanied by another recommended amendment embodying changes in section 3, sub- BOARD OF HEALTH REPORT, 1938. HH 13
section (2), of the Act pertaining to the means of dealing with persons affected with venereal
disease refusing treatment. The amendments were passed by the Legislative Assembly in
December. They constituted a very definite improvement in the Act and facilitated venereal
disease control.
STATISTICS.
New Notification of Venereal Infections, 1938.
The total new notifications were 3,034 in 1938 as compared with 3,182 in 1937.
The notifications of syphilitic infections dropped from 1,778 in 1937 to 1,430 in 1938,
whereas the notifications of gonorrhceal infections increased from 1,404 in 1937 to 1,604 in
1938. It is generally assumed that the incidence of gonorrhoea is considerably greater than
that of syphilis, even to the point of being several times more frequent. The figures for 1938
in this regard are obviously out of line owing to incomplete reporting.
Although it is believed that the number of infected persons under the care of private
physicians is much greater than those attending the clinics of the Division, the opposite
state of affairs is represented by the notifications. Of the total, 1,776 were reported by
clinics and 1,120 by physicians. In the case of gonorrhoea only 523 were reported by physicians as compared with 1,059 by clinics.
The Reported Venereal Disease Population as at December 31st, 1938.
It has been difficult to estimate the actual venereal disease population in British Columbia. The new record system for the first time has permitted a calculation. As mentioned
earlier in this report, the figures are based only on reported infections and it is believed that
reporting is far from being complete. It is questionable whether a person with syphilis
should ever be discharged from the group of the syphilitic population. This has been done,
however, and it tends to reduce the figures for both the total venereal disease and syphilitic
population. At the end of 1938, the total venereal disease population was 4,887, of which
3,140 had syphilis and 1,747 had gonorrhoea. The higher figure for syphilis was due to the
longer treatment period, amounting to two or more years, which results in an accumulation
of the syphilitic infections; whereas with the gonorrhceal population, although the rate of
infection is higher, the short duration of the disease results in a quicker turnover of the
gonorrhoeal population, with a consequent actual smaller number at any one time.
Sea; Distribution of the Venereal Disease Population.—At the end of 1938, the figures
showed 3,437 males and 1,450 females. For syphilis, the comparable figures were 2,059 and
1,081, respectively, and for gonorrhoea 1,378 and 369. It will be seen that the preponderance
of infected males in the population is very striking, and particularly so in the case of
gonorrhoea, where the infections in males were almost four times those in females.
Marital Status of the Venereal Disease Population.—Of the total venereal disease population of 4,887, 2,282 were single. The significance of this fact is obvious, particularly the
1,185 with syphilis who would be potential candidates for marriage. It is interesting to
note that of the single syphilitic population 894, or 75 per cent., were males and 291 were
females. In comparison, among the married syphilitic population of 1,263, the number of
males were 697, or 55 per cent., and the females 566. The change in the per cent, of
syphilis in the female in the married group, as compared with the single group in the direction of a substantial increase in the former, is evidence of the hazard that marriage carries
for the uninfected woman.
STATIONARY CLINICS.
The experience of the Division in 1938 demonstrated the inefficiency of establishing
clinics in communities of less than 10,000 population. In smaller communities persons cannot
lose their identity and will not run the risk of being stigmatized by attending a clinic. For
this reason, clinics at Courtenay-Comox, Duncan, and Alberni were closed on June 30th and
in their place a travelling consultative service was established. In March, 1938, a clinic was
opened at the Royal Columbian Hospital, New Westminster, and in September the Division
took over the management of venereal disease at Oakalla Prison Farm. Dr. J. A. Leroux
continued to do excellent work as physician in charge of the Nanaimo, New Westminster, and
Oakalla Gaol clinics and the rural travelling consultative service. HH 14 BRITISH COLUMBIA.
During the year 4,035 persons were admitted to the various clinics, of whom 2,121 were
found to have venereal disease—997 had syphilis and 1,124 had gonorrhoea. Of the total
admissions, 2,714 were adult males and 846 adult females. An increasing number of the
admissions to the clinics has been that of persons requesting examination and found to be
apparently free from infection.
The total number of visits of patients for treatment in the clinics was 45,395. Of this
number 37,375 were for syphilis and 8,020 for gonorrhoea.
The total attendance which included visits for treatment and consultation were 54,150,
of which 41,276 were for syphilis, 12,324 for gonorrhoea, and 5,876 for not yet diagnosed
cases.
Vancouver Clinic.
The Vancouver Clinic is the largest in the Division. During 1938 an attempt was made
to develop a unit which would serve as a medical educational centre for improving the
methods of diagnosis and treatment of venereal disease throughout the Province.
During this year 3,155 patients were admitted, of whom 810 had syphilis and 999 had
gonorrhoea. There were 462 patients discharged apparently cured of syphilis and 805 of
gonorrhoea. Of all patients examined 1,605 were found to have no apparent evidence of
venereal disease.
Victoria Clinic.
During 1938 an increase in the volume of work at this clinic was noted. Changes in
procedure, instituted in the Vancouver Clinic, were applied here. There were 311 new
patients admitted, of whom sixty-five had syphilis and eighty-four had gonorrhoea. These
figures are approximately the same as for 1937. The total number of patient visits was
5,142. This was considerably lower than for 1937, but does not reveal the true state of
affairs unless it is analyzed. The decrease has been due essentially to a reduction in visits
for gonorrhoea.
New Westminster Clinic.
This clinic is well situated in the basement of the Royal Columbian Hospital. The
attendance of patients has increased steadily through all months of operation of this clinic.
For the most part new patients are referred by their private physicians. Sixty-eight new
patients were admitted, of whom twenty-one had syphilis and sixteen had gonorrhoea. Twelve
were discharged as apparently cured of syphilis and eight of gonorrhoea. Eight patients
lapsed from treatment.    The total attendance was 1,278.
Oakalla Prison Farm Clinic.
On October 1st, 1938, Dr. J. A. Leroux was appointed to take charge of the work of
venereal disease control in Oakalla Prison by arrangement with the prison officials and Dr.
W. H. Sutherland, Gaol Surgeon. Diagnostic and treatment facilities were provided for
syphilis and gonorrhoea. This service operates as a clinic of the Division. Equipment and
drugs required are supplied by the Division. The volume of the work has been considerable,
requiring five 2%-hour clinics weekly. All new admissions to prison are interviewed briefly
and undergo routine examination for syphilis and gonorrhoea (when indicated, in men only).
The co-operation of prison officials and of prisoners has been very satisfactory.
Three hundred and fifteen patients were examined routinely. Of these forty-eight were
found to have venereal disease, thirty-nine with syphilis and nine with gonorrhoea. The total
attendance of venereal patients was 366. One hundred and ninety-three injections of bismuth
or arsenical were given.
CONSULTATIVE SERVICE.
Because of the impossibility of opening clinics in smaller rural communities, an effort
was made to assist by providing a consultative service from the Vancouver and Victoria
Clinics. This service has become very popular and is serving both patient and physician in
an effective manner.    Nine hundred and ninety-eight consultations were written.
FREE MEDICATION.
The policy of free distribution of medication for syphilis and gonorrhoea has been continued.    This service supplements the free consultative service effectively.    Arsenicals and BOARD OF HEALTH REPORT, 1938.
HH 15
bismuth were the largest items.    The figures for 1938 and for the preceding four years are
as follows:—
Year.
Neoarsphenamines
(Ampoules).
Bismuth
(C.C.'s).
Tryparsamide
(Ampoules).
1934 	
6,215
6,332
6,456
11,337
11,590
330
390
1,397
15,539
16,125
1935. '.	
1936     	
1937 -	
855
1938   	
1,076
EXTRACT FROM ANNUAL REPORT OF THE
DIVISION OF LABORATORIES, 1938.
NUMBERS AND TYPES OF TESTS PERFORMED.
During the year, 113,774 tests of all kinds were performed at the Vancouver Laboratories
as compared with 91,569 in 1937, an increase in numbers of 24.2 per cent. As in previous
years, roughly 90 per cent, of all tests performed in the Vancouver Laboratories were concerned with specimens sent in by public-health officials and practising physicians from within
Vancouver City limits. The combined total of examinations conducted by the six branch
laboratories in 1938 amounted to 27,480 as compared with 20,384 in 1937, an increase of 34.8
per cent. Altogether, 141,254 public-health laboratory tests were performed by all units of
the Division of Laboratories during the year. This figure represents approximately one
test relating to the diagnosis and control of communicable disease for every five persons in
British Columbia, a ratio believed to be considerably higher than that shown by the Laboratories Division of any other Provincial Board of Health in Canada.
TESTS RELATING TO VENEREAL DISEASE CONTROL.
The Division of Laboratories as a whole carried out no less than 96,249 tests for syphilis
or gonorrhoea, representing 65.3 per cent, of all public-health laboratory tests done in British
Columbia. Tests in this category have trebled since the present Director took over his duties
in October, 1935, and by the end of 1938 their monthly total amounted to nearly double the
total number of tests of all kinds performed during the corresponding month three years
previously. Such facts emphasize the indispensable contribution being made by the Division
of Laboratories towards the control of venereal diseases.
By recent Act of the Legislature, amendments to the " Marriage Act " of British Columbia were made which, when proclaimed, will require a serodiagnostic test for syphilis to be
performed on every prospective party prior to marriage. Proclamation of these clauses
would entail performance of an additional number of Kahn tests in Vancouver, estimated at
not less than 15,000 per annum in the first year. The Laboratories could not attempt such
an undertaking in their present quarters. The Director of the Division has thus found
himself in the anomalous position of feeling compelled to advocate, in the public interest,
measures which he knew the Laboratories, as at present accommodated, could not undertake
to carry out.
In our view, the circumstances under which blood specimens are taken for Kahn tests
and the skill with which the laboratory reports are interpreted and followed up are of far
greater concern in venereal disease control than is the actual turnover of Kahn tests in the
Laboratory. In this connection we would point out the significant fact that less than one-
twelfth of all specimens relating to venereal disease control reach the laboratories operating
under the Ministry of Health in England and Wales from private physicians. The great majority
of specimens are there sent in from the special clinics. In British Columbia, the situation is
almost reversed. Of a total of 26,699 Kahn tests done in Vancouver in 1938, only 5,527, or
15 per cent., related to specimens from the Venereal Disease Clinic. Again, of 16,495 smears
examined for gonococcus, only 6,766 specimens were from the clinic. Combining both groups,
out of a total of 53,194 specimens only 12,293, or 23 per cent., came from the special clinic
operated by the headquarters of the Division of Venereal Disease Control. In other words,
more than three-quarters of our specimens came from private physicians. HH 16 BRITISH COLUMBIA.
OTHER TYPES OF PUBLIC HEALTH LABORATORY TESTS.
In the small town of Merritt, a milk-borne epidemic of typhoid fever involving over
thirty persons and resulting in two deaths was identified through cultures of blood and stool
specimens sent to the Laboratories. Single cases, and small groups of cases, of pyrexia of
unknown origin, living in remote parts of the Province, had their ailments diagnosed in the
Laboratories as typhoid or paratyphoid fever, or bacillary dysentery. The continuing occurrence of these diseases entails the possibility of an increasing carrier incidence. In view of
the water-supply and sewage-disposal difficulties facing many municipalities, industrial sites,
and camps throughout the Province which have come to our attention, and in view of the
fact that not a single town or city in British Columbia has enforced pasteurization of milk,
the implications of a high incidence of carriers of enteric infection cannot be lightly dismissed.
Bacteriological analyses of milk and water increased in numbers during the year. In
view of the potential health-hazards represented by the milk- and water-supplies of many
communities in the Province, to which reference has already been made, the bacterial counts
and coli-Eerogenes tests performed by the Division of Laboratories for various municipalities
must be accounted an indispensable service. In the City of Vancouver, in particular, a very
regular and close vigilance has been maintained by the Laboratories, the value of which in
safeguarding the health of its citizens cannot be computed in terms of dollars and cents.
Bacteriological analysis indicates that the water-supply of Greater Vancouver remains of
fairly good quality, but is no longer of such unusual excellence as was formerly the case.
As the population of the Greater Vancouver area increases and the watershed becomes more
prone to be entered by hikers, skiers, or workers on relief projects, further deterioration in
the water-supply may be anticipated. Samples of the raw milk distributed by the various
dairies operating within the city have been regularly examined and have provided further
evidence, supplementing that alluded to in the last report, of a high incidence of Bang's
disease among the dairy herds concerned and of a corresponding risk of contracting brucellosis among human raw-milk consumers. The Laboratories were able to show conclusively
that the risk to consumers could not be significantly reduced by attempts to eliminate
" reactors" (cows containing specific brucella agglutinins in their blood serum) from
infected herds. Surveys conducted throughout the year, in close co-operation with the
Department of Bacteriology and Preventive Medicine at the University of British Columbia,
showed that Br. abortus could be isolated from a surprisingly high proportion of samples of
pooled raw milk, as distributed in the City of Vancouver, both before and after reactors had
ostensibly been eliminated from the infected herds. Pasteurization of all milk sold within
the city is the only satisfactory prophylactic against undulant fever. The Laboratories have
now provided the Health Department concerned with abundant evidence that compulsory
pasteurization needs to be enforced in Vancouver, and no scientific public-health organization
doubts the importance of such a measure. If Ontario can enact legislation enforcing Province-wide compulsory pasteurization, it is surely matter for anxious concern that not a single
municipality in British Columbia has adopted such a measure. Our new findings in connection with milk-borne undulant fever in and around Vancouver were presented at two scientific
meetings during the year, and have since been published (vide infra).
GENERAL OBSERVATIONS.
The urgent need for a new building for the Laboratories has already been sufficiently
stressed. I would again draw attention to those deficiencies of organization which are
brought home to the Laboratories more frequently, and more forcibly, perhaps, than to other
Divisions of the Provincial Board of Health—namely, to the non-existence of Divisions of
Sanitary Engineering and of Epidemiology. Wonderful opportunities for carrying out
important public-health projects in collaboration with the Division of Laboratories are
repeatedly being missed, to the detriment of the health of our people and of the progress of
scientific medicine, because these Divisions have not been created.
Relations with the medical profession, with other Divisions of the Provincial Board of
Health, and with the branch laboratories, continue friendly and co-operative. Acknowledgments of indebtedness are few, but this is a state of affairs with which public-health laboratories everywhere are familiar. That complaints are even fewer is the best possible testimony to our efficiency.   The loyalty and competence of the staff at the Vancouver Laboratories BOARD OF HEALTH REPORT, 1938. HH 17
have been beyond reproach. To select for praise would entail discrimination. But I cannot
close without acknowledging my own personal debt, and that of all other members of the
staff, to Miss Donna Kerr, who, as Assistant Director, has carried a tremendous load of duties
and responsibility with unfailing tact, patience, and good-will.
SANITARY INSPECTION.
Sanitary Inspector's Office,
Victoria, B.C., July 10th, 1939.
H. E. Young, B.A., M.D., CM., LL.D.,
Provincial Health Officer, Victoria, B.C.
Sir,—I have the honour to submit my Twenty-eighth Annual Report on general sanitary
conditions throughout British Columbia.
AUTO TOURIST CAMPS.
Commencing alphabetically, we may deal with auto tourist camps. During the year just
ended much has been accomplished to bring the standard of comfort at these places to such
perfection that many of the patrons are inclined to remain weeks instead of overnight. The
sites are carefully chosen, the matter of pure drinking-water and approved drainage is
seriously considered, shower-baths are standard equipment and, in many camps, swimming-
pools are provided, also modern incinerators. What is said by tourists to be the best on the
Pacific Coast is located adjacent to the Victoria City limits.
CANNERIES.
The canning industry of British Columbia has already reached a stage of development of
which every British Columbian can be justly proud. The world-famous fruit of the Okanagan
holds the pick of the world's market through sheer merit in quality and precision-like' care
in cultivation, picking, packing, and canning. Cleanliness is a byword in every British
Columbia fruit and berry cannery and packing establishment. Employees are also carefully
selected. Our regulations are posted at every cannery, but enforcement has never yet been
necessary. The products of the Okanagan are found on the tables of the best hotels in the
civilized world. The same may be said of the salmon-canneries located on our very extensive
coast-line from Alaska to Esquimalt, with many inlets and rivers, including the Nass,
Skeena, and Fraser. The salmon run on our coast last season was above the average, both
in quality and numbers. Canning equipment is being constantly improved and at this date
through the most ingenious yet almost magical mechanical devices the fish, after being landed,
are cleaned, gutted, weighed, canned, and cooked with scarcely the touch of human hands,
under scrutiny of trained experts. Every fish landed from the boats is carefully scrutinized
for its freshness and firmness. Operators are very exacting in this respect, realizing the
fact that it is the only way to sustain the enviable reputation of British Columbia canned
salmon against the keen competition of Japanese and Russian canners of Siberian waters.
Many of our fish-canners are also turning their attention to the propagation of shellfish with very satisfactory results. Beds on the Vancouver Island and Lower Mainland
coasts are under development. The temperature and natural salinity has proved these
waters to be highly satisfactory. One of our largest canning firms has installed the most
modern equipment for the canning of oysters, clams, and juices under the supervision of
qualified experts. Another development allied to the fish-canneries is factories for converting fish-offal and scavenger fish into valuable by-products, such as oil, meal, and guano.
The operation of these new modern factories get results without the nauseating odours of
former days when they were admittedly a foul-smelling nuisance.
INDUSTRIAL CAMPS.
Under this heading is included what are termed " company towns," such as Powell
River, loco, Ocean Falls, Port Alice, Tadanac, and Kimberley. These places are all known
to be models of sanitation and general administration. This Department is seldom needed
except in an advisory capacity, although they are inspected periodically. HH 18 BRITISH COLUMBIA.
The larger logging camps are also observing our regulations, plus reading-rooms, gymnasiums, and recreation halls and grounds. The smaller camps call for more action from
this branch of your Department. This applies especially to the many mining camps during
their early stages of development. What is now the third richest gold-mine on this continent
gave the writer considerable trouble in its early struggles when they lacked funds to install
lawful sanitary requirements.
Speaking of industrial-camp conditions, it does not require a " very old-timer" to
attempt a description of the transformation of living conditions for the workers of to-day
and what they were in 1902. This change has come surely and slowly through the introduction of health regulations for industrial plants, works, and camps throughout the unorganized
part of British Columbia. Your Inspection Department does not crave the credit for the
improved conditions or evolution. It was purely a matter of persuasion and co-operation
between all parties concerned. I had but one Court case. During the past twenty years
there has been no industrial strife through living conditions in any camp in British Columbia.
During the year just past approximately 300 visits of inspection have been made to such
camps; 33 canneries have been periodically visited; 30 auto camps visited; 47 nuisance
complaints investigated and dealt with; 90 specimen samples of water and food products
collected for laboratory tests.
MISCELLANEOUS.
Water-pollution has been very much in the foreground this year from various sources;
foreshore contamination from industrial plants; mountain streams polluted by unauthorized
house-drainage and also by industrial refuse. These have been dealt with accordingly, and
with a view of preserving the purity of our streams and protecting our bathing-beaches.
Under the category of nuisances, insanitary stables, fox-farms, piggeries, and unauthorized slaughter-houses and stockyards have been dealt with and, in two cases, condemned and
closed.
SUMMER RESORTS.
The majority of British Columbia summer resorts are located in unorganized territory
and in consequence they are our responsibility. Ninety per cent, are on the coast-line and
all have been well patronized during the summer of 1938. These are visited periodically and
drinking-water tested. During the season just past not a single case of sickness was reported
from these resorts.
The foregoing brief report is simply a skeleton of this division of your Department.
The files will show details of the work which has been carried out in a thorough and systematic manner, with various sanitary problems met and dealt with as they arise, and invariably the results have been so satisfactory as to evoke letters of thanks to the writer for skill
and patience mixed with experience in bringing order out of chaos between neighbours.
In conclusion, I beg to remind you of the unstinted and valuable assistance given to this
Department by our much-respected Provincial Police and also by Dr. C. E. Dolman and his
Laboratory Staff.
I have, etc.,
Frank DeGrey,
Chief Sanitary Officer. BOARD OF HEALTH REPORT, 1938.
HH 19
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<u rrt rrj rp   o -Q REPORT OF FRASER VALLEY HEALTH UNIT.
Abbotsford, B.C., January 27th, 1939.
Dr. H. E. Young,
Provincial Health Officer, Victoria, B.C.
Sir,—I have the honour to submit the annual report for the Fraser Valley Health Unit
in the Province of British Columbia for the year 1938.
HISTORY AND ORGANIZATION.
It has long been realized that an inequality exists in so far as modern preventive health
services are concerned as between the citizen who resides in a city in which modern health
services are available and the citizen who resides in a rural area or small urban centre in
which no such service is provided. The town or village as well as the single rural municipality is unsuitable as a unit of government in dealing with the health problems of to-day.
The organization of health-work by the establishment of district health units, serving all
municipalities embraced in such units, is the solution to the problem, thus making modern
preventive health services available to the resident of the rural district and smaller urban
centres. In such a set-up the Provincial Health Department acts in a supervisory and
advisory capacity.
It was with this object in view that the Fraser Valley Health Unit was organized. As
in the case of the Peace River Health Unit, this Unit has materialized as a result of the
consolidation of the school districts of the area. In August, 1935, with the consent of all
School Boards concerned, the trustees of four school districts relinquished their duties and
an official Inspector was appointed to administer the newly-formed Matsqui-Sumas-Abbots-
ford Educational Area. In September of the same year, a school nurse was appointed to
administer and supervise the health of the school population in co-operation with the local
Medical Health Officer. A medical survey and a dental survey conducted at this time revealed
the need for much preventive work. As a result of the dental survey dental clinics were
organized in several focal points throughout the area.
The dental and medical work continued in this form until 1937, when the staff was
increased by the appointment of two more fully qualified Public Health Nurses and a Supervisor of Nurses, who had had considerable experience in the public-health field in other districts in the Province.    In August, 1938, a full-time Medical Director was appointed.
There exists a close relationship between the Health Unit and the Department of Education. The Advisory Board to the administrator of the Educational area also acts in an
advisory capacity to the director of the Health Unit. This arrangement facilitates to a considerable extent the solving of the problems which affect the school population directly and
the health of the community to a lesser extent.
The personnel of the Unit is as follows:—
J. A. Taylor, B.A., M.D., D.P.H. „__ Medical Director.
Marion C. Miles, B.A.Sc, R.N., P.H.N Supervisor of Nurses.
Evelyn Maguire, B.A.Sc, R.N., P.H.N Public Health Nurse.
Maryon J. Arnould, R.N., P.H.N Public Health Nurse.
Elisabeth Ochs, R.N., P.H.N Public Health Nurse.
F. H. Quinn, D.D.S School Dentist.
LOCATION.
The Fraser Valley Health Unit is located on the south side of the Fraser River, comprising the Municipalities of Matsqui and Sumas and the Village Municipality of Abbotsford.
It constitutes an area of approximately 94,640 acres, bordered on the north by the Fraser
River, on the south by the International Boundary, on the west by the Municipality of
Langley, and on the east by the Municipality of Chilliwack, with the Vedder River on the
south-east.
The area is essentially a farming and dairying country, supplying a considerable amount
of the milk and farm produce consumed in the Cities of Vancouver and New Westminster.
The majority of the population have lived in the area for a considerable number of years, BOARD OF HEALTH REPORT, 1938.
HH 25
although there has been an influx of new settlers during the past two years from the drought
areas of the Prairies.
POPULATION AND DISTRIBUTION.
The population of the whole area is estimated to be approximately 8,000; with Matsqui
Municipality being the most heavily populated, constituting 68 per cent, of the whole. Sumas
Municipality has only about 26 per cent, of the total population, although it has considerably
the better farming land, a considerable portion of it being composed of the Sumas Lake
Reclamation area. There are only the two main villages in the area, namely, the Village of
Matsqui and the Village of Abbotsford, the latter being considerably the larger.
The central office of the Health Unit is located in the Village of Abbotsford, where members of the nursing staff are required to report at least once a day.    For convenience and
ease in the covering of the work the area has been divided into four separate districts with
a nurse in charge of each.    These four districts are, namely:—
(1.)   Municipality of Sumas.
(2.)  Village of Abbotsford.
(3.)   Matsqui Municipality, northern section.
(4.)   Matsqui Municipality, southern section.
COMMUNICABLE DISEASES.
From the following table the part played by certain communicable diseases is at once
evident:—
Number of Cases
and Deaths
from Communicable Diseases,
1934-38.
Disease.
1934.
1935.
1936.
1937.
1938.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
Cases.
Deaths.
9
1
3
1
25
2
2
1
1
3
2
60
1
11
36
9
2
3
28
2
1
61
2
293
38
172
8
15
1
13
1
1
2
1
6
2
1
1
1
1
65
2
2
196
3
4
37
4
3
4
45
48
1
1
14
16
92
3
1
1
30
5
Septicemia (puerperal)	
A fact worthy of note in this table is the marked increase in the number of certain
communicable diseases—notably chicken-pox, measles, and rubella—in the year 1935. At
first glance the statistics in this connection may be disturbing. However, on analysis, one
finds that this increase occurred when the first Public Health Nurse was appointed. Human
frailty in the reporting of minor illnesses is well known to all of us. It is self-evident that
once the Public Health Nurse commenced to check school absentees considerably more cases
of communicable disease were discovered. Thus, the increase in the statistics may be the
direct result of improvement in reporting.
In this day and age, with the facilities for more rapid transportation between communities, there is a greater intermingling of the population, both throughout their own area
and in other areas of the Province. The Fraser Valley area, consequently, reflects the communicable disease records of its neighbouring municipalities. This intermingling is further
accentuated in a consolidated school area where children from several districts are transported to the higher grade schools. An increasing vigilance on the part of the Health staff
is necessary to bring about control of communicable disease.    Thus, we find it necessary to HH 26 BRITISH COLUMBIA.
keep close check on absentees from school in the hope of detecting any communicable disease
in its inception in order to carry out quarantine measures among contacts before it becomes
spread throughout the school.
During the past year there was a marked increase in the number of scarlet fever cases.
Fortunately, this was a mild form of the disease which was occasioned by extremely few complications or sequela. No deaths from this source were recorded. Further reference to the
problem of scarlet fever control will be mentioned under immunization.
The usual epidemic of chicken-pox commenced in the latter part of November and carried through the month of December; but a few less cases occurred this year than in
previous years.
There has been an increase in the number of reportable cases of pneumonia this year,
with a slight increase in the number of deaths. The majority of these cases have occurred
in the winter months; nine cases, or 56 per cent, of the total, occurred during December.
It might be questioned whether the use of antipneumonic serum might not have prevented a
considerable number of these deaths. However, those cases which were typed revealed a
case to be due to a type of pneumococci for which there is no serum. But pneumonia would
seem to constitute a problem which must command increasing attention.
SCHOOL MEDICAL SERVICES.
Since the inception of the Health Unit we have enjoyed the full co-operation of the
Director of Education and the members of the teaching staff. School health services bulk
largely in the time of the Health Unit, but it is time well spent. There are 1,825 school
children enrolled in the sixteen schools of the consolidated area.
Physical examination of all the pupils is accomplished each year by the staff. In addition, all those participating in competitive sports receive special examination with a view to
ascertaining their physical ability to pursue their respective extra-curricular hobbies. A report
of all the findings is submitted to the parents, and in the case of the more serious defects a
home visit is made by the nurse to discuss the problem with the parents. They are exceedingly willing to co-operate, but, owing to economic straits, a large percentage of the defects
remain uncorrected.
The service might be considerably improved if arrangements could be made to have the
parents present at the time of the examination. However, much of the physical examination
work must be carried out in the fall and early spring when the farm men and women are
busy at their vocation. Unfortunately, in these rural schools there is no room provided
where these examinations may be conducted, with the result that they must be carried out in
the small cloak-rooms where there is hardly room for the doctor, nurse, and patient, far less
for parents. These halls, which are unheated, open directly to the outside, and are, therefore, cold and unfit for examination purposes in the winter months. Consequently, we are
forced to conduct these examinations in the early part of the fall term and the late months
of the spring term. The only other alternative is to conduct the examination in the classroom, which disrupts the whole teaching programme for two to three days. We endeavour
where possible to cause as little inconvenience in this regard as possible.
GOITRE PREVENTION.
As in previous years, iodine in the form of tablets is distributed to all those desiring it.
Some 895 pupils are receiving this treatment at present. Check is made to locate those whom
it is felt require more intensive remedial efforts, these being advised to consult their family
p ysician. CONTROL OF COMMUNICABLE DISEASE.
Reference has already been made to the check-ups made by the nurse concerning absentees.
In cases where a communicable disease has appeared in a school daily inspection of the class
is made during the incubation period of the disease.
During the year quarantine measures were imposed in 184 cases, necessitating 556
quarantine calls. sCH()0L gANITATI0N_
To a person accustomed to the modern sanitary facilities of the larger city schools, rural
school sanitation appears totally inadequate. A survey of school sanitation has been carried
out during the fall months from the view-point of heating, lighting, ventilation, water-supply, BOARD OF HEALTH REPORT, 1938. HH 27
and toilet facilities.    Information concerning the survey will be embodied in a special report
as soon as an analysis of the findings can be completed.
SCHOOL DENTAL SERVICES.
School dental services have been carried on throughout this year as in previous years.
The following table reveals the amount of dental-work carried out during the year:—
Number of patients   493
Number of fillings—
Silver  (simple)    740
Silver  (compound)    496
Porcelain     87
Cement       79
Number of extractions—
Deciduous teeth   473
Permanent teeth     96
Number of local anaesthetics   452
Number of cement linings   162
Prophylaxis    162
Treatment        8
Completed    298
CLINICS.
Immunization Clinics.
Smallpox vaccination clinics have been carried out each year by the local Medical Health
Officer. However, there has never been any attempt to establish immunization clinics against
other communicable diseases. Consequently, a toxoid campaign was commenced during the
fall of the year and has been carried on into the new year. Fortunately, there has not been
an epidemic of diphtheria in this area for several years. Only three cases have been
recorded during the past five years. Nevertheless, it was felt that with a population almost
100 per cent, unprotected the ground was ripe for the wholesale spread of this disease should
the infection occur.
Unfortunately, early in the campaign one child developed a violent local and systemic
reaction to the initial dose of diphtheria toxoid. There developed immediate repercussions
throughout the whole area and we were receiving daily notices of withdrawal of consent to
the toxoiding. In order to prevent other incidents of a similar nature and since our whole
campaign was jeopardized, we commenced to carry out reaction tests on all pupils in the
schools. This entailed considerable more work and prolonged our campaign several weeks.
In spite of this precautionary measure, two somewhat less severe reactions were recorded.
However, we were able by means of talks in the schools and by discussions with the parents
to obtain consent in a large number of cases and to carry out the treatment on a large percentage of the school population. We may expect greater returns in another campaign, for
particularly in this field does work already accomplished assist us. When we can point to
several hundred children in the community who have been immunized without dire results,
most of the doubters are either convinced or are sufficiently passive to give permission for
their children to be protected.
The following table represents the immunization-work carried out during the year:—
Smallpox vaccination   395
Diphtheria toxoid—
Reaction tests       681
First doses     681
Second doses   617
Completed doses     592
Staphylococcic toxoid        1
Cold vaccine        1
As mentioned under communicable disease, an item of serious consideration is scarlet
fever.    It was the most prevalent communicable disease recorded last year and must assume HH 28 BRITISH COLUMBIA.
major responsibility in a preventive programme.    It is hoped to commence a scarlet fever
toxoid campaign during the new year.
Pre-school and Baby Clinics.
Early in May baby clinics were commenced in the area, the first clinic being held in
Abbotsford. These were essentially clinics for the weighing and measuring of babies. In
September, with the appointment of a full-time Medical Director, these clinics were enlarged
in scope, advice being given concerning feedings and immunization treatments being carried
out on those children whose parents desired it. These clinics are held monthly in each of
four centres, namely, Sumas, Abbotsford, Matsqui, and Pinegrove. Attendance has been
exceedingly gratifying and, from the requests received, we expect that it will be necessary to
commence two more clinics in other parts of the area.
To date there have been 158 babies and pre-school children registered. During the past
four months 578 children have been seen by members of the staff at these clinics. Some
seventy-six of these have been given immunization treatment.
Chest Clinics.
The travelling chest clinic of the Division of Tuberculosis Control, in the person of Dr.
Kincade, assisted by Miss B. Erickson, spent two days in the area during the early part of
December. Prior to their arrival tuberculin tests were carried out on contacts of tuberculosis—ten persons availing themselves of this opportunity. There were some seventy-seven
individuals examined at the clinic; one case of active tuberculosis was discovered and
institutionalized. Of the remainder, fifty were found to be negative and twenty-six were
listed for further observation.
Close check is maintained in a follow-up programme on all arrested and quiescent cases,
through periodic home visits and periodic sputum examinations.
Eye Clinics.
The correction of eye defects still remains a major problem. Through the combined
co-operation of various organizations in the area, a fund was set up for the examination of
children with eye defects and the supplying of glasses. This fund, however, permits only
correction of the more serious defects and still leaves a vast number of children who show
minor refractive errors which could be corrected by glasses, but who are unable to afford the
necessary financial outlay.
During the year twenty-eight children have been transported to Vancouver, where they
received examination by a specialist. Of these nineteen were fitted with glasses and four are
awaiting beds in the hospital for operation.
Child Guidance Clinic.
Child Guidance clinics have been held periodically in Chilliwack. Children who have
become problem children, either at school or at home, have been transported to these clinics
for examination and advice. There they are given a complete psychometric examination to
determine whether the difficulty is due to environment, lowered mentality, or emotional upset.
A complete report of the findings is supplied to the central office and corrective measures
discussed with the parents by the nurses. Seven children were given this service during the
year.
Crippled Children's Clinic.
Through arrangements with the Crippled Children's Hospital in Vancouver, we are able
to provide special examination and treatment for cases requiring such aid. Six trips have
been made to the Crippled Children's Hospital, resulting in examination of seven children.
Five of these were much improved following a brief stay in hospital for treatment. They are
required to return to the hospital for re-examination at periodic intervals to note improvement, if any, following massage and exercises at home.
INDUSTRIAL HYGIENE.
There are two industries in the district, namely, the Pacific Milk Condensery and the
Clayburn Brick and Tile Company, neither of which presents much of a problem from a BOARD OF HEALTH REPORT, 1938. HH 29
public-health point of view. The industry which requires the greatest supervision is the
Canadian Hop-growers' Association, which gives transitory employment to 3,000 to 4,000
individuals during the months of August and September when hop-picking is at its peak.
This company was found to be exceedingly willing to co-operate with the Department of
Health.
During the period of peak employment the company employs a local physician as Medical
Officer and maintains a company nurse on the premises at all times. Sick parade is held
each morning when cases are referred to the attending physician. In this way all sickness
amongst the employees is carefully supervised.
A sanitary staff under the direction of the foreman is kept busy during the picking
season in the maintenance of sanitary measures. Prior to the harvest season all cabins and
privies are inspected, repaired, cleaned, and disinfected. Each morning the company nurse
and foreman inspect each cabin, when, in the event of a family maintaining a dirty cabin,
instructions are given to clean it up or to discontinue employment. In addition, the pit privies
which are located in various centres throughout the hop-fields as well as in close proximity
to the cabins receive a daily inspection, following thorough cleaning and disinfection by the
sanitary staff.
The water for the use of the employees is obtained from a pipe-line which runs from a
small stream at the foot of the Vedder Mountain and is conveyed to the fields by large water-
wagons, where it is drawn off as required by the employees.
Periodic inspection is carried out by the Health Department in co-operation with the
company medical officer and the foreman.
MILK INSPECTION.
There are approximately 700 milk producers in the combined area, the majority of whom
are shipping milk either to the city or to the Pacific Milk Condensery, as there are only four
or five dealers retailing to the local market. The area is a T.B. accredited area as far as
cattle are concerned and has been for a considerable number of years. At present milk
inspection is carried out by the Dairying Branch of the Department of Agriculture. We
are working in collaboration with them, through Dr. Sparrow, the official Inspector for the
Fraser Valley. Milk is sold in only the raw state, and so far as can be ascertained has
never created a public-health problem. There have been two cases of undulant fever recorded
this year, in both cases due to an infection which has not been definitely traceable to the milk
consumed.
The work in the line of milk inspection will receive more attention in the new year, when
periodic inspections of the local dealers will be carried out.
GENERAL SANITATION.
The problem of general sanitation in a rural community commands a considerable amount
of time and is a subject which will only be completely developed by the appointment of a full-
time sanitary engineer. Under the present system we can only attend to the more pressing
demands, and in the future more thorough investigation must be devoted to the problem.
General sanitation is discussed under the headings of water-supplies, sewage disposal, and
refuse disposal.
WATER-SUPPLIES.
There exist at present two municipal water-supplies in the area, namely, that of the
Village of Abbotsford and that of the Village of Matsqui. These two systems supply only a
small proportion of the population of the area, the remainder of the area being dependent
upon well and spring supplies.
The system of the Village of Abbotsford is derived from a system of springs situated at
the north-east limits of the municipality. This system has outlived its usefulness and can
no longer be depended to supply enough water for the needs of the consumers. The area
from which the springs flow is not protected in any way and is subject to contamination from
either human or animal sources. Periodic laboratory analysis has been carried out and so
far has shown no bacterial contamination. During the month of December the supply
became dangerously low and it was necessary to obtain additional water in order to cope
with the demand.    At this time water was pumped from Thompson Creek to the swimming- HH 30 BRITISH COLUMBIA.
pool, where it was chlorinated and then pumped to the mains. This, of course, was only a
temporary measure to tide over until heavier precipitation increased the flow from the
springs. At present the village council is conducting surveys in order to locate a more
plentiful supply, when it is hoped that the present antiquated system will be discarded.
The system of the Village of Matsqui is derived from a dam placed across a stream at
the back of Sumas Mountain. Laboratory analysis has revealed no bacterial contamination
in this water, but during the dry summer months this supply became so low that it was
found necessary to curtail the consumption considerably. Again, there is no effort made to
have a protected watershed and the danger of contamination is ever present. There have
been no records of water-borne epidemics in the history of the Health Unit.
As regards the well and spring supplies, examinations have been conducted where necessary and at any request. Laboratory analysis has shown contamination in several cases,
but the solution of the problem remains unanswered. The owners find themselves financially
unable to carry out the recommendations made by this Department and are definitely opposed
to chlorination of the supplies. It is too much to expect that all water used for drinking
purposes will be boiled. SEWERAGE.
The whole of the area is dependent upon septic tanks or privies for sewage disposal.
Fortunately, the soil is gravel in nature and will cope with the effluent and sludge from these
systems. However, too many people expect a septic tank to carry on indefinitely, not realizing that they require periodic cleaning out. In all cases we advise cleaning out at least once
every three years.
The Village of Abbotsford presents the greatest problem in the connection of sewage
disposal, for over a period of years the grounds, due to constant shifting of privies, have
become saturated with sludge and will not accommodate further systems of this sort. The
only answer to the difficulty seems to lie in the construction of a municipal sewerage system,
especially if the village is to be expected to attract new home-owners.
REFUSE DISPOSAL.
At present there is no system of garbage disposal. It is left entirely to the discretion
of the home-owner and the business houses. As a result there is very little attention paid
to the matter. The matter has been placed before the village authorities and plans are
made to initiate a system of garbage disposal. Several nuisances have been investigated in
this regard and orders left to have the refuse disposed of.
SOCIAL SERVICE.
The district is covered by a social service worker in the person of Miss Berna Martin,
who co-operates with the Health Unit in all matters affecting this area. Health Unit records
are very useful in reference to matters of information pertaining to her work.
The Welfare Club has had heavy demands and has been extremely useful in providing
clothing and food to necessitous families. We have appreciated their co-operation on many
occasions when we have approached them for requests for assistance.
RECORD SYSTEM.
The record system has been brought up to date during the year and is beginning to
prove its usefulness. It has entailed a considerable amount of clerical work which has been
carried on under difficulties, since none of the staff have had experience in typewriting. It
has thus been more time-consuming than necessary if an experienced typist were available.
In concluding this report we wish to express our sincere appreciation to the various
individuals who have given us much valuable assistance, particularly the Director of Education, the municipal clerks, and the members of the teaching profession. We are extremely
grateful to the Abbotsford-Sumas-Matsqui News for the publicity which has been granted
us in the matter of clinics and monthly reports.
Last, but not least, I cannot conclude without expressing my appreciation for your continued help and encouragement in the work of the area.
I have, etc.,
J. A. Taylor,
Medical Director. BOARD OF HEALTH REPORT, 1938. HH 31
REPORT OF ACTIVITIES OF METROPOLITAN HEALTH
COMMITTEE.*
Retrospect of the activities" of the Metropolitan Health Committee during the second
calendar year of its existence shows not only many gratifying results but, in addition, opens
up various avenues of new endeavour and improvement over older methods.
The territory covered by the Committee has been extended to include the Municipality
of Burnaby, an area of 33.59 square miles. The total area directly covered now totals 210.47
square miles, and includes an estimated population of 316,437. Burnaby adjoins the City of
Vancouver throughout Vancouver's whole eastern boundary. It is separated from the
Municipality of Richmond by the Fraser River on its southern boundary. The population
is concentrated in two portions and scattered in between, thus including urban, suburban,
and rural problems. The population of Burnaby is estimated at 28,500 and is practically
99 per cent, white, English predominating. The work carried on is similar in all respects
to the rest of the Area, but, in addition, because of the large number of citizens on relief, a
considerable percentage of time is given toward dealing with the social problems of health
and disease.
The North Vancouver Health Unit, through special arrangements with the West Vancouver School Board, now supervises and examines the school children of this latter municipality. The school population of West Vancouver is approximately 1,000 and a full-time
school nurse is in attendance. Because of this special arrangement, considerable general
public-health work is carried on, and although West Vancouver is not a Unit directly in the
Committee's sphere of activity, indirectly a certain degree of control results.
Repeated attempts have been made to bring the Municipality of West Vancouver and the
City of New Westminster into the Metropolitan set-up, but as yet none has been successful.
Their officials realize the importance of public-health activities, but are loath to spend the
extra money required to gain definite insurance of the preventive medical type offered by the
Metropolitan Health Committee. The inclusion of these two municipalities would make a
very logical set-up, with boundaries including inlets, river, uninhabitable mountains, and
sparsely settled rural areas;   thus, geographically, the area would be complete.
The per capita cost of the public-health programmes carried out in the Metropolitan
Area is approximately 74 cents. Public health medical and nursing staffs are reasonably
adequate with the present programme, there being eleven full-time and two part-time doctors
and fifty nurses. (Two Oriental nurses, one Japanese and one Chinese, work in the Units
serving their people.) With a total estimated population of approximately 316,000, this
allows an average of one doctor per 27,000 and one nurse per 6,300 population. With the
possible extension of the programme to do more intensive mental hygiene work and more
health education, the addition to the staff of one more doctor and four more nurses would
be very helpful. Thought must also be given to the inclusion of a psychologist-social worker
and a dietitian to the staff.
In the technical services, including sanitation and food and milk control, the inspectors
are definitely below the required number for the carrying-out of efficient inspectional, regu-
lational, and educational Work. The very large area covered necessitates considerable travel
time, which is, of course, non-productive. The economic restrictions created by world conditions have increased the need in all phases of sanitary work, with a resulting increase in
reported nuisances and other insanitary conditions, thus necessitating investigation of individual problems rather than preventive surveys. The per capita expenditure for food and
milk inspection and sanitation in Vancouver City is approximately 9 cents, which is entirely
inadequate.
Clerical assistance is at present reasonably adequate in all parts of the Metropolitan
Service.
During 1938, many changes in the personnel occurred. In January, Dr. J. S. Cull,
Director of Health Unit No. 4, became Assistant to the Provincial Health Officer. The work
in this Unit was covered by a temporary appointment until September, when Roy A. Walton,
M.D., D.P.H., was appointed.
* From report of the Senior Medical Health  Officer for the  City  of Vancouver and the  Greater Vancouver
Metropolitan Health District, Year 1938. HH 32 BRITISH COLUMBIA.
In February, Dr. K. F. Brandon, who was Director of Health Unit No. 3, was transferred to the position of Epidemiologist and Assistant to the Western Branch of the Con-
naught Laboratories.    He was replaced by J. S. Kitching, M.D., D.P.H.
On April 19th, Miss Elizabeth Breeze, R.N., Directress of Nurses, passed away. The
loss of Miss Breeze has been keenly felt by all members of the staff. Miss Breeze contributed
immeasurably to the efficient organization of the Nursing Service specifically and to the
whole organization generally. Miss Aletha McLellan, R.N., Nursing Supervisor of the
School Health Division, was appointed temporarily as Directress and has carried on in a
most efficient manner. Miss Mary Henderson, R.N., B.A.Sv. Nursing, was appointed as
Acting Supervisor in Miss McLellan's position.
In June, Roy H. Fraser, M.D., D.P.H., was appointed Director of the Burnaby Unit and
Dr. Wm. Sager was appointed Assistant.
In September, Miss Lyle Creelman and Miss Geraldine Homfray were granted a year's
leave of absence for further postgraduate study. Miss Creelman was granted a Rockefeller
Foundation fellowship to study at Columbia. Miss Homfray went to Tennessee for her
studies.
September 30th brought an end to the very efficient and stimulating guidance of the
whole programme by the retirement of Dr. J. W. Mcintosh. Dr. Mcintosh contributed
greatly to the formation of the Metropolitan set-up and was an ever-ready source of ideas to
improve the public health.    He was succeeded by the present incumbent.
Dr. K. F. Brandon became full-time Assistant and Epidemiologist on December 1st.
The above-noted changes deal only with those in senior positions. Other changes
occurred in the staffs, necessitating replacements of individuals who have contributed wholeheartedly and efficiently toward making the programme results effective.
The Division of Child Welfare, including babies and pre-school children, reports increased
clinics and attendance in addition to improved work. Reduction in illnesses necessitating
hospitalization in the Infants' Hospital is shown by the reduction in admissions to this
Institution. Credit in part for this reduction is given to the Metropolitan Health Services,
Child Welfare Division.
The Division of School Health reports improvements in all its activities, and reports
from school authorities and parents corroborate the findings. Starts were made in studying
lighting and ventilation in schools. Public Health Nurses are receiving greater co-operation
from parents and Parent-Teacher clubs.
The Division of Communicable Disease Control reports considerably increased numbers
of procedures carried out. In Richmond, for example, 85 per cent, of the school children are
immunized to both diphtheria and smallpox, and progress is being made in scarlet fever and
pertussis prevention.
No serious epidemics were reported during the year. Control of tuberculosis is steadily
improving, and progress in venereal disease control is definitely under way. In both these
latter groups splendid co-operation is afforded by the Provincial Divisions for these services.
The Division of Food and Milk Control carried on a busy year, maintaining standards
previously reached.
The Division of Sanitation not only maintained previous records but improved swimming-
pool sanitation control.
The Division of Industrial Hygiene and Cancer Control, grouped for convenience only,
showed no progress.
Health education and publicity showed progress in increased papers printed and
increased health talks given. Practically all members of the staff are members of various
lay and professional groups carrying on health work and in many cases take part in the
leadership of such groups.
The laboratory work carried on in the Provincial Laboratories, under the direction of
Dr. C. E. Dolman, contributed greatly to the high standard of public-health field-work carried
on by the staff.
The reports of the Unit directors show increased activities, both in and out of the Unit
offices. All show an appreciation and a perspective promising continued progress. Each
Unit serving a different type of public and having individual problems is meeting the situation with gratifying results. BOARD OF HEALTH REPORT, 1938. HH 33
The Senior Medical Health Officer is indeed grateful for the excellent co-operation given
by all members of the staff and for the sympathetic understanding and advice given by the
Metropolitan Health Committee and the Provincial Health Department, under the leadership
of Dr. H. E. Young, who is ever ready to give advice and guidance.
VICTORIA,  B.C. :
Priuled by Chables F. Banfield, Printer to the King's Most Excellent Majesty.
1939.
825-1239-2743   

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