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PROVINCE OF BRITISH COLUMBIA TWENTY-NINTH AND THIRTIETH REPORTS OF THE MEDICAL INSPECTION OF SCHOOLS… British Columbia. Legislative Assembly [1941-1942]

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 PROVINCE OF BRITISH COLUMBIA
TWENTY-NINTH AND THIRTIETH REPORTS
OF   THE
MEDICAL INSPECTION OF
SCHOOLS
YEARS ENDED JUNE 30th,-1940 AND 1941
PRINTED BY
AUTHORITY OP THE LEGISLATIVE ASSEMBLY.
VICTORIA, B.C. :
Printed by Charles F. Banfield, Printer to the King's Most Excellent Majesty.
1942.  Provincial Board of Health,
Victoria, B.C., December 15th, 1941.
To His Honour W. C. Woodward,
Lieutenant-Governor of the Province of British Columbia.
May it please Your Honour:
The undersigned has the honour to present the Reports of the Medical Inspection of
Schools for the years ended June 30th, 1940 and 1941.
G. S. PEARSON,
Provincial Secretary. Provincial Board of Health,
Victoria, B.C., December 15th, 1941.
The Honourable Geo. S. Pearson,
Provincial Secretary, Victoria, B.C.
Sir,—I have the honour to submit the Twenty-ninth and Thirtieth Reports of the Medical
Inspection of Schools for the years ended June 30th, 1940 and 1941.
. I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Provincial Health Officer. FOREWORD.
Due to the time of holding the present session of the Legislature instead of in the fall
of 1941, it has been possible to collect and compile the data covering school medical examinations for both the school-years 1939-40 and 1940-41. This has made possible the presentation
of the Twenty-ninth and Thirtieth Reports of the Medical Inspection of Schools in one volume.
In contrast to previous reports an attempt has been made in this report to explain in
more detail the rationale of procedures and policies, and also to give in review an outline of
activity and progress as well as an idea of the trend of modern public health opinion. The
detailed tables have been replaced with summary tables, since the former are usually made
available, if required, to the local School Board by the School Medical Inspector. Any of the
detailed material can be furnished for individual schools or school districts on request to the
Provincial Board of Health, Victoria, B.C.  REPORT ON MEDICAL INSPECTION OF SCHOOLS.
The entire programme of school-health services in the Province of British Columbia has
been thoroughly reviewed and studied during the two years under report and numerous
changes have been planned. Many of these changes have already been put in operation and
are proving of considerable value.
It is anticipated that in the report for the school-year 1941-42 it will be possible to
present data of a more comprehensive type that will substantiate the wisdom of the numerous
changes already undertaken and those planned for the future.
SCHOOL AND COMMUNITY HEALTH.
With the permission and co-operation of the Superintendent of Education a meeting was
arranged in July, 1940, between the School Inspectors and the Provincial Health Officer, at
which the entire field of school-health services, including medical inspection of school children,
was discussed. Many useful suggestions were made by the School Inspectors which have
assisted in formulating the plans now being put into effect. This meeting also provided a
clarification of the possibility of closer co-operation between health and school authorities.
The willingness to adopt new procedures on the part of the various officials of the Department
of Education as well as the Inspectors and teachers has been very gratifying and has assisted
greatly the Provincial Health authorities in the reorganization of the programme.
In the new school-health programme it is being emphasized that all children should have
every opportunity of receiving full benefits from public health and preventive services in
those important years of physical and mental development during their early life. It has
been demonstrated many times that the defects found in the school child develop in the prenatal, infant, or the pre-school period of the child's existence and are first discovered at the
time of the school medical examination. If the extensive knowledge already available for the
prevention of disease and the promotion of health is to be satisfactorily utilized it must be
applied throughout the life of the individual, particularly in early years of mental and
physical growth. Therefore, only by providing adequate community health services can the
school, which with its children, teachers, and other employees is a definite part of the
community, be safeguarded against the existing health hazards.
Though there is already in existence a large volume of data dealing with the health of
school children, collected over a period of twenty years or longer, this is not in a form that
can be utilized on a comparative basis. The first problem to be faced, therefore, was the
development of a satisfactory form on which could be recorded the individual pertinent health
data about every school child. A special committee of trained public health personnel spent
nine months through weekly meetings in complete revision of the school health record form,
and the school medical inspection report form, on which the School Medical Inspector reports
his findings. An entirely new summary health form was devised for the use of teachers to
aid them in understanding the health problems of their pupils. A manual explaining the
detailed uses of the various forms was also prepared. The main object of this manual, which
took a great deal of time, study, and work, was to provide instructions for the uniform
recording of the data obtained through the physical examination of the school child. The
new forms were prepared in time to be put into use for the school-year 1941—42.
Previously many requests had been received from School Medical Inspectors for instructions which would outline their duties. In response, a letter was sent out with this information at the commencement of the school-year 1940-41 to all School Medical Inspectors
appointed in unorganized territory by the Provincial Board of Health. Because the results
of this letter were so gratifying and the co-operation of the School Medical Inspectors so
helpful, it was decided to further augment this service by preparing for the School Medical
Inspectors instructions and a letter of explanation to be sent out with the new form and
manual at the beginning of the 1941-42 school-year. It was felt that this would be a further
aid to the School Medical Inspectors in understanding their duties and carrying them out.
Before the changes affecting the School Medical Inspectors were made this problem was fully
discussed with the Council of the College of Physicians and Surgeons of British Columbia
and received their complete approval and whole-hearted support.
Copies of the new school medical card, the manual, report form, and the class-room health
record, together with a copy of a letter from the Provincial Health Officer, were sent to each Z 8 BRITISH COLUMBIA.
School Inspector by the Chief School Inspector. Their co-operation was solicited in regard
to the application of the new school-health programme. The principal of each school was
also sent a copy of all pertinent information regarding the new programme by the Superintendent of Education. It is felt in this way that the closest possible co-operation between the
educational personnel and the school-health services can be maintained.
At the time when the school-health records were changed and the manual prepared
definite changes were made in other forms which were part of the Public Health Record
System in use in the Province. Considerable simplification and standardization of terminology
and instructions for recording in the manual was also included for the entire record system.
This will aid the revision of each of the record forms to be studied in the future.
Much difficulty has been experienced in the preparation of a new report form on which
could be recorded the details of the environmental sanitation of each school. The object in
preparing the new form was to have one on which could be recorded definite facts and not
opinions. In this way a method of evaluating the sanitary conditions of each school would
be provided. The form naturally would include all details of environment which might
influence the health of the children, such as illumination, ventilation, heating, playground
facilities, lunch-room and where food is served in the school, the method of food-handling,
and the dish-washing facilities provided. Pacts concerning the water supply, milk-supply,
and the storage of food applicable would be included on the form. Unfortunately, it was
impossible to have this form prepared in time to be used during the school-year 1941-42.
However, the form will be ready for the next school-year and, it is felt, should prove invaluable
in this regard.
The immunization of school children has again been stressed to the School Medical
Inspector, who is supplied free biological products for this purpose. In unorganized territory
the School Medical Inspector or the Health Officer is paid by the Provincial Board of Health
for this service. The emphasis must be on the infant and the pre-school child if protection
is to be provided against those diseases which may kill children in these younger age-groups.
The Medical Health Officers in unorganized territory have been informed again that the
biological products are available and that they will be paid for undertaking immunization of
all infants, pre-school, and school children.
In organized municipalities immunization is the duty of both the School Medical Inspector
and the Medical Health Officer and the cost is the responsibility of the municipality. The
biological products are provided, however, by the Provincial Board of Health also in these
organized areas.
PREVENTIVE DENTISTRY.
Considerable study was made of the results of the various local dental clinics which have
been conducted in British Columbia during the past years. The programme was then completely revised and considerable education undertaken in an effort to inform interested persons
and organizations of the need for sound and scientific planning of their dental programmes
for effective results. In this connection the Provincial Board of Health makes available certain
financial assistance if the local dental committees agree to follow a practical policy of preventive dentistry. An outline of the prerequisites to be met before financial assistance is
given are listed below:—
(1.)   The submission of a detailed description of the existing dental programme or
the proposed programme.
(2.)   Report from dental committee concerning financial arrangements for clinic.
(3.)   The programme should be so organized as to operate on an annual basis, if at
all possible.
(4.)   Pre-school children between the ages of 2% and 6 years must be included in the
programme to the extent of at least one for every five school children.
(5.)   Service offered to all pupils regardless of economic status or dental condition.
(6.)  Treatment must begin with Grade I. and the proportionate ratio of pre-school
children and be completed before Grade II. is commenced with a further number
of pre-school  children.    Thus  each  grade  is  finished  before  doing  the  next
higher grade.
(7.)  Report from dentist of the work performed on each child. MEDICAL INSPECTION OP SCHOOLS, 1939-1941. Z 9
The response to this new system has been very gratifying and where these programmes
have been developed the results are much more encouraging than under the former system.
It is hoped that in a year or two there will be available data that will be entirely new and of
a character that will make it possible to evaluate organized programmes and provide a guide
for future developments. Too few people realize that a dental clinic is not simply a service
to be provided but rather that it is essentially an educational activity. The ultimate objective
of this type of educational, preventive dental programme is to prevent the serious decay, pain,
and loss of children's teeth, with the resultant saving in health. Experience has amply
demonstrated that such a policy results not only in improved health but also in a reduction in
cost of treatment dentistry, days' absence from school, school taxes for repeaters, and fewer
social problems because of improper dental growth due to lack of any dental care.
It was possible for the Provincial Board of Health to employ a full-time, well-trained
dentist to work in unorganized territory where no dentists were resident. These clinics were
financed jointly as between the community and the Provincial Board of Health. Unfortunately, this work has been at a standstill since September, 1941, when our dentist joined the
Army Dental Corps. It has not so far been possible to obtain another young dentist trained
in children's dentistry. However, it is anticipated that after the war it should again be
possible to procure the right type of dentist to do preventive dentistry in the unorganized
territory and to direct the entire Provincial programme and co-operate with the dentists
throughout the Province.
Considerable difficulty is now being experienced in organized communities due to the
shortage of dentists, because of the number who have joined the forces. However, many
programmes are carried on because of the sincere help and co-operation of those dentists who
remain. Many of these dentists, in spite of the fact that they have more private practice
than they can possibly undertake, are providing services to the children through a dental
clinic. This opportunity is taken to commend these men for their co-operation, help, and
interest in the welfare of the children of their community.
It is hoped that in the near future valuable information will be made available through
this and other reports to the people of British Columbia in the field of preventive dentistry.
INSTITUTE FOR PUBLIC HEALTH NURSES.
It has been the custom in British Columbia for many years to hold a Refresher Course
for Public Health Nurses every Easter week. Unfortunately, during the fiscal year 1939-40,
because of the demands on the budget due to the war and the confusion following the death
of the late Dr. H. E. Young, it was deemed advisable not to hold this Refresher Course.
In Easter week of 1941 the new Provincial Health Officer and staff felt that they had
sufficient material prepared to make it worth while to call the public health nurses of the
Province to Victoria for a conference. Invitations were extended to all public health and
school nurses outside of the Greater Vancouver and Victoria area to be present at the conference. The conference was called an " Institute for Public Health Nurses." At this Institute the various types of programmes carried out by the public health nurses were fully
reviewed, suggestions for improvement made with particular reference to the effectiveness of
a generalized programme. The protection of the health of the people in war-time is perhaps
more important than any one item, and every nurse was impressed with the idea that she
should completely review her programme with the object of making every improvement possible. Emphasis was laid on the importance of a well-balanced public health programme that
would take into consideration all the health problems of the community.
Considerable time was spent on outlining the importance of making available public
health and preventive information that could be applied throughout the entire life of an
individual, particularly in the pre-natal, infant, and pre-school periods. Confining a programme to the school was shown to be less effective than if the time was spent on both the
school and the community, including the younger age-groups.* The benefits resulting from
prevention in early life naturally mean that the children who start to school are in a better
condition, both mentally and physically, to absorb the education provided at considerable cost
for them by the people.    The mere finding of defects in the school child and then attempting
* An article entitled " Public Health Nursing and the Community " can be procured by writing to the Provincial
Board of Health, Parliament Buildings, Victoria, B.C. Z 10 BRITISH COLUMBIA.
to have them corrected is simply taking care of the end results of neglect and of failing to
apply preventive measures when these conditions could have been influenced and in many
instances completely prevented.
The nurses were asked to work in co-operation with their nursing committees in this
regard and do everything possible to extend the scope and usefulness of their programme.
During the Institute a complete review of the various services available to the people
through the Divisions and Bureaus of the Provincial Board of Health was made. It was
demonstrated to the public health nurses that a local health department in the form of a
Health Unit, adequately established and staffed, was the agency through which these services
could be made available to the people in a manner that would produce the greatest results
for the money expended on them. The public health nurse naturally plays' an important part
in the field of local health services.
Since this Institute the majority of the public health nurses throughout the Province have
definitely improved and enlarged their programme to better serve the people and at the same
time have made more use of the available Provincial health services.
CO-OPERATION WITH TEACHERS.
The public health nurses of the Peace River Health Unit and in the Okanagan Valley
meet with the teachers at their annual local Teachers' Convention and discuss related problems
with the teachers. This provides an excellent opportunity for them to understand each other
and their programme.
A series of lectures were given to the students of the Provincial Normal School in
Victoria, dealing with the organizational plan of the Provincial Board of Health and the
details of the generalized programme and the specialized services made available by the
various Bureaus and Divisions. Plans have been made to continue this with some modifications. The response to this endeavour has been most gratifying. In the Provincial Normal
School, Vancouver, special instruction in health matters was provided by the officers of the
Greater Vancouver Metropolitan Health Committee and various Divisional Directors of the
Provincial Board of Health. Both of these programmes have been developed with the idea
of acquainting the teachers with the services that are available and how they may be best
utilized. The importance of the development of health units providing full-time health service
by trained public health personnel in all parts of the Province of British Columbia was
emphasized to the teachers. Only through adequate local health services can the people reap
the benefits in leadership in the field of public health that they have a right to expect.
SUMMARY TABLES.
Table 1 of the summary tables shows the number of children enrolled and the number
examined, together with the percentage examined in each group of schools throughout the
Province.    This is given for the last five-year period.
Again the defect usually recorded as malnutrition has not been included because of the
unreliability of this information.
In studying the summary tables showing the number of defects and the rate per thousand
children examined, again this year there seems to be no uniformity in the rate of occurrence
of these particular conditions. Over a period of five years one would expect a gradual change
in one direction or the other; however, there does not seem to be any definite trend. Defects
chosen for this summary are those which might be expected to remain fairly constant each
year because of not being greatly affected by the presence or absence of epidemics.
Tables 9 and 10 give the general summary of defects by types of school for the two
school-years covered by this report. It is anticipated that the report for the school-year
1941-42 will contain new information of a type not previously available, and which will serve
as a practical guide for school-health programmes throughout the Province.
(See article by Dr. Mayhew Derryberry in the Twenty-eighth Report of the Medical
Inspection of Schools for the year ending June 30th, 1939.) MEDICAL
INSPECTION OF SCHOOLS, 1939-1941
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BRITISH COLUMBIA.
TABLE 9.-
-SUMMARY OF
DEFECTS, 193£
-40.
Normal
Schools.
High
Schools.
Junior
High
Schools.
Graded
City
Schools.
Rural
Municipal
Schools.
Rural and
Assisted
Schools.
Total.
Defective mentality 	
Defective vision ._	
16
8
5
20
37
2
31
13
304
304
3
1,433
261
172
260
1,482
5,005
338
622
485
23,269
21,017
1
562
113
77
142
945
1,947
447
395
197
9,321
8,274
66
2,880
1,159
973
998
6,841
16,158
2,589
1,114
1,115
40,680
37,659
102
1,364
498
570
1,063
2,958
6,554
1,514
548
443
17,983
16,756
303
2,118
360
1,332
2,040
5,263
7,496
2,921
1,270
609
23,665
22,707
465
8,373
2,399
Defective nasal breathing 	
3,129
4,503
17,509
37,197
7,811
3,980
Other conditions 	
2,862
115,222
106,717
TABLE 10.-
-SUMMARY OF
DEFECTS, 1940-41.
Normal
Schools.
High
Schools.
Junior
High
Schools.
Graded
City
Schools.
Rural
Municipal
Schools.
Rural and
Assisted
Schools.
Total.
15
7
8
16
33
9
29
24
274
281
1
1,060
167
1,119
164
1,092
4,176
479
431
323
20,740
18,279
3
395
74
63
130
651
1,940
345
341
147
8,099
7,253
68
2,235
982
628
702
6,052
17,033
2,034
563
260
35,057
30,718
69
1,115
268
392
1,035
2,490
6,823
1,287
398
303
18,257
15,297
208
2,106
248
1,255
2,101
4,628
6,808
2,698
978
674
21,817
20,688
349
6,926
1,746
Defective nasal breathing ,. -
2,465
4,132
14,929
Defective teeth. - -	
Enlarged glands... -	
36,813
6,852
2,740
1,731
104,244
92,516
VICTORIA, B.C. :
Printed by Charles F. Banfield, Printer to the King*s Most Excellent Majesty.
1942.
825-142-5687  

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