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PROVINCE OF BRITISH COLUMBIA FORTY-EIGHTH REPORT OF THE PROVINCIAL BOARD OF HEALTH FOR THE YEAR ENDED… British Columbia. Legislative Assembly 1945

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 PROVINCE OF BRITISH COLUMBIA
FORTY-EIGHTH REPORT
OF THE
PROVINCIAL BOARD OF
HEALTH
FOR the
YEAR ENDED DECEMBER 31st
1944
PRINTED BY
AUTHORITY OF THE LEGISLATIVE ASSEMBLY.
VICTORIA,  B.C. :
Printed by Chabi.es F. Banfield, Printer to tbe King's Most Excellent Majesty.
1945.  Office of the Provincial Secretary,
Victoria, B.C., January 19th, 1945.
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 Report of the Provincial
Board of Health for the year ended December 31st, 1944.
G. S. PEARSON,
Provincial Secretary. Provincial Board of Health,
Victoria, B.C., January 19th, 1945.
The Honourable Geo. S. Pearson,
Provincial Secretary, Victoria, B.C.
Sir,—I have the honour to submit the Forty-eighth Report of the Provincial
Board of Health for the year ended December 31st, 1944.
I have the honour to be,
Sir,
Your obedient servant,
G. F. AMYOT, M.D., D.P.H.,
Provincial Health Officer. THE PROVINCIAL BOARD OF HEALTH.
The Provincial Board of Health of British Columbia is the Lieutenant-
Governor in Council, under the provisions of the " Health Act." For the year
1944 the members of the Provincial Board of Health were:—
The Hon. JOHN Hart    - Premier, Minister of Finance, and Presi
dent of the Executive Council.
- Provincial Secretary, Minister of Labour,
and Commissioner of Fisheries.
Attorney-General.
- Minister of Lands.
Minister of Agriculture.
- Minister of Mines and Minister of Trade
and Industry.
Minister of Public Works, Minister of Railways, and Minister of Municipal Affairs.
The Hon. H. G. T. Perry  -     -     - Minister of Education.
The Hon. G. S. Pearson, Provincial Secretary, acts as Minister of Health.
The Hon. G. S. Pearson   -
The Hon. R. L. Maitland
The Hon. E. T. Kenney   -
The Hon. K. C. MacDonald
The Hon. E. C. Carson    -
The Hon. H. Anscomb   -
SENIOR PUBLIC HEALTH TECHNICAL STAFF.
G. F. Amyot, M.D., D.P.H.      -     -     -
J. S. Cull, B.A., M.D., D.P.H.    -     -     -
R. Bowering, B.Sc. (C.E.), M.A.Sc.    -
J. J. Carney, M.R.S.I., B.V.Sc.   -     -     -
C. R. Stonehouse, C.S.I. (C) -     -     -
Miss D. E. Tate, R.N., B.A.Sc, M.A. -     -
Miss M. Frith, R.N.,B.A., B.A.Sc, M.P.H.
Miss Mary Baldwin, B.Sc. (H.Ec.) -
Miss Edith Stewart, B.A., B.A. in Lib.
C. E. Dolman, M.B., B.S., D.P.H., Ph.D. -
W. H. Hatfield, M.D. -----
J. D. B. Scott, B.A., B.Com. -     -   . -     -
D. H. Williams, B.Sc, M.D., M.Sc     -
W. C. Mooney, M.D., D.P.H.
(Major, R.C.A.M.C.)   -     -     -     -     -
Provincial Health Officer.
Assistant Provincial Health Officer.
Public Health Engineer.
Consultant in Milk and Food Control.
Senior Sanitarian.
Director, Public Health Nursing.
Consultant, Public Health Nursing.
Consultant in Nutrition.
Public Health Educator.
Director, Division of Laboratories.
Director, Division of Tuberculosis
Control.
Director, Division of Vital Statistics.
Director, Division of Venereal Disease Control (on Active Service).
Acting-Director, Division of Venereal Disease Control.  TABLE OF CONTENTS FOR THE YEAR 1944.
Page.
Introduction    9
The Health of the People of British Columbia  14
Bureau of Local Health Services—
Public Health Nursing  17
School Medical Services ,  18
Notifiable Diseases  19
Full-time Health Services .    21
Public Health Education  — 24
Preventive Dentistry  25
Public Health Engineering  25
Report of the Director of Public Health Nursing—
Public Health Personnel .  26
Programme  28
Education  30
Uniforms — 31
Salary Schedule  31
Report of the Consultant in Nutrition—
Organization for Nutrition Education  32
Report of Provincial Board of Health Nutrition Services in 1944  33
Report of the Division of Vital Statistics—
Introduction ;  36
The Contribution of the Division of Vital Statistics to Canada's War
Effort    37
Summary of Registration and Related Procedures  38
Preservation of Records—Microfilm  40
Transfer of Original Records  40
Completeness of Registration  40
District Registrars' Offices, etc  42
Administration of the " Marriage Act"  42
Legislation  43
Co-operation within the Provincial Board of Health and its Divisions-__. 44
Mechanical Tabulation Problems  45
Fourth Dominion-Provincial Conference on Vital Statistics  46
Problems Outstanding at the End of the Year  48
Report of the Division of Laboratories—
Introductory Comments  49
Tests relating to Venereal Disease Control  50
Tests relating to Tuberculosis Control  53
Tests relating to Control of Intestinal Infections  54
Bacteriological Analyses of Milk and Water  55
Other Types of Laboratory Tests  56
Distribution of Biologicals  57
Red Cross Blood Donor Service  58
General Comments   59
Table No. I.—Statistical Report on Examinations done during the Year
1944 !  63
Table No. II.—Number of Tests performed by Branch Laboratories in
1944  64 LL 8
BRITISH COLUMBIA.
Report of the Division of Venereal Disease Control-
Introduction	
Page.
- 65
Information and Public Relations    66
Diagnostic and Treatment Service  68
Epidemiology—Welfare and Rehabilitation  69
Problems of 1945 and Suggested Solution  71
Report of the Division of Tuberculosis Control—
Introduction	
  72
New Cases—Pulmonary and Non-pulmonary  74
New Cases—Pulmonary  74
Tuberculosis Mortality  75
Institutions  75
Clinics  76
Public Health Nursing  77
Social Service  77
Nurses' Training  78
Examination of Government Employees  78
Statistics  78
Relation with Local Services  78
Legislation  79
General.:  79
Review of Tuberculosis Control Programme
80
Report of the Division of Public Health Engineering—
Introduction  83
Water-supplies  84
Sewage-disposal .  84
Milk Sanitation  85
Shell-fish Sanitation  86
Cannery Sanitation  87
Industrial Camp Sanitation  88
Sanitary Complaints  88
Auto Camps and Summer Resorts  88
General Observation  gg
Table showing Return of Cases of Notifiable Diseases in the Province for
the Year 1944  90 REPORT of the PROVINCIAL BOARD OF HEALTH
YEAR ENDED DECEMBER 31st, 1944.
G. F. Amyot, M.D., D.P.H., Provincial Health Officer.
INTRODUCTION.
At the termination of the year 1944, after five years of war, it is gratifying to be able to report considerable progress in maintaining and extending
the Provincial Health Services to meet the rapidly expanding health demands
of the Province of British Columbia. The shortage of technically trained personnel has been one of the most difficult problems to overcome. However, by
the wholehearted co-operation of the senior and key technical and professional
members of the Provincial Health staff and the loyalty and progressiveness of
all members, many of the programmes have received considerable study resulting in more effective administration and, through this means, an expansion
and greater use of the services provided.
A few of the highlights of the year's activity of the Provincial Health
Services seem worthy of note in this introductory part of the 1944 Report.
Stimulation and development of local health services and their maintenance at a high level of efficiency is one of the first responsibilities of any
Provincial Health Department. An extended programme of local health supervision by the Consultants of the Provincial Board of Health has been provided
to help the local health officials meet many of their difficult health problems.
In addition, every Division of the Provincial Board of Health has given more
consideration to the needs of local health services and modified or extended
their programmes to meet these needs.
A new Health Unit was established in the fall of 1944 in the North Okanagan Valley, with headquarters in Vernon. This was in answer to the continued
demands of the local people, particularly the Council at Vernon, following a
disastrous milk-borne typhoid epidemic which occurred in the latter part of
1943, resulting in fifty-three cases and four deaths. It is anticipated that this
Health Unit will be extended to include the entire North Okanagan Valley.
A number of new public health nursing services were established. Further
nursing services would have been developed if trained Public Health Nurses
were available.    The same is true of Health Units.
In co-operation with the executive of the College of Physicians and Surgeons
and the District Advisory Committee of the Canadian Medical Procurement
and Assignment Board, of which latter committee the Provincial Health Officer
is a member, physicians were procured to serve various parts of the Province
where no medical service was available. These practising physicians were then
appointed part-time Medical Health Officers for the area.
In Telegraph Creek and Atlin, where there has been no medical service
available for some time, nurses appointed through the Deputy Provincial Sec- LL 10 BRITISH COLUMBIA.
retary are functioning to provide a service in lieu of medical service and working in close co-operation with the Provincial Board of Health.
The nutrition programme of the Provincial Board of Health and the Provincial Nutrition Committee has been extended to many parts of the Province
and is being developed in co-operation with local committees, schools, the Education Department, the Red Cross Nutritionist, and the Nutritionist appointed
by the Greater Vancouver Metropolitan Health Board. In addition, arrangements have been completed by the Division of Nutrition of the Federal Government to provide a Consultant Nutritionist to work in British Columbia and
Alberta in co-operation with the Provincial Consultant in Nutrition. A school-
lunch programme has been developed jointly with the Provincial Department
of Education, School Inspectors, local School Boards, principals, and teachers.
Surveys have been made of various Provincial and other institutions to aid
them in providing a balanced diet.
Considerable progress has taken place in the Division of Public Health
Engineering to augment the broad programme of environmental sanitation.
A Consultant in Food and Milk Control, experienced in public health and having
a degree in veterinary medicine, was appointed to aid local health services in
their problems of food and milk control. A Senior Sanitarian, needed for a long
time, has also been appointed to the staff of this Division to work in close
collaboration with local health services, their Sanitarians, the Provincial Police,
and particularly to investigate the sanitary conditions in mining, lumbering,
and other camps employing large numbers of men. Further study of the sanitary conditions in the living-quarters in canneries has been completed and
reports sent to the various companies concerned, with recommendations for
improvements.
A number of regulations dealing with sanitary matters are under review
and revision to bring these up to date and provide a guide to general improvement in sanitation.
Much work has been done in the field of Public Health Engineering and
environmental sanitation in co-operation with the armed forces.
The survey of rodents is at present confined to Coast cities and towns and
is a co-operative endeavour between the Federal Department of Health and
Welfare and the Provincial Board of Health. Reports have been sent to various
communities surveyed with recommendations for improving the rat situation
in these communities.
The Division of Tuberculosis Control has continued its extensive programme and made considerable advances during the year. Two mobile Chest
Survey Units are operating throughout the Province, providing a free chest
X-ray to industry, schools, and other groups of people. This is in addition to
the four Travelling Units that cover the Province. All clinics, both stationary
and travelling, are now using more rapid methods to provide chest examinations
for more people.
Reorganization of the course in the control of tuberculosis for undergraduate nurses from various hospital training schools also took place. This new
method should provide a much more adequate course to supplement that given
in the nurse-training schools. BOARD OF HEALTH REPORT, 1944. LL 11
The urgent demand for tuberculosis beds has been met by the commencement of a temporary structure to house seventy beds and a plan for the erection
of a permanent tuberculosis hospital to provide eventually 500 more beds, with
300 beds in the first wing.
Closer co-operation with local health services has been developed by the
Division of Tuberculosis Control, with the result that more effective case-finding
methods have been devised and better service provided for patients, prior to
and after sanatorium care.
The Provincial Laboratories have continued to meet an increasing demand
for public health laboratory services in the same overcrowded and unsatisfactory quarters located in four houses in Vancouver. Blood plasma processing
in co-operation with the Red Cross continued and expanded with a great deal
of credit being due to the staff of the Provincial Laboratories who contribute
considerably of their time on a volunteer basis to aid in this important war-
work.
It is planned to provide new and adequate quarters for the main Public
Health Laboratory in the near future. This will be in a building in which are
brought together all the Provincial health services.
The Division of Vital Statistics is receiving increased demands on its services as the need for statistics receives greater emphasis and birth and other
certificates are required by more agencies.
A Dominion-Provincial conference was held in Ottawa in conjunction with
the Dominion Health Council meeting in the fall to discuss the many related
statistical problems of the Federal and Provincial Governments. Plans were
evolved at this conference in connection with checking the birth certificates
for Family Allowances. Mr. J. D. B. Scott, Director of Vital Statistics, attended
this conference as the British Columbia representative.
The Division of Vital Statistics has expanded its services to all the Provincial Health and Welfare Services as well as to local health services, in aiding
them to make better use of statistics and statistical facilities.
The Division of Venereal Disease Control has suffered again extensively
through loss of trained personnel. However, in spite of this difficulty, extension in the programme has taken place with a resultant increase in case-finding
and therefore the placing of more persons under treatment who are suffering
from venereal disease. A study of the complete organization of the Division
was carried out through the Provincial Health Officer, the Assistant Provincial
Health Officer, the Director of Vital Statistics, and the Director of Public Health
Nursing, in co-operation with the staff of the Division of Venereal Disease
Control. As a result of this survey, a complete plan of reorganization to
simplify administration and more effectively utilize the services of the technical, professional, and other personnel available was evolved.
Through money made available by the then Department of Pensions and
National Health, Public Health Nurses specially trained in the epidemiology
of venereal disease control were added to the staff of the Division to work in
close co-operation and collaboration with all local health services and private
physicians in improving case-finding and case-holding methods. The result of
this has been an increased interest on the part of the local physicians and health
workers with resulting improvement in the venereal disease control programme. LL 12 BRITISH COLUMBIA.
Two important venereal disease conferences were held during the year:
One a Dominion-Provincial conference in Ottawa and the other a Western
venereal disease conference in Regina, where the four Western Provinces had
an opportunity to discuss their related problems. The Acting-Director of the
Division of Venereal Disease Control attended both these conferences, and also
the International conference held in St. Louis, Mo., where a great deal of valuable information in the advanced control and treatment of venereal disease was
obtained. The Provincial Health Officer also attended and spoke at the meeting
in Regina.
Due to the serious shortage of trained venereal disease physicians the
Department of National Defence, acting on a request from the Provincial Secretary, made available the services of Major W. C. Mooney, as Acting-Director
of the Division, on a seconded basis. Previous to this time, Dr. Dorothy Saxton
had carried a tremendous load as a treatment physician and also as Acting-
Director of the Division. Due to health reasons, it was necessary for Dr.
Saxton to tender her resignation shortly after Major Mooney was appointed
Acting-Director of the Division. x
In the field of Public Health Education, considerable progress has been
made by all the Divisions of the Provincial Board of Health. Numerous talks
by various members of the Central and Divisional staffs have been given to
various organizations and groups, as well as a number of radio presentations.
The usual courses for undergraduate nurses in the various specialities of public
health have been continued and in Victoria a course of lectures was again given
to the Normal School students.
The Provincial Police School for experienced police officers asked for a special series of lectures on public health which lectures were given by the senior
officials of the Provincial Health Services.
A start on the development of a Division of Public Health Education for
the Provincial Board of Health was made when a candidate was chosen to
utilize a fellowship made available by the W. K. Kellogg Foundation, and now
Miss McNevin is taking a course at the University of North Carolina leading
to a degree in Public Health Education. A place in this course, one of the few
of its kind on the North American Continent, was kindly made available to
British Columbia through the courtesy of the Professor in charge, with the
consent of the United States Public Health Service. It is hoped that more
candidates for Public Health Education can be secured in the coming year and
sent for their specialized training. When these return they will be detailed to
local Health Units for duty. In this way it is hoped to broaden and unify the
programme of Public Health Education throughout the Province.
A number of general highlights which are worthy of mention include
changes in the " Health Act" transferring statutory grants paid to local communities on behalf of Public Health Nurses, dentists and dental assistants,
from the Education Department to. the Provincial Board of Health. This
enabled the one Provincial service to provide all monetary grants-in-aid to the
local Public Health Services and also the necessary technical supervision that
is so essential if these services are to be maintained on a high scientific basis.
Two additional changes were made in the " Health Act," one clarifying the BOARD OF HEALTH REPORT, 1944. LL 13
term " Health Officer," and the other making provision for hospitalization of
difficult chronic invalids who refuse this service.
An amendment to the " Municipal Act" permitting municipalities to hold
a plebiscite in connection with the pasteurization of milk has an important
bearing on public health. The " Milk Act" was also changed to permit the
" short-holding period" method of pasteurization as well as the formerly
accepted method.    This is a decided advance.
A Dominion-Provincial conference on Health Insurance was held in Ottawa,
at which was discussed a proposed draft of a Health Insurance Bill. The Hon.
George S. Pearson, Provincial Secretary; Mr. J. V. Fisher, Assistant Deputy
Minister of Finance; Mr. J. D. B. Scott, Director of Vital Statistics; and the
Provincial Health Officer attended this conference. The entire field of Health
Insurance was covered in the deliberations but no definite action arose following the meeting. This meeting was held in lieu of the spring meeting of the
Dominion Health Council.
The Provincial Health Officer attended the fall meeting of the Dominion
Health Council, at which many matters of an Interprovincial and Provincial
nature were discussed. Among other presentations, the Provincial Health
Officer presented a summary showing the serious disability caused by arthritis
and the need for a study of this problem to determine the development of a
suitable programme to prevent as much of this disability as possible. A special
committee of the Dominion Health Council was set up to study the matter
further, with instructions to bring in a report at the first meeting in 1945.
During the year the Provincial Health Officer was honoured by the appointment as one of four members of the Special Public Health Advisory Committee
to the W. K. Kellogg Foundation. He was also elected as a member of the
Governing Council of the American Public Health Association, and a member
of the major committee of this Association known as the Committee on Administrative Practices.
Among the many distinguished visitors to the Provincial Health Offices in
Victoria are to be noted Dr. George Buchan, of the British Ministry of Health,
and Col. George Hayes, of the Alaska Territorial Health Department.
A great deal of credit is due to all those engaged in public health activities
for their sincere and progressive interest in their work and their willingness
to meet each new obstacle and find a method to overcome these many difficulties.
This performance of duty is well beyond that which might be expected under
normal circumstances and the advance in the public health programme has been
possible only because of the faithful and whole-hearted co-operation of this
group of public health workers.
Tribute must be paid to the many Departments of the Provincial Government which have worked in close co-operation with the Health Services. Notable
ones among this group are the Departments of Public Works, Municipal Affairs,
Lands, Fisheries, Agriculture, Provincial Police, Education, and Labour.
The help and co-operation received from the medical profession, teachers
in the schools, Municipal Councils and School Boards, Women's Institutes,
Parent-Teacher Associations, and other men's and women's organizations
deserve special mention for the part they have played in furthering public
health in the Province. Further advances have been planned for the coming year and it is to be
hoped that more technical personnel will be available to meet the increasing
health demands of the people and the need for extension of health services
throughout the Province, both on a local and a Provincial basis. The new
Federal Department of Health and Welfare, it is anticipated, will provide
valuable leadership, help, and consultative service which will further aid in
the protection of the health of the people.
THE HEALTH OF THE PEOPLE OF BRITISH COLUMBIA.
The following is a brief summary of the health of the people of British
Columbia, based on the statistical data available. The information used was
that obtained from the registrations with the Division of Vital Statistics during
1944. As there are always a number of delayed registrations, the figures of
which were not available at the time of writing this article, it will be seen that
the figures herein are only preliminary. For instance, at the time of writing,
January returns which will include some December figures have not been
received. It is felt that a summary of this nature should be of considerable
interest.
The health of the people of British Columbia is reflected only to a certain
extent in the mortality figures for 1944 and care should be exercised in studying
these, if correct impressions are to be gained. The preliminary death-rate in
1944 was 10.9 which was a decrease of 0.6 death per 100,000 population over
the previous year. Again there is an increase in the actual number of deaths
at ages 60 and over—6,024 in all. Over one-half (61 per cent.) of the total
deaths in the Province were in this age-group—almost one out of every five
deaths were of persons between the ages of 40 and 59; approximately 7 per
cent, between the ages of 20 and 39, and 12 per cent, under 20 years of age.
There were 751 infant deaths (children dying under 1 year of age) in
British Columbia in 1944. This figure represents 60 per cent, of the deaths
under 20 years of age. The preliminary infant mortality rate was 37.6 per
1,000 live births, which is slightly lower than the 1943 figure compiled by the
Dominion Bureau of Statistics. There were 48 maternal deaths in 1944, giving
a provisional fate of 2.4 per 1,000 live births. This shows a slight increase
from the 1943 rate, which was 2.1, but lower than that for 1942, which was 2.6.
Of primary importance in a study of this nature is the necessity to ascertain
the leading causes of death. Causes of death naturally fall into certain broad
groups. As was done in last year's report, " Diseases of the Heart" and
" Diseases of the Arteries " have been grouped together to form one cause of
death.
A study of the leading causes of death for all ages reveals that diseases of
the heart and arteries were responsible for more deaths than any other condition, accounting for 3,231 in all. Cancer was the second leading cause of death;
1,325 persons died of this disease. The third cause of death was accidental
deaths, and the fourth was tuberculosis; 532 persons died in the Province from
tuberculosis in 1944. This gives a provisional tuberculosis mortality rate of
59.1 per 100,000 population. This shows a decline from the 1943 rate of 64.8.
If Indian deaths are excluded the provisional tuberculosis rate becomes 41.7. BOARD OF HEALTH REPORT, 1944. LL 15
Pneumonia ranked fifth as a cause of death, followed by nephritis. Diseases
of early infancy was the seventh cause of death and cerebral haemorrhage
ranked eighth.    Diabetes ranked ninth and influenza tenth.
To gain a full appreciation of the mortality picture of the Province of
British Columbia the effect of Indian deaths on certain specified diseases must
be considered. In general, Indian mortality exerts little influence on the ranking of the leading causes of death in the age-groups 30 years and over. It is
under 30 years of age that the most significant differences occur; 67 per cent,
of all Indian deaths were under 30 years of age; 28 per cent, were under 1 year
of age; and 43 per cent, were under 5 years of age.
Almost 30 per cent, of all Indian deaths were due to tuberculosis, over three-
quarters of these deaths were among Indians under 30 years of age. Tuberculosis mortality figures and those of other diseases such as pneumonia and influenza are affected very unfavourably by Indian mortality. Indians are the wards
of the Federal Government and so do not constitute a direct responsibility of
the Provincial Board of Health. However, they cannot be ignored in a public
health programme as long as they present a threat to the health of the rest of
the people.
If a strictly accurate picture of the responsibility of the Provincial Board
of Health is to be estimated, Indian deaths must be excluded from a study of
this nature. Therefore the following statistics are exclusive of Indians. The
figures must be analysed with an eye to both the cause thereof and the means
of prevention to be of assistance to the Provincial Board of Health in its programme. A study of the chief causes of death of infants under 1 year of age
reveals that prematurity ranked first, accounting for over one-third of the
deaths in this age-group. Undoubtedly, improved prenatal and postnatal care
could reduce this figure considerably. The second cause of death among infants
was found to be congenital malformations. This cause does not respond to
treatment as readily as many others, but improved prenatal care can exert
favourable influences. The third cause of death among infants was pneumonia,
and injury at birth was fourth.
Among pre-school children accidents were the leading causes of death,
accounting for over one-quarter of the deaths between the ages of 1 to 4 years.
Most of these deaths could have been prevented if more care had been taken by
the parents. The second cause of death in this age-group was appendicitis and
tuberculosis third.
Between the ages of 10 and 39 years the leading cause of death was accidental death. Many of these deaths are preventable as are those caused by
tuberculosis, which ranked second. The Division of Tuberculosis Control of
the Provincial Board of Health has in recent months greatly increased its case-
finding which, with continued application, should ultimately, because of early
diagnosis and treatment, reduce greatly the number of deaths due to tuberculosis.
The chief cause of death between the ages of 40 and 59 years was disease
of the heart and arteries. The second leading cause of death in this age-group
was cancer. It is unfortunate that these degenerative diseases should take such
a heavy toll in these most productive years. Deaths from these diseases can
be prevented or at least postponed until later years if diagnosed and cared for
at an early stage.    Accidental deaths ranked third in this middle-age group. LL 16 BRITISH COLUMBIA.
Diseases of the heart and arteries ranked first in the ages over 60. The
second cause of death in this age-group was cancer and nephritis was third.
When the figures are examined for communicable diseases it is found that
the 1944 figures in general compare favourably with those of previous years.
Especially is this so in the case of measles. Also the situation regarding whooping-cough is improving. The 1944 figure of 122 deaths from influenza is well
below the 1943 Dominion Bureau of Statistics figure of 189 but is still far above
the 1942 figure of 78. The very existence of deaths from communicable diseases
is a constant reminder that the methods designed to control and eliminate them
must be continued without relaxation. The public health worker and private
physician alike must be continually on the alert to discover the presence of communicable diseases and institute control measures. For further information
regarding communicable diseases reference should be made to the Epidemiological Report of the Bureau of Local Health Services on page 19, where an
analysis is made of increases and decreases in comparison with previous years.
The field of public health is continually expanding. To-day it is concerned
not only with measures to prevent illness and premature death, but also with
those designed to prevent premature crippling and invalidism. It must also
plan means of lengthening the life of the people. Also its attention must be
concentrated on reducing the number of deaths caused by degenerative diseases
in people at the time of their maximum economic use to society. Now, more
than ever, with an acute man-power shortage, it is doubly important that emphasis be placed on this aspect of public health. On account of the limitations
of the statistical data at hand at the moment pertaining to British Columbia,
little or no mention has been made in this article of the injuries which, all too
frequently, disable; or of the many diseases which although not in themselves
serious enough to kill do incapacitate, temporarily at least. Sufficient is now
known about the common cold, for example, to place it as one of the most important causes of loss of time in industry. To mitigate such minor diseases much
can be done by the general populace in practising good health habits, particularly in regard to having an adequate and varied diet, proper rest, exercise and
relaxation. These are the fundamentals which must oft be reiterated, especially
in war-time with the withdrawal of so many physicians for service in our armed
forces.
The subject of this article tends to be misleading as the main emphasis is
on the mortality picture in the Province rather than on the morbidity or sickness aspects of the health of the people. It is impossible to give an adequate
analysis of the current health conditions of the people without statistics of the
incidence of many of the common illnesses, especially those of the non-fatal
type. It will only be after health insurance has been implemented that a true
picture of the morbidity situation can be obtained.
BUREAU OF LOCAL HEALTH SERVICES.
J. S. Cull, M.D., D.P.H., Assistant Provincial Health Officer and
Director, Bureau of Local Health Services.
The passing of 1944 brings to a close a year fraught with its full quota of
difficulties and problems.    Among others might be mentioned difficulties in BOARD OF HEALTH REPORT, 1944. LL 17
general administration under prevailing conditions, shortages of trained and
qualified public health personnel to meet the demand, unexpected losses among
public health personnel in the field at the present time, as well as the provision
and maintenance of transportation for members of various Health Units and
Public Health Nursing Services. However, these have come gradually to be
accepted as part of the daily and monthly work of the Department. A considerable amount of progress and advance can be reported, as will be evidenced
as the various sections of this Bureau of Local Health Services are reviewed.
PUBLIC HEALTH NURSING.
The report of the Director of Public Health Nursing js appended herewith
and gives a broad picture of the activity in this phase of public health work in
the Province, with the exception of that in the Greater Vancouver and Greater
Victoria areas. The report also outlines the changes in personnel that have
taken place during 1944, summarizes information relative to policies which
have been established during the year, and also provides for public consumption
information relative to public health nursing services in general.
It is gratifying to note that two new Public Health Nursing Districts were
established in the Province during 1944. These were in the Cumberland district and the Nakusp district. In addition, the services of the Public Health
Nurse stationed at Fernie were extended to include the Michel-Natal area, and
those of the Public Health Nurse stationed at Langford to include the Colwood
district. It is expected that the Fernie Public Health Nursing District will in
the not too far distant future be extended south to the International boundary,
and that similarly other areas will be included in the Esquimalt rural nursing
services at Langford, so that in both cases the area included will be such as to
make for an economic service and also to ensure that there are no districts which
do not receive service in the territory through which the Public Health Nurse
travels.
Due to the shortage of public health physicians, it was necessary in the
late summer to ask one of the Public Health Nurses to assume the position of
Supervisor in the Peace River Health Unit, and as such also act in the capacity
of Acting-Director of the Unit. This will be referred to in more detail under
the section on Full-time Health Services.
It was mentioned in last year's report that it was hoped that the graduation of the public health nursing class in the spring of 1944 would result in
some easing of the shortage of this type of personnel, and while this was partially the result, nevertheless, at the present time there are still districts where
public health nursing services are desired, but such personnel are not available
to establish these services. Nevertheless, while this is unfortunate to a degree,
at the present time it does augur well for the future of Public Health Nursing
Services in British Columbia, and the provision of this type of service to a still
higher percentage of the population than at the present time. As closely as
can be estimated, it is of interest to note that more than 80 per cent, of the
population is supplied with Public Health Nursing Service in British Columbia.
Again, the annual " Institute for Public Health Workers " was held just
prior to the Easter holiday, following in a general way the programme of last
year, with more time being allowed for group discussion.    As was the case last LL 18 BRITISH COLUMBIA.
year, all material was presented either by Health Unit personnel or the technical
staff of the Provincial Board of Health. This year, the Public Health Nurses
were not only given an afternoon to meet by themselves with the Director of
Public Health Nursing, but also another afternoon to discuss records and record
systems, and bring in such recommendations which they, as a group, considered
worthy of consideration and practical from a field worker's point of view. The
Sanitary Inspectors from the various Health Units also met as a group with the
Public Health Engineer and discussed the problems related to their particular
field of activity. The Health Unit Directors met with the Provincial Health
Officer and discussed matters of policy and administration. Later, an opportunity was provided for a meeting of Health Unit Directors and Sanitary
Inspectors with the Provincial Health Officer. This proves a splendid opportunity for discussing all related problems of local health services, and always
results in the solution of a number of problems, and interchange of examples
of practical ingenuity which have been tried out on a local level, and the clarification of interpretation of legislation and policy. It is planned to continue in
general with the same type of programme, subject only to minor variations
because of the splendid reception which it has enjoyed by those attending the
Institute.
The " News Letter " from the Provincial Board of Health to the Public
Health Nurses throughout the Province has been continued as a medium of
instruction and education. It continues to be a valuable medium for the
exchange of information between the Department and the Public Health Nurses
in the field. There is still, however, much room for improvement in the matter
of participation in its activities by the Public Health Nurses throughout the
Province.
The effort to standardize salaries for Public Health Nurses and also establish a salary schedule is, perhaps, one of the most important advances to be
reported for the year 1944. Further details will be found in the appended
report of the Director of Public Health Nursing. Efforts are continuing to
endeavour to surmount some of the technical difficulties with regard to a plan
for superannuation for Public Health Nurses.
The former Director of Public Health Nursing, Miss Heather Kilpatrick,
left early in the year to offer her services for work in foreign countries under
the auspices of the United Nations Relief and Rehabilitation Administration.
Miss Kilpatrick was the first Director of Public Health Nursing in this Province,
and during her four years of association with the Provincial Board of Health
did a great deal of organizational work and laid the foundation for many of the
policies in effect to-day. For her efforts in this regard much credit is due her.
Miss Dorothy Tate, formerly a Consultant in Public Health Nursing, assumed
the position of Acting-Director of Public Health Nursing in May, and the position of Director in October. Commendation is due Miss Tate for the energetic
enthusiasm and effectiveness with which she has both handled and controlled
the numerous problems which have come to her desk during this difficult year.
SCHOOL MEDICAL SERVICES.
With reference to the medical inspection of school pupils, it was again
deemed advisable in the school-year 1944-45 to continue to examine only certain BOARD OF HEALTH REPORT, 1944. LL 19
grades of enrolled pupils. This makes the third school-year that this policy has
been in effect, and by the end of June, 1945, all school children will have been
examined since the policy was first instituted. This procedure was made necessary as has been outlined in previous reports because of the continued shortage
of physicians and also the heavy burden of extra work which all of them in
civilian practice have been carrying.
The joint report for the school-years 1941-42, 1942-43, and 1943-44 is now
available, and shows for the first time a breakdown of the pupils in the various
grades on a basis of a physical status rating. In addition, information is also
available now for the first time on the relative protection for the school-age
population against certain preventable diseases, as a result of widespread
immunization by Medical Health Officers, School Health Inspectors, and public
health personnel. While much has been accomplished along this line still much
remains to be done. The interpretation of these figures concerning physical
status and immunization is discussed in the joint Medical Inspection of Schools
report referred to above.
For some years now, an increasing number of individuals associated with
medical inspection of school children and health work in schools have questioned
the value of the policy of having school pupils examined regularly by a physician
on an annual basis. It is a programme on which much time, effort, and money
are spent here, and if the same result, whether that result be tangible or
intangible, can be secured by having Public Health Nurses, or teachers, or both,
carry on an inspection programme, with referral for specific reasons to the
School Health Inspector, it seems only logical that serious consideration should
be given to the wisdom of modifying what is now tending to become, and be
considered, an antiquated form of school health service.
A word of appreciation is due the School Health Inspectors for the interest
which they have shown and their co-operation during the year just ended. The
majority of these are medical practitioners and the willingness with which they
have given up some of their time to investigate, on request, reports of outbreaks
of communicable disease in some of the outlying schools of their district has
been much appreciated.
NOTIFIABLE DISEASES.
A table on pages 90-93 shows the number of reported cases of notifiable
disease. The total number reported—namely, 25,076—represents a slight
decrease from that reported during the previous year. In 1943 the figures
showed a total of 27,259 cases reported. The year 1944 has thus continued to
be a very favourable one for British Columbia, in so far as communicable disease
is concerned. The movement of population, together with the overcrowding
which exists in all the large centres throughout the Province, has not decreased
but rather, perhaps, has increased if anything at all, and in the face of this it is
rather surprising that not only has the total figure for notifiable diseases gone
down, but, in addition, there has been no widespread outbreak of any one particular communicable disease.
The figures for chicken-pox, encephalitis, erysipelas, influenza, scarlet
fever, septic sore throat, and whooping-cough show only minor changes which
are relatively unimportant.    On the other hand, dysentery in all forms, after LL 20 BRITISH COLUMBIA.
showing a sharp rise from 39 cases in 1942 to a peak of 143 cases in 1943,
showed a decline to 79 cases for 1944. Measles, also, showed a spectacular drop
from over 8,200 cases for 1943 to just under 1,500 cases for the year just ended.
Poliomyelitis (infantile paralysis) increased from 8 cases the previous year to
18 cases during 1944. Again, this Province was extremely fortunate in so far
as this disease was concerned, because there were a considerable number of
cases in both the Province of Alberta and the State of Washington during the
year, with a very widespread epidemic being prevalent through the entire
eastern half of the United States. Mumps showed a very considerable decline
from more than 4,700 cases reported last year to 1,657 cases for the year just
ended. Because of the very poor and incomplete reporting of the minor communicable diseases, the rise in rubella (German measles) from 546 cases last
year to 1,180 cases in 1944 is not thought to have any great significance with
regard to a very marked increase occurring during 1945.
Cancer showed a slight increase in the number of cases reported but, as
was pointed out last year, this figure has little or no significance since we have
no accurate statistics as to the incidence of cancer in the general population of
this Province. Cerebrospinal meningitis reached a low of 5 cases in the year
1939. This was followed by a rather sudden rise to a total of 138 cases in 1941.
Since that time, the number of cases reported annually has decreased and during
1944 only 47 cases were reported. Whether this is due to an increased number
of carriers in the general population, coupled with an increased number of individuals who have been automatically immunized through contact with carriers,
or whether this is a downward cycle of the disease incidence which would have
taken place irrespective of the conditions which have held during the past four
or five years, is impossible to say at the present time. However, the fact that
the incidence of cerebrospinal meningitis has declined in England in recent
years after a preliminary rise early in the war, in spite of the housing shortage
and the terrific overcrowding which has been the unfortunate result of war over
there, makes one think that the latter supposition may be worthy of more consideration than would ordinarily be given to it.
Four cases of botulism were reported during the year. Three of these
were fatal and all three of them were members of one family. This was a most
unhappy and unfortunate experience, and one that could perhaps have been
prevented with a little greater appreciation of the dangers of home-canned food,
where due precaution is not taken for its safe preservation. There would
appear to be still some considerable need for widespread information concerning
precautions to be taken with the home preservation of certain food products,
and other precautions to be observed on the opening of food products which may
indicate by appearance, or odour, the possibility of contamination with pathogenic organisms of the food-poisoning type.
Diphtheria continued in decline and showed a 40-per-cent. drop from 28
cases last year to 17 cases in the year just ended. It is to be hoped that the
widespread immunization against this disease which has been carried on during
the past two or three years will soon result in a still greater reduction in the
incidence of this preventable disease. The figures on deaths from diphtheria,
so far only available to the end of October, show that during 1944 there have
been two deaths. BOARD OF HEALTH REPORT, 1944. LL 21
While the table shows 22 cases of paratyphoid fever, it should be pointed
out that 11 of these were gastro-intestinal outbreaks of the Salmonella typhi
murium type. Pending further discussion, on revision of the List of Notifiable
Diseases, outbreaks of this type of infection have been listed under the heading
of paratyphoid fever. It is felt that a more correct listing would show the
major heading of Salmonellosis, with paratyphoid fever, typhi murium, and
other varieties as sub-headings.
Typhoid fever showed a reduction in the number of reported cases from 63
for the previous year to 34 for 1944. Fortunately, no outbreak occurred similar
to that of the previous year at Vernon. The cases of typhoid fever that did
occur were not lumped in any one area of the Province, but rather were scattered throughout the various centres of population.
One fatal case of tularasmia occurred at Williams Lake. This was a most
interesting occurrence since the unfortunate patient obtained the infection from
a coyote. This animal is only occasionally the cause of this disease, wild rabbits
being a much more common source. This man happened to have an abrasion
on his finger which apparently became contaminated during the time that he
was skinning the coyote.
For some two years the regulations of the Provincial Board of Health for
the control of communicable disease have been undergoing revision. These
regulations have been drawn up in a way which it is hoped will prove to be
practical for both reference and application. They represent a very considerable difference of opinion with the existing regulations which were drawn up
many years ago. However, the variations in the isolation and quarantine
periods and procedures are based, as far as can be determined, on scientific facts
and principles. It is expected that the new regulations will be available for
distribution very early in the new year.
FULL-TIME HEALTH SERVICES.
This section of last year's report made particular reference to the formation
of the Central Vancouver Island Health Unit as a noteworthy advance in local
health administration in British Columbia for 1943. A similar step was made
during the year just ended in that the North Okanagan Health Unit commenced
operation in October, 1944. The plans for this Health Unit were completed
early in the year in so far as the City of Vernon was concerned, but again, owing
to shortage of trained and qualified personnel it was not possible to commence
operations until the fall of the year. As a matter of fact, because of the urgency of a number of problems in and about Vernon, coupled with the fact that
this was the scene of a large army camp, it was finally decided to transfer Dr.
J. A. Taylor, Director of the Peace River Health Unit, to Vernon, in order to
commence the full-time local health service for this section of the Province. We
were fortunate enough to secure the other personnel required, and at the present
time this North Okanagan Health Unit operates with a staff of Dr. J. A. Taylor,
as Director, two Public Health Nurses, a Sanitary Inspector, and a Statistical
Clerk. The headquarters at the present time are located on the second floor of
the City Hall in Vernon. This Health Unit, at the present time, serves only the
City of Vernon and the surrounding unorganized rural territory, but plans are LL 22 BRITISH COLUMBIA.
under way so that during the coming months the service will be extended north
to include Armstrong, Enderby, Salmon Arm, and, eventually, east to Revelstoke. When this becomes a fact, it will represent the fruition of a plan
envisioned many years ago by the former Provincial Health Officer, the late Dr.
H. E. Young, whereby the entire Okanagan Valley would some day enjoy the
benefit of a full-time local health service. The completion of this plan will be
watched with interest by many who are familiar with the early history of public
health in the Okanagan Valley, and which in reality dates back to the formation
of the Kelowna Rural Schools Health Association in 1928. This enthusiastic
group of public-spirited citizens have no doubt watched the expansion of public
health work from their original efforts with much interest. Credit is due the
original members of this Association. As a matter of fact, some of the original
members are still active in the Association and it is always a pleasure to discuss
health work with them, for their ideas and outlooks are just as progressive and
up-to-date to-day as they no doubt were some sixteen years ago.
The area served by the Central Vancouver Island Health Unit has now been
extended to include the cities of Alberni and Port Alberni and the unorganized
rural territory in the immediate environment. Much credit is due Dr. J. M.
Hershey for the splendid educational programme which was carried on in order
to demonstrate the value of full-time local health service. The staff of this
Health Unit have made very splendid progress during the one year of operation,
and this is perhaps most evident in the increase in immunization and the
improvement in community sanitation. The most interesting development is
the formation of a Farmers' Co-operative Dairy Association whereby ten of the
twelve producer-vendors in the district have joined together on a co-operative
basis in order to establish a pasteurization plant and a common distribution
system. The formation of such a co-operative or municipally owned plant
would appear to be the logical method whereby pasteurized milk may be made
available to the people living outside of the larger centres of the Province. The
progress of this Association, the first of its type in the Province, will be watched
with much interest.
The Okanagan Valley Health Unit serves that section of the Province from
Oyama in the north to, and including, Penticton, Naramata, and Kaleden in the
south. Special mention was made in last year's report on the fact that this
Health Unit had received an award in the 1942 National Health Honour Roll.
This honour was repeated when, early in 1944, it was announced that another
award in the National Health Honour Roll for 1943 had been made to the
Okanagan Valley Health Unit. When it is remembered that such awards are
made not necessarily to the healthiest community, but rather for the effectiveness with which the community problems are met, one realizes the credit that
is due the staff of the Okanagan Valley Health Unit. Not only has this group
of public health workers carried out an efficient programme in the area served,
but they have also sold the programme to the people of their area. The result
is that the people are thoroughly in support of, and in accord with, the public
health work that is being carried on for their protection.
The Prince Rupert Health Unit has also continued to carry on a good, generalized public health programme.    Venereal disease and tuberculosis control BOARD OF HEALTH REPORT, 1944. LL 23
work, and community sanitation, coupled with improvement of sanitation in the
salmon-canneries on the Skeena River, appear to be the major problems with
which this Health Unit is faced.
It was mentioned earlier that it was necessary to transfer Dr. J. A. Taylor,
former Director of the Peace River Health Unit, to Vernon in order to open up
the North Okanagan Health Unit. Nowhere in Canada was it possible to secure
the services of another trained and qualified public health physician to assume
the position of Director of the Peace River Health Unit. Finally, as a war-time
expedient, and on a temporary basis, Mrs. Pauline Yaholnitsky, Public Health
Nurse at Quesnel, was asked to assume the position of Supervisor of the Peace
River Health Unit, and as such to carry on the duties of Acting-Director. Fortunately, with the completion of the Alaska Highway, the population of Fort St.
John and Dawson Creek and the immediate surrounding areas decreased considerably, and at the same time there was a reduction in the problems associated
with the overcrowding which had been so much in evidence there previously.
The lack of a full-time medical health officer did not, therefore, constitute quite
such a difficulty as it would have during the preceding year. Nevertheless, to
step from public health nursing and assume the duties of directing a Health
Unit represents a very dramatic change, and particularly when one has not had
any administrative experience. Mrs. Yaholnitsky's willingness to undertake
this difficult task and her commendable spirit of courage and enthusiasm is not
only admired, but appreciated, by this Department. Unfortunately, the shortage of Public Health Nurses is reflected directly in the number on the staff of
the Peace River Health Unit. Up until the end of this summer there were four
Public Health Nurses on the staff. At the present time, when there should be
at least four, in addition to the Supervisor, there are only two. It is appreciated
and realized that this constitutes a terrific overloading of these nurses, including
the Supervisor, but, unfortunately, little can be done about it until such time as
the shortage of Public Health Nurses becomes less acute.
The water-supply for the Village of Dawson Creek, and which was mentioned in last year's report, was completed early in 1944. Installation of a
sewerage system is under way at the present time and will likely be completed
early in 1945. This was made possible through co-operation between the Provincial and Federal Governments. These two installations represent a very
considerable advance in community sanitation for Dawson Creek, and will go
a long way in eliminating many of the sanitary problems which have existed
there for some considerable time.
Again, the many part-time Medical Health Officers throughout this Province are to be congratulated for their splendid co-operation and help during the
past year. The amount of time and effort which some of them give to public
health work and the health problems of their area is very gratifying indeed. It
is unfortunate that there is not sufficient staff in the Central Office of the Provincial Board of Health to make it possible for the senior officials to visit the
local areas throughout the Province at least once a year, in order to discuss
problems with these part-time health officers. It is known that such visits
would be appreciated by the health officers in the field, and would also prove to
be an excellent way of clarifying many of the problems which confront them LL 24 BRITISH COLUMBIA.
from day to day.    These problems are frequently easily solved, but worrisome
to the part-time health officer who has not had public health training.
PUBLIC HEALTH EDUCATION.
An increasing consciousness on behalf of the people in regard to all phases
of group and community health was responsible for a very busy year in the field
of public health education. All senior officials, both from the various Divisions
and the Central Office of the Provincial Board of Health, on numerous occasions
have met and held discussions with community groups, including Municipal
Councils and School Boards, Parent-Teacher Associations, Boards of Trade, and
other official and voluntary groups.
The idea put forth in last year's report in relationship to a Health Educator
being a member of the staff of Health Units would appear to be coming closer
to accomplishment. This year the Provincial Board of Health has provided
field training in the Central Vancouver Island Health Unit for a hand-picked
teacher who has chosen public health education as her future vocation. This
individual has just recently left to secure postgraduate training in public health
education through the medium of a Fellowship from the W. K. Kellogg Foundation. She will return in one year's time and assume the position of Health
Educator in one of the Health Units. The success of this experiment will be
watched with a great deal of interest.
A Junior Public Health Educator was added to the staff this year with a
specific purpose in mind. The person picked has had Library experience, as
well as being a teacher, and it will be her function to reindex the Library of the
Provincial Board of Health and its various Divisions, and then to develop such
techniques and procedures as will best enable her to act as a liaison between all
available sources of education material in the Central Office and public health
workers in the field. It is too early as yet to make any comment on the success
of this new policy.
The usual series of lectures to the students at the Provincial Normal School
in Victoria were given in the spring of 1944. These were given by senior technical officials of the Provincial Board of Health, and covered among other things
public health administration in British Columbia, local health services, public
health nursing, tuberculosis control, venereal disease control, vital statistics,
and community sanitation with particular reference to the rural areas of the
Province. All of the senior technical officials of the Provincial Board of Health
have continued to act as voluntary lecturers to the Public Health Nursing
students at the University. In addition, lectures were also given to the Social
Service students at the University.
Some four years ago a series of lectures was arranged for the student police
constables at the Training School of the British Columbia Provincial Police.
These lectures at that time dealt primarily with water-supplies, milk-supplies,
and sewage-disposal, and were given by our Public Health Engineer. However,
two years ago it was felt that a more broad series of instructional lectures
should be given and arrangements were made whereby other phases of public
health would be covered. These lectures were continued this year and included
talks on public health administration in British Columbia, tuberculosis and BOARD OF HEALTH REPORT, 1944. LL 25
venereal disease control, vital statistics and all phases of rural sanitation. In
addition, a special series of lectures was arranged for a group of officers and
senior constables of the British Columbia Provincial Police which dealt primarily with sanitation in new rural areas and venereal disease control.
Miss Baldwin, Consultant in Nutrition, has carried on a very extensive and
energetic programme on health education in the field of nutrition during this
year. Local Nutrition Committees and study groups have been formed, surveys
have been made in various parts of the Province, and a wealth of nutritional
information given to the people by word of mouth, through pamphlets, and by
motion-picture film. The appended report by Miss Baldwin gives further details
of the variety of work that has been carried on in this field of public health.
No increase in the supply of public health literature has taken place as yet.
Copies of many of the more worth-while publications are not available, although
for a few of them we have secured permission to reprint them. A considerable
number of letters to expectant mothers has again been sent out during the year.
This has again been made possible through the co-operation of the Canadian
Welfare Council. During 1944, more than 4,383 prenatal letters were sent to
467 expectant mothers who requested this service. Postnatal letters covering
the first year of the baby's life were sent to 3,066 mothers who requested them;
a total of almost 36,792 postnatal letters being forwarded. Requests for letters
covering the pre-school ages totalled 823, while those for the school-age period
totalled 155. It must be pointed out that the above figures only relate to the
area outside of the Greater Vancouver Metropolitan Health area, since requests
for letters from people of this area are handled locally.
It is gratifying to note that the National Film Board of Canada is investigating the whole field of public health films, since this may be the means of
producing, on a co-operative basis, a number of really worth-while films early
in the post-war period.
PREVENTIVE DENTISTRY.
The situation with regard to preventive dentistry remains identical with
that of last year. In other words, the majority of the local dental clinics which
have functioned in past years were still unable to carry on during the year just
ended. In some cases there are no local dentists, while in others the dentists
have been so busy as not to be able to find time for children's preventive clinics.
In one or two instances, dentists who are particularly interested in this phase
of the work have given some of their time in order that clinics might be carried
on. The interest of these particular dentists in preventive work is much appreciated. It has still been possible to continue our arrangements with one of the
Victoria dentists to carry on a limited amount of work on a weekly basis in the
Langford area, just outside of the Greater Victoria district.
PUBLIC HEALTH ENGINEERING.
The full report of the Public Health Engineer is appended and shows both
the variety and the volume of activity under this phase of the work. During
the year there was added to the staff a Consultant in Food and Milk Control,
who has had basic training in Veterinary Science, and also a senior Sanitarian LL 26 BRITISH COLUMBIA.
who has had not only experience as a Sanitary Inspector in a Health Unit, but
also in the construction business. These two new staff members will be of
considerable assistance to the Public Health Engineer in relieving the burden
on him in so far as non-engineering sanitation problems are concerned.
No known cases of clam and mussel poisoning occurred during 1944, but
the joint survey between the Department of National Health and Welfare, the
Fisheries Research Board of Canada, and the Provincial Board of Health indicated the advisability of continuing the ban on the taking of clams and mussels
on the west coast of Vancouver Island. It is of interest to note here that the
State Health Department of California recently extended their ban indefinitely
on the taking of mussels. The ban normally was released on October 31st, but
was extended indefinitely this year because of toxic mussels after this date producing illness in the individuals who consumed them. The survey of canneries
along the coast which was commenced last year was continued during the
summer of 1944, and there would appear to be reasonable assurance that an
improved standard of both sanitation and housing will result from these surveys. The discussion with cannery officials on the recommendations arising
out of the survey has resulted in a better appreciation of all matters and points
of view related to cannery sanitation.
Some indication of the appreciation of the consultive public health engineering advice available through this Department is given by the increasing
number of municipalities seeking advice on all matters which have public health
engineering implications.
REPORT OF THE DIRECTOR OF PUBLIC HEALTH NURSING.
Miss Dorothy E. Tate, R.N., B.A.Sc, M.A.
Encouragement is necessary in carrying on any type of work—the encouragement that is experienced by progress, and that experienced by a piece of
work done in spite of difficulties. A review of the past year's work affords
satisfaction. The people participating in the programme, the programme itself,
special features of it and future plans are the nucleus of this review.
PUBLIC HEALTH PERSONNEL.
The appointment of a Public Health Nurse in Saanich in 1917 was the
beginning of a service which has continually expanded. In the Province,
exclusive of Greater Vancouver, to-day there are fifty-three Public Health
Nurses, two Consultants in Public Health Nursing, and a Director. Practical
assistance and consultative service is carried on in the field by a specialized
worker from the Division of Tuberculosis Control and the epidemiological workers attached to the Division of Venereal Disease Control. Two Victorian Order
of Nurses assist in the programme by carrying on a completely generalized
service, along with the bedside and instructive service with which they are
usually associated.
The changes in the staff of Public Health Nurses to maintain the field positions are due to the following diverse reasons: Two Public Health Nurses
opened new districts;  two resigned to join the services;  one resigned to be BOARD OF HEALTH REPORT, 1944. LL 27
married; one resigned for further study; one resigned because of illness; one
resigned to make her home in another Province; two registered nurses with
temporary appointments were replaced by qualified Public Health Nurses; two
transferred to take special courses and returned to the field as specialized
workers; five transfers took place when moves were made from one area of the
Province to another; eight new members joined the field staff; one registered
nurse was appointed temporarily. Therefore, twenty-five public health workers
were directly affected in order to maintain the minimum of public health
nursing personnel in the districts.
The resignation of Miss Heather Kilpatrick, who had filled the position of
Director of Public Health Nursing for four years, was the first one to affect the
hopes of a year ago that there would be a director and four consultants. Miss
Dorothy Tate, who had previously been Consultant in Public Health Nursing,
was appointed to the position. Miss Helen Carpenter, Consultant, Public
Health Nursing, who had made a definite contribution to the programme,
resigned to accept a Rockefeller Fellowship to attend Johns Hopkins.
Mrs. Isabel Foster (nee Loucks) was welcomed as a successor to Miss
Carpenter. Mrs. Foster completed the Public Health Nursing course at the
University of British Columbia, obtaining the degree of Bachelor of Applied
Science in 1940. After graduation, she held a position on the staff of the
Greater Vancouver Metropolitan Health Committee. The following year she
was employed by the Cowichan Health Centre, Duncan, leaving there in 1942
to accept the position as Public Health Nurse in Cranbrook. In 1943, Mrs.
Foster was awarded a Fellowship by the Commonwealth Fund. After a year's
study at the Johns Hopkins School of Hygiene and Public Health, Mrs. Foster
received her Master of Public Health degree. This was followed by field experience in the States of Maryland, Tennessee, Mississippi, and New York.
Miss Monica Frith, who has returned to British Columbia following the
completion of a Commonwealth Fellowship, is a welcome addition as Consultant,
Public Health Nursing, under the Provincial Board of Health. Miss Frith
completed the double course in Public Health Nursing at the University of
British Columbia in 1940. After graduation she was employed as Public
Health Nurse in the rural Kelowna area until 1942, when she accepted a position in the Creston Valley Public Health Nursing District. In 1943, Miss Frith
was awarded a Commonwealth Fellowship to attend the School of Public Health
at the University of Michigan in Ann Arbor. Following the year's work at the
University, an observation period in the State of Michigan was provided by the
W. K. Kellogg Foundation. Following receipt of Master of Public Health
degree, she obtained further field experience in the States of Tennessee, Mississippi, Maryland, and New York.
Stabilization of any service is difficult with many changes in personnel.
For four years the percentage of changes has been high. With the staff changes,
greater importance had been placed on assistance and stabilization through
supervision.    Unfortunately, the Consultant's group have been affected as well.
PROVINCIAL   LiBRART
VICTORIA, B. C. PROGRAMME.
Public health nursing activities continue to extend throughout the Province.
The extensions now include the Arrow Lakes district and Cumberland and
district, Colwood was included in the Esquimalt Rural District, and Michel-
Natal in the Fernie Public Health Nursing Service. The programme carried
on in these areas, as in others, is outlined as follows:—
Maternal.
Prenatal—
(1.)  Getting in touch with expectant mothers to assist them in securing medical and dental examination and supervision early in
pregnancy.
(2.) Interpreting the doctor's orders; explaining details of nutrition.
(3.) Advising adequate clothing for mother and baby, preparing those
in the home to receive mother and baby on return from hospital.
Postnatal—
(1.)  Helping the family to carry out specific medical advice for the
mother's and baby's care.
(2.)  Stressing the value of breast-feeding the baby.
(3.)  Stressing the importance of the postpartum physical examination.
Infant and Pre-school.
(1.) Providing suitable environment for the baby by the demonstration in
the home of bathing, making the bed, preparing the feeding when on
a formula.
(2.) Assisting in the supervision of the baby in order that normal physical
and mental growth may be maintained.
(3.)  Advising medical care as a preventive and curative measure.
(4.) Assisting in the control of communicable diseases through teaching
the importance and the value of immunization, and teaching recognition of early symptoms of disease.
(5.) Assisting the family to carry out general and specific instructions
concerning early child care and training.
(6.) Establishing and carrying on child health conferences, bringing information on child care to more mothers.
School.
(1.) Visits to the school on a planned schedule—
(a.) To confer with teachers, parents, and selected pupils.
(6.) To promote the maintenance of a physically healthful school
environment,
(c.)  To give instruction and assist in plans for physical examination
and first aid.
(d.) To make additional visits for communicable disease control.
(2.)  Contact with the home—
(a.)  To follow up and explain defects discovered through physical
examination of pupils. BOARD OF HEALTH REPORT, 1944. LL 29
(&.) To assist in control of communicable disease and to give advice
concerning other public health problems in the home.
(3.)  Co-ordination of public health nursing activities for school children
with all other health services in the community.
Adult.
(1.) To teach the fundamentals of personal hygiene in order to assist in the
prevention and retardation of disease specific to adult life.
(2.)  To teach the importance of personal hygiene in community health.
(3.) To encourage early treatment of defects.
Communicable Disease Control.
(1.) Acute communicable disease—
(a.) To assist in making available specific immunizations and to
encourage and educate groups to avail themselves of the opportunity to be immunized.
(b.) To carry out proper precautions to prevent the spread of
infection.
(c.)   To interpret the regulations governing quarantine and isolation.
(2.)  Tuberculosis—
(a.)  To assist in finding tuberculous individuals.
(6.) To educate all contacts of tuberculous patients of the necessity of
examination and to assist them in obtaining these examinations.
(c.) To arrange for necessary nursing care, to teach through demonstration, and to supervise care of patient given by responsible
persons.
(d.) To teach patient and contacts the importance of personal hygiene
and the precautions to be taken to prevent the spread of infection.
(e.)  To assist in the integration of local and Provincial health and
welfare services so that patient and family may make emotional
and social adjustments necessary to a long-term communicable
disease.
(3.)  Venereal disease—
(a.) To promote reporting of infected individuals and to report
results of epidemiological investigations of early infections and
contacts and secure medical examination and supervision for
them.
(b.) To assist in preventing the spread of infection by teaching
patient and groups the scientific facts of the disease.
(c.) To promote continuity of treatment by explaining its value and
by interpreting medical directions.
Bedside Demonstrations.
(1.) To assist in securing early medical diagnosis and treatment.
(2.) To teach responsible persons nursing care of patient through demonstration and supervision and arrange for special care for patients with
special types of disabilities. LL 30 BRITISH COLUMBIA.
(3.) To realize the necessity of convalescent care and the value of rehabilitation for the patient so that as local and Provincial facilities
increase they are made available to the patient.
Sanitation.
(1.)  To give advice in securing safe milk, safe water, adequate sewage-
disposal, and in proper food-handling methods in the home.
(2.)  To refer problems dealing with sanitation in the home, school, or
community to local sanitarian  or the Division of  Public  Health
Engineering.
Up to this point some of the phases of public health nursing have been
briefly outlined.   In addition, there are other phases which are receiving concentration in certain areas now, and will be expanded in other areas as personnel
is available and problems arise.    Examples of these are cancer, industrial
hygiene, mental hygiene, adult education, accident-prevention, nutrition, oral
hygiene, and public health education.
EDUCATION.
In order to maintain a standard of service the nurses participating should
be qualified. Once the qualifications have been attained it is a continual educational process to keep up with the latest information, to modify programmes,
and be able to help in the formation of policies for field practices. The Institute
for Public Health Workers has been this year, as in the past, the most practical
form of in-service education. Reviews of actual field practices made a lasting
impression on the Public Health Nurses as did several papers reviewing progress of special services. The adoption of new forms to simplify recording were
received with interest and later accepted into field practices with varying
degrees of modification, as were also the practical suggestion in the field of sanitation and nutrition. Results of past experience led those arranging for the
Institute to plan discussion groups where Health Unit Directors, Public Health
Nurses, and Sanitary Inspectors may reach a solution to their difficulties as a
result of group thinking.
The appointment in September of Miss Edith Stewart as Public Health
Educator opened up a new field of education for the field staff. Not only are
the library resources of the Provincial Board of Health more accessible, but the
Provincial Library and the Open Shelf Library have been made available too.
The increase in resources is continuing in our own library because there is some
one to keep up to the current material in a wider range of books and journals
and bring them to the attention of the field staff.
The " P.H.N. News and Views " continues to function as the means of
spreading information and changes in programmes. Book reviews and material dealing with public health activities Provincially or Internationally are
presented by this medium. Information which has a Provincial-wide significance though gathered specifically at the request of individuals is spread by
the News Letter; material for the Reference Manual, which includes services
given by allied agencies, co-operative efforts of health and other community
groups has its first general circulation to public health staff through the News BOARD OF HEALTH REPORT, 1944. LL 31
Letter. The letter is flexible; it is expected to grow in scope and use, depending
on the demand for and value of material circulated.
Groups of Public Health Nurses hold district meetings from time to time
throughout the year to discuss pertinent topics of interest to the particular
group. Their efforts have made available contributions to public health nursing in the rural field. A discussion of the tuberculosis programme, school programme, and also infant welfare problems, which have or will be appearing in
the News Letter, are examples of group accomplishments.
The consultants, who carry on supervisory duties as well, have had to
spread their services much more extensively than was formerly anticipated.
Acting as interpreter of Provincial policies and bringing field impressions and
problems to the central office is one of their important duties. Education by
consultants provides assistance to the public health nursing field staff which
has a bearing on the programme carried on in the field.
UNIFORMS.
The final adoption of a uniform for Public Health Nurses brings to a head
the insistent requests of the field staff for a uniform acceptable to them and to
headquarters. The medium blue tailored suit, white shirt-waist, navy felt tams,
and brown oxfords have met with approval. The nurses are gradually adopting
the new uniform in lieu of the former varied ones. Financial aid by the Provincial Board of Health has had, undoubtedly, a bearing on the anticipation and
pleasure with which every Public Health Nurse looks forward to the time when
she will be one of a group dressed in a distinctive uniform of the public health
nursing field staff.
SALARY SCHEDULE.
A salary schedule has materialized after several years of preliminary planning. It recognizes basic preparation necessary before a Public Health Nurse
is appointed in a permanent position. The first year of a generalized practical
experience is a probation period for which the annual salary is $1,380. Increments are given for years of service and efficiency at the rate of $60 at the
completion of the first, second, and third years of permanent service, and again
at the fifth, seventh, and ninth. Length of service after ten years is recognized
by further increases every five years. A Public Health Nurse may, however,
change her status by progressing to a senior position for which there is a salary
increase in recognition of increased responsibility. Because of varying circumstances in each local area the schedule is not fully in operation, but strides have
been made because of the interest and foresightedness of some public health
nursing boards in recognizing the system as a means of stabilizing and unifying
public health nursing personnel.
The coming year holds promise of having the salary schedule in full operation and the uniform adopted by every Public Health Nurse. Simplification of
records, recognized as an asset, has been discussed and drawn up and will be
brought to the field before very long. A long needed Manual on public health
nursing procedures has been started and will be circulated section by section till
every phase has been covered. It will never be static but will be subject to
revision and additions, as programmes change and emphasis within these
programmes change. LL 32 BRITISH COLUMBIA.
The past year has been one of credit to every Public Health Nurse in the
field. That the standards of a public health programme have been maintained,
even advanced in some fields, is due to the co-operation and combined efforts
of every one.
REPORT OF THE CONSULTANT IN NUTRITION.
Mary F. Baldwin, B.Sc. (H.Ec.).-
The advances which have been made in the science of nutrition in the past
few years fire the imagination. There is, however, a gap between scientific
knowledge of nutritional principles and their practical application. The extent
of this gap and its effect on the health of the people are brought home to us
when we study dietary surveys and examine the medical records of young men
and young women called up for defence training. The aim of the Federal,
Provincial, and local nutrition programmes outlined in this report is to fill this
gap and help make Canadians healthier through the application of well-established principles of nutrition.
ORGANIZATION FOR NUTRITION EDUCATION.
Federal.
The Dominion Government in 1941 established Nutrition Services—now
the Nutrition Division under the Department of National Health and Welfare.
This Division acts as a clearing-house for nutritional information, serves as a
consultative service for other departments of Government, sponsors and advises
on nutrition research, and carries out the inspection of feeding facilities in war
industries. The problems of the various Provinces are brought to the attention
of the Federal division through an advisory body known as the Canadian Council on Nutrition. The Provincial Health Services of each Province are represented by a member on this council. The member for British Columbia is the
Nutrition Consultant of the Provincial Board of Health. The Provincial Health
Officer is a member ex officio.
Late this year the Nutrition Division appointed a regional representative
to cover Alberta and British Columbia.   This representative will carry on the
inspection of food facilities in war industries, be prepared to offer refresher
courses to such groups as Public Health Nurses and teachers and generally
serve as liaison officer between the Federal department and the Provincial
committee.
Provincial.
Organization for nutrition education in British Columbia was extended in
1942 with the appointment of a Nutrition Consultant to the Provincial Board
of Health and the setting-up of a Provincial Nutrition Committee. This committee is under the chairmanship of the Provincial Health Officer. The members
of the committee are representatives of Provincial organizations and groups
interested in nutrition. The Nutrition Consultant of the Provincial Board of
Health serves as secretary of this committee.
The function of the Provincial committee is to co-ordinate nutrition work
done in the Province and advise on the future expansion of a broad programme BOARD OF HEALTH REPORT, 1944. LL 33
of nutrition education. The nutrition services of the Provincial Board of
Health, the British Columbia Division of the Red Cross Society, and the Metropolitan Health Committee of Vancouver are co-ordinated through this committee. Each of these bodies employs a Nutritionist, and each Nutritionist, in
order to avoid duplication, has a definite geographical area of the Province
to work in.
There is, as well, a technical advisory committee to advise on technical
problems.
Local.
Local nutrition committees have been formed in a number of British
Columbia communities. These committees meet with the Nutritionists in their
respective areas and advise regarding methods of carrying on a programme of
nutrition education in their community.
REPORT OF PROVINCIAL BOARD OF HEALTH NUTRITION
SERVICES IN 1944.
Work started in 1943 was extended in 1944. A second Nutritionist was
appointed by the Provincial Board of Health from September to December to
assist with the field-work.
Surveys.
Studies of eating habits, made first in the Okanagan in 1943, were made in
six Kootenay centres and in six centres on Vancouver Island. A recheck was
made on larger groups in three Okanagan centres where the original studies
were made. Surveys were also undertaken in two Okanagan centres not
checked before.   These surveys were made through the schools in each case.
The survey results were evaluated according to a score sheet prepared by
the Nutrition Division in Ottawa and, although the surveys were by no means
complete, they gave much valuable information. Total scores reached in the
various centres were very similar, although use of the different food groups
varied widely.
Scores for cereals were uniformly low, due to the fact that people consumed such large proportions of refined cereal products in preference to whole
grain. On the other hand, scores for meat were uniformly high. The people
in British Columbia seem to consume more than adequate quantities of meat
and meat alternates but do not include sufficient of the liver, heart, and kidney
group. The use of the other food groups—milk, fruit, and vegetables—varied
widely in the different centres. Price and availability seem to be the governing
factors so far as the use of these three were concerned. This would point to
the importance of a Government food policy designed to provide adequate production and distribution, at a reasonable cost to the consumer, of the foods
necessary for health.
Educational Programme.
Following the surveys methods of improving deficiencies were discussed
with public health staff, health teachers, representatives of men's and women's
organizations, and the general public. In each case suggestions were given
which would be of assistance to them in their own field. LL 34 BRITISH COLUMBIA.
Teachers were shown how they might make use of the survey results in
presenting the nutrition part of the health course to their classes. The use of
available printed leaflets and charts on nutrition was discussed. Kits of such
material were sent to all schools in the Province in November.
Local Public Health staff were acquainted with material they could use in
their clinics and on home-visits. They were also urged to bring the kits of
nutrition material to the attention of teachers in outlying centres not visited
by the nutritionist.
Whenever time and interest permitted, forum meetings were held with
representatives of men's and women's organizations. These meetings were for
the purpose of acquainting the representatives with the need for improvement
of eating habits and discussing with them information and material available
for members of their groups. Following the food forum, each representative
was to discuss the material and information at a meeting of his or her own
organization.
Meetings with the general public were in the form of a demonstration on
how the foods recommended could be worked into three daily meals. Local
organizations supplied the food and the products were sampled by the audience.
Pertinent printed material was given to those attending.
This whole programme, including the survey and follow-up with the four
groups mentioned, was carried out in eight centres and partial programmes in
nine other centres. Local Nutrition Committees assisted with the complete
programme in five centres. The eating habits of over 3,000 school children
were checked, and the results discussed with 275 teachers representing twenty
school districts. Between 90 and 100 organizations took part in food forum
meetings and approximately 850 people were contacted through the public
meetings.
School Lunch Programmes.
More and more attention is being paid to the institution of school lunch
programmes as the most effective means of improving the nutrition of school
children. Such programmes also serve as a practical demonstration to others
of the value of properly balanced meals. Work done in co-operation with the
Department of Education in 1943 in the compilation of a handbook and wall
chart for teachers and leaflets for distribution to the home was followed up in
1944 by meetings with school inspectors, principals, and teachers to discuss
problems in their respective areas. This led to the drawing-up of plans for
cafeterias and the preparation of lists of necessary equipment for a number
of schools.
Two problems hold up the rapid expansion of this programme. One is
lack of sufficient funds to equip lunch-rooms and serve meals at a cost sufficiently low so that every one can take advantage of the programme and the
other is lack of trained personnel to assist with the programmes locally.
To help with the latter, a programme to train Normal students in the
organization and preparation of school lunches was started at the Victoria
Normal School in 1944. It is hoped that this plan may be extended to the Vancouver Normal School, the Faculty of Education at the University of British
Columbia, and the Summer School of Education. BOARD OF HEALTH REPORT, 1944. LL 35
With regard to financial assistance, the Provincial Department of Education has set aside funds for equipment in rural areas and Junior Red Cross
funds can now be used for this purpose. Further assistance is necessary and
would seem to await the adoption of a plan for Federal aid, such as is being
recommended by both the Newfoundland and Canada Educational Association
and the Canadian Council on Nutrition.
Inspection of Institutions.
The Provincial Secretary's Department is charged with the management of
a number of institutions such as Industrial Schools and old people's homes.
Many of these are too small to employ the services of a full-time dietitian. As
the need is shown and as the opportunity arises, the feeding facilities in these
institutions are inspected and recommendations made regarding any necessary
changes. Although just one such institution, the Boys' Industrial School, was
inspected in 1944, plans for 1945 include expansion of this service.
Co-operation with other Government Departments and Divisions.
At the request of the Child Welfare Division, the Nutrition Consultant has
assisted with the compilation of low-cost food lists. These lists are to serve
as a basis for review of foster-home maintenance rates. On completion of the
study and after any necessary revision of the rates, it is expected that the field-
workers of the Social Assistance Branch will be instructed as to the basis for
the food lists. This will be a step forward in acquainting these workers and,
through them, a section of the public, with the essentials of a well-balanced diet.
During the summer, at the request of the Supervisor of Illustration Stations, Dominion Department of Agriculture, the Nutrition -Consultant attended
field-days planned by this Department. Women in rural areas not reached
through the broad educational programme discussed earlier were contacted at
these field-days.
Work done in the schools through co-operation with the Department of
Education was outlined earlier in this report.
Work on Committees.
Work on two committees should be mentioned. One is the Canadian Council on Nutrition, a body set up by Order in Council to advise the Nutrition
Division of the Department of National Health and Welfare. The other is a
committee of the British Columbia Government Employees' Association set up
to manage the operation of a cafeteria in the Parliament Buildings for the use
of Government employees.
Early in the year the Nutrition Consultant attended the meeting of the
Canadian Council on Nutrition as official representative of the Provincial
Health Services. This meeting is an annual one held in Ottawa. Highlights
of the meeting were reports of the school-lunch committee mentioned earlier
and a lengthy discussion regarding future policy with regard to the manufacture of Canada Approved Flour. The manufacture and promotion of a white
flour of the approved type is important in the light of surveys of eating habits
made in this Province as well as in other parts of the Dominion.   Aside from LL 36 BRITISH COLUMBIA.
the information and contacts gained through this meeting, the trip enabled the
Nutrition Consultant to observe at first hand work being done in the Federal
Division in Ottawa and in other Provinces of the Dominion.
The British Columbia Government Employees' cafeteria in Victoria is
worthy of mention from the standpoint that it is a Government sponsored
institution managed by the employees for their own benefit. Staff cafeterias
of this type are recommended by Nutritionists since they make available to
workers well-balanced meals at reasonable cost.
In conclusion, the work covered by the Nutrition Services of the Provincial
Board of Health during the year 1944 follows along the general lines reported
in 1943. Few new local Nutrition Committees were formed in 1944 because
of the difficulty found with the present personnel in maintaining contact with
and giving guidance to those already formed. There was a tendency to do less
work directly with the general public and more with groups such as public
health personnel and health teachers who in turn are in contact with the public.
This trend will continue as other agencies employ Nutritionists to carry out the
field-work and as Public Health Educators become a part of Provincial and
local health serviees.
Much remains to be done. In spite of an improvement during the war
years, the eating habits of many Canadians are still below the standard necessary for optimum health. In our own Province, many communities and many
institutions have yet to be visited by a Nutritionist for the first time. The
problem of restaurant feeding has barely been touched.
The most encouraging aspect of the Nutrition programme is the growing
recognition on the part of International, National, Provincial, and local bodies
of the fundamental importance of proper nutrition for good health. Not only
health departments are interested and not only health departments are concerned. To produce the food required, to get it to the people at a price they
can afford to pay, and then to induce them to use proper selection in its eating,
are problems of agriculture, transportation, commerce, and education. The
fact that there has been an improvement in eating habits in recent years is
a direct result of improved economic conditions and increased agricultural production coupled with the broad educational programme outlined in this report.
REPORT OF THE DIVISION OF VITAL STATISTICS.
J. D. B. Scott, B.A., B.Com., Director.
INTRODUCTION.
. Before outlining in detail the work of the Division of Vital Statistics during
the year under review it is worth while to point out the main functions of the
Division. The first is registration, collection, tabulation, and analysis of births,
deaths, and marriages and other associated data like adoptions, divorces,
changes of name, etc., occurring within the Province. The second is to provide
statistical analyses and services for the Provincial Board of Health. It must
co-operate with the other Divisions of the Provincial Board of Health in carrying out the public health programme laid down by the Provincial Health Officer. BOARD OF HEALTH REPORT, 1944. LL 37
The ensuing report endeavours to give an idea of what has been done
during the year and also what remains to be done in the future. It will be
noticed that many of the activities of the Division and the progress made has
been summarized under the headings " The Division's Contribution to the War
Effort" and " Summary of Registrations and Related Procedures." Under
these headings subjects are dealt with such as the volume and extent of the
verifications done by the Division, the services performed in connection with
legal procedures relating to vital statistics, various lists of births, deaths, and
marriages supplied, especially to the Federal authorities, the handling of the
death records of overseas casualties and comments on the volume of registrations received. A summary of the problems in connection with the completeness of birth and other registrations has been made. Legislation, both new
and proposed, governing the administration of the Division has been mentioned.
Details of active co-operation between the Provincial Board of Health and the
Division has been outlined. The fourth Dominion-Provincial Conference on
Vital Statistics is reviewed.
In general, the report purports to show a somewhat greater degree of
activity along most lines than in comparison with the previous years. However,
the increases have not been so great as during some of the other war years and
there is a very definite tendency towards a levelling off in the upward trend.
THE CONTRIBUTION OF THE DIVISION OF VITAL STATISTICS
TO CANADA'S WAR EFFORT.
The Division's contribution to the war effort was again a significant part
of its duties. Only the most important items of assistance in the war effort are
outlined herein.
Documentation for Dependents' Allowance Board.—The Division assisted
in the searching and certifying of 19,493 vital records pertaining to members
of Canada's armed forces. This was an increase over the previous year, when
18,788 records were searched and certified. The total number of records so
documented since the outbreak of war is 80,144.
Military Verification.—The number of verifications for recruiting purposes dropped from 4,786 in the year 1943 to 1,087 in the current year. Proof
of age is a general recruiting requirement for the Air Force. Any army
recruits around the age of 17 or 18 must also supply proof of age. The decrease
may largely be attributed to reduced recruiting for the Air Force as well as to
the elimination of a certain amount of duplication in military documentation
to which attention was drawn in the previous year's report.
Fees waived for Military Purposes.—The Division continued to waive the
statutory fees for delayed registration of birth, legitimation of birth, alteration
of Christian name and correction of documents, etc., providing such services
were for military purposes. A complete report was made on each of these
cases to the Dependents' Allowance Board in Ottawa. Sometimes investigations were necessary which required considerable time and effort.
Co-operation with Wartime Federal Agencies.—There was no change in
the amount or degree of co-operation given by the Division to the National
Registration authorities, Selective Service, Wartime Prices and Trade Board, LL 38
BRITISH COLUMBIA.
and the Department of External Affairs, whereby proof or verification is
regularly given to these bodies.
SUMMARY OF REGISTRATION AND RELATED PROCEDURES.
Volume of Registration.—The volume of birth registrations received was
almost equal to the number received in the previous year. There were 18,846
registrations of which 1,123 were of Indians within the meaning of the " Indian
Act." The following is a table showing the increase in registration over a ten-
year period, 1935 to 1944:—
Year.
Live Births.
Deaths.
Marriages.
Still-births.
Adoptions.
Divorces.*
Total.
1935 	
10,987
6,927
5,020
232
183
264t
23,618
1936	
11,186
7,254
5,465
236
80
463
24,684
1937	
13,033
7,981
6,232
254
109
536
28,145
1938	
13,812
7,455
6,158
259
134
652
28,470
1939	
13,176
7,626
7,897
279
150
608
29,736
1940	
15,616
8,386
9,694
280
163
687
34,826
1941	
17,025
8,617
9,828
308
191
563
36,532
1942-.   	
18,346
8,916
10,905
313
157
847
39,484
1943	
20,068
9,918
9,476
338
249
886
40,935
1944
19,969
9,833
8,552
321
303
1,030
40 008
* Act in force May 1st, 1935.        f Includes nullities and judicial separations.
The all-time peak in marriages occurred in the year 1942 and it is not
expected that the figure for that year will be exceeded until the war is over or
in the event of this Province becoming a large base for military operations in
the Pacific area.
The number of adoption orders sent by the Registrars of the Supreme
Court to this Division reached an all-time high of 303 for the year. A notation
of adoption is made on each original registration, showing the name of the child
by adoption and the names of its adopted parents, the date of adoption and
place of adoption. Any certificate which is subsequently issued from the document is issued under the name by adoption of the child and does not give any
indication of its previous status.
The number of copies of decrees of dissolution and nullity of marriage
filed with this Division by the Registrars of the Supreme Courts showed a very
substantial increase. Altogether 1,030 decrees were registered during the
year, of which 1,010 divorces, 14 were nullities, 3 legal separations, and 3 dismissals.
There was a slight increase in the number of persons who were granted
a delayed registration of their birth in comparison with the year previous, when
985 such registrations were accepted compared to 973. Each one of these
registrations requires careful investigation before acceptance. The establishment of definite national standards of minimum requirements for delayed registration of birth on a national basis should be of definite assistance to this
Division in determining whether a registration should be accepted or not.
These standards will become effective at the beginning of the year 1945.
Legitimation of Birth.—There were 105 births of children born out of
wedlock legitimated subsequent to the marriage of their natural parents during BOARD OF HEALTH REPORT, 1944. LL 39
1944. In each case, after complete investigation by the Division, a new registration was filed showing the child as legitimate from birth.
A certain number of legitimations have occurred because of the careful
documentation of the personnel of Canada's armed forces by the Dependents'
Allowance Board. All details of marriages, births, etc., are carefully checked
before granting payment to dependents, and hence cases where natural parents
of a child previously registered as illegitimate have married, legitimation
procedures have been instituted and the birth reregistered as legitimate. The
annual check on children entering school for the first time also provides a means
of intimating to natural parents, who subsequently married, of their ability to
legitimate their offspring born prior to their marriage.
The Division has adopted the routine procedure of referring all cases of
intended legitimation to the Superintendent of Child Welfare to be checked,
unless both natural parents had acknowledged parentage by registering the
birth promptly and by jointly signing the original document showing the child
to be illegitimate.
Statutory Notations entered.—During the year 664 notations were entered
upon registrations which had been previously filed. One hundred and one of
such notations were alteration of Christian name of children under 12 years of
age and the remainder were for correction of errors involving dates of birth,
misspelling, incomplete answers, etc.
Change of Name.—Since the " Change of Name Act" was assented to on
December 6th, 1940, there have been 692 changes of name granted by this
Division. During the year 1944 there were 210 changes of name granted.
All applicants have to be British subjects, 21 years or over, and must be
domiciled in this Province.
Section 13 of the " Change of Name Act" specifies that notice had to be
filed with the Division within three months after the Act was proclaimed of any
changes of name of persons resident in the Province who have changed their
name in the twenty years prior to the date of enactment of the Act. Since that
date 2,048 notices have been filed. In many instances certificates have been
issued which have proved useful to people in helping to provide an explanation
of their change of name at some date prior to December 6th, 1940. The Division has continued to receive notices of change of name because there is no limitation placed by the Act upon it in receiving such notices, although the Act made
it mandatory for persons who had changed their name to file notice within a
three-month period. During the year 315 notices of change of name were
accepted.
Death Registrations of Overseas Casualties.—As pointed out in last year's
report this Division has received, through the co-operation of the Dominion
Bureau of Statistics and the Department of National Defence, information on
the regular death registration form of personnel of Canada's armed forces who
were killed or died overseas during their period of enlistment. These registrations are collected for their statistical importance. No certificates are issued
nor is there any documentation for legal purposes done from these records.
The time-lag between the date of death and the time the Division receives the
registration may be anywhere from six months to at least a year.   There have LL 40 BRITISH COLUMBIA.
been 1,425 such registrations received up until December 31st, 1944, of which
752 were received during the year under review.
PRESERVATION OF RECORDS.
Microfilm.—The necessity to preserve the records of the Division and the
solution to this problem through the process of microfilming has been outlined
in detail in the report for the year 1942. Last year's report mentioned that the
necessary equipment had been received toward the end of the year and that the
work had been commenced forthwith. At the end of this year all the records
of births registered from 1872 to 1943 have been photographed upon "micro-
file " film. It is expected that by the end of the forthcoming year all the records
of deaths and marriages from 1872 to date will be photographed. When this
work is completed the members of the staff now typing certificates from the
original records at the vault will return to the general office and certificates will
be typed from the film itself. This will mean that the public will benefit as a
certificate can be obtained immediately instead of after a delay of two or three
hours. It is planned to eventually issue positive prints from the original negative film and thus do away with the typing of practically all certificates now
issued from the central office.
TRANSFER OF ORIGINAL RECORDS.
For the period 1899 to 1913 all original registrations were left in the
district offices and only copies were forwarded to the Division. For some years
the process of transferring the original records to the central office and returning the copies to the district offices has been going on. A considerable effort
was made during the year under review to complete this work, with the result
that practically all the deaths and marriages outstanding were transferred by
the end of the year. This work was necessary in order to permit the microfilming of the original documents. It also means that each original document
is kept in a place of undeniable safety. Only a small number of records remain
to be transferred. This work has resulted in the discovery of certain missing
registrations which, although on file in the district offices, had never been
received by the central office.
COMPLETENESS OF REGISTRATION.
Indians.—Further improvement is necessary in the promptness of registration of Indian births. While the measures outlined in last year's report have
resulted in some progress it is felt that if the Indian Agents were paid the
customary commission paid to District Registrars that this should be a further
stimulus. If commissions are paid in the future, the doctors, Indian nurses,
priests and missionaries, and others who have been responsible in securing the
registrations for the Indian Agent should in turn be paid their share by the
Indian Agent. This matter will be taken up with the officials of the Indian
Affairs Branch and if it proves practicable it is expected that it will be put into
operation during the forthcoming year.
Doukhobors.—When the report of the previous year was written there had
been disturbances amongst the Doukhobors regarding registration with the BOARD OF HEALTH REPORT, 1944. LL 41
National Selective Service. In turn this affected the registration of vital statistics adversely. This, however, was a temporary situation and within a short
time the registration of births, deaths, and marriages of these people was proceeding at its normal rate. A rough estimate given by an official dealing with
Doukhobors indicates that about 80 per cent, of all Doukhobor births are registered at the present time, virtually all deaths, and only about 1 per cent, of the
marriages. It is expected that there may be some improvement in birth registration on account of the regulations that no Family Allowance will be paid for
a child unless its birth is registered beforehand. Until Doukhobors are married
in legal ceremony it is not expected that there will be any improvement in marriage registration.
Registration of Births.—Because of rationing, payment of Dependents'
Allowance, and a greater awareness of the parents' responsibilities in the
matter, there has been virtually 100 per cent, registration of all births. Even
although rationing were to cease at any time, the fact that a birth must be
registered before a Family Allowance will be granted will mean that births will
be promptly registered in the future. Thus, in years to come, there will be no
problem of delayed registration such as the Division now experiences.
The co-operation of the physicians in sending in notifications of a live birth
or still-birth has continued to be excellent, in spite of the very heavy demand
on their time. Hospitals, both public and private, have continued to send in
most regularly and without exception their monthly returns of births. The
final method of checking on birth registration—namely, a return from all
schools (public, private, and elementary correspondence schools) in the Province
of pupils entering school for the first time—brought in a fewer number of
unregistered births than in previous years. It is possible that within a year or
two this check on completeness of birth registration may be eliminated.
Registration of Deaths.—The quarterly return of burials and cremations
from all superintendents of cemeteries in Victoria, in accordance with the provisions of section 17 of the " Vital Statistics Act," will be instituted for the first
time during the forthcoming year. Meanwhile the registration of deaths has
not presented any fundamentally different problems in 1944 from that experienced in previous years.
Registration of Marriages.—Whenever a fresh marriage register is
requested by a clergyman the Division requires that the completed register be
returned for checking. However, there are many marriage registers wherein
only a few marriages are entered each year. Hence in the normal course of
events these might be only checked once in ten years. Rather than delay so long
in order to determine whether or not all marriages have been registered, the
Division has called in during the year registers in the hands of Roman Catholic
priests, Mennonites, and some in the hands of United Church clergymen.
Registers in the hands of clergymen of other denominations will be called in by
the Division in rotation in the future. It has not been possible to locate all the
marriage registers issued many years ago. Efforts will be continued to locate
these records, as undoubtedly they will contain more unregistered marriages
than those issued in later years. As a result of the check on marriage registers,
103 delayed registrations of marriages were effected during the year under
review. LL 42 BRITISH COLUMBIA.
The Division has continued to check all marriage registers located with
military units whenever a chaplain having custody of a marriage register
changes. Once the service-man or the chaplain has left the Province, either
for service overseas or elsewhere, it becomes increasingly difficult to correct any
errors or omissions on a registration of marriage.
DISTRICT REGISTRARS' OFFICES, ETC.
In March, 1944, the registration districts of Ladner and New Westminster
were consolidated. For some years all the work of the Ladner registration
district has been done by the District Registrar at New Westminster and it was
felt that in order to eliminate unnecessary indexing for both registration districts that the consolidation would be warranted.
At the close of the year the Division of Vital Statistics had eighty-five
district offices and fourteen sub-offices. There are 120 Marriage Commissioners
and thirty-five Issuers of Marriage Licences appointed under the " Marriage
Act." Some twenty-nine district offices were inspected during the year and
four out of the nineteen Indian Agencies of the Province were also inspected.
Some of these district offices had never been visited before and others very infrequently. The inspections proved most worth while from the standpoint both of
checking on the records kept in the district offices and instructing the District
Registrars and their Deputies on points in connection with their work. The
Division is keenly appreciative of the co-operative attitude shown by the District Registrars and their Deputies.
ADMINISTRATION OF THE "MARRIAGE ACT."
Last year's report set forth in considerable detail some of the highlights
in connection with the administration of this Act. It is only necessary this
year to mention the problem confronting the Division in the administration of
this Act in connection with the qualifications of a religious denomination making application for the first time for authority for its ministers or clergymen
to perform marriages within the Province. The governing authority of the
denomination must submit evidence in conformity with section 4 of the " Marriage Act." Decision must be made by the Registrar (Director of Vital Statistics) as to whether the religious body is sufficiently well established both as to
continuity of existence and as to recognized rites and usages respecting solemnization of marriage to warrant, in his opinion, the registration of its ministers
and clergymen as authorized to solemnize marriage. A new letter of instructions was drafted during the year wherein the requirements of the Division are
more completely set forth. In addition, before any new denomination can be
registered a petition must be signed by at least fifty heads of households who
are members of the religious denomination seeking registration.
During the year seven denominations applied for registration under the
" Marriage Act." Two, Beth Hamidrosh, a Jewish congregation, and the Old
Colony Mennonite Church were recognized. None was refused. At the end
of the year there were seven applications pending, two carried over from the
year previous. It is not the policy of the Division to recognize any denomination of a " mushroom growth " type of organization as this does not appear to
be the intent of the " Marriage Act." BOARD OF HEALTH REPORT, 1944. LL 43
LEGISLATION.
The " Marriage Act."—This Act was amended to permit the marriage of
a married person whose husband or wife had been missing for more than seven
years and whose death had been presumed by a Judge of the Supreme Court.
The amendment has no other legal effect than to permit the solemnization of
a form of marriage, it does not in any way interfere with the validity of a prior
marriage if the person presumed to be dead should reappear. The Court Order
of Presumption of Death must be filed with the Division of Vital Statistics.
The "Vital Statistics Act."—No amendments were made in 1944; however, the Act should be amended in the next year for the following reasons:—
At the present time there "is no specific authority in the Act whereby the
Provincial Secretary may enter into an agreement with the Dominion Government regarding verification for such purposes as Family Allowances, Contributory Old-age Pension, Health Insurance, and for other miscellaneous matters
where proof of birth is required by various Dominion authorities. Authorization of such authority on the part of the Provincial Secretary would make for
flexibility in the Division's relations with the Federal Government Departments.
If a well-balanced public health programme is to be carried on within
a health unit or a public health nursing district it is necessary to have information regarding the birth of infants and also to know the causes of death of the
people under their care. At the present time the " Vital Statistics Act " does
not make any provision for such data to be made available to public health
personnel. It is proposed to ask for legislation permitting the Provincial
Health Officer to authorize the Director of Vital Statistics to give information
to Health Unit Directors and to Public Health Nurses where necessary for the
carrying-out of a proper public health programme.
With the advent of Family Allowances in July, 1945, and the possible beginning of other social measures in the near future requiring proof of birth,
and also on account of the necessity for more prompt statistical reports, provision should be made whereby the returns of births, deaths, and marriages,
etc., which are now received monthly by the Division may, by regulation, be
made on a semi-monthly or weekly basis by the District Registrar to the
central office.
The " Vital Statistics Act" would appear to give more discriminatory
powers to a District Registrar in accepting a registration of a current birth
than is given to the Registrar in accepting evidence of a delayed registration of
birth. It is proposed to give the Registrar the equivalent powers of a District
Registrar in this matter.
At the present time it is mandatory for each school teacher in the Province
to make a return of the birth of all children entering school for the first time.
In the advent of what should prove to be 100 per cent, registration under
Family Allowances it would appear that such a provision should no longer be
effective and it is proposed that the provisions of the Act regarding this matter
may be discontinued subject to regulation by the Lieutenant-Governor in
Council.
At the present time District Registrars, in order not to cause any inconvenience to both the public and undertakers, have issued burial permits occur- LL 44 BRITISH COLUMBIA.
ring outside their registration district. This is contrary to the provisions of
the Act. However, it is desirable that permission for this unauthorized practice should be given by Statute.
While the number of divorces has been increasing very greatly in British
Columbia the number has also been increasing in most of the other Provinces
of the Dominion. At the present time no adequate divorce statistics are being
collected on a National basis and it is proposed that legislation be initiated by
means of an amendment to the " Vital Statistics Act" whereby the Registrars
of the Supreme Courts would transmit a statistical return of each divorce to
the Division who, in turn, would send a copy to the Dominion Bureau of
Statistics for purposes of National tabulation.
The " Change of Name Act."—No amendments were made during the
year under review. However, two points in connection with the Act are under
review and may warrant an amendment at some future date. The first is the
fact that a divorced woman is unable to resume her surname prior to her
marriage. Before the Act came into force on December 6th, 1940, it was
a fairly common practice of the Judges when pronouncing a decree of divorce
to state that the divorcee would take back her maiden surname or whatever
surname she was known under before her marriage.
The second point deals with the inability of a widowed or divorced woman
to change the surname of her children, even although she is their sole legal
guardian. Very often it happens that a widowed or divorced woman remarries
and she endeavours to have the children's surname changed to her newly
married surname. The only way this can be done is to have the children
adopted by her husband and herself.
There is no provision in the Act whereby the mother of an illegitimate
child may change that child's surname in the event of her changing her own
surname. It is questionable whether such a change should be permitted. Much
careful consideration will have to be given by the Division before it would advocate this type of change.
CO-OPERATION WITHIN THE PROVINCIAL BOARD OF
HEALTH AND ITS DIVISIONS.
The policy of having the Division act as an adviser on forms, codes, and
statistical procedures and format of reports has been carried out in accordance
with the general plan of co-ordinated effort outlined by the Provincial Health
Officer. The Division continued to render very tangible assistance to the
Divisions of Tuberculosis Control and Venereal Disease Control respectively
in the preparation, tabulation, compilation, and presentation of their monthly
and annual reports. Acting in his capacity as Supervisor of Medical Records
to the Provincial Board of Health, the Director of Vital Statistics checks all
statistical and medical forms for duplication of data and uniformity in questions, etc.
On account of changes made in the previous year in the record system of
the Division of Tuberculosis Control, wherein that Division assumes a greater
responsibility for the compilation of its own statistics on a cumulative daily
basis, it became less necessary for the Division of Vital Statistics to supply the
services of a full-time statistical clerk.    Furthermore, on account of the iriany BOARD OF HEALTH REPORT, 1944. LL 45
changes in personnel and organization within the Division of Venereal Disease
Control, and the necessity to stream-line their record system, it was considered
advisable to close out the Vancouver Section and transfer the statistical clerk
in charge, Miss Jean Gilley, to the Division of Venereal Disease Control.
The Division of Vital Statistics continued to give assistance to the Bureau
of Local Health Services of the Provincial Board of Health by supplying statistical information regarding population estimates, budget estimates, etc., for
both established and proposed Health Units. Statistics from the reports of
the Medical Inspection of Schools were compiled by the Division. Similarly,
the Division continues to assume responsibility for the collection of statistics
on the work of the Public Health Nurses as recorded in their daily reports.
Statistics on cancer notifications were punched and certain tabulations made.
The Division of Vital Statistics continued to carry on the editing and publishing of the Provincial Board of Health Monthly Bulletin. Several articles
were contributed by members of the staff of the Division.
Problems relating to health insurance were referred both from the Interdepartmental Committee on Health Insurance and by the Provincial Health
Officer to the Division for statistical information. Statistical data were collected which were used by the representatives of the Province attending the
conference of Ministers and Deputy Ministers of Health at Ottawa in May.
Since that date certain other compilations on the same subject have been prepared by the Division under the direction of the Provincial Health Officer. The
Division is keenly interested in health insurance both from the standpoint of
its importance in influencing the development of public health and also because
it will be the only source of adequate morbidity statistics—which are now so
much needed.
It should be emphasized that only the most important work done by the
Division for the Provincial Board of Health has been mentioned above. It is
the aim of the Division of Vital Statistics to be the workshop of public health
for the Provincial Board of Health and therefore many small tasks of minor
importance are also performed by the Division.
MECHANICAL TABULATION PROBLEMS.
At the present time all the alphabetic punching and much of the counting-
sorter work done in connection with the alphabetic and statistical punch-cards
of the Provincial Board of Health is performed within the Division of Vital
Statistics. The listing and tabulating of these cards is done at the Bureau of
Economics and Statistics. Schedules on routine work have been fairly well
maintained by the Bureau; however, experience has shown that there has often
been considerable lag in obtaining tabulations from other than routine applications. It is felt that the time has now come when there is sufficient work on
hand within the Division to warrant a small though complete installation of
mechanical equipment.
Certain advantages will accrue to the Division by having its own equipment. Foremost among these will be the fact that the personnel working with
the records will have an intimate knowledge of the particular application gained
from their specialized experience with records of the Provincial Board of
Health.    Coupled with this will be a greater sense of responsibility for the LL 46 BRITISH COLUMBIA.
work, the operators being members of the staff of the Division. Secondly,
there will be greater flexibility. Tabulations in progress can be checked at
the various stages and, if necessary, runs rearranged in order to take full
advantage of the information as it appears. This lack of flexibility is also
accentuated by the fact that this Division is some distance away from the
Bureau of Economics and Statistics and it is not always feasible to have a statistician on hand at the time of tabulation. To have a compact installation will
mean a saving in costs both of transportation of cards and in time spent by
the staff in coming back and forth between the Bureau and the Parliament
Buildings.
FOURTH DOMINION-PROVINCIAL CONFERENCE ON
VITAL STATISTICS.
Following a recommendation made at the conference of the preceding year
the Fourth Dominion-Provincial Conference on Vital Statistics was called in
Ottawa on September 26th. The following were the most important topics
dealt with at the Conference:—
Delayed Registration Standards.—This subject was one of the most contentious at the previous year's conference. A committee was formed of representatives from Alberta, Manitoba, Nova Scotia, and British Columbia to work
on the problems. The result was the adoption by all Provinces of " Standard
Minimum Evidence Acceptable for Delayed Registration of Birth " set forth
below:—
STANDARD MINIMUM EVIDENCE ACCEPTABLE FOR
DELAYED REGISTRATION OF BIRTH.
(As adopted by all Canadian Provinces.)
Class " A " Evidence.
(One item sufficient if document discloses parentage, date, and place of birth.)
A copy of the hospital record of the birth, certified by a competent official of the hospital.
A copy of the record of the physician who was in attendance at the birth, certified by himself,
or in the event of his absence or death a copy certified by the person who has the custody
of his records.
A baptismal, cradle roll, or other church record copied from the original entry, if such record
was made before 4 years of age.
Production of a newspaper giving the date of publication, or a certified extract from same,
containing the announcement of the birth, if such announcement establishes the date,
place, and parentage.
Insurance policy if taken out before 4 years of age.
A certified copy of the record of the nurse or midwife who was in attendance at the birth.
Class " B " Evidence.
(More than one item necessary.)
Class " B " evidence consists of documents which are made after the fourth birthday, or
if made before the fourth birthday do not contain conclusive evidence as to the date, parentage, or place of birth.    Affidavits from memory alone are not acceptable unless supported by
at least one item of Class " B " value.    Examples of Class " B " evidence are:—
Dated letter or telegrams received shortly after birth.
Birthday or baby books.
Record of entering school for the first time, if record shows date of birth. BOARD OF HEALTH REPORT, 1944. LL 47
Vaccination or other health record if made when an infant, and which discloses dates of
birth and vaccination.
Census, immigration, or consular records.
Records from Child Welfare Departments if made within 4 years of birth.
Affidavits from two disinterested persons who saw the child shortly after birth, provided that
one of them gave birth to a child of her own within a few months (either before or after)
of the date of birth of the applicant's child, thereby establishing a reason why this date
and place of birth is fixed in her memory. It is essential, of course, that a registration
of her child's birth be found in the departmental records before such affidavit is accepted.
Any other recorded event such as a marriage or death would have equal value.
Divorce Statistics.—The conference of the previous year agreed in principle
upon the desirability of developing a system of national divorce statistics and
requested the Dominion Bureau of Statistics to canvass the field with the Provincial and Federal authorities concerned and prepare a draft form for consideration at the next conference. This was done at this year's conference and
after some discussion it was decided that the matter should be given further
detailed study in consultation with local representatives. In view of the
increasing number of divorces in this Province it is felt that this Division should
have the necessary legislative authority to collect the required information
from the Registrars of the Supreme Courts and transmit it to Ottawa on a
nationally approved form.
General Remarks. — The conference discussed reports submitted by the
Vital Statistics Section of the Canadian Public Health Association. The proposed Canadian Still-birth Code, the revision of the Handbook on Death Registration and Certification, Current Vital Statistics Data, and the Form and
Content of the Annual Vital Statistics Report were among the subjects dealt
with.    These items were carried over for further discussion and report.
The conference itself was considerably shorter than the Third Conference
because of two factors. The first was an all-day joint session with representatives of the Province of Ontario to discuss a proposed revision in draft form
of the Ontario " Vital Statistics Act." The discussions were mutually beneficial to all Provinces. The second factor was the joint session between the
Deputy Ministers of Health, the Directors of Vital Statistics, and officials of
both the Dominion Bureau of Statistics and the Federal Treasury. The session
dealt with the services now given by the respective divisions of vital statistics
to the various Federal Government agencies with particular reference to the
application of vital statistics to Family Allowances — proof of birth being
required for every child.
Several alternative plans were discussed. At the same time it was known
that Contributory Old-age Pensions and Health Insurance are potential sources
of demand for further verification procedures. The third plan was adopted in
principle by all Provinces. Briefly, Plan III. called for the creation of a National Register of Vital Statistics Records by means of microfilming the vital
statistics records of each Province monthly and sending a photographic copy
of each registration to the Dominion Bureau of Statistics in place of the regular
transcript. These photographic copies would be the source from which the
Federal Government would obtain its verifications. The basic equipment would
be supplied by the Dominion. In addition, a Vital Statistics Council made up
of one representative from each Province and one respectively from the Yukon LL 48 BRITISH COLUMBIA.
and Northwest Territories, and the Chief of Vital Statistics of the Dominion
Bureau of Statistics is to be established forthwith. This Council will discuss
and advise on problems arising out of the administration of the vital records
system and relative statistics. A proposed agreement has been drafted by the
Dominion Bureau of Statistics and approved by the Federal Minister of Trade
and Commerce and National Health and Welfare. The Division is of the
opinion that the Province should retain the final word as to what verifications
should be done by the Dominion Bureau of Statistics for the various Federal
departments from the records of the Province. The proposed agreement, in
effect, would hand over to the Federal authority for whatever purpose it deemed
necessary the records of the Province without further control. An alternative
proposal has been made by the Division that specific approval should be given
for each type of verification granted to the Federal Government. At the close
of the year the subject was still a matter of negotiation.
PROBLEMS OUTSTANDING AT THE END OF THE YEAR.
Goal in Registration.—The statement made in last year's report " the first
and perhaps most fundamental problem of the Division remains the necessity
for full and complete registration of births, deaths, and marriages " must be
again reiterated. The fact that Family Allowances will be granted conditional
to registration of a birth should immeasurably help in the achievement of almost
perfect registration of births. The process of following up marriage registers,
long overdue for checking, has to be quickened during the coming year and a
regular checking schedule maintained thereafter. Section 17 of the " Vital
Statistics Act" must be implemented during the forthcoming year in order
that a full check should be regularly made of all burials or cremations, etc.
Standards for Correction of Documents, Legitimation Procedures, etc.—
A beginning must be made towards the establishment on a national basis of
acceptance by the respective Provinces of correction of documents, legitimation
procedures, alteration of Christian names, and other items relating to documentary revision.
Reorganization of Central Office of the Division.—Since the war has commenced the duties of the various members of the staff have changed, in many
instances considerably, from the work which was done by the occupant of the
same position formerly. It is becoming more and more necessary that a reorganization of the staff of the employees in the central office should be carried
through during the ensuing year. The volume of registrations has grown so
that the work will have to be split up with the responsibility being more equally
shared by the key members of the staff. Before this reorganization can be
effectively completed it will be necessary to draft functional, administrative,
and personnel charts of the Division to provide a proper means of analysis.
District Registrars' Manual.—Another important piece of work that must
be completed within a short time is the revision of the manual for District
Registrars of Births, Deaths, and Marriages and also one for Marriage Commissioners and Issuers of Marriage Licences. This work has barely commenced
—manuals have been received from various states and notes have been gathered
on results of inspection trips.    It is planned to bring the manual out in loose- BOARD OF HEALTH REPORT, 1944. LL 49
leaf form so that revisions may be made from time to time without the inconvenience of reprinting all the instructions.
Development of further Services to the Provincial Board of Health.—Before
sound programmes can be initiated by the Bureau of Local Health Services
respecting the growth of public health measures in local communities it is necessary to obtain all pertinent data relating to each community. It is the function
of the Division of Vital Statistics to supply as much of the needed information
as required. Information relating to estimates of population, birth, and mortality statistics of all kinds are usually requested from the Division. However,
much more tangible service must be rendered in the future than is now given
by the Division. For instance, a course of training for Health Unit Clerks
should be outlined and instituted. Census data which is now compiled on the
basis of the Dominion Statistical Publication Areas and the subdivisions thereof
will have to be interpreted in terms of the much smaller local settlements.
A sound basis for census data would appear to be the individual census enumeration areas, provided the Division can be instrumental in having them redistributed according to the Dominion Statistical Publication Areas and the subdivisions thereof instead of according to electoral districts which are subject
to change from time to time. Such census enumeration data would allow the
Division to accurately compile the statistics of potential health units. Efforts
must be made by the Division to show the desirability of having the enumeration
areas redefined to lie within the Dominion Statistical Publication Areas. Once
this is done it would be possible for the vital statistics of the Province to be also
compiled on the same basis. Morbidity and other statistic^ might also be compiled similarly. However, it is first necessary to convince the Dominion Bureau
of Statistics of the necessity of having this work done. An effort is being made
in this direction at the close of the year.
General Remarks.—Other problems will present themselves to the Division
in the forthcoming year. The experience of the past has been that the staff of
the Division has a spirit of co-operation and interest in their work that will
ensure a sustained effort toward solution of the many and varied problems
before them.
REPORT OF THE DIVISION OF LABORATORIES.
C. E. Dolman, M.B., B.S., M.R.C.P., D.P.H., Ph.D., Director.
INTRODUCTORY COMMENTS.
For the past several years it has seemed that the Division of Laboratories
had reached the limits of its capacity to cope with increasing demands. But
each year, by enlarging either the staff or the accommodations, or both, means
were found of enabling the Division to handle a greater number of specimens
and to undertake new responsibilities. Since the fourth house on Hornby
Street was taken over by the Government in February, 1943, no additional
accommodation has been available in, or adjacent to, the " temporary " premises
occupied by the Division for the past fourteen years. The only means of increasing resources during 1944 was therefore by staff expansion. Several resignations, some involving fairly senior members of the staff, complicated the task
of training the fourteen newcomers who joined the Division for replacement LL 50 BRITISH COLUMBIA.
or reinforcement. There were times, especially during the summer vacation
season, when it was tempting to follow the short-sighted but simpler policy
of distributing the increasing pressure from the stream of incoming specimens
among the remaining fully-trained technical staff, rather than have them divert
part of their attention to the task of supervising novices. However, the sounder
policy was followed of recruiting a larger technical staff, as far as appropriations and available personnel permitted; and of quickly broadening their training by circulating them among the different sections of the Division whenever
circumstances made this feasible. Despite all the difficulties encountered,
201,767 examinations were made during 1944 at the central laboratories in
Vancouver, a figure nearly 8 per cent, greater than for 1943.
The branch laboratories also faced serious difficulties, chiefly due to staff
changes and shortages. These problems were cheerfully met, despite an increased load at Kamloops, Kelowna, Nanaimo, and Nelson—in fact, in all the
branch laboratories save those at Victoria and Prince Rupert, where certain
special conditions which had disproportionately inflated their turnover last year
were alleviated.
TESTS RELATING TO VENEREAL DISEASE CONTROL.
As in previous years, tests relating to syphilis and gonorrhoea accounted
for roughly two-thirds of all examinations made by the Division. Blood tests
for syphilis, totalling 114,690, remained at substantially the same level as in
1943, although there were larger numbers of the more time-consuming standard
Kahn and Kolmer-Wasserman complement-fixation tests. Since these two tests
are only performed on specimens giving a doubtful or positive presumptive
Kahn reaction, a higher ratio of the former to the latter might be deemed a
possible indication of a rising incidence of syphilis in the community. However, further analysis of our figures would be required to substantiate this
interpretation; and a more probable explanation would seem to lie in the
elimination of tests upon the Red Cross blood donors, among whom the incidence
of doubtful and positive reactions had locally proved remarkably low.
In view of the 1943 total having included over 17,000 blood donor specimens, it is obvious that the current trend in serodiagnostic testing in this
Province remains upward. Had these blood donor specimens not been eliminated from routine testing, the serodiagnostic department would have been
saddled with an altogether unmanageable burden. The situation would have
been far worse had the Division attempted to undertake routine premarital
tests. It is definitely not yet feasible, in the face of the rising general demand
for blood tests, and of the present inadequate laboratory accommodation, to
contemplate enforcement of premarital tests. These general and particular
demands for more serodiagnostic tests have resulted from public health education, applied persistently to all groups in the community, including physicians;
and may be regarded as one of the most important and hopeful consequences
of campaigns against syphilis. But gratifying though this response may be
to those in charge of such campaigns, it is only fair to emphasize that the
laboratories bear (almost entirely unadvertised) the brunt of the work entailed.
Only those with laboratory experience, or with unusually sympathetic imagination, can visualize the problems entailed, for example, in a doubling of the BOARD OF HEALTH REPORT, 1944. LL 51
number of blood specimens tested annually since 1940, despite an ever-changing
staff and the same unsatisfactory accommodations. In 1935, when the present
Director was appointed, the total tests of all kinds performed in the central
laboratories was less than one-half the number of blood tests for syphilis now
carried out there. The Division as a whole examined about 120,000 different
blood specimens for syphilis, which is roughly equivalent to one such test for
every eight persons in the population at large. It may be confidently claimed
that no State or Provincial laboratory in North America can point to a higher
rate of testing.
Assurance was received during the year that the quality of performance
was as notable as the quantity. The central laboratories participated in a survey of the accuracy of performance of serodiagnostic tests for syphilis, initiated
by the Laboratory of Hygiene of the Department of National Health and Welfare. All Provincial laboratories throughout Canada were sent some 200 blood
samples, from syphilitic and non-syphilitic sources, carried out on each of them
the presumptive Kahn, standard Kahn, and Kolmer-Wasserman tests, and sent
in their reports made out in the customary manner. No special refinements of
technique were applied to these samples, nor were experienced technicians
assigned to these tests. Yet in respect of both specificity and sensitivity, the
central laboratories ranked first or second among those participating. The
fine showing achieved in a similar survey conducted two years ago has thus been
maintained or even surpassed.
Apart from private physicians, the Division of Venereal Disease Control,
and medical health officers, the armed forces continued an important supplementary source of blood samples for these tests. By far the greater number
of specimens were sent in by Army authorities. Specimens from recruits,
from hospitalized patients, and from personnel about to be discharged totalled
nearly 14,600, for which the Division received payment of 15 cents per specimen. Considerable numbers of R.C.A.F. specimens were also examined, although
not according to any systematic plan, the majority of Air Force personnel
having been apparently tested in the earlier years of the war. At the year's
end negotiations were proceeding in regard to routine blood testing of R.C.A.F.
personnel prior to discharge, the Division tentatively offering to examine up to
200 specimens weekly in consideration of a payment of 15 cents per specimen.
Incidentally, this sum is somewhat less than the actual cost entailed. Relatively
few samples have been received from the Navy by the central laboratories,
specimens from this Service being sent mainly to the Victoria branch laboratory,
owing to its proximity to Esquimalt.
Public attention has frequently been drawn to the incidence of syphilis
being lower in the Pacific Command than in the armed forces elsewhere in
Canada. It may be opportune to point out here that blood tests performed by
this Division have provided the main basis for such pronouncements. A comparatively low incidence of syphilis among the civil population of British Columbia no doubt largely accounts for this favourable experience in the Pacific
Command. The Division continued its policy of carrying out such serodiagnostic surveys of civilian groups as time and opportunity permitted. In one
such survey conducted during the summer at the request of an important commercial air line company, only four positive and three doubtful results were
PROVINCIAL  LIBRARY
VICTORIA, S. C. LL 52 BRITISH COLUMBIA.
obtained among a total of 1,163 specimens tested. This gives a maximum possible incidence of syphilis of 0.6 per cent., and a probable incidence of 0.34 per
cent, for the group. These figures conform with those given in last year's
Annual Report, where reference was made to the maximum incidence of sero-
logically-detectable syphilis among some 20,000 prospective Red Cross blood
donors being below 0.3 per cent. Throughout 1944, as in the previous two
years, shipyard workers were routinely tested as soon after enrolment as possible. Among this group, comprising men and women of a wide range of age
and social strata, but with male labourers predominating, the incidence of
syphilis again proved surprisingly low. Of 6,574 persons tested during the
twelve-month period, eliminating repeat tests, 150 gave positive or doubtful
reactions, a maximum possible incidence of 2.28 per cent. Another survey,
carried out in the last few months of the year in co-operation with the Division
of Venereal Disease Control, yielded even more gratifying information. Among
520 employees of a fish-cannery, representing largely casual labour, and including a high percentage of Indians, only eight had positive or doubtful blood
reactions, a maximum incidence of about 1.5 per cent. In this group were 120
Indians, of whom four, or 3.3 per cent., gave positive or doubtful reactions.
These figures are not given in an endeavour to minimize the seriousness of the
syphilis situation; but rather to help place in proper perspective some of the
more extravagant claims and implications respecting the local incidence of this
disease.
Continuing the trend of the past several years, there was a significant
increase in the numbers of cerebrospinal fluids examined by Kahn and complement-fixation tests, and for colloidal reaction. This indicates a growing recognition by physicians of the importance of requesting at least one such examination on all cases of syphilis under their care, in order that the onset of
neurosyphilis may be detected as early as possible.
An even more important trend continued during the year was that manifested by dark-field examinations for Treponema pallidum, which increased
from 242 to 393, or by over 62 per cent. This is encouraging evidence of
success in the campaign to promote diagnosis of syphilis in its earliest stages.
In an effort to further this campaign, the Division distributed to every hospital
in the Province a supply of outfits for collecting specimens for dark-field examinations, with instructions to send in such specimens by air mail whenever
possible. All positive reports were telegraphed. Although, with only one or
two exceptions, the branch laboratories have the equipment for carrying out
these intricate tests, it has seemed preferable to divert the great majority of
such specimens from the interior of the Province to the central laboratories in
Vancouver.
The rather favourable impression conveyed by the foregoing figures relating to syphilis cannot be gathered from the figures applicable to gonorrhoea.
The year was marked by an increase from 19,852 to 28,739—i.e., of 44.8 per
cent.—in direct microscopic examinations for gonococci. Bearing in mind that
such examinations, unlike blood tests for syphilis, are rarely requisitioned unless
there be definite clinical signs of gonorrhoea, or a history of past infection, it is
apparent that such a notable increase in these examinations must be taken as
an index of greater numbers of suspected gonococcal infections.    The increase BOARD OF HEALTH REPORT, 1944. LL 53
in specimens for gonococcus culture reaching this Division from the Division of
Venereal Disease Control was even more notable. A total of 8,545 gonococcus
cultures were performed in 1944, as compared with 5,713 in 1943, an increase
of 49.6 per cent.
The comments made in last year's report upon these two types of examination for gonococci; namely, that they involved the laboratories in disproportionately heavy administrative and interpretive problems, may be applied with
even greater emphasis to the year under review. For instance, the smear
examinations can only be reliably carried out by experienced technicians, and
are yet exceptionally tedious and eye-straining. The numerous changes in the
technical staff during the year rendered difficult the training of newcomers for
this work. Senior members, although fully occupied with their own special
responsibilities, handled a share of these specimens whenever possible; while
Miss Kerr, despite her many duties as Assistant-Director, assumed personal
charge of these specimens for several months. The newer methods of treatment
for gonorrhoea have resulted in the criteria formerly accepted as characteristic
of a gonococcal smear being no longer adequate. Only by very close correlation
of the clinical and epidemiological aspects of this infection with certain laboratory findings can the true significance of the latter be determined. This statement applies equally to the gonococcus culture method. It is urgently desirable
that research be prosecuted for more satisfactory means of identifying gonococcus colonies. Present shortages of technical personnel, mounting pressure
of " routine " activities, and inadequacy of the Division's existing facilities have
regrettably prevented work along these lines.
TESTS RELATING TO TUBERCULOSIS CONTROL.
As in previous years, all types of tests for tubercle bacilli underwent an
increase. Direct microscopic examinations increased from 6,295 in 1943 to
6,901, or by 9.6 per cent.; while the far more time-consuming cultures for
M. tuberculosis increased from 561 to 763, or by 36 per cent. Much of the
marked increase in cultures was due to requisitions from the Shaughnessy
Military Hospital and from the Coqualeetza Indian Hospital—both operating
under Dominion Government auspices—for which work the Division received no
financial or other compensation. The sending-in of stomach-washings from
infants or sputumless cases is rapidly increasing, and in view of the troublesome preliminary treatment of the specimens required prior to culture or animal
inoculation, is bound to involve the laboratories in future difficulties.
Animal inoculations (the great majority of which were for M. tuberculosis)
showed an increase of 8.5 per cent., despite the Division's inability to carry out
these tests for a period of several weeks during the summer, owing to unavailability of guinea-pigs. Reference has been repeatedly made to the uncertainty
surrounding our supplies of guinea-pigs. Sources hitherto reliable have either
ceased to breed laboratory animals since the war or had only infected stock to
offer. In recent years the pseudo-tuberculosis infection prevalent among rats
in and around Vancouver became apparent in the guinea-pig colonies of local
breeders. Last year another type of infection, due to Salmonella typhi murium,
was identified as the cause of fatalities among our guinea-pigs. This microorganism is also a common cause of infection among wild rodents, and may LL 54 BRITISH COLUMBIA.
have been transferred to our animals by infected rats or mice. It is certain
that rats and mice have access to the laboratories, and it would not be feasible
to render the buildings proof against them. An important feature of the more
satisfactory accommodation which must soon be made available for the Division
will be properly-designed quarters for laboratory animals, so that a healthy
supply may be assured. Meanwhile, the supply situation showed considerable
improvement towards the end of the year through the purchase of several small
colonies from private sources. Arrangements have also been made with the
Provincial Mental Home at Colquitz whereby guinea-pigs for use of this Division
will be bred there; and it is hoped that there will thus be no necessity during
1945 to postpone performance of animal inoculation tests for the presence of
tubercle bacilli.
TESTS RELATING TO CONTROL OF INTESTINAL
INFECTIONS.
The year was marked by numerous sporadic small outbreaks and isolated
cases of intestinal infections, due to organisms of the typhoid-paratyphoid-
Salmonella-dysentery group. There were no large-scale epidemics, although
early in the year specimens were still reaching the Division from secondary
cases or contacts arising out of the Vernon epidemic of 1943. Most of this
year's cases were due to unsuspected carriers, chiefly in the Vancouver area,
and the central laboratories played a crucial part in the identification of many
of these carriers, as well as supplying the private physician and the medical
health officer with the correct diagnosis in many instances of puzzling or trivial
clinical symptomatology.
Of special interest and concern was the finding of numerous cases of
Salmonella typhi murium infection, mainly in or around Vancouver. As mentioned above, this organism is a frequent cause of epidemics among small
rodents, which may, by pollution of human food with their excreta, convey a
paratyphoid-like infection to man. No evidence could be found by the laboratories that this was, in fact, the mode of origin of the Vancouver cases of 5.
typhimurium infection. Nor did success attend a few attempts made to incriminate as vectors flies caught in the vicinity of houses where these infections
occurred. Although the probable mode of conveyance in these cases was
through direct contamination with infected human excreta, it should be borne
in mind that many members of the Salmonella group of organisms are liable to
infect a wide variety of wild and domestic animals, as well as man, and that
this situation both multiplies the potential modes of conveyance and complicates their control.
Positive stool cultures for Salmonella organisms were detected in the
central laboratories from sixty-six different individuals during 1944. S. typhi
(the cause of typhoid fever) was isolated from thirty-four of these persons, of
whom nineteen were domiciled in Vancouver. There were thirty-two persons
from whom S. typhi murium, S. paratyphi B, or S. newport were isolated,
twenty-five of these being residents of Vancouver; and the first-named of these
three organisms accounted for two-thirds of the cases.
An identical number (sixty-six) of positive stool cultures for Shigella
organisms (dysentery bacilli) were detected during the year. There were
forty-three persons from whom the Flexner dysentery bacillus was isolated, BOARD OF HEALTH REPORT, 1944. LL 55
twenty-three being Vancouver residents; while of twenty-three persons yielding the Sonne bacillus, thirteen were Vancouver residents. In all, the record
number of 132 cases or carriers of typhoid-paratyphoid-Salmonella-dysentery
infections were identified by the central laboratories during 1944.
Such factors as war-time interchanges of population, general overcrowding, and laxity in food preparation and handling have no doubt contributed to
this high incidence of excreta-borne infections. Such an increase had been
foretold by the Director in various addresses and scientific papers. It can be
asserted with equal confidence that unless improvements are accelerated in the
general sanitation level of numerous communities throughout the Province, the
sporadic carrier-borne outbreaks of 1944 may well lead to milk, water, or
sewage-borne epidemics of major proportions in 1945.
Every such disaster befalling a community involves the Division in an
enormous amount of extra work, for which again it is seldom publicly credited.
Not one of the cases alluded to above could have been diagnosed, nor a single
carrier traced, without much highly skilled work, resulting in a specific report
from the laboratories. The stool culture and blood agglutination tests used in
the detection of these infections are especially time-consuming. Increases in
numbers of cultures for organisms of the typhoid - paratyphoid - Salmonella-
dysentery group of from 1,977 to 2,674, or 35.3 per cent., and in blood agglutination tests for the same group of from 4,503 to 7,810, or 73.4 per cent.,
therefore presented problems of serious concern.
The branch laboratories as a whole likewise showed some increase in blood
agglutination tests for this group of organisms. But with few exceptions,
stool specimens for cultural examinations were referred by them to the central
laboratories. This type of examination, for proper performance, requires
a wide variety of differential media on hand, and extensive experience with
supplemental procedures for the identification of suspicious colonies, such as
could be expected of few of the branch laboratories. Those branch laboratories
which have continued this work will be requested to divert it to Vancouver, so
that the very hard-pressed among them may more readily cope with other and
simpler demands upon their resources.
BACTERIOLOGICAL ANALYSES OF MILK AND WATER.
An appreciable increase occurred in the numbers of bacterial counts and
coli-aerogenes tests on milk samples from dairies distributing in the City of
Vancouver and in certain other municipalities within easy distance of the city.
Especially important was a continued increase in the number of phosphatase
tests performed. These tests provide a valuable and accurate index of the
efficiency of the pasteurization process to which a milk sample may have been
exposed. The war has operated in various ways to eliminate from business
many of the dairies formerly distributing raw milk in Vancouver; and the
application of some laboratory test to pasteurizing plants became very desirable.
During the year, 781 of these tests were performed in the central laboratories,
an increase of 33.3 per cent, over the total for 1943, and numerous instances
of faulty pasteurization were revealed. Several of the branch laboratories
have now made this test available, and are carrying it out routinely upon the LL 56 BRITISH COLUMBIA.
increasing percentages of their local milk supplies which are subject to pasteurization.
The main relevant comment on bacteriological analyses of water is the
remarkable change evident in the bacterial flora of Vancouver's water-supply
as a result of the chlorination introduced towards the end of 1943. Whereas
prior to chlorination it was not uncommon for 1 cc samples of the city's
drinking-water to give a positive coli-serogenes test, all the 10 cc samples
examined throughout 1944 (with the exception of one solitary sample, following a heavy rainfall) gave negative tests. There could be no better proof than
this of the extreme efficiency of the small and tasteless quantities of chloramine
introduced into the city's water-supply.
Early in the year, the branch laboratories were requested to conduct regular
examinations of the drinking-water supplies of their own and adjacent municipalities, the number of such tests to be performed monthly being based on the
population, according to the standards recommended by the United States Public
Health Service. Mr. R. Bowering, Chief Sanitary Inspector, arranged with the
appropriate local public health officials for collection and shipment of the specimens. The Directors of all the branch laboratories readily co-operated, and the
extent of the extra work entailed in the fulfilment of this request is shown by
an increase of from 1,132 to 1,586, or 40 per cent., in the numbers of such tests
performed by them.
Considerable numbers of samples from common carriers were sent in for
bacteriological examinations by Mr. Perry, of the Sanitary Engineering Division, Department of National Health and Welfare. As in previous years, these
tests were performed, both in the central laboratories and in certain of the
branch laboratories, without charge to the Dominion Government.
Requests for examination of private water-supplies, mostly from farmers
with wells, were referred to the Chief Sanitary Inspector; while requests for
chemical examinations were referred to the Provincial Analyst.
OTHER TYPES OF LABORATORY TESTS.
Blood agglutination tests for brucellosis (undulant fever) increased from
1,147 to 1,957, or by 70.6 per cent. A slight decline was apparent in the percentage of positive reports on specimens from Vancouver residents, which was
probably due to the diminishing amounts of raw milk consumed in the city.
However, there was no evidence that the risk of contracting brucellosis was any
less for those who insisted on taking raw milk. Blood specimens were received
from several persons, both residents and non-residents of Vancouver, with
clinical signs of acute brucellosis, who showed high titres of Brucella agglutinins; while from three such persons, all of whom were habitual raw-milk
consumers, Br. abortus was isolated by blood culture. Both central and branch
laboratories received numerous requests from farmers for examinations of milk
or blood specimens from cows suspected of Bang's disease. These requests
were particularly difficult for branch laboratories to refuse; but the official
policy of the Division has been that the diagnosis of Bang's disease in cattle is
properly a problem for veterinarians and for the Department of Agriculture,
under whose auspices the requisite laboratory facilities for such tests should be
operated.    In an area in which the incidence of active or latent Bang's disease BOARD OF HEALTH REPORT, 1944. LL 57
is as high as it is in British Columbia, detection and eradication of the disease
is most difficult. Apart from calf-hood vaccination, repeated, large-scale
" reactor " surveys are required in laboratories specially set up for this purpose.
Only confusion and embarrassment would result from the very occasional,
isolated tests which is all that the present public health laboratory services of
the community could possibly afford.
There was a slight decline in the numbers of throat and nose swabs examined for C. diphtherise, but no appreciable reductions in the numbers of positive findings from cases or carriers, most of whom were adults. The intensive
immunization of pre-school and school children with diphtheria toxoid has
proved its worth in the community, in that remarkably few secondary cases
of infection occurred in children who were contacts of these adult cases and
carriers.
The very marked reduction in the numbers of cultures for hsemolytic
staphylococci and streptococci expresses a changed method of listing results,
rather than a diminution in the number of specimens handled. While the presence or absence of each of these organisms is reported separately, such reports
are usually based on the results of a single isolation procedure. It was therefore deemed more consistent to group these organisms together for statistical
purposes; and the total of 4,316 examinations for 1944 is therefore only one-
half the total which would have been recorded in previous years.
Cultures for H. pertussis, involved in the cough-plate diagnosis of whooping-cough showed a slight decline; and since the numbers of these examinations
have never been large, it was decided to include them under the heading " Miscellaneous Cultures." Local physicians tend to give cough-plates to parents for
collection of the specimen, which militates against the usefulness of the method.
Since the isolation of these organisms is often quite troublesome, the Division,
purely from its own standpoint, would not press for more extensive use of the
cough-plate. But from the standpoint of public health at large, it is regrettable
that this method of securing a specific diagnosis of whooping-cough in early,
mild, or atypical cases, is not more widely and effectively employed.
Finally, an increased incidence of ringworm in Vancouver was reflected in
the total examinations for Tricophyton, rising by 142 per cent, from 78 in 1943
to 189 in 1944.
DISTRIBUTION OF BIOLOGICALS.
The rapidly increasing rate of distribution of toxoids, vaccines, and serums
for the prevention and control of communicable disease, which has been the
subject of comment in each Annual Report since this Division assumed the
responsibility of distributing these products, showed a tendency to level off in
1944. However, the trend is still upward, and biological products to the value
of about $25,000 were distributed during the year free of charge to physicians
and other authorized persons throughout the Province. Although a small token
payment of $2,000 from the City of Vancouver is the only, financial return
received by the Division for this service, incalculable benefits accrue, in terms
of freedom from certain specific infections, to the people of the Province from
this form of investment of public funds. The materials distributed were all
obtained, under an extremely favourable price contract, from Connaught Lab- LL 58 BRITISH COLUMBIA.
oratories, University of Toronto, whose reputation for the highest quality
products is inviolate.
The only notable change in the list of available products was the deletion
of anti-meningococcus serum. With the consent of Health Departments throughout Canada, Connaught Laboratories ceased manufacturing this product early
in 1944, in view of the success attending treatment of meningococcic meningitis (cerebrospinal fever) with sulpha drugs.
In an attempt to avoid delays in the immunization of Indians resident in
the Province the Division adopted the policy early in the year, with the approval
of the Provincial Health Officer, of supplying certain biological products gratis
to physicians operating under the Department of Indian Affairs. Again, certain minor inconsistencies which had persisted in connection with the supply
of certain biological products to a few of the larger hospitals in the Province
were eliminated; so that any product on the Division's current list may be
requisitioned for use on hospitalized patients by the authorized representative
of any recognized hospital or institution. The Division has, of course, continued
to scrutinize, and wherever necessary to modify, all requisitions for biologicals;
and there is reason to believe that very little wastage now occurs from surplus
products becoming outdated.
RED CROSS BLOOD DONOR SERVICE.
In the last Annual Report it was intimated that the Vancouver laboratories
had reached the maximum turnover of blood donations (2,500 monthly) which
could be handled. This capacity was reached just towards the end of 1943.
However, as a result of the remarkably fine spirit which animated both the paid
and volunteer workers who participated in this work during certain months of
1944, nearly 3,500 donations monthly were treated and shipped; and the total
number of donations processed in the laboratories rose from 17,338 in 1943 to
double this figure, 34,574, in 1944.
This very notable achievement was accomplished without increasing the
full-time staff of seven. In fact, one of the main difficulties was to find and
train suitably qualified persons to replace the four who unavoidably resigned.
The Red Cross Society paid the salaries of three Assistant Bacteriologists (all
University graduates), one Laboratory Assistant, and three Cleaners; and also
supplied a few volunteer helpers from the Red Cross Corps, who worked for
occasional half-days. The Provincial Government supplied, through the laboratories, the accommodation, the direction and supervision, much skilled technical
assistance, and most major items of essential equipment, such as refrigerators,
hot-air sterilizer, autoclave and centrifuges. The work remained under the
immediate supervision of Miss Malcolm, Senior Bacteriologist, who devoted
over half her time to this task, and to whom chief credit is due for adjusting the
numerous minor difficulties which arose in co-ordinating the laboratories' limited
facilities with the fluctuating attendance of donors at the Red Cross clinics.
The lengthening casualty lists following " D-day " made increased demands
for blood serum inevitable. This resulted in a raising of the Red Cross quotas
for donations across Canada, British Columbia being assigned a quota of 750
weekly during the latter half of the year. This quota was frequently exceeded.
On only two occasions were prospective donors asked to postpone their dona- BOARD OF HEALTH REPORT, 1944. LL 59
tions because the laboratories were quite unable to cope with the unexpected
demand. On the other hand, there were numerous occasions when an exceptionally poor response on the part of the public to the call notices sent out by the
clinic left the laboratories' facilities not used to capacity. In several conferences with Red Cross officials, the Director emphasized the reasons why the
laboratories were an unavoidable " bottle-neck," and it may be fitting here to
summarize the main difficulties.
The long distance between Vancouver and Toronto, where the serum is
dried and bottled in Connaught Laboratories, made serum separation essential
before shipment. Whereas centres nearer Toronto could simply ship the
" whole blood " donations in the original collecting bottles, in Vancouver it was
necessary to employ highly trained personnel, and to supply special accommodation and apparatus, in order that serum separation could be performed under
sterile conditions. Factors contributing to the bottle-neck situation were alternating and unavoidable shortages of trained personnel, of accommodation, or
of equipment; the problem of synchronizing serum centrifugation, separation,
and pooling; the co-ordination of glassware cleaning and disassembling with
sterilizing and reassembling; and the unpredictable fluctuations in the response
of the public to call notices, so that the clinic was rarely able to maintain the
fairly constant quota of donations which the laboratories desired. Additional
difficulties arose from local adoption of the policy of holding three evening
clinics, so that certain laboratory-work which had to be promptly done on these
specimens might not be completed until nearly midnight. That most of this
late night-work was done voluntarily by several members of the technical and
non-technical staff of the laboratories, after a strenuous day in the same totally
unglamorous surroundings, is most creditable to all concerned. In sum, the
contribution made by the laboratories to this vital Red Cross project, while
very little publicized, has been all-important and should be a source of great
satisfaction throughout the Division.
GENERAL COMMENTS.
At the year's end, the staff at the central laboratories totalled forty-one,
of which twenty-five had administrative and technical duties, fourteen had
clerical and cleaning duties, and two had part-time janitorial duties. Of this
total, seven were Red Cross employees, as already explained, but were regarded
in every sense as members of the laboratories' staff. This number stands in
marked contrast with the total of eleven persons of all ranks when the present
Director joined the staff in 1935, less than ten years ago. The general trend
in public health laboratory-work is undoubtedly upward, and still further staff
expansion will be necessary. The present buildings cannot accommodate more
than one or two additional workers. In fact, by all ordinary standards the
laboratories have been overcrowded for years. The many other unsatisfactory
features of the buildings have been repeatedly emphasized, and constructive
proposals for their alleviation, by providing the laboratories with new quarters
at the University, have been presented to the proper authorities. It is hoped
and believed that plans for worthy new quarters will in the near future be
approved. LL 60 BRITISH COLUMBIA.
Such a decision would permit the further broadening of responsibilities
and enlargement of staff imposed upon the Division by local circumstances.
Important laboratory-work which cannot now be attempted, such as the premarital blood tests, could then be readily undertaken. Attachment of one or
more medically qualified epidemiologists to the Division could then be conveniently contrived, so that the valuable data uncovered in the laboratories
might be applied in the field far more effectively than at present. Moreover,
it would then become feasible to review the present organization of the branch
laboratories with the possibility in mind of eliminating certain of the branches
now operating. Under present arrangements a subsidy is paid to a hospital
laboratory, or to some person attached to a hospital, and engaged primarily in
clinical laboratory-work, in return for performance of such tests relating to
the control of communicable disease as may arise from local sources. These
arrangements have served their purpose well, with credit to all concerned; but
recent advances in technique and changes in type of public laboratory-work
have increasingly handicapped the small units. It is believed that more economical and more efficient services could be rendered by consolidating the
existing six branches into three larger units, staffed by whole-time personnel
under direct supervision of the central laboratories. Those classes of specimens
which involve the more complicated procedures, which can be shipped without
deterioration, and on which reports are not urgently required, could then be
diverted to Vancouver without fear of overtaxing the central laboratories' facilities. That some such diversion of specimens has been already encouraged was
noted earlier in this report, and is made apparent by the fact that of 201,767
tests performed in the central laboratories during 1944, 40,690 or 20.2 per cent,
came from sources outside the Greater Vancouver area. Prior to the war, only
about 10 per cent, of specimens examined in Vancouver were from the Province
at large. But since 1938, while total examinations have almost doubled, those
relating to specimens received from outside Vancouver have more than trebled.
This trend is welcome evidence both of the increasing extent to which the
central laboratories are directly serving the whole Province and of the greater
utilizing of public health laboratory resources by physicians and health officials
in the smaller cities and rural areas.
Other divisional changes already initiated, but requiring proper accommodation for their full development, are the inevitable involvement of the central
laboratories in research, and the progress made in the internal organization of
the staff. In connection with research activities, it need only be pointed out
here that under present-day conditions to be proficient a public health laboratory must be animated by an investigational spirit. The Division has been
fortunate in its close relationship, through unified direction, with the Western
Division of Connaught Laboratories, and with the Department of Bacteriology
and Preventive Medicine at the University; for this association has both reinforced its resources, and sustained the impulse, for engaging in research. The
type of research has necessarily been strictly related to the work in hand, but
has repeatedly proved its importance in maintaining a high general level of
performance, a keen attitude among the technical staff, and a good reputation
among sister institutions.   The consequence has been that the branch labora- BOARD OF HEALTH REPORT, 1944. LL 61
tories and hospital laboratories throughout the Province have grown accustomed
to referring problematical specimens to the central laboratories. One particularly interesting finding during the year centred upon an investigation into
home-canned salmon and chicken, sent to Vancouver by Mr. George Darling, in
charge of the branch laboratory at Nanaimo. Three deaths occurred in a
Nanaimo family, attributed to botulism on clinical grounds. A protracted
laboratory examination of the numerous " blown " cans remaining in the household showed Clostridium botulinum, Type E, to be present in one can of chicken.
This particular type of the causal organism of botulism is very rare and had
never before been isolated from any foodstuff other than fish. Investigation of
the remaining cans is proceeding, and the whole findings will eventually be
reported in an appropriate scientific journal. Again, during the summer it was
a pleasure to perform a service for the Provincial Laboratories of Alberta, by
testing the phage-susceptibility of numerous strains of S. typhi isolated in the
course of an epidemic of typhoid fever in that Province, which was thought to
be cheese-borne. The Vancouver laboratories found all the strains isolated
from cases consuming the suspected cheese to be of the same type, thus providing an epidemiological clue whose value to the Alberta Health Department has
already been acknowledged in a recent report of the outbreak in the Canadian
Journal of Public Health.
For several years the Director had endeavoured to obtain official recognition of certain titles for the technical staff which would more satisfactorily
define their status as a group, and would also provide several categories of
different seniority and enrolments within the group. It was indeed gratifying
that these recommendations were embodied in the Civil Service Commission
Reclassification Committee's schedules of salary ranges and rates of promotion.
The title " Bacteriological Technician " has given way to that of "Assistant
Bacteriologist," the higher rank of " Bacteriologist" or " Serologist " being
accorded those carrying supervisory responsibilities. A University degree,
which must as a rule have been taken in Bacteriology, is a prerequisite for these
and senior ranks. The additional junior rank of " Laboratory Assistant " was
officially established, applicable to persons lacking the necessary academic background, but quite capable of learning the simpler laboratory procedures. Creation of this latter rank not only opens an avenue of promotion for persons of
suitable calibre who may join the staff as glassware-cleaners, but also released
the more senior technical ranks from preoccupation with the simpler repetitive
procedures.
Another factor contributing to the excellent morale of the staff during the
year was the policy of rotating the Assistant Bacteriologists between the various departments; so that, as far as circumstances permitted, they might soon
grow familiar with all aspects of the technical work. Although there is, of
course, no reason why an interchange of duties between the more senior members should not occasionally be arranged, in the period under review an attempt
was made to assign fairly definite responsibilities to each such person. As the
staff enlarges still further, a broader recognition of the principle of delegated
responsibility will become necessary. Meanwhile, each Bacteriologist or Serologist has working under her one or more Assistant Bacteriologists and one or
more Laboratory Assistants. LL 62 BRITISH COLUMBIA.
At the year end the central laboratories' staff comprised—apart from the
Director (part time)—one Assistant Director, one Senior Bacteriologist, one
Serologist, three Bacteriologists, nine Assistant Bacteriologists, five Laboratory
Assistants, two Media-makers, two Clerks, three Stenographers, four Cleaners,
and two part-time Janitors. During the year, three left from the technical
staff, including Miss J. McDiarmid, who was granted leave of absence to join
the R.C.A.M.C. as Bacteriologist after having given excellent service for nine
years; Miss E. Hooley, who left to be married; and Miss F. Foehlmer, whose
retirement was unfortunately necessitated by illness. There were also two
resignations from the clerical staff, Miss N. Lumb leaving to be married and
Miss I. Robertson to take another appointment. In their place, and as additions, the following were welcomed: Mrs. Hutchison (formerly Miss M. Gardiner) and Mrs. Sully (formerly Miss F. Jamieson) returned as Assistant
Bacteriologists; while Mrs. P. Y. Meier and Misses J. Thicke, N. Scott, and
M. Whimster were newcomers in the same capacity. Two new Laboratory
Assistants, Misses M. Petavel and R. L. Rempel; three Stenographers, Misses
D. Todd, J. Hall, and L. Froese; and two Cleaners, Mrs. D. Trezona and Miss
N. Taylor, also joined the staff in Vancouver during the year.
The Division suffered a sad loss in the untimely death of Dr. Gordon A.
McCurdy, Director of Pathology in the Royal Jubilee Hospital, who gave loyal
and very competent supervision to the Victoria branch laboratory for the past
seven years. Dr. Jan. Hoogstraten has ably carried on as Acting-Director in
Dr. McCurdy's place. Numerous lesser difficulties due to staff shortages have
beset all the branch laboratories during the year.
The Director addressed numerous medical and lay audiences during the
year and published three papers in scientific journals. The central laboratories
were visited by numerous distinguished persons, including representatives of
the National Research Councils of Great Britain and of Canada and the Directors of the Provincial Laboratories of Alberta and Saskatchewan.
Finally, the Director wishes to record his warm appreciation of the work
done by all in the Division under exceptionally trying circumstances. Miss
D. Kerr, Assistant Director, has displayed her usual resourcefulness and fine
spirit of devotion to duty. Miss M. Malcolm, Senior Bacteriologist, deserves
personal credit for much of the excellent record in connection with the Red
Cross blood donor work. Credit for splendid work in their various fields
should also be given to Miss E. M. Allan, Serologist in charge of serodiagnostic
tests for syphilis; Miss V. Hudson, Bacteriologist in charge of milk and water
analyses and throat cultures; Mrs. J. Hardy, Bacteriologist in charge of stool
cultures and blood agglutination tests for enteric infections; Miss H. Chang,
Bacteriologist in charge of tuberculosis cultures and animal inoculations; Mrs.
M. B. Allen, Clerk in charge of the office; and Miss E. Thompson, Clerk in
charge of supplies. It is believed that the Division deservedly feels the satisfaction that comes from the knowledge of important tasks properly and cheerfully
performed. BOARD OF HEALTH REPORT, 1944.
LL 63
Table I.—Statistical Report on Examinations done during the Year 1944.
Examination.
Out of Town.
City.
Total in 1944.     Total in 1943.
Animal inoculations 	
Blood agglutination—
Typhoid-paratyphoid-dysentery group .
Brucellosis    ,	
Miscellaneous     	
Cultures-—
M. tuberculosis  	
Typhoid-paratyphoid-dysentery group.
H. pertussis  	
C. diphtherise..
Ha_molytic staphylococci and streptococci.
Gonococcus    	
Miscellaneous  .-. 	
Direct microscopic examination for—•
Gonococcus    	
M. tuberculosis (sputum). 	
M. tuberculosis (miscellaneous)...
Treponema pallidum (dark-field).
Vincent's spirillum 	
Tricophyton (ringworm)	
Helminths (parasites).
Serological tests for syphilis—
Blood-
Presumptive Kahn—
Standard Kahn	
Complement fixation _
Cerebrospinal fluid—
Kahn   _ 	
Complement fixation..
Cerebrospinal fluid—
Routine _ _ 	
Colloidal reaction 	
Milk-
Bacterial counts  _
Coli-aerogenes 	
Phosphatase tests	
Water-
Total bacterial counts	
Coli-aarogenes	
Special examinations _ _
Miscellaneous tests 	
Totals 	
80
1,263
317
9
188
957
*
1,041
1,027
122
186
4,167
1,548
178
38
25
3
29
16,900
4,733
3,877
408
444
357
408
248
248
122
2
1,627
138
394
6,547
1,640
9
575
1,717
*
7,921
3,289
8,423
322
24,572
4,868
307
355
194
186
66
65,836
12,577
10,767
1,437
1,523
1,007
1,447
1,218
1,218
659
590
1,223
190
474
7,810
1,957
18
763
2,674
*
8,962
4,316
8,545
508
28,739
6,416
485
393
219
189
95
82,736
17,310
14,644
1,845
1,967
1,364
1,855
1,466
1,466
781
592
2,850
328
437
4,503
1,147
59
561
1,977
44
9,430
8,808
5,713
510
19,852
5,867
428
242
264
78
70
85,888
16,621
11,730
1,805
1,296
1,063
1,720
1,272
1,272
586
697
2,626
121
488
40,690
161,077
201,767
187,175
* Included under " Miscellaneous Cultures." LL 64
BRITISH COLUMBIA.
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Eh BOARD OF HEALTH REPORT, 1944. LL 65
REPORT OF THE DIVISION OF VENEREAL DISEASE
CONTROL, 1944.
W. C. Mooney, Major, R.C.A.M.C., Acting-Director.
INTRODUCTION.
The keynote of the activities of the Division of Venereal Disease Control for
the year 1944 can be summed up in a word " change." Many changes in personnel have taken place, some variation in policy has occurred and there appears
to be a significant alteration in the trend of reported new diseases. Some of
these altered states appear to be of a fortunate nature while others have a not
so happy outlook.
During the year there have been two changes of Acting-Director and a loss
of an Educational Supervisor. There have been gains and losses in the medical
staff and many new faces added to the substaff. The addition to, and subtraction from, the staff has been a mixture of vinegar and honey, with the
result that the Division has become strengthened in some of its parts while
suffering irreplaceable losses in others.
The total venereal disease notifications for eleven months have increased
over the previous year. An analysis and explanation of this increase must
await the publishing of the Division's detailed annual report, when the full
breakdown of pertinent statistical data is available.
In the middle of the year a survey of the record and filing system of central
office was made and recommendations submitted to increase their efficiency.
These recommendations were adopted and the results have been to date very
gratifying. To enable these suggestions to be carried out most expeditiously
a branch secretary with previous administrative experience was transferred to
this Division from the Division of Vital Statistics.
The last quarter of the year significantly began with a plan to reorganize
the Division into four sections for what was considered the most effective
manner of co-ordinating the various components of the present organization.
The four sections which comprise the new arrangement are: (1) Section of
Information and Public Relations; (2) Section of Epidemiology; (3) Section
of Diagnostic and Treatment Service; (4) Section of Welfare and Rehabilitation. It is anticipated that when personnel are available that each of these
sections will have a well-trained full-time individual in charge, responsible to
the Director for the section activities.
To the Federal Division of Venereal Disease Control, under first the Department of Pensions and National Health and later the Department of National
Health and Welfare, must go sincere thanks for their contribution to the
programme, of grants-in-aid, expert advice on all aspects of venereal disease
control, and, more than these, the assistance received in correlating the British
Columbia programme with those of other Provinces. The Federal-Provincial
Conference on Venereal Disease Control, sponsored by the Federal Division of
Venereal Disease Control, which was attended by the Acting-Director and
held in Ottawa in August of this year, and the suggestion which resulted in the
Acting-Director attending the Conference of Post-war Venereal Disease Control
in St. Louis in November, 1944, are examples of the leadership which the LL 66 BRITISH COLUMBIA.
Federal Division is showing in this most important aspect of venereal disease
control.
INFORMATION AND PUBLIC RELATIONS.
Greater stress is being laid to-day on the role of education in the fight to
eradicate venereal disease than at any time in the history of control programmes. The doctors, nurses, and social workers on the staff of the Division,
as well as lay-groups, have assisted in furthering the venereal disease educational programme. Because of the appointment of the Educational Supervisor
of this Division to a similar position at Ottawa on a Federal basis, the Provincial
programme of necessity had to be curtailed to more or less local efforts.
Nursing education included lectures to undergraduate students of the
Vancouver General and St. Paul's Hospital, Vancouver; Royal Columbian
Hospital, New Westminster; and Royal Jubilee and St. Joseph's Hospitals at
Victoria. The undergraduates from the Vancouver General Hospital received
practical instruction and training in venereal disease therapy and epidemiology.
Public health students from the University of British Columbia were trained in
venereal disease education and epidemiology.
The Vancouver High School educational programme was arranged with the
Superintendent of Schools and the Senior Medical Officer of the Metropolitan
Health Committee. In all, lectures were given to thirty schools, reaching 1,905
girls and 1,000 boys.
The films " With These Weapons " and " Nine Cents Per Capita " were
shown and 94,374 pieces of literature distributed. Fifteen copies of " Shadow
on the Land " were placed in school libraries.
The Junior Board of Trade, wishing to pursue further their very successful Industrial Health Week campaign of 1943, offered to provide speakers and
projectionists who would go out and give a twenty-minute talk and show the
films " With These Weapons " and " Nine Cents Per Capita " to any organization desiring this service. Such a venture had never before been embarked on
by this Division but obviously it had advantages. In the first place, it made
available a large group of instructed and enthusiastic speakers; secondly, it
would retain for the Division the interest and effort of a large and influential
group of citizens; and thirdly, the speakers were required to equip themselves
with correct factual information and became nuclei of knowledge on the subject
in their community and among their business associates. A specimen lecture
was prepared and the programme planned. Fifty-six lectures and film showings were given and 40,371 pieces of literature were distributed.
The Women's Protective Committee of the Welfare Council of Greater Vancouver is composed of representatives from various women's clubs throughout
the city. Quoting from the chairman's remarks, " the purpose of this committee will be to serve as a medium through which they can unite in common
action to strengthen the work they are doing or will do themselves, clear plans
for the strategy of the campaign on the local front and be of greater mutual help
to one another in our common cause." The Division of Venereal Disease Control was asked to prepare study outlines and provide speakers for this group so
that they would become conversant with the problems involved in venereal
disease control and in turn be able to present them to their own organizations.
The outlines were prepared and seven very interesting round-table discussions BOARD OF HEALTH REPORT, 1944. LL 67
were held. All members discussed the problem with their own organizations
and some arranged for the distribution of literature.
Three window displays depicting Canada's four sector attack on venereal
disease were completed in February. It was decided that for the first half of
the year they would remain in Vancouver. Cunningham Drug Stores kindly
consented to carry the display. The large window display " That Baby You
Love " was shown at the British Columbia Registered Nurses' Association convention and again exhibited at the Canadian Nurses' Association convention at
Winnipeg on June 26th, 1944. Exhibits of venereal disease educational
materials were also made at the Parent-Teachers Association convention.
Excellent relationships have been maintained with the churches. Films
were shown to the Presbytery of the Baptist Church and also at their annual
convention. An invitation to speak at the Temperance convention at St. Giles
Church was extended and accepted. A series of lectures was arranged in New
Westminster and the Fraser Valley under the auspices of the United Church.
In all instances the churches came to us requesting our services.
In November a special luncheon meeting for representatives of the various
women's organizations in Vancouver, North Vancouver, West Vancouver, and
New Westminster was held in the Hotel Georgia to hear an address by Captain
W. G. Allison, Venereal Disease Control Officer for the C.W.A.C, on the necessity for enforcing legislation with regard to premarital and prenatal blood
testing. The address was followed by a film " Fight Syphilis." The pamphlets
" Victory Over Disease " and " Isn't She Lovely " were distributed.
Also in November, continuing into December, a short version of " Fight
Syphilis " was shown as part of the current film being presented by the National
Film Board on their Industrial Circuit covering approximately sixty of the
larger industrial plants in the Greater Vancouver and New Westminster area.
Over 10,000 copies of the pamphlet " Victory Over Disease " were distributed
following the film. This programme has been very well accepted and requests
from industrial firms for further showing of films pertaining to venereal disease
have been received.
Under the auspices of the Federal Division of Venereal Disease Control
a series of three radio broadcasts relative to venereal disease education were
heard over the national network in November. A short announcement regarding the availability of literature, free examinations and treatment for venereal
disease for this Province was made.
Lectures on venereal disease with special reference to the participation of
the Provincial Police in suppressing prostitution and controlling facilitation
were given to the British Columbia Police School in Victoria during December.
Through the co-operation of the full-time Medical Health Officers, and Field
Epidemiologists, educational programmes were sponsored in some of the rural
areas. Dr. R. G. Knipe, Prince Rupert, organized a programme of lectures and
films for the physicians and local police. Dr. J. M. Hershey and Miss Ann
Murray, Central Vancouver Island Health Unit, Nanaimo, have carried on
a sustained programme of physician education. A special lecture was given
and films were shown to the physicians and nurses of the Nanaimo Hospital.
Suitable literature was provided. LL 68 BRITISH COLUMBIA.
An industrial educational programme was arranged at Kimberley by Miss
Janet Kennedy, newly appointed Field Epidemiologist for the Kootenay area.
Films and literature were provided from the Division for this programme.
We have within the last few months received from Ottawa through a
Federal grant considerable literature, two films " Fight Syphilis " and " Subject
for Discussion," and a new Bell and Howell filmo-sound projector. These
additions to the educational facilities are a real asset and very useful in meeting
the many requests for lectures, literature, and films.
DIAGNOSTIC AND TREATMENT SERVICE.
Vancouver Clinic.—In January, 1944, a survey was made of the Vancouver
clinic and it was recommended that an appointment system for patients be
instituted and that all case-holding for diagnosed cases which represents 65 per
cent, of the case-load be carried by the nursing staff. The appointment system
was set up and went into effect February 1st. Nurses without previous social
work were assigned to a social worker for a period of training, commencing
February 7th. Following the period of instruction the case-holding of diagnosed cases was equitably distributed among the nurses and carried on under
the supervision of the Supervisor of Epidemiology until the Division was
reorganized this autumn and the nursing section divided into clinic nurses and
epidemiologists. At present two of the clinic nurses are carrying some of
the case-holding.
To facilitate clinic service, routine diagnostic procedures are now being
done under a blanket order from the Director and patients do not see a doctor
until their diagnostic procedures have been completed. This measure has
proven to be a great time-saver, and has left the physicians free to do the necessary physical examinations, lumbar punctures, and consultations.
Changes in the record system were indicated, so specific recommendations
were made in February; the recommendations were accepted and went into
effect on June 1st; i.e., on admittance patients are given a medical card only,
they are assigned a number and given a chart only if a diagnosis of syphilis
or gonorrhoea is made.
Personnel changes have been many among the physicians, nursing staff,
and laboratory assistants, and at times it has been most difficult to maintain
a high standard of clinical efficiency. In spite of this there has been an increase
in work done over 1943.
Oakalla clinic, which is staffed by members of the Vancouver clinic, has
shown an increase in work particularly on the women's side. New Westminster
clinic, too, has shown an increase in work and this increase has entailed the
expenditure of additional medical and nursing time which is taken from the
service which supplies the Vancouver clinic.
Because of the increased work and the Public Health Nurses spending more
time in epidemiology, it has been necessary to engage a part-time nurse for four
half-days per week. A ward assistant has been engaged twenty-two hours
per week who relieves the nurses of cleaning, sharpens the intravenous and
intramuscular needles, assists in care of equipment, and counting and packaging drugs. BOARD OF HEALTH REPORT, 1944. LL 69
In collaboration and co-operation with the epidemiology section, public
health students' education has been effectively carried out. From February 22nd
to May 20th seventeen of these nurses received instruction and training in treatment and control, and between September and December, 1944, eight more
received similar training. Lectures and films on the general aspects of venereal
disease control were given in the spring and again in the autumn to student
nurses at the Vancouver General Hospital and Royal Columbian Hospital.
During the year eighty-five student nurses from the Vancouver General Hospital
have spent a two weeks' training period at the Vancouver clinic. They have
received from the nurse-in-charge three or four lectures on the general aspects
of venereal disease, medical aspects, epidemiology, and control measures.
In addition, this Division participated in industrial surveys. Nurses from
the Vancouver clinic assisted by blood testing 1,200 employees of the Canadian
Pacific Airlines, and to date have taken 500 Kahns at the Imperial Canneries,
Steveston.
Other permanent clinics now operating outside of the Greater Vancouver
and New Westminster area are in Victoria, Prince Rupert, and Trail. Their
problems have been similar, although of a lesser degree than the Vancouver
clinic. In spite of the increased work, changes in physicians, nurses and
laboratory technicians, it can be said that patients are still receiving adequate,
well-administered therapy, and the essentials of medical and epidemiological
care.
EPIDEMIOLOGY—WELFARE AND REHABILITATION.
It is recognized that in any venereal disease control programme the development and expansion of epidemiological procedures is very essential. The failure
to control sources and contacts of infection favours the spread of venereal
disease. Therefore, emphasis is placed on the importance of interviewing every
person diagnosed as having a venereal disease in order to obtain information
regarding all persons who may have been intimately exposed to the patient.
Because of the moral issues involved and the indifference and reticence of many
to divulge such information a great deal of tact and diplomacy is required.
Sometimes frequent interviews are necessary before satisfactory details are
obtained. The patient is assured that all information will be regarded as
strictly confidential. Obtaining adequate information is the first step in finding
the contact. Up to November 30th of this year, 1,730 women and 276 men in
the Vancouver area alone have been reported to our central office as contacts
to venereal disease. Of this number, 920 women and 163 men have been located
and examined. As investigations have not yet been completed on many contacts
these figures are incomplete. In addition, the armed forces, private physicians,
clinic patients, other Provinces, and the United States report contacts who are
residing in other cities and in the rural areas. These are followed up by our
Field Epidemiologists and the Medical Health Officers. Persons residing in
other Provinces or the States are referred to the health department concerned.
There has been a very close liaison with the venereal disease control officers
of the armed forces in locating and bringing in for investigation civilian contacts to venereal disease. Monthly meetings with the venereal disease control
officers, a representative of the Metropolitan Health Committee of Vancouver, LL 70 BRITISH COLUMBIA.
the Acting-Director of the Division of Venereal Disease Control, and the Supervisor of the Epidemiology staff of the Division have been held to discuss and
solve mutual problems pertaining to case-finding and facilitation.
During the year three Epidemiologists have been trained in the Division
and placed in the field, one on Vancouver Island, one in the Kootenay District,
and the third in the Fraser Valley. Two of these Epidemiologists are Public
Health Nurses and the other is a graduate nurse. Their responsibilities are
many and varied. Apart from the epidemiological investigations which they
carry out they play a very important part in establishing a liaison between the
Division and the private physicians in rural areas, interpreting to them the
venereal disease control programme and explaining how the physician may use
the facilities of the Division to his advantage. They co-operate with the Indian
Agents in locating contacts and lapsed cases. The Field Epidemiologist also
carries on a teaching programme for all Public Health Nurses in rural areas
with the idea of preparing them to assume more responsibility for venereal
disease work. Plans for the extension of our epidemiological service include
at least one more Field Epidemiologist.
Since 1938 all epidemiology for the Vancouver clinic has been done by
a staff of medical social workers under the supervision of a physician. As the
programme has developed and expanded, it is realized that this work should
now be the responsibility of Public Health Nurses with special training in epidemiology and that medical social workers should be using their special training
in developing a welfare and rehabilitation programme.
Accordingly, the Public Health Nurses of the nursing staff as their experience in epidemiology investigations is expanding are gradually assuming more
responsibilities in this field. It has been planned that eventually the epidemiology will be done entirely by Public Health Nurses.
Increased use has been made of the provisions of the " Venereal Diseases
Suppression Act" whereby the Provincial Health Officer may order persons
refusing examination or treatment to be committed to Oakalla. From January 1st to December 1st, 1944, there were twenty-two women committed to
Oakalla under this Act. Orders for the detention of inmates examined and
requiring treatment for venereal disease were obtained for thirty-six women
and three men. Apart from the venereal disease aspect, it is felt that this
action is of decided value in that it demonstrates that the Division can and will
take definite action to enforce the provisions of the Act with regard to examinations and treatment.
Certain recommended techniques have been adopted against facilitation,
the means whereby the healthy individual meets the infected individual. There
are certain persons and premises which contribute in this way to the spread of
venereal disease either wittingly or unwittingly. For the past two years
emphasis has been placed on the importance of suppressing such activities.
Persons involved in this way may be certain taxicab drivers, pimps, procurers,
brothel-keepers, owners of establishments such as certain dance-halls, cafes,
cabarets, rooming-houses, hotels, and beer-parlours. Certain dance-halls, beer-
parlours, and cafes are frequently named as places where pick-ups are made
which lead to the acquisition of venereal disease. From January 1st, 1944, to
October 1st, 1944, for the Province dance-halls were reported 345 times, beer- BOARD OF HEALTH REPORT, 1944. LL 71
parlours 145 times, and cafes 254 times. These figures represent only those
reports received in the central office of the Division. It is realized that many
persons acquiring venereal disease in this way do not come to the attention of
the clinics of this Division. These figures, therefore, can only serve to indicate
certain trends and to stress the importance of continued supervision of these
places. In this regard we have been assured of the whole-hearted support and
co-operation of dance-hall managers, the Hotels Association, and cafe proprietors.
PROBLEMS OF 1945 AND SUGGESTED SOLUTION.
As the war in Europe reaches a climax, British Columbia as a part of
Canada is faced with a possibility which has inevitably occurred after previous
world conflicts, namely, a post-war pandemic of venereal disease. These facts
are evident: That in war-time there are certain features of patriotism, morale,
self-respect, and other indefinable factors that tend to prevent many individuals
from exposing themselves to possible venereal infection. The immediate postwar period is followed by a let-down of these forces with a resultant increase in
promiscuity, and in its wake a higher number of venereal infections. To this
probability we must face and to combat it the programme for the coming year
has been planned.
Rapid Treatment Centre.—The purpose of this centre would be to provide
accommodation for promiscuous girls who would be confined preferably on a
voluntary basis until cured of their infection, also for non-co-operative women
patients who would be confined under the compulsory provisions of the
" Venereal Diseases Suppression Act " but who are of an age or class for whom
incarceration in Oakalla Prison Farm would be most undesirable. Tentative
plans have been made for acquiring suitable accommodation for fifty women
near the City of Vancouver. The services of the medical staff of the Vancouver
clinic would then be available. Although this institution would be primarily
one for treatment, the present plan provides for a trained social worker to be
attached to the staff who would be responsible for a definite rehabilitation programme so that these girls could be redirected into useful and remunerative
jobs. A definite follow-up of all persons after discharge would be arranged
so that the usefulness of the centre could be evaluated from both a treatment
and a rehabilitation point of view.
Night Clinic.—It is proposed to increase the Vancouver clinic services in
the evening, and if at all possible to arrange for these to be held in the downtown district. At present one evening clinic per week is held and the attendance is approximately 200 men and women. The nursing and medical staff are
seriously overtaxed and the present clinic facilities will not allow for more
expansion. To have the night clinics in the district which is most accessible to
the majority of the patients would undoubtedly contribute towards increased
regular attendance.
Girls' Industrial School and Juvenile Detention Home.—Both of these institutions are situated in Vancouver, the former being operated by the Provincial
Government and the latter by Vancouver City. At present any inmates of the
Juvenile Detention Home requiring treatment are brought to the Vancouver
clinic, but it is felt arrangements should be made to provide for this treatment LL 72 BRITISH COLUMBIA.
at the institution itself because of the frequent escapes made from the clinic
and the difficulties in examining young girls in a busy clinic. Also it is felt
most undesirable to have them mingling with the regular clinic patients.
The inmates of the Girls' Industrial School are brought in for special
laboratory tests such as cultures for gonorrhoea. Otherwise their examinations
and treatments are supervised by the medical officer of the school. It would be
a distinct advantage for this Division to have the full responsibility for the
examination and treatment for venereal disease of all girls admitted to the
Girls' Industrial School. It is therefore planned to survey the facilities already
available at the Juvenile Detention Home and the Girls' Industrial School for
clinic service so that the necessary equipment required may be obtained as soon
as possible.
Penicillin.—An ample quota of penicillin has been assigned to the Division
by the Controller of Chemicals. This new and valuable chemotherapeutic agent
will not be available, however, until January, 1945. The drug will be used in
the first instance for the treatment of patients with sulphonamide resistant
gonorrhoea and selected cases of syphilis. It is hoped that at a later date when
sufficient penicillin is available we may be able to use it for treatment of all
forms of gonorrhoea. Because of its specificity for syphilis and gonorrhoea, its
rapid effective action, and freedom from serious toxic reactions, this agent may
well represent the greatest single forward step in the treatment of the venereal
diseases in the history of medicine.
Much of any success attained in the year 1944 has been due to a spirit of
co-operation which has existed in all our relationships. Particular mention
must be made of the invaluable aid received from the Provincial Police, for
without their sympathetic assistance the Division's advances upon a legal front
would have been seriously curtailed. The liaison meetings held in the Acting-
Director's office with the Command Venereal Disease Control Officers of the
three services and a representative of the Metropolitan Health Committee has
created an even better understanding of the problems facing the armed forces
and the civilian health representatives, and has resulted in definite concerted
action, particularly in the control of facilitation. To the staff, for their loyal
support and excellent quality of work, goes the sincere thanks of the Acting-
Director. A major portion of the credit for the excellent showing of the
Division must be given to Doctor Dorothy E. Saxton, Acting Assistant Director,
who carried the responsibility of this important work under the most adverse
conditions, and thus achieved an enviable record in a short time in the field of
venereal disease control. With the same spirit evinced on the part of the organizations and individuals associated with the Division and its activities, the challenge of the forthcoming year is viewed with interest and anticipation.
ANNUAL REPORT OF THE DIVISION OF TUBERCULOSIS
CONTROL.
W. H. Hatfield, M.D., Director.
The Division of Tuberculosis Control is able to report considerable progress
during the year 1944 in the face of the most challenging situations that have
been confronted since the inception of the Division. BOARD OF HEALTH REPORT, 1944. LL 73
The population of the Province, particularly in the Lower Mainland area,
continues to increase, creating further housing problems and overcrowding.
A considerable number of new cases of tuberculosis have come to British Columbia from other Provinces. Of the new cases coming to the attention of the
Division during 1944, one out of every five cases had come to this Province
since January, 1942.
The armed forces continue to X-ray all recruits and any cases found are
referred to the Division of Tuberculosis Control. Healthy recruits are admitted
to the armed forces and removed from the community, thus there is some
dilution of the general health standard.
During the past year we have begun to feel the increase of tuberculosis
amongst the armed forces. The healthy recruits who have mixed with populations with high tuberculosis rates in England, Europe, and the Mediterranean,
where tuberculosis control has been difficult or impossible, are beginning to
show an increase in their tuberculosis rate and are being returned to us for
treatment. For example, 15 per cent, of all the admissions to our tuberculosis
institutions during 1944 were referred to us by the Department of Veterans'
Affairs.
The staff situation throughout the Division has shown no improvement
during the year, but by rearrangement of work and intensification of effort
where it was most needed the challenge of meeting an increasingly difficult
situation has been well met and all facilities have been used to the maximum.
The most serious situation that has confronted the Division is the lack of
bed facilities. It is only by the very close correlation of work that exists
between the Division and the local health services, the work of the visiting
Public Health Nurse and the members of the Social Assistance Branch, together
with centralized admission of patients, that the number of cases requiring care
have received the attention that they have, either as in-patients or out-patients.
The basis of the tuberculosis control programme has been case-finding and
every effort has been made with the equipment and staff available to uncover
as many cases of tuberculosis as possible. Mass surveys have been carried out
during 1944, one mobile bus unit being used since the beginning of the year and
a second unit starting operation on November 15th. In addition to this survey-
work all clinics of the Division, stationary and travelling, are carrying out
surveys. With these facilities over 100,000 people have passed through our
clinics during 1944.
Due to these efforts more new cases of tuberculosis have been reported.
During 1943 there were 1,550 new cases of tuberculosis whereas during 1944
there were 2,317. Of all the new cases either reported to the Division or found
by our clinics during 1944 the clinics of the Division diagnosed 1,364. If the
Indians, who come under the Indian Affairs Branch of the Dominion Government, are excluded the percentage is 79.1.
The encouraging feature of these surveys is that tuberculosis is being
diagnosed very much earlier. Of the total number of new pulmonary cases in
the Province 1,005 or 48.8 per cent, were minimal. It is to be noted, however,
that of this 744 or 74 per cent, were diagnosed by the clinics of the Division.
This fact is further brought out when we note that of the total far-advanced
cases only 109 or 27.7 per cent, were found by the clinics.    This bringing to LL 74
BRITISH COLUMBIA.
light of early cases of tuberculosis shortens the period of treatment and makes
it possible to start treatment either before or very soon after the case becomes
infectious, thus eliminating much of the spread of infection throughout the
community. In addition, those cases that are apparently arrested or apparently cured can be kept under observation so that breakdowns are either prevented or discovered at the earliest possible date.
NEW CASES.
Pulmonary and Non-pulmonary.
1940.
1941.
1942.
1943.
1944.
Total	
1,568
295
156
1,117
1,342
270
127
945
1,432
327
108
1,016
1,688
419
106
1,163
2,317
580
Orientals  	
Whites	
156
1,585
Pulmonary.
Total pulmonary—
Total population....
Indian	
Other than Indian .
Minimal—
Total population ...
Indian	
Other than Indian .
Moderately advanced-
Total population —
Indian	
Other than Indian _
Far advanced—
Total population._
Indian	
Other than Indian .
Primary—
Total population—
Indian — 	
Other than Indian .
Type not stated—
Total population	
Indian	
Other than Indian .
1,447
280
1,167
489 (34%)
48 (17%)
441 (38%)
319 (22%)
34 (12%)
285 (25%)
427 (29%)
159 (57%)
268 (23%)
52 (4%)
16 (6%)
36 (3%)
160 (11%)
23 (8%)
137 (11%)
1,193
221
972
454 (38%)
25 (12%)
429 (44%)
310 (26%)
28 (13%)
282 (29%)
357 (30%)
151 (68%)
206 (22%)
56
14
42
16
3
13
(5%)
(6%)
(4%)
(1%)
(1%)
(1%)
1,157
254
903
400 (35%)
61 (24%)
339 (37%)
317 (27%)
57 (22%)
260 (29%)
378 (33%)
118 (47%)
260 (29%)
33 (3%)
6 (2%)
27 (3%)
29 (2%)
12 (5%)
17 (2%)
1,484
345
1,139
593 (40%)
68 (20%)
525 (46%)
357 (24%)
56 (16%)
301 (26%)
389 (26%)
142 (41%)
247 (22%)
122 (8%)
72 (21%)
50 (4%)
23 (2%)
7 (2%)
16 (2%)
2,058
498
1,560
1,005 (49%)
108 (22%)
897 (58%)
506 (25%)
94 (19%)
412 (26%)
393 (19%)
203 (40%)
190 (12%)
150
93
57
(7%)
(19%)
(4%)
At the end of 1944 there were 12,004 known cases of tuberculosis in the
Province, giving a ratio of known cases to deaths of 22.6:1. When Indians are
excluded the number of known cases totals 9,890, giving a ratio of known cases
to deaths of 27.2:1.
The follow-up of these cases, the referral of contacts to the clinics, health
teaching in the home, is the responsibility of the local health services and has
been carried out very efficiently by these services. The development of full-
time Health Units has materially helped in the tuberculosis control programme
throughout the Province. The Division is pleased to report complete cooperation with every Health Unit.
Despite the conditions developing in the Province which are conducive to
the spread of tuberculosis we are pleased to be able to report a very definite
reduction in the death-rate during 1944.    It is our hope that our control pro- BOARD OF HEALTH REPORT, 1944.
LL 75
gramme is reflecting its activities through this lower death-rate and that we
shall continue to see a decrease. However, it should be remembered that one
year is not sufficient to show trends and that it is only after due time that
accurate conclusions can be drawn.
TUBERCULOSIS MORTALITY.
Total Population.
Indians.
Other than Indians.
Deaths.
Rate per
100.000
Population.
Deaths.
Rate per
100,000
Population.
Deaths.
Rate per
100.000
Population.
1940
598
531
548
613
532
76.6
65.6
66.4
68.1
59.1
199
168
162
208
168
739.2
638.2
650.3
777.6
624.1
399
363
386
405
364
53.0
1941- „   	
46.4
1942    	
1943       	
48.2
46.4
1944*  -.- - '-
41.7
* Preliminary only.
INSTITUTIONS.
All institutions of the Division have continued to work at full capacity.
The total bed capacity of 639 has remained the same. The number of beds
available has been quite inadequate to meet the tuberculosis problem in this
Province and there has remained a constant waiting-list for admission. In
spite of this waiting-list British Columbia has the shortest time between application for admission and admission of any Province in Canada. This is due
to the fact that cases are carefully selected for admission and that as soon as
possible patients are returned to their homes where they receive supervision
from local health services and follow-up treatment through the clinics of the
Division.
The new increased social allowance for tuberculosis patients has also facilitated caring for patients in the home, allowing some cases to remain at home
that would otherwise have had to be admitted and allowing shorter institutional
stay for certain groups.
Applications were received during the year for 549 men and 334 women.
There were 800 patients admitted during 1944 and 15 per cent, of these were
admitted through the Department of Veterans' Affairs.
During the year a careful analysis was made of all the bed facilities in the
Province, indicating the present need to modernize the existing institutions and
detailing the future planning for existing institutions.
Because of the urgent necessity of providing extra beds it was decided to
build a temporary addition to the Vancouver Unit. To this end an agreement
was reached with the Vancouver General Hospital whereby this building will be
erected on their property and they will provide certain services as they do for
the present Vancouver Unit. It has further been agreed to remove this building
when a new permanent sanatorium is ready for occupancy. Plans for this temporary addition to house seventy patients were completed and the contract let.
It is hoped that these extra facilities will be available for patients by May
of 1945.
An analysis of the bed needs for tuberculosis in British Columbia has been
made and the Provincial Secretary has announced that a new sanatorium with LL 76 BRITISH COLUMBIA.
a first unit of 250 beds will be constructed for patients (in the Lower Mainland
area). At the year end a definite site has not been selected, but many possibilities have been reviewed and with a selection of a site, which should be done
early in the new year, plans for construction will be developed.
One of the main problems confronting the institutions has been the maintenance of an adequate staff. It has been difficult to obtain the required numbers and with changing staff and untrained personnel it has been difficult to
maintain our past standards.
All institutions continue to hold weekly medical conferences at which all
new admissions and all cases for discharge are carefully reviewed and changes
in treatment of each individual patient are thoroughly discussed. With a
shortage of trained personnel it has been found difficult to keep up with technical treatments required, such as chest surgery, pneumolysis, bronchoscopy,
etc. Despite the difficulties encountered we feel that we have been able to
maintain a high standard of medical treatment.
The Division would again like to point out the necessity of reaching a
decision regarding the continued use of a portion of the isolation hospital in
Vancouver and the necessity of developing a surgical centre within the Vancouver Unit.
A completely integrated programme for all institutions has been outlined
in a special report.
CLINICS.
The Division now operates four types of clinics: stationary survey clinics,
mobile survey clinics, stationary diagnostic clinics, and travelling consulting
clinics. In addition to this the Division offers a consultation service throughout
the Province for the rural areas. Any physician may have a patient X-rayed
between visits of a travelling clinic and forward the film with a completed consultation form to one of the units of the Division for consultive advice.
A big expansion in the Division's case-finding programme was carried out
during the year. A new mobile bus X-ray unit, using 4- by 5-inch films, started
in the Vancouver area, carrying the X-ray directly to industries. At the end
of the year a second bus was put into operation and started work in the Kootenay district, beginning at Trail. These units are able to X-ray approximately
300 people per day. During the year there were 55,868 cases X-rayed and 1.4
per cent, of these were referred to a diagnostic clinic for further study. Of this
group 45 per cent, were diagnosed as having tuberculosis and 29 per cent, of the
tuberculous were considered to require active treatment. A very high proportion of early minimal cases has been found through these mass X-ray surveys.
The Division's aim is to some day X-ray all people in the Province annually. By
this means every case of tuberculosis will be known and the cases developing
will be found early, institutional stay will be shortened, the infectious cases will
diminish and tuberculosis will then be truly under control.
In addition to the survey-work done by the two mobile bus units, cases are
surveyed through the stationary clinics and a certain amount of survey-work is
being done by the travelling clinics. The number of cases surveyed in this way
amounted to 29,317. This survey-work increases the work of the diagnostic
clinics.    The diagnostic stationary and consulting travelling clinics examined BOARD OF HEALTH REPORT, 1944. LL 77
24,095 during the year. Thus there was a total number of examinations
throughout various types of clinics of the Division of 109,280.
One new stationary clinic was planned during the year. The New Westminster Gyro Club offered to build a clinic to house the Tuberculosis Division
and the Red Cross Society in the New Westminster area. As the work through
New Westminster and district has materially increased the Department accepted
the generous offer of the Gyro Club and further the offer of the British Columbia
Tuberculosis Society to provide the basic equipment for this clinic. Construction was started towards the end of the year and the clinic should be open for
operation early in 1945.
In addition to the routine travelling clinic work of the Division we have
continued to assist the Indian Affairs Branch in their survey and diagnostic
work and to assist the British Columbia Security Commission through consultation on cases in their New Denver Sanatorium.
PUBLIC HEALTH NURSING.
AH public health nursing in relation to tuberculosis is done by the local
public health nursing services. The Division continues to have a consulting
Public Health Nurse who correlates the work of the Division through the
Director of Public Health Nursing for the Province. The Division has participated in a review of all the various forms used by the public health nursing
services and improved instructions have been prepared for distribution to all
Public Health Nurses. The new Handbook on Tuberculosis has been distributed
to nurses throughout the Province and acts as a general guide in their tuberculosis activities. With the further development of Health Units there has been
a distinct improvement in the follow-up of tuberculosis cases in the home.
SOCIAL SERVICE.
There has been considerable consolidation of the work of the Social Service
Section of the Division during the year 1944. There has been a general
improvement in the standard of the social work done within the institution and
a greater correlation between the Social Service Section and other workers of
the Division, such as occupational therapists, teachers, librarians, and medical
staff.
The early part of 1944 was devoted mainly to trying to clarify some adequate form of social assistance for tuberculosis patients and their families.
A complete scheme was finally worked out and approved. This is now being
administered through the Social Assistance Branch by the various municipalities. It is recognized that this is the most forward move in social work in
relation to tuberculosis that has been made anywhere on this continent. The
details of this scheme may be found in special reports of the Department.
Forward strides have been made in the problem of rehabilitation. A conference on the subject was called towards the end of the year and a special
report on this meeting shows the importance of this phase of the tuberculosis
programme. Special rehabilitation committees have functioned within the
Division and through these committees an improved understanding of the rehabilitation problem has been brought about, with steadily progressive practical LL 78 BRITISH COLUMBIA.
application of this work bringing improved results. The Vancouver Occupational Industries in Vancouver and the Kiwanis Crafts Building in Victoria
continue to give assistance.
NURSES' TRAINING.
The new nurses' training programme has been put into effect during the
year and has developed very successfully. A re-evaluation of the course was
made at the end of the year with the course being shortened to five weeks: three
weeks on the wards, one week in the clinic, and one week of district nursing.
By thus shortening and intensifying the course it has been possible to admit
more students so that now the course will be available to all student nurses
throughout the Province. This is probably the only programme of this type in
Canada and is an aid to the nurses' training schools in giving this phase of the
nurses' training to all their students. This will, further, undoubtedly aid the
Division's work as these students take their place in active hospital work or go
on to public health nursing in the Provincial or municipal service. A full-time
trained teacher supervises this course at the Vancouver Unit. The new Handbook on Tuberculosis has proved very valuable for these students.
EXAMINATION OF GOVERNMENT EMPLOYEES.
Annual X-ray examination is now carried out as a routine in all Provincial
Government institutions and the Division of Tuberculosis Control has taken the
responsibility of keeping a centralized file of all these employees and of notifying each institution of the date the annual X-ray of each employee is due.
STATISTICS.
A new ledger system was put into effect within the Division at the first of
the year and has proven most effective in giving us immediate statistics at the
end of each month of all work done by the various units of the Division, allowing
for more careful planning of the Division's activities.
The Division of Vital Statistics has co-operated fully in providing monthly
statistics on morbidity and mortality, analyses of new and known cases and of
the results of examinations done in diagnostic clinics. The Division of Vital
Statistics has prepared all the graphs and charts for the Division of Tuberculosis Control's own annual report. These give a detailed study of the various
phases of work done through the tuberculosis control programme. .
RELATION WITH LOCAL HEALTH SERVICES.
Under the " Health Act" the primary responsibility for the control of communicable disease rests with the local health service.
The Division of Tuberculosis Control was created to provide services that
it would be illogical for the local health services to duplicate. In addition to
providing bed facilities the Division has assumed the responsibility for providing diagnostic services; that is, the technical equipment, space for clinics, and
the necessary specialists to man such services. These services are available to
the local health service and the basic responsibility for referring patients to
such clinics is that of the local health service.    In addition, the Division has BOARD OF HEALTH REPORT, 1944. LL 79
furnished literature and consultation to any local health service at any time
upon request. Further, the Division has studied the epidemiology of tuberculosis throughout the Province and where it is felt that the local health service
has been lagging behind, stimulative efforts have been made to try and bring
this service up to the level of others throughout the Province.
LEGISLATION.
The problem of clarifying legislation relative to tuberculosis in British
Columbia still remains to be accomplished. A complete review of the " Health
Act" with regulations pertaining to all communicable diseases is in the hands
of the Provincial Health Officer and the tuberculosis regulations await this
full review.
It is recommended that attempts be made to clarify interprovincial problems and to this end the Division has recommended that a Dominion Tuberculosis Council with representation from all Provinces be formed.
GENERAL.
During 1944 there has again been placed on the technical staff of the Division an increased load. They have responded without complaints and it is only
through their co-operative effort that it has been possible to put the increased
programme into effect during the year.
With the increased bed facilities being provided during 1945 there will of
necessity be an increase of staff which we trust will be more readily obtainable
than they have been to date. One of the greatest shortages has been in the
nursing staff and there has also been a shortage of trained medical personnel.
During the year a special commission reviewed all salaries throughout the
Government Services and considerable changes have been made in the staff of
the Division of Tuberculosis Control, which undoubtedly will help to produce a
greater continuity of staff and greater incentive.
The budget of the Division for the ensuing year will show a substantial
increase. The increase is due to the general increase of salaries by the special
committee of the Provincial Government, the establishing of a new clinic in
New Westminster, the extension of mass survey-work, the development of the
student nurses' training programme, the increased prices for commodities, the
necessity of replacing old equipment and providing new, and the opening of a
seventy-bed temporary unit.
The Division wishes to acknowledge the co-operation that it has received
from the Metropolitan Health Committee, the local Health Units, Public Health
Nurses, the Social Assistance Branch, and other departments of Government.
There continues to be considerable voluntary assistance, particularly from
those groups engaged in Christmas Seal activities. The following groups assist
in this work: Imperial Order Daughters of the Empire at Vancouver, Chilliwack, Kelowna, Ladner, Penticton, Revelstoke, Trail, and Vernon; the Kinsmen
Club at Vancouver, New Westminster, North Vancouver, and Prince Rupert;
the Kiwanis Club at Victoria and Nanaimo; the Rotary Club at Kimberley,
Nelson, and Fernie; the Stagette Club at Cranbrook; and the Soroptimist Club
at Courtenay. LL 80 BRITISH COLUMBIA.
The Board of Directors of the Vancouver Preventorium has continued to
provide accommodation for children between the ages of 2 and 14.
It is hoped despite the increasing population and war-time problems that,
with the extension in X-ray services and bed facilities, there will be a marked
inroad made on the tuberculosis problem during 1945.
REVIEW OF TUBERCULOSIS CONTROL PROGRAMME.
The Division of Tuberculosis Control was inaugurated in 1935 as a Division
of the Provincial Board of Health. It handles all phases of tuberculosis work
in British Columbia, including operating all clinics doing diagnostic work relative to tuberculosis and all institutions treating tuberculosis. There are no
private or municipal clinics or institutions for tuberculosis in British Columbia.
The whole work is centralized in a central office situated in Vancouver and
staff throughout the Province are employed as one organization. The central
office correlates the work of the institutions and clinics with that of local health
services and other divisions of government. All patients are admitted through
a central admitting office and all accounting is. centralized through a central
accounting office.
The work of the Division is divided into various phases.
I. Case-finding.—The Division  operates four types  of clinics.    These
are:—
(a.) Mobile Survey Clinics.—These are the bus type of clinic, carrying a staff of three and complete X-ray facilities for taking 4- by
5-inch films. They do mass X-ray surveys in industries and in
schools and, in certain areas, even X-ray whole towns. It is the
hope of the Division to some day X-ray every one in the Province
annually.
(b.)  Stationary Survey Clinics.—These are operated in large centres
and the service is available to any one.
(c.)  Stationary Diagnostic Clinics.—All " other than negative " cases
from the survey clinics are referred to the diagnostic clinics for
complete diagnosis.    These clinics have complete facilities for
diagnosis—X-ray, bronchoscopy, laboratory, or whatever may be
necessary.
(d.)   Travelling Consulting Diagnostic Clinics.—There are four of
these with headquarters in strategically placed areas.    They visit
eighty centres throughout the Province, thus carrying the work
to all-rural areas.
In addition to the clinic facilities there is a consultive service for rural
areas.    Any physician who wishes to have an X-ray examination done between
clinic visits may have a film taken at the local hospital and forward the film
and consultation form to one of the clinics of the Division for interpretation.
The Division pays the local hospital for taking such films.
All this diagnostic work is free to the individual, being paid for by the
Provincial Government.
This case-finding programme has made possible the finding in British
Columbia of a very high ratio of known cases to deaths, over twenty cases per BOARD OF HEALTH REPORT, 1944. LL 81
death now being registered, and has permitted early diagnosis of tuberculosis,
over 60 per cent, of all cases throughout the Province being now classified as
minimal on original diagnosis.
2. Institutions.—British Columbia has a low ratio of beds, but centralized
control has made possible the careful selection of cases for admission and earlier
discharge than previously. Despite a ratio of only 1.8 beds per death the average length of time between application and admission is only one month. At
the end of 1944 construction of more beds had been started and plans had been
made for further expansion of bed facilities.
All medical services are available in all institutions. The central Vancouver Unit handles most of the more difficult cases, as in this centre all forms of
specialization are available.
The Division has developed in its institutions an integrated service among
physicians, occupational therapists, social workers, teachers, librarians, and
nurses. These services are available in all institutions and a standard has been
set up for all technical personnel.
All diagnostic and clinic facilities are free. When institutional treatment
is required the patient pays upon ability to pay, the amount being decided after
a careful social analysis.
3. Follow-up Work.—The public health nursing follow-up service is carried out by full-time Health Units in many areas and in other areas there are
Public Health Nurses. Over 80 per cent, of the population of the Province is
covered by trained Public Health Nurses. In the few areas where no Public
Health Nurse is available the work is done by social service field workers.
4. Social Service.—Medical social workers are attached to all institutions
of the Division and trained social workers are available throughout the Province through the Social Assistance Branch of the Provincial Government.
During 1944 a new special tuberculosis allowance was established which is
considered one of the most forward social steps that has been taken anywhere
on this continent to control a preventable disease. Under the old basis of social
assistance one had to be destitute to receive assistance. Now the tuberculous
patient, or patient's family, may apply for assistance on the basis of cessation
of income. Thrift is sponsored in that they are allowed to keep certain liquid
assets. The question of rent, mortgages, life insurance premiums, special food
and comforts allowances are all taken into consideration. This is administered
by the municipalities with the Provincial Government paying 80 per cent, of
the cost.
Thus the family unit may be kept intact during the time the patient is
unable to work and some assets that the patient may have are available for his
rehabilitation.
5. Occupational Therapy and Rehabilitation.—Occupational therapy
is available in all in-patient units of the Division. In addition there are two
workshops, one in Vancouver and one in Victoria. A rehabilitation committee
holds weekly meetings to guide patients in their increasing activities and
attempts to place them, when physically able, in gainful occupations.
6. Relation to Local Health Services.—The primary responsibility for
the control of a communicable disease is that of the local health services.    The LL 82 BRITISH COLUMBIA.
Division of Tuberculosis Control provides facilities and trained personnel that
it would be illogical or impossible for local areas to duplicate. Thus, all diagnostic and treatment facilities are provided by the Provincial Government. The
follow-up work in the homes, the rounding-up of contacts, the initiating and
developing of surveys are all the responsibility of the local health services.
The Division of Tuberculosis Control also acts as a stimulator of local health
services where death-rates are found to be high.
7. Rural Pneumothorax.—In order to allow discharge of patients from
hospital to rural areas there has been established a series of pneumothorax
centres throughout the Province where patients are able to obtain their pneumothorax refills.
8. Nurses-in-training.—A nurses' training programme has been developed which offers an intensive course to any student nurse from any training-school in the Province.
The heads of the various training-schools and the Registered Nurses' Association were brought together when this was inaugurated and, consequently,
practically all student nurses in the Province are now going through this course.
They come to the Vancouver Unit of the Division, with the Provincial Government paying three-fifths of the student nurses' expenses for the whole course
and also paying for necessary teachers, supervisors, library facilities, etc.
9. Statistics.—Statistics that are wanted day by day by the Division are
kept in a ledger system by the Division itself. Statistics for annual analysis
are placed on punch-cards and kept by the Division of Vital Statistics. Through
the co-operation of the Division of Vital Statistics it is possible to give a comprehensive analysis of the tuberculosis problem in British Columbia each year.
10. Workmen's Compensation Board.—In British Columbia all hospital
employees come under workmen's compensation for tuberculosis. All such
employees are compelled to be X-rayed annually and any one developing
tuberculosis who was shown not to have it at the time of employment in a
hospital is eligible for compensation.
11. Educational Work.—The Division has prepared a considerable
amount of literature and also distributes literature from the Canadian Tuberculosis Association and moving-picture films to various local health services.
Through the British Columbia Tuberculosis Society a full-time person is
engaged in educational work in tuberculosis.
12. Christmas Seals.—Christmas seal campaigns are operated by three
voluntary groups in the Province under franchise from the Canadian Tuberculosis Association at Ottawa. These groups are the Vancouver Christmas Seal
Committee, composed of the Municipal Chapter of the Imperial Order Daughters of the Empire and the Kinsmen Club; the Kiwanis Club in Victoria; and
the British Columbia Tuberculosis Society in the remainder of the Province.
These groups have proved of great assistance in the tuberculosis work in British
Columbia and closely correlate their activities with the work of the Division of
Tuberculosis Control.
13. Indians and Orientals.—There are two racial problems in British
Columbia. British Columbia has the highest ratio of Indians to whites of any
Province, with 22 per cent, of the Indians in Canada residing in the Province. BOARD OF HEALTH REPORT, 1944. LL 83
The Indian work comes under the Indian Affairs Branch of the Dominion Government, but the Division of Tuberculosis Control assists them in their diagnostic work through the medium of the clinics of the Division. The Indian
Affairs Branch has increased the hospital accommodation for Indians in British
Columbia and intends to further expand it.
In addition to the Indians, there are the Chinese and Japanese. The Chinese are a direct responsibility of the Provincial Government, whereas the
Japanese have been taken over by the British Columbia Security Commission,
financed by the Dominion Government. This Commission has constructed a
sanatorium at New Denver, in British Columbia, where there are approximately
100 Japanese patients.
REPORT OF THE PUBLIC HEALTH ENGINEERING
DIVISION.
By R. Bowering, B.Sc. (C.E.), M.A.Sc, Public Health Engineer
and Chief Sanitary Inspector.
The Public Health Engineering Division exercises supervision and control
over such environmental factors as may have an effect on the public health.
These factors include water-supplies, sewage-disposal, milk plant sanitation,
cannery and industrial camp sanitation, and other miscellaneous features of
environmental sanitation.
The year 1944 was one of considerable expansion in that two technical
officers were added to the staff. Dr. J. J. Carney, B.V.Sc, was added to the
staff in June. Dr. Carney brings with him the training of a veterinarian,
together with knowledge gained by a number of years' experience in the Health
Department of the International Concession at Shanghai, China. Dr. Carney's
title is " Consultant in Milk and Food Control." In December, Mr. C. R. Stonehouse, C.S.I. (C), was added to the staff as Senior Sanitarian. Mr. Stonehouse
is a qualified Sanitary Inspector with considerable experience in local public
health service. Mr. Stonehouse left the Prince Rupert Health Unit to assume
his duties with the Public Health Engineering Division. Mr. Stonehouse will
assume the duty, among others, of supervising the sanitation of industrial and
other types of camps. In addition, the services of an engineering student from
the University of British Columbia were obtained for the summer months.
With this assistance the Division was able to continue its detailed survey of a
large number of fishing canneries on the Coast and, in addition, make sanitary
surveys of several towns.
There was an increase in the number of certified Sanitary Inspectors
employed by local health authorities in the Province. This increase in the
number of qualified Sanitary Inspectors throughout the Province will have a
tremendous effect in improving sanitation wherever these men are employed.
It is hoped that with the increased availability of men in the post-war period
this number will be greatly increased until such time as the whole Province is
covered by qualified men. These Sanitary Inspectors do not come under the
direct supervision of the Public Health Engineering Division, but are responsible to the Director of the Health Unit in which they serve. The Public Health
Engineering Division provides a consultative service for these men. LL 84 BRITISH COLUMBIA.
The tremendous development of the north country that was noted in the
1943 report became more stabilized during 1944. Only one trip was made by
the Director into the Prince Rupert area.
The various activities of the work of the Division will be discussed under
separate headings.
WATER-SUPPLIES.
There are in British Columbia over 150 public water-supply systems serving
over 75 per cent, of the population of the Province. Most of these public water-
supply systems are owned by municipalities, although a number are owned by
local improvement districts and by companies. Due to the topography and
climate the majority of the water-supplies are drawn by gravity from mountain
streams or lakes. There are very few public water-supplies in the Province
drawn from wells or springs.
The Division has made a large number of sanitary surveys of watersheds
during the past year. In addition, a large number of water samples have been
examined for faecal contamination by the Division of Laboratories. These surveys and tests show that there has been a considerable improvement in the
bacteriological quality of the water supplied in British Columbia during the past
two or three years. Most of this improvement is due to the effects of chlorination. Approximately 70 per cent, of the population of the Province now use
chlorinated water. There has now been more than a year's experience of using
chlorinated water in the Greater Vancouver Water District. Bacteriological
results of tests of both the raw and the chlorinated water show a marked
improvement in the bacteriological picture for the chlorinated water. In addition, the general public, for the most part, do not notice any harmful taste effect
due to the use of chlorinated water.
There are still a number of water-supplies in the Province which have been
shown to require some form of treatment. It is believed that continued advance
will be made during the year 1945.
As a result of the now widespread use of chlorine, the Division is considering the matter of preparing regulations for the control and operation of
chlorination plants.
There are several water-supplies in the Province where filtration is needed
as well as chlorination. It is believed that these filtration plants will have to
wait until the post-war period.
SEWAGE-DISPOSAL.
Most of the larger communities have public sewerage systems. Since the
main centres of population are near salt water, where the sewage is disposed of
by dilution, there are relatively few sewage treatment plants. Some work that
was done during the year in connection with outdoor bathing-places indicates
that disposal by dilution is not always satisfactory where there is any question
of contamination of bathing-beaches. Some additional work will be done in
1945 on the bacteriological quality of water in bathing-beaches as affected by
sewers. This means that many cities which are now disposing of sewage by
dilution should make a thorough study of their disposal points in order to
protect bathing-beaches and to ensure that dilution is good in harbours in which BOARD OF HEALTH REPORT, 1944. LL 85
the movement of water is restricted by floats, log-booms, and boats, etc. In
Vernon, the efficiency of the sewage-treatment plan was improved by the installation of apparatus for chlorinating the sewage-plant effluent.
There was very little new sewerage-work done in the Province as the large
defence housing projects and the military camps are, to all intents and purposes,
completed. Plans and specifications of several sewage plants were approved
during 1944, the construction to take place in some cases in 1945 and in other
cases in the post-war period. A case in point is the approval of a $750,000
extension to the sewerage system of Vancouver. Sewers were constructed in
the Village of Dawson Creek, and a sewage plant should be completed early
in 1945.
The problem of sewering of unorganized communities remains. During
the year sanitary surveys of two large unorganized communities were made.
It is hoped that during 1945 an interdepartmental committee will be able to
suggest to the Government a method of having sewers built in unorganized
territory.
In the case of private sewage-disposal problems, a number of pamphlets
were sent out to interested parties, describing methods of building septic tanks
for farm homes and rural residences. In addition, plans for the sewerage for
two schools were also drawn up. Many of the pamphlets were accompanied by
letters containing considerable information for the guidance of each applicant
for information, based upon the individual case.
In 1945 it is expected that there will be a considerable amount of sewerage
construction-work done, particularly if the war should end during 1945.
MILK SANITATION.
Although milk sanitation is one of the major features of environmental
sanitation, the inspecting and grading of dairy-farms is not a function of the
Provincial Board of Health but of the Department of Agriculture. The principal function of the Division of Public Health Engineering, therefore, lies in
the inspection of engineering features of pasteurizing plants. The Division has
also provided a consultative service to local municipalities in the enforcement
of their own milk by-laws.
During the year 1944, as was mentioned previously, a consultant in milk
and food control was added to the staff. Under Dr. Carney the Public Health
Engineering Division's contribution to the milk sanitation programme will be
greatly enlarged and extended.
In the 1944 Session of the Legislative Assembly of British Columbia, the
" Milk Act" was amended to permit the high-temperature short-time method of
pasteurization. This amendment in the Act required the making of regulations
dealing with the type of equipment and the method of operation that would be
required for the high-temperature short-time method of pasteurization.
There are still a number of localities in the Province where it is impossible
to purchase pasteurized milk. Efforts will be continued in the coming year to
arouse sufficient interest in these localities to have pasteurized milk made available. One event worthy of mention is the formation of a co-operative among
a number of milk producers at Nanaimo for the purpose of constructing a pasteurizing plant.    This plant should be producing pasteurized milk by January, LL 86 BRITISH COLUMBIA.
1945. This is an instance where the people who were in the business of selling
raw milk, seeing the increasing demand for pasteurized milk, co-operated in
building the plant in order to provide consumers with pasteurized milk, and yet
retaining their own business. This procedure might well be followed in other
localities.
There were no large milk-borne epidemics in British Columbia during the
year 1944. This is the first year for a considerable number of years that there
were no known epidemics traced to raw milk. This does not mean that there
was no milk-borne disease, since there are, from time to time, cases of human
disease which are probably milk-borne. The number of cases of undulant fever
is a case in point.
Also in the 1944 Session of the House, the " Municipal Act" was amended
to permit municipalities to require, by by-law, the pasteurization of all milk sold
within the municipal limits. In order to pass this by-law a favourable vote of
the electors of the municipality is required. In spite of the fact that some
cities are very much concerned about the use of raw milk, there were no municipalities that took the opportunity of passing a pasteurization by-law during
1944. In the City of Rossland a series of samples of milk were taken from each
dairy for bacteriological examination. This series of samples showed that the
milk produced on the Grade A farms was, on the average, no better than that
produced on a Grade B farm. This illustrates the greater need for local control
of the milk-supply than is at present permitted by the " Milk Act," since the
appearance of the words " Grade A " on a milk-bottle cap does not guarantee to
the consumer that the milk is of satisfactory quality or that the milk is free
from disease germs, but merely states that the farm on which the milk was
produced is rated a Grade A dairy-farm.
It is anticipated that during 1945 the work of the Public Health Engineering Division in milk control will be greatly enlarged and extended.
SHELL-FISH SANITATION.
One of the important duties of the Division of Public Health Engineering
is the sanitary inspection of oyster-producing areas. Oysters are usually cultured on foreshore lots leased from the Provincial Government. These leases
are not granted until the Provincial Board of Health has made a sanitary survey
of the lot and notified the Department of Lands that there is no objection from
a public health point of view to the granting of such lease. Any leases that
come up for renewal are not renewed until such a sanitary survey has been
made. Reinspection of existing leases is made from time to time in order to
see that no new contaminating influences have been introduced since the time
of the previous inspection. Leases which have been issued since 1942 have a
clause stating that the lease may be cancelled if, in the opinion of the Provincial
Health Officer, the operation of such lease has become a menace to the public
health.
The inspection and sanitary supervision of plants handling and shucking
oysters and other shell-fish is also important and this work will come under
supervision of the consultant in milk and food control. During 1945 it is hoped
that a survey of all such plants may be made. BOARD OF HEALTH REPORT, 1944. LL 87
CANNERY SANITATION.
The advance that was noted in the 1943 report in fish-canneries' inspection
was continued in 1944. With the assistance of an engineering student from the
University of British Columbia, a thorough sanitary survey of several additional
fish-canneries was made. There have thus been made sanitary surveys of all
of the fish-canneries in the Province, except for one or two on the west coast of
Vancouver Island and on the Queen Charlotte Islands. These will be completed
in 1945. Inspection of fish-canneries by the Provincial Board of Health does
not include the inspection of the actual fish product, but is confined to inspection
of the environmental conditions of the cannery-workers.
Large-scale maps of each cannery were drawn and the important sanitary
features shown. These included the location and size of all the housing units,
privies, sewers, pig-pens, wells, wharves, sheds, and cannery plants, with relationship to each other and to the high- and low-tide water marks. By using this
information, future inspectors will be able to observe as to whether the recommended improvements have been made. Copies of these reports, with recommendations, are being sent to the cannery operators.
These inspections have shown that there are three classes of people living
at the canneries—the whites, the native Indians, and the Chinese. Each of
these three classes of people have their own peculiar standards of housing and
sanitation.
Regarding housing, the white residents are usually well housed. The
Chinese accommodation is, in many cases, overcrowded according to western
standards. The Indian housing problem has always been difficult, principally
due to the fact, as a rule, only one small inadequate hut is provided for a family.
Families vary in number from two to nine or ten. It is obvious, therefore, that
there is considerable overcrowding in some of the Indian huts. The newer
houses are better. Many of the older Indian huts are poorly constructed and
are in a dilapidated condition. Overcrowding of Indian huts is often intensified
by the custom of some Indians of inviting relatives and friends to live with
them, although these people may not be employees of the cannery. It is felt
that some method of control in which both the Native Brotherhood and the companies each have a part would have some beneficial result.
Toilet facilities at most of the canneries are not satisfactory. Privies are
generally of the over-the-water type, with the result that faecal material is
deposited on the beaches and left open to the atmosphere for many hours of each
day. Where water-closets are provided the sewers rarely extend to minimum
low water. As far as the public health is concerned, this is one of the most
hazardous features at the salmon-canneries.
Water-supplies at the canneries are generally of a quality equal to that of
the average municipality in British Columbia.
Pigs are kept by the Chinese at most canneries. The pig-pens are, as a
rule, kept in fairly good condition, although some are too close to other dwellings.
One of the features adding to the insanitary appearance of some of the
canneries is that there are generally no garbage collecting and disposal facilities.
This is due partly to the habits of the majority of the people living in the canneries and partly to lack of interest on the part of the operators.    It is felt that LL 88 BRITISH COLUMBIA.
if good garbage-cans were provided, and if the people were made to use them,
much of this insanitary condition could be eliminated.
The major problems to be faced in cannery sanitation appear to be the
question of disposal of human excreta, disposal of garbage, and the question of
good housing. Most of these problems require for their solution the cooperation of the employees as well as action on the part of the employer. There
is considerable room for education of its members by the Native Brotherhood
of British Columbia. It is felt that only by co-operation of the employees'
organization with the company that living conditions will be improved at the
fish-canneries.
INDUSTRIAL CAMP SANITATION.
As in other years, a considerable number of camps were inspected by the
Division of Public Health Engineering, by Sanitary Inspectors attached to the
local Health Units, and by British Columbia Provincial Police officers. The conditions of the camps were, on the whole, fairly good in 1944. However, it has
been felt for some time by the Division that a more intensive programme of
industrial camp sanitation should be carried on by the Provincial Board of
Health. This more intensive programme would include more frequent inspection, and the preparation of and enforcing new regulations that would ensure
good living conditions for employees who have to live in camps. It was to aid
in this work that a Senior Sanitarian was added to the staff. Mr. Stonehouse
will have charge of the industrial camp sanitation programme.
SANITARY COMPLAINTS.
Each year there are a considerable number of sanitary complaints. Most
of these complaints are of minor importance, although a considerable amount of
time is required in their investigation. Many of these complaints are investigated by medical health officers, Sanitary Inspectors, and by British Columbia
Provincial Police officers. A considerable number are investigated by members
of the staff of the Division of Public Health Engineering.
A number of the complaints investigated concerned the disposal of septic-
tank effluent into ditches and small watercourses. Where a number of complaints originate from a certain area, an attempt has been made to make
sanitary surveys of the community. It has been found that some of these problems can only be solved by the construction of sewerage systems. Some of the
complaints concerned disposal of sewage by army camps. In these cases the
matter was discussed with the proper military authorities and in most cases
satisfactory results were obtained.
Another constantly occurring cause of complaint relates to the collection of
garbage and its disposal in unorganized communities. In some instances these
problems cannot be solved without expenditure of money. For this reason, it is
probable that some local organization is necessary. It is hoped that the committee formed of officials of interested departments to study such matters will
be able to deal with this problem during the year 1945.
AUTO CAMPS AND SUMMER RESORTS.
There are a large number of auto camps and summer resorts in the Province.    The importance of good sanitation and environmental conditions in and BOARD OF HEALTH REPORT, 1944. LL 89
around these auto camps and summer resorts is obvious when one considers the
volume of tourist industry in British Columbia. A number of these auto camps
and resorts have been inspected from time to time, although no all-inclusive
programme has been in operation for the sanitary control of these places in the
past years. The Division of Public Health Engineering is now preparing draft
regulations and in co-operation with other interested departments of the Government a set of procedures for the proper sanitary and public health control
of auto camps, trailer camps, and summer resorts. During 1945 this programme will be brought into operation, and it is hoped within another year
or two that the matter of inspection of auto camps will be a routine.
GENERAL OBSERVATION.
The year 1944 has been one of expansion for the Division of Public Health
Engineering. The increase in its staff has resulted in an opportunity for the
Division to perform valuable service on a much more intensive scale. This
expansion in technical personnel will not only mean that the Division will
perform more work, but it also means that the work of Sanitary Inspectors
employed in Health Units will be improved as a result of the better consultative
services that will be available.
The Division would again like to record its thanks to the Division of.
Laboratories for its co-operation in the examination of samples of water, sewage, and milk. The Provincial Police deserve mention for their valuable work
in inspection of sanitary complaints in outlying districts. Co-operation with
the Division of Sanitary Engineering of the Federal Department of National
Health and Welfare has been of the best with mutual advantages to both
agencies. The Division also desires to acknowledge with thanks the unstinted
and valuable assistance rendered by other members and staff of the Provincial
Board of Health. LL 90
BRITISH COLUMBIA.
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H VICTORIA,  B.C. :
Printed by Charles F. Banfield, Printer to the King's Most Excellent Majesty.
1945.
1,105-445-6232  

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