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PROVINCE OF BRITISH COLUMBIA PROVINCIAL BOARD OF HEALTH FORTY-NINTH REPORT YEAR ENDED DECEMBER 31ST 1945 British Columbia. Legislative Assembly 1947

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 PROVINCE OF BRITISH COLUMBIA
PROVINCIAL
BOARD OF HEALTH
FORTY-NINTH REPORT
YEAR ENDED DECEMBER 31st
1945
PRINTED BY
AUTHORITY OF THE LEGISLATIVE ASSEMBLY.
VICTORIA,  B.C. :
Printed by Charles P. Banfiet.d, Printer to the King's Most Excellent Majesly.
1916.  Office of the Provincial Secretary,
Victoria, B.C., January 30th, 1946.
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, 1945.
G. S. PEARSON,
Provincial Secretary.
. Provincial Board of Health,
Victoria, B.C., January 30th, 1946.
The Honourable Geo. S. Pearson,
Provincial Secretary, Victoria, B.C.
Sir,—I have the honour to submit the Forty-ninth Report of the Provincial Board
of Health for the year ended December 31st, 1945.
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 1945 the members of
the Provincial Board of Health were:—
Premier, Minister of Finance, and President
of the Executive Council.
Provincial Secretary, Minister of Labour, and
Commissioner of Fisheries.
Attorney-General.
Minister of Lands and Forests.
Minister of Agriculture (deceased, 1945).
Minister of Agriculture (appointed, 1945).
Minister of Mines and Minister of Trade and
Industry.
Minister of Public Works, Minister of Railways, and Minister of Municipal Affairs.
Minister of Education (retired, 1945).
Minister of Education (appointed, 1945).
The Hon. G. S. Pearson, Provincial Secretary, acts as Minister of Health.
The Hon. John HarT
The Hon. G. S. PEARSON
The Hon. R. L. Maitland
The Hon. E. T. Kenney     -
The Hon. K. C. MacDonald
The Hon. F. Putnam
The Hon.
E.
C. Carson
The Hon.
H.
Anscomb
The Hon.
H.
G. T. Perry
The Hon.
G.
M. Weir
SENIOR PUBLIC HEALTH TECHNICAL STAFF.
G. F. Amyot, M.D., D.P.H.
J. S. Cull, B.A., M.D., D.P.H.     -     -     -
J. M. Hershey, B.Sc, M.A., Ph.D., 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 E. M. Yvonne Love, B.Sc. (H.Ec.)
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.
Provincial Health Officer.
Deputy 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 (resigned,
1945).
Consultant in Nutrition (appointed,
1945).
Director, Division of Laboratories.
Director, Division of Tuberculosis Control.
Director, Division of Vital Statistics.
Director, Division of Venereal Disease
Control.
Assistant Director, Division of Venereal
Disease Control.
__  TABLE OF CONTENTS FOR THE YEAR 1945.
Page.
Introduction  9
The Health of the People of British Columbia , ~_ 16
Bureau of Local Health Services—
Public Health Nursing  19
School Medical Services  21
Notifiable Diseases  22
Full-time Health Services  24
Public Health Education  27
Preventive Dentistry  29
Report of the Director of Public Health Nursing—
Public Health Personnel  30
Education  32
Changes in Policies  34
Plans for 1946 ..  35
Report of the Consultant in Nutrition—-
Organization of Nutrition Services  37
Report of Provincial Board of Health Nutrition Services in 1945  38
Report of the Division of Vital Statistics—
Introduction _  42
Administration of the Division of Vital Statistics  42
Summary of Registration and Related Procedures...  54
The Contribution of the Division of Vital Statistics to Canada's War Effort._ 57
Preservation of Records  58
Completeness of Registration .  58
District Registrars' Offices, etc  59
Administration of the " Marriage Act "  59
Legislation  59
Co-operation with the Provincial Board of Health and its Divisions  62
Mechanical Tabulation Problems  63
Relations with the Federal Government  64
Appendix A—Constitution of Vital Statistics Council for Canada  66
Problems outstanding at the End of the Year  68
Report of the Division of Laboratories—
Introductory Comments  70
Tests relating to Venereal Disease Control  70
Tests relating to Tuberculosis Control  71
Tests relating to Control of Intestinal Infections  72
Other Types of Laboratory Tests  73
Red Cross Blood Donor Service  74
General Comments  75
Table No. I.—Statistical Report of Examinations done during the Year 1945 78
Table No. II.—Number of Tests performed by Branch Laboratories in 1945 79
Report of the Division of Venereal Disease Control—
Introduction  80
Increase in New Venereal Infection    80
Reorganization and Administration     81
Information and Public Relations  82
Public Health Nurses as Epidemiology Workers  83
Distribution of Free Penicillin  83 C 8 BRITISH COLUMBIA.
Report of the Division of Venereal Disease Control—Continued. Page.
Clinic Services     84
Social Service     84
Facilitation     85
Control Needs and Future Plans     85
Review of Venereal Disease Control Programme     86
Report of the Division of Tuberculosis Control—
Introduction     96
New Cases—Pulmonary and Non-pulmonary     97
New Cases—Pulmonary     97
Tuberculosis Mortality     98
Clinics     98
Institutions  .  100
Nursing   101
Social Service  101
Statistics  102
Local Health Services  102
Budget _  102
General Remarks  102
Report of the Division of Public Health Engineering—
Introduction  103
Water-supply  104
Sewage-disposal  105
Milk Sanitation  106
Shell-fish Sanitation..  107
Cannery Sanitation  107
Industrial Camp Sanitation  108
The Use of D.D.T. in Insect-control  108
Sanitary Complaints  108
Auto Camps and Summer Resorts  109
General Observations  109 REPORT of the PROVINCIAL BOARD OF HEALTH
YEAR ENDED DECEMBER 31st, 1945.
G. F. Amyot, M.D., D.P.H., Provincial Health Officer.
INTRODUCTION.
This Forty-ninth Annual Report of the Provincial Board of Health for the
year 1945 provides an opportunity to present a summary of the extensive and
varied programme of the Provincial Health Services. It is gratifying to be
able to record considerable progress in health services during this year of transition from war to what is hoped will be a period of peace and progress. The
termination of hostilities did not bring the hoped-for solution of many of the
health problems but instead created many new situations that had to be met
with the same greatly curtailed services.
One of the most difficult problems at present is the shortage of trained
public health personnel. There now are two Health Units without Directors
and little chance of procuring suitable trained public health physicians to fill
these positions at least for some months. However, there is hope that in the
early summer it will be possible to obtain a number of newly trained public
health physicians who have returned from the armed forces to the School of
Hygiene, University of Toronto, to undertake their public health studies. If a
sufficient number of these trained personnel are available, it should be possible
to continue to extend the much needed programme of full-time local Health Units
to serve other parts of the Province not now enjoying this type of modern public
health service. There is also need for new personnel in the central services of
the Provincial Board of Health to bring these up to a strength sufficient to
handle the routine procedures. Additions to the central staff will also permit
the development of new programmes that are essential if the people of British
Columbia are to benefit fully from the newest developments in the field of public
health.
This report presents the work of the various Divisions and other services
of the Provincial Board of Health, including those health services located in
many rural parts of the Province, and a summary of the activities of the Divisions of Vital Statistics, Tuberculosis Control, and Venereal Disease Control,
which Divisions publish a more complete report later on in the year. All other
reports, except Tuberculosis Control, Venereal Disease Control, and Vital
Statistics, are the final annual reports.
Some relief was experienced, in the last few months of the year, in obtaining greatly needed public health personnel for some of the Provincial Health
Services. Dr. J. M. Hershey was appointed Assistant Provincial Health Officer
to undertake the supervision and co-ordination of all Provincial Health Services
in the Greater Vancouver area and to act as liaison officer to local health services C 10 BRITISH COLUMBIA.
and other related services in that area, and at the same time to provide certain
additional help in the Victoria headquarters of the Provincial Board of Health.
Dr. J. S. Cull was raised to the rank of Deputy Provincial Health Officer,
which enables him to sign certain documents on behalf of the Provincial Health
Officer and also gives him an opportunity to perform further greatly needed
services which are essential if the Provincial Health Services are to expand
rapidly enough to meet the growing health demands and needs of the people of
the Province. These changes should simplify central administration considerably and provide a closer link between the various Divisions of the Provincial
Board of Health and headquarters and local health services.
At last a start has been made in the field of public health education. Miss
Kathleen McNevin, who was granted a fellowship by the W. K. Kellogg Foundation to take studies in the advanced School of Public Health Education in the
University of North Carolina, will return from her studies early in January and
undertake the many duties waiting for her in this important new advance in
the public health field in British Columbia. Miss McNevin is to be appointed
Consultant in Public Health Education. The course undertaken in North Carolina has only been in operation for three years and meets more adequately than
any other course the needs in modern public health education. A place in this
class was provided for Miss McNevin through the co-operation of the School of
Public Health of the University of North Carolina, the United States Public
Health Service, and the W. K. Kellogg Foundation, who granted the fellowship.
Forty-five students from both the North and South American Continents were
registered in this course.    Miss McNevin was the only Canadian.
Mr. A. R. Peers, who was the only commissioned officer in the Canadian
Army in the field of general sanitation who did not have a degree in medicine or
public health, has been chosen as a sanitarian on the staff of the Provincial
Board of Health to undertake extended duties in the broad field of sanitation,
particularly those in connection with tourist accommodation in the Province.
It is anticipated that this new development will greatly assist in extending the
interest now being shown in the development of adequate, safe, sanitary tourist
accommodation.
Miss Mary Baldwin, Consultant in Nutrition with the Provincial Board of
Health, resigned following her marriage, and her place was taken by Miss
Yvonne Love, who served with the Nutrition Service of the R.C.A.F. Miss Love
is a Home Economics graduate with special training in dietetics, and although
only appointed in the fall of 1945 she has contributed to the expansion of the
nutrition programme of the Provincial Board of Health. Mrs. E. M. Trenholm
was appointed as Junior Nutritionist to assist Miss Baldwin and then Miss Love
in an expansion of this programme.
Other employees have been added to the different Divisions in various
capacities, and many of these have returned from the armed forces. However,
there are still a number of vacancies to be filled, particularly in the technical
fields of nursing, public health nursing, physicians, public health physicians, and
other specialties, to bring the health services to even above normal strength.
One of the difficulties in attracting trained public health personnel to the
Province, except in the field of public health nursing, is the low salaries paid by
this Province in comparison with those of the Department of National Health, BOARD OF HEALTH REPORT, 1945. C 11
city health departments, and some of the other Provinces, notably Ontario and
Saskatchewan. A study of these public health salaries is under way, and it is
hoped that this difficulty may be overcome by more equitable salary grades and
ranges. If this difficulty can be met, it should be possible to attract to the Provincial Health Services a type of highly qualified and efficient public health personnel who can give an excellent quality of service and assist in more rapidly
expanding the health programme to meet the needs of the people.
Another innovation during the year was the organization of senior staff
meetings in the headquarters of the Provincial Board of Health at Victoria.
Meetings are held weekly, and many of the complicated problems concerning
administration are discussed, including programmes and developments in the
Provincial and local health services.
During 1945 the war placed additional demands on the Provincial services,
particularly in connection with the Japanese balloons and the return of large
numbers of Canadian and British repatriates from the Pacific area after V-J
Day. The Division of Tuberculosis Control made available their survey X-ray
facilities to assist in taking chest X-rays of returning British and Canadian
prisoners of war from Japan, to supplement the services of the armed forces.
Provision of this help was just one of the many types of assistance provided to
the armed forces whenever required. Laboratory facilities and a consultative
service through the various specialized public health personnel of the Provincial
Board of Health has always been available to the forces on request. The Division of Vital Statistics has assisted with records of births, deaths, and marriages
in connection with the provision of dependents' allowances for members of the
armed forces.
Plans are under way for a new Provincial Health building, to be located in
Vancouver to house the three Divisions of the Provincial Board of Health and
their services which are located in that area. This building will make provision
for the much needed space for the Provincial laboratory, lack of which has held
up the development of some programmes of public health, particularly premarital blood testing, and the Division of Venereal Disease Control, which must
vacate its present quarters during July, 1946, to make way for the new nurses'
home of the Vancouver General Hospital. It is hoped that this building can be
started soon.
Such a building will prevent much overlapping between these now widely
separated Divisions and make it possible to unify and centralize all services
which are common to the three Divisions of Laboratories, Tuberculosis Control,
and Venereal Disease Control. It will also make it possible to co-ordinate the
local clinics provided by these Divisions, and then through centralization and
unification prevent overlapping and provide a better and more easily administered out-patient clinic service to serve the people of the Greater Vancouver
area. By the unification of the Divisions and their programme on a Provincial
level, it will be possible to give a better co-ordinated service to the people, hospitals, physicians, and other groups.
A series of lighting-surveys.have been conducted in the central offices of the
Provincial Board of Health and the Division of Vital Statistics, as well as for
some of the Provincial Social Assistance services in Vancouver, with the object C 12 BRITISH COLUMBIA.
of demonstrating the need for adequate lighting at all times in these offices to
save eye-strain.
DOMINION COUNCIL OF HEALTH.
The Provincial Health Officer attended the two semi-annual meetings of the
Dominion Council of Health in Ottawa, which Council discusses the many complicated interprovincial and national problems of public health and advises all
interested groups regarding these matters. In addition, this Council provides
opportunities for voluntary standardization of procedures between the Provinces in Canada. The Council membership consists of the following: The
Deputy Minister of the National Department of Health, chairman; the Deputy
Minister or Senior Medical Health Officer of each Province; four lay representatives from labour, farm, and women's organizations; and one technical adviser
from the School of Hygiene, University of Toronto. The expenses to this conference are paid by the Department of National Health.
DOMINION-PROVINCIAL CONFERENCE.
The Provincial Health Officer also attended the plenary Dominion-
Provincial Conference held in August in Ottawa, and the senior staff of the
Provincial Board of Health assisted in the preparation of extensive material
concerning population and statistics in connection with health insurance and
the other problems to be discussed at the conference.
There is an urgent need for more office space to house the central offices of
the Provincial Board of Health in Victoria, which will be provided in the new
building to be constructed as soon as materials are available.
THE COMMUNICABLE DISEASE REGULATIONS.
New communicable disease regulations were passed by the Provincial Board
of Health (the Lieutenant-Governor in Council) and now are the official Communicable Disease Regulations for the Province of British Columbia. A great
deal of study was necessary in preparing these regulations and they now provide
control measures that are up to date, eliminating many of the irksome controls
that existed in the past.
LOCAL HEALTH SERVICES.
Although no new Health Units were established during the year, considerable extension of existing Health Units took place to provide for full-time health
service for more people in the Province. Considerable study was given to the
method of financing Health Units and a revised plan was outlined, which will
simplify this procedure considerably. This plan will make it possible for municipalities and other local areas to know the exact local costs of health services
over a period of years, the only changes being brought about by an increase or
decrease in population.
Four new public health nursing services have been established and other
public health nursing services have been expanded to cover more territory.
Provision was made in the estimates for two full-time dentists to serve the
rural parts of the Province of British Columbia, but unfortunately to date it has
been impossible to obtain personnel to fill these positions.    However, some prog- BOARD OF HEALTH REPORT, 1945. C 13
ress has been made in expanding the dental programmes, and it is hoped that
in the near future more children's dentistry will be made available to the various
parts of the Province now without this service.
Dental programmes in the City of Vancouver, Burnaby, and the City of
Victoria have continued to operate on an increasingly satisfactory basis.
The nutrition programme is steadily advancing and more practical
information is being made available to the people through various local outlets,
including local health services, home economists, and community voluntary
groups.
DIVISION OF PUBLIC HEALTH ENGINEERING.
This Division receives many requests for advice or consultative service
from all over the Province concerning water-supplies, milk and food control,
model by-laws for milk, sewage-disposal, and many other phases of environmental sanitation important to the health of the people. It has been difficult
for the Division with its small staff to meet these demands.
In addition to routine procedures and advice to local health services, the
staff of the Division has been engaged in rewriting regulations for food and
drinking establishments, cold-storage lockers, plumbing, septic tank and sanitary privies, lumber, mining, and other camps, and have in addition amassed a
tremendous volume of modern information on these and other related subjects.
DIVISION OF TUBERCULOSIS CONTROL.
Tuberculosis death-rate continues its downward trend, and at the same time
more persons suffering from tuberculosis are being found through the expansion
of the survey and diagnostic clinics provided throughout the Province. A new
tuberculosis clinic was opened in New Westminster during the year to serve
that city and the Fraser Valley.
The demand for tuberculosis hospital beds has continued with the findings
of new cases, and though a temporary seventy-bed tuberculosis ward was opened
in conjunction with the Vancouver T.B. Unit, this is now full and more beds are
planned in a new tuberculosis hospital to be erected in Greater Vancouver.
The bed facilities available in the Province have been even more effectively
used, treating more persons with the existing facilities, thus bringing under control earlier the active cases of tuberculosis and preventing further the spread
of the disease.
DIVISION OF LABORATORIES.
The Division of Laboratories again shows a substantial increase in the
number of tests performed in the same cramped laboratory quarters, which condition, it is hoped, can soon be relieved by the construction of the new Health
building in which the laboratory and the Provincial Health Services will be
housed in more satisfactory and modern quarters.
The quality of the service performed by the Provincial laboratories is of a
very high standard, as proved by tests conducted by the Department of National
Health   in   conjunction   with  the   other   Provincial   laboratories   throughout
Canada.
The work in the branch laboratories at Victoria and Nelson has also
increased during the year. C 14 BRITISH COLUMBIA.
DIVISION OF VITAL STATISTICS.
During the year the administration of the Division of Vital Statistics was
reorganized on a modern basis to more effectively and efficiently carry out the
many and increasing duties required of this Division. Some personnel have
returned from the armed forces to their former positions, which should stabilize
the staff more effectively in this Division in the future.
A National Council of Vital Statistics was organized with representatives
from the nine Provinces and the Bureau of Statistics in Ottawa, through which
Council a great deal of standardization and elimination of overlapping of procedures has already taken place. The Director of the Division attended the
meeting of the Council.
In connection with Family Allowances, a tremendous load was placed on the
Division of Vital Statistics to provide the Dominion with the necessary statistical data that would enable them to establish and maintain Family Allowances.
Besides the many necessary routine procedures conducted by the Division of
Vital Statistics, as shown in their summary report, extensive studies were made
on the health insurance proposals of the Federal Government and a large volume
of statistical data was provided for the Dominion-Provincial Conference.
The method of microfilming vital records, introduced in the Province of
British Columbia some three years ago, has been adopted throughout Canada
and will simplify the submitting of copies of births and deaths to the Bureau of
Vital Statistics in Ottawa.
DIVISION OF VENEREAL DISEASE CONTROL.
An administrative organization of this Division was also undertaken during the year, which enabled the staff to more efficiently meet the demands of the
tremendous increase of cases found suffering from venereal disease and institute
in co-operation with local health services a much more effective control programme. It will be noted from the figures published elsewhere in this report
that more cases of venereal disease are being found and put under treatment
than ever before in the Province. This is the direct result of the extensive programme developed over a period of years by the Division. Just as an increase
of reported cases in the field of tuberculosis is an example of the efficiency of the
programme, so also is an increase in reporting cases of venereal disease.
The co-operation of the medical profession in reporting venereal disease has
assisted in increasing the numbers known and has developed a greater interest
in the treatment of private patients.
The Division of Venereal Disease Control has suffered from a very extensive loss of personnel during the war years, and only toward the latter part of
1945 were some of the shortages made up. Major Monk, one of the Venereal
Disease Control Officers from the armed forces, will join the staff of the Division
early in 1946, and it is anticipated that another full-time Venereal Disease Control Officer will also be available.
More part-time clinical physicians are now assisting with treatment, which
has made it possible to handle the increased number of cases reporting to the
clinics for treatment. BOARD OF HEALTH REPORT, 1945. C 15
The field staff of the Division, in co-operation with the local health services,
has greatly extended case-finding and case-holding facilities, which again has
assisted in bringing more cases under control and treatment. This expansion
was aided by the substantial increase in funds allotted to venereal disease control for the year 1945-46.
Colonel Donald H. Williams, who joined the armed forces to undertake
direction of joint-co-ordinated venereal disease control programme of the three
armed forces and the National Department of Health, returned to the Province
during the year to assume his duties as Director of Venereal Disease Control.
With his duties as consultant for the Department of Veterans' Affairs in dermatology and his private practice, Dr. Williams found the directorship of the Division of Venereal Disease Control too heavy to continue in this position, and his
resignation was accepted with regret, to take effect at the end of the year.
Major W. C. Mooney, who was seconded from the armed forces to take charge of
the Division of Venereal Disease Control during the absence of Colonel Williams, was again promoted to the position of Acting-Director of the Division.
CANCER-CONTROL.
The Provincial Health Services have taken an active part and interest in
the promotion and development of services in the Province in connection with
the important subject of cancer-control. A special item of $25,000 made it
possible to purchase a deep X-ray therapy unit and loan this to the British
Columbia Cancer Institute, a philanthropic organization for the treatment of
cancer cases. In addition, the Provincial Health Services met the deficit of the
cancer clinic or institute.
A special budget item of $25,000 has been placed in the 1946-47 estimates
to aid in the further expansion of cancer-control. Close co-operation is maintained with the Cancer Department of the British Columbia Medical Association and the Provincial Branch of the Canadian Cancer Society. The services
of the Provincial Hospital Inspector have been extensively utilized by the British
Columbia Cancer Institute in connection with a plan of reorganization to provide more service with the facilities available.
CO-OPERATION WITH OTHER DEPARTMENTS OF GOVERNMENT.
Co-operation received from other Provincial services and Departments during the year has been very helpful in meeting many of the problems facing the
Provincial Health Services. Particular mention must be made of the help provided by the Provincial Police in dealing with emergencies throughout the rural
and isolated parts of the Province and in the important field of venereal disease
control. The Department of Education, the Department of Agriculture, the
Department of Public Works, the Lands Department, and others have all
assisted in the work of the Provincial Health Services. The Social Assistance
Branch of the Provincial Secretary's Department in their co-operation have
made it possible to satisfactorily deal with many problems.
Excellent co-operation has been received from the teachers throughout the
Province, local health services, School Boards and Councils, and the medical and
dental, legal, veterinarian, and pharmaceutical professions. C 16 BRITISH COLUMBIA.
Attention is directed to the loyalty, co-operation, and outstanding service
provided by the technical and other employees of the Provincial Board of Health
and the public health workers throughout the Province. Without their loyalty
and outstanding contribution to the welfare of the people, it would have been
impossible to have met the health demands which developed during the war
period. If the same high calibre of trained public health personnel can be
obtained, together with the small amount of funds necessary for expansion, the
future of preventive services for the people of the Province is assured.
THE HEALTH OF THE PEOPLE OF BRITISH COLUMBIA.
The health of the people of British Columbia is reflected only to a certain
extent in the mortality figures for 1945, and care should be exercised in studying
these if correct impressions are to be gained. The preliminary death-rate in
1945 was 10.4, which was a decrease of 0.5 death per 1,000 population over the
previous year. There is again a slight increase in the actual number of deaths
at ages 60 and over, 6,034 in all. Over one-half (61 per cent.) of the total
deaths in the Province were in this age-group; 19 per cent, were of persons
between the ages of 40 and 59; 7 per cent, between the ages of 20 and 39; and
13 per cent, under 20 years of age.
Maternal and infant mortality rates have both shown increases during the
year under review. There were 810 infant deaths (children dying under 1 year
of age) in British Columbia in 1945. This figure represents 63 per cent, of
deaths under 20 years of age. The preliminary infant mortality figure was
40.03, which is an increase of 2.4 per 1,000 live births over the figure for the
previous year. There were 53 maternal deaths in 1945, giving a provisional
rate of 2.6 per 1,000 live births, an increase over the 1944 rate, which was 2.4.
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 3,201 in all. Cancer was the second leading cause—1,399
persons died of this disease. Third cause was intracranial lesions of vascular
origin, including cerebral haemorrhage, embolism, thrombosis, and paralysis,
which accounted for 770 deaths. Accidents were the fourth cause of death,
taking 761 lives. This was an increase of 105 deaths due to this cause over the
number in 1944. Especially notable is the large increase in the number of
deaths due to conflagration and accidental burns; deaths due to the former were
almost doubled and there were three times as many deaths due to the latter in
1945 as compared with the previous year. There also were sizable increases in
deaths in water transport accidents and deaths due to mechanical suffocation.
Tuberculosis ranked fifth as a cause of death—518 persons died in the Province from tuberculosis in 1945. This gives a provisional tuberculosis mortality
rate of 54.6 per 100,000 population, a decline of 35 from the previous year. If
Indian deaths are excluded, the provisional tuberculosis rate becomes 38.5. BOARD OF HEALTH REPORT, 1945. C 17
Pneumonia ranked sixth as a cause of death, followed closely by nephritis.
Diseases of early infancy was the eighth cause, while diabetes was ninth and
suicide tenth.
There was a very marked decrease in deaths from influenza in 1945. In the
year under review there were only 48 deaths from this cause as compared with
121 in 1944.
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; 31 per cent, were under 1 year
of age; and 43 per cent, were under 5 years of age.
Twenty-seven 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 were 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 can not 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 injury at birth and fourth was
pneumonia.
Among pre-school children accidents were the leading causes of death,
accounting for 36 per cent, 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 tuberculosis and
pneumonia 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 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 C 18 BRITISH COLUMBIA.
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.
Diseases of the heart and arteries ranked first in the ages over 60. The
second cause of death in this age-group was cancer, intracranial lesions was
third and nephritis fourth.
Despite a very considerable decrease in the number of deaths from
influenza, meningitis, and whooping-cough, there was an increase in deaths
from measles, erysipelas, and paratyphoid fever.
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 22, 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. 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, 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, not only in war-time but as the
basis for building a sound post-war health programme.
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.
The writing of this report brings to a close another year of work in local
health service in British Columbia; 1945 has been a year of varied activity in
this particular field.    Numerous health problems of one type and another have continued to occur for a number of reasons, not the least of which has been the
continuation of activities directly related to the war, for the greater part of the
year. Again, it has meant the making of adjustments and readjustments from
time to time with regard to policies and personnel in order that as efficient and
as effective a health programme as possible might be carried on for the protection of the people in British Columbia. In spite of all difficulties, it is generally
felt that the standard of work has not been lowered, but on the contrary has
been well maintained and in certain instances advances made which can be
definitely considered as progress achieved. The highlights of the various
phases of the work will be dealt with under the headings which follow:—
PUBLIC HEALTH NURSING.
The report of the Director of Public Health Nursing is appended herewith
and gives a broad picture of the activities in this phase of public health work
in the Province. This report deals for the most part with the area outside of
the Greater Vancouver and Greater Victoria areas. It also outlines the experience during 1945 re the changes in personnel, new policies established during
the year, revision of records, and difficulties in the matter of providing transportation in rural areas.
It is a matter of satisfaction to note that during 1945 four new public
health nursing districts were established in the Province. These were in the
Tsolum-Campbell River area, the Municipalities of Surrey and Langley, and
the City and Municipality of Salmon Arm. The public health nursing service
in the latter city and municipality was an extension of the North Okanagan
Health Unit. A number of established public health nursing services were
expanded to cover more territory as neighbouring communities realized the
value of a public health nursing service. Further details about this are given
in the appended report of the Director of Public Health Nursing.
There still exists an acute shortage of Public Health Nurses, which makes
it impossible at the present time to open up a number of additional new areas
where the communities are both interested and anxious to have such a service,
and are willing and ready to carry the cost of finance when qualified Public
Health Nurses do become available. It "is hoped that the markedly increased
enrolment in the public health nursing course at the University will help somewhat in relieving the shortage during 1946. During 1945 it was necessary,
for example, because of the shortage of Public Health Nurses to close the Williams Lake Public Health Nursing Service for a period of time, and in other
areas to approve the appointment of nurses untrained in public health as a temporary expediency. The Public Health Nurses in the field at the present time
are worthy of the highest commendation for the willingness and cheerfulness
with which they have carried on during the past year in spite of heavy burdens
and inconveniences in many cases.
As was mentioned in last year's report, it was necessary during 1944 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 situation has had to be continued during 1945
because of the continued shortage of public health physicians. C 20 BRITISH COLUMBIA.
The News Letter from the Provincial Board of Health to the Public Health
Nurses throughout the Province has been forwarded monthly from the central
office and has continued to serve as a valuable medium of instruction and
education. Unfortunately, it has not been used to its fullest extent as a medium
for exchange of information covering the experience, ideas, and suggestions of
the Public Health Nurses located in various parts of the Province. It is anticipated that some revision of policy concerning this publication will take place
during the coming year, and further details concerning this expected change
are given under the section of Public Health Education.
The acceptance by local School Boards and Public Health Nursing Committees of the recommended salary schedule for Public Health Nurses has been
gratifying to this Department. While all the Public Health Nurses have not
yet had their salaries rearranged in line with the new schedule, nevertheless
this is taking place as rapidly as possible, and in general one of the much
argued and much debated problems of the past year is rapidly being solved.
Efforts are still continuing to arrange a plan for superannuation for public
health personnel in the field, and at the present time the prospects do look
somewhat brighter than in the past.
Again, the annual Institute for Public Health Workers was held just prior
to the Easter holiday, and followed in a general way the programme of previous
years, with a considerable amount of time being allowed for group discussions
on topics of current interest. Reports of these discussions were read to the
whole assembly by the chairman of the discussion group the following day so
that all might benefit from the various points brought out by the particular
discussion groups. Again, the majority of the talks were given by the technical
staff of the Provincial Board of Health dealing with matters of practical interest
and concern to the field-worker.
Two or three innovations of interest were tried out this year. For example,
the statistical clerks of Health Units were brought to Victoria for the meetings,
and it is felt that they gleaned something of value from listening to the various
discussions covering the gamut of public health activities from policy on the
one hand to problems on the other. One afternoon was set aside during which
Health Unit Directors met with the Provincial Health Officer to discuss matters
of policy and administration, the Public Health Nurses met as a group to discuss
matters of interest and concern to them, the Sanitarians met with the Director
of Public Health Engineering for discussion of problems incident to their field,
and the statistical clerks met with the Director of Vital Statistics for a discussion on charts and Health Unit statistics districts.
Further, for part of another afternoon all Health Unit personnel met with
a panel of senior officials from the central office of the Provincial Board of
Health to discuss various phases of Health Unit administration and correlation
of procedure as between the local health services and the Provincial Board of
Health. At the same time the Public Health Nurses met with the Director of
Public Health Nursing to discuss similar subjects, with particular reference to
the field of public health nursing. It was agreed by all that the four days per
year spent this way were very worth while and that much benefit by way of
stimulation and new ideas was obtained. BOARD OF HEALTH REPORT, 1945. C 21
It is the hope of the Provincial Board of Health that it may be possible
some year to try out an entirely different type of annual Institute, whereby
an outside public health authority may be invited to conduct the whole programme, covering some large subdivision of public health work. This would
be carried on by means of lectures, demonstrations, and group discussions.
If it is possible to secure one of the outstanding authorities who have already
been contacted in the United States, it may be possible to execute such a policy
for the Institute in 1946.
SCHOOL MEDICAL SERVICES.
It was mentioned in last year's report that by the end of June, 1945, all
school children will have been examined since the new policy re school medical
examination was first instituted. Under this policy only children in Grades
I., IV., VII., and X. are examined as a routine measure and, in addition, such
other children from other grades as are referred by the teachers or the Public
Health Nurses to the School Medical Inspector. This procedure was made
necessary, as outlined previously, because of the continued shortage of physicians and also because of the heavy burden of extra work which all those in
civilian practice have been carrying during the war years. These conditions
still hold, and sufficient physicians have not yet been released from the armed
forces to alter materially the picture as far as the rural areas are concerned.
It was therefore deemed advisable to continue the same policy in effect during
the school-year 1945-46.
The new report forms mentioned in previous reports, and in which the
pupils of the various grades are categorized in so far as their health status is
concerned, have continued to prove practical, and as experience has increased
with the use of these forms, the completeness of recorded information has also
improved. Analysis of the figures from these reports will be given in the
Medical Inspection of Schools Report for the Year 1944-45.
The policy of endeavouring to classify school pupils by physical status and
the new school report form just mentioned have aroused considerable interest
in numerous other centres of the North American Continent. A number of
communications have been received from such centres, in which it has been
stated that the policy in effect in British Columbia to-day represents definitely
a forward step.
Time must also be taken at this point to state a word of appreciation to
the School Health Inspectors for the interest which they have shown and their
co-operation during the year just ended. The time that these men have given
to school health work is much appreciated by this Department. Their willingness to make special trips to schools and also to investigate on request reports
on outbreaks of communicable disease in such schools has been of very material
assistance.
One of the highlights of 1945 in this particular field was the introduction
of a new form covering environmental sanitation of schools. The Division of
Public Health Engineering has worked on this form for some time and it represents a very considerable departure from the simple type of report form previously in use. As the School Health Inspectors become familiar with it, they
will realize it does not take a great deal of time to complete and that it does C 22 BRITISH COLUMBIA.
present a much more complete picture of the school environmental sanitation
than was possible in the past.
NOTIFIABLE DISEASES.
A table on pages 111-114 shows the number of reported cases of notifiable
disease. The total number reported—namely, 27,588—represents a slight increase from that reported during the previous year. In 1944 the figures showed
a total of 25,076 cases reported. The year 1945 has thus continued to be a
favourable one in general for British Columbia in so far as communicable disease is concerned. The movement of population, together with overcrowding
in all the large centres throughout the Province, has not materially changed
during the year, but in spite of this there has been no widespread outbreak of
any particular disease other than chicken-pox and measles. During 1944 there
were slightly more than 5,000 cases of chicken-pox reported and during 1945
practically the same number of cases was reported. These were not concentrated in any one centre of the Province but were scattered fairly well through
the whole Provincial territory.
Measles frequently runs in cycles of four to five years. This was fairly
generally true in British Columbia until the war years; 1937 was a peak year
with 30,923 cases and four years later in 1941 there were more than 15,000
cases of measles reported. There was some decline in 1942 but again in 1943
more than 8,000 cases were reported. There was a marked reduction in 1944
to just less than 1,500 cases but again in 1945 a very marked rise to slightly
more than 9,000 cases were reported during the year. Again, these cases were
reported from no few centres in particular but from every corner and part of
the Province during the year. It is interesting to note that measles and chicken-
pox together make up close to 50 per cent, of the notifiable disease reported
during the year.
Cancer showed an increase of reported cases from 1,220 in 1944 to 1,979
for the year just ended. This figure by itself, as has been pointed out in previous reports, does not have a great deal of significance since the incidence of
cancer in the general population is not accurately known. The difference between these two years might be accounted for to a degree by a greater number
of people taking advantage of such diagnostic services as are available to them.
Cerebrospinal meningitis reached a peak of 138 cases in 1941 and since that
time has shown an annual decrease. During 1944 there were 47 cases reported
and during 1945 a still further decrease to 25 cases has occurred. Dysentery
(all forms) showed a very considerable rise from 79 cases last year to 207
cases during 1945. A certain amount of this increase can be credited to the
policy in some of the larger hospitals of doing routine stool cultures on all
patients suffering from diarrhoea.
No cases of botulism were reported during the year.
Paratyphoid fever showed a considerable increase from 11 cases for the
previous year to 28 cases for the year just ended. It is of interest to note that
25 of the cases were reported from Quesnel and district as occurring during
one outbreak. Unfortunately, it was not possible to accurately locate the source
of this infection. This year infections of the Salmonella type are not included
under the heading of Paratyphoid Fever.   In fact, all types of Salmonella infec- BOARD OF HEALTH REPORT, 1945. C 23
tion are listed separately under the heading of Salmonellosis. Of this type of
infection there were 46 cases reported during the year. Of these, 39 were
reported from the Greater Vancouver area. This does not mean that there
is necessarily more of this type of infection in Vancouver than elsewhere,
but a considerable amount of study has been done by the health authorities in
the Greater Vancouver area in co-operation with the Division of Laboratories
of the Provincial Board of Health. This has resulted in the uncovering of
a number of cases of this disease and also a number of carriers who otherwise
would have been unidentified.
Epidemic hepatitis has again shown an increase, a total of 390 cases being
reported for the year. In the past, no doubt a number of cases of this disease
occurred, but it is only within the last year or two that they have been reported
by Medical Health Officers. There is a definite increase in interest in this
disease, as evidenced by the number of communications which have been received from physicians during the year. Mumps showed a 50-per-cent. decrease,
there being only 1,050 cases reported during the year.
Poliomyelitis (infantile paralysis) showed a very considerable increase
from 18 cases in 1944 to a total of 51 cases during the current year. Again,
this Province can be considered fortunate in the relatively small number of
cases that occurred in view of the fact that there was a widespread epidemic
of this disease in the State of Washington during the year. Rubella (German
measles) also showed a considerable reduction, there being only 737 cases
reported during the year. Scarlet fever was unusually low, there being only
1,009 cases reported during 1945. Unfortunately, there was an increase in the
number of cases of tetanus reported, there having been only one case during
1944, but 5 cases during the year just ended.
Septic sore throat increased from 219 cases previously to 365 cases during
1945. It is interesting to note that 103 of these cases were reported from the
City of Salmon Arm, where a widespread outbreak occurred during the spring
of the year and lasted over two months. The origin of this outbreak was
finally traced to one dairy supplying raw milk and at which the people engaged
in the handling of milk had had a series of septic sore throat infections. This
epidemic again demonstrates the potential danger of raw milk and adds another
chapter of evidence in favour of the use of safe milk, which means only powdered, evaporated, or pasteurized milk.
Toward the end of the year 90 cases of septic sore throat were also reported from Powell River and the evidence to date also makes this appear to
be a milk-borne epidemic of a rather severe type. Septic sore throat is usually
due to a streptococcus type of infection and this organism together with its
toxin may, in the human body, give rise to various symptoms, among which
are the septic sore throat syndrome, a scarlet fever type of rash, rheumatic
affection of the joints, and rheumatic disease of the heart. In this particular
epidemic at Powell River all of these results of streptococcic infection were
manifest. It is unfortunate indeed that it requires epidemics of this type with
accompanying suffering and crippling to have communities realize the potential
health menace of raw milk.
Typhoid fever showed a reduction in the number of reported cases from
34 for the previous year to 5 for the year 1945.    The cases that did occur were C 24 BRITISH COLUMBIA.
not lumped in any one area of the Province but were scattered throughout the
various centres of population.
As was forecast in last year's report, the new Regulations for the Control
of Communicable Diseases were brought into effect early in 1945. They have
so far proved to be quite practical and there has been no major difficulty in
their application. There are minor changes that will have to be made in the
wording of certain sections in order to overcome a certain ambiguity, but in
general they would appear to be serving their purpose quite well.
Diphtheria unfortunately showed an increase from 17 cases previously to
36 for 1945. The fact that any cases of this disease should occur is unfortunate when to-day it is a preventable disease. The discovery late in the year
of a number of diphtheria carriers in Vancouver only serves to strengthen the
argument that immunization against this disease is highly important in order
to protect the infant and young child. No less important is the reimmuniza-
tion of pre-school children in order to make sure that their immunity is maintained at the highest protection level possible.
FULL-TIME HEALTH SERVICES.
It has usually been possible in this section of the report to make reference
to the establishment of a new Health Unit as having been opened up during the
year. However, 1945 saw no such development in local health services in British Columbia. This was not due to any lack of interest on the part of a number
of areas in the Province but rather directly due to the fact that nowhere in
Canada was it possible to secure the services of trained and qualified public
health physicians to assume positions as Directors of Health Units. In spite of
this difficulty, considerable developmental work has been done and at least two
areas and possibly three in the Province are ready to support a full-time local
health service in the form of a Health Unit when qualified personnel become
available. It is hoped that such personnel will become available during 1946
and that the coming year will see additional Health Units developed in British
Columbia. The East Kootenay area, including Cranbrook, Fernie, Kimberley,
Creston, and the surrounding territory, has been interested for a considerable
period of time in the establishment of a Health Unit for that section of the Province. It is likely that this is where the first new Unit will be opened up. There
is also considerable interest in Health Unit service in the Chilliwack-Abbotsford
area, as well as the Prince George district.
The North Okanagan Health Unit, which was commenced in October, 1944,
and which was mentioned in last year's report, has made satisfactory progress
in establishing a generalized public health programme in the City of Vernon and
some of the surrounding territory. Unfortunately, it has not yet been possible
to bring under the administration of this Unit all the territory originally
planned because of a lack of appreciation of the value of Health Unit services
by certain communities in the area concerned. However, progress is being
made and it is hoped that during 1946 the entire territory served by this Health
Unit will be considerably extended. Following the outbreak of septic sore
throat in the City of Salmon Arm, there was an increased interest in full-time
service, and the result was that both the City and Municipality of Salmon Arm
in the fall of this year became a part of the territory served by the North BOARD OF HEALTH REPORT, 1945. C 25
Okanagan Health Unit. There is considerable interest in this type of local
health service in the City of Armstrong and the Municipality of Spallumcheen
which it is hoped will be crystallized into action before long. It is unfortunate
that in spite of the abundant evidence in the past it still requires epidemics to
outline to communities the cheap cost of prevention through the establishment
and maintenance of an effective local health service.
Unfortunately, during the summer of 1945 Dr. R. G. Knipe saw fit to
relinquish the position of Director of the Prince Rupert Health Unit to return to
the practice of therapeutic medicine. This left the Prince Rupert Health Unit
without a Director, a vacancy which it has not yet been possible to fill because
of the shortage of public health physicians. Arrangements were made with
one of the physicians in the city to carry on as Medical Health Officer and
Acting-Director of the Health Unit on a part-time basis. The kind co-operation
of Dr. W. S. Kergin in this regard is much appreciated.
As was mentioned earlier in this report, it has been necessary to continue
temporary arrangements with regard to the Peace River Health Unit whereby
Mrs. Pauline Yaholnitsky, Public Health Nurse, has acted as Supervisor of the
Peace River Health Unit, and as such to carry on the duties of Acting-Director.
It is hoped that it will not be necessary to continue this arrangement very long
during 1946, with the hope that public health physicians may become available
early in the new year. Mrs. Yaholnitsky is to be congratulated for the splendid
way in which she has carried on the supervision of the activities of the staff
of this Health Unit in spite of numerous difficulties and problems which have
arisen from time to time. It was possible during the year to increase the
public health nursing staff by one nurse, and while this relieves the situation
somewhat there is still urgent need for another Public Health Nurse on the
staff of this Health Unit. To the personnel of this Unit, and particularly the
Sanitarian, should go full credit for the marked improvement in restaurant
sanitation which has taken place during recent years in the main centres of
population in the Peace River District of the Province.
The Okanagan Valley Health Unit was expanded somewhat by the addition
to the area covered of Allen Grove in the south and Oyama in the north. This
Unit has continued its usual high standard of generalized public health programme, with considerable emphasis on immunization during the year just past.
A further step was taken in consolidating administration within the Health Unit
area toward the end of the year when the Penticton School Board agreed to have
the Public Health Nurse, formerly employed by them, to be employed by the
Union Board of Health. This leaves only one Public Health Nurse in this
Health Unit area not being directly employed by the Union Board of Health.
When this occurs all local health services will then be under the direct supervision of the Health Unit Director. During the year the Kelowna School Board
agreed to have immunization work in the school carried on by the Health Unit
Director. The shortage of Public Health Nurses has made it extremely difficult
for this Health Unit to provide as effective a service in the Kelowna rural area
as might be desired because of the heavy burden being carried in that area by
the one Public Health Nurse. Another Public Health Nurse is urgently needed
in this particular district. C 26 BRITISH COLUMBIA.
The Central Vancouver Island Health Unit staff have continued their investigation into what were formerly accepted as routine procedures, with a view to
determining their time factor versus their effectiveness. This group of public
health personnel have also been responsible for putting together a pre-school
programme, together with three booklets which are outstanding in their simplicity but thoroughly sound in content and method of application. The staff of
this Health Unit are to be congratulated on their forward and progressive views
with regard to Health Unit policies and practices.
The Saanich Health Unit, serving the Municipality of Saanich, has carried
on an effective generalized public health programme, and various members
of the staff have assisted the central office of the Provincial Board of Health
from time to time in the revision of various record forms in use throughout the
Province.
In the City of Victoria it is interesting to note that during the year amalgamation was brought about between the school health services and those of
the city health department. It is anticipated that in 1946 Dr. J. L. Murray
Anderson will assume the directorship of this joint service. It is hoped that the
Municipality of Esquimalt will join with the City of Victoria in making the first
step toward the formation of the Greater Victoria Metropolitan Health Area.
For several years the question of budgets for Health Units has been a
problem. The budgets of many of the earlier Health Units were not arranged
on any set plan but rather on whatever agreement could be arrived at with the
local area concerned. This has meant that there has been no*uniform plan as
between Health Units. In addition, local costs both as between Health Units
and also as between local areas in any one Health Unit have varied considerably.
In an endeavour to equalize local costs to a certain extent in proportion to
responsibility the Provincial Board of Health has contributed 25 per cent, of the
cost in organized territory and 75 per cent, in unorganized territory. However,
this has not been entirely satisfactory. Furthermore, because the Health Unit
personnel are employed locally it has not been possible to date for any superannuation plan to be made applicable to them and, further, it has also made more
difficult the transfer of personnel from one area of the Province to another when
this has been desirable or necessary. It would appear logical to state that the
time has arrived for a complete revision of the method of Health Unit financing
whereby a fixed flat rate would be the basis for local contribution with a variation in rates between organized and unorganized territory. It would also seem
desirable to have Health Unit personnel employed by the Provincial Board of
Health if at all possible. This would make for greater facility in the transfer
of staff and also, it is hoped, would lead to some arrangement whereby superannuation could be made available to these public health workers.
During the year a request was made by the Connaught Laboratories, of
Toronto, as to whether it might be possible to utilize in Health Unit areas a new
type of immunization material against scarlet fever. It was possible to arrange
for this work to be carried out in the Okanagan Valley Health Unit, the North
Okanagan Health Unit, and the Central Vancouver Island Health Unit. This
work is rapidly nearing completion and the results would tend to indicate that
the new product is superior to the old in so far as relative immunity is concerned,
and also has the further advantage that only three doses are required instead of BOARD OF HEALTH REPORT, 1945. C 27
the usual five.    The results will be available early in 1946 and will be more fully
reported on in next year's report.
Again, the many part-time Medical Health Officers throughout the Province
are to be congratulated for their splendid co-operation and help during the past
year. The amount of time and effort which some give to public health work
and the health problems of their areas has been much appreciated. It has been
possible during the year just ended to have senior officials from the central office
of the Provincial Board of Health visit local areas a little more frequently than
in the past, and this has been the means of clarifying a number of problems for
Medical Health Officers in the field. Further, it has also been possible to bring
more assistance this year to a number of Medical Health Officers where outbreaks of communicable disease have occurred and where the resident physician
has not had time to make proper epidemiological investigation.
PUBLIC HEALTH EDUCATION.
This year has been a very active one in the field of public health education,
not only for the various Divisions but also for the central office of the Provincial
Board of Health. All senior officials on numerous occasions have met and held
sessions with community groups, including Municipal Councils and School
Boards, Parent-Teacher Associations, Boards of Trade, and other official and
voluntary groups.
It was mentioned in last year's report that it had been possible to secure
a fellowship from the W. K. Kellogg Foundation for postgraduate training in
public health. Miss K. McNevin will return to British Columbia at the end of
the year and will commence her work as Public Health Educator on the staff of
the Provincial Board of Health in January of the new year. It was originally
planned that Miss McNevin would assume the position of Public Health Educator in one of the Health Units, but because of the volume of work to be done
in this particular field in the central office it has been necessary to change the
original plan and consider a Public Health Educator for Health Units as a later
development.
Miss McNevin will have among other duties the critical appraisal and revision of all public health literature distributed by the Provincial Board of Health,
as well as assembling of the monthly bulletin and the News Letter to the
Public Health Nurses. Plans at the present time call for the monthly bulletin
to be changed into a medium for the distribution of current, popular health
material to the public and the former News Letter to become a technical
bulletin for distribution to all field public health personnel. It is anticipated
that this will overcome a number of deficiencies which are evident at present
with reference to these two publications. The Public Health Educator will also
supervise the central library of the Provincial Board of Health and will be available in a consultant capacity to Health Units, with particular reference to not
only their library but an effective public health education programme.
The usual series of lectures to the students at the Provincial Normal School
in Victoria was given in the spring of 1945. They were given by senior technical officials of the Provincial Board of Health and, while modified somewhat
from previous years, were given with a view to acquainting the students with
. C 28 BRITISH COLUMBIA.
public health administration in British Columbia both on the Provincial and
local level. An endeavour was made to give as practical information as possible
so that the prospective teacher could see how she might best assist in making the
local health programme as effective as possible in her community and in her own
school in particular. 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.
The Consultant in Nutrition has continued her extensive and energetic programme on health education in the field of nutrition. An attempt was made this
year to work more closely with Health Unit personnel in order to have people jn
areas served by Health Units come to look upon their local health service as
the source of authentic information on all phases of public health work. The
addition of two Nutritionists to the staff to assist the Consultant has helped
materially in expanding this phase of the work. The appended report by Miss
Baldwin gives more detail of the variety of work carried on in this field of
public health.
A considerable number of letters to expectant mothers has again been
sent out during the year. This has been made possible, as before, through the
co-operation of the Canadian Welfare Council. During 1945 more than 3,600
prenatal letters were sent to 400 expectant mothers who requested this service.
Postnatal letters covering the first year of the baby's life were sent to 2,516
mothers who requested them, a total of almost 30,200 postnatal letters being
forwarded. The series of letters covering the first year of the baby's life is
also made possible through the co-operation of the Canadian Welfare Council.
However, with the kind permission of this Council the Provincial Board of
Health has somewhat revised and re-edited this series, and it is expected that
in 1946 the Provincial Board of Health will publish the new series of letters
covering the child's first year. Requests for letters covering the pre-school age
totalled 570, while those for the school age totalled 239. It must be pointed out
that the above figures relate only to the area outside of the Greater Vancouver
Metropolitan Health Area as requests from people of this area are handled
locally.
It is of interest to note that a Film Liaison Committee has been set up as
between the National Film Board and the Department of National Health and
Welfare. This Committee has previewed a very extensive list of films and provided the Provincial Health Departments of Canada with copies of the lists of
films previewed, together with comments on the contents and value of the films.
The best of these films have been purchased and from them a preview library is
being built up in Ottawa. Copies of these films are made available on request
to the Provincial Health Departments for preview with a view to determining
whether the Department wishes to purchase such films or recommend them for
purchase to local health services. This is a very splendid development and of
considerable assistance to the Provincial Health Departments in helping them
to keep in touch with what films become available from time to time and through
what sources they are available.
The Provincial Board of Health has already screened a number of the
recommended films and is making arrangements for screening more of them early in the new year. A few new films have already been added to the film
library and it is anticipated that more will be added during the coming year.
The films are available on request to the local health services throughout the
Province for short periods to assist them in their public health educational
programmes. A close working relationship is also being established with the
regional representative of the National Film Board in British Columbia with a
view to determining how best the rural and industrial film circuits might be
utilized for public health education purposes.
PREVENTIVE DENTISTRY.
The situation with regard to preventive dentistry remains identical with
that of last year. Outside of the Cities of Vancouver and Victoria, to the best
of our knowledge there is only one local dental clinic operating on a more or less
permanent basis. In many of the rural areas there are still no dentists available, 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 particularly
interested in this phase of the work have given some of their time so that a
dental clinic for pre-school children and the lower grades of school children
might be carried on for a short period. Their help and co-operation in this
regard is much appreciated.
With the release of dentists from the armed forces, it is hoped that it may
be possible to interest a number of young men in public health preventive dentistry so that this type of service may be brought to much of the rural territory
throughout British Columbia. The majority of communities realize, more than
ever before, the need for some form of preventive and periodic dental care. One
sees on every hand the great need for a very drastically increased number of
dentists in order to bring this essential service to the people in the rural areas
and to assist in overcoming the terrific number of untreated dental caries which
has accumulated during the war years as a result of the acute shortage of dentists. A logical development would appear to be a public health dentist as a
staff member of each Health Unit or serving two Health Units, devoting his
entire time and attention to the pre-school children and the lower grades of
school children in the area served by the Health Units. It is hoped that such a
development may not be too far distant in order to make real progress in restoring and adequately maintaining the dental health of the future citizens of this
Province.
REPORT OF THE DIRECTOR OF PUBLIC HEALTH NURSING.
Miss Dorothy E. Tate, R.N., B.A.Sc, M.A.
Among the notable signs of progress during 1945 have been an increase in
the number of districts receiving public health service, initiation of new
emphasis on programmes, and advancement in educational work. Events of
the year have kept every one exceedingly busy adjusting to the demands made
of them professionally and personally. Now, at the end of the year, the
opportunity is taken to review the work of the year and foretell activities for
the coming year. It has been of some significance that until recently 80 per cent, of the
people of British Columbia have been in receipt of public health nursing service.
The service has expanded again this year to include three of the larger rural
municipalities. Another municipality wishing to have Health Unit services
was sufficiently large to require the full-time services of a Public Health Nurse.
Two districts in which it was necessary to temporarily suspend public health
nursing service last year due to lack of staff have again been reopened as additional Public Health Nurses were obtained this year. This brings the number
of public health nursing districts to forty-five, which means that 85 per cent,
of the population of British Columbia is now receiving a recognized type of
public health nursing service. A public health nursing district may or may not
be confined to one city or larger centre; it may be a municipality or it may
serve a section of unorganized territory, or any combination of these three. The
determination of district boundaries depends upon a number of factors, such as
the size of the population, its distribution, roads, facilities, and conditions for
travelling. It is interesting to note that all new services are instigated by the
people of the communities. Activities of the Public Health Nurse demonstrate
the value of public health service and thus provide opportunities to explain the
increased value of Health Units. As a result, the interest in the more complete service is stimulated and Health Unit organization follows. A centre having public health service passes on its feeling of satisfaction for the type of
service directly to adjoining areas and also indirectly by movement of its members to communities where there is no public health service. On request, assistance is given by the Department of Health regarding methods of interesting
citizens in obtaining public health service by outlining the scope of the service,
by suggesting an economic budget, equipment necessary, and means of obtaining it, and by recommending a satisfactory local administrative group. Policies
regarding employment of staff and those governing working-hours, holidays,
educational standards, in-service education, and salaries are submitted for consideration to the communities. Much of the information is given through
correspondence but is followed up by a personal visit of one or more senior
members of the Department to the district. This policy is adopted because of
the desire of the Department to understand the local conditions governing local
needs and to answer the numerous unexpected questions which arise because of
differences in local administration and understanding of public health activities.
The satisfaction of the citizens receiving the service and persons involved in
organizing a district compensates for the effort expended. So it is that gradually the number of unserved areas between districts already organized is being
reduced. Encouragement can be given to many of the interested districts as
public health personnel become available. Under present conditions the supply
of Public Health Nurses is limited and great expansion can not be considered.
PERSONNEL.
Public health nursing in the Province has made progress. Stabilization of
the service has been difficult and only possible because of the whole-hearted
co-operation of the Consultant, Public Health Nursing, the Consultant in Tuberculosis Nursing of the Division of Tuberculosis Control, and the senior epidemiology worker of the Division of Venereal Disease Control.    The specialized BOARD OF HEALTH REPORT, 1945.
C 31
field-workers have given unfailing assistance, not only in their respective
specialized programmes but in the generalized public health service as well.
Their background of generalized service and understanding of field problems
has added to the assistance which they have been in a position to give.
Turnover in personnel has been the greatest problem this year, as it has
been in the past five years. With the increase in staff changes, greater importance has been placed on assistance and stabilization through guidance.
Changes in personnel from 1941 to 1945, inclusive, and percentage increases in
changes of the Public Health Nursing staff of 1945 compared with that of 1941
is shown in Table I., as follows:—■
Table I.—Comparison of Provincial Public Health Nursing Staff
Changes during the Five-year Period 1941 to 1945.
1941.
1942.
1943.
1944.
1945.
Increase during
Five-year Period.
Total.
Percentage.
Positions available.— 	
Total staff changes	
44
26
59
10
8
8
47
31
66
11
9
11
52
37
71
17
12
8
56
33
59
13
11
9
64
48
75
22
16
10
20
22
17
12
8
2
45.1
84.6
28.8
120.0
100 0
25 0
The " positions available " are shown from 1941 to 1945. Generally, the
opening of a new district or an addition to staff requires additional personnel.
However, it was necessary in a few cases to meet more critical situations in
some areas by reducing staffs in other areas. The increase shown in this
category, therefore, does not necessarily correspond with the increase in new
public health nursing districts.
In 1945 there were sixty-four positions available to Public Health Nurses
for which a total of forty-eight changes were necessary. Although the 75-percent, turnover at first seems very high, it is not more than one would expect,
coming at the end of nearly six years of war. The change of marital status of
many of the Public Health Nurses and the increase in districts wanting public
health service accounted for the majority of placements necessary. There were
sixteen resignations: One by reason of marriage, eight married nurses wishing
to return to their homes, one to enlist in the armed forces, one to accept a position elsewhere in public health, one to accept a position in another field of nursing, two for attendance at University, and two for other reasons. Twenty-two
new appointments were made and ten Public Health Nurses transferred to meet
replacements and new positions opening during the year.
In comparing the changes in Public Health Nurses for 1945 to 1941, it is
noted that varying increases have taken place, the most encouraging being an
increase of 45.1 per cent, in positions available. New appointments have been
120 per cent, higher than in 1941. Resignations for this year have been just
double or 100 per cent, greater than in the year 1941. The new appointments
showing 120-per-cent. increase is the factor responsible for satisfactorily meeting the situation caused by the necessary increase in positions and resignations. C 32 BRITISH COLUMBIA.
Will the next five-year period show the same trends? The increasing
interest in prevention of illness and maintenance of sound health through public
health methods indicates that the programme will show continuous growth.
In reviewing the records of the presently employed Public Health Nurses,
notice is drawn to the fact that 31.2 per cent, have been field staff members for
less than one year, 45.3 per cent, have been in the field from one to five years,
18.8 per cent, for from five to ten years, and 6.3 per cent, over ten years.
Table II.—Length of Service of Public Health Nurses in Provincial Public Health Nursing by Number of Years of Service, December, 1945.
«■ vr     t. PerCent.
Years of Service. Number. 0f Total.
Under one year   20 31.2
One year   9 14.8
Two years   8 12.5
Three years   7 10.9
Four years   4 5.5
Five years  1 1.6
Six years  2 3.1
Seven years   4 5.5
Eight years   4 5.5
Nine years   1 3.1
Ten years   1 1.6
Eleven to fifteen years   2 (13, 15)      3.1
Sixteen to twenty years   1 (19) 1.6
Total   64 100.0
It can readily be seen from the foregoing summary showing turnover of
staff that adequate supervision is essential if standards are to be maintained.
Increase in supervisory staff is the only solution to meet the total problem. During the past year guidance has been available and planned to meet the most
pressing needs. Every district was visited at least twice and a few more often
during the year, with the exception of the Peace River. The staff in the Peace
River had an opportunity of discussing their problems with the Assistant Provincial Health Officer. New appointees to the staff were given an orientation
period with an experienced Public Health Nurse before assuming the responsibility for their own district. Credit should be given to the Public Health Nurses
who contributed their service in assisting newly employed members through
their orientation period.
EDUCATION.
Although only qualified Public Health Nurses are appointed to permanent
positions, it is necessary for all Public Health Nurses to keep abreast of the
never-ending changes. Continual education is necessary to keep informed of
the latest public health information, to modify programmes, and to contribute
to the drawing-up of policies for field practices. The Institute for Public Health
Workers, held April 3rd, 4th, 5th, and 6th, was again found to be a most practical form of in-service education. The highlight of the Institute was a lecture
given by Dr. J. M. Ewing, " The Balanced Life." Lectures and discussions on
the most closely allied service—Social Service—were enlightening. Papers presented by members from the Divisions of the Provincial Board of Health and 3
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field members provided tangible material which was adopted and put into effect
in the field programmes during the year.
" P.H.N. News and Views " continues to function as the means of exchanging information, emphasis on programmes, and notification of new policies.
A wide scope of subjects which appeared as articles in national and international
journals was circulated by the News Letter. Information which has a Provincial-wide significance, although gathered specifically at the request of individuals, is distributed through 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 the public
health staff through the News Letter. This semi-personal method of interchange of ideas between the field personnel and senior staff has proven its value.
Definite progress has been made in the regional group meetings of the Public Health Nurses and in staff meetings at which each person actively participates. We are indebted to the Vancouver Island Public Health Nursing group
for their discussion and practical suggestions in regard to the new simplified
record forms; to the Fraser Valley group for their revision of the prenatal
letters; to the East Kootenay group, who have simplified home sanitation
problems for Public Health Nurses; to the Okanagan Valley for their wide
variety of reports and specific projects, which were made available Provincially;
to the Peace River for their interest in clarification of personnel policies and
educational facilities. We admire the Prince Rupert, Cariboo, and East Kootenay groups who, in spite of difficult circumstances, held meetings for general
discussion of programmes and problems.
Every encouragement by way of suggestion, financial assistance, and recognition of accomplishments will continue from the senior staff of the Provincial
Board of Health as an incentive to this type of education.
PUBLIC HEALTH NURSING STUDENT PROGRAMME.
Student field experience is provided for public health nursing students from
the University of British Columbia in selected areas served by Public Health
Nurses in the Province to orient the student to a public health nursing programme in a rural community and to provide definite experience in various
phases of a generalized public health nursing programme. During the past
year thirty-two students were given two- and three-week periods of experience
in public health nursing and Health Unit areas. Much credit is given the field
Public Health Nursing staff for their part in making this rural experience possible. Tangible evidence of the value of the work they carried on with students
is shown in the number of students who returned to rural public health nursing
work following completion of their course.
CHANGES IN POLICIES.
A new simplified record system for charting results of educational efforts,
demonstrations, and actual public health nursing services has been in use for
nine months and promises to be the most effective system yet adopted. The
Record Instruction Manual has been brought up to date and clarifies the use of
all public health records now being used in the field.    Review of records resulted BOARD OF HEALTH REPORT, 1945. C 35
in discontinuation of several forms which did not warrant the time and use for
which they were at first intended.
A salary schedule materialized after several years of preliminary planning.
After having been in effect for one year, need for adjustment was necessary to
have a standard adaptable to all Public Health Nurses. The schedule makes
allowance for a probationary period of one year at which the salary is $1,620.
The basic salary of $1,680 is paid at the end of the probationary year. Increases
are then given at the rate of $60 a year for two years and then every other year
until the maximum of $1,980 is reached. Length of service after ten years is
recognized by further increases every five years. A Public Health Nurse may
change her classification by progressing to a senior position for which there is
a salary comparable to the increased responsibility. In the year and a half in
which the schedule has been recommended, all but one district have given favourable consideration to it. Further consideration is expected in this district, and
it is hoped that as a result the salary schedule will be in operation in every public
health nursing district.
Associated hospital services have been made available to public health field
members. Although the number participating was well above that required,
it is expected that others will take advantage of the service next year. Attempts
to obtain medical service through Medical Services Association have been to no
avail as yet. Public Health Nurses desiring medical service seem to want it
very much but as yet have not been able to influence sufficient numbers to meet
the 75-per-cent. membership which is necessary.
The Bureau of Economics and Statistics devised a method by which Public
Health Nurses receive monthly statistical reports of their work as compiled from
the daily reports. The Division of Vital Statistics, Provincial Board of Health,
will be compiling the information in the new year. It is expected that the Division's efficient methods and understanding of public health activities will be
apparent in the statistics made available promptly to the field.
An innovation of a temporary record for noting the amount of venereal
disease work carried on by each Public Health Nurse has been in use for three
months. It is the intention to determine the need of such work in various areas
of the Province and the adjustment necessary to meet the needs of controlling
the spread of venereal diseases. Pertinent items from the temporary report
will be included in the daily report following the trial period.
Success and co-operative efforts are practically synonymous in public health
nursing. Difficulties have seemed out of proportion at times, and it has only
been with the assistance of every Public Health Nurse individually and in group
activities that progress has been made this trying year. Appreciation of every
staff member is expressed for the work carried on to the best of her ability.
PLANS FOR 1946.
To-day the great problem of our organization is that of meeting difficulties
resulting from a shortage of qualified workers, both professional and non-professional. In order to attract more qualified Public Health Nurses, to show
appreciation for past services of employed Public Health Nurses, and so improve
public health service to citizens of a community, it will be necessary to continually increase the attractiveness of public health nursing positions. C 36 BRITISH COLUMBIA.
The principal factors that determine the attractiveness of any jobs seem
obvious. They are financial remuneration, selection on merit, opportunity for
professional development and adequate tools with which to work, and other
reasonable personnel policies. Some of these principles already are claimed as
ours but there are many more to strive for in the coming year.
An evaluation record for Public Health Nurses has been considered for the
near future. It is anticipated that a plan will be drawn up and sent to the field
staff for suggestions which will be incorporated into the revised and final form.
Uniforms, long a necessity for Public Health Nurses, have been supplied in
inadequate numbers because of material shortages. The next year promises a
more satisfactory outlook through better supply of materials. Plans for financial assistance made previously will be reconsidered as the complete uniform
requirements are met.
The appointment of a Public Health Educator broadens the scope of help
which can be extended to every one. Educational material, such as papers,
pamphlets, and posters, will be part of the programme, which will be expanded
and also include co-ordination of educational activities of all Divisions within the
Department.
Plans for health insurance are still being discussed and as yet are only in the
formative stages. New developments will be placed before the Nurses so that
they may be kept up to date and ready to co-operate in the plan as it affects them.
The student programme, which has enlarged through increase in numbers of
nurses working toward their degree or certificate in public'heaith nursing at the
University, and because of longer periods spent in the rural field, will lead to a
discussion of more efficient service to students. Recognizing the additional educational demands which all health organizations have made on them, the Provincial Board of Health expects to utilize offers of assistance made from international groups. The strengthening of the student rural field programme will
undoubtedly lead to a closer correlation of the theory and the practice of public
health.
The Institute for Public Health Workers is anticipated to bring forth assistance from leaders in the Provincial public health field and noted teachers experienced in public health.
Instruction manuals are anticipated to be ready for use within the year.
The Division of Tuberculosis Control has the section on Tuberculosis Public
Health Nursing practically ready for printing. The Division of Venereal
Disease Control has concentrated on reference material for public health
workers and will be presenting instruction for the public health nursing programme in venereal diseases. Other sections of the generalized programme
will be ready in 1946. Information in the public health work of the Cancer
Institute and more detailed assistance on mental hygiene programmes will be
forthcoming following clarification with the respective associations carrying
out corrective measures.
With the continual change and advancement in public health work, it is
imperative to have an understanding and competent person on hand to help in
directing the programmes to meet the needs of the community. For this purpose, three Public Health Nurses with experience, personal and leadership quali- BOARD OF HEALTH REPORT, 1945. C 37
fications, and the opportunity of participating in supervisory courses will be
chosen to give assistance.
This year has been primarily a year of overcoming problems resulting from
years of international conflict. The coming year holds promise of advancement
based on the experience gained in 1945 and determination to complete plans
which will influence public health personnel and programmes.
REPORT OF THE CONSULTANT IN NUTRITION.
Mary F. Baldwin, B.Sc. (H.Ec).
The establishment with the Provincial Board of Health in October, 1942, of
a Nutrition Service with qualified personnel showed recognition of the fundamental importance of proper nutrition for good health. Broadly speaking, the
aim of the Nutrition Service of the Board of Health is to co-ordinate the efforts
of nutrition workers already in the field and to stimulate and assist local health
services to carry on nutrition instruction as part of their regular health programme. The purpose of the programme is to help make Canadians healthier
through the application of well-established principles of nutrition.
ORGANIZATION OF NUTRITION SERVICES.
Federal.
The Nutrition Division of the Department of National Health and Welfare
provides valuable technical advice and services which are not practicable to
maintain on a Provincial level. Through regional representatives stationed
throughout Canada, they also serve as a clearing-house for nutritional information for the Provinces.
Late this year a Dominion-Provincial Nutrition Committee was formed as
a sub-committee of the Canadian Council on Nutrition. This latter is an advisory body to the Federal Nutrition Division. Formation of this new committee
will facilitate bringing purely Dominion-Provincial problems to the attention of
the Federal Nutrition Division.
Provincial.
A Provincial Nutrition Committee under the chairmanship of the Provincial Health Officer was formed in 1943 to co-ordinate nutrition work done in the
Province and advise on the expansion of a broad programme of nutrition education. The nutrition services of the Provincial Board of Health, the British
Columbia Division of the Canadian Red Cross Society, and the Greater Vancouver Metropolitan Health Committee 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 in which to
work.
Nutrition services are maintained by other agencies in the Province not
represented on the British Columbia Nutrition Committee. Nutritionists with
these agencies have been working jointly with those represented on the Committee on several projects during the past year. It is hoped that reorganization of the British Columbia Nutrition Committee may be effected to include all
such agencies with an-established nutrition service. C 38 BRITISH COLUMBIA.
Local.
Although local nutrition committees were formed in a number of British
Columbia communities, these have functioned mainly when the Nutritionist was
working in that community.
Many of the local programmes are carried on directly through public health
staff, teachers, and welfare staff without the assistance of a local committee.
REPORT OF PROVINCIAL BOARD OF HEALTH NUTRITION
SERVICES IN 1945.
Less field-work of the type reported on in 1944 has been carried on in 1945.
Many other services have been extended.
I. CO-OPERATION   WITH   OTHER   GOVERNMENT   DEPARTMENTS   AND   BRANCHES
CONCERNED WITH NUTRITION.
1. Social Assistance Branch.—A resolution from the British Columbia
Nutrition Committee resulted in a request for the preparation of a report on
food allowances and costs. This report has been prepared and is to be considered as a basis for social allowances. The basis for food lists given in the
report is an adequate nutritional standard endorsed by the Canadian Council on
Nutrition. If the report is approved, social allowances for food will be subject
to periodic review to keep them in line with the latest nutritional information
and with current food prices.
2. Department of Education.—Nutritionists with the Board of Health
co-operated with the Department of Education on two projects correlating
nutrition and art. One was a place-mat contest sponsored by the Federal
Nutrition Division and the other a play competition sponsored by the Victoria
Nutrition Committee.
At the present time the Department of Education does not employ a Nutritionist to do work in connection with school-lunch programmes. This work is
supervised and carried out in part by Nutritionists with the Board of Health in
consultation with Department of Education officials.
Up-to-date nutrition information and teaching materials were drawn to the
attention of teachers several times during 1945 through articles contributed to
the Department of Education magazine, " The Rural School." A display of
material useful to teachers was also prepared for the Victoria Summer School
of Education. A number of new teaching aids are in the process of preparation
and will be available to teachers in 1946.
II. Quantity Food Service.
1. Institutional Service.—The feeding facilities and food served in Provincial institutions under the jurisdiction of the Provincial Secretary are inspected
periodically. Such institutions visited during 1945 included the Allco Infirmary, the Provincial Home at Kamloops, and the Boys' and Girls' Industrial
Schools.    This service has also been requested for Provincial gaols.
Certain other centres licensed under the " Welfare Institutions Licensing
Act " were visited with a view to determine what service might be provided.
As a result of these visits, arrangements are being made with the Chief Inspector of Welfare Institutions and Hospitals to have certain information furnished BOARD OF HEALTH REPORT, 1945. C 39
by their Inspectors regarding the food served in institutions and hospitals.
This information will show the necessity of follow-up work on the part of a
Nutritionist.
2. Industrial Plants.—The Federal Nutrition Division is empowered as long
as the war emergency period lasts to inspect food service and facilities in industrial plants on war contracts. The Board of Health has been provided with
records of such inspections in British Columbia so that they will be in a position
to take over this service on a request basis when the war emergency period is
declared over.
3. Cafeteria for Provincial Employees in Victoria.—This cafeteria is managed by a committee of the Provincial Government Employees Association, of
which the Nutritionist with the Board of Health has been chairman for the past
two and one-half years. During 1945 record forms and recipes which might be
useful for quantity food service were tried out in this cafeteria.
4. School-lunch Programmes. — Programmes already under way were
inspected and help given when a Nutritionist was in the district. Since less
field-work was done during 1945, fewer schools were visited by the Nutritionist
than in previous years. A number of requests for assistance with lunch programmes were dealt with through correspondence.
5. Restaurant Service.—Contact was made late in the year with British
Columbia branches of the Canadian Restaurant Association regarding establishment of a training-school in British Columbia for restaurant help. Restaurant-
owners have been asking for this for some time, and machinery is now set up
for such training under the Canadian Vocational Training plan for ex-service
personnel. The Senior Nutritionist with the Board of Health has been invited
to meet with those making arrangements for this training programme.
It is hoped through the establishment of such a training programme that
instruction can be given in nutritional principles. In this way it will be possible
to affect indirectly the eating habits of a large number of persons who eat regularly in restaurants.
6. Summer Camps.—The serving of well-balanced meals in camps and in
schools, through lunch programmes, provides an unequalled opportunity to
demonstrate the value of adequate nutrition. Eating habits established in these
places have been shown to carry over into the home and so affect the habits of
the whole family.
Information regarding the planning of camp meals has been furnished the
Provincial Boy Scouts Association this year. It is planned to extend this
service to other such groups as they request it and as time allows.
III.   NUTRITION DEMONSTRATION CLINICS.
The Federal Nutrition Division has made available to the Provinces a team
of doctor and nurse with specialized training to conduct nutrition demonstration
clinics.    British Columbia will be the first Province to make use of this service.
Arrangements have been made to have a clinic team visit the Province for
six weeks in January and February. While in the Province they will examine
groups of school children in six distinct areas for physical signs of nutritional
deficiencies. C 40 BRITISH COLUMBIA.
The clinic itself follows these examinations and is a meeting of local public
health personnel and others concerned with the health of the people; it is
devoted to the discussion of various types and degrees of malnutrition generally
found in the area, together with suggestions for their improvement.
The purpose of the clinic is to acquaint professional and non-professional
persons interested in nutrition and health with their local problems. The work
is primarily educational but will also contribute to scientific knowledge of general trends in the nutritional status of the whole population.
Preliminary work for the clinics has been handled through the nutrition
services of the Greater Vancouver Metropolitan Health Committee, the British
Columbia Division of the Red Cross, and the Provincial Board of Health. To
date this has meant contacting the local people in the districts where clinics are
to be held and obtaining a week's diet record from the children to be examined.
These diet records have been checked for adequacy and will provide a basis for
follow-up work in the homes following the physical examinations. This follow-
up work will be done through local public health services.
IV.   INFORMATION SERVICE.
Up-to-date scientific information on all aspects of nutrition was interpreted
and furnished to a number of key groups during 1945. This was done through
the review and preparation of new material and the release of information
through the most appropriate channels, as follows:—
1. Members of the Provincial Board of Health staff are kept up to date
through regular staff meetings and the circulation of regular staff bulletins.
2. Public health personnel in the field are kept up to date through the
monthly News Letter and through correspondence and periodic visits. The
Institute held each spring affords another opportunity to discuss the use of
nutritional materials with this group. Considerable work for the benefit of
public health workers was done on nutrition sections of the Public Health
Nursing Manual.
3. Other professional groups, such as welfare field service staff and health
teachers, are supplied with information and material through public health personnel in the field and also directly through their department heads and regular
staff bulletins.
The low-cost food lists mentioned earlier in this report will be of value to
welfare staff. Materials furnished teachers were referred to earlier in this
report.
A nutrition refresher course for professional groups was held in Victoria
early in 1945. This was given on a trial basis by the regional representative of
the Federal Nutrition Division to a group of Public Health Nurses, home economics and health teachers, and welfare staff in the Greater Victoria area. It
was felt that the course was of too general a nature and should be modified to
deal more specifically with cases and problems met by these groups in their work.
4. Public.—Comparatively little of the Nutritionists' time is spent meeting
the public directly. It is more economical of time and also more effective to
work with professional groups such as those mentioned above. These workers
are in contact with and are known to the people in their district and are in a
better position to carry on a continuous and effective programme. BOARD OF HEALTH REPORT, 1945. C 41
V. Staff.
Mrs. E. Trenholm was appointed, August 1st, to the temporary staff as
Junior Nutritionist. She has been supervising the work done in the Government employees' cafeteria and has also reviewed and catalogued considerable
nutrition material for the Board of Health library.
Miss E. M. Yvonne Love was appointed, October 1st, to succeed Miss Baldwin as Senior Nutritionist with the Board of Health. Miss Baldwin resigned
her position on December 19th. It is hoped that another Nutritionist will be
appointed early in 1946 in order that Miss Love will be in a position to take postgraduate work in public health in the fall.
VI. Extra-Provincial Meetings.
The Canadian Council on Nutrition met in Ottawa in May. The Senior
Nutritionist with the Board of Health is a member and attended the sessions.
The most far-reaching decision reached was the adoption of a new statement on
dietary standards to replace, for specific purposes, the former standard drawn
up by the United States Food and Nutrition Board and adopted by the Canadian
Council on Nutrition in 1942. The food lists prepared for the Social Assistance
Branch are based on this new standard.
A national nutrition conference was held following the Council meetings.
This was the first of its kind in Canada and was attended by almost 200 nutrition workers from all parts of the Dominion. The large attendance was indicative of the active interest in nutrition education of groups all across Canada.
A meeting of Nutritionists employed by Dominion and Provincial Departments of Health was referred to earlier in the report. This was the first meeting of its kind and was held in Ottawa early in December. As a result of the
meeting, a Dominion-Provincial Nutrition Committee was formed, which will
meet several times a year to discuss purely Dominion-Provincial matters.
VII. Conclusions and Observations.
Less field-work of the sort reported on in 1944 was carried on during 1945.
The time of the Senior Nutritionist has rather been spent in attempting to evaluate work done in the past so as to plan a more effective programme for the
future.
Work has also been started on a number of new projects, such as the low-
cost food lists and the Public Health Nursing Manual, which should have far-
reaching effects.
Much remains to be done. Results from the nutrition demonstration clinics
will probably show that some signs and symptoms of nutritional deficiency exist
amongst the people of British Columbia. Plans for the future must therefore
include further development of services now being given, with particular emphasis on the instruction of public health and other trained persons in the field in
nutritional principles which they can in turn make use of in their work.
New approaches to the problem of inadequate nutrition must continue to be
tried, and the most effective ones incorporated into a continuing programme.
The most encouraging sign for the future has been the growing spirit of
co-operation between Nutritionists in the Federal, Provincial, and local fields.
With such a spirit behind the programme, an adequate solution can be found to
new problems which may arise in the future. C 42 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF VITAL STATISTICS.
J. D. B. Scott, B.A., B.Com., Director.
INTRODUCTION.
For some years the Division of Vital Statistics has experienced a steady
growth both in the volume and variety of work and in the number of personnel
required to do that work. In order to efficiently carry out the duties expected
of it and also to plan for the future, a thorough survey was made of the functions of the Division, its organization, and especially the duties performed by the
key personnel. As a result of the survey, the central office of the Division was
reorganized to include seven sections, each headed by a section head. Thus the
basis of responsibility was broadened to include more of the senior staff and a
more clear-cut division of duties was made.
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 have been
summarized under the headings " The Division's Contribution to the War
Effort " and " Summary of Registration 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.
Problems in connection with the completeness of registration have been summarized. Legislation, both new and proposed, governing the administration of
the Division has been mentioned. Details of active co-operation between the
Division and both the central office of the Provincial Board of Health and its
other Divisions have been outlined. Reference is also made to the work done
for the Family Allowance Branch of the Department of National Health and
Welfare. The formation of the Vital Statistics Council for Canada is mentioned,
together with a review of the proceedings.
The report concludes with an outline of the problems confronting the Division in the immediate future, including Doukhobor and Indian registration,
drafting of instruction manuals, introduction of pocket-book size plasticized
birth certificates, and the extension of statistical services to the Provincial
Board of Health, etc.
ADMINISTRATION OF THE DIVISION OF VITAL STATISTICS.
Principal Functions.—Briefly, the principal functions of the Division are
twofold.
First, under the authority of the " Vital Statistics Act," to ensure accurate
registration of every birth, death, still-birth, and marriage occurring in the
Province. Also, to make any change in compliance with the aforementioned
Act or the " Change of Name Act." Certification for documentary purposes is
an essential corollary of registration. Furthermore, the administration of the
" Marriage Act," because of the close association with the statutory requirements for the recording of marriages, is the responsibility of the Division. BOARD OF HEALTH REPORT, 1945. C 43
The second important function is to provide statistical tabulations and
analyses as required, especially for the Provincial Board of Health. It must
co-operate with the other Divisions of the Provincial Board of Health in carrying out a public health programme laid down by the Provincial Health Officer.
To do this effectively, there must be full utilization of all relevant facts either
from data collected within the Provincial Board of Health or elsewhere.
Thus the two main functions of the Division are legal and demographic in
concept.
A series of eight charts is included hereafter which illustrate not only the
relationships of the sections within the framework of the Division but also indicate the work which must be done in each section. Personnel charts were also
prepared according to the respective section but these are not shown herein.
Chart I., Organization Chart of the Division of Vital Statistics.—This chart
shows the relationship of the Division of Vital Statistics within the Department
of the Provincial Secretary. It should be noted that the chain ^if responsibility
goes from the Provincial Secretary to the Provincial Health Officer and from
him through the Bureau of Administration and the Bureau of Local Health
Services to the Division of Vital Statistics. Within the Division itself the flow
of responsibility is through the Administration Section to each of the other six
sections. It should be borne in mind that all sections are not necessarily of
equal importance but rather they constitute what appears to be the most logical
division of the work. An example of this is the " Marriage Act " section. The
work of this section is so different from that of the other sections that it constitutes a separate entity, yet there is at the present time not sufficient work to
require a staff similar to that needed in the Registration Section or Certification
Section.
The chain of responsibility follows through from the respective sections to
the local officials of the Division, namely, the District Registrar and Marriage
Commissioner. Local Health Services are shown occupying an intermediate
position between the District Registrar, Marriage Commissioner, and the public
designated as " communities." With the development and stabilization of full-
time Health Units on a Province-wide basis, it is likely that several registration
districts will lie within the boundaries of a separate Health Unit. In order for
each Health Unit to carry out an effective programme, it must have complete
vital statistics information pertaining to the area it serves. Such information
will be in the form of lists of births for its maternal and child welfare programme, deaths from communicable diseases, and other related public health
data, including statistics of population, mortality and morbidity rates, etc.
Much of this information is being compiled for local health services, but a more
highly developed and closely integrated system must be developed to meet the
full requirements of the local health services. This development will take place
with the advice and full concurrence of the Bureau of Local Health Services.
It should be understood that in some instances, based on the practical reality
of the situation, the flow of work is directly from each section to the public and
not through the intermediate steps; an example is the many requests for birth
certificates by private individuals. The Certification Section deals directly with
them in all routine instances. It should be understood though that channels are
established and are operative as and when the need arises. C 44
BRITISH COLUMBIA.
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Chart II., Administration Section.—The name of the section, " Administration," connotes its function without a great deal of explanation being necessary.
It includes planning and policy, personnel problems, generalized office functions,
and certain specialized functions best controlled in this section.
Under the heading of " Planning and Policy," such matters as amendments
to the " Vital Statistics Act," " Marriage Act," " Change of Name Act," and
other allied legislation bearing on the work of the Division is drafted or
appraised. Orders in Council, instructions, estimates, and the various reports
stem from this section also. The term " interdivisional" includes " interdepartmental " and signifies the advisory and consultative service rendered in
connection with annual reports, record systems, statistical analyses, etc. If and
when any of these matters have become formalized, they become the responsibility of the respective sections, but while they are in the formative stage or
affect interdivisional or interdepartmental policy and procedure, they come
directly under the purview of this section. Often matters of policy occur arising from the considerable amount of work done by the Division for the various
Departments of the Federal Government. The formation of the Vital Statistics
Council for Canada foreshadows much more extensive relationships on the part
of the Division both between the Dominion Bureau of Statistics and the other
Provinces. The Division is interested in promoting the professional activities
of its key personnel within such organizations as the Canadian Public Health
Association, the American Public Health Association, the American Association
of Registration Executives, etc., in the belief that the stimulation acquired keeps
alive a progressive spirit among the staff and promotes interest and efficiency
in all matters relating to public health, vital statistics, and allied subjects.
Personnel problems, ranging from proper placement of new appointments,
promotions, sick-leave, etc., are the definite responsibility of the Administration
Section. Staff welfare, too, can not be ignored. Unless the personal problems
of the employees are studied and an attempt made to solve them, they tend to
interfere not only with an individual's own work but also with the efficiency of
his associates. Included under the heading of " Staff Welfare " are the organized social activities of the Division.
There are certain functions within an organization such as the Division of
Vital Statistics which are common to or affect all other sections; for example,
correspondence, or rather the way in which it is routed and handled and filed.
Likewise, stock'control, the ordering of supplies and equipment is a function of
this section in order to ensure a proper degree of control.
Utilization of modern photographic procedures is in its early stages in the
Division. Photostating is an established procedure. The microfilming of the
vital statistics records of the Province nears completion. However, apart from
safeguarding these records, miniature film must be utilized as a means of conserving storage space and reducing it to a minimum; for example, microfilming
of hospital returns, physician's notice of birth cards, letter files, etc. There is
also microfilming work to be done interdepartmentally, with the same purpose
in view. Also, reproduction of negative images of registrations into positive
enlargements in lieu of certificates will become a standard practice as soon as
equipment is available. C 46
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The Division possesses multilith and mimeograph equipment sufficient to
meet its own requirements as well as to provide rapid service for the central
office of the Provincial Board of Health and the other Divisions. Forms, form
letters, bulletins, instructions and manuals, etc., are duplicated within the
Division.
Chart III., Registration Section.—The most of the work of this section is
divided between the processing of current returns and delayed registrations.
Current returns must be carefully scrutinized, and any incomplete or incorrect
registrations are returned to the District Registrar. Returns must be in good
order on account of the time and effort involved in making microfilm retakes and
in correcting punch-cards, indexes, and statistical tabulations.
The section must be for ever watchful to ensure that registration of births,
deaths, marriages, and still-births is complete. For this reason a number of
checks have been instituted, such as the physician's notice of birth, hospital
returns, school returns (where children entered school for the first time), marriage registers, Coroners' reports, motor-vehicle accident reports, etc. Hence,
it is the responsibility of this section to make sure that no vital statistics event
goes unregistered.
Delayed registration, or rather the effecting of unregistered births, deaths,
and marriages, is one of the major registration problems of the Division. Documentary evidence must be submitted and carefully evaluated before an application for delayed registration can be accepted. Minimum Standards of Acceptable Evidence for Delayed Registrations have been adopted by all Provinces.
Care has to be taken to ensure that delayed registrations come up to these
standards.
Registrations of the deaths of personnel in the armed forces killed or missing overseas, who were residents of British Columbia at the time of their
enlistment, have been filed in the central office of the Division through the
co-operation of the Department of National Defence and the Dominion Bureau
of Statistics. These registrations will be received for some time to come as
there is a considerable time-lag between the date of death and the date this
section receives the documents. Deaths of residents of British Columbia
occurring in other states or Provinces are made known to the Division by the
receipt of copies of registrations from the state or Province of occurrence of the
death. These registrations, as well as the overseas casualties, are filed principally for the purpose of completing the statistical picture regarding the absent
members of the population.
In order to assist the public in connection with delayed registration, the
Division has, over a period of years, done everything possible to obtain early
records of baptisms, burials, doctors' personal records, etc. This effort must
be continued because too many people whose births are unregistered are unable
to obtain proof satisfactory for registration purposes. To prevent relevant
records and documents now in existence from becoming lost or destroyed is a
function of this section under the general designation of "Archives."
Chart IV., Certification Section.—The work of this section is less diverse
than that carried on in the other sections. Also, on account of the consistent
demand for certificates, its routines have been established. Searching requires
definite rules, which have been built up through experience.    A considerable C 48
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amount of free verification is provided to Dominion, Provincial, and municipal
authorities for different purposes. The maintenance of the indexes of the Division are an essential responsibility of this section. A variety of revenue-producing certificates are issued, depending upon the requirements—regular, short
form, certified true copies, etc. Pocket-book size plastic birth certificates will
be issued shortly by this section. A glance at the chart shows the number of
lists which are compiled, each containing varying information, depending upon
the use to which it will be put by the various official agencies. Most of these
lists are compiled weekly.
Chart V., Documentary Revisions Section.—The function of this section is
to handle all changes of a documentary nature, as provided for under the
" Change of Name Act" or the " Vital Statistics Act." In addition, it must
make notation of adoptions and divorces on the corresponding birth and marriage records respectively on file in the Division. The work of this section
must be handled with the greatest care and discrimination. Applications for
change of name must be scrutinized to ensure that all the provisions of the
" Change of Name Act " are complied with before a change of name is granted.
Alteration of Christian names requires the consent of both parents in the form
of a statutory declaration. Fraudulent registrations require a careful investigation of all evidence before cancellation can take place under the provisions of
section 13 of the " Vital Statistics Act." Adoption orders are received from the
Court registries of the Province. Orders are accepted, providing the adopted
child was born in British Columbia, from competent Courts of jurisdiction of
other Provinces and states. If the adoption occurred within the Province but
the child was born outside, the Division notifies the respective state or Province
of adoption, sending a photostatic copy of the order. Machinery is being set
up to handle divorces in a similar manner.
Chart VI., Accounts Section.—This section handles the daily cash receipts
of the central office received through mail and across the counter. In addition,
it is responsible for a system of accounts, based on punch-card methods, designed
to give information on expenditures of the Provincial Board of Health and its
Divisions on a budget as well as a costing basis.
Chart VII., " Marriage Act " Section.—This section is concerned with the
system of registration of ministers and clergymen eligible to perform marriages
in the Province. The recognition of a religious denomination previously unregistered under the Act often involves considerable investigation as to the background of the organization, its present status, and its possible continuity of
existence. Denominations of a " mushroom " type of growth are not registered.
Once a denomination is recognized, any number of applications for registration
of ministers and clergymen may be made by its governing authority. Transfers,
cancellations, etc., are all included in maintaining the system. The registration
of every marriage is checked to ascertain if any marriages have been performed
by unregistered clergymen.
As administration of the " Marriage Act " is one of the primary responsibilities of the Division, it is therefore concerned with the qualifications of persons for marriage. Such matters as caveats, adequate proof of divorce, proof
of age and consent of parents for minors, presumption of death and orders for
remarriage are all included in the responsibilities of this section. BOARD OF HEALTH REPORT, 1945.
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Marriages may be performed by ministers and clergymen either after the
publication of banns or on the authority of a licence. A marriage can also be
performed by civil contract. All notices of publication of banns are filed in the
Division, where they are checked and indexed. Questions by Issuers of Marriage Licences and Marriage Commissioners are referred to this section.
A number of miscellaneous functions carried out by this section include the procedures relating to validation of marriages, marriage licence refunds, etc. Marriage registers are issued to each congregation, in which all marriages must be
recorded. These registers are recalled periodically for checking to locate any
unregistered marriages.
Chart VIII., Statistical Section.—Besides providing the statistical information relating to births, deaths, marriages, adoptions, divorces, population, etc.,
this section does a considerable amount of work for the other services of the
Provincial Board of Health. Communicable disease reports, Public Health
Nurses' reports, medical inspection of schools reports, and population estimates
are part of the work done for the Bureau of Local Health Services. The Division compiles the majority of the statistics of the Divisions of Venereal Disease
Control and Tuberculosis Control. Cancer statistics are collected and analysed.
Special reports or studies are made by the section from time to time on such
subjects as health insurance, car operating costs, food costs for nutritional
studies, etc., depending upon the requirement of the time.
As the public health programme of the Provincial Board of Health develops,
so the responsibilities of this section will increase to provide the means of evaluating the progress made and to determine the needs of the future.
SUMMARY OF REGISTRATION AND RELATED PROCEDURES.
Volume of Registration.—In 1945 the volume of live-birth, still-birth, adoption, and divorce registrations each reached an all-time high. The following is
a table showing the increase in total volume of registrations over a ten-year
period, 1936 to 1945 :—
Year.
Live Births.
Deaths.
Marriages.
Still-births.
Adoptions.*
Divorces.t
Total.
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
1945	
20,234
9,855
9,327
352
373
1,405
41,543
* Includes ex-Province adoptions of British Columbia born children.
t Act in force May 1st, 1935.
The volume of birth registrations received rose over the previous high in
1943. There were 20,234 birth registrations filed, of which 1,639 were Indians
within the meaning of the " Indian Act." There was also an increase in the
number of persons who were granted a delayed registration of their birth in
comparison with the year previous. In 1945, 1,092 such registrations were
accepted, compared with 985 in 1944.    Each delayed registration requires care-  C 56 BRITISH COLUMBIA.
ful investigation before acceptance. The establishment of definite national
standard minimum requirements for delayed registration of birth on a national
basis has been of definite assistance to this Division in determining whether an
application for delayed registration should be accepted or not.
The number of marriages registered increased over the number in 1944
but did not exceed the number registered during each of the first four years of
the war.
Legitimation of Birth.—There were 126 births of children born out of wedlock legitimated subsequent to the marriage of their natural parents during
1945. 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, the possibility of
legitimating the birth of any 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 523 notations were entered
upon registrations which had been previously filed. One hundred and eleven 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,
mis-spelling, incomplete answers to questions on the registration form, etc.
Change of Name.—Since the " Change of Name Act" was assented to on
December 6th, 1940, there have been 992 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 2,272 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 224 notices of change of name were accepted.
Death Registrations of Overseas Casualties.—This Division has received,
through the co-operation of the Dominion Bureau of Statistics and the Depart- BOARD OF HEALTH REPORT, 1945. C 57
ment 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
at least six months to a year. There have been 2,680 such registrations received
up until December 31st, 1945, of which 1,255 were received during the year
under review.
Adoption Orders.—The number of adoption orders sent by the Registrars
of the Supreme Court to this Division reached an all-time high of 373 for the
year. This number includes 39 ex-Province adoptions of children born in British Columbia. A notation of adoption is made on each original registration
showing the name of the adopted child and the names of its parents by adoption,
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.
Decrees of Dissolution and Nullity of Marriage.—The most outstanding
increase, however, is to be found in the number of copies of decrees of dissolution and nullity of marriage filed with this Division by the Registrars of the
Supreme Courts. Altogether 1,405 decrees were registered during the year, of
which 1,366 were divorces, 33 were nullities, 3 legal separations, and 3 dismissals.
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. Despite the end of hostilities in 1945, which has led to a decrease in
some phases of the work, the Division continued to give its assistance in many
ways.    A few of the more important items of assistance are outlined herein.
Documentation for Dependents' Allowance Board.—The Division assisted
in the searching and certifying of 10,044 vital records pertaining to members of
Canada's armed forces. This was a decrease over the previous year when 19,493
records were searched and certified. This decrease is due to the falling-off in
enlistment and discharge of members of the armed forces. The total number
of records so documented since the outbreak of war is 90,188.
Military Verification.—The number of verifications for recruiting purposes
dropped from 1,087 in the year 1944 to 175 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 during the year.
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. C 58 BRITISH COLUMBIA.
Co-operation with War-time Federal Agencies.—The Division continued to
give its co-operation to the National Registration authorities, Selective Service,
Wartime Prices and Trade Board, and the Department of External Affairs,
whereby proof or verification is given to these bodies. Details of this kind of
assistance appear in earlier annual reports.
PRESERVATION OF RECORDS.
Microfilm.—The necessity to preserve the records of the Division through
the process of microfilming was outlined in detail in the report for the year 1942.
As foreshadowed in last year's report, all the marriages on file in the Division
were microfilmed in 1945, the births having been completed the previous year.
At the end of the year a start was made on the death registrations. The replacement of typed transcripts for the Dominion Bureau of Statistics by microfilm
plus a serious amount of mechanical trouble prevented completion of the deaths
by the year's end. When all the vital records in the Division have been microfilmed, certificates may be typed from the film itself or positive enlargements
made from the negative film. In addition, consideration is being given to the
possibility of establishing a duplicate set of microfilmed records for the whole
Province in the office of the District Registrar at Vancouver. As this office
serves almost half of the population of the Province, such a plan would appear
to be extremely worth while. Often certificates are required in a rush and this
demand could be met without delay.
COMPLETENESS OF REGISTRATION.
Indians.—With the establishment of Family Allowances payable to Indians,
there has been a marked increase in the number of Indian registrations. Indian
Agents have been most co-operative in assisting to register the births not only
of all the Indian children living on the reserve of Family Allowance age but also
in registering many adults. Indian registration should not be the same problem
in the future as it was in the past.
Doukhobors.—For several years past the Division had a special representative working among the Doukhobors in connection with the registration of vital
statistics. The services of this representative were terminated during the year
and a new approach to the problem is being worked out in conjunction with the
Provincial Police.
Registration of Births.—A check on the completeness of birth registration
was made by the Family Allowance Branch. Less than 1 per cent, of births
were found to be unregistered. 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—besides
bringing in a number of unregistered births, also made possible a certain
number of legitimations, alteration of Christian names, correction of documents, etc. BOARD OF HEALTH REPORT, 1945. C 59
Registration of Deaths.—The registration of deaths has not presented any
fundamentally different problems in 1944 from that experienced in previous
years.    Some of the Coroners could be more prompt in filing death registrations.
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 only be 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, forty-nine delayed registrations of marriages were effected during
the year under review.
DISTRICT REGISTRARS' OFFICES, ETC.
At the close of the year the Division of Vital Statistics had eighty-five district offices and fourteen sub-offices. There are nineteen Indian Agents acting
as District Registrars for Indians. Some thirty district offices were inspected
during the year and four Indian Agencies of the Province were also inspected.
Some of these district offices had been visited very infrequently in the past. The
inspections proved 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.
The Government Agents' Conference held in the fall enabled members of
the Division to meet and discuss mutual problems with these officials, who in all
cases were District Registrars. In turn, they were given an opportunity to see
the workings of the Division.
ADMINISTRATION OF THE " MARRIAGE ACT."
During the year five denominations applied for registration under the
" Marriage Act." Three, B.C. Evangelical Mission, Khalsa Dewan Society, and
the Maple Ridge Baptist Church, were recognized; one was refused. At the
end of the year there were four applications pending, one carried over from the
year previous. Five other applications were dropped during the year. 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."
LEGISLATION.
The " Marriage Act."—This Act was amended to prevent any marriages by
proxy by providing that both parties should be present at the ceremony.    The C 60 BRITISH COLUMBIA.
amendment also removes the discrimination as to residence requirements for
persons married by civil contract compared to those married by licence. With
the growth of better transportation facilities, many people tend to come to the
bigger centres to transact their business. Often the centre was just outside the
boundaries of the registration district of residence of one of the parties to the
intended marriage. Previously, at least one of the parties to a civil marriage
had to reside for at least eight days in the district where the Marriage Commissioner was located. This meant that such marriages could not be performed.
The amendment had the effect of broadening the residence qualifications from a
district to a Provincial basis. The Act was further amended to provide that
where a marriage by civil contract was performed in good faith although an
irregularity might have occurred therewith, the marriage shall not become
invalid because of the irregularity. This amendment gives similar protection to
that previously in effect in connection with the irregular issuance of a licence.
The " Vital Statistics Act."—This Act was amended to strengthen the
administrative procedures in regard to the work of the Division and to create
a properly defined legal means of making agreements between the Dominion and
the other Provinces.
The amendment is briefly summarized hereunder section by section:—
Section 2: Still-birth, previously undefined, was defined along with one or
two other minor additions to the definition.
Section 3: Permits the Director of Vital Statistics to accept such evidence
as hospital records, baptismal certificates, and other forms of proof substantiating the facts of birth in connection with applications for delayed registrations
of birth. Previous to this amendment, no evidence of this nature was required
by the Act.
Section 4: The time for appeal to a Judge of the Supreme Court against the
refusal of the Director of Vital Statistics to register a birth was limited by the
amendment to one year.
Section 5: The practice of issuing certificates of adoption under signature
of the Provincial Secretary had become obsolete and, therefore, the reference to
this method of certification was deleted from the Act.
Section 6: This section permits the issuance of a birth certificate in the
adopted name of a child born in this Province but adopted in any country
through a Court of competent jurisdiction, providing evidence of adoption is
submitted to the Division.
Section 7: Before the given or Christian name of any child under 12 years
of age is altered, the consent of both parents must be obtained, except under
exceptional circumstances. Previously, only one parent need apply for alteration of a child's given or Christian name.
Section 8: This section permits a notation of change of name to be made on
the birth registration of a child born in this Province in the event of evidence
being received of a proper change of name being made in another Province.
Section 9:  Introduces a proviso—see section 11.
Section 10: Permits the acceptance of a delayed registration of death by
the Director of Vital Statistics, together with the machinery to provide an
appeal to the Court against the decision of the Director. This is similar to
the procedure in connection with the delayed registration of birth. BOARD OF HEALTH REPORT, 1945. C 61
Section 11: Prior to the enactment of this section and contrary to the
provisions of the " Vital Statistics Act," many deaths were registered originally
in the District Registrar's office other than the office of the district where the
death occurred. Strict enforcement of the Act as it stood would have caused
the undertakers considerable inconvenience.
Section 12: Permits the Director to obtain additional statistical information on divorces from information in the hands of the Supreme Court
Registrars.
Section 13: Permits a notation of divorces occurring in another Province
to be made on the original registration of marriage on file within the Division.
Section 14: Permits the correction of an error on the registration on file
in the District Registrar's office if initialed by the person who originally completed the registration, otherwise the correction will have to be made by marginal notation.
Section 15: Permits the Lieutenant-Governor in Council to authorize the
period whereby returns are made from the District Registrar to the central
office of the Division. As a result of this amendment, an Order in Council
was passed which read as follows:—
Commencing October 22nd, the District Registrars of Births,
Deaths, and Marriages shall mail or deliver to the Director of Vital
Statistics on each Monday the returns accompanied by all original
registrations made by the District Registrars under the " Vital Statistics Act " during the week immediately preceding.
Section 16: The method of indexing as previously specified in the Act was
obsolete and had become inoperative. Therefore, mention of it was removed
from the Statutes.
Section 17: After fulfilling certain conditions, fully qualified public health
officials may obtain all necessary information pertaining to vital statistics for
carrying out a proper public health programme.
Section 18: This section permits the Division to issue photographic prints
or photostatic copies of certificates and it gives them the same legal status as
ordinary certificates issued by the Director or the District Registrars.
Section 19: This section deletes the word " monthly." An explanation
for this deletion is provided by section 15.
Section 20: This section deleted any reference to verification or certification for the Department of Pensions and National Health, making possible a
broader arrangement.    See section 21.
Section 21: Permits the Provincial Secretary to enter into an agreement
with other Provinces or with the Dominion in regard to vital statistics. Vital
statistics records are more and more in demand for all purposes of government,
and this section has been drafted to permit flexibility in making arrangements
with the Dominion or the other Provinces in respect to vital statistics matters.
Section 22: No other system of registration of births, deaths, and marriages is permitted by this section.
A time may come when it will be no longer necessary for teachers to make
a return of births of all children entering elementary school for the first time. C 62 BRITISH COLUMBIA.
If this stage in registration is attained, there is provision whereby an Order
in Council can be proclaimed ending the making of returns by the teacher.
The volume of certificates issued in the Division is so great that it is
impossible for the Director of Vital Statistics to sign each one. This section
of the amendment permits what has already become an established practice,
that is, of printing his signature on such documents.
The " Wills Act."—This Act was amended to allow a person who has
executed a will to file a notice in the Division of Vital Statistics stating where
the will is situated. Upon fulfilling certain conditions, a search can be made
in the files of the Division to ascertain whether or not a notice has been filed.
Fees are charged both for the filing of a notice and for a search.
Following the passage of this legislation, a rule was made by the Chief
Justice of the Supreme Court that before any estate was probated a search
has to be made of the notices on file with this Division. The result was a
greater number of searches than was anticipated by this Division at the time
the legislation was passed.
" An Act respecting the Status of Children of certain Marriages."—Where
a presumption of death has been obtained and a marriage has subsequently
been performed and the person presumed dead is later found to be alive, the
children of the persons entering into such a marriage ceremony shall for all
purposes be deemed to be legitimate from the time of birth. Prior to this
amendment, there was no protection for the children born of such a marriage
in so far as their legitimacy was concerned.
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 as outlined by the Provincial
Health Officer. The Division continued to render very tangible assistance to
the Divisions of Tuberculosis 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.
The Division of Venereal Disease Control, following advice from the Division of Vital Statistics, streamlined its record system. The same policy was
adopted which has proved so successful in connection with the records of the
Division of Tuberculosis Control, namely, that the Division of Venereal Disease
Control assume a greater responsibility for the compilation of its own statistics
relating to patient visits, tests, etc., on a cumulative daily basis. However,
data relating to individuals are coded, punched, and tabulated. Cross classifications for analytic purposes are best obtained from utilization of the punch-
card method.
The Division of Vital Statistics has given assistance to the Bureau of
Local Health Services of the Provincial Board of Health by supplying statis- BOARD OF HEALTH REPORT, 1945. C 63
tical information regarding population estimates, budget estimates, etc., for
both established and proposed Health Units. Statistics from the reports of
the Medical Inspectors of Schools were compiled by the Division. The Division
continued to assume the responsibility for the collection of statistics on the
daily work of the Public Health Nurses. Considerable effort was made to
stimulate the reporting of cancer cases, with a result that towards the end
of the year the number of new cases reported monthly doubled. Notifiable
diseases were coded and punched, and the system of recording was tested
against the manual method currently in use. After a fairly exhaustive test,
it was decided to use the punch-cards only for monthly and annual statistics
and for special studies. The Division continued to carry on the system of
costing and budget accounting on a punch-card basis for all the accounts of
the Provincial Board of Health.
Considerable work was done by the Division in compiling as much relevant
information as possible on the subject of health insurance. Data were compiled not only for the use of the Provincial Health Officer but also for the
economic adviser to the Premier on Dominion and Provincial relations.
In June the Division obtained multilith equipment in order to do its duplicating work, using the offset process. The format of the bulletin of the
Provincial Board of Health was changed in an endeavour to make it more
useful. Fresh emphasis was placed on the writing of leading articles by
members of the staff of the Provincial Board of Health, especially members
of the Division. Its circulation was more than doubled. While it is felt that
the bulletin was improved during the year, yet there is room for many changes
in order that it should become a better organ for the dissemination of public
health information.
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 duty of the Division to be the statistical workshop of public health for
the Provincial Board of Health and, therefore, many small tasks of minor
importance are performed by the Division.
MECHANICAL TABULATION PROBLEMS.
Many of the problems which were outlined in last year's report have been
solved through the acquisition of an alphabetic tabulator and an additional
sorter. Apart from this equipment, the Division also has a horizontal sorter,
three alphabetical key punches, two alphabetical verifiers, and share in the
part-time use of a numeric key punch. With the co-operation of the Bureau
of Economics and Statistics, the transitional stage was effected smoothly so
that by the end of the year the Division was in a position to handle all its
work effectively and fully. A considerable back-log of alphabetical work has
been built up which will take some time to complete. In the meantime, additional applications are being added as warranted. It is not too much to say
that the efficiency of the Division has been greatly strengthened by the possession of this equipment and the ability to control the flow of work from beginning
to end. C 64 BRITISH COLUMBIA.
RELATIONS WITH THE FEDERAL GOVERNMENT.
The year under review has been a most momentous one from the standpoint of change in established procedures and developments in new relationships. An agreement was entered into between the Province and the Dominion
Government regarding the creation of a National Register of Vital Records
and the compilation of vital statistics. The Vital Statistics Council for Canada
held its first meeting during the year. Plans were made to map future progress
in vital statistics. Lastly, but certainly not least, was the assistance given by
the Division to the Family Allowance Branch of the Department of National
Health and Welfare. It may be anticipated that vital statistics in Canada
will take a great stride forward in the next few years as a result of the decisions
and changes that were made during the year 1944.
The agreement in effect 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 microphotographic copy of each registration to the Dominion Bureau of Statistics in place of typed transcript. The
agreement signed by this Province is essentially the same as that signed by
all the other Provinces, with the exception of section 17, which limits the use
of verification on the part of the Federal Government to Family Allowance
purposes only. The basic equipment was supplied to all Provinces by the
Dominion. As this Province already had a microfilm camera, it was decided
to transfer the old machine to another department and to carry on with new
equipment. A Vital Statistics Council, made up of one representative of each
Province and one from the Yukon and the North-west Territories and three
representatives of the Dominion Bureau of Statistics, including the Dominion
Statistician, the Chief of the Vital Statistics Branch, and the Chief of the
Census Branch, was established forthwith. The purpose of the Council is to
discuss and advise on problems arising out of the administration of the vital
records system and relative statistics.
The following are the terms of the agreement regarding the creation of
a National Register of Vital Records and the compilation of vital statistics
signed by the Provincial Secretary on the 22nd day of December, 1944:—
Canada.
THE GOVERNMENT OF THE DOMINION AND THE GOVERNMENTS
OF THE PROVINCES.
AGREEMENT REGARDING THE CREATION OF A NATIONAL REGISTER OF
VITAL RECORDS AND THE COMPILATION OF VITAL STATISTICS.
For the purpose of co-ordinating and improving the efficiency of the national system of
Vital Records and Vital Statistics in relation to the prospective social security measures and
for other purposes, a conference between officers of the Dominion Bureau of Statistics and the
Dominion Treasury, the Dominion Council of Health and representatives of the Provincial
Vital Statistics offices, was held in Ottawa on September 28th, 1944, at which time an agreement was reached in principle along the lines set forth below:
1. In order to facilitate co-operation between Dominion and Provincial Governments with
respect to the use of vital records and statistics and to ensure the creation and maintenance
of a system that is adequate to meet increasing demands both for Dominion and Provincial BOARD OF HEALTH REPORT, 1945. C 65
purposes, there shall be established a Vital Statistics Council for Canada under the terms set
forth in Appendix "A."
2. In order to modernize the system of Vital Records and Statistics of the Dominion and
the Provinces and in order to provide information now necessary for various Dominion and
Provincial purposes, the procedure specified in Regulation 1, P.C. 693, dated 22nd day of April,
1919, which provided that—
" the Dominion Bureau of Statistics may receive transcripts or certified copies of the
original returns of marriages, births and deaths made by the clergymen, physicians,
undertakers and other persons upon whom it is incumbent to make such returns "
be changed and the following procedure substituted therefor.
Records as from July 1st, 1945.
3. As and from the first day of July, 1945, in place of the present transcripts, the Provinces will supply, each month or oftener if possible, to the Dominion Bureau of Statistics,
photographic copies of all registrations of births, stillbirths, marriages and deaths occurring
in the preceding month or since the copies were previously supplied. These copies will be in
positive microfile form, subject to the alternative mentioned in Regulation 19.
4. The microfilm copies shall be used by the Dominion Bureau of Statistics to create a
National Register of Vital Records and continue to be used by the Dominion Bureau of Statistics for the purposes of statistical analysis under the terms of the agreement between the
Dominion and the Provinces as set forth in P.C. 693.
5. In order to assist the Provinces in carrying out the responsibilities which they agree to
assume under Regulation 3, the Dominion Bureau of Statistics will purchase outright and turn
over to each Province, free of charge, one Recordak Model " Cl " Microfilm Camera and one
translucent screen Film Reader, Model " C."
6. The Provinces will be given outright ownership of the camera equipment aforesaid, but
should a Province require additional readers or enlargement equipment for its own purposes,
such equipment shall be purchased at the expense of that Province.
7. The Dominion Bureau of Statistics will pay to each Province for each microfilm image
of a registration of birth, stillbirth, marriage or death subsequent to July 1st, 1945, an amount
to be agreed to by the Provinces and the Dominion following the recommendations of the Vital
Statistics Council, it being understood that if the figure agreed upon as the basis for such payment exceeds the actual cost of preparing the microfilm images, the excess shall be applied to
improving the vital statistics records of the Provinces.
8. The Provinces will guarantee priority in the use of the camera equipment for the
filming of the vital records each month or at other stated periods as may be agreed upon from
time to time, and each Province will be permitted to use the camera and reader for its own
purposes during idle time.
9. The Provinces will purchase at their own expense the necessary microfilm each month
for photographing the registrations after July 1st, 1945.
10. The Dominion Bureau of Statistics will provide the initial technical instruction in the
use of the microfilm cameras.
Records prior to July 1st, 1945.
11. The Provinces agree that, in respect of any vital records filed in a Province prior
to July 1st, 1945, which may be required in the creation of the National Register of Vital
Records, such records shall be microfilmed at the expense of the Dominion, for the purposes of
the National Register using the equipment mentioned in Regulation 5.
12. In order to provide a basis for the introduction of the National Register of Vital
Records, all births registered within the Provinces from January 1st, 1925, to June 30th, 1945,
shall be photographed forthwith and the negative films or duplicate positives forwarded
immediately to the Dominion Bureau of Statistics.
13. The Dominion Bureau of Statistics shall prepare Hollerith cards from the negative
films of the birth registrations from January 1st, 1925, to June 30th, 1945, and from such
cards shall prepare lists by year of birth in alphabetical order.
14. The said lists of the births for each Province shall be sent, in the first instance, to a
representative of the Dominion Government in that Province to be designated by the Dominion
Bureau of Statistics. C 66 BRITISH COLUMBIA.
15. Such designated officer of the Dominion Government may use the lists of births to
verify such births and he shall indicate on the said lists those births that have been verified
for a particular purpose.
16. Such officer, after using such lists of births prior to July 1st, 1945, shall turn the lists
over to the Vital Statistics office of the Province.
General Provisions.
17. The National Register shall be used by the respective governments for the purposes of
verification of Family Allowances and statistics only. Any further use shall be approved by
each Province in respect to its part of the records in the National Register after recommendation by the National Council of Vital Statistics for Canada.
18. The microfilm copies and any indices compiled therefrom shall be subject to the same
restrictions as imposed by the Secrecy clauses of the " Statistics Act " of the Dominion, except
in such cases as may be determined by the said Council from time to time, and upon authorization from a Provincial Government in respect to its own records.
19. As an alternative to the Provinces supplying to the Dominion Bureau of Statistics the
positive microfilm copies referred to in Regulation 3, the Provinces may supply the negative
films. In either case the Government of the Dominion of Canada will guarantee that they will
be kept under fire-proof conditions, and that should the Provincial records be destroyed or
damaged at any time they will be replaced by the Dominion Bureau of Statistics at the
expense of the Dominion.
20. The Dominion Bureau of Statistics shall be the sole custodian of the microfilm copies
furnished to the Dominion and the National Register of Vital Records created under the terms
of the said agreement except as herein provided in Regulations 14 to 16, in connection with the
births registered in the Province from January 1st, 1925, to June 30th, 1945, or as may be
determined from time to time by the Vital Statistics Council.
21. In the event that any one of the Provinces or the Dominion is dissatisfied with the
foregoing provisions of the agreement, at least one year's notice in writing to the other party
shall be given before such agreement can be terminated.
Dated at Victoria, in the Province of British Columbia, this 22nd day of December, 1944.
(Signed) Geo. S. Pearson,
Provincial Secretary.
APPENDIX "A."
Constitution of Vital Statistics Council for Canada.
For the purpose of carrying out and giving effect to the provisions of the " Statistics
Act " of the Dominion, in connection with securing uniform methods of collecting, compiling
and publishing the Vital Statistics of Canada and the Provinces, and other matters related
thereto, under an agreement with the Provinces and the Dominion, agreed to at a conference
between officers of the Dominion Bureau of Statistics and the Dominion Treasury, the
Dominion Council of Health and representatives of the Provincial Vital Statistics offices, held
in Ottawa on September 28th, 1944, the Minister of Trade and Commerce, pursuant to Section
9 of the said Act, does hereby constitute a Vital Statistics Council for Canada under the following terms:
1. That there shall be established a Vital Statistics Council for Canada comprising one
representative for each Province (the officer actively in charge of the Provincial Vital Statistics office), one representative for Yukon and the Northwest Territories (to be designated
by the Minister of Mines and Resources) and the Chief of Vital Statistics in the Dominion
Bureau of Statistics.
2. That the Chairman of the Council shall be the Dominion Statistician and the Vice-
Chairman shall be elected annually from the representatives of the Provinces, and Yukon and
the Northwest Territories.
3. That the Secretary shall be a member of the Council and shall be appointed for a
term to be determined by the Council. BOARD OF HEALTH REPORT, 1945. C 67
_
4. That the Vital Statistics Council shall meet at least once a year for the purpose of discussing and advising on problems arising out of the administration of the Vital Records
system and relative statistics.
5. That the expenses of the Vital Statistics Council shall be borne jointly by the Dominion
and the Provinces on the following basis:
(a.) By the Dominion, transportation expenses of all Council members to and from
the place of meeting and other expenses incidental to the meeting;   and
(b.) By the Provinces, the living expenses of the respective Provincial Council members while at the place of meeting.
The system of mechanization of vital statistics registrations considered by
the Vital Statistics Council was designed to meet the following broad objective:—
(a.) The linking of vital records of births, still-births, legitimations,
change of name, adoption, marriage, dissolution, immigration,
emigration, and death.
(b.) A system of numerical identification of the individual and of the
family, based on registrations of vital records which would be
acceptable to and used in preference to other systems by all
official Dominion and Provincial agencies.
The mechanics of the system required in order to accomplish the above
consist of microfilm records of the Provincial registrations and the use of
punch-cards and all electrical tabulating equipment. The system of numerical
identification proposed to the Council is (a) the birth registration number for
the individual and (6) the marriage registration number for the family.
Both of these numerical identifications would have the number of the
Province of event as a prefix and the last two figures of the year as an affix.
This system of identification is both basic and permanent and permits of the
limitless use of linking the events of life. It is suggested that a uniform
punch-card be drafted for the national index, on which would be punched
births, still-births, change of name, adoption, marriage, dissolution, immigration, emigration, and death. The birth registration numerical identification
will be punched on all cards covering all events. The marriage registration
numerical identification will be punched on all birth cards to serve as a family
identification. This combination of identification will permit of bringing all
events of life together on an individual or family basis. Further, it was suggested that the registrations should be sent in weekly from the District
Registrars' offices. After careful checking, the completed registrations should
be numbered and microfilmed according to a procedure common to all Provinces. Members of the Council were asked to make a detailed study of the
recommended procedures in connection with the establishment and maintenance
of the National Register of Vital Records. It is anticipated that this Province will co-operate fully in this matter.
Several resolutions were passed by the Council, including one recommending to the Dominion Bureau of Statistics that tabulations of published vital
statistics data should include municipalities. At present, cities, towns, and
villages only are included, although some urban municipalities are larger than
certain small cities. C 68 BRITISH COLUMBIA.
The coming into operation of the " Family Allowance Act " on July 1st
has meant much to the Division. In the first place, the Division had a gap
of unpunched birth index-cards between 1928 and 1935 to complete punching.
An extra shift was put on for a few weeks and the work finished on time.
All the birth index punch-cards from 1925 to June 30th, 1944, were sorted
into proper sequence and sent to Vancouver for reproduction. The reproduced
cards were then sent to the Dominion Bureau of Statistics at Ottawa where
an alphabetic index was prepared and sent to the Family Allowance Branch.
All applications for Family Allowance were checked against this index,
and any births not located were referred to this Division to be checked in the
indexes. Differences were noted on the application for search forms received
from the Family Allowance Branch if the particulars thereon were different
from those appearing on the registration. If a birth could not be located
after a careful check, the Family Allowance Branch notified the applicant for
allowance advising her to contact this Division, a copy of the letter being sent
to this office. As a result, a number of applications for delayed registration
of birth have been made. In many instances it was found that the birth had
occurred in another Province, or that a mistake had been made in the date of
birth, or that the name on the application had been changed either by adoption
of a foster surname or sometimes by anglicizing a foreign-sounding surname.
A list of children whose names had been changed by other than legal procedures was sent to the Child Welfare Branch for its use in locating children
whose whereabouts were temporarily unknown. A preliminary check would
indicate that less than 0.5 per cent, of all births were unregistered. It should
be noted that Family Allowances, apart from causing a considerable amount
of work, have been of advantage to the Division in ensuring more complete
and accurate registration of birth. It can also be stated that there has been
full co-operation between the staff of the Family Allowance Branch and the
personnel of the Division.
PROBLEMS OUTSTANDING AT THE END OF THE YEAR.
Goal in Registration.—The first and perhaps most fundamental problem
of the Division is to have a complete registration of all births, deaths, and
marriages. In this connection, Doukhobor registration is the largest single
problem. Improvement of returns from Indian Agents is also necessary.
Marriage registers issued years ago must be traced in order to locate any
unregistered marriages.
If rationing ends during the forthcoming year, an incentive to prompt
birth registration will be lost. At the present time, birth certificates are
required to obtain a ration book for a new-born infant. With the elimination
of rationing, registration officials will have to be prompt and persistent in
their efforts to obtain all registrations as soon as possible.
Standards for Correction of Documents, Legitimation Procedures, etc.—
To date there are no national standards for the above procedures. Each
Province has its own rules. Creation of a standard of acceptance on a Dominion-
wide basis is highly desirable. An effort will be made by the Division to promote the adoption of these standards by all Provinces. BOARD OF HEALTH REPORT, 1945. C 69
Instruction Manuals.—Practically no progress was made on the preparation of the District Registrar's Manual. With the release of service personnel,
it is anticipated that there will be staff available in the coming year to complete
this manual. It will be followed up by a manual of instructions on central
office procedures. Rules for searching, detailed outlines of duties, etc., must
be prepared.
Plasticized Birth Certificates.—Another problem to be met in the forthcoming year will be the introduction to the public of tamper-proof pocket-book
size birth certificates. They will be in the nature of a birth card placed between
strips of plastic and laminated together under heat and pressure. It is expected
that the other Provinces of the Dominion will introduce similar miniature
certificates at approximately the same time. If the experience of several of
the State Vital Statistics Divisions is any criterion, there should be quite a
demand for these certificates.
Development of further Services to the Provincial Board of Health.-—■
Many of the same problems outlined in last year's report under this heading
are still existent. 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. Data relating to estimates
of population and birth and mortality statistics of all kinds are usually requested
from the Division. With the development of a Province-wide system of Health
Units, the Division will be expected to give a more extensive consulting service
regarding records and statistics. Doubtless some of the boundaries of the
present vital statistics registration districts will have to be changed to conform
with Health Unit boundaries so that vital statistics can be collected for these
Units.
General Remarks.—Problems are bound to arise due to the changes in
the Province from a war to a peace time economy. Certificates will not be
needed for war-time official purposes, but undoubtedly a greater demand will
arise from travel requirements, possible contributory old-age pensions, proof
of age for sports eligibility, etc.
New problems will be met in connection with the creation of the National
Register of Vital Records which will require the full co-operation of each
Provincial vital statistics office. In addition, many staff changes are bound to
occur, such as the proper placement of those members of the staff returning
from military service to clerical duties on the one hand and, on the other hand,
the replacement of married women who are mainly stenographers and typists.
However, the experience of the past indicates that a splendid spirit of
co-operation exists among the staff, which will do much to successfully solve
the many and varied problems ahead. C 70 BRITISH COLUMBIA.
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.
During the year the main laboratories in Vancouver performed the extraordinary total of a quarter of a million tests, an increase of roughly 25 per cent,
over the previous year's total and double the turnover for 1940. In the last few
months of the year an average of nearly 25,000 tests was performed monthly or
approximately half the total 1935 turnover. Thus the laboratories trebled their
turnover in the first five-year period of the present Director's incumbency,
1935-40, and doubled this again in the second five-year period. Apart from this
sixfold increase in routine tests during a single decade, the central laboratories
have also assumed heavy additional responsibilities in supervising the work of
the six branch laboratories, in releasing biological products for distribution
throughout the Province, and, during the war years, in undertaking the laboratory aspects of the Red Cross blood donor project for British Columbia.
To cope with this unusually rapid expansion in the scope and quantity of
work, the staff and budget of the central laboratories has more than trebled
while the available accommodation has nearly trebled during the past decade.
But these enlarging facilities have at no time kept pace with the demands made
upon them. Indeed, it was pointed out in last year's annual report that no
reasonable possibilities existed for further additions to the present quarters,
while the staff had about reached the maximum number which could be housed
there. The markedly increased load of 1945 was only just manageable because
of an early reduction, and subsequent cancellation, of the laboratories' commitments to the Red Cross blood donor service. This released the ground floors of
two houses, previously required solely for the Red Cross work, and permitted a
long overdue rearrangement of space affecting especially such basic services as
glassware cleaning and media preparation.
Among the branch laboratories, those at Victoria and Nelson showed substantial increases in turnover. The Victoria laboratory at the Royal Jubilee
Hospital deserves special praise for having successfully met numerous emergency demands despite critical shortages of trained staff.
TESTS RELATING TO VENEREAL DISEASE CONTROL.
The various tests concerned with diagnosis and control of syphilis and
gonorrhoea have always represented roughly two-thirds of all examinations
made by the Division. In 1945 this proportion rose to about four-fifths, largely
because of the undertaking to perform serodiagnostic tests for syphilis on every
person discharged from the armed forces, and to a lesser extent because of the
increased incidence of venereal disease. That the central laboratories during
the year should have tested for syphilis over 120,000 separate blood specimens,
and the Division as a whole over 150,000 such specimens, certainly indicates that
this Division has continued to make an indispensable contribution toward the
control of this disease in British Columbia. More than one-quarter of the total
blood specimens examined by the Division were from men enlisting in, or discharged from, the armed forces.    During the first eleven months of 1945 the BOARD OF HEALTH REPORT, 1945. C 71
central laboratories tested nearly 25,000 specimens from the Canadian Army
alone, and during the first ten months nearly 15,000 from the R.C.A.F. From
both branches of the armed forces, 15 cents per specimen was received for this
work. In view of the increasing percentage of specimens giving positive or
doubtful reactions with the presumptive Kahn test, and therefore requiring supplemental tests, it seems unlikely that these payments covered the cost. However, it would seem reasonable that a small share of the cost should be borne by
the Province, in view of the close relationship between the civilian and military
incidence of syphilis.
One of the most direct indications of an increasing local prevalence of
syphilis is to be found in an almost doubled number of dark-field examinations
performed during 1945 as compared with the previous year. A disconcertingly
high proportion of these specimens were positive for Tr. pallidum.
The widespread assumption that gonorrhoea has also increased in prevalence seems likewise borne out by laboratory findings. Substantially greater
numbers of direct microscopic examinations of smears for gonococci were made.
The comments made in recent annual reports on the significance of this trend,
and on the increasing difficulties encountered in this branch of the laboratories'
work, are still applicable. A definite start was made upon attempts to improve
the sensitivity and specificity of gonococcus culture techniques. The comparative advantages of the serumlysed blood medium recently described by Peizer,
and of the chocolate agar medium hitherto used, were investigated by Miss
Chang, who, along with Miss Kerr and through the co-operation of the Division
of Venereal Disease Control, spent several hours weekly during October and
November at the Vancouver clinic plating specimens directly on these media so
that errors due to faulty plating technique might be reduced to a minimum. No
definite conclusions have yet been reached as to the respective merits of these
two media.
TESTS RELATING TO TUBERCULOSIS CONTROL.
All types of tests for M. tuberculosis again showed an increase. The
increase in direct microscopic examinations was comparatively slight but was
from 15 to 20 per cent, in the much more time-consuming cultures and guinea-
pig inoculations. Larger numbers of stomach-washings were received. As
in previous years, difficulties were experienced in the supply and maintenance
of guinea-pigs. The supply situation improved after the first half of the
year as the labour situation eased, with the release of personnel from the
armed forces. But the need to maintain a larger pig colony in order to cope
with increased demands for animal inoculation tests multiplied the already
serious difficulties incidental to the unsuitable construction and location of
the buildings, the inadequate heating arrangements, and the impossibility of
rendering them rodent-proof. Despite installation of new tiers of metal cages
and the care given to feeding and cleaning the animals by Mr. Page, the full-
time janitor appointed during the year, some individual pigs died inexplicably,
and at least one major outbreak occurred of an unidentified and fatal infection. C 72 BRITISH COLUMBIA.
TESTS RELATING TO CONTROL OF INTESTINAL
INFECTIONS.
As foretold in previous reports, the incidence of infections due to organisms of the Salmonella-Shigella groups continued to rise. Most of these infections occurred as small family outbreaks or as sporadic cases without obvious
history of source. There were also numerous instances of apparent food poisoning, some involving quite large groups, in which the symptomatology suggested
Salmonella infection, but no laboratory confirmation could be obtained.
Failure to identify the cause of food-poisoning outbreaks is a common
characteristic, and is usually due to a combination of such circumstances as
inadequate, inaccurate, or belated sampling of the foodstuffs involved, and omission to submit promptly faeces specimens from the victims. Many of these
transitory outbreaks of gastro-enteritis were doubtless due to staphylococcal
food poisoning, and laboratory evidence confirmatory of this was quite often
obtained. But to a greater degree than in any previous year, the prevalent
food-poisoning syndrome was apt to have an incubation period of ten to fifteen
hours after consumption of the incriminated meal—too long for staphylococcal
food poisoning—while diarrhoea and cramps, rather than vomiting, were conspicuous.
Contacts of cases involved in the foregoing episodes were found to be
healthy carriers of Salmonella organisms, with sufficient frequency to suggest
that the time has come when the routine laboratory examinations of all food-
handlers in public eating-places is desirable, and should be instituted throughout
the Province so far as laboratory facilities permit. Since stool cultures, and not
blood agglutination tests, provide the only satisfactory means of identifying
these carriers, the extent to which such examinations of food-handlers could be
conducted would be delimited by the facilities available at the main laboratories
in Vancouver and at the Victoria branch laboratory, which are alone at present
equipped for the proper performance of stool cultures.
As yet no very large-scale disaster, such as a milk- or water-borne outbreak
of Salmonella-Shigella infection (typhoid and paratyphoid-like fevers and bacil-
lary dysentery), has occurred in British Columbia, although the Vernon typhoid-
fever outbreak in 1943-44 was serious enough. But with every passing year
the accumulating reservoir of carriers of these infections presents a growing
menace to any community in which unpasteurized milk and unchlorinated water
is distributed. Sooner or later disaster will befall any community which spurns
these proven and elementary safeguards of the public health. The reality of
the hazard which would exist if chlorination were withdrawn in Vancouver was
dramatically illustrated in the laboratories late in November. A faeces specimen, collected in the course of a routine check-up by the City Health Department
from an employee of the Greater Vancouver Water Board, yielded Salmonella
typhi murium. The man had been working around the Seymour and Coquitlam
intakes at about the time of an attack of gastro-enteritis, which he had suffered
a week or so before the examination was made. Two fellow-workmen had been
similarly afflicted. No matter what regulations may be imposed upon Water
Board employees respecting sanitary disposal of their excreta, chlorination
offers the only guarantee against epidemics due to pollution of drinking-water BOARD OF HEALTH REPORT, 1945. C 73
supplies by such means as the above. Moreover, the established transmissibility
of S. typhi murium infection to and by rodents points to another possible
mechanism of pollution against which sanitary regulations covering excreta-
disposal are powerless. During the last two years nearly 250 cases and carriers
of Salmonella-Shigella organisms have been identified in the laboratories among
persons resident or hospitalized in Vancouver. This figure may serve to emphasize the extent of the hazards against which this growing city needs protection
by continuing to chlorinate its drinking-water.
S. typhi murium was the type of Salmonella most frequently isolated by
stool culture during the year in Vancouver. Infection therewith carries a mortality rate of 4 to 5 per cent., and in 1945 at least two deaths occurred from this
organism in Vancouver. The Flexner dysentery bacillus, S. paratyphi B., and S.
newport were the next most frequently identified. S. typhi itself was encountered a few times, chiefly in specimens from the Essondale Mental Hospital.
One or two rare types, notably S. madelia and <S. Oregon, were isolated from
cases in Vancouver. The former of these, isolated from four human cases of
Salmonellosis, one of which was fatal, had not previously been known as a
human pathogen. It was originally isolated from birds. All final identifications of Salmonella cultures were carried out by Dr. L. E. Ranta in the Western
Division of Connaught Laboratories at the University of British Columbia,
which is the only Canadian centre for complete Salmonella typing.
OTHER TYPES OF LABORATORY TESTS.
A slight increase occurred in the numbers of milk samples submitted to
bacterial counts and coli-serogenes tests. More important, there was a 15-percent, increase in the number of phosphatase tests. A rather disturbing percentage of these tests showed evidence of faulty pasteurization, particularly
among specimens from dairies operating outside Vancouver. This points to a
real need for a more extensive and intensive inspection service for pasteurizing
plants. In few fields of public health laboratory-work is it so important that
proper arrangements should be in force for interpretation and follow-up of the
laboratory findings.
The number of water samples examined bacteriologically in the main laboratories underwent a small decrease. This largely reflects the somewhat lesser
number of specimens received from various collecting-points in the Greater Vancouver area. Since chlorination was instituted just over two years ago, the
Water Board has maintained its own laboratory, and conducts a fairly rigid
bacteriological scrutiny of the water at the various intakes prior to chlorination. This practice has permitted the Provincial Laboratories to confine its
examinations to the treated water, as delivered to the consumer. It is a notable
testimony to the value of chlorination of our water-supply that since this procedure was instituted about two years ago, the coli-aerogenes type of organism
has been detected in only 20 among over 6,000 standard 10-c.c. amounts of water
tested—a rate of about 0.3 per cent, positive samples. Previously, at some
seasons, up to 100 per cent, of such samples were positive. Indeed, coliform
organisms were often found in 1-c.c. and occasionally in 0.1-c.c. amounts of
water under test. Charts based on the Water Board's own laboratory findings
on samples collected at the intakes before treatment show that up to the present C 74 BRITISH COLUMBIA.
time the Greater Vancouver water-supply fails by a considerable margin to meet
internationally accepted standards, and hence is unsafe without treatment.
While certain branch laboratories managed to increase the number of their
milk and water examinations, there is need of better control of the Province's
milk and water supplies. The Division of Laboratories is doing its part in
supplying the necessary data for action. A travelling laboratory would help
greatly to solve some of the difficulties now encountered in shipping samples
from a distance.
Cultures for C. diphtherix remained about unchanged in total number for
the year but increased markedly during the last few months. This trend probably reflected a higher local incidence of the disease, due in part to overcrowding and other war-time and post-war conditions favouring droplet-borne infection, and in part to the return to Canada of men discharged from the armed
forces in Europe and of former prisoners of war from the Far East. Virulent
forms of diphtheria have been rampant in Holland and Japan during the war,
and it will be surprising if sporadic outbreaks of diphtheria do not occur among
the civilian population brought into contact with these returned men. The
extent of artificial immunization with diphtheria toxoid among the pre-school,
school-child, and adult groups in this Province is still inadequate to ensure freedom from scattered outbreaks, despite the very liberal and efficient arrangements for free distribution of biological products now operating under this
Division's control.
The importance of the laboratory in the field of diphtheria-control is exemplified by the fact that in early December six carriers of virulent C. diphtherix
were detected in one Vancouver family, from whom to date about two dozen
cases of diphtheria have been directly and indirectly acquired. The laboratories
are indebted to Dr. E. T. Bynoe, Bacteriologist in the Laboratory of Hygiene at
Ottawa, for undertaking to perform the new serological typing test upon gravis
strains of C. diphtherix isolated in Vancouver and forwarded to him. This new
method appears of considerable potential value to the epidemiologist.
The only other type of test requiring any special comment would seem to be
microscopic examinations for intestinal parasites. These examinations more
than doubled in number during the year, and it seems probable that requisitions
for such examinations, especially for E. histolytica (the causal parasite of
amoebic dysentery), will increase still more in future. Members of the armed
forces returning from overseas, particularly from Italy and the Far East, are
liable also to have contracted malaria, hookworm, and other tropical or subtropical diseases. Addition of a trained parasitologist to the staff may prove
very desirable in the not distant future.
RED CROSS BLOOD DONOR SERVICE.
The heavy casualties resulting from the fierce fighting in Europe in the first
few months of the year seriously depleted the armed forces' available reserves
of blood fluids, and necessitated strenuous efforts to meet the expanded quota of
45,000 donations set for this Province for 1945. Previous reports have described
the difficulties and improvisations of staff and equipment which had to be met
from the beginning of this war-time undertaking of the laboratories, and there
would be no point in repetition.    It need only be said that the problems tended BOARD OF HEALTH REPORT, 1945. C 75
to increase as the war in Europe drew to an end. Donor interest slackened, so
that the amounts of blood reaching the laboratories were more unpredictable
than ever; the help received from volunteers was no longer as dependable; the
salaried Red Cross staff attached to the laboratories felt they should seek more
secure employment; and, finally, circumstances did not make for settled policies
on the part of Red Cross headquarters.
After V-E Day the weekly quota of donors was halved, and when members
of the Red Cross staff resigned, replacements were not made. Immediately after
V-J Day the blood donor clinics were closed. By the end of September, Red
Cross glassware and apparatus was all cleaned, packed, and returned to its
owners, while the staff had either been discharged or transferred to the Division
of Laboratories. The extraordinarily onerous chapter in the history of the
laboratories' activities, which thus ended, is believed to represent a fine contribution to the war effort. In the three and one-half years of operation, the laboratories handled about 80,000 blood donations and shipped to Toronto for final
processing nearly 3,000 4-litre bottles, or approximately 2,500 gallons of blood
serum. This amount would furnish nearly 50,000 transfusions, a high proportion of which could no doubt be looked upon as life-saving.
Up to the end, Vancouver's record for low percentage of contaminated
serum remained unapproached throughout Canada. This remarkable achievement can not be ascribed to excellence of equipment or to well-designed accommodation, but rather to careful supervision and to the policy of using only fully
trained personnel for technical procedures. The Director takes pleasure in
recording his appreciation of the invaluable help received from so many people
in this effort, most of it given voluntarily. Special thanks are due to Miss M.
Malcolm, Senior Bacteriologist, who remained in charge throughout; to several
other members of the laboratories' staff who faithfully returned one or more
nights each week to keep late hours on blood donor work; and to a long list of
citizens in all walks of life who gave up their time to wrapping corks, cleaning
needles, plugging tubes, and other tedious and unglamorous aspects of a vital
project. Perhaps it may be appropriately added here that from the beginning
the Provincial Government of British Columbia met without hesitation the costs
of providing such accommodation as was available and could be adapted for the
purpose, and also furnished, without expense to the Canadian Red Cross Society,
all the items of major equipment necessary for the work, with the exception of
three centrifuges.
GENERAL COMMENTS.
Staff changes during the year were again numerous. Mrs. Janet Hardy,
Bacteriologist, left after five years' service; Mrs. Florence Sully, Miss Margaret
Buller, and Miss Ruth DesBrisay, Assistant Bacteriologists, also resigned; and
we were particularly sorry to lose Mrs. D. M. Jefferson, glassware-cleaner and
outfits-maker, who retired on superannuation after serving the Vancouver laboratories faithfully for fourteen years, in fact since the Division was created.
• Newcomers to be welcomed were Mrs. M. Jackson, Miss K. McLeod, and
Miss M. Gurvitz, Assistant Bacteriologists; Mrs. E. Wilson and Miss V. Baillie,
Laboratory Assistants; Mrs. M. Martin and Mrs. F. Page, cleaners; and Mr. H.
Page, janitor.    Several others were taken on as temporary Assistant Bacterio- C 76 BRITISH COLUMBIA.
logists, mostly for summer holiday relief, including Miss M. Roblin, Miss A.
Leith, and Miss E. Lotzker.
For these frequent staff changes, the war has been primarily responsible
both by imposing uncontrollable burdens upon the laboratories and by aggravating the matrimonial and other causes of restlessness among the staff. Most of
the younger women recruited during the war years accepted positions with the
intention of working only for the duration. Certainly the future interests of
the Division now require the recruitment of two or three senior staff members,
possibly male. The necessary further reorganization of the whole Division must
await the provision of proper accommodation.
Release of the ground-floor space of two houses used for the Red Cross
blood-work during the war gave opportunity for a long overdue consolidation
and expansion of facilities for the glassware cleaning and sterilizing, outfits-
making, and media preparation departments. A few structural alterations permitted these basic activities to be carried out in close proximity to the necessary
autoclave, hot-air ovens, sinks, and refrigerators. The three small " sterile "
rooms which had been specially fitted up for serum separation and pooling under
the Red Cross blood donor service were readily adapted to media preparation.
These activities were all placed under the direction of Miss Malcolm, Senior
Bacteriologist, who so successfully co-ordinated, in the same quarters, a similar
assortment of Red Cross activities. This rearrangement of space also allowed
two extra rooms to be transferred to the department for serodiagnosis of syphilis. A staff of nine persons, under the conscientious supervision of Miss E. M.
Allan, had previously been confined to two rooms only. The situation as regards
total space available may thus be defined as perhaps more satisfactory than it
has been for years. However, all that has been stated in previous reports as to
the quality of the accommodation, and of the general amenities at the Vancouver laboratories, remains unaltered. These grave defects have all along added
immensely to the technical difficulties of performing essential skilled work and,
with the enlarging staff, have contributed to a perceptible lowering of morale
which may take many years of hard effort to rectify. It is hoped that before
the annual report for 1946 is presented, a definite and satisfactory decision may
have been reached regarding the future location and organization of the laboratories. The views of the Director of the Division, and of the medical profession, on these matters have been repeatedly and clearly expressed.
Reference was made in last year's annual report to the need for revision of
the branch laboratory arrangements. Now that the war is over, it is hoped
this overdue step can soon be taken. During the year Dr. R. G. D. McNeely,
the new Director of the Victoria laboratory at the Royal Jubilee Hospital, visited
the central laboratories twice. Visits were also received from Dr. R. J. Brum-
mitt, Dr. A. G. Naismith, and Mr. George Darling, who are in charge of the
Nelson, Kamloops, and Nanaimo branch laboratories. The Bacteriologists at
the Nelson, Prince Rupert, and Kelowna laboratories—Miss Johnson, Miss
Rushworth, and Miss Forcade—also called in at Vancouver during the year to
discuss local problems. Fairly close touch was thus maintained with all six of
the branch laboratories, and they continued to do extremely useful work despite
numerous difficulties. BOARD OF HEALTH REPORT, 1945. C 77
In September the Prince Rupert laboratory reverted to its pre-war status,
with Dr. R. E. Coleman being solely responsible for the work. Even before the
end of the war, withdrawal of United States troops from the area had considerably reduced the turnover of laboratory-work there, and since Prince Rupert
was not, like Vancouver and Victoria, a discharge centre for the armed forces,
routine serological tests did not compensate for the decline in other types of
tests. Dr. Coleman and Miss Rushworth, therefore, both felt the latter's whole-
time services were no longer needed. At personal inconvenience, Miss Rush-
worth agreed to help out the Victoria laboratory, which was temporarily overwhelmed with serological work from naval personnel, and she remained at the
Royal Jubilee Hospital in the employ of the Royal Canadian Navy until the end
of the year.
The Kelowna laboratory suffered a loss in the death of its Bacteriologist,
Mr. F. Smith, early in the year. Mr. Smith had struggled, with fortitude, for
many years against increasing illness. He was succeeded by Miss B. M. For-
cade, who spent a week familiarizing herself with procedures used in the main
laboratories later in the summer.
Finally, the Director wishes to record once more his appreciation of the
meritorious work done by the staff during the year. Special acknowledgments
are due to Miss D. E. Kerr, Assistant Director, who shouldered heavier responsibilities than ever, and to the following senior staff members: Miss M. Malcolm,
Senior Bacteriologist; Miss E. M. Allan, Serologist; Miss V. G. Hudson, Bacteriologist in charge of milk and water analyses and throat cultures; Miss H.
Chang, Bacteriologist in charge of tuberculosis cultures and animal inoculations,
and miscellaneous examinations; Mrs. M. B. Allen, clerk in charge of the office;
and Miss B. Thompson, clerk in charge of supplies. Without their loyal and
efficient co-operation, the year's many problems would have been insuperable. C 78
BRITISH COLUMBIA.
Table I.—Statistical Report on Examinations done during the
Year 1945.
Examination.
Out of Town.
City.
Total in 1945.
Total in 1944.
114
1,612
445
56
14
225
498
708
593
408
6,416
1,722
175
56
745
2,346
8,891
2,544
10,619
320
27,974
4,636
745
621
326
57
194
101,829
13,693
11,451
1,696
1,783
965
1,292
1,719
1,273
1,273
740
525
1,064
115
522
8,028
2,167
231
70
970
2,844
9,599
3,137
10,619
492
31,275
6,671
970
666
359
62
224
119,207
17,351
14,362
2,067
2,166
1,220 1
1,542 \
2,084
1,577
1,577
918
534
2,709
188
474
Blood agglutinations—■
7,810
1,957
*
18
Cultures—
763
2,674
8,962
H_emolytic staphylococci and streptococci
4,316
8,545
172
3,301
2,035
225
45
33
5
30
17,378
3,658
2,911
371
383
255
250
365
304
304
178
9
1,645
73
508
Direct microscopic examination for—
28,739
M. tuberculosis (sputum).—  	
6,416
485
393
Vincent's spirillum  	
219
189
95
Serological tests for syphilis—
Blood-
82,736
17,310
Complement fixation 	
Cerebrospinal fluid—
Kahn 	
Complement fixation  	
Cerebrospinal fluid—
14,644
1,845
1,967
1,364
1,855
Milk-
Bacterial count	
1,466
1,466
781
Water—
Total bacterial count  	
592
2,850
328
Totals  	
38,195
208,213
246,408
201,767
* Previously included under " Miscellaneous Tests.' BOARD OP HEALTH REPORT, 1945.
C 79
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is C 80 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF VENEREAL DISEASE
CONTROL.
Donald H. Williams, M.D., Director.
INTRODUCTION.
A review of the effort of the Division of Venereal Disease Control, Provincial Board of Health, in relationship to the problem confronting the Division
during the year 1945 should produce upon an interested citizenry in the Province
of British Columbia concern for the growing magnitude of the menace of venereal infection. This reaction will be tempered, however, by hopefulness for
the future through the knowledge that during the year portents of more effective future control over the twin scourges of syphilis and gonorrhoea became
evident.
With the termination of war during the year, it was reasonable to anticipate
the dissipation of administrative difficulties related to personnel shortages. The
gradual beginning of improvement in this regard was observed. Reorganization of the central office was begun along lines agreed upon in 1944, and to a
large extent the major portion of this reorganization was accomplished. As a
supplement to this annual report of the Division, there follows a presentation of
the programme of venereal disease control measures, Provincial Board of
Health, British Columbia, which outlines the Division's historical development,
organization, administration, functions, and -principles of policy.
During the year the beneficence of science in the form of penicillin became
widely available to sufferers from venereal infection in the Province. Ironically,
as with the war of 1914-18, the coming of peace brought with it the onset of
the expected and much feared post-war epidemic of venereal infection.
INCREASE IN NEW VENEREAL INFECTION.
At this time complete and corrected statistics on the notification for venereal infection for 1945 are not available. Estimates, based upon eleven months
of the year, however, portray a disturbing public health picture. Total new
notifications from all sources—clinics, private physicians, and armed forces-—
increased over the 1944 figure of 4,737 infections by 16 per cent. It is not easy
to assess the exact significance of this increase, nor, indeed, that of many of the
statistics on venereal infection, based as they are upon only partial reporting of
the total cases. Viewed from any angle, the amount of reported disease for the
year represents a very serious health problem.
The increase of 16 per cent, might be ominously significant, indicating a
real increase in new disease on the one hand or, on the other, it might represent
only an apparent increase, based upon better notification of previously unreported instances of infection. The disquieting feature lies in the record of
recently acquired syphilis in the clinics of the Division for the year. The
number of primary and secondary syphilis cases doubled in 1945 as compared
with 1944. Neither better reporting, greater and earlier popular use of the
clinics, increase in population, nor improved contact-finding can entirely or
probably even to any great extent explain the unfavourable rise in incidence.
This figure, taken in conjunction with the reporting of 3,578 new gonorrhoea BOARD OF HEALTH REPORT, 1945. C 81
infections in the first eleven months of 1945, indicates a rapidly increasing
health hazard already of alarming magnitude and fraught with grave future
potentialities unless it is curbed aggressively by all means available.
What is responsible for this unsatisfactory situation? This question has
given the Division much thought and indeed it should be pondered by all citizens
concerned with the welfare of the Province. The complete answer is not yet
available. At present special studies are being carried out to clarify it. Certain
causative elements are known, however, and should be noted. First and foremost, it is an inescapable epidemiological fact that sexual promiscuity is the
great spreader of venereal infection, and from this fact and the venereal disease
picture for 1945, it is evident that there is extensive sexual promiscuity in the
Province. How much stimulus is given to this form of conduct by the excessive
alcoholic beverage consumption of the Province, and the unfavourable conditioning influence of certain types of motion pictures and popular literature, is
worthy of very serious consideration. Undoubtedly the prolonged tension of
war and the acknowledged disintegration of home and family life have accelerated the loosening of moral standards which, it is agreed, have been gradually
tumbling since the war of 1914-18. To meet the challenge which these endangering elements suggest, there most certainly exists a task for the co-ordinated
efforts of the health, welfare, legal, and moral forces in the Province of British
Columbia.
REORGANIZATION AND ADMINISTRATION.
In 1944 a committee of senior Board of Health personnel reviewed the
organization and administration of the Division of Venereal Disease Control and
recommended reorganization of the Division under five sections: Administration, Information and Public Relations, Epidemiology, Diagnostic and Treatment Services, and Social Service. During 1945 these recommendations were
implemented. Five sections were established, each with a qualified person in
charge and each with its functions and scope specified. Regular weekly conferences of the section heads were held. A system of daily recording of items
of administrative importance was inaugurated. Each week key items from
these daily reports were compiled in a regular weekly report for the transmission to senior Board of Health personnel in Victoria for their information.
The Provincial Board of Health indicated to the Department of Veterans'
Affairs its willingness to accept responsibility for the provision of medical care
for all veterans resident in the Province who suffered from venereal infection
and who sought care at any clinic operated by the Board. In the matter of care
for soldiers' dependents with venereal infection, the Dependents Advisory
Board was informed that in those instances where treatment was required by
dependents living in areas where clinic service is available, they should receive
treatment in these clinics. Where soldiers' dependents requiring treatment in
areas where clinic service was not available, the Board of Health agreed to
arrange through the Health Unit Director or the local health officer for treatment by a qualified physician of the patient's choice who would be remunerated
on the same basis as for indigent patients.
A tentative agreement was made with hospitals in rural areas and in
municipalities outside Vancouver and Victoria to pay for the hospital care of C 82 BRITISH COLUMBIA.
patients with early infection in a communicable state. Where Indians were
concerned, the Indian Affairs Branch agreed to pay for hospital services.
In keeping with good public health practice, a policy was instituted of
annual examinations of the staff of the Division, including blood tests and
chest X-ray.
The excellent liaison with the armed forces' medical services in Pacific
Command on venereal disease matters continued during the year and was a
source of great gratification to the Division. The services provided detailed
information on contacts and facilitating community conditions in most instances
of infection. Each month meetings were held to discuss problems of mutual
interest and to plan co-ordinated action against common sources of disease
dissemination.
The assistance of the Department of National Health and Welfare in
supplying the annual grant of $15,400, including $1,738 for education and the
provision of arsenical medication valued at $3,895, was appreciated. Additional
help from the Department in the form of recently developed educational media
contributed considerably to the effectiveness of the Division's educational effort.
The value of the weekly compilation of new notifications of venereal infection in Canada by the Dominion Bureau of Statistics added much to the better
appreciation of the national venereal disease problem and its Provincial
components.
INFORMATION AND PUBLIC RELATIONS.
Following a period of two years, during which it was impossible to obtain
the services of a full-time Health Educator, the Division was fortunate in filling
this personnel deficiency. The broad educational field again came under the
care of one individual, and immediately renewed progress in this field of activity
became evident.
One of the most important projects launched was the study of the nature
and scope of venereal disease education in senior high schools in British Columbia. A detailed memorandum on the subject was prepared for the consideration of senior personnel of the Provincial Board of Health and the
Department of Education. This memorandum recommended the introduction
of venereal disease education through amendments to the present programme
of senior high school health education as outlined in " Health and Physical
Education for Senior High Schools of British Columbia, Bulletin II., 1945."
The adoption of this approach would do away with the previous programme
of lectures by members of the Division. In the meantime a limited number of
high schools were given lectures pending change of policy.
Arrangements were completed for distribution of educational literature
and posters to all deep-sea merchant vessels entering the ports of Vancouver
and New Westminster. This arrangement also covered most coastal vessels.
The Merchant Seamen's Manning Pool and the office of the Shipping Master
were additional distributing centres for materials. With the co-operation of
the B.C. First Aid Attendants Association and the St. John's Ambulance Association, a variety of industrial groups received educational materials of all
types on a regular repetitive basis.    The So-Ed College of the Y.M.C.A. and BOARD OF HEALTH REPORT, 1945. C 83
the community leaders of the Pro-Rec centres were addressed. The Provincial
Director of the Pro-Rec agreed to have community leaders act as distributing
agents for educational items.
During the year the Division assisted in the venereal disease educational
campaign sponsored jointly by the Health League of Canada and the Canadian
Pharmaceutical Association. This effort was supported by the majority of
drug-stores in British Columbia, who co-operated by displaying special window
exhibits and by distributing literature.
The professional educational aspect of the programme was not neglected.
A symposium on " Recent Advances in Venereal Disease Control " was given
by consultants at the annual meeting of the British Columbia Medical Association. Consultants of the Division attended medical meetings in the Okanagan
and the Kootenay areas. Special lectures continue to be given to student
nurses, graduate nurses, social service students and workers, and to Normal
School students.
PUBLIC HEALTH NURSES AS EPIDEMIOLOGY WORKERS.
With reorganization and the creation of the section on epidemiology,
clarification of the duties of the Public Health Nurse in the Division was
undertaken. The staff of nurses was increased to ten, including the nurse in
charge of the section. Division of responsibilities as between Public Health
Nurses and social workers was accomplished satisfactorily. Contact-tracing
and case-holding became a function of these nurses, and accordingly the case
load was transferred from the Social Service Section to that of Epidemiology.
A detailed memorandum on all phases of policy concerning epidemiology
work was prepared. This document dealt with policy as it related to authority,
responsibilities, lines of communication, correspondence, and relationships with
local programmes and social assistance workers.
A concise guide for case-finding and case-holding was prepared for the
use by Public Health Nurses of the Division acting as field epidemiology
workers. The purpose of this guide is to promote more effective epidemiology
by reducing the time spent on cases which are not a public health problem,
and thereby leaving the nurse free to concentrate her efforts on those cases
which are more important from the public health point of view.
During the year active participation of the Public Health Nurses of the
Cities of Vancouver and Victoria in case-finding and case-holding was inaugurated. To assist in developing this new extension of the nurses' duties in these
municipalities, the Division provided special preparatory observation and training periods at its clinics.
The Indian Affairs Branch notified the Division of its approval of Public
Health Nurses performing epidemiological duties on Indian reservations.
DISTRIBUTION OF FREE PENICILLIN.
World stocks of penicillin reached such an extent during 1945 that the
military requirements were met and sufficient of the drug remained for extensive civilian use. In keeping with the Provincial Board of Health's policy of
providing physicians, upon request, with approved medication for the treatment C 84 BRITISH COLUMBIA.
of venereal  disease,  penicillin  was  added to the list of therapeutic  agents
available.
Arrangements were made for distribution through all clinics and all full-
time Health Units. It was necessary to restrict its free distribution to cases
of early communicable infection in which the public health significance was
important. Accordingly, the distribution was limited to all proven and suspected (clinical and (or) epidemiological evidence) cases of gonorrhoea, and
to cases of early syphilis which fall into one of the following categories:
Serious reactions to routine arsenic-bismuth therapy; relapsing, resistant, or
fulminating forms of early infection; early syphilis in asocial promiscuous
persons; early syphilis in persons unable to obtain regular weekly treatment
(remote rural areas, certain seamen, fishermen, loggers, miners, etc.) ; elderly
persons with early infection; and for persons with " difficult " veins—addicts,
obesity, etc.
CLINIC SERVICES.
The clinics of the Division continued to provide diagnostic and treatment
services for a large number of citizens. The increase in venereal infection and
the transference of veterans discharged from the armed forces requiring further
treatment added considerably to the clinic case loads.
New clinics were opened at the Juvenile Detention Home and the Girls'.
Industrial School. Unfortunately, the Prince Rupert clinic had to be closed
because of inability to obtain a physician-in-charge, following the resignation
of the Health Unit Director of that area. The New Westminster clinic was
transferred from the Royal Columbian Hospital to the fine new building erected
by the Gyro Club in the City of New Westminster. In this building the Division
shares accommodation with the Division of Tuberculosis Control.
The administration of penicillin on an ambulant basis to all clinic patients
with gonorrhoea was instituted and appeared to be a decided improvement over
previous therapeutic measures.
SOCIAL SERVICE.
For the first time since the reorganization of the Division of Venereal
Disease Control in 1936, a section of social service devoted completely to welfare problems and related aspects of the Division's programme began its work.
The beneficial effect of this much needed innovation was immediately evident.
The role of the social worker in the field of venereal disease control was
clarified in a special study and memorandum on the subject. This memorandum outlined the criteria for an adequate case work service, agency referral
policy, including the interpretative function, the collection of social data, and
the objectives of the Provincial programme.
A special study on social factors contributing to the acquisition of venereal
infection was instituted. A series of fifty case-studies were made on persons
between the ages of 16 and 25 years with recently acquired syphilis. This
outstanding study will be the basis of community action during the coming
year.    The final section in the study merits quotation in full:—
" The family is the fundamental unit of society and it is the basic training
in the family group which determines in which direction the child will go. BOARD OF HEALTH REPORT, 1945. C 85
Every child has a deep-seated emotional urge to belong to a normal family with
two parents living in harmony together, having an adequate home and income
and opportunities for recreational and social activities. He has a natural desire
for affection, security, approval, and recognition in his home. The family group
is a complex relationship of different individuals and the anti-social behaviour
trends which sometimes develop in its members are frequently a symptom
of conflicts, frustrations, and disappointments which were suffered during
childhood.
" From our study of the home-life and family background of fifty young
persons with new syphilis infections, we find that the basic disabilities are the
same and that the roots of their present behaviour are in their home training
and family relationships where both physical and emotional needs were lacking.
" Venereal disease is a symptom and a result of deeply rooted maladjustments, the remedy of which must begin in early childhood through the combined
efforts of such community resources as the home, school, church, police, medical,
social, and recreational bodies who must work together as a co-ordinated group."
Arrangements were completed whereby infected pregnant women who required hospital care would be admitted to the United Church Home, Our Lady
of Mercy Home, and the Salvation Army Home.
FACILITATION.
The function of collecting data on facilitation and compiling them as a
basis for community action became a responsibility of the Social Service Section. The distribution of data on facilitating premises each month to responsible authorities and to interested agencies was continued. During the year
this policy brought increasing community action, particularly in respect to
certain dance-halls and cafes.
Again this year as in former years, the Division records that certain well-
known brothels at well-known addresses, operated by well-known madame-
owners, in the City of Vancouver continued their profitable disease-spreading
activity without any apparent restrictive legal restraint. Certain cafes, dance-
halls, beer-parlours, and hotels continued to provide opportunities for infected
persons to meet uninfected citizens and thereby spread disease.
The receipt of two outstanding draft manuals developed by the Department of National Health and Welfare—namely, " Techniques of Action Against
Facilitation in V.D. Control " and " The Community Attacks Venereal Disease "
—represented a distinct contribution to the Province in the field of directing
specific action against various types of facilitation.
CONTROL NEEDS AND FUTURE PLANS.
No annual assessment of a venereal disease control programme can be»
considered complete unless reference is made to existing deficiencies in the
programme, which, within reason, it may be hoped can be corrected in the
ensuing year.    A few of these are listed as follows:—
(1.) The extension of full-time health service to the entire Province
would enable the development of a sound venereal disease control
service on a comprehensive basis to all communities, and in par-
. ticular would strengthen the existing inadequate service to rural
areas.
(2.) A minimum of three full-time administrative medical officers
should be appointed to the Division.
(3.) The separation of the central office and its personnel from the
Vancouver clinic unit would influence favourably the administration of venereal disease control in the Province as a whole.
(4.) The co-ordination of Vancouver clinic services into a polyclinic
with other Provincial Board of Health clinic services in the
Vancouver area merits consideration.
(5.) The organization of a "four-sector front" attack against venereal
disease in the Province is an urgent need.
(6.) A professional educational programme for physicians should be
launched preliminary to the implementing of pre-marital blood-
testing legislation.
(7.) Further study should be given to the development of a rehabilitation and treatment centre for women.
REVIEW OF VENEREAL DISEASE CONTROL PROGRAMME.
To give a concise word-picture of a progressively developing health programme to meet a complex and constantly changing public health problem of
great extent is the difficult purpose of this presentation. During the seven-year
period ended in 1944, there were reported to the Provincial Board of Health
22,776 persons suffering from venereal infection in British Columbia. Of these,
14,566 had gonorrhoea and 8,210 were infected with syphilis. The magnitude of
the problem is self-evident. An outline is given of the venereal disease control
programme of the Provincial Board of Health as it is organized to meet this
threat to the citizens of the Province.
HISTORICAL.
In 1919, as part of a Canada-wide concern over the venereal disease problem arising out of the war of 1914-18, the first organized effort of the Provincial
Board of Health in British Columbia was launched. To provide the legal basis
for the administration of control measures, " An Act for the Suppression of
Venereal Diseases " was passed by the Provincial Legislature. During the following year the new programme was inaugurated. It consisted of two outpatient clinics, one each in the Cities of Vancouver and Victoria; the distribution of free medication to physicians; the payment of physicians for services
rendered to indigent patients in rural areas; and a system of notification of
venereal infection. The programme was administered directly by the Provincial Health Officer without creation of a special administrative division.
The Dominion Council of Health presented the seriousness of the venereal
disease situation in Canada to the Federal Government, with the result that the
Government in 1920 instituted a policy of issuing annual grants to the Provinces. The total Federal grants to British Columbia from 1921 to 1932 were
$105,460. At the end of the latter year the subsidies were temporarily discontinued.    In addition to these grants, the Federal Government annually provided BOARD OF HEALTH REPORT, 1945.
C 87
arsenical preparations for free distribution to physicians. In 1943 the Federal
Government resumed its annual Provincial grants. The amounts for recent
years are listed in the following table:—
Table of Expenditure on Venereal Disease Control, Province of
British Columbia, 1941-45.
Year.
Provincial
Funds.
Federal.
Funds.
FTu0nds.             Population.
Per
Capita.
1941  	
1942                    _
$82,600
82,200
82,700
85,300
137,900
$3,000*
3,000*
12,200
13,600
15,400
$85,600
85,200
94,900
98,900
153,300
818,000
870,000
900,000
932,000
956,000
Cents.
10.4
9.8
1943	
1944
10.5
10.6
1945                                                 	
16.0
* Value of arsenical medication only.
With the gradual development of a more realistic attitude on the part of the
public toward the neglected problem of venereal infection, the non-effectiveness
of existing control measures in the Province was recognized. Accordingly, in
October, 1936, the Provincial Board of Health created a Division of Venereal
Disease Control for the purpose of developing and directing a comprehensive
programme of preventive health measures on a Province-wide basis. Funds,
personnel, equipment, and accommodation were provided commensurate with
the magnitude of the problem.
PRINCIPLES OF VENEREAL DISEASE CONTROL IN
BRITISH COLUMBIA.
The programme of the Division of Venereal Disease Control is based upon
the recognition of certain fundamental principles which influence the form of
the existing organization and administration, and delimits the scope of the field
in which the Division operates. Full recognition is given to the fact that the
venereal diseases can not be eradicated by health measures alone. The factors
associated with the acquisition and transmission of syphilis and gonorrhoea are
complex. They are rooted in inherent defects in human behaviour and in
certain inadequacies of our social and economic life.
The National Venereal Disease Control Conference in 1943 subscribed to
this view-point, and on this basis a charter was adopted to guide Canada's venereal disease control effort. The principles approved by this national conference
have been adopted in British Columbia.
THE FOUR-SECTOR FRONT AGAINST THE VENEREAL
DISEASES.
To reduce venereal infection in the Province, it has been considered necessary to attack the problem simultaneously from four directions, one of which,
the health thrust, comes within the purview of the Provincial Board of Health,
Division of Venereal Disease Control. The Department of National Health and
Welfare describes the four-sector front against the venereal diseases as consisting of:— C 88 BRITISH COLUMBIA.
" Health, Welfare, Legal, and Moral Sectors—components of an indivisible
whole aligned against a common foe. The ultimate objective is to destroy syphilis and gonorrhoea. The purpose of each sector is to take the offensive with the
weapons peculiar to its own method of attack. Waging unrelenting war on the
Health Sector, with weapons of modern medical science and public health procedure, will be physicians, nurses, and health departments. Leading the attack
on the Welfare Sector will be found social workers and welfare agencies armed
to battle squalor, overcrowding, lack of food, neglect, and insecurity. Directing
a vigorous action on the Legal Sector will be the Courts, the legal profession, and
police agencies whose action seeks out and brings to justice those who for personal gain purvey to man's weaknesses. On the Moral Sector the battle is to be
led by the churches and homes of Canada, strengthening the moral fibre of our
nation and upholding the sanctity of marriage and family life. Each sector has
its own territories, its own personnel and armaments. The ultimate objective
is the same."
This announcement of policy defines the principles and objectives of the
four fields of action envisaged in a comprehensive approach to venereal disease
control.
THE SIX-POINT STRATEGY OF THE HEALTH SECTOR.
The National Venereal Disease Control Conference adopted an outline of
policy which it considered should be the basis of the public health programme of
control measures. Along the lines outlined by this policy, the British Columbia
programme has been developed since 1938. As announced by the Department
of National Health and Welfare the six-point strategy is as follows:—
(1.) Health Education.—The facts concerning venereal disease will
end the conspiracy of silence, banish outworn fallacies, and
remove false fears. Lectures, motion pictures, posters, and pamphlets will tell the story of how venereal disease may be vanquished.
(2.) Medical Care.—Every Canadian who requires examination and
treatment should have the best that medical science can provide
by health departments. It is cheaper to cure and prevent venereal
disease than to pay taxes for the end results of neglected infection.
(3.) Abolition of Quackery.—Laws exist in Canada to protect citizens
from the quack and charlatan. Only qualified physicians are permitted by law to care for those suffering from venereal diseases.
The public must be protected from the incompetent and the rogue.
(4.) Prenatal Blood Tests.—Every expectant mother must have a
blood test for syphilis before the fifth month. Demand it! Insist
upon it!    It is the only protection many unborn children have.
(5.) Pre-marital Blood Tests.—Health examinations, including blood
tests, are a safeguard against the sinister encroachment of syphilis on home and family life.
(6.) Contact Investigation.—Careful search must be made for all who
have been contacts to known venereal disease.    Only by seeking BOARD OF HEALTH REPORT, 1945. C 89
these people and by bringing them under medical supervision can
the extending network of venereal disease be destroyed.
ADMINISTRATION OF THE DIVISION OF VENEREAL
DISEASE CONTROL.
In the Province of British Columbia the responsibility for the administration of venereal disease control measures rests with the Provincial Board of
Health. Under the Board, the Division of Venereal Disease Control operates
as one of the Board's principal organizational sections. The organization chart
of the Provincial Board of Health in the " Administration of the Provincial
Health Services of the Provincial Board of Health, Victoria, B.C., 1943,"* shows
" the chain of responsibility and authority and the flow of services from the
various bureaus and divisions to the local health services and through them to
the people of the Province of British Columbia." Each Division is " developed
to simplify administration and not to act as a water-tight compartment." Full
recognition is given to the interdependence of all public health effort in each
Bureau and Division. In the case of the Division of Venereal Disease Control
this is particularly apropos where the Division of Laboratories, the Division of
Vital Statistics, and the Bureau of Local Services all perform duties essential to
the adequate control of venereal infection in the Province.
In Figure 1 an organizational chart of the Division of Venereal Disease
Control portrays the principal services of the Division with the respective sections created to perform these functions. It also shows the relationship of
these Provincial Board of Health services to the local community organizations
and thereby to the public for whom they are primarily provided.
There are five sections in the Division—Administration, Information and
Public Relations, Epidemiology, Diagnosis and Treatment, and Social Service.
Each section, with a qualified person in charge and with necessary staff, has
a specific programme to accomplish within a specified field of public health
action. The central office of the Division which houses these sections is situated at 2700 Laurel Street, Vancouver, B.C. These central administrative
offices occupy a building jointly with the Vancouver clinic, as shown in Figure 2.
Funds for the services of the Division of Venereal Disease Control are provided by the Provincial Government with an annual grant from the Federal
Government. For the five-year period from 1941 to 1945, amounts available
are shown in the table on page . Population figures and per capita grants
for each year are listed in relationship to the annual expenditure. The Provincial funds listed are only those voted by the Legislature specifically for the
Division. To get the complete Provincial expenditure, certain portions of the
voted expenditure of other Bureaus and Divisions, notably that of the Division
of Laboratories, would have to be added.
A Director responsible to the Provincial Health Officer is in charge of the
administration of the Division. Sixty persons are employed under the following personnel categories:—
Director and Assistant Director      2
Physicians (part time)   18
* Copies may be obtained from the Provincial Health Officer, Provincial Board of Health, Victoria, B.C. C 90
BRITISH COLUMBIA.
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0 91
Staff Room
(Women's)
l \
Rest
Room
(Patient's)
Entrance Women's CJinic
■        n
Director's  Office
Women's
Treatment Room
(Gonorrhoea)
Women's
Waiting
Room
Central
Office
Examining I
Room Women's
(Women)       Treatment
Examining I    #°°m
Room     I
(Women)
Business Offke
« Entrance
Examining,
Room
(Women)
Examining
Roam
(Dermatology)
Social Service
Records
I
Social
Service
Examining
Room     1
(Cardioloqu)\
Examining
1 Room
_________
Utility
Room and
Laboratory
Admitting Office
Examining
Room
(Neurology
andf.E.NSl)\
^Counter
Examining
Room(Men)
Men's
Treatment
Room
i
LRVArORY    j
("public
lavatory
Examining
Room(Men)'
»
t
Examining _ \^(
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RaomiSV^Y
(Men)
Social
Service I
Waiting \
Room
Social
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Men's
Waiting
Room
Entrance Men's Clinic >
N-
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Figure 2.
Plan of central office and Vancouver clinic, Division of Venereal Disease Control,
2700 Laurel Street, Vancouver, B.C. C 92 BRITISH COLUMBIA.
Nurses—
Public Health  10
Clinic     9
Social workers     2
Health Educator     1
Clerks and stenographers  15
Technician  :     1
Janitor      1
Clinic assistant (part time)      1
These individuals are distributed in the various sections of the Division's
central office and in its clinics. The highest standards of training and experience are required in all personnel employed.
" VENEREAL DISEASES SUPPRESSION ACT."
The " Venereal Diseases Suppression Act," passed in 1919 and amended in
1938, with regulations made pursuant to the Act, provides the legal basis for
venereal disease control in the Province of British Columbia. The terms of the
Act are far-reaching and the powers granted are comprehensive. Briefly, it
provides for the following:—
(1.)  Physicians must report all known cases of venereal infection.
(2.)  Persons affected and refusing treatment, or acting in such a
manner as to spread infection, may be detained for examination
and treatment.
(3.)  Adequate facilities for laboratory diagnosis and treatment must
be provided.
(4.)  Secrecy in the administration of the Act must be maintained.
(5.)  Only legally qualified medical practitioners may treat venereal
diseases.
(6.)  Advertising of drugs, medical instruments, etc., for the treatment
of venereal diseases is prohibited.
(7.)  The Provincial Health Officer is given wide powers to make regulations under the Act.
INFORMATION AND PUBLIC RELATIONS.
A section on information and public relations, headed by a qualified Health
Educator, is responsible for the development and maintenance of a programme
of professional and public enlightenment on the subject of the venereal diseases
and their control. The function of this section is to organize informational
projects which will, on the one hand, assist the professional groups—public
health, welfare, physicians, nurses, pharmacists, teachers, police, etc.—in keeping abreast of new medical and technical advances in a rapidly developing field
and, on the other hand, bring to an interested public factual information on
a wholesome dignified basis.
For both groups, carefully selected media, some of it developed by the
Division, are available in the form of books, pamphlets, leaflets, posters, motion
pictures, displays for show windows and conventions, etc. In the five-year
period ended 1944, a total of 949,095 pieces of literature were distributed and, BOARD OF HEALTH REPORT, 1945. C 93
in the same period, members of the staff of the Division addressed public
gatherings on 631 occasions.
In keeping with the general policy of the Provincial Board of Health, the
personnel of the Division devote their educational activities principally to key
organizational groups such as Women's Institutes, Parent-Teacher Associations, church organizations, British Columbia School Trustees, Teachers' Federation, Union of British Columbia Municipalities, labour unions, service clubs,
etc. Through local health services, and in particular through Health Units,
the programme reaches each community. Here on a local level the Health
Unit Director and the Public Health Nurse devote attention to the key community groups.
The press, radio, motion picture, and journal publications are all utilized
as the occasion requires. Specific educational programmes are organized to
meet particular needs and have included in the past the development of a
Province-wide high school educational programme, a prenatal programme, an
industrial campaign, and a programme of public enlightenment on the health
hazard of commercialized prostitution.
All physicians are provided with informative literature pertaining to public
health procedure and approved diagnostic and therapeutic measures. Films
and speakers are available for medical society meetings. Lectures or lecture
material are given to all nurses' training-schools in the Province, and special
lectures are given at the Public Health Nurses' course at the University of
British Columbia. Each year the students of the Normal Schools receive lectures. The annual meetings of public health personnel and welfare workers
enable the Division to present pertinent educational problems to these important community groups.
EPIDEMIOLOGY.
The paramount importance of the epidemiological approach in the control
of venereal infection is given recognition by the provision of a special section
to deal with this phase of control and other closely related aspects of the problem. A specially trained Public Health Nurse responsible to the Director of
the Division and to the Director of Public Health Nurses is in charge of the
section. Nine additional Public Health Nurses constitute the field personnel
of the section. Six are employed in the metropolitan Vancouver area, and one
each assigned to the Vancouver Island territory, to the Fraser Valley, and to
the remaining portion of the Province.
This section is responsible for the development and maintenance of an
adequate contact-finding and case-holding programme. The staff, in addition
to performing field duties in their respective areas, assist local health services,
and in particular train and assist Public Health Nurses in duties related to
those coming within the scope of the Epidemiological Section. In the Cities
of Vancouver and Victoria the Public Health Nurses of the municipal health
service are gradually assuming a greater responsibility for the epidemiology
of venereal infection in their respective territories.
Contact-finding demands special training and the qualities of ingenuity,
patience, tact, and discretion on the part of the Public Health Nurse engaged
upon this work.    The approach varies, depending upon the completeness of C 94 BRITISH COLUMBIA.
identifying data provided and upon the arbitrary group into which the contact
falls—independent single person, marital, extra marital, dependent minor;
when data concerning contacts are obtained, information is collected in each
instance on the facilitation process involved. The promotion of continual and
voluntary treatment of actual or potential delinquent patients in the face of
difficult emotional, social, and economic problems is the task of these nurses.
That part of the duties of the personnel of the Section of Epidemiology
pertaining to liaison with Public Health Nurses in the field throughout the
Province consists in stimulating:—
(1.)  The control of syphilis in pregnancy and the prevention of prenatal syphilis as an extension of the local maternity programme.
(2.)  General nursing and health supervision programmes containing
all procedures required for the care of children with prenatal
syphilis.
(3.)  Assistance in control of gonorrhoea through the local maternity
and communicable diseases services.
(4.) Nurses in schools and industrial organizations assisting in case-
finding through observation of systems, knowledge of health and
programme records, and by assistance with medical histories and
examinations.
(5.) The inclusion of education on venereal infection in a programme
of public health education as planned and incidental teaching.
DIAGNOSTIC AND TREATMENT SERVICES.
The diagnostic and treatment facilities represent a prominent feature of
the Provincial Board of Health's venereal disease control service in the Province. Public clinics, laboratory services, medication, and consultative advice
are the chief means by which diagnostic and therapeutic assistance reaches the
citizen requiring it. These services are free to all persons without restriction
or barrier of any kind.
Free out-patient public clinics are operated at Vancouver, Victoria, New
Westminster, Trail, and Dawson Creek. A clinic is operated at Oakalla Prison
Farm. Each year approximately 3,000 persons are admitted to the clinics, of
which 2,000 are found infected and given treatment. The total clinic attendance averages 36,000 visits annually.
The Vancouver clinic, providing services for the Greater Vancouver area
with a population of 392,000, is the largest clinic unit. Figure 2 portrays the
accommodation features of this clinic. A full range of diagnostic and treatment services is available. Qualified consultants in the specialities of neurology, cardiology, pediatrics, dermatology, gynaecology, urology, and eye, ear,
nose, and throat are on the staff. Short-term appointments for physicians in
general practice enable the clinic to train interested men in the adequate management of venereal infection in private practice. Each year 2,500 persons
are admitted for care. Associated with the clinic is a seven-bed hospital ward,
situated in the infectious diseases hospital unit, Vancouver General Hospital.
With the exception of the Vancouver clinic, all other clinics are operated on a BOARD OF HEALTH REPORT, 1945. C 95
part-time out-patient basis.    Hospital beds are available as required in adjacent community hospitals.
In much of the rural area, organization of clinic service has not been
feasible. In these areas assistance reaches the citizen through the private
physician who is given free medication, laboratory service, and written consultative service by the staff of the Vancouver clinic. Payment for services is
available for indigent patients and in instances where epidemiological investigation is performed at the request of the Provincial Board of Health.
Free medication is supplied upon request to any qualified physician for
any person reported by him as suffering from venereal infection. This medication includes a wide range of standard therapeutic agents, including arseni-
cals, bismuth, mercury, sulphonamides, and penicillin. Silver nitrate drops
for the prevention of ophthalmia neonatorum are supplied to all hospitals. Each
year more than 11,000 ampoules of arsenical for intravenous therapy and
25,000 c.c: of insoluble bismuth for intramuscular injection are distributed to
private physicians.
SOCIAL SERVICE.
The social component in the problem of the venereal diseases is of such
moment that a special section exists to deal with the matters pertaining to it.
Since venereal infection is both " cause and effect " of social problems, the
scope of this section is very broad.
A qualified medical social worker is in charge. She is responsible to the
Director of the Division and to the Assistant Director of Welfare, Social Assistance Branch. She plans all social work related to the activity of the Division
and co-ordinates social effort with Government and private social agencies.
The section has been established very recently and its staff is not up to full
strength, being limited to two workers. Social workers are provided by the
Social Assistance Branch. Activity is restricted to the Vancouver clinic where
all juveniles, expectant mothers, and patients presenting special social problems
are interviewed. All data referrable to " facilitation " are collected, analysed,
and organized for community action. This action includes the stimulation of
effort to correct unsavory community conditions associated with certain hotels,
beer-parlours, dance-halls, restaurants, rooming-houses, bawdy-houses, etc., and
interesting responsible community groups in the development of wholesome
community recreation facilities, better housing, satisfactory leisure-time activities, etc.
Special studies and investigations are carried out as conditions merit them.
Among these have been included a study of the environmental background of
persons between the ages of 15 and 25 infected with syphilis and investigation
of commercialized prostitution in the City of Vancouver.
As this section develops, its activities will be extended to the point of active
liaison with all field social workers throughout the Province. C 96 BRITISH COLUMBIA.
REPORT OF THE DIVISION OF TUBERCULOSIS CONTROL.
W. H. HATFIELD, M.D., DIRECTOR.
The work of the Division of Tuberculosis Control continues to increase,
with the programme expanding according to a definitely laid-out plan. A
greatly intensified case-finding drive during 1945 has located tuberculosis in an
earlier stage and brought to light sources of infection and of potential infection.
The improvement in social assistance to patients' families introduced in 1944
has shown its effect during 1945. With the increase in new cases, due to intensified case-finding and the return to the Province of many patients diagnosed by
the armed forces, bed facilities are still much behind the requirements. The
seventy-bed temporary addition was opened during the year, and plans are well
under way for a new modern sanatorium in the Vancouver area. Property has
been obtained, and it is hoped to start construction early in 1946. In addition
to the provision of extra bed facilities, plans have been completed for the modernization of present institutions of the Division during the next year.
Staff difficulties have continued to confront us, there being a shortage of
technically trained personnel, particularly physicians and nurses. Toward the
end of the year it begins to appear for the first time that it will soon be possible
to remedy this situation.
There has been expansion of the clinic facilities of the Division with a new
clinic opening in the New Westminster area. New equipment has been ordered
for all the stationary clinics to bring them up to the highest possible standard of
diagnosis and out-patient treatment.
The general picture in British Columbia remains relatively the same as far
as housing, the influx of cases of tuberculosis from other parts of Canada, and
the racial problems, such as the Chinese, are concerned. The Japanese continue
to be handled by the British Columbia Security Commission, a Dominion Government agency. Forward steps have been taken by the Indian Affairs Branch
to help to reduce the very high tuberculosis rate amongst the native Indians of
this Province. An official advisory committee on tuberculosis amongst Indians
has been appointed by the Dominion Government, with the Director of the Division acting on behalf of British Columbia.
Case-finding work through mobile X-ray units has produced closer correlation between the work of the Division and that of local health services. The
extent of this work has necessitated the opening of an office, for which funds
have been provided by the British Columbia Tuberculosis Society, to co-ordinate
and control the whole mass X-ray programme. These funds have been provided
for one year to afford an opportunity to study the efficiency of such an organizing office. If it is successful, as apparently it is turning out to be, then the
Department will be asked to take this over the following year.
With the increasing facilities in both hospitals and clinics, it is recommended that a general superintendent of nurses be appointed to the central
office of the Division to supervise all nursing services within our hospitals and
clinics and to correlate the work of the Division with other services.
With the size of the Division's budget and the scattered institutions, it has
also been recommended that the position of central accountant be changed to BOARD OF HEALTH REPORT, 1945.
C 97
that of business manager. It is felt that the position is thus better described
and that such an official is essential to the efficiency of the organization.
As problems in connection with food keep arising from time to time, it has
been recommended that an official committee be appointed, composed of the
dietitians of each of the units and the Provincial Nutritionist, who will at regular intervals survey and correlate the food services throughout the various hospitals operated by the Division.
During the year the Division had the privilege of initiating through the
American Trudeau Society what is termed an " off the record " correspondence
group. Through this international group we have been given opportunities of
seeing material and taking part in discussions in advance of the ordinary scientific literature published in current medical journals.
The new regulations under the " Health Act" brought into effect during
the year provide for compulsory isolation and, where necessary, institutionalization can be accomplished.
The need is still apparent for clarification of interprovincial problems, and
we again recommend that a Dominion tuberculosis council be formed with
representation from all Provinces. This might be accomplished by creating a
division within the Department of Health and Welfare at Ottawa, but if such
were done, the Provinces should have some voice in policy.
NEW CASES.
Pulmonary and Non-pulmonary.
1941.
1942.
1943.
1944.
194S.
Total ■	
1,342
270
127
945
1,432
327
108
1,016
1,688,
419
106
1,163
2,317
580
156
1,585
2,081
Indians          	
Orientals  	
Whites	
416
143
1,521
Pulmonary.
Total pulmonary—
Total population-
Indian 	
Other than Indian.
Minimal—
Total population-
Indian  	
Other than Indian
Moderately advanced
Total population.	
Indian	
Other than Indian..
Par advanced—■
Total population.	
Indian	
Other than Indian
Primary—
Total population.	
Indian	
Other than Indian..
Type not stated—■
Total population-
Indian	
Other than Indian..
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
6
27
29
12
17
(3%)
(2%)
(3%)
(2%)
(5%)
(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 (7%)
93 (19%)
57 (4%)
4 ...
1,854
334
1,520
1,003 (54%)
80 (24%)
923 (61%)
430 (23%)
80 (24%)
350 (23%)
263 (14%)
82 (25%)
183 (12%)
148 (8%)
91 (27%)
57 (4%)
10 (1%)
1 	
9 (1%) C 98
BRITISH COLUMBIA.
At the end of 1945 there were 13,032 known cases of tuberculosis in the
Province, giving a ratio of known cases to deaths of 25.2:1. With Indians
excluded the number of known cases is 11,170, giving a ratio of known cases to
deaths of 31.4:1. This is an increase of 4.2:1 over 1944. With the expanding
programme in mass X-ray surveys, there is a natural increase in the number of
known cases.
It is gratifying to note that these new cases are largely in the minimal
group, many of them being found before they reach an infectious stage. Prompt
treatment is thus possible, with some shortening of institutional stay and a
higher percentage of cures. Our surveys have shown us a decrease in the
amount of tuberculosis found in young people. For example, a survey of the
high school students in the Vancouver area toward the end of the year did not
reveal a single case. It is felt that this situation is due to the finding of tuberculosis in older people, and with prompt treatment and isolation thus preventing
the older group spreading the disease to the younger generation. With a group
growing up relatively free of tuberculosis, there should be a steady decline in
the tuberculosis death-rate.
There has been an increase in the number of new cases found in the armed
forces with all those discharged being routinely X-rayed and with many returning from the European front where they have had contact with populations with
high tuberculosis rates. Of the total admissions to our institutions during 1945,
21.7 per cent, were from the armed forces, there being 182 cases out of 890
admissions.
MORTALITY.
During 1944 British Columbia had the greatest drop in death-rate of any
Province in Canada. We are pleased in 1945 to be able to report a further
reduction in death-rate. We reiterate that one or two years is not sufficient to
show trends, although we have now had four years in which the death-rate has
steadily decreased, and it is anticipated that this will continue.
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.
1941	
1942	
1943	
1944     	
533
558
613
532
518
65.2
64.1
68.1
57.1
54.6
174
170
208
169
162
699.3
682.7
834.4
677.1
648.5
359'
388
405
363
356
45.3
45.9
46.3
40.0
1945*	
38.5
* Preliminary only.
CLINICS.
The Division continues to operate four types of clinics: Stationary survey
clinics, mobile survey clinics, stationary diagnostic clinics, and travelling consulting clinics.
The consultation service which is offered throughout the rural areas of the
Province has been used most extensively during the year. At any time between
the visits of travelling clinics any physician may have a patient X-rayed locally BOARD OF HEALTH REPORT, 1945. C 99
at the expense of the Division and forward the film and consultation form for
interpretation. With the development of X-ray units in local hospitals throughout the rural areas, this service is most effective. It assures every one within
the Province of being able to have a diagnosis made any time there is suspicion
of chest disease.
Two mobile units are in use, which during 1945 spent most of their time in
the rural areas of the Province, ending up the year by beginning a mass X-ray
survey of the Vancouver area. These two units X-rayed 89,572, and this
coupled with the stationary survey clinics totalled 119,186, which is one out of
eight in the Province X-rayed within the twelve-month period. Another mobile
unit which is on order and is anticipated early in 1946 will provide greater facilities for this essential work. Of those X-rayed in all survey clinics, 2.4 per cent,
were referred to diagnostic clinics for further study. The analysis of this
group is as follows: 600, or 21.1 per cent., were diagnosed as tuberculous, and
70.3 per cent, of these cases were minimal, 20.7 per cent, moderately advanced,
and 6.7 per cent, far advanced. One hundred and eighty-eight, or 31 per cent.,
of those diagnosed required active treatment.
With the increased number of cases going through survey clinics, the work
of the diagnostic stationary and consulting travelling clinics tends to increase.
In this phase of the work there were 24,590 examinations.
Including all types of clinics, there was a total of 144,478 examinations during the year, including tuberculin tests in surveys.
With the shortage of medical staff, the travelling consulting clinics have had
to continue to function with nurse-technicians taking films and referring these
films to centres for interpretation. It is hoped that during the ensuing year
physicians will again be available to the Division for travelling consultative
work.
The new clinic in New Westminster was officially opened in June, 1945, in
a building constructed by the Gyro Club which houses both the Division of
Tuberculosis Control and the Red Cross Society. The equipment for the chest
clinic was furnished by the B.C. Tuberculosis Society through Christmas seals.
Later in the year arrangements were made for the Division of Venereal Disease
Control to have two sessions a week within this clinic.
Improvements have been recommended for the Victoria clinic. Up to the
present time the Division has had to have its X-ray work done in the X-ray
department of the Royal Jubilee Hospital. By close co-operation this has
worked fairly effectively, but with the expanding survey and diagnostic work
of the Division, it was felt that this could only be handled properly with the
Victoria clinic operating its own X-ray services. Equipment for this is on order
and has been provided by the B.C. Tuberculosis Society through Christmas seals.
Thus 1946 should see all diagnostic clinics adequately equipped. It is
hoped that all travelling consulting clinics will have a physician with them, and
there will be three mobile X-ray units for mass X-ray surveys in addition to
miniature-film equipment in the three stationary clinics at Vancouver, Victoria,
and New Westminster. C 100 BRITISH COLUMBIA.
INSTITUTIONS.
As usual all institutions of the Division continue to work at full capacity.
The total bed capacity is 705, an increase of 66 over the number of beds in 19.44.
By carefully planned central admitting, and careful control of those in hospital
through medical conferences and ward rounds, and correlation of the patient to
his family through the social service section, it has been possible to keep the
waiting-list for admittance at a relatively low level. British Columbia continues to have the shortest interval between application for admission and
admission of any Province in Canada.
Due to the shortage of beds, it has been necessary to limit admission to
those cases which are infectious or potentially so, which means limiting treatment to cases of pulmonary tuberculosis. It is recommended that when sufficient beds are available the Division should admit all forms of tuberculosis for
treatment. We have had to ask local hospitals to care for straight pleurisy
or pleurisy-with-effusion cases. Such types would be better treated in a
sanatorium.
The work from the Department of Veterans' Affairs continues to show an
increase. In 1944 these cases represented 15 per cent, of all admissions and in
1945 were up \o 21.7 per cent. The Department of Veterans' Affairs is planning a new 150-bed unit at Shaughnessy Hospital which, it is expected, will be
primarily an admitting hospital for tuberculosis but will also handle other types
of chest disease. It is to be pointed out that tuberculosis should not be handled
as a problem of the individual but as a problem of the family. Thus it is
essential that there be correlation between the Department of Veterans' Affairs
and the Division of Tuberculosis Control of the Provincial Board of Health in
the operation of this new hospital.
A site for the tuberculosis hospital in Vancouver has been obtained on
Fifty-ninth Avenue between Heather and Cambie Streets, and at the end of the
year the plans for construction are well on the road to completion.
It is necessary to again point out that the Division is still utilizing one floor
of the Vancouver Isolation Hospital. This occupancy will sooner or later have
to be terminated, and it is recommended that surgical facilities be provided in
the present Vancouver unit of the Division.
A decision will have to be made as to the hospitalization of Japanese in
British Columbia. The British Columbia Security Commission still continues
to operate a sanatorium at New Denver. We feel that for future planning it
should be known whether the Japanese are to continue as Dominion Government
responsibilities or whether they are likely to revert to the Province from a
health standpoint. If they are to become a Provincial responsibility, will
segregation continue with the operation of the sanatorium at New Denver or
will other facilities have to be provided?
The present St. Joseph's Oriental Hospital has been inadequate in capacity
and facilities for the treatment of Chinese. It is understood that the sisters
are planning an addition to be used for tuberculous patients in connection with
their new hospital in Vancouver. It is understood that this is to be a temporary
institution.    The Division again recommends that it own and operate all its BOARD OF HEALTH REPORT, 1945. C 101
own institutions rather than utilizing facilities that are part of local municipal
or private hospitals.
At Tranquille it is planned to begin the modernizing programme as previously outlined. This will provide an addition to the nurses' home, improved
housing conditions for medical staff, and improved facilities within the hospital
itself, particularly in relation to the main building and the services connecting
this building with the rest of the institution. A new laundry building will also
be provided.
NURSING.
With the expansion of institutions and clinics, there are increasing nursing
services throughout the Division, and it has been recommended that a general
superintendent of nurses be appointed. This nurse would also correlate the
work of the Division of Tuberculosis Control with other Divisions of the
Provincial Board of Health and with local health services.
A continued staff-training programme has been carried out, keeping all
nurses up to date, and it is felt that there has been a general improvement in
nursing standards throughout the institutional services.
The Handbook of Tuberculosis was reprinted during the year and continues
to serve as a general guide in both the training of student nurses and the
programme of the Division.
The student nurses' programme continues to be unique in Canada and is
proving very effective. All student nurses in the Province are now receiving
a five-week course, three weeks of which is spent on the wards, one week in
out-patient clinics, and one week in home-visiting. It is felt that this course
not only helps the student to understand infectious disease technique, thus
protecting her in her nursing career, but also has interested many of the
younger nurses in the tuberculosis control programme. In addition, it has
stimulated interest on the part of nurses in public health work. During 1945,
230 students completed their affiliation in tuberculosis at the Vancouver unit.
The full-time trained teacher continues to supervise this course.
With continued expansion of public health nursing services in rural areas,
there is a continued improvement in the follow-up of tuberculosis case in the
home. This service is closely correlated with the institutional and clinic work
of the Division and the service rendered by the Social Assistance Branch.
SOCIAL SERVICE.
The social service work of the Division is done by a group of trained social
workers supplied to the Division by the Social Assistance Branch. There are
trained medical social workers attached to each institution, doing both in-patient
and out-patient work. The work outside of the institutions and clinics is done
by the field staff of the Social Assistance Branch. During the year there were
many changes in staff which naturally created some difficulties. There were
improvements in the clerical services, which were made necessary by the larger
volume of referrals. A part-time trained social worker was this year available
to the Victoria unit and a second worker was added to the Tranquille staff. C 102 BRITISH COLUMBIA.
Special tuberculosis allowances have now been in operation for a full year
and their distinct value is beginning to unfold. They have materially aided in
the cure of patients because of relief from anxiety concerning their families
which previously existed. In addition, these allowances have facilitated the
discharge of patients from hospital.
Boarding-home care has been further developed, but it is still not as extensive as needed. More facilities of this type are required for women patients in
the older age group and for Chinese patients. The extension of comforts
allowances to cases in boarding-homes has been helpful.
The Division appreciates the close co-operation that has existed between
the Division and the Social Assistance Branch.
STATISTICS.
The ledger system introduced in 1944 has proven quite satisfactory and
gives immediate statistics on the main fundamental operations of the Division.
There has been every co-operation from the Division of Vital Statistics in giving
special statistics from time to time, in reviewing our record systems, and in the
preparation of the graphs and charts for the annual report.
LOCAL HEALTH SERVICES.
Every co-operation has been received from the local health services
throughout the Province. One of the major activities of the Division in connection with local health services has been the furnishing of equipment and staff
for mass X-ray surveys. In addition, consultative services are available to all
areas.
BUDGET.
The budget for the next fiscal year has been completed, with increases
primarily due to statutory increases in salary and operation of the temporary
unit in Vancouver for twelve months as compared with ten months in the last
fiscal year. A recommendation has been made to place all members of the staff
on an eight-hour day. This is a material increase, particularly at the Tranquille
unit. There will be an increased cost for mass X-ray surveys due to the addition of another unit. This unit will operate with a smaller type of film, which
will decrease the per capita cost. With the expanding services of the Division,
several recommendations have been made for staff reorganization. Other costs
of the Division will be reflected in the estimates of the Public Works Department, with the improvements planned at Tranquille and the construction of a
new sanatorium in the Vancouver area.
GENERAL REMARKS.
In general there was very little increase in the technical staff available to
the Division during the year. It is hoped that with the war's end technical
staff will be returning from the armed services, making more available to us.
During the year the Director of the Division attended the executive meeting of the Canadian Tuberculosis Association and a meeting at Ottawa of the
advisory committee in connection with the control of tuberculosis amongst Indians. It is hoped that during the ensuing year there will be an improvement in travelling facilities, which will allow members of the medical staff to
attend certain national and international conferences.
The annual staff meeting of the Division was held in the month of October,
with a full report of proceedings being prepared, which is available in the
central office of the Division and the central office of the Provincial Board of
Health.
A review of patients' literature has been initiated, and it is anticipated
that there will shortly be many improvements in this regard.
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 the Government. Special mention must be made of the B.C. Tuberculosis Society, which
was reorganized during the year to include all organizations in the Province
dealing with Christmas seals. This voluntary organization now has nineteen
local committees. The funds for special studies and certain equipment, notably
X-ray equipment and mobile units, have been furnished by this organization.
Funds for educational work are also provided by this society. This group is
playing a real part in the tuberculosis work in this Province and has given
the Division a great deal of support and assistance. The large sum of money
raised by this organization through Christmas seals, where the average donation
is $1 to $2, shows the very widespread interest of the general population in the
tuberculosis problem in this Province.
The board of directors of the Vancouver Preventorium has continued to
provide accommodation for children between the ages of 2 and 14. There has
in general been a decrease in tuberculosis amongst this age-group and it is hoped
that the Preventorium will be able to extend this service to the age-group from
birth to 2 years. The Division of Tuberculosis Control is responsible for the
admitting to this institution and the follow-up medical work, including X-ray
examinations, laboratory and dental services at the Vancouver unit. Every
co-operation has been given by the board of directors to the Division in respect
to this work.
The extension of mass X-ray surveys, the improvement of stationary
clinics, the return of staff to allow more intensified travelling diagnostic work,
and the addition of more bed facilities will round out the programme of the
Division of Tuberculosis Control which we hope will each year more and more
bring about a steady reduction in the death-rate from this disease.
REPORT OF THE PUBLIC HEALTH ENGINEERING
DIVISION.
R. Bowering, B.Sc (C.E.), M.A.Sc, Public Health Engineer
and Chief Sanitary Inspector.
The work of the Public Health Engineering Division includes supervision
and control of such environmental factors as may have an effect on the public
health. Water-supply sanitation, sewage-disposal, milk plant sanitation, cannery and industrial camp sanitation, shell-fish sanitation, and other miscel- C 104 BRITISH COLUMBIA.
laneous items of environmental sanitation all come within the scope of the
Division of Public Health Engineering.
The technical staff of the Division consists of a Public Health Engineer
and Chief Sanitary Inspector who is Director of the Division, a public health
veterinarian who has the title of Consultant in Food and Milk Control, and a
certified Sanitary Inspector who has the title of Senior Sanitarian. The year
1945 was the first full year that the latter two officials were on the technical
staff, and as a result the year saw considerable advance in certain phases of the
work. In addition, an engineering student was employed during the summer
months for special survey-work in connection with oyster-beds and cannery
sanitation.
There was an increase in the number of certified Sanitary Inspectors
available during 1945. The result is that all Sanitary Inspectors now working
in full-time Health Units are fully certified men. The Director of the Division
of Public Health Engineering served as chairman of the British Columbia
board of examiners for the certificate which, on behalf of the Canadian Public
Health Association, conducted the examinations leading to the certificate in
sanitary inspection (Canada) for British Columbia in 1945. Although Sanitary Inspectors employed in local Health Units do not come under direct supervision of the Division of Public Health Engineering, the Division provides a
consultative service for them. In this way the value of the special training
of the technical staff of the Division is made much more available to the people
on the local level.
WATER-SUPPLY.
One of the major functions of the Division of Public Health Engineering
is in the field of water-supply sanitation. The " Health Act " requires that
whenever a public water-supply is constructed, extended, or altered, the plans
and specifications must be approved by the Provincial Board of Health before
construction may commence. These plans are always gone over very carefully
by the Division of Public Health Engineering, and a proper course of action to
take in regard to these plans is recommended to the Provincial Health Officer.
Another important feature of the programme of the Division of Public
Health Engineering is the sanitary survey of water-supplies in the Province.
Since there are more than 150 separate water-supply systems in British Columbia, with the present staff it is impossible to make a thorough sanitary survey
of these sources each year. However, the Division of Public Health Engineering of the Department of National Health and Welfare makes sanitary surveys
of water-supplies used by common carriers. There is good co-operation between
the Federal Department and the Provincial Department, and as a result a larger
number of sanitary surveys are made than would be otherwise possible. It is
interesting to note that over 75 per cent, of the population of the Province
consume water from public water-supply systems.
The question of treatment of water for the better protection of the public
health has been very much to the fore in 1945. Experience with the use of
chlorination equipment in Greater Vancouver and Greater Victoria has shown
that the results obtained by such treatment are worth while. Whereas in both
cases bacteriological examinations of a large number of samples taken at the BOARD OF HEALTH REPORT, 1945. C 105
source show that the untreated water will not meet the standard which had
been approved by the Dominion Council of Health, samples taken from the distribution system in both communities have shown that the treated water is well
within the standard. A large amount of data concerning the bacteriological
quality of various water-supplies in the Province has been accumulated during
1945. These data will be used in guiding the Division into the proper emphasis
to be placed on the water-supply sanitation programme in the future.
An interesting incident that occurred during the year was the sudden death
of a number of fish, ducks, and muskrats at a lake on Vancouver Island. This
lake is used as a water-supply by about forty littoral residents. A warning was
posted advising these people not to use the water. The lake in the early stages
had a high pH, a fairly high oxygen content, and a high lead content. The
water of the lake apparently returned to normal after several weeks, as the pH,
oxygen, and lead became normal again. Exhaustive investigations were made
which led to the belief by most observers that the death of the animals was
due to Type " C " Botulinus toxin. Type " C " Botulinus toxin is not harmful
to man as far as is known. During the investigation it was found that many
samples of water which were bacteriologically examined showed the presence
of faecal bacteria. These fecal bacteria could not have caused the death of the
animals mentioned but indicated that the water is not always safe for human
consumption. For this reason, when the people were again told that they could
use the water for drinking purposes, they were advised to boil or chlorinate the
water as a safeguard against intestinal bacteria.
SEWAGE-DISPOSAL.
There are two general classifications of the sewerage and sewage-disposal
problem in British Columbia. The first is the question of sewerage and sewage-
disposal in organized municipalities, and the second is the problem of sewage-
disposal in unorganized communities and rural areas.
The larger cities of the Province have sewerage systems. Since the largest
cities are located on the sea coast, the most common method of sewage-disposal
in British Columbia is by dilution in salt water. Although this method is generally satisfactory for the prevention of gross nuisances, some of the salt water
bathing-beaches in the Province which are near sewered municipalities have a
fairly high degree of fecal contamination. All city health departments would
be well advised to look into the question of the safety of water in the public
bathing-beaches under their jurisdiction. In the Interior the Division of
Public Health Engineering will stress the value of proper sewage treatment.
In certain areas of the Province complete treatment of sewage is now insisted
upon. Complete treatment includes primary filtration, secondary treatment of
the effluent from the sedimentation process, final sedimentation, and chlorination
of the effluent.
The sewage-treatment plant for the Village of Dawson Creek was put into
operation during 1945. Several fairly large private sewerage jobs were completed also in 1945, including the sewerage system for the hospital at Fort St.
John, B.C. This sewerage system was designed so that it could be extended to
serve a portion of the town at some future date.    Several cities had engineers C 106 BRITISH COLUMBIA.
investigate the possibilities of building sewerage systems, and preliminary
reports and plans have received provisional approval of the Provincial Board
of Health. Included in these is an approval of a $750,000 extension in
Vancouver for the second consecutive year.
The problem of sewering unorganized communities still exists, although a
great deal of study has now been made on this problem by an interdepartmental
committee under the chairmanship of the Provincial Health Officer. It is hoped
that a report of this committee will be available for the Government early in
1946.
A large number of pamphlets and plans were given to private individuals
wishing to construct sewage-disposal units in rural homes. Many nuisances
caused by improper construction of septic tanks, and particularly by improper
construction of agricultural tile beds used for the absorption of the effluent into
the soil, were abated during the year by improving the construction of these
devices upon the advice of the Division of Public Health Engineering. The
number of complaints concerning faulty sewage-disposal were not as great in
1945 as they were in former years.
MILK SANITATION.
The year 1945 saw considerable advance made by the Division of Public
Health Engineering in milk sanitation. The Consultant in Food and Milk
Control, at the request of local authorities, made several surveys of the milk-
supplies available to local communities. Among these were Prince George,
Quesnel, Powell River and Westview, Kimberley, Michel-Natal, and Fernie. As
a result a considerable amount of interest in safe milk has been evidenced
throughout the Province. New milk-pasteurization plants have been put into
operation during the year in Nanaimo, Port Alberni, Alberni, Quesnel, Langley
Prairie, Powell River, Courtenay, and Armstrong. The Pacific Great Eastern
Railway has changed over from the use of raw milk to the use of pasteurized
milk in its dining-cars.
In the spring of 1945 there was a spectacular epidemic of septic sore throat
at Salmon Arm. Investigation by officials of the North Okanagan Health Unit
and the Provincial Board of Health showed this epidemic to be milk-borne. In
the latter part of the year a similar epidemic occurred at Powell River. Investigation has led to the belief that this was also a milk borne epidemic.
Another service of the Division in 1945 has been the preparation by the
Consultant in Milk and Food Control of model by-laws to be used by municipalities for the better supervision of the local milk-supply. This has resulted in
the adoption by a large number of municipalities of a milk by-law which is
modern and leads to the use of a safer and better milk in many of our
communities.
At the close of the year the Division had information concerning plans of
a number of new pasteurization plants. By the end of 1946 it is estimated that
there will be very few large communities in the Province in which pasteurized
milk will not be available. BOARD OF HEALTH REPORT, 1945. C 107
SHELL-FISH SANITATION.
In the field of shell-fish sanitation, the largest individual piece of work done
in 1945 was a fairly complete sanitary survey of Ladysmith Harbour. This
harbour is probably the largest shell-fish growing area in British Columbia.
The survey was made in co-operation with the Public Health Engineering Division of the Department of National Health and Welfare. The result of the
survey has made it possible for a line to be drawn on the map of the harbour
between the areas where it is considered safe for the production of shell-fish
and the areas where it is not safe. This means that when applications to the
Department of Lands for leases are received, and referred to the Provincial
Board of Health, that a recommendation can be made with respect to leases
applied for in Ladysmith Harbour by return mail. It also means that there are
no shell-fish in Ladysmith Harbour now being produced on contaminated beds.
Toward the end of the year it was brought to the attention of the Division
that oysters were being taken from contaminated ground on a free basis. In
1946 the most important of these so-called free oyster grounds will be examined
in order to protect the public from shell-fish products produced on contaminated
ground.
In the coming year the supervision of sanitation in plants handling and
shucking oysters and other shell-fish will be handed over to the Consultant in
Food and Milk Control. Sanitary surveys of oyster-producing areas will still
be done by the Public Health Engineer.
In connection with the problem of clam and mussel poisoning that was
apparent on the west coast of Vancouver Island for the past two or three years,
a committee with representatives from both Federal and Provincial Departments of Fisheries and Health was formed under the chairmanship of the
Provincial Health Officer. This committee has formulated a plan, and the plan
is being carried out, for the further study of shell-fish poisoning with a view to
adopting a permanent programme with respect to the closing and opening of
seasons for the taking of clams and mussels in the affected area. No deaths
from shell-fish poisoning have occurred in British Columbia since the original
emergency ban was placed on the taking of shell-fish from the west coast of
Vancouver Island in May, 1942.
CANNERY SANITATION.
A considerable amount of space was devoted to the subject of cannery
sanitation in the report for 1944. During that year a very complete sanitary
survey of most of the fish-canneries was made. In 1945 the reports of the
survey-work done in 1944 were made available to the owners and operators of
the various fish-canneries. The result has been that most of the larger operators are planning to improve living and housing conditions at canneries by the
construction of more modern-type housing units, and by improving the various
other features of environmental sanitation. It is felt that this work has been
appreciated both by the cannery operators and by the Native Brotherhood of
British Columbia. It is believed that during the next few years most of the
undesirable features of our fish-cannery camps will be eliminated. C 108 BRITISH COLUMBIA.
INDUSTRIAL CAMP SANITATION.
Considerably more attention to industrial camp sanitation was given by
the Division of Public Health Engineering in 1945 than in any other past year.
This was due mainly to the fact that the Senior Sanitarian devoted a major
portion of his time to this important work. A large number of industrial camps
of various kinds were inspected, and instruction and helpful advice were given
to operators of such camps that has helped considerably in improving the living
conditions of men whose work compels them to live in camps. The Senior
Sanitarian has advised camp operators on various items of industrial camp
sanitation such as water-supply, rodent-control, vermin-control, food-handling
methods, and the question of sewage-disposal.
One of the interesting points that was noted with regard to the sanitation
in bunk-houses was that where a bunk-house was finished inside with a smooth
finish, and painted with a light-coloured paint and was well lighted, a much
better atmosphere prevailed in the bunk-house. It was noted that the better
the provision made for the health and comfort of the men, the more the men
responded in doing their share to maintain the camp in a sanitary condition.
THE USE OF D.D.T. IN INSECT-CONTROL.
One of the features of environmental sanitation that was notable during
the year was the effects of the greater use of D.D.T. as an insecticide. During
1945 D.D.T. was released by the Controller of Chemicals for general use. Trial
work with D.D.T. has been carried on by a number of the Sanitary Inspectors
employed by local Health Units. This work has shown that D.D.T. will have a
very useful place in the control of the house-fly, bedbugs, cockroaches, and other
insects which infest the dwelling-places of men.
SANITARY COMPLAINTS.
Sanitary complaints are complaints of nuisances which are brought to the
attention of the Division of Public Health Engineering by various people
throughout the Province. Most of these complaints are of minor importance,
although a considerable amount of time is often required in their investigation.
Some of them on the other hand are rather important, and they serve the purpose of bringing to the attention of the Division various matters that are of
importance in the making of a more sanitary and healthful environment for the
people.
Most of these complaints concern the disposal of septic-tank effluent into
ditches and small watercourses. The Division has had a considerable amount
of success in instructing people as to how to abate these nuisances by better construction of septic-tank sewage-disposal systems. In some areas the problems
can only be solved by the construction of public sewerage systems. In one community of the Province, the Department of Public Works built a storm sewerage
system which has had a great deal of value in eliminating public health
nuisances.
One of the more usual type of complaint relates to the collection and disposal of garbage in unorganized communities.    In many instances these prob- BOARD OF HEALTH REPORT, 1945. C 109
lems can not be solved without the expenditure of money. This problem is
being investigated by the interdepartmental committee which has been formed
to investigate sanitary conditions in local communities. The Division issues
plans of a small incinerator to those interested in the problem of incineration
of garbage. The Division has also, for the benefit of certain municipalities,
issued instructions as to the operation and maintenance of sanitary garbage
fills.
In general the number of complaints was not as great during 1945 as they
have been in past years. This is probably due to the fact that a number of conditions which have been occurring annually, causing complaints, have been
abated permanently by proper application of public health engineering principles to public health problems.
AUTO CAMPS AND SUMMER RESORTS.
In 1945 a " Tourist Camp Regulation Act " was passed by the Legislature.
Under this Act the Lieutenant-Governor in Council is given power to pass regulations for the control of the tourist industry. A set of regulations was passed
therefore which deal with, among other things, sanitation and public health
problems in tourist resorts. A licensing board was established consisting of
five members drawn from various Departments of the Government, and the
Public Health Engineer of the Provincial Board of Health was appointed to the
board.
In the past the question of auto-camp and tourist-resort sanitation has not
been given the full attention that it deserves due partially to lack of authority
and partially to lack of staff. However, with the passing of the " Tourist Camp
Regulation Act " and regulations, all resorts in the Province must live up to a
minimum set of sanitary standards or be endangered of losing their licences.
In the beginning of 1946 a sanitarian with wide experience will be
appointed to the staff of the Division of Public Health Engineering to take
charge of the sanitary inspection of auto camps and summer resorts. This
official will personally inspect camps in areas where there are no local full-time
health services. Where there are local full-time health services, much of the
sanitary inspection-work will be done by the local Sanitary Inspectors. Their
work will be co-ordinated by the new sanitarian who will be placed in charge of
this work.
GENERAL OBSERVATIONS.
The year 1945 has been a year in which a very much more extended programme has been carried on by the Division of Public Health Engineering.
The increase in staff that was noted in the 1944 report enabled the Division to
extend its services throughout the whole year. This expansion in the number
of technical personnel employed by the Division has also helped the local Sanitary Inspectors in providing for them a better consultative service. The fact
that all Sanitary Inspectors employed by Health Units are now fully certified
men has improved the quality of the work being done in the Health Units.
The Division would like to again record its thanks to the Division of
Laboratories for its co-operation in the examination of samples of water, sew- C 110 BRITISH COLUMBIA.
age, and milk, and for technical advice in the interpretation of certain laboratory reports. The Provincial Police deserve mention for their valuable work
in inspection of sanitary complaints in outlying districts. The Division would
also like to thank officials of the Federal Division of Public Health Engineering
of the Department of National Health and Welfare for their whole-hearted
co-operation on mutual problems. 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. BOARD OF HEALTH REPORT, 1945.
C 111
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